Account of 

 W. Hamilton. 



(48) HIS "Tort of the sociErr, 



the cavity it formed for itfelf in diflocation, but is made to prefs 

 on the furrounding parts, fo that if the force is continued to be 

 exerted in the fame dire6tion, a new pafTage mufl be torn for it. 

 This, Hke the laft, may be avoided, by attending to the mofl 

 probable pofition of the Hmb when the accident happened. We 

 have attempted to prove, that, in general, diflocation is moft apt 

 to happen when the arm is raifed ; and therefore that this pofi- 

 tion is the preferable one for reduction. I fufpe<5l in many 

 cafes, where improper attempts to reduce the bone have been 

 made, that the difiiculty is increafed by the bone tearing a paf- 

 fage for itfelf in a new direction, and thus, by twilling the muf^ 

 cles, preventing reduction from being accomplilhed. 



" The laft obftacle is from the burfal ligament. As in no 

 cafe of diflocation the head of the bone can pafs out without la- 

 cerating it, fo, in redudlion, it cannot be replaced, unlefs it is 

 brought through the fame opening by which it went out j for 

 if we attempt to bring the humerus over the glenoid cavity in a 

 wrong dire(9;ion, the ligament will get between it and the fca- 

 pula, and thus, when apparently reduced, the bone will return 

 to its old fituation, as foon as the arm is let loofe. This can 

 .be avoided only by the pofture of the limb ; and here alfo, in 

 the xaifed ftate of the arm, the bone will return moft readily 

 through the opening in the ligament, as being put into the fame 

 pofition in which it was luxated. 



" These three great difficulties in redudlion, then, are to be 

 remedied by a proper pofition of the patient and of his arm ; and 

 this, I think, there can be no doubt, is by placing him fo, that 

 the extenfion may be made when his arm is raifed. In order to 

 this, I inake him fit on the ground, the fcapula, with the glenoid 

 cavity upwards, being kept fixed by two afTiftants who are pla- 

 ced behind him. I put a towel round the humerus, immediate- 

 ly above the elbow, both to give me .a firmer hold of the part, 

 :and likewife, that, if neceflfary, I may have a place for an afliflant 



or 



