The principles of surgery . of the inflammatory process of the sthenic character. The twointerior portions are incapable of efficient reproduction or repair ; theexternal is busy, as it were, atoning for their deficiency by throwingout new osseous matter, sometimes in great abundance. Thus thecarious cavity is surrounded, first by spongy worm-eaten bone ; andmore exteriorly by osseous spicula or granules forming a hard irregu-lar ridge, sometimes but slight, at other times extensive. It is notmeant that such is the arrangement in all cases, but only in the ma-jority; in some the ulcerous margi
The principles of surgery . of the inflammatory process of the sthenic character. The twointerior portions are incapable of efficient reproduction or repair ; theexternal is busy, as it were, atoning for their deficiency by throwingout new osseous matter, sometimes in great abundance. Thus thecarious cavity is surrounded, first by spongy worm-eaten bone ; andmore exteriorly by osseous spicula or granules forming a hard irregu-lar ridge, sometimes but slight, at other times extensive. It is notmeant that such is the arrangement in all cases, but only in the ma-jority; in some the ulcerous margin terminates abruptly on the regionof osseous repair. Sometimes necrosis is engrafted on the ulcerativeprocess; and in the cavity may be found dead portions, either of can-cellated or laminated texture ; partially adherent, or altogether loose assequestra. 384 CARIES. The system invariably suffers to a greater or less extent; and thedisorder is of the asthenic type—constitutional irritation. Very often Fig. 121. Fig. Fig. 121. Caries of the elbow J mainly affecting the condyle of the humerus. The vegetative effortaround the carious surface well exemplified. Fig. 122. Necrosis and Caries combined; in phalanges of the toes. In the upper, the carious cavityrepresented still containing its sequestrum. In the lower the cavity and sequestrum separate. the patient has been for some time manifestly cachectic, previously toaccession of the local mischief. If not, symptoms of a hectic characterare not long in supervening; all the more early and formidable, if thecaries implicate an important articulation. Caries may be Simple, as just described; or it may be of a Scrofu-lous or Tubercular character. In the former case, it is unattended byany peculiar deposit. In the latter it is often both preceded and ac-companied by deposit of tubercle in the loose texture of the bone ; origi-nating, in fact, in the morbid condition formerly detailed as constitutingscrofulous abscess of bone (p
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