APPENDIX-Section on Surgery and Anatomy. was found lying transversely across the bladder. It was necessary to change its position, so that its long axis would correspond with the line of extraction and the long axis of the blades of the forceps. Owing to the size of the stone, and the stunted and undeveloped condition of the patient, it required very careful manipulating to avoid bruising the neck of the bladder and the prostate gland. Sufficient digital dilation, however, was accomplished, and during the extraction the edges of the wound through the bladder neck and prostate were carefully pushed back with the fingers of the left hand as the calculus emerged from the viscus. After extraction, the stone was found to be 234 inches long, and 11⁄2 inches in width, and weighs 614 grains, and is of the phosphatic variety. On the morning succeeding the day of operation, hist pulse was 120. and temperature *90. He was given freely of milk punch, alternated with wine, every three hours, until his temperature went up to 98, and pulse reduced to 100. This supportive treatment was continued. There has been no cystitis, nor any local inflammatory trouble, and the wound has healed kindly by granulation. By the twelfth day, the urine was passing per urethra, and he has made, in all respects, a satisfactory recovery. Displacement of Long Head of the Biceps-O. Eastland, M. D., Wichita Falls. DISPLACEMENT OF THE LONG HEAD OF THE BICEPS. By O. EASTLAND, M. D., WICHITA FALLS, TEXAS. Ory M., aged 3, was brought to my office, June 4, 1885; his parents having their attention attracted to the fact, that since the day previous, he was unable to use the right arm, except in a limited way, the preternatural immobility being noticed first just after some visiting relative had, in playful mood, been tossing the little fellow by grasping by the arm and about the shoulder. There was free antero-posterior motion of the arm, whether volutary or passive. The next step taken excluded the existence of a fracture, since the axis of the humerus corresponded with the position of the head. The relation of the bony prominences being next investigated, the coracoid process was found in the normal position and relation with the clavicle and acromion, but the head of the humerus presented at a point slighly above and anterior to the normal position, seemingly crowded forward to an occupancy of the anterior half of the glenoid cavity, in which position we find a ready solution for the restricted outward and upward motion, since the greater tuberosity must impinge upon the acro APPENDIX-Section on Surgery and Anatomy. mion in any upward movement. Another manifestation I might just here introduce, was an echymotic spot, on the morning of my first observation, being about the size of a silver quarter-dollar, quite circumscribed, subsequently becoming diffused under the skin, but at what depth I was unable at the time to ascertain, hence could not assert as to its connection with a ruptured muscle or ligament. This disappeared in about four or five days. After the investigation made, we felt warranted in a diagnosis of "displacement of the long head of the biceps," an accident long declared impossible, but now proven by anatomical specimens. We find reasons for the infrequency of the accident when we perceive the safeguards nature has placed around this important tendon, yet we can conceive of forces brought to bear under which the integrity of the parts must yield. The tendon of the long head of the biceps flexor cubiti plays in the bicepital groove under a strong covering of tendons and muscles, and in its backward displacement we have more or less of the following injury: Laceration of the capsule, detachment of the insertion of the infraspinatus and the supraspinatus on the greater tuberosity. Conceiving that I had this state to deal with, the suggestions of Dr. David Prince, of Illinois, was followed in the process of manipulation: Flexion of the forearm, followed by outward rotation of the arm, then circumduction, first backward, then outward, upward, forward and downward. This proceedure, imperfectly performed, without an anesthetic, failed in results, and Displacement of Long Head of the Biceps-O. Eastland, M. D., Wichita Falls. there being contra-indications to the use of the anesthetic, I was forced to desist from further manipulations. Directing the internal use of syr. phos. quinia, ferri et strych., and application of a stimulating lotion, with free massage of the parts, instruction was given for the little fellow to be brought to my office daily. For three days the condition seemed unchanged, but on the fourth day, much to my satisfaction, the normal state and relation of the bony prominences, including the head of the humerus, was found to obtain, and the arm responded punctually to my direction for an upward movement to grasp an object held on a plain corresponding with the top of the head, instead of remaining limp at the side as before, when similar directions had been given, to heed which, the strongest power of will and muscle were futile. Examination over the bicepital groove showed nothing abnormal, there being entire freedom from the prominence mentioned, as existing under the observation of some surgeons. It is, however, worthy of remark, that this prominence over the bicepital groove has been reported in cases where the displacement had existed for some weeks. Some may rightfully question how this displacement, so marked, could occur, then become spontaneously replaced? I have to offer, as the most plausible theory, the age of the patient, and the relaxed fibre before mentioned as an idiosyncrasy, as in this case we conceive an elasticity of ligaments and muscles that would |