DISLOCATION OF THE HUMERUS ON THE DORSUM SCAPULÆ.

696 this consisted his foot still hanging in the stirrup ; he wa be called subcutaneous vene. conscious of some sudden slip in his shoulsection ; the proceeding consisted in the der at the moment of the fall. Finding that passage of a convex bistoury under the vein, he suffered severe pain, and was greatly and cutting towards the skin without divid- bruised, I bled him on his first arrival home, ing it; this was to be followed up by the w]ie!n he seemed greatly relieved, but being application of compresses and bandages. caudle-light I deferred operating on his disMr. Mayo had recommended the application located arm till the morrow. The sympof caustic potash over the varix, but in this toms of this luxation, of which I took note, proceeding the vein was apt to become in- were as follow slight oedema of the whole volved in the slough and haemorrhage occa- arm, numbness, and a sensation even as if sioned ; when this did occur, if the patient the member were deficient; pain on the inwas erect the blood flowed out with amazing side of the arm, about the situation of the rapidity, and in great volume, though not nerve; elbow slightly turned out; the with force ; it was, however, easily stopped patient obliged, through pain in the shoul. by pressure and friction. He (Mr. L.) had der, to support the arm gently, and with followed, for a long period, the mode recom- the greatest care, yet the extremity could mended by Mr. Mayo ; it was generally suc- be placed close to the side, and carried out without pain, but forward cessful, and only in one instance did bleed- to ing occur. A plan, had, however, lately and backward motion caused great sufferbeen proposed by M. Velpeau, and this ing referred to the head of the humerns, consisted in passing pins under the ves- which appeared under a thin covering of sel, and applying over them a twisted muscle (infraspinatus) behind and below thread; these pins made their escape by the acromion, and quite posterior to the anulceration, or were not removed until terior costa, or thickened margin of the scathis occurred. This plan, modified and pula. This position made the joint seem, improved, they had seen often practised as it were, particularly broad in the anterohere; the object aimed at, was to produce posterior direction, or gave the joint a coagulation and obliteration of the vessel at double aspect, as if there were two heads one or more points. For this purpose two of the os brachii present, or a twofold long harelip pins were passed under thei volume of the deltoid; on accurate meavessel, leaving about half an inch of it inter- surement the two arms werefoand of equal posed ; the threads were then applied. Itt length. The other symptom deserves espeoften was necessary to obliterate the canal cial notice, and has not been recorded by at various points, as when the lesser saphena any author ; from the course taken by the was also implicated. The part of the vein shaft of the bone to its unnatural location, operated upon soon became firm and perma- it necessarily left the front margin of the nently closed ; the blood coagulating and the deltoid in its due course to the centre of the coats becoming thickened; in some cases shaft, so that an obtuse angle appeared in even in twelve hours this happened, but more the arm, formed below by the inferior porfrequently from twenty-four to forty-eight tion of the shaft, and above by the descendhourswere required for the completion of ing anterior margin of the deltoid ; and, the piocess, and the pins could safely be again, an extraordinary width and flatness taken out at the expiration of a few days, a of the whole upper part of the outside of the drop or two of blood only coming away. limb, was naturally produced by the posteMr. Blake had found in some experiments rior course now assumed by the humerus. In the reduction I determined to pursue that the blood in the jugular vein of a dog, in whom he had adopted this proceeding, the mode recommended by Mr. Coley. Havbecame coagulated in the space of sixteen ing rendered the scapula a fixed point, by hours. He (Mr. L.) was, however, afraid the long towel encompassing that bone, and that such a short time could not be safely having the arm passed through an aperture taken as a standard in operations upon the in its centre, and being held at its two ends human frame, and on veins in a dilated and by a strong assistant on the opposite side of diseased state. The operation produced no the patient, I raised the arm, without great suffering. pain, above the horizontal position, aud turned it so as to give the head of the hu-

a.

plan for relieving varix, and

in what

might

horizontality,

merus an

DISLOCATION OF THE HUMERUS ON THE

DORSUM SCAPULÆ.

insinuating

movement

over or on

the costa scapulae. I then directed an assistant to make extension directly outwards, and, finally, somewhat downwards. The bone almost immediately returned, and two

were distinctly heard, one, peroccasioned by the passage of the bone WtLLiAM SMALE, aged about 50, whilst over the costa, and the other when it finally tmntiug, was precipitated to the ground, by sunk into its natural cavity. The patient his horse falling under him, and was then remarked on the instantaneous relief which drawn a considerable way by the animal, the reduction afforded him.

By J. C BELLAMY, M.R.C.S., Yealmpton. crepitations haps,