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which belonged to them before. There still exists a free trade

in roguery and imposture; and they are at liberty to make themost of it. All England, Scotland, and Ireland, open still anample and no doubt a profitable field for the exertions of thewhole tribe of rubbers, bone-setters, mesmerists, and mounte-banks. We have gained the right of registering our degreeson-the roll. We have no monopoly over the lives and healthof free-born Britons. The outsiders who have so long mingledin our ranks are excluded; but they never had any properfooting there. We present an orderly and soldier-like front;the ragamuffins are expelled from their stolen places in therank. But the act of despotism is no greater than that of thepoliceman who collars the "gamin" that has sought refugeamongst the military ranks at a review, and restores him tohis proper place. They cannot any longer steal the showyclothing. But this is hardly a grievance which will excitegeneral sympathy. If any man prefer to have his bones setby Smith, who is not on the roll, a paternal Government per-mits him to dispose of his own anatomy as he will. His vestedinterest in the conformation of his thigh-bone is not interferedwith. He has still the uncontrolled sovereignty of his organs:he can physic himself as he will, and by whatsoever combina-tions he pleases, by whomsoever compounded. He loses,therefore, none of his free-born privileges and natural rights.What have we gained? A recognised unity of organization :a legal claim to remuneration for time, skill, and labour: apower to register upon the State roll; and to call ourselves byour true titles, which rogues dare not now assume. This

tyranny has no terrors for honourable men: it is only to befeared that it permits too many loopholes to remain open forimposture and evasion.

THE MEDICAL CORNER.

WHAT business has an honest journalist, who undertakes tosupply the good people of Sussex with the news of their countyand their bshionable sea-side town, to open a " MedicalCorner" in his paper, in which" 1Iedicus" professes to answerall questions relative to the preservation of health, and trulyand fully to explain the nature, cause, and proper treatmentof each disease? Such promises can never be fulfilled. Theyare false and delusive. No man, however able, can carry themout unless he personally examines tLe patient. What end, then,,can this " Medical Corner" serve. The answer is probably tobe found in the following sentence addressed to an invalid lady:—" ’ Medicus’ will not correspond with any patient, unless pro-fessionally consulted, when the usual professional fee will beexpected." The hoof shows before we have travelled far. Weearnestly counsel the editor of this otherwise respectable journalnot to allow his columns to be converted to purposes so ob-

viously disreputable and deceptive.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, DECEMBER 14TH, 1858.

SIR CHAS. LOCOCK, BART., M.D., PRESIDENT, IN THE CHAIR.

ON A CASE OF EXCISION OF THE HEAD OF THE HUMERUS,WITH ITS RESULTS.

BY JOHX BIRKETT, ESQ., I

SURGEO_1T TO GUYS HOSPITAL.

A MAN, aged fifty-seven, came under the care of Mr. Birkettin July, 1855, on account of acute disease of the right shoulder-joint. He was cachectic, much reduced, and suffering intensepain. Two years and a few months before, h2 had the rightshoulder injured by being thrust violently against a wall. Theclavicle was fractured; inilammation and suppuration of theshoulder-joint ensued, and abscesses and sinuses were developed.

From local indications, it was quite clear that diseased boneexisted; and Mr. Birkett, being unable to feel the dead bonewith a probe, exposed the head of the humerus and sawed itoff. There was a piece of necrosed bone in the head, but allthe other parts and the glenoid cavity were healthy. Thewound healed rapidly, although sinuses formed and remainedopen for some months after. The health of the patient rapidlyimproved, and all pain subsided. In about eighteen monthsafter the operation the sinuses were all healed, and for verynearly the last two years he has been able to use the limb inthe varied occupation of a farm labourer.The preparation of the head of the humerus accompanied the

paper.The details of another case were given, in which Mr. Aston

Key excised the head of the humerus from a healthy man, agedthirty-four, in Jan., 1849. The bone, especially the cancelloustissue, was affected with scrofulous degeneration. The casewas highly successful, and the man has been actively engagednow for many years as a workman in an engineer’s factory.The head of the bone was shown, together with a drawingillustrating the condition of the upper extremity seven yearsafter the operation.

ON DISABTICULATION OF THE SCAPULA FR07II THE SHOULDER-

JOINT, WITH REMOVAL OF THE ACHOMIAL END OF THECLAVICLE.

BY GEORGE MATTHEW JONES, ESQ., M.B.C.S.E.,susoEOr TO THE JERSEY HOSPITAL.

(Communiccded by F. C. SKEY, Esq., F.R.S.)

