320 
RICHARD MIDDLETON. 
Besides the lesions in the bones there are also lesions in the 
articulations, which produce a reddish effusion. The le- 
maining organs of the body remain unaffected, and through¬ 
out the course show no change whatever. By continued 
wasting and weakness there is induced a cachectic state o 
the patient, which is constituted by hydrasmia, transudations 
into the several cavities, and a disappearance of the normal 
fat; also a fading of the muscular tissue and an infiltration 
of the same with a gelatinous fluid. 
The symptoms of osteoporosis do not manifest themselves 
at the beginning of the affection, but rather when the changes 
interfere with some physiological function; fractures occur 
under ordinary driving and with the advance of the disease 
mastication becomes no more possible, the patient becomes 
anxious and his steps are short, as if by instinct he was 
fearful of every act of locomotion. Pressure upon the locally 
diseased spot causes pain. _ 
Symptoms of osteomalacia are likewise postponed ; 
they do not reveal themselves with the beginning of 
the lesions in the bones, and the painful character, 
together with the progressive marasmus, incident to the 
disease, may not be noticed for a considerable time. 
These symptoms consist in a painful, stiff and anxious man¬ 
ner of progression; after continued exercise, sudden lameness; 
in standing, the body weight is alternately placed upon one 
and then the other of the feet; pain upon assuming the de¬ 
cumbent position and also when rising. Pain also in the 
region of the withers, shoulder, and lumbar vertebrae. 
Under some circumstances the joints are swollen and emit a 
crackling sound ; later comes parting of the ligaments, dislo¬ 
cations and fractures; and these, moreover, from the most 
trivial causes. In both affections fractures of the ribs and 
external angle of the ileum are oftenest observed ; but, re¬ 
markable to state, these are painful only in a slight degree, 
and are not inclined to heal. 
In summing up the two conditions—improperly so-called, 
it is evident that the aetiology, pathology, semeiology, course 
and termination are practically the same. Osteoporosis oc- 
