Necrosis from Pus-forming Organisms. 251 



Another smooth necrosed patch is seen in front of the small 

 trochanter, and is evidently portion of a large and deep necrosis. 

 Before the fracture this has apparently been continuous with 

 the loAver necrosed piece. Some new bone has been thrown out 

 on the front of the shaft, and also behind for a few inches below 

 the seat of fracture. The cancellated tissue at the upper and 

 lower ends of the bone, especially near the necrosed portion, 

 has been rarefied, and is a good illustration of what has been 

 already noted as septic caries. (See Nos. 6.82 to 6.87.) 



B. C. I. 1. M. 24. 



6. 114. Acute Suppurative Osteo-myelitis of the Femur. 



^Left femur of a young person — soft parts cleaned off and in 

 spirit, to show the above. 



There is a fracture about the middle of the bone, which 

 may have been a compound one, and therefore possibly the 

 starting-point of the disease. A large portion of the whole 

 thickness of the shaft below the fracture is smooth, and evidently 

 has necrosed. It has been in process of separation from the 

 bone below. Above the fracture, for some distance, there has 

 been some periosteal new growth. Just below the level of the 

 small trochanter the bone has been entirely destroyed. Loose 

 fragments of necrosed bone are seen here and there at the 

 upper end of the shaft. The substance of the bone above this 

 point has been softened and partially absorbed, and has been 

 separated into distinct pieces, some evidently necrotic. The 

 whole bone, with the exception of the lower epiphysis, seems 

 to have been affected. 



This specimen, like the last, illustrates what might be 

 called septic caries and septic necrosis. 



If it were certain that the disease in this case had resulted 

 from a compound fracture, this specimen would have been 

 placed in group B, i.e. among those in which pus-forming 

 organisms have attacked the bones through wounds. 



G. C. 3353. 



