Commentary. The account here given of Hippocrates’s method of reduction is taken from his work, ‘De Articulis,’ (31.) When a few of his technical terms are explained in the commentary of Galen, the description is sufficiently distinct, and is upon the whole a very correct account of the symptoms and treatment of this accident. The prominence of the coronoid bone is well described by Hippocrates. Galen remarks that the end of the jaw-bone slips under the zygomatic arch. It has been a matter of dispute what Hippocrates means by slackening, or incomplete luxations of the jaw. It is worthy of remark that such an accident is described by Sir Astley Cooper. (See further Littré’s Hippocrates, t. iv, 29.)
Galen’s description of the method of reduction is given in the Collection of Nicetas. (Chirurg. Vet. ed. Cocchius.) It is substantially the same as that of Hippocrates.
A mode of reducing the dislocation by means of a machine is described by Oribasius, in his work De Machinamentis, 30.
The account which Celsus gives of this accident is upon the whole very accurate, and corresponds very well with modern descriptions. If dislocated only at one end, the chin inclines to the opposite side, and the teeth of the upper and lower jaws do not correspond. If at both ends, the whole chin projects outwards, the lower teeth are more prominent, and the muscles appear stretched. The patient being properly seated, and his head held by an assistant, the surgeon having wrapped his thumbs with linen cloths, is to put them into the patient’s mouth, while the fingers are applied externally. The jaw being firmly grasped, the chin is to be shaken, and then, at one and the same instant, the head is to be seized, the chin moved, the jaw forced into its place, and the mouth shut. After reduction, if pain in the eyes and neck has been brought on by the accident, he recommends us to let blood from the arm. The patient is to live upon liquids, and avoid talking.
Albucasis follows Hippocrates in distinguishing dislocations of the lower jaw into partial and complete. In addition to the symptoms already detailed, he mentions a flow of saliva from the mouth, and an inability to speak. When the dislocation is partial or incomplete, he says, it soon returns of itself to its proper place. When the luxation is complete, he directs us to reduce it by introducing the thumbs into the mouth, and grasping the jaw in the manner described by Hippocrates. He states that when not reduced the accident often proves fatal by superinducing fevers and coma. Avicenna, in like manner, affirms, that if not reduced, it may bring on fatal consequences. His account is borrowed entirely from Hippocrates. Rhases and Haly Abbas give exactly the same description of the symptoms and mode of reducing as Albucasis.
Monteggia, Fabricius ab Aquapendente, Sir Astley Cooper, and Mr. Samuel Cooper (the author of the well-known Surgical Dictionary) affirm that there is no foundation for the prognostic of Hippocrates, that the accident will prove fatal if the dislocation be not speedily reduced. We can say, however, from our own personal knowledge, that such fatal consequences do occasionally occur. We once knew a poor woman who was very liable to dislocations of the lower jaw, which we reduced three or four different times. At last, owing to circumstances which it is unnecessary to explain, an interval of more than a day elapsed between the accident and the reduction. By this time she was become seriously indisposed, and died a few days afterwards with all the symptoms described by Hippocrates. We may mention also that Heister states that fatal consequences may result from the accident. (Chirurg. p. i, iii, 4.) The same thing is affirmed also by Brunus (Chirurg. Mag. i); by Theodoricus (ii, 43); and by Guido de Cauliaco (v, 2.)
That species of sub-luxation described by Hippocrates, is mentioned by Guy of Cauliac in the following terms: “Mandibula quandoque mollificatur.” (v, 2.)
SECT. CXIII.—ON THE CLAVICLE AND ACROMION.
The clavicle, at its inner extremity, is not liable to dislocation, for there it is articulated with the sternum, where it admits of no motion. But if from any sudden and violent force from without, it should be torn from its place, it is to be subjected to the same treatment as a fracture. And its extremity which is articulated with the shoulder does not readily fall out of the joint, being prevented by the biceps muscle and the acromion. But neither does the clavicle admit any strong peculiar motion of its own, being made solely for the expansion of the thorax, and hence man is the only animal which has a clavicle. If it should sometimes happen to be dislocated in wrestling, it is to be replaced with the hand, assisted by the application of many-folded compresses, together with convenient bandages. When the acromion is sub-luxated it may be restored to its proper place by the same treatment. It is a small cartilaginous bone connecting the clavicle to the scapula, which is not to be seen in the skeletons. This, if moved a little from its place, exhibits the appearance to inexperienced persons of the head of the arm being dislocated; for the top of the shoulder appears sharper, and there is a hollow from which it was removed; but the cases are to be distinguished from one another by the symptoms about to be enumerated.