On necrosis at the extremity of the diaphysis, and in the epiphysis of growing bones / by F.S. Eve.

  • Eve, Frederick Samuel, Sir, 1853-1916.
Date:
[1879]
Catalogue details

Licence: Public Domain Mark

Credit: On necrosis at the extremity of the diaphysis, and in the epiphysis of growing bones / by F.S. Eve. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    other and more numerous cases is not opposed to the view that the inflammation originated in the neighbourhood of the epiphy- sial line, as the morbid process, when once set up, has necessarily a tendency to spread. Granted, then, the special liability, there must be a common cause inherent in the tissue of the part which renders the growing bone the seat of election of inflammatory processes. This is clearly the active nutritive changes incident to the growth and development of the bone—the multiplication of cartilage cells, development of blood-vessels, and hypertemia at the line of growth. It is evident that the normal balance of nutrition would be more easily overturned, and the unrestrained activity, which is so characteristic a feature of inflammation, more readily excited in an actively growing than in a fully developed tissue. Further, that a portion of developing bone, in which the vascular supply had not yet been perfected, would readily suffer necrosis. The liability to inflammation of bone in young subjects from slight exciting causes, such as a blow, sprain, chill, or febrile attack, is thus explained. And further, I may suggest that the almost unaccountable way in which diffuse periostitis is set up in young subjects by exposure to cold or a blow is due to the active nutritive changes attending the circumferential growth of the bone. Case I, and specimen (Fig. 2) referred to with it, suggest an ex- planation of the not uncommon cases of acute inflammation of joints, especially the hip and shoulder, in which the epiphysis is found lying loose in the articulation, since the first result of inflamma- tion at the extremity of the diaphysis would be destruction of the epiphysial cartilage and separation of the epiphysis. The inherent liability to inflammation of the growing tissue of bones is most strikingly illustrated by a disease of the° bones in infants. Mr. dhomas Smith1 first drew attention to cases of acute joint-disease in infants, the result of abscess in the articular ends of the bones, bursting in most cases into the articulation, but rarely external to it. Sometimes the epiphysis was found lying loose in the cavity of the joint. In all the cases related there is°evidence that the inflammation commenced in the neighbourhood of the epiphysial line. In six cases, in which the exact position of the abscess could be made out from the descriptions and plates, it occupied the extremity of the diaphysis and encroached on the epiphysial cartilage; in one only it was situated in the epi- physis. In seven cases out ’of twenty-one related, the disease attacked more than one joint, and in three of the seven cases four joints were attacked. vol. x.°pn i8oUte Arthntis of Infants-” St. Bartholomew’s Hospital Reports,