^^ * PHILOSOPHICAL TRANSACTIONS. [aNNO 1746. 



y 



lous cavities, and fistular openings, and tiie main bone rotten, at a time that the 

 exfoliations inclosed preserve their primitive state and solidity. The patient then 

 cannot survive it long : for, as a hectic fever and diarrhoea are fed by the continual 

 absorption of some of the matter into the blood, so the body is drained by the 

 large discharge from such wounds. The amputation of the limb is then the usual 

 remedy; but a better may be hoped for, before it comes to this pass, as will ap- 

 pear from the following observations. 



Observation 1. — One Thomas Pentney, a shepherd in Norfolk, aged about 22, 

 was admitted into St. Greorge's Hospital, towards the beginning of August 1739, 

 and committed to Mr. Middleton's care. Five years before, on the crisis of a 

 fever, he had felt a great pain in the os humeri of his right arm, which continued 

 several months; during which, the dimensions of this bone were so increased, 

 that, towards the end of the year, it was half as large again as is usual in the 

 natural state. About this time the bone imposthumated ; and the matter being 

 <iischarged by the breaking of the integuments on the outside of the arm, the 

 patient was eased, so as to have been able to attend his flock as before. 



When he came to the hospital 4 years after this, he had above 1 2 holes through 

 the integuments on the outside of the arm, answering to, and corresponding with, 

 as many leading into the medullary cavity of the bone; some of which were large 

 enough to admit the finger. These imposthumations had been most vexatious of 

 late. There was an anchylosis at the elbow; and, for 2 years last past, he neither 

 could bend his arm, nor use it in pronation and supination. The whole bone 

 felt thick and unequal up to the shoulder, where the articulation was free. 

 The patient now did not complain much. The discharge from the wounds was 

 moderate ; his rest, stomach, and pulse, as well as could be expected ; and there- 

 fore he was determined to forego any thing, rather than submit to the amputa- 

 tion that was proposod. 



In consultation with Mr. Pawlet, Mr. Wilkie, Mr. Middleton, and Mr. 

 Hawkins, it was agreed to make an incision from the deltoid muscle down to the 

 elbow, thereby to lay the distempered bone bare, so far as it appeared to be 

 affected; and, with the exfoliative trepan, to make a fair opening into the 

 medullary cavity of the bone, by taking off so much of it as was perforated in 

 the external part of the arm, and so to make way for the application of the actual 

 cautery, if that was found necessary. 



The first 2 operations were performed with ease : for, as in the incision the 

 periosteum was readily detached from the bone, so the bone in view, being nearly 

 of a cartilaginous nature, and making little resistance, was soon removed, by the 

 repeated application of the exfoliative trepan. In the course of the operation, 

 Mr. Middleton found a bone loose, which hitherto had lain concealed under the 

 cortex of the bone ; which, being taken out entire, measured above 7 inches in 



