Roll the bones!

During life, a goat’s knucklebones allow for ankle motion, which the goat finds useful but probably not fascinating. In their afterlife, however, knucklebones from goats and sheep have fascinated humans for thousands of years, probably beginning in ancient Egypt or in what is now western Turkey. Roughly rectangular, each bone is about the size of a hard candy. Four or five fit easily in the palm, and it is almost impossible not to jiggle them momentarily and roll them out—a thrill of touch, sight, sound, and … anticipation.

Although the ends are too small and rounded for them to stand straight up, the knucklebones’ four long sides are uniquely shaped, so the odds vary for one coming to rest on any given side. Without concern for how they landed, children played jacks with them or tossed them up and tried to catch them on the backs of their hands. By attributing different values for each landing surface, adults used them for gambling, hence the expression, “Roll the bones.” Fortune tellers attributed meaning to the landing positions both of the individual bones and their relationships to one another.

Kuncklebones’ ageless popularity for gaming and forecasting is apparent from their frequent presence in archaeological discoveries, with the objects both in their original osseous forms as well as reproductions made from metal or clay. Through the ages, sculptors, potters, and painters have recorded people’s fascination with knucklebones. 

Cubic dice evolved from knucklebones and standardized the odds of a gaming piece landing on a given side. Other shapes ensued, from four sides to twenty sides and nearly every sidedness in between.

Goats and sheep are not the sole original possessors of knucklebones. Any hoofed animal with cannon bones (the topic of a previous blog post) has knucklebones. This includes horses and cattle. These, however, would be too large to jiggle and roll more than one, which would have made a game of Monopoly tediously slow.

Obsessing Over the Beauty Bone

Bones are structural and aesthetic wonders. They epitomize the melding of form and function.Each one is beautiful. What then accounts for the current chatter on social media regarding the “beauty bone”? Is this one really more stunning than the others? 

To look at the collar bone in isolation, it has a gentle S-shape with flattened ends, one connecting to the breast bone and the other to the shoulder blade. The collar bone is the only bony connection between our upper limb and the chest skeleton, which accounts for its proclivity to fracture when reaching out to stop a fall. It also provides attachment for a number of large and important shoulder muscles. Absence of the collar bones, a rare birth anomaly, allows the owner to draw the shoulders together in front such that they nearly touch–definitely not beautiful.

What then, in life, makes the collar bones, draped closely with skin, alluring? To some owners and observers, prominent collar bones signal “skinny” and “fit” even if the rest of the torso is loosely tented. The beauty bones become an easy and noncontroversial expression of sex appeal–perfection without apparent effort.

Ah, but the effort required to fulfill this obsession. Websites encourage wannabes to regularly perform pushups, abdominal crunches, shoulder shrugs, yoga exercises including bridge position, and local massage. How these help I am not certain. Weight loss through aerobic exercise and diet is paramount, and I suppose it is in the eyes of the beholder where allure stops and emaciation starts. For those less committed, makeup helps, and Youtube videos can show you the tips. To date, it seems that surgical enhancement has not been tried. Liposuction, anyone?

One can demonstrate the magnitude of the depression above the beauty bone by placing a stack of quarters in the hollow. (I’ve seen the photos.) It might also work with golf balls, but they would probably roll out during your backswing. For me, I noticed that the depression becomes more pronounced when I shrug my shoulders; so if you see me in a tank top walking with a Frankenstein posture, you will know that I am styling my beauty bones, but not obsessing over them, because the other bones are equally functional and aesthetic.

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Versatile Venerable Vertebrae

Fish, frogs, snakes, birds, and humans all have spines, which consist of individual vertebral segments that protect our spinal cord while allowing neck and trunk movements. The vertebral column distinguishes “vertebrates” from spineless creatures such as squid, worms, snails, and beetles. Not that we should feel particularly smug about possessing a spine, because the spineless animals don’t have to concern themselves with lumbago, pinched nerves, and chiropractic adjustments.  

