458 



BONE, PATHOLOGICAL CONDITIONS OF. 



spina ventosa of the lower jaw to a blow re- 

 ceived forty-one years previously, during the 

 last twelve of which the tumour had been 

 opened or given way spontaneously three seve- 

 ral times. In hospital it was punctured through 

 the mouth, and found to consist of three dis- 

 tinct cells, each containing its own collection 

 of a fluid of the consistence of oil, varying from 

 a straw colour to that of coffee, the darkest 

 being lodged within the largest cell. This 

 patient, though at the advanced age of sixty- 

 seven, was relieved by the operation, and left 

 the hospital convalescent. If, however, by the 

 term malignant is meant a disease that may 

 prove destructive of life or limb, spina ventosa 

 can occasionally lay claim to the title. For it 

 sometimes happens that small dark red or pur- 

 ple elevations appear on the surface of the skin, 

 which soon ulcerate and burst, discharging a 

 quantity at first of the material contained within 

 the bone, the character of which subsequently 

 alters into a brown, unhealthy, fetid, and often 

 putrid sanies. This ulceration is much more 

 likely to take place when the surface of the 

 tumour is uneven and lobulated, and at this 

 period the disease in appearance bears no very 

 faint resemblance to fungus haematodes. The 

 external sores next become fistulous and fun- 

 goid ; they lead down to the cavity or cavities 

 within the bone, and the patient, worn and 

 wasted by an ill-formed irritative hectic fever, 

 sinks exhausted and dies. 



Boyer* in his description recognizes these 

 two forms of spina ventosa. " Sometimes," 

 says this author, " having attained a size dou- 

 ble or triple that of the natural dimension of 

 the bone, the tumour ceases to make further 

 progress : it no longer causes pain ; it does not 

 interfere with the motions of the part, but re- 

 mains stationary, and continues thus during 

 life, without any alteration of the soft parts, 

 which accustom themselves by degrees to the 

 state of distension in which they are placed. 

 But much more commonly it continues to in- 

 crease, until it slowly arrives at an enormous 

 size, still preserving its inequalities of surface 

 or acquiring new ones." Having proceeded to 

 the period of ulceration, the conclusion of the 

 case is thus delineated. " Arrived at this 

 point, the local disease exercises a baneful in- 

 fluence on the constitution of the patient: the 

 edges of the fistulous apertures become de- 

 pressed and inverted towards the interior of the 

 tumour ; the discharge becomes every day more 

 copious and more fetid ; the fever which ap- 

 pears commonly at the period of ulceration, but 

 which at first is intermittent and irregular, 

 comes at last to be continued, and assumes the 

 character of hectic : the pains are unceasing, 

 and sometimes intolerable ; sleep and appetite 

 are deranged or lost ; consumption establishes 

 itself, and the patient dies exhausted and worn 

 out." 



Other authors, however, have considered 

 spina veutosa in all its forms as a malignant 

 disease. Such must have been the opinion of 



Mr. B. Bell,* of Edinburgh, not only from his 

 descriptions, but from the practice he incul- 

 cates. " The treatment," he says, " of spina 

 ventosa is very simple, as the surgeon, when he 

 is insured of its existence, must at once have 

 recourse to the amputating knife. If the dis- 

 ease is seated in the bones of the metacarpus 

 or metatarsus, as is generally the case in child- 

 hood, they should be removed at the articula- 

 tions. If it has attacked the tibia and fibula, 

 or radius and ulna, the amputation may be 

 performed either at the knee or elbow, or a short 

 way above these joints. The general rule to be 

 observed is, that the entire bone in which the 

 disease has its seat should be removed." 



The morbid anatomy of spina ventosa throws 

 but imperfect light on its pathology, principally 

 because the first and early changes induced by 

 the disease are wholly unobserved, and there- 

 fore are we ignorant both of the peculiarity of 

 constitution that disposes to it, and of the local 

 alterations that are first developed. Even at a 

 more advanced period, when an opportunity is 

 afforded of examining the part after death or 

 removal, there is no striking uniformity of ap- 

 pearance. The bone itself, as Boyer remarks, 

 seldom seems to have suffered any actual loss 

 of substance : on the contrary, it often appears 

 rather to have gained in weight, the walls ex- 

 panding and becoming thinner in proportion as 

 the cavity within increases in size. As to the 

 number, size, and shape of these cells, there is 

 an infinite variety as well as in the appearance 

 of the surface, which may be smooth, irregular, 

 or lobulated, and in the character of the mem- 

 brane lining the cells and the material secreted 

 by it. There is in the museum of the Anato- 

 mical School, Park-street, Dublin, a very curi- 

 ous specimen, exhibiting a perfect bony cyst 

 developed within a spina ventosa of the supe- 

 rior maxilla, and completely contained within 

 the expanded walls of the bone. It is a very 

 remarkable circumstance connected with these 

 alterations of structure, that although they usu- 

 ally commence near the extremities of the long 

 bones, they never attack the joints, and conse- 

 quently the motions of the adjacent articulation 

 may be but slightly impaired, even although 

 the size of the tumour may be such as to inter- 

 fere with the natural shape of the joint, and 

 render its usual appearance obscure and indis- 

 tinct. 



Exottosis. We employ this term to indicate 

 certain tumours growing from the outer sur- 

 face, or rather the external structure of a bone, 

 in the production of which neither the medul- 

 lary substance within nor the periosteum with- 

 out have any participation. And although our 

 notions of the nature of the disease may not 

 be perfectly correct, and our descriptions lame 

 and incomplete, we still prefer this arrange- 

 ment in order to separate the disease under 

 consideration from spina ventosa on the one 

 hand, and osteo-sarcoma on the other. It will 

 be necessary also to distinguish it from nodes 

 and some other affections of the periosteum, in 



Loc. citat. 



* Treatise on Diseases of the Bones, by Benjamin 

 Bell, edit. 1828. 



