instruments of reduction-第2章

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elbow；　either　inside　or　outside；　but　the　sharp　point　（olecranon？）
remains　in　the　cavity　of　the　humerus；　make　extension　in　a　straight
line；　and　push　the　projecting　parts　backward　and　to　the　sides。

　Part　8
In　complete　dislocations　to　either　side；　make　extension　while　the
arm　is　in　the　position　it　is　put　in　to　be　bandaged　for　a　
fracture；　for
thus　the　rounded　part　of　the　elbow　will　not　form　an　obstacle　to　it。
Dislocation　most　commonly　takes　place　inward。　The　parts　are　to　be
adjusted　by　separating　the　bones　as　much　as　possible；　so　that　the
end　of　the　humerus　may　not　come　in　contact　with　the　olecranon；　but
it　is　to　be　carried　up　and　turned　round；　and　not　forced　in　a
straight　line；　at　the　same　time　the　opposite　sides　are　to　be　pushed
together；　and　the　bones　reduced　to　their　place。　In　these　cases
rotation　of　the　elbow　cooperates；　that　is　to　say；　turning　
the　arm　into
a　state　of　supination　and　pronation；　so　much　for　the　reduction。　With
regard　to　the　attitude　in　which　it　is　to　be　put；…the　hand　is　to　be
placed　somewhat　higher　than　the　elbow；　and　the　arm　by　the　side；　this
position　suits　with　it　when　slung　from　the　neck；　is　easily　borne；　is
its　natural　position；　and　one　adapted　for　ordinary　purposes；　unless
callus　form　improperly：　the　callus　soon　forms。　Treatment：…By
bandages　according　to　the　common　rule　for　articulations；　and　
the　point
of　the　elbow　is　to　be　included　in　the　bandage。

　Part　9
The　elbow；　when　luxated；　induces　the　most　serious　consequences；
fevers；　pain；　nausea；　vomiting　of　pure　bile；　and　this　especially　in
dislocations　backward；　from　pressure　on　the　nerve　which　occasions
numbness；　next　to　it　is　dislocation　forward。　The　treatment　is　the
same。　The　reduction　of　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。　In　it
a　hard　ball　is　to　be　placed　in　the　bend　of　the　elbow；　and　
the　fore…arm
is　to　be　bent　over　this　while　sudden　extension　is　made。

　Part　10
Diastasis　of　the　bones　may　be　recognized　by　examining　the　part
where　the　vein　which　runs　along　the　arm　divides。

　Part　11
In　these　cases　callus　is　speedily　formed。　In　congenital
dislocations；　the　bones　below　the　seat　of　the　injury　are　shorter
than　natural；　in　this　case；　the　greatest　shortening　is　in　
the　nearest；
namely；　those　of　the　fore…arm；　second；　those　of　the　hand；　
third；　those
of　the　fingers。　The　arm　and　shoulders　are　stronger；　owing　to　the
nourishment　which　they　receive；　and　the　other　arm；　from　the　
additional
work　it　has　to　perform；　is　still　more　strong。　The　wasting　of　the
flesh；　if　the　dislocation　was　outward；　is　on　the　inside；　or　if
otherwise；　on　the　side　opposite　the　dislocation。

　Part　12
In　dislocation　at　the　elbow；　whether　outward　or　inward；
extension　is　to　be　made　with　the　fore…arm　at　right　angles　to　the
arm；　the　arm　is　to　be　suspended　by　a　shawl　passed　through　the
armpit；　and　a　weight　is　to　be　attached　to　the　extremity　of　the
elbow；　or　force　is　to　be　applied　with　the　hands。　The　articular
extremity　being　properly　raised；　the　parts　are　to　be　
adjusted　with　the
palms　of　the　hands；　as　in　dislocations　of　the　hands。　It　is　to　be
bandaged；　suspended　in　a　sling；　and　placed；　while　in　this　attitude。

　Part　13
Dislocations　backward　are　to　be　rectified　with　the　palms　of
the　hands　along　with　sudden　extension。　These　two　acts　are　to　be
performed　together；　as　in　other　cases　of　the　kind。　In　dislocation
forward；　the　arm　is　to　bend　around　a　ball　of　cloth；　of　proper　size；
and　at　the　same　time　replaced。

　Part　14
If　the　displacement　be　on　the　other　side　both　these　operations
are　to　be　performed　in　effecting　the　adjustment　of　the　arm。　With
regard　to　the　treatment；…the　position　and　the　bandaging　are　the　same
as　in　the　other　cases。　For　all　these　cases　may　be　reduced　by
ordinary　distention。

