DEVELOPMENT IN NINETEENTH CENTURY 359 



ion of the superior and inferior maxillas, the hyoid bone, the entire 

 clavicle, the entire scapula, the ulna and radius, the coccyx and ribs; 

 also trephining for relief of osteomyelitis; the most perfect speci- 

 mens of reproduced bone, be subtracted from the sum total of 

 operative surgery upon the bones, there is little left that is not the 

 offspring of American surgery. 



In the surgery of the joints, American surgeons have accom- 

 plished brilliant work, since in the management of dislocations they 

 have contributed much to the sum total of our knowledge. Phy- 

 sick was the first to perform venesection to cause muscular relax- 

 ation, in order to reduce a dislocation. This was a most valuable 

 means, to which resort was made prior to the introduction of anes- 

 thetics. McKenzie and Smith, in 1805, reduced a dislocation of 

 the shoulder of six months' standing by the employment of vene- 

 section. This patient had been to England and all attempts at re- 

 duction failed, and upon his return to Baltimore, the reduction 

 was effected by relaxing the muscular system by blood-letting ad 

 delequium animi. The plan is now abandoned since the introduc- 

 tion of anesthetics. Warren excised the head of the humerus to 

 restore the usefulness of it after an unreduced dislocation of the 

 shoulder-joint. The invention of plaster-of-paris jacket by Sayre, 

 for the treatment of Pott's disease, in 1874, is one of the most im- 

 portant surgical discoveries of the century. The same apparatus he 

 devised for the treatment of lateral curvature. These cases of Pott's 

 disease, which hitherto were consigned to a distressing death, are 

 now permanently relieved of their sufferings, and are in many cases 

 entirely cured. Excision of the hip-joint was performed as a sys- 

 tematic operation, and successfully, for the first time in this country, 

 by Sayre, in 1854. To this same surgeon is due the credit of sug- 

 gesting and carrying into execution the principle of free drainage 

 in cases of empyema of joints. In hydrops articuli, Martin, of Bos- 

 ton, in 1853, suggested equable uniform compression by means of 

 an elastic bandage, and Sayre has applied the same principle by 

 using compressed sponges. Martin, in 1877, also employed the 

 elastic bandage for the cure of chronic ulcers of the leg. In 1826 

 Barton divided with a saw the great trochanter and the neck of 

 the thigh to relieve ankylosis of the hip-joint. In 1830 Rodgers 

 removed a disk of bone, and in 1862 Sayre perfected the operation 

 and introduced a new principle by removing a plano-convex wedge 

 of bone between the two trochanters, and made rotund the end of 

 the lower fragment in order to form a new and artificial joint. In 

 1835 Barton removed a cuneiform wedge just above the condyle 

 and fractured the bone, and made the limb straight to relieve angu- 

 lar ankylosis of the knee-joint. This operation is practically the 

 osteotomy of the present time. In 1840 Carnochan first operated 



