278 MORBID ANATOMY.
heads of all the metatarsal bones, the three cuneiform bones, and the cuboid, all of which were diseased, were removed. A large incision was made longitudinally through the thickness of the sole, to permit the escape of pus. In making the dorsal incision, the extensor tendons were disregarded, as their usefulness had already been destroyed by the primary injury and the subsequent inflam- mation. Aug. 17th the patient sat up. Aug. 27th he began to walk by the aid of crutches. Sept. 1st the wound was entirely healed.
"Sept. 11. Having been about the hospital grounds for ten days, the cicatrix being perfectly sound and firm, and his health entirely re-established, the patient was discharged. The foot was somewhat shortened, though otherwise but little deformed. Its plantar aspect was convex instead of concave ; the bulging being due to the flexion caused by ap- proximating the surfaces of the gap made in the skeleton of the foot. The pressure of further use promised to remedy this. For walking, the stump was preferable to any which could have been left by an amputation of a portion of the foot, the only alternative of the operation performed." 1865. Dr. E. M. Hodges.
1448. Cast of a foot, from which all of the tarsal bones had been excised, with the ends of the tibia and fibula.
The patient, a little boy five and a half years old, was run over July 14th, 1865, and three hours afterwards entered the hospital (120, 74). The right foot was very extensively lacerated, but without fracture or dislocation ; and the left was similarly, but less, injured. On the 15th numerous punctures and incisions were made, to relieve the tension, which was very great, and with much relief. On the 18th there was a mild attack of scarlet fever, but with prolonged convalescence ; and, meanwhile, all active inflammation of the feet subsided, and the left got quite well. Over each malleolus of the right there was broad ulceration, and dead bone could be felt.
Sept. 6th, the general health being sufficiently improved, the foot was examined, and it was found that there was general necrosis of the tarsal bones, and that the ends of the tibia and fibula were also involved. About 1 in. of
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