. General surgical pathology and therapeutics, in fifty-one lectures .. . have not been vertebrae, the epiphyses of thelarger hollow bones, and the cal-caneus, are the most frequent seatof this ostitis interna form is only recognizable in afew cases during life; we grad-ually arrive at the diagnosis of os-titis interna, but can only deter-mine its special form in caseswhere the half-fluid caseous pulpis evacuated through an externalopening. Lastly, we must notomit to mention that in rare cases,usually in the vicinity of caseousdeposits, true miliary tubercles,small,
. General surgical pathology and therapeutics, in fifty-one lectures .. . have not been vertebrae, the epiphyses of thelarger hollow bones, and the cal-caneus, are the most frequent seatof this ostitis interna form is only recognizable in afew cases during life; we grad-ually arrive at the diagnosis of os-titis interna, but can only deter-mine its special form in caseswhere the half-fluid caseous pulpis evacuated through an externalopening. Lastly, we must notomit to mention that in rare cases,usually in the vicinity of caseousdeposits, true miliary tubercles,small, at first gray, later cheesynodules, come in the spongy sub-stance of the epiphyses in the an-kle-bones and vertebras and inducesolution of the bone and partialnecrosis. A diagnosis of this true bone tuberculosis cannot be cer-tainly made during life, we may only consider it as probable wherethere is marked tuberculosis of the lungs or larynx. For all forms of ostitis, which induce softening of the bone-sub-stance, H. Vblkmann employs the designation rarefying Point of caseous degeneration in the spinalcolumn of a man. From the occasional remarks that I have made concerning thediagnosis of chronic periostitis and ostitis, you will have already seenthat, after they have lasted a certain time, their recognition is notgenerally difficult, but that it is not always possible to state thevariety and extent of any given case. There are two very importantfactors for the diagnosis in those cases that cannot be examined di-rectly by the sound, viz., the displacement of the bones, which mustresult, in many parts of the body at least, from their partial solution,and formation of abscesses, which often accompanies it. DISLOCATION OF BONES AFTER PARTIAL DESTRUCTION. 465 Carious destruction of the larger hollow bones rarely goes so deepas to cause a solution of continuity; where this might otherwise oc-cur, it is often prevented by osteophytes growing on the outside whilethe destruct
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