IG THE TONER LECTURES. 



dead bono found. By Oct. 1, the bone was loose, and on the 

 5th, an incision of tliree inches was made and a loose piece of 

 the frontal was removed. The rest of the dead bone was firm, 

 but the incision was extended backwards till the whole of the 

 necrosed portion was exposed. It was then carefully chiselled 

 loose and separated at the squamous suture. At the anterior 

 inferior angle the necrosis was there found to extend on the 

 internal surface only ; with a fine chisel this internal lamella, a 

 piece 1^x2 c. m., was chiselled away from the great wing of 

 the sphenoid. In it was a groove in which lay the anterior 

 branch of the middle meningeal, filled with the detritus of a 

 clot. The whole piece was 5^x9 cm. The dura mater was 

 but slightly injected. The scalp and the dura mater united and 

 in fourteen days he was nearly well, having recommenced his 

 Latin and Greek with the greatest zest eight daj^s after the 

 operation. Two small pieces of loose bone afterwards caused 

 threatening symptoms, but improvement followed immediatel}' 

 upon their discharge. In March he was entirely well, and 

 went to Gottingen to study philology at the University. Epi- 

 leptiform attacks followed during 1869, but then disappeared, 

 and had not reappeared in I8T2. 



As to treatment, the ordinary operation for the removal of 

 necrosed bone is to be done at the proper time, especial care 

 being taken to remove any small central sequestrum. Occa- 

 sionally the disease of the bone may cause extensive disease 

 in the soft parts, or ma}^ extend to a neighboring joint, though 

 either complication is rare. Amputation then becomes impera- 

 tive. Only four such amputations occurred in the eases 

 rei)orted ; two died, one recovered, and one was under treat- 

 ment. About the face not infrequently extensive plastic ope- 

 rations are required. 



