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Show or DISLOCAI'I‘ON. or DISI.OCATION. iron: the friction of the parts. But, if in the violent and tr. regular motions of the joints there should be no sensation communicated, then would there be an absence of the governing principle, and no restraint, and no means of renovation. We may see now, why, in experiments on the tendons and liga-ments by pouring acids upon them, and pricking them with needles, the animal gives no sign of pain ; and yet in sprains, by ineffectual applications, or, in other words, after all active inflammation has subsided. To ascertain the nature of the accident when we have rea~ son to think there is dislocation, we must consider these points ; and dislocations there is extreme torture ;--we wonder only that the distinction should have been overlooked. To preserve the natural state of a joint that inferior degree of activity of vessels only is necessary, which, perhaps errone~ ousiy, we call a weak action. However, it is important to observe, that whenever this na< 'tural state of action is changed, there is also a change in the nature of the part. The pain I have described is followed by its usual effect, inflammation: the ligaments when inflamed r»l'""'"\? ‘Wgfiwfl-‘W .4 ~4.; .4 m~v-:-_-. ,m_,3.,w- 7.-...- lose their density and firmness, they swell, become weak, and acquire a new kind of sensibility, and no longer bind the bones with their former strength. This is the explanation of the weakness of a joint after a dislocation, or a sprain: without this increased activity of vessels there could be no regeneration of the ruptured parts; injury to ajoint would be like the breaking of the parts of a machine which possess no pror perty of restoring themselves. Nothing, however, is more difficult, than to change this low degree of continued inflammation, and to restore the state of the parts to their natural density and firmness. In the scrophulous constitution there is, unfortunately, a tendency to this inflammatory action in the joints, which it is very ditlicult to allay. It is not bleeding 163 1. we, perhaps, find the joint much discoloured, and marks of a blow re .eived upon it. This implies, though it be no absolute proof, that the bones are not dislocated, but only the joint bruised; because, as I have said, it is the long lever of the bones receiving the force upon the extremity dis» tant from the joint, which does violence to the connecting ligaments. For example, if there has not been a blow on the shoulder, but the patient falling on the wrist, has pain and lameness of the shoulder joint, then sprain or dislocation of the shoulder is the probable cause of the pain and incapacity ; if, on the contrary, there shall be evident marks of a bruise on the shoulder, it is probably not a dislocation. 2. The knowledge of the natural form and position of the limb will often enable us with a glance of the eye, to discover the distortion caused by dislocation. Generally the limb is shorter, though sometimes it is lengthened; when with this there is joined a stiti‘ and awkward position, from which the limb is not moved without great pain, and when. upon examining it more particularly, there is a rigidity of one set of muscles, the dislocation is ascertained. We consider the new position of the head of the bone ; the effect of this change, on the muscles inserted into it; we feel these muscles, and they are rigid like cords; and this, with the circum- stance of the accident having produced this immediate consequence, is decisive of the nature of the case. There may oc- and purging which will reach a local disease of this kind ; far cur a contraction and stillness of the muscles from spasm, pro- less will this do good if there be any constitutional tendency to scrophulous actions. "'6 may take a hint from quacks and bone-setters; I have known them remarkably successful by employing severe and continued irritation on the surface while they have forcibly moved the stifl‘ and pained joint- ducing a resemblance to the unnatural position of the dislocated limb, but there will not be the actual distortion proceeding from the new position of the bone, and the change in the angle of insertion of the muscle ; there will be no shorten- But this has been after the surgeon has exhausted the patient to the limb is often interrupted and unequal. There is also a particular checking occasioned by the head of the bone strik- ing of the limb. In dislocation, the motion which is allowed |
