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they are mostly deficient even in the poetical imagery pre-valent in Ireland, which explains the occurrence of infantileparalysis so common during dentition upon the ground of super-natural agencies-such infants being called " fairy struck."

Bridge-street, Blackfriars, Feb. 1860.

ON THE USE OF CHLOROFORM IN A CASEOF LINGERING LABOUR.

BY F. DUMARESQ ROSS, ESQ., M.R.C.S., Guildford.

I WAS summoned at ten P.M. on the 29th December, 1859,to attend Mrs. L- in her first confinement. On my arrivalI was informed that she had had slight pains all day, which

had become stronger, but still recurred at long intervals. Onexamination I found the os uteri situate high up, lookingdirectly backwards towards the sacrum, and not dilated to

more than the size of a sixpence. Through the os (the mem-branes being entire) the vertex of the child could be distinctlyfelt. She was a woman of middle height, generally healthy,but of an excitable temperairent. She had suffered little in-convenience during pregnancy save from loss of appetite, whichhad persisted to the last.

Dec. 30th, Ten A.M.-—The pains during the night had beenstrong, but had recurred irregularly. On examination, therewas tenderness of the parts; the os uteri was of the same sizeas last night, the lips being very thin. At each successivepain, the head, or rather the membranous cyst, was forcedwith violence against the undilated os, which caused considera-ble pain. I now gave her a full dose of opium, and injected aquantity of warm water into the rectum. This was followedby the escape of some hardened faeces, and she seemed to feela little temporary relief. Leaving her for a few hours in hopesthat she might obtain a little rest, I returned at four butfound her sufferings in no way mitigated, and the os uteri stillobstinately undilated. To try antimony seemed the best plan;accordingly I sent her a mixture containing in each dose fifteenminims of antimonial wine, a dose to be taken every hour untilnausea supervened.On leaving her house I met a brother practitioner of this

town, Mr. Henry Taylor (to whom I am much indebted forhis valuable suggestions in this case,) and on my mentioningthe case of Mrs. L- to him, he told me, that he had foundchloroform invaluable in a similar case some time since underhis care; I therefore made up my mind, that should antimonyfail in bringing about a better state of matters I would givechloroform a trial.At seven p. M. (30th) I again saw her, and found that the second

dose of the mixture had brought on most distressing vomiting;but still, on examination, the os uteri was no greater in circum-ference. I now ordered her beef-tea at shorter intervals thanthose at which she had been taking it for the last eight or tenhours. Her condition at ten P.M. was as follows :-Counte-nance anxious, tongue inclined to dryness, pulse rapid butfeeble. She had passed urine freely; the vagina was hotterand less lubricated than at previous examinations; os uteristill about the size of a sixpence; lips thin, dry, and tender onpressure; membranes entire. I gave her about eight ouncesof beef tea, with a little brandy, and about eleven P.M. com-menced putting her under the influence of chloroform. Forthe first hour she seemed distressed at each return of the pains,but during the last hour and a half was wholly insensible. Oncoming to, at the end of two hours and a half, her conditionwas in every respect improved; the os uteri had dilated to thesize of about a half-crown; lips tumid, moist, and less tender;vagina well lubricated; the pains recurring about every twentyminutes.

31st, Eleven A.M.-The pains had continued since the timeof last note pretty regularly up to about two hours ago, sincewhich time, though strong, they have been irregular, and mostirritating, without, however, doing much service. The os wasdilated but very little more than at the time of the last note.As symptoms of exhaustion seemed once more coming on, Ideemed it advisable again to put her under chloroform, andcommenced doing so at half-past twelve P.M., keeping her underits influence for an hour and a half. At the end of this timeshe seemed much refreshed; the os was more dilated, and thepains recurred at intervals of fifteen minutes. The Dains

continued steady and good up to ten P.M., when symptoms ofexhaustion again supervened, the pains becoming irritable andirregular. Not wishing a third time to put her under the in.fluence of the anmsthetic agent, I redoubled the doses of beef-tea, but to no purpose; and for the last time, at half-pasteleven, I put her under the influence of chloroform, and con.tinued it for an hour. At the end of this time labour set in ingood earnest; in half an hour the membranes ruptured, and inanother half-hour a fine boy was born. There was some con-siderable haemorrhage, and a little difficulty was experiencedin removing the placenta, as the uterus seemed inclined to con-tract irregularly. The mother and child have both done well,no bad symptom having arisen after this protracted labour ofabout fifty hours’ duration.

