Part 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
[p. 214]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 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.