242 Diseases of Bone. 



"A little in front of the right malleolus externus there is the orifice 

 ■of a sinus which runs underneath the extensor tendons, and terminates by 

 .another opening a little below the inner malleolus. From both of these 

 orifices the probe may be passed into the articulation of the astragalus 

 and tibia, the articulating surfaces of which bones are felt rough ; 

 discharge copious but healthy ; the motions of the joint are very confined, 

 and the surrounding parts much swelled and slightly inflamed. General 

 health pretty good ; pulse 100 ; tongue a little furred ; slight sweating ; 

 bowels rather costive.' 



The leg was amputated by the single flap operation two or three 

 •days after his admission, and he made a good recovery. 



When fresh, "the tibia was dry, of a deadly whiteness, and not a 

 particle of blood or of marrow oozing from its cut surface." 



"The tibia appears to have been the seat of long-standing 



and inveterate disease. This bone is enlarged throughout its 



whole length, but more particularly at its extremities, and on 



laying it open by a longitudinal section you observe its whole 



medullary cavity occupied by osseous depositions. This internal 



structure has been in several places the seat of caries, or, 



perhaps, I should rather say, of internal abscesses. A small one is 



observable just at the point where the bone was cut across in 



removing the limb, another immediately below this point, a 



third towards the middle of the bone, and a fourth very large 



•cavity is situated in the distal extremity of the tibia 



immediately above its junction with the astragalus. This cavity, 



in the recent state, contained a quantity of purulent matter. 



It opens in front by a circular aperture immediately over the 



ankle joint, and it was, I suspect, into this opening that the 



probe passed when I conceived it to be going into the cavity of 



the joint. On the posterior surface of the bone, nearly opposite 



to the seat of this abscess, you will find some adventitious 



deposition of ossific matter in a stalactitic form. The fibula 



scarcely presents anything worthy of notice. Its lower extremity 



is divested of its articular cartilage, and apparently roughened, 



but whether this is the effect of disease or maceration is not 



very easily determined." (Sir George Ballingall's Clinical 



Lectures, No. 4, p. 18.) 



The pockets on the wall of the lowest abscess cavity in the 



tibia resemble somewhat the results of tubercular invasion, but 



