DOI: 10.7925/drs1.ucdlib_280565
title: Fracture of the tubercles of the Humerus

description: Watercolour medical illustration depicting fracture to the shoulder joint. It has the alternative reference number 1746, P18 and 28 on the front. The Richmond Hospital Museum reference is C.b.72. The entry for this in P263/1 pg. 23 reads 'Fracture of the greater tubercle of the humerus & glenoid cavity. Eliza Dillon. Mr Adams'. The typescript note underneath the illustration reads 'Fracture of the Tubercles of the Humerus'. The typescript note on the back begins 'Injury of the Shoulder-joint'.
description: Scope and content: The full typescript note on the back reads 'Injury of the Shoulder-joint MR ADAMS said: I beg leave to lay before the meeting the history of a case of dislocation of the head of the humerus forwards, which had been reduced, with the account of the post mortem examination of the articulation, made thirty days after the occurrence of the luxation, the patient having died from the effects of another injury sustained fourteen days before her decease. Eliza Dillon, aet 65, applied for surgical aid at the Richmond Hospital on October 27, 1849. She stated that she had fallen with much violence, and with her left arm extended from her side, in such a manner that the shock was chiefly sustained by the inner part of the elbow. The resident pupil, Mr Johnston, recognised the usual characters of dislocation of the head of the humerus forwards; he noticed a remarkable flattening of the deltoid muscle, and felt the head of the bone in its new situation. His colleague, Mr Roden, also recognised the injury, as did likewise Surgeon Bichaque. The head of the bone was replaced without difficulty, Mr Johnston having adopted the plan of placing the knee in the axilla; the patient expressed herself relieved, and returned to her home. In a few days she returned to the hospital, complaining of more pain in her shoulder-joint than patients usually do after the reduction of the dislocation. She was subjected to the ordinary treatment for a subinflammatory condition of the articular structures. On the sixteenth day after the shoulder had been luxated, this woman, being deaf and rather feeble, while heedlessly walking across the street, was knocked down by a passing vehicle, and received a compound fracture of the elbow-joint, of which, after having suffered from constitutional irritation and erysipelas for fourteen days more, she died. Anatomical Examination of the left Should-joint – When the deltoid muscle was thrown down, it was seen that the supra and infra spinatus muscles had torn off a large portion of the great tuberosity of the humerus. This portion had been partially re-united to the shaft by recent bony deposit. The anterior portion of the tuberosity, which lay next to the bicipital groove, still remained entire, and gave attachment to some of the tendinous fibres of the posterior articular muscles already mentioned. Upon exposing the subscapular muscle, its upper margin, near to the coracoid process, seemed somewhat ecchymosed; and upon lifting up this muscle from the subscapular fossa, in the vicinity of the coracoid process, some well-formed pus was evacuated from the interior of the joint. The capsular ligament was of a yellowish white colour and thickened, but no rupture could be discovered in it. On cutting into it the whole of the synovial membrane was found to be in a high state of vascularity. The appearance which it presented might be compared to that of the conjunctiva when in a state of acute inflammation. Upon examining the glenoid cavity he discovered that a portion of its inner margin was torn off. This portion of bone was more than half an inch in length, and three lines broad. The cartilage of incrustation of the head of the humerus presented a porous appearance, as if punctuated by small pin-points, was very thin, as in some examples of diffuse inflammation'.
description: Numbering/sequence: Original reference number: 1746.