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.
546/700
![of the as- the appearance of the parts bears at first sight a great re- semblance to that of disease of the ankle-joint. The annexed representation gives a faithful idea of the state of the parts in a case where the diagnosis of disease limited to the astragalus was made, and was justified by a successful operation for the re- moval of that bone afterwards. The diagnosis involves three ques- tions, viz. as to the implication of the ankle-joint, of the os calcis, and of the anterior part of the tarsus. The ankle-joint is shown not to be implicated, inasmuch as the foot is movable at the ankle without pain, the outline of the [Kg. 83. a drawing to show the condi- malleoli is natural, and there is won of the foot m a case (Alice Jones) no swelling between them and where excision of the astragalus was , , . , .... m. afterwards successfully performed.] the tendo AchllllS. llie SUlUSeS all lead to bone situated above the os calcis, and behind the scaphoid: and it may perhaps be possible to prove that moving these bones on the astra- galus is not attended with pain; but this must usually be uncertain. I do not mean to assert that the diagnosis can be made in most instances with absolute certainty, although I have now met with several cases in which I have been able to announce a pretty confident opinion, and that opinion has been verified at the subsequent operation. If, however, such an opinion were formed erroneously, we shall see presently that it would be a matter of very little moment, provided the disease be really incurable without surgical operation. In cases of disease limited to the astragalus, the whole of that bone may be removed with perfect ease from its arti- culations, whether the latter be diseased or not, and a very useful foot will be left. I have frequently showed to my class, in clinical lectures at the Hospital for Sick Children, patients from whose feet the astragalus has been thus re- moved, and have proved to them, by actual inspection, that the child can walk pretty nearly as well as ever. I have not as yet had an opportunity of recommending or performing](https://iiif.wellcomecollection.org/image/b20416325_0546.jp2/full/800%2C/0/default.jpg)
