APPENDIX. (51) 



tion of the end of the inftrument as a lever to force the humerus u' u'T^lf.o 

 into its place, while the prefliire on the patient's fide is equal to 

 the force of the extenfion. It can likewife be properly ufed on- 

 ly in the diflocation downwards. 



" In all dlflocations of the humerus, the extenfion, I think, 

 fliould be made with the hands, in place of pulleys, as by the 

 firft, the diredlion of the bone can be better adapted to the re- 

 fiftance and fituation of the furrounding parts. 



" In what we called the fecond flate of an unreduced diflo- 

 cation, the obflacles are more numerous than in the recent. The 

 mufcles have now adapted themfelves to the fituation of the 

 bones, the hole in the ligament is in part grown up, and the la- 

 cerated pafTage in the foft parts is obliterated, the fides of it ha- 

 ving, by inflammation, adhered to each other. Thefe being 

 added to the difliculties in recent luxations, render the reduclion 

 here both more difficult, and more apt to be attended with lace- 

 ration, than in the other. Thefe obflacles are to be got over, 

 however, by the fame means. The patient ought to be put in- 

 to the fame pofition, and the extenfion made in the fame man- 

 ner, only it will require the force to be greater, and to be longer 

 continued, before it accomplifhes the end in view. I do not 

 think, however, it will be necefTary to employ any other me- 

 thod, (as that of Mr White), as every thing may be done by 

 the hand, that can be expedled from pulleys. 



" In the lafl ftate, and even in the latter part of the fecond, 

 inflead of redudlion, we fliould attempt to render the new joint 

 that is forming as perfedl as pofTible. This is to be done prin- 

 cipally by making the patient ufe his arm as often, and for as 

 long a time as he can, without pain or fatigue, and to perform, 

 with it a variety of motions. 



" In this way we will haften the formation of the new joint, 

 and render him fooner capable of ufing his arm. That this is 

 pofTible is evident from the cafe of the feiacing-mafter already 



(G 2) mentioned. 