Excluding sharks, skates, and rays, whose spines are made of cartilage, all other vertebrates have bony spines. Most mammals, giraffes and humans included, have seven vertebrae in their necks, while birds may have more. For instance, owls have 14, which allows them to turn their heads 270 degrees; and those contortionist flamingos have 19. Lower in the spine, the number of vertebrae is even more variable from species to species; and depending on the need for stability over flexibility, multiple segments may be fused together. The human sacrum, for example, consists of five fused segments, and the coccyx has four. Conversely, in snakes, with as many as 500 vertebrae, none of them are fused together. In short, vertebrae are versatile.

The bony ones are also hard, dense, and have complex shapes. The first two features mean that these bones endure a long time after the original owner is finished with them. Their complex shapes fascinate various people, who have re-purposed them in many ways, hence versatile and venerable.

For function, the Inuits hollowed out the cylindrical portion of whale vertebrae to make flues for their rib bone/tundra/hide dwellings. Other cultures have use scooped out vertebral bodies of smaller animals to serve as drinking cups.

Perhaps functional but of questionable esthetic value, vertebra have also morphed into chairs.

Solely for beauty, vertebrae have found second lives in necklaces, bracelets, and brooches.

They have also been crafted into likenesses of John Wesley (1703-1791), a British religious leader and founder of Methodism. It is unclear whether the folk artists were devout Methodists or were detractors who placed the effigies in pubs and soused them in beer to protest Wesley’s call for temperance.

The highest artistic achievement inspired by vertebrae belongs to British sculptor Henry Moore (1889-1986). He is well known for his semi-abstract bronze forms of reclining women, which grace sculpture parks worldwide. These monumental sculptures often have hollow spaces and openings, which some viewers compare to the undulating landscape of Moore’s native Yorkshire; but those observers should look more closely at bone. In 1940 Moore was bombed out of his London home and moved to a farmhouse appropriately named Hoglands because it was situated on a former pig farm. On walks, Moore would pick up scattered bones and take them into his studio. He commented that his primary interest was the human figure but that he paid great attention to natural forms, including bones, pebbles, and shells. It is apparent that he studied vertebrae closely and was taken by their rounded openings and curved, merging surfaces. They inspired him to create his shapes, iconic in their own right, and referencing beautiful, timeless bone.  

Viewing Bones Through Telescopes

Probably primitive man’s curiosity markedly increased soon after he stood up and started walking on just his feet. He could both peek into caves and drop back onto all fours to peer down badger holes. Looking into his family’s mouths and ears soon followed. Many generations later his progeny developed metal tubes and glimpsed human interiors through all of our natural orifices. Lighting, however, was always an issue, and the torch that satisfactorily illuminated the cave was poorly accepted by early patients in the proctology clinic.

This changed in 1879 with Edison’s invention of the incandescent light bulb. Just seven years later, two German doctors were lighting up bladders with a tiny bulb on the end of a steel tube through which they squinted. Heat from the bulb and risk of breakage, however, posed problems. Nonetheless, enterprising doctors began poking holes in the skin and exploring the bladder, abdomen, and chest with lighted tubes. In 1912, Severin Nordentoft, a Danish doctor, extended this concept to the knee and coined the word “arthroscopy” (joint-view). Multiple investigators from the world around then refined and continue to refine the technique.

Prior to antibiotics, tuberculosis, especially in the knee, occupied much of orthopedists’ time. This was particularly so in Japan, where squatting and kneeling have long been cultural imperatives. In 1918 Doctor Kenji Takagi began using a bladder scope to examine tuberculous knees. His idea was to develop early treatment that would preclude the awkward outcome of an entirely stiff knee. Over the next 20 years he designed and tested 12 versions of arthroscopes that were progressively smaller in diameter and that incorporated better optical systems. None of them, however, were entirely practical.

