The head of the humerus was much en larged and altered from its normal figure par ticularly above, in the neighbourhood o'f the great tuberosity, which bulged out much ex ternally ; the usual deep groove above, sepa rating the tuberosity from the head, and here marking the anatomical neck of the humerus, was effaced.
The under surface of the neck of the hu merus was furnished with a vast number of the synovial fimbrix before noticed by us when describing the anatomical characters of chronic rheumatic arthritis of •the shoulder and other articulations.* These were in the recent state of a very red colour. The humerus seemed habitually to have remained in contact with the glenoid cavity, rotated inwards, and in this position these synovial fimbrim lay in contact with the inferior and broadest part of the glenoid cavity ; and it was very. remarkable that wherever these red sy novial fimbrim had been in exact apposition with the cartilage of incrustation of the gle noid cavity, exactly in the extent of' the con tact the cartilage had been removed, satisfac torily proving that these vascular fimbrim had been absorbing villous surfaces.
The glenoid articular surface presented but little worthy of notice, except a porous ap pearance Where its cartilaginous investment had been removed by the absorbing villi, and the commencing state of disintegration of the glenoid ligament. The cartilage vvhich re mained on a portion of the head of the hu merus, as well as that which still adhered to the surface of the glenoid cavity of the sca pula, was rough, and altered from its natu ral state. The acromio-clavicular articula tion of this side seemed enlarged externally, the periosteum about it thickened. When the articular surfaces were exposed, it was found that the cartilaginous covering had been re moved, and that the articular surfaces were nearly double their normal size.
It is quite plain that the movements of the head of the hunterus in the glenoid cavity in this case had been confined to those of a species of semi-rotation only ; the adhesions which were found to exist between the head of the humerus and the inner surface of the synovial membrane of the joint sufficiently suggest this, as well as the new form which the head of the humerus had assumed.
The left shoulder joint in almost every re spect was symtnetrically affected with the right, but particularly as regarded the dis location of the tendon of the biceps, the ex istence of fimbrim, &c. &c., and therefore it does not require a separate description.
It does not appear to us necessary to enter into any details here, relative to the condition the ether articulations were found in. The lungs and other viscera were sound. Whether the patient ever had rheumatic fever or not we are not now able to learn ; but we may mention that upon looking to the state of the heart and its membranous coverings we found the peri cardium adherent to the heart on all its sur faces except where it lay on the diaphragm. It seems to us plain that hereafter, when the tendon of the biceps shall be found displaced internally, we are not at once to refer the dislocation to accident, but that inquiry must be made as to whether chronic rheumatic arthritis may not have been its cause. That the tendon of the biceps should, under the influence of changes which the structures of the joint may have undergone from disease, be thus thrown off the head of the humerus over which it arches, does not appear to us extraordinary, because we have known similar displacement of tendons under analogous circumstances ; indeed, we have generally found the extensor tendons of the fingers displaced, and the ligament of the patella and patella itself are sometimes thrown on the outer side of the external condyle of the femur when the knee joint has been the seat of chronic rheumatic arthritis.
In Mr. Soden's case accident may have had just so much to do with the displacement of the tendon, that the injury was the immediate exciting cause of the development of a local disease, a predisposition to which had pre viously existed in the constitution of the patient.
The writer regrets much that he has not as yet had any opportunity of examining the preparation of the shoulder joint presented by Mr. Soden to the museum of King's Col lepo,London ; but he requested his friend Dr liacdowell, at the time in London, and who was familiar with the many preparations of chronic rheumatic arthritis contained in the Richmond Hospital Museum, to report to him his opinion on the appearances the pre paration presented, and he writes to say, " that frotn the partial examination he could make of the preparation he had only to re. mark, that the head of the humerus is con. siderably enlarged, and that the long tendon of the biceps, which has been dislocated in. ternally, is in a state of atrophy." In these two additional circumstances, as well as those already mentioned, the preparation resembles those of the shoulder joints in the case of Mailly.