Solly,  p. 192.)
Excision  of. — The  following  two  suggestions  maybe  worthy  the  atten-
tion of  practical  surgeons  in  the  management  of  these  cases. The
first  is  the  division  of  the  hamstriiig  tendons,  so  as  to  prevent  the
displacement  of  the  bones,  which  is  so  troublesome  in  the  after
treatment. The  second  is  the  inaJeing  of  an  opening  into  the  popli-
teal space  for  the  direct  escape  of  pus,  to  prevent  it  bagging  and
burrowing. (Mr. J. Hutchinson,  p. 194.)

To  Mr. Hutchinson's  suggestions  as  regards  the  operation,  we  may
add  another,  viz.,  that  the  limb  be  put  up  in  one  of  Ester's  swing-
ing fracture  apparatus,  having  an  opening  at  the  posterior  part
through  which  pus  may  escape,  and  the  wound  be  dressed  without
disturbing  the  limb. (Dr. 0. Vitalis,  p. 439.)

Necrosis. — Whenever  tendons  pass  over  newly  developing  bone,  it  is
of  the  greatest  importance  that  union  should  be  averted  between
them,  by  commencing  passive  motion  as  soon  as  it  may  safely  be
done. (Mr. S. Solly,  Lancet,  Jan. 5, 1856,  p. 6.)

Painful  Stumps. — From  considerable  experience  we  know  that  pain-
ful stumps  are  much  more  common  after  flap  amputations  than  cir-
cular amputations  ;  in  the  latter  the  nerves  are  cut  off  short  and
buried  in  the  stump,  while,  in  long  flaps,  the  nerves  are  cut  ob-
liquely, and  are  more  likely  to  be  pressed  upon. When  very  trouble-
some you  must  dissect  out  the  bulbous  extremity. (Mr. E. Stanley,
p. 197.)

Paralytic  Deformities. — In  the  treatment  of  these  cases  you  must
remove  existing  deformity  by  tenotomy  and  mechanical  appliances,
and  subsequently  compensate  for  the  paralysis  by  mechanical  sup-
port. When  the  muscles  of  the  leg  are  paralysed,  those  about  the
hip  joint  are  not  involved,  and  may  be  made  available  in  the  effort
of  progression  by  properly  adapting  mechanical  supports  to  the
thigh,  and  rendering  the  knee-joint  immovable  when  in  the  erect
position. (Mr. W. Adams,  p. 204.)

Shoulder  Joint,  Disease  of — In  a  case  which  required  excision  of
the  head  of  the  humerus,  Mr. Syme  enlarged  an  opening  existing
on  the  inner  side  of  the  shoulder ;  he  then,  by  means  of  a  probe-
pointed  bistoury,  guided  on  his  finger,  detached  the  connections  of
the  spin  ati  iniiscies,  and  pushing  the  arm  upwards,  protruded  the
head  of  the  bone,  which  was  then  removed. 