188 INITIATIVE IN EVOLUTION 



tumour moved on the lower. It was found that the tumour consisted 

 of two parts, the upper three-and-a-half and the lower seven inches 

 long, altogether a mass about ten inches in length. Muscular 

 bur.dles of the vastus externus were included in this ossific form- 

 ation, one passed through a tunnel in the bone through which it 

 worked, and the sides of it were polished. At the point where the 

 newly formed bone came in contact the surfaces fitted each other and 

 were polished as if they were covered with cartilage, and were here 

 surrounded by a capsule. (Italics not in original.) This fibrous 

 covering when opened was seen to contain a thin serum, which, 

 though not of the consistence of synovial fluid, still aided in 

 lubricating the polished surfaces as they played over one another. 



A similar case was reported also by Dr. C. Paterson, surgeon 

 to the Glasgow Royal Infirmary. 



A very interesting address by the Hunterian Professor, Mr. 

 Jonathan Hutchinson, was given in February, 1917, on Dupu try en's 

 work, especially in the discovery of the cause and treatment of 

 the contraction of palmar fascia known by his name. Professor 

 Hutchinson described his method of curing this by the removal 

 of the head of the first phalanx, and showed excellent results and 

 evidence of the formation of a perfect new joint to take the place 

 of the old distorted one, and the fingers were as efficient as in the 

 normal state in the exercise of flexion. He gives photographs of 

 the hand some months after the operation showing it to be capable 

 of easy and full extension as well as of flexion. This again agrees 

 well with the cases of Sir W, MacEwen and Dr. Paterson of the 

 formation of a functional joint by use and habit. 



Another distinguished Hunterian Professor A. Keith, also gave 

 two lectures in January, 1918, on the " Introduction of the Modern 

 Practice of Bone-grafting," which, in its modern form, he assigns 

 to the credit of Sir William MacEwen. He lays great stress on 

 the important work performed in such cases by the osteoblasts 

 without whose living and formative action these results could not 

 be obtained. He explains how necessary it is that these living 

 elements should be stimulated into action by work. They thrive 

 only so long as they have work to do. Another surgeon, Oilier, 

 " wondered why the fragments of bone which he had succeeded in 

 laising from slips of periosteum planted beneath the scalp or 

 amongst muscles ceased to grow and tended to disappear. These 

 bony grafts withered because they were not subjected to the strains 

 and stresses which rouse the activity of osteoblasts." MacEwen, 

 "by a fortunate chance, planted his tibial grafts in a situation 

 where they soon became subjected to muscular strains and stresses. 



