The matter is in general thick and laudable; at first it is secreted
profusely, but afterwards in smaller quantity. The external openings,
or papillæ, through which it is discharged, are found to lead to
cloacæ, or apertures in the new and living bone, which encase the dead,
and through these the dead portions can be discovered by the probe;
and it will thus be ascertained whether the sequestrum is fixed or
detached: when loose, it can sometimes be moved upward and downward in
the cavity. When the shaft of a bone is much affected, the whole limb
is enlarged, by the inflammation having extended to a considerable
distance above and below the portion about to become necrosed. The
unshapely appearance of the limb continues until the sequestra are
discharged; for by their presence incited action is still continued,
and subsides only after their removal. Some time before any portion of
bone has become dead, or begun to be separated, great effusion of new
bone has, in general, occurred; thus a preparation has been made for
the strengthening of the limb, which, after a considerable portion of
the bone has been detached, would otherwise be incapable of supporting
the weight of the body. The unnatural bulk of the limb is afterwards
much diminished, for the new bone gradually becomes consolidated, and
smooth on the surface by the action of the absorbents. Nature seems to
construct her substitute after the model of the original, and in some
instances but very little change can afterwards be observed in the limb.
In external necrosis, or death of the outer lamella, reparation is
chiefly made by the subjacent parts; and this species of necrosis
occurs most frequently in the flat bones. In necrosis involving a
greater thickness of the bone, the new matter is also furnished by
the subjacent parts, which, however, are materially assisted in the
process by the living bone, which forms the margins of the void caused
by the absorbent process for the detachment of the dead portion. The
bony matter is deposited with great activity, and frequently columns of
the new deposit cross over the sequestrum, binding it firmly down, and
rendering it almost immovable, although it may be completely detached
from the living parts.
It has already been stated, that those vessels which ramify within the
substance of the periosteum have no share in the reproduction of bone,
but plastic matter is effused by the ramifications extending from the
membrane to the bone: this effusion becomes organised, and greatly
assists in forming the substitute.
It has been formerly remarked, that a limited, and, on after
examination, an apparently trifling necrosis of the cancellated
structure, may produce the most violent local symptoms; the painful
feelings, the discharge, and the thickening of the bone, continue, as
long as the cancellated sequestrum remains; severe symptomatic fever
is induced, endangering the life of the patient, and often rendering
removal of the limb absolutely necessary.
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