I shall briefly consider each kind of dislocation, that an accident makes a man liable to.
Dislocation of the Arm with the Shoulder.
The dislocation of that, may be two ways; (viz) downwards, and forwards; but it cannot be backwards nor upwards; except some part of the shoulder-blade be broke.——The best method to examine the patient what kind of dislocation it is, (especially to one unacquainted with these branches of surgery) is strictly to compare both shoulders, and the difference will be very plain, both to sight and touch.
If the dislocation is downwards that is, the head of the arm-bone, slipt in the arm-pit, there will be a cavity on the top of the shoulder, different from the sound arm, and the elbow will be drawn upwards, without being able to be moved either towards the body; or so, as the patient to put his hand out without the greatest pain.
When this is found to be the case, then, in order to reduce it, set the patient low, on a steady seat. Take a napkin or towel, of which make a girt; put one part over your neck, and the other part under the arm-pit. Let an assistant hold the patient steady, another take hold of the patient’s arm, with the elbow bent, and extend it gradually; then with both your hands take the arm, and whilst you lift up the arm by help of the napkin resting on your neck, you press gently down the arm with your hands like a lever; in the mean time the assistant extends, and thus you reduce it; which you will hear by its snapping: upon which the patient will be able to move his arm in all kind of direction, without much pain.
If the head of the arm-bone is dislocated forwards, there will be a cavity backwards on the shoulder, and the elbow will stick backwards, and remain motionless, with great pain. In this case, as before, let the patient sit low, and with the help of the napkin, and assistances, first extend the arm forwards; then like a lever bring the head of the bone in its cavity; which, like the former, will be perceived by a snapping, and the voluntary motion of the patient’s arm.
When the shoulder is reduced, secure the whole with a long double-headed bandage, cross-wide over the shoulders, and round the body. Foment it night and morning with spirits of wine and camphor (A). Keep the arm close to the body, with the elbow bent, and wear it in a sling, that it may be free from motion till it is well.
Dislocation of the Elbow, or the Knee.
The elbow, as I said before, is very seldom dislocated, unless fractured, and the ligament tore at the same time; and when so, the case is terrible. But very often those joints receive a wrench, which, though nothing out of its place, is often very painful, on account of the many tendons that surround the parts. The only thing in such wrenching, is to foment it with spirit of wine and camphor (A), or else the saponaceous linament (B). The same method should be observed with the knee, securing it well with a bandage, in order to give it rest to recover: For rest is a principal remedy.