V. METABOLIC AND NUTRITIONAL DISEASES

Metabolism is defined as the process whereby protoplasm is built up, and destroyed, incidental to life. It is the chemical changes in living cells by which the energy is made available for the vital processes and activities, and new material is provided to repair the waste.

Nutrition is the process through which new materials are assimilated into the organism.

A. EXAMPLES OF METABOLIC AND NUTRITIONAL DISEASES

[5] A fibula is seen having a rind like periostitis. In one place it is thickened. A resolving subperiostial hematoma is likely. Scurvy is a potential.

Va,Vb. Fragments of a skull demonstrates cribra crania, paramortem cuts from scalping, and in indentation of the outer cortex. The mild cranial cribra are supposedly characteristic of porotic hyperostosis.

XXI. On the antero-lateral surface of the upper tibia there is a smooth, rounded swelling that suggests a subperiosteal hematoma. The smooth texture would suggest that it is old and stable.

XXIII. A fibula has marked periostitis reaction.

XXIV. A tibia above and a humerus below. The tibia shows an old organized subperiostial hematoma. The ulna has sustained a fracture.

LIII. Fragments of the external surface of the occipital bone have markings on the surface.

LXX. A localized bump on a tibia suggesting an organized subperiostial hematoma.

LXIX. On the anterior surface of the tibia there is an old subperiosteal hematoma, to which is added a new one.

LXXIV. Tibia with an old subperiosteal hematoma anteriorly.

LXXXI. There is evidence of moderately advanced degenerative joint disease in the knee.

LXXXVI. Tibia with periostitis suggesting old and new hematomas.

LXXXVIII. Femur showing metaphyseal accentuation as evidence of arrest before death (top). The lower two tibiae have metaphyseal accentuation, and the lower has an area of subperiosteal hemorrhage.

XCVIII. Skull fragment, external surface, showing extracranial porosity commensurate with porotic hyperostosis.

CIX. Extracranial porosity is mirrored in the porous surface of these skull fragments.

CXI. Tibia and fibula showing an old, organized subperiosteal hemotoma.

CXIII. Two tibiae and two fibulae showing hematomas in various stages of resolution. The upper tibia shows active and past lesions, the upper mid one shows past bleeding, and the two fibulae demonstrate an active process.

CXIV. On the proximal humerus there are markings of fresh periosteal bleeding.

CXIX. On the anterior surface of the tibia and the fibula there is an accentuated mark from the periostium, suggesting recent hemorrhage.

CXXI. On the lateral surface of the humerus there punched out areas, possibly the site of recent bleeding.

CXXIX. A tibia shows rounded, slightly raised lumps suggesting old hemorrhages.

CXXXV. A tibia shows multiple old hemorrhages.

CXXXVI. A juvenile skull showing cribra orbitalia bilaterally, more so on the left.

CXXXVIII. Skull fragments showing extracranial porosity

CXL. Skull fragment, demonstating marked extracranial porosity.

CXLIII. A skull demonstrating mild extracranial porosity.

CXLVI. External surface of a skull showing moderately severe extracranial porosity.

CXLVIIA. Occipital view of external surface of a skull showing moderately severe external markings of porotic hyperostosis.

CXLVIIB. A view of the orbits shows a moderate number of cribra.

CLVIII. Small orbital cribra in a child's skull.

CLII. External surface of a cranium shows a moderate degree of extracranial porosity.

CLX. Skull showing extracranial porosity.

CLXI. Small orbital cribra on three orbits from children's skulls.

CLXIV. Humerus showing erosions in the cortex, proximally.

CLXXII. Humerus showing periostial reaction proximally, suggesting hemorrhage. CLXXIV. Skull with mild ectocranial porosity.

CLXXIX. Child's skull with cribra orbitalia and porotic hyperostisis of mild degree.

CLXXXI. Occipital view of a skull with mild porotic hyperostosis. CLXXXIV. Skull fragments showing cribra orbitalia.

CLXXXV. Skull with cribra cranii of moderate severity.

CLXXIV. Skull with cribra cranii.

CLXXXVIII. Skull fragments with cribra cranii.

CXCII. Tibia showing old and recent hemorrhage.

CXCIII. Tibia showing old hemorrhage.

CXCVII. Tibia demonstrating recent hemorrhage.

CXCIX. Skull fragment showing faint cribra orbitalis, right.

CC. Tibia showing old hemorrhage, multiple,

CCIII. Fragment of subadult bone with proximal metaphyseal accentuation. CCVI. Skull fragments showing extracranial porocity and cribra orbitale. CCX. Cribra orbitale, greater on the left, in a child's skull.

CCXIII. Cranial porocity, external and internal views.

CCXV. Skull with extracranial porocity and vermiculate markings in the supraorbital margins,

CCXXII. Faint cribra orbitale.

CCXXV B. Tibia showing a prominent subperiosteal hemorrhage, old.

