on the articulations-第5章

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part；　and　that　which　has　been　displaced　from　its　natural　position。
It　is　obvious；　therefore；　that　there　is　no　other　way　of　applying　force
to　it　（for　the　bandages　no　more　force　it　to　than　they　force　it
from）；　but　if　one　will　push　the　arm　when　at　the　sides　as　much　as
possible　upward；　so　that　the　shoulder　may　appear　as　sharp　as　possible；
it　is　clear　that　in　this　way　it　will　be　adjusted　to　the　fragment　of
the　bone　connected　with　the　breast　from　which　it　was　torn。　If　one　then
will　apply　a　bandage；　secundum　artem；　for　the　purpose　of　promoting　a
speedy　cure；　and　will　reckon　everything　else　of　no　value；　except　the
position　as　described；　he　will　form　a　correct　opinion　of　the　case；　and
will　effect　a　cure　in　the　speediest　and　most　appropriate　manner。　It　is
of　great　importance；　however；　that　the　patient　should　lie　in　a
recumbent　posture。　Fourteen　days　will　be　sufficient　if　he　keep
quiet；　and　twenty　at　most。

　　15。　But　if　the　clavicle　be　fractured　in　the　opposite　manner　（which
does　not　readily　happen）；　so　that　the　fragment　of　bone　connected
with　the　breast　is　depressed；　while　the　piece　connected　with　the
acromion　is　raised　up　and　rides　over　other；　this　case　does　not　require
much　management；　for　if　the　shoulder　and　arm　be　let　go；　the
fragments　of　the　bone　will　be　adjusted　to　one　another；　and　an　ordinary
bandage　will　suffice；　and　the　callus　will　be　formed　in　the　course　of　a
few　days。

　　16。　If　the　fracture　be　not　thus；　but　if　it　incline　either　forward　or
backward；　it　may　be　restored　to　its　natural　position；　by　raising　the
shoulder　with　the　arm　as　formerly　described；　and　brought　back　to　its
natural　place；　when　the　cure　will　be　speedily　accomplished。　Most　of
the　varieties　of　displacement　may　be　rectified　by　raising　the　arm
upward。　When　the　upper　bone　is　displaced　laterally　or　downward；　it
would　favor　the　adaptation　of　the　parts　if　the　patient　would　lie　on
his　back；　and　if　some　elevated　substance　were　placed　between　the
shoulder…blades；　so　that　the　breast　may　be　depressed　as　much　as
possible　upon　the　two　sides；　and　if；　while　another　person　raised　the
arm　extended　along　the　sides；　the　physician；　applying　the　palm　of
the　one　hand　to　the　head　of　the　bone；　would　push　it　away；　and　with　the
other　would　adjust　the　broken　bones；　he　would　thus　reduce　the　parts
most　readily　to　their　natural　position。　But；　as　formerly　stated；　the
upper　bone　（sternal　fragment？）　is　rarely　depressed　downward。　In　most
cases；　after　the　bandages　have　been　applied；　that　position　is
beneficial　in　which　the　elbow　is　fixed　to　the　same　side；　and　the
shoulder　is　kept　elevated；　but　in　certain　cases；　the　shoulder　is　to　be
raised；　as　has　been　directed；　and　the　elbow　is　to　be　brought　forward
to　the　breast；　and　the　hand　laid　on　the　acromion　of　the　sound　side。　If
the　patient　has　the　resolution　to　lie　in　bed；　something　should　be
placed　so　as　to　support　the　shoulder；　and　keep　it　as　much　elevated
as　possible。　But　if　he　walk　about；　the　arm　should　be　slung　in　a　shawl；
which　embraces　the　point　of　the　elbow；　and　is　passed　round　the　neck。

　　17。　When　the　elbow…joint　is　displaced　or　dislocated　to　the　side　or
outward；　while　its　sharp　point　（olecranon？）　remains　in　the　cavity　of
the　humerus；　extension　is　to　be　made　in　a　straight　line；　and　the
projecting　part　is　to　be　pushed　backward　and　to　the　side。

　　18。　In　complete　dislocations　toward　either　side；　extension　is　to
be　made　as　in　bandaging　fracture　of　the　arm；　for　thus　the　rounded　part
of　the　elbow　will　not　form　an　obstacle　to　it。　Dislocation；　for　the
most　part；　takes　place　toward　the　sides　（inwardly？）。　Reduction　is　to
be　effected　by　separating　（the　bones）　as　much　as　possible；　so　that　the
end　（of　the　humerus）　may　not　come　in　contact　with　the　olecranon；　and
it　is　to　be　carried　up；　and　turned　round；　and　not　forced　in　a　straight
line；　and；　at　the　same　time；　the　opposite　sides　are　to　be　pushed
together；　and　propelled　into　their　proper　place。　It　will　further
assist　if　rotation　of　the　fore…arm　be　made　at　the　elbow；　sometimes
turning　it　into　a　supine　position；　and　sometimes　into　a　prone。　The
position　for　the　treatment　consists　in　keeping　the　hand　a　little
higher　than　the　elbow；　and　the　arm　at　the　sides；　then　it　may　either　be
suspended　or　laid　at　rest；　for　either　position　will　answer；　and　nature
and　the　usage　of　common　means　will　accomplish　the　cure；　if　the
callus　does　not　form　improperly：　it　is　formed　quickly。　The　treatment
is　to　be　conducted　with　bandages　according　to　the　rule　for　bandaging
articulations；　and　the　point　of　the　elbow　is　to　be　included　in　the
bandage。

