Editorials and Medical Intelligence
Boston Medical and Surgical Journal
pinched it, that I was obliged to remove the last to some extent before it yielded. And it is strange that the boy has a serviceable joint at this day, traversing an angle of about 45°. Here is another sequestrum with a wisdom tooth in it, larger than you would suppose could be contained in the ramus of the jaw. Necrosis is sometimes rapid. I removed this from a patient of Dr. Dale. It was eliminated from the first metatarsal bone of a boy in a few weeks, and is, as you see, quite a piece of
... shaft. This operation has its reverses. Here is a femur of a patient, of two years ago, in a case where the fistulous opening was directly in the track of the artery, and where it could not be pursued. I therefore attacked the bone upon the outside through the vastus externus, and made this opening into it. The patient, a healthy laborer, died the next day of a remarkable affection ; a secretion of pus beneath the layers of deep fascia and into the muscles of the whole thigh, showing universal inflammation there. Besides which, before death, the limb was inflated by gas as in a decomposing subject. There are a few points of diagnostic interest which should be mentioned. The size of the sequestrum may be judged of, sometimes, by the enlargement of the bone, and by exploring it through different apertures. Yet where it is deep, and where these signs fail, the size of the dead bone may be deceptive, and a very small one may give the idea of being large. Its mobility is sometimes unequivocal ; and upon this point there are two signs I have noticed, not, I believe, mentioned in the books, to which I attach some value. One of these is the possibility of causing pus to escape from one fistulous opening, by pressing upon the sequestrum with a probe through another and separate aperture. How is this likely to happen, unless the sequestrum moves? Again, pain, not a common local and acute tenderness, but a deep and distant pain, sometimes attends the forcible movement of a large sequestrum by a probe in a fistulous opening. The sequestrum is then tilted against soft granulations at a remote part of the cavity. In such cases, the sooner the sequestrum is removed, the better. The pathology of necrosis belongs to another part of our surgical course.