In my April 29, 2019 post, Big Bone Business on eBay, I noted that the fossilized skeleton of a baby Tyrannosaurus rex were for sale on eBay for $2.95 million. It is still up for auction; and remember, the seller accepts credit cards and includes shipping. Do humankind and science a favor. Buy it now and give it to a natural history museum. On the eBay posting, the seller counters with some cock and bull about not letting this treasure fall into the hands of a museum, which has limited opening hours and might be prohibitively expensive for some to visit. Rather, the seller states, “Once put ONLINE, the entire World can enjoy it 24/7/365.” OK, give it to a museum while stipulating that the museum posts the images online. Then everybody can enjoy the photos, and interested paleontologists can access the real deal for close study.

Only 20 relatively intact T rex specimens exist overall, and there is recent good news about several sets of T rex‘s stone bones that are safely ensconced for scientific study and public awe. Sue, the most intact specimen found to date, is about 90% complete and continues to terrify and delight museum goers at the Field Museum in Chicago. Since December she resides in the museum’s new Griffin Halls of Evolving Planet and is now positioned in a more crouched and threatening position than before. Because her supporting armature allows temporary removal of any of her bones individually for intense study, a generation of paleontologists has learned much about T rex’s posture and movement and has even estimated her body weight.

Opening with much anticipation and fanfare on June 8, the David H. Koch Hall of Fossils at the National Museum of Natural History in Washington, DC, displays “The Nation’s T Rex“, which is posed to devour a hapless Triceratops. The T rex is on 50-year lease from the Army Corps of Engineers, which owns it since it was discovered on federal land in Montana.

A few months earlier came a full scientific description of Scotty, a T rex originally discovered in 1991, the year after Sue surfaced. Full-scale excavation of Scotty began in 1994 and proceeded slowly because of the dense stone encasing the specimen. This and other difficulties delayed the publication of a complete analysis until now. Investigators estimate that Scotty lived into his early 30’s (extremely long for a dinosaur) and, based on the length and girth of his bones, stretched 40 feet from snout to tail tip. They estimate that he weighted about 10 tons, slightly more than Sue. A full-scale replica of Scotty recently went on display at the Royal Saskatchewan Museum in Regina, near his discovery site.

In addition to nicknames such as Sue and Scotty, other T rex specimens sport monikers such as Stan, Bucky, Tristan, and Trix, although the sex of any dinosaur has yet to be determined. Supposing Sue was actually male, I wonder if his name predisposed him to bar fights? If so, what do you think his assailants had been drinking? Who do you think would win?

After World War II, Takagi’s student, Masaki Watanabe, took up the banner and continued to make design improvements. In 1957, Watanabe presented a color movie describing his work, first to an international orthopedic meeting in Spain and then to major European and North American orthopedic groups on his way home to Japan. The response was tepid at best.

Undaunted, Watanabe pressed on. The twenty-first version finally provided an adequate view and good focus even though it necessitated grinding each lens by hand. By 1958 this version became the world’s first production arthroscope, but breakage of the incandescent bulb on the end of the tube continued to be problematic. Watanabe began to receive international visitors interested in learning his technique, but when they returned home, began using it, and reported their results, collegial criticism, even ridicule, prevailed.

In 1967 the twenty-second version, for the first time, incorporated a novel fiber optic cable. Now the hot, fragile light bulb could be 6 – 10 feet away from the operative field and transmit “cold light” into the knee joint via thousands of bundled glass threads.

Watanabe developed at least three more versions to further address the conflicting goals of better illumination and visualization vs. smaller diameter scopes that could probe the deepest recesses of small joints. His final version was less than 1/12th of an inch in diameter—about the diameter of a coat hanger wire.  Later came miniaturized television cameras that could be attached to the arthroscope. A video monitor in the operating room displayed the images. Now residents, nurses, and students no longer had to stare at the back of the surgeon’s head as he squinted into an eyepiece attached to a narrow tube. Patients, when awake, could watch too, and a video recording of the event later allowed their families untold hours of viewing pleasure. Well, maybe minutes.

