1881.] Observations concerning Transplantation of Bone. 239 



Necrosed Bone Removed. — On August 7th, 1878, the part of the 

 necrosed bone exposed at the aperture already mentioned was divided 

 by the bone forceps. The upper part of the shaft was then caught by 

 lion forceps, rotated in order to loosen its periosteal attachments, and 

 then pulled out. The lower portion was similarly dealt with. The 

 two portions removed comprised the whole humeral diaphysis. The 

 periosteum opposite the opening in the soft parts was nowhere seen or 

 felt, its place being occupied by granulation tissue. Granulations like- 

 wise lined the tunnel from which the bone was removed ; but at the 

 upper part toward the head of the bone, the finger detected periosteum 

 with rough calcareous matter adhering. The apertures left by the 

 removal of the shaft were stuffed with carbolised lint, and the arm 

 was carefully fixed on a splint. The suppuration continued profuse 

 for about a fortnight, then gradually diminished. The tunnels left 

 by the withdrawal of the bone were kept patent as long as possible, 

 but they slowly coalesced from the epiphyses toward the superficial 

 openings without the formation of new bone, except for a short dis- 

 tance from the head of the humerus. After the first fortnight the 

 patient's constitutional state improved under good diet, cod liver oil 

 and lime water. Local applications, with a view of stimulating the 

 bone growth, were tried, but were found unavailing. The wounds were 

 quite healed on 1st November, and he was dismissed from the ward 

 on the 23rd November, 1878, with about an inch and three-quarters of 

 shaft attached, to the head of the bone; even this was thin and 

 tapered. There was no bone from this down to the condyles. There 

 was, therefore, over two-thirds of the humeral shaft wanting. A 

 month after (in December, 1878), he was seen, and the tapered portion 

 had increased by about a quarter of an inch. The measurement from 

 the acromion process to the end of this tapered process was 2 inches. 

 He was seen monthly for some time, but no further growth of bone 

 followed.* 



Appearance of the Arm one year and three months after. — On November 

 7, 1879, the patient was re-admitted to the hospital. The bone had 

 not grown further, though one year and three months had elapsed since 

 the subperiosteal resection of the humerus. When the limb was placed 

 hanging down by the side, the measurement from the tip of the 

 acromion process to the distal extremity of the proximal portion of 

 the humeral shaft was nearly 2 inches. In form, this upper fragment 



* Cases of subperiosteal resections of the humerus have occurred in which the 

 hone has not been reproduced. Thus, Nedopil performed a subperiosteal resection 

 of the humerus in a boy twelve years of age, the shaft not being reproduced. In 

 order to render this boy's arm of some use an orthopcedic apparatus, devised by 

 Billroth, was applied. Neudorfer also mentions a case in which the humeral shaft 

 was not reproduced after subperiosteal resection. (Professor D. Vogt, " Die Chirur- 

 gischen Krankheiten der Oberen Extremitaten," p. 225, paragraph 212.) 



