on the articulations-第6部分

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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　unite；　and
in　gluing　them；　the　flesh　of　the　thong　should　be　turned　to　the
patient's　skin；　for　in　this　way　it　will　be　more　tenacious；　then　we
must　stretch　this　thong；　but　still　more　so　the　one　at　the　chin；　in
order　to　prevent　the　fragments　of　the　jaw　from　riding　over　each　other；
and　the　thongs　are　to　be　fastened　at　the　vertex；　and　then　a　bandage　is
to　be　bound　round　the　forehead；　and　a　proper　apparatus　is　to　be　put
over　all；　to　prevent　the　bandages　from　being　displaced。　The　patient
should　lie　upon　the　sound　side　of　the　jaw；　not　resting　upon　the　jaw；
but　upon　the　head。　He　is　to　be　kept　on　a　spare　diet　for　ten　days；
and　then　nourished　without　delay。　If　there　be　no　inflammation　during
the　first　days；　the　jaw　is　consolidated　in　twenty　days；　for　callus
quickly　forms　in　this；　as　in　all　the　other　porous　bones；　provided
there　be　no　sphacelus　（exfoliation？）。　But　much　remains　to　be　said　on
the　sphacelus　of　bones　in　another　place。　This　method　of　distention
with　glued　substances　is　mild；　of　easy　application；　and　is　useful
for　many　dislocations　in　many　parts　of　the　body。　Those　physicians
who　have　not　judgment　combined　with　their　dexterity；　expose　themselves
in　fractures　of　the　jaws；　as　in　other　cases；　for　they　apply　a
variety　of　bandages　to　a　fractured　jaw…bone；　sometimes　properly；　and
sometimes　improperly。　For　all　such　bandaging　of　a　fractured　jawbone
has　a　tendency　rather　to　derange　the　bones　connected　with　the
fracture；　than　to　bring　them　into　their　natural　position。

　　34。　But　if　the　lower　jaw　be　disjointed　at　its　symphysis　in　the
chin　（there　is　but　one　symphysis　in　the　lower　jaw；　but　there　are
several　in　the　upper；　but　I　am　unwilling　to　digress　from　the
subject；　as　these　matters　will　have　to　be　touched　upon　in　other
kinds　of　disease）…if；　then；　the　symphysis　be　separated　at　the　chin；　it
is　the　work　which　anybody　can　perform；　to　rectify　it；　for　the　part
which　protrudes　is　to　be　pushed　inward　by　pressure　with　the　fingers；
and　the　part　that　inclines　inward　is　to　forced　outward　by　pushing　with
the　fingers　from　within。　It　is　after　having　applied　extension　to
separate　the　fragments　that　this　is　to　be　done；　for　they　will　thus
be　more　easily　restored　to　their　natural　position；　than　if　one
should　bring　them　together　by　using　force。　This　is　proper　to　be
known　as　applying　to　all　such　cases。　When　you　have　set　the　parts；
you　must　fasten　the　teeth　on　both　sides　to　one　another；　as　formerly
directed。　The　treatment　is　to　be　accomplished　with　cerate；　a　few
compresses；　and　bandages。　This　part；　in　particular；　requires　a　short
but　complex　（？）　bandaging；　for　it　is　nearly　cylindrical；　though　not
exactly　so；　but　the　turn　of　the　bandage　is　to　be　made；　if　the　right
jaw　was　dislocated；　to　the　right　hand　（that　is　said　to　be　to　the　right
hand　when　the　right　hand　conducts　the　bandaging）；　but　if　the　other　jaw
be　the　seat　of　the　dislocation；　the　bandaging　is　to　be　made　in　the
other　direction。　And　if　matters　be　properly　adjusted；　and　the
patient　keep　quiet；　there　will　be　a　speedy　recovery；　and　the　teeth
will　be　uninjured；　but　if　not；　the　recovery　will　be　more　protracted；
the　teeth　will　be　distorted；　will　give　trouble；　and　become　useless。

　　35。　Of　fractures　of　the　nose　there　are　more　than　one　variety；　but
those　who；　without　judgment；　delight　in　fine　bandagings；　do　much
mischief；　most　especially　in　injuries　about　the　nose。　For　this　is
the　most　complex　of　all　the　forms　of　bandaging；　having　most　of　the
turns　of　the　bandage　called　〃ascia；〃　and　rhomboidal　intervals　and
uncovered　spaces　of　the　skin。　As　has　been　said；　those　who　practice
manipulation　without　judgment　are　fond　of　meeting　with　a　case　of
fractured　nose；　that　they　may　apply　the　bandage。　For　a　day　or　two；
then；　the　physician　glories　in　his　performance；　and　the　patient　who
has　been　bandaged　is　well　pleased；　but　speedily　the　patient
complains　of　the　incumbrance　of　the　bandage；　and　the　physician　is
satisfied；　because　he　has　had　an　opportunity　of　showing　his　skill　in
applying　a　complex　bandage　to　the　nose。　Such　a　bandaging　does
everything　the　very　reverse　of　what　is　proper；　for；　in　the　first
place；　those　who　have　their　nose　flattened　by　the　fracture；　will
clearly　have　the　part　rendered　still　more　flat；　if　pressure　above　be
applied　to　it；　and　further；　those　cases　in　which　the　nose　is　distorted
to　either　side；　whether　at　the　cartilage　or　higher　up；　will
evidently　derive　no　benefit　from　bandaging　above　it；　but　will　rather
be　injured；　for　it　will　not　admit　of　having　compresses　properly
arranged　on　either　side　of　the　nose；　and　indeed；　persons　applying　this
bandage　do　not　seek　to　do　this。

　　36。　This　bandaging　would　appear　to　me　to　answer　best　when　the　skin
surrounding　the　bone　is　contused　on　its　ridge　near　the　middle；　or　if
the　bone　itself　have　sustained　some　injury；　but　not　a　great　one；　in
such　cases；　redundant　callus　forms　in　the　nose；　and　the　part　becomes　a
little　too　prominent；　and　yet；　even　in　these　cases；　the　bandaging　need
not　require　much　trouble；　if；　indeed；　any　bandage　be　applied　at　all；
for　it　is　enough　if　one　lay　a　waxed　compress　on　the　contusion；　and
then　apply　the　double…headed　bandage；　thus　taking　one　turn　with　it。
The　best　application　to　such　accidents　is　a　small　cataplasm　of　wheaten
flour；　washed；　and　mixed　up　into　a　viscid　mass。　If　the　flour　be　made
from　good　wheat；　and　if　it　be　glutinous；　it　should　be　used　alone　for
all　such　cases；　but　if　it　be　not　very　glutinous；　a　little　of　the　manna
of　frankincense；　well　pulverized；　is　to　be　moistened　with　water；　and
the　flour　is　to　be　mixed　up　with　it；　or　a　very　little　gum　may　be　mixed
in　like　manner。

　　37。　In　those　cases　in　which　the　fractured　portions　are　depressed　and
flattened；　if　it　is　depressed　in　front　at　the　cartilage；　something　may
be　introduced　into　the　nostrils　to　rectify　the　parts。　If　not；　all　such
deformities　may　be　restored　by　introducing　the　fingers　into　the
nostrils；　if　this　can　be　managed；　but　if　not；　a　thick　spatula　is　to　be
introduced　with　the　fingers；　not　to　the　fore　part　of　the　nose；　but
to　the　depressed　portion；　and　the　physician　is　to　take　hold　of　the