ABNORMAL CONDITIONS OF THE SHOULDER JOINT. 



595 



herent, and in time, probably, anchylosis might 

 have taken place." 



Observations on this case. In this interest- 

 ing case, recorded by Mr. Soden, it is true 

 that the tendon of the biceps was dislocated; 

 but, we may ask, are the appearances noticed 

 during life, as well as the condition of the 

 shoulder joint found on examination after 

 death, capable of any other explanation than 

 that given to them by Mr. Soden ? Upon 

 such a matter we feel we ought to speak with 

 the greatest diffidence, because this case is so 

 far unlike almost every case of partial luxa- 

 tion yet published in this circumstance, that 

 its history was known before the post-mortem 

 examination of the joint was instituted. 

 However, we must confess that we do not as 

 yet feel convinced that the case of partial 

 displacement upwards of the head of the hu- 

 merus, as the immediate and direct result of 

 accident, has been full}' proved by Mr. Soden. 

 If we analyse the symptoms the patient him- 

 self reports to have observed immediately 

 after the accident, we find that he at first 

 supposed he had either suffered a fracture or 

 a dislocation, but finding that " he could raise 

 the arm over his head" lie felt re-assured, and 

 endeavoured to resume his work. It would 

 appear to us, that if the tendon of the bi- 

 ceps were accidentally dislocated the patient 

 would not be able, immediately after the acci- 

 dent, to raise his arm over his head; while 

 the circumstance here noticed seems quite 

 reconcilable with Mr. Soden's own impres- 

 sion, that there was in this instance no other 

 injury than a severe sprain of the joint. The 

 symptoms under which the patient subse- 

 quently laboured were those of an inflamma- 

 tory character, such as might have been 

 expected where so severe a sprain had oc- 

 curred, as we may suppose the shoulder joint 

 in this instance to have suffered. The ap- 

 pearance the joint presented externally when 

 the disease became subacute, or chronic, 

 namely the flattening of the outer and poste- 

 rior part of the joint, and the appearance of 

 the head of the bone, which had been drawn 

 up higher in the glenoid cavity, the crepitating 

 sensation caused by the friction of the head 

 of the humerus against the under surface of 

 theacromion, the pain felt in the whole course 

 of the biceps muscle, the difficulty experienced 

 in abduction of the elbow from the side, the 

 prominency of the head of the bone in front, 

 almost to " the amount of a partial disloca- 

 tion," all these symptoms we have repeatedly 

 noticed to belong *to the affection of the shoul- 

 der joint which we have called chronic rheu- 

 matic arthritis, and all these have been present 

 in patients who have had this disease in both 

 shoulder joints at the same time, and in whom 

 they could not by any means be referred to 

 accident. Finally, before we leave our analy- 

 sis of the symptoms of this case, we must not 

 omit to allude to the author's own observa- 

 tion " The patient being of a rheumatic habit, 

 inflammatory action of that character was 

 soon established in the joint, so that the 

 peculiar symptoms of the injury were masked 



by those of general articular inflammation, 

 which added greatly to the man's suffering, 

 and to the difficulty of diagnosis." 



The patient being, as we are told, of a 

 rheumatic habit, or predisposed to this ar- 

 ticular disease, it may be readily conceived 

 that any injury this man, aged fifty-nine, 

 might receive in the shoulder joint would be 

 well calculated to give rise to the disease which 

 we have called chronic rheumatic arthritis. 



As to the anatomical examination of the 

 joint, it will be recollected that the disease 

 had been only six months established, and 

 therefore that the more striking results of 

 chronic rheumatic disease should be found 

 was not to be expected. Those which were 

 noticed, however, were such as might be sup- 

 posed to represent the anatomical characters 

 of chronic rheumatic arthritis of the shoulder 

 in an early stage. 



As to whether Mr. Soden's interpretation 

 of his own case be the correct one, or the 

 doubt we have ventured to express should 

 be considered to have a just foundation, we 

 must leave to the judgment of others, to 

 time, and to the result of future investigations 

 to determine ; but the subject must be con- 

 fessed to be one of a truly practical nature, 

 and therefore worthy of further inquiry. 



We had written thus much on the subject 

 of partial dislocation of the head of the hu- 

 merus upwards, with displacement inwards of 

 the long tendon of the biceps, when (on the 

 12th of August, 1848) an opportunity occurred 

 to us of examining anatomically both shoulder 

 joints of a patient who had died in the North 

 Union Poor House the day before, who had 

 been for eight years one of the severest 

 sufferers the writer had ever known from 

 chronic rheumatic arthritis in almost all his 

 joints. The disease existed in an aggravated 

 form in his hips and knees, wrists and elbows, 

 and of late years began also to affect equally 

 both shoulder joints. It was very remark- 

 able that, on examining anatomically the 

 shoulder joints in this case, we discovered 

 the same displacement of the head of the 

 humerus upwards, with dislocation of the 

 tendon of the biceps inwards, as in Mr. So- 

 den's case, in both shoulder joints, and with the 

 dislocation of the long tendon in both shoulder 

 joints in this case, which we shall now relate, 

 were found associated the ordinary anatomical 

 characters of chronic rheumatic arthritis in 

 rather an early stage of the disease; while in 

 the other articulations of this same individual 

 the chronic rheumatic disease was in a very 

 advanced state. 



Case. Charles Mailly, aetat. 48, had been a 

 farming servant in the country, and was remark- 

 able for his strength and activity. He was 

 addicted to drinking ardent spirits to excess, 

 and it was stated of him that he frequently 

 lay whole nights in the open air in a state of 

 insensibility from drunkenness. To these 

 circumstances he attributed the origin of his 

 disease, which disabled him from earning his 

 bread ; he was therefore admitted into the 

 poor house, in 1840. For the last five years he 



QQ 2 



