to
the displacement of the head of the humerus by the force of gravity,
when the circumflex nerve is injured. In the instance I refer to, a
fracture of the surgical neck of the humerus was accompanied by
complete motor paralysis of the deltoid and very rapid wasting of the
muscle. Circumflex sensation was impaired, but not absent at the time
the condition of the muscle was noted--a favourable prognostic sign of
much importance. At the end of five weeks, when the fracture of the bone
was consolidated, the head of the humerus had dropped vertically at
least an inch, but could be replaced with ease. Shortly afterwards an
improvement in the condition of the muscle commenced, and with this the
head of the humerus was gradually raised. This patient later recovered
his power in great part, but not completely.

In a few cases bullets lodged in the neighbourhood of joints in such
positions as to limit movement by mechanical impact with the bones. Thus
I saw one case in which a bullet lay between the radius and ulna just
below the lesser sigmoid cavity; in another the bullet lay in front of
the ankle-joint, and limited the possibility of flexion; and in a case
related to me by Mr. Bowlby, a bullet was removed by him from the wall
of the acetabulum where it was tightly fixed in the substance of the
bone. In two other cases I saw bullets lying deeply on the anterior
surface of the hip capsule and so limiting flexion. In all such cases
the indication for removal of the bullet was sufficiently strongly
marked.

WOUNDS OF THE JOINTS

These may be divided into several classes, varying much in comparative
severity, and in prognostic importance.

1. The comparatively rare instances in which a wound implicated a joint
cavity, without accompanying lesion of any bone.

2. Perforating wounds in which the bullet was retained within the
articular cavity. These were also rare.

3. Wounds of the joints accompanied by grooving of the articular
extremities of the bones.

4. Complete perforating tracks through the articular ends of the bones,
crossing the joint cavity in various directions.

5. Comminuted fractures of the terminal parts of the diaphyses extending
into joints.

Of these several classes, the first was of the least prognostic
importance. In the absence of bone injury the wounds usually healed
without any obvious ill effect beyond the transient effusion into the
joints of a mixture of blood and synovial fluid. When suppu