Calendar: 1875-1876 Page 626

622 MEDICAL DEPARTMENT with slight stoop of the shoulder forwards The upper arm muscles on the right side were considerably wasted especially the deltoid and the pectorals tumefaction was readily ap- parent along the vertebral border and below tbe angle of the right scapula tbe last-mentioned part being much more prominent than the rest of the bone The latissimus dorsi and trapezius muscles could be felt when in action to ride over the tumour No swelling was apparent in the axilla or on the side of the chest upon which the serratus magnus muscle could be felt to lie close to the ribs and the intercostal spaces could be easily dis- tinguished He could use tbe arm pretty freely and lift the hand to the head without difficulty He complained of little or no pain anywhere unless the swelling were roughly handled The tumour was soft doughy and fluctuating in places The last sign was most evident to the vertebral side of the angle of the scapula On percussion dulness was observed at the apex of the right lung in front with somewhat increased vocal vibration With the stethoscope the expiratory sounds were found to be prolonged with some bronchophony The respiratory sounds at the lower part of tbe chest subpectoral and axillary were normal but weak The swelling was punctured at the lower angle of the scapula and by the use of the aspirator about pint of pure pus was drawn off This produced subsidence of the swelling and re- stored the normal position of the scapula In few days the swelling gradually returned and the detormity of the shoulder returned with it Aspiration was twice repeated with similar results The last puncture remained patulous however and dis- charged little pus The patient having improved much in health and appearance under generous diet cod liver oil and iodide of iron was then sent home In week or ten days bow- ever he returned with hectic cheeks and febrile condition with foul discharge from the puncture He was readmitted and large drainage tube passed through the cavity of the abscess which was freely injected through the tube and washed out with the car- bolic lotion The discharge speedily became more laudable and the bov again improved in health and appearance He was then recommended to go for change of air and went out of the