_By the heel in the axilla_ (fig. 61).—The patient lies flat on a couch; the surgeon pulling off his boot from the left foot if he has to reduce a left dislocation, and _vice versâ_ the right boot, seats himself on the couch facing the patient. Putting his unbooted foot into the armpit, he grasps the forearm with both hands and pulls steadily downwards. When the head of the bone is disengaged the muscles draw it into the socket, and the movements of the limb become at once easy and natural. The arm must then be fixed to the side by a roller for a fortnight, and the shoulder is wetted with an evaporating lotion to allay the pain and inflammation resulting from the laceration of the soft parts. Should the surgeon’s strength be insufficient for the requisite extension, a jack towel may be attached in a _clove hitch_ round the wrist and held by an assistant, who standing behind the surgeon draws steadily in the same direction. _To make a clove hitch._—Grasp the towel in the left hand, the little finger being downwards, then pronating the right hand till the little finger is upmost, seize the towel below the left hand; if the wrists are then rotated in opposite directions the towel will be drawn into two loops, of which the ends cross above the connecting part between the loops (see fig. 62); if one hand holds the loops and the other pulls the ends, the loops will be found not to slip, however tight the ends are pulled. [Illustration: Fig. 62.—The Clove-hitch knot.] _Reduction by simple extension._—The patient again lies flat on his back, a jack towel is passed round his body and fastened behind the opposite shoulder for counter-extension, while a second towel is attached to the wrist by a clove hitch and intrusted to two or three assistants, who are desired to pull quietly and steadily directly away from the patient’s body. The surgeon meanwhile watches the progress of the extension, altering its direction as he finds the head more or less engaged against the scapula, and finally with his hands thrusts the head into its socket. Sometimes there is much difficulty in getting the head back to the glenoid fossa, even when the humerus is completely disengaged from the scapula; this difficulty is often overcome if an assistant rotates the humerus backwards and forwards, while the extension at the wrist and the pressure on the head of the humerus is steadily maintained. When the limb is replaced it is fixed to the side as before directed. [Illustration: Fig. 63.—Dislocation of the shoulder reduced by simple extension.] If the dislocation has existed more than a few hours, relaxation of the muscles by chloroform and extension of the limb carried directly away from the body are more sure of success than the heel in the axilla, because they allow greater power to be exerted in a steadier manner than is possible by the other mode.