The surgical treatment of the diseases of infancy and childhood / by T. Holmes.
- Timothy Holmes
- Date:
- 1868
Licence: Public Domain Mark
Credit: The surgical treatment of the diseases of infancy and childhood / by T. Holmes. Source: Wellcome Collection.
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![ing a drainage-tube through the softened bone from one side to the other. In a little child under my care I bored a hole through the whole thickness of the bone, which I kept open for some time with a drainage-tube. The ultimate result of the case will, I think, be successful; but if so, at an expense of time and suffering which renders the advantage of the proceeding rather dubious; nor does what I have seen of the affections of the os calcis lead me to expect much good from M. Chassaignac's proposal. The diagnosis may have been so far erroneous that the Resection disease may be found not entirely limited to the os calcis, but caneo-as- affecting also the lower surface of the astragalus. In a case loi(i of this kind, after the excision of the calcaneum, I removed with the chisel the lower part of the astragalus until sound bone was reached, and the operation was perfectly successful. This is, I think, the only way of dealing with incurable dis- ease of the calcaneo-astragaloid articulations. Besides the ankle-joint and the substance of the os calcis, Excision disease of the tarsus has for its starting-point very commonly tra* alus. some part of the astragalus. The joint-surfaces between the astragalus and os calcis are, as we have seen, often the point of departure of the disease. In other instances the disease commences in the central osseous structure of the astragalus, leaving the cartilaginous surfaces long unaffected. This con- dition is illustrated by the appended drawing of the astragalus, in a case where the bone was excised with suc- cess. The central part is seen to be entirely disorganised, while the surfaces of articulation with the neighbour- ing bones are all un- affected. In this case the disease had been months. In disease affecting the astragalus only, there is consider- Symptoms able swelling over the dorsum and both sides of the foot, and of disease [Fig. 82. A drawing to show the condition of the astra- galus in a case (Gertrude Weiner) in which the bone was excised. The upper cartilaginous surface was partially loose and detached, and is represented sepa- rate. The interior is seen to be composed of a mass of crumbly carious bone.] known to be in progress for four](https://iiif.wellcomecollection.org/image/b20416325_0545.jp2/full/800%2C/0/default.jpg)