Along with further advances in arthroscopic instrument and in scope design, international interest began to grow. At first, every procedure was merely diagnostic and was followed immediately by a large incision and exploration of the joint under direct vision to treat whatever pathology the arthroscope had revealed.

Tiny nippers and shavers, first manual and then also powered, began to allow for arthroscopic treatment as well as diagnosis. Current techniques and instruments even allow the surgeon to place and tie sutures inside a joint. Such minimally invasive surgery allows for faster and more complete rehabilitation. Because the knee joint is large, the innovations started there, but now orthopedists also routinely apply these techniques to the shoulder, elbow, wrist, hip, and ankle joints. Undoubtedly our caveman ancestors, torches and clubs in hand, would be pleased to know where their curiosity for peering into holes has led.

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The Mystery of Circles and Dots on Bone

In my never-ending search for objects made of bone in museums and on the web, I have found some finely crafted items with similar decorations. These are small circles that surround central dots. The objects come from far-flung regions of the world and span thousands of years. Is there an overarching meaning? Was the motif designed anew in various cultures or did it originate in one place and then go viral? Why this motif and not stars or hearts?

To find an answer, I queried several art historians, decorative art historians, as well as curators and collection managers at the museums where I found these objects. I received a number of thoughtful replies. These included leads to several books and journal articles on primitive art. Here is a synopsis of what I have learned.

RL Anderson writes in his book, Art in Primitive Societies: Are there universal symbols? Freudian iconography? [Carl] Yung felt that all human beings, no matter what their cultural background, held in their minds a share of the “collective unconsciousness”. … Circle: a symbol of Self. It expresses the totality of the psyche in all its aspects, including the relationship between man and the whole of nature.

Another reference noted that the circle is a universal symbol with extensive meanings. These include the concepts of totality, wholeness, original perfection, self, infinity, eternity, timelessness, all cyclic movement, God.

Those explanations are rather encompassing, but neither says anything about the dot. Other sources have addressed both:

Shamans have the ability to see into other worlds. Thus the circle and dot, both an eye and a hole, equate physical and spiritual movement between worlds.

Images and hunting fetishes marked with the circle and dot were supposed to watch for game, and by clairvoyant powers, sight it at a great distance.

For succinctness and mastery of English, I particularly like the British Museum’s Marcel Marée’s observation: The circle and dot motif is so common because it is so easy to create, to great ornamental effect, simply by applying a drill.

How was the circle and dot motif inscribed? Anthropologists think that a thin strip of flint, filed to a V shape at its tip with one point slightly longer than the other, would suffice when spun by rubbing it between the artisan’s palms. Metal drills would be more efficient, and the Shuswap tribe in British Columbia made such drills from handles of kettles procured from the Hudson Bay Company. (The author does not explain what they did with the handleless containers.)

So the conclusions run the gamut from mystical “collective unconsciousness” to simple aesthetic practicality. Maybe there is a middle ground, at least for the Inuit, where the motif appears on many hunting charms and everyday objects. In one Inuit language the circle-dot motif is designated as “the eye of awareness” and marks joints on the skeleton. William Thalbitzer in 1908 wrote, “According to Eskimo notions, in every part of the human body (particularly every joint, as for instance in every finger joint) there resides a little soul. How nice. Certainly, across time and space, the soul of each person crafting the circle and dot motif reaches out to us.

How to take out a bone loan. Part II

In the previous post, I began drawing an analogy between borrowing money and borrowing bone to repair/replace a skeletal defect produced by trauma or tumor removal. As with borrowing money, choosing the source of the bone loan depends on its proposed use, how much is needed, and the terms of repayment. I also noted that small bone loans have minimal obligations and are available from several local sources (pelvis, wrist, fibula). Small grafts, however, may not fund a major project quickly enough for the loan to achieve its ultimate purpose. What else is possible?

