Professor Spence lost only 16 in 189 cases, or 8.3 per cent. Gurlt's statistics for gunshot injury give a mortality of over 24 per cent. Out of 82 cases where the joint was excised for injury in the Schleswig-Holstein and Crimean campaigns, only 16 died; and out of 115 cases in which the joint was excised for disease, only 15 died. The period after the injury at which the excision is performed seems to be important. Deaths. Thus of 11 cases within first twenty-four hours, 1 = 1-11 " 20 " between second and fourth days, 4 = 1-5 " 9 " " eighth and thirty-seventh, 1 = 1-9 -- -- 40 6 EXCISION OF THE WRIST.--Very various methods have been proposed and executed for the purpose of excising this joint. These vary much in difficulty and complexity, in proportion to the endeavours made to save the tendons from being cut. The principles which must guide all attempts at operative interference with this joint are-- 1. To remove all the diseased bone, including the cartilage-covered portions of the radius, ulna, and of the metacarpal bones, as little of these bones being removed as possible, beyond the cartilage-covered portions. 2. To disturb the tendons as little as possible, especially to avoid isolating them from the cellular sheath. 3. To commence passive motion of the fingers very soon after the operation. It is rarely possible to remove the carpal bones as a whole, from the diseased condition which renders the operation necessary, and the digging out of the various bones piecemeal renders the operation very tedious, especially if the proximal ends of the metacarpal bones are involved and require to be removed, hence this operation was practically impossible till after the discovery of anæsthesia. In describing the operation elaborated and described by Professor Lister, the type of the various plans in which the tendons are saved is given, while a very few words descriptive of the incisions used by others who cut the tendons will suffice. LISTER'S OPERATION OF EXCISION OF THE WRIST-JOINT.--Even an abridgment of Mr. Lister's account of his operation must necessarily be long, because the operation itself is so complicated and prolonged, and guided by such precise principles, as to render much abridgment almost impossible. A tourniquet is put on, to prevent oozing, which would conceal the state of the bones; any adhesions of the tendons must be then broken down by free movement of all the joints.