the horizontal (Fig. 23). While
an assistant makes counter-extension and fixes the scapula, the
surgeon gradually draws the arm away from the body till the head of
the humerus is felt to pass laterally. The humerus is then rotated
medially by dropping the hand (Fig. 24), and the bone gradually glides
into the socket.

[Illustration: FIG. 23.--Miller's Method of reducing Sub-coracoid
Dislocation--First Movement.]

[Illustration: FIG. 24.--Miller's Method of reducing Sub-coracoid
Dislocation--Second Movement.]

In a certain number of cases reduction can be effected by
_hyper-abduction_ of the shoulder with traction. The patient is laid
upon a firm mattress, and the surgeon, seated behind him while an
assistant fixes the acromion, slowly and steadily extends the arm
until it is raised well above the head. In some cases the head of the
humerus spontaneously slips into its socket; in others it may be
manipulated into position by pressure from the axilla. This method is
restricted to recent cases, as in those of long standing the axillary
vessels are liable to be stretched or torn.

The method of reduction by traction on the arm with the heel in the
axilla is only to be used when other measures have failed, as it
depends for its success on sheer force.

_After-Treatment._--After reduction, the part is gently massaged for
ten or fifteen minutes, a layer of wool is placed in the axilla, the
forearm is supported by a sling, and the arm fixed to the side by a
circular bandage. Massage is carried out from the first, and movement
of the shoulder in every direction except that of abduction may be
commenced on the first or second day. The circular bandage may be
dispensed with at the end of a week, and abduction movements
commenced, and by the end of a month the patient should be advised to
use the arm freely.

The #sub-clavicular dislocation# (Fig. 17) is to be looked upon as an
exaggerated degree of the sub-coracoid rather than as a separate
variety. It is produced by the same mechanism, but the violence is
greater, and the damage to the soft parts more severe. The head passes
farther upwards and towards the middle line under cover of the
pectoralis minor, resting under the clavicle against the serratus
anterior and chest wall. The symptoms are usually so marked that they
leave no doubt as to the diagnosis. The outline of the head of the
humerus in its abnormal position is visible through the skin, and the
shortening of t