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On The Articulations   

I am acquainted with one form in which the shoulder-joint is
dislocated, namely, that into the armpit; I have never seen it take
place upward nor outward; and yet I do not positively affirm whether
it might be dislocated in these directions or not, although I have
something which I might say on this subject. But neither have I ever
seen what I considered to be a dislocation forward. Physicians,
indeed, fancy that dislocation is very apt to occur forward, and
they are more particularly deceived in those persons who have the
fleshy parts about the joint and arm much emaciated; for, in all
such cases, the head of the arm appears to protrude forward. And I
in one case of this kind having said that there was no dislocation,
exposed myself to censure from certain physicians and common people on
that account, for they fancied that I alone was ignorant of what
everybody else was acquainted with, and I could not convince them
but with difficulty, that the matter was so. But if one will strip the
point of the shoulder of the fleshy parts, and where the muscle
(deltoid?) extends, and also lay bare the tendon that goes from the
armpit and clavicle to the breast (pectoral muscle?), the head of
the humerus will appear to protrude strongly forward, although not
dislocated, for the head of the humerus naturally inclines forward,
but the rest of the bone is turned outward. The humerus is connected
obliquely with the cavity of the scapula, when the arm is stretched
along the sides; but when the whole arm is stretched forward, then the
head of the humerus is in a line with the cavity of the humerus, and
no longer appears to protrude forward. And with regard to the
variety we are now treating of, I have never seen a case of
dislocation forward; and yet I do not speak decidedly respecting it,
whether such a dislocation may take place or not. When, then, a
dislocation into the armpit takes place, seeing it is of frequent
occurrence, many persons know how to reduce it, for it is an easy
thing to teach all the methods by which physicians effect the
reductions, and the best manner of applying them. The strongest of
those methods should be used when the difficulty of reduction is
particularly great. The strongest is the method to be last described.

2. Those who are subject to frequent dislocations at the
shoulder-joint, are for the most part competent to effect the
reduction themselves; for, having introduced the knuckles of the other
hand into the armpit, they force the joint upward, and bring the elbow
toward the breast. The physician might reduce it in the same manner,
if having introduced his fingers into the armpit on the inside of
the dislocated joint, he would force it from the ribs, pushing his own
head against the acromion, in order to make counter-pressure, and with
his knees applied to the patient's elbow pushing the arm to the sides.
It will be of advantage if the operator has strong hands, or the
physician may do as directed with his head and hands, while another
person brings the elbow toward the breast. Reduction of the shoulder
may also be effected by carrying the fore-arm backward to the spine,
and then with the one hand grasping it at the elbow, to bend the arm
upward, and with the other to support it behind at the articulation.
This mode of reduction, and the one formerly described, are not
natural, and yet by rotating the bone of the joint, they force it to
return.

3. Those who attempt to perform reduction with the heel, operate
in a manner which is an approach to the natural. The patient must
lie on the ground upon his back, while the person who is to effect the
reduction is seated on the ground upon the side of the dislocation;
then the operator, seizing with his hand the affected arm, is to
pull it, while with his heel in the armpit he pushes in the contrary
direction, the right heel being placed in the right armpit, and the
left heel in the left armpit. But a round ball of a suitable size must
be placed in the hollow of the armpit; the most convenient are very
small and hard balls, formed from several pieces of leather sewed

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