on the articulations-第6章

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separated。　In　these　cases　strong　extension　is　to　be　applied；　and
pressure　is　to　be　made　on　the　projecting　bone；　and　counter…pressure　on
the　opposite　side；　both　at　the　same　time；　behind　and　at　the　side；　with
the　hands　upon　a　table；　or　with　the　heel。　These　accidents　give　rise　to
serious　consequences　and　deformities；　but　in　the　course　of　time　the
part　gets　strong；　and　admits　of　being　used。　The　cure　is　with　bandages；
which　ought　to　embrace　both　the　hand　and　fore…arm；　and　splints　are
to　be　applied　as　far　as　the　fingers；　and　when　they　are　used　they
should　be　more　frequently　unloosed　than　infractures；　and　more
copious　affusions　of　water　should　be　used。

　　28。　In　congenital　dislocations　（at　the　wrist）　the　hand　becomes
shortened；　and　the　atrophy　of　the　flesh　occurs；　for　the　most　part；
on　the　side　opposite　to　the　dislocation。　In　an　adult　the　bones
remain　of　their　natural　size。

　　29。　Dislocation　at　the　joint　of　a　finger　is　easily　recognized。
Reduction　is　to　be　effected　by　making　extension　in　a　straight　line；
and　applying　pressure　on　the　projecting　bone；　and　counter…pressure
on　the　opposite　side　of　the　other。　The　treatment　is　with　bandages。
When　not　reduced；　callus　is　formed　outside　of　the　joint。　When　the
dislocation　takes　place　at　birth；　during　adolescence　the　bones　below
the　dislocation　are　shortened；　and　the　flesh　is　wasted　rather　on　the
opposite　than　on　the　same　side　with　the　dislocation。　When　it　occurs　in
an　adult　the　bones　remain　of　their　proper　size。

　　30。　The　jaw…bone；　in　few　cases；　is　completely　dislocated；　for　the
zygomatic　process　formed　from　the　upper　jaw…bone　（malar？）　and　the　bone
behind　the　ear　（temporal？）　shuts　up　the　heads　of　the　under　jaw；
being　above　the　one　（condyloid　process？）；　and　below　the　other
（coronoid　process？）。　Of　these　extremities　of　the　lower　jaw；　the　one；
from　its　length；　is　not　much　exposed　to　accidents；　while　the　other；
the　coronoid；　is　more　prominent　than　the　zygoma；　and　from　both　these
heads　nervous　tendons　arise；　with　which　the　muscles　called　temporal
and　masseter　are　connected；　they　have　got　these　names　from　their
actions　and　connections；　for　in　eating；　speaking；　and　the　other
functional　uses　of　the　mouth；　the　upper　jaw　is　at　rest；　as　being
connected　with　the　head　by　synarthrosis；　and　not　by　diarthrosis
（enarthrosis？）：　but　the　lower　jaw　has　motion；　for　it　is　connected　with
the　upper　jaw　and　the　head　by　enarthrosis。　Wherefore；　in　convulsions
and　tetanus；　the　first　symptom　manifested　is　rigidity　of　the　lower
jaw；　and　the　reason　why　wounds　in　the　temporal　region　are　fatal　and
induce　coma；　will　be　stated　in　another　place。　These　are　the　reasons
why　complete　dislocation　does　not　readily　take　place；　and　this　is
another　reason；　because　there　is　seldom　a　necessity　for　swallowing
so　large　pieces　of　food　as　would　make　a　man　gape　more　than　he　easily
can；　and　dislocation　could　not　take　place　in　any　other　position　than
in　great　gaping；　by　which　the　jaw　is　displaced　to　either　side。　This
circumstance；　however；　contributes　to　dislocation　there；　of　nerves
（ligaments？）　and　muscles　around　joints；　or　connected　with　joints；　such
as　are　frequently　moved　in　using　the　member　are　the　most　yielding　to
extension；　in　the　same　manner　as　well…dressed　hides　yield　the　most。
With　regard；　then；　to　the　matter　on　hand；　the　jaw…bone　is　rarely
dislocated；　but　is　frequently　slackened　（partially　displaced？）　in
gaping；　in　the　same　manner　as　many　other　derangements　of　muscles　and
tendons　arise。　Dislocation　is　particularly　recognized　by　these
symptoms：　the　lower　jaw　protrudes　forward；　there　is　displacement　to
the　opposite　side；　the　coronoid　process　appears　more　prominent　than
natural　on　the　upper　jaw；　and　the　patient　cannot　shut　his　lower　jaw
but　with　difficulty。　The　mode　of　reduction　which　will　apply　in　such
cases　is　obvious：　one　person　must　secure　the　patient's　head；　and
another；　taking　hold　of　the　lower　jaw　with　his　fingers　within　and
without　at　the　chin；　while　the　patient　gapes　as　much　as　he　can；
first　moves　the　lower　jaw　about　for　a　time；　pushing　it　to　this　side
and　that　with　the　hand；　and　directing　the　patient　himself　to　relax　the
jaw；　to　move　it　about；　and　yield　as　much　as　possible；　then　all　of　a
sudden　the　operator　must　open　the　mouth；　while　he　attends　at　the
same　time　to　three　positions：　for　the　lower　jaw　is　to　be　moved　from
the　place　to　which　it　is　dislocated　to　its　natural　position；　it　is
to　be　pushed　backward；　and　along　with　these　the　jaws　are　to　be　brought
together　and　kept　shut。　This　is　the　method　of　reduction；　and　it　cannot
be　performed　in　any　other　way。　A　short　treatment　suffices；　a　waxed
compress　is　to　be　laid　on；　and　bound　with　a　loose　bandage。　It　is　safer
to　operate　with　the　patient　laid　on　his　back；　and　his　head　supported
on　a　leather　cushion　well　filled；　so　that　it　may　yield　as　little　as
possible；　but　some　person　must　hold　the　patient's　head。

