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BY CHARLES FREIOTT, M.D,






    OF TROY, NEW-YORK.




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AMPUTATION  AT THE SHOUIjfell-JOINT.

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          BY CHARLES  FREIOTT.  M. D.
 John Christopher Stevens, a stocking-weaver by occupa-
 tion, aged forty-six, of a melancholic temperament, a native
 of Saxony, had been  in this country about six weeks.   On
 the morning of the 5th of July last, while engaged in under-
 mining a bank of clay about eight feet high, near the steam
 mills of the " Albany  Nail Factory," the bank caved in upon
 him, forcing the right  arm between the spokes of one of the
 wheels  of a wagon he had been loading.  In order  to get
 room to extricate him, the driver, not knowing the situation
 of his arm, drove his team forward, and thus added to the in-
jury.  Soon after the accident he was seen by my colleague,
 Dr. James Thorne, and other physicians, who recommended
 his immediate removal  to the Hospital, where  he  arrived
 about eleven o'clock.
   On examination, the humerus was found to  be comminu-
ted at about three inches below the head.  The integument
and muscles were torn away, leaving the bone exposed from the
anterior and external side of the neck of the humerus, from a
line one inch posterior to the acromion process, to the insertion
of the pectoralis  major muscle.   His pulse was very small 
o
and  thready, and his extremities were cold.   Brandy  was
given him very liberally, which in a short time produced slight
reaction, when I commenced the operation, with the concur-
rence and approbation of my colleague Dr. Thorne, and sev-
eral medical gentlemen of this city.
  The first step of the operation consisted in removing the
torn shreds of muscle on the anterior and external portion of
the shoulder.  I then cut through the integument and mus-
cle  to the bone, commencing an  inch below the acromion
process of the scapula, to a point corresponding to the inser-
tion  of  the latissimus dorsi  into the humerus,  when it be-
came necessary  to ligate the  posterior  circumflex artery,
which for a moment  bled very freely.   The posterior  flap
was dissected to the glenoid cavity, afterwards the anterior flap
was  also dissected back, and both were held  back by an
assistant.  I then passed a scalpel from the anterior to the pos-
terior flap, just below and close to the internal portion of the
neck of the humerus, and made an incision an inch and a
half in  length. I now directed  one of my assistants to pass
his thumb into the wound in the axilla,  and compress  the
artery while  I completed the section of the axillary artery,
rein, muscles, and integument.  The artery was immediately
seized and ligated without the loss of a drachm of blood. The
dissection was now continued until the joint was  exposed,
which was punctured, and the head of the bone easily disar-
ticulated.  My assistants, during this part of the operation,
strongly retracted the flaps, thereby enabling  me to have
plenty of room to see and feel the capsular ligament.
  The wound, after being thoroughly sponged, was dressed
by bringing the opposing flaps together, and retaining them
by sutures, after which a compress of lint was laid on  the
wound, and retained by strips of adhesive plaster, and cold-
water dressings applied. 
3
  July  6th.—Patient  complains of considerable pain, and
had slept very little, pulse 90 and full, tongue clean and no
appetite ; ordered morphiae sulph. gr. %, at night, and  con-
tinue cold-water dressings.
  July  7th.—Has passed a good night, little pain, pulse 80,
tongue clean, has a good appetite, feels cheerful, asks permis-
sion to drink " lager-bier," which was granted, with full diet,
cold-water dressing, and morphine at night continued.
  July 8th.—Rested well, pulse 72, other symptoms favora-
ble.   A slight discharge was noticed to issue from underneath
the dressing, accompanied with slight odor.   The dressings
were removed, when several maggots were seen in the pus, 
4
which was of a healthy appearance; creosote lotions were used,
with  a  dressing of resin cerate, and the morphine was con-
tinued at night.
  July 9th.—Symptoms still favorable, wound looks healthy,
the upper and lower portions are uniting by first intention.
Continuj the same treatment  as yesterday.
  The patient now continued  to improve daily, with chloride
of soda and creosote lotions, and an occasional application of
the nitrate of silver.   The ligature came away on the 2Sth
of July.  The pulsations of the artery, which, from the time
of the operation, were forcible, from this time began to dimi-
nish,  and now are scarcely perceptible.  The wound was
cicatrized, excepting about   half an inch, on the  28th  of
August, at which time the accompanying drawing  was taken.
   Note.—The left arm is represented in the cut as having been amputated,
instead of the right, by mistake of the artist in not reversing the drawing made
from the daguerreotype from which it was copied.