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time, but because the gauze packing will cause reaction of the pleura and cofferdamming, since the pleura is just as liable to acute infection as is the peritoneum. The abscess could also have been treated by pneumothorax-compression, and thus drained through the bronchus, because of the non-adherence of the pleura. The wound was closed by interrupted sutures of silkworm-gut, between the intervals of which a continuous catgut suture was placed.

The fifth patient was a baby with congenital club-feet. Subcutaneous tenotomy of the tendo achillis, followed by subcutaneous division of the plantar fascia just in front of the tubercle of the os calcis, was performed on each side. Such a young baby has no heel. It is best to do these operations as early as possible. The tendo achillis expands and reunites more than any tissue in the body. Its ends may be separated as much as two and three-quarters inches and yet heal together. The tendon of the tibialis anticus, on the other hand, would go up after division and stay up without union. The plantar fascia reunites equally well. When applying the dressing the strips of gauze were applied in a longitudinal, and not a circular, direction. Otherwise, in case of swelling, cutting of the plaster cast would be of no avail. Beyond the dressing, Dr. Murphy applied the plaster-of-Paris directly upon the skin, stating that better control is thereby secured in babies. The Gigli saw was used to cut the cast.

John Benjamin Murphy was born in Appleton, Wis., December 21, 1857, the son of Michael and Ann (Grimes) Murphy. He studied in the public schools of Appleton, graduating from the high school. As a youth John B. Murphy worked on his father's farm. Much of his tireless energy, endurance, and physical strength can be attributed to the outdoor work of that period of his life.

He began the study of medicine under Dr. John R. Reilly, of Appleton, as preceptor. Graduating with the degree of M.D. from Rush Medical College in 1879, he entered at once on his service as interne at Cook County Hospital and received his certificate from the hospital in 1880.

In the same year Dr. Murphy began the practice of medicine and surgery associated with Dr. Edward W. Lee, one of the attending surgeons at Cook County Hospital. From September, 1882, to April, 1884, he studied surgery in European hospitals. He married Miss

Jeanette C. Plamondon in 1885. Mrs. Murphy has always taken the keenest interest in all of his scientific work, and was a great stimulus, as well as factor, in his undertakings.

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His first teaching position was that of instructor in surgery in Rush Medical College in 1884. He next filled the position of professor of surgery in the College of Physicians and Surgeons in 1892. For two years he was professor of surgery and co-head of the department in Rush Medical College. For the last fourteen years, with the exception of the two years (1905-1907) at Rush, he has been head of the Department of Surgery at Northwestern University Medical School. For more than thirty years he has been attending and consulting surgeon at Alexian Brothers' Hospital, and is now consulting surgeon for that hospital, as well as for St. Joseph's Hospital, Columbus Hospital, and the Hospital for Crippled Children. He is now attending surgeon and chief of staff at Mercy Hospital.

In 1902 the University of Notre Dame awarded him the Laetare Medal. In 1905 he was given the degree of LL.D. from the State University of Illinois; the University of Sheffield, England, the degree of D.Sc., in 1908; and St. Ignatius College that of M.A. He is a life member of the Deutsche Gesellschaft für Chirurgie, an honorary member of the Société Chirurgical de Paris, an honorary fellow of the Royal College of Surgeons of England, and a charter member of the American College of Surgeons. He has been president of the American Association of Railway Surgeons, the Chicago Medical Society, The American Medical Association, and the Clinical Congress of Surgeons of North America.1

Dr. Murphy has written numerous articles, edits the General Surgery Volume of the Practical Medicine Series, and writes the valuable" Surgical Clinics of John B. Murphy," published bimonthly by the W. B. Saunders Company, of Philadelphia.

1 Guy C. Hinsdale, INTERNATIONAL CLINICS, 12th Series, ii, 247.

AUTOPLASTIC BONE TRANSPLANTATION

BY VINCENT ANTHONY LAPENTA, A.M., M.D.
Indianapolis, Indiana

THE history of osteal transplantation can be said to have begun before the era of experimental work on transplantation of other tissues and organs. Ollier, before the age of asepsis, transplanted bone and periosteum with good results and many disappointments, which we now understand to have been due to infection.

While the transplantation of organs may be said to have yet to emerge from the experimental stage, that of bone has reached a stage of enormous usefulness and a very wide application. Indeed, it may be said to represent to-day one of the most glorious conquests of modern surgery. Before entering upon the consideration of the principles, indications, and methods of transplantation, etc., it is necessary to refer briefly to the theories of this work as well as to the histology of bone and periosteum.

