. The diseases of infancy and childhood. shell of new bone,which is formed from the periosteum. If no operation is done the dis-charge continues for weeks or months, other abscesses often form, andfinally several small sequestra are exfoliated—sometimes a single largeone—which is the shell of the diseased phalanx almost entire. TUBERCULOUS OSTEOMYELITIS 913 In some cases the disease is arrested before necrosis occurs, but in themajority this is not so. After the wounds have all healed the fingerremains shortened, deformed, and often useless. In some cases the dis-organization is so extensive t
. The diseases of infancy and childhood. shell of new bone,which is formed from the periosteum. If no operation is done the dis-charge continues for weeks or months, other abscesses often form, andfinally several small sequestra are exfoliated—sometimes a single largeone—which is the shell of the diseased phalanx almost entire. TUBERCULOUS OSTEOMYELITIS 913 In some cases the disease is arrested before necrosis occurs, but in themajority this is not so. After the wounds have all healed the fingerremains shortened, deformed, and often useless. In some cases the dis-organization is so extensive that amputation is necessary. Diagnosis.—The recognition of dactylitis is usually easy, but assymptoms almost identical may be seen in a syphilitic inflammation, itis often difficult to tell with which of the two forms one has to tuberculous form is much more frequent and is usually seen inchildren over two years of age; it may occur in a patient with tuber-culous antecedents, or it may be associated with other tuberculous. Fig. 148.—Tuberculous Dactylitis. lesions. Syphilitic dactylitis is distinguished by the fact that it is moreoften seen in young infants, that the lesion is more frequently multiple,that it is often symmetrical, and that other manifestations of syphilisare generally present. The Wassermann and the tuberculin tests givedefinite information in nearly all cases. Treatment.—Painting with iodin and like measures are useless. Thediseased part should be kept at rest—if a finger, by the applicationof a splint. Every means should be taken to build up the patients gen-eral health, as this is the most effective way to influence the local general verdict of surgeons is against early excision as a means ofarresting the disease. Abscesses should be opened early and freely, alldiseased bone removed, the finger kept in proper position, and the woundtreated according to general surgical principles. Under almost anytreatment the disease is a pr
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