A Case in Which the Head of the Os Humeri Was Sawn off, and Yet the Motion of the Limb Preserved. By Mr. Daniel Orred, of Chester, Surgeon. Communicated by Thomas Percival, M. D. F. R. S. and A. S. and Member of the Royal Society of Physicians at Paris

II. A Case in which the Head of the Os Humeri was sawn off, and yet the Motion of the Limb preserved. By Mr. Daniel Orred, of Chester, Surgeon. Communicated by Thomas Percival, M. D. F. R. S. and A. S. and Member of the Royal Society of Physicians at Paris. SIR, Read Oct. 12, 1778. A very eminent surgeon at Chester has desired me to transmit the inclosed case to the Royal Society, and I hope it will be deemed worthy of publication. It not only affords a confirmation of an important fact inserted in the Philosophical Transactions, vol. LIX. art. vi.; but shews also that the chirurgical improvement, proposed in that article by my ingenious friend Mr. Charles White, may be extended to operations on other parts of the human body. I am, &c. THO. PERCIVAL. A FRIEND A FRIEND of mine, an ingenious surgeon, settled at Tarporley, in this county, sent for me about the middle of last month to see a patient of his, a gentleman's servant in that neighbourhood. This was a man of about forty years of age, who had much injured a good constitution by hard drinking before the following accident happened to him. From an injury received more than three years before the time I saw him, by a fall from the top of a ladder, I found a suppuration had taken place in the shoulder joint. The matter had made its way through three small openings; one in the axilla, directly opposite to the cavity of the joint; the other two lower than the strong tendons of the pectoral muscle, and betwixt the deltoides and biceps muscles. Upon introducing a probe into the joint by the upper orifice, I found the head of the os humeri exceedingly carious. A few weeks before I saw him, a collection of matter had formed upon his foot, I suppose from an absorption and translation from the shoulder. Upon letting out the matter with a lancet, I found the metatarsal bones also very carious: with these shocking complaints no wonder he was much enfeebled and reduced. As the disease in his shoulder would evidently soon have put a period to his life without immediate relief, I proposed to him, him, either to amputate the arm at the diseased joint, or, with a view of making it of some use to him, endeavour to saw off the head of the affected bone only. As the least of two evils he chose the last; though this indeed is a most painful, hazardous operation. We are indebted to Mr. White, of Manchester, for the mode of this operation, as well as for many other valuable hints and discoveries in surgery. In order to allow the arm as much action as possible after the operation, I began my incision a little above the joint, and continued it in a right line directly through the middle of the fleshy portions of the deltoides, and a little lower than its insertion: then elevating the arm to relax the muscle, an assistant with both hands distended the upper part of the opening made by the incision, whilst, with a narrow knife, I endeavoured, by the direction of the fore-finger of the left hand, carefully to divide the capsular ligament. This was effected with very great difficulty, as from preceding inflammation it was much thickened, and adhered closely to the joint: and till it was separated nearly round (for the under, and most dangerous part to cut through, was corroded with matter) I found my utmost efforts to throw the head of the bone out of its socket quite ineffectual. After a sufficient separation I made the dislocation, by pressing the elbow to the body with one hand, and with the the other pulling the head of the humerus directly towards me. After guarding the great artery against the action of the saw, by introducing a piece of paste-board under the bone, I separated it across, as Mr. White directs, as low down as I possibly could to prevent an exfoliation. The loss of blood was very trifling. After dressing the wound very superficially, I took particular care that the artery was not pressed upon by the bandages; and advised, when the inflammation subsided, and a good digestion came on, that his arm should always be dressed when the body was erect, and suspended a little from it, with the fore arm a little bent: this was accordingly done. In a few days after the operation, he got up, and continued to sit up the day through ever after. He had a cold infusion of the Peruvian bark with the weak spirit of vitriol ordered him. In consequence of his very reduced habit of body, his shoulder was long in curing. A small exfoliation took place. The cure, I fancy, was also much retarded by the diseased foot, which still continued very bad; the man being so exceedingly terrified by the former operation, that he would not suffer us to do any thing to any purpose to it. I saw him about three months after the accident. The wound was nearly cicatrized; but the ossification was not so far advanced as I expected it would have been, the callus being much smaller than the lower part of the humerus, and bending with the weight of the arm. However, he could raise it from his body more than could be well supposed, and had the perfect flexure and use of his fore arm. This case, with all the disagreeable circumstances attending it, strongly proves the utility of the above operation. By a similar operation diseases of other joints may be as easily cured. About five years ago, a young man of the name of Moores, about fifteen years of age, and son to a farmer at Aldersey, a village in this neighbourhood, applied to me with a disease in the lower part of the ulna, where it joins the bones of the carpus. A variety of means for several years had been tried to no purpose, to relieve him before he came to me. The patient was of a good habit of body, and seemed to enjoy tolerable good health. With his consent I carefully separated from the adjoining parts, and sawed off, more than three inches of the enlarged bone. A callus at a proper time formed in the intermediate space. He is now able to undergo the most laborious parts of husbandry business; though that part of the fore arm where the operation was performed is still something smaller than the same part in the other arm.