Licence: Public Domain Mark
Credit: A treatise on dislocations / by Lewis A. Stimson. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![ally recognized, traction by the hands of assistants or by pulleys or by other apparatus was substituted, but although this was an improvement upon its barbarous predecessors it was still employed blindly, and evi- dently was often ineffectual. There are indications in the older writings that the practice was not so wholly bad as the teaching, that here and there men were found who not only appreciated the importance of the direction in which traction should be made, but even occasionally reduced dislocations by manipulation alone, but the writer who seems to have been the first to recognize the importance of the principle enunciated so long before by Galen of bringing back the head of the bone by the route along which it had escaped, and of the position to be given to the limb during the attempt, was Jean Louis Petit. His Traite dcs maladies des Os was published in 1705 ; a second edition followed in 1723, and a third in 1741. He clearly pointed out the mechanical defects of the methods then in use, and the necessity of first bringing the head of the bone back to the opening in the capsule through which it had escaped before attempting to replace it in its cavity ; and he drew from observation of the different degrees of tension of the different muscles inferences as to the position in which the limb should be placed and the direction in which traction should be made, which were of great practical value, although based upon notions concerning the obstacles that opposed reduc- tion which were incomplete in that they took no account of the untorn ligaments and capsule. Thus, in dislocation inward or downward of the shoulder he abducted the elbow widely, and in those of the thigh back- ward he flexed the limb and then changed its position when the head of the bone had been brought down to the proper level.' Recognizing the necessity of making counter-extension upon the scapula instead of the thorax in reducing dislocations of the shoulder, he invented a machine consisting of two parts: one, to make extension, was composed of two long parallel bars bearing a small windlass near one end ; the other, for counter-extension, was a strip of stout canvas covered with soft leather, split longitudinally for some distance in the centre, and furnished with a pocket at each end. The arm was passed through this centi'al slit to the shoulder, and the ends of the parallel bai's fitted into the pockets. The limb rested between the bars. Extension was made by a cord fiistened to the arm above the elbow and carried around the windlass ; counter-extension was made by the canvas against the acro- mion and anterior border of the scapula. The machine used for the hip was similar. Petit, in thus departing from the practice of his predecessors and con- temporaries, had entered upon the right path ; he erred in not following it far enough, and his error arose from a too limited notion of the obstacles to be overcome. He noticed that some muscles were tense and I Si la ciiifse est luxee en haut et en dedans, c'est-;\-dire sur I'os pubis, le bout inferieur de la machine [which made traction and extended beyond the knee] doit etre poile un pen en arriere, quand on commence I'estension ; et il faut le raprocher en devant, quand on croit que I'extension est siilBsante. Au contraii-e, si la cuisse est luxee en hautet en dehors, il faiidra, en commencant I'extension, porter le bout de la machine en devant, et le repousser en arriere, lorsque les muscles paroitront suflSsament allonges. Petit,loc cit., p. 201.](https://iiif.wellcomecollection.org/image/b21987063_0074.jp2/full/800%2C/0/default.jpg)
