204 Diseases of Bone. 



following" Anchylosis from Rheumatism.— Bones of a 



right leg and foot, soft parts cleaned off — dried, to show the 

 above. 



D. W., aged 18 years, was troubled with pains in the joints of his 

 right foot at the age of 10. Shortly after this he was confined to bed for 

 three months with a "fever" (probably rheumatic), which affected all the 

 joints of his body. Two years later he had a relapse of the same fever, 

 with implication of most of his joints, especially those of the right foot. 

 Since then he has had several similar attacks, and, with the exception of 

 the sterno-clavicular and temporo-maxillary, all the joints of liis body 

 have become deformed and more or less rigid. He has thus been 

 completely crippled and helpless, even in bed. The right knee was 

 excised on 10th May, but as the operation was unsuccessful. Professor 

 Annandale performed amputation above the knee on 24th July. 



The muscles of the leg, although greatly diminished in 

 bulk, were of a fairly good colour. The periosteum stripped 

 off very easily. The shafts of the tibia and fibula are much 

 reduced in thickness, and the muscular markings are slight. 

 The compact tissue is hard, but the cancellous tissue at the 

 articular ends of the long bones and in the tarsal bones 

 is extremely soft and fatty, and is surrounded by a scale of 

 bone so thin and soft that it yields to the slightest pressure, 

 and can be cut with the finger-nail. The joints of the ankle 

 and tarsus are all anchylosed by bone, as are also those of the 

 metatarsus, except that of the first metatarsal bone. The joint 

 between the first and second phalanges of the great toe is anchy- 

 losed, but all the other phalangeal joints have a certain amount 

 of movement. G. C. 3581. 



Presented by Professor T. Annandale, F.R.C.S.E. 



6. 15. Atrophy and Alteration in the Bones of the Foot, 



following" Injury. — Section of the bones of a right foot — 

 macerated, showing the above. 



The patient was a middle-aged man. Early in life his foot had 

 been injured, and gi-eat distortion resulted (see G. C. 2818). The skin 

 had been greatly destroyed, and an ulcer which appeared on the heel broke 

 out from time to time, and caused so much inconvenience that on account 

 of it the foot was at last amputated. 



