Bone marrow

“ The primary area of infection is always in the bone marrow. The bony trabeculae and the cortex are destroyed only secondarily. The process nearly always begins in the diaphysis, but then may extend into the epiphysis and produce suppuration of the joint. Once the organisms have gained access to the marrow, they produce a toxin which causes necrosis of the adjacent marrow cells, and this necrosis may extend over a very considerable portion of the bone before marked infiltration with leucocytes occurs. ”

“ Although the tissue elements in this disease resemble those of a new growth arising in the marrow, they differ in their arrangement and in their method of growth; there is no tendency to erupt through the cortex of the bone, to invade the soft parts, or to give rise to secondary growths.
_Clinical Features._--The onset of the disease is insidious, and attention is usually first directed to it by the occurrence of fracture of the shaft of one of the long bones--usually the femur--from violence that would be insufficient to break a healthy bone. ”

“ New growths which originate in the skeleton are spoken of as _primary tumours_; those which invade the bones, either by metastasis from other parts of the body or by spread from adjacent tissues, as _secondary_. A tumour of bone may grow from the cellular elements of the periosteum, the marrow, or the epiphysial cartilage. ”

“ On longitudinal section of a long bone during the active stage of the disease, the marrow is seen to be replaced by a vascular young connective tissue which encroaches on the surrounding spongy bone, reducing it to the slenderest proportions; the formation of bone from the periosteum does not keep pace with the absorption and replacement going on in the interior, and the cortex may be reduced to a thin shell of imperfectly calcified bone which can be cut with a knife. The young connective tissue which replaces the marrow is not unlike that seen in osteomalacia ”

“ Dissect out a long bone from one upper and one lower limb and one of the largest ribs. Prepare cultures from the bone marrow in each case. Set aside these bones for the subsequent preparation of marrow films.
24. Film preparations of bone marrow are best made by the Price-Jones method. Seize the bone in a pair of pliers and squeeze out some of the marrow; receive it in a platinum loop, and transfer to a watch glass of dissociating fluid and emulsify. The dissociating fluid is a neutral 10 per cent. solution of glycerine prepared as follows:—
Measure out 10 c.c. ”

“ The short, square, and flattened bones of the body, such as those of the wrist, the skull, and the hips, instead of being hollow inside are spongy; and the spaces in the bone-sponge are filled with a soft tissue called the red marrow in which new red and white corpuscles for the blood are born, to take the place of those which die and go to pieces. ”

“ The soft cellular tumours are composed mainly of spindle or round cells; they grow from the marrow of the spongy ends or from the periosteum of the long bones, the diploë of the skull, the pelvis, vertebræ, and jaws. As they grow they may cause little alteration in the contour of the bone, but they eat away its framework and replace it, so that the continuity of the bone is maintained only by tumour tissue, and pathological fracture is a frequent result. ”

“ You see the larger part at the end is full of little holes, like a sponge. This makes it light and strong. There is a hollow place in long bones filled with marrow. It also fills the spongy parts. Marrow is made of fat and cells.
You must not think that live bones look like one which has been lying out-of-doors a long time. Live bones are full of blood and have a pinkish color. They also have an outside skin, which can be peeled off, as you see in this picture.
A bone with the outside skin partly peeled off.
Amy: What are the bones made of?
[Pg 29]
End of a bone sawed open. ”

“ A bone from the leg or thigh of a man who had died a violent death, emptied of its marrow, and then filled with human ordure, closed up with wax, and placed in boiling water, compelled the unfortunate ejector of the excrement to evacuate just as long as the bone was kept in the water, and it could even be so used that he would be compelled to defile his bed every night. ”

“ The most common is an osteomyelitis commencing in the marrow exposed in a wound infected with pyogenic organisms. In amputation stumps, fungating granulations protrude from the sawn end of the bone, and if necrosis takes place, the sequestrum is annular, affecting the cross-section of the bone at the saw-line; or tubular, extending up the shaft, and tapering off above. The periosteum is more easily detached, is thicker than normal, and is actively engaged in forming bone. ”

