THE EXPLORATION, EXCAVATION, AND ILLUMINATION OF 
THE INTERIOR OF BONES IN ANY PART 
OF THE BODY.* 
BY MILTON JOSIAH ROBERTS, M.D., 
Professor of Orthopaedic Surgery and Mechanical Therapeutics in the ?' w York Post-Graduate 
Medical School and Hospital; Visiting Orthopaedic Surgeon to the City Hospitals on 
Randall’s Island ; Member of the American Association for the 
Advancement of Science, etc. 
I wish to make a preliminary communication to this society upon a 
subject to which I have been giving some thought during a period of 
about a year and a half or two years. Not only have I been giving some 
thought to the subject, but have actually spent considerable time in the 
elaboration of instruments for executing the work in question. I refer 
to the exploration, excavation, and illumination of the interior of bones 
in any part of the body. 
The object of the operative procedure which I contemplate, stated in 
general terms, is the speedy cure or termination of morbid processes 
which, when left to take their course, tend to long continuance and are 
usually followed by a train of disastrous sequences. I refer more partic- 
ularly to caries of the ends of long bones entering into the formation of 
joints, whether the morbid process be tubercular or not. We find abun- 
dant support in favor of pathological experimentation and clinical research 
in the direction indicated. 
First. Most of our pathological observations on the bone diseases of 
joints go to support the general idea that the morbid process, as a rule, 
primarily attacks the central or cancellous portions of the ends of bone rather 
than the compact tissue on the surface; and Jurthermore, that the area of 
bone affected, in the early clinical history of these ailments, is not only well 
defined but of limited extent, f 
*Addressed to the Clinical Society of the New York Post-Graduate Medical School 
and Hospital, Feb. 21, 1885. 
f Attention was called to this fact in a paper which I read before the Medical 
Society of the State of New York, February 6th, 1884. entitled “The Fundamental 
Principles of Mechanico-Therapy in Hip Disease ; based on a Consideration of Clini- 
cal, Pathological, and Physico-Physiological Data, with a description of New Forms 
of Elastic Tension Hip Splints.” Second. That, “ whenever artificial or pathological irritation causes an 
exuberant development 0/ embryonic elements, and the irritation be removed, 
the new embryonic tissue tends ,0 return to the primitive form of the tissue 
which served as a matrix.’'* 
Third “For new osseous tissue to be rapidly developed on the sur- 
face of a denuded bone it is not necessary that it should be covered with 
periosteum.” . . . “It is not only, moreover, on the surface of in- 
flamed bones that osseous tissue is produced ; in fact, when inflamma- 
tion ceases, the anfractuous cavities which have been hollowed in the 
bone are soon filled up by new osseous layers, which are developed in 
exactly the same way as on the surface of the bone.’’"I" 
The benefit which it is believed will accrue to suffering humanity 
from a thorough elaboration of these ideas will be to place such informa- 
tion in the hands of the surgeon as will enable him to make, 
First, An early positive diagnosis of the existence of disease in the 
bone ; 
Second, To determine its site and probable extent; 
Third, To remove by operative procedures the diseased area of 
tissue; 
P'ourth, By properly conducting the after treatment, to secure the fill- 
ing up of this cavity with new and healthy osseous tissue. 
Much study and careful thought, to say nothing of the expense of 
conducting experiments and elaborating instruments and apparatus will 
be required to realize fully what, it is believed, will ultimately accrue to 
medical science. 
In order to successfully conduct an operation of the interior of the 
head of any of the bones entering into the formation of the larger articu- 
lations, it will be necessary that the surgeon possess an intimate knowl- 
edge of intta-epiphyseal topographical anatomy ; that is to say, it will be 
necessary for him, in conducting these excavations, to be able to estimate 
very closely the distance from any point in the interior of the bone, to its 
surface in any direction Otherwise, the healthy and compact outer 
layer of bone will be unnecessarily perforated. 
I may be permitted to briefly state what I have already done in the 
way of promoting the proposed line of research. 
