Online Encyclopedia
Search over 40,000 articles from the original, classic Encyclopedia Britannica, 11th Edition.
BONE DISEASES AND INJURIES
Online EncyclopediaEncyclopedia Home :: BLA-BOS
del.icio.us it!
|
See also:BONE DISEASES AND INJURIES .—The more specific diseases affecting the bones of the human See also:body are treated under See also:separate
headings; in this See also:article inflammation of bone and fractures are dealt with.
Ostitis (oorov, bone), or inflammation of bone, may be acute or chronic. Acute ostitis is one of the most serious diseases which 0stitis. can be met with in See also:young See also:people. It is due to the
cultivation of virulent germs in the delicate growing See also:tissue of the bone and in the marrow. Another name for it is septic osteomyelitis, which has the See also:advantage of expressing the cause as well as the exact seat (,uveXos, marrow) of the inflammation. The name of the micro-organism causing the inflammation is Staphylococcus pyogenes aureus, which means that the germs collect in clusters like grapes, that they are of the virulent pus-producing See also:kind, and that they have a yellow tinge. As a See also:rule, the germs find their way to the bone by the See also:blood-stream, which they have entered through the membrane lining the mouth or gullet, or some other See also:part of the alimentary See also:canal. In the pre-antiseptic days they often entered the sawn bone during the amputation of a See also:limb, and were not infrequently the cause of blood-poisoning and See also:death. When the individual is well and strong, and there has been no hurt, See also:strain or See also:accident to See also:lower the See also:power of resistance of the bone, the staphylococci may circulate harmlessly in the blood, until they are gradually eaten up by the See also: The starting-point of the disease is the delicate growing tissue recently deposited between the See also:main part of the See also:shaft of the bone (diaphysis) and the cartilaginous end. And it often happens that the earliest complaint of See also:pain is just above or below the See also:knee; just above the See also:ankle, the See also:elbow or the See also:wrist. It the surgeon is prompt in operating he may find the disease limited to that spot. In the case of infants, the germs are very apt to make their way into the neighbouring See also:joint, giving rise to the very serious disease known as acute See also:arthritis of infants. Probably the first sign of there being anything amiss with the limb will be a complaint of aches or pains near a joint; and these pains are apt to be miscalled rheumatic. Perhaps they occur during convalescence from See also:scarlet or typhoid See also:fever, or after exposure to injury, or to wet or See also:cold, or after unusual fatigue. The part becomes swollen, hot, red and excessively See also:tender; the tenderness, however, is not in the skin but in the bone, and in the engorged membrane around it, the periosteum. The temperature may run up to ro4°, and may be associated with See also:convulsions or shiverings. The patient's nights are disturbed, and very likely he has violent See also:delirium. If the case is allowed to See also:drift on, See also:abscess forms, and death may ensue from septic See also:pneumonia, or pericarditis, or from some other See also:form of blood-poisoning. As soon as the disease is recognized an incision should be made down to the bone, and the affected See also:area should be scraped out, and disinfected with a See also:solution of corrosive sublimate. A considerable area of the bone may be found stripped See also:bare by sub-periosteal abscess, and See also:necrosis is likely to ensue. Perhaps the shaft of the bone will have to be opened up in the See also:chief part of its length in See also:order that it may be cleared of germs and pus. The surgeon is more apt to err on the See also:side of doing too little in these serious cases than too much. It may be that the whole of that piece of bone (diaphysis) which lies between the joint-ends is found loose in a large abscess cavity, and in some cases immediate amputation of the limb may be found necessary in order to See also:save life; in other cases, amputation may be called for later because of See also:long-continued suppuration and See also:grave constitutional disturbance. Several bones may be affected at the same See also:time, and large pieces of them may be killed