im the end of the shoulder-blade. This cavity, however, is so super- - 
ficial, that, in the bone, it does not appear to contain above a tenth part 
of the head of the arm; but the cavity is considerably e : 
means of a cartilaginous brim ; and a capsular ligament surrounds 
the whole joint. This mechanism makes the motion of the joint 
more free ; but at the same time exposes it to more frequent luxa- 
tions. 
_ The arm bone is most frequently luxated downward into the arm: 
pit. Itmay also be drawn downward and forward, resting on the 
ribs ; or downward and backward. 
We judge that the arm bone is out of joint, by the patient being 
unable to move the arm ; by pain being excited by pressing the arm 
to the side ; by its being longer or shorter than the other arm. 
‘When long out of joint, the arm is apt to become dropsical, and 
swell, from the pressure produced upon the nerves and lymphatic 
vessels of the arm, by the head of the bone. 
In simple dislocation of the shoulder, the reduction is easy, if 
properly managed. But if it has been long out, the Operation is 
more difficult; for in such cases the head of the bone has formed a 
socket for itself among the contiguous parts, from whence it cannot 
be moved without tearing asunder some of the muscles which sur- 
round it; and even then the natural et may have me. sc 
diminished, or grown up, as to be almost unf tain it. In such 
long standing cases, however, we must attem reduction gradu- 
+* 
ally, after softening and relaxing the parts with the proper oint-— 
ments, &c. = 
Various modes of replacing this bone are practised ; but as no sur- ; 
ae 
— 
geon can be at a loss, as to what should be done, I shall not p 
ticuJarize much. 
The joint is sometimes replaced by putting the naked heel into the 
arm-pit, inside-of the arm, and then extending the arm, till, with the 
heel pressing out the head~of the bone, it slips mto its place. It 
may be reduced also, by extending the arm, inclining a little out- 
wardly from the body, till the joint comes in place: or while the arm 
is thus extending, to pull the head of the bone outwardly into place, 
by a towel or handkerchief around the arm, at its upper end. An- 
other method, and perhaps equal to any, is, to extend the arm, with. 
its muscles and those of the fore-arm, relaxed as much as possible, 
and, at the same time, to push back the shoulder-blade, thus favoring 
the reduction. 
It would be advisable, perhaps, in most cases, to apply the relax- 
ing ointments, before proceeding to operate, as it will render the re- 
duction much safer and-easier, both to the surgeon and patient. — 
DISLOCATIONS AT THE ELBOW JOINT. 
The bones of the fore-arm are generally dislocated upward and 
im 
aa, 
backward ; and they can scarcely be dislocated in any other direc~" eS: 
tion without a fracture. 
_ As the joint of the elbow is but thinly covered, a dislocation iseasily 
discovered by the feeling, unless swelling and tension have t 
place. In whatever way the joint is out, the arm becomes st 
On es 
