CASES of persistent chronic osteomyelitis resulting from wounds have been a constant legacy from all wars. The persistent or recurring sinus is perhaps as frequent as any other condition amongst our pensioners, and it is one which constitutes not only a troublesome disablement in itself but also a potential danger to life and limb. This condition is curable, provided we realize its pathology and found upon this a rational line of surgical treatment. Hence it is to the pathology of chronic osteomyelitis that the author first devotes his attention, devotes in fact about half of his niost useful little book.
Aftcr a consideration of the modc of union of a compound fracture ; the functions of the periosteum ; the mode of formation of sequestra ; the cavities that contain them, and the involucrum, the author says : '' Before commencing to treat any case, the surgeon should, after thorough clinical and skiagraphic examination, consider it in the terms of three factors (i.e., the amount of periostcal destruction, actual bone loss, and displacement), and on this plan, and with the aid of the evidence thus obtained as material, build up in his imagination an accurate picture and realization of the full details of the actual pathological condition present." There follows a most useful and suggestive division of compound fractures into types depending upon the amount of comminution, the loss of periosteum, and displacement. Such a classification must aid greatly in arriving a t the clinical and pathological picture desired, helping to guide us as to the shape and position of the cavities, and the probable primary and secondary sequestra present.
Coming to treatment, the desiderata needed to attain final healing are laid clown as : ( 1 ) The elimination-either spontaneously or by surgical measures-of all sequestra and β¬oreign bodies ; ( 2 ) The surgical removal of all patches of infected and carious bone ; (3) The obliterat,ion of all cavities and tunnels, and of chronic sinuses in the soft parts if they are bounded by dense scar tissue. Too often the tirst of these points is the only one realized by the surgeon ; in fact by some, even its importance is not recognized, so that we see chronic sinuses treated by chemicals, special dressings, by the injection of pastes or by electrical methods, all of which must obviously fail w-hen there is a persistent mechanical cause. The consideration of the pathology leads to a rational radical surgical procedure, involving nothing altogether new, bnt valuable, because explained npon a rational basis, and being definitely aimed a t attaining the desiderata laid down.