thin spatula is to be pushed through these holes which have been
burned； while； at the same time； the skin is stretched； for
otherwise the instrument could not pass through； but when you have
passed it through you must let go the skin； and then between the two
eschars you should form another eschar with a slender iron； and burn
through until you come in contact with the spatula。 The following
directions enable you to determine how much of the skin of the
armpit should be grasped； all men have glands in the armpit greater or
smaller； and also in many other parts of the body。 But I will treat in
another work of the whole constitution of the glands； and explain what
they are； what they signify； and what are their offices。 The glands；
then； are not to be taken hold of； nor the parts internal to the
glands； for this would be attended with great danger； as they are
adjacent to the most important nerves。 But the greater part of the
substances external to the glands are to be grasped； for there is no
danger from them。 And this； also； it is proper to know； that if you
raise the arm much； you will not be able to grasp any quantity of skin
worth mentioning； for it is all taken up with the stretching； and also
the nerves。 which by all means you must avoid wounding； become exposed
and stretched in this position； but if you only raise the arm a
little； you can grasp a large quantity of skin； and the nerves which
you ought to guard against are left within； and at a distance from the
operation。 Should not； then； the utmost pains be taken in the whole
practice of the art to find out the proper attitude in every case？
So much regarding the armpit； and these contractions will be
sufficient； provided the eschars be properly placed。 Without the
armpit there are only two places where one might place the eschars
to obviate this affection； the one before and between the head of
the humerus and the tendon at the armpit； and then the skin may be
fairly burned through； but not to any great depth； for there is a
large vein adjacent； and also nerves； neither of which must be touched
with the heat。 But externally； one may form another eschar
considerably above the tendon at the armpit； but a little below the
head of the humerus； and the skin must be burned fairly through； but
it must not be made very deep； for fire is inimical to the nerves。
Through the whole treatment the sores are to be so treated； as to
avoid all strong extension of the arm； and this is to be done
moderately； and only as far as the dressing requires； for thus they
will be less cooled （for it is of importance to cover up all sorts
of burns if one would treat them mildly）； and then the lips of them
will be less turned aside； there will be less hemorrhage and fear of
convulsions。 But when the sores have become clean； and are going on to
cicatrization； then by all means the arm is to be bound to the side
night and day； and even when the ulcers are completely healed； the arm
must still be bound to the side for a long time； for thus more
especially will cicatrization take place； and the wide space into
which the humerus used to escape will become contracted。
12。 When attempts to reduce a dislocated shoulder have failed； if
the patient be still growing； the bone of the affected arm will not
increase like the sound one； for although it does increase in so far
it becomes shorter than the other； and those persons called
weasel…armed； become so from two accidents； either from having met
with this dislocation in utero； or from another accident； which will
be described afterward。 But those who while they were children have
had deep…seated suppurations about the head of the bone； all become
weasel…armed； and this； it should be well known； will be the issue；
whether the abscess be opened by an incision or cautery； or whether it
break spontaneously。 Those who are thus affected from birth are
quite able to use the arm yet neither can they raise the arm to the
ear； by extending the elbow； but they do this much less efficiently
than with the sound arm。 But in those who have had the shoulder
dislocated after they were grown up； and when it has not been reduced；
the top of the shoulder becomes much less fleshy； and the habit of
body at that part is attenuated； but when they cease to have pain；
whatever they attempt to perform by raising the elbow from the sides
obliquely； they can no longer accomplish as formerly； but whatever
acts are performed by carrying the arm around by the sides； either
backward or forward； all those they can perform； for they can work
with an auger or a saw； or with a hatchet； and can dig； by not raising
the elbow too much； and do all other kinds of work which are done in
similar attitudes。
13。 In those cases where the acromion has been torn off； the bone
which is thus separated appears prominent。 The bone is the bond of
connection between the clavicle and scapula； for in this respect the
constitution of man is different from that of other animals；
physicians are particularly liable to be deceived in this accident
（for as the separated bone protrudes； the top of the shoulder