“ In the larger bones, the fine oil, by the gentle heat of the body, is exhaled through the pores of its small vesicles, and enters some narrow passages which lead to certain fine canals excavated in the substance of the bone, that the marrow may supply the fibres of the bones, and render them less liable to break. Blood-vessels also penetrate the bones to supply this marrow and this blood; and consequently the marrow is supplied in the infant by means of the umbilical cord. From the marrow diffused, as mentioned above, through the bones, they derive their solidity and strength. ”

“ If the articular surface is extensively diseased, a thin slice of bone should be removed, and if foci in the marrow are then revealed, it is better to gouge them out than to remove further slices of bone, as this involves sacrifice of the cortex and periosteum. ”

“ The portion of the diaphysis which has sustained the action of the concentrated toxins has its vitality further impaired as a result of the stripping of the periosteum and thrombosis of the blood vessels of the marrow, so that necrosis of bone is one of the most striking results of the disease, and as this takes place rapidly, that is, in a day or two, the term acute necrosis, formerly applied to the disease, was amply justified. ”

“ In bacterial diseases originating in the marrow, if the epiphysial junction is directly involved in the destructive process, its bone-forming functions may be retarded or abolished, and the subsequent growth of the bone be seriously interfered with. ”

“ When there is widespread suppuration in the marrow, and the shaft is extensively bared of periosteum and appears likely to die, it may be resected straight away or after an interval of a day or two. Early resection of the shaft is also indicated if the opening of the medullary canal is not followed by relief of symptoms. In the leg and forearm, the unaffected bone maintains the length and contour of the limb; in the case of the femur and humerus, extension with weight and pulley along with some form of moulded gutter splint is employed with a similar object. ”

“ Here, for instance, is a preparation of a mortified foot. See how nature has set to work, and entrenched herself against the further spread of death. The living and the blackened portions of flesh seem divided as if by a sharp knife, and across this gap death cannot leap. Or note again this diseased bone, and the delicate way in which the reparative process is to be seen building up a new framework of osseous matter within it. ”

“ When necrosis is extensive, there is a risk of fracture occurring, if motion of the limb be permitted before a sufficient quantity of matter has been effused, before nature has had sufficient time for the consolidation of her substitute, and consequently before the new bone has come to resemble the old in thickness and cohesion. ”

“ Necrosis, fortunately, seldom occurs in the heads of the long bones, or penetrates the separation betwixt the cancelli of the shaft and the epiphysis. Bits of dead bone in the articular ends, however, very often lead to disease in the joint. ”

“ As the muscles and bones have a richer blood supply than the integument, the death of skin and subcutaneous tissues extends higher than that of muscles and bone, with the result that the stump left after spontaneous separation is conical, the end of the bone projecting beyond the soft parts. ”

“ In external necrosis, or death of the outer lamella, reparation is chiefly made by the subjacent parts; and this species of necrosis occurs most frequently in the flat bones. In necrosis involving a greater thickness of the bone, the new matter is also furnished by the subjacent parts, which, however, are materially assisted in the process by the living bone, which forms the margins of the void caused by the absorbent process for the detachment of the dead portion. ”

“ In the process of healing and repair of a wounded part of the body, a fluid, perfectly structureless substance, is secreted, or poured forth, from the parts about the wound. In this substance, cells arise and become abundant; so that the substance, at first structureless, becomes what is called cellular tissue. Then, by degrees, this structure transforms itself into vessels, tendons, nerves, bone, and membrane—into some or all of such parts—according to the circumstances of the case. ”

“ Tumours with broad bases, and of soft medullary consistence, attended with extensive change in the structure of the membrane, and softening of the bones and cartilages, grow very rapidly, fill the cavities and expand them, giving rise to great deformity, as seen opposite. They show themselves on the face, through the nostrils—protrude through the floor of the orbit—get into the mouth behind the palate, through the tuberous processes of the superior maxillary bone—or project through the alveolar processes. ”

