Un traité sur la chirurgie orthopédique . s traité à l'hôpital pour Euptured andCrippled. 1 an ou moins 2 ans 3 1 6 1 13 ans 15 18 . 3 2 3 4 3 5 5 3 19 20 4 6 1 23 17 34 26 28 27 1 9 6 34 1 10 1 48 1 11 5 56 1 12 4 Total 62 mâles, 38 femelles, 24 ; ; à droite, 35 ; à gauche, 27. Symptômes.--l'histoire de l'alléger indique la persis-tent et caractère progressif de l'invalidité, mais le symp-toms caractéristique de la maladie tuberculeuse sont beaucoup moins marquée à l'épaule qu'à d'autres articulations. Cela s'explique par la factthat le membre supérieur n'est pas soumis à son poids sur sa andbec

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A treatise on orthopedic surgery . s Treated at the Hospital for Euptured andCrippled. 1 year or less 2 years old 3 1 6 1 13 years old 15 18 . 3 2 3 4 3 19 5 5 3 20 4 6 1 23 1 7 3 4 26 2 8 27 1 9 6 34 1 10 1 48 1 11 5 56 1 12 4 Total 62 Males, 38; females, 24; right, 35; left, 27. Symptoms.-—The history of the ease will indicate the persis-tent and progressive character of the disability, but the symp-toms characteristic of tuberculous disease are far less marked atthe shoulder than at other joints. This is explained by the factthat the upper extremity is not subjected to weight bearing andbecause the mobility of the scapula upon the thorax lessens the Kevue de Chir., 1892. Transactions American Orthopedic Association, vol. vii. DISEASES OF ARTICULATIONS OF UPPER EXTREMITYAS^ injury caused bj unguarded movements of the arm. Thismovement at the shoulder masks the interference with the func-tion of the joint, and the strain caused bj overuse may belessened by the unconscious restraint that the patient can ex- FiG. 320.. Tuberculous disease of the shoulder-joint. ercise upon motion at this joint. In fact, even when anchylosisis present the patient may think that motion is but moderatelyrestricted. The symptoms of the disease may be classified as pain, sensi-tiveness, restfiction of motion, atrophy. There is usually a dull ache about the joint, with occasionalneuralgic pain referred to the elbow and arm. The discomfortis increased by movements that pass beyond the limits allowedby the mobility of the scapula, especially on attempting to rotatethe humerus, as in clothing ones self or brushing the hair. Thejoint is sensitive to pressure; thus the patient finds that he can-not lie on the affected side at night. 484 OBTHOPEDIC SUEGEBY. On examination the limitation of motion caused by muscularspasm will be evident if the scapula is fixed. Pressure about the head of the humerus usually causes pain, and in many instances local heat and swelling are present. Theatrophy of the

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