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factory result of that operation in Mr. Liston’s recorded case,-the fearful mutilation which it would involve,-and the smallhope of a successful issue to so formidable a procedure at heradvanced age; whilst, on the other hand, the chief obstacles torecovery seemed likely to be serious haemorrhage, (which itwas thought might be prevented,) or excessive drain upon thepatient’s strength in the subsequent suppuration,-Mr. Symedetermined to remove the entire bone. This was done as fol-lows : an incision was made from the acromian process trans-versely to the posterior edge of the bone, and another from thecentre of the first directly downwards below the lower marginof the tumour. The flaps thus formed were then reflected. Thescapular attachment of the deltoid, aud the connexions of theacromial end of the clavicle were next divided. With a viewto prevent the most serious source of haemorrhage, the sub-scapular artery was next cut across, and secured. The jointand circumference of the glenoid cavity were next divided;the finger being hooked under the coracoid process greatlyfacilitated the division of its attachments, and enabled theoperator to pull back the bone, and separate its remainingattachments with rapid strokes of the knife. The limbwas supported and retained in situ by a bandage. Thetumour, on examination, was found to consist of a nearlyuniform expansion of the bone into a bag, partly membranous,partly osseous, containing a cerebriform growth, and extendedto the margin of the glenoid cavity and spine of the bone. Allseemed to promise well after the operation; the wound healedrapidly. At the end of a fortnight the amount of dischargewas scarcely sufficient to stain the bandage. The shoulderassumed a very natural appearance, and it seemed that by thesupport afforded by the clavicular portion of the deltoid, toge-ther with the action of the pectoralis and latissimus dorsi, thelimb would be able to execute a fair degree of motion,-indeed,the woman was with difficulty prevented using the limb toofreely; but the patient’s strength did not improve in a corre- ’,sponding degree, and towards the end of November she sud- denly sank, and died on the first day of December. The authorconcluded with-the expression of a hope that this case wouldtend to encourage greater freedom in operating for diseases ofthe shoulder-joint as well as scapula, proving, as it did, thatthe scapula may be removed without serious loss of blood;that the resulting wound does not necessarily occasion excessivedischarge, and that the arm becomes afterwards a serviceablelimb-

Mr. HALE THOMSON regarded the operation which had beendetailed in the paper as most undesirable to be performed.Looking at the age of the patient, and other circumstances, afavourable result could not have been expected. He did notbelieve that the woman could use the arm on the side fromwhich the scapula had been removed any better than she couldthe paralysed arm. He thought the operation unjustifiable.The PRESIDENT said it was interesting to know that a patient

might recover the use of the arm, to a certain extent, aftersuch an operation. There were few cases, however, in whichthe operation could be practised, since there were few in whichthe tumours were circumscribed b bony coverings. The

greater number of cases would be those of medullary disease :he had one such under his care at the present time-that of anenormous medullary tumour growing in every direction fromthe outside bone.

Mr. CURLING differed in opinion from Mr. Thomson, andthought the operation was a skilful and able attempt on thepart of the surgeon to effect a good object. The patient wasno doubt in an unfavourable position for the success of theoperation; but the effort of the surgeon was for the prolon-gation of life. He had seen Mr. Luke remove the greaterpart of the scapula, leaving the glenoid cavity. He thoughtthe operation of Mr. Syme was to be justified on every soundsurgical principle.

Mr. SYME observed, that it appeared to him remarkablethat after the removal of the scapula the arm should still beuseful; and on this ground, that the case would be interestingto the Society. It was still more surprising, that the removalof the clavicle should not produce any alteration in the positionof the shoulder, or interfere with the motion of the arm; yet thiswas the fact in a case in which he had operated. There was,in truth, no difference between one arm and the other. Manythings which appeared à priori impossible, were not really so.Other cases of tumour of the scapula were also fit for the ope-ration he had performed. He mentioned one in particularwhich had come under the care of the late Mr. Liston, whowished to amputate the scapula, but could not get any othersurgeons to countenance the proceeding. ,

.

(To be continued.)

PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, FEB. 17TH, 1857.DR. WATSON, PRESIDENT, IN THE CHAIR.

