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alterations of the osseous tissue. The atrophy or wasting, similar to what occurs in the softer textures, for the most part depends on the want of exercise, or, as Hunter would call it, the stimulus of action, and is met with in bed-ridden persons, or those who labour under diseases of the joints, which require in the treatment, almost absolute inaction in one or more limbs. We must also content ourselves with merely alluding to the section on exostosis, which, however, we recommend to the attentive perusal ef the student, and pass to the subject of spina ventosa.

This disease has its general seat in the shafts of the long, and bodies of the short, cylindrical bones, and occurs in the young, the adult, or the aged.

"When a bone is affected with spina ventoso, its parietes seem, as it were, to swell out or expand; and hence, in its first stage, when no pain is felt by the individual in whom it occurs, as is frequently the case when it is seated in the metacarpal bones, it may be confounded with simple interstitial enlargement. As the disease advances, the expansion of the bone appears (if I may be allowed the expression) to be circumscribed, and to be confined either to the middle of the shaft, or to one of the extremities of the bone. The skin covering the diseased bone remains perfectly sound, and does not become ulcerated, nor discoloured, until a very advanced period of the ailment. The superficial veins, however, appear gorged, and form a kind of blue net-work on the surface of the swelling.

"As the tumour increases in bulk, the peculiar darting and burning pain, which attends its formation, becomes more and more severe, and if the limb in which it is situate be not amputated, acute irritative fever almost always supervenes.

"When the patient will not suffer an operation for his relief, the expansion of the bone proceeds to a prodigious extent, and by the distention of the soft parts which it occasions, at last produces ulceration of the attenuated muscular tissue and skin. From the ulcerated spots an unhealthy-looking ichorous pus is poured out, and the ulcerations degenerate into irritable sinuses, that closely resemble in appearance those which exist in the advanced stage of white swelling, or scrofulous inflammation of bone.

"On introducing a probe into one of the sinuses, it will be found that it communicates with an opening in the wall of the bone, and that the instrument may be pushed forwards, so as to traverse the diameter of the swelling." 128.

On examination of the bone after amputation, the periosteum is found in a thickened state, the shell of the expanded portion of the bone remarkably attenuated, its internal surface lined by a delicate membrane, from which small spiculæ and plates of bone sometimes project, and the contents of the tumour, consisting of a sero-purulent matter, combined with a substance, in appearance, like gelatine.

"Spina ventosa differs from simple abscess of bone in the following respects:-1. Spina ventosa in general affects the apophyses, and seldom the epiphyses, of a bone; 2. Simple abscess, when it does occur in the shaft of a bone, is in general confined to one side of the wall of the bone, and while the pus contained in it is working its way to the surface of the body, organizable lymph, which at last becomes ossified, is poured out into the medullary cavity and cancellar tissue, in the vicinity of the apostema. On the other hand, in the spina ventosa, the entire circumference and substance of a portion of the cylinder of the bone is affected, and no appearance of reparative or adhesive inflammation can be traced in the neighbouring cancelli or medullary canal.

3. The comparatively trifling degree of swelling which attends common abscess, depends upon interstitial enlargement and deposition in the bone surrounding it, whereas the enormous tumefaction, which constitutes the peculiar characteristic of spina ventosa, is the result of interstitial degeneration, and the actual expansion of the attenuated walls of the bone, at the seat, and not in the vicinity, of the disease.

4. Abscess of bone has been cured by means of the combined efforts of nature and

art, without having recourse to amputation. Spina ventosa, so far as I know, has never been relieved, except by the removal of the entire bone in which it was seated.

"The treatment of spina ventosa is very simple, as the surgeon, when he is assured of its existence, must at once have recourse to the amputating knife. If the disease is seated in the bones of the metarcarpus or metatarsus, as is generally the case in childhood, they should be removed at their articulations. If it has attacked the tibia and fibula, or radius and ulna, the amputation may be performed either at the knee or elbow, or a short way above these joints. The general rule to be observed is, that the entire bone, in which the disease has its seat, should be removed." 131.

