第1章

byHippocratestranslatedbyFrancisAdamsPart1

Withregardtotheconstructionofbones，thebonesandjointsofthefingersaresimple，thebonesofthehandandfootarenumerous，andarticulatedinvariousways；theuppermostarethelargest；theheelconsistsofonebonewhichisseentoprojectoutward，andthebacktendonsareattachedtoit。Thelegconsistsoftwobones，unitedtogetheraboveandbelow，butslightlyseparatedinthemiddle；theexternalbone（fibula），whereitcomesintoproximitywiththelittletoe，isbutslightlysmallerthantheother，moresowheretheyareseparated，andattheknee，theouterhamstringarisesfromit；

theseboneshaveacommonepiphysisbelow，withwhichthefootismoved，andanotherepiphysisabove，*inwhichismovedthearticularextremityofthefemur，whichissimpleandlightinproportiontoitslength，intheformofacondyle，andhavingthepatella（connectedwithit？），thefemuritselfbendsoutwardandforward；itsheadisaroundepiphysiswhichgivesorigintoligamentinsertedintheacetabulumofthehip—joint。Thisboneisarticulatedsomewhatobliquely，butlesssothanthehumerus。Theischiumisunitedtothegreatvertebracontiguoustotheossacrumbyacartilaginousligament。Thespine，fromtheossacrumtothegreatvertebra，iscurvedbackward；inthisquarteraresituatedthebladder，theorgansofgeneration，andtheinclinedportionoftherectum；fromthistothediaphragmitproceedsinastraightlineincliningforward，andthepsoaearesituatedthere；fromthispoint，tothegreatvertebraabovethetopsoftheshoulders，itrisesinalinethatiscurvedbackward，andthecurvatureappearsgreaterthanitisinreality，fortheposteriorprocessesofthespinearetherehighest；thearticulationoftheneckinclinesforward。Thevertebraeontheinsideareregularlyplacedupononeanother，butbehindtheyareconnectedbyacartilaginousligament；theyarearticulatedintheformofsynarthrosisatthebackpartofthespinalmarrow；behindtheyhaveasharpprocesshavingacartilaginousepiphysis，whenceproceedstherootsofnervesrunningdownward，asalsomusclesextendingfromthenecktotheloins，andfillingthespacebetweentheribsandthespine。Theribsareconnectedtoalltheintervertebralspacesontheinside，fromthenecktothelumbarregion，byasmallligament，andbeforetothesternum，theirextremitiesbeingspongyandsoft；theirformisthemostarchedinmanofallanimals；forinthispart，manis，ofallanimals，thenarrowestinproportiontohisbulk。Theribsareunitedtoeachvertebrabyasmallligamentattheplacefromwhichtheshortandbroadlateralprocesses（transverseprocesses？）arise。Thesternumisonecontinuousbone，havinglateralpitsfortheinsertionoftheribs；itisofaspongyandcartilaginousstructure。Theclaviclesareroundedinfront，havingsomeslightmovementsatthesternum，butmorefreeattheacromion。Theacromion，inman，arisesfromthescapuladifferentlyfrommostotheranimals。Thescapulaiscartilaginoustowardthespine，andspongyelsewhere，havinganirregularfigureexternally；itsneckandarticularcavitycartilaginous；itdoesnotinterferewiththemovementsoftheribs，andisfreeofallconnectionwiththeotherbones，exceptthehumerus。Theheadofthehumerusisarticulatedwithits（glenoid？）

cavity，bymeansofasmallligament，anditconsistsofaroundedepiphysiscomposedofspongycartilage，thehumerusitselfisbentoutwardandforward，anditisarticulatedwithits（glenoid？）

cavitybyitsside，andnotinastraightline。Attheelbowitisbroad，andhascondylesandcavities，andisofasolidconsistence；

behinditisacavityinwhichthecoronoidprocess（olecranon？）oftheulnaislodged，whenthearmisextended；here，too，isinsertedthebenumblingnerve，whicharisesfrombetweenthetwobonesoftheforearmattheirjunction，andterminatesthere。

*Epiphysismeansacloseunionofthetwobonesbymeansofaligament。

Part2

Whenthenoseisfractured，thepartsshouldbemodeledinstantly，ifpossible。Ifthefracturebeinitscartilaginouspart，introduceintothenostrilsatentformedofcaddis，inclosedintheouterskinofaCarthaginianhide，oranythingelsewhichdoesnotirritate；theskinistobegluedtothepartsdisplaced，whicharetobethusrectified。Bandaginginthiscasedoesmischief。Thetreatmentistoconsistofflourwithmanna，orofsulphurwithcerate。Youwillimmediatelyadjustthefragments，andafterwardretaintheminplacewithyourfingersintroducedintothenostrils，andturningthepartsintoplace；thentheCarthaginianskinistobeused。Calliusformsevenwhenthereisawound；andthesamethingsaretobedone，evenwhenthereistobeexfoliationofthebones，forthisisnotofaseriousnature。

Part3

Infracturesoftheears，neitherbandagesnorcataplasmsshouldbeused；or，ifanybandagebeused，itshouldbeputonverytight；thecerateandsulphurshouldbeappliedtoagglutinatethebandages。Whenmatterformsintheears，itisfoundtobemoredeeplyseatedthanmightbesupposed，forallpartsthatarepulpy，andconsistofjuicyflesh，provedeceptiousinsuchacase。Butnoharmwillresultfrommakinganopening，forthepartsarelean，watery，andfullofmucus。Nomentionisheremadeoftheplacesandcircumstanceswhichrenderitfataltomakeanopening。Thecureissoonesteffectedbytransfixingtheearwithacautery；buttheearismaimedanddiminishedinsize，ifburnedacross。Ifopened，oneofthegentlemedicinesforfleshwoundsshouldbeusedasadressing。

