248 PHILOSOPHICAL TRANSACTIONS. [^ANNO 1746, 



settling towards the middle of the os humeri, where several fistular openings now 

 were, and coming to suppuration thereabout in a short time after, a great quantity 

 of matter was discharged by incision in Nottingham ; when the surgeon had told 

 him, that the bone was bare; and soon after had cut another opening in the hind 

 part of his arm, where there was another gathering, and the bone also laid bare, 

 and dressed both wounds, as expecting the bone to scale off; but that meeting 

 with no cure, but, on the contrary, the wounds breaking open as often as they 

 had been healed up, and that matter was still gathering in new places, and the 

 swelling in the bone increased, had determined him to look for a cure in London. 



At this time there were 5 or 6 fistular openings leading to the bone distilling a 

 sanous matter on the sides of the tendon of the deltoid muscle, and the hind part 

 of the arm, where the bone was principally enlarged; though it was very re- 

 markably increased in bulk the whole way down to the elbow. Mr. A. could not 

 with his probe discover the state the bone was in; but, being satisfied it was cari- 

 ous, and that this distemper was a spina ventosa, he proposed for the cure the 

 laying open all the bone in the anterior part of the arm ; which the patient readily 

 submitted to. 



This distemper was found to be a spina ventosa, or cariosity in the body of the 

 OS humeri, by which above 4 inches of the solid bone had been destroyed; all 

 which was cased in by an exostosis, or callous expansion ; saving in a few places, 

 where the matter flowing from the medullary cavity of the bone had preserved an 

 opening. 



This spina ventosa was treated nearly in the same manner as the above- 

 mentioned, and the cure performed as follows. It was entered on the 7th of 

 November, by making an incision to the bone on the external part of the arm, 

 about 6 inches long, and 1 broad, beginning it above the place in the bone where 

 the deltoid muscle is inserted; but on the side of it, almost down to the supina- 

 tores radii ; and then, by destroying with the lapis infernalis all the flesh growing 

 on the exostosis or callous expansion encompassing round, and as it were incasing 

 the carious bone, which the next day being scraped off, the fistular opening, 

 leading into the medullary cavity, then came in view, and the probe going a great 

 way into it, he immediately proceeded to trepan the bone, and enlarge that fistular 

 opening into it with the exfoliative trepan, perforating through the callous expan- 

 sion or exostosis, which was spread externally almost -• of an inch upon it, quite 

 into the medullary cavity. The next day he applied this instrument above and 

 below the preceding perforation ; and, by cutting and paring off the angles be- 

 tween them and the sides of the perforations, with an instrument the engravers 

 make use of, then made a fair opening into the medullary cavity of the bone, and 

 a convenient one too; for the discharge of the matter hitherto confined within it, 

 which whilst pent in had occasioned the cariosity, and the progress of it, now 



