In cases where proper assistants cannot be had, temporary closure of the axillary vessel could easily be made by carrying a strong silver wire or silk ligature completely round the vessel by a curved needle before the incisions are commenced, and by tying this firmly over a pad of lint. Pressure on the artery above the clavicle is best made by the thumb of a strong assistant, who endeavours to compress it against the first rib; where the parts are deep and muscular, the padded handle of the tourniquet, or of a large door-key, will do as the agent of pressure. A brief notice of three of the best methods of operating will be quite sufficient to show what should be aimed at in shoulder-joint amputations:-- #1.# In cases where the surgeon can choose his flaps, the following method will be found the most satisfactory, as resulting in the smallest possible wound, in having less risk of hæmorrhage during the operation than any other method, and in providing excellent flaps. It is Larrey's method slightly modified. _Operation._--With a moderate-sized amputating knife an incision of about two inches in length, extending through all the tissues down to the bone, should be made from the edge of the acromion process to a point about one inch below the top of the humerus; from this latter point a curved incision, enclosing a semilunar flap, should be made on each side of the limb to the anterior and posterior folds of the axilla respectively (Plate IV. fig. 9, and Plate III. fig. 3). These flaps should then be dissected back, including the muscles and exposing the joint. When thoroughly exposed, the joint must then be opened from above, and the bone separated. One small portion of skin lying above the artery, vein, and nerves still remains to be divided (Plate I. fig. 13). This may be done by an oblique cut from within outwards, in such a direction as to form part of the anterior or internal incision, and with the precaution of having an assistant to command the vessels before they are divided. The resulting wound is almost perfectly ovoid, the flaps come together with great ease in a straight vertical line, which admits of easy and thorough drainage. Union is generally rapid. Larrey's success by this method was very remarkable: ninety out of a hundred cases in military practice were saved, notwithstanding the well-known risks of such operations.