FEVER-SORE. (NECROSIS.)
By the term necrosis we mean mortification, or the state of a bone when it is deprived of life. Dunglison says: "This condition is to the bone what gangrene is to the soft parts." It is popularly known as fever-sore, there being no distinction made between this species of sore and those ulcers which affect only the soft tissues of the body. When any part of a bone becomes necrosed, it is treated as a foreign body. Nature makes an effort for its removal, and at the same time attempts to replace it with new and healthy materials. In consequence of this process, the dead portion is often inclosed in a case of new, sound bone, termed the involucrum; when this is the case the dead portion is termed the sequestrum. If, however, it be superficial, and separate from the parts beneath, it is called an exfoliation. This healing process, by which the involucrum is formed, cannot be completed while the dead portion remains. Hence, numerous openings are made through the involucrum, to permit the escape of the sequestrum. When a surgical operation is performed for the removal of the necrosed bone it is called sequestrotomy. The instruments which our specialists usually employ for this practice are represented in Figs. 3, 4, and 5.
Causes. Fever-sore may be due to inflammation, injuries, working in phosphorus, or from the inordinate and protracted use of mercury.
Symptoms. The pain frequently commences in the night, and all the different stages succeed, until, finally, the result is frequently mortification or death. The entire bone, or only a part of it, may be affected; the parts become swollen, "matter" forms, and unless it be artificially evacuated, it will in time work its way out through a fistulous opening. As the disease progresses, the adjacent tissues become thickened and numerous openings are formed, which communicate with the bone, and often with each other, so that a probe may be passed from one to another, as represented in Fig. 6, copied from a drawing by Dr. Howe. The discharge from fever-sores varies in character, and usually has a fetid odor. The surgeon can readily distinguish between healthy and unhealthy bone by the use of a probe. The pus discharged in necrosis contains minute particles of bone, which may be felt by rubbing it between the fingers. Sometimes large pieces present themselves at the openings. The general health is seriously impaired, and the patient becomes debilitated, anæmic, and hectic.
Treatment. The process of repair is necessarily tedious, and nature should be assisted to remove the old bone and promote the formation of the new. An alterative course of treatment is indicated and must be persistently followed. Give Dr. Pierce's Golden Medical Discovery and Pleasant Pellets in sufficient doses to keep the bowels regular. However, all efforts to heal the sores, as long as dead bone remains, will prove fruitless. The sores should he throughly cleansed with injections of an alkaline solution, after which bandages, moistened with glycerine, may be applied. If they emit a fetid odor, add a few drops of carbolic acid to the glycerine. The dead bone can be but slowly removed by suppuration, therefore time, and, indeed, sometimes life itself, may be saved by removing it with surgical instruments. In the operation of sequestrotomy, the surgeon must exercise great judgment. Carelessness may prolong the disease and subsequently necessitate another operation, or, perhaps, an amputation.
Usually the dead bone is easily removed by the skilled specialist surgeon, and, when thoroughly taken out, the parts readily heal and the patient rapidly recovers. The removal, therefore, of the dead bone which is a constant source of irritation, and the cause of protracted suffering, should not be delayed, for very rarely indeed can it be removed at all without the assistance of the surgeon. Besides, delay often results in the loss of the limb, and not unfrequently occasions the death of the patient. Under the influence of a reliable local anæsthetic, carefully applied, the operation of removing the decayed and offensive bone is speedily and painlessly performed, the use of chloroform or ether not generally being required.