J P r E N D I X. (49) 



or two in the extenfion to lay hold by. The fore arm is bent 

 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 

 mnfcles that gives any diiHculty in redutflion. When the bone 

 is luxated diredlly downwards, I make the extenfion fcanding 

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

 inwards, 1 place myfeif towards that fide, oppofite to wliere the 

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

 recftion. If, for example, the head of the humerus is under the 

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

 back, and vice verfa. 



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

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

 refiftance 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 a<flion of the furrounding mufcles, fo as 

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

 manner 1 have reduced feveral diflocations of the flioulder ; and 

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

 feen applied in other modes of redudlion, and v7ithout effedl. 

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

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

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

 Manchefter* has employed a mode of reduclion 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 flate of 

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

 he fo\md the mufcles in the diffecflion of tv/o men with difloca- 

 ted humeri, who had died before redudlion had been efFedied. 



"In this manner of redu(5lion, all the extended mufcles are 

 relaxed by the arm being raifed ; the fuprafpinatus and deltoid 



(G) in 



* Medical Obfervalions, vol. 2. p. 373. 



Account of 

 W. H.huliton. 