Orthopedists have several ways to coax the fibula into early service. If the bone gap to be bridged is less than half the fibula’s length, the fibular strut can be cut in half and doubled. It will still take many months for the grafts to thicken enough to provide adequate support, but it will take less time than using a single segment. In other words, it doubles the loan’s productivity without increasing the debt.

Whatever its size, getting a loaner part into service quickly also improves its effectiveness. An orthopedic surgeon can kickstart a fibula graft into service by meticulously harvesting the bone along with the blood vessels that supply it. After the bone graft is secured in the gap, the surgeon connects the fibula’s artery and vein to nearby vessels. Blood then flows through the fibula just the same as it did in the bone’s original location. With the immediate restoration of circulation, the grafted fibula can heal and enlarge far more quickly to make the loan pay off.

The bone loans described so far all come from the patient’s own body, so the patient’s immune system raises no concern, and there is no risk of rejection. At times, however, huge segments of bone are required and constitute loans too large for patients to make. Consequently, the surgeon may turn to a gift from an organ donor. These bones are taken from the donor immediately after removal of the recently deceased’s heart, liver, and kidneys, which require placement on ice, immediate transplantation into a grateful recipient, and life-long protection against immune rejection with powerful, rather risky anti-rejection drugs. By contrast, the bones undergo a leisurely cleaning to remove all the blood and protein they contain. Then they are dried, sealed in plastic bags, sterilized, cataloged, and shelved until needed. Absent their proteins, bones generate no immune response when implanted into a different person, so they can provide grafts of the needed size and shape without any risk of rejection. This is a wonderful gift, but it comes with some strings attached. Since the grafted cadaver bone has no blood supply and no cells, the recipient site has to supply these, which it does, but ever so slowly. In the meantime, the cadaver bone graft can crack, crumble, or dissolve. For that reason, grafting cadaver bone is not undertaken lightly.

If you happen to have an identical twin, you could borrow living bone filled with cells and do so without risk of rejection, since you both have the same immune system. Careful though, your twin might need one of your kidneys sometime—payback for the bone loan.

Just as you weigh the options before borrowing money, orthopedists weigh with patients the pros and cons of one type of bone graft over another and discuss the relative merits of each. For instance, spongy bone is readily available without causing any permanent skeletal defect, and it heals faster than compact bone; but compact bone is immediately stronger than spongy bone. The surgery is much longer and more difficult when moving bone around with its blood supply intact, but healing time can be markedly shorter. Cadaver bone comes in any desired size and shape but is slow to heal. Sometimes the trade-offs are reduced by using two types of bone graft for the same debt—taking out a home loan and accepting a unique gift.

How to take out a bone loan. Part I

What happens when a segment of bone is missing after a severe fracture or removal of a tumor? The bone ends try to grow into one another as they do after routine fractures, but the gap and lack of immobilization are usually insurmountable despite how hard the world’s best building material tries to repair itself. The gap instead fills with fibrous scar tissue; this gristle-like material does not restore stability, and a false joint forms. Orthopedists can overcome this situation by bringing in new bone from afar. To help you understand bone grafts, consider the analogy of borrowing money.

If you find yourself just a couple of dollars short, searching under the sofa cushions and raiding the piggy bank may produce the necessary cash. Nobody misses the money, and there is no pressing need to pay off the loan. If you need a substantial amount of money, perhaps you can borrow from your retirement account or from your kid’s educational fund. Doing so solves the immediate gap in your finances but leaves a deficit elsewhere, which may or may not recover over time. Finally, if you cannot fund it yourself, you could go to the bank, and as strange as it might seem, ask for a gift.

