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Show 176 msLocArrox or THE HUMER'US. There is no occasion for any bandage being used after re; duction to keep the humerus in its place, that is effected by the bracing of the muscles round the joint. If any thing be required it is that some check may be given to the raising of the elbow too far from the side until the ligament has united. The surface may be rubbed with warm stimulating oils, and the arm gently and regularly moved. In this violent operation one can imagine, that if the axillary artery were at all diseased it might be torn ; but I have not known of such an accident, though I have known such an ecchymosis succeed the operation of reduction, as would imply the rupture of some considerable vein. In ellipleying the ambe in the Net‘vcastle Infirmary both the axillary artery and the muscle have been torn! so that they were obliged to amputate on the instant: one would expect that such a proof was not wanting to show that it was not the muscles but the ligaments which caused the very great dilfieulty in reducing the bone in dislocations. Having proceeded thus far in what I had to say on the dislocation of the shoulder, I recollected that there was much still this; it is the direction of the humerus more than the force employed which occasions the seeming difference in the various cases of dislocation. 177 Mr. Hey observes, " When the head of the bone has desert ed the axilla, and has slipped under the pectoral muscle, I have observed that it is brought back into the axilla the more readily if the extension is made in a direction opposite to that in which it has passed from the axilla. This efl‘ect is often greatly promoted by making the extension with the arm elevated as Mr. White has advised. But when the head of the bone has advanced far under the pectoral muscle, strong extension by closing the passage through which the protub erant part of the bone should return, often'prevents instead of promoting reduction." p. 29.1. The first part of this quotation resolves into the advice, that the bone must be elevated to the position in which it was when dislocated, before the force be used to exten d the arm. The second part of the excerpt has, however, 3. refer- ence to the opinion that the bone passes through a noose, which I hope I have shown to be a groundless supposition. In Case IV. we have these words: " The body being supported, and counter extension made by means of abroad towel put round the thorax of the patient, the extension of the arm was made by three or four men, first in a direction at right angles to the body, and when the extension was in its greatest degree, by pulling the arm towards the ground at an acute angle with the body, while I attempted to raise the head of the bone by my hands placed as near it as I could. This method failed; so did that with the heel in the axilla." So I conceive the attempt in this way will ever do if the state of the ligament be as I have alleged. Then it will be asked, how does it happen that simply by extending the arm at right angles with the body the dislocation is so often reduced .9 I believe the fact to be, that the arm is not at right angles with the body in most of the cases thus reduced, but that the counter extension being made imperfectly, the body of the patient falls so far towards the assistants, that the inclination of the humerus is changed to that direction which I have so much insisted upon as being necessary to reduction. For it is not the position of the arm, or of the patient's body. vor. n, a rM-‘WNI‘ ~‘rwamfwwx~ H-a. -- --< ‘3 ‘ ingenious observation in Mr. Hey's Surgery on this subject; I find too that there is much for animadversion. The student finds an example in that work under the head of Dislocation, of what most surgeons have experienced in their practice, a want of principle, and consequently a want of method. In the three first cases we have an example of the easy re duction wherethe bone, we might almost say spontaneously, falls into its place. The conclusion Mr. Hey draws is, " that reduction might sometimes be efl‘ected with less extension than is commonly used, and consequently with less pain 2" it appears to him, " that the muscles when so far stretched as to be rendered painful, begin to re-aet and resist the eli'orts made for their further elongation." The fact seems to me to be msLocnron or run HUMERUS. 7. W, «sir -rm" mm M099 ‘ |