The second section of the fifth chapter is occupied with the description of the malignant diseases of bone. These Mr. Bell arranges under two heads, the first consisting of cartilaginous degeneration-fleshy degeneration of bone-cystic sarcoma of bone-osteo steatoma-and encysted medullary sarcoma of bone, degenerations which are confined entirely to the osseous tissue itself, and never throw out fungous growths, nor ulcerate on their surfaces until a very late stage of their progress. Under the last head are considered cancer of the bones, fungus hæmatodes, and cartilaginous degeneration, diseases which implicate not only the bone itself, but also the periosteum and neighbouring soft parts, and have, when the skin is broken, a tendency to fungate. The whole are included under the generic term of osteo-sarcoma, which expressing an anatomical condition not present in many of the diseases it comprises, is highly objectionable. Mr Bell himself admits the impropriety of the designation, but apologises for its use by his unwillingness to coin new terms. There was no necessity, however, for that, as the general heading, "malignant diseases of the bone," would have answered infinitely better than any barbaous Greek or Latin coinage. The diseases of the first class are so closely commingled with each other, that no rational hopes can be entertained of their ever admitting of accurate diagnosis in practice, indeed we believe that even the anatomical distinctions are much too finely spun. It is a comfort to think that a slip in diagnosis is no such great matter, for the treatment in all is the same-amputation, whenever it can be done without risk to the life of the patient.

The lines of demarcation between cancer and fungus hæmatodes are somewhat more broad, but alas, it can signify little to the patient whether his surgeon is aware that he is dying by one or by the other, for both are alike irremediable by art. Cancer of the bones, though not a common affection, is yet occasionally met with, and presents some well-marked characters. The disease, says Mr. Bell, in general depends upon extension of cancerous action from the neighbouring soft parts, and seems more especially confined to the periosteum and its interstitial process. Those peculiar cartilaginous bands, so characteristic of scirrhus, proceed from the periosteum, which is thickened, and intersect the softened and disorganized bone. Between the cartilaginous intersections, the osseous tissue is converted into a soft matter, containing minute spiculæ, granules of bone, and cartilage. Ulceration at length takes place, the sore is covered by unhealthy, angry-looking, granulations, secreting a stinking ill-conditioned matter, and the patient dies a loathsome object. Cancer of the bone is rarely a primary affection.

"I know of no plan of treatment which is calculated either to cure or relieve this inveterate affection; the knife, gouge, and cautery, possess no power in arresting its progress; it extends its ravages from bone to cartilage and synovial membrane, and from them to

bone again. The whole system appears to be contaminated; the stomach is irritable, and rejects its contents; the features are sunk, sallow, and listless; the eye anxious and dull; the skin harsh and dry; and the pulse rapid, thrilling, and feeble. All that the surgeon can do is, to attempt, by every means in his power, to allay the constitutional and local irritability, by the internal administration of hyosciamus, opium deprived of its narcotin, cicuta, digitalis, camphor, citrate of ammonia; and by the external application of the solution of chloride of soda, cicuta, and powder of the leaves of hyosciamus made into a paste with axunge, and applied to the diseased surface, beneath any common emollient cataplasm." 148.

Fungus hæmatodes Mr. Bell has never either seen or read of, as originating in the tissue of the bone. It invades it by extending from the neighbouring soft parts, and " seems to be produced in the bone, in consequence partly of the pressure, and partly of the altered condition of its nutrient vessels, which are involved in the diseased soft parts." We lately witnessed a well marked example of this disease, attached to the upper portion of the femur, but evidently not originating in the bone. The periosteum was in part destroyed, but whether in a primary or secondary manner is more than we can pretend to affirm. The "cartilaginous degeneration of bone, beginning in the soft tissue" is usually seen in the cavity of the antrum, and alveolar processes of the upper jaw.

