516 



ABNORMAL CONDITIONS OF THE HAND. 



ternally through the large circular apertures 

 already mentioned. 



We have thought it right to detail this re- 

 markable case at length, as it is the hislory of 

 an important fact, from which, it is true, differ- 

 ent conclusions may be drawn ; for our part, we 

 consider the case a well-marked specimen of a 

 disease described by some of the older writers 

 as spina ventosa. Boyer adopts this appella- 

 tion, and in his work will be found a good 

 account of the disease; and, indeed, he so 

 accurately depicts the appearances we observed 

 in this case, and which were discovered by dis- 

 section, that we feel satisfied his description has 

 been drawn from nature. Boyer says, " We 

 understand by spina ventosa an affection of 

 the cylindrical bones, in which the walls of the 

 medullary canal are subjected to a slow, gra- 

 dual, but sometimes enormous, distension ; 

 while, at the same time, they are considerably 

 thinned, and even pierced in many points, in 

 which their tissue undergoes a singular rarefac- 

 faction, a disease whose primitive seat would 

 appear to reside in the medullary cavity," &c. 



Sanson, from two careful dissections of recent 

 specimens of this disease, considers it to origi- 

 nate in a degeneration of the membrane which 

 lines the interior of the bone. The substance 

 which is found to fill up the cavity of the bone 

 can only proceed from the system of the me- 

 dullary membrane, the action of which becomes 

 so altered and diseased, as to produce the new 

 growth which is found in the interior of these 

 globular tumours. This product distends by 

 degrees the walls of the medullary canal and 

 reticular structure of the bones. The dilatation, 

 in which the articular surfaces do not partici- 

 pate, is generally sudden, so that the part imme- 

 diately near the point where the disease is 

 situated preserves its natural dimensions. When 

 the globular tumours thus formed are cut into, 

 in the early stage of the affection, their interior 

 presents a fibro-cartilaginous appearance, sur- 

 rounded by a thin shell of bone. A section 

 of one of those tumours of the fingers in the 

 early stage appears to us to present a striking 

 resemblance to the common fibrous tumour of 

 the uterus, which is often encased in a similar 

 bony shell. The description Mr. Crampton 

 has given of the structure of the benign osteo- 

 sarcoma may well be applied to this disease. 

 He says, " the interior of the tumour presents 

 a great variety of structure, but I should say, 

 in general, that the cartilaginous character which 

 the tumour exhibits in its origin prevails to the 

 last. In the early stages of the disease, the 

 tumour consists of a dense elastic substance, 

 resembling fibro-cartilaginous structure ; but 

 the resemblance is more in colour than in con- 

 sistency, for it is not nearly so hard, and it is 

 granular rather than fibrous, so that it breaks 

 short. On cutting into the tumour, the edge of 

 the knife grates against spiculae, or small grains 

 of earthy matter with which the substance is 

 beset. If the tumour acquires any considerable 

 size, it is usually (bund to contain cavities filled 

 with a fluid differing in colour and consistency ; 

 but in general the fluid is thick ish, inodorous, 

 and of tiie colour of chocolate. Sometimes the 



growth of the tumour, and the secretion of the 

 fluid within its substance, is so slow, that the 

 deposition of bony matter keeping pace with 

 the absorption, the bone becomes expanded into 

 a large thick bony case, in which the tumour is 

 completely enclosed."* 



Strumous osteitis oft/it metacarpal bones, and 

 of the phalanges /' the fingers. It is by no 

 means difficult to distinguish the disease last 

 described under the name of spina ventosa, or 

 benign osteo-sarcoma, from that enlargement of 

 the metacarpal bones and of the fingers which we 

 frequently witness in children of the strumous 

 diathesis. The strumous affection of the pha- 

 langes we allude to seems little else than an 

 osteitis, which terminates usually either in caries 

 or necrosis. The disease, when fully formed, 

 shows itself in the shape of either a pyriform 

 or globular swelling of the phalanx of one or 

 more of the fingers. There is at first no sensi- 

 ble alteration of the surrounding soft parts ; the 

 swelling has usually been preceded by pains 

 of a dull and obtuse character ; the movements 

 of the part affected are for a long time preserved, 

 and indeed are not at all restrained, except 

 when the tumefaction of the bone becomes 

 sufficient to turn aside the tendons from their 

 natural direction, or to cause deformity of the 

 articular surfaces, which rarely happens. 



As the disease advances, the soft parts are 

 distended, suppuration takes place, and the 

 integuments of the swollen part always ulcerate 

 at a point corresponding to some deficient part 

 of the bony cylinder. Through the ulcerated 

 opening a probe may be passed freely into a 

 cavity which the bone contains; the opening 

 becomes fistulous, and for a long time continues 

 to give exit to a moderate quantity of thin, 

 serous, and ill-conditioned matter ; sometimes, 

 however, we notice an improvement in the ge- 

 neral health of the patient, and, at the same 

 time, the local disease assumes a new and more 

 favourable aspect, the discharge diminishes, and 

 at length dries up. Such a decided amendment, 

 however, seldom occurs, until a process of ne- 

 crosis, or exfoliation of a part of the bone, has 

 taken place; after which the wound heals up, 

 the use of the finger is restored, and all that 

 remains of the disease is an unseemly, depressed, 

 and adherent cicatrix. 



Malignant tumours (if the hand. Malignant 

 osteo-sarcoma, and even fungus hsematodes, are 

 diseases which may show themselves in the 

 region of the hand and fingers; but these dis- 

 eases are readily distinguished from the spina 

 ventosa, or benign osteo-sarcoma, above alluded 

 to. The pains of the malignant disease are 

 lancinating, the progress is more acute, the con- 

 stitution and health are more quickly and deeply 

 implicated ; the prognosis, too, is very different. 

 Although life may perhaps be prolonged by an 

 amputation of the hand of a patient affected 

 by either of these malignant diseases, the terri- 

 ble disorder will almost uniformly recur. On 

 the contrary, if the disease be spina ventosa, a 

 portion of the hand may be amputated, or a 

 finger removed, and the disease shall notrecu r 



* VUlu Dublin Uospiiiil Reports, vol. iv. p. 042. 



