There is a peculiar affection of the cervical ver tehrm confined at first to the articulations of the occiput and atlas, and atlas and dentata, which consists in ulceration of the cartilages, ligaments, and bones, ultimately involving the periosteum, the theca vertebralis, the dura mater, the medulla oblongata and brain, and also the pharynx. There is a peculiar expression of pain in the countenance, with dread at moving the head, which inclines generally to one side, and that most frequently the left, and when moved a most acute pain darts to the larynx and scapula of the affected side. The pa tient experiences most insufferable pain when swallowing a large mouthful, or taking a deep in spiration. These symptoms increase, and excite others fully as distressing, under which the patient lingers for months, when death puts a period to his sufferings. The treatment consists in repeated cuppings and moxas to the nape of the neck, con finement to bed, with the head and neck fixed with the chin-stay, see Fig. 22, Plate DXVI; low diet, and attention to the bowels.
When the long cylindrical bones are attacked with inflammation, their vessels having no latitude to expand and form ulcerative papillae, become gan grenous, so that the bones are deprived of vitality, and either exfoliate or undergo necrosis. Exfo liation or necrosis seems to take place, according to the exposure or non.exposure of the bones; thus the bones of the cranium exfoliate, while the os femoris becomes necrosed: the tibia, however, either Bates or necroses. If the tibia be inflamed, and an abscess occurs superficially to it, the bone gene rally exfoliates; the inflammation being too violent for necrosis, according to the interpretation of tlya term by s urgical writers, who consider it the death of the old bone, with the formation of a new one ex terior to it, whereas, etymologically, it means merely the destruction of the old bone, being derived from yoqoa, to destroy. In such a case, the abscess is to be freely laid open, and the condition of the bone examined; and if it appear divested of vitality, either the nitrate of silver or copper applied to ac celerate the exfoliation of the sequestrum, or re moved with cutting instruments, the latter of which is preferable. The tibia is sometimes deprived of vitality in extensive ulcers of the leg, in consequence of the periosteum being removed by the ulcerative absorption; in which case granulations are occa sionally formed beneath the outer layer of bone, N% hich thus becomes a sequestrum, so that both caries and necrosis exist at the same time. Caries and necrosis also sometimes exist together in ulcer ation of the spongy bones. When the cranial bones are exfoliating, they are to be gently shaken from time to time, and not rudely removed. When the shaft of one of the long bones dies, a separation takes place between it and the epiphyses; the peri osteum inflames, with an accumulation of blood vessels, and thickening of this membrane; and if the inflammation be moderate, these vessels, together with those of the epiphyses, begin to secrete callus, in order to replace the decayed portion; and after the secretion of the new bone has extended from the one epiphysis to the other, the periosteum loses its injected appearance, and returns to its natural colour and density. The new shell now separates from
the old bone, and the latter is either forced through the former, or is absorbed. A profusion of callus is at first poured into this new shell, rendering it solid for a time, hut afterwards the absorbents make it nearly as hollow as the original. The new bone is at first merely a reddish fluid, next gelati nous, then cartilaginous, fourthly ossific or the phosphate of lime is deposited.
Necrosis occurs chiefly in early life, except when the inferior maxillary bone is affected, which is generally after thirty years of age: it attacks the tibia, os femoris, clavicle, os brachii, fibula, radius, and ulna; and there is a case detailed by M'Donald, wherein nearly all the banes of the body were af fected. This peculiar disease of the bones is cha racterized by inflammation, either acute or chronic, tumefaction of the limb, diffused pain along the bone, ulcerous openings or abscesses, discharging purulent matter, which ultimately become fistulous. There is more or less fever throughout, which at first is inflammatory, and afterwards hectic. As long as the fever is inflammatory, and the limb acutely inflamed, the treatment should be anti phlogistic, with fomentations and poultices; and when these conditions have been subdued, if no ulcers have formed, moxas should be repeatedly applied; but if there are ulcerous or fistulous open ings, simple dressings and gentle bandaging; the constitutional remedies being mild nutritious diet, exposure to the open air, and sea-bathing if prac ticable. The dead bone ought to be left alone as long as the health will permit, unless it has begun to force its way outwards, when it should be re moved; but whenever the health begins to sink, the bone must be removed, otherwise amputation will be the only alternative, which otherwise need not be considered, until hectic fever threatens to destroy the life of the patient. During the cure, the patient must be guarded against using the limb before the bone has become properly consolidated, as it is very liable to be fractured. Various absurd remedies are recommended for this disease, as madder, assafcetida, hemlock, Ste. Its causes are very obscure; the exanthematous fevers, syphilis, mercury, scrofula, and scurvy, also cold and blows, are considered predisposing; while inflammation is the proximate cause in early life, and obliteration of the blood-vessels in advanced age.