The constitutional disorder attendant on caries is at first very great;
the sympathetic fever is followed by hectic, under which, and the
discharge, many patients sink. The general affection in some degree
keeps pace with the local in violence and duration. The irritation is
in some cases so great as to destroy the patient in a very few months
or weeks; but not unfrequently a constitution, by no means strong, will
be enabled to bear up for a long period under very extensive disease of
a bone. The paroxysms of pain and inflammation occasion fresh attacks
of constitutional derangement: this occurs till the patient’s health
and strength are exhausted, and he sinks under the disease, or is
relieved by the spontaneous or artificial removal of the cause.
A natural cure of caries may occur in consequence of the diseased
parts so far recovering their natural degree of vascular action as to
form granulations and repair the breach; but most frequently it is
necessary, for the accomplishment of this purpose, that incited action
occur to a very considerable degree; and the diseased parts, already
extremely weak, have not sufficient power to withstand the action, but
perish; whilst the action of the surrounding parts, not being increased
to such a degree as to overcome their powers, throws off the dead,
secretes a more bland discharge, and deposits healthy granulations,
which gradually fill up the cavity.
_Treatment._—In inflammation of bone, resolution must be brought
about, if possible; the other terminations are to be prevented by all
possible means, since they frequently endanger the limb, and even the
life, of the patient, and, at best, never admit of a speedy cure. To
promote resolution, blood must be drawn copiously from the part; and
general bleeding may also be required, though in some constitutions it
cannot be safely carried to any great extent. After local bleeding,
fomentations assiduously applied will tend much to relieve the
sufferings of the patient. Purgatives, nauseating doses of antimony,
and all safe measures likely to subdue the vascular action, must at the
same time be adopted. Free incisions through the periosteum sometimes
relieve the pain, and cut short the disease, the distended vessels
being thereby emptied; but such practice is only a last resource, when
the action has resisted all other means, and threatens an unfavourable
termination. If, notwithstanding the resolutive means employed, the
inflammation proceeds unabated, and suppuration occurs, the effused
pus ought never to be allowed to remain on the surface of the bone,
but must be evacuated by early incision. Otherwise the pressure of
the extraneous fluid will cause absorption of the bone, or detachment
of periosteum and superficial necrosis; the absorbed surface will,
in its turn, secrete pus, and thus an ulcer will be produced; and,
from the vascular action becoming debilitated in consequence of the
previous incitation, that ulcer will in all probability degenerate into
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