The concepts are the same for bone grafting. If surgeons only need some hearty bone cells to stimulate new bone formation, maybe to supplement local bone for spinal fusion, then they can temporarily open the hard outer surface of the pelvis and scrape spongy bone from the pelvis’s interior. Several tablespoons of bone can be obtained in this manner without changing the outer contour of the pelvis. The crumbly graft offers no mechanical stability, but it is full of bone-forming osteoblasts that quickly overcome the small debit in the recipient bone. At the same time, the donor site fills with new bone and could be re-excavated later if necessary.

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Sometimes a surgeon needs a short section of structurally sound bone to fill a gap at the site of a nonhealing fracture or to span a gap after removal of a bone tumor. In these instances, a chunk of full-thickness bone from the patient’s own pelvis works well.

It comes from the rim of the pelvis, near where your thumb rests when you put your hands on your hips. Unless the owner is quite thin or the chunk is bigger than an inch square, the withdrawal is harmless and invisible. Otherwise there is permanent, but manageable evidence of the loan.

If a long, straight bone graft is needed, attention often turns to the leg. Of the two bones between the knee and the ankle, the sturdy one that transmits weight is the robust shinbone, aka tibia. Just to its outside is the half-inch-in-diameter fibula. Except for a short portion near the ankle, the fibula is expendable because it is mainly an attachment site for ankle and toe muscles, which are fully functional even if the fibula had been borrowed. Hence the fibula is a mainstay in the orthopedist’s “long-bone lumberyard.” Depending on the patient’s height, a six-to-ten-inch strut is available to span a large gap in a critical bone.

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The fibula strut is far more slender than most of the bones it replaces, so it will need support from a sturdy internal plate and an external brace for at least a year. This bridging graft is “seed money” and will grow stronger over time allowing it to resist the limb’s normal bending, twisting, and compression forces. The complete conversion of a grafted fibula from scrawny to robust and from muscle anchor to body-weight resister usually takes several years.

In the next post I will describe jumbo loans.

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Big Bone Business on eBay

Here is an item you may want to acquire—the fossilized skeleton of a baby Tyrannosaurus rex. Yes, you can “Buy It Now” (May 2019) for $2.95 million, which might seem a bit steep, but shipping is included, and you can get frequent flyer miles if you pay by credit card.

Regardless of the deal’s value, the offering is making professional paleontologists’ skin crawl. The upsetting issue started in 1990 with a flat tire. While the rest of the team from the Black Hills Institute (BHI), the world’s largest commercial fossil dealer, went to town to get the flat fixed, experienced amateur paleontologist Sue Hendrickson decided to have a look at a previously unexplored cliff. Along its base, she found several small fossilized bones. Looking up, she discovered the end a large fossil sticking out. On return, the team, led by BHI owner Peter Larson, recognized her find as a Tyrannosaurus rex, the top-of-the-food-chain carnivore of the late dinosaur era 66 million years ago. In honor of the discoverer and his then-girlfriend, Larson named the beast Sue, although the sex of this or any other dinosaur has never been determined.                                                                                      

On a handshake deal, Larson paid land owner Maurice Williams $5000 to extract the entire find, which proved to be 90% intact and therefore by far the largest and best-preserved T rex skeleton ever discovered. Larson removed the fossils to the BHI lab in Hill City, South Dakota, for cleaning and eventual display or sale, but ownership of Sue was in dispute between Larson, Williams, and the federal government, to whom Williams had leased his land. In the end, the court awarded ownership of Sue to Williams.

Williams then contacted Sotheby’s to sell Sue. At the auction in 1997, some private collectors were in competition with several natural history museums for ownership, yet all but one of each were priced out as the bids passed an astounding $7 million mark within ten minutes. The representatives for Chicago’s Field Museum of Natural History had reached their predetermined bidding limit, and it looked like Sue would fall into private ownership. On a hunch that one more offer would work, the Field rep bid again. The auctioneer’s gavel came down. “Sold to the Field Museum for $7.6 million.” Sotheby’s got an extra 10% for its troubles.

