[Read to the Section on Surgery and Anatomy, June, 1883.]
A careful study of the vascular relations of a bone to its periosteum and medulla, leads to the conviction that there can be no serious deviation from the normal in either without implication of the remaining parts. Of the three component parts of a bone, the osseous tissue proper, owing to its comparatively passive nutritive state, is naturally least liable to inflamatory changes. As a rule, its morbid conditions are therefore secondary in character, and follow upon disturbances of the periosteum or medulla. From the superficial position of the former, its lesions, whether primary or secondary, are always easily recognized. Those of the medulla, on the other hand, are as usually ignored until the periosteum and the bone itself have become involved in a manner to attract attention by irregularities of outline, swelling of the soft parts, abscesses and fistulæ.
RANSOHOFF J. EARLY TREPHINING IN DISEASES OF BONES. JAMA. 1883;I(10):299–302. doi:10.1001/jama.1883.02390100011001d
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