linen towel, and put it into the form of a ring of such a size as to admit the arm, and to pass easily over the shoulder. After fixing the ring on the shoulder, so that one part of it laid on the clavicle, and another part about the middle of the lower costa of the scapula, I attached one corner of a sheet to the fore part of the ring, and another to the back part of it, for the purpose of making counter-extension; in proportion to the force applied to the fore and back parts of the ring, it became narrower, and embraced the parts more closely. Napkins were fixed as usual on the injured arm. After these preparations were made, I desired the assistants who were there, on either side, to make a steady and forcible extension and counter extension; which they did without any other effect than that of giving the patient considerable pain, for the head of the bone remained immoveably fixed in the axilla. A vein was then opened, and the patient was directed to stand up as long as he could; the assistants were instructed to apply their force as soon as he fainted. After the loss of half a gallon of blood he fainted, and in his fall was placed on a small bench. The distraction was made at the proper time, and from his situation all muscular exertion was obviated; the head of the bone was without difficulty drawn out from the axilla, accompanied by a considerable noise of laceration. As soon as the head of the bone was sufficiently drawn out, the bone was easily returned to its natural socket, by suddenly depressing the elbow while my knee was placed in the axilla. The time that had elapsed from the accident to the reduction of the bone was about one hundred and twenty days. We then applied some bandages to prevent the part from becoming displaced.

The inflammation caused by the reduction very soon disappeared, and in a short time the arm began to have its power restored. When I saw the man last there remained from this accident only a slight stiffness of the thumb and fore-finger of the hand; but I understand from Dr. Potter, who saw him sub

sequently, that he was entirely freed from all the consequences of the accident, and that he entered on board of a ship as an able-bodied seaman.

I consider this case as valuable in several points of view. It shows that the advice of some surgeons who have recommended that after eight or ten weeks from the time of the accident no attempt should be made to relieve it, should not be regarded. It points out the utility of blood-letting in cases of this kind, which remedy has been revived and successfully practised by Dr. Physic; in as much as the same force was ineffectually applied before bleeding which succeeded after it.

I am also disposed to attach some importance to the ring which I used, and which appeared to me perfectly calculated to keep the scapula in its place, and to throw the distracting force on the only part where it could be useful.

THOMAS CARROLL, aged twenty-six years, in walking after night, attempted to pass over a pile of stones, from which he fell and struck the point of his shoulder. The accident gave him some pain on the instant, and he perceived that his arm was no longer capable of performing its ordinary motions. Two or three hours after the accident he called on me, and, on examination, I found the portion of the clavicle which was connected with the scapula displaced.

I had seen only two cases of the same kind before, both of which were in Guy's Hospital, and both of the patients left the institution without being relieved. A recollection of the failure in these cases had caused me to direct my attention considerably to the nature of the accident, and to the means which would probably be successful in relieving it. But I had not been able to satisfy myself that any plan of which I had thoughtwould have the effect of keeping the shoulders sufficiently back,

and of supporting the arm to a proper degree. I therefore gave a very doubtful prognostic as to the issue of the case. As the late hour of the night at which he called on me rendered it impracticable to have any machinery constructed for the occasion, I found myself under the necessity of resorting to the means within my reach.

After drawing the shoulder back until the clavicle was restored to its proper position on the scapula, I tied a cravat round the shoulder joint on either side, placing the knots about the middle of the base of the scapula, and leaving the ends of the cravat of considerable length. The arm was very well supported by a common string, made by a silk handkerchief, and the ends of the cravats were tied together and drawn so strongly as to bring both the shoulders back, and to retain them in the position which I wished; whereby the torn ends of the ligaments which connect the clavicle with the scapula were kept in apposition. I had occasion to adjust this simple contrivance every day for five or six days, by which time the parts appeared to have got into a very favourable condition, and in three or four weeks my patient returned to his trade, which was that of a smith, perfectly relieved.

To the Editors of the Medical and Philosophical Journal and Review.

GENTLEMEN,

The following case is sent to you for insertion on account of its singularity and importance. It was my intention to have subjoined some remarks, but upon writing to my friend, Mr. Baynham, of Virginia, who I knew had performed the operation in two instances with success, he was kind enough to promise me an account of them drawn up at length, with some observations on the symptoms which characterize the disease, and on the best manner of performing the operation.* These will entirely supersede the necessity of my saying any thing on these topics. His communication will, Fexpect, be received in time for your next number, and will be immediately sent to the publishers.

Yours, &c.

J. AUGUSTINE SMITH.

A CASE of EXTRA-UTERINE CONCEPTION, in which an Operation was performed. By J. AUGUSTINE SMITH.

ON Monday, the 10th of October, I was requested to visit a free negro woman, living in James-street, in consultation with several medical gentlemen of this city. The account we received from the patient was as follows: That she conceived, as she supposed, not quite twelve months from that time; that she felt the child move until she was seven months gone, according to her reckoning, after which all its motions ceased, at which time she was seized with what she supposed labour pains, which

*This operation is so extremely rare, that we have been unable to find any instance of it on record except the first which occurred to Mr. Baynham, and of this there is a mere sketch; we shall, therefore, feel particularly obliged to this gentleman for his communications on the subject. Editors.

soon went off, and did not again recur: that she was conscious, during the whole course of her pregnancy, that the swelling was more on one side than on the other; she had menstruated regularly, and her breasts contained milk. The uterus, on examination, was found healthy. Ulceration had taken place in the tumour, she informed us, some weeks before; since which it had discharged a fetid matter, occasionally mixed with small pieces of bone. Upon examination we found a considerable enlargement, of which the umbilicus was nearly the centre, for it projected rather to the right side. There were two small orifices through which the matter made its way, the one somewhat above, the other directly in the umbilicus. Upon introducing a probe into the latter, bone could be distinctly felt at no great depth. As the patient was rapidly sinking under hectic fever and diarrhea, it was unanimously decided that a speedy performance of an operation was the only means of saving her life, and the next morning was fixed upon for that purpose; the patient having consented, after being apprised of its danger and uncertainty. Accordingly the next morning I performed the operation. Having first introduced a probe into the sac, I made an incision at the inner edge of the right rectus abdominis muscle, from an inch and a half above, to the same distance below the umbilicus. At three strokes of the knife I got into the sac, and introducing my finger, dilated upwards and downwards as far as could be done with safety; for had I gone beyond the adhesion of the sac to the parieties of the abdomen, and thus exposed the cavity of the peritoneum, the patient must have died. I then proceeded to extract the bones with my dressing forceps, conducted by my finger, which at first was easily done, but after removing two or three it became more and more difficult, and at last I found it absolutely impracticable to get away any more, at least without doing a violence to the woman which she could not possibly survive. This disappointment arose from a circumstance which it was impossible to foresee; for, from the length of time which had