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The post-mortem appearances are those of pyæmia. Differential Diagnosis. Acute osteomyelitis is to be diagnosed from infections of the soft parts, such as erysipelas and cellulitis, and, in the case of the tibia, from erythema nodosum. Tenderness localised to the ossifying junction is the most valuable diagnostic sign of osteomyelitis.

Repeated hæmorrhages into a joint may result in appearances which closely simulate those of tuberculous disease. Recent hæmorrhages into the cellular tissue often present clinical features closely resembling those of acute cellulitis or osteomyelitis.

Its observed effect upon the brain-cells was that of wide-spread destruction. Infections. For example, in fatal infections resulting from bowel obstruction, in peritonitis, and in osteomyelitis, the real lesion is in the brain-cells.

In the later stages of acquired syphilis, gummatous periostitis and osteomyelitis occur, and are characterised by the formation in the periosteum and marrow of circumscribed gummata or of a diffuse gummatous infiltration. The framework of the bone is rarefied in the area immediately involved, and sclerosed in the parts beyond.

The conditions most liable to be mistaken for syphilitic disease of bone are chronic staphylococcal osteomyelitis, tuberculosis, and sarcoma; and the diagnosis is to be made by the history and progress of the disease, the result of examination with the X-rays, and the results of specific tests and treatment. Treatment.

Truly one has lived through wonderful days in the history of the healing art. The first operations which I saw performed at our hospitals were before Lord Lister's teaching was practised; though even in my boyhood I remember getting leave to run up from Marlborough to London to see my brother, on whom Sir Joseph Lister had operated for osteomyelitis of the leg.

It may be instructive to describe the X-ray appearances of a long bone that has passed through an attack of acute osteomyelitis severe enough to have caused necrosis of part of the diaphysis.

The secondary suppurations are liable to be overlooked unless sought for, as they are rarely attended with much pain. In these multiple forms of osteomyelitis the toxæmic symptoms predominate; the patient is dull and listless, or he may be restless and talkative, or actually delirious.

The young connective tissue which replaces the marrow is not unlike that seen in osteomalacia; it is highly vascular and may show hæmorrhages of various date; there are abundant giant cells of the myeloma type, and degeneration and liquefaction of tissue may result in the formation of cysts, which, when they constitute a prominent feature, are responsible for the name osteomyelitis fibrosa cystica sometimes applied to the condition.

Clinical Features. There may be an incubation period of some hours between the infection and the first manifestation of acute septicæmia. In such conditions as acute osteomyelitis or acute peritonitis, we see the most typical clinical pictures of this condition. The onset is marked by a chill, or a rigor, which may be repeated, while the temperature rises to 103° or 104°