—After a bone injury, as in the case of fracture, blood and serum are effused at the af fected spot. The periosteum and sur rounding parts become infiltrated with lcucocytes. From the periosteum and the adjacent bone stellate cells are pro liferated. The effusion in which they occur becomes first hardened and stri ated and lime-salts are deposited. The stellate cells become full-fledged osteo blasts, which finally develop into bony tissue. In cases resulting from simple injury the natural state of affairs is soon re-established, but occasionally an anomalous course is pursued. The bone may become uniformly increased in all dimensions, constituting a true HYPER OSTOSIS, or, if the density is increased as well as thickness, an osTnoscLERosts.
In this disorder the bones of the head are most often affected, and the disease may last many years. When ostitis at tacks the bones of the face a very pe culiar appearance results, to which Vir chow has given the name LEONTIASIS ossium. The disease begins in youth in otherwise apparently healthy persons and lasts many years.
Leontiasis essium regarded as a modifi cation of rickets. Case noted in a young man aged 24. Pathological changes of the skull in this case are shown in the accompanying illustration. Sutton (Il lus. Med. News, Mar. 9, 'S9).
[In a case, aged 26 years, observed by me, the pctient noticed that her nostrils were growing shut when ten years of age, the nose gradually growing broader. There was evidently an increase of bony tissue cn the face from the eves down ward, and the nostrils were blocked shut with bony masses. The posterior nares were practically normal, while the lower jaw was enlarged on its anterior surface, but not the posterior one, giving her face a peculiarly massive appearance. The increase in the size of the jaw took place within the past year and has been rapid. G. G. DAVIS.] —This is a dis ease described by Sir James Paget in which many of the bones of the body are affected with osteosclerosis. A large proportion of the cases die from malig nant disease.
Forty-one cases of ostitis deformans have been reported. It is manifestly a distinct general disease, arising from nu tritive disturbances, although the cause is yet unknown. The frequency with which the disease is followed by malig nant tumors emphasizeu. Thibierge (Arch. Gen. de Mad., Jan., '90).
Ostitis deformans, according to Hutch inson, chiefly belongs to the senile peri ods of life; it may occur in either sex, but is more frequent in men; it often happens to those who have a gouty family history. It consists of a process of ostitis and periostitis, tended by the abundant formation of ill developed new bone and the wakening, to some extent, of the old. It is often in
the early stages restricted to one bone, and tends in all cases to become gener alized, involving all the bones of the body. It has no connection with syph ilis, although it may be stimulated by it, especially by the hereditary form, and it runs a very chronic course, lasting ten to twenty years. Of itself, it rarely causes death.
Osteomyelitis.
Osteomyelitis is an acute inflamma tory disease which originates in the spongy and medullary tissue of bone, but not in the compact tissue.
Symptoms.—It usually begins with a chill, soon followed by severe pain in the affected part, sometimes by redness and fluctuation and severe constitutional disturbance, including a high tempera ture. In young children the disease may traverse the epiphyseal cartilage and affect the neighboring joint. A mild case may be attended by very slight symptoms and proceed to recovery. When the suppurative form is present, however, there may be a prominence over the affected area or a fungous ab scess into which the probe readily sinks deeply. Periostitis, which is invariably present, however, may mask the true nature of the case. After the femur and tibia, the vertebrfe are the most frequent seats of this affection; an abscess forms which tends to break down the vertebral column, or bring about meningitis and myelitis by penetration, and thus cause paraplegia. Curvature of the spine is seldom observed, however. Severe cases may end fatally as a result of py2emia or septicemia.
Study of 106' cases of acute osteomye litis in the vicinity of the hip-joint from the clinic at Tfibingen. It may originate in the acetabulum or more commonly in the upper end of the femur; many cases run their course without suppuration; extensive necrosis is exceptional; sepa ration of the femoral epiphysis is usually accompanied by destructive changes in the joint. It begins with shivering. high fever, and severe pain. The hip soon pre sents a uniform, doughy swelling, and, if suppuration occurs, it usually makes its way to the surface, and results in mul tiple sinuses. Among the sequelw may be contraction or actual ankylosis, sepa ration of the epiphysis, and spontaneous fracture of the neck of the femur. Dis location occurs in nearly one-third of the eases, usually backward and upward. The disease terminated fatally in 7 per cent. of the cases. Bruns and Hansen (Centralb. f. Chir., Mar. 2, 1900).