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IXFLAMMATIOX. I45

separate from the living bone, no attempt should be made to
remove them, but the suppurating surfaces should be frequently
irrigated with antiseptic solutions. The fetid odor of the breath
may be corrected by freely using a solution of permanganate of
potassium and cinnamon : also the fetid odor of the discharges.
The treatment of phosphorus-necrosis and other toxic forms,
consists in the use of antiseptic solutions, the opening of
abscesses, and the removal of diseased bone, and especially of
dead bone upon the first provocation. The constitutional treat-
ment in all forms of necrosis should be supporting, and liquid
foods given where there is inability to open the mouth. Such
tonics as iron, quinine, cod-liver oil, malt extracts are indicated,
together with change of air.
Caries of Bone.— Caries affecting bone is a chronic inflamma-
tion, with rarefaction or absorption of bone-tissue attended by
suppuration ; it is molecular death of bone, being a disintegration
of the tissue. Both necrosis and caries of bone bear the same
relation to the osseous tissue, that gangrene and ulceration do to
the soft tissues. When percussion is made a different sound is
distinguished between necrosis and caries of bone, owing to the
difference in the degree of density. The probe reveals a sharp
sound in the case of necrosed bone, owing to its hardness, while
the use of this instrument reveals a dull sound in the case of
caries of bone, and the probe also penetrates the diseased structure.
The causes of caries of bone depend upon a chronic inflamma-
tory condition generally due to tubercular or syphilitic infection.
Among the bones most frequently attacked are the bones of the
face, and the lower jaw, especially the latter. The syphilitic
form most commonly affects the bones of the nose and palate.
When carious bone is exposed, it is found to be softened and
disintegrated, and portions have been removed by liquefaction or
absorption, leaving a greater or less cavity, the surface of which is
covered with granulations and pus. Among the granulations may
be found small spiculas of dead bone, surrounded by pus. In
caries of bone resulting from syphilis, ulceration destroys the
external surface of the bone, leaving a granulating surface, dis-
charging the gummy pus.
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