Southern Medical and Surgical Journal - Georgia Regents University

1867] Hamilton on Dislocation. 481placed between the two feet of the stool. Two strongmen, who were at hand, kindly lending their assistance,reduction was effected after a few minutes' traction. Iwas so much pleased with the results in these instances,that I was thinking of having constructed a suitable apparatuswhich I could keep by me foruse in such dislocations,when I cast my eyes upon a set of painter's steps,which immediately struck me as precisely the article Iwanted.I have used this now in three cases, and its useseems to me to give very considerable advantages overthe modes of reduction generally employed.The "steps" I use are four feet ten inches high, andthe moveable support should be fixed with an iron rod,and not with a rope, as is often the case, as the formersecures a greater amount of steadiness. A pillow is laidacross the top step, and the patient ascends as high asmay be convenient, of course placing the axilla on thetop of the pillow. One or two assistants now lay hold ofthe arm, drawing, at first, steadily outward and slightlydownward, traction in the latter direction being graduallyand cautiously increased by approximating the arm to thesteps. Reduction in all the cases I have had has beeneffected easily, and even, if I may use the expression,elegantly, but none of the dislocationshad remained unreducedfor more than twenty-four hours. The greatpower that we here possess, however, seems to me torender it highly probable that, in cases of longer standing,this simple apparatus will also be found very efficacious.The three agencies mainly to be relied on in ordinarycases of shoulder-joint dislocation are evidently extension,counter-extension, and leverage, and especially the combinationof these. When the dislocation has remainedlong enough unreduced for adhesions to form, perhaps,also, the putting in practice preliminarily some such39