string tendons on one side to those on the other, passing below the patella. The flap thus formed was dissected up, and the patella removed. It was found bound down by fibrous adhesions, and locked in between the external condyle of the femur and the external head of the tibia. There was found to exist fibrous anchylosis in the portion of the joint corresponding to the external, and bony anchylosis in that corresponding to the internal condyle of the femur. After freeing the outer portion of the joint with the knife, the leg was forcibly flexed, and the bony anchylosis broken. By working carefully around the periphery of the tibia, this bone was fully exposed, and a section made from before backward, at right angles to the axis of the limb, with a common amputating-saw. When the section was nearly completed, the back of the saw was raised so as to break off the piece, in order not to wound the artery. This section was about half an inch thick. A slice was then removed in the same manner from the femur, of about three-quarters of an inch in thickness. The cut end of the internal condyle showed points of disease. As the amount removed was not sufficient to permit the bones being brought into apposition, another piece was taken from the femur, leaving the cut end of that bone healthy; it was also found necessary to take a second section from the tibia, in order to allow the leg to be brought into a straight line with the thigh. Two pieces of malleable iron wire were then passed through holes made in the following manner: one, beginning at a point about one inch and a half below the cut edge of the tibia, and corresponding to the middle of its external head, passed upward and backward so as to emerge at about the middle of the cut surface of this bone; another, beginning at a point the same distance from the cut edge of the femur, and corresponding accurately with that on the tibia, was made to pass downward and backward so as to emerge on the cut surface of the femur directly opposite the first. Similar holes were made to pass from the internal head and internal condyle. The wires being placed in position, the bandage was removed. There was but little hæmorrhage from the soft parts, but the oozing from the cut ends of the bone was profuse. The cut surfaces of the bones were irrigated with a strong so

lution of carbolized water, until the oozing had greatly diminished. The wires were then twisted so as to hold the bones in apposition. The limb was then put up in the following manner: A splint was made, consisting of a thigh-piece made of sheet-steel, gauge No. XX., extending from just below the trochanter to within an inch of the point of section; this was accurately fitted to the posterior aspect of the thigh, wider above and narrow below; another piece of steel, ex tending from just above the malleoli to within an inch of the point of section, being cut out at its lower end, so as to take off all pressure from the tendo Achillis; this was also accurately fitted to the back of the leg; these two pieces were united by a short piece of iron riveted firmly to one of the back splints, while it was held to the other by a screw, so that it could be lengthened or shortened; the edges of both pieces were turned back, so as to prevent any cutting. The piece of iron connecting the two was so bent as to leave a free space behind the joint. The leg was bandaged from the toes up to the joint, and the thigh from above downward, with flannel bandages. The limb was then laid on the splint, and the whole surrounded with plaster-of-Paris bandages, so as to hold everything securely, leaving an interval on top of three or four inches in the location of the wound, but almost meeting behind the iron bar uniting the leg and thigh pieces. A long iron rod extending from the groin to the toes, with a loop over the situation of the joint, in order to sling the whole limb, was then fastened on to the splint. The wound was brought together with carbolized catgut sutures. No vessels were ligated. The plaster-of-Paris splint about the wound was then brushed over with melted paraffin, so as to protect it from being soiled by the discharge. The same material was applied over the edge of the splint and the skin, especially behind the popliteal space, so as to prevent the discharge from getting between the limb and the bandage. A musquitonetting bandage was firmly applied over the knee, in order to control hæmorrhage; over this an ice-bag, separated from the bandage by a layer of flannel, covered the whole wound. Patient put to bed with limb suspended. Sol. sulph. morph. Mag., . viij.

June 10th.-Rested well last night; all oozing ceased. The ice-bag was discontinued on the 13th. There was no heat or swelling about the knee. An air-cushion was placed under the nates, so as to prevent bed-sores.

15th. There was considerable sloughing of the old cicatricial tissue on the inner side of the knee. The rest of the wound is uniting; discharge slight.

