Bone cyst of tibia. (Buffalo Clinic.)

Myeloma (Kahler’s Disease).

—Collins[36] reports the tenth recorded case in this country. The disease was first described by Bence Jones in connection with a peculiar proteid found in the urine. It is characterized by changes in the bones, with pain in the chest, back, and loins. In the urine albumose appears, which seems to be pathognomonic when taken in connection with such symptoms as those above. On section numerous small tumors are seen in the bones. The disease has hitherto been regarded as an expression of osteomalacia. All the bones of the skeleton may be involved without any tendency to metastasis in other tissues. On minute examination the myelomatous tumors met with seem to be found alike in the bone substance and the marrow, and to be cell proliferations of myeloid tissue. The matter is still left somewhat in doubt as to what should be meant by the term myeloma, this being a feature to be cleared up later. It is seen more often in males than in females, and in the later part of life. Aside from constant malaise, with pain in the back and side, there occur progressive weakness, with anemia, and such final softening and fragility of bones as to lead to spontaneous fractures, or to the projection of tumors, which may be especially noted about the ribs, with deformity of the vertebræ. On close inspection the urine will be found turbid and albumose is detected. The disease is usually regarded as hopeless; there is no information regarding its successful treatment.

[36] Medical Record, April 29, 1905.

Fig. 252

Sarcoma developing in callus. (Haberen.)

CHAPTER XXXIII.
DEFORMITIES DUE TO CONGENITAL DEFECTS OR ACQUIRED DISEASES OF THE LOCOMOTOR APPARATUS; ORTHOPEDICS.

In previous chapters have been considered the various morbid conditions of bones, joints, muscles, and tissues which help to form the locomotor apparatus of the body. It would seem then quite proper in this place to insert the chapter usually relegated to the end of text-books on surgery where it stands by itself, i. e., the chapter on Orthopedics. As a subject orthopedics deals with the causation and the treatment of deformity, whether inherited or caused by disease. The term is used in a more or less elastic sense, and is made by some to cover a larger field than others would accord it. The subject divides itself into two parts:

1. The consideration of deformities produced by tuberculous or other infectious disease, and