{'fraction_non_alphanumeric': 0.020332090816672314, 'fraction_numerical': 0.004744154523890207, 'mean_word_length': 4.612167300380228, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Discussion on the Treatment of Acute Osteomyelitis

Mr. Gwynne Williams: In discussing the treatment of acute osteomyelitis, the first difficulty to be met with in assessing the results of differing methods of treatment is the great variety of the disease. This variety combined with the relatively infrequent occurrence of the disease in the ordinary practice of a surgeon, makes it difficult for any one person to come to a satisfactory conclusion. (1) I shall assume that "acute" osteomyelitis meaDs a sudden illness associated with fever and evidence of inflammation of the bone, the duration of the illness being for days rather than for weeks. (2) It would be convenient to limit the discussion to cases in which the condition occurs in the bones with a definite medullary cavity. (3) It would be of advantage to consider only those cases due to the Staphylococcus aureus, or at least to consider these separately from the streptococcal group, since it is improbable that the same treatment is likely to be equally successful in both varieties. It might also be advantageous to consider cases of osteomyelitis in the growing bone separately from those in which the condition occurs in the adult one, but so far as I have seen, the great difference in the adult bone is the slowing of the process, so that such cases do not, for the most part, belong properly to the class of case we are considering. In assessing the results there should be considered: (1) The immediate mortality; (2) the saving of the limb; (3) the extent of the resulting acute necrosis of the bone; (4) the persistence of suppuration of varying degrees in the bone in after-years. I have looked over the records of acute primary osteomyelitis of the long bones at University College Hospital during the last 20 years. There were 91 cases, of which only 7 cases were adults; there were 18 deaths. It is not always possible to be sure that they were staphylococcal, but in most cases this fact has been noted. There were ten deaths within from one to four days of the operation. Most of these deaths seem incapable of having been prevented by operative methods; in some cases it might be thought that the shock of the operation and the loss of blood might be factors in influencing the result, but the majority must be regarded as septiceemias, and for the purposes of the present discussion might be omitted. The next group of deaths, of which there are seven, occur round about the tenth day after the operation, and the usual course of events has been that pus has been found beneath the periosteum, the medullary cavity has been chiselled open and laid bare to the extent to which pus has been visible; the resulting wound has been plugged with gauze and possibly treated with the Carrel-Dakin method. Fever has persisted and the patient has died in about ten days with preor post-mortem evidence of pericarditis and other signs of widespread infection. It is clear that a