CCXXVII B. Distal femur, posterior surface showing metaphyseal accentuation. CCXXVIII B. Tibia with recent hemorrhage.

CCXXX. Adult tiba, above, showing old hemorrhages, and juvenile below showing metaphyseal accentuation.

CCXXXIII. A subadult tibia with metaphyseal accentuation at both ends. CCXXVI. Tibia with old subperiosteal hemorrhage.

CCXXXIX. Subadult tibia showing metaphyseal accentuation.

CCXL. Child's tibia with metaphyseal accentuation.

CCXLII. Referred to in Infectious and inflammatory processes. In addition there are multiple sites suggestive of recent bleeding.

CCLV. Child's bone having metaphyseal accentuation.

CCXLVII. Child's bone with metaphyseal accentuation.

CCLI A. Metaphyseal accentuation at distal end, and

CCLI B. proximal end of femur.

CCLIII. Tibia showing metaphyseal accentuation.

CCLIV. Subadult tibia and fibule demonstration metaphyseal accentuation. CCLV. Tibia showing evidence of a recent hemorrhage.

CCLVIII. Tibia with metaphyseal markings that are prominent.

CCLIX. Accentuated markings in the proximal tibia.

CCLXIII A. A skull with porotic hyperostosis of moderate degree.

CCLXIII B. On the open skull view note the thickness posterior parietal bone.

CCLXIV. Parietal bones show the extracranial porocity and thickening of the bones.

CCLXV. A skull with faint ectocranial porocity.

CCLXVIII. Three tibiae and one fibula. The tibias show islands of organizing hemorrhage. The other tibia and fibula show other smaller hemorrhages.

CLXXXXVII. Tibia with old hemorrhage.

CCXCIII. Tibia of a subadult with two fresh hemorrhages on its surface. CCXCIV. Tibia with old, organised subperiosteal hemorrhages.

CCXCVI. Fragment of child's skull with cribra orbitalia.

CCXCVII. Child's tibia with hemorrhage subperiostially.

CCXCVIII. Tibia with multiple old hemorrhages.

CCCI. Two tibiae and one fibula with multiple old, organised, subperiosteal hemorrhages.

CCCII. A childs skull with a few orbital cribra.

CCCIV. The occipital portion of a skull with ar area of porotic hyperostosis. CCV. A fragment of child's skull with orbital cribra.

CCCIX. A child's distal femur with accentuated metaphyseal markings.

CCCXXXIX. Proximal femur with botton osteoma and roughening of the anterior surface, possibly from subperiosteal hematoma.

CCCXLV. Fragmented child's skull with orbital cribra.

CCCXLVII. Bones with evidence of recent hemorrhage.

CCCLIII. Occipital fragment demonstrating porotic hyperostosis. CCCLVIII. An adult fibula with a localized area of periostitis.

CCCLIX. A tibia with localized mounds indicating old and organized hematomas.

CCCLXVIII. Fragment of a child's skull showing orbital cribra on the right.

CCCLXX. An area of recent subperiosteal hemorrhage on the tibia. It resembles a scab on the bone cortex.

CCCLXXI. A juvenile humerus showing recent periosteal irritation from blood. [4] A humerus and fibula with roughening of the periostium.

[5] A fibula with raised periostium as though an old hemorrhage.

[9] Occipital view showing porotic hyperostosis.

[10] An ulna having periostial elevation on the proximal surface.

[12] A mandible with periosteal elevation in the ramus.

[14] There is erosion on the cuneform-proximal metatarsal joint surface.

[19] A scapula with slightly raised, stained deposit (? residua of bleeding). [21] A humerus with a roughened area and staining.

[34] A symphysis pubis with an area of new bone formation on its surface (? a subperiosteal hematoma).

[38] A right fibula having a localized area of periostitis suggesting a hematoma.

[39] Temporal bones with adherent material and roughening of the bone.

[41] Clavicle with periostitis in its surface.

[43] Right temporal bone with an area of periostitis superior to the canal. [44] Left temporal bone with marked periostitis on is surface.

[46] Radius and ulna with periostial elevation suggesting old, organized subperiosteal hematoma. Note the beginning arthritis on the head of the radius,

[50 A] Child's skull showing orbital cribra.

[50 B] There is also extracranial marking suggesting a localized hematoma.

[53] A radius and ulna with a probable fracture of the ulna, and periosteal roughening suggesting the effect of hemorrhage on the radius.

[57] Distal femur, anterior surface, showing a probable organizing subperiosteal hemorrhage.

[63] A child's left temporal bone showing firmly adherent material suggesting the possibility of hemorrhage.

[67] Temporal bones and orbital surfaces showing mastoid porosity and faint orbital cribra.

[69] Proximal tibia and distal femur showing metaphyeal accentuation.

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