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the patient returned to his bed. Very little blood was lost during the operation, and no vessel required tying.

The operation was followed by almost instant relief of his constitutional symptoms. He was a little sick for the first forty-eight hours from the chloroform, but otherwise his course has been one of uninterrupted improvement. His countenance soon became cheerful and free from

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From a photogram of Timothy Dacey, 4 months after excision of the right hip.

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anxiety his night-sweats ceased in two days from the operation. On the third day the wound in the groin was entirely healed. The discharge from the wound made at the operation, which, for the first few days, was very abundant, gradually became thicker, and diminished in quantity, until it did not amount to a teaspoonful in the twenty-four hours. He was able to sit up in bed, for the first time for nearly a year, with the knee straight, in fourteen days after the operation. In three weeks he dressed himself and sat in a chair by the fire. In five weeks he was able to walk with a crutch and a stick; at the end of eight weeks, however, he imprudently dispensed with both crutch and stick: inflammation ensued, followed by abscess external to the pelvis. This, however, soon subsided, and he then progressed steadily, gaining flesh and strength. At the beginning of April, 1857, he was able to enjoy daily a walk in the Park. At this time a photogram was taken, from which the woodcut in p. 446 is copied. . On May 15th, 1857, the boy went down to Ramsgate, where he imprudently employed himself in taking much walking exercise. On the 6th July, 1857, he returned to the hospital with phthisis, and died on the 13th July, 1858.

It is interesting to observe the mode in which the truncated end of the femur and the pelvis act, so as to acquire a new point for the support of the body. On examination of this patient, it was found that the end of the femur abutted against the sawn surface of bone which represented the upper margin of the acetabulum. It was enclosed and shut into the cavity by a tough, fibrous capsule, which was deficient at the posterior part, whence pus escaped (a portion of this capsule is represented hanging down as a triangular fold). On turning out the end of the femur, it was found rounded off; the extremity of the medullary tube was partially closed in by a thin plate of bone. The opening still remaining had jagged, uneven edges, and it seemed as

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ANDREW del

Condition found 19 months after excision of the HipParts in situ.

though the osseous covering had at some former period been complete, and had subsequently yielded to the absorption produced by pressure at that part. The cavity which took the place of the acetabulum was roomy, and had a large perforation still patent. The upper part, against which the end of the bone had pressed, was covered by a thin but dense fibrous structure; at its back was a carious spot, about the size of a sixpence, the diseased action being quite superficial. A singular

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adaptation of parts, in order to compensate for the absence of the cervix femoris, was found, namely, a bending inwards of the descending ramus of the pubis and of the ascending branch of the ischium. The pelvic abscess was consolidated, and the iliac fascia was tightly stretched over the opening in the acetabular (?) cavity.

The boy who was operated on by White died some five years afterwards, and the parts are preserved in the Museum of the College of Surgeons. "Both the os innominatum and the remains of the femur are slender, small, and light. The upper part of the shaft of the femur is placed opposite the posterior part of the acetabulum, to which, as well as to the adjacent part of the ilium, it is firmly but moveably attached by dense ligamentous tissue, portions of which appear to be formed of the capsule of the joint doubled in between the bones. Connected with the same tissue, and with the upper part of the shaft, is a portion of muscle, enclosed and mingled with the cellular tissue.' It may be added that the truncated end of the femur appears to rest upon no bone, but to be simply invaginated in a fibrous socket, which is bound to the pelvis by firm broad bands, clasping the pubis, ilium, and ischium.

The girl from whom the annexed figure is taken was operated on in 1848 by Mr. French, of Marlborough Street.† The head of the femur was dislocated upon the dorsum ilii. The acetabulum almost obliterated. The bone was sawn off just below the trochanter minor. The girl was ten years old when the operation was performed, therefore is now twenty-two; is five feet four and a half inches high. The truncated end of the femur lies in the greatly depressed scar, and is evidently bound to the pelvis by dense fibrous tissue. She has power of flexing the thigh a little up and down. When she stands upright the foot does not come to the ground by 4 inches. The measurements on the sound side are, thigh 13, leg to sole 16 inches; operated side, thigh 11, leg to sole 15 inches. Thus the actual loss of length is but 3 inches. We cannot then conclude that the femur has ceased to grow; it is even now only 2 inches less than that of the sound side, and there could not have been much less than this removed during the operation. Of the other 21 inches lost, one is absent from the lower leg, the other is accounted for by the position of the thigh, which is adducted very

* Catalogue of the Museum of the College of Surgeons, Pathological Series, vol. iv.

A portion of this case is reported in the Lancet,' 1848. I am indebted to

Mr. French for kindly giving me further details, and for allowing me to have the photograph taken, from which the woodcut is copied.

much inwards, so that the knee tends to cross the other. This is compensated for by abduction of the leg at the knee, the position being that of genu valgum. Whenever she bears slight weight on the limb this malposture increases, and she cannot

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