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fore, represented this accident in Fig. 4, by which it may be seen that the same principles are applicable also to it. Here, as well as

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in the other instances, it is only the upper end of the humerus that touches the thorax, and the elbow projects strongly forwards. In this dislocation, it might be possible to bring the elbow against the side of the trunk, by carrying the humerus down parallel with the axis of the body; but any contact of the elbow with the chest is impossible, if the fingers be directed towards, or placed upon the sound shoulder, for then the form of the thorax would offer an insuperable obstacle.

Having now, I trust, sufficiently demonstrated the truth of the proposition that it is physically impossible to bring the elbow against the front of the thorax in dislocations of the shoulder, I would simply add, that it is equally true, that no other injury of the shoulder-joint than a dislocation can induce this physical impossibility. It is obvious, that a mere contusion of the soft parts may render motion of the joint so painful as to deter the patient from the effort necessary to carry the fingers upon the other shoulder. But there can be no difficulty on the part of the surgeon in placing the limb in this position, and an anesthetic might be used, if desirable, so as to render manipulation painless. The same may be said of fractures of the upper end of the humerus, of the acromion, of the coracoid process, and of the neck of the scapula. In neither of these accidents can there be any physical impediment in the way

of bringing the elbow in contact with the front of the chest, for in neither of them can the upper end of the humerus be so fixed against the ribs as to make it impossible for the lower end to touch the chest. Nothing, therefore, but a dislocation can prevent the limb from being placed in the position indicated.

If it be justly esteemed a matter of great importance to be in possession of correct principles of diagnosis in occult diseases, it is certainly not the less so with regard to surgical accidents, especially when these demand prompt interference. Our professional records unfortunately establish too conclusively the imperfection of our diagnostic resources in injuries of the joints, to permit any indif ference on the subject. If, therefore, the views here presented may facilitate, in the least degree, the detection of injuries confessedly more or less obscure, my object will have been attained.

AUGUSTA, GA., April 25, 1857.

REPORT

ON THE

FAUNA AND MEDICAL TOPOGRAPHY

OF

WASHINGTON TERRITORY.

BY

GEO. SUCKLEY, M.D.,

U. S. ARMY, FORT STEILACOOM, W. T., OCT. 1, 1856.

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