First of all, it was evident to me that we must be provided with some 
means which would enable us to cut bone with greater facility and accu- 
racy than could be done with any instrument now in use. To this end I 
have devoted much thought and time, and have expended a very consid- 
* Manual of Pathological Histology by Cornil and Ranvier, translated by A. M. 
Hart, Vol. I., p. 116. London, 1882. 
f Loc. cito., p. 331. erable amount of money. My aim has been to make as nearly a universal 
osteotome as possible; that is, an instrument with which the surgeon 
can cut bone with ease, safety, and accuracy in any desired direction. 
The instrument which I have elaborated is called the electro-osteotome. 
Public attention was first directed to it in the issue of the Medical Record 
for October 27th, 1883. bince that time I have improved the instrument 
very materially. A full description of these improvements was given and a 
practical demonstration of the working of the instrument was made before 
the New York Academy of Medicine, the 19th of February, 1885. 
I cannot here again give a full description of the instrument, but 
will simply say that, as it is now constructed, it is provided with two 
head-pieces, one for the carrying of various sizes of circular saws, and the 
other for the holding of drills and burrs of various shapes and sizes. By 
means of this instrument a bone may be perforated with any size drill up 
to a quarter of an inch in diameter, or a cross or longitudinal section of 
it made with as much facility as a similar wound could be made in the 
soft parts by means of a sharp scalpel. 
As to the use of this instrument for the work in hand : 
First. For the early positive diagnosis of the existence of diseased 
bone. For this purpose the instrument is provided with very fine drills 
from the one-sixteenth to the one thirty-second of an inch in diameter. 
These drills are constructed, not after the form of the ordinary twist drill, 
but upon the principle of a cheese-tester ; that is, they have a longitudinal 
groove on one side. By means of such a drill a plug or sample can be 
removed from any suspected area of bone. No incision through the soft 
parts is necessary. The drills revolve at a very high rate of speed, and 
readily penetrate the soft parts and bone. Upon removal of the drill, 
the debris lodged in the groove is placed upon a glass slide and 
examined under the microscope. If there be commencing ostitis, the 
characteristic findings will be manifest. Of course, when drilling into the 
head of a bone, and a cavity or soft spot is reached, the sensation com- 
municated to the hand will be all that is desired to establish the fact. 
The use of the drill in this manner is analagous to the use of the hypo- 
dermic needle in the soft parts for diagnostic purposes. If no disease 
exists, no harm is done by means of the puncture. 
Once having thus positively determined the existence, site and prob- 
able extent of disease, an incision is made down to the bone, and a large 
drill or trephine, from a quarter of an inch to a half inch in diameter, is 
carried through the bone into the diseased area or cavity. Upon remov- 
ing this, smaller drills or burrs may be passed in through the opening thus 
made, and used to excavate the affected bone. 
For the thorough inspection of the parts, I have had constructed a 
miniature incandescent lamp, so small as to readily pass through a quar- ter inch drill hole. These lamps, (half-candle) furnish sufficient light U> 
thoroughly illuminate the interior of any bone cavity. 
In operating upon the living subject there may be more or less bleed- 
ing. The haemorrhage, however, may be controlled by the use of rhigo- 
lene spray. 
Regarding the dangers of systemic poisoning from local operations 
on bones, I have thought that continuous irrigation with a disinfecting 
solution, for a period of two or three days following operations, would 
be an excellent preventive. The danger from septic poisoning in all 
operations upon bones is confined principally to the period immediately 
following the operation, when the lymph spaces are exposed to the dis- 
charges. After the active inflammatory stage has passed and a granulating 
surface is established, the danger of septic poisoning from this cause is 
no longer to be apprehended. 
For the purpose of continuous irrigation of an intraosseous cavity, 
I have thought of using short silver or aluminium tubes, of a size which 
will fit closely into the opening leading to the excavated area of bone. 
Into this a cork, provided with two holes and two glass rods, is intro- 
duced. Through one of these glass rods the disinfecting solution is 
conveyed into the cavity, and out of the other it finds its into the 
external world. After the period of danger from septic poisoning is 
past the continuous irrigation may be dispensed with and the wound 
washed out as occasion requires. 
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