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LECTURE-CONVALESCENT CASES.

A CLINICAL LECTURE BY PROF. LEWIS A. SAYRE, AT BELLEVUE HOSPITAL

CASE 6.-MARY CASHEN. Here is a little girl I feel proud to show you. Look at that smiling face, compared with what it was when she came here several months ago. The operation was performed three months ago. You will recollect that this girl came here with chronic disease of the knee-joint, which she had had ever since she was seven months old. From the age of seven months on, she remained with her knee in a state of chronic inflammation. It was plastered, and issued, and fired, and iodined, and she took internal remedies all the time, until within a few weeks of the time when she came here, but she never had extensions and counter-extensions, to overcome reflex muscular contraction. The muscles contracted in such a way as to produce a complete luxation backward of the leg upon the thigh, so that the head of the tibia lay in the intercondylic notch.

You will recollect that the leg and foot were models of symmetry and beauty, never having been stepped upon, or never having worn a shoe The disease had so thoroughly involved the joint, that an extension alone could not save the limb. If a resection had been performed, the leg would have been too short to walk upon, and on that account I decided to perform an ampu tation upon the knee-joint, leaving the patella to form the end of the stump.

Mr. A. A. MARKS, the instrument maker, has been kind enough to present to this little girl an artificial leg, and I feel under great obligations to him. He makes, as I think, altogether the best artificial leg I have ever seen, simply because of its durability and simplicity. The foot has no joint at the ankle, and this is where the great advantage comes in. The core of the foot is a small solid piece of wood in the shape of a foot, only much smaller. This core is covered with a thick layer of sponge rubber, so that from the instep to the toes, and back to the heel, the foot is simply rubber. The elasticity of the toes and heel compensates for the absence of the ankle-joint, and in walking there is none of the jarring, dot-andgo-one walk, so characteristic of the jointed leg. With this rubber foot she can walk with the Stealthy, noiseless tread of a cat. The spring and elasticity of the foot is a positive comfort to the patient.

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