Modern surgery, general and operative . is not desirable to curet the cav-ity. A delay of a very few hours will be responsible for pus and dead meduUarv^ ca\dty must then be freely opened, curetted, and disinfectedwith piire carbolic acid. The former custom was to pack with iodoform gauzeand wait for the formation and loosening of a sequestrum. It is safer andwiser to freely remove dead bone at the primary operation (Le Conte, BostonMed. and Surg. Jour., June i, 1911). In any case if the joint is involved itmust be drained. In all cases employ rest, anodynes, strong suppor
Modern surgery, general and operative . is not desirable to curet the cav-ity. A delay of a very few hours will be responsible for pus and dead meduUarv^ ca\dty must then be freely opened, curetted, and disinfectedwith piire carbolic acid. The former custom was to pack with iodoform gauzeand wait for the formation and loosening of a sequestrum. It is safer andwiser to freely remove dead bone at the primary operation (Le Conte, BostonMed. and Surg. Jour., June i, 1911). In any case if the joint is involved itmust be drained. In all cases employ rest, anodynes, strong supporting treat-ment, and other remedies advised in septicemia. Amputation may be a neglected or prolonged case very extensive necrosis occurs and a formid-able operation may be required. Even amputation may be necessary. Theentire shaft may have to be removed, a bloody and dangerous operation. Chronic osteomyelitis is usually Unked with osteitis. Pus may ormay not form. There may be only thickening of and pain in the bone. Such. Fig. 254.—Chronic osteomyelitis of the tibia. 5o8 Diseases and Injuries of the Bones and Joints a condition can be caused by attenuated bacteria or by bacteria of ordinarypower acting on tissue possessed of a very high vital resistance. It mayeventuate in osteosclerosis with filling up of the medullary canal, in limitedsuppuration, in chronic abscess of the cancellous tissue (Brodies abscess),or in necrosis. A tuberculous inflammation is one form of chronic osteomye-litis (see page 249). Syphilis, typhoid fever, etc., may cause it, and it can becaused by glanders, leprosy, and actinomycosis. The typhoid bacillus under certain conditions is pyogenic. Frankeltaught this some years ago, and Keen proves it in his work on The Surgeryof Typhoid Fever. Osteomyelitis due purely to typhoid bacilli is the medulla contains typhoid bacilli pus infection is apt to take place, and if such a mixed infectionarises acute osteomyelitis de-velops. I
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