a good deal depressed, but there was nothing for it but primary amputation; and bearing in mind Dr. Fayrer's late remarks about osteomyelitis, when the shaft of a long bone is opened, I determined to amputate through the knee-joint without opening the medullary canal of the femur. I made an anterior long flap operation of it, saving the patella, removing the inter-articular cartilages, and sawing off tiie end of the condyles ; an endeavour was then made to acupress the popliteal artery, but, owing to the looseness of the surrounding textures, it could not be done, as there was nothing firm to pin the artery to; consequently, to avoid delay, I used the usual silken ligature. The man progressed favourably, the greater part of the wound healing by first intention ; but as the ligature did not separate for some 15 days, suppuration was set up around it, accompanied by irritative fever, and up to this date (May 10th) healing is not complete, though the leg was amputated on March 19th. I am fully convinced, considering the previous case, that had I exercised a little more patience, ?md employed, perhaps, Dr. Simpson's third method of acupressure, (see p. 334 of Druitt) the patient would have been saved much suffering, and the cure would have been more speedy and complete.

TWO CASES OF AMPUTATION, ILLUSTRATIVE OF THE ADVANTAGE OF ACUPRESSURE OVER LIGATURE. By Geo. K. Poole, M.D.,

Surgeon,

25th

Regiment

F. N. I.

A woman of the Chamar caste was admitted under my care during the month of March, having been knocked down and gored by a wild boar; tibia and fibula were fractured above the ankle, and the lower two-thirds of the leg below the knee was a mangled mass, with the denuded ends of the two bones for about 2? inches sticking out through the mass. The woman was collapsed, and it was accordingly determined to delay operative measures for a few days. Irritative fever coming on at regular intervals of 12 hours, and the woman evidently sinking, amputation, as a last recourse, was determined on. The limb was removed immediately below the tubercle of the tibia by the ordinary flap of operation, and the common trunk of the posterior tibial and fibula arteries was " acupressed" by a common sewing needle, threaded with wire for facility of removal. The needle was passed into the muscular tissue, and out again on one side of the artery, which was bridged over, and the needle was then passed into and out again of the muscular tissue on the other side, so that the arterial trunk was completely secured, and not a drop of arterial blood was lost. On the morning of the third day, about 70 hours after the operation, the wire was pulled upon and the needle withdrawn without pain or haemorrhage; the wire sutures were removed, and the whole of the line of incision healed by first intention, the only obstacle to the discharge of the patient from hospital being a sloughing of the skin over the sharp edge of the tubercle of the tibia, which should have been bevilled off before the edges of the incision were adjusted. This case contrasts somewhat favourably with the following, the result of a railway injury to a strong healthy native, and I think it may be fairly presumed that, had the usual silken ligature been used in theformer as it was in the following case, an ajnount of irritative lever would have been set up, or rather ?would have continued, and the result would have been less favorable than it was. A fireman, native, in the employ of Messrs. Brassey & Co., of the Delhi Railway, having completed some oiling to his engine, missed the step as the engine was in motion, and slipped under the driving wheel; the leg was completely smashed?a

contused

mass

from the knee downward. The

man was

necessarily