on the articulations-第2部分

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reduction　of　the　shoulder；　for　one　thus　operates　with　the　lever　upon
the　most　correct　principles；　provided　only　the　piece　of　wood　be　placed
as　much　as　possible　within　the　head　of　the　humerus；　and　thus　also
the　counter…balancing　weights　will　be　most　properly　adjusted；　and
safely　applied　to　the　bone　of　the　arm。　Wherefore　recent　cases　in
this　way　may　be　reduced　more　quickly　than　could　be　believed；　before
even　extension　would　appear　to　be　applied；　and　this　is　the　only　mode
of　reduction　capable　of　replacing　old　dislocations；　and　this　it　will
effect；　unless　flesh　has　already　filled　up　the　（glenoid）　cavity；　and
the　head　of　the　humerus　has　formed　a　socket　for　itself　in　the　place　to
which　it　has　been　displaced；　and　even　in　such　an　old　case　of
dislocation；　it　appears　to　me　that　we　could　effect　reduction　（for　what
object　would　a　lever　power　properly　applied　not　it　move？）；　but　it
would　not　remain　in　its　place；　but　would　be　again　displaced　as
formerly。　The　same　thing　may　be　effected　by　means　of　the　ladder；　by
preparing　it　in　the　same　manner。　If　the　dislocation　be　recent；　a　large
Thessalian　chair　may　be　sufficient　to　accomplish　this　purpose；　the
wood；　however；　should　be　dressed　up　as　described　before；　but　the
patient　should　be　seated　sideways　on　the　chair；　and　then　the　arm；　with
the　piece　of　wood　attached　to　it；　is　to　be　brought　over　the　back　of
the　chair；　and　force　is　to　be　applied　to　the　arm；　with　the　wood　on　the
one　side；　and　the　body　on　the　other　side。　The　same　means　may　be
applied　with　a　double　door。　One　should　always　use　what　happens　to　be
at　hand。

　　8。　Wherefore　it　should　be　known　that　one　constitution　differs　much
from　another　as　to　the　facility　with　which　dislocations　in　them　may　be
reduced；　and　one　articular　cavity　differs　much　from　another；　the　one
being　so　constructed　that　the　bone　readily　leaps　out　and　another
less　so；　but　the　greatest　difference　regards　the　binding　together　of
the　parts　by　the　nerves　（ligaments？）　which　are　slack　in　some　and　tight
in　others。　For　the　humidity　in　the　joints　of　men　is　connected　with　the
state　of　the　ligaments；　when　they　are　slack　and　yielding；　for　you
may　see　many　people　who　are　so　humid　（flabby？）　that　when　they　choose
they　can　disarticulate　their　joints　without　pain；　and　reduce　them　in
like　manner。　The　habit　of　the　body　also　occasions　a　certain
difference；　for　in　those　who　are　in　a　state　of　embonpoint　and　fleshy
the　joint　is　rarely　dislocated；　but　is　more　difficult　to　reduce；　but
when　they　are　more　attenuated　and　leaner　than　usual；　then　they　are
subject　to　dislocations　which　are　more　easily　reduced。　And　the
following　observation　is　a　proof　that　matters　are　so；　for　in　cattle
the　thighs　are　most　apt　to　be　dislocated　at　the　hip…joint；　when　they
are　most　particularly　lean；　which　they　are　at　the　end　of　winter；　at
which　time　then　they　are　particularly　subject　to　dislocations　（if　I
may　be　allowed　to　make　such　an　observation　while　treating　of　a　medical
subject）；　and　therefore　Homer　has　well　remarked；　that　of　all　beasts
oxen　suffer　the　most　at　that　season；　and　especially　those　employed
at　the　plow　as　being　worked　in　the　winter　season。　In　them；
therefore；　dislocations　happen　most　frequently；　as　being　at　that
time　most　particularly　reduced　in　flesh。　And　other　cattle　can　crop　the
grass　when　it　is　short；　but　the　ox　cannot　do　so　until　it　becomes　long；
for；　in　the　others；　the　projection　of　the　lip　is　slender；　and　so　is
the　upper　lip；　but　in　the　ox　the　projection　of　the　lip　is　thick；　and
the　upper　jaw　is　thick　and　obtuse；　and　therefore　they　are　incapable　of
seizing　short　herbs。　But　the　solidungula　as　having　prominent　teeth
in　both　their　front　jaws；　can　crop　the　grass　and　grasp　it　with　their
teeth　while　short；　and　delight　more　in　short　grass　than　in　rank；
for；　in　general；　short　grass　is　better　and　more　substantial　than　rank；
as　having　not　yet　given　out　its　fructification。　Wherefore　the　poet　has
the　following　line：

