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If the erosion proceeds uniformly, the cavity is spherical or oval; if it is more active at some points than others, diverticula or tunnels are formed, and one of these may finally erupt through the shell of the bone or into an adjacent joint. Small irregular sequestra are occasionally found within the abscess cavity.
The trabecular framework of the bone undergoes erosion and absorption rarefying ostitis and either disappears altogether or only irregular fragments or sequestra of microscopic dimensions remain in the area affected.
When foci of suppuration have been scattered up and down the medullary cavity, and the bone has died in patches, several sequestra may be included by the new case; each portion of dead bone is slowly separated, and comes to lie in a cavity lined by granulations.
I can tell you she was simply delicious in Les Trois Magots." "Inter oves locum presta Et ab hædis me sequestra, Statuens in parte dextra." "So then, it is for Nanteuil's sake that he blew out his brains? A little ninny who isn't worth spanking!" The celebrant poured the wine and the water into the chance, saying: "Deus qui humanæ substantiæ dignitatem mirabiliter condidisu...."
There are still circumstances, however, in which an operation is required; for example, in disease of the lymph glands for the removal of inert masses of caseous material, in disease of bone for the removal of sequestra, or in disease of joints to improve the function of the limb.
The size of the abscess affords no indication of the extent of the bone lesion from which it originates. As the abscess reaches the surface, the skin becomes of a dusky red or livid colour, is gradually thinned out, and finally sloughs, forming a sinus. A probe passed into the sinus strikes carious bone. Small sequestra may be found embedded in the granulation tissue.
Syphilitic sequestra are heavier and denser than normal bone, because sclerosis usually precedes death of the bone. The bones especially affected by gummatous disease are: the skull, the septum of the nose, the nasal bones, palate, sternum, femur, tibia, and the bones of the forearm. In the bones of the skull, gummata may form in the peri-cranium, diploë, or dura mater.
The commonest sequel is the presence of a sequestrum with one or more discharging sinuses; owing to the abundant formation of scar tissue these sinuses have rigid edges which are usually depressed and adherent to the bone. The Recognition and Removal of Sequestra.
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