BONE, PATHOLOGICAL CONDITIONS OF. 



450 



Caries from a scrofulous cause, generally, if 

 not always, commences in the cancellated 

 structure ; that from syphilis affects the firmer 

 and more external parts of the bone. The 

 former attacks the ends of the long bones and 

 the spongy and cuboid bones generally ; the 

 latter, the centres of the long bones and the flat 

 ones. Venereal nodes principally affect the 

 bones which are nearest to the surface of the 

 body, the skull, the tibia, or the sternum; it 

 being rare to see the humerus or femur thus 

 diseased, whilst they are by no means exempt 

 from idiopathic or strumous inflammation. 

 But the most remarkable differences to be ob- 

 served between caries arising from a specific 

 cause, and that which occurs idiopathically or 

 from injury in a constitution otherwise good, 

 occur in the progress and termination of the 

 disease. The process seems to be analogous 

 to that of ulceration in the softer tissues, and 

 when recovery takes place, it is by granulation 

 and cicatrization in like manner. Thus, if we 

 suppose an abscess to occur on the surface of a 

 bone in a healthy man, when it is opened or 

 has burst, we find that a scale or shell has lost 

 its vitality and must be thrown off by exfo- 

 liation, and soon exuberant and florid granula- 

 tions are seen springing from below as if to 

 force the offending substance off, and the dis- 

 charge from the cavity is healthy pus. On the 

 other hand, if a venereal node is opened on the 

 skull, the pericranium is here detached, the 

 table is carious and will exfoliate, but there is 

 (as long as the taint remains) no effort at re- 

 paration ; the discharge is thin, ichorous, and 

 unhealthy ; and if we may judge by the repre- 

 sentations we see of venereal caries, (for in 

 modern times mercury is not so unsparingly 

 used and real specimens are not numerous,) the 

 disease would progress until the skull was 

 fairly corroded through. Again, the lymph 

 secreted in scrofulous inflammation is not 

 healthy, and there are seldom granulations; 

 whilst the matter is either of that whey-like 

 appearance so remarkable in such affections, or 

 else a foul and fetid sanies. Every one con- 

 versant with surgery must know how tedious 

 and obstinate a scrofulous caries is, and how 

 frequently it involves the loss of limb or of 

 life. 



The true scrofulous affection of the bones 

 occurs so frequently in this country as to re- 

 quire particular attention ; it constitutes the 

 vast majority of the diseases of the osseous 

 system that we are called upon to see and to 

 treat. It commences (as we have said) in the 

 cellular or cancellated structure. In the first 

 instance there is an increase of vascularity, 

 which, though not always apparent to the eye, 

 may easily be proved by injection. Next, 

 there is an absorption of the natural contents 

 of the cancelli, and in their room a substance 

 is deposited of a yellow or white colour that 

 has been described as resembling cheese in 

 consistence; it is, however, most probably a 

 species of that flocculent unorganized lymph, 

 such as is seen coating the cysts of scrofulous 

 abscesses. The cancelli themselves are oc- 

 casionally removed, and masses or patches of 



this unorganized material deposited in their 

 stead, hence the bone becomes lighter, and so 

 soft as to allow of being cut with a knife. It 

 is remarkable that the disease may have existed 

 up to this period, when it is probably incura- 

 ble, without much pain and without external 

 swelling to attract attention to the mischief 

 underneath. In the Museum of the School of 

 Anatomy, &c. of Park-street, Dublin, there is 

 a preparation to illustrate necrosis of the centre 

 of the shaft of the thigh-bone, for which the 

 limb was amputated. The patient during life 

 never complained of the knee, neither was 

 there the smallest enlargement of the articula- 

 tion; yet after removal the condyles of the 

 femur internally were completely softened, the 

 external shell of solid bone being reduced in 

 thickness nearly to that of parchment, the can- 

 cellated structure completely removed, and its 

 place occupied by this cheesy substance. 



This condition of the bones is considered by 

 Mr. Lloyd* as constituting the first stage of 

 scrofulous disease, and he justly remarks that 

 it is quite uncertain how long they may con- 

 tinue in this state without further mischief 

 taking place. The next step is the erosion or 

 absorption of the cartilages, if the affection is 

 situated in the head of a bone, (see JOINT,) or 

 otherwise near an articulation, and probably 

 about the same period the external soft parts 

 sympathise, and lymph is extensively deposited 

 around the deep fibrous tissues in the neigh- 

 bourhood. This lymph is afterwards to be- 

 come the seat of abscesses, which always 

 communicate with the diseased bone, and very 

 generally with the cavity of the adjacent joint. 

 The limb or part is now swollen : the tume- 

 faction is round and well defined, tolerably 

 firm in consistence, and elastic to the touch ; 

 the colour of the skin is of a more than ordi- 

 nary paleness, and its surface is marked by 

 the meandering lines of numerous small blue 

 veins. The growth of the tumour seems to be 

 limited, for having reached a given size it 

 becomes stationary and never increases, al- 

 though the disease may appear at times even 

 more fully developed. Subsequently the pain 

 is very variable ; that attending on scrofulous 

 diseases being generally described as dull and 

 heavy rather than acute, but this idea must be 

 received with some limitation, for occasionally 

 the very reverse is the truth. We have seen 

 some patients the victims of most intense irri- 

 tation and suffering throughout every stage of 

 carious ulceration ; and even when it is other- 

 wise, they are always liable to severe exacer- 

 bations on any injudicious attempt at motion, 

 any improper diet or other irregularity. In 

 all cases there seems to be a considerable ag- 

 gravation of symptoms, both local and consti- 

 tutional, about the period when suppuration is 

 established, and whilst the matter is progress- 

 ing towards the surface. 



It may be a long time before the tumour 

 gives indications of being about to burst exter- 

 nally, partly perhaps from the imperfect organi- 

 zation of the lymph by which the matter is 



* See Lloyd on Scrofula. 