DR. BRISTOWE and Mr. HUTCHINSON gave a report on Mr.Nunn’s case of " Ovarian Tumour," exhibited a.t the last meet-ing. The report stated that the tumour was one of the uterus,and not of the ovary. It was of the ordinary fibrous kind, butthe earthy deposit was on the periphera, instead of in the in-terior, as was usual in these growths. The cervix uteri waspresent and healthy ; the body of the uterus was absorbed.There was but one ovary and one Fallopian tube.Mr. HUTCHINSON referred to the rarity of the deposit of

chalky matter round the circumference of the tumour, as inthis case, instead of in the middle. He had seen only one suchspecimen, and that was in the museum of St. Bartholomew’sHospital. The tumour was a fibrous one, and almost pedun-

culated.Some conversation followed between the reporters and Mr.

Nunn, who expressed his conviction that the tumour was ova-rian, and this was the opinion of several of his colleagues.Eventually the specimen was referred to Dr. West and Dr.Brinton for further examination.

Dr. MARKHAM related a case ofDISEASE OF THE AORTA; ANEURISMS ; FIBRINOUS CLOTS IN THEARTERIA INNOMINATA AND THE LEFT CEREBRAL ARTERY.

L. S-, a female, aged fifty, had long suffered from short-ness of breath and palpitations : latterly, also, and especiallyin cold weather, she has been troubled with attacks of faint-ness and giddiness. The difficulty of respiration increasing,she sought relief at St. Mary’s Hospital, on Feb. 4, 1857. Atthis time the breathing was much impeded, her face livid, andthe cervical veins swollen, and no pulse was perceptible at theright wrist. Shortly after her admission, she was found lyingin bed insensible, her right arm and leg entirely paralysed, thepupils of the eye immovable and contracted; no pulse couldbe felt at the right wrist, nor in the vessels on the right sideof the head and neck ; a diastaltic murmur was heard over thesternum. She lay in this state, the difficulty of breathing gra-dually increasing, for sixty hours, when she died.’

A large amount of serum was found in both pleuræ, thelungs much congested, and in parts compressed. The pericar.dium was everywhere adherent by old and orgaiiized attach.ments. The heart was larger than natural; the aortic valves,somewhat thickened and retracted, were incompetent; thearch of the aorta was much diseased, exhibiting everywhere atits internal surface the signs of fibroid and atheromatous dege-nerations. One small aneurism was found at the left side ofthe aorta, immediately above the left valve ; two small aneurisms also existed on the right side, above the semi-lunarvalves ; the larger, about as big as a pigeon’s egg, pressed uponthe right auricle and also on the vena cava descendens, so as tohave much diminished its size. The arteria innominata wascompletely closed by a firm fibrinous clot, closely adhering toits walls; a clot also reached up the whole common rightcarotid. The opening of the left carotid artery was contractedto one-fourth of its proper size, by hard fibroid deposit beneathits inner membrane. The brain was congested ; its ventriclescontained much serum ; the left internal carotid, after leavingtne sella turcica and left middle cerebral artery, was closed bya firm red clot of blood ; the left corpus striatum and partsaround, supplied by the artery, were much softened.

This interesting case seems to demonstrate : that the arrestof the circulation of blood through the innominata had pro-duced no marked changes either in the locomotion or sensationof the individual, (for, before the paralysis came on, no pulsecould be felt at the right wrist,) and that life was carried onfor sixty hours solely by the blood which was conveyed to thebrain through the left vertebral artery. The paralysis, we maycertainly presume, occurred at the moment the clot was formedin the left internal carotid. The cause of the formation of thefibrinous clots in this artery, and in the innominata is hypo-thetical ; but we may fairly suggest that the clots were in someway connected with the aneurismal fibrinous layers ; the open-ings of the aneurisms were large, and thus broken down bits offibrin might have readily escaped, and been carried along bythe current of blood into the arteries, blocking them up, afterthe manner first described by Dr. Kirkes. That no return ofsensibility or movement took place after the paralysis, we mayof course attribute to the circumstance that no blood could passto the brain through the right carotid, and thereby in part oom-

