The arm is maintained at one level by thongs affixed by a clove hitch above the elbow and passing over pulleys above and below. On rotating the lower axle the frame is pushed upwards, forcing the head of the bone into position, while at the same time an assistant forces the head of the bone outwards by a half turn of the upper axle, causing the padded projection to push outwards.
Extemporized Apparatus and Substitutes. Having now described the apparatus which was used by practitioners settled permanently in populous places, we may consider the substitutes for these which were used by surgeons on their travels, or under other circumstances where the major apparatus was unavailable.
Hippocrates says we must always be ready to make use of whatever happens to be at hand.
He says that dislocation inwards at the hip may be reduced in the following manner.
Fig. 24. Ladder arranged as a machine for the reduction of dislocations. A Plinthium of Nileus has been tied on the lower part of it and below this are two pulleys for the converting of the direction of extension. A similar pair of pulleys have been tied on the top step of the ladder.
Fig. 25. Reduction of shoulder by ladder with Plinthium of Nileus. Extension having been made, the operator is pulling out the head of the humerus by a thong. The assistant is bearing down on the patient’s neck.