We have received several papers from respectable physicians, detailing modes of practice, and beneficial resultg which, although not unknown to the profession, deserve to be announced. lt is not, in general, necessary to publish such communications in extenso, and we shall, therefore, limit ourselves to a notice of their contents.—-Ed.
AMPUTATION of a PART of the FOOT. John Slavens, M.D. of Mount Sterling, Kentucky, in 1825, had occasion to amputate a part of the foot. Gangrene had succeeded to the violent bruise, and metatarsal luxation, that were produced by the fall of a forge-hammer upon the top of the foot. Finding the cuneiform bones diseased, and the os cuboides fractured transversely in the line of the scaphoido-cuneiform articulation, he made his amputation through that joint and the fissure of the broken bone. The flap was formed out of the soft parts beneath, so as to place the escar upon the top of the foot. Nearly the whole wound healed by the first intention, and in four weeks the patient was quite well. By the aid of a shoe, with its anterior part filled with cork wood, and a plate of steel between the soles, his patient was able to walk so well, that an ordinary observer would scarcely perceive him to be lame.
Dr. S. does not distinctly inform us whether it was his design, if he had not met with the fracture of the os cuboides, to have sawed through the bones of the foot without reference to sutures; or to have amputated 'at the junction' of that bone and the scaphoides, with the astragalus and os calcis, in the manner first practised by Chopart; he seems, however, to have had the former operation in view; and Sir Astly Cooper expressly prefers it to the method of Chopart, as producing "less irritation and danger." But is not the operation which Dr. S. was led to perform, in consequence of a fissure in cuboid bone, preferable to either? By sawing through that bone only, and completing the operation with the knife, passed along the scaphoido—cuneiform junction, less violence would seem to be done, than by carrying the saw through the whole bony frame work of the tarsus; while the stump produced would approach sufficiently near to a plain surface, to admit of being well covered. On the other hand, it possesses in its results some obvious advantages over the mode proposed by Chopart. Thus it saves to the patient half the cuboides and the whole of the scaphoid bone, leaving the base of the limb more extensive, than after his operation; and it leaves untouched the principal insertions of the tibialis posticus muscle, which are necessarily destroyed by the removal of the os scaphoides and whole of the cuboides, and thus preserves more of the extending power of the foot; as well as the power which sustains the body, when from any cause it inclines too far in the direction of the affected side.
Western Journal of the Medical and Physical Sciences. Hatch & Nichols, Cincinnati, 1828-9.
Gangrene having resulted from the bruise, and metatarsal luxation produced by the fall of a forge hammer on the top of the foot; he had occasion to amputate it. "Finding the cuneiform bones diseased, and the os cuboides fractured trans versely in the line of the scaphoido-cuneiform articulation, he made his amputation through that joint, and the fissure of the broken bone. The flap was formed out of the soft parts beneath, so as to place the scar on the top of the foot." Nearly all the wound healed by the first intention, and in four weeks the recovery was entire. This suggests to the author an improvement in the method of amputating the foot; first, to cut through the scaphoido-cuneiform articulation, and then to saw through the os cuboides in a line with it.
The Medical Recorder of Original Papers and Intellgence in Medicine and Surgery.
Conducted by James Webster, M.D., Caleb B. Matthews, M.D., and Isaac Remington, M.D. Vol. XII. Philadelphia, 1827.