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；　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　b