Necrosis from Pus-forming Organisms. 255 



6.121. Acute Suppurative Osteo-myelitis of the Tibia- 

 Necrosis, great periosteal Enlarg-ement, Amputa- 

 tion. — Left tibia, showing an enormously thickened case of 

 new bone round necrosed fragments. 



" James B., aged 20, labourer, admitted to the Royal Infirmary, 

 Edinburgh, November 1825. 



' ' Three years before amputation the disease commenced without any 

 cause, and with a very severe pain. Inflammation, swelling, and suppura- 

 tion ensued a year after this. A piece of bone was discharged. The 

 sinuses have gradually increased in number, from which a great quantity 

 of small bones have been discharged. His general health began to suffer 

 about three months before amputation. 



"On 20th November 1825 the following was observed. Upon the 

 anterior part of his left leg are numerous small ulcerations, all of whichlead 

 down to the tibia, which can be felt to be in a state of caries. The limb, 

 particularly at its lower part, is swollen and altered in form. From the 

 sinuses there is a great discharge of pus, of a very fcetid odour. He 

 experiences a constant dull pain. His general health is very much im- 

 paired, and his strength much reduced. Pulse 100. Frequent shivering 

 and flushing of the countenance. Incessant thirst, tongue red, bowels 

 loose. 



" The limb was amputated through the thigh, but the patient died 

 of septicemia and secondary hemorrhage." 



This is a beautiful example of a new periosteal shell 



formed round necrosed fragments. Numerous cloacal apertures 



may be observed, especially along the inner surface of the bone, 



and sequestra can be seen through these apertures, lying loose, 



but imprisoned within the new shell. G. C. 1000. a. 



6. 122. Acute Suppurative Osteo-myelitis of the Tibia- 

 Necrosis, Chronic Periosteal Enlargement. — Lower 



end of a right tibia — macerated, to illustrate the above. 



This specimen closely resembles the lower end of the 

 previous one. INo doubt there has been a similar clinical 

 history. G. C. 1160. 



Presented by Professor James Russell. 



6. 123. Acute Suppurative Osteo-myelitis of the Tibia— 



