seat of the disease, but frequently extends to those articulated with
it. The soft parts are commonly more or less thickened, and rendered
exceedingly dense by effusion of lymph into the cellular texture; and
so great is this thickening sometimes, that the knife is resisted as
if by cartilage. The discharge which proceeds from the carious part is
generally highly fetid, very profuse, is often poured through several
openings, and the surrounding skin is excoriated and generally of a
livid colour. The ichorous discharge occasionally dries up for a short
period and again breaks out more violently. The surface of the ulcer
is, in some cases, occupied by soft unhealthy granulations; in others
the earthy part of the bone is most prominent. When the parts have been
macerated and dried, the disease is often found to have proceeded more
in width than in depth, and the absorption has not reduced all points
of the diseased surface to the same level, thin portions remaining
somewhat elevated, and giving the part a cancellated appearance; and
there often project numerous minute osseous fibrillæ of considerable
length, which intermix with one another, and form a most delicate
network. In other instances, the ulceration has extended more deeply
and uniformly, and a considerable cavity is formed, with irregular
margins and surface; not unfrequently it contains dead portions of the
cancellated structure, in some of a dark, in others of a light colour;
or it is occupied, in the recent state, by a substance resembling
lard. The surrounding bone is much softened, and, after maceration,
becomes exceedingly light. The disease is generally confined to one or
two bones, but occasionally involves a whole chain. It may be limited
to a part of one bone in a joint, or may embrace the whole of it. Its
extent will depend on the severity of the primary action, or on the
degree and duration of the pressure of fluid which has been allowed to
exist, whether from the nature of the superincumbent texture or the
carelessness of the surgeon.
Interstitial absorption of those bones which are in the neighbourhood
of the carious ulceration often occurs in the tarsus and carpus. The
superincumbent integuments are livid and cold, and pain is felt in
the situation of the bones; yet they are not affected with continuous
ulceration, but portions of their substance are gradually removed
by absorption, so that they are much loosened in texture, and may
be altogether destroyed, or come to consist merely of a thin and
reticulated osseous shell, whilst at the same time their cartilaginous
surfaces often remain in their healthy condition.
Public-domain text, read in full here on John Shaqi.
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