Infection with the _staphylococcus albus_, the _streptococcus_, or the
_pneumococcus_ also causes a mild form of osteomyelitis which may go on
to suppuration.
_Necrosis without suppuration_, described by Paget under the name "quiet
necrosis," is a rare disease, and would appear to be associated with an
attenuated form of staphylococcal infection (Tavel). It occurs in
adults, being met with up to the age of fifty or sixty, and is
characterised by the insidious development of a swelling which involves
a considerable extent of a long bone. The pain varies in intensity, and
may be continuous or intermittent, and there is tenderness on pressure.
The shaft is increased in girth as a result of its being surrounded by a
new case of bone. The resemblance to sarcoma may be very close, but the
swelling is not as defined as in sarcoma, nor does it ever assume the
characteristic "leg of mutton" shape. In both diseases there is a
tendency to pathological fracture. It is difficult also in the absence
of skiagrams to differentiate the condition from syphilitic and from
tuberculous disease. If the diagnosis is not established after
examination with the X-rays, an exploratory incision should be made; if
dead bone is found, it is removed.
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