684 FOURTH REPORT— 1834. 



On Excision of diseased Joints. By Professor S y m e . 



The author explained that his object was not to discuss the 

 merits of the operation, to institute a comparison between it 

 and amputation, to estabUsh the principles which seem most 

 conducive to its safe and effectual performance, or to enter into 

 any more particular details concerning the different modes of 

 procedure which are requisite for the different joints, but merely 

 to prove by actual demonstration that the two great objections 

 which have been urged against the operation, however specious 

 in theory, are not supported by experience. These objections 

 he stated to be, 1st, that the diseased bone could not be com- 

 pletely removed by excision, so as to afford a perfect and per- 

 manent cure ; and, 2ndly, that the limb preserved by the opera- 

 tion must be nearly or altogether useless to the patient. In reply 

 to the first of these objections, he produced a woman, 44 years 

 of age, who eight years ago had the shoulder-joint removed, 

 on account of caries in the head of the os humeri which had 

 existed for six or seven years, and reduced her to an extreme 

 degree of weakness. The head of the bone, completely hollowed 

 out by disease, was exhibited, and the woman showed that while 

 her general health and strength were quite restored, there was 

 hardly any perceptible difference in the utility of her arms. He 

 also placed before the meeting a boy who had his elbow-joint 

 excised between five and six years ago, on account of caries 

 which had existed twelve months. The articulating extremities 

 of all the bones entering into the formation of the joint were 

 exhibited ; and the boy proved, by free and varied movements 

 of his arm, that he retained completely the power of flexion, ex- 

 tension, and rotation of the elbow, without any diminution of 

 strength. In reply to the second objection, he stated that it 

 seemed to be grounded on the difficulty of conceiving how the 

 tendons, after being cut away from their attachments, could 

 again adhere to the bones so as to move them in obedience to 

 the action of the muscles, and on the erroneous idea which ge- 

 nerally existed as to the changes that occur between the osseous 

 surfaces subsequently to the operation. In order to show that 

 when tendons have their attachments divided they readily ac- 

 quire new ones, so as to perform their usual oflices, he brought 

 forward a patient who had suffered Chopart's amputation of the 

 foot for caries of the tarsus and metatarsus, and who conse- 

 quently, having only the os calcis and astragalus remaining, had 

 had all the tendons opposing the extensors of the ankle divided, 

 but who nevertheless retained completely the power of bending 



