pressed the operation urgently. Consent, however, was not immediately given, and time was asked for consideration.

The mother and her son returned home to the neighbourhood of Oxford.

In the first week of August, they again came up to town. I was astonished to see my patient bending his knee, and walking with only a slight limp. He had on the previous day been playing roughly with his brother, when he was thrown to the ground, and in falling he bent his knee under him. He felt something yield about the knee, and was much frightened; but on being carried into the house, and recovering from his fear, he had no pain in the joint.

I found that almost the entire motion of the joint could be borne, and that scarcely more had to be done than to order a thicker sole to be added to his shoe.

CASE XVI.

Rheumatic inflammation of the hip-joint- Intracapsular adhesions-Gradual extension.

E. B-, in 1853, when fourteen years of age, was seized suddenly, and during the night, with

severe pain in the right hip. The joint continued to be painful for eighteen months, when the pain ceased, and the patient was again able to use the limb. Pain soon, however, returned, and the joint remained painful until Christmas of 1856. In April, 1857, he was sent up to London, to have the advantage of Sir Benjamin Brodie's opinion; and Sir Benjamin, thinking that it was a fit case for the forcible rupture of the adhesions, very kindly sent him to me.

The thigh was flexed, so that the heel was three inches from the ground; the buttock was somewhat flattened; there was slight motion at the hip-joint.

It appeared to me probable that the adhesions might be overcome and that the limb might be extended by mechanical means alone, and without the application of sudden force; and I consequently gained permission to try the effect of gradual extension before proceeding to forcible rupture.

In the course of three and a half months, the limb was perfectly extended, and such a useful amount of motion was gained that it was not necessary to resort to more force. Passive motion and friction were employed to gain the use of the extremity, and before he left London he could walk, using the limb very fairly. Motion caused very little pain, and it was, therefore, employed somewhat roughly after he had

returned home, in the hope that it would expedite the cure; and in consequence an abscess formed. But notwithstanding, when I last saw him, he enjoyed considerable power over the limb, with motion at the hip-joint.

CASE XVII.

Rheumatic inflammation of the hip-joint—Intracapsular adhesions-Section of tensor vagina femoris-Gradual extension.

A. B-, in 1850, when she was five years of age, after sitting on the damp grass, suffered from rheumatic inflammation of the hip-joint. Abscess formed around the joint, which broke and healed at various points: contraction took place, and the limb was rendered immovable.

When she was nine years of age I saw her. The thigh was flexed upon the pelvis, the foot being raised eighteen inches from the ground; an abscess in the neighbourhood of the trochanter discharged a small quantity of pus; very slight motion remained at the hip-joint, and attempts at motion excited pain.

Gradual extension was employed, and it had been carried only to a slight extent when the abscess healed.

It was continued, and flexion was, in a great measure, overcome, but the limb could not be entirely extended, in consequence, as it appeared, of contraction of the tensor vaginæ femoris muscle, as well as of some cicatrices in its immediate vicinity. With the concurrence and assistance, therefore, of Mr. Scannell and Mr. Mould, I divided the muscle at its origin, as well as the cicatrices subcutaneously, and again, after some days, when the punctures had healed, extension of the limb was recommenced. All difficulty seemed now to be removed, and the limb was soon fully extended. Passive motion afterwards completed the cure, and I had the satisfaction of knowing that, before twelve months had expired from the commencement of the treatment, the child was able to walk well and firmly with the aid of a stick.

At the present time the limb is strong. It is somewhat shorter than the other; but when this deficiency is compensated for by an extra thickness of the sole of the boot, there is little or no weakness apparent, and exercise can be taken freely.

CASE XVIII.

Inflammation of the knee-joint after scarlatina-Subluxation of the tibia-Intra-capsular adhesionsSection of hamstring tendons-Restoration of

motion.

J. N-, fourteen years of age, of a healthy aspect and a dark complexion, was placed under my care in July, 1855.

When he was five years old he suffered severely from scarlatina, and he had not recovered when his knee became inflamed; abscess formed, which, burrowing, surrounded the joint, and discharged itself at various points. Numerous adhesions were consequently formed, the flexor muscles became contracted, and subluxation of the tibia resulted. The limb was atrophied; the knee was bent at a right angle ; there was just appreciable motion at the knee-joint.

I divided the hamstring tendons and some tense fascia, as well as several points of adhesion; and a week later, the punctures having healed, I ruptured the adhesions in flexing the limb, being assisted by Dr. Dick, and by Dr. Snow who administered chloroform.