OSSEOUS SYSTEM, DISEASES OF. Periostitis.—Inflammation of the peri — In an ordinary acute periostitis following injury there is a localized swelling, redness, heat, and pain—which is usually worse at night. The tenderness is exquisite and the use of the part is much interfered with. A spindle-shaped thickening can often he felt, often due to detachment of the periosteum from the underlying bone. The anterior surface of the tibia, being most exposed, is the most frequent site of the trouble. When no infection occurs from purulent micro-organisms, suppuration may not occur. If, how ever, the acute form supervenes during some infectious disease, suppuration is apt to take place, and constitutional symptoms—severe in proportion to the extent of the inflammation — ensue. Diffuse periostitis is a serious variety in which the inflammation spreads rapidly, sometimes including the periosteum of the entire shaft. It may reach the epiph yses and the joints and reach deeply into the osseous tissues, as far as the medulla. Pyaamia sometimes appears in these cases and generally ends fatally.
Periostitis frequently follows injuries; it may also arise spontaneously as a se quel to variola, typhoid fever, scarlet fever, and other infectious diseases. The complication, as a rule, however only occurs at the end of convalescence. After typhoid fever the tibia is usually implicated, and the jaws after scarlatina and measles. Periostitis more frequently occurs as a complication in the young than in the adult.
It may be primary or secondary as the result of inflammation of the underlying bone or the medulla. In syphilitic and tuberculous subjects a local periostitis may arise without any discoverable traumatic cause. It is probable, how ever, that in many of these apparently idiopathic cases there has been a previ ous unnoticed trauma, but of a degree which would not have affected a healthy periosteum.
— The morbid changes consist in a temporary thickening of the periosteum, followed by rapid cell proliferation and the formation of in flammatory lymph. The parts may re
main thickened or hardened (sclerosed), though the underlying bone, through defective nutrition, becomes soft. Dif fuse inflammation so reduces the osse ous nutrition sometimes as to cause death of bony areas: necrosis. (See OSTEOMYELITIS, farther on.) -Many cases of periosti tis are kept acti-Te by the continued irri tation of the part through lack of rest. The muscles being inserted in the peri osteum, their contraction disturbs the latter, and the periostitis cannot sub side. The first indication, therefore, is to order the patient off his feet. Not only should this be done, but all move ments of the affected member should be prevented by incasing the limb in a plaster-of-Paris dressing or securely bandaging it to a splint.
Local depletion is also efficient. Leeches may be applied or multiple punctures of the swelling may be made with a slender tenotome or cataract knife.
Instead of these punctures. a subcutaneous incision may be made through the swollen tissues down to the bone. In chronic, troublesome cases in which the upper layers of bone are in volved, making an incision down to the bone and then boring several small holes into it—the aim being to relieve tension —and finally putting the limb in plaster of Paris has been followed by the most gratifying results in my hands. To wait for the formation of pus in these cases before operating is, in the highest de gree, undesirable, as an earlier boring of the bone cuts short the disease at once and prevents the occurrence of suppu ration.
Ostitis.
inflammation of the osseous tissue proper is seldom, if ever, witnessed as a primary affection and without involve ment of the medulla. The osseous structure is often involved, however, in periosteal and myelitic disorders. The symptoms are described under perios titis, but they are somewhat more marked as regards pain and tender ness, while greater ambulatory impo tence exists.