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243 without crepitus, but attended with great pain. The knee- jerks of the left leg were greatly increased, but no rigidity or ankle clonus was present. On account of the pain and discomfort amputation was performed in November, 1895. The patient recovered, and at the present time is in fairly good health. No other bones of the body were diseased. The upper half of the tibia had undergone a uniform trans- formation into a minutely cancellous, bone-like substance, so devoid of earthy salts that the bone itself was as pliable as indiarubber. Precisely similar tissue completely filled the medullary cavity. Microscopic sections were cut quite readily without artificial decalcification. They were stained with carmine and haematoxylin. The trabeculae, which took the carmine stain like bone decalcified artificially, were surrounded with a definite layer of osteoblasts, the amount of re-absorption by osteoclasts being quite insignificant com- pared with that of new production. The spaces between the trabeculse were everywhere occupied by a highly cellular connective tissue, which contained but few leucocytes. The ’’ sections of the nerves in the periosteum exhibited a perfectly normal structure. In the gross the anatomical result was like that presented by the calvaria in osteitis deformans before sclerosis had supervened, but differed in the absence of calcification. The tissue most closely resembled the un- calcified osteoid tissue seen in rickets around the shafts or upon the flat bones. Rickets in this case was excluded by reason of the clinical differences, the strict localisation of the disease to the upper half of the bone, the filling of the medullary cavity with the osteoid tissue, &c. Mr. Pitts and Mr. Shattock regarded the condition as an osteitis in the sense in which any chronic osteoplastic process could be called inflammatory. Following Virchow’s teaching, Recklinghausen, in his recent monograph on fibrous or deforming osteitis, had adopted the view which took osteomalacia to be an inflammatory lesion. In this disease, however, the amount of bone-production was con- spicuous by its absence ; the osteitis was almost completely aplastic ; moreover, the decalcification and metaplasia of the decalcifying bone into fibrous tissue seen in osteomalacia were absent in the specimen under consideration. Reck- linghausen had adopted the term osteitis fibrosa as a synonym for osteitis deformans for the reason that in certain cases an obvious amount of fibrous tissue may be met with in the bones, but in none had want of calcification been observed ; moreover, there was no fibrous formation in the present specimen. The cases of frontal leontiasis recorded by Mr. Horsley exhibited an inter-trabecular formation of fibrous tissue, but the bone, again, was not uncalcified and the operations for its removal were conducted by means of the trephine and saw. Mr. Pitts and Mr. Shattock, in conclu- sion, found it impossible to class the specimen under the head- ing either of osteomalacia or osteitis deformans. The lesion was an osteitis occurring in the adult of a pronounced plastic character, but unaccompanied with calcification of the new osseous tissue, and in all this was so remarkable that they had proposed the term non-calcifying plastic osteitis," thinking that its etiology might prove to be different from that underlying other better known and commoner anatomical con- ditions.-Dr. KANTHACK did not think that the possibility of new growth had been satisfactorily excluded. He had found an osteoblastic layer similar to that described almost always present in the new bone of osteoid sarcomas, and here also calcareous salts were often absent. He had seen cases of sarcoma of bone, with secondary growths elsewhere, having macroscopic and microscopic appearances just like those in this case. The long history was against the theory of the change being due to a growth, but it was possible that secondary growths might yet occur.-Mr. SpBNCBB suggested that possibly it might be a case of new growth arising from the white cells of marrow—"myeloma" or lymph-adenoma of bone. Several of these cases recorded had occurred as single tumours, and had lasted as long as in the present case without giving rise to secondary growths, and in several an injury appeared to have been the exciting cause,- The PRESIDENT hoped that Mr. Pitts and Mr. Shattock would place their case under the heading osteitis deformans. He thought that the specimen illustrated a stage in that disease at which the bones were plastic and the deformity took place. The tumour origin of osteitis deformans had been suggested some years ago by Dr. Goodhart and others, but unless secondary growths should occur there was no evidence for regarding this specimen as a tumour.