on the articulations-第1部分
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400 BC
ON THE ARTICULATIONS
by Hippocrates
translated by Francis Adams
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
together。 For without something of the kind the heel cannot reach to
the head of the humerus； since； when the arm is stretched； the
armpit becomes hollow； the tendons on both sides of the armpit
making counter…contraction so as to oppose the reduction。 But
another person should be seated on the other side of the patient to
hold the sound shoulder； so that the body may not be dragged along
when the arm of the affected side is pulled； and then； when the ball
is placed in the armpit； a supple piece of thong sufficiently broad is
to be placed round it； and some person taking hold of its two ends
is to seat himself above the patient's head to made counter…extension；
while at the same time he pushes with his foot against the bone at the
top of the shoulder。 The ball should be placed as much on the inside
as possible； upon the ribs； and not upon the head of the humerus。
4。 There is another method of reduction performed by the shoulder of
a person standing。 The person operating in this way； who should be
taller than the patient； is to take hold of his arm and place the
sharp point of his own shoulder in the patient's armpit； and push it
in so that it may lodge there； and having for his object that the
patient may be suspended at his back by the armpit； he must raise
himself higher on this shoulder than the other； and he must bring
the arm of the suspended patient as quickly as possible to his own
breast。 In this position he should shake the patient when he raises
him up； in order that the rest of the body may be a counterpoise to
the arm which is thus held。 But if the patient be very light； a
light child should be suspended behind along with him。 These methods
of reduction are all of easy application in the palestra； as they
can all be performed without instruments； but they also be used
elsewhere。
5。 Those who accomplish the reduction by forcibly bending it round a
pestle； operate in a manner which is nearly natural。 But the pestle
should be wrapped in a soft shawl （for thus it will be less slippery）；
and it should be forced between the ribs and the head of the
humerus。 And if the pestle be short； the patient should be seated upon
something； that his arm can with difficulty pass above the pestle。 But
for the most part the pestle should be longer； so that the patient
when standing may be almost suspended upon the piece of wood。 And then
the arm and forearm should be stretched along the pestle； whilst
some person secures the opposite side of the body by throwing his arms
round the neck； near the clavicle。
6。 But the method with a ladder is another of the same kind； and
still better； since by it the body can be more safely counterpoised on
this side； and that； while in the method which the piece of wood
resembling a pestle； there is danger of the body tumbling to either
side。 But some round thing should be tied upon the step of the
ladder which may be fitted to the armpit； whereby the head of the bone
may be forced into its natural place。
7。 The following； however； is the strongest of all the methods of
reduction。 We must get a piece of wood； five； or at least four
inches broad； two inches in thickness； or still thinner； and two
cubits in length； or a little less； and its extremity at one end
should be rounded； and made very narrow and very slender there； and it
should have a slightly projecting edge （ambe） on its round
extremity； not on the part that is to be applied to the side； but to
the head of the humerus； so that it may be adjusted in the armpit at
the sides under the head of the humerus； and a piece of soft shawl
or cloth should be glued to the end of the piece of wood； so as to
give the less pain upon pressure。 Then having pushed the head of
this piece of wood as far inward as possible between the ribs and
the head of the humerus； the whole arm is to be stretched along this
piece of wood； and is to be bound round at the arm； the fore…arm；
and the wrist； so that it may be particularly well secured； but
great pains should be taken that the extremity of this piece of wood
should be introduced as far as possible into the armpit； and that it
is carried past the head of the humerus。 Then a cross…beam is to be
securely fastened between two pillars； and afterward the arm with
the piece of wood attached to it is to be brought over this
cross…beam； so that the arm may be on the one side of it and the
body on the other； and the cross…beam in the armpit； and then the
arm with the piece of wood is to be forced down on the one side of the
cross…beam； and the rest of the body on the other。 The cross…beam is
to be bound so high that the rest of the body may be raised upon
tip…toes。 This is by far the most powerful method of effecting
reduction of the shoulder； for one thus operates with the lever upon
the most correct principles
