L. Klenerman pp. 80 London: Bone and Joint 2012 ISBN: 0-9525921-9-3
In this elegant short monograph, Professor Klenerman traces the history of osteomyelitis not only from the earliest records of the disease but from the earliest appearance of the infecting organisms. He starts his narrative 3½ billion years ago with the emergence of bacteria on Earth and follows their palaeopathological progress via a description of the development of bone in the earliest vertebrates (the heterostracan ostracoderms, lest one forgets) to the oldest recorded evidence of osteomyelitis in a fracture of the vertebral spine of a primitive tetrapod which was knocking around between 285 and 245 million years ago. We then leap the best part of 240 million years to the first evidence of osteomyelitis in man which appears some 2½ million years ago in Australopithecus africanus in the form of vertebral lesions typical of brucellosis. The tubercle bacillus appears some time during the Pleistocene era: staphylococci may be a lot older.
Its later history, that is from Hippocrates onwards, is, or should be, more familiar to practising orthopaedic surgeons. This is, at one point, concisely summarised by Prof Klenerman in a single sentence: “From the time of Hippocrates to the First World War, the treatment of open fractures was the treatment of osteomyelitis, which invariably supervened”. It was not until the 19th century that the scientific basis of osteomyelitis was established. The difference in its treatment before and after the advent of antibiotics is clearly described as are its, fortunately rarer, mycobacterial and treponemal types, tuberculosis, syphilis and leprosy. The author’s comment that “(chronic osteomyelitis) should not occur today” is probably true but is not likely to be realised in either the first world or the third given the prevailing approach to the use of antibiotics.
This is a fascinating book; beautifully written and produced, notably well illustrated and thoroughly referenced. It should be read by anyone who has ever had to treat chronic osteomyelitis and, more importantly, by those who may have to in future. The “intelligent layman” will also be captivated.Alistair Ross
Associate Editor, BJJ
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