APPENDIX. (47) 



wards replacing it, muft be to draw it out, fo as to bring it over 

 that cavity out of which it was thrown. 



" Tnis^is to be done by making the extenfion of the arm, 

 with fuch a degree of force as to feparate the bones from each 

 other, and fo appHed that it may a(5t only upon the parts round 

 the diflocated joint. When extenfion is omitted, as was the 

 cafe among the old furgeons, the attempts made by the lever to 

 force the humerus into its place, fo far from having falutary, 

 were attended with very bad, confequences. Extenfion, how- 

 ever, in the modern pra6lice, is our firfl view. The refiftance 

 to the exteniion is owing to the contradlion of the furrounding 

 mufclcs, which is partly voluntary, and partly the efFe6t of their 

 being much flretched, from the new fituation of th^ bone. The 

 firft it is feldom in our power to prevent, as the terror of reduc- 

 tion, and the uneafinefs confequent upon moving: the arm, 

 makes the patient exert his mufcles to refifl what gives him 

 pain ; and fo far as no refolution in him can prevent this ac- 

 tion, it may be faid to be involuntary. Were it poilible to de- 

 ceive him, and make him fuppofe we were only examining the 

 ftate of his arm, when we were really making the proper exten- 

 fion, this caufe of difficulty might be overcome in feme degree. 

 The refiflance from the overftretched mufcles is of more impor- 

 tance, as it is in our power to prevent it, and, when not attend- 

 ed to, mufl increafe the furgeon's difficulty, and by extending 

 the mufcles, already too much on the flretch, may produce 

 greater laceration than from the difeafe intended to be remedied. 



'* The obfervations we have already made on the ftate of the 

 mufcle after diflocation, mufl now appear neceffary, being on a 

 fubjedl little attended to, though of great importance, and par- 

 ticularly as they lead us to place our patient in fuch a manner 

 as to remove this caufe of difficulty and danger. 



" Another caufe preventing redudlion, is the bone being 

 pulled in fuch a diredlion by the furgeon, as not to pafs through 



the 



Account of 

 Vv'. Hamikoii, 



