Suppuration in bones is necessarily connected with loss of substance,
and condensation of the surrounding parts; and purulent collections
exteriorly, if allowed to press long, or if bound down by unyielding
sheaths, will sooner or later produce a breach of continuity, by
causing absorption of the outer lamella and the subjacent cancellated
texture. A similar effect is produced by aneurismal and some other
tumours. Such loss of substance is, in some instances, speedily
repaired, after removal of the cause, by effusion of new matter
from the surrounding bloodvessels of the bone; thus, in disease in
consequence of pressure from large aneurism, there is reason to suppose
that the healing process commences as soon as the aneurismal sac begins
to diminish, as after operation. But, as has been already observed,
the healthy actions are more vigorous in the softer tissues than in
bone; and when ulceration has occurred in the latter, it is generally
attended with weak action, and presents the same general characters
as an ulcer in the soft parts, connected with a feeble action of the
bloodvessels; the discharge is thin and fetid, absorption gradually
proceeds, and there is little or no effort towards reparation.
Cavities in bones are necessarily slower in healing than those in
the soft parts; the vitality and power of reparation are lower; and
there being no elasticity in the parts, the walls cannot come rapidly
together, contract and coalesce. It may tend to prevent confusion of
the two different morbid states, if we confine the term ulceration to
suppuration in, and absorption of, bone, whilst the vessels retain
a considerable power of action, throw out new matter, and procure a
reparation of the breach; and this condition of the osseous tissue
exists when the disease is situated in the surface of the bone, and
when it has been produced by an external cause. On the contrary, the
term caries will denote that peculiar kind of ulceration in which
reparation is hardly attempted by nature, and is with difficulty
obtained by the most active interference; and this disease will most
generally be found to affect the cancellated structure. The comparative
frequency of one or other of the terminations of inflammation depends
much on the kind of bone implicated.
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