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tending the application of the principles of tenotomy to the tendons of the flexor muscles of the legs, renders it, so far as my observation and reading extend, entirely unique. It is, besides, well calculated to encourage us in subsequent applications of tenotomy in similar pathological conditions, in whatever part located. This leads me to allude to a highly important application of the same principle to the treatment of strabismus or squinting, by Prof. Dieffenbach, of Germany. This ingenious surgeon has divided the internal rectus muscle (or rather, tendon I conclude,) of the eye in internal strabismus, with success. Several similar cases have appeared in

, the “ London Lancet,'* in which this operation has been successful in the hands of P. B. Lucas, Esq.

And we conclude that the same operation may be applied to the rectus externus, internal oblique, and tendons of other muscles of the eye, where these are found concerned in the production of abnormal direction of the axis of that organ.

The same pathological states will, no doubt, be found in the muscles and tendons of the thoracic extremity, besides the illustrations contained in the first cases which I treated.

This essay might be protracted, by considering certain subjects indirectly connected with tenotomy, but it has already equalled the limits contemplated in the outset.

Reference is more particularly had to the manuals, which I have found safest for executing tenotomy at the popliteal region-together with Wm. Bennet's details of his modications of Dieffenbach's operation upon the rectus internus oculi.

The most suitable age for treating congenital Kyllopodia, when this can be selected, as well as the whole subject of anchylosis, the correct diagnosis of which becomes so indispensa

*London Lancet, May 21, 1840. p. 188.

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ble in the interpretation of deformity in certain cases, are not less intimately associated with our subject.

I have found it safest in operating at the ham to make the preliminary incision through the skin on the inner side of the centre of the flexor tendons, and to introduce the tenotome from within outward, so as to make the section of the tendons from without inward. This is founded upon the relations sustained between the popliteal nerves and the tendons. These nerves aster descending to about the centre of the popliteal space, are found in the remainder of their course through this region, to lie almost in contact with the inner aspect of the flexor tendons. The section of the tendon being made from without inward, so soon as the section is complete, (evidenced by its sensible contraction, the instrument should be withdrawn and the nerve is safe, whereas it is possible if passed first around the inner side of the tendon the accompanying nerve will be embraced.

This modification I have also made in operating upon the tendo-achilles with a similar view of avoiding a wound of the posterior tibial artery and nerve.

In only one instance have I declined operating for Kyllopodia from the tender age of the patient.

This was an interesting and vigorous child of four months old, brought by its parents from a distant state last .year, which I advised to be brought back when it had attained its second year.

Doubtless tenotomy, so far as this alone is concerned, might be safely executed at a very early age, and when the torsion of the foot would offer the least obstacle to redress, but I should not feel inclined to impose the necessary restraints of the restoring appareil when the excitability of the nervous and vascular systems are known to be most exalted. From the fifth to the eighteenth year, must be considered as a very favorable age for treating any of the varieties of Kyllopodia. In illustration of the third and last topic named, of collateral importance in practical tenotomy, I will only add the following instructive case, in which tenotomy was unsuccessful.

Mrs. M. at about forty years, as a consequence of acute articular rheumatism, three years before, of the right knee joint, had the leg permanently flexed upon the thigh, about one third-i. e. it formed a very open angle with the thigh. The leg could be permanently flexed, but did not admit of extension beyond the degree named, and consequently lameness existed. It was evident enough that partial anchylosis existed in the knee joint, but inasmuch as the flexor tendons of the leg were rendered tense, in efforts at complete extension of the leg, the degree of agency which these exerted in maintaining the abnormal posture could not a priori be decided. Besides, preliminary diagnostic essays were resorted to with the original apparatus of Amesbury for fractures, with perceptible extension of the leg, beyond what she could voluntarily accomplish.

Encouraged somewhat by these trials, and knowing the doubtful nature of the result, this lady solicited the operation of tenotomy.

This operation was accordingly executed about the middle of May, 1839, in which sections of the biceps flexor cruris, and of the semi-membranosus and semi-tendinosus were executed. The limited cutaneous incisions were brought together by adhesives and united without suppuration. The third day succeeding these operations the appareil named was re-applied and by slight and repeated movements in the rack of the machine, the limb was extended beyond what it had been in the preliminary treatment.


Nothing was gained after this time, as further effort at extension of the limb produced pain and soreness in the joint, and after a short time, all further treatment was abandoned.

Tendinous reformation was as speedy and perfect in this, as in the preceeding operations upon the tendons of the flexors of the leg, and in due time the power of flexing the limb was recovered.

From all the facts as well as the history of Tenotomy in our possession, we feel authorized in advancing the following conclusion, viz.; that there is no variety of Kyllopodia, or any of its pathological congeners, recent or old, congenital or acquired-uncomplicated with anchylosis—which is not remediable in a very large proportion of instances by the treatment which we have endeavored to elucidate, and that the most aggravated of these deformities, from age or otherwise, may in like manner be decidedly ameliorated.

August 24th, 1840.

Art. II.-A Fourth Supplementary Catalogue of the Plants

of Kentucky. By C. W. SHORT, M. D., Professor of Materia Medica and Medical Botany in the Medical Institute of Louisville.

Having several years ago, published in the Transylvania Journal of Medicine, a catalogue of the phenogamous and filicoid plants, native to and naturalized in this state, so far as they had then been observed by me, I afterwards published, in three subsequent numbers of the same Journal, supplementary catalogues of other species, as they became known to me, either by personal observation, or the reports of others competent to determine them. I now offer a fourth supplement to the preceding lists, embracing merely the names of, and a few remarks on, some other plants, which have occurred to my notice in different parts of Kentucky, since the publication of the last. Like the others, this list is arranged alphabetically, without reference to systematic classification.

Ampelopsis cordata, on the banks of the Ohio River.
Aspidium dilatatum.
Aspidium asplenoides.
Acerates angustifolia.

Arabis lyrata, found by Dr. Riddell among the knobs of Greenup county, Ky.

Aronia latifolia, from the same locality, detected by the same botanist.

Anthoxanthum odoratum, (Sweet-scented Vernal grass.) This grass, which imparts such delightful odor to new-mown hay, is becoming gradually naturalized in our meadows.

Adonis autumnalis, (Pheasant's eye.) A showy exotic flower, found in the barrens of Kentucky, where it was introduced from a neighbouring garden.

Allium striatum.
Arenaria serpyllifolia.
Angelica triquinata, barrens of Ky.

Angelica atropurpurea, borders of Rock-Castle River, and other mountainous situations.

Asclepias parviflora. This species, so common in the southern States, has only been observed by me in the wet lands bordering on Green River.

Azalea nudiflora. (Bush Honey-suckle.)

Bumelia tenax, on the rocky banks of Little River, a branch of the Cumberland.

Boltonia glastifolia, swamps around Louisville.
Cyperus filiculmis, Islands of the Ohio.

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