There is at present a considerable amount of controversy in regard to the function of the periosteum in transplantation. The teaching handed down by generations, and comprising the work of Malpighi, Durante, Axhausen, Ollier, Pascale, and Lejars, distinctly, and I believe correctly, attributes to the periosteum the important function of not only nourishing bone, but of being the chief agent in bone formation in fractures and transplantations.

Of the modern authorities holding opposite views, it will be sufficient to cite Macewen and Cohen, who believe the periosteum to be nothing more than a limiting membrane, preventing the growth of bone in the soft tissues, and not at all concerned with osteogenesis in transplantation. Murphy not only holds this view, but believes that a transplant is not in itself osteogenetic, but only osteoconductive, and that to obtain success it must be in contact with living osteogenetic bone at either end.

The fallacy of these views is clearly demonstrated by the embryologic development of bone. The large amount of clinical results, emphasized by the excellently-conducted animal experiments of McWilliams, have most emphatically strengthened the teaching of the old masters in ascribing to the periosteum the chief rôle in bone formation.

Albee and Murphy, while holding the opposite views above mentioned, have, in all their human transplantations, as McWilliams has personally ascertained from them, always transplanted the periosteum. This practice is not in accord with their views.

Let us bear in mind that in the embryonal osteal development practically all of the bone formed in the cartilage is absorbed and destroyed by osteoclasts, to be quickly replaced by bone growing from the osteoblastic layer of the periosteum.

McWilliams's experiments emphasize the following conclusions: 1. That the periosteum is osteogenetic.

2. That bone transplanted with periosteum always lives and grows without regard of its being or not being in contact with osteogenetic bone.

3. That bone transplanted without periosteum generally dies and is absorbed, exception being made for very small transplants.

4. That the periosteum, far from being only a limiting membrane, plays the most important rôle in osteogenesis, and serving further to establish and maintain a satisfactory blood supply for the transplant.

Transplantations done with periosteum-covered transplants have been successful in 99 per cent. of cases, while those done with bone have succeeded only in 41 per cent. While the successes attained in transplantation with bone and periosteum obtained from the patient himself have been uniform and good, the same cannot be said for heterogeneous transplantation.

INDICATIONS FOR AUTOPLASTIC TRANSPLANTATION

1. In ununited fractures, properly performed transplantation will give 100 per cent. of results. While the fixation of these fractures by Lane's plates, ivory pegs, wire sutures, etc., is occasionally successful, these foreign bodies usually tend to favor non-union by in

ducing a rarefying osteitis. They are frequently the source of future trouble by becoming loose and requiring another operation for removal. Thomas, in reviewing the results obtained at Cook County Hospital in fractures immobilized by Lane's plates, finds that in over 48 per cent. of all cases the plate had to be removed for suppuration. For each case these foreign bodies benefit there are 100 where they have been the cause of great harm.

2. Albee has been recently advocating fixation of fresh fractures by an autoplastic transplant, instead of Lane's plate. This is certainly correct and conducive to perfect results.

3. Autoplastic transplantation is used to replace bone destroyed from osteomyelitis; to replace the shaft of a bone lost by the removal of an osteosarcoma, etc.

4. In scoliosis following Pott's disease excellent results have been obtained. Albee has satisfactorily treated a large number of cases in this manner. Transplantation of an entire phalanx of a toe into a finger has been successfully employed by many in cases necessitating the removal of a phalanx.

In fresh fractures or in old ununited ones requiring immobilization and approximation of fragments, especially in comminuted fractures, I believe that autoplastic transplantation is far superior to any other form of fixation. Metal bone plates, external or internal pins, while occasionally successful, often cause a great deal of trouble and have been the direct cause of many amputations. These foreign bodies not only excessively traumatize tissues, but actually prevent bone regeneration. The autoplastic transplant not only immobilizes the fragments very effectively, but it adds stimulus to osteogenesis, often being the chief factor in reunion. No infection need be feared if your technic has been faultless; no plates, no screws to become loose and need removal.

GENERAL TECHNIC IN OSTEOPERIOSTEAL TRANSPLANTATION

As a most fundamental law to successfully transplant bone, we must regard asepsis. The aseptic technic must be extremely rigid. Next in importance we must consider the trauma caused by the soft tissue and bone. This must be minimal. Dissections must be made wit delicacy. Removal of callus or eburnated ends of bone to be

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