though originally somewhat strumous, does not offer any very striking features of scrofula.

On May 21, Mr. Fergusson, having ascertained the existence of disease in the wrist, proceeded to operate, and removed most of the carpal bones, and also gouged out a small portion of the extremity of the radius. Mr. Fergusson took advantage of the openings already existing, in order to take hold of the different carpal bones, being at the same time careful not to injure any of the flexors or extensors. The operation was of an extremely laborious character, as it was a matter of some difficulty to seize upon the bones, and remove them without injuring the tendons, and without considerably enlarging the openings. Mr. Fergusson succeeded, however, in taking away the greater portion of the carpal bones. The wrist and lower part of the forearm were wrapt in wet lint, and the patient sent to bed.

Fifth day after the operation. Wound healing by granulation; to have cod-liver oil. The wound progressed very favourably until June 10, twenty days after the operation, when a rash appeared at the back of the hand, and the wrist swelled again, the discharge being somewhat foetid. Mr. Fergusson made a small puncture over the wristjoint, when some ill-smelling pus escaped. The appearance of the part was thereby materially improved. The dressing, with gentle compression, was continued.

Two months after the operation another puncture was made, when only blood was evacuated, and the patient progressed pretty satisfactorily for several weeks, as far as his general health was concerned; but no signs of active cicatrizing effort were noticed in the wrist, which lay on the splint, displaying the different apertures which had been made, and which did not show any disposition to heal. Some motion was retained in the fingers to a very small extent, but enough to show that the flexors and extensors, as well as the extremities of the corresponding muscles, had not sustained any damage.

Mr. Fergusson, fearing that possibly some carious bone had been left, had the patient brought into the theatre on October 7, and narcotized with chloroform. Diseased bone in the region of the wrist was removed in the same manner as had been done before, and a portion of the end of the radius taken away at the same time. The treatment was continued as before, but on January 7, eight months after the original excision, some more carious bone was removed; and when we saw the wrist and hand a few days ago, the parts were in a pretty favourable state. Several ulcerated apertures might be observed both on the palmar and dorsal aspect of the hand; these were smaller than they had originally been, and Mr. Fergusson conceives that there is some likelihood of a final cicatrization taking place, leaving to the patient a moderately useful hand.-Lancet, Jan 28, 1854, p. 98.

99.-Disease of the Carpus; Excision of the Wrist-joint. By J. SIMON, Esq., F.R.S., St. Thomas's Hospital. -[John Ll., aged 19, was admitted May 25, 1852. A year ago an abscess formed in his thigh and discharged profusely. It gradually healed, but as it healed another formed over the metacarpal bone of the left hand. At the end of two months Mr. Simon was obliged to remove the bone. More abscesses formed, and it was found that most of the bones of the wrist were in a carious state; it was resolved, therefore, to remove all the diseased bone of the articulation.]

It will here be necessary, before mentioning the mode of operation adopted by Mr. Simon, to remind our readers that Mr. Erichsen removed the bones of the wrist by lateral incisions, and Mr. Fergusson also, by lateral incisions in one case, and by enlarging the orifices of fistulous tracts in another case. Mr. Simon, in contemplating the same excision, thought that the diseased osseous texture might be advantageously taken away by making two long incisions on the anterior and posterior aspects of the joint, reaching from about two inches above the wrist, back and front, to the centre of the palm and dorsum of the hand, the incisions being so managed as to run between the tendons coursing down to their destination on the metacarpal bones and fingers. On the 9th of October, Mr. Simon proceeded to operate in the manner just mentioned, and took away all the bones of the wrist except the pisiform and trapezius; one of the metacarpal bones was also excised. The wound made in front was brought together by sutures, but none were applied to the solution of continuity on the dorsum of the hand. Merely two vessels had to be tied. When the suppurative stage had set in, the wounds looked somewhat large; but after a few weeks' careful dressing, contraction began to take place. The patient progressed as favourably as might be expected for the first three months; but the time came, as happens with many excisions of joints, when reparative action ceases, several portions of the wound remaining unclosed, and discharging a rather large quantity of pus, whilst the boy was regaining, under the influence of good diet, cod-liver oil, tonics, &c., a fair amount of health. One year thus passed away, and just when it might be hoped that the final cicatrization of parts was not far distant, the patient was seized with all the symptoms of continued fever, and died about thirteen months after admission. It is to be regretted that no post-mortem examination was made; but it is clear, from the manner in which the patient was attacked, that he sunk under an affection independent of the operation above detailed. One circumstance should, however, always be taken into account-viz., the protracted stay of patients in hospital; this is, in most cases, extremely prejudicial to general health, and should always, as far as practicable, be avoided. It is very probable that many cases of partial or complete resection would end more favourably if the patients were as soon as possible removed from the wards, and placed under the most favourable influences as regards

general health. In fact, there is but little to do beyond simply dressing the wound after a few weeks are elapsed, and we consider that attention to this suggestion will tend to render the practice of excision of bones and joints more popular, as the results will be obtained in a shorter time than is now the case.—Lancet, Jan. 28, 1854, p. 100.

100.—Case of Excision of the Proximal Phalanx of the Thumb. By T. P. TEALE, Esq., F.L.S., Surgeon to the Leeds General Infirmary.

George Brooke, aged 15, was admitted April 15, 1853, for disease of the thumb. He is tall and thin, but without marks of scrofula. First felt pain in the thumb six months ago. On May 11, an abscess formed on the palmar side of the first phalanx, which was opened and the bone found to be bare.]

Aug. 25. Mr. Teale proposed to remove the diseased phalanx, and to leave the terminal one. For this purpose, he made an incision, rather more extensive than the phalanx, along its radial border. The ligaments and capsule connecting it with the terminal phalanx were next cautiously divided; the shaft of the bone was then separated from the surrounding soft parts; and, lastly it was detached from the metacarpal bone. The thumb was dressed with wet lint, and the patient confined to bed. The case proceeded well, without any unfavourable occurrence.

