American practice of surgery : a complete system of the science and art of surgery . atism is rarely confined to a single joint, and, moreover,when it is so confined the pain and tenderness complained of are in the jointand the immediate periarticular structures, and not opposite the epiphysis orthe shaft of the bone. In rheumatism, also, the central point of the swellingis opposite the joint, and becomes manifest at an earlier period of the disease INFLAMMATORY AFFECTIONS OF BONE. 289 than is the case in osteomyelitis. Rheumatic manifestations never suppurate,and the disease seldom presents t
American practice of surgery : a complete system of the science and art of surgery . atism is rarely confined to a single joint, and, moreover,when it is so confined the pain and tenderness complained of are in the jointand the immediate periarticular structures, and not opposite the epiphysis orthe shaft of the bone. In rheumatism, also, the central point of the swellingis opposite the joint, and becomes manifest at an earlier period of the disease INFLAMMATORY AFFECTIONS OF BONE. 289 than is the case in osteomyelitis. Rheumatic manifestations never suppurate,and the disease seldom presents the evidences of septic intoxication that arepresent in osteomyelitis. The pain in rheumatism is more of a dull aching character, and is seldomso severe as in the disease under consideration. Leucocytosis is not presentin rheumatism and is seldom absent in osteomyelitis, except perhaps in thevery mildest types, which subside without suppuration. The characteristic sour perspiration of rheumatism also should aid in diag-nosis, since in osteomyelitis the skin is usually hot and Fig. 138.—Skiagraph of a Chronic Abscess (Brodies) in the Lower End of the Radius, justAbove the Epiphyseal Line, a, Abscess quite pervious to :r-rays; b, lower epiphyseal cartilage ofradius; c, lower epiphyseal cartilage of ulna. (Skiagraph by Dr. S. Cummings, of Toronto.) Typhoid fever sometimes gives rise to symptoms very similar to those ofosteomyelitis, but the application of Widals test and the absence of leucocy-tosis in typhoid are important aids in arriving at a diagnosis. In the fulminating type of osteomyelitis, that comes on with convulsionsand delirium in young children, the local condition ma} be overlooked and adiagnosis of meningeal inflammation might be made. In meningitis, however,there is usually retraction of the head with irritability of the muscles and painon moving any of the limbs of the body. Prognosis.—(1) As regards life. Occasionally there is encountered a ful-minating
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