After this somewhat tedious but necessary recital, I wouldremark that in this case the reputed remedies seemed power-less in bringing about the dilatation of the os uteri. There isa remedy which has obtained in some quarters considerablerepute, but which was not tried-viz., venesection-a remedywhich, to use Dr. Ramsbotham’s words, is "powerful, but notdevoid of danger;" and the same authority, in speaking ofthis expedient, says that, as there must be a certain loss ofblood after the birth of the child, and as it is not known whatthat loss may be, " it would be wanton to take blood from thearm without grave occasion, when the few ounces we mayhave voluntarily abstracted, had they been preserved, mighthave turned the vacillating beam of life in the patient’s favour,and have snatched her from impending death." I feel con-vinced that had I bled my patient sufficiently to have madean impression on her system, the result would have been verydifferent from that which ensued. Opium seemed to have noeffect, and antimony appeared to make matters worse, byhastening exhaustion. With respect to chloroform, in this caseits effects were unmistakable and most salutary. The principalobject of placing her under its influence a second and thirdtime was to obtain for her what she stood so much in need of-sleep, and to her it was a restorative of no ordinary value.

February, 1860.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

KING’S COLLEGE HOSPITAL.

EXTENSIVE DISEASE OF THE SHOULDER, WITH NUMEROUS

ABSCESSES; EXCISION OF THE JOINT; RECOVERY

WITH A USEFUL ARM.

(Under the care of Mr. FERGUSSON.)

Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum etdissectionum historias, tam aliorum ploprias, collectas habere et inter se com-parare.—MoBGAeNi. De Sed. et Caus. 3fof&., lib. 14. Proceniium.

THE infrequency with which the parts entering into the forma.tion of the shoulder are removed at the present day, as con.trasted with the elbow, the hip, or the knee, necessarily investsthe operation with some amount of interest. The subject of ex-cision of joints has been fully illustrated for the last few yearsin our "Hospital Mirror," and we take some credit to our-selves for having most fully entered into it, and thus been themeans of exciting the attention of the profession generally toits consideration and adoption. Excision of the knee, the hip,and the elbow are now established operations in surgery, andso is excision of the ankle. With regard to the wrist, furtherexperience is required to pronounce a positive opinion, althoughit has been practised with success by Mr. Fergusson and byMr. Butcher, of Dublin, to whom surgeons are much indebtedfor their labours in this branch of surgical science.With regard to the shoulder, there is no doubt upon the

question of its propriety, only that the cases are few whichpresent themselves as demanding the operation; and the reason

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is sufficiently obvious-namely, that disease in that joint is by ino means of common occurrence, and when met with, it hasperhaps terminated in anchylosis. Resection of the shoulderhas been performed, however, in a considerable number of caseswith good success. The condition which demands the opera-tion in this situation is, long-continued and exhausting sup-puration, proceeding direct from the articulation or from itsimmediate vicinity, which may be the result of necrosis of theshaft or head of the humerus, or of the acromion and coracoidprocesses of the scapula. The glenoid cavity itself may be theseat of mischief, as occurred in the following case. Generalstrumous disease of the joint is perhaps the form in which it ismost usually witnessed. As, however, the results of the

operation have been proved to be remarkably successful-moreso than in the knee or the hip, or even in the elbow-we seeno reason against its being resorted to with fair prospects of Isuccess in anchylosis of the shoulder which cannot be forciblybroken up. An anchylosed shoulder renders the arm power-less, and if a false joint can be made to replace this condition,by excision, it is worthy of being attempted. The successwhich has been met with of late years by army surgeons in ex-cising the shoulder-joint for gunshot injuries is as remarkableas it is gratifying, and is a great encouragement to active in-terference in chronic disease. If, on the other hand, portionsof dead bone can be otherwise got rid of with fair prospects ofcure, excision should not enter into the calculations of thesurgeon.In former "Mirrors" we have given several illustrations of this

operation on the shoulder, which we may here refer to. Theywere : excision of the joint for old-standing disease, associatedwith partial anchylosis, in a man at Guy’s Hospital, under Mr.Birkett’s care, followed by recovery, (THE LANCET, voL ii.,1855, p. 169 ;) an instance of gun-shot wound of the shoulder onboard H.M.S. Belleisle, excision being performed with successby Dr. Beith, R.N., with a hinge-like movement of the articula-tion, (ibid, vol. ii., 1856, p. 207;) and a case of disease of thejoint, with widely-spread suppuration, in St. Bartholomew’sHospital, in which excision was performed by Mr. Coote; butdeath ensued from diarrhoea (then prevailing) two weeks after-wards, (ibid, vol. ii., 1857, p. 271.) And to-day we add twoothers, with a third example, which justly comes within thesame category, for it was to some extent a partial excision,more particularly involving the acromion.

In many of these cases of disease of the shoulder-joint themischief is attributable to former attacks of rheumatism. Suchwas the fact with Mr. Coote’s patient, and also with Mr. Fer-gusson’s. We have seen many instances of anchylosis of theshoulder attributed to the same cause. An example of the kindhas already appeared in our "Mirror," in which the adhesionswere forcibly broken up with perfect success by Mr. Erichsenat University College Hospital, (ibid, vol. i., 1859, p. 389.)Those who are opposed to the removal of the hip-joint from