Sept. 21. The wound is healed, the end of the thumb is preserved, and the entire thumb has much of its natural aspect, being a little shorter and thicker than its opposite fellow. The thumb has free motion through the medium of the metacarpal bone, and forms an excellent opponent to all the fingers.

Dec. 5. Since the last note, the boy has been regularly at work. There does not appear to have been any attempt at the production of a new bone, as the place of the excised phalanx is occupied by a firm ligamentous structure only. The terminal phalanx has free motion on the metacarpal bone, and the amount of shortening is exactly fiveeighths of an inch.

The disease in this case was caries, and not necrosis; and at the time of the operation what remained of periosteum being adherent, was removed with the bone. The latter circumstance accounts for there having been no reproduction of an osseous shaft. The success of the operation with so unhopeful a form of disease is the more satisfactory. In some cases of diseased metacarpal or phalangeal bones, a genuine necrosis of the shaft takes place, and a thin shell of new bone is formed by the periosteum. The success of an operation is of course much more probable in such a condition than in one of caries. On Wednesday last, Dec. 7, we saw Mr. Simon remove from a man in St. Thomas's Hospital the whole metacarpal bone of the right thumb. The necrosis was quite recent, but the periosteum had

entirely separated from the bone; and Mr. Simon stated that he could feel in it, in parts, distinct plates of new deposit.-Med. Times and Gazette, Dec. 10, 1853, p. 603.

101.-Thickness of the Articular Cartilages at Different Periods of Life in the Human Subject. By DR. P. REDFERN, Aberdeen.— Of the various phenomena presented to us by a living being, there are perhaps none more interesting, nor more strikingly illustrative of the action of the vital forces upon the tissues, than those of the development of different structures from the same primitive blastema, or from the same blood. What is the precise nature of the process by which a certain amount of material is converted in one position into bone, in another into muscle or nerve, it seems entirely beyond the reach of our present faculties to comprehend. We are, therefore, limited to the determination of the particular modes of development of different tissues, and the general laws which may be deduced from them. In such inquiries, nothing is more likely to lead away from the truth than prejudice in favour of a particular doctrine or system, nor does anything more surely obstruct the progress of science, or more certainly lead to the sacrifice of valuable time, than the existence of conclusions drawn by previous observers or authors from data which were not sufficiently accurate or extensive.

In investigations into the structure of healthy and diseased cartilage, commenced in the year 1848, and continued since that time, I have often been surprised at the statement that the thickness of articular cartilages gradually diminishes as life advances, owing to the conversion of the cartilage into bone; and my object in this contribution to the history of articular cartilage, is to show how far that statement is strictly accordant with facts. I do not hesitate to state that my earliest impressions were, that articular cartilages do not become gradually thinner as life advances, for I had observed them very thick in the aged on many occasions, and spongy and fibrous in old people generally. As such observations increased in number, I at length resolved to test the matter fairly, and with that view I made a large number of measurements of the cartilages of various joints at different ages, at a great sacrifice of time and labour when compared with the importance of the result.

If the thickness of the articular cartilages concerned merely their amount of elasticity, and their adaptation to the uses of the parts of the body to which they belong, it would be of great importance to know precisely what changes take place in them as life advances. We know that the bones and muscles of the aged person are very different from those of the young adult, and it might be expected that the cartilages would also be found changed, or if they should not be so, we should look for some cause for this exemption in the case of tissues made use of for the same general purposes as the

bones and muscles, and intended to harmonise with them in their action.

Mr. Toynbee, in his admirable paper "On the Organization and Nutrition of Non-vascular Animal Tissues," read before the Royal Society, and published in the 'Philosophical Transactions,' says:"The articular cartilage is gradually being converted into bone during the whole of life; thus, it is thicker in young than in old subjects, and, as Sir Benjamin Brodie informs me, it is much thinner in old age than in the adult; in fact, it is not very rare to find that the articular cartilage of the head of the os femoris, in many old persons, has completely disappeared-a change which is probably to be attributed to its entire ossification." In a note, Mr. Toynbee adds:-"This appears to be another of the many instances of the disappearance of the animal, and the increased deposit of the earthy, constituents of the body in old age." And again as one of seven leading facts which Mr. Toynbee believes that his researches tend to establish, he gives the following:-"Articular cartilage, during the whole of life, gradually becomes thinner, by being converted into bone."

[Dr. Redfern has compiled an elaborate table of the measurements he has made. He adds:]

From a conversation with Mr. Toynbee on the statement made in his paper before referred to, I found that his evidence on this matter had been derived from the observations and statements of others, rather than from measurements or observations of his own, and thus I believe that he has been thrown off his guard, and made to appear as the author and supporter of a statement which, under other circumstances, his habitual care and anxiety to arrive at the truth, would effectually have prevented from being made in so definite a

manner.

In conclusion, I may state my conviction, founded on the measurements indicated in the table appended, that articular cartilages do not become gradually thinner as life advances, and that they are not uniformly thinner in aged persons than in early life. I may also remark that, in endeavouring to estimate the thickness of articular cartilages at different periods of life, I have had presented to me a large amount of evidence in addition to that which I formerly made public, that, as life advances, these structures, and especially those of certain joints, change their elementary characters, and become fibrocartilaginous, or altogether fibrous. This change has its analogues in the conversion of the costal cartilages into bone, of tendons into fibrocartilage and bone, and in those changes which age induces in the bones generally, in the cornea and other tissues. It may not improperly be styled senile degeneration of cartilage.-Monthly Journal of Med. Science, Jan. 1854, p. 21.