“When he had laboured under this complaint fifteen months, he was advised to undergo the amputation of his hand; but before he would consent to submit to this operation, he chose to have an account of his case transmitted to the Royal Academy of Surgery at Paris, that he might have their opinion of it: The result of which was, that the members of the academy pronounced the fungus not cancerous, but merely scorbutic. This decision, by the bye, should make us extremely cautious in delivering our sentiments on similar occasions, without seeing the patient, as much depends on the general appearance of the sores in cases of this sort. The academy were of opinion, that the disease was entirely local, and required only local treatment. For this purpose, they advised that the fungus should be taken down by means of euphorbium, savine, &c. and afterwards washed with salt water. If this method proved ineffectual, recourse was to be had to the actual cautery, from the application of which they seemed to expect the most decisive advantages. To this mode of treatment the unhappy sufferer submitted; and, during the space of six weeks, the fungus was almost every day burnt down with the actual cautery; but his complaint all the while continued to gain ground apace; so that being now disappointed in all his expectations of relief from regular practitioners, he had recourse to quacks of every denomination. The arsenic plaster of Plunket was applied, and he was salivated for seven weeks. At length, after undergoing the operation of a variety of nostrums, he again placed himself under my care. In consultation, it was much doubted whether amputation should now be thought of, as the patient seemed to be in the last stage of a cancerous consumption. His limbs were swelled, and his whole habit was wasted by the repeated hemorrhage from the fungus, which was now so increased in bulk as to weigh down his arm, and entirely cover the back of his hand. In short, after every return of hemorrhage, it was apprehended that the next would put a period to his sufferings. “The hazard of the operation, and the little chance he had of its proving successful, being explained to him, the unfortunate man earnestly begged to be relieved from so hideous a load, even though he should die under the operation. I therefore yielded to his entreaties, and took off the hand a little above the wrist, in November 1782, although there was a small indurated gland above the elbow. On dissecting the hand immediately after I had taken it off, the fungus, on being cut, appeared to be extremely similar to the substance of the brain, and to arise from the metacarpal bones of the middle and fore-finger. These bones were in part dissolved, and the other bones of the hand were also in a morbid state.