　Part　15
With　regard　to　the　modes　of　reduction；　some　act　upon　the
principle　of　carrying　the　one　piece　of　bone　over　the　other；　some　by
extension；　and　some　by　rotation：　these　last　consist　in　
rapidly　turning
the　arm　to　this　side　and　that。

　Part　16
The　joint　of　the　hand　is　dislocated　inward　or　outward；　but
most　frequently　inward。　The　symptoms　are　easily　recognized；　
if　inward；
the　patient　cannot　at　all　bend　his　fingers；　but　if　outward；　he
cannot　extend　them。　Reduction：…By　placing　the　fingers　above　a　table；
extension　and　counter…extension　are　to　be　made　by　assistance；　while；
with　the　palm　of　the　hand　or　the　heel　on　the　projecting　bone；　one
presses　forward；　and　from　behind；　upon　the　other　bone；　and　lays　some
soft　substance　on　it；　and；　if　the　dislocation　be　above；　the　
hand　is　to
be　turned　into　a　state　of　pronation；　or；　if　backward；　into　a　state
of　supination。　The　treatment　is　to　be　conducted　with　bandages。

　Part　17
The　whole　hand　is　dislocated　either　inward；　or　outward；　but
especially　inward；　or　to　this　side　or　that。　Sometimes　the　
epiphysis　is
displaced；　and　sometimes　there　is　displacement　（diastasis）　of　the
one　bone　from　the　other。　Powerful　extension　is　to　be　made　in　this
case；　and　the　projecting　part　is　to　be　pressed　upon；　and
counter…pressure　made　on　the　opposite　side：　both　modes　being　
performed
at　the　same　time；　both　backward　and　laterally；　either　with　the　hands
on　a　table；　or　with　the　heel。　These　accidents　give　rise　to　serious
consequences　and　deformities；　but　in　time　the　parts　get　so　strong　as
to　admit　of　being　used。　The　treatment　consists　of　bandages
comprehending　the　hand　and　forearm；　and　splints　are　to　be　applied　as
far　as　the　fingers；　when　put　in　splints；　they　are　to　be　more
frequently　loosed　than　in　fractures；　and　more　copious　allusions　of
water　are　to　be　used。

　Part　18
In　congenital　dislocations　the　hand　becomes　shortened；　and　the
atrophy　of　the　flesh　is　generally　on　the　side　opposite　the
dislocation。　In　the　adult　the　bones　remain　of　their　proper　size。

　Part　19
The　symptoms　of　dislocation　of　the　finger　are　obvious；　and　need
not　be　described。　This　is　the　mode　of　reduction：…By　stretching　in　a
straight　line；　and　making　pressure　on　the　projecting　part；　and
counter…pressure；　at　the　opposite　side；　on　the　other。　The　proper
treatment　consists　in　the　application　of　bandages。　When　not　reduced；
the　parts　unite　by　callus　outside　of　the　joints。　In　congenital
dislocations；　and　in　those　which　occur　during　bones　below　the
dislocation　are　shortened；　and　the　flesh　is　wasted　principally　on
the　side　opposite　to　the　dislocation；　in　the　adult　the　bones　
remain　of
their　proper　size。

　Part　20
Dislocation　at　the　hip…joint　occurs　in　four　modes；　inward　most
frequently；　outward　next；　the　others　of　equal　frequency。　The
symptoms：…The　common；　a　comparison　with　the　sound　leg。　The　peculiar
symptoms　of　dislocations　inward；　the　head　of　the　bone　is　felt　at　the
perineum；　the　patient　cannot　bend　his　leg　as　formerly；　the　limb
appears　elongated；　and　to　a　great　extent；　unless　you　bring　both
limbs　into　the　middle　space　between　them　in　making　a　comparison　of
them；　and　the　foot　and　the　knee　are　inclined　outward。　If　the
dislocation　has　taken　place　from　birth；　or　during　one's　growth；　the
thigh　is　shortened；　the　leg　less　so；　and　the　others　according　to　the
same　rule；　the　fleshy　parts　are　atrophied；　especially　on　the
outside。　Such　persons　are　afraid　to　stand　erect；　and　crawl　along　on
the　sound　limb；　or；　if　compelled；　they　walk　with　one　or　two　staves；
and　bear　up　the　affected　limb；　and　the　smaller　the　limb　so　much　the
more　do　they　walk。　If　the　accident　happens　to　adults　the　bones
remain　of　their　proper　size；　but　the　flesh　is　wasted；　as　formerly
described；　the　patients　walk　in　a　wriggling　manner；　like　oxen；　they
are　bent　toward　the　flank；　and　the　buttock　on　the　uninjured　side　is
prominent；　for　the　uninjured　limb　must　necessarily　come　below　that
it　may　support　the　body；　whilst　the　other　must　be　carried　out　of　the
way；　as　it　cannot　support　the　body；　like　those　who　have　an　ulcer　in
the　foot。　They　poise　the　body　by　means　of　a　staff　on　the　sound　side；
and　grasp　the　affected　limb　with　the　hand　above　the　knee　so　as　to
carry　the　body　in　shifting　from　one　place　to　another。　If　the　parts
below　the　hip…joint　be　used；　the　bones　below　are　less　atrophied；　but
the　flesh　more。