appears low and hollow）； so that they make preparations as if for
dislocation of the shoulder； for I have known many physicians；
otherwise not inexpert at the art； who have done much mischief by
attempting to reduce such shoulders； thus supposing it a case of
dislocation； and they did not desist until they gave over mistake of
supposing that they had reduced the shoulder。 The treatment； in
these cases； is similar to that which is applicable in others of a
like kind； namely； cerate； compresses； and suitable bandaging with
linen cloths。 The projecting part must be pushed down； and the greater
number of compresses are to be placed on it； and most compression is
to be applied at that part； and the arm being fastened to the side
is to be kept elevated； for thus the parts which had been torn asunder
are brought into closest proximity with one another。 All this should
be well known； and if you choose you may prognosticate safely that
no impediment； small or great； will result from such an injury at
the shoulder； only there will be a deformity in the place； for the
bone cannot be properly restored to its natural situation； but there
must necessarily be more or less tumefaction in the upper part。 For
neither can any other bone be made exactly as it was； which having
become incorporated with another bone； and having grown to it as an
apophysis； has been torn from its natural situation。 If properly
bandaged； the acromion becomes free of pain in a few days。
14。 When a fractured clavicle is fairly broken across it is more
easily treated； but when broken obliquely it is more difficult to
manage。 Matters are different in these cases from what one would
have supposed； for a bone fairly broken across can be more easily
restored to its natural state； and with proper care the upper part may
be brought down by means of suitable position and proper bandaging；
and even if not properly set； the projecting part of the bone is not
very sharp。 But in oblique fractures the case is similar to that of
bones which have been torn away； as formerly described； for they do
not admit of being restored to their place； and the prominence of
the bone is very sharp。 For the most part； then； it should be known；
no harm results to the shoulder or to the rest of the body from
fracture of the clavicle； unless it sphacelate； and this rarely
happens。 A deformity； however； may arise from fracture of the
clavicle； and in these cases it is very great at first； but by and
by it becomes less。 A fractured clavicle； like all other spongy bones；
gets speedily united； for all such bones form callus in a short
time。 When； then； a fracture has recently taken place； the patients
attach much importance to it； as supposing the mischief greater than
it really is； and the physicians bestow great pains in order that it
may be properly bandaged； but in a little time the patients； having no
pain； nor finding any impediment to their walking or eating； become
negligent； and the physicians finding they cannot make the parts
look well； take themselves off； and are not sorry at the neglect of
the patients； and in the meantime the callus is quickly formed。 The
method of dressing which is most appropriate； is similar to that
used in ordinary cases； consisting of cerate； compresses； and
bandages； and it should be most especially known in this operation；
that most compresses should be placed on the projecting bone； and that
the greatest pressure should be made there。 There are certain
physicians who make a show of superior skill by binding a heavy
piece of lead on the part in order to depress the projecting bone； but
this mode of treatment does not apply to the clavicle； for it is
impossible to depress the projecting part to any extent worth
mentioning。 There are others who； knowing the fact that the bandages
are apt to slip off； and that they do not keep the projecting parts in
their place； apply compresses and bandages like the others； and then
having girt the patient with a girdle； where it is usually applied
with most effect； they make a heap of the compresses upon of the
compresses upon the projecting bone when they apply them； and having
fastened the head of the bandage to the girdle in front； they apply it
so as to bring the turns of it into the line of the clavicle； carrying
them to the back； and then bringing them around the girdle they
carry them to the fore part and again backward。 There are others who
do not apply the bandage round the girdle； but carry the rounds of
it by the perineum and anus； and along the spine； so as to compress
the fracture。 To an inexperienced person these methods will appear not
far from natural； but when tied； they will be found of no service； for
they do not remain firm any length of time； even if the patient keep
his bed； although in this position they answer best； and yet even when
lying in bed； should he bend his leg； or should his trunk be bent； all
the will be displaced； and； moreover； the bandaging is inconvenient；
in as much as the anus is comprehended by it； and many turns of the
bandage are c