broken, and good motion was restored. These adhesions were, of course, extra-capsular.

I entirely agree, however, in the opinion expressed by M. Velpeau, that to rupture consolidated osseous anchylosis is cruel and barbarous; but I would further say, that such treatment is unwarrantable and never to be thought of, when the safety of the patient is a primary consideration.

CHAPTER IV.

THE TREATMENT OF FALSE ANCHYLOSIS.

Rupture of adhesions by forcible extension-Section of tendons, and subsequent separation of adhesions -Gradual extension.

IT has already been shown that the causes of false anchylosis are various. It has also been shown that the results of inflammation differ in some measure as the causes. It will be reasonable, therefore, to expect

that the treatment of these varied effects of inflammation shall differ, and that it will be advantageously adapted to each case, according to its peculiarities. Thus, we will suppose five classes of cases of false anchylosis.

1st. Extra-capsular adhesions without alteration in the form of the articulation.

2dly. Extra-capsular adhesions with muscular retraction, or with cicatrices, but without alteration in the form of the articulation.

3dly. Slight intra-capsular adhesions.

4thly. Slight intra-capsular adhesions, with muscular retraction and cicatrices.

5thly. Intra-capsular adhesions, with alteration in the form of the articulation.

It will be seen at a glance that these several forms of false anchy losis differ materially. I will now endeavour to show that successful treatment requires that measures shall be adapted to each case according to its pathological conditions.

In some forms of anchylosis, the adhesions will alone yield to forcible extension; in others, they will yield to forcible extension after the sub-cutaneous division of tendons; while, again, in other cases, the adhesions will yield to gradual extension.

I have seen cases of false anchylosis treated by gradual extension for months and years, without the slightest benefit being derived. I have further seen cases of true anchylosis treated in the same manner as false anchylosis, when, by such means, any advantage was impossible. Such treatment is simply empiricism and cannot be defended.

With pathological knowledge and chloroform, an accurate diagnosis may be made. It is, therefore, to be hoped that a great change may be effected in the treatment of this important class of affections.

It is a great gain to exchange a position in which the limb is useless for another in which it is made available for some of its purposes; when, for instance, the thigh, having through neglect been allowed to become fixed at a right angle with the trunk, is brought into a slightly flexed position; or when the forearm, having been left fully extended, is bent at an acute angle, &c. How much greater is the gain, when, instead of a good position of the limb merely, motion can be restored. That this can be done-that motion can be obtained, without danger to the limb and without pain, in a large number of cases, and in many others with patient, painful perseverance, I will show.

In no instance in which I have been concerned has there been injury to the limb or to the health or to the life of the patient; but, on the contrary, the removal of so great a misfortune as anchylosis of a large joint has always been hailed with unbounded satisfaction. I have not known any cases in surgery which have caused so much delight as the restoration of motion to an anchylosed hip-joint, for instance. The freedom which is thus given can only be compared to the removal of the fetters from a prisoner. Some few cases of this description have impressed me deeply.

Occurring, as these cases very frequently do, in the young-in the hey-day of life, when action is a neces

sity, it requires to be seen to be fully understood, how the advantages of restored motion are appreciated, when the hip-joint, for instance, has been for several months motionless. In three instances, the careers of young officers were supposed to be closed by misfortunes of this nature, which had befallen them. And in a fourth instance marriage was made dependent on the successful termination of the operation. I am proud to say that, in two of these cases, hip-joint motion was perfectly restored; and that, in the other two, motion was so perfect that it was sufficient for all the ordinary purposes of life. I may perhaps be excused in thus expressing myself, since it had been determined, in various consultations which had been held in reference to three of these cases, that the restoration of motion was impossible.

Palasciano followed the practice of Louvrier, but with more success than the latter; and having directed attention again to this operation, several of the leading surgeons of Europe, as Bonnet, Schuh, and others, but especially the Germans, followed in his steps-Berend, Buehring, Lorinser, and others.

Dieffenbach was among the first to modify this forcible extension of an anchylosed limb, by the previous

* Durchschneidung der Sehnen und Muskeln.