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ing good in the cases of long ligamentous union. Possibly the point of union of the ligament, might have something Buy Levitra Discount to do with its usefulness ; as, for instance, in cases where it was at- tached to the anterior portion of the edge of the fractured sur- face, a manifest disadvantage would ensue when attempts were made to use these two irregularly shaped masses of bone, with their tendency, under these circumstances, to tilt backward, as portions of the extensor apparatus of the leg. In this instance the ligament was mostly made up of a thickening of the aponeu- rotic expansion Buy Levitra Discount overlying the patella in health, while compara- tively little of its formation was due to the capsule. On the other hand, when the latter took a larger part in the formation of the ligamentous union, the lateral aspects as well as the un- der surface of the fragments were so supported as to prevent tilting as the knee was flexed and extended. In one case, at least, of considerable disability, the speaker made the observa- tion, at the time of wiring, that a thick fibrous cord, made up almost entirely of thickened Buy Levitra Discount aponeurotic structure, was attached to the anterior edges of the fragments, while the capsular at- tachments were thin and thrown into loose folds, allowing, without doubt, of sufficient tilting to account for the uselessness of the limb. Reduction of a Dislocation of the Humerus of Long Standing by Open Incision. — The Peesidext read the follow- ing: Three years ago Minnie Post, aged thirty-eight, single, a seamstress, while attempting to save herself from falling down stairs, suffered a dislocation of the right humerus at the shoul- der joint. It was reduced at once. Two weeks afterward the dislocation recurred, the patient being Buy Levitra Discount unable to account for the accident in this instance. This dislocation was reduced after a month had elapsed. Six weeks later another apparently spon- taneous dislocation occurred, upon which latter occasion reduc- tion was at once accomplished. Following this, recurrences of the dislocation took place Buy Levitra Discount repeatedly, and, although reduction was promptly efiTected in each instance, the bone never re- mained in position more than two weeks before it would again, and without apparent cause, become displaced. At the time Buy Levitra Discount of her coming under my observation the head of the humerus was resting below the coracoid process, where, the patient stated, it had been for Buy Levitra Discount more than six months. She suft'ered constant pain in the arm, and in the condition she was then in it was impossible for her to earn her living at her vocation of seam- Buy Levitra Discount stress. 80 PROCEEDINOS OF SOCIETIES. [N. T. Med. Joub., On April Buy Levitra Discount 1, 1886, I performed the following Buy Levitra Discount operation for the reduction of this dislocation: An incision was made, com- mencing at a point just within the tip of the acromion process of the scapula and curving downward and inward, and then upward, so as to terminate at a point about two fingers' breadth to the inner side of the coracoid process. The prominence formed by the displaced head of the humerus lay in about the center of the space marked out by this U-shaped incision. A flap, consisting of integument, fascia, and fat, was now dissected and turned upward, the fibers of the deltoid muscle were sepa- rated with the handle of the scalpel, and the tendinous margin of the pectoralis minor was brought into view and Buy Levitra Discount retracted, when the capsular ligament was exposed. This latter had been pushed under the coracoid process and seemed untorn. A strong adventitious band was found lying across the humerus at the site of its anatomical neck; this being divided, attempts to re- duce the dislocation by manipulation were made, but failed, although the head of the bone moved more freely than before. An attempt was now made to reduce the dislocation by the or- dinary method, with the heel in the axilla, but this, too, proved nnsuccessful. The strong downward Buy Levitra Discount traction made during this latter attempt, however, showed the presence of dense adhe- sions between the capsular and coraco-humeral ligaments and the aponeurotic structures attached to the coracoid process. These were divided with blunt scissors, and another attempt at reduction with the heel in the axilla was made, but without effect other than to disclose the existence Buy Levitra Discount of a strong and sharply defined band occupying the site of the coraco-humeral ligament. Tliis seemed to be the ligament itself very much shortened, and, upon applying the scissors to it while strong traction was made upon the arm in a downward direction, it gave way with a decided snap. The head of the bone was now- replaced in the glenoid cavity by simple manipulation and with Buy Levitra Discount the characteristic " thud." It was noted that the capsular liga- ment upon the anterior and outer Buy Levitra Discount aspects of the displaced bone was somewhat attenuated from prolonged strain in its abnormal position. After reduction, several buried catgut sutures were so ap- plied as to take up a loose fold of the capsular ligament which remained, and attach it to the sheath of the deltoid wall toward its humeral portion, witli the view of re-enforcing this portion of the capsule and keeping its loose portion well over toward the glenoid cavity. A rubber drainage-tube was then passed to the deeper portion of the wound and so arranged as to rest in the most dependent angle of the latter, which, with the patient ly- ing upon her Buy Levitra Discount back, was at its acromial end. The " dead space" in the depths of the wound was closed, as far as possible, with buried catgut sutures, and the edges of the cutaneous incision were brought together with a continuous suture of the same ma- terial. During the operation the wound and surrounding parts were frequently irrigated with a Buy Levitra Discount 1-3,000 solution of hydronaph- Buy Levitra Discount thol, and, just before ap[)lying the sutures, sterilization was ac- complished by means of a 1-12,000 solution of potassio-mercuric iodide. Perforated oil-silk next to the wound, and paper wool, the whole held firmly in place, constituted the dressing. The arm and forearm were secured to the chest by means Buy Levitra Discount of a roller bandage. But one vessel had required ligature, a small cutane- ous branch at the inner extremity of the incision. The following day the dressings were stained with serous exudation and were changed. The pain was very slight, and there was no rise of temperature. On the second day the dressings were again found' to be stained and were re- moved. Some tension upon the edges of the wound was noted at one point, and a slight reddish blush observed. The suture was liberated at this point and the wound redressed. Tem- perature 100-5' F. On the third day the temperature rose to 101*8° F., and, upon removing the dressings, a very small amount of pus was Buy Levitra Discount found upon them at the site corresponding to the point of redness and tension observed the day previous. The redness had not disap- peared. The parts were thoroughly irrigated with a 1-3,000 solution of hydronaphthol and redressed as before. Ten grains of sulphate of quinine were given. On the fourth day the temperature fell to 99° F., and no further rise occurred. The drainage-tube was removed. No