REMAINS, FROM ARKANSAS AND LOUISIANA. 239 
NOTES. 
“Inflammatory Changes.’—Under this heading are included pathological 
changes which first affect limited areas of the surface of the shaft, or body of the 
bone, and in more advanced cases cover most or all of the surface of the shaft, or 
body of the bone and involve more or less its walls. In the earlier stages the 
changes are apparently due to slow inflammatory conditions originating in the perio- 
steum and accompanied by more or less perceptible osteophytic deposits. Later, 
as the inflammatory process progresses, the surface of the shaft becomes more or 
less irregular and nodular, and the pathological alteration extends to the intersti- 
tial parts of the bone, causing considerable thickening, with increase in weight of 
the shaft of the bone. It affects most often the tibiw; the vertebra and pelvic 
bones appear to be immune. In all probability this process indicates syphilis; 
but there are instances in which it is impossible to decide whether the changes 
should be ascribed to this disease or to that systemic condition which results in 
arthritic changes in various articulations. In the majority of the cases іп which 
such inflammatory changes have occurred in one or more bones of an individual, 
the skull has been found normal. 
“ Marginal Exostoses."—These are characteristic excrescences of a definite 
though as yet somewhat obscure significance, occurring with great frequency, indeed 
quite generally, in older subjects, both among whites and among the Indians. 
These excrescences may form about the articular surface of long bones, but are most 
common about the surfaces of the bodies of the lumbar vertebra. They begin along 
the upper margin of the last three lumbars, then appear along the upper margins of 
the two superior vertebra of that region and possibly along those of one or two of 
the last dorsals, and then develop along the lower borders of the same bones. They 
frequently involve the free border of the uppermost segment of the sacrum, and 
occasionally accompany arthritic changes in cervical or other lateral articulations. 
On the whole they bear close etiological relation with the systemie condition that 
results in osteoarthritis. In advanced stages these marginal exostoses are always 
accompanied with roughening and other inflammatory changes of the articular 
surface about which they occur, and in the end the result is a fusion of the adjacent 
vertebra. In extreme cases whole regions of the spine, and even the entire spine, 
as well as the pelvie bones, become consolidated through this change. The begin- 
nings of the condition may be observed in middle-aged adults, but it is especially a 
feature accompanying old age. It may coexist with other slow inflammatory con- 
ditions of the bones, in which case a diagnostic separation of the processes may be 
very difficult. 
“ Arthritic Changes on Articular Surfaces.” —These changes begin generally 
in augmented porosity of the articular surface, followed by increased roughness and 
irregularity of the same. They are most commonly observed on the lateral articu- 
lar surfaces of the cervical vertebra, but are occasionally seen on those of the upper 
dorsal or some of the lumbar vertebra, on the sacro-iliac surfaces, and even on the 
articular facets of the long and other bones. As above mentioned, these changes 
