Not less interesting than these two cases is an instance of necrosis symmetrically affecting both condyles of the femur, and communicating with the knee-joint, recorded by Mr. Wm. Adams in the seventh volume of the "Transactions of the Pathological Society." A sequestrum was present in both condyles in an advanced stage of separation, each being the size and shape of a large thimble, and accurately filling their cavities. These sequestra were of remarkable density in the neighbourhood of their

more »

... oint surfaces, and protruded within the cavity of the knee-joint, as might be imagined from the appearance of the following drawing, which gives an excellent idea of this unique and remarkable specimen :- The disease here must have previously implicated the bony structure, and then spread to the soft structures. This preparation would almost explain how a cure might be expected in such a form of disease; for if it were possible that the sequestra could pass into the cavity of the knee, and there become isolated without inflammation and its consequences, Nature would thus have converted the case into one of moveable bodies in that articulation. Henry E-, aged five years, admitted April llth, 1856, of scrofulous habit, light, curly hair, fair complexion, delicate skin. Two years previously he had a fall, and struck his right knee, which continued painful for about a month, and then became swollen. The swelling gradually subsided, but recurred a few months afterwards, and was attended with pain in the joint. He became a patient in the hospital, and remained about nine weeks. On leaving, he continued as an out-patient, but getting materially worse, was re-admitted at the above date. The knee was greatly enlarged, exceeding the other in circumference by nearly four inches, and extremely tender to the touch. From two to three inches above the outer condyle of the femur was a fistulous opening, into which a probe could be passed downwards, within the bone, for an inch and a half. The boy was placed on a nourishing diet, and ordered cod-liver oil; all motion of the limb was carefully guarded against. June 9th.-An abscess which had formed in front of the knee was laid open, and discharged about an ounce of seropurulent fluid mixed with blood. Poultices were directed to be applied. August 7th. -During the preceding ten days the condition of the knee became evidently worse. An abscess had formed on the outer side of the joint; this was punctured, leaving a fistulous opening, which communicated with the cavity of the joint. The joint itself had an elastic feel, and measured in circumference twelve inches and a quarter, while that of the other limb measured eight inches only. There was a superficial ulcerated cavity on the inner side of the knee, about two inches by one in extent. He complained of pain referred to the outer side of the patella. The appetite was variable; the tongue clean, and he slept tolerably well. He was ordered steel wine. 13th. —As the boy's health was rapidly giving way, and there was evidently extensive disease of the different tissues constituting the knee-joint, with an unsound condition of the lower portion of the femur, it was determined, after consultation, to remove the limb. Mr. Ure accordingly performed amputation of the thigh at its lower third by circular incision, the patient having been rendered insensible by chloroform. Nine vessels were tied, but very little blood was lost during the operation. A few points of suture, with a compress of lint, and a few turns of a roller, completed the dressing. The boy was placed in bed, and had a draught containing five minims of laudanum. On laying open the j oint, the synovial membrane was found in a state of pulpy degeneration. There was pus in the joint, and also in different parts of the periarticular cellular tissue. There was an opening in the femur, about two inches and a half superior and posterior to its external condyle, sufficiently large to admit a small bougie; this communicated with a cavity, the size of a hazel-nut, situate about the centre of the epiphysis of the external condyle, and which contained fragments of dead bone. The cartilage covering the condyles was eroded to some extent, as was also that of the tibia opposed. The periosteal vessels were much enlarged. 14th.-Pulse 108; skin cool; slept well; tongue clean and moist; appetite good. There was no bleeding from the stump. The laudanum draught was repeated at night. 15th.-The patient slept well; his appetite was so increased that he asked for an additional allowance of food; the tongue was clean ; the pulse and skin natural; the stump looked well. He was allowed half diet with eggs, and two ounces of wine. l6th.-General health was much improved; the sutures were removed; the stump looked well. l9th.-The pulse was good; appetite excellent; tongue clean; bowels regular. The stump had healed throughout, with the exception of the angle where the ligatures were placed, two of which separated the day before. 25th.-He continued to improve in health, and gained flesh considerably; took his food better, and slept more soundly, than he had done for weeks before the operation. 26th.-Two more ligatures separated, one only being left. The patient was so far recovered as to be able to sit up in bed. 29th.-On dressing the stump, a little pus was seen to ooze from near the centre out of a small opening in the line of the cicatrix. The boy seemed indisposed ; the appetite was impaired, but the pulse was good, and he slept well. The strapping was discontinued, and water-dressing substituted. 31st.-The last ligature separated; a second opening made its appearance on the surface of the stump, from which a little . thin sanious discharge exuded; the general health was improved. ! Sept. 4th. -Both openings were closed, and the stump . looked firm and solid; the health was good. llth.-The patient was feverish, and complained of uneasiness (referred to the stump); had no appetite for food. The ! wine, &c., were left off, and effervescing saline draughts prescribed. 12th.-He passed a restless night; was very feverish and . thirsty; the pulse extremely rapid; tongue clean. There was an erysipelatous blush over the lower part of the thigh, and a small abscess seemed to be forming at the outer angle of the . stump; a man in the ward was, at the same time, suffering . from erysipelas. A limitary line was drawn round the confines ; of the erysipelas with a pencil of lunar caustic, and a cooling lotion applied. Saline medicines were prescribed. l5th.-The condition of the stump was much improved; the . erysipelas and swelling were abated, as were also the febrile symptoms; but there was the threatening of the formation of . an abscess on the inside of the thigh, about seven inches from 'the extremity of the stump. Dilute nitric acid, with decoction and tincture of cinchona, was prescribed, to be taken thrice daily. ! l7th.-There was every indication of the impending abscess terminating in resolution; there was no fever; the pulse was ! natural, and the appetite much improved; there was still some redness of the surface, which was directed to be pencilled over with tincture of iodine, and bran-poultices applied. 20th.-The patient was much improved in every respect; the thigh was well. He was allowed to remain in the hospital till the beginning of October, when his parents took him home into the country. He was in good health and spirits, with a firm, well-formed stump. -