　　19。　Dislocations　at　the　elbow　give　rise　to　the　most　serious
consequences；　such　as　fevers；　pain；　nausea；　vomitings　of　pure　bile；
and　more　especially　when　the　humerus　is　displaced　backward　from
pressure　on　the　nerve；　which　occasions　numbness；　next　to　it　is　the
dislocation　forward；　the　treatment　is　the　same；　reduction　in
dislocation　backward　is　by　extension　and　adaptation；　the　symptom　of
this　variety…loss　of　the　power　of　extension；　of　dislocation
forward…loss　of　the　power　of　flexion；　and　in　this　case　reduction　is　to
be　accomplished　by　placing　a　hard　ball　（in　the　bend　of　the　elbow）；　and
bending　the　fore…arm　about　it；　along　with　sudden　extension。

　　20。　Diastasis　of　the　bones　may　be　recognized　by　examining　the　part
where　the　vein　that　runs　along　the　arm　divides。

　　21。　In　those　cases　callus　is　quickly　formed。　In　congenital
dislocations　the　bones　below　the　seat　of　the　injury　are　shorter　than
natural；　and；　mostly；　those　nearest　to　the　place；　namely；　the　bones　of
the　fore…arm；　next　those　of　the　hand；　and；　third；　those　of　the
fingers。　The　arm　and　shoulder　are　stronger；　owing　to　the　nourishment
which　they　receive；　and　the　other　arm；　from　the　additional　work
which　it　has　to　perform；　is　still　more　strong。　Wasting　of　the　flesh
takes　place　on　the　inside　if　the　dislocation　be　on　the　outside；　or
otherwise；　on　the　side　opposite　the　dislocation。

　　22。　When　the　elbow　is　dislocated　either　inward　or　outward；　extension
is　to　be　made　with　the　fore…arm　at　a　right　angle　to　the　arm；　the
arm；　suspended　by　means　of　a　shawl　passed　through　the　armpit；　and　a
weight　attached　to　the　extremity　of　the　elbow；　or　force　may　be　applied
with　the　hands；　when　the　articular　extremity　has　been　cleared；　the
displaced　parts　are　to　be　rectified　with　the　palms　of　the　hand；　as
in　dislocations　of　the　hands。　It　is　to　be　bandaged；　suspended　in　a
sling；　and　placed　while　in　this　attitude。

　　23。　Dislocations　backward　are　to　be　rectified　by　the　palms　of　the
hands；　along　with　sudden　extension；　the　two　acts　are　to　be　performed
together；　as　in　other　cases　of　the　kind。　But　in　dislocation　forward
the　arm　is　to　be　bent　around　a　ball　of　cloth　of　proper　size；　and　at
the　same　time　replaced。

　　24。　But　if　the　displacement　be　on　the　other　side；　both　these
operations　are　to　be　performed　in　effecting　the　adjustment。　For
conducting　the　treatment；　the　position　and　bandaging　are　the　same　as
in　the　other　cases。　But　all　these　cases　may　be　reduced　by　ordinary
distention。

　　25。　Of　the　methods　of　reduction；　some　operate　by　raising　up　the
part；　some　by　extension；　and　some　by　rotation：　the　last　consists　in
rapidly　turning　the　fore…arm　to　this　side　and　that。

　　26。　The　joint　of　the　hand　is　dislocated　either　inward　or　outward；
most　frequently　inward。　The　symptoms　are　easily　recognized：　if　inward；
the　patient　cannot　at　all　bend　his　fingers；　and　if　outward；　he
cannot　extend　them。　With　regard　to　the　reduction；…by　placing　the
fingers　above　a　table；　extension　and　counter…extension　are　to　be
made　by　other　persons；　while　with　the　palm　or　heel　of　the　hand　on
the　projecting　bone　one　pushes　forward；　and　another　from　behind　on　the
other　bone；　some　soft　substance　is　to　be　applied　to　it；　and　the　arm　is
to　be　turned　to　the　prone　position　if　the　dislocation　was　forward；　but
to　the　supine；　if　backward。　The　treatment　is　to　be　conducted　with
bandages。

　　27。　The　whole　hand　is　dislocated　either　inward　or　outward；　or　to
this　side　or　that；　but　more　especially　inward；　and　sometimes　the
epiphysis　is　displaced；　and　sometimes　the　other　of　these　bones　is
separated。　In　these　cases　strong　extension　is　to　be　applied；　and
pressure　is　to　be　made　on　the　projecting　bone；　an