238 



Dr. W. Macewen. 



[May 19, 



that the osteogenic cells contained in the Haversian canals cannot 

 proliferate (except at the expense of the hard tissue) as long as they 

 are bound in — imprisoned by — calcareous walls ; the division of these 

 hard walls gives the soft tissues contained therein room to proliferate. 

 Besides, the graft when composed of small portions of bone, is more 

 easily moulded into any form which the surgeon may desire. 



It was resolved to give practical expression to these views in the 

 following case. In order to place all the particulars of the case before 

 those interested, the history is given in detail. 



Case in ivhich Interhuman Transplantation, was Successfully Performed. 



William Connell, aged three years, was admitted into the Royal 

 Infirmary, Glasgow, under my care on the 17th July, 1878, in a much 

 emaciated and exhausted condition arising from suppuration in con- 

 nexion with necrosis of the right humerus. 



He came of healthy, though poor and itinerant parents. He pre- 

 sented the appearance of a much neglected child. Constitutionally 

 he was weak, his pulse a mere thread, his cheek surmounted by a 

 hectic flush, and on slight effort beads of perspiration bedewed his 

 forehead. The right upper arm was greatly distended, and fluctuant 

 from shoulder to elbow. About the middle of the upper arm there 

 were two cicatrices, which were stated to be the marks of recent 

 openings through which pus had escaped to within a week of his 

 admission to the hospital. Toward the middle of the outer aspect of 

 the arm, the skin, including these cicatrices, was for about a couple of 

 inches thin and reddened. A puncture was made at this point, giving 

 vent to foui'teen ounces of thin foetid pus. When the abscess was 

 evacuated the shaft of the humerus was found to be totally necrosed, 

 and already separated from its head at the epiphyseal junction. At 

 the condylar epiphyses slight crepitation was elicited. From the 

 condition of the bone, as well as from the few items of history which 

 could be relied on, it was evident that the destruction of the bone had 

 occurred from four to six weeks previously. After the pus had been 

 evacuated, and the distention of the soft parts had thereby been 

 reduced, the shaft of the humerus was exposed through an aperture 

 measuring nearly an inch square, situated on the outer aspect of the 

 arm. The bone at this point was dark-coloured and foetid. The arm 

 was dressed, the patient was placed on generous diet, and otherwise 

 attended to in the hope that his strength might improve, and that he 

 would thereby be placed in a better condition for the removal of the 

 necrosed shaft. Not withstanding treatment, the daily discharge of 

 foetid pus was great, and as the amount was not much lessened at the 

 end of three weeks, it was considered advisable to remove the source 

 of irritation. 