　　As　when　to　horned　cattle　dear　the　vernal　season　comes；*

because　rank　grass　appears　to　be　most　sought　after　by　them。　But
otherwise　in　the　ox；　this　joint　is　slacker　than　in　other　animals；　and；
therefore；　this　animal　drags　his　foot　in　walking　more　than　any
other；　and　especially　when　lank　and　old。　For　all　these　reasons　the
ox　is　most　particularly　subject　to　dislocations；　and　I　have　made　the
more　observations　respecting　him；　as　they　confirm　all　that　was　said
before　on　this　subject。　With　regard；　then；　to　the　matter　on　hand；　I
say　that　dislocations　occur　more　readily；　and　are　more　speedily
reduced　in　those　who　are　lean　than　in　those　who　are　fleshy；　and　in
those　who　are　humid　and　lank　there　is　less　inflammation　than　in　such
as　are　dry　and　fleshy；　and　they　are　less　compactly　knit　hereafter；　and
there　is　more　mucosity　than　usual　in　cases　not　attended　with
inflammation；　and　hence　the　joints　are　more　liable　to　luxations；
for；　in　the　main；　the　articulations　are　more　subject　to　mucosities
in　those　who　are　lean　than　in　those　who　are　fleshy；　and　the　flesh　of
lean　persons　who　have　not　been　reduced　by　a　proper　course　of
discipline　abounds　more　with　mucosity　than　that　of　fat　persons。　But　in
those　cases　in　which　the　mucosity　is　accompanied　with　inflammation；
the　inflammation　binds　（braces？）　the　joint；　and　hence　those　who　have
small　collections　of　mucosities　are　not　very　subject　to
dislocations；　which　they　would　be　if　the　mucosity　had　not　been
accompanied　with　more　or　less　inflammation。

*There　is　no　such　line　in　the　works　of　Homer　as　they　have　come　down　to
us。

　　9。　In　cases　of　dislocation　those　persons　who　are　not　attacked　with
inflammation　of　the　surrounding　parts；　can　use　the　shoulder
immediately　without　pain；　and　do　not　think　it　necessary　to　take　any
precautions　with　themselves；　it　is　therefore　the　business　of　the
physician　to　warn　them　beforehand　that　dislocation　is　more　likely　to
return　in　such　cases　than　when　the　tendons　have　been　inflamed。　This
remark　applies　to　all　the　articulations；　but　particularly　to　those
of　the　shoulder　and　knee；　for　these　are　the　joints　most　subject　to
luxations。　But　those　who　have　inflammation　of　the　ligaments　cannot　use
the　shoulder；　for　the　pain　and　the　tension　induced　by　the　inflammation
prevent　them。　Such　cases　are　to　be　treated　with　cerate；　compresses；
and　plenty　of　bandages；　but　a　ball　of　soft　clean　wool　is　to　be
introduced　into　the　armpit；　to　fill　up　the　hollow　of　it；　that　it　may
be　a　support　to　the　bandaging；　and　maintain　the　joint　in　situ。　The
arm；　in　general；　should　be　inclined　upward　as　much　as　possible；　for
thus　it　will　be　kept　at　the　greatest　possible　distance　from　the
place　at　which　the　head　of　the　humerus　escaped。　And　when　you　bandage
the　shoulder　you　must　fasten　the　arms　to　the　sides　with　a　band；
which　is　to　be　carried　round　the　body。　The　shoulder　should　be　rubbed
gently　and　softly。　The　physician　ought　to　be　acquainted　with　many
things；　and　among　others　with　friction；　for　from　the　same　name　the
same　results　are　not　always　obtained；　for　friction　could　brace　a　joint
when　unseasonably　relaxed；　and　relax　it　when　unseasonably　hard；　but　we
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　treate