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There is little doubt that defective nutrition and bad hygienic surroundings are prominent factors in its production. The principal pathologic change is seen in the epiphyseal lines of long bones and beneath the periosteum. In rachitis epiphyseal swellings are seen at the wrists and ankle-joints, and in superior cases at the ends of the phalanges of the fingers and toes.
This gramophone Linda learnt to work; and while Michael read voraciously the works of Hunter, Hugh Owen Thomas, Stromeyer, Duchenne, Goodsir, Wolff, and Redfern on bones, muscles, ligaments, tendons, cartilage, periosteum and osteogenesis or, more often, Keith's compact and lucid analysis of their experiments and conclusions Linda let loose in the scented air of a log fire these varied melodies which attuned the mind to extraordinary perceptibility.
The tuberculous diseases of bone result from infection of the marrow or periosteum by tubercle bacilli conveyed through the arteries; it is exceedingly rare for tubercle to appear in bone as a primary infection, the bacilli being usually derived from some pre-existing focus in the bronchial glands or elsewhere. According to the observations of John Fraser, 60
It is not uncommon for the gangrenous area to continue to spread both in width and in depth till it reaches the periosteum or bone. Bed-sores over the sacrum sometimes implicate the vertebral canal and lead to spinal meningitis, which usually proves fatal.
In typhoid fever the bone marrow is liable to be invaded by the typhoid bacillus, which may set up osteomyelitis soon after its lodgment, or it may lie latent for a considerable period before doing so. The lesions may be single or multiple, they involve the marrow or the periosteum or both, and they may or may not be attended with suppuration.
When there is widespread suppuration in the marrow, and the shaft is extensively bared of periosteum and appears likely to die, it may be resected straight away or after an interval of a day or two. Early resection of the shaft is also indicated if the opening of the medullary canal is not followed by relief of symptoms.
The group includes lumbago, stiff-neck, and pleurodynia conditions which have this in common, that sudden and severe pain is excited by movement of the affected part. It would appear to involve mainly the fibrous tissue of muscles, although it may extend from this to aponeuroses, ligaments, periosteum, and the sheaths of nerves. The term fibrositis was applied to it by Gowers in 1904.
It most frequently originates from fascia, intermuscular connective tissue, periosteum, bone-marrow, and skin, and forms a rounded or nodulated tumour which appears to be encapsulated, but the capsule merely consists of the condensed surrounding tissues, and usually contains sarcomatous elements.
In certain fibromas in those, for example, which grow from the periosteum of the base of the skull and project into the naso-pharynx the blood vessels are dilated into sinuses and have no proper sheaths; they therefore tend to remain open when divided, and to bleed excessively.
Central or medullary tumours as they increase in size replace the surrounding bone, and simultaneously new bone is formed on the surface; as this is in its turn absorbed, further bone is formed beneath the periosteum, so that in time the bone is increased in girth, and is said to be "expanded" by the growth in its interior.
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