Talk:Paper - The growth of the long bones in foetal life, as exemplified by a case of foetal syphilis (1929)

JOURNAL OF ANATOMY

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. \ THE GROWTH OF THE LONG BONES IN FOETAL LIFE,

AS EXEMPLIFIED BY A CASE OF FOETAL SYPHILIS

By H. A. HARRIS, M.B., B.S., D.Sc.

Institute of Anatomy, University College and Medical Unit, University College Hospital, London

Tue experiments of both Hunter and Duhamel on the growth in length of the long bones of pigs and birds showed that there was no intercalated growth in the diaphysis and that all growth in length took place by apposition of new bone on the diaphysial side of the epiphysial cartilage. There is no justification for the statement of Macewen(1): “Interstitial growth occurs in the diaphysis of long bones, contributing slightly to increase of length.” Accordingly it is essential that no opportunity should be lost of placing on record any case which confirms the early observations of Hunter and Duhamel, both of whom, as Sir Arthur Keith (2) has pointed out, have been unfortunate in their commentators.

A mother was admitted to the ante-natal clinic with a history of four previous pregnancies. The first yielded a full-time child now alive and well. The second resulted in a babe born near term, but death supervened at the seventh month. During this pregnancy the mother had a cutaneous rash, sore throat and syphilitic sores for which she received intravenous antisyphilitic medication. The third and fourth pregnancies terminated in the abortion of premature macerated foetuses. When seen during the fifth pregnancy the mother presented a positive Wassermann reaction and was placed on active antisyphilitic treatment consisting of the intravenous injection of novarsenobenzol over a period of eight weeks. A still-born foetus was delivered at the thirty-sixth week.

The radiograms of the bones of the still-born babe (Plate I) show the progress of the disease in the embryo in a unique manner. All the bones display evidence of arrested growth(3). The ilium in particular shows that bone formation had proceeded normally for a period of about 22 to 24 weeks as judged by the size of the innermost zone of homogeneous bone. This was followed by a dense line of bony deposition, about 1mm. wide, indicating a definite period of acutely arrested growth. The line of arrested growth was followed by a zone 8 to 4mm. wide in which the trabeculae are but poorly differentiated. This zone of poorly differentiated bone is followed in turn by a dense line of arrested growth, the deposition of which occurred in the weeks immediately preceding death.

The series of changes so clearly seen in the ilium are similarly recorded in the long bones and even in the centra of the vertebrae. In all the bones there is distinct evidence of normal bone growth for the first half of pregnancy.

Anatomy LXxIv 1 2 H. A. Harris

The line of arrested growth immediately following probably corresponds to the onset of toxic symptoms due to the syphilis. The zone of poorly differentiated bone laid down in the following weeks shows that failure of active osteogenesis and excessive formation of fibrous tissue which is characteristic of chronic infection. The terminal line of arrested growth immediately preceding birth may be due to a summation of the effects of the syphilis and novarsenobenzol or to the effect of either singly.

The radiograms offer definite evidence in support of many of the facts known to the pathologist. The embryo or foetus shows no gross manifestations of congenital syphilis before the fifth month of intrauterine life. This is probably due to the fact that the placenta is not permeable to the spirochaete of syphilis or its toxins until it has already commenced those degenerative changes in the way of endarteritis, fatty degeneration and calcification which normally commence at the end of the fifth month. There is no evidence that the foetus ever displays gross lesions of any infectious disease, transmitted from the mother, previous to the initiation of the processes which lead to placental infarction. It is also of interest that osteo-chondritis syphilitica of the new born and also lines of cessation of growth due to the administration of toxic doses of phosphorus and arsenic were both described in the first place by Wegner (4) as far back as 1874,

From the point of view of the growth in length of the long bones the radiogram affords a striking parallel to the work of John Hunter with madder fed to the growing animal. In this case the spirochaete, by reason of the faulty bone laid down under its influence, not only shows the region of deposition, but clearly shows the amount of growth at each end of the respective long bones. Even in the case of the metacarpals and phalanges the radiogram indicates which is the more rapidly growing end. The first metacarpal is seen to conform in type to a first phalanx.

(Note. Since the demonstration of the above case Dr McNee has called my attention to a similar case recently described by Pick (5) of Berlin.)

REFERENCES

(1) Macewen, W. (1912). The Growth of Bone. Glasgow, p. 198.

(2) Kerru, A. (1919). Menders of the Maimed. London, p. 226.

(3) Harris, H. A. (1926). “The Growth of the Long Bones in Childhood.” Arch. Int. Med. vol. XXXVI, pp. 785-806.

(1928). ‘‘Bone Formation and the Osteoblast.”’ Lancet, Sept. 8th, pp. 489-491.

(4) Weener, G. (1870). ‘Ueber hereditére Knochensyphilis bei jungen Kindern.”’ Arch. f. path. Anat. vol. L, p. 305.

—— (1874). “Ueber das normale und pathologische Wachstum der Roehrenknochen.” Jbid.

vol. LXI, p. 44.

(5) Prox, L. (1928). “Ueber Osteochondritis syphilitica im Kindesalter.” Verhandl. d. deutsch. path. Gesellsch. vol. XxIll, pp. 248-255.

DESCRIPTION OF PLATE I

Radiograms of the bones of a congenital syphilitic foetus of 36 weeks. Note the dense lines of arrested growth laid down in the sixth and ninth lunar months and the intervening zone of imperfect bone formation. Journal of Anatomy, Vol. LXIV, Part 1 Plate I

HARRIS—Tue Growrs or THE Lone Bonss in Foetat Lire