An address on chronic inflammation of bone : read in the Section on Pathology / by Charters J. Symonds.

  • Symonds, Charters James, 1852-1932.
Date:
[1883]
Catalogue details

Licence: Public Domain Mark

Credit: An address on chronic inflammation of bone : read in the Section on Pathology / by Charters J. Symonds. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    bones from what they are in the long bones, this is almost sufficient to negative the conclusion of enlargement. Again, in some well-marked examples of the disease, the cranial vault is, if anything, thinner than usual; at least it is not increased- in thickness, though showing well the chavacteiisLic changes. Mr. Solly recoids one such case, and explains the absence of thickening by the short duration, which was four and a half years, while that in which the enlargement occurred had existed eight years; and he says he has no doubt that, had his second patient lived, an increase would have taken place. In opposition to this opinion, it must be said that, though uhe skull was not thick, the other bones exhibited the softening effects of the malady in an extreme degree, the cranial bones themselves being deeply affected. Mr. Duj ham’s patient in whom the skull was thick had been ill but three years; so that, upon the ground of duiation of the disease,' little support can be given to Mr. Solly’s conclusion. Mr. Dmham founded his statement also upon certain microscopical appearances, which he found to be alike in his case of osteomalacia, and in a soft spot in one of these thick skulls. He concluded that the latter was an example of cured osteomalacia. I am unable at present to dis- pute the obsei vation, for it would require minute examination of several of these osteoporotic crania, and this at present I have not made. Again, here is a specimen showing all the changes of osteoma- lacia, without any increase in thickness—-in fact, it is rather thin. This is the ground upon which, so far as I can find, the statement is based; and, in opposition to it, I will suggest, believing I am nearer the truth, that osteomalacia does not give rise to any in- crease in thickness of the cranial bones, but that the occurrence of this appearance is a coincidence of a normally thick skull made porous by the disease. Moreover, neither Mr. Solly’s nor Mr. Dur- ham’s specimens are by any means so thick as the bone is in osteitis deformans. Finally, I may add that Mr. Durham’s conclusion that some of these porous skulls are due to osteomalacia, infers that the disease is curable. The rarity of this result in well marked ex- amples—if, indeed, it ever occur—is an argument against his deductions. If we remove this disease as a factor in producing examples of these porous skulls, but one cause is left, and that is Osteitis De- formans. I do not, for a moment, mean to state that this is the only cause, but that, so far as we can say at present, it is the only one we know. 3. A third group, illustrated by this example, exhibits, besides a general increase in size, numerous nodular projections from the inner surface, varying from small rounded nodules to the large irre- gular agglomeration of bony ridges seen in this specimen. The bone besides is heavier and more dense than in the previous class. The cause of this change is obscure, but it may possibly be an earlier stage of the n^xt group, in which a more definite tumour-formation occurs. They have been found in lunatics; and the smaller nodules are said to occur in puerperal women. 4. In the next class comes the disease known as leontiasis ossea. This differs, however, in so many respects from the previous group, that there is not much difficulty in associating examples of this affection. The bones of the face are affected as well as the vault of the skull, and, moreover, the change is more irregular and nodular, at least, so far as the vault is concerned. Again, some of the speci- mens of this disease show definite growths, which are evidently exostoses, indicating probably the association of the affection. Coming next to these specimens, are those skulls covered with smooth bossy masses of bone, and, at the same time, showing
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