Portal de Periódicos da CAPES

PROPHYLACTIC VACCINATION AGAINST EPIDEMIC MENINGITIS

1913; American Medical Association; Volume: 60; Issue: 17 Linguagem: Inglês

10.1001/jama.1913.04340170017009

1538-3598

J. H. BLACK,

Bacterial Infections and Vaccines

which xvas closely adherent to the bone.X-ray shoxved absence of about G cm. of the loxver end of the fibula. 1 exposed the upper end of the fibula and split it longitudinally so Hint about one-third of the cpiphysis xvith its cartilage was removed, together xvith a portion of tho shaft xvith its periosteum', C> cm. in length.This xvas transplanted into the defect below, the graft being secured to tho freshened stump of the lihiila by a collar of free fascia, and the opipliysenl end fastened snugly to the astragalus by a free fascia bund.In spile of unfavorable conditions on account of poor blood-supply this graft has done xvell.Skiagrams from time to time have shown the opiphyseal line to be present.Dr. Baetjer reported to me last week that ¡in a'-ruy taken then shoxved the epiphyseal line still intact and that the bone xvas undoubtedly growing.Tliis result is, to say the least, encouraging.Du. Funu 11.Auuîiï, New York: My experience xvith the transplantation of tissues has been confined wholly to bone, about thirty-six cases.All the transplants have been auto- transplants, and the xx'ork xx-as all done from the point of vlexv of an orthopedic surgeon.There xvere cases of congenital defects in the bony skeleton, pseudo-arthrnscs, club-feet, etc., and I believe that in tlie latter class of cases this is the ideal treatment.We can reconstruct tho skeleton of the foot com- pletely by using bone wedges, thus securing a properly shaped foot.The use I have made of bone transplantation has been mostly in Pott's disease.I believe that this xvill be eventually the accepted treatment, und the earlier the operation is done the better.I have kept in storage recently infants' bones to be used for bone-grafting.Auto-transplantation is better, but there xvill be certain cases in which it is better to use some other bone, and not to subject the patient to the extra hazard of taking some of bis bone.My xvork in animal experimentation has been cruder tliiin Dr. Carrel's, but I have been able to preserve dogs' bones for four days in an ordinary isotonic Ringer's solution.I have transplanted this bone and it has lived and groxvn.In the ice-box, of course, die temperature is far above that of cold storage, showing that xve have considerable leeway» in the handling of bone.Dit. A. Carrel, New York: I agree xvith xvhnt Dr, Davis and Dr. Albee said in regard to transplantation.It is cer- tain that the question of the usefulness of transplantation of tissue has not been settled.Auto-transplantation giyes better results than iso-transplantation, and it is only by making nexv investigations that it xvill be possible to know the value of homo-transplantation, especially if the tissues are taken fron) small children.That question cannot be very easily decided hy skin-grafting.My experiments are too fexv in number to enable mo to come to any definite conclusion.Many other experiments should be made.