on the articulations-第3章

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will　define　what　we　know　respecting　friction　in　another　place。　The
shoulder；　then；　in　such　a　state；　should　be　rubbed　with　soft　hands；
and；　moreover；　in　a　gentle　manner；　and　the　joint　should　be　moved
about；　but　not　roughly；　so　as　to　excite　pain。　Things　get　restored
sometimes　in　a　greater　space　of　time；　and　sometimes　in　a　smaller。

　　10。　A　dislocation　may　be　recognized　by　the　following　symptoms：…Since
the　parts　of　a　man's　body　are　proportionate　to　one　another；　as　the
arms　and　the　legs；　the　sound　should　always　be　compared　with　the
unsound；　and　the　unsound　with　the　sound；　not　paying　regard　to　the
joints　of　other　individuals　（for　one　person's　joints　are　more
prominent　than　another's）；　but　looking　to　those　of　the　patient；　to
ascertain　whether　the　sound　joint　be　unlike　the　unsound。　This　is　a
proper　rule；　and　yet　it　may　lead　to　much　error；　and　on　this　account　it
is　not　sufficient　to　know　this　art　in　theory；　but　also　by　actual
practice；　for　many　persons　from　pain；　or　from　any　other　cause；　when
their　joints　are　not　dislocated；　cannot　put　the　parts　into　the　same
positions　as　the　sound　body　can　be　put　into；　one　ought　therefore　to
know　and　be　acquainted　beforehand　with　such　an　attitude。　But　in　a
dislocated　joint　the　head　of　the　humerus　appears　lying　much　more　in
the　armpit　than　it　is　in　the　sound　joint；　and　also；　above；　at　the
top　of　the　shoulder；　the　part　appears　hollow；　and　the　acromion　is
prominent；　owing　to　the　bone　of　the　joint　having　sunk　into　the　part
below；　there　is　a　source　of　error　in　this　case　also；　as　will　be
described　afterward；　for　it　deserves　to　be　described；　and　also；　the
elbow　of　the　dislocated　arm　is　farther　removed　from　the　ribs　than　that
of　the　other；　but　by　using　force　it　may　be　approximated；　though　with
considerable　pain；　and　also　they　cannot；　with　the　elbow　extended；
raise　the　arm　to　the　ear；　as　they　can　the　sound　arm；　nor　move　it　about
as　formerly　in　this　direction　and　that。　These；　then；　are　the
symptoms　of　dislocation　at　the　shoulder。　The　methods　of　reduction
and　the　treatment　are　as　described。