-Mr. PITTS, in reply, said he did not believe there was a growth. The name was provisional. He regarded the condition as most closely allied to osteitis deformans.--Mr. SHATTOCK also thought there was no evidence of growth. This cae differed from the other conditions which had been mentioned, the softness being due here, not to decalcification of pre- existing bone, but to new formation of uncalc:fied bone. Dr. KANTHACK and Mr. T. STRANGEWAYS PIGG gave the result of their recent examination of a Specimen in the Museum of St. Bartholomew’s Hospital which was described forty years ago by Sir James Paget as one of Enchondroma of the Testicle. The specimens showed to the naked eye a cartilaginous looking tumour of the testis, with growth extending along the spermatic cord and the pampiniform plexus and extending into the inferior vena cava, where there was a mass of new growth projecting into the lumen. Sir James Paget found numerous secondary cartilaginous growths in the lungs, and an intra-vascular growth in a branch of the pulmonary artery. The lymphatic glands were not enlarged. Mr. Butlin in his work on Sarcoma had thrown doubt on whether this were a case of enchondroma. The result of the examination by Dr. Kanthack and Mr. Pigg left no doubt in their minds that this was a columnar-called carcinoma in which metaplasia of the fibrous tissue into cartilage had taken place, this chondrification being in places so extensive as quite to mask the carcinomatous nature of the tumour. The tumour had extended by the veins and not, as originally described, by the lymphatics. Sections through the pam- piniform plexus showed that the lumen of the veins was filled by a fibrous stroma containing alveoli lined by columnar epithelium. There were also (as in other cases of carcinoma, of the testis recently described by Dr. Kanthack and Mr. Pigg) masses of squamous-lookicg epithelium with concentrically arranged cell nests. The fibrous stroma con- tained much cartilage, usually in round masses, but in places showing gradual transition from fibrous tissue. In some parts the tissue was loose and almost myxomatous in character. In the testis cartilage was predominant, but the existence of columnar epithelium in alveoli could be traced. The occur- rence of cartilage in carcinomata and their secondary deposits bad been described by Virchow and figured by Ziegler. It illustrated the importance of the stroma as well as the epi- thelial elements ot a malignant growth. Dr. Kanthack and Mr. Pigg referred to the remarkable acumen and accuracy displayed by Sir James Paget in his original description not- withstanding the imperfections of histological technique at his disposal.-The PRESIDENT thought the main point was the malignancy of the ’tumour. He had been led to doubt its innocence both from the naked-eye appearance of the tumour and from Sir James Paget’s description, but had not till now seen sections. He agreed that it was a carcinoma.- Dr. SNOW considered that from the variety of tissues present the specimen should be regarded as a 11 blastoma" arising from fcetal residua.-Mr. BOWLBY thought the demonstration clearly showed the tumour to be a carcinoma with chon- drification of the matrix. The absence of involvement of the lymphatic glands was exceptional. The existence of columnar cells was noted by Sir J. Paget ; but, probably owing to the imperfect histological methods of the day, their arrangement and significance had escaped him. The following card specimens were shown :- Mr. PERCY PATON : (1) Fracture of the Radius and Ulna at the Epiphysis ; and (2) Prævertebral Abscess. Dr. TURNEY: Intra-pericardial Aortic Aneurysm com- municating with the SuDerior Vena Cava. HUNTERIAN SOCIETY. Exhibition of Specimens. AN ordinary pathological meeting of this society was held on Jan. 13th, the President, Dr. G. E. HERMAN, being in the chair. Mr. T. H. OPENSHAW showed a Solid Ovarian Tumour-a small-celled sarcoma-removed from a woman who had been confined ten days before admission to hospital. Dr. Herman examined the patient and diagnosed a sarcomatous tumour. There was a large amount of ascitic fluid in the abdomen. The uterine cavity was three and a half inches in length. The interesting points of the case were : (1) the size of the tumour-71/2 Ib.; (2) its solidity ; and (3) the pedicle was twisted.-Dr. HERMAN spoke on the question cf recurrence of sarcomatous tumours of the ovary and said that it was by no means certain-Mr. TARGETT alluded to the fact that
