The principles of surgery . rmed a Papilla; and in every casewhere necrosis is at all extensive, there are not one,but several such purulent canals ; through the cloacae,in connection with which, a probe may be made toimpinge on the sequestrum. Through these apertures, the condition of the deadportion may be from time to time ascertained; andso soon as it has become loose, it is through theseapertures, enlarged if need be, that it is removed. When it has beendischarged, the two portions of the new osseous formation coalesce ; andso complete the construction of the dead bones substitute. Hither
The principles of surgery . rmed a Papilla; and in every casewhere necrosis is at all extensive, there are not one,but several such purulent canals ; through the cloacae,in connection with which, a probe may be made toimpinge on the sequestrum. Through these apertures, the condition of the deadportion may be from time to time ascertained; andso soon as it has become loose, it is through theseapertures, enlarged if need be, that it is removed. When it has beendischarged, the two portions of the new osseous formation coalesce ; andso complete the construction of the dead bones substitute. Hitherto thesequestrum, as a foreign substance, was interposed between; now thecortical frame, descending, comes ultimately to mingle the soft osseousgranules of its internal aspect with those which are rising from the sub-jacent stratum of original bone. And so, somewhat as in chasm of thesoft parts, the cavity, previously occupied by the sequestrum, is filledup ; partly by continued formation of new matter, partly by mutual ap-. Necrosis of tibia. At a,the dead bone 6, 6. the papillae repre-sented, communicatingthrough cloacae with thesequestrum. FORMATION OF NEW BONE. 397 proach of the parts already formed. Suppuration ceases gradually ; thecloacae, no longer useful, may slowly fill up—or at least diminish—by newformation from the osseous margins ; the whole part becomes firmlyconsolidated ; and the inflammatory process altogether subsides. Shouldthe cloacae remain unclosed, the soft parts will notwithstanding healkindly over them ; provided there be no dead bone remaining, to keepup inflammation and discharge. Before removal of the dead part, there was much bulky swelling ofthe limb; partly from the infiltrated condition of the soft parts, partlyfrom the elevated position of the cortical bone. But now this latterseeks a lower level. Besides, absorption so acts as to condense andstrengthen the new texture ; rendering it more efficient as part of acolumn of support.
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