. Modern surgery, general and operative. bend and thebones of the skull bulge. An .v-ray pictureshows great thickening of the bones of the skull and perhaps of the jaws. Thebending of the long bones has been believed to depend upon the weight of the bodyacting on uncalcified new bone, but fracture is not particularly apt to occur. It isnow maintained that the bending and bulging are active processes, since thebending is always well marked in those bones which are fixed at both ends bymuscles and ligamentous attachments, , the clavicle, radius, and tibia,theaccompanying bone (fibula or ulna
. Modern surgery, general and operative. bend and thebones of the skull bulge. An .v-ray pictureshows great thickening of the bones of the skull and perhaps of the jaws. Thebending of the long bones has been believed to depend upon the weight of the bodyacting on uncalcified new bone, but fracture is not particularly apt to occur. It isnow maintained that the bending and bulging are active processes, since thebending is always well marked in those bones which are fixed at both ends bymuscles and ligamentous attachments, , the clavicle, radius, and tibia,theaccompanying bone (fibula or ulna) acting as the string to the bow (Gruner,Scrimger, and Foster, in Archives of Internal Medicine, June, 1912). It is ex-tremely rare before the age of forty, and usually begins between forty and fifty orlater, but cases are reported which began between eight and twenty. The enlarge-ment of the bones is usually accompanied by pain in the back and legs, which maybe severe. Headache is unusual. Enlargement maybe first detected in the cra-. FiG. 296.— Tagcts disease. Osteo-arthropathie Hypertrophiante Pneumique 585 nium, but is more often first seen in some other bone—for instance, the clavicle,the tibia, the spine, or the radius. The tibia in most cases suffers first, and otherbones become involved later. In fact, in some cases the bones of the head donot enlarge at all; but, taking all the reported cases, the skull is affected morefrequently than any of the other bones. In some cases the enlargement of thebones seems to be symmetrical; in others it is not. The man finds that atintervals he has to buy a hat of larger size, the forehead is prominent and ex-tremely broad. The posterior part of the head bulges less than the sides andfront. In the disease known as leontiasis ossea the chief enlargement is mani-fested in the face; in Pagets disease there is no enlargement of the bones ofthe face, or else these bones are trivially involved. In Pagets disease the thick-ened bones are
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