nd in nervous patients who do
not bear pain well, and particularly when the dislocation has existed
for a day or two. In quite recent cases, however, the surgeon may
succeed in replacing the bone by taking advantage of a temporary
faintness, or by engaging the patient's attention with other matters
while he carries out the appropriate manipulations.

When an anaesthetic is employed, the patient should be laid on a
mattress on the floor, or on a narrow, firm table; otherwise he should
be seated on a chair.

_Kocher's method_ is suitable for the great majority of cases of
sub-coracoid dislocation. (1) The elbow is firmly pressed against the
side, and the forearm flexed to a right angle. The surgeon grasps the
wrist and elbow and firmly _rotates the humerus away from the middle
line_ (Fig. 20) till distinct resistance is felt and the deltoid
becomes more prominent. In this way the rent in the lower part of the
capsule is made to gape, and the head of the humerus rolls away from
the middle line till it lies opposite the opening, rotation taking
place about the fixed point formed by the contact of the anatomical
neck of the humerus with the anterior lip of the glenoid cavity (D.
Waterston). (2) _The elbow is next carried forward, upward, and
towards the middle line_ (Fig. 21); the humerus acting as the long arm
of a lever on the fulcrum furnished by the muscles inserted in the
region of the surgical neck, the head, which forms the short arm of
the lever, is carried backward, downward, and laterally, and is thus
directed towards the socket. (3) The humerus is now _rotated towards
the middle line_ by carrying the hand across the chest towards the
opposite shoulder (Fig. 22). The anatomical neck of the humerus is
thus disengaged from the edge of the glenoid, and the head is pulled
into the socket by the tension of the surrounding muscles.

[Illustration: FIG. 20.--Kocher's Method of reducing Sub-coracoid
Dislocation--First Movement; Rotation of Arm away from Middle Line.]

[Illustration: FIG. 21.--Kocher's Method--Second Movement; Elbow
carried forward, upward, and towards the Middle Line.]

[Illustration: FIG. 22.--Kocher's Method--Third Movement; Rotation of
Arm towards Middle Line.]

A method of reduction has been formulated by A. G. Miller, which we
have found to be quite as successful as Kocher's method. The limb is
grasped above the wrist and elbow, the forearm flexed to a right
angle, and the upper arm abducted to