The Field then invested an additional $2 million building a custom support frame for Sue, one that allows removal of any individual bone for study without disturbing the remainder of the display. And on its opening in 2000, what an impressive display it was. Sue, lunging with mouth open and sharp teeth exposed, greeted museum visitors in the main atrium for 17 years. Surely the Field Museum has recouped their hefty investment with ticket, book, and gift shop sales as well as museum memberships and international visibility as an institution dedicated to research and education. In 2018, the Field Museum moved Sue to her own exhibition hall and replaced her in the main reception atrium with a much larger and much older herbivorous dinosaur for the tune of $16.5 million. Sue’s replacement will have to work hard to prove its financial investment.

Coincidentally, publicity surrounding Sue occurred within several years of the debut of Jurassic Park, the fanciful, frightening computer-animated movie portraying dinosaurs in modern times. If dinosaur mania needed its flames fanned, this combo did the trick. Fossil hunting intensified as collectors saw million-dollar figures swirling around the discovery and retrieval of Sue-like specimens.

Many land owners began selling their property’s fossil rights to the highest bidder regardless of the digger’s method or intent. Those interested in fossils’ commercial value do not necessarily recognize or care much from which layer of rock their treasures were found. They have no incentive to consider the context of their find, for example, what other plant and animal fossils were present in the same layer.

By contrast, trained and disciplined paleontologists excavate methodically and respect the fossils’ scientific and educational import far above any sense of their commercial value. The pros take pains to carefully record the exact location of any finds in three dimensions and meticulously search the surrounding stratum for other deposits that will aid placing the fossil in context of the world as it then existed.

Furthermore, when a commercially mined fossil goes up for sale, cash-strapped universities and museums typically lose out. If the new owners display their treasures at home, their scientific and educational value plummets, much to the chagrin of professional paleontologists. A writer for Slate commented, “There is no more need for self-styled paleontologists than there is for amateur gynecologists.” Commercial enterprises counter that the exposed fossils they retrieve would otherwise crumble and weather away, useful to no one. I guess they are saying that an amateur gynecologist is better than none. You decide; but if you do buy Baby Rex, please donate it to a public institution, take a tax deduction, and keep the frequent flyer miles.  

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If $2.95 million is too steep for your budget, consider bidding on a nearly complete dodo skeleton that Christie’s in London is auctioning on May 24. It is expected to go for somewhere between $500,000 and $700,000.

Comments: “Love it, but it is bigger than my apartment.” “I already have one.” “I’ll take two.”

People and Places with Bone Names

Bones have not only infiltrated the arts and popular culture, they also flavor place names. For some, the derivation is obvious, for example, Bone Creek, Saskatchewan; Bone Valley, Florida; Bone River, Washington; Bowlegs, Oklahoma; Bay of Bones, Macedonia; and Bone, Indonesia. Bone Cabin Quarry is a rich fossil field in Wyoming that was named for a nearby sheepherder’s cabin made out of stacked dinosaur bones.

For other locations, the connection is obscure. The Place of the Skull (Golgotha in Greek, Calvary in Latin) is the site near Jerusalem where Jesus was crucified. The exact location is disputed, as is the source of the name. Perhaps the name denoted a skull-shaped hill or the site where Adam’s skull was buried or maybe a site rich in skeletal remains.

Undisputed in both name origin and location is the Calaveras River in California. An early explorer came upon skeletal remnants of Native Americans on the bank of a then-unnamed river and exclaimed in Spanish, “Calaveras” (“Skulls”). Later the surrounding county received the same name, which makes the title of Mark Twain’s short story much more rhythmic than if it had been The Celebrated Jumping Frog of Skulls County.

By the way, skullduggery and Marylebone have nothing to do with bones, although bonfire does. It is a condensation of bone fire and comes from the time when the marrow fat of bone fueled open cremation pyres.  

