but malignant-looking growth at the seat of disease ; and to a considerable extent the periosteum could be traced over it. In bulk it was larger than the fist. 1869.
Dr. G. H. Gay.
1494. A second specimen, prepared by Dr. Thomas Dwight, Jr., and that contrasts remarkably with the last ; the two cases having occurred at about the same time. In this one the disease is mainly upon the back part of the bone, ex- tends longitudinally about 4 in., and laterally involves about one-half of the circumference of the bone. The surface to this extent is quite rough, but the structure looks firm, and there is very little loss of substance. Around this surface is a high wall of periosteal growth, and that is formed, to a considerable extent, of large, broad, thin, flattened laminae, and seeming to have stood off perpendicularly and regularly, like crystals, from the surface of the bone, and the cancerous growth that was formed upon it. The deposit beyond the seat of the dis- ease is not extensive, as in the last case, nor at all thick and irregular ; but looked rather like what is often seen as the result of simple inflammation. The whole cir- cumference of the bone is affected ; but, anteriorly, there is very much less of the deposit ; and the disease is alto- gether much less marked than upon the back of the femur. Otherwise the bone is quite healthy.
The patient was a lad, about thirteen years of age, and the disease was developed very rapidly. Dr. C. V. Bemis, of Medford, states that he came to see him on the 7th or 8th of Sept. ; that there was a little stiffness and tender- ness of the muscles just above the knee, but no swelling. He had been riding a good deal upon a velocipede, but suggested no other cause for his disease. Three or four days afterward Dr. B. found swelling, with some pain ; and from that time he regularly attended him. The swelling became hard, without any great amount of pain, and it appeared like a case of simple periostitis. There had been but little swelling of the integument, but about the 1st of October it increased, and all at once the hard swelling be- came soft and elastic, as from a yielding of the bone ; the pain, meanwhile, having much increased. Oct. 7th the
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