34. Luxations of the humerus are but rarely followed by any serious
accidents. Sometimes a swelling more or less considerable appears,
immediately after the fall, in and around the arm-pit. This is the
effect of an increased irritability of the part, and is seldom of long
duration. Desault’s remedy for it was the application of compresses wet
with vegeto-mineral water, or of cataplasms moistened with the same
liquid.
35. Several authors, particularly Bell, speak (as if it were a familiar
accident) of an œdematous swelling of the whole upper extremity,
caused, in inward luxations, by a compression of the axillary glands.
This phenomenon has not often occurred in the Hotel-Dieu, except in
luxations of long standing: and when it has been met with in certain
cases, very happy effects have been produced, by the action, continued
for several days, of a roller applied with considerable tightness after
the reduction, and reaching from the fingers to the arm-pit.
CASE II. Maria ***, falling from some height, her elbow being separated
from her body and directed backwards, luxated her shoulder inwardly.
Several days elapsed before she received any surgical aid. She was
afterwards admitted into the Hotel-Dieu, where the displacement was
discovered through a very considerable swelling, which occupied the
parts around the articulation of the humerus. The reduction was
accomplished, and the swelling left to itself, which, far however from
disappearing, with the cause that produced it, seemed to gain ground.
A roller was then applied, and on the day following the tumefaction
was reduced to half its former size. The same means are continued. The
compression is gradually increased, and by the ninth day, the limb
restored to its natural form, performs, as before, all its functions.
36. There is another accident, on which authors have dwelt a little,
which was known to Avicenna, and which oftentimes fell under the notice
of Desault. I allude to a paralysis of the upper extremity, the effect
of compression made by the head of the bone, in inward luxations, on
the nerves of the brachial plexus. This accident sometimes resists
every expedient of art, as appears from the following case, collected
by myself, in the Hotel-Dieu.
CASE III. Maria Dougour, fell on her right side, and experienced
immediately all the signs of a downward luxation. A surgeon was called,
who moved the bone violently in every direction; he made no extension;
he kept the patient in torture for an hour; and at the expiration of
that time pronounced the luxation irreducible, because the head of the
bone, instead of returning into its natural cavity, had moved inwardly.
Indeed, in the midst of his unskilful efforts, a consecutive luxation
inwards had succeeded to a primitive one downwards.
On the same evening, an evident insensibility occurred in the part. A
swelling, joined to a sense of coldness, accompanied it. On the fourth
day, the paralysis was complete.
On the tenth day the patient was brought to the Hotel-Dieu, where the
processes of art which we shall presently describe, replaced the bone,
without removing the effects of its luxation.
To remedy this, irritating means were employed, simple at first, but
multiplied and combined afterwards, and pushed so far as to occasion
redness accompanied by small blisters. These were continued for three
weeks; blistering plasters were applied; all in vain; the paralysis
continued, and as long as a year afterwards the patient was still
affected with it.
37. This accident is, in general, extremely obstinate, when, as in
the preceding case, the nerves have experienced a long continued
pressure. Under such circumstances, the most powerful means are
often ineffectual. Moxa has been oftentimes used by Desault, which
he applied over the clavicle, at the very origin of the brachial
plexus. The success, with which he at first applied this remedy, did
not always accompany his use of it, so that notwithstanding several
cures performed by it, yet, to the majority of patients to whom it was
applied, it was wholly useless.
39. But, if the head of the humerus make on the nerves but a momentary
pressure, and the reduction be accomplished shortly after the paralytic
symptoms occur, oftentimes then the insensibility disappears of itself,
and the cure may be always greatly assisted by the application of
powerful stimulants; such, for instance, as volatile liniment, composed
of oil of almonds and ammonia, which Desault frequently employed, and
of which he increased the strength, so as to render it rubefacient.
CASE IV. Joanna Saq luxated her arm, by falling on her right side,
in the month of July, 1788. In the evening of the same day, all the
precursory symptoms of paralysis made their appearance. The affection
was complete on the day following.
The patient was brought to the Hotel-Dieu, where the reduction, being
accomplished, afforded no relief. On the third day, the paralysis still
continuing, the volatile liniment was directed, in the proportion at
first of two drachms of ammonia to an ounce of the oil of almonds.
This produced no effect. Being increased in strength on the fifth day,
it still appeared to be useless. On the eighth it was made of such a
degree of strength, as to occasion slight pustules over the whole of
the diseased extremity. On this, motion began to return, feeble at
first, but increasing by degrees, till by the sixteenth day, it was
as free and perfect as in a natural state. During all the time, the
liniment was applied twice a day over the arm and fore-arm, which were
at the same time subjected to strong friction during the space of half
an hour.
39. The pains which accompany luxations of the humerus, claim in
general some attention from the practitioner. These have sometimes
arisen to such a height, as to produce real disorder in the animal
economy, particularly in luxations inwardly, where, resulting, no
doubt, from the compression of the axillary nerves, they render
immediate reduction more necessary, and are generally removed by it.
§ VII.