opened spontaneously, producing permanent fistulæ, communicating with the femur both above and below the insertion of the capsular ligament. No bone at any time escaped from any of the fistulous openings. He had been treated by different physicians, but to no purpose, and on November 7, 1871, he was brought to the clinic of the Medical Department, of the Iowa State University, when he exhibited the following condition.

Small in stature, nervous temperament, much emaciated, and of a leucocythemic color. The countenance showed that the patient had suffered severely from pain and exhaustive discharges. The digestive functions were imperfectly performed, there being scarcely any appetite, associated with decided inactivity of the bowels. The left hip was extensively swollen, the thigh being contracted upon the abdomen, and the leg upon the thigh, and no ability on the part of the patient to extend either leg or thigh, and, in fact, pressure gave him much pain. Clonic spasms had been present since early in the commencement of the disease. The number of sinuses surrounding the joint, and communicating with the intraand extracapsular portion of the femur, were in all twenty-two, many of them were quite tortuous, but dead bone could be reached through most of them. On the inner side of the upper portion of the thigh, where adduction was very great, there was considerable sloughing of tissue down to the adductor muscles. So great was the suffering of the patient that a satisfactory examination could not be made, except under the influence of ether.

An operation, explorative in character, for the removal of dead bone, was advised, and accordingly on November 10, 1871, assisted by Dr. Pryce and several other medical men, I removed, before the class, four and a half inches of the upper portion of the femur. The head of the bone was destroyed completely by absorption and discharge; and the periosteum, for two or more inches below the trochanter major, was found separated from the bone. The first section made by the chain saw (see "e," Fig. 1) did not remove all of the necrosed bone, so a second section was made, and healthy tissue was left in the proximal extremity of the femoral shaft. The entire substance of the bone, except those portions indicated by "c" and "f," Fig. 1, was carious, and most of it in a condition of actual necrosis. The acetabulum was also necrosed, but the disease was superficially confined.

After the operation, the patient was placed in the wire breeches

used by Sayre. The wound was filled with oakum saturated in carbolate of glycerine (carbolic acid f3j, glycerine f3iv), and each day the wound was syringed out with warm water, containing carbolic acid. The patient was treated internally, medically, and dietetically, in a supportive manner. He continued to improve,

suffering for about two weeks during convalescence from diarrhoea, and on March 5, 1872, he was able to walk with the aid of a crutch and cane. In April the cane was only needed to assist progression. Although four and a half inches of bone, making due allowance for that portion removed before the operation, was removed, measure

ment only exhibits three and a half inches of shortening. Fig. 2 represents to some extent his present appearance. It is wanting in completeness, because the patient could not be persuaded to conform to the requirements in having it taken.

REMARKS

UPON THE

SOFT PALATE AND ADJACENT PARTS IN HEALTH AND DISEASE.

BY

HARRISON ALLEN, M.D.,

PHILADELPHIA.

DIVISIONS OF SUBJECT.

I. THE SOFT PALATE SEEN FROM THE ORO-PHARYNX, p. 538. (a.) The Palato-Glossal Fold and Tonsil, p. 539.

(b.) The Uvula, p. 542.

(c.) The Pre-Coronoid Space, p. 543.

(d.) The Palato-Pharyngeal Fold, p. 545.

II. THE SOFT PALATE SEEN FROM THE NASO-PHARYNX, 548.

(a.) The Palato-Salpingal Fold, 548.

III. THE RELATION EXISTING BETWEEN THE MECHANISM OF THE SOFT PALATE AND ITS SUPERFICIAL VEINS, p. 549.

IV. REMARKS UPON NAMING OF THE PARTS ASSOCIATED WITH THE SOFT PALATE, p. 556.