A Treatise on Dislocation of the Shoulder. By George 0. Jarvis,
M. D., Author of Lectures on Fractures and Dislocations, &c.,
&c.; together with important cases illustrating the benefits of
the Adjuster. Compiled by George Kellogg, A. M.
This is the title of a well-written pamphlet of about thirty
pages, detailing a single case of dislocation of the shoulder, with
the head of the humerus in the axilla, together with a mention of
other cases of injury to the bones and joints. It comes to us as a
recommendation of the instrument well known as “ Jarvis’ Surgi-
cal Adjuster,” which was the apparatus relied upon and used with
success in the instances of w7hich an account is given by our
author. It is presented, as stated in the preface, “ at the solici-
tation of many members of the profession,” and is thought by the
compiler, Mr. George Kellogg, to demonstrate “ the indispensable
necessity of the adjuster,” while he states his disinterested motive
in making the publication, to be, a desire “ to promote the useful-
ness and unfailing success of the whole body of practicing sur-
geons.”
If the instrument thus strenuously advocated possess the merits
ascribed to it by its manufacturer, a desideratum is doubtless at-
tained in the healing art, and on its adoption in practice the sur-
geon must soon banish from our midst the many cases of perma-
nent deformity from severe injuries of the bones and joints which
have heretofore been his opprobria, and put an end to costly and
vexatious suits for malpractice, by which he is too frequently an-
noyed at the present day.
The author, Dr. Jarvis, prior to entering on an account of the
case of dislocation of the shoulder, on which the essay is based,
undertakes to lay down the principles on which all such injuries
should be treated, and claims for the adjuster the ability to carry
out the different indications, without regard to the character,
extent, or duration of such injuries. The Dr. very truly states,
that there is a difference between the pathology of a recent and
old luxation of the shoulder joint, but still insists that the same
instrument is equal alike to the reduction, unaided by the adju-
vants usually resorted to, such as venesection, tartar emetic, the
warm bath, and other means for the production of muscular re-
laxation, which have been commonly considered necessary in cases
at all difficult of reduction. On the contrary, he seems to insist
that much strength of the muscles is necessary (and the more the
better) to accomplish the object, as upon their contraction, after
having been put sufficiently on the stretch to dislodge the head of
the bone from its unnatural position, does the success of the treat-
ment depend. By the instrument, extension is made' in one way
only, and the surgeon is deprived of the ability to change its
direction when desirable, as is the case when the pullies are used,
or when the heel or knee is placed in the axilla. He also discards
one of the old and fundamental directions and modes of practice,
that the extension should be made in the line of the dislocation,
and is entirely content with bringing the head of the bone on a
level with the glenoid cavity, when all extension is to be suddenly
removed, and the head of the bone driven forcibly by the contrac-
tion of the muscles, through the capsular ligament, (in which the
laceration is presumed to have been closed,) into its natural
position.
It is presumed that the laceration in the ligaments, through
which the head of the bone has escaped, is often partially closed
after old luxations; and it is known that all the muscles about
the shoulder, and not alone the deltoid and supra spinatus, have
become to a great extent paralyzed, certainly too much so to
admit of such powerful contractions as to inflict on the closed cap-
sule “the impetus of a blow, from the head of the bone being for-
cibly driven against it,” which will lacerate it “ on the same prin-
ciple that an arrow is driven into a board.” The case related as
having been operated on successfully at the Marine Hospital in
Mobile, was certainly a fair one for the trial of the adjuster, as
the dislocation of the shoulder was of’fifty-two days’ standing, and
its reduction had been well attempted by other means. Still we
are unwilling to throw aside appliances which have been found
heretofore generally equal to the end, for one, which can only be
applied in one way, and which for its success entirely depends on
the strong contraction of muscles, the functions of which must be
too much interfered with, to exercise so great power after having
been for so long a time totally inactive.
The author gives a series of reasons why the adjuster should be
used to the exclusion of other means of extension and counter-
extension, which are ingenious and applicable to his invention,
though he certainly loses sight of the injury which may be done
to the axillary artery and veins by the powerful and long-continued
force which must be applied to old and obstinate cases, no matter
what apparatus is used for the purpose. He does not allude to
the dislocation of the humerus with the head of the bone beneath
the pectoralis muscle and below the clavicle, though we presume
that he considers the adjuster equally applicable to the reduction
of this as to the other varieties of luxation of the same bone.
The cases appended to the article on dislocation of the shoulder
in which the adjuster was successfully applied, are three of
similar injury, one of which was of four years’ standing, one of
thirty-nine days, with fracture of the upper part of the humerus, a
case of oblique fracture of the tibia and fibula, one of compound
luxation of the thumb, one of luxation of the metatarsus upon the
tarsus, one of luxation of the hip, and one of united fracture of the
femur with great deformity. In the latter case the bone was re-
fractured by the adjuster, “ and the limb dressed on the double
inclined plane in the manner directed in Jarvis’ Lectures, pp.
47, 48 and 49, for oblique fracture of the thigh,” and the recovery
took place “ with a limb in every respect as good as the other.”
These cases, if they do not prove too much, are more than enough
to establish the value of the instrument, which is so modified as
to be applied to the injuries of all the limbs and many joints of
the body.
The essay, as we have before stated, is well written, and for it
we are thankful to its author and compiler; but we would be
pleased to receive accounts of cases treated by the adjuster from
professional men uninterested in its manufacture and sale, so that
we may not by possibility regard it in the same light as Peter
Pindar’s razors, “ made to sell.”