The patient, a girl aged fourteen years and a half, hadenjoyed good health until December, 1857, when she first feltpain at the top of the left shoulder. ascribed to the exertion ofcarrying a heavy child; severe inflammation about the shoulderfollowed, being most intense over the upper part of the hu-merus ; an abscess formed, and burst spontaneously. The con-stitution suii’ered severely. When Mr. Jones first saw the

patient, there were four large fistulous openings over the leftshoulder, two communicating with the clavicle, one with thehead of the humerus, one with the glenoid cavity, and one withthe dorsum of the scapula, bare bone being easily felt in each.Several small fistulae, which did not apparently lead to necrosedbone, existed in the scapular region, and yielded an offensivedischarge. The textures covering the shoulder were generallythickened and puffy, and tender to the touch. The patient’shealth and strength were failing rapidly, and Mr. Jones deemedoperative interference imperatively called for. Accordingly,on the 19th of May, 188, the patient having been placed underchloroform, the operation was performed. An incision wasfirst made along the whole extent of the spine of the scapula,and carried an inch beyond towards the mesial line of the back;another incision was then made to meet this along the upperborder of the bone down to its angle. The integuments wereraised by careful dissection, and by this process the whole bonewas fairly exposed, its periosteal investment being everywherefound so thickened, pulpy, and softened, as to yield easily topressure of the finger. The acromial end of the clavicle beingfound to be softened and altered by disease, an inch of thebone was removed. The posterior scapular artery was the onlyvessel which needed a ligature; several small ones were closedby torsion. Sutures and strips of plaster were used to bringthe edges of the wound together, the deeper cavities, includingthe glenoid fossa, being plugged with lint. The operationoccupied three quarters of an hour.On the scapula was found so extensively dis-eased that its characters were almost destroyed. The glenoid

surface and neck were entirely removed, and no vestige of thespine remained, its position being occupied by new, irregularly-deposited osseous matter, at the base of which lay a deepchasm, that extended three-fourths across the body of the bone.The inferior angle of the bone was the seat of extensive caries.The body of the bone presented two deep perforations, and allthese different cavities contained sequestra of dead bone, whileother portions of the scapula were in different stages of exfolia-tion. ihere was also a large amount of new osseous matterdeposited in different situations about the bone. The head ofthe humerus was found healthy, and covered with its naturalcartilage.

With the exception of a very critical condition during thefirst two or three days, which was ascribed to the action of thechloroform, the patient made a good recovery. The wound

healed entirely by granulation, the head of the humerus beingexposed for some time. She was unsparingly supplied with

nutritious diet and stimulants. She left her bed and walked

16

in the garden in three weeks and as many days, and at the endof a month she could sew without pain or difficulty. At pre-sent she can raise her arm twelve inches from her side, and cansupport it horizontally from the body, with very slight exer-tion ; she can raise the hand to the opposite shoulder or to themouth with ease, but not to the top of the head; she can puther arms behind her, can lift a large and heavy hospital registerbook, and can scrub the floor or make her bed. There is adecided falling of the shoulder, but by no means amounting todeformity. There is no wasting of muscular substance on thechest or back, and when dressed it would not be perceivedthat any serious operation had been performed. The deltoidis fully developed. The head of the humerus is easily feltmoving freely in its new bed, and not the slightest pain is felton any amount of motion. Up to this present time, the rangeof this motion has steadily increased, and, with the exceptionof the movements for which the scapular origin of the deltoidis indispensable, it may be confidently expected to increasestill further, and nearly to equal that of the other arm.The author concluded his communication by observing that

he considered there was much less danger from haemorrhage inthe removal of the entire bone, than, as in Mr. Liston’s case, inthe excision of only a portion; that he should prefer the formeroperation in any future instance, and he trusted that the relationof this successful case would go far to remove many preju-dices now existing against this operation.

Mr. FERGUSSON regarded with interest both the papersbefore the Society, but particularly the case related by Mr.Jones. It was too much the fashion to report operations assuccessful when the history of the case extended only a daybeyond the operative proceeding. In the cases of Mr. Birkett,results after a lapse of years were given. The successful issueof cases of resection of the head of the humerus was creditableto modern surgery, the patient being relieved from suffering,and retaining the use of the extremity. Cases of resection ofthe shoulder-joint were usually favourable, but the operationhas been but rarely performed in consequence of diseases of theshoulder-joint being less frequent than those of other articula-tions. Resection of the scapula was a more important opera-tion from its rarer occurrence. He believed that Mr. Jones’scase was the second authentic one brought before the professionof this country ; and it appeared to be the result of carrying outa principle laid down some few weeks since by Mr. Syme inthat Society. It was true that the scapula had been frequentlyremoved, but not until after amputation of the superior ex-tremity. Mr. Jones’s and Mr. Syme’s cases differed in manyparticulars. Mr. Jones’s patient had the very great advantageof having youth on her side, and it was a case of simple necrosis.In Mr. Syme’s case there was a tumour in the bone, either ananeurism or a very vascular medullary sarcoma. Mr. Jones’scase afforded a good example to follow. Mr. Liston someyears since suggested the removal of the scapula after amputa-tion of the upper extremity, but he could find no one whowould countenance so formidable a proceeding. In a case inwhich he (Mr. Fergusson) had removed the scapula after am-putation of the upper extremity, he believed that if the planfollowed by Mr. Jones had been resorted to the patient mighthave had a useful arm.

Mr. URE suggested that by making a straight incision be-tween the tubercles of the humerus, the tendon of the bicepswould be avoided, and that this proceeding would be preferableto the V-shaped incision resorted to by Mr. Birkett.