　　31。　When　the　jaw　is　dislocated　on　both　sides；　the　treatment　is　the
same。　The　patients　are　less　able　to　shut　the　mouth　than　in　the
former　variety；　and　the　jaw　protrudes　farther　in　this　case；　but　is　not
distorted；　the　absence　of　distortion　may　be　recognized　by　comparing
the　corresponding　rows　of　the　teeth　in　the　upper　and　lower　jaws。　In
such　cases　reduction　should　be　performed　as　quickly　as　possible；　the
method　of　reduction　has　been　described　above。　If　not　reduced；　the
patient's　life　will　be　in　danger　from　continual　fevers；　coma
attended　with　stupor　（for　these　muscles；　when　disordered　and　stretched
preternaturally；　induce　coma）；　and　there　is　usually　diarrhea
attended　with　billous；　unmixed；　and　scanty　dejections；　and　the
vomitings；　if　any；　consist　of　pure　bile；　and　the　patients　commonly　die
on　the　tenth　day。

　　32。　In　fracture　of　the　lower　jaw；　when　the　bone　is　not　fairly　broken
across；　and　is　still　partially　retained；　but　displaced；　it　should　be
adjusted　by　introducing　the　fingers　at　the　side　of　the　tongue；　and
making　suitable　counter…pressure　on　the　outside；　and　if　the　teeth　at
the　wound　be　distorted　and　loosened；　when　the　bone　is　adjusted；　they
should　be　connected　together；　not　only　two；　but　more　of　them；　with　a
gold　thread；　if　possible；　but　otherwise；　with　a　linen　thread；　until
the　bone　be　consolidated；　and　then　the　part　is　to　be　dressed　with
cerate；　a　few　compresses；　and　a　few　bandages；　which　should　not　be　very
tight；　but　rather　loose。　For　it　should　be　well　known　that　in
fracture　of　the　jaw；　dressing　with　bandages；　if　properly　performed；　is
of　little　advantage；　but　occasions　great　mischief　if　improperly
done。　Frequent　examinations　should　be　made　about　the　tongue；　and
prolonged　pressure　should　be　applied　with　the　fingers；　in　order　to
rectify　the　displaced　bone。　It　would　be　best　if　one　could　do　so
constantly；　but　that　is　impossible。

　　33。　But　if　the　bone　be　fairly　broken　across　（this；　however；　rarely
happens）；　it　is　to　be　set　in　the　manner　now　described。　When
adjusted；　the　teeth　are　to　be　fastened　together　as　formerly　described；
for　this　will　contribute　much　toward　keeping　the　parts　at　rest；
especially　if　properly　fastened；　and　the　ends　of　the　thread　secured
with　knots。　But　it　is　not　easy　to　describe　exactly　in　writing　the
whole　manipulation　of　the　case；　but　the　reader　must　figure　the　thing
to　himself　from　the　description　given。　Then　one　must　take　a　piece　of
Carthaginian　leather；　if　the　patient　be　a　younger　person；　it　will　be
sufficient　to　use　the　outer　skin；　but　if　an　adult　the　whole
thickness　of　the　hide　will　be　required；　it　is　to　be　cut　to　the　breadth
of　about　three　inches；　or　as　much　as　will　be　required；　and　having
smeared　the　jaw　with　a　little　gum　（for　thus　it　sticks　more
pleasantly）；　the　end　of　the　skin　is　to　be　fastened　with　the　glue
near　the　fractured　part　of　the　jaw；　at　the　distance　of　an　inch　or　a
little　more；　from　the　wound。　This　piece　is　to　be　applied　below　the
jaw；　but　the　thong　should　have　a　cut　in　it；　in　the　direction　of　the
chin；　so　that　it　may　go　over　the　sharp　point　of　the　chin。　Another
piece　of　thong　like　this；　or　somewhat　broader；　is　to　be　glued　to　the
upper　part　of　the　jaw；　at　about　the　same　distance　from　the　wound　as
the　other　thong；　this　thong　should　be　so　cut　as　to　encircle　the　ear。
The　thongs　should　be　sharp…pointed　at　the　part　where　they