Quotation from: Manual of Surgery

Written by: Alexander Miles and Alexis Thomson


_In superficial bones_, such as the sternum, the formation of
tuberculous granulation tissue in the deeper layer of the periosteum,
and its subsequent caseation and liquefaction, is attended by the
insidious development of a doughy swelling, which is not as a rule
painful, although tender on pressure. While the swelling often remains
quiescent for some time, it tends to increase in size, to become boggy
or fluctuating, and to assume the characters of a cold abscess. The pus
perforates the fibrous layer of the periosteum, invading and infecting
the overlying soft parts, its spread being influenced by the anatomical
arrangement of the tissues. The size of the abscess affords no
indication of the extent of the bone lesion from which it originates. As
the abscess reaches the surface, the skin becomes of a dusky red or
livid colour, is gradually thinned out, and finally sloughs, forming a
sinus. A probe passed into the sinus strikes carious bone. Small
sequestra may be found embedded in the granulation tissue. The sinus
persists as long as any active tubercle remains in the tissues, and is
apt to form an avenue for pyogenic infection.

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