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extension may be made in both directions。 The thing commonly
used is a
bench six cubits long； two cubits broad； one fathom in thickness；
having two low axles at this end and that； and having at its middle
two moderate sized pillars； to which is to be adjusted a transverse
piece of wood like the step of a ladder； which is to receive
the piece
of wood tied below the limb； as is done in dislocation at the
shoulder； and the bench is to have excavations like trays； smooth；
four inches in breadth and depth； and at such an interval as to
leave room for the lever used to reduce the limb。 In the
middle of the
bench a square hole is to be scooped out to receive a small pillar；
which； being adjusted to the perineum； will obviate the tendency of
the body to slip downward； and being rather loose may act somewhat
as a lever。 In certain occasions a piece of wood is
required； which is
inserted into a hole scooped out of the wall； the other end of it is
then to be pressed down； something moderately soft being placed
under it。
Part 39
In those cases where the bone of the palate has exfoliated；
the nose sinks in its middle。 In contusions of the head without a
wound； either from a fall； a fracture； or pressure； in certain of
these cases acrid humors descend from the head to the
throat； and from
the wound in the head to the liver and thigh。
Part 40
The symptoms of subluxations and luxations； and where； and
how； and how much these differ from one another。 And the cases in
which the articular cavity has been broke off； and in which the
ligament has been torn； and in which the epiphysis has broken in
which； and how； when the limb consists of two bones； one or both are
broken： in consequence of these the dangers； chances in
which bad； and
when the injuries will result in death； and when in recovery。 What
cases are to be reduced or attempted； and when； and which； and when
not； the hopes and dangers in these cases。 Which and when congenital
dislocations are to be undertaken： the parts in a state of
growth； the
parts fully grown； and why sooner； or slower： and why a part becomes
maimed； and how； and how not： and why a certain part is
atrophied； and
where； and how； and in what cases to a less extent。 And why
fractured parts unite sooner or slower； how distortions and
callosities form； and the remedy for them。 In what cases there are
external wounds； either at first or afterwards： in what fractures
the bones are shortened； and in what not： in what cases the
fractured bones protrude； and when they protrude most： in what cases
dislocated bones protrude。 That physicians are deceived； and by what
means； in what they see； and in what they devise； regarding
affections； and regarding cures。 Established rules with regard to
bandaging： preparation； presentation of the part； extension；
adjustment； friction； bandaging； suspension and placing of the limb；
attitude； seasons； diet。 The more porous parts heal fastest； and
vice versa。 Distortions； where the bones are crooked。 Flesh and
tendons wasted on the side of the dislocation。 The force used in
reduction to be applied at as great a distance as possible from the
seat of the displacement。 Of nerves （ligaments？）； those which are in
motion and in humidity （flabby？） are of a yielding nature； those
that are not； less so。 In every dislocation the most speedy
reduction is best。 Reduction not to be made while the patient is in
a febrile state； nor on the fourth or fifth day； and least of all；
in those of the elbow； and all cases which induce torpor； the
soonest the best； provided the inflammatory stage be avoided。 Parts
torn asunder； whether nerves； or cartilages； or epiphyses； or parts
separated at symphyses； cannot possibly be restored to their former
state； but callus is quickly formed in most cases； yet the use of
the limb is preserved。 Of luxations； those nearest the
extremities are
least dangerous。 Those joints which are most easily
dislocated are the
least subject to inflammation。 Those which have been least inflamed；
and have not been subjected to after…treatment； are most liable to
be dislocated anew。 Extension should be made in the position most
calculated to enable the one bone to clear the extremity of
the other；
attention being paid to configuration and place。 Adjustment
to be made
in the direction of the displacement； to push the displaced limb
straight backward and sideways。 Parts suddenly drawn aside are to be
suddenly drawn back by a rotatory motion。 Articulations which have
been oftenest dislocated are the most easily reduced； the
cause is the
conformation of the nerves （ligaments？） or of the bones； of the
ligaments that they are long and yielding； and of the bones； the
shallowness of the articular cavity； and roundness of the
head ＇of the
bone that enters it＇。 Usage； by its friction； forms a new socket。
The cause…the disposition； and habit； and age。 A part somewhat
mucous is not subject to inflammation。
Part 41
In those cases where there are wounds； either at first； or
from protrusion of the bones； or afterwards； from pruritus； or
irritation； in the latter case you are immediately to unloose the
bandages； and having applied pitched cerate to the wound； bandage
the limb； placing the head of the roller upon the wound； and
proceeding otherwise as if there were no wound in the case； for thus
will the swelling be reduced as much as possible； and the wound will
suppurate most quickly； and the diseased parts will
separate； and when
it becomes clean the wound will most quickly heal。 Splints are not
to be applied to the place； nor is it to be bound tight。 Proceed
thus when no large bones exfoliate； but not in the latter case； for
then there is great suppuration； and the same treatment is not
applicable； but the parts require to be exposed to the air on
account of the abscesses。 In such cases where the bones protrude；
and whether reduced or not； bandaging is not befitting； but
distention
is to be practiced by means of rolls of cloth； made like those used
upon shackles； one of these is to be placed at the ankle； and the
other at the knee； they are to be flattened toward the leg； soft；
strong； and having rings； and rods made of cornel； and of a proper
length and thickness are to be adjusted to them； so as to keep the
parts distended； and straps； attached to both extremities； are to be
inserted into the rings； so that the extremities being fixed into
the rolls； may effect distention。 Treatment：…Pitched cerate； in a
hot state； the attitudes； position of the foot and hip； regulated
diet。 The bones which have protruded through the skin are to be
replaced the same day； or next； not on the fourth or fifth； but when
the swelling has subsided。 Reduction is to be performed with levers；
when the bone does not present any place upon which the lever can
rest； a portion of the part which prevents this is to be sawed off。
But the denuded parts will drop off； and the limb become shortened。
Part 42
Dislocations at the joints are to a greater and less extent。
Those that are to a less extent are the most easily reduced； those
that are to a greater extent occasion lesions of the bones； of the
ligaments； of the joints； of the fleshy parts； and of the attitudes。
The thigh and arm resemble one another very much in their
dislocations。
THE END