change. The sphenoidal sinus seemingly enlarged is the only change in the skull. Figure 7, the bones of the skull outlined to indicate point mentioned in figure 6. It was hoped to complete this study by taking pictures of all the joints, especially of knees, left hip, pelvis, and spine, but at this stage the patient's patience gave out, and although she made numerous engagements she never came for more sittings. In the English literature I find one case reported by Sir George Campbell of a boy with multiple osseous tumors. The exostoses were connected with the epiphyses of the ends of long bones. The long bones of the arms and legs were short and thick; no explanation was given, and the family history was negative. The child was rachitic, and did not walk until the fifth year, the trouble apparently ceasing at the age of twelve. A remarkable case is reported by James T. Whitaker in the February edition, 1894, of The Internal Medicine Magazine. In this case the exostoses were principally in the heads of long bones, and there was shortening of the right forearm, three inches; the right thigh, six inches; the right leg, three inches, with exostoses at the external malleolus. The character of the tumors is described as of cartilage and bone. The disease commenced at the age of six years, and ceased at puberty. Virchow, commenting, reports a case of multiple exostoses of childhood commencing at the ribs, and extending to various long bones to the number of sixty-five tumors, and gives, as the cause of the disease, rheumatism. The fact that multiple growths, multiple exostoses, distinctly shorten the long bones, but do not affect the skull, proves that they are not rachitic. Hereditary syphilis, on the other hand, does not produce exostoses, and acquired syphilis affects short bones and develops exostoses in the skull. MacLean, in the same article, reports six cases of multiple exostoses in one family, with the arrest of growth at puberty. He does not state whether they were of one or several generations. J. H. Morgan, in the Lancet of 1897, reported a case of multiple exostoses developing in childhood, running until fifty years of age, and becoming quite rapidly osteo sarcomatous. J. Bland Sutton, in his book on tumors, defines osteomata "as ossifying chondroma." "The germ contains two species, one, compact osteoma; two, cancellous osteoma. Cancellous osteomata resemble the cancellous tissue of bones and are softer than the first class. (Note our picture, Fig. 2.) They usually possess a thick covering of hyaline cartilage, and when growing at the distal end of the radius or tibia present a series of deep channels for the passage of tendons." "Multiple cartilage-tipped osteomata are most frequent on the long bones of the arm and forearm, thighs and legs,and are often congenital, hereditary and symmetrical." This description fits our case most exactly. The German literature contains a number of articles with splendidly illustrated descriptions of multiple osteo mata. Rubenstein, in the Berliner Klinische Wochenschrift, 1891, page 794, reports a case of multiple exostoses with the growth at the joint end of long bones. Hartman reports a case of multiple cartilaginous exostoses in the Archives for Clinical Surgery, Berlin 45, page 572. Dr. Jungmann, reports a case of multiple hereditary exostoses from the clinic of Dr. Joachimstall for ortho |