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like the others, and at the same time treatment was applied to the diseased hip-joint on the opposite side. The issue in this case appeared doubtful for many days, on account of the profound sepsis present, but finally the little fellow began to improve, and, after a long and tedious illness, he recovered, with an excellent new tibia in the left leg and a good result from treatment
of hip-joint disease of the other side. The after-treatment of this case was the same as in the previous cases, including the fracture-box. After the new bone had formed and the wound completely cicatrised, a plaster-of-Paris cast was applied for the protection of the new bone and to give rigidity to the limb. At the end of ten weeks the boy was able to go on crutches, and later, by the aid of a high-soled shoe, could walk without great lameness, and what lameness was present arose from the injury to the right hip.
I regret not being able to present a skiagraph of this case, but an excellent photograph of the injured leg is shown.
This boy lived comfortably and was able to get about in excellent shape for several months. In the spring of 1903, he was
seized with some acute abdominal trouble, supposedly an abscess of the mesentery, from which he died.
Case VI.-H. T., a sturdy boy, aged 5 years, was referred by his uncle, Dr. Henry Turnbull, of Lawrenceville. This little fellow came in one evening from play and complained to his mother of pain in his leg, over the fibula, saying he wanted to go to sleep. His mother examined his leg and found the ankle a little red and somewhat swollen. The next morning the leg was very much swollen, and there was high fever. He suffered greatly and was not able to walk, and the limb remained in this swollen condition for five or six weeks, when a “soft place” was
noticed on the ankle, and the attending physician opened this and kept it open. In two weeks small particles of bone worked out of the wound. At this juncture I saw him.
I discovered that the major portion of the shaft of the fibula was necrotic. Incision over the bone was made, extending upward from the external malleolus to within three inches of the head of the fibula. It was manifest that no part of the bone could be
saved except the lower malleolus and a small portion of the upper extremity.
With a Gigli saw the bone was divided through its healthy parts and the diseased portion removed. With the free drainage thus accomplished and the removal of the necrotic bone, septic symptoms quickly subsided. The after-treatment was precisely as in the others, viz., antiseptic dressings and immobilisation in a fracture-box. This little fellow did remarkably well, and in six weeks was able to leave the hospital with his leg in a plasterof-Paris dressing. The bone rapidly reformed, and in six months the child was entirely restored to health, with the limb'unimpaired. Eight years after operation the accompanying photograph (Fig. 9) of the leg and a skiagraph of the bone were made. It will be seen, from the skiagraph, that the bone is perfect. The leg is absolutely perfect in function, and the youth, now thirteen, is as sturdy and healthy as any boy of his age.
In considering these cases I am impressed with a number of facts well worth emphasising:
1. All my cases were in males.
4. Exposed bones were involved: the tibia in five instances, the fibula in one.
5. There was remarkable variation in the degree of virulence of infection.
6. The extent of destruction was dependent upon the character of the infection.
7. There were profound constitutional symptoms where the infection was virulent.
8. The condition was often mistaken for "growing pains," rheumatism, or erysipelas.
9. Regeneration in my cases was entirely of periosteal origin, and was rapid and complete.
10. Deformity resulted only in such cases as had suffered destruction of the epiphyseal line.
11. There is no deformity where a disk of bone is left between the shaft and the epiphysis.
12. Invariably the companion bone takes on compensatory hypertrophy. 13. Time to operate:
(a) In acute cases (imperative) immediately.
bone tissue has begun to appear.