On the Articulations (8-9)

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.

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.