A system of surgery . oarrest the circulation as to causenecrosis (Fig. 334). (See page 885.) This condition is also speciallyprone to give rise to embolic pyaemia,for the veins within the medullarycanal are unable to collapse and assistin the formation of an adherent andhealthy thrombosis. Symptoms.—Deep-seated swell-ing of the soft parts covering thebone affected, whilst the skin remainsalmost in its natural condition, severedull aching pain, and much tender-ness on pressure are the chief localsigns. An increase of the dischargefrom the wound or stump, which has become offensive, is also lik
A system of surgery . oarrest the circulation as to causenecrosis (Fig. 334). (See page 885.) This condition is also speciallyprone to give rise to embolic pyaemia,for the veins within the medullarycanal are unable to collapse and assistin the formation of an adherent andhealthy thrombosis. Symptoms.—Deep-seated swell-ing of the soft parts covering thebone affected, whilst the skin remainsalmost in its natural condition, severedull aching pain, and much tender-ness on pressure are the chief localsigns. An increase of the dischargefrom the wound or stump, which has become offensive, is also likely to occur. If the bone isexposed and capable of examination, the periosteum will be foundswollen and easily separated from its attachment. The boneitself when visible, as in the case of the skull, will be dry, yellow,and dead. If a probe can be introduced into the medulla it willencounter no resistance, and no bleeding will be produced till healthymarrow be reached. But the constitutional symptoms of an infective. *^isp Fig. 334.—Necrosis of Stump from infec-tive Osteomyelitis. (St. ThomassHospital Museum, No. 577.) 882 DISEASES OF BONES. osteomyelitis are the most important, and lead to a careful examina-tion for the local signs above enumerated. Shortly, they are those ofsepticaemia and pyaemia. A man who has had a compound fracture,or whose leg has been removed by amputation, may show signs ofseptic poisoning by a high temperature with considerable fluctuations,profuse sweats, and much depression. The surgeon naturally looksfor some explanation, and if he finds the local condition beforedescribed, he at once suspects the presence of osteomyelitis. Should,a rigor take place with a temperature of 105° Fahr., he feels convincedthat such is the case. But even without this last evidence of generalinfection, the continuance of septic poisoning for a few days wouldinduce him to open the wound and examine the bone in the mannerdetailed under treatment. If this is not done, a
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