第5章

The bone of the shoulder is dislocated downward.I have never heard of any other mode.The parts put on the appearance of dislocation forward,when the flesh about the joint is wasted during consumption,as also seems to be the case with cattle when in a state of leanness after winter.Those persons are most liable to dislocations who are thin,slender,and have humidities about their joints without inflammation,for it knits the joints.Those who attempt to reduce and rectify dislocations in oxen,commit a blunder,as forgetting that the symptoms arise from the manner in which the ox uses the limb,and that the appearance is the same in a man who is in a similar condition,and forgetting also that Homer has said,that oxen are most lean at that season.In this dislocation,then,when not reduced,the patient cannot perform any of those acts which others do,by raising the arm from the side.I have thus stated who are the persons most subject to this dislocation,and how they are affected.In congenital dislocations the nearest bones are most shortened,as is the case with persons who are weasel-armed;the fore-arm less so,and the hand still less;the bones above are not affected.And the parts (near the seat of the injury)are most wasted in flesh;and this happens more especially on the side of the arm opposite the dislocation,and that during adolescence,yet in a somewhat less degree than in congenital cases.The deep-seated suppurations occur most frequently to new-born infants about the joint of the shoulder,and these produce the same consequences as dislocations.In adults,the bones are not so diminished in size,and justly,seeing that the others will not increase as in the former case;but wasting of the flesh takes place,for it is increased,and is diminished every day,and at all ages.And attention should be paid to the force of habit,and to the symptom produced by the tearing away of the acromion,whereby a void is left,which makes people suppose that the humerus is dislocated.The head of the humerus is felt in the armpit,and the patient cannot raise his arm,nor swing it to this side and that,as formerly.The other shoulder shows the difference.Modes of reduction:-The patient himself having placed his fist in the arm pit,pushes up the head of the humerus with it,and brings the hand forward to the breast.Another:-Force it backward,so that you may turn it round.Another:-Apply your head to the acromion,and your hands to the armpit,separate the head of the humerus (from the side?),and push the elbow in the opposite direction;or,instead of your knees,another person may turn aside the elbow,as formerly directed.Or,place the patient on your shoulder,with the shoulder in his armpit.Or,with the heel,something being introduced to fill up the hollow of the armpit,and using the right foot to the right shoulder.Or,with a pestle.Or,with the step of a ladder.Or,by rotation made with piece of wood stretched below the arm.Treatment:-As to attitude,the arm placed by the side,the hand and shoulder raised;the bandaging and adjustment of the parts while in this attitude.If not reduced,the top of the shoulder becomes attenuated.