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pensate for the cutting off the blood by the clot in the leftcarotid.Mr. OLIVER CHALK related a case of

PARTIAL DISLOCATION OF THE, LOWER JAW,which occurred in J. S-, a female aged thirty-seven. Bythe constant and long-continued pressure of an enlarged tongue,the condyles of the maxilla inferior have been partially luxatedfrom the glenoid cavities, so that this bone has been carriedobliquely downwards and forwards, projecting nearly an inchbeyond the superior, and forming a prominence beneath thechin. The tongue, which undergoes considerable variation inform and size, being at times so swollen as to protrude fromthe mouth, was, when measured, three inches in width bythree quarters of an inch in thickness ; it was deeply indentedby the teeth of the upper jaw. Mastication was exceedinglydifficult, her speech impaired, and she suffered from severefacial pains in the vicinity of the articulating surfaces of thejaw. The preceding case is interesting, inasmuch as it affordsan additional proof to that already given by Mr. C. Vasey(" Transactions," vol. vi., p. 172) of the effects of slow andcontinued pressure of the tongue on the lower jaw. The cases,however, differ, inasmuch as in the instance cited by thatgentleman, the protrusion was caused by the cicatrix of a burnon the neck and chest, together with an altered condition ofthe alveolar processes, whilst in this it is the result of partialluxation without any alteration whatever in the osseous struc-ture.

TUESDAY, JAN. 6TH, 1857.Mr. BRYANT exhibited a specimen of

DISLOCATION OF THE VERTE13RA; PARTIAL REDUCTION BY EX-TENSION AND LOCAL PRESSURE.

Francis A , thirty-four years of age, a healthy labourer,fell from a scaffold, a distance of twelve feet, across a wallupon his back. He was taken up powerless, and admitted intoGuy’s Hospital, one hour after the accident, on May 3rd, 1856,under the care of Mr. Cock. On admission, he was sufferingintense pain over the lower dorsal vertebra, the seat of injury;this pain shooting across the abdomen and round the hips.Perfect paraplegia and anaesthesia, of the lower extremities werepresent, with retention of urine and slight priapism. The skinwas cold; pulse 52, small. The only position he could lie in,on account of the pain, was upon his left side. Eight hoursafter admission, chloroform was given, and a careful examina-tion made, when a considerable depression and prominenceover the lower dorsal vertebra was most marked. Moderateextension and pressure over the projecting bones were appliedwith success, the deformity being considerably reduced, andthe intense pain which was previously experienced much re-lieved, enabling the patient to recline upon his back. Uponthe third day a peculiar catching cough, with slight bronchitis,made its appearance,-but this latter soon disappeared. Perfect

paralysis of the sphincters existed from the beginning, and anydistension of the bladder occasioned more abdominal pain. On

May l4th, the integuments over the sacrum first became in-flamed, and on the 21st the bladder had lost its power of dis-tension, the urine flowing away as secreted. On May 3lst, adecided bed-sore made its appearance, which, in spite of re-medies, gradually became worse. On September 15th, severalsmall pieces of necrosed bone came away from the sacrum, andfrom this time the patient’s powers gradually gave way, and onDecember 25th, being nearly eight months after the accident,the man died. On necroscopic examination, the body was ob-served to be wasted, and legs slightly œdematous. There wasa sloughing bed-sore over the sacrum, exposing necrosed bone,and the sacral canal, which admitted the passage of a probe.No permission being given to inspect the body, the seat of in-jury was alone examined. Externally over the lower dorsalvertebra some irregularity was observed; but the bones werequite firm, the muscles round the part were pale, but no signsof inflammatory products were detected in the soft parts. Onremoving the lower dorsal and upper lumbar vertebras, themischief was clearly seen to have been produced by a disloca-tion of the eleventh dorsal vertebra forwards, causing thetwelfth and lower vertebra to be projected backwards. Theseparation had taken place at the intervertebral cartilage, andthis had now almost entirely disappeared; a thin layer only re-maining in parts; in others, the bones were in contact, pro-ducing almost complete anchylosis. The eleventh vertebra, asa whole, seems to have been thrown forwards for half an inch,and downwards, rupturing all the ligaments, confining it to the

