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A CASE OF DIFFUSE OSTEO-MYELITIS, WITH REMARKS UPON THE PARASITIC ORIGIN' OF THE DISEASE.* By GEORGE R. FOWLER, M. D., SUROBOX TO 9T. MART S GENERAL HOSPITAL, In bringing to your attention the subject of the parasitic ■origin of the disease commonly known as osteo-myelitis, 1 desire to preface my remarks by the history — as yet incom- plete, to be sure — of an e.vceedingly interesting case of the disease, which has been under my observation for the past year and a half in Purchase Generic Levitra my service at the hospital. I will also exhibit to you the patient and a specimen of the bone re- moved by operation. Purchase Generic Levitra The subject of the affection under ■observation, Eddie B., aged seven, born in the United States, •of healthy parents, was admitted to the hospital October 7, 1884, and the following account of the case was derived from his father : A short time before his admittance the boy stepped upon a nail while at play in the street. The punctureil wound, situ- ated at about the center of the Purchase Generic Levitra plantar surface of tl.e os calcis, was an exquisitely painful one from the beginning, :ind the fami- ly praciitioner ordered it to be poulticed, which order was most faithfully carried out; suppuration rapidly supervened, occasion- ing several spontaneous openings. He had always been a healthy, rosy-cheeked boy, but within Purchase Generic Levitra a short time after the accident, owing Purchase Generic Levitra to excessive pain and profuse discharge from the wound, his health rapidly broke down, and he emaciated con- eiderably. His status on adinission was as follows: The foot was extensively swollen, ichorous, offensive pus exuding from several apertures. Both elbow joints were swollen and tender, with enlarged veins plainly discernible. At the inner third of the right clavicle and extending to the sterno-elavicular articu- lation there was found a swelling of the size of a hazel-nut, and at Purchase Generic Levitra the site of the inner extremity of this an opening having the characteristic appearance of leading to diseased bone. This sup- posed condition was verified by the j)robe, and the same state of affairs was found to exist at the bottom of the sinus in the foot. The slightest attempt at moving the elbow joint at Purchase Generic Levitra once Purchase Generic Levitra occa- sioned the most excruciating pain. On October 22d each elbow joint was punctured with a trocar and cannula, and a small quantity of grumous, purulent material removed. Following the punctures, thorough irriga- tion with a warm solution of mercuric bichloride was practiced until the irrigating fluid returned clear, after which the punc- tures were dusted over with iodoform, an antiseptic dressing was applied, and the arm and forearm were supported by angu- lar wire-cloth splints. No reaction followed the invasion of the joints, and the small punctures soon healed. The right elbow joint showed some improvement after ten ■days, the left one perhaps rather less. Movements of the arm on either side could be made with less discomfort to the pa- tient. On December 8th Syme's amputation of the foot was per- formed, and the sinuses were thoroughly curetted with Volk- niann's sharp spoon, the largest sinus being utilized in passing a * Read before the Brooklyn Patliologiual Society, May 16, 1886. rubber drainage-tube through the most depending portion of the heel-flap. Much to my surprise, the line of coaptation healed perfectly by first intention, and even the old sinus through which tlie drainage-tube passed closed rapidly after its with- drawal. No suppuration occurred, and this Purchase Generic Levitra was attributed to the thorough carrying out of antiseptic precautions in every- thing pertaining to the treatment of the operation wound. Within three weeks after the removal of tlje foot the parts had thoroughly healed, and the boy had markedly improved in health. His appetite returned and he gained considerably in weight. On January 1.5, 1885, excision of the entire right clavicle was performed. Its periosteum was easily peeled Purchase Generic Levitra away and the bone lifted from its thickened investment. Here, also, surpris- ingly rapid healing ensued under antiseptic treatment, union by first intention occurring along the whole line of incisinn except where the drainage-tube Purchase Generic Levitra emerged. Prompt closure of the open- ing occupied by the latter Purchase Generic Levitra followed its removal. Following these operations the little fellow improved wonderfully in gen- eral health, and for a while it seemed as if the disease had spent its Purchase Generic Levitra force. It was observed that new bone was forming at the site of the removed clavicle ; the elbow joints were diminished in size, and seemed more freely movable. The hopes thus encouraged, however, proved to be delusive for it was noticed that an enlargement of the remaining clavicle WHS taking place, and also that the right radius was becoming involved in the disease. The latter soon presented a decidedly fusiform enlargement, and several openings appeared. On July 13th an Purchase Generic Levitra incision was made down to the left clavicle, which was found to be the seat of a central necrosis. An open- ing which was discovered leading down to a loosened seques- trum was enlarged, and the latter removed. The cavity was thoroughly curetted, washed out with a mercuric-bichloride solution, insufflated with iodoform, a drainage-tube inserted, and a dressing applied in the usual way. Suppuration followed, but this finally ceased, and in about three weeks the wound closed. On September 1-lth the oi)erution for the excision of the entire radius was performed. A long incision was made on the raPurchase Generic Levitra tissue, and detached from the shaft and removed separately. The lower epiphysis was likewi.se found to be detached, and, as the portion of bone adjacent to the epiphyseal line looked com- paratively healthy, it was determined to leave this fragment in situ. Some difficulty was experienced in thoroughly curetting the lining of the Purchase Generic Levitra larger sinuses, for the reason that both approxi- mated important articulations, and it was deemed important not to o])en into the latter. Some suppuration followed tlie opera- tion, and union only took place in about one half, in Purchase Generic Levitra the aggre- gate, of the line of incision. This was attributed, in part, to the circumstance just mentioned, and the fact that some irrita- tion and excoriation ensued, due, doubtless, to a profuse Purchase Generic Levitra use of pure hydronaphthol along the line of Purchase Generic Levitra incision. Complete union, however, finally occurred, the case after the third day pursuing an ajiyretic course. This arm soon became decidedly tlie tnore useful of the two members. Following the excision of the radius and the operation upon the left clavicle the patient again improved, the improvement