whether osteo-sarcoma can be separated so clearly and so satisfactorily from medullary and other alterations of bone, as Mr. Mayo seems disposed to think. A boy had the thigh amputated for a growth possessing all the characters attributed here to true osteo-sarcoma, which grew from the internal condyle of the femur. The wound made by the amputation was not quite healed, when symptoms resembling those of phthisis supervened. The boy died, and tubercles of medullary sarcoma were found to exist in the lungs. We believe it is acknowledged that morbid growths from bone resembling in their origin osteo-sarcoma, may finally be converted into true malignant degenerations. Here then we see two reasons why osteo-sarcoma can scarcely be altogether separated from other malignant tumours of bone, and probably the amount of our present knowledge is little more than this—that tumors possessed of these particular characters are less generally followed by the evidences of constitutional contamination, than other malignant growths, and that though they sometimes become confounded with the latter, they are sometimes found distinct from them.

Mr. Mayo relates an interesting case of osteo-sarcomatous growth from the tibia. The tumor was dissected off the bone. A fungous tumor sprang from the cicatrix. Amputation was then performed above the knee. The stump healed, but the cicatrix again ulcerated, and the disease re-appeared at the end of the femur. Mr. Mayo proposed amputation at the hip-joint, which the patient very judiciously declined, and, the tumor slowly increasing, he died. Mr. Mayo remarks that the practical deduction from the preceding case is that, in osteo-sarcoma, it is a degree safer to amputate at a joint, than to risk, in a constitution disposed to this action, the exciting it in another bone by the saw. We do not clearly perceive the force of this conclusion. The case proves certainly the ill success of amputation; but it does not, nor do we see that it possibly can prove, that no re-appearance of the malady would have occurred, if another operation had been practised.

Mr. Mayo makes a remark, the propriety of which we are disposed to doubt. "When new formations (he adds) appear in bone with the local characters of malignant disease, they have not the same rootedness in the system, as when they originate in the soft parts; so that the removal of a bone attacked by malignant disease is not in general followed by a return of the complaint. For example, in one who has suffered amputation of the breast for medullary sarcoma, the disease is sure to recur; but when the leg is amputated for the same disease originating in the tibia, the chances are greatly in favour of the patient's permanent escape." We almost fear that Mr. Mayo overrates the chances of escape after operations for malignant growths from bone. Did we trust our own observation and experience, we should say that the disease appears in other parts, in a very large proportion We could call to our memory, at the present moment, too many instances of failure after amputation of a limb.

of cases.

3. Medullary Sarcoma. On this we have only two remarks to make. 1. Mr. Mayo declares that medullary sarcoma of bone generally, if not always, arises in the cancellous structure. That it does not always do so, we are certain. In two cases of medullary sarcoma of the femur, the disease clearly originated in the superficies of the bone, or between it and the pe riosteum; and, in an instance of medullary sarcoma of the ilium, we noNo. 63.

3

ticed the same thing. At the same time it must be owned, that the cancelli form the most frequent nidus for this morbid growth.

4. Fibrous Sarcoma. There is a form of malignant disease of bone, of which the texture is firm, white, and fibrous. Its origin, Mr. Mayo believes, and its place, to be exclusively periosteal.

This disease is met with on the tibia. If simply removed from the bone it grows again: the limb must be amputated.

The same growth is liable to form upon the cranial aspect of the dura mater, to push its way through the bone by absorption, and to project great masses of sarcomatous growth upon the head and face.

5. Cyst-like Tumor. In the heads of the bones of the extremities, and in the lower jaw, a disease, which has the general characters of malignant growth, is found, when examined after death or amputation, to consist in a great cyst, or series of cysts, containing gelatinous liquid.

6. Melanosis in bone is rare.

"The diseases which have been enumerated are as often met with combined as separately.

Mr. Stanley possesses a specimen of ivory exostosis, combined with medullary

sarcoma.

Mr. Stanley gave to the King's College museum a section of a tumour upon the femur, which he had amputated. It consists, at one part, of medullary sarcoma; at another of fibrous sarcoma. The medullary sarcoma appeared to have originated in the cancelli of the bone, and had caused absorption of the cortex, which became extenuated, and the femur broke. The fracture is surrounded by a large soft tumour; part of this tumour is medullary, part consists of a firm, white, opaque substance, not cartilaginous.

In a leg amputated at the Middlesex Hospital for malignant disease, the cancelli of the tibia contained brain-like substance, or true medullary sarcoma. The crust of the bone was thin and brittle. The muscles of the back of the leg were externally healthy; but near the bone, in place of their proper texture, there was substituted a firm white substance, corresponding to Mr. Abernethy's description of mammary sarcoma. The fore part of the leg had a remarkable tenseness and brawny hardness: the skin was red and thickened. The former appearances were produced by a very singular lobulated subcutaneous texture, to which Mr. Abernethy's term of pancreatic sarcoma was strikingly applicable. This part of the disease appeared to me a conversion of the adipose tissue into a malignant growth.

