540 PHILOSOPHICAL TRANSACTIONS. [anNO 1774. 



situated just below the processus acromion." Now as the processus acromion 

 reaches a little over the joint, his beginning his incision below that must, of 

 course, be below the insertion of the capsular ligament. 



Mary Turner, a farmer's daughter, of Ipstones, in this county, applied to 

 Mr. B. in October, 177l> on account of an abscess in the joint of her right 

 shoulder, with which she had been afflicted near 3 years. On examining it, he 

 found 3 apertures ; 1 near the middle and lower edge of the clavicle ; and the 3d, 

 near the insertion of the pectoral muscle into the humerus. By introducing 1 

 probes, from the upper and lower orifices, they easily met in the joint, the 

 opening into which, through the ligament, seemed to be very small, and he 

 could perceive the head of the humerus carious. As in this case, there seemed 

 nothing to be proposed for her relief, but either to amputate the arm, or by an 

 opening, to cut away the head of the bone. He determined on the latter; and 

 accordingly began an incision from the upper orifice, near the clavicle, and con- 

 tinued it over the joint to the insertions of the pectoral muscle: but finding 

 a single incision too small, to allow him to get at the head of the bone readily, 

 he separated a part of the deltoid muscle from its insertion into the clavicle ; and 

 likewise a little of its insertion into the humerus; which gave him liberty to 

 come at the joint, the capsular ligament of which, from frequent inflammation, 

 was so thickened, and kept the head of the bone so close to its socket, that it 

 was with difficulty he could introduce a spatula between them. This likewise, 

 after opening the ligament, prevented the head of the bone from rising out of 

 its socket, on pressing the elbow backward, as is common in performing the 

 operation on a dead body, when the joint is in a sound state; so that he was 

 obliged to separate it quite round, before he was able to come at the bone with 

 the saw. He then moved the elbow backwards, and brought the head of the 

 bone over the pectoral muscle, as he found it impossible to saw it directly across, 

 as Mr. White directs, without leaving a considerable portion behind, tiiat had 

 been laid bare with the knife, and which, in all probability, must have exfoliated. 

 By placing a card between the edge of the deltoid muscle and the bone, and the 

 saw within the incision, with its point into the joint, he cut off all that had been 

 deprived of the periosteum, and had no exfoliation ; nor had he occasion to take 

 up one artery. As the tendon of the biceps muscle was cut through, he kept the 

 fore-arm suspended. The patient walked from his house to her own lodgings; 

 her pain was not very considerable, and she recovered, by the common treat- 

 ment, without any bad symptom. She left this town in 6 weeks after the 

 operation. 



By using her arm too freely when she got home, the cicatrix was torn open 

 about H inch, which retarded its healing for 3 weeks longer; but from that 

 time she had remained well. She had the perfect use of the fore-arm; could 



