Southern Medical and Surgical Journal - Georgia Regents University

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742 Dugas, on Fracture of the Scapula. [November,graphical Notices" who seem to think their only duty to findfault with the papers placed in their hands, even at the expenseof justice. The disingenuous perversion of quotations and inferencesin the "notice" to which I refer, cannot fail, however,to be detected by any one familiar with the subject, and thereforeneeds no refutation in this place. With your permission,I will now read the history of another instance of Fracture ofthe Neck of the Scapula, which came under my observationsince the publication of those to which I have just referred.My apology, if any be necessary, for bringing this case beforeyou, will be found in the fact that injuries of the shoulder jointare often so obscure that, although they have been longstudied by able and experienced surgeons, their diagnosis isstill the subject of controversy.In the absence of post-mortemconfirmation, we have to rely principally upon the accuracywith which symptoms are investigated and detailed.On the 9th of May, 1858, Mr. Partlow, of Abbeville District,South Carolina, brought to me for consultation his negro boy,Lewis, between six and seven years of age, well formed andwell grown. Mr. P. stated that about two months before, theboy, while at play in the woods, was stricken down by thefalling of a tree, one of the limbs coming down upon his leftshoulder. The direction in which the blow was received wasnot known, but upon approaching the boy he found him rational,and was told that he had not lost his consciousness at thetime of the accident. There was no evidence of injury tothe head, nor any where else than in the shoulder. The boycomplained of his shoulder, and said that the pain was also verygreat in the arm, the ability to move which was entirely lost.Upon feeling the pulse, it was found much more feeble in theleft than in the right limb, and the temperature of the injuredarm was lower than that of the other. In handling the limb andshoulder Mr. P. detected nothing like crepitation, and thereforeconcluded that there was no fracture.Swelling supervened inthe shoulder, soon after, accompanied with great pain in thearm down to the elbow, but none below this. At the end often or fifteen days the swelling had disappeared, the shoulderwas flattened and seemed to droop, but the pain in the arm continuedmuch longer.Cold water dressings, and subsequently stimulating frictions,
1859.] Dugas, on Fracture of Hie Scapula. 743constituted the treatment to which the patient had been subjectedprior to my seeing him.Examination.— By causing the boy to stand erect before me,with his chest bare, the left shoulder appears drooped, emaciatedand very much flattened. The deltoid muscle feels looseand flabby, as though in a state of atrophy. This is not so perceptiblein the other muscles connected with the shoulder;the supra-spinatus, infra-spiriatus and pectoralis major are evidentlysmaller here than on the other side. The acromionprocess projects in a sharp angle, and the head of the humerusis depressed about three-fourths of an inch ;but may be easilyreplaced by pushing up from the elbow. The left hand can becarried upon the right shoulder while the elbow rests againstthe thorax, thereby precluding the idea of a dislocation properlyso-called.By grasping the head of the humerus, which is distinctly felt,with one h?nd, and rotating the lower end of the bone with theother hand, it is found that the head moves continuously w r iththe shaft, and without any crepitation whatever. There istherefore no fracture of the humerus at any point.By placing one hand upon the shoulder so as to fix the bodyof the scapula, the acromion process and the clavicle, at thesame time that various movements upward and laterally areimparted to the humerus, very distinct crepitation can be perceivedin the shoulder-joint. Crepitation is also distinctlyinduced by grasping the head of the humerus with the ends ofthe fingers resting upon the margin of the glenoid cavity in theaxilla, where it is easily felt in this case, and moving simultaneouslyboth the head and the glenoid cavity,the scapula is fixed as above mentioned.yetwhile the body ofThere must then bea solution of continuity somewhere between the glenoid cavityand the body of the scapula.The coracoid process is here very distinctly felt, and it doesnot follow the movements of the humerus when this is alternatelycarried up into its proper position and allowed to fall.By placing the fingers upon the coracoid and the acromion processesthey are found to move in unison with the lower angleof the scapula without crepitation, and are therefore continuouswith it, showing that the fracture must implicate some pointbetween the glenoid cavity and the root of thecoracoid pro-
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Page 3 and 4: 1859.] Climate to the Consumptive,
Page 7 and 8: Aug.Oct.1859.] Climate to the Consu
Page 13 and 14: 1S59.] Climate to tJte Consumptive,
Page 15 and 16: 1859.] Climate to l/ie Consumptive,
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Page 23 and 24: 1869.] Lecture upon Cerebral Fever.
Page 25 and 26: • of1859.] Lecture on Cerebral Fe
Page 27 and 28: 1859.] Lecture on Cerebral Fever. 7
Page 29 and 30: 1859.] Lecture on Cerebral Fever. 7
Page 31 and 32: 1859.] Lecture on Gerebral J' 753un
Page 33 and 34: 1859.] Lecture on Cerebral Ftthey a
Page 35 and 36: :1859.] Attempted Abortion and Deat
Page 37 and 38: 1859.] Attempted Abortion and Death
Page 39 and 40: :—:1859.] Diphtheria. 761by its o
Page 41 and 42: —:1859.] Diphtheria. 763ride of i
Page 43 and 44: ——1859.] Diarrhoea of Infants a
Page 45 and 46: 1859.] Action of Mercury on the Sec
Page 47 and 48: 1859.] Defective Assimilation in In
Page 49 and 50: —1859.] Cancerous Ulceration clos
Page 51 and 52: —1859.] Vegetation of the Genital
Page 53 and 54: 1859.] Gases of Suppression of the
Page 55 and 56: 1859.] Cases of Suppression of the
Page 57 and 58: ——;1859.] After-treatment of th
Page 59 and 60: 1859.] Dr. 0. C. Gibbs. Summary. 78
Page 61 and 62: 1859.] Dr. 0. C. GrBBS. Summary, 78
Page 63 and 64: :;1859.] Secale Cornulam for t?ie E
Page 65 and 66: 1859.] Divisions for the Cure of De
Page 67 and 68: ;1859.] Incision in Anthrax. 789Inc
Page 69 and 70: :;1859.] Editorial and Miscellaneou
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———and1859.] Miscellaneous. 7
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