fears as to its inutility because of disease existing in the aceta-bulum-a circumstance which we have shown on previousoccasions to be a secondary matter, and which was still furtherelucidated by Mr. P. C. Price before the Medical Society ofLondon last Monday evening-might consider that disease inthe glenoid cavity also is an objection to resection. The re-sults, however, have proved that when the disease has beencarefully extirpated, good recoveries have been made. In thepatient who was the subject of the following case, the glenoidcavity was found diseased ; its affected portions were removedby the gouge, and it did not in the least interfere with theperfect success of the operation, although before its performancethe parts generally around the shoulder were discovered to bemuch disorganized. A little carious bone was also present inthe same cavity in Mr. Solly’s patient, but this again interferedin no wise with an excellent recovery. Differing widely fromthe hip-joint, the glenoid cavity, if extensively diseased, canbe wholly removed by the bone-nippers-an undertaking whichcannot be so easily accomplished in the hip, although we haveseen nearly all of it removed by Mr. Hancock at the Charing-cross Hospital, and with success.As is well known, in disease of the shoulder-joint the long

head of the biceps tendon is usually destroyed by ulceration.In the present instance, however, it was found passing up thebicipital groove, where it was closely adherent to the peri-osteum. Above the end of this groove the tendon could notbe traced, and had been destroyed by ulceration.For the notes of the following case we are indebted to Mr.

Francis Mason, house-surgeon to the hospital :-M. A-, aged forty six, was admitted in October last,

under the care of Mr. Fergusson. She is married, and hadalways enjoyed good health up to about eighteen years ago,

when she fancied that she had rheumatism in her right shoulder.The usual remedies were applied, but the part seemed to bebut little benefited. Four years after this, an abscess formed atthe back of her shoulder, which was punctured, and a greatquantity of matter evacuated. Other abscesses formed in the

region of the neck; but the pain did not diminish in any way.In this state she continued, sometimes better than at others,until last Christmas, when she noticed a tumour, about the sizeof an orange, in front of the shoulder-joint, and another abovethe clavicle. She, therefore, applied at one of the metropolitanhospitals, and as the tumours proved to be abscesses, they werepunctured, and matter was discharged. The pain in the regionof the joint, however, increased in severity; and blisters,iodine, setons, and various other applications were used with-out benefit.On admission into King’s College Hospital, she was a healthy-

looking woman, but having a somewhat anxious expressionof countenance. On examining the right arm, two or threesinuses were found at about the anterior border of the deltoid,and one sinus at the back of the arm, about four inches belowthe acromion. A probe introduced detected bare bone; mani-pulation gave the patient great pain, and the joint seemedpartially anchylosed, the limb being completely useless to her.On Oct. 29th, Mr. Fergusson determined to examine the partmore carefully; and the patient having been put under the in-fluence of chloroform, an incision of about four inches wasmade, commencing just below the acromion process, and pro-ceeding in a downward direction. Mr. Fergusson now dis-covered that the disease was far more extensive than he at firstanticipated; and, on making a further examination, found thewhole of the joint disorganized. He, therefore, made an inci-sion, an inch in length, outwards and at right angles to, andat each end of, the first incision. With a little manipulation,the head of the bone was turned out and sawn off; the glenoidcavity, having been found diseased, was gouged, and the partswere then brought into apposition, silver sutures being used tounite the cut edges of the wound. There was some littlehaemorrhage from a vessel which Mr. Fergusson believed to bethe posterior circumflex artery; but this was easily arrested.Since the operation, the patient has not had a single bad symp-tom ; the appetite has been good; and, in fact, all the func-tions of the body have continued perfectly healthy. At thepresent time (Nov. 18th) the wound looks remarkably well,and is all but healed. The patient can move the arm slightlywithout any pain, and says she was never better in her life.She left the hospital some weeks afterwards perfectly cured;and when seen subsequently, she was found to have a usefularm mith mnrh mntinn H’h thn shoulder

ST. THOMAS’S HOSPITAL.

DISEASE OF THE SHOULDER, WITH CARIES OF THE BONES;EXCISION OF THE JOINT ; RECOVERY WITH

A USEFUL ARM.

(Under the care of Mr. SOLLY.)

Mr. FERGUSSON mentions, in the last edition of his" Prac-tical Surgery," that excision of the shoulder has now been per-formed so frequently in civil practice, that it is justly esteemedone of the most legitimate and brilliant achievements of modernsurgery. This opinion is fully borne out by what we have our-selves seen of the operation and its results, although we havereported but few cases in our " Mirror." Notwithstandingthat the measure of success hitherto attending it is greaterthan that of any other joint, it must not be forgotten thatsome judgment is necessary in selecting the cases for its appli-cation. The two examples which we now place upon recordwere very suitable for it, and their favourable result is en-

couraging ; for not only have the patients recovered fromthe effects of the operation itself, but they have acquired toler-ably free motion at their shoulders, with most useful arms.Mr. Solly’s patient has been under observation for some time,and the cure has proved permanent. It may be observed that hehad phthisical consolidation of the lung before the operation;this was either dispelled or relieved by treatment, and thenthe joint was removed. For the notes of the case we are in.debted to Mr. W. Allingham, surgical registrar to the hospitalR. D-, aged nineteen, a print-colourer. was admitted into