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Related post: Chambers Street Hospital, and when discharged he had a stiff
joint, but now (three years and a half after the accident) its
function was perfect, and the muscular development of the leg
was normal. It was interesting to note such a good result
after this somewhat rare lesion. (The case was reported by
Dr. Jessup in the "New York Medical Journal" for January
3, 1885, page 12.)
Dr. McBiTENEY asked if the patient had been at work since
the accident.
Dr. Bull replied that he had probably resumed his duties as
in engineer soon after he left the hospital.
Dr. MoBuRNET suggested that after such an injury flexion
ind extension alone might occur without the actual repair being
complete. If a real test of the strength of an injured joint was
nade, it might be found tiiat it was still weak. Patients with
iislocation of the shoulder might recover and after several
nonths have a fresh dislocation, showing that the normal con-
lition of the joint had not yet been fully restored. He said
;hat if the lateral ligament was torn away together with the
jeriosteum, firm union might result.
Dr. Bull said that it had been impossible to ascertain ex-
ictly. He said that the case was of peculiar interest as regarded-
;he question of prognosis in cases of rupture of the internal
ateral ligament. He would expect that the joint would always
36 weak, and that there would be some lateral motion. He
il ways treated cases of rupture of the lateral ligaments with
ipparatus for at least six weeks, since for union of the torn
igament as much time was required as for union of bone.
Two Cases of Exsection of the Astragalus for Caries ;
Elecovery with Good Motion.— Dr. Wteth showed a patient
ipon whom he had operated two years and a half before, re-
noving the astragalus, the lower end of the tibia and fibula, and
il portion of the os calcis. Fixation of the bones was obtained
i)y means of a long steel drill, which extended up into the tibia.
in this case the disease affected the astragalus, the articular sur-
aces of the tibia and fibula, and the calcaneo-astragaloid articu-
ation. but was probably not tuberculous. The patient made a
lOod recovery, and was able to walk perfectly well.
The second case was that of a patient (a young man) upon
phom he bad operated a year before for tubercular osteitis of
ihe astragalus. In this case the posterior planes of the scaphoid
nd cuboid bones were removed and, as in the preceding case,
ihe upper surface of the os calcis was chiseled off. The patient
ad not been allowed to walk very much, and the recovery was
erfect.
\\ In reply to a question by Dr. Sands, the reporter stated
that tlie disease had begun in the astragalus in both instances;
in the last case the astragalo-scaphoid articulation was in-
volved.
Dr. R. Abbe asked if it was easy to remove the astragalus
entire.
Dr. WvETn replied that he had removed it piecemeal with
a common chisel, as by this method the operation could be
easily done through a small incision.
Dr. MoBuKNHY asked if the disease was so extensive as to
justify the removal of so much bone.
Dr. Wyetii replied in the attirmativo.
Division of the Brachial Generic Mirtazapine Plexus ; Suture of the Divided
Ends. — Dr. Sands presented a patient with the following his-
tory: John S., aged twenty-one, single, a painter by occupa-
tion, accidentally stabbed himself above the middle of the left
clavicle on November 29, 1887. Profuse bleeding followed, but
it was readily checked. Immediately after the injury many of
the muscles of the left arm became paralyzed. Some hours
later the patient began to experience burning pain in the first
three fingers of the corresponding hand. He was admitted into
the Roosevelt Hospital on December 17th. There was a cicatrix
an inch and a half long on the left side of the neck, extending
along the outer margin of the sterno-mastoid muscle ; the ar-
tery pulsated beneath it. There was loss of reaction to the
faradaic current, and the galvanic showed An C C > K 0, the Purchase Mirtazapine Online
affected muscles being the deltoid, biceps, coraco-brachialis, and
supinator longus. There was loss of faradaic reaction in the
infraspinatus, pectoralis major, and extensor carpi radialis lon-
gior, but no change in the galvanic. Sensation seemed to be
diminished over the skin-area supplied by the musculo-spiral
and circumflex nerves. On December 24th the brachial plexus
was exposed by making a V-shaped incision, one branch of
which extended along the outer edge of the sterno-mastoid, the
other along the upper border of the clavicle. The clavicle was
then sawed through, and the plexus was reached after long and
tedious dissection. The external jugular vein was accidentally
divided, and a small amount of air entered it, but no harm re-
sulted. The large vessels were felt, but were not seen. It was
found that the external bundle of nerves, which appeared to be
derived from the fifth and sixth cords, had been divided just
above the clavicle; at the point of division the bundle had di-
vided into three parts, and two of the lower ends had retracted
below the clavicle, where they were included in cicatricial tis-
sue. The divided ends were freshened and brought into appo-

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