Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
Such an abscess may persist for years with no symptoms beyond a
moderate enlargement of the shaft of the bone at the point of abscess,
and the enlargement may be so slight that it is not recognized by the
patient. In other cases the entire shaft may be enlarged, but the bone
may not be tender. In most cases, however, such a localized abscess
sooner or later gives rise to recurring attacks of pain, which, as a
rule, are extremely violent. The intervals between such attacks may
vary from days to weeks, or to months, or even to years. The attacks
of pain may come on, apparently, perfectly spontaneously. Associated
with these attacks of pain, the bone over the abscess usually is
exceedingly tender to touch. With the attacks of pain may come a rise
of temperature, or in some cases, there may be no disturbance of the
general condition. This kind of abscess may be of small size, no
larger than a pea, or may involve a great portion of the shaft of the
bone; in such abscesses no definite sequestrum may ever form.
The recognition of such conditions depends upon recurrent attacks of
violent pain over circumscribed areas of bone, with or without
constitutional disturbance, and nearly always with extreme local
tenderness.
+Treatment.+ In the acute stage there is suppuration of the marrow, more
or less extended throughout the shaft, with often a subperiosteal
abscess and perhaps abscess of the soft parts.
The indications are the same as in any other acute suppuration; the
pus must be evacuated and the bone cavity drained. This demands not
only an incision into the soft parts, but an opening into the shaft of
the bone. If a piece of necrotic bone is present, it should be
removed.
In the chronic stage there is usually an old necrotic shaft perforated
by sinuses, and often freely movable, inclosed by a shell of dense
periosteal bone. The sequestrum must be removed, but the bony defect
fails to heal, and for months persists as a filthy, discharging
cavity, with the constant danger of secondary infection and phlegmon,
or erysipelatous inflammation. The healing of this cavity is very
difficult and requires a very long time.
Many methods have been tried for the filling of these bone cavities
with blood clot, iodoform and oil of sesame, but they have not been
successful, because it is almost impossible to render such cavities
absolutely aseptic.
+Tuberculosis of Bone.+ Tuberculosis of bone is always dependent upon
infection of the marrow of bone by the tubercule bacillus. This germ
obtains entrance to the bone marrow and causes the formation of
miliary tubercules which arise from the proliferation of the
connective tissue of the marrow around the primary tubercule. Other
secondary tubercules are formed by extension of the tubercule
bacillus. The centres of these tubercules become caseous, and, by
fusion of adjacent caseous areas, also cause softening in the bone
marrow.
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