Charles Everitt

“ Stiff hands and feet after fracture are much less frequently met with. By the aid of the X-rays it is now easy for the surgeon to assure himself that fractured surfaces have been well adjusted and are in close apposition. But if they are not in a satisfactory position, and it be found impracticable to assure their close adjustment by ordinary methods, the surgeon now, without undue loss of time, cuts down upon the broken ends and fixes them together by a strong wire suture, which remains permanently in the tissues. ”

“ In either case there is a communication between the external air and injured bone, and the probability arises of the germs of suppuration finding their way to the seat of fracture. This greatly increases the risks of the case, for septic inflammation and suppuration may lead to delayed union, to death of large pieces of the bone (necrosis) , and to osteomyelitis and to blood-poisoning. In the treatment of a fracture, every care should be taken to prevent any sharp fragment coming near the skin. Careless handling has often been the means of a simple fracture being converted into a compound one. ”

“ When the individual is well and strong, and there has been no hurt, strain or accident to lower the power of resistance of the bone, the staphylococci may circulate harmlessly in the blood, until they are gradually eaten up by the white corpuscles; but if a bone has been injured it offers a likely and attractive focus to the wandering germs. ”

“ That is to say, the micro-organisms having begun to germinate in the damaged bone find their way by the blood-stream into other tissues, and developing after their kind, are apt to cause blood-poisoning. Should a surgeon prick his finger whilst operating on a case of septic osteomyelitis his blood also might be poisoned, and he would run the risk of losing his finger, his hand, or even his life. ”

“ Many surgeons are still content to follow the old plan of fixing the limb on a back-splint, or in plaster of Paris splints, and awaiting the result. It is beyond question that a large percentage of these cases recover with a perfectly useful limb—especially if the fibrous bond of union between the pieces of the broken knee-cap is adequately protected against being stretched by bending the leg at too early a date. But in some cases the fragments have been eventually found wide apart, the patient being left with an enfeebled limb. ”

“ Bone Diseases and Injuries.—The more specific diseases affecting the bones of the human body are treated under separate headings; in this article inflammation of bone and fractures are dealt with.
Ostitis (ὀστέον, bone) , or inflammation of bone, may be acute or chronic. Acute ostitis is one of the most serious diseases which can be met with in young people. It is due to the cultivation of virulent germs in the delicate growing tissue of the bone and in the marrow. ”

“ To take a common example,—in fracture close to the wrist joint, it is necessary to arrange the splint so that the patient can move his fingers and thumb, and the splint must be taken off every day, in order that the wrist and fingers may be gently bent, straightened and exercised. ”

“ Other surgeons secure the fragments in close contact for bony union by passing a silk or metal suture around them circumferentially. Many years ago Lister remarked that the careful selection of one’s patients is an antiseptic measure—by which he meant that if a surgeon intended to get the most perfect results for his operative work, he must carefully consider whether any individual patient is physically adapted for the performance upon him of any particular operation. ”

“ Composed of mineral matter—phosphates, &c.—fat and gelatinous substances, the phosphates are used as artificial manures, the fat is worked up by the soap-maker and chandler, and the gelatinous matter forms the basis of the gelatin and glue of commerce; while by the dry distillation of bones from which the gelatin has been but partially removed, there are obtained a carbonaceous residue—animal charcoal—and a tarry distillate, from which “bone oil” and bone pitch are obtained. ”

“ Industrial Applications of Bones.—By the increasing inventiveness of man, the industrial utilization of animal bone has been so developed that not one of the constituents fails to reappear in commerce. ”

“ Several bones may be affected at the same time, and large pieces of them may be killed outright (multiple necrosis) by inflammatory engorgement and devastating abscess.
Septic ostitis may be confounded with erysipelas and rheumatism, but the central thickening and tenderness should suffice to distinguish it. ”