adaptability. Why should medicine linger to adopt what chemists, engineers, physicists, and other professional men who have to do with facts and figures so heartily indorse and approve? One can hardly peruse a continental work without finding either the use of the gramme for weight or the centigrade degree for fevers. Germany, although it despises France and her institutions, gives PARTS in her Pharmacopoeia. Boston has advanced to the use of the metric notation. The New York Medical Society, awakened to the issue, resolves to abandon the heathenish figure which clings with such pertinacity to all prescriptions, and this Medical Society of the State of Pennsylvania should recommend similar action to the scientific and enlightened physicians composing her body. A MODIFICATION OF SYME'S AMPUTATION AT THE ANKLE-JOINT. By W. R. HAMILTON, M.D., OF PITTSBURGH. THE following modification of the operative procedure in the performance of Syme's amputation at the ankle-joint possesses the merit of lessening or avoiding the danger of sloughing of the posterior flap. Having taken the necessary precautions to control hemorrhage, commence the incision at the lower tip of the external malleolus, and, cutting down to the bone, carry the knife across the sole of the foot, and terminate the incision at a point about a half inch below the centre of the tip of the internal malleolus; then join the extremities of this incision by cutting directly across the front of the ankle, and open the joint in front; divide the lateral ligaments and proceed at once to dissect the posterior flap from the os calcis, proceeding from the joint downward, dividing the attachment of the tendo Achilles, and terminating the dissection at the point where the books direct it to be commenced. The advantages of this method of performing this operation are— 1. The comparative facility and rapidity with which this part of the operation may be performed. 2. The preservation of the heel portion of the flap from injury from the excessive stretching and contusion, which is almost unavoidable by the old method. By this method the os calcis may be dissected out without any unnecessary fingering of the flap, and the structures to be divided by the knife being always in view, the dissection may be carried so close to the bone as to leave the outer fibres of the periosteum attached to the flap; thus avoiding the division of any arteries (except the nutrient arteries of the calcaneum), and also escaping the danger of injuring the subcutaneous tissue of the heel by thrusts of the knife into it, or of making button holes through it, or by the forcible dragging backward and contusion of the flap, which almost necessarily attend the efforts of the operator to dissect past the turn of the heel, and to dig out the os calcis. 3. The flap is not only preserved from injury, but the troublesome hemorrhage occasioned by accidental punctures of the heel portion by the point of the knife (an accident almost impossible to escape in the other methods) is almost entirely prevented. 4. By this method it is not necessary to carry the incision far back across the sole toward the point of the heel; nor to direct the line of the incision across the front of the ankle so far downward upon the instep. The plan of sawing off the malleoli obliquely, and leaving the cartilage on the remaining portion of the articular surface of the bones of the leg-originally advocated by Professor Gouley, of New York, is another improvement of great importance, especially when the operation is required during childhood. This modification of Syme's amputation at the ankle-joint will probably, in all favorable cases, prevent the sloughing of the heel flap, an accident which has hitherto been the chief source of failure. I have now performed this operation four times by the method above described, and it has been twice performed in the same manner by other gentlemen in this city. In all these cases the results have been most favorable, the flaps uniting at least as well and as favorably as after an ordinary amputation of the leg. In two of the above cases the entire incision united by first intention, except at the point at which the ligatures were brought out of the wound. |