dislocations。 In adults； the bones are not so diminished in size；
and justly； seeing that the others will not increase as in the
former case； but wasting of the flesh takes place； for it is
increased； and is diminished every day； and at all ages。 And
attention
should be paid to the force of habit； and to the symptom produced by
the tearing away of the acromion； whereby a void is left； which
makes people suppose that the humerus is dislocated。 The head of the
humerus is felt in the armpit； and the patient cannot raise his arm；
nor swing it to this side and that； as formerly。 The other shoulder
shows the difference。 Modes of reduction：…The patient himself having
placed his fist in the arm pit； pushes up the head of the
humerus with
it； and brings the hand forward to the breast。 Another：…Force it
backward； so that you may turn it round。 Another：…Apply your head to
the acromion； and your hands to the armpit； separate the head of the
humerus （from the side？）； and push the elbow in the opposite
direction； or； instead of your knees； another person may turn aside
the elbow； as formerly directed。 Or； place the patient on your
shoulder； with the shoulder in his armpit。 Or； with the heel；
something being introduced to fill up the hollow of the armpit； and
using the right foot to the right shoulder。 Or； with a pestle。 Or；
with the step of a ladder。 Or； by rotation made with piece of wood
stretched below the arm。 Treatment：…As to attitude； the arm placed
by the side； the hand and shoulder raised； the bandaging and
adjustment of the parts while in this attitude。 If not reduced； the
top of the shoulder becomes attenuated。
Part 6
When the acromion is torn away； the appearance is the same as
in dislocation of the shoulder； but there is no impediment； except
that the bone does not return to its position。 The figure should be
the same as in dislocation； both as regards bandaging and suspending
the limb。 The bandaging according to rule。
Part 7
When partial displacement （sub…luxation？） takes place at the
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