In the earliest stages of the disease, the induction of hyperaemia is
indicated, and should be employed until the diagnosis is definitely
established, and in the meantime preparations for operation should be
made. An incision is made down to and through the periosteum, and
whether pus is found or not, the bone should be opened in the vicinity
of the ossifying junction by means of a drill, gouge, or trephine. If
pus is found, the opening in the bone is extended along the shaft as far
as the periosteum has been separated, and the infected marrow is removed
with the spoon. The cavity is then lightly packed with rubber dam, or,
as recommended by Bier, the skin edges are brought together by sutures
which are loosely tied to afford sufficient space between them for the
exit of discharge, and the hyperaemic treatment is continued.

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.

Amputation of the limb is reserved for grave cases, in which life is
endangered by toxaemia, which is attributed to the primary lesion. It may
be called for later if the limb is likely to be useless, as, for
example, when the whole shaft of the bone is dead without the formation
of a new case, when the epiphyses are separated and displaced, and the
joints are disorganised.

Flat bones, such as the skull or ilium, must be trephined and the pus
cleared out from both aspects of the bone. In the vertebrae, operative
interference is usually restricted to opening and draining the
associated abscess.

#Nature's Effort at Repair.#--_In cases which are left to nature_, and
in which necrosis of bone has occurred, those portions of the periosteum
and marrow which have retained their vitality resume their osteogenetic
functions, often to an exaggerated degree. Where the periosteum has been
lifted up by an accumulation of pus, or is in contact with bone that is
dead, it proceeds to form new bone with great activity, so that the dead
shaft becomes surrou