150 
A. A. HOLCOMBE. 
the cellular tissue covering tendons and muscles hardly ever occurs 
and that when it does it seldom begins with so much pain. Where we 
have acute periostitis, it is not unusual to have osteomyelitis accom¬ 
panying it, or we may have osteomyelitis independent of the periostitis, 
in which instance there will be the symptoms of periostitis, minus the 
swelling, which does not come'on for several days. If the periosteum 
be examined at this period of the disease (third or fourth day), the 
blood vessels will be found distended with blood, and the tissue infil¬ 
trated with young granular cells, or in other words we have plastic 
infiltration. If osteomyelitis is present also, there will by extravasations 
into its substance, so that it assumes a purplish-blue tinge, instead of 
the normal bright yellow color. If proper treatment is used at this 
stage, complete recovery may be effected. If it is allowed to progress 
further, a part of the exudate upon the surface of the bone, becomes 
ossified, and the bone is left thickened. This thickening may be per¬ 
manent, 01 it may be absorbed in the course of time. But all cases of 
acute periostitis do not have so favorable a termination, in fact a great 
peicentage of them run on to suppuration. In these cases the joints in 
the neighborhood of the diseased bone swell and become very painful, 
the constitutional symptoms are severe, the patient eats but little, loses 
flesh rapidly, and seldom lies down. In about two weeks time pus will 
be detected, and puncturing of the abscess will give relief. If the pus 
has collected between the loose and the deeper layers of the periosteum 
well and good, but if it is beneath the periosteum proper the bone will 
be denuded, and the greater this destruction of periosteum the more 
severe are the symptoms. After the pus is evacuated the cavity may rapidly 
fill up, the soft parts adhering to the denuded bone, and ultimately 
forming a new periosteum. In other instances, the cutting off of the 
suppiy of nutrition to part of the bone, by reason of the destruction of 
the periosteum, necrosis will follow, but before the chronic inflamma¬ 
tion of necrosis supervenes, acute suppuration will continue for a time, 
and it is duimg this period that various complications may occur, the 
most serious of which is pyaemia. Whenever a patient in the above 
condition is found with fever they are in danger. 
T he osteomyelitis which accompanies acute periostitis so often, 
may also terminate in suppuration, and if the disease is diffuse the en¬ 
tire medulla may suppurate. If extensive suppurative osteomyelitis 
accompanies suppurative periostitis, death of a considerable part of the 
bone must result, and if the suppuration becomes putrid in character, 
septicaemia will be likely to supervene. 
