Part 30

Septic ostitis may be confounded with erysipelas and rheumatism, but the central thickening and tenderness should suffice to distinguish it.

_Chronic ostitis_ and _periostitis_ denote long-continued and increased vascular supply. This may be due to injury, syphilis or rheumatism. The disease is found chiefly in the shafts of the bones. There is a dull pain in the bone, which is worse at night, and the inflamed piece of bone is thickened and tender. The lump thus formed is called a _hard 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 potassium is the most useful 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 escape of colourless corpuscles from the blood, which, collecting around the bacilli, form a small greyish white heap, a _tubercle_. These tubercles may be present in large 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 surface. They should not be allowed to open spontaneously, however, as the wounds are then likely to become infected with pus-producing germs, and fuel being added to the fire, as it were, destruction advances with increased rapidity. The treatment for these tuberculous foci is to place the limb or the part at absolute rest upon a splint, to give plenty of fresh air to the patient, and to prescribe cod-liver oil and iron. And when it is seen that in spite of the adoption of these 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. Consideration should also be given to the treatment by injection of tuberculin.

_Caries_ (rottenness, decay) is the name given to tuberculous disease of bone when the tubercles are running together and are breaking down the cancellous tissue. In short, caries generally means tuberculous ostitis, though syphilitic ulceration of bone has also received the same name.

Fracture.

_Fractures._--A bone may be broken at the part where it is struck (fracture from direct violence), or it may break in consequence of a strain applied to it (fracture from indirect violence), or the fracture may be due to muscular action as when a violent cough causes a rib to break. In the first case the fracture is generally transverse and in the second more or less oblique. The fully developed bone is broken fairly across; the soft bones of young people may simply be bent--_green stick_ or _willow fracture._ Fractures are either _simple_ or _compound_. A simple fracture is analogous to the subcutaneous laceration in the soft parts, and a compound one to an open wound in the soft parts. The wound of the soft parts in the compound fracture may be due either to the force which caused the fracture, as in the case of a cart-wheel going over a limb, first wounding the soft parts and then fracturing the bone, or to the sharp point of the fractured bone coming out through the skin. 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.

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 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 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 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 good 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 gentle exercises, and by passive movement during the process of cure, to keep the joint and tendons free. 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.

The treatment of fractures has undergone considerable improvement of late years. Simple fractures are not kept so long at rest in splints, but are constantly "taken down" in order that 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 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 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. 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 primary treatment. The French surgeon, Just 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.

_Special Fracture in Young People._--The long bones of 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 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 local or constitutional causes, but provided the bones are in good position, nothing further than patience, with massage, and with due attention to general health-measures, is necessary.

An _ununited fracture_ is one in which after many weeks or months no 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 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 screw. Ununited fracture of the leg-bones in children is a most unsatisfactory and rebellious condition to deal with.

There is still a difference of opinion as to the best way of treating a recent _fracture of the patella_ (knee-cap). 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. Still, at any rate, this line of treatment was unassociated with risk. But after 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 change. The great advantage of Lister's treatment was that the fragments, being fixed close together by the wire stitch, became solidly united by bone, and the joint became as 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 compromise, Professor A.E.J. Barker introduced the method, which he deemed to be less hazardous, of holding the fragments close together by means of a strong silver wire passed round them vertically by a large 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 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. This aphorism implies that not every patient with

a broken knee-cap is suited for the opening of his knee-joint, or even for the subcutaneous adjustment of the broken fragments. An operative 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.*)

_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. 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. To these by-products there must be added the direct uses of bone--for making buttons, knife-handles, &c.--when an estimate is desired of the commercial importance of these components of the animal frame.

