the diseased bone, and the probe also entered from behind into the elbow-joint. The disease in the ulna was imagined to ter. minate about an inch above the wrist, but to extend into the elbow-joint. The radius did not appear to be engaged in the disease. The patient's general health was good. August 30th. -The whole of the ulna, as well as an inch and a half of the extremity of the humerus, and also the head and neck of the radius, were removed by a single incision along the posterior and inner side of the forearm by me. The skin was dissected back, and the ulnar nerve cleared away from the internal condyle. The disease was found to extend the entire length of the ulna. An endeavour was at first made to disarticulate at the wrist by cutting the lower attachments of the ulna; but it was found to be much more easily accomplished by cutting the triceps and lateral ligaments, and getting into the elbow-joint. The entire ulna was now disarticulated and dissected out. An inch and a half of the ends of the humerus and radius were then removed. No vessels required to be tied. The wound was left open for three hours, when sutures were inserted, and the arm placed upon a straight splint. September 1st.-The arm was placed in a semi-bent position, and laid upon a guttapercha splint. 5th.-The whole of the wound had healed by the first intention, and the sutures were removed. 8th.-The splint was taken away, and he could move his fingers and hand, and get his left hand to the mouth with the assistance of the right, but could not do so of his own accord. 10th.-The wound completely healed twelve days after the operation. 12th. -He continues to move the joint and use his finger; but is only just able at present to raise the forearm, showing that he is beginning to regain the power over the biceps muscle. The arm is, however, small and weak. There is every prospect of the patient having a very useful arm and hand. His general health is good, and he is out of bed and going about. No. 3636 (see Plate X, fig. 1).—On examination of the parts removed, it was found that the whole of the ulna was much enlarged, from deposition of new osseous matter, enclosing several portions of necrosed bone. The whole of the cartilages covering the ends of the bones forming the elbow-joint were absorbed, and the bones carious. Dr. Woodhouse, of the

Norwich Dispensary, gave the following account of the condition of this case, dated 26th March, 1860:-"I have to-day seen your old patient, W-, and regret to say that he is quite unfit to undertake the journey to Fort Pitt; he is in a very emaciated condition, and will, I think, soon succumb to his disease phthisis pulmonalis.' His arm is in a satisfactory condition, inasmuch as there is a good sound cicatrix, and the limb presents a healthy aspect; there is not at present, however, much power in the arm." This must be expected in a patient dying of consumption. Died 5th July, 1860, thirty-two months after the operation.

It is not often that a case occurs where the disease is entirely confined to the ulna and bones of the elbow-joint. With regard to the operation, it was found much more easy to disarticulate from the elbow than from the lower extremity of the ulna, and care was required to avoid cutting the arteries and nerves by keeping close to the bone. It is also worthy of remark that no vessel required to be tied, although they must have been increased in size to supply the enlarged ulna. The rapidity with which the wound healed is also remarkable.

The following is a case of partial excision of the wrist-joint : 78th Regiment. - Corporal David Fotheringham, wounded July 12th, 1857, by a musket ball, in the right wrist-joint. The ball entered on the anterior surface, and passed directly out on the posterior. Several small pieces of bone were taken away at the time. The hand has been kept in a straight splint ever since, and he has now nearly lost the use of the fingers. The wrist-joint is much enlarged; the aperture of entrance of ball is long since healed, that of exit still remains open; diseased bone can be felt. May 10th, 1858.-Diseased bone taken away by the gouge. June 2nd.-Invalided. General anchylosis of the carpal bones. Wound nearly healed; has the use of the fingers to some extent.

RADIUS.

Fractured or necrosed portions of the radius, or even the whole of the bone, may be removed by incisions on the outside or posterior aspect of the forearm.

WRIST-JOINT.

This joint may be excised, and the ends of the radius and ulna, with portions of the carpal bone, for gunshot wounds or disease; but no definite rule can be laid down, as a good anatomist and surgeon will have no difficulty in knowing how to act in any particular case.

FINGERS.

It is always necessary to take into consideration the probable after utility of the part which it is wished to save in excision of the metacarpal bones and phalanges; for after the removal of a portion of bone or finger, it may be so stiff as to be perfectly useless and very much in the way, and may ultimately require to be amputated. If the hand itself can by any possibility be saved, however multilated or stiff it may be, it will most probably be of more service than any after substitute, as even a stiff wrist and shrunken hand is better than none at all.

INFERIOR EXTREMITIES.

EXCISION OF THE HIP-JOINT.

Ten cases of wounds of the hip-joint are returned in the report on Crimean wounded. In 3 there had been such extensive injury inflicted that they proved fatal in a few hours; 7 were discharged for operation, 1 of which was for amputation at the hip-joint, in a case of extensive longitudinal fracture into the joint; the remaining 6 for resection of the head of the bone.

Excision of the hip-joint for gunshot injury has been performed eleven times. Of these, but one recovered, that of a soldier wounded by a shell at Sebastopol, and operated upon by Dr. O'Leary. The patient was twenty-five years of age; the head, neck, and trochanter of the femur, were removed.

Of the 11 cases recorded, 6 occurred in the Crimean war; 1 occurred in the Schleswig Holstein war; 1 by Dr. Ross, 1