AMPUTATION AT THE SHOULDER-JOINT.--This operation, like that at the hip joint, can, from the nature of the joint to be covered, and the abundant soft parts in the normal state of the tissues, be performed on the dead in very various ways, by single, double, or triple flaps, by transfixion or dissection, rapidly or slowly. Hence manuals of operative surgery might collect at least twenty different methods, most of which have some recommendation, and all of which are practicable enough. When, however, we reflect that in the living body, in cases where amputation at the shoulder-joint is required at all, the severity of the accident, or the urgency of the disease, will, in general, leave no room for selection, we shall see how utterly valueless is any knowledge of mere methods of operating, and of how much greater importance it is that we should be simply thoroughly familiar with the anatomy of the joint. For example, an accident which necessitates amputation so high up has, in all probability, opened into the joint and destroyed the soft parts on at least one aspect; in such a case the flaps must be cut from the uninjured soft parts only. If an aneurism has rendered amputation through it and through the joint a last resource, the flap must be gained chiefly at least from the outside; a malignant tumour of the humerus will almost certainly prevent any transfixion, and require flaps to be made by dissection, wherever the skin is least likely to be involved. Again, some of the most vaunted and most rapid operations almost require for their success the integrity of the humerus, which has to make itself useful as a lever in disarticulation, while in most cases of accident we are amputating for compound injury of the humerus, almost certainly implying fracture with comminution. From its proximity to the trunk, hæmorrhage is one of the chief dangers to be apprehended during this operation, especially from the axillary artery. As far as possible to obviate this danger, most plans of operating are based on the principle that the vessels and nerves should be the last tissues to be cut; in some they are not divided till after disarticulation. While a good assistant, to make pressure on the subclavian above the clavicle, is a most advisable precaution, too much must not be trusted to this pressure above, as the struggles of the patient and the spasmodic movements of the limb, which are so apt to occur under the stimulus of the knife, are apt to render futile the best efforts at compression. The operator should trust rather to making the incisions in such a manner that the great vessel be not divided till the hand of an assistant, or in default of a suitable one, his own left hand, is able to follow the knife and grasp the flap. The bleeding from the circumflex, subscapular, and posterior scapular arteries can easily be arrested by a dossil of lint till the great vessel is tied, and they can be secured.