“ When the clot or the tumour, or whatever it is, has been removed, the disk of bone which, during the operation, has been kept in a warm liquid, is cut up into pieces which are put back into the opening and the skull flap is brought up into its proper position.
Fractures of the base of the skull are always serious, in that they may run across important nerves and large blood-vessels; passing through the roof of the nose, or the ear, they may be compound — that is to say, they may communicate with air- cavities from which pathogenic germs may readily enter the injured tissues. ”

“ Extravasation of blood in the bone indicates a wound made before death. If doubts exist as to the identity of the remains, a son or grandson of the deceased is required to shed some of his blood upon it. If there is relationship, the blood will penetrate the bone, otherwise it will not. ”

“ Wounds heal slowly, the slightest contusion often causing bone diseases of long standing, although amputation of the arms and legs, and even the mutilations of eunuchs, are rarely mortal, and in general heal rapidly. ”

“ Only a part of the marrow, the so-called red marrow, is normally occupied by erythroblastic tissue, the rest of the medullary cavity of the bones being taken up by fat. If any long-continued demand for red corpuscles is made, the fat is absorbed, and its place gradually taken by red marrow. ”

“ If the attachments of the dura mater be strong, and the separation which has taken place between it and the bone be small, the blood effused is compressed by the bone on one side, on which it can exert no influence, and is resisted by the dura mater, which will recede no further on the other. ”

“ For the most part, the bones separate most quickly in those cases in which suppuration takes place most quickly, and when new flesh is most quickly formed, and is particularly sound, for the flesh which grows up below in the wound generally elevates the pieces of bone. ”

“ A similar process goes on in regard to the bone and its pericranium, a tumour forms externally, and the bone, being deprived of its supply of blood, necessarily dies, either in part, or throughout its whole thickness. When an external wound exists, the altered appearance of the bone, with the sloughy state of the detached pericranium, gives evident warning of the mischief which is proceeding internally. ”

“ Such is not my object, but to place the Osteopath's eye of reason on the hunt of the great whys that the knife is useful at all, I am sure it comes often to remove growths and diseased flesh and bone that have [Pg 155] gotten so by man's ignorance of a few great truths. 1st, If blood is allowed to be taken to a gland or organ, and not taken away in due time the accumulation will become bulky enough to stop the excretory nerves and cause local paralysis; then the nutrient nerves proceed to construct tumors, and on and on until there is no relief but the knife or death. ”

“ Finally, this red zone was covered with a fairly thick layer of 42 white bone: this was the layer formed after the madder had been left off.... We shall have no further difficulty in understanding whence transudes the osseous juice that was thought necessary for the formation of callus and the filling-up of the wounds of the bones, now we see that it is the periosteum that fills up the wounds, or is made thick round the fractures, and afterward becomes of the consistence of cartilage, and at last acquires the hardness of bones. ”

“ The operation is to commence with first cutting the skin, and then when the bone of a limb is to be sawn, you must not cut through the whole flesh at once, lest an immoderate discharge of blood take place from the veins and arteries so as to occasion the death of the patient and interrupt the process of sawing the bone; except the flesh of the limb be wasted or putrid. ”

“ The cure of fractures has been accelerated by blood-letting, and, where the union of a broken bone has not taken place from a defect of bony matter, it has been produced by passing a seton between the fractured ends of the bone, and effecting a union thereby between them. Luxations, which have long resisted both force and art, have been reduced in a few minutes, and without pain, by bleeding at deliquium animi. ”

“ The skull in the figure has undergone three mutilations, D, E, and F, doubtless for the purpose of making amulets. Nor ought we to deride this superstition which attaches supernatural virtue to a bone from the human head: as late as the last century, a powder made from certain bones of the cranium used to be prescribed as a cure for epilepsy. It has been remarked that all the skulls in which disks of bone were found, were pierced during the life of the individual. ”