244 



Dr. W. Macewen. 



[May 19, 



a couple of pegs were inserted with the aid of a drill. They were kept 

 in for five weeks, and when removed the bone was found firm. At the 

 beginning of March, 1881, the bone was found firmly united, from the 

 head to the condyles, and measured 6 inches ; while the left humerus 

 measured 6| inches, that is to say, half an inch longer than the trans- 

 planted one. On rotating the condjdes the head of the humerus 

 responded to the movement. The patient could lift his arm to his head 

 and otherwise use it. 



Resume. — This was a case of extensive suppurative periostitis 

 followed by complete necrosis of the humeral diaphysis. The 

 necrosed humerus was divided at its exposed part, and each half was 

 pulled out from what was supposed to be its periosteal sheath ; but on 

 withdrawal doubts were expressed as to whether the periosteum had 

 not, for the most part, undergone destruction. As a result, at the 

 proximal extremity bone was formed, of a pyriform shape, tapering 

 from the head toward a point an inch and three-quarters from the tip 

 of the acromion process. This left over two-thirds of the shaft want- 

 ing. There was no further attempt at bone formation. A year and 

 three months afterwards, the state of the parts remained the same. 

 After this time the first transplant was performed. In making the 

 sulcus for the reception of the graft, reliance had to be placed on the 

 anatomical relations as to the correct position for the graft, as there 

 was no trace of periosteum or fibrous structure to indicate the former 

 whereabouts of the bone. Portions of human bone were transplanted 

 on three different occasions. The grafts were obtained from patients 

 affected with anterior tibial curves, from whom wedges of bone had 

 to be removed for the purpose of straightening their limbs. These 

 osseous wedges, with their periosteum, were each divided, after 

 removal, into many small pieces, which were immediately placed in 

 the sulcus prepared for them in the boy's arm. These small portions 

 nnited together and adhered to the head of the humerus above and 

 the condyles below, ultimately forming a solid rod, only half an inch 

 shorter than the humerus of the opposite side. The transplantation 

 of bone converted a useless arm into a thoroughly useful one. 



Deductions from these Transplantations. 



Though the foregoing is only a single case, as far as the individual 

 is concerned, yet from the number of transplants which have been 

 performed it may be regarded as a series of experiments. It is now 

 necessary to ask, what conclusions may be drawn from the data sup- 

 plied by these experiments ? Before answering these, the way may 

 be cleared by reference to two points. First, some who have heard 

 of this case without having seen the operations, have asked, whether 

 it was not possible that some old periosteum remained in the arm and 

 produced the new bone, the operation of transplantation having only 



