in bone tumors. At the present time we know that albumose is found in the urine in a great variety of pathologic conditions, chief among which may be mentioned chronic suppuration in any part of the body. It is also quite a constant finding in osteomalacia and in certain tumors of bone, particularly enchondromata and myelomata. It can usually be found in the urine in bone sarcoma but can not be used as a means of differentiating malignant from benign tumors, nor chronic infections of bone from new growths.
It is well known that the prognosis in bone sarcoma is generally bad. In sarcoma of the femur, 70 per cent. of the periosteal are the osteoid variety, which are among the most malignant of all bone sarcoma.
In the central giant-celled tumors, the prognosis is relatively good. In a few, the disease seems to be essentially benign. It has been generally held that freedom from recurrence for three years should be considered as a cure. This is farther from the truth in sarcoma of the bone than in other malignant tumors. Local recurrences have occurred as late as twelve years after amputation, while in one case of central sarcoma lung metastases were first evident twenty-five years after the tumor began to develop.
Max Bussey reports a case of death from lung metastasis four and one-half years after disarticulation of the hip. In a case of hip-joint amputation for sarcoma of the femur operated on by McGraw, metastasis upon the shoulder occurred thirteen years after the amputation. Borck collected from the literature, 111 cases of disarticulation of the hip for sarcoma of the femur operated on in European clinics, of which 87 survived the operation. Of these, not one could be said to have been cured. In a recent paper, Jenckel was able to collect ten cases of recovery after operation for sacoma of the femur. He reports thirty-five cases, nineteen of which are from the clinic of Koenig (1880–1895) and sixteen from Braun’s clinic, operated on between the years 1884–1901. Of these thirty-five cases four should be considered cured. Of these four recoveries, three were treated by amputation of the thigh and one by disarticulation of the hip. In the literature he was able to find six recoveries recorded. These cases were operated on by Holmes, Rose (two cases), Kramer, Weisenger and Mikulicz. The length of time that had elapsed after the operation was respectively 8, 5, 16, 12, 6, and 44 years.
In the four cases of record reported by Jenckel from the clinics of Koenig and Braun, the patients had survived the operation, 154,