There is an excellent case related in the 120th Number of the Edinburgh Medical and Surgical Journal, illustrating at once the connexion between osteosarcoma and medullary sarcoma of bone, and a remarkable feature, which is occasionly present in the latter disease-a pulsation, namely, as if the tumour were aneurismal. The pulsation is probably communicated from the contiguous arterial trunk." 55.

These remarks, taken with what we have incidentally observed, will serve, we fear, to shew that, however we may artificially arrange the various morbid growths from bone, much uncertainty still exists with respect to the real nature of each, and the actual amount of relationship of all. It is certain hat they are more or less convertible, and more or less combined, and, in

the present condition of our knowledge, we can hope for no more than a general approximation to the truth. The practical deduction is, we fear, unsatisfactory that too many of these morbid growths are liable to return after an operation, in the site of the wound or in other parts, and that the knife should be employed early, if at all.

"True scirrhous in bone I suppose to be of rare occurrence. I have mentioned that there exists, in the King's College museum, a specimen which looks like a scirrhous tumour, which was found in the medullary cavity of the femur of a person labouring under cancer; and there are in London several other preparations of a similar description. But I am not acquainted with an instance of an undoubted scirrhous enlargement of bone.

Mr. Sweatman has a remarkable specimen of scirrhous periosteum. A woman, about seventy years of age, was a patient in the cancer ward of the Middlesex Hospital, for carcinoma of the breast. About a month before she died, one eye was observed to protrude; and three days before her death she became suddenly comatose. Upon examining the skull, the dura mater and pericranium, and orbital periosteum, for a considerable extent on the affected side of the head, were found to be thickened and hard: the dura mater was, at one part, a third of an inch in thickness; the arachnoid adhered to it, and partook in the same thickening. The bone is not diseased, but is something more vascular than usual.

In the museum of the College of Surgeons there are several specimens of thickening of the pericranium and dura mater. No. 607 is a section of the right temporal and parietal bones of a young woman, twenty-five years of age. A tumour projects externally, about half an inch above the surface of the parietal bone; and there is a similar tumour situated exactly opposite, on the inside of the skull. These tumours appear, in the preparation in spirits, not unlike that just described, except that the part towards the skull appears opaker than the rest. The opposite section, however, is preserved dried; by which means the opaker part is shown to consist of short bony threads, in close apposition, which have no continuity with the cranial bones, on which they rest, but must have formed within the tumour. The tumour I suppose to have been malignant periosteal growth. The intervening portion of the cranium is sound, but unusually vascular." 57.

HYDATIDS IN BONE.

All writers who have noticed this affection of bone, have transcribed the case, or an epitome of the case, published by Mr. Keate in the tenth volume of the Medico-Chirurgical Transactions. In that case the hydatids were found in the os frontis, just over the left eye-brow. The case has been so frequently quoted, and must now be so familiar, being contained more than once in the pages of this Journal. that we may safely pass it by.

This terminates the Pathology of the Bones. The second Chapter is devoted to that of the Articulations. On casting back a glance at the pages we have quitted, we perceive some interesting facts, and what is professed an outline of a systematic arrangement. Yet much, of course, is matter devoid of novelty, and even what has some claims to novelty, is, probably, from the very nature of the subject, in some degree obscure and doubtful.

THE JOINTS.

Mr. Mayo considers first the diseases of the Synarthroses, or Immoveable

Articulations, and, secondly, those of the Diarthroses, or Moveable Articulations.

Synarthroses exist between the bodies of the vertebræ, and between the pelvic bones. Mr. Mayo first enumerates, which we need not do, the component textures of these articulations, and then their properties and their alterations.

"Fibro-cartilage, when torn, is susceptible of reparation. In fracture of a vertebra, the adjacent fibro-cartilage is generally ruptured; if the patient lives, it unites just as bone unites. The texture of the cartilage of a rib is perhaps too dissimilar to that of intervertebral substance, to be used in illustrating the properties of the latter; but I may take the present opportunity of mentioning some experiments made by myself upon reunion of these parts. The cartilage of a rib was divided in several animals, which were killed at different periods afterwards. I found the initiatory stages of reparation which had been set on foot to be exactly similar to those in bone. The cellular membrane surrounding the divided part was first consolidated into a firm capsule, which contained the cut ends of the cartilage. This consolidation was produced by infiltration with lymph; an exudation of the same substance formed a medium of direct union between the ends of the divided cartilage. The reparatory capsule gradually became converted into a texture resembling cartilage. As, in the reparation of bone, the callus changes into cartilage, and then ossifies, subsequently to which direct union of the broken ends by bone takes place, so, in the restoration of a costal cartilage, the exterior thickening becomes cartilaginous, while the direct union of the divided ends is still by lymph alone." 63.

