58 SURGERY. 



able to walk, the toes merely touching the ground. Bleeding, a 

 warm bath, and tartar emetic must be administered, according to 

 the patient's constitution, in order to produce relaxation of the 

 muscles. Counter-extension is to be made by a folded sheet or 

 large towel placed in the perineum, the patient being in the recum- 

 bent position, and secured to a ring or hook firmly fastened m the 



wall or floor. ^ , , i i v ♦ 



Extension is to be eflfected by secunng a folded towel or sheet 



above the knee, by means of a damp roller ; this towel is to be 



acted upon gradually, by numerous assistants or by pulleys. The 



Fig. 18. 



extension is to be made gradually, in such a direction as to draw the 

 thigh across the opposite one, a little above the knee. A third band 

 or towel is to be passed around the pelvis, in order to fix it more 

 firmly, the ends of which are to be tied on the sound side, which is 

 to be given to an assistant. , , 



Dislocations bacUvards and dowmvards in the sciatic notch are 

 next in point of frequency. The head of the bone rests on the pyri- 

 formis muscle, between the sacro-sciatic ligaments and the upper part 

 of the notch, a little above the level of the middle of the acetabulum. 

 The shortenincr and inversion of the foot is not so great as in the 

 first variety ; the head of the bone can seldom be felt ; the joint is 

 extremely rigid, and motion of the limb almost impossible In re- 

 ducina this dislocation it is necessary that the head of the bone 

 should first be brought out of the notch, before it can be restored to 

 the acetabulum. 



Dislocations dow7iicards a7id inwards are comparatively rare ; 

 the limb is elongated nearly two inches; the foot is advanced, though 

 neither inverted or everted; the thigh is abducted and cannot be 

 broucrht near to its fellow ; the psoas and iliacus muscles form a ridge 

 which can be seen or felt ; the trochanter is flattened and depressed 

 and the space between it and the anterior superior spinous process of 

 the ilium is much increased. To reduce this form, counter-exten- 

 sion is to be made outwards by a band across the upper and inner 