one below, and permitting a separation of the spinous processesto the extent of nearly one inch. The edge of the anterior andsuperior surface of the body of the twelfth was also broken offwith the downward pressure. The lower lumbar vertebra andsacrum were black and necrosed; the sacral canal was exposed,and the cord within of a dark-green colour, and sloughing;this state of medulla extended up into the lumbar region. Thecord at the seat of injury was compressed and disorganized,but both above and below it was healthy. The above is aspecimen of a class of cases which have been generally regardedas somewhat rare, the majority of authors believing that frac-ture of the spine, the result of accident, is by far the most fre-quent occurrence, the toughness of the ligaments resisting whatthe bones break under. That such an opinion is not altogethercorrect, this present specimen tends to prove, as a direct blowupon the spine was followed by a dislocation and not a fracture.Three other cases have occurred at Guy’s Hospital within thelast sixteen months, illustrating the same opinion-two of puredislocation of the lower cervical vertebra (where dislocationcertainly may generally be expected), and one of the upperdorsal, proving at any rate that such a result from accident isnot a rarity. Another point of interest in the case is the factof the dislocation having been partially reduced by extensionand local pressure, the relief afforded by the operation being ofa most marked character. The fact that bed-sore had provedthe immediate cause of death was too evident; such exaggeratedresults being present of such a complication as are seldomwitnessed in any case where every means for their preventionare fairly tried.Mr. WM. ADAMS exhibited

A DISSECTED SPECIMEN OF CLUB-FOOT.

The leg was removed from the body of George T-, agedthirty-seven, a basketmaker, who died in University CollegeHospital on Dec. 9th, 1856. Excision of the opposite kneehad been performed by Mr. H. Thompson on the 1st October.For the opportunity of examining the foot Mr. Adams wasindebted to Mr. Erichsen. The deformity at the time of deathwas a well-marked example of &aelig;quino-varus; probably theinversion of the foot had been more severe, and the case mighthave been one of varus. It was of non-congenital origin, andundoubtedly the result of infantile paralysis, though said tohave been caused by a burn at the age of two years. On dis-section, all the muscles of the leg were found to be in an ex-tremely advanced stage of fatty degeneration, except thetibialis anticus, which was of a pale-red colour. The tendo,<-Achillis had been divided several times, and in one instancenew tissue appeared to have been cut into. The posteriortibial tendon had been once divided, only half through, abovethe inner malleolus, a wedge-shaped portion of new tendonexisting in this situation ; and once completely through behindthe inner malleolus, and in the latter situation the dividedextremities of the tendon had never re-united. A small quantityof new tendon had formed in connexion with each of the dividedextremities, but towards the centre each portion of new tendonwas firmly adherent to the anterior wall of the sheath behindthe malleolus. It thus afforded an example of non-union ofdivided tendon. The new tendon presented to the naked eye,a grayish, translucent appearance, and was thus readily distin-guishable from the opaque, glistening old tendon. Micro-

scopically examined, the fibrous tissue was seen to be muchmore delicate than that of old tendon, and its general charac-ters were the same as those described by Mr. Adams as exist-ing in the newly-formed tendon in rabbits after subcutaneousdivision. (See Path. Soc. Trans., vol. vi., and represented inPlate 18 of this vol.) There was an irregular distribution ofthe arteries of the leg. The posterior tibial was absent. Theperoneal, which occupied its position, was enlarged to the sizeof the posterior tibial, and, behind the outer malleolus, crossedthe ankle-joint towards the inner side of the os calcis, and fromthis point its distribution in the sole of the foot was normal.The posterior tibial nerve was enlarged to twice its normalsize. The nature of this enlargement was specially investi-gated by Dr. G. Harley, of University College Hospital, whoreported that the common neurilemma was thickened, and aconsiderable increase of cellular tissue distributed amongst thenerve fibres. The tubular nerve fibres show very distinctlytheir normal sinuous outline and double contour. Dr. Harleyconsidered the enlargement to be similar to that found at thepoint of union of divided nerves.Mr. COOPER FOSTER showed specimens of

MALIGNANT DISEASE OF TIIE FIBULA,taken from a girl, eight years old, whose leg was that day