BONE, PATHOLOGICAL CONDITIONS OF. 45,1 



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that her sufferings were not of long duration, its death, and is analogous to mortification in 



and an opportunity was speedily afforded for the soft parts, where the slough is thrown off, 



examining the pathological condition of the and the consequent ulcer subsequently heals by 



back. It appeared that three of the vertebrae granulation and cicatrization, 



had been engaged, the spongy portion of one Necrosis is the death of a bone or part of a 



of which had been completely removed. There bone accompanied by a process of regeneration 



was nothing like a reproduction of osseous established at a time coeval or nearly coeval 



material, although the caries had long ceased, with the inflammation or accident that deprives 



and the spine was sufficiently strong for every it of vitality. In this point of view the disease 



ordinary purpose of support ; but the space is singular, there being nothing like or ana- 



that had been left by the absorption of the logous to it in any affection of the soft parts, 



bone was filled up by a ligamento-cartilaginous Necrosis is rarely a disease of early and 



substance, which, attached like a new and never of advanced life, being, except in cases 



adventitious ligament to the vertebrae above where it attacks the lower jaw, almost exclu- 



and below, held them with a sufficient tight- sively confined to the period between the ages 



ness to prevent the smallest motion, and gave of ten and twenty-two : exfoliation may occur 



to the entire column a tolerable degree of firm- at any time, but is more likely to appear in the 



ness. We have also seen examples of true adult or the aged. 



bony anchylosis in patients apparently scrofu- Necrosis, although it may succeed to acci- 



lous, but it seems to occur generally in males dent, as in this manner compound fractures and 



rather than in females, and more particularly other injuries are not infrequently repaired, yet 



in patients about or approaching to the age of is it more generally an idiopathie disease, or 



puberty, a period at which it is generally sup- may be the sequela of continued fever ; whilst 



posed some important change takes place in exfoliation in the great majority of instances is 



the constitution of scrofulous subjects. Where the consequence of injury, 



there is no such taint, or where, as Sir B. According to the acceptation in which we 



Brodie expresses it, the bones retain their na- employ the term, it is extremely questionable 



tural texture and hardness, it may be easily whether necrosis is ever a disease of the flat 



conceived that a cure is effected in less time bones; at least, except in the instance of the 



and with less difficulty. lower jaw, we have never met with an example 



There is another specimen of caries or ulce- of the death of one of these structures accom- 



ration of bone without the formation of matter, panied or even followed by a regenerative pro- 



occasionally observed in the neck of the thigh- cess. 



bone of very old persons, the symptoms of As necrosis, then, presents a solitary exam- 



which have particular relation to the hip-joint; pie of the efforts of nature in counteracting, or 



we shall therefore postpone our remarks on it rather in providing against the ravages of dis- 



until we come to discuss the pathology of ease, the process by which it is accomplished 



joints. becomes an exceedingly interesting subject of 



Necrosis. There are few subjects more in- inquiry. Different opinions are entertained 

 teresting either to the pathological inquirer or upon this subject. It seems to be agreed 

 to the practical surgeon than the death of a upon all sides that the commencement of the 

 portion of the osseous system, and the circum- disease is marked by inflammation of the bone: 

 stances connected with this event. Neither is at this period it is red, vascular, and receives 

 there any one with respect to which the ideas the tinge of coloured injections. How this in- 

 of medical men generally are less definitively flammation may be caused or why it is followed 

 settled. Thus also some confusion has crept by the formation of new bone, are points not so 

 into our nomenclature, and necrosis and ex- easily determined. Troja introduced a sharp 

 foliation have been often indifferently used, as instrument through a bone, by which he con- 

 if they applied to one and the same diseased trived to destroy the internal periosteum and 

 action ; or, perhaps, to speak more correctly, marrow, and thus produced a number of cases 

 the term necrosis has been made to extend to of necrosis, which presented the same sym- 

 every case in which a bone or a portion of a ptoms and ran the same course as if they had 

 bone is deprived of vitality, no matter how been examples of idiopathie disease. Hence it 

 the dead material is to be removed or replaced, came to be believed that the death of the inter- 

 According to the etymology of the term such nal periosteum was a necessary prelude to 

 is in fact its true meaning; nevertheless, we necrosis, until it was observed that the parts 

 are hardy enough to dissent from this applica- surrounding a bone had assumed those actions 

 tion of the word, and to confine its use to one which end in the formation of a new one before 

 form of the death of a bone, exfoliation more the absolute destruction of any part of the old 

 properly belonging to another. And we do so one whatsoever ; and therefore that, although 

 the more readily because not only do these two the injury inflicted on the internal periosteum 

 affections present different pathological pheno- might cause necrosis, yet it was only one cause, 

 mena, but there are such practical discrepancies and acted by creating inflammation within the 

 between them that it is essential to every sur- substance of the bone. Thus we are obliged to 

 geon to have a distinct and separate notion of return to the point from which we set out : we 



know that inflammation is established within 



Exfoliation, then, expresses the death of a the bone, and, coeval with this or nearly so, 



portion of bone which is either never replaced, that nature commences the process of repro- 



or replaced by a process which is set up after duction ; but why this latter is confined to a 



