A treatise on diseases of the bones / By Thomas M. Markoe.

  • Thomas M. Markoe
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on diseases of the bones / By Thomas M. Markoe. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    |1 V arteries, it would seem certain that the mischief must be due to some action in the medullary circulation, wherebjthis particu- lar portion of the bone loses its vascular supply. ]^ow, this may be produced in various ways. It may be, for example, that the medulla is killed by the direct vio- lence of the saw, as we often see lacerated and contused wounds elsewhere mortify on their surface. That this is often the case, and that such a death may explain the narrow ring of bone which often exfoliates from the sawed end, I am not disposed to deny; but that such vio- lence could extend so far as eight or nine inches uj) into the stump, and j^roduce its effects with- out entirely destroying the medulla itself, it does not seem to me reasonable to believe. Again, it might be supposed that inflammation attacking the medulla, and suppuration occur- ring, might sej)arato the bone from the vascular substance of the medulla, and thus produce its necrosis. But such an inflammation would be accompanied, we may well suppose, with very marked and probably very serious symptoms, both local and general, such as accompany os- teo-myelitis, wherever it occurs, under other cir- cumstances, No such symptoms are present, however, in cases where the most extensive sequestrum is found; in fact, the cases presenting this trouble are usually most favorable in their demeanor during all the early period of their healing, many of them not presenting a bad symptom until the evidences of necrosis begin to show themselves, and even then these evidences accu- mulate slowly from day to day, not being pre- ceded by any thing which can stand for an ap- parent cause. We are, therefore, it seems to me, debarred from assuming either direct injury of the medulla, or suppurative inflammation of it, as the cause of these peculiar sequestra. Some cause must be found which will explain all the phe- nomena, and this cause, I think, it is not difficult to arrive at. Fig. 85.—(N. T. Hos- pital Museum.) Fig. 36.—rNT. T. Hos pital Museum.)
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