Selected monographs.

  • Kussmaul, Adolf, 1822-1902.
Date:
1859
Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    seems to be the latter, since separate parts of newly formed bbhe oft the ends of the radius and ulna are represented similarly; Roux found the lower end of the humerus rounded off, smbbth> and as it were encrusted (encroutee) by cartilage. The upper end of the ulna was ift the same condition. In the upper end of the •radius was a carious spot, corresponding to a fistulous channel in the soft parts. In no case had a new articular capsule been formed. The muscles of the arm were atropliied in Heyfelder's case, and a considerable deposit of fat was found in them, as weU as in the subcutaneous cellular tissue. All the other muscles, except thfe triceps, had their natural points of insertion. Whether these had been spared in the resection is left undecided by the statement, that the portion of bone removed was not large. The triceps was in- serted, in the case described by Syme, into the posterior surface of the newly formed ligamentous tissue, and through this was connected with the upper end of the ulna. In Tetter's case, in which the flexion and extension of the arm had been quite perfect, the triceps was firmly united to the cicatrii in the skin, without any prolongation to the ulna. Heyfelder found the median and radial nerves in their natural position. The ulnar nerve made a pecuhar bend at the point where it runs behind the inner condyle of the humerus. The nerves were more broken up, and disproportionaUy thicker and softer than in the natural condition, ahnost like strings of cellular tissue. Betweeft the separate nerve-fibres were found numerous fat - vesicles. Heyfelder believes that tliis formation of fat must be considered as the most potent determining cause of the incapacity for motion t6 which the arm had recently been reduced. The ends of the ulnar nerve, in Syme's case, where it had been divided, were encysted in an oblong swelling, an inch and a half ■long, and overlapped one another inside this. The substance of this swelling was grayish in colour, and extraordinarily hard and tough; it was united to the sheath of the nerve, and stretched inward between the separate nerve-fibres, which Were thus spread asunder. Most of them terminated in the swelling in a free extremity, which appear- ance, howev'er, might have been produced in the dissection. The remaining nerve-fibres became broader, stronger, and whiter in thfe swelling than they were elsewhere. Their upper and lower ends approached one another in tliis altered condition, and finally were united by a flnky substance hardly a line in width, which, under