Part4

Thejaw—boneisoftenslightlydisplaced（subluxated？），andisrestoredagain；itisdislocatedbutrarely，especiallyingaping；

infact，theboneisneverdislocatedunlessitslipswhilethemouthisopenedwide。Itslips，however，themorereadilyfromitsligamentsbeingoblique，supple，andofayieldingnature。Thesymptomsare:thelowerjawprotrudes，itisdistortedtothesideoppositethedislocation，andthepatientcannotshuthismouth；

whenbothsidesaredislocated，thejawprojectsmore，themouthcanbelessshut，butthereisnodistortion；thisisshownbytherowsoftheteethintheupperandlowerjawcorrespondingwithoneanother。

If，then，bothsidesbedislocated，andnotimmediatelyreduced，thepatientforthemostpartdiesonthetenthday，withsymptomsofcontinuedfever，stupor，andcoma，forthemusclesthereinducesucheffects；thereisdisorderofthebowelsattendedwithscantyandunmixeddejection；andthevomitings，ifany，areofthesamecharacter。Theothervarietyislesstroublesome。Themethodofreductionisthesameinboth:—Thepatientbeinglaiddownorseated，thephysicianistotakeholdofhishead，andgraspingbothsidesofthejaw—bonewithbothhands，withinandwithout，hemustperformthreemanoeuvresatonce，—rectifythepositionofthejaw，pushitbackward，andshutthemouth。Thetreatmentshouldconsistofsoothingapplications，position，andapplyingasuitablebandagetosupportthejaw—bone，soastocooperatewiththereduction。

Part5

Theboneoftheshoulderisdislocateddownward。Ihaveneverheardofanyothermode。Thepartsputontheappearanceofdislocationforward，whenthefleshaboutthejointiswastedduringconsumption，asalsoseemstobethecasewithcattlewheninastateofleannessafterwinter。Thosepersonsaremostliabletodislocationswhoarethin，slender，andhavehumiditiesabouttheirjointswithoutinflammation，foritknitsthejoints。Thosewhoattempttoreduceandrectifydislocationsinoxen，commitablunder，asforgettingthatthesymptomsarisefromthemannerinwhichtheoxusesthelimb，andthattheappearanceisthesameinamanwhoisinasimilarcondition，andforgettingalsothatHomerhassaid，thatoxenaremostleanatthatseason。Inthisdislocation，then，whennotreduced，thepatientcannotperformanyofthoseactswhichothersdo，byraisingthearmfromtheside。Ihavethusstatedwhoarethepersonsmostsubjecttothisdislocation，andhowtheyareaffected。Incongenitaldislocationsthenearestbonesaremostshortened，asisthecasewithpersonswhoareweasel—armed；

thefore—armlessso，andthehandstillless；thebonesabovearenotaffected。Andtheparts（neartheseatoftheinjury）aremostwastedinflesh；andthishappensmoreespeciallyonthesideofthearmoppositethedislocation，andthatduringadolescence，yetinasomewhatlessdegreethanincongenitalcases。Thedeep—seatedsuppurationsoccurmostfrequentlytonew—borninfantsaboutthejointoftheshoulder，andtheseproducethesameconsequencesasdislocations。Inadults，thebonesarenotsodiminishedinsize，andjustly，seeingthattheotherswillnotincreaseasintheformercase；butwastingofthefleshtakesplace，foritisincreased，andisdiminishedeveryday，andatallages。Andattentionshouldbepaidtotheforceofhabit，andtothesymptomproducedbythetearingawayoftheacromion，wherebyavoidisleft，whichmakespeoplesupposethatthehumerusisdislocated。Theheadofthehumerusisfeltinthearmpit，andthepatientcannotraisehisarm，norswingittothissideandthat，asformerly。Theothershouldershowsthedifference。Modesofreduction:—Thepatienthimselfhavingplacedhisfistinthearmpit，pushesuptheheadofthehumeruswithit，andbringsthehandforwardtothebreast。Another:—Forceitbackward，sothatyoumayturnitround。Another:—Applyyourheadtotheacromion，andyourhandstothearmpit，separatetheheadofthehumerus（fromtheside？），andpushtheelbowintheoppositedirection；or，insteadofyourknees，anotherpersonmayturnasidetheelbow，asformerlydirected。Or，placethepatientonyourshoulder，withtheshoulderinhisarmpit。Or，withtheheel，somethingbeingintroducedtofillupthehollowofthearmpit，andusingtherightfoottotherightshoulder。Or，withapestle。Or，withthestepofaladder。Or，byrotationmadewithpieceofwoodstretchedbelowthearm。Treatment:—Astoattitude，thearmplacedbytheside，thehandandshoulderraised；thebandagingandadjustmentofthepartswhileinthisattitude。Ifnotreduced，thetopoftheshoulderbecomesattenuated。

Part6

Whentheacromionistornaway，theappearanceisthesameasindislocationoftheshoulder；butthereisnoimpediment，exceptthatthebonedoesnotreturntoitsposition。Thefigureshouldbethesameasindislocation，bothasregardsbandagingandsuspendingthelimb。Thebandagingaccordingtorule。

Part7

Whenpartialdisplacement（sub—luxation？）takesplaceattheelbow，eitherinsideoroutside，butthesharppoint（olecranon？）

remainsinthecavityofthehumerus，makeextensioninastraightline，andpushtheprojectingpartsbackwardandtothesides。

Part8

Incompletedislocationstoeitherside，makeextensionwhilethearmisinthepositionitisputintobebandagedforafracture，forthustheroundedpartoftheelbowwillnotformanobstacletoit。

