A manual of the practice of surgery / by W. Failie Clarke.
- William Fairlie Clarke
- Date:
- [1882], ©1882
Licence: Public Domain Mark
Credit: A manual of the practice of surgery / by W. Failie Clarke. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![CARIES is commonly described as the molecular death and disintegration of bone. It would appear that the nutrition of the bone undergoes a morbid change. The bone-tissue becomes soft and vascular. Pre- sently it breaks down, ulcerates, and is discharged in the form of pus, mingled with minute fragments and spicula of bone. Caries is very apt to begin in the deep layers of bone, in the centre of the cancellated tissue—perhaps because the circulation there is feeble. This description of caries is very common in persons who are of a strumous habit of body, and is often found to co-exist with tubercular deposits in the viscera. Sometimes, on the other hand, it attacks the surface of flat bones. Here it produces an extensive sore, but never penetrates to any great depth. To this kind of caries the term ulceration of hone is sometimes applied. It is often seen on the surface of the cranium, as a consequence of syphilis (see Fig* 161). The early symptoms of caries are much the same as those of abscess. There is pain and tenderness, redness and swelling. Presently an abscess forms, and discharges itself. It is then found that the pus is gritty and offensive. If a probe is passed along the track of the abscess, it comes in contact with the sur- face of the bone, which is stripped of its periosteum, and feels rough and excavated. The appearance of a part afiected with caries is very character- istic. The tissues are thickened; the skin glazed, and of a dusky red; while here and there are the openings of sinuses, which dis- charge a thin unhealthy pus, and are commonly surrounded by coarse granulations. It is evident at a glance that the disease is of a chronic inflammatory character, and is due to some permanent source of irritation. Treatment.—The first thing is to ascertain whether the disease depends upon a strumous habit, a syphilitic taint, or any other special cause of debility. If it does, we must endeavour to meet this condition by appropriate remedies. Many cases of caries improve with the improvement in the general health, and ulti- mately undergo a spontaneous cure. Everything therefore should be done which can contribute to this desirable end. The part should, if ]iossible, be kept at rest by a moulded splint of leather or gutta-percha (see Figs. 55 and 57). The patient should have a change of air; if possible, he should go to the sea-coast. He should have a light but nutritious diet, and take regular exercise in the open air. At the same time alteratives should be pre-](https://iiif.wellcomecollection.org/image/b21225813_0130.jp2/full/800%2C/0/default.jpg)