"The first symptom of the disease frequently consists in the formation of a small and irregularly shaped indurated swelling of the gum. If this be not removed by the knife, the periosteum covering the alveolar margin of the superior maxillary bone becomes thickened, and of a dense structure; the bone beneath is at length affected, and is converted into a cartilaginous substance.

"It is frequently the case, however, that the disease arises, in the first instance, in the lining membrane of the maxillary antrum, and extends from it to the bony parietes. When this is the case, the earthy matter of the bone is absorbed, and the cartilaginous degeneration increases in bulk, and, if left to itself, gradually acquires a prodigious magnitude. It is surprising to remark the very great size that these malignant cartilaginous tumours attain, without causing any ulceration of the enormously distended integuments.

"Their formation and progress are sometimes unattended with pain, but in other cases they are productive of much local uneasiness and constitutional irritation.

"Cases have been met with, in which this disease has extended, previous to the occurrence of a fatal result, from the bones of the face to those of the cranium. It usually happens, however, that the bones below the orbit only are implicated." 152.

An operation for this disease Mr. Bell considers as not only useless, but worse than useless, and culpable even on the part of the operator. The sixth chapter, dedicated to anomalous affections of bones, and comprising the bloody tumour of bone, described by M. M. Breschet and Lallemand, and hydatid tumours of bone, can merely be glanced at here. Having given a full account of M. Breschet's memoir at the time that it appeared in the Répertoire, we shall not go over the ground again, although we may mention that there are two specimens of the disease in the Museum of St. Bartholomew's Hospital, one in that of the Royal College of Surgeons of Edinburgh, and one in Mr. Bell's collection. Those in the Bartholomew collection illustrate the disease as occurring in the humerus; in that which is in the Museum of the College of Surgeons it affects the metarcarpal bones. of the hand of a young woman, which was amputated by Mr. Joseph Bell; and the last mentioned instance is the humerus of a lady, whose arm was

removed at the shoulder-joint, by Mr. G. Bell, in the year 1823. This lady's case is detailed at length by Mr. Bell, and though we have not space for its insertion here, our readers will find the particulars in the periscope department of the Journal. The following is a summary of Mr. Bell's ideas on this curious disease.

"On considering attentively the phenomena presented in the cases described above, I am inclined to consider the bloody tumour of bone to be an affection similar in many respects to the anastomotic aneurism of the other tissues;-like aneurism from anastomosis, it is sometimes, though not always, found to pulsate. It undoubtedly derives its origin from a morbidly increased developement of the capillary vessels of the bone, conjoined most probably with increased vascular action of the second and third classes of arteries. It differs, however, from aneurism from anastomosis in other textures,-in this respect, that the structure of the bone, in some cases, undergoes alteration, and assumes a fibrous character; and in so doing, perhaps exhibits the power which nature possesses in accommodating parts to the changes which morbid actions occasion. For, if the fibrous change of structure did not occur, a complete solution of continuity would be apt to take place, either from the tension occasioned by the flow of blood into the cavity of the bone, or from the mere contractions of the muscles of the limb.

"In those specimens of the disease which have come within the sphere of my observation, the parieties of the tumour have differed in appearance from those described by the French pathologists. In the cases mentioned by M. BRESCHET, the parieties were thin, and in some parts of a cartilaginous character; in the four preparations alluded to by myself, they conisted, partly of a thick and dense fibrous matter, and partly of bone.” ́ 163.

