Transplantation of tissue from lower animals to man, and a report of the case of bone-transplantation at Charity Hospital, Blackwell's Island, N.Y. 1891.

of the Case of Bone-Transplantation at Charity Hospital, Blaekuuell’s Island, fl* Y. BY A. M. PHELPS, M. D. , NEW YORK, Professor of Surgery University of Vermont; Professor of Orthopedic Surgery Medical Department University of the City of New York; Professor Ortho­ pedic Surgery New York Post Graduate School and Hospital; Surgeon in Charge of Orthopedic Wards, Visiting Surgeon to Charity Hospital; Con­ sulting Surgeon Mary Fletcher Hospital, etc. IVHB CASK of transplantation from an animal, recently performed at Charity Hospital, has commanded a wide-spread attention, and all sorts of absurd rumors have been circulated. The operation is a success in so far as it establishes the principle that it is possible to grow large masses of tissue from an animal to man, and to establish the circulation until the union takes place between opposite species without danger to either. It also demonstrates that a growth of new bone takes place when a sec­ tion of bone is transplanted and its nutrition maintained 'by the artery of the animal. This, if continued four or five weeks, would probably unite a fracture. Owing to the inefficient dressings which is apt to occur in early operations, the contact of the transplanted bone could not be continued sufficiently long for bone to unite to bone. But I am confident, after viewing the specimen, and taking all the conditions and surroundings into account, that bony union would have taken place if actual contact had been maintained for a longer period. The stimulation of the graft, however, has excited a reparative process in the fracture, and it now promises fair to unite. The boy walks with the aid of one crutch, or a cane. * history of the case. In the month of November, last year, the patient at Charity Hospital was sent to me for operation. Briefly the history of the case is this: The lad, John Gethins, was suffering from an ununited frac­ ture of the lower third of the leg, the result of an operation to remedy an anterior curve of the tibia, which had existed and had slowly increased from early childhood, until he was compelled to go upon crutches. Fig. '5 is a photograph of the case, before the operation of oste­ otomy. There was no paralysis of the limb, neither was it atro­ phied, excepting from non-use. The muscles were perfect in every respect. This case was referred to my clinic two years ago, by Drs. *A similar operation had been previously made by Dr. Phelps, but it failed; the details of the first case and the illustrations are omitted for want of room. The Journal is indebted to Dr. W. C. Wile, of the New England Medical Journal, for the paper and illustrations. It appears simultaneously in the New England Medical Journal. —Ed. Wey and Flood, of Blmira, and Assemblyman Dr. Bush, of Horsehead. A few months after the operation of osteotomy, I cut down upon the fracture and wired it, but failed in getting union. After a few months I again operated, removing all cicatricial tissue, carefully stitching the periosteum together, and wired the bone. This failed. A few months later I again cut down upon the frac­ ture, removed all cicatricial tissue, and again freshened the ends of the bone, and engrafted decalcified bone chips, according to Senn’s method. This failed; the chips came away from the wound a few weeks after the operation. I then' resorted to Thomas’ method of hammering, damming, and adjusting an appliance for the boy to walk upon. This he wore for several months, but again we failed to secure union. In the mean time the boy had returned to his home. From time to time I received letters from the lad, beseeching me again to make an effort to restore his limb to usefulness, and avoid an amputation. He returned again to New York, and was referred to one of the largest and best hospitals in the city; and one of the most eminent surgeons of this country operated upon him twice, with a failure each time. The poor boy, discouraged, returned to his home again. Last fall, in October, I received a most pathetic letter from him, asking if I would again attempt to unite the fracture. A letter was written to him stating that an attempt at bone-trans­ plantation from a dog, of which I had previously told him, would be tried if he desired. In answer to the letter, his parents at once sent him to New York. He was sent to Charity Hospital. The limb, at the time of the operation, November 16, 1890, was in very good condition, excepting the shortening of about four inches, the result of previous operations, which had been per­ formed to unite the fracture. It seemed a pity to amputate the leg. And surely we had ar­ rived at that stage of the case where, so far as our present knowledge was concerned, amputation was the last and only step to be taken. With all of these facts before us, we felt per­ fectly justified in attempting aay experiment which would prom­ ise to succeed in restoring the limb to usefulness, provided the danger to life was not too great. The brave lad had submitted to every means known to surgery for the relief of his condition, and, discouraged and heart-broken, had returned to his home. When he was told there was an­ other chance for his limb, his face brightened, and he said, “Doc­ tor, I w’ill take that chance. ” After consulting with the mem­ bers of the Medical Board of Charity Hospital, and several emi­ nent surgeons of this city, we decided upon an operation. It is a well-known surgical fact that an amputation performed in' the growing limb below the knee or in the humerus frequently results in what is known as a conical stump. This necessarily 'leads to re-amputation, and many amputations have been per­ formed from year to year, in the same case, for this abnormality. This was one of the reasons, but not the greatest, why we hesi­ tated to amputate the limb. A dog two years old was secured and prepared for the opera­ tion, carefully cleansed with soap and water, and made aseptic with a solution of bichloride o£ mercury. While the patient was being anaesthetised and the ends of the fractured bones freshened, my assistants, Drs. Plimpton and Mooney, prepared the dog, in the following manner: She was etherized, and then enveloped in a thick layer of absorbant cot­ ton to the thickness of several inches, while placed in the natural sitting posture. Over this soft covering of cotton a few turns of a plaster-of-Paris bandage were made, to hold the dressing in place. The dog was not encased in plaster-of-Paris; the right foreleg of the animal protruded through the dressing. This leg was carefully shaved, and again made aseptic with bichloride of mercury, and finally'with ether. The dog was now ready for the operation. With the assistance of Dr. James E. Kelley, Visiting Surgeon to Charity Hospital, and also Drs. Charles D. Roy, C. Stephenson and J. D. Wood, members of the house staff, we proceeded to the operation upon the patient, which was per­ formed before the matriculates of the Post-Graduate School and Hospital. There were also present Dr. Huntington, of Sacra­ mento, Cal. , and Dr. J. F. Winn, of Richmond, Va. , and the hospital staff. No one else was present. Two elliptical incisions were made down to the fracture, four inches in length, removing the old cicatrix and cicatricial tissue about the ununited ends of the bone, together with an elliptical piece of the soft parts. With a saw the ends of the bqnes were freshened, leaving a space about one inch between them. The portions removed proved to be eburnated, and more like ivory