cover, while the cut edges of aponeurosis and ligaments form its walls; and when the anterior flap is drawn over the end of the femur and fixed to the posterior one, this cavity becomes the receptacle of fluid, which, in a few days, probably suppurates, and burrows upwards between the layers of muscle and fascia; often perforates the skin in front, and requires much time and attention, and often frequent incisions before the parts become sound. Such results in my experience are less liable to occur when the patella is not disturbed or interfered with, or when its articular surface is alone removed. This is best done with a pair of forceps especially constructed for the purpose at my suggestion by Mr. Blaise. The instrument consists of one concave semicircular blunt blade, claw-like, to receive the edge of one half of the patella; the other blade is a semicircular convex-cutting surface: with such an instrument the operator can easily and smoothly shave off as much of the articular face as he may desire. In amputation through a healthy joint I have seen no ill effects from the articular cartilage of femur and patella being left intact. Mr. Erichsen thinks it better to leave the patella in this operation, but to remove the cartilage from it as well as from the condyles.1 Mr. Butcher advocates the removal of the articular surfaces of the condyles, and is of opinion that the patella should always be removed.2 But it is not customary to remove the articular cartilage from the glenoid cavity after amputation at the shoulder joint, or from the acetabulum after amputation at the hip, or from the head of the humerus when requisite to remove the scapula. It is equally unnecessary at the knee-joint. Months after the removal of the leg, and long after the wound has healed, I have found the patella partially moveable when its articular cartilage had not been interfered with. Mr. James Lane has made a similar observation. I have never experienced the least drawback after this operation when the articular cartilages have been left to be dealt with by nature. I have never seen it exfoliate, or retard the healing of the stump.

The more I have compared the stumps secured by amputation at the knee, whether the condyles were removed or not, with those after the amputation through the shaft of the femur, the more satisfied I have been that there is no comparison between the two in strength and facility for locomotion, in subsequent comfort and freedom from pain, and in capability to bear weight and endure exercise.

To adapt a good, useful, and inexpensive artificial leg to such a stump is a matter of no difficulty. A cast of the stump of a recent case under my care, and a fac-simile of the artificial leg adapted to it, have been placed on the table. I have to express my thanks to Mr. Blaise for carrying out my suggestions in the construction of the latter. It fits the stump most perfectly, offers a firm broad bearing surface for its extremity, and, by a very simple contrivance, may be fixed in a straight position when required for walking, or flexed when the patient sits.

In conclusion, I should observe that I do not wish to attach more importance to the operation of amputation through the knee-joint than it really deserves. I hope and believe I have brought forward sufficient evidence to induce surgeons more generally to test its merits, and if hereafter it should prove that a small percentage of life is gained by its more common adoption, the object of this communication will not have been unsuccessful.

from collapse.

Osteo-sarcoma

Mr. Coulson

Ditto

Long posterior flap.

Long anterior flap. Pyæmia.

Ditto. Died three days after operation; a lunatic.

Secondary hæmorrhage. Long anterior flap.

Recovered 25

Died 13.

Total 48.