A system of surgery . fore, amputation high upin the shaft, and scraping out of the remaining medulla if it isfound to be diseased, would be the best line of treatment. Theremoval of the suppurating medullary tissues by scraping has beenvery successful, provided, of course, pyaemia has not been alreadyfirmly established. It is, therefore, probable that with increasedexperience this method of treatment will be preferred to a high am-putation, even when the patients condition admits of its successfulperformance. 3. Chronic Osteomyelitis takes place most frequently in con-junction with chronic os
A system of surgery . fore, amputation high upin the shaft, and scraping out of the remaining medulla if it isfound to be diseased, would be the best line of treatment. Theremoval of the suppurating medullary tissues by scraping has beenvery successful, provided, of course, pyaemia has not been alreadyfirmly established. It is, therefore, probable that with increasedexperience this method of treatment will be preferred to a high am-putation, even when the patients condition admits of its successfulperformance. 3. Chronic Osteomyelitis takes place most frequently in con-junction with chronic osteitis and periostitis. It leads to a gradualnarrowing of the medullary canal, and the bone undergoes the same EPIPHYSITIS. 883 changes as in osteosclerosis. (See page 873 and Fig. 342.) Thereis a tuberculous variety of osteomyelitis which is, as a rule,chronic or sub-acute in its progress, and often terminates in theso-called chronic abscess of bone. This will be described underTuberculous Disease of Bone (page 889).. Fig EPIPHYSITIS. Acute epiphysitis is an infective disease of the same natureas that already described under acute necrosis and acute osteo-myelitis, occurring in the epiphysial end of a long bone frecpuentlyopening into the adjacent joint, but rarely extending along theshaft. Many of the cases recorded by T. Smith as acute arthritisof infants were cases of this disease.(See also Article XXXIII., on Diseasesof Joixts.) Pathology and aetiology. — Inmost instances it is impossible to tracethe origin of the infection. In babies afew weeks old it might possibly arise asa pysemic process during the separationof the umbilical cord. In older childrenthe ulcerated throat of scarlet fever ordiphtheria may in a similar manner giverise to this affection. It must be re-membered that in acute necrosis andosteomyelitis we are often unable to tracethe source from which infection hasarisen. There does not seem to be anyclear reason why this disease should beseparated from thos
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