While most of the world's supply of bones goes to the glue and gelatin 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 water, and allowed to simmer for about six 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 lathe, &c. The fat is skimmed off, and, after bleaching, reappears as a component of fine soaps, or, if unbleached, the oil is expressed and is used as an adulterant of other oils, while the stearine or solid matter goes to the candle-maker; the gelatinous water is used (after filtration) for making 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 residue is worked up for manures, &c. These residues are ground to a fine or coarse meal, and supplied either directly as a fertilizer or treated with sulphuric acid to form the more soluble superphosphates, which are more readily assimilated by growing plants. In some places, especially South America, the residues are burned in a retort to a white ash, the "bone-ash" of commerce, which contains some 70-80% of tricalcium phosphate, and is much used as a manure, and in the manufacture of high-grade superphosphates. In the gelatin 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 milk of lime, or some similar neutralizer. The slightly soluble bicalcium phosphate, CaHPO4, is first precipitated, which, with more lime, gives ordinary tricalcium phosphate, Ca3(PO4)2. The contents of the vats are filter-pressed, and the cakes dried on plates supported on racks in heated chambers. This product is a very valuable manure, and is also used in the manufacture of phosphorus.

Instead of extracting all the gelatinous matter from degreased bones, the practice of extracting about one half and carbonizing the residue is frequently adopted. The bones are heated in horizontal 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 mills, and is subsequently riddled by revolving cylindrical sieves. The yield is from 55 to 60% of the bones carbonized, and the product contains about 10% of carbon and about 75% of calcium phosphate, the remainder being various inorganic salts and moisture (6-7%). Animal charcoal has a deep black colour, and is much used as a filtering and clarifying material. The vapours evolved during carbonization are condensed in vertical air condensers. The liquid separates into two layers: the upper tarry layer is floated off and redistilled; the distillate is termed "bone oil,"[1] and mainly consists of many fatty amines and 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 steam, and the 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 tar inflammable gases are evolved; these are generally used, after purification, for motive or illuminating purposes. (C. E.*)

FOOTNOTE:

[1] Bone oil, also known as Dippel's oil, was originally produced by the distillation of stags' horns; it is of interest in the history of chemistry, since from it were isolated in 1846 by T. Anderson pyridine and some of its homologues.

BONE BED, a term loosely used by geologists when speaking generally of any stratum or deposit which contains bones of whatever kind. It is also applied to those brecciated and stalagmitic deposits on the floor of caves, which frequently contain osseous remains. In a more restricted sense it is used to connote certain thin layers of bony fragments, which occur upon well-defined geological horizons. One of the best-known of these is the Ludlow Bone Bed, which is found at the base of the Downton Sandstone in the Upper Ludlow series. At Ludlow itself, two such beds are actually known, separated by about 14 ft. of strata. Although quite thin, the Ludlow Bone Bed can be followed from that town into Gloucestershire for a distance of 45 m. It is almost made up of fragments of spines, teeth and scales of ganoid fish. Another well-known bed, formerly known as the "Bristol" or "Lias" Bone Bed, exists in the form of several thin layers of micaceous sandstone, with the remains of fish and saurians, which occur in the Rhaetic Black Paper Shales that lie above the Keuper marls in the south-west of England. It is noteworthy that a similar bone bed has been traced on the same geological horizon in Brunswick, Hanover and Franconia. A bone bed has also been observed at the base of the Carboniferous limestone series in certain parts of the south-west of England.

BONE-LACE, a kind of lace made upon a cushion from linen thread; the pattern is marked out with pins, round which are twisted the different threads, each wound on its own bobbin. The lace was so called from the fact that bobbins were formerly made of bone.

BONER (or BONERIUS), ULRICH (fl. 14th century), German-Swiss writer of fables, was born in Bern. He was descended of an old Bernese family, and, as far as can be ascertained, took clerical orders and became a monk; yet as it appears that he subsequently married, it is certain that he received the "tonsure" only, and was thus entitled to the benefit of the _clerici uxoriati_, who, on divesting themselves of the clerical garb, could return to secular life. He is mentioned in records between 1324 and 1349, but neither before nor after these dates. He wrote, in Middle High German, a collection of fables entitled _Der Edelstein_ (c. 1349), one hundred in number, which were based principally on those of Avianus (4th century) and the _Anonymus_ (edited by I. Nevelet, 1610). This work he dedicated to the Bernese patrician and poet, Johann von Rinkenberg, advocatus (_Vogt_) of Brienz (d. c. 1350). It was printed in 1461 at Bamberg; and it is claimed for it that it was the first book printed in the German language. Boner treats his sources with considerable freedom and originality; he writes a clear and simple style, and the necessarily didactic tone of the collection is relieved by touches of humour.

