tory action which had been present so long before its removal. That portion of the glenoid cavity which had been left when the arm was amputated is in a state of caries, the margin of the cavity is surrounded by a mass of new ossific matter, and the lower part of the neck has numerous rough spiculæ projecting from it.

In almost every part of its extent the scapula is thickened and hardened in texture,-changes which are particularly remarkable on the coracoid process, the spine, and the acromion. The portion of the clavicle which was removed partakes of the general condition of the scapula, but there is no appearance of caries upon it.

At the time when this operation was performed, there was a double interest connected with it. It was one of the most formidable and severe as yet effected under the influence of ether, and it was supposed to be the only case of the kind, as a surgical proceeding, which had occurred in this country. The interest connected with the anaesthetic agent has now in some degree passed away; but, in so far as I am aware, the case is still peculiar as one of rare occurrence, and it is chiefly for this reason that I have presumed to bring it under the notice of this society. In various modern surgical works, cases are detailed or referred to wherein portions of the scapula have been removed, either during amputation at the shoulder-joint, by excision of the articulation, or for disease of the bone elsewhere. These proceedings have involved small portions, (such as the spine, acromion process, or glenoid cavity, all of which I myself have removed in different cases,) or as much as three-fourths of the bone. In some instances, the whole of the bone, with a portion or the whole of the clavicle, has been taken away, in consequence of secondary disease, after amputation at the shoulder-joint. In other examples, the upper extremity and bones of the shoulder have been removed simultaneously; and doubtless the surgeons, (Cumming, Mussey, M'Clellan, Gaetani Bey, Rigaud, and Gilbert,) who have resorted to those proceedings, have been encouraged to anticipate success by judging of the

favourable issue of the various examples which have been recorded, wherein the upper extremity, including a portion or the whole of the clavicle, has been torn away by machinery.

In contemplating such an operation for my patient, I felt that there was no want of precedent. In fact, the case related by Rigaud,* of Strasbourg, is in most respects analogous; and the chief point to decide was, whether, under all circumstances, such a formidable proceeding should be resorted to. Three years had elapsed since the arm was amputated at the shoulder-joint; the patient had suffered more or less ever since; and, latterly, the swelling had increased, as had also the discharge, while his health seemed gradually to decline. At an earlier period an operation would probably not have been advisable, as there was a chance of the disease ceasing spontaneously. Further delay seemed passing over the most favourable opportunity for such a proceeding. At one time I was in hopes that, by a partial resection, I might get away all the carious points. A glance at the macerated bone might countenance such a project; but the great enlargement of the soft parts, as well as the numerous sinuses, induced me to adopt the steps which I have detailed. The sloughing of portions of the indurated mass which was left at the operation, and the subsequent strumous abscesses which formed in the remaining parts, perhaps sufficiently prove how much more severe the after consequences would have been, had I left behind any portion of the bone or of the structures with which it was closely invested.

* Comptes Rendus, vol. xix., 1844.

CASE OF A PATIENT

IN WHOM A

FOREIGN BODY HAD BEEN INTRODUCED INTO THE PELVIS THROUGH THE VAGINA,

AND

A DESCRIPTION OF A SUCCESSFUL OPERATION FOR ITS REMOVAL.

BY JOHN C. W. LEVER, M.D.,

PHYSICIAN-ACCOUCHEUR TO GUY'S HOSPITAL.

AND

JOHN HILTON, F.R.S.,

ASSISTANT-SURGEON TO GUY'S HOSPITAL.

Received April 27th-Read June 13th, 1848.

E—— P——, 34 years of age, a woman of tall stature, fair complexion, and rather delicate appearance, was admitted into Petersham Ward, Guy's Hospital, under the care of Dr. Lever, Dec. 31, 1847.

Her general health is pretty good. She has had two attacks of acute rheumatism, one when 16 years of age, and another six years ago. Her relatives are stated to be consumptive, and her husband died of phthisis.

History. On the 6th of June 1847, whilst in the act of applying some ointment on the end of a bone netting-mesh to allay a local irritation in the vagina, she was disturbed by a person entering the room, and suddenly sat down. This caused her great pain, and a small quantity of blood escaped

from the vagina, the mesh being forced quite out of sight, so that only the extremity of it could be felt; and in consequence of her repeated fruitless attempts to remove it, was at length forced so far into the pelvis that she could not feel it. Immediately after the accident she discovered that she could not bend her body or sit down, being obliged to keep herself either in the erect or horizontal position.

:

She has ever since experienced severe pain in the right side of the pelvis, extending down the extremity of the same side the thigh and leg often feel cold and benumbed. The pain is at times so acute as to make her afraid to attempt any movement, and it is always increased by any sudden jerk or motion, as treading on a stone, &c.

During the summer months she was able to walk a short distance, and to go up and down stairs without any great inconvenience: but in November her health became impaired; and the pain was so severe as to confine her to bed, and to require large doses of opium before any relief was obtained.

Before admission into the hospital, she was seen by Mr. Callaway, who requested Dr. Lever to examine the uterus: this was performed by the finger, and by the uterine sound, but he could detect nothing in its cavity. Subsequently the case was treated, by another physician who was consulted, as one of severe sciatica.

Symptoms on admission.-She appears much exhausted and emaciated from the protracted suffering she has endured; she complains of severe pains extending from the posterior part of the thigh and leg to the heel; this pain is at times much more intense than at others, and during the paroxysms she obtains some relief by extending the limb as much as possible. The pain appears to follow pretty exactly the course of the great ischiatic nerve, over the situation of which, as it emerges from the pelvis, there is much tenderness on pressure. There is also some amount of tenderness in the right inguinal region, especially on making firm and deep pressure, but neither the anterior crural not obturator nerves appear

to be implicated: there has not been any tendency to maintain the thigh fixed upon the pelvis.

During her illness the menses, though scanty in quantity and attended with pain, have appeared regularly; and in the intervals there has been slight leucorrhoea.

The bowels are so confined as to render the constant use of aperients necessary; there is slight pain in defæcation, but the evacuations have not been observed to be flattened, or to assume any unusual form. Micturition is painful and difficult, and, when attempted, only a small quantity of urine passes, and much time is consumed before the bladder can be emptied.

But little sleep is obtained without the use of opium. The tongue is clean; the appetite somewhat deficient; the pulse 96, feeble; the sounds of the heart rather harsh. Respiration is natural, and, by external examination, nothing abnormal can be detected in the abdomen. The right lower extremity is wasted, and much smaller than the left.

Per vaginam scrutans.-The pelvis is large, and the vagina capacious; the cavity of the latter is not constricted at any part, nor is there any cicatrix to be discovered. The end of the examining finger impinges on a resisting substance, which appears to be from a quarter to half an inch broad, but neither extremity of it can be reached. It is lying obliquely in the pelvis to the right of the vagina, (the parietes of which can be rolled over it,) and its direction appears to be, stretching from the tuberosity of the right ischium towards the right sacro-iliac-synchondrosis.

The patient's general health was attended to, and improved under the employment of tonics and a generous diet, while the pains were for a time mitigated by belladonna plaster and liniment, but again became excessive on the setting in of the cold weather.

1848.-Jan. 23rd.-At Dr. Lever's request, Mr. Hilton examined the patient to-day, and expressed his conviction that the foreign body was lying obliquely in the pelvis, with its lower extremity firmly fixed near the tuberosity of the