452 



BONE, PATHOLOGICAL CONDITIONS OF. 



frequently met with in the neck, but when so 

 situated it is easy to conceive how they may 

 occasion dysphagia or difficult respiration. 

 We have seen a case where such an abscess 

 occasioned symptoms resembling those of com- 

 pression of the brain, and we have the notes of 

 one in which death was produced in a very 

 sudden and unexpected manner, the matter 

 having burst into the sheath of the spinal 

 marrow. They may also occur in connexion 

 with disease of the dorsal vertebrae, and within 

 the chest give rise to symptoms resembling the 

 different forms of deranged respiration tho- 

 racic aneurism and, under peculiar circum- 

 stances, even of empyema. Such difficulties 

 are now not so likely to occur, as we have 

 auscultation to assist the diagnosis ; but we 

 recollect to have seen more than one case 

 treated as a pulmonary affection, the real nature 

 of which was caries of the dorsal vertebrae, 

 complicated with abscess pressing forward 

 within the posterior mediastinum. Abscess in 

 the loins connected with diseased vertebrae is 

 too familiar an occurrence to require any 

 lengthened details. 



As far as our own observation can guide us, 

 we believe the appearance of abscess as an 

 accompaniment of spinal disease to be almost 

 always a fatal symptom ; and when, in the 

 course of a wasting and protracted discharge, 

 spiculae of carious bone, or portions of a sub- 

 stance resembling ivory or enamel are seen to 

 come away, the aspect of the case is still 

 farther formidable very few, if any, ever 

 recover under such circumstances. 



2. " In other cases the vertebrae retain their 

 natural texture and hardness, and the first 

 indication of the disease is ulceration of one or 

 more of the intervertebral cartilages, and of 

 the surfaces of bone with which they are con- 

 nected."* 



" There is still another order of cases, but 

 these are of more rare occurrence, in which 

 the bodies of the vertebrae are affected with 

 chronic inflammation, of which ulceration of 

 the intervertebral cartilages is the consequence." 

 We shall now proceed to detail the results 

 of our own observations, in order to see how 

 far they coincide with those of the learned and 

 accurate surgeon already quoted. 



In two instances we have, in the dissecting 

 room, seen the intervertebral substance eroded 

 at the anterior edge, the bodies of the adjacent 

 bones remaining unaltered in shape or consis- 

 tence, and to every appearance in a perfectly 

 healthy condition. These were, at the time, 

 regarded as specimens of the very earliest and 

 incipient stage of the disease, and although no 

 clue could be obtained as to the history of the 

 cases, it is worthy of remark that not a trace of 

 scrofulous disease could be discovered in any 

 other parts of the bodies. 



In general, however, it is otherwise. The 

 body of the bone seems to be seized with 

 scrofulous inflammation, and the peculiar ef- 

 fects of this morbid action are produced within 

 it. It becomes softer in consistence, in conse- 



* Brodie, loc. citat. 



quence of the absorption of its osseous parti- 

 cles, and a deposition of the cheesy lymph in 

 its stead. At this time, although so soft as to 

 admit of being cut with a knife, the bone ap- 

 pears unaltered as to size or shape, but its 

 absorbents begin to act upon the ligaments and 

 intervertebral cartilages, and hence is it that 

 the separation and ulceration of these are 

 amongst the earliest appearances. In many 

 instances the connexion between the cartilage 

 and bone is so much impaired, that if we 

 wanted to separate them with a knife, the former 

 would come off in one entire flake. The 

 edges then begin to be eroded and ulcerated, 

 as if gnawed by a mouse ; and at this period 

 also the ligaments are often found thickened 

 and softened, and matted up together into a 

 confused and indistinct mass. The body of 

 the bone then becomes carious, and the ulce- 

 ration commences at the anterior part of it : 

 very rarely is the posterior layer of firm bone, 

 that forms the front of the canal for the spinal 

 marrow, affected; and never does the caries 

 spread to the processes. Up to this period it 

 may be, and often is, a specimen of purely dry 

 caries, being unattended by the formation of a 

 single drop of purulent matter. 



As the disease proceeds, and the bodies of 

 one or more vertebrae are removed, those which 

 remain approximate more or less above and 

 below : the spinous processes project, and a 

 bending of the body forward is produced. 

 The character of this curve is influenced by 

 the extent of the destruction that has been 

 accomplished within ; it is sharper and more 

 angular when the body of one vertebra only has 

 been removed; it is more sweeping and gradual 

 when three or four have suffered. Never, we 

 believe, is the angle so sharp as to permit the 

 denuded surfaces of the vertebrae above and 

 below to come into actual contact, the sound 

 condition of the bony parietes of the spinal 

 sheath effectually preventing this ; and hence, 

 when recovery takes place, it is not by the 

 adhesion of these surfaces, but by the forma- 

 tion of a quantity of new bone which fills up 

 the vacant space, producing a perfect example 

 of true anchylosis. 



The developement of such a curative pro- 

 cess as this is scarcely to be expected in a 

 scrofulous system, yet is it satisfactory to know 

 that even under such circumstances the case is 

 not utterly hopeless. We have seen repeated 

 instances of angular curvature without the 

 occurrence of abscess, in patients apparently 

 deeply tainted with scrofula, one of which is 

 so very remarkable as to deserve particular 

 notice, because it illustrates a mode of union 

 that frequectly occurs in scrofulous cases, and 

 because the preparation is in existence to de- 

 monstrate the fact. In July, 1830, a wretched 

 young girl was brought into the Meath hospital 

 with a very acute angular curvature of the 

 dorsal vertebrae. Almost every joint in her 

 body was diseased, and the knees so extensively 

 that the eroded condyles of the thigh-bones were 

 exposed, from the surface of one of which the 

 mud of the street was wiped away after 

 her admission. It need scarcely be added 



