Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol 1: A-Dea
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25759/469/
457 
BONE, PATHOLOGICAL CONDITIONS OF. 
shall give to each class of disease its own ge¬ 
neric term ; and although occasionally such 
deviations from the usual operations of nature 
will present themselves to the pathologist as to 
baffle all his attempts at classification, still we 
believe such a foundation as we allude to will 
be eminently useful, whatever superstructure 
may be raised upon it. 
Spina ventosa.—In our museums of morbid 
anatomy, there is no want of specimens exhi¬ 
biting the separation, or rather expansion of 
the solid walls of a bone, leaving one or more 
cavities within it ; these cavities having during 
the patient’s life been filled with a secretion that 
presents considerable variety in different cases, 
sometimes possessing a moderate degree of 
firmness and consistency, but more frequently 
consisting of a fluid of a serous character and 
reddish colour. This is the disease to which 
we apply the name of spina ventosa in contra¬ 
distinction to abscess within a bone, from which 
it differs in its extremely chronic nature and 
tedious progress ; in its not containing purulent 
matter; in its having no tendency to burst into 
any contiguous joint; and (until at a very ad- 
I vanced period) in its not being complicated 
with caries.* Boyer divides this disease into 
two species, one of which is peculiar to chil¬ 
dren, and continues to the age of puberty ; the 
other, the spina ventosa of adults, which ex¬ 
hibits the characteristic features of the disease 
t more perfectly. 
It is, indeed, difficult to separate the first- 
mentioned of these affections from our com¬ 
monly-received notions of caries, and in the 
various instances we have seen we have always 
regarded them as such. Boyer attributes it to 
the influence of a scrofulous taint within the 
system, and says that it attacks the metacar¬ 
pus, the metatarsus, and the phalanges. It 
commences and continues for a length of time 
either without pain or with very trivial suffer¬ 
ing ; the tumefaction of the parts is moderate, 
t their motions scarcely interfered with, and re¬ 
covery finally takes place about the age of pu¬ 
berty by a species of necrosis. Its course is 
thus described : “ The progress of the disease 
and the distension the soft parts undergo, cause 
them to ulcerate at a spot always corresponding 
to some aperture in the osseous cylinder, and 
! permitting the introduction of a probe within 
its cavity. The external aperture becomes 
fistulous, and for a long time discharges a 
moderate quantity of ill-digested serous matter. 
The part, however, remains indolent, the con- 
f stitution does not suffer, and if the patient can 
thus attain that epoch of life at which nature 
commonly can struggle with success against 
scrofula, this form of spina ventosa may be 
cured by necrosis of a part of the spoiled bone. 
Then the sequestrum is detached, the re- 
_ mainder of the osseous parts subside, resolu- 
. tion is established, and the disease ends by a 
deep, adherent, and deformed cicatrix.” We 
have not met with the affection as here described 
—we have never seen any thing like the rege- 
I neration of a bone thus lost, nor can we con¬ 
* Diet, des Sciences Médicales, tom. lii. p. 311. 
ceive necrosis, which is essentially a reproduc¬ 
tive process, to be in anywise allied to or con¬ 
nected with scrofula ; we therefore still regard 
this disease, which after all is not very frequent 
of occurrence in these countries, as a modifica¬ 
tion of caries. 
“ The other species, fortunately more rare 
but much more serious, most frequently attacks 
adult persons, and affects the extremities of the 
long and cylindrical bones of the limbs.” Its 
exciting cause seems to be involved in utter 
obscurity, nothing being known with certainty 
concerning it. Very often the patient traces it 
to the receipt of some injury, bnt it occurs so 
frequently without any such provocation, that 
it must be considered as an idiopathic disease. 
It is found most frequently, as Boyer has re¬ 
marked, in the long bones, where the medullary 
cavity is best developed, but it is seen in the 
flat bones also, and in so many instances in the 
lower jaw as to render it an object of attention 
with reference to this bone alone. Its com¬ 
mencement has no characteristic by which it 
can with certainty be known, and its progress 
is equally variable, being generally slow, but 
sometimes remarkably rapid. It commences 
with pain, occasionally deep and dull, occa¬ 
sionally severe to excess, either when its pro¬ 
gress is rapid, or it presses on some sensible or 
important part. This pain, with very few ex¬ 
ceptions, precedes the swelling, and when the 
disease attacks the lower jaw is almost con¬ 
stantly mistaken for common tooth-ache—a 
mistake that leads to the extraction of one or 
more of the teeth and the consequent exacerba¬ 
tion of morbid action. The tumour seems to 
engage the entire circumference of the bone, if 
it be a round one; if flat, the swelling is more 
oval, and sometimes it is irregular and lobula- 
ted. It is hard, firm, unyielding, and incom¬ 
pressible : pressure on it does not occasion an 
aggravation of pain, unless it shall have hap¬ 
pened that the periosteum is inflamed, when 
of course the smallest pressure will occasion 
suffering. In the commencement it bears a 
strong resemblance to necrosis of the long bone, 
except in not being preceded or accompanied 
by fever, and in not being so painful or so 
rapid in its progress. In the flat bone it has a 
greater likeness to osteo-sarcoma, from which 
it is so difficult to distinguish it that many 
cases of spina ventosa have been operated on 
and removed as examples of the other disease. 
Nevertheless at a more advanced period the 
diagnosis is more easy, for spina ventosa does 
not reach the great, or rather the illimitable size 
to which osteo-sarcoma may attain. 
Ina pathological point of view, spina ven¬ 
tosa should not be considered as a malignant 
disease : it often endures for a length of time 
or during life without engaging adjoining 
structures or contaminating the constitution, 
and if removed by operation it does not recur 
in another place or seize on some other bone. 
It is, moreover, not infrequently capable of 
relief or even of cure by the simple operation 
of exposing the cavity and evacuating its con¬ 
tents We have at this moment before us the 
details of a case in which the patient referred a
        

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