necrotic bone appears as soft, friable granules (molecular necrosis)
or sequestra, between which living bone or granulation-tissue may be
found. The necrotic granules feel like fine grains of sand when the
finger is rubbed over the cut-surface. The color depends essentially
upon the amount of granulation-tissue present (gray, grayish-red or
deep bluish-red). Purulent areas are cloudy, opaque and yellowish.
Tubercles appear as round, grayish, semitranslucent areas, with
opaque yellowish centers when calcification has occurred. In young
subjects the developing portions of the bone (epiphyses, cartilages)
should receive especial examination. Note _amount_, _color_ and
_consistence_ of bone-marrow. In the young individual the marrow is
red; after puberty the red marrow gradually becomes restricted to
the flat bones and the short spongy bones, while in the long bones
there develops a yellow, fatty marrow. In old age the marrow of the
long bones may become brownish, transparent, myxomatous or soft like
colloid, or contain large cystoid spaces filled with a thin mucoid
fluid or liquid fat. Red lymphoid marrow is found in the long bones
in severe anæmias; it is grayish-red or deep red according to its
blood-content. In leukæmia the marrow may be red, violet, pink,
grayish or grayish-yellow (pyoid); in chloroma the marrow may be
greenish. In cachexias the marrow may become gelatinous as in old
age. A hyperæmic fatty marrow should not be mistaken for lymphoid
marrow; the fatty shine serves to distinguish the former. Cloudy
yellowish areas in the marrow point to purulent infiltration. Firm
sulphur-yellow masses are gummata.
The most important pathologic conditions of the bones are: atrophy,
osteomalacia, rachitis, fractures, dislocations, periostitis,
osteomyelitis, ostitis, acromegaly, necrosis, syphilis, tuberculosis,
actinomycosis, leprosy, exostosis, hyperostosis, hyperplasia,
defects, hypoplasia, dwarfism, giantism, neoplasms (primary sarcoma
the most common malignant tumor [periosteal, myelogenous, myeloma,
lymphosarcoma, chloroma, leukæmia]; secondary carcinoma [primary in
mamma, thyroid, prostate, adrenal] also relatively common; osteoma,
lipoma, exostosis cartilaginea, fibrosa and ossificans, fibroma,
myxoma, lipoma, angioma, chondroma, etc.), cysts, and parasites
(echinococcus, cysticercus).
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