of the bone. When the epiphysis is the seat of disease, the extremity of the bone is uniformly enlarged. Rarely, we find circumscribed growths projecting from one surface. When the shaft is involved, the enlargement is spindle-shaped. When the tumor has broken through the periosteum, the growth becomes extremely irregular and nodular.
In the vascular central tumors, absorption of the bone may take place rapidly without occasioning much pain; in such a case, pathologic fracture may first direct the patient to a surgeon. In central tumors spontaneous fracture or fracture from slight injury occurs in about 60 per cent. of the cases. The early occurrence of such a fracture favorably influences the prognosis of the disease.
In central round-celled sarcoma of the shaft, spontaneous fracture occurs more frequently than in any other variety of bone sarcoma. In peripheral tumors, particularly in spindle-celled and osteoid sarcomas, spontaneous fracture seldom occurs. Invasion of the neighboring lymphatics occurs most frequently in peripheral and round-celled tumors. In spindle-celled peripheral growths it is rarely that we find the glands enlarged. In osteoid tumors, erandular involvement, as well as metastasis by way of the blood vessels, occurs early and is nearly a constant finding. It may be well to call attention to the fact that hyperplasia of the glands without there being any sarcomatous invasion of the organ, is quite common. Lymphatic involvement occurred in five of the forty-four cases collected by Nasse. Of these three were periosteal and two myelogenic tumors. Leeffler states that lymphatic invasion occurs in 13 per cent. of all cases of peripheral sarcoma. In all cases where the lymphatics are involved, the prognosis is extremely bad. In many cases of sarcoma, particularly rapidly growing vascular tumors, an elevation of the body temperature is constant, varying from 99 to 102 degrees. In some it is only present after exercising or when the tumor has been subjected to trauma.
The cause of this elevation of temperature is probably due to the absorption of toxines, resulting from degenerative changes occurring in the tumor, or from absorption of the blood from the blood cysts within the growth. Usually in these cases, where absorption of blood is the cause of the temperature, rest in bed with cold applications to the diseased part will cause the temperature to drop. In soft tumors, particularly those undergoing retrograde changes, the temperature is constant and continued throughout the entire course of the disease.
Of late years a considerable number of writers have directed attention to the diagnostic significance of persistent albumosuria
