-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. The starting-point of the disease is the delicate growing
tissue recently deposited between the main part of the shaft of the bone
(diaphysis) and the cartilaginous end. And it often happens that the
earliest complaint of pain is just above or below the knee; just above
the ankle, the elbow or the wrist. If 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 joint,
giving rise to the very serious disease known as _acute 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
scarlet or typhoid fever, or after exposure to injury, or to wet or
cold, or after unusual fatigue. The part becomes swollen, hot, red and
excessively 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 104 deg., and may be associated with
convulsions or shiverings. The patient's nights are disturbed, and very
likely he has violent delirium. If the case is allowed to drift on,
abscess forms, and death may ensue from septic pneumonia, or
pericarditis, or from some other form of blood-poisoning.

As soon as the disease is recognized an incision should be made down to
the bone, and the affected area should be scraped out, and disinfected
with a solution of corrosive sublimate. A considerable area of the bone
may be found stripped bare by sub-periosteal abscess, and necrosis is
likely to ensue. Perhaps the shaft of the bone will have to be opened up
in the chief part of its length in order that it may be cleared of germs
and pus. The surgeon is more apt to err on the 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 save life; in other
cases, amputation may be called for later because of long-continued
suppuration and grave