442 



BONE, PATHOLOGICAL CONDITIONS OF. 



organized vascular partis diminished, but their 

 oily animal matter is increased. 



Mollities ossium is a disease, the phenomena 

 of which are directly the reverse of those we 

 have just considered. In fragilitas the bone 

 snaps across from the most trifling causes : in 

 mollities it is flexible, bends in every direction, 

 and, of course, is useless for the purposes of 

 support or motion. The morbid condition 

 seems to arise from a want of accordance be- 

 tween the secreting and absorbing vessels of 

 the bones affected : if the earthy material is 

 not secreted at all or in insufficient quantity, 

 or if it is absorbed too rapidly, mollities will 

 be the consequence, and we may presume that 

 there will be variety in the rate of its progress 

 and in the intensity of its symptoms, according 

 to the degree of derangement of function ex- 

 isting at different times. It may thus be easily 

 comprehended how fragility of bone may be 

 an early symptom of mollities, at a period 

 when the earthy material has been removed to 

 an extent which renders the bone completely 

 flexible. 



Of the causes that produce this curious dis- 

 ease, or of the change of structure that occurs 

 at an early period, nothing is certainly known, 

 indeed, it is so rare an affection that little oppor- 

 tunity for anatomical or chemical examination 

 in any of its stages has occurred. Boyer 

 seems to regret our deficiency in this branch of 

 pathological knowledge, and doubts that there 

 are a sufficient number of authentic cases to 

 establish such a difference between the fragility 

 and the softness of bone as to authorize them 

 being considered distinct diseases. There can 

 be no doubt that in the cases of cancer, &c. 

 which have occasioned, or been attended by, a 

 softening of the bones, the symptom of fra- 

 gility has been observed at one period or 

 another, and perhaps there is no such thing as 

 a softening of the bones independent of some 

 malignant taint in the constitution. " There 

 is scarcely any case," observes the author just 

 quoted, " of a pure and simple softening 

 (ramollissement) of the bones:" not one (we 

 believe) in which they have been found merely 

 deprived of their earthy constituent, leaving 

 the animal material healthy and unaltered, 

 like a bone that had been prepared by macera- 

 tion in muriatic acid; whilst all the dissections 

 of mollities exhibit such decided alterations of 

 structure as to justify an opinion of the exis- 

 tence of some malignant disposition in the 

 entire system. This view of the case ought to 

 remove the disease from the position it holds 

 in our classification, and place it among the 

 derangements of structure, only that there is 

 some reason for supposing that the first and 

 early stages may be accompanied with the 

 absorption of the phosphate of lime, and it 

 must therefore signify little where we place an 

 affection, of the nature of which we are con- 

 fessedly so ignorant. 



There is, however, a softness and pliability 

 of bone (we use the word softness in opposi- 

 tion to softening) in which there is no malig- 

 nant tendency whatever. It is original and 

 congenital, that is, from birth the process of 



ossification is suspended in some part or limb. 

 We have seen two instances of this : the most 

 remarkable occurred in a poor man forty years 

 of age, whose right arm was perfectly flexible, 

 and of course powerless. He stated that he 

 had been so from birth, but in every other re- 

 spect had enjoyed the very best health; he earned 

 his livelihood with the other arm, with which 

 he had become wonderfully dextrous. On 

 the nature of the cause that could suspend a 

 particular process of nutrition in one limb, the 

 remainder of the body being perfectly healthy, 

 it would be useless to speculate at present. 



The most extraordinary instance of mollities 

 ossium on record is that of Madame Supiot. 

 It may be found at length detailed by Brom- 

 field, to whom it was communicated by M. 

 Supe, surgeon to the hospital of La Charite.* 

 This woman appears to have been an in- 

 valid for fifteen years, during the first five of 

 which she suffered from great weakness in her 

 loins and lower extremities, accompanied by 

 great pain, which, however, did not prevent 

 her giving birth to two children within the 

 time. When M. Supe saw her, " the trunk 

 was extremely shortened, and did not exceed 

 twenty-three inches in length. The thorax 

 was exceedingly ill-formed, and the bones of 

 the upper extremity were greatly distorted ; 

 those of the lower were very much bent ; and 

 the thigh-bones became so extremely pliable 

 as to permit the legs to be turned upwards, 

 insomuch that her feet lay on each side of her 

 head. The softness of her bones daily in- 

 creased to the hour of her death." It is unne- 

 cessary to dwell on the symptoms under which 

 she laboured, as it must be obvious that no 

 one viscus could perform its function properly 

 in such an extraordinary mass of deformity as 

 she eventually became. On dissection, M. 

 Supe says, " the bones, one may truly say, 

 had arrived at the utmost degree of softness, 

 as we have not heard of any observations 

 similar to this case. In effect we have, now 

 and then, remarked that bones become mem- 

 branous and of the consistence of flesh, but 1 

 believe there never was before seen an instance 

 of the osseous particles in the great bones of 

 the extremities being so totally dissolved, leav- 

 ing no more than the form of a cylinder by 

 the periosteum remaining unhurt." 



Mr. Goochf relates a case which lasted five 

 years, and which at an early period exhibited 

 the symptoms of fragility, the patient having- 

 broken her leg as she was walking from the bed 

 to her chair and heard the bones snap. The 

 winter after breaking her leg, she had symptoms 

 of scurvy, and bled much at the gums, and 

 throughout her illness her legs and thighs were 

 cedematous, and subject to excoriate, discharg- 

 ing a thin yellow ichor. From the commence- 

 ment of the attack the bones continued to grow 

 softer, and a year before her death " she 

 breathed with difficulty, and the thorax ap- 

 peared so much straitened as necessarily to 



* Bromficld's Surg rv, vol. iii. p. 30. 

 f The Cliirurgical Works of benjamin Gooch, 

 vol. ii. p. 393. 



