. La chirurgie moderne, général et du dispositif. ent, et sutur-ing l'acromion à l'extrémité externe de la clavicule. Les os sont suturés withsilver ou fil kangaroo tendon, ligament l'articulation acromio-claviculaire est suturé, withcatgut la plaie est fermée avec des sutures de l'intestin, et le patient couché sur le iskept au lit pendant trois semaines. J'ai fonctionné avec succès sur 5 de thesecases. La luxation est réduite et traités de la même manière que dis-location à la hausse. Luxation simultanée des deux extrémités de la clavicule est une blessure très rare. Il est traité comme seule dislocation. La luxation soi-disant

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. Modern surgery, general and operative. ent, and sutur-ing the acromion to the outer end of the clavicle. The bones are sutured withsilver wire or kangaroo tendon, the acromioclavicular ligament is sutured withcatgut, the wound is closed with sutures of silkworm-gut, and the patient iskept supine in bed for three weeks. I have operated successfully on 5 of thesecases. Dislocation downward is reduced and treated in the same manner as dis-location upward. Simultaneous dislocation of both ends of the clavicle is a very rare injury. Itis treated as is single dislocation. The so-called dislocation of the lower angle of the scapula is not, as was long1 Annals of Surgery, May, 1902. 752 Diseases and Injuries of the Bones and Joints taught, a dislocation at all. The lower angle and vertebral border deviatefrom the chest. This condition was thought to be due to the bone sUppingfrom under the latissimus dorsi muscle, but it is now known to be due to par-alysis of the serratus magnus muscle, iht bone being acted upon by the trapezius, . Fig. 455. Fig. 456. Figs. 455, 456.—Rhoadss apparatus for treating dislocation upward of the acromial end of the clavucle. pectoralis minor, levator anguU scapulae, and the rhomboid muscles. Examina-tion shows that the scapula will not rotate normally forward. This is demon-strated by extending the arms in front to a right angle, the gliding forward of the scapula upon the sound side^ being marked, but upon the dis-eased side being slight or absent Treatment of paralysis of theserratus magnus muscle comprisesmassage, electricity, passive mo-tion, and deep injections of strych-nin. Katzenstein advocates opera-tion for serratus palsy. He makesan incision near to the midline ofthe back, exposes portions of originof the trapezius and rhomboideusmajor, divides them, carries thecut muscles downward and out-ward, and sutures them to theperiosteum of the seventh, eighth, and ninth ribs and to the latissimusdorsi. He then makes an incisionalong the inn

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