upon the very abundant hemorrhage from the smaller ves- sels where there had been much previous inflammation in the amputated limb. 1865. Dr. J. M. Warren.
1290. Necrosis of the femur, with disease of the knee-joint. From a man set. thirty-five, who entered the hospital
Sept. 9th, 1869 (141, 197). Eighteen years previously he broke the lower third of the femur, and for a year small pieces of bone were occasionally discharged. A stiff knee was the result. Eleven months before entrance he fell through a barrel, struck the knee, and sharp pain followed. Three months afterwards an opening formed upon the in- side of the knee, and subsequently behind the joint, with free discharge. On the 15th Dr. G. amputated the limb, and there was much hemorrhage, with great exhaustion for a day or two. On the 27th there was a sudden and copious hemorrhage that made it necessary to open the wound and tie the bleeding vessel. After this the man did well, and on the 25th of October he left the hospital. inches in length, much enlarged, closely cancellated throughout upon the amputated surface, and without any appearance of central cavity. Surface irregular, and with spiculse. In the back part of the bone is a cavity, more than an inch in diameter, that opened largely into the knee-joint, and that is just seen upon the amputated sur- face ; not very rough within, and contains a sequestrum, 2 in. in length that is smooth upon the outer surface, and in- volves a large portion of the circumference of the original bone. The knee-joint contained pus, and the cartilage was to a great extent destroyed ; the patella resting upon the outer condyle. 1869. Dr. G. H. Gay.
1291. Extensive necrosis of the tibia. A sequestrum, 9 in. in length, rough upon the surface, quite thick and perfectly loose, lies along the front of the bone, and so perfectly ex- posed that it might be removed at once, if it were not for its connection with a second that lies deep in the substance of the bone, and toward its posterior face. The whole shaft of the bone is enlarged, misshapen, curved, and rough or granulated upon the surface anteriorly. Through
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