When I saw her on the following day, she still complained of excruciating pain in the hand and arm, to relieve which a linseed-meal poultice was applied. The pulse being 130, and full, about another pound of blood was taken from the other arm. Next day a number of little vesicles made their appearance on the back of the hand and a little above the wrist, which, when opened, discharged a watery fluid. For the next two days she continued to suffer much pain, to relieve which poultices were constantly applied. More vesicles formed, and the cuticle began to peel off in the vicinity of the bite. On the morning of the 29th, that is, on the fourth day after the accident, when the poultice was removed, she complained of no pain at all in her hand, and on careful examination I found that gangrene had taken place, all below the wrist being dead. From the state of the arm, there was every appearance of the mortification extending. On making an incision into the living portion above the wrist, a considerable quantity of a very fœtid whitish watery fluid discharged itself; and, on pressing the arm between the finger and thumb, a crepitation was felt from the air which had generated beneath the integuments. She was now very weak, the pulse 136, small and feeble, and she appeared to be fast sinking. Amputation being the only means that seemed to offer her a chance of recovery, I decided at once to take off the arm. As the crepitation extended to a few inches above the elbow, and the swelling itself to the shoulder, I determined to take it off as close to the latter as possible. As there was no room for the application of the tourniquet, I got Mr. Heath to apply pressure with a padded key over the artery where it passes under the clavicle, and Mr. March held the arm while I performed the operation. A good deal of blood was lost before I could secure the artery, which had to be done before the bone was sawn through. In a fortnight after, the stump had nearly healed up, and she was walking about the room. Four years afterwards I again saw her, and her general health had not suffered in the least, but she had become extremely irritable and ill-tempered.