Part 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
[p. 219]slender iron,
and burn through until you come in contact with the spatula. The following
directions enable you to determine how much of the skin of the armpit
should be grasped; all men have glands in the armpit greater or smaller,
and also in many other parts of the body. But I will treat in another
work of the whole constitution of the glands, and explain what they
are, what they signify, and what are their offices. The glands, then,
are not to be taken hold of, nor the parts internal to the glands;
for this would be attended with great danger, as they are adjacent
to the most important nerves. But the greater part of the substances
external to the glands are to be grasped, for there is no danger from
them. And this, also, it is proper to know, that if you raise the
arm much, you will not be able to grasp any quantity of skin worth
mentioning, for it is all taken up with the stretching; and also the
nerves, which by all means you must avoid wounding, become exposed
and stretched in this position; but if you only raise the arm a little,
you can grasp a large quantity of skin, and the nerves which you ought
to guard against are left within, and at a distance from the operation.
Should not, then, the utmost pains be taken in the whole practice
of the art to find out the proper attitude in every case? So much
regarding the armpit, and these contractions will be sufficient, provided
the eschars be properly placed. Without the armpit there are only
two places where one might place the eschars to obviate this affection;
the one before and between the head of the humerus and the tendon
at the armpit; and then the skin may be fairly burned through, but
not to any great depth, for there is a large vein adjacent, and also
nerves, neither of which must be touched with the heat. But externally,
one may form another eschar considerably above the tendon at the armpit,
but a little below the head of the humerus; and the skin must be burned
fairly through, but it must not be made very deep, for fire is inimical
to the nerves. Through the whole treatment the sores are to be so
treated, as to avoid all strong extension of the arm, and this is
to be done moderately, and only as far as the dressing requires; for
thus they will be less cooled (for it is of importance to cover up
all sorts of burns if one would treat them mildly), and then the
[p. 220] lips
of them will be less turned aside; there will be less hemorrhage and
fear of convulsions. But when the sores have become clean, and are
going on to cicatrization, then by all means the arm is to be bound
to the side night and day; and even when the ulcers are completely
healed, the arm must still be bound to the side for a long time; for
thus more especially will cicatrization take place, and the wide space
into which the humerus used to escape will become contracted.