The Ethmoid Cells at Birth and Their Development during Fetal Life

Abstract

case was similar in details and results; the third is too recent to admit of report as to results. Outward displacement of the heel we have dealt with but once. This was a case operated on by one of us in 1903 for extreme upward, as well as outward, displacement. Operation was done two months after injury to relieve practically total disability due to extreme flat foot combined with pain from pressure underneath the flattened arch. In this case the operation elone was Gleich's operation for flat foot. A cross section of the os calcis behind the joint was executed with a chisel through lateral incisions. Probably the Gigli saw, then not available, would work better. The heel was then displaceel elownward about three quarters of an inch, inward about the same distance. Tenotomy of the tendo achillis was done and the position retaineel by plaster. At the end of five weeks he was already walkingbetter than before the operation and was discharged with the os calcis firmly uniteel in its new position. We have been unable to trace him since and can give no further elata. CONCLUSIONS. The points we would wish to emphasize in this preliminary paper are as follows: Comminuted fracture of the os calcis is relatively common. Nearly all cases arc of substantially the same type. The results are rather frequently so imperfect as to interfere seriously with work or to disable the sufferer entirely.-The cause of disability is not the fracture as such, but certain displacements, outlined above, which should be remediable or rather preventable. The treatment orelinarily advocateel and carried out is no treatment at all. We have till of us been guilty of what is very nearly criminal ne'gligence in regard to these cases. Certain measures are practicable in the treatment of fresh cases that will minimize, or often Prevent, the special displacements which are the cause of disability. It is our duty to adopt a 1-outine embodying some such measures along the fines of the routine above suggested. Provided such measures have not been carried out, and provided disability is present, palliation 's possible by apparatus in some cases, while in others operations of no great gravity or technical difficulty will insure decided improvement of •unction. "his paper is, then, a plea for more accurate study and more active treatment, a plea, in other words, for a real surgical treatment for this class of lesions.