Club-foot : its causes, pathology, and treatment. Being the essay to which the Jacksonian Prize for 1864, given by the Royal College of Surgeons, was awarded / by William Adams.

  • Adams, William
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: Club-foot : its causes, pathology, and treatment. Being the essay to which the Jacksonian Prize for 1864, given by the Royal College of Surgeons, was awarded / by William Adams. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    In 1809 Michiiclis, of Marburg, in Germany, treated several cases of talipes equinus by partially dividing tlie tendo Achillis; but it must be presumed he either ruptured the undi- vided portion, or made complete sections, from his having brought the feet at once, as he is reported to have done, into a natm-al position. In the year 1816 Delpech,* of Montpellier, next suggested an important modification in this operation, viz., the avoiding of direct exposure of the tendon by open wound. He did not expose the tendon by dissection, but transfixed the limb be- tween the tendo Achillis and the deep muscles with a common scalpel, the wound in the integuments on either side being an inch in length; after introducing a convex edged bistoury, he divided the tendon from before backwards, taking care to leave the bridge of the skin over the space between the divided ends of the tendon. He performed this operation in May, 1816, on a boy aged nine afflicted with talipes equinus. Here for the first time we see an approach made towards the present sub- cutaneous method. Delpech also conceived the idea that the divided ends of the tendon should be retained in apposition after the operation until union had taken place, after which the uniting fibrous substance should be gradually and carefully extended until it assumed a degi-ee of length equal to the shortened muscle. This was a most valuable suggestion, and gradual mechanical extension after tenotomy is the method we at present adopt, but immediate extension is employed by some surgeons.f Delpech's mode of operating, although ultimately successful, was attended with some serious consequences from the extent of the wound made. There ensued symptomatic fever, suppura- tion, and sphacelus of some portions of tendon and cellular tissue; extension was not commenced until four weeks after the * Chirurgie cliniquo de Montpellier, ]}o,v le Professor Dolpecli, Tome i page l'J2, Paris ct Montpellier, 1823. t The plun of immediate oxtonsion has been reeonimeuded by Professor Symo of Edinburgl) (see Lancet, March iVth, 1855j, and a reply by Mr. W Adams in Medical Times and Uazeltc, April 28tli, 1855.