outright (multiple necrosis) by inflammatory engorgement and devastating abscess. Septic ostitis may be confounded with See also:erysipelas and rheuma-tism, but the central thickening and tenderness should suffice to distinguish it. Chronic ostitis and periostitis denote long-continued and increased vascular See also:supply. This may be due to injury, syphilis or See also:rheumatism. The disease is found chiefly in the shafts of the bones. There is a dull pain in the bone, which is worse at See also:night, and the inflamed piece of bone is thickened and tender. The lump thus formed is called a hard See also:node, and its outline shows clearly by X-rays. The affected limb should be rested and kept elevated. Leeches and fomentations may ease the pain, and iodide of See also:potassium is the most useful See also:medicine. Chronic inflammation of tuberculous origin affects the soft, cancellated tissue of such bones as the vertebrae, and the bones of the hands and feet, as well as the spongy ends of the long bones. In tuberculous ostitis the presence of the bacilli in the spongy tissue causes an See also:escape of colourless corpuscles from the blood, which, See also:collecting around the bacilli, form a small greyish white heap, a tubercle. These tubercles may be See also:present in large See also:numbers at the expense of the living tissue, and a rarefying ostitis is thus produced. Later the tubercles break down and form tuberculous abscesses, which slowly, and almost painlessly, find escape upon the See also:surface. They should not be allowed to open spontaneously, however, as the wounds are then likely to become infected with pus-producing germs, and See also:fuel being added to the See also:fire, as it were, destruction advances with increased rapidity. The treatment for these tuberculous foci is to See also:place the limb or the part at See also:absolute See also:rest upon a splint, to give plenty of fresh See also:air to the patient, and to prescribe See also:cod-See also:liver oil and See also:iron. And when it is seen that in spite of the See also:adoption of these See also:measures the tuberculous abscess is advancing towards the surface, the surgeon should cut down upon the part, scrape out the foci, and disinfect with some strong antiseptic lotion. See also:Consideration should also be given to the treatment by injection of tuberculin. See also:Caries (rottenness, decay) is the name given to tuberculous disease of bone when the tubercles are See also:running together and are breaking down the cancellous tissue. In See also:short, caries generally means tuberculous ostitis, though syphilitic ulceration of bone has also received the same name. Fractures.—A bone may be broken at the part where it is struck (fracture from See also:direct violence), or it may break in consequence of a strain applied to it (fracture from indirect Fracture. violence), or the fracture may be due to See also:muscular See also:action as when a violent cough causes a See also:rib to break. In the first case the fracture is generally transverse and in the second more or less oblique. The fully See also:developed bone is broken fairly across; the soft bones of young people may simply be bent—green stick or See also:willow fracture. Fractures are either See also:simple or. See also:compound. A simple fracture is analogous to the subcutaneous laceration in the soft parts, and a compound one to an open See also:wound in the soft parts. The wound of the soft parts in the compound fracture may he due either to the force which caused the fracture, as in the case of a See also:cart-See also:wheel going over a limb, first wounding the soft parts and then fracturing the bone, or to the See also:sharp point of the fractured bone coming out through the skin. In either case there is a communication between the See also:external air and injured bone, and the See also: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 See also:lead to delayed See also: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. In most cases of fracture crepitus can be made out; this is the feeling elicited when two rough osseous surfaces are rubbed together. When a bone is merely See also:bent there is, of course, no crepitus. It is also absent in fractures in which the broken extremities are driven into one another (impacted fracture"). In order to get See also:firm bony union it is necessary to secure accurate apposition of the fragments. 
