1881.] Observations concerning Transplantation of Bone. 243 



acromion to the extremity of the shaft was 4 inches, being a gain of 

 an inch and a quarter.* 



The third Transplant. —On 9th July, 1880, the third transplant was 

 performed. On this occasion the condyles were exposed, and a cartilagi- 

 nous spike an eighth of an inch in length, situated between the condyles 

 was seen to be the sole representative of the shaft from that direction. 

 This cartilaginous spike was removed, and the upper portion of the con- 

 dyles was refreshed. A sulcus between the muscles was then made from 

 the condyles to the distal extremity of the upper fragment. Two osseous 

 wedges were removed from a patient aged nine years, affected with 

 anterior tibial curves. Each of those wedges was half an inch thick 

 at its base, and measured three-quarters of an inch in length from 

 apex to base. They were divided into smaller fragments than the last, 

 and were laid into the groove between the muscles. The wound 

 healed, all but a small part of the lower border, from which four small 

 portions of dead bone were removed at the second and third dressings. 

 About the middle of August there remained a firm osseous ridge 

 running from the condyles towards the upper fragment. At this 

 date the patient was dismissed from the hospital, and returned on 27th 

 October, 1880. On his return the last transplant was found to 

 be still firm, and measuring from If to 2 inches in length. It was 

 also thicker than that resulting from the others. The proximal and 

 distal grafts were now touching and could be rubbed together. 



Tivo Ends of transplanted Bones refreshed. — It was thought advisable 

 to refresh the ends of these grafts, and bring them together by sutures. 

 This was done on October 31st, 1880 (over three and a half months 

 from the last graft, and about one year from the time of the first 

 graft). Both extremities were seen to be distinctly osseous, and 

 appeared to be living bone. They were covered by a fibrous vascular 

 membrane, resembling periosteum. It was somewhat difficult to 

 secure correct apposition, and some portions had to be removed by 

 the bone forceps in order to permit of better adaptation. Six weeks 

 after, when the wound was looked at, union was not perfect. The 

 extremities of the bones were rubbed firmly together, and on January 

 9, 1881, union was found to be taking place. In order to hasten it 



* On July 6th, 1880, a little girl was admitted into the ward suffering from a 

 crush of the upper arm received by a railway accident. Amputation at the upper 

 third of the arm had to be performed. The lower third of the humerus, though 

 somewhat crushed, was so nearly what was wanted to fill up the gap in the boy's 

 arm, that it was determined to transplant it. Owing to the manner in which it 

 fitted into the gap in the boy's arm it was considered advisable, in an experimental 

 sense, not to divide it into small pieces, but to preserve it entire. It was transferred 

 on July 6th, but three days after the periosteum was found to be in great measure 

 stripped, leaving the cylinder bare. The bone was therefore removed ; the granu- 

 lations in the sulcus between the muscles scraped, and what may be regarded as the 

 third regular transplant proceeded with. 