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Of hydatids in the bony tissue our author has never seen an instance, and only read of three M. Cruveilhier, in his first volume of the Anatomie Pathologique, page 236, relates a case from the hospital practice of M. Cullerier, where a number of hydatids, of the species termed by M. Laennec acephalocystes," were contained in a tumour, situated in the anterior part of the tibia; Sir Astley Cooper, in Part I. page 163, of his Surgical Essays, has alluded to a case which occurred in the practice of Mr. Foster, at Guy's Hospital, were the hydatids were also found in the upper part of the tybia; and, lastly, Mr. Keate, in a very valuable paper in the tenth vol ume of the Medico-Chirurgical Transactions has described the case of a young woman, where a tumour externally resembling exostosis, was seated in the frontal bone, which, on being cut into, disclosed hydatids, surrounded by a serous fluid. These cases comprise the whole of what is known upon the subject, which we need not say is lamentably little. In the treatment of the affection, Mr. Bell recommends us to strike at once at the root of the disease, and endeavour in the first instance, to remove as much of the membranous parieties of the cavity, containing the hydatids, as the safety of the patient will permit. Having done this, the sides of the cavity should be powerfully cauterized, and that as often as a single hydatid cyst remains, however minute it may be.

Our work of analysis is now at an end; for the remainder of the volume, consisting of upwards of a hundred pages, does not fall within the Scope of a review. The observations on fractures of the neck of the thigh-bone are ingenious and just, but the subject has of late been so hacknied, in every imaginable shape, that we would not for the world inflict it again upon our readers. It is usual for the critic, on parting with his author, to pronounce a sort of judgment on his worth, and deliver his novissima verba, whether of reproof or approbation. The lengthened notice we have taken of this little book of Mr Bell's is the highest praise that we can offer, the most flattering earnest of our sense of its merits. It is really worth more than half

of those tumid octavos and quartos, pampered, by the care of their authors and printers, into an unwieldly and unwholesome obesity. We conscientiously recommend it, not only to those students to whom it is so modestly addressed, but also to our surgical brethren in general.

X.

AND ON MEDIATE Translated from the

A TREATISE ON THE DISEASES OF THE CHEST, AUSCULTATION. By R. T. H. Laennec, M. D. latest French Edition, by John Forbes. M.D. &c. Third Edition, revised, with additional notes.

The circumstance of a translation of any kind, much more the translation of a medical work, coming to a THIRD EDITION, is, in itself, no common phenomenon; but when we find that a large impression of this work has been sold in the short space of twelve months-of a book, too, costing not less than twenty-four shillings, we must believe that there is something more than usually attractive in such a publication: and this is certainly true of the work before us. It is of matchless excellence in its matter, and it has been excellently translated. It has, therefore, only met the success which it deserves. But we are particularly gratified, on this occasion, by viewing the rapid sale as an unequivocal proof of the great and rapidly increasing attention of the profession, in this country, to AUSCULTATION, as a means of diagnosis in thoracic diseases. We take some credit to ourselves, for having been, not only the first, but the most zealous and constant advocate of this practice from the first period of its introduction, and we flatter ourselves that our labours and opinions have not been in vain, towards the furtherance of the great cause. This we may now consider as having fully triumphed; since we cannot regard the opposition still made to it, in certain quarters and by certain persons, as any thing else than what must be expected; indeed, as necessary consequences of the combined influence of their moral constitution, course of study, time of life, and civil and social relations. So far from being surprised that there are still found some disbelievers in the doctrines of Laennec, and some scoffers at the stethoscope, we are surprised that there are so few; and we congratulate ourselves on the more enlightened and liberal views and more Christian temper of the age in which we live, and the more philosophic and more tractable spirit of our own profession, which have accorded a meed to the author of auscultation, so different from that which attended many of the discoveries of former periods. Need we do more in reference to this difference, so flattering to our times, than to call to mind the names of Roger Bacon, of Harvey, and of " the starry Galileo with his woes?" The present edition, the translator informs us, has been carefully revised, and such alterations and improvements made in various parts of it as seemed desirable. From the new notes to this edition, we shall extract one relating to MEDIATE PERCUSSION, and another respecting a theoretical point of great importance, viz. the cause of the sounds produced by the action of the heart.

"An important improvement on the method of percussion was recommended some time since by M. Piorry, and has been recently fully explained in his treatise 'De la Percus

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