coming on suddenly, and referred, by the patient, to a blow at the spot where, no doubt, the aneurism had suddenly given way. Then there was resolution of the muscles of voluntary motion, supplied by the spinal nerves, occasioned by the pressure of the clot upon the medulla oblongata. The extraordinary character of the respiration would be accounted for by the respiratory nerves being involved in the clot. While the power of motion and sensation continuing in the face, is amply accounted for by the fifth pair of nerves not being included in the mischief. The sensibility of the retina, the intelligence that was exhibited in the attempt to put out the tongue, the power of hearing which that effort indicated, and the continued action of the fifth pair of nerves, all pointed out that the injury was situated below the tuber annulare. These, with the distinct reference of the pain to the upper part of the neck, induced me to predict, before the dissection, that the injury would be found about the medulla oblongata. The great improvement that took place, in consequence of the large abstraction of blood, was another marked feature in the case; and it becomes a question of some interest, whether the hæmorrhage were not then put a stop to, and whether recovery might not have taken place, had not the attempt to vomit, by increasing the impulse of the circulation in the brain, again occasioned it. No doubt the clot was increased after the attempt to vomit, for I cannot suppose hearing to have existed, as it did even before the bleeding, when the seventh pair of nerves had become so much involved in the mischief, as it will be seen, by the plate, that they ultimately

were.

ON

FIXING THE SCAPULA,

IN DISLOCATIONS OF THE HUMERUS.

BY JONATHAN TOOGOOD,

Senior Surgeon of the Bridgewater Infirmary.

In almost all surgical works in which dislocations of the shoulder joint are treated of, various methods of reduction are proposed, according to the situation of the head of the bone. Dislocations of the shoulder are, generally, easily reduced, but there is scarcely a surgeon, of any standing, who has not, in the course of his practice, met with cases which have occasioned him a great deal of trouble; and, I believe, it has sometimes happened that reduction has never been effected. In the course of thirty years extensive practice, it has fallen to my lot to see a considerable number of these accidents, and I have been, and have seen other surgeons of great experience, foiled in their attempts, from the difficulty of fixing the scapula. Attention to this point renders the operation easy, as I have often witnessed, where violent and long-continued efforts have entirely failed. Sir Astley Cooper, in his excellent work on dislocations, observes that this is the principal object to be attended to, without which all efforts will be ineffectual. The bandages commonly used for this purpose, do not appear to me calculated to effect the object intended, but, on the contrary, add greatly and unnecessarily to the patient's sufferings, and do not prevent the

T

scapula from being drawn forwards when the extension is made. For many years past I have practised a very simple method, which has never failed even in cases where the head of the bone has been thrown into the most unfavourable position. The method I adopt is as follows:

Having seated the patient on a low chair or stool, firmly secured the body and fixed the pulley, I stand over him, and place the heel of my right hand on the acromion, leaning my weight on my hand: by this means the scapula is fixed and rendered immoveable, the extension is then made, and the reduction quickly completed.

I lately had a case in one of the most muscular men I ever saw, who, having met with a similar accident on a former occasion, dreaded, and with good reason, any attempt at reduction, and declared that he would allow one trial only to be made, and that if it did not succeed, he would be content to let the limb remain unreduced; for that on the occasion alluded to, he had submitted to the efforts of four surgeons and a physician, with sixteen assistants, for three days, and that at length, after bleeding and other remedies, he became perfectly exhausted, when the bone was replaced.

Notwithstanding the head of the bone lay under the pectoral muscle, the whole operation, performed in the manner described, did not occupy two minutes. So satisfied, indeed, do I feel of the great importance of this point, that I do not hesitate to say that all dislocations of the shoulder may be speedily and easily reduced, by fixing the scapula in this manner, without any bandage whatever.

Bridgewater, Nov. 30, 1832.

CASE OF

OSTEO-SARCOMA OF BOTH JAWS,

IN WHICH

AMPUTATION AT THE JOINT WAS EFFECTED,

AND VERY CONSIDERABLE

PORTIONS OF EACH BONE WERE REMOVED BY OPERATION.

BY WILLIAM HETLING, ESQ. M. R. C. S.

Lecturer on Surgery, and Surgeon to the Infirmary, Bristol.

MR. Samuel Cooper, in his highly valued Surgical Dictionary, states that amputation of considerable portions of the jaw bone is one of the achievements of modern surgery; that it was first performed by Dr. Mott, in America, and has since been accomplished by several of the most distinguished English and Foreign surgeons. It may, therefore, though still a new, be considered as an established operation, and as forming one considerable step in the advancement of operative surgery. But, in all the instances I have seen recorded on this subject, only portions of one jaw have been removed, and I am induced to lay the following case before the Provincial Association, as it presents one of the most extensive and complicated instances I have met with in my researches; the disease not only involving both jaws, but also having spread its ravages to the articulation. Hence this case required, in the operation attempted for its cure,

not only the removal of very considerable portions of each jaw, but likewise amputation at the joint. It has also suggested many other practical considerations, the relation of which, it is considered, may not prove unacceptable to the profession, more particularly as this department of surgery is, in many respects, still in its infancy, not only with reference to the operative part, but to the pathology, diagnosis, and prognosis.

A very able and intelligent provincial surgeon, James Barlow, Esq. of Blackburn, Lancashire, has lately well observed, "It is evidently the nature of all morbid phenomena, to be liable to a change of structure, thus, a tumour, when bearing in itself no appearance of malignity in its primary state, will eventually assume a more formidable and alarming aspect; and if its removal be too long delayed, will often prove a source of regret to the patient, whilst he, on the one hand, from motives of timidity, and the surgeon, on the other, through a mistaken fear of risking his reputation, by the hazard of an operation, lulls the patient into a state of supineness: thus they implicitly combine to deceive each other from day to day, during which time their minds are agitated by a succession of alternate hopes and fears, till, by the slow but unnoticed lapse of time, the disease becomes inveterate and incurable." This lamentable effect of surgical procrastination, I have witnessed in a great variety of instances. The following extreme case is one more to be added to the list of those unfortunate and almost inexplicable examples of delay on the part of the patient. It, however, affords the pathologist the opportunity of