　Part　21
The　symptoms　and　attitudes　in　dislocation　outward　are　the
opposite；　and　the　knee　and　foot　incline　a　little　inward。　When　it　is
congenital；　or　occurs　during　adolescence；　the　bones　do　not　grow
properly；　according　to　the　same　rule；　the　bone　of　the　hip…joint　is
somewhat　higher　than　natural；　and　does　not　grow　proportionally。　In
those　who　have　frequent　dislocations　outward；　without　inflammation；
the　limb　is　of　a　more　humid　（flabby？）　temperament　than　natural；　like
the　thumb；　for　it　is　the　part　most　frequently　dislocated；　
owing　to　its
configuration；　in　what　persons　the　dislocation　is　to　a　
greater　or　less
extent；　and　in　what　persons　it　is　more　difficultly　or　easily　
produced；
in　what　there　is　reason　to　hope　that　it　can　be　speedily　reduced；　and
in　what　not；　and　the　remedy　for　this；　and　in　what　cases　the
dislocation　frequently　happens；　and　treatment　of　this。　In
dislocation　outward　from　birth；　or　during　adolescence；　or　from
disease；　（and　it　happens　most　frequently　from　disease；　in　which　case
there　is　sometimes　exfoliation　of　the　bone；　but　even　where　
there　is　no
exfoliation）；　the　patients　experience　the　same　symptoms；　but　to　an
inferior　degree　to　those　in　dislocations　inward；　if　properly　managed
so　that　in　walking　they　can　put　the　whole　foot　to　the　ground　and
lean　to　either　side。　The　younger　the　patient　is；　the　greater　care
should　be　bestowed　on　him；　when　neglected；　the　case　gets　worse；　when
attended　to；　it　improves；　and；　although　there　be　atrophy　in　all
parts　of　the　limb；　it　is　to　a　less　extent。

　Part　22
When　there　is　a　dislocation　on　both　sides；　the　affections　of　the
bones　are　the　same；　the　flesh　is　well　developed；　except　within；　the
nates　protrude；　the　thighs　are　arched；　unless　there　be　sphacelus。　If
there　be　curvature　of　the　spine　above　the　hip…joint；　the　patients
enjoy　good　health；　but　the　body　does　not　grow；　with　the　exception　of
the　head。

　Part　23
The　symptoms　of　dislocation　backward　are：…The　parts　before
more　empty；　behind　they　protrude；　the　foot　straight；　flexion
impossible；　except　with　pain；　extension　least　of　all：　in　these　the
limb　is　shortened。　They　can　neither　extend　the　limb　at　the　
ham；　nor　at
the　groin；　unless　it　be　much　raised；　nor　can　they　bend　it。　The
uppermost　joint；　in　most　cases；　takes　the　lead：　this　is　common　in
joints；　nerves；　muscles；　intestines；　uteri；　and　other　parts。　
There　the
bone　of　the　hip…joint　is　carried　backward　to　the　nates；　and　on　that
account　it　is　shortened；　and　because　the　patient　cannot　
extend　it。　The
flesh　of　the　whole　leg　is　wasted　in　all　cases；　in　which　most；　and　to
what　extent；　has　been　already　stated。　Every　part　of　the　body　which
performs　its　functional　work　is　strong；　but；　not　withstanding；　if
inactive；　it　gets　into　a　bad　condition；　unless　its　inactivity　arise
from　fatigue；　fever；　or　inflammation。　And　in　dislocations　
outward；　the
limb　is　shortened；　because　the　bone　is　lodged　in　flesh　which　yields；
but；　not　withstanding；　in　dislocations　inward；　it　is　longer；　because
the　bone　is　lodged　on　a　projecting　bone。　Adult