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On The Articulations   


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

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