Putting the broken ends together is termed " setting the fracture," and the needful amount of rest is obtained by the use of splints. As a rule, it is also advisable to See also:fix with the splint the joint above or below the fracture. In cases in which a splintering of the bone into a joint has taken place, more especially in those cases in which tendons have been injured, there may be a See also:good See also:deal of effusion into the joint and the tendon sheaths, and this may be organized into fibrous tissue leading to permanent stiffness. This is particularly apt to occur in old people. Care must be taken in such instances by See also:gentle exercises, and by passive See also:movement during the See also:process of cure, to keep the joint and tendons See also:free. To take a See also:common example,—in fracture See also: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 See also:day, in order that the wrist and fingers may be gently bent, straightened and exercised. The treatment of fractures has undergone considerable improvement of See also:late years. Simple fractures are not kept so long at rest in splints, but are constantly " taken down " in order that See also:massage and movements of the limb may be resorted to. This, of course, is done with the utmost gentleness, and with the result that swelling, pain and other evidences of the serious injury quickly disappear, whilst a more rapid and See also:complete recovery is ensured. 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 See also:adjustment by See also:ordinary methods, the surgeon now, without undue loss of time, cuts down upon the broken ends and fixes them together by a strong See also:wire suture, which remains permanently in the tissues. If the fracture be associated with an open wound of the part (compound fracture), and the broken ends are found incapable of easy adjustment, immediate wiring together of the fragments is now considered to be a necessary part of the See also:primary treatment. The See also:French surgeon, Just See also:Lucas-Championniere, has done more than any one else to show the advantage of discreet movements, of massage and of exercises in the treatment of fractures. See also:Special Fracture in Young People.—The long bones of See also:children and growing persons consist of a shaft with cartilaginous ends in which bone is developed. As the result of injury, the end of the bone may become detached, a variety of fracture known as diastasis. Such a fracture—however well treated—may be followed by See also:arrest of growth of the bone or by stiffness of the neighbouring joint. Delayed union means that consolidation is taking place very slowly, if at all. This may be due to See also:local or constitutional causes, but provided the bones are in good position, nothing further than See also:patience, with massage, and with due See also:attention to See also:general See also:health-measures, is necessary. An ununited fracture is one in which after many See also:weeks or months no See also:attempt has been made by nature to consolidate the parts. This may be due to the ends not having been brought close enough together; to the seat of fracture having been constantly disturbed; to muscle or tendon being interposed between the broken ends, or to the existence of some constitutional defect in the patient. Except in the last-named See also:condition, the treatment consists in cutting down to the broken ends; freshening them up by sawing off a thin slice, and by adjusting and fixing them by a wire or See also:screw. Ununited fracture of the See also:leg-bones in children is a most unsatisfactory and rebellious condition to deal with. There is still a difference of See also:opinion as to the best way of treating a See also:recent facture of the patella (knee-cap). Many surgeons are still content to follow the old See also:plan of fixing the limb on a back-splint, or in See also:plaster of See also: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 See also:bond of union between the pieces of the broken knee-cap is adequately protected against being stretched by bending the leg at too See also:early a date. But in some cases the fragments have been eventually found wide apart, the patient being See also:left with an enfeebled limb. Still, at any See also:rate, this See also:line of treatment was unassociated with risk. But after See also:Lister showed (1883) that with due care and cleanliness the knee-joint could be opened, and the fragments of the broken patella secured in close apposition by a stout wire suture, the treatment of the injury underwent a remarkable See also:change. The See also:great advantage of Lister's treatment was that the fragments, being fixed close together by the wire stitch, became solidly See also:united by bone, and the joint became as See also:sound as it was before. Some surgeons, however, objected to the operation—in spite of the excellence of the results obtainable by it—because of the undoubted risk which it entailed of the joint becoming invaded by septic micro-organisms. As a sort of See also:compromise, See also:Professor A. E. J. See also:Barker introduced the method, which he deemed to be less hazardous, of holding the fragments close together by means of a strong See also:silver wire passed See also:round them vertically by a large See also:needle without actually laying open the joint. But experience has shown that in the hands of careful and skilful surgeons Lister's operation of openly wiring the fragments gives a perfect result with a comparatively small risk. Other surgeons secure the fragments in close contact for bony union by passing a See also:silk or See also: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 See also:work, he must carefully consider whether any individual patient is physically adapted for the performance upon him of any particular operation. This See also:aphorism implies that not every patient with a broken knee-cap is suited for the opening of his knee-joint, or even for the sub-cutaneous adjustment of the broken fragments. An operative See also:procedure which is admirably suited for one patient might result in disaster when adopted for another, and it is an important part of the surgeon's business to know what to advise in each individual case. (E. O.