Mr. HOLMES COOTE had performed resection of the shoulderby a straight incision; and the only difficulty he had experi-enced in this proceeding was in the separation of the tendon ofthe sub-scapularis muscle. Except in gun-shot wounds, how-ever, the tendon of the biceps was rarely to be found, it havingdisappeared or become reduced to a fibrous cord in most casesof disease. His experience was rather in favour of the opera-tion of resection of the shoulder-joint, the cause of the rarityof which consisted in the fact that there was often in thesecases osseous anchylosis of the head of the humerus to theglenoid cavity. He recollected Mr. Skey removing the scapulasome thirty years since at St. Bartholomew’s Hospital.

, Mr. SKEY observed, that highly creditable as was Mr. Bir-kett’s case to him, there were precedents for it; Mr. Joneshad very few precedents for the proceeding which he adopted,and in which great accuracy of diagnosis was conjoined withthe most skilful application of the operative art. Mr. Cootewaa not quite correct in stating his (Mr. Skey’s) case as one ofremoval of the scapula. The patient was a man about fortyyears of age, who suffered from a fibrous tumour three-fourthsof the size of an ordinary hat, which was situated at the baseof the scaDula. He (Mr. Skevl never saw haemorrhaQe more

frightful than in this case, and which was only arrested by theimmediate assistance of several of his colleagues. All but theglenoid cavity of the scapula was removed, and the man re-covered so far as to be able to use his arm; but he eventuallyfell a victim to the return of the disease. In Mr. Jones’s case,which he had seen, and which was one of the greatest interest,the girl was able to use her arm for all ordinary and most ofthe extraordinary requirements of daily occupation. He (Mr.Skey) believed that the patient would, however, never regainthe power of elevating the arm, inasmuch as the bones formingthe attachment for the muscles which raise the arm had beenremoved, in addition to which tliree-fourths of the trapezius,four-fifths of the deltoid, and all the supra-spinatus, had beentaken away. The patient, however, could bring the bicepsfully into action, but she could not rotate the arm either in-wards or outwards. She could elevate the arm to an angle ofabout forty-five degrees from the body.

Mr. LUKE had some years since removed the greater portionof the scapula of a woman for supposed malignant tumour. Shehad since been married twice, had had several children, andher arm was nearly equal to the other in power and usefulness.

Mr. BIRKETT had employed the V kind of incision in hiscase, in consequence of the presence of fistulous openings, whichcommunicated with the bone. In any future case he mightprobably be disposed to make a single incision, as this proceed-ing would involve less destruction of the deltoid muscle, andthere might consequently be a better use of the extremity..With regard to the tendon of the biceps in this operation, hebelieved that it was so completely altered in its position, thatit would not come in the way of the knife. In his own case,a portion of the glenoid cavity was entirely denuded of carti-lage, and he was not certain that he should not have to removea portion of that cavity. This condition kept up the mischieffor some time, but the parts eventually healed, probably fromsome exfoliation having taken place. The operation performedby Mr. Jones was highly creditable to him, but it was not tobe compared with those formidable cases in which a new growthor tumour was developed in the scapula. Mr. Jones had doneno more in his case than would have been done by any othersurgeon, the bone being necrosed. (Marks of disapprobation.)The real question to determine was, whether if a case similar

, to that related by Mr. Syme presented itself to us, we couldexpect permanent success by the performance of an operation.

PATHOLOGICAL SOCIETY OF LONDON.

DR. WATSON, PRESIDENT.

FAUCES, LARYNX, AND TRACHEA OF A DOG THAT HAD

BEEN INOCULATED WITH DIPHTHERITIC ESTJDATION.

DR. HAPLEY, while showing the above-mentioned specimensto the Society, said that he had inoculated five animals withthe exudation taken from the fauces of a woman, aged twenty-three (one of Dr. Walshe’s patients, in University CollegeHospital), supposed to be labouring under diphtheria. The

experiments were performed as follows :-1st. As children are especially liable to diseases accompanied

with membraniform deposit-such as croup, for example, two-young pups were selected.

2nd. As badly-nourished, sickly people have been supposedto be favourable subjects for diphtheria, a sickly, ill-fed, full-grown dog was procured.

3rd. A perfectly healthy adult dog.4th. As the foregoing were all warm-blooded animals, and

the experiment was wished to be made as complete as circum-stances would admit of, a common snake, which is a cold-blooded animal, was also employed.Some of the membrane, carefully removed from the fauces

of the woman, together with some of the yellowish- colouredmucus secreted from the denuded surface of the pharynx,which was found on microscopical examination to contain aMthe cell elements of the perfectly-formed membranous deposit,was collected in watch-glasses, and covered up from the actionof the atmosphere. The fauces and pharynx of each of thefour dogs were now scarified, and while two of them had theabraded surfaces well rubbed over with the solid diphtheriticmembrane, the other two were inoculated in a similar mannerwith the yellow mucus. The snake, on the other hand, wasinoculated on the back of the neck, close to the head. Twenty-four hours after the performance of the operations, the twopups were killed and examined, but nothing was detectedsave the marks of the scarification. Four days afterwards the