Nothing worthy of note occurred. The discharge from the wound did not exceed half an ounce a day. There was a collection of sanious discharge, occupying the position from which the patella had been removed; this was evacuated. There also occurred a small collection of pus just above the internal condyle.

July 6th.-As the plaster-of-Paris bandage had become loose, it was to-day removed, and a new one applied. There was considerable union between the femur and tibia. is now only a small opening on the inner side of the knee.

14th.-Wires were removed to-day; union firm.

There

20th.-A small sinus was found on the inner aspect of the knee, leading down to uncovered bone. There is no discharge. The sinuses from which the wires were removed are closing, and the bones cannot be reached by the probe.

August 1st.-All splint removed; union firm; patient about.

9th. All the sinuses have closed; cicatrix firm; shortening four inches. With a shoe with a high sole he can go about.

October 1st.-Goes about without the use of a crutch or cane. Has no pain; is to-day discharged cured.

December 6th.-Patient is about town; walks well without a crutch or cane. He walked three miles to-day without dis

comfort.

This was an exsection for anchylosis at a right angle, and chronic osteitis of the condyles of the femur. It was not treated antiseptically, yet the discharge at any time did not exceed half an ounce a day. The mode of putting the limb up, after the operation, was a slight modification of the splint described by Watson. I think that the iron bar permits of an easier access to the popliteal space than the Watson splint

does. This, in my case, was a necessity, on account of the ulcer in the popliteal space. The use of paraffin to protect the bandages was of great benefit, and was freely used during

the progress of the case, whenever there appeared any retraction of the limb from the splint. It melts at a low temperature, and is easily applied with a brush. I think that, in another case, I would make an opening on the flap in the position occupied by the patella, in order to get more perfect drainage, as I found it impossible, by careful padding, to prevent the accumulation of matter in this position. As it was, I had to make an opening at this point; and I think that firm union of the flap to the parts beneath was delayed by this condition. The amount of shortening was due partly to the atrophy of the leg. The amount of bone removed was not more than one inch and three-quarters.

III.-Case of Laceration of Os Uteri; Operation; Cure. Reported by E. C. DUDLEY, M. D., House-Surgeon, Woman's Hospital.

SERVICE OF DR. T. ADDIS EMMET.

A PATIENT entered the Woman's Hospital, October 4, 1877, with the following history: Previous to marriage, at eighteen, she had always been perfectly well. During the following nineteen years she bore six children, and miscarried

three times. The last child was born eight years ago; the last miscarriage occurred seven years ago. At the fourth labor, nine years after marriage, the uterus was forced into complete procidentia, and has since remained in that position, except when held in place by mechanical support, or by the recumbent posture. During the first nine years of this complete procidentia there were four pregnancies, of which two terminated nominally at full term; and, in the early months of all, the gravid uterus not infrequently fell completely outside the body.

Menstruation was normal until last May, when an intermission of three months occurred. The flow reappeared August 1st, and continued constant, and often very profuse, for seven weeks, finally terminating in several attacks of profound syncope.

Upon admission, examination showed subinvolution of the uterus, vagina, and perinæum ; cystocele and rectocele; laceration of the perinæum, extending to the sphincter ani muscle: bilateral laceration of the cervix uteri, extending on each side past the vaginal junction, through the vaginal wall, about one inch into the cellular tissue of the pelvis. All the mucous membrane of the cervix, and that of the lower part of the body, had rolled out, and was in contact with the acid secretions of the vagina. This everted membrane was eroded, and presented a red, angry appearance; and the mouths of the muciparous follicles having been occluded, and the follicles themselves distended by their own secretion, the membrane had undergone cystic degeneration. With one tenaculum hooked into the anterior lip of the lacerated cervix, near the vaginal junction, and another into the corresponding part of the posterior lip, the two lips were brought in contact with each other, and the everted tissue rolled back inside the uterus. The diameter of the everted cervix was three inches; but by rolling back the everted tissues, this diameter was reduced about one-third. The depth of the uterine canal, measured from the angle of the laceration-point o (Fig. 2) to the fundus, was five inches.

The patient was assigned to the service of Dr. T. A. Emmet, and, by his advice, the following treatment was prac