*) See also:Industrial Applications of Bones.—By the increasing inventiveness of See also:man, the industrial utilization of See also:animal bone has been so developed that not one of the constituents fails to reappear in See also:commerce. Composed of See also:mineral matter—phosphates, &c.—fat and gelatinous substances, the See also:phosphates are used as artificial See also:manures, the See also:fat is worked up by the See also:soap-maker and See also:chandler, and the gelatinous See also:matter forms the basis of the See also:gelatin and See also:glue of commerce; while by the dry See also: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 See also:pitch are obtained. To these by-products there must be added the direct uses of bone—for making buttons, See also:knife-handles, &c.—when an estimate is desired of the commercial importance of these components of the animal See also:frame. While most of the See also:world's supply of bones goes to the glue and gelatin See also:works, the leg and thigh bones, termed " marrows " and knuckles," are used for the manufacture of bone articles. The treatment which they receive is very different from that practised in the glue-works. The ends are removed by a saw, and the bones are steeped in a 1% brine solution for three to four days, in order to separate the fibrous matter. The bones are now heated with See also:water, and allowed to simmer for about six See also:hours. This removes a part of the fat and gelatinous matter; the former rises as a scum, the latter passes into solution, and the bones remain sufficiently firm to be worked up by the See also:lathe, &c. The fat is skimmed off, and, after See also:bleaching, reappears as a component of See also:fine soaps, or, if unbleached, the oil is expressed and is used as an adulterant of other See also:oils, while the stearine or solid matter goes to the See also:candle-maker; the gelatinous water is used (after filtration) for making See also:size for cardboard boxes; while the bones are scrubbed, dried, and then transferred to the bone-worker. The glue-worker first removes the fat, which is supplied to the soap and candle trades; the bones are now treated for glue (q.v.); .and the See also:residue is worked up for manures, &c. These residues are ground to a fine or coarse See also:meal, and supplied either directly as a fertilizer or treated with sulphuric See also:acid to form the more soluble superphosphates, which are more readily assimilated by growing See also:plants. In some places, especially See also:South See also:America, the residues are burned in a See also:retort to a white ash, the " bone-ash " of commerce, which contains some 7o–8o% of tricalcium phosphate, and is much used as a manure, and in the manufacture of high-grade super-phosphates. In the gelatin See also:industry (see GELATIN) the mineral matter has to be recovered from its solution in hydrochloric acid. To effect this, the liquors are freed from suspended matter by filtration, and then run into vats where they are mixed with See also:milk of See also:lime, or some similar neutralizer. The slightly soluble bicalcium phosphate, CaHPO4, is first precipitated, which, with more lime, gives ordinary tricalcium phosphate, Caa(PO4)2. The contents of the vats are See also:filter-pressed, and the cakes dried on plates supported on racks in heated See also:chambers. This product is a very valuable manure, and is also used in the manufacture of See also:phosphorus. Instead of extracting all the gelatinous matter from degreased bones, the practice of extracting about one See also:half and carbonizing the residue is frequently adopted. The bones are heated in See also:horizontal See also:cast-iron retorts, holding about 5 cwt., and the operation occupies about twelve to thirteen hours. The residue in the retorts is removed while still red-hot to air-tight vessels in which it is allowed to cool. It is then passed through grinding See also:mills, and is subsequently riddled by revolving cylindrical See also:sieves. The yield is from 55 to 6o % of the bones carbonized, and the product contains about 10 % of See also:carbon and about 75 % of See also:calcium phosphate, the See also:remainder being various inorganic salts and moisture (6-7 %). Animal See also:char-See also:coal has a deep See also:black See also:colour, and is much used as a filtering and clarifying material. The vapours evolved during carbonization are condensed in See also:vertical air condensers. The liquid separates into two layers: the upper tarry Iayer is floated off and redistilled; the distillate is termed " bone oil," ' and mainly consists of many fatty See also:amines and See also:pyridine derivatives, characterized by a most disgusting odour; the residue is " bone pitch," and finds application in the manufacture of black varnishes and like compositions. The lower layer is ammoniacal liquor; it is transferred to stills, distilled with See also:steam, and the See also:ammonia received in sulphuric acid; the ammonium sulphate, which separates, is removed, drained and dried, and is principally used as a manure. Both during the carbonization of the bones and the distillation of the See also:tar inflammable gases are evolved; these are generally used, after See also:purification, for See also:motive or See also:illuminating purposes. (C. Additional information and CommentsThere are no comments yet for this article.
» Add information or comments to this article.
Please link directly to this article:
Highlight the code below, right click, and select "copy." Then paste it into your website, email, or other HTML. Site content, images, and layout Copyright © 2006 - Net Industries, worldwide. |
|
|
[back] BONE BED |
[next] BONE, HENRY (1755-1834) |