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lancing of the gums in dentition, so the early division of thewounded nerve, or amputation in tetanus, has at once checkedthe morbid affection. Is it possible that hydrophobia mightbe arrested by a similar procedure ? The subject is of intenseinterest, and deserving of the fullest attention."My patient, about twenty-seven years of age, of sanguineous

temperament and robust constitution, was bitten bv a supposedrabid animal (immediately destroyed after the occurrence) inthe fleshy margin of the nail on the ulnar side of the rightmiddle finger. Two days afterwards I was sent for, and founda rugged, unhealing wound, of small dimensions, with nofurther extension of pain or irritation. I dressed the woundwith cantharidine ointment, &c., and after five or six dayspuriform discharge, I allowed it to heal, feeling every appre-hension as to the sequlæ.Eleven weeks of good health elapsed, when my patient com-

plained of headache and nausea, took an aperient at bed-time,and on the following morning (my first visit at this stage) com-plained of " rheumatism" in the right forearm. I examinedthe hand, and could detect no remains of the cicatrix.Complaint was made of a sensation in the bitten locality, asthough "the skin had worn-thin," and a dull pain extendingup the ulnar nerve to the elbow-joint. No redness or otherexternal mark was visible. On the following morning, mypatient shuddered on seeing water poured from a caraft, had amost uncontrollable difficulty and distress in swallowing fluids,with frequent sighings, and now felt the pain extending to thebrachial plexus, and thence to the right pectoralis minormuscle. In the evening, the corresponding pectoralis major ’,became painful and tumid, and at this epoch dyspncea wasmost distressing. The pain shortly proceeded to, and concen-trated itself about, the junction of the fifth rib, with itscartilage, extending over the whole right side of the thorax,the dyspnoea having increased in the ratio of its peripheralradiation. After two days more of intense suffering, the graveasserted its victory.I do not dwell further on this case than in directing attention

to the probable seat of the incubate virus, and the apparentroute of the disease. It is rare that one can observe the symp-toms of hydrophobia at so early a period of its development.Did the virus wholly reside in the finger during the period ofincubation ? If so, would not amputation of the limb, beforethe disease strode to the brachial plexus, when the excito-motory disturbance first manifested itself, have saved the life ofthe patient ? Were the headache and cachexia of the first dayevidence that the morbific agent then pervaded the system, orof sympathetic indisposition, arising from local irritation ?These are facts, I think, worth recording, and deserve being

placed before the profession.Thames Ditton, August, 1855.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

CHARING-CROSS HOSPITAL.

CARIES OF THE ELBOW; NECROSIS OF THE SHAFT OF THE

HUMERUS; AMPUTATION OF THE ARM.

(Under the care of Mr. CANTON.)

Nulla est alia pro certo noscendi via, nisi qnam plurimas et morborumet disseetionum historias, tam aliorum proprias, collectas habere et interse comparare.—MORGAGNI. De Sed, et Caecs. Morb. lib. 14. Frooeminm.

THE following case presents us with an example of two diseasesbeing removed by one operation-diseases, however, which,whilst they involved but one tissue, showed themselves in twoforms, different in situation, alike in kind, but varying in degree.Caries and necrosis imply the death of bone-the one in detail,the other in gross; the former in molecules, the latter in masses.Necrosis may extend into the domains of caries; caries is less

disposed to invade the habitat of necrosis. Caries is prone to

destroy an articulation, and there alone to expend its violence ;necrosis involves more or less of the shaft, but not unfrequently

intrudes also upon a joint. And in the case before us we findthese facts exemplified; for whilst caries and necrosis wereconjoined in the lower part of the humerus, the shaft of thebone was the seat of necrosis only. Again, the examination ofthe limb after its removal demonstrated another very interest-ing point in the pathology of these diseases-viz., that whereasthe reproductive efforts in caries are slight and non-ossific,those in necrosis are great and osseous. In the former we havedeath to be almost completed before repair commences; in thelatter the process of dying goes hand in hand with the work ofregeneration. Caries is too often dependent upon the presenceof tuberculous matter, which gradually disintegrates, and mustbe slowly eliminated, before healthy action sets in; necrosismay often be readily cured by extrusion of the sequestrumentire and at once. In the instance before us it was deemedunadvisable to wait for the processes which Nature establishesto be further completed, inasmuch as the extent of these dis-eases was too great, and their co-existence too grave a compli-cation for the preservation subsequently of a useful limb, andwhilst the surgeon might wait the patient might die. As itwas, however, and with the character, extent, and most pro-bable termination of the diseases known, the opportunity wastaken advantage of when amputation could be performed with

‘

the patient’s health in a sufficiently good state to warrant theanticipation of a favourable result.

Elizabeth G-, aged twelve years, a rosy-faced countrygirl, seemingly in very good health, but presenting marks ofthe dark variety of scrofula, states that about four monthsbefore her admission into the hospital, she suffered from anattack of low fever, which confined her to bed for upwardsof a fortnight. About ten days after her recovery, she fellagainst a gate, and struck her left elbow near the olecranonprocess and inner condyle of the humerus. Very little incon-venience, however, was experienced at the time, but aboutthree or four days afterwards the arm began to swell, and a,

sudden, sharp, pricking pain attacked it. A surgeon was sentfor, who did not attend to the case, however, for more than a.week after receiving his summons. Linseed and oil-cake poul-tices were applied by the mother, and ordered to be continuedby the surgeon. At the end of fourteen days, the skin gaveway about three inches above the inner condyle. and thick,creamy matter issued forth. At the above spot there is now a.small ulcer, which gives vent to thin pus; and the introductionof a probe here leads on to carious bone. The arm is semi-flexed, generally swollen around the elbow, (where a ratherlarge quantity of hair is noticeable,) and little, if any pain isfelt in the articulation, except on movement. Since the timeof the onset of the disease, she has felt pain extending from theelbow towards the shoulder, and on examining the upper arm,it is found to be swollen, especially towards the latter joint,the swelling being dependent upon somewhat irregular enlarge-ment of the bone, and only slightly upon infiltration of thesurrounding tissues. Manipulation of this part-i. e., for theextent of three inches above the centre of the humerus, causesgreat inconvenience, but the skin here is free from redness.The motions of the shoulder-joint are natural in all respects.

Double-flap amputation of the arm was performed by Mr.Canton, a short way below the shoulder-joint, and just above’the chief swelling of the bone. A rather large number of-vessels had to be secured, whilst the axillary artery was ablycompressed by Mr. Goldsbro’. The ligatures have come away,and the wound united without a bad symptom.On examining the limb after removal, the elbow was found

to contain about a drachm of flaky pus; the cartilages were to>a great extent removed, and the subjacent bone everywherecarious. A sequestrum occupied the inner condyle, and ex-tended obliquely over the articulation into the shaft. Thesurface of the bone generally around the joint was rough andtuberculated; above this, the shaft was smooth, but a littleswollen for the extent of an inch and a half; above this, again,it was enlarged and rough to within a short distance of theshoulder. A section of this part being made, and which waschiefly formed of new porous bone, showed it to contain a long-and irregular sequestrum, just above which the saw had dividedthe humerus in the amputation.

GERMAN HOSPITAL, DALSTON.IDIOPATHIC NECROSIS OF THE WHOLE SHAFT OF THE TIBIA;

RAPID DEATH; NECROPSY.

(Under the care of Mr. DE MERIC.)SiNcE the great success of David and other surgeons in ex-

tracting the sequestrum in cases of necrosed bones, these casespossess considerable interest. We have seen, during the past