STRANGE BONE DISEASE

Otago Daily Times, Issue 23631, 15 October 1938, Page 15

STRANGE BONE DISEASE

TREATMENT HAS LITTLE EFFECT In 1877 a famous British surgeon, Sir James Paget, described a disease of the bone which has since been known by his name (writes Dr Irving Cutter, in the Chicago Tribune). He had observed his' first patient for many years—a man who was tall, thin, wellformed, and active in both mind and body. The first symptom was aching in the legs and thighs, ch'efly after exercise. On examination the left lower leg was found to be enlarged. The tibia, the large bone in this area, was broader than normal and “ felt nodular and uneven.” There was no tenderness on pressure. “Similar but less marked changes,” wrote Dr Paget, “appeared in the lower third of the thigh.” There was no difficulty with movement except a slight stiffness on walking. Seventeen years later Dr Paget reported that the progress of the malady had been very slow, but the bones had become definitely larger and heavier, and somewhat more curved. At this time some enlargement of the skull was the subject of conynent by the sufferer’s friends. On measurement it was found that the circumference of the, head had increased nearly five inches. There was no change whatever in his features or his intellectual power. The disorder essentially is one of middle life or beyond, the largest number of instances being found in the fifth and sixth decades. For Innately it is not a life-taking affliction, and by means of the X-ray we are in a position to study its behaviour accurately. Just as in Dr Paget’s original case, the tibia usually exhibits the earliest manifestations.

The chief danger is in the likelihood to fracture, as the bones lose much of their normal strength and elasticity. Persons known to be afflicted should use special precautions to avoid falls and other injuries. Nevertheless, healing does take place, although the time may be somewhat prolonged. Sometimes the lime absorbed —for that is what occurs—makes the affected region more porous.

Naturally the cause has been sought long and earnestly, and numerous theories have been brought forward. The thyroid and the parathyroids, particularly the latter glands, because they have so much to do with the metabolism of lime, have been suspected. Again, injury is said to be the starting point by some while others believe that the element fluorine in the water, or the inhalation of the fumes of this gas, may be the offender. It seems to be clearly established that syphilis is not a factor; neither is heredity. Most patients present themselves to their physicians for some incidental difficulty, whereupon the trouble is discovered. Occasionally, however, victims complain of marked discomfort in the knees and legs, especially

at night. They state that they are unable to place the limbs in a comfortable position. Treatment apparently has little effect. In other words, with the present state of our knowledge no method or regime of restoring calcium and phosphorus to the diseased parts of the skeleton has been found. The administration of suprarenal extract, obtained from the adrenal glands, relieves pain. X-ray has shown similar results. From the standpoint of preserving an erect posture the early use of splints or other types of support has been advocated. The feeding of vitamins is urged by many authors, and, while numerous reports of improvement have appeared, we should recall that the ailment in question possesses a marked tendency to recede. Fortunately—and the reason is not clear—certain cases become arrested spontaneously. At any rate, one or two decades may pass without the slightest advance. Whether the employment of X-ray is responsible has not been proved. At any rate, this therapeutic measure is recommended because of the numerous favourable suggestions as to its influence. Again, most of these patients enjoy good health, particularly if exercise does not place too great a strain on the abnormal structures.