BONE, PATHOLOGICAL CONDITIONS OF. 



457 



shall give to each class of disease its own ge- 

 neric term ; and although occasionally such 

 deviations from the usual operations of nature 

 will present themselves to the pathologist as to 

 baffle all his attempts at classification, still we 

 believe such a foundation as we allude to will 

 be eminently useful, whatever superstructure 

 may be raised upon it. 



Spina ventosa. In our museums of morbid 

 anatomy, there is no want of specimens exhi- 

 biting the separation, or rather expansion of 

 the solid walls of a bone, leaving one or more 

 cavities within it ; these cavities having during 

 the patient's life been filled with a secretion that 

 presents considerable variety in different cases, 

 sometimes possessing a moderate degree of 

 firmness and consistency, but more frequently 

 consisting of a fluid of a serous character and 

 reddish colour. This is the disease to which 

 we apply the name of spina ventosa in contra- 

 distinction to abscess within a bone, from which 

 it differs in its extremely chronic nature and 

 tedious progress ; in its not containing purulent 

 matter ; in its having no tendency to burst into 

 any contiguous joint; and (until at a very ad- 

 vanced period) in its not being complicated 

 with caries.* Boyer divides this disease into 

 two species, one of which is peculiar to chil- 

 dren, and continues to the age of puberty ; the 

 other, the spina ventosa of adults, which ex- 

 hibits the characteristic features of the disease 

 more perfectly. 



It is, indeed, difficult to separate the first- 

 mentioned of these affections from our com- 

 monly-received notions of caries, and in the 

 various instances we have seen we have always 

 regarded them as such. Boyer attributes it to 

 the influence of a scrofulous taint within the 

 system, and says that it attacks the metacar- 

 pus, the metatarsus, and the phalanges. It 

 commences and continues for a length of time 

 either without pain or with very trivial suffer- 

 ing ; the tumefaction of the parts is moderate, 

 their motions scarcely interfered with, and re- 

 covery finally takes place about the age of pu- 

 berty by a species of necrosis. Its course is 

 thus described : " The progress of the disease 

 and the distension the soft parts undergo, cause 

 them to ulcerate at a spot always corresponding 

 to some aperture in the osseous cylinder, and 

 permitting the introduction of a probe within 

 its cavity. The external aperture becomes 

 fistulous, and for a Jong time discharges a 

 moderate quantity of ill-digested serous matter. 

 The part, however, remains indolent, the con- 

 stitution does not suffer, and if the patient can 

 thus attain that epoch of life at which nature 

 commonly can struggle with success against 

 scrofula, this form of spina ventosa may be 

 cured by necrosis of a part of the spoiled bone. 

 Then the sequestrum is detached, the re- 

 mainder of the osseous parts subside, resolu- 

 tion is established, and the disease ends by a 

 deep, adherent, and deformed cicatrix." We 

 have not met with the affection as here described 

 we have never seen any thing like the rege- 

 neration of a bone thus lost, nor can we con- 



* Diet, des Sciences Medicales, torn. lii. p. 311. 



ceive necrosis, which is essentially a reproduc- 

 tive process, to be in anywise allied to or con- 

 nected with scrofula ; we therefore still regard 

 this disease, which after all is not very frequent 

 of occurrence in these countries, as a modifica- 

 tion of caries. 



" The other species, fortunately more rare 

 but much more serious, most frequently attacks 

 adult persons, and affects the extremities of the 

 long and cylindrical bones of the limbs." Its 

 exciting cause seems to be involved in utter 

 obscurity, nothing being known with certainty 

 concerning it. Very often the patient traces it 

 to the receipt of some injury, bnt it occurs so 

 frequently without any such provocation, that 

 it must be considered as an idiopathic disease. 

 It is found most frequently, as Boyer has re- 

 marked, in the long bones, where the medullary 

 cavity is best developed, but it is seen in the 

 flat bones also, and in so many instances in the 

 lower jaw as to render it an object of attention 

 with reference to this bone alone. Its com- 

 mencement has no characteristic by which it 

 can with certainty be known, and its progress 

 is equally variable, being generally slow, but 

 sometimes remarkably rapid. It commences 

 with pain, occasionally deep and dull, occa- 

 sionally severe to excess, either when its pro- 

 gress is rapid, or it presses on some sensible or 

 important part. This pain, with very few ex- 

 ceptions, precedes the swelling, and when the 

 disease attacks the lower jaw is almost con- 

 stantly mistaken for common tooth-ache a 

 mistake that leads to the extraction of one or 

 more of the teeth and the consequent exacerba- 

 tion of morbid action. The tumour seems to 

 engage the entire circumference of the bone, if 

 it be a round one; if flat, the swelling is more 

 oval, and sometimes it is irregular and lobula- 

 ted. It is hard, firm, unyielding, and incom- 

 pressible : pressure on it does not occasion an 

 aggravation of pain, unless it shall have hap- 

 pened that the periosteum is inflamed, when 

 of course the smallest pressure will occasion 

 suffering. In the commencement it bears a 

 strong resemblance to necrosis of the long bone, 

 except in not being preceded or accompanied 

 by tever, and in not being so painful or so 

 rapid in its progress. In the flat bone it has a 

 greater likeness to osteo-sarcoma, from which 

 it is so difficult to distinguish it that many 

 cases of spina ventosa have been operated on 

 and removed as examples of the other disease. 

 Nevertheless at a more advanced period the 

 diagnosis is more easy, for spina ventosa does 

 not reach the great, or rather the illimitable size 

 to which osteo-sarcoma may attain. 



In a pathological point of view, spina ven- 

 tosa should not be considered as a malignant 

 disease : it often endures for a length of time 

 or during life without engaging adjoining 

 structures or contaminating the constitution, 

 and if removed by operation it does not recur 

 in another place or seize on some other bone. 

 It is, moreover, not infrequently capable of 

 relief or even of cure by the simple operation 

 of exposing the cavity and evacuating its con- 

 tents We have at this moment before us the 

 details of a case in which the patient referred a 



