| OCR Text |
Show DISLOCATION or me annexes. DXSLOCATION or rm: HUMERUS. but the relation betwixt the humerus and scapula that is im_ . portant. There is a method by which the operator's neck 18 yoked to the patient: a towel is put under the arin-pitland over the surgeon's neck, who raises himself while the aSSistants pull ; he thinks he assists the reduction by raising the humerus over the edge of the glenoid cavity, while he is only pressmg the head of the humerus against the neck of the scapula. This is axilla. This appearance of success encouraged us however to repeat the operation, but the event was the same. We now imagined that some portion of the capsular ligament might be folded so as to be intercepted between the head of the bone and the glenoid cavity, into which we judged the bone to have been twice brought. On this supposition, after making i- 1",--- vv,‘,__.?rv_v v"..- m4. w .27...» v; .vm..-" 1E8 somewhat more harmless, but no less unscientific, with the operation of the ambe, or the dragging by the wrist with the heel in the axilla. In all these cases it is still locking of the bones, or the ligament which resists, by preventing the extension of the limb. I return to Mr. Hey's Cases :--In Case VI. after several methods had been tried, as Freke's improved ambe, that by the towel round the operator's neck, &c. he proceeds, " Mr. rw"".‘ 'Wumfi-ww ,. M-_- ,.- ._ "it , ~n~u .fi-._.---. baseman," ,- 7..-A..v. H U Lucas and Mr. Jones afterwards tried to reduce the bone by the heel in the axilla, and Mr. Lucas perceived a noise during one effort as if the bone had returned to its place. While the last method was in use it occurred to me, that extension made in a direction parallel to that of the body was not likely to 179 the reduction the third time, the os humeri was moved in various directions, sometimes upon its own axis, sometimes upwards and downwards, before we attempted to bring the arm to the patient's side. Also while the extension was continued, a flattened ball of tow was thrust up into the axilla by the heel, to prevent the head of the bone from retiring again into the axilla ; the arm was then brought into contact with the patient's side, &c. by this means the reduction was completed and confirmed." See p. 297. REMARKS. This is a just picture of the bustle, the varied and illdirected efforts where there is no principle drawn from anatomy to direct the operator. The next Case Mr. Hey gives, is one where after some ineffectual endeavours the bone was reduced by the assistants elevating the patient by towels round the arm from his seat succeed, While the head of the bone lay so deeply sunk, and on the ground, and then, while the arm was thus stretched, behind the pectoral muscle. I therefore advised, that one person should extend the arm at right angles to the body, by a hold of the fore-arm, placing his foot against the side of the patient's thorax. In this way the person making the e):tension would not only have a firm support, but would also be enabled to repress the lower part of the scapula by his heel placed against it. That during this extension another perv son lying by the side of the patient, should place his heel against the upper part of the os humeri, as near to its head as possible, and should push it in a direction parallel to that of the patient's body. By this method the bone altered its situation with such a noise as is usually heard in reductions, and we concluded that the head of the bone had re-entered the socket ; but when the arm was brought close to the patients side, we found that the head of the bone was still in the carrying it forward. Further experience must determine, says Mr. Hey, whether this method of reduction is superior to those which he has mentioned. Now we believe that what is called experience has kept this part of surgery in unusual darkness. Let any person take the dissected shoulder joint in his hand, and there will be no occasion for further experience to inform him that this is the best of all the methods employed by Mr. Hey. The reason I hope I have sulficiently explained already. One more observation I am led to by Mr. Hey's work; in page 304 he says, that in several of the cases the counter ex- tension was applied so as to press back the inferior angle of the scapula, contrary to the directions given by Mr. Bromfield, who used to cause the acromion to be pushed backward. These different methods of practice, he adds, merit an atten~ " M? 'Vtwnw WI More y |
