APPENDIX. (49) 



or two in the extenfion to lay hold by. The fore arm is ber.t fv^HTmuL. 

 up, fo as to relax the biceps completely ; and this I prefer to the 

 flate of half flexion, as the extenfor triceps is not one of the 

 mufcks that gives any difficulty in reduiftion. When the bone 

 is luxated directly downwards, I make the extenfion {landing 

 oppofite to the patient's fide ; but, when it is either outwards or 

 inwards, 1 plac; m.yfeif towards that fide, oppolite to where the 

 head of the bone is lying, and I carry the arm in the fune di- 

 reftion. If, for example, the liead of the humerus is under the 

 peroral mufcle, I carry the arm outwards towards the patient's 

 back, and vice verfiu 



" I THEN begin to make the extenfion with a flow and fteady 

 force, but of fuch a kind as I find is capable of overcoming the 

 refinance of the mufcles, and of bringing the bone out of its 

 place. After it is completely difengaged, it is pulled into the 

 glenoid cavity by the adlion of the furrounding mufcles, fo as 

 not to require any preifure in the axilla to raife it up. In this 

 manner I have reduced feveral diflocacions of the flioulder ; and 

 in none have I failed, or been obliged to ufe the force I have 

 fcen applied in other modes of reducftlon, and v7ithout elfefl. 

 Among the cafes 1 have fucceeded in, there were feven where 

 all the other inethods had been tried in vain ; and in three of 

 thefe the arm had been out for three weeks. Mr White of 

 Manchefler * has employed a mode of redu(ftion fimilar to this, 

 as to the pofition of the arm; but I think the other parts of -his 

 plan are not equal to that here defcribed. The raifed (late of 

 the arm is likewife advifed by Mr Thomson, from the fituation 

 he found the mufcles in the diflre<5lion of two men with diiloca- 

 ted humeri, who had died before reducflion had been effecfled. 



"In this manner of rcdu(R;ion, all the extended mufcles are 

 relaxed by the arm being raifed ; the fuprafpinatus and deltoid 



(G) in 



• Modical Obfervalions, vol. 2. p. 373. 



