736 THE BOXES AND JOINTS. 



osteomyelitis, the changes may be very rapid and destructive. The 

 medulla is disintegrated and gangrenous; the joints are soon involved; 

 necrosis of large portions of the bone, sometimes of the whole shaft, 

 occurs ; the periosteum and surrounding parts become gangrenous ; the 

 veins contain thrombi , and pya3inic infarctions and abscesses may form 

 in various parts of the body. ' 



CHRONIC OSTEOMYELITIS. In prolonged cases of osteomyelitis there 

 is apt to be more or less ossifying periostitis and osteosclerosis, and 

 fistula} may form in the bone, through which the exudates are dis- 

 charged. 4 



Tuberculous Osteitis is essentially a rarefying osteitis associated with 

 the formation of tubercle tissue and cheesy degeneration. The tubercles 

 are sometimes small, scattered, and mil iary inform (see Fig. 487); some- 

 times they unite to form larger and smaller masses. There may be 



: 



FIG. 487. TUBERCULOUS OSTEITIS. 

 A mlliary tubercle formed in the cancellous tissue near the joint in tuberculous arthritis. 



extensive involvement of the medulla. There may be much simple gran- 

 ulation tissue or the formation of abscess associated with the process. 

 Earefyiug and condensing osteitis and necrosis are not infrequently 

 present, so that the bone becomes spongy and fragile (Fig. 485). Tuber- 

 culous osteitis is often associated with tuberculous inflammation of the 

 joints (Fig. 484). It is most apt to occur in cancellous bone tissue, and 

 is most common in the bodies of the vertebrae and in the carpal and tarsal 

 bones. 



Syphilitic Osteitis. Syphilitic infection may lead to one or other of the 



1 Consult for an elaborate treatment of acute osteomyelitis in its relationship to 

 other forms of inflammation, with bibliography, Jordan, Beitr. z. klin. Chir., Bd. x., p. 

 587. For a study of this condition in childhood see Koplik and Van Arsdale, Am. Jour. 

 Med. Sciences, vol. ciii., pp. 422 and 535, 1892. 



2 For a resume of the deformities resulting from osteomyelitis consult Park, Medi- 

 cal Record, November 3d, 1895. 