Fibro-cartilages are susceptible of absorption, through pressure made upon them, but the quantum of absorption is less in them than in bone. In aneurism of the descending aorta, the intervertebral fibro-cartilages are found to be only superficially absorbed, when the bodies of the vertebræ are already deeply excavated. Mr. Mayo thinks that the intervertebral cartilages are partially absorbed also in cases of lateral curvature of the spine.

"Fibro-cartilages generally, it may be presumed, are susceptible of inflammation. The only instance, however, in which I have found this demonstrable, occurred in the semi-lunar cartilages of a knee-joint. Ulceration of the cartilages covering the bones had taken place, with high inflammation of the adjacent surface of the bones, and of the capsular synovial membrane. The semilunar cartilages (the knee having been injected after amputation) were red with the vermilion, swollen, and softer than natural; and when divided, showed, upon the surface of the section, extremities of cut vessels." 63.

Fibro-cartilages may undoubtedly ulcerate, become the seat of suppuration, and slough. These morbid changes are seen in the intervertebral substances.

Mr. Mayo classes the diseases of the vertrebral column under two headsatrophy and inflammation. The first is exhibited in the lateral curvature of young persons-the second in ordinary spinal disease. To this subject, however, we need advert no further, in consequence of the full manner in which we treated of it, in our review of the work of Sir Benjamin Brodie. The only other observations on the subject of diseases of the synarthroses, which deserve particular attention are contained in the following quotation.

"Disease of the pelvic joints is of unfrequent occurrence. At the time of labour, however, an affection occasionally takes place in these joints, which is

sometimes distinctly inflammatory, while at other times it bears the character of simple absorption of the fibro-cartilage. I witnessed an instance in which, after labour, an abscess formed behind the symphysis pubis, which was attended by a sense of weakness and giving of the pubic joint, which lasted several weeks, but gradually went away. Cases of this description are the most common. But sometimes the sacro-iliac joints are principally affected: there is no suppuration, but extreme weakness at these joints, which lasts many months. The patient is obliged for a long period to keep the recumbent posture; and then, and afterwards while recovering strength, derives remarkable comfort from bandages round the pelvis.

The following case, which was under my care, exemplifies commencing disease in the sacro-iliac synchondrosis, brought on by external violence.

A gentleman was riding in Hyde Park, when his horse reared, and fell backwards, bearing him to the ground. He was lifted up by those around, when he found himself capable of walking, with assistance. I saw him a short time after the accident. The only part bruised was the integument covering the back of the sacrum, and more to the right side than the left. There was no fracturc that I could ascertain, nothing but the bruise; and, as it afterwards appeared, a strain of the right sacro-iliac joint. The patient could bear the ilium to be pressed in any direction, and could, as I have mentioned, both stand and walk. In the evening considerable pain came on: he was cupped upon the hip, and experienced relief. The following day the cupping was repeated. After a month, during which this patient had kept his room, and the pain had nearly left him, he went, for change of air, to Richmond; when a child accidentally touching his foot, as he lay on a sofa, he drew up the limb suddenly. Upon this he experienced a sensation, which he described to be like displacement of the bones at the right sacro-iliac joint; and he fancied he recollected, that, at the time of the accident, he had felt a similar sensation; but certainly neither then, nor at this time, did pressure upon the ilium, in a direction to strain the sacro-iliac joint, bring on this sensation, or cause any thing like sensible motion of the joint. The pain now became gradually very severe, and extended down the limb, in the course of the sciatic nerve.

It was a year and a half from the occurrence of the accident before this patient had recovered. In this period many remedies were tried; those which were most beneficial were, strict observance of rest, and the application of caustic issues over the joint. When by these means the pain had been entirely subdued, cold sea-bathing rapidly restored his strength." 70.

We are disposed to agree with Mr. Mayo that slight inflammatory action, must be looked on as the ordinary and operative agent in the production of most of the alterations of the synarthrodial joints. No doubt the inflammation is of a low description, but the evidence and probability are in favour of its existence.

Diarthroses, or moveable articulations, and their affections, are next treated of by Mr. Mayo. The affections of the bones that enter into their composition he enumerates thus:-restorative action after fracture-atrophyeburnation, or the solidifying into a texture like ivory-inflammation, with its numerous consequences-and deposite of scrofulous matter in the cancelli. The affections of cartilage are-reparation,-softening-ulceration -inflammation—and gouty concretion. We may notice Mr. Mayo's account of the varieties of softening and of ulceration of which cartilage is susceptible.

"Cartilage is susceptible of two forms of softening; one may be considered true atrophy. It is often met with on the cartilage of the patella in persons a