Bone Growth in Diaphyslal

An example of cartilaginous exostoses-believed by some to be the first described in detail in the literature-was reported in the Guy’s Hospital Reports of the Lancet of July 23, 1 825. However, it is certain that the condition was known at least half a century before that. In the series of Lectures on the Principles of Surgery which John Hunter delivered in I 786 and 1 787 he described the condition of exostosis and distinguished between those that affect one bone and those that affect “ almost every bone in the body.” The bone ends might be enlarged “ as in rickets,” which observation led him to suppose that the two conditions were closely related. There are more numerous references to the condition in the literature of the late nineteenth century, among which the classic papers of Virchow (1876) and Bessel-Hagen (1891) are remarkably detailed and accurate. In all these descriptions, as in those of recent times, interest centred mainly on the multiple cartilage-capped exostoses which are so striking and curious a feature of the disease. However, an equally important and perhaps a more fundamental aspect of this malady is the widespread effect on the growth of the appendicular skeleton. It was this, above all, that impressed Keith (1920) when he first encountered the condition and led him to adopt the name “ diaphysial aclasis,” suggested to him by Morley Roberts and still commonly used in this country. He urged that the condition of multiple exostoses be removed altogether from the category of “ tumours “ and placed among the “ disorders of growth.” In spite of this, bone growth in diaphysial aclasis has received scant attention. The present investigation forms part ofa detailed study ofhereditary multiple exostoses carried out at the Royal National Orthopaedic Hospital and the Hospital for Sick Children, Great Ormond Street. The findings are presented in the hope that they will stimulate further study on what is probably the basic defect in this puzzling disease.