25<D PHILOSOPHICAL TRANSACTIONS. [aNNO 1746. 



.this encasing or encircling bone. If they had been lingering in their proceedings, 

 it is likely the great discharge would have exhausted the strength that was neces- 

 sary to carry on this cure, before they could have got through so many that were 

 unavoidable ; and that the flesh growing from the edges of the external wound 

 would have rendered more painful and difiicult the several operations on the bone. 

 By this proceeding, this difficult cure was ascertained in less than a month, and 

 entirely finished in 6; the patient having now the power of his arm as complete 

 as ever. Nor was the limb at all disfigured or shortened ; the expanded encircling 

 bone attached to the ends of the os humeri preventing this ; so that the only ap- 

 pearing defect was, that the bone about the wound was thicker than usual; but 

 that strengthens it, and supplies a defect in the anterior part of the arm^ where 

 there is a considerable hollowness. 



In favour of the young surgeons, Mr. A. closes this account with a few re- 

 marks, by way of inference. 



1 . That it is highly probable, a suppurated phlegmon in the marrow, on the 

 crisis of a fever, was the original cause of the spina ventosa in these 2 cases, and 

 that if the bone had been denudated, and the opening through it enlarged, when 

 the matter first made its way through the integuments, that the progress of the 

 evil had been prevented in both, and the cure brought about in the last case with 

 far greater ease. 



2. That a large opening is always more advantageous than many smaller, 

 seemingly equal to it. And this appears plain in the 2 cases mentioned, inasmuch 

 as the matter which was discharging through the many large foramina in the 

 bones corresponding with the medullary cavity in them, have not prevented the 

 progress of the evil ; and therefore it may be concluded, that as a large opening in 

 the bone, by giving a free vent to the matter, will afford the nearest prospect of a 

 cure in the spina ventosa of all bones, so that must be the work of the surgeon, 

 when that distemper breaks out towards the centre of long bones. 



3. That, in the spina ventosa affecting long bones towards their centre, the 

 application of the trepan, or of any other instrument as shall take away a con- 

 siderable portion of the substance, is particularly necessary, were it only to make /, 

 way for the removal of such exfoliations as are detached from the inner cavity of 

 the bone in the first stage of the distemper ; which, in these 2 cases were con- 

 cealed and shut in ; and in many others may be wedged and locked in by the in- 

 duration of the callous matter on the surface of the bone. 



4. That in a spina ventosa, in the centre of long bones, though the discharge 

 attending it is not great, if any of their joints are made stiff by an anchylosis, viz. ■ 

 by a callous expansion that shall solder together the bones in contact, the only 

 resource will be the immediate amputation of the limb; forasmuch that, if that is 

 delayed till the patient labours under a hectic fever, colliquative sweats, a diarrhoea. 



