on the articulations-第5部分

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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；　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　a