_Der Edelstein_ has been edited by G.F. Benecke (Berlin, 1816) and Franz Pfeiffer (Leipzig, 1844); a translation into modern German by K. Pannier will be found, in Reclam's _Universal-Bibliothek_ (Leipzig, 1895). See also G.E. Lessing in _Zur Geschichte und Literatur_ (_Werke_, ix.); C. Waas, _Die Quellen der Beispiele Boners_ (Giessen, 1897).

BO'NESS, or BORROWSTOUNNESS, a municipal and police burgh and seaport of Linlithgowshire, Scotland. Pop. (1891) 6295; (1901) 9306. It lies on the southern shore of the Firth of Forth, 17 m. W. by N. of Edinburgh, and 24 m. by rail, being the terminus of the North British railway's branch line from Manuel. In the 18th century it ranked next to Leith as a port, but the growth of Grangemouth, higher up the firth, seriously affected its shipping trade, which is, however, yet considerable, coal and pig-iron forming the principal exports, and pit props from the Baltic the leading import. It has an extensive harbour (the area of the dock being 7-3/4 acres). The great industries are coal-mining--some of the pits extending for a long distance beneath the firth--iron-founding (with several blast furnaces) and engineering, but it has also important manufactures of salt, soap, vitriol and other chemicals. Shipbuilding and whaling are extinct. Traces of the wall of Antoninus which ran through the parish may still be made out, especially near Inveravon. Blackness, on the coast farther east, was the seaport of Linlithgow till the rise of Bo'ness, but its small export trade now mainly consists of coal, bricks, tiles and lime. Its castle, standing on a promontory, is of unknown age. James III. of Scotland is stated to have consigned certain of the insurgent nobles to its cells; and later it was used as a prison in which many of the Covenanters were immured. It was one of the four castles that had to be maintained by the Articles of Union, but when its uselessness for defensive purposes became apparent, it was converted into an ammunition depot. Kinneil House, 1 m. south of Bo'ness, a seat of the duke of Hamilton, formerly a keep, was fortified by the regent Arran, plundered by the rebels in Queen Mary's reign, and reconstructed in the time of Charles II. Dr John Roebuck (1718-1794), founder of the Carron Iron Works, occupied it for several years from 1764. It was here that, on his invitation, James Watt constructed a model of his steam-engine, which was tested in a now disused colliery. Though Roebuck lost all his money in the coal-mines and salt works which he established at Bo'ness, the development of the mineral resources of the district may be regarded as due to him.

BONFIGLI, BENEDETTO, 15th century Italian painter, was born at Perugia. Until near the middle of the 15th century the Umbrian school was far behind those of Florence and the North, but in the person of Perugino and some of his followers it suddenly advanced into the very first rank. Among the latter none holds a more distinguished place than Benedetto Bonfigli. The most important of his extant works are a series, in fresco, of the life of St Louis of Toulouse, in the communal palace of Perugia.

BONFIRE (in Early English "bone-fire," Scottish "bane-fire"), originally a fire of bones, now any large fire lit in the open air on an occasion of rejoicing. Though the spelling "bonfire" was used in the 16th century, the earlier "bone-fire" was common till 1760. The earliest known instance of the derivation of the word occurred as _ban fyre ignis ossium_ in the _Catholicon Anglicum_, A.D. 1483. Other derivations, now rejected, have been sought for the word. Thus some have thought it _Baal-fire_, passing through _Bael_, _Baen_ to _Bane_. Others have declared it to be _boon_-fire by analogy with _boen-harow_, i.e. "harrowing by gift," the suggestion being that these fires were "contribution" fires, every one in the neighbourhood contributing a portion of the material, just as in Northumberland the "contributed Ploughing Days" are known as _Bone-daags_.