Clinical report [on cases in the Edinburgh Surgical Hospital] for the summer session 1835 / [James Syme].

  • Syme, James, 1799-1870
Date:
[1835]
Catalogue details

Licence: Public Domain Mark

Credit: Clinical report [on cases in the Edinburgh Surgical Hospital] for the summer session 1835 / [James Syme]. Source: Wellcome Collection.

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    the epiphyses, When the finger was carried along the surface of the dead bone through an incision that had been made to ex¬ pose it, a dense case or shell was felt, which, when displayed by dissection, proved to be the periosteum greatly thickened, with osseous matter deposited in its substance. The membrane was traced distinctly from its sound part where covering the epi¬ physes, over the dead shaft, and no one who saw it could doubt that it afforded the bed or matrix in which the new bone was de¬ posited. Where covering the posterior surface of the tibia, though detached from the bone, it had suffered comparatively little change, which rendered its recognition at other parts more certain. The new bone did not constitute a continuous shell, but was deposited in flat masses or scales of various extent, be¬ tween which the periosteum intervened so as to insulate them completely from each other, or any portion of the old bone re¬ taining its vitality. The osseous substance lay on the inner sur¬ face of the periosteum, with merely a fine film of the membrane covering it, but with a considerable quantity of soft gelatinous substance like coagulable lymph effused over this, so as to line the interior of the case. At several parts of irregular size and figure, the periosteum did not exist, and at these parts there was a corresponding deficiency in the new bone. These apertures resembled the cloacce, as they are named, which exist in the in¬ vesting shells that are formed in cases of necrosis, and are usually ascribed to absorption induced by the pressure of matter confined within the bone. But it seems more probable from this case, that the deficiencies in question depend upon the periosteum being destroyed at particular points in the commencement of the dis¬ ease. In explaining the history of this case, I think it may be rea¬ sonably supposed that the strain of the ankle occasioned inflam¬ mation of the joint, which extended to the tibia, and led to ulceration of the articular cartilages, and death of the shaft of the bone ; that then suppuration took place under the pe¬ riosteum, which having become at some parts disorganized, al¬ lowed the matter to pass outwards and distend the skin; that lymph was effused from the inner surface of the remaining pe¬ riosteum, and also into its substance, so as to render it much thicker and softer than usual; and that then bone was deposited towards the inner surface of the membrane in numerous detached points, from which it was proceeding so as to make them coalesce, and constitute a cylindrical, case to the shaft. The engraving, Figure 1, Plate I. represents the appear¬ ance of the bone after being dissected and dried. The largest deficiencies in the shell were at A and B. The one at A has been enlarged by an incision which was made after the operation