　　11。　It　deserves　to　be　known　how　a　shoulder　which　is　subject　to
frequent　dislocations　should　be　treated。　For　many　persons　owing　to
this　accident　have　been　obliged　to　abandon　gymnastic　exercises；　though
otherwise　well　qualified　for　them；　and　from　the　same　misfortune　have
become　inept　in　warlike　practices；　and　have　thus　perished。　And　this
subject　deserves　to　be　noticed；　because　I　have　never　known　any
physician　treat　the　case　properly；　some　abandon　the　attempt
altogether；　and　others　hold　opinions　and　practice　the　very　what　is
proper。　For　physicians　have　burned　the　shoulders　subject　to
dislocation；　at　the　top　of　the　shoulder；　at　the　anterior　part　where
the　head　of　the　humerus　protrudes；　and　a　little　behind　the　top　of
the　shoulder；　these　burnings；　if　the　dislocation　of　the　arm　were
upward；　or　forward；　or　backward；　would　have　been　properly　performed；
but　now；　when　the　dislocation　is　downward；　they　rather　promote　than
prevent　dislocations；　for　they　shut　out　the　head　of　the　humerus　from
the　free　space　above。　The　cautery　should　be　applied　thus：　taking
hold　with　the　hands　of　the　skin　at　the　armpit；　it　is　to　be　drawn
into　the　line；　in　which　the　head　of　the　humerus　is　dislocated；　and
then　the　skin　thus　drawn　aside　is　to　be　burnt　to　the　opposite　side。
The　burnings　should　be　performed　with　irons；　which　are　not　thick　nor
much　rounded；　but　of　an　oblong　form　（for　thus　they　pass　the　more
readily　through）；　and　they　are　to　be　pushed　forward　with　the　hand；　the
cauteries　should　be　red…hot；　that　they　may　pass　through　as　quickly
as　possible；　for　such　as　are　thick　pass　through　slowly；　and　occasion
eschars　of　a　greater　breadth　than　convenient；　and　there　is　danger　that
the　cicatrices　may　break　into　one　another；　which；　although　nothing
very　bad；　is　most　unseemly；　or　awkward。　When　you　have　burnt　through；
it　will　be　sufficient；　in　most　cases；　to　make　eschars　only　in　the
lower　part；　but　if　there　is　no　danger　of　the　ulcers　passing　into　one
another；　and　there　is　a　considerable　piece　of　skin　between　them；　a
thin　spatula　is　to　be　pushed　through　these　holes　which　have　been
burned；　while；　at　the　same　time；　the　skin　is　stretched；　for
otherwise　the　instrument　could　not　pass　through；　but　when　you　have
passed　it　through　you　must　let　go　the　skin；　and　then　between　the　two
eschars　you　should　form　another　eschar　with　a　slender　iron；　and　burn
through　until　you　come　in　contact　with　the　spatula。　The　following
directions　enable　you　to　determine　how　much　of　the　skin　of　the
armpit　should　be　grasped；　all　men　have　glands　in　the　armpit　greater　or
smaller；　and　also　in　many　other　parts　of　the　body。　But　I　will　treat　in
another　work　of　the　whole　constitution　of　the　glands；　and　explain　what
they　are；　what　they　signify；　and　what　are　their　offices。　The　glands；
then；　are　not　to　be　taken　hold　of；　nor　the　parts　internal　to　the
glands；　for　this　would　be　attended　with　great　danger；　as　they　are
adjacent　to　the　most　important　nerves。　But　the　greater　part　of　the
substances　external　to　the　glands　are　to　be　grasped；　for　there　is　no
danger　from　them。　And　this；　also；　it　is　proper　to　know；　that　if　you
raise　the　arm　much；　you　will　not　be　able　to　grasp　any　quantity　of　skin
worth　mentioning；　for　it　is　all　taken　up　with　the　stretching；　and　also
the　nerves。　which　by　all　means　you　must　avoid　wounding；　become　exposed
and　stretched　in　this　position；　but　if　you　only　raise　the　arm　a
little；　you　can　grasp　a　large　quantity　of　skin；　and　the　nerves　which
you　ought　to　guard　against　are　left　within；　and　at　a　distance　from　the
operation。　Should　not；　then；　the　utmost　pains　be　taken　in　the　whole
practice　of　the　art　to　find　out　the　proper　attitude　in　every　case？
So　much　regarding　the　armpit；　and　these　contractions　will　be
sufficient；　provided　the　eschars　be　properly　placed。　Without　the
armpit　there　are　only　two　places　where　one　might　place　the　eschars
to　obviate　this　affection；　the　one　before　and　between　the　head　of
the　humerus　and　the　tendon　at　the　armpit；　and　then　the　skin　may　be
fairly　burned　through；　but　not　to　any　great　depth；　for　there　is　a
large　vein　adjacent；　and　also　nerves；　neither　of　which　must　be　touched
with　the　heat。　But　externally；　one　may　form　another　eschar
considerably　above　the　tendon　at　the　armpit；　but　a　little　below　the
head　of　the　humerus；　and　the　skin　must　be　burned　fairly　through；　but
it　must　not　be　made　very　deep；　for　fire　is　inimical　to　the　nerves。
Through　the　whole　treatment　the　sores　are　to　be　so　treated；　as　to
avoid　all　strong　extension　of　the　arm；　and　this　is　to　be　done
moderately；　and　only　as　far　as　the　dressing　requires；　for　thus　they
will　be　less　cooled　（for　it　is　of　importance　to　cover　up　all　sorts
of　burns　if　one　would　treat　them　mildly）；　and　then　the　lips　of　them
will　be　less　turned　aside；　there　will　be　less　hemorrhage　and　fear　of
convulsions。　But　when　the　sores　have　become　clean；　and　are　going　on　to
cicatrization；　then　by　all　means　the　arm　is　to　be　bound　to　the　side
night　and　day；　and　even　when　the　ulcers　are　completely　healed；　the　arm
must　still　be　bound　to　the　side　for　a　long　time；　for　thus　more
especially　will　cicatrization　take　place；　and　the　wide　space　into
which　the　humerus　used　to　escape　will　become　contracted。

　　12。　When　attempts　to　reduce　a　dislocated　shoulder　have　failed；　if
the　patient　be　still　growing；　the　bone　of　the　affected　arm　will　not
increase　like　the　sound　one；　for　although　it　does　increase　in　so　far
it　becomes　shorter　than　the　other；　and　those　persons　called
weasel…armed；　become　so　from　two　accidents；　either　from　having　met
with　this　dislocation　in　utero；　or　from　another　accident；　which　will
be　described　afterward。　But　those　who　while　they　were　children　have
had　deep…seated　suppurations　about　the　head　of　the　bone；　all　become
weasel…armed；　and　this；　it　should　be　well　known；　will　be　the　issue；
whether　the　abscess　be　opened　by　an　incision　or　cautery；　or　whether　it
break　spontaneously。　Those　who　are　thus　affected　from　birth　are
quite　able　to　use　the　arm　yet　neither　can　they　raise　the　arm　to　the
ear；　by　extending　the　elbow；　but　they　do　this　much　less　efficiently
than　with　the　sound　arm。　But　in　those　who　have　had　the　shoulder
dislocated　after　they　w