Dislocationmostcommonlytakesplaceinward。Thepartsaretobeadjustedbyseparatingthebonesasmuchaspossible，sothattheendofthehumerusmaynotcomeincontactwiththeolecranon，butitistobecarriedupandturnedround，andnotforcedinastraightline；atthesametimetheoppositesidesaretobepushedtogether，andthebonesreducedtotheirplace。Inthesecasesrotationoftheelbowcooperates；thatistosay，turningthearmintoastateofsupinationandpronation；somuchforthereduction。Withregardtotheattitudeinwhichitistobeput，—thehandistobeplacedsomewhathigherthantheelbow，andthearmbytheside；thispositionsuitswithitwhenslungfromtheneck，iseasilyborne，isitsnaturalposition，andoneadaptedforordinarypurposes，unlesscallusformimproperly:thecallussoonforms。Treatment:—Bybandagesaccordingtothecommonruleforarticulations，andthepointoftheelbowistobeincludedinthebandage。

Part9

Theelbow，whenluxated，inducesthemostseriousconsequences，fevers，pain，nausea，vomitingofpurebile；andthisespeciallyindislocationsbackward，frompressureonthenervewhichoccasionsnumbness；nexttoitisdislocationforward。Thetreatmentisthesame。Thereductionofdislocationbackwardisbyextensionandadaptation:thesymptomofthisvariety，lossofthepowerofextension；ofdislocationforward，lossofthepowerofflexion。Initahardballistobeplacedinthebendoftheelbow，andthefore—armistobebentoverthiswhilesuddenextensionismade。

Part10

Diastasisofthebonesmayberecognizedbyexaminingthepartwheretheveinwhichrunsalongthearmdivides。

Part11

Inthesecasescallusisspeedilyformed。Incongenitaldislocations，thebonesbelowtheseatoftheinjuryareshorterthannatural；inthiscase，thegreatestshorteningisinthenearest，namely，thoseofthefore—arm；second，thoseofthehand；

third，thoseofthefingers。Thearmandshouldersarestronger，owingtothenourishmentwhichtheyreceive，andtheotherarm，fromtheadditionalworkithastoperform，isstillmorestrong。Thewastingoftheflesh，ifthedislocationwasoutward，isontheinside；orifotherwise，onthesideoppositethedislocation。

Part12

Indislocationattheelbow，whetheroutwardorinward，extensionistobemadewiththefore—armatrightanglestothearm；thearmistobesuspendedbyashawlpassedthroughthearmpit，andaweightistobeattachedtotheextremityoftheelbow；orforceistobeappliedwiththehands。Thearticularextremitybeingproperlyraised，thepartsaretobeadjustedwiththepalmsofthehands，asindislocationsofthehands。Itistobebandaged，suspendedinasling，andplaced，whileinthisattitude。

Part13

Dislocationsbackwardaretoberectifiedwiththepalmsofthehandsalongwithsuddenextension。Thesetwoactsaretobeperformedtogether，asinothercasesofthekind。Indislocationforward，thearmistobendaroundaballofcloth，ofpropersize，andatthesametimereplaced。

Part14

Ifthedisplacementbeontheothersideboththeseoperationsaretobeperformedineffectingtheadjustmentofthearm。Withregardtothetreatment，—thepositionandthebandagingarethesameasintheothercases。Forallthesecasesmaybereducedbyordinarydistention。

Part15

Withregardtothemodesofreduction，someactupontheprincipleofcarryingtheonepieceofboneovertheother，somebyextension，andsomebyrotation:theselastconsistinrapidlyturningthearmtothissideandthat。

Part16

Thejointofthehandisdislocatedinwardoroutward，butmostfrequentlyinward。Thesymptomsareeasilyrecognized；

ifinward，thepatientcannotatallbendhisfingers，butifoutward，hecannotextendthem。Reduction:—Byplacingthefingersaboveatable，extensionandcounter—extensionaretobemadebyassistance，while，withthepalmofthehandortheheelontheprojectingbone，onepressesforward，andfrombehind，upontheotherbone，andlayssomesoftsubstanceonit；and，ifthedislocationbeabove，thehandistobeturnedintoastateofpronation；or，ifbackward，intoastateofsupination。Thetreatmentistobeconductedwithbandages。

Part17

Thewholehandisdislocatedeitherinward，oroutward，butespeciallyinward，ortothissideorthat。Sometimestheepiphysisisdisplaced，andsometimesthereisdisplacement（diastasis）oftheonebonefromtheother。Powerfulextensionistobemadeinthiscase；andtheprojectingpartistobepressedupon，andcounter—pressuremadeontheoppositeside:bothmodesbeingperformedatthesametime，bothbackwardandlaterally，eitherwiththehandsonatable，orwiththeheel。Theseaccidentsgiverisetoseriousconsequencesanddeformities；butintimethepartsgetsostrongastoadmitofbeingused。Thetreatmentconsistsofbandagescomprehendingthehandandforearm，andsplintsaretobeappliedasfarasthefingers；whenputinsplints，theyaretobemorefrequentlyloosedthaninfractures，andmorecopiousallusionsofwateraretobeused。

Part18

Incongenitaldislocationsthehandbecomesshortened，andtheatrophyofthefleshisgenerallyonthesideoppositethedislocation。Intheadultthebonesremainoftheirpropersize。

Part19

Thesymptomsofdislocationofthefingerareobvious，andneednotbedescribed。Thisisthemodeofreduction:—Bystretchinginastraightline，andmakingpressureontheprojectingpart，andcounter—pressure，attheoppositeside，ontheother。Thepropertreatmentconsistsintheapplicationofbandages。Whennotreduced，thepartsunitebycallusoutsideofthejoints。Incongenitaldislocations，andinthosewhichoccurduringbonesbelowthedislocationareshortened，andthefleshiswastedprincipallyonthesideoppositetothedislocation；intheadultthebonesremainoftheirpropersize。

Part20

Dislocationatthehip—jointoccursinfourmodes，inwardmostfrequently，outwardnext，theothersofequalfrequency。Thesymptoms:—Thecommon，acomparisonwiththesoundleg。Thepeculiarsymptomsofdislocationsinward；theheadoftheboneisfeltattheperineum；thepatientcannotbendhislegasformerly；thelimbappearselongated，andtoagreatextent，unlessyoubringbothlimbsintothemiddlespacebetweentheminmakingacomparisonofthem；andthefootandthekneeareinclinedoutward。Ifthedislocationhastakenplacefrombirth，orduringone’sgrowth，thethighisshortened，theleglessso，andtheothersaccordingtothesamerule；thefleshypartsareatrophied，especiallyontheoutside。Suchpersonsareafraidtostanderect，andcrawlalongonthesoundlimb；or，ifcompelled，theywalkwithoneortwostaves，andbearuptheaffectedlimb；andthesmallerthelimbsomuchthemoredotheywalk。Iftheaccidenthappenstoadultsthebonesremainoftheirpropersize，butthefleshiswasted，asformerlydescribed；thepatientswalkinawrigglingmanner，likeoxen；theyarebenttowardtheflank，andthebuttockontheuninjuredsideisprominent；fortheuninjuredlimbmustnecessarilycomebelowthatitmaysupportthebody，whilsttheothermustbecarriedoutoftheway，asitcannotsupportthebody，likethosewhohaveanulcerinthefoot。Theypoisethebodybymeansofastaffonthesoundside，andgrasptheaffectedlimbwiththehandabovethekneesoastocarrythebodyinshiftingfromoneplacetoanother。Ifthepartsbelowthehip—jointbeused，thebonesbelowarelessatrophied，butthefleshmore。

Part21

Thesymptomsandattitudesindislocationoutwardaretheopposite，andthekneeandfootinclinealittleinward。Whenitiscongenital，oroccursduringadolescence，thebonesdonotgrowproperly；accordingtothesamerule，theboneofthehip—jointissomewhathigherthannatural，anddoesnotgrowproportionally。Inthosewhohavefrequentdislocationsoutward，withoutinflammation，thelimbisofamorehumid（flabby？）temperamentthannatural，likethethumb，foritisthepartmostfrequentlydislocated，owingtoitsconfiguration；inwhatpersonsthedislocationistoagreaterorlessextent；andinwhatpersonsitismoredifficultlyoreasilyproduced；

inwhatthereisreasontohopethatitcanbespeedilyreduced，andinwhatnot；andtheremedyforthis；andinwhatcasesthedislocationfrequentlyhappens，andtreatmentofthis。Indislocationoutwardfrombirth，orduringadolescence，orfromdisease，（andithappensmostfrequentlyfromdisease，inwhichcasethereissometimesexfoliationofthebone，butevenwherethereisnoexfoliation），thepatientsexperiencethesamesymptoms，buttoaninferiordegreetothoseindislocationsinward，ifproperlymanagedsothatinwalkingtheycanputthewholefoottothegroundandleantoeitherside。Theyoungerthepatientis，thegreatercareshouldbebestowedonhim；whenneglected，thecasegetsworse；whenattendedto，itimproves；and，althoughtherebeatrophyinallpartsofthelimb，itistoalessextent。

Part22

Whenthereisadislocationonbothsides，theaffectionsofthebonesarethesame；thefleshiswelldeveloped，exceptwithin，thenatesprotrude，thethighsarearched，unlesstherebesphacelus。Iftherebecurvatureofthespineabovethehip—joint，thepatientsenjoygoodhealth，butthebodydoesnotgrow，withtheexceptionofthehead。

Part23

Thesymptomsofdislocationbackwardare:—Thepartsbeforemoreempty，behindtheyprotrude，thefootstraight，flexionimpossible，exceptwithpain，extensionleastofall:inthesethelimbisshortened。Theycanneitherextendthelimbattheham，noratthegroin，unlessitbemuchraised，norcantheybendit。Theuppermostjoint，inmostcases，takesthelead:thisiscommoninjoints，nerves，muscles，intestines，uteri，andotherparts。

Theretheboneofthehip—jointiscarriedbackwardtothenates，andonthataccountitisshortened，andbecausethepatientcannotextendit。Thefleshofthewholelegiswastedinallcases，inwhichmost，andtowhatextent，hasbeenalreadystated。Everypartofthebodywhichperformsitsfunctionalworkisstrong，but，notwithstanding，ifinactive，itgetsintoabadcondition，unlessitsinactivityarisefromfatigue，fever，orinflammation。Andindislocationsoutward，thelimbisshortened，becausetheboneislodgedinfleshwhichyields；

but，notwithstanding，indislocationsinward，itislonger，becausetheboneislodgedonaprojectingbone。Adults，then，whohavethisdislocationunreduced，arebentatthegroinsinwalking，andtheotherhamisflexed；theyscarcelyreachthegroundwiththeballofthefoot；theygraspthelimbwiththehand，andwalkwithoutastaffiftheychoose；ifthestaffbetoolong，theirfootcannotreachthegrounds—iftheywishtoreachtheground，theymustuseashortstaff。Thereiswastingofthefleshincasesattendedwithpain；andtheinclinationofthelegisforward，andthesoundleginproportion。Incongenitalcases，orwheninadolescence，orfromdisease，theboneisdislocated（underwhatcircumstanceswillbeexplainedafterward），thelimbisparticularlyimpaired，owingtothenervesandjointsnotbeingexercised，andthekneeisimpairedforthereasonsstated。Thesepersons，keepingthelimbbent，walkwithonestaffortwo。Butthesoundlimbisingoodfleshfromusage。

Part24

Indislocationsforwardthesymptomsaretheopposite:avacuitybehind，aprotuberancebefore；ofallmotionstheycanleastperformflexion，andextensionbest；thefootisstraight，thelimbisoftheproperlengthattheheel；atitsextremitythefootalittleturnedup；theyareespeciallypainedatfirst:ofallthesedislocationsretentionofurineoccursmostfrequentlyinthisvariety，becausetheboneislodgedamongimportantnerves。Theforepartsarestretched，donotgrow，arediseased，andareobnoxioustoprematuredecay；thebackpartsarewrinkled。Inthecaseofadults，theywalkerect，restingmerelyontheheel，andthistheydodecidedlyiftheycantakegreatsteps；buttheydragitalong；thewastingisleastofallinthisvarietyofdislocation，owingtotheirbeingabletousethelimb，butthewastingismostbehind。Thewholelimbbeingstraighterthannaturaltheystandinneedofastaffontheaffectedside。Whenthedislocationiscongenital，orhasoccurredduringadolescence，ifproperlymanaged，thepatienthastheuseofthelimbaswellasadults（otherwise？）haveofit。But，ifneglected，itisshortenedandextended，forinsuchcasesthejointisgenerallyinastraightposition。Thediminutionofthebones，andwastingofthefleshyparts，areanalogous。

Part25

Inreduction—theextensionofthethighistobepowerful，andtheadjustmentwhatiscommoninallsuchcases，withthehands，oraboard，oralever，which，indislocationsinward，shouldberound，andindislocationsoutward，flat；butitismostlyapplicableindislocationsoutward。Dislocationsinwardaretoberemediedbymeansofbladders，extendingtothebarepartofthethigh，alongwithextensionandbindingtogetherofthelimbs。Thepatientmaybesuspended，withhisfeetalittleseparatedfromoneanother，andthenapersoninsertinghisarmwithintheaffectedlimb，istosuspendhimselffromit，andperformextensionandreadjustmentatthesametime；andthismethodissufficientindislocationsforwardandtheothers，butleastofallindislocationsbackward。Aboardfastenedunderthelimb，liketheboardfastenedbelowthearmindislocationsattheshoulder，answersindislocationsinward，butlesssointheothervarieties。Alongwithextensionyouwillusepressureeitherwiththefoot，thehand，oraboard，especiallyindislocationsforwardandbackward。

Part26

Dislocationsatthekneeareofamildercharacterthanthoseoftheelbow，owingtothecompactnessandregularityofthejoint；andhenceitismorereadilydislocatedandreduced。Dislocationgenerallytakesplaceinward，butalsooutwardandbackward。Themethodsofreductionare—bycircumflexion，orbyrapidexcalcitration，orbyrollingafilletintoaball，placingitintheham，andthenlettingthepatient’sbodysuddenlydropdownonhisknees:thismodeappliesbestindislocationsbackward。Dislocationsbackward，likethoseoftheelbows，mayalsobereducedbymoderateextension。

Lateraldislocationsmaybereducedbycircumflexionorexcalcitration，orbyextension（butthisismostapplicableindislocationbackward），butalsobymoderateextension。Theadjustmentiswhatiscommoninall。Ifnotreduced，indislocationsbackward，theycannotbendthelegandthighupononeanother，butneithercantheydothisintheothersexcepttoasmallextent；andtheforepartsofthethighandlegarewasted。Indislocationsinwardtheyarebandy—legged，andtheexternalpartsareatrophied。But，indislocationsoutward，theyinclinemoreoutward，butarelesslame，forthebodyissupportedonthethickerbone，andtheinnerpartsarewasted。Theconsequencesofacongenitaldislocation，oroneoccurringduringadolescence，areanalogoustotheruleformerlylaiddown。

Part27

Dislocationsattheankle—jointrequirestrongextension，eitherwiththehandsorsomesuchmeans，andadjustment，whichatthesametimeeffectsbothacts；thisiscommoninallcases。

Part28

Dislocationsofthebonesofthefootaretobetreatedlikethoseofthehand。

Part29

Dislocationsofthebonesconnectedwiththeleg，ifnotreduced，whetheroccurringatbirthorduringadolescence，areofthesamecharacterasthoseinthehand。

Part30

Personswho，injumpingfromaheight，havepitchedontheheel，soastooccasiondiastasis（separation）ofthebones，ecchymosisoftheveins，andcontusionofthenerves，—whenthesesymptomsareveryviolent，thereisdangerthatthepartsmaysphacelate，andgivetroubletothepatientduringtheremainderofhislife；forthesebonesaresoconstructedastoslippastoneanother，andthenervescommunicatetogether。And，likewiseincasesoffracture，eitherfromaninjuryinthelegorthigh，orinparalysisofthenervesconnectedwiththeseparts，or，wheninanyothercaseofconfinementtobedtheheel，fromneglect，becomesblackened，inallthesecasesseriouseffectsresulttherefrom。Sometimes，inadditiontothesphacelus，veryacutefeverssupervene，attendedwithhiccup，tumors，aberrationofintellect，andspeedydeath，alongwithlividityofthelargebloodvessels，andgangrene。Thesymptomsoftheexacerbationsarethese:iftheecchymosis，theblackenedparts，andthosearoundthem，besomewhathardandred，andiflividitybecombinedwiththehardness，thereisdangerofmortification；but，notwithstanding，ifthepartsaresublivid，orevenverylividanddiffused，orgreenishandsoft，thesesymptoms，inallsuchcases，arefavorable。Thetreatmentconsistsintheadministrationofhellebore，iftheybefreefromfever，butotherwise，theyaretohaveoxyglykyfordrink，ifrequired。Bandaging，—agreeablytotheruleinotherjoints；butthisistobeattendedtoalso，—thebandagesshouldbenumerous，andsofterthanusual；compressionless；morewaterthanusualtobeusedintheallusions；tobeappliedespeciallytotheheel。Thesameobjectshouldbesoughtafterinthepositionasinthebandaging，namely，thatthehumorsmaynotbedeterminedtotheheel；thelimbtobewelllaidshouldhavetheheelhigherthantheknee。Splintsnottobeused。

Part31

Whenthefootisdislocated，eitheralone，orwiththeepiphysis，thedisplacementismoreapttobeinward。Ifnotreduced，inthecourseoftimethepartsofthehips，thigh，andleg，oppositethedislocation，becomeattenuated。Reduction:—Asindislocationatthewrist；buttheextensionrequirestobeverypowerful。Treatment:—Agreeablytotherulelaiddownfortheotherjoints。Lessapttobefollowedbyseriousconsequencesthanthewrist，ifkeptquiet。Dietrestricted，asbeinginaninactivestate。Thoseoccurringatbirth，orduringadolescence，observetheruleformerlystated。

Part32

Withregardtoslightcongenitaldislocations，someofthemcanberectified，especiallyclub—foot。Thereismorethanonevarietyofclub—foot。Thetreatmentconsistsinmodelingthefootlikeapieceofwax；applyingresinouscerate，andnumerousbandages；orasole，orapieceofleadistobeboundon，butnotuponthebareskin；theadjustmentandattitudestocorrespond。

Part33

Ifthedislocatedbonescauseawoundintheskin，andprotrude，itisbettertoletthemalone，providedonlytheyarenotallowedtohang，norarecompressed。Thetreatmentconsistsinapplyingpitchedcerate，orcompressesdippedinhotwine（forcoldisbadinallsuchcases），andcertainleaves；butinwinterunwashedwoolmaybeappliedasacovertothepart；neithercataplasmsnorbandaging；

restricteddiet。Cold，greatweight，compression，violence，restrictedposition，allsucharetobeaccountedasfatalmeasures。

Whentreatedmoderately（theyescape），maimedanddeformed；for，ifthedislocationbeattheankle，thefootisdrawnupward，and，ifelsewhere，accordingtothesamerule。Thebonesdonotreadilyexfoliate；foronlysmallportionsofthemaredenuded，andtheyhealbynarrowcicatrices。Thedangerisgreatestinthegreatestjoints，andthosehighestup。Theonlychanceofrecoveryis，iftheyarenotreduced，exceptatthefingersandhand，andinthesecasesthedangershouldbeannouncedbeforehand。Attemptsatreductiontobemadeonthefirstorsecondday；or，ifnotaccomplishedthen，onthetenth，bynomeansonthefourth。Reductionbylevers。Treatment:—Asininjuriesofthebonesofthehead，andthepartistobekepthot；anditisbettertogivehelleboreimmediatelyafterthepartshavebeenreduced。Withregardtotheotherbones，itshouldbewellknown，that，ifreplaced，deathwillbetheconsequence；themoresurelyandexpeditiously，thegreaterthearticulation，andthemorehighitssituation。

Dislocationofthefootisattendedwithspasm（tetanus）andgangrene；

andif，uponitsbeingreplaced，anyofthesesymptomscomeon，thechanceofrecovery，iftherebeanychance，isindisplacingitanew；forspasmsdonotarisefromrelaxation，butfromtensionoftheparts。

Part34

Excision，eitherofarticularbonesorofpiecesofbones，whennothighupinthebody，butaboutthefootorthehand，isgenerallyfollowedbyrecovery，unlessthepatientdieatoncefromdeliquiumanimi。Treatment:—Asininjuriesofthehead；warmth。

Part35

Sphacelusofthefleshypartsisproducedbythetightcompressionofbleedingwounds，andbypressureinthefracturesofbones，andbyblackening，arisingfrombandages。Andinthosecasesinwhichaportionofthethighorarm，boththebonesandthefleshdropoff，manyrecover，thecasebeinglessdangerousthanmanyothers。

Incases，then，connectedwithfractureofthebones，theseparationofthefleshquicklytakesplace，buttheseparationofthebone，attheboundaryofitsdenudedpart，isslowerintakingplace。Butthepartsbelowtheseatoftheinjury，andthesoundportionofthebody，aretobepreviouslytakenaway（fortheydiepreviously），takingcaretoavoidproducingpain，fordeliquiumanimimayoccasiondeath。Theboneofthethighinsuchacasecameawayontheeightiethday，butthelegwasremovedonthetwentiethday。Thebonesoftheleg，inacertaincase，cameawayatthemiddleofthesixtiethday。Inthesecasestheseparationisquickorslow，accordingtothecompressionappliedbythephysician。Whenthecompressionisgentlyappliedthebonesdonotdropoffatall，neitheraretheydenudedofflesh，butthegangreneisconfinedinthemoresuperficialparts。Thetreatmentofsuchcasesmustbeundertaken；formostofthemaremoreformidableinappearancethaninreality。Thetreatmentshouldbemild，but，notwithstanding，witharestricteddiet；hemorrhagesandcoldaretobedreaded；theposition，soasthatthelimbmaybeinclinedupward，andafterward，onaccountofthepurulentabscess，horizontally，orsuchasmaysuitwithit。Insuchcases，andinmortifications，thereareusually，aboutthecrisis，hemorrhagesandcrisis，hemorrhagesandviolentdiarrhoeas，which，however，onlylastforafewdays；thepatientsdonotlosetheirappetite，neitheraretheyfeverish，norshouldtheybeputuponareduceddiet。

Part36

Displacementofthespine，ifinward，threatensimmediatedeath，attendedwithretentionofurineandlossofsensibility。

Outward，theaccidentisfreefrommostofthesebadeffects，muchmoresothanwherethereismerelyconcussionwithoutdisplacement；theeffectsintheformercasebeingconfinedtothespotaffected，whereasinthelattertheyarefurthercommunicatedtothewholebody，andareofamortalcharacter。Inlikemanner，whentheribsarefractured，whetheroneormore，providedtherebenosplinters，thereisrarelyfever，spittingofblood，andsphacelus，andordinarytreatmentwithoutevacuationwillsuffice，providedtherebenofever；—bandaging，accordingtorule；andthecallusformsintwentydays，thebonebeingofaporousnature。Butincasesofcontusion，tuberclesform，alongwithcough，suppuratingsores，andsphacelusoftheribs，fornervesfromallthepartsrunalongeachrib。Inmanyofthesecaseshaemoptysisandempyemaalsotakeplace。Themanagementofthiscaseconsistsincarefultreatment，bandagingaccordingtorule，dietatfirstrestricted，butafterwardmoreliberal，quiet，silence，position，bowels，andvenerealmattersregulated。Evenwhenthereisnospittingofblood，thesecontusionsaremorepainfulthanfractures，andaremoresubjectintimetorelapses；andwhenanymucouscollectionisleftinthepart，itmakesitselfbefeltindisordersofthebody。Treatment:—burning，whentheboneisaffected，downtothebone，butnottouchingtheboneitself；ifintheintercostalspace，theburningmustnotextendthroughit，norbetoosuperficial。Insphacelusoftheribs，tentsaretobetried，allotherparticularswillbestatedafterward:buttheyshouldbelearnedbysightratherthanbywords，namely，food，drink，heat，cold，attitude；medicines，dry，liquid，red，dark，white，sour，fortheulcers，andsowithregardtothediet。

Part37

Displacements（ofthevertebrae）fromafallrarelyadmitofbeingrectified，andthoseabovethediaphragmaremostdifficulttorectify。Whentheaccidenthappenstochildren，thebodydoesnotgrow，withtheexceptionofthelegs，thearms，andhead。

Excurvation，inadults，speedilyrelievestheindividualfromthediseaseheislaboringunder，butintimeitrenewsitsattack，withthesamesymptomsasinchildren，butofalessseriousnature。Someindividualshavebornethisaffectionwell，andhaveturnedouttobebrawnyandfat。Butfewofthemhavelivedtotheageofsixty。

Lateralcurvaturesalsooccur，theproximatecauseofwhichistheattitudesinwhichthesepersonslie。Thesecaseshavetheirprognosticsaccordingly。

Part38

Theruleforthereductionandadjustment:—Theaxle，thelever，thewedge，pressureabove；theaxletoseparate，thelevertopushaside。Reductionandadjustmentaretobeaccomplishedbyforcibleextension，thepartsbeingplacedinsuchapositionaswillfacilitatetheconveyingofthedisplacedboneovertheextremityofthebonefromwhichitwasdisplaced:thisistobeaccomplishedeitherwiththehands，orbysuspension，oraxles，orturnedroundsomething。Withthehandsthisistobeeffectedproperly，accordingtothestructureoftheparts。Inthecaseofthewristandelbow，thepartsaretobeforcedasunder，atthewristinthelineoftheelbow，andtheelbowwiththefore—armatarightanglewiththearm，aswhenitissuspendedinasling。Whenwewanttoseparatetheprotrudingbones，andforcethemintoplace，inthecaseofthefingers，thetoes，orthewrist，theproperseparationmaybemadebyhands，whiletheprojectingpartisforcedintoitsplacebypressingdownwiththeheelorthepalmofthehanduponsomeresistingobject，whilesomethingmoderatelysoftislaidundertheprojectingpart，butnothingsuchundertheother，andthenpressureistobemadebackwardanddownward，whetherthedislocationbeinwardoroutward。

Inlateraldisplacement，pressureandcounter—pressuremustbemadeontheoppositesides。Displacementsforwardcanbereducedneitherbysneezing，norcoughing，norbytheinjectionofair，norbythecupping—instrument；andifanythingcandogoodinsuchacase，itisextension。Peoplearedeceivedinfracturesofthespinalprocesses，thepainofwhichcausingthepatienttostoopforward，thecaseistakenfordislocationinward；thesefractureshealspeedilyandeasily。Dislocationoutwardistoberemediedbysuccussion，whenhighup，towardthefeet；andwhensituatedlowdown，inthecontrarydirection；thepartistobepressedbackintoitsplace，eitherwiththefootoraboard。Dislocationstoeitherside，iftheyadmitofanyremedy，aretobetreatedbyextension，andsuitableattitudes，withregimen。Thewholeapparatusshouldbebroad，soft，andstrong；orotherwise，theyshouldbewrappedinrags；

beforebeingused，theyshouldallbepreparedproportionatelytothelength，height，andbreadth。Inapplyingextensiontothethigh，forexample，thebandsshouldbefastenedattheankleandabovetheknee，thesestretchinginthesamedirection，anotherbandtobepassedbytheloins，andaroundthearmpits，andbytheperineumandthigh，oneendpassingupthebreastandtheotheralongtheback，theseallstretchinginthesamedirectionandbeingfastenedeithertoapieceofwoodresemblingapestleortoanaxle。Whenthisisdoneonacouch，eitherofitsfeetistobefastenedtothethreshold，andastrongblockofwoodistobelaidacrosstheother，andthepiecesofwoodresemblingapestlearetoberaisedonthese，tomakeextensionandcounter—extension；thenavesofawheelaretobefastenedinthefloor，oraladderistobeadjusted，sothatextensionmaybemadeinbothdirections。Thethingcommonlyusedisabenchsixcubitslong，twocubitsbroad，onefathominthickness，havingtwolowaxlesatthisendandthat，andhavingatitsmiddletwomoderatesizedpillars，towhichistobeadjustedatransversepieceofwoodlikethestepofaladder，whichistoreceivethepieceofwoodtiedbelowthelimb，asisdoneindislocationattheshoulder；andthebenchistohaveexcavationsliketrays，smooth，fourinchesinbreadthanddepth，andatsuchanintervalastoleaveroomfortheleverusedtoreducethelimb。Inthemiddleofthebenchasquareholeistobescoopedouttoreceiveasmallpillar，which，beingadjustedtotheperineum，willobviatethetendencyofthebodytoslipdownward，andbeingratherloosemayactsomewhatasalever。Incertainoccasionsapieceofwoodisrequired，whichisinsertedintoaholescoopedoutofthewall；theotherendofitisthentobepresseddown，somethingmoderatelysoftbeingplacedunderit。

Part39

Inthosecaseswheretheboneofthepalatehasexfoliated，thenosesinksinitsmiddle。Incontusionsoftheheadwithoutawound，eitherfromafall，afracture，orpressure，incertainofthesecasesacridhumorsdescendfromtheheadtothethroat，andfromthewoundintheheadtotheliverandthigh。

Part40

Thesymptomsofsubluxationsandluxations，andwhere，andhow，andhowmuchthesedifferfromoneanother。Andthecasesinwhichthearticularcavityhasbeenbrokeoff，andinwhichtheligamenthasbeentorn，andinwhichtheepiphysishasbrokeninwhich，andhow，whenthelimbconsistsoftwobones，oneorbotharebroken:inconsequenceofthesethedangers，chancesinwhichbad，andwhentheinjurieswillresultindeath，andwheninrecovery。Whatcasesaretobereducedorattempted，andwhen，andwhich，andwhennot；thehopesanddangersinthesecases。Whichandwhencongenitaldislocationsaretobeundertaken:thepartsinastateofgrowth，thepartsfullygrown，andwhysooner，orslower:andwhyapartbecomesmaimed，andhow，andhownot:andwhyacertainpartisatrophied，andwhere，andhow，andinwhatcasestoalessextent。Andwhyfracturedpartsunitesoonerorslower，howdistortionsandcallositiesform，andtheremedyforthem。Inwhatcasesthereareexternalwounds，eitheratfirstorafterwards:inwhatfracturesthebonesareshortened，andinwhatnot:inwhatcasesthefracturedbonesprotrude，andwhentheyprotrudemost:inwhatcasesdislocatedbonesprotrude。Thatphysiciansaredeceived，andbywhatmeans，inwhattheysee，andinwhattheydevise，regardingaffections，andregardingcures。Establishedruleswithregardtobandaging:preparation，presentationofthepart，extension，adjustment，friction，bandaging，suspensionandplacingofthelimb，attitude，seasons，diet。Themoreporouspartshealfastest，andviceversa。Distortions，wherethebonesarecrooked。Fleshandtendonswastedonthesideofthedislocation。Theforceusedinreductiontobeappliedatasgreatadistanceaspossiblefromtheseatofthedisplacement。Ofnerves（ligaments？），thosewhichareinmotionandinhumidity（flabby？）areofayieldingnature；thosethatarenot，lessso。Ineverydislocationthemostspeedyreductionisbest。Reductionnottobemadewhilethepatientisinafebrilestate，noronthefourthorfifthday；andleastofall，inthoseoftheelbow，andallcaseswhichinducetorpor；thesoonestthebest，providedtheinflammatorystagebeavoided。Partstornasunder，whethernerves，orcartilages，orepiphyses，orpartsseparatedatsymphyses，cannotpossiblyberestoredtotheirformerstate；butcallusisquicklyformedinmostcases，yettheuseofthelimbispreserved。Ofluxations，thosenearesttheextremitiesareleastdangerous。Thosejointswhicharemosteasilydislocatedaretheleastsubjecttoinflammation。Thosewhichhavebeenleastinflamed，andhavenotbeensubjectedtoafter—treatment，aremostliabletobedislocatedanew。Extensionshouldbemadeinthepositionmostcalculatedtoenabletheonebonetocleartheextremityoftheother，attentionbeingpaidtoconfigurationandplace。Adjustmenttobemadeinthedirectionofthedisplacement；topushthedisplacedlimbstraightbackwardandsideways。Partssuddenlydrawnasidearetobesuddenlydrawnbackbyarotatorymotion。Articulationswhichhavebeenoftenestdislocatedarethemosteasilyreduced；thecauseistheconformationofthenerves（ligaments？）orofthebones；oftheligamentsthattheyarelongandyielding；andofthebones，theshallownessofthearticularcavity，androundnessofthehead[ofthebonethatentersit]。Usage，byitsfriction，formsanewsocket。

Thecause—thedisposition，andhabit，andage。Apartsomewhatmucousisnotsubjecttoinflammation。

Part41

Inthosecaseswheretherearewounds，eitheratfirst，orfromprotrusionofthebones；orafterwards，frompruritus，orirritation；inthelattercaseyouareimmediatelytounloosethebandages，andhavingappliedpitchedceratetothewound，bandagethelimb，placingtheheadoftherolleruponthewound，andproceedingotherwiseasiftherewerenowoundinthecase；forthuswilltheswellingbereducedasmuchaspossible，andthewoundwillsuppuratemostquickly，andthediseasedpartswillseparate，andwhenitbecomescleanthewoundwillmostquicklyheal。Splintsarenottobeappliedtotheplace，norisittobeboundtight。Proceedthuswhennolargebonesexfoliate，butnotinthelattercase，forthenthereisgreatsuppuration，andthesametreatmentisnotapplicable，butthepartsrequiretobeexposedtotheaironaccountoftheabscesses。Insuchcaseswherethebonesprotrude，andwhetherreducedornot，bandagingisnotbefitting，butdistentionistobepracticedbymeansofrollsofcloth，madelikethoseuseduponshackles；oneoftheseistobeplacedattheankle，andtheotherattheknee；theyaