./? Treatise on the Diseases of the Bones. By Edward Stanley,
F. R. S., President of the Royal College of Surgeons, England,
and Surgeon to St. Bartholomews’ Hospital. Philadelphia,
Lea & Blanchard, pp. 286. 8vo.
Among the reprints of valuable original works, with which the
American press has lately favored the profession, few we think,
will be more widely sought for than that of Mr. Stanley on the
Bones. Coming from high authority, and treating of a subject,
the accurate study of which has been long neglected, this treatise
will be found to furnish an amount of practical information, that
we are sure will be highly appreciated by most practitioners.
Although admitting in the abstract, the evils resulting to English
authors from the present state of the copy right, we are convinced
that the mass of readers in this country, are. benefitted by it, and
we cannot but believe that the increased circulation thus furnished
to works which would be otherwise unknown, must, by an extend-
ed reputation, repay the pecuniary loss 'which writers imagine
they suffer, under existing circumstances. Without, however, wish-
ing to lay open a vexed question, we thank the publishers for the
present volume, and congratulate the author; on the fact, that
though his ideas appear in an American dress, they are not sad-
dled with the name of another, who, as editor or annotator, would
doubtless have improved upon his opinions.
But before noticing more in detail the volume which heads this
article, we cannot resist the desire of giving our feeble praise to a
previous work of Mr. Stanley on the same class of diseases. We
allude to his magnificent colored “ Illustrations ” of the Diseases
of Bones, &c. In such works, Europe is yet far in advance of us,
and we cannot but envy our medical friends there, the opportuni-
ties which they possess, of issuing plates which are not only most
creditable as artistic pieces, but also admirable, as true delineations
of appearances in specimens, which the lapse of a few days would
otherwise destroy for ever. Selfish as it may seem, we most sin-
cerely wish, that any of our publishers could reprint Mr. Stanley’s
plates, as readily as they have done his treatise; but as they are as
yet not equal to this task, we advise every medical librarian to
secure an English copy, assuring them that they will find the
volume well worth the cost. For the labor and expense evidently
bestowed on his illustrations, Mr. Stanley deserves high praise,
and in them he has furnished a volume that will well compare with
Cruveilhier, Carswell, &c., and one that must extend his reputation
to after ages.
The “ Treatise,” we are informed in the preface, is an indepen-
dent volume, having no connection with the Illustrations, except
in occasional references. The two works are therefore complete
in themselves, and each is independent of the other.
In the arrangement of the Treatise, we are presented, first, with
a chapter of general considerations, in which are too briefly speci-
fled some of the peculiarities of bone, and in which, we were dis-
appointed in not finding a more detailed account of the special
anatomy of their structure. In order properly to appreciate
pathological changes, the observer must necessarily be correctly
acquainted with healthy tissue. But in the bones, the accounts of
minute structure are not universally credited, and we much doubt
whether most of those who read the Treatise, will not find them-
selves unable to understand, in its present form, the opinions which
are so concisely given throughout most of its pages. Osteology,
as a portion of Histology, is a branch of Anatomy only specially
taught within a very few years, and as additions are being con-
stantly furnished by the observations of the microscopists, it re-
quires constant reading to prevent their progress from leaving in
a false position, those who rely upon the doctrines taught in the
schools in former days.
The body of the work is divided into four parts:
Part 1st embraces eight chapters on changes of structure, and
constitutes the basis of many of the subsequent observations. It
includes Hypertrophy, Atrophy, Neuralgia, and Inflammation and
its results, as Enlargement, Expansion of Tissue, Induration, Osse-
ous deposits, Suppuration, Caries, Ulceration, and Necrosis.
In the first pages of this part, the peculiar arrangement, extreme
brevity, and also want of accuracy in the signs furnished as
characteristic of the diseases referred to, cannot but be apparent
to all; whilst the absence of any observations respecting the Peri-
osteum and its diseases, in this portion of the work, struck us as
an error. Why the author prefers placing the periosteum last, is
not apparent. We therefore imagined that he entertained some
special views of its functions, until, in the chapter on Necrosis, we
found that his opinions were very much the same as those of other
observers.
The chapter on Neuralgia is also far from satisfactory, as at
present described. What portions of structure are affected in this
neuralgia ? Has Mr. Stanley traced nerves from the nutritious
foramen throughout the bone ? Or does his neuralgia mean a dis-
order of the internal or external periosteum and its expansions?
Two of the three cases cited as examples of neuralgia, arose from
injuries which might have acted on these membranes, and as the
diagnosis of neuralgia from periostitis and suppuration within the
cancellated tissue, is most important in practice, we cannot
but regret that the description is not more explicit.
In the chapters on Suppuration, Caries, Ulceration and Necrosis,
we at once find the author’s forte, as there is a marked difference
in his description of such matters of a practical character, as he has
seen in disease, and those more immediately connected with
minute changes of structure. In the practical surgery of the
volume, the reader will be sure to find much to instruct him, but
in the special anatomy and physiology, he will be disappointed.
Suppuration, Caries, Necrosis, &c., are from the pen of one who
has felt and recognised what he describes, and who, therefore, can
point out such lines of difference as at once establish the correct-
ness of his views ; but the explanations of minute changes of
structure, as the production of tumors, morbid changes, or osseous
nourishment in healthy bone, might have been left to other hands.
In a disease of common occurrence, as caries, this is especially
true. Mr. Stanley at once recognises the characters of the disease,
and does not tell us that caries “is an affection analogous to ulcera-
tion in the soft parts,” but defines it accurately as “ the changes
which are consequent on chronic suppuration in the cancellous
texture of bones, which, in its progress, exhibits the follow-
ing phenomena—Inflammation extending from the bone to its in-
vesting soft parts ; these become swollen, thickened and tender,
and abscesses are formed in them which contract into fistulous
passages leading to the diseased bone. The bone itself is at first
very vascular ; then its cells become filled with a reddish-brown
fluid, apparently a mixture of blood and pus, and occasionally
combined with oily particles.”
“ Absorption of the bone, but chiefly of its animal part, ensues ;
that which remains is porous, fragile, and of a grey, brown or
black color, probably from decomposition of the matter within its
cells, to which cause likewise, the fetid odor of the discharge may
be ascribed.
“ The surface of ulcerated bone is rough and porous, except in
instances where its texture has been previously hardened by in-
flammation. Around the ulcer, from simple inflammation, its tex-
ture becomes expanded and hardened ; also around the ulcer of
bone, from simple inflammation, osseous deposits occur in the
periosteum in the forms of tubercles and spines. But the scrofulous
or other specific ulcers of bone are not accompanied by these
changes, either in the surrounding periosteum or bone.”
Without, however, quoting more, we venture the opinion that
any reader of this portion of the work will recognise an ulceration
of bone analogous to ulceration of soft parts, but soon find that
this ulceration is not caries.
The history, &c., of Necrosis occupies near fifty pages of the
book, and will, we think, bear a close scrutiny. In it the reader
will find one of the best articles that has yet appeared on this
interesting disease, and one also that is fully worked up with the
investigations of the day. The necessary brevity of this notice
must, however, preclude our doing more than state its apparent
value. Our remarks also of the remaining portions of the work
must be less extended.
Part II. treats of Tumors of Bone, and contains 1st, Tumors of
Bone which pulsate, and 2d, Osseous Growths arising in con-
siderable numbers from the skeleton and in the soft tissues. It
occupies fifty-two pages, and contains a large amount of valuable
observation. Necrosis and these tumors, are decidedly the portions
that will most add to the author’s reputation.
Part III. contains Rickets, Conditions of Bone designated as
Mollities and Fragilitas, Scrofula in Bone, Hard Carcinoma and
Melanosis in Bone.
The article on Scrofula is good as far as it goes, though it is
but too evident that the excellent monograph of Nelaton on Tu-
bercles in Bone, published at Paris in 1839, has not reached the
author; otherwise we think he would have modified some of his
descriptions of the progress of the disease.
Part IV. treats of Morbid Growths from the Jaws, Diseases of
the Bones of the Spine, and lastly of Diseases of the Periosteum.
The frequent repetition of the operation of Resection of the
Jaws at the present day, will doubtless induce many operators to
consult Mr. Stanley’s article in the first portion of this part; and
as they will not fail to learn something from its perusal, we cannot
but hope that they may hesitate longer than we fear is often done,
before performing a painful operation, and one which too fre-
quently is of but little service to the patient. Mr. Stanley’s ob-
servations on the importance of operating so as to avoid if pos-
sible injuring many branches of the portio dura, will, we think, be
recognised as true. The present number of this Journal contains
an improvement by Prof. Wm. E. Horner, on the ordinary mode
of operating, which seems likely to accomplish this important
object.
In thus hurriedly noticing the Treatise on the Bbnes, it is evi-
dent that we can only imperfectly touch upon the more prominent
characteristics of the volume. As a treatise, it wants methodical
arrangement and often clearness of description, whilst the brevity
of many opinions is a decided fault. But it also contains a large
amount of useful information, and must prove a valuable addition
to the library of every surgeon. The value of what we do find
only makes us wish for more. Coming from the pen of one
who has such a fine field for verifying his views, we cannot but
feel dissatisfied. We would therefore hint that more Anatomical,
Physiological, Microscopical, Pathological and Diagnostic details,
might be substituted for many of the accounts of cases and opi-
nions of medicinal articles, which would, we believe, enhance the
value of the volume.	*