that was caused by any movement of the limb. At this time she first consulted a physician, who recommended rest and the application of a plaster of Paris cast. This treatment was carried out, but only seemed to make the pain more severe. After a few weeks, the cast was removed, but was later reapplied. When she consulted me she was wearing a cast, the case being considered one of tuberculosis of the knee.
During the last few months preceding her entrance into the hospital she had steadily lost flesh. Her appetite was poor and her rest was broken by the severe pain she suffered. During the whole course of the disease her temperature had been above normal, varying from 99 to 102 degrees.
Physical examination, at the time of entrance, showed the patient to be greatly emaciated, pale and extremely nervous. The chest and abdomen were apparently normal. Examination of the urine, negative; the muscles of the left lower extremity were markedly atrophied. The left knee and lower third of the thigh were apparently larger than the right. On measurement, the left femur, just above the condyles, was found to be 4 c. m. larger in circumference than the right. The left knee joint, measured across the center of the patella, was slightly larger than the right. There was a uniform enlargement of the lower end of the left femur that was regular in outline, and exceedingly sensitive on pressure. The knee was fixed with the leg flexed at an angle of 45 degrees. Any attempt at movement of the joint caused great pain. Under anesthesia, the leg could be fully extended. No limitation of movements in any direction was present. Nothing abnormal about the joint was found. Puncture of the joint was made, but no fluid obtained. Upon the negative findings in the joint and the peculiar enlargement of the femur a diagnosis of the sarcoma of the femur was made. Through a small incision made while the patient was under the anesthetic, a piece of the tumor was excised, and subjected to a microscopic examination. It proved to be a peripheral ossifying spindle-celled sarcoma.
Upon recognizing the nature of the disease, amputation at the hip-joint was recommended. This was performed on the 20th of May, 1899, the method of Wyeth for the control of hemorrhage being employed. The patient suffered but little shock from the operation, and made a rapid and satisfactory recovery from the operation. The wound healing throughout by primary union. At the time of the operation, the inguinal and iliac glands were found enlarged, and were removed. Microscopic examination did not, however, show any evidence of carcinomatous change in them. The
