ABNOIIMAL CONDITIONS OF THE SHOULDER JOINT. 



591 



cavity in the cervix scapulae, which received 

 the head of the bone. At the upper and 

 back part of the joint there was a large piece 

 of the cartilage which hung loosely into the 

 cavity, being connected with the synovial 

 membrane at the upper part only by two or 

 three small membranous bands. The long head 

 of the biceps muscle seemed to have been 

 ruptured near to its origin at the upper part 

 of the glenoid cavity, for at this part the 

 tendon was very small, and had the appear- 

 ance of being a new formation.' Signed, 

 James Patey. 



"This accident," adds Sir Astley, "hap- 

 pens from the same cause which produced 

 the dislocation forward. The anterior part 

 of the ligament is torn, and the head of the 

 bone has an opportunity of escaping forwards 

 to the coracoid process." * 



The foregoing dissection, which is illus- 

 trated by an engraving in Sir A. Cooper's 

 work on Fractures and Dislocations, should 

 not, in our opinion, be considered in any 

 other light than as an excellent specimen 

 of the anatomical appearances to be found in 

 those who have had chronic rheumatic ar- 

 thritis of the shoulder joint ; for we consider 

 that these appearances were not the result of 

 an accidental luxation, but the true effects of 

 this slow chronic disease. If Sir A. Cooper 

 had known any thing of the history of the 

 case during life, we might hesitate to call in 

 question the opinion of so eminent an au- 

 thority on such a subject ; but as the only 

 grounds he possessed for forming any opinion 

 were derived from the mere anatomical ap- 

 pearances observed in the shoulder joint of 

 the subject in the dissecting-room, we con- 

 ceive that every one who studies the report 

 of this dissection, accompanied as it is by an 

 engraving, is at liberty to draw his own con- 

 clusion as to what was the real nature of the 

 case ; and to us it seems quite clear that the 

 appearances observed in the examination of 

 the case referred to by Sir A. Cooper were 

 exactly those most frequently found to be the 

 result of chronic rheumatic arthritis as itaffects 

 the shoulder joint. The new form assumed by 

 the head of the humerus, the fact of the cartilage 

 having been removed, and its place supplied by 

 an ivory enamel the piece of cartilage which 

 hung loosely into the cavity being connected 

 with the synovial membrane, at the upper 

 part only, by two or three small membranous 

 bands the attachment of the capsular liga- 

 ment to the coracoid process all these cir- 

 cumstances related in the above-mentioned 

 case strongly remind us of what we now know 

 to be characteristic marks of the disease we 

 have denominated chronic rheumatic arthritis, 

 as we have so often met with them. Add 

 to this, the observation that the intra-ar- 

 ticular portion of the long tendon of the 

 biceps muscle did not exist ; or, as is pre- 

 sumed, to have been " ruptured " at its origin. 



* See Sir A. Cooper on " Dislocations," p. 449. 

 Plate 21. fig. 2. ; also octavo edition of this work by 

 Mr. B. Cooper, p. 401. 



In all these details we find a very complete 

 account of the anatomy of the shoulder joint 

 which had been the seat of chronic rheumatic 

 arthritis. 



On the other hand, such appearances afford 

 no evidence whatever that an accidental luxa- 

 tion was the cause of them ; certain it is that 

 appearances exactly resembling those de- 

 scribed in Sir A. Cooper's case have been 

 met with in cases in which their cause could 

 not be attributed to accident, because no in- 

 jury had been received; while in others it was 

 useless to refer to accident, inasmuch as the 

 morbid action had similarly affected both 

 shoulder joints ; so that by the dissection of 

 such cases we have convinced ourselves that 

 disease, not accident, was the source of the 

 morbid appearances. If the reader will com- 

 pare the woodcut (fig. 429.), which is designed 

 to represent the anatomical appearances pre- 

 sented by the examination of a case (J.Byrne) 

 already detailed, of chronic rheumatic ar- 

 thritis of the shoulder, with the engraving of 

 Sir A. Cooper's case of partial luxation of 

 the head of the humerus, he will, we think, 

 agree with us that the writer, in believing 

 that whatever causes influenced the produc- 

 tion of the morbid appearances in the one 

 were identical with those which produced 

 them in the other. Sir A. Cooper, in our 

 opinion, somewhat gratuitously supposes that 

 his specimen was the much sought-for ex- 

 ample of the anatomy of the accident called 

 partial luxation. We say gratuitously, because 

 the previous history of the case he alludes to 

 was unknown, and the accident supposed to 

 have occurred. 



In the case the writer has adduced (J. 

 Byrne, (^/%. 429.), the history was known, 

 and has been preserved, with the account 

 of the post-mortem appearances which the 

 examination of the shoulder joint presented. 



At the meeting of the British Association 

 at Bristol in September, 1836, the author 

 gave an account of this chronic rheumatic 

 disease, as it engages most of the joints. 

 When speaking of its effects on the shoul- 

 der, he alluded to this case published by Sir 

 A. Cooper ; and then demonstrated, as he 

 thought, to the satisfaction of the meeting, that 

 the specimen (Jig- 429.) of this chronic rheu- 

 matic disease which he then laid before them 

 for inspection, corresponded exactly to the ap- 

 pearances found in the supposed case of " par- 

 tial luxation of the humerus " delineated in 

 Sir A. Cooper's work. The opinion which 

 he at that time expressed (now twelve years 

 ago) has since been amply confirmed by his 

 subsequent experience *, and by the opportu- 

 nities he has had of further investigating the 

 nature of this disease. 



In the Museum Anatomicum^ of Sandi- 

 fort, 1827, we find delineated the bones of the 

 shoulder joint which present all the cha- 



* See Athenaeum, September 10, 1836 ; also Pro- 

 ceedings of the Dublin Pathological Society, Dub- 

 lin Journal, vol. xv. p. 502. 



f Vol. iv. tab. 24. figs. 1, 2, 3. 