In the Middle Ages, surnames emerged, first usually describing a location (e.g., Hill, Rivers) or an occupation (e.g., Miller, Shepherd). I guess when they ran out of those, along came Bone, Smallbone, Boner (no kidding), Bonebreak, and Brisbane. I will leave it to your imagination how the Boner family got its name, but Brisbane is rooted in old English where brise meant break and ban meant bone; but your imagination is again required, because nobody knows whether this family suffered broken bones, broke the bones of others, or set broken bones.

What is clear, however, is that hundreds of years later, one Thomas Brisbane was governor of New South Wales, Australia, and he shared his name with the local river and government seat.

“City of Bones” is the nickname for Derry, Northern Ireland, and its coat of arms includes a seated skeleton. How this came about is lost in time. Some wag said that the skeleton was that of a citizen waiting for a decision from the city council.

Perhaps the first person with a bone nickname was Ivar the Boneless, about whom I have previously blogged. Other folk with osseous nicknames include Sawbones (historically, any surgeon), Billy Bones (character in Treasure Island), and Brother Bones (mid-20th century musician, known for his rendition of Sweet Georgia Brown). There are also Ebony Bones (British actress), Bonebreaker (Marvel comic character), BONES (rapper), and the hip hop group BoneThugs-N-Harmony, consisting of Bizzy Bone, Wish Bone, Layzie Bone, Krayzie Bone, and Flesh-n-Bone.

What is it about bone? Why aren’t any people or places named Kidney or Skin or Nerve? Bone rules!!

Gigantic public works project spawns new surgical specialty.

In the last half of the 19th century, quickly following the advent of general anesthesia and the discovery of bacteria, some surgeons began specializing in treatments of the brain, eye, or other body parts. Fracture treatment, however, remained within the domain of the generalist in cities and at times left to the care of bone setters in rural and impoverished areas.

This changed with the Industrial Revolution and specifically with the building of the Manchester Ship Canal in England, which remains the world’s longest river navigation canal at 36 miles.

Rather than war, which historically has been the usual catalyst for rapid advances in surgery, it was this massive peace-time project involving hundreds of cranes, locomotives, and excavators, thousands of trucks and wagons, and tens of thousands of construction workers. The mix produced a great number of skeletal injuries over the six-year construction period.

A few years earlier and because of hard times at home in London, Robert Jones, then a teenager, moved to Liverpool to live with his uncle, Hugh Owen Thomas. Thomas was an orthopedist. His father, grandfather, and great grandfather had been bone setters.

Thomas made multiple contributions to the management of skeletal diseases that included published treatises on tuberculosis and on femur fractures. He encouraged his nephew, Robert, to attend medical school and then to join him in practice, which Robert did. Together Thomas and Jones developed a unique interest in fracture management whereas most orthopedists at the time dealt primarily with children’s skeletal deformities. 

In 1888 there was a fortuitous turn of events. Jones became Surgeon-Superintendent of the Manchester Ship Canal construction project and took advantage of this opportunity to develop the world’s first comprehensive accident service. He spaced three hospitals at intervals along the canal with intervening first aid stations and a railroad connecting them all. Jones trained and staffed the hospitals with personnel skilled in fracture management, and he operated on many of the injured workers himself. This intense operative experience, along with great proficiency in the non-operative management of fractures, markedly improved fracture care techniques.

Soon after, these advances proved invaluable during the Great War when Jones became Inspector of Military Orthopaedics and oversaw a 30,000-bed organization. Knighthood followed.

In the course of their work, Thomas devised a splint for temporary immobilization of broken legs, and Jones devised a bulky bandage to be used after knee surgery. Both of these advances bear their innovator’s name and are still used today.

The most significant and lasting mark that these two orthopedists made on medicine, however, was that they defined a new specialty. Canal building and then a war ended a decades-long discussion about the nature of the specialty of orthopedics. Should it include surgical procedures or just focus on straightening crooked children with casts and splints? From 1920 on, the specialty has been appropriately called orthopedic surgery.