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Updated: May 1, 2025
A third group of chronic inflammations are those that begin as an acute pyogenic inflammation, which, instead of resolving completely, persists in a chronic form.
The edges and deep surface of the sequestrum present a serrated or worm-eaten appearance due to the process of erosion by which the dead bone has been separated from the living. The most important diseases in this group are the pyogenic, the tuberculous, and the syphilitic.
In the human subject, multiplication in the blood-stream does not occur to any great extent. In some general acute pyogenic infections, such as osteomyelitis, cellulitis, etc., pure cultures of staphylococci or of streptococci may be obtained from the blood. In pneumococcal and typhoid infections, also, the organisms may be found in the blood.
In relation to the bones also there may be reactive changes, resulting in the formation of spicules of new bone on the periosteal surfaces and at the attachment of the capsular and other ligaments; these are only met with where pyogenic infection has been superadded. Terminations and Sequelæ. A natural process of cure may occur at any stage, the tuberculous tissue being replaced by scar tissue.
This condition is well defined by Bollinger as quoted by Hoare, when he calls it a purulent omphalophlebitis due to local infection of the umbilicus and umbilical vessels, by pyogenic organisms, causing a metastatic pyemia.
The seventeenth of May, 1879, a woman, three days past confinement, was ill, as well as the child she was nursing. The lochia were full of the pyogenic vibrio and of the organism of furuncles, although there was but a small proportion of the latter. The milk and the lochia were sowed. The milk gave the organism in long chains of granules, and the lochia only the pus organism.
It would appear, for example, that pyogenic organisms can pass through the healthy urinary tract without doing any damage, but if the pelvis of the kidney, the ureter, or the bladder is the seat of stone, they give rise to suppuration. Similarly, a calculus in one of the salivary ducts frequently results in an abscess forming in the floor of the mouth.
In the ribs it is more satisfactory to remove the diseased portion of bone along with the wall of the associated abscess or sinus. If all the tubercle has been removed and there is no pyogenic infection, the wound is stitched up with the object of obtaining primary union; otherwise it is treated by the open method. The individual focus varies in size from a pea to a walnut.
The bursæ and tendon sheaths in the vicinity may influence the direction of spread of the abscess and the situation of resulting sinuses. When the abscess is allowed to burst, or is opened and becomes infected with pyogenic bacteria, there is not only the risk of aggravation of the disease and persistent suppuration, but there is a greater liability to general tuberculosis.
The further progress is complicated by the occurrence of pyogenic infection leading to necrosis of bone, in the knee-joint, for example, the patella or one of the condyles of the femur or tibia, may furnish a sequestrum. In such cases, anti-syphilitic treatment must be supplemented by operation for the removal of the diseased tissues.
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