164 MORBID ANATOMY.
B. removed the pieces here shown ; first dissecting up and reflecting the periosteum, then drawing the fragments to- gether by a wire, and then replacing the periosteum. June 24th the man was doing well, and left the hospital. Sept. 17th he returned to have the wire removed ; and the union then was quite firm. " Dec. 16th, 1865 : The arm is per- fectly firm, and for some time the man has done a great deal of heavy lifting, such as wheeling coal, without favor- ing the injured arm in the least." The wire is shown with the bones. 1865. Dr. H. J. Bigelow.
The above was the first of eleven cases, in which Dr. Bigelow has done an operation for ununited fracture, which was original with himself, and in all of which the result was successful, excepting one (No. 1010) in which the bone was diseased. The principal points of the operation consist in a dissecting-up, and preservation, with the least possible injury, of the periosteum, in consideration of its " osteoplastic function ; " the drawing together of the bones, and securing them by wires, after the ends have been sawed off; and the removal of burrowing pus. These cases, all of which occurred at the Mass. Gen. Hospital, have been published by Dr. B., with remarks upon the history of the operation, and also a clinical lecture upon the subject, in the Med. Jour. Vol. LXXVI. pp. 297 and 325.
1006. A second case. The patient, a laborer, set. twenty-six, entered the hospital (121, 150) June 12th, 1865, and the accident happened a year before ; the fracture being com- pound, and caused by the passage of .the wheel of a hand- car over his arm. At the end of six weeks it was again fractured ; and it never again united.
On ,the 21st, Dr. B. made an incision upon the outside of the arm, turned aside the musculo-spiral nerve, stripped back the periosteum from each fragment of the bone, and sawed off J in. from the lower, and f in. from the upper. The ends of the bone were then drilled on the outer side, and a silver wire passed through ; and, the bones having been placed in apposition, the wire was twisted by four half-turns. The arm was then placed in an inside and out- side angular splint, and the wound closed by sutures.
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