236 MORBID ANATOMY.
The bone appears healthy where sawed across. Knee-joint probably bent to an acute angle during life, as the articular surfaces, to some extent, look directly backward. These last are generally sufficiently healthy, though partly con- nected by cellular adhesions. 1847.
Dr. J. O. Warren.
1288. Chronic inflammation of the femur. From a man, forty- two years of age. Disease of fifteen or sixteen years' du- ration. Lower portion of thigh enlarged, with an offensive, sanious discharge. General appearance of necrosis, though no bone had been discharged.
The enlargement begins just above the middle of the bone, and extends to the condyles ; the surface being quite rough posteriorly. About 3 in. above the condyles, ante- riorly, is a defined opening, about three lines in diameter, and leading upward into a cavity within the bone ; the structure of the bone being generally healthy. 1855.
Dr. W. N. Lane, of Charlestown.
1289. Extensive necrosis of the femur. From a man twenty- seven years of age. (Hospital, 110, 130, and Med. Jour. vol. LXXII. 129.) At the age of fifteen he jumped from a wall, and the shock was followed by severe inflammation, ab- scesses and discharge of bone during the first year. Dur- ing the same year the femur broke in its lower third but united again with a shortening of 3 or 4 inches. Con- fined by attacks of inflammation during one-half of the time since disease began ; and for some years the knee-joint had been involved. Amputated Feb. 27th ; convalescence slow, but in Oct. he was seen by Dr. W. in fine health and spirits.
In the lower back part of the femur is a large and per- fectly loose sequestrum, 5 inches in length, with a cloaca leading from the cavity that contains it, and opening upon the front of the femur. The cavity of the bone, where sawed, is obliterated. Appearances of former fracture nearly effaced. Knee-joint disorganized.
Dr. W. remarked, in connection with this case, upon the very few cases of extensive necrosis of the femur that had been relieved by operation, so far as he had seen ; and also
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