Pathology.—The morbid anatomical changes observed in osteomalacia are not always the same. In some cases bone-absorption is the chief element, in others the disappearance of earthy salts; but decalcification appears to be the earlier process, and it is only later that the organic portions are absorbed. In the long bones the medullary cavity is found enlarged, and the whole bone more cancellous; and as the disease vances the periosteum is stripped off, and a number of openings are seen, from which a clear fluid exudes. Fehling re gards increased vascularity and friability of the ovaries as characteristic of the disease; and a hyaline degeneration of the arteries has been observed. Winckel and Kleinwachter deny that these changes are characteristic. (Ritchie.) Treatment.—Phosphorus, which is of no particular value in rickets, is some times very effective in this disease. The most successful method is that of Kas- minski. who gives it with codliver-oil.
He first gives two teaspoonfuls a day o 1/3 f a mixture containing , grain of phos phorus and 3 ounces of codliver-oil. He then gradually increases the daily dose until 6 teaspoonfuls are taken daily, the patient being closely watched. The mouth must be kept scrupulously clean, The treatment lasts from four to four teen months.
Another method tending to favorably influence the disease is removal of thE ovaries, as proposed by Felling. This has frequently been followed by success, In osteomalacia non-pregnant cases dc well with the administration of phos. phorus and the use of saline baths. E a faithful trial of these measures without result, removal of the ovaries is indicated. Pregnant cases often cic well with the bath and phosphoru; treatment. When important changes ir the pelvis are threatened, pregnancy should be interrupted. Should Cmsa. rear, operation be performed, the uterus tubes, and ovaries should be removed Stieda (Monats. f. Geburts. u. Gyniik. B. S. H. 1, '98).
Castration suppresses the cause of th( disease since the ovary, by its internal se. eretion, exercises a certain action on th( system; that secretion may undergc such a change as to act prejudicially or the processes of assimilation and dis assimilation, especially on such processe: as affect the bones. M. F. Schnell (Zeits f. Geb. u. Gyn., B. 39, II. 3, '99).
Fragilitas Ossium.
• The term "fragilitas ossium" is at tributed to abnormal brittleness of the bones, due mainly to rarefaction, and • predisposing the sufferer to fractures ! under the influence of slight trauma ! tism, falls, and occasionally without as ! signable cause. Successive fractures of ! many bones may thus occur; but, rapid recovery ensuing, the only result is gradually-increasing deformity of the patient as a whole and the gradual loss ' of ambulatory powers.
ETIOLOGY.—In the majority of cases ; fragilitas ossium is an inherited dys • crasia, the origin of which is still un ) known. It is at times associated with - malignant growths, syphilis, rickets, general paralysis, locomotor ataxia, and after injuries involving lowered nutri ) tion of the bony structures through long 3 confinement in bed.
TREATMENT.—Once recognized, proph ylactic measures calculated to avoid traumatism and other fracture-causing factors are alone indicated.
Bone Tuberculosis.
This name is applied to a chronic tu ' berculous inflammation of the osseous structures, which may be diffuse or ) local, superficial or deep. Superficial , bone tuberculosis is termed caries by - some authors: a term which formerly s was attributed to what was thought to be a special form of necrosis.
Symptoms.—Pain in the affected re removal of the ovaries and uterus cannot be carried out, pregnancy should be avoided, since child-bearing tends greatly to aggravate the disease.
Among the less effective—though valuable—methods are long-continued warm baths, salt baths, bone-marrow, and chloroform,—though the last has hardly been sufficiently tried to merit confidence.
5 gion, stiffness of the overlying muscles and of the nearest joint, localized ten derness to pressure, and slight increase of local temperature constitute the first series of symptoms observed. The pain is deep-seated, but not sharp; the tis sues may feel boggy and are sometimes slightly tumefied, owing to interference with the circulation, as indicated by the enlargement of superficial veins occa 5 sionally observed. As long as the in flammatory- process is in its incipiency, the general health does not suffer. As soon as the bone-tissues begin to disin tegrate, however, and pus and tubercu lar deposits are formed, and caseation occurs, the local manifestations become decidedly more marked and constitu tional symptoms appear: those of dis tinct pymmia of slow development. The pain is much greater; pus-channels and fistulae are formed. When the purulent products are evacuated through the lat ter, however, the general health becomes improved. The fact that the disease may be arrested by removing the purulent foci indicates the pathogenic influence upon the general organism. The verte brm, the upper end of the femur, the bones of the hands and feet, and the elbows are the regions most frequently involved. Under SPINE, DISEASES OF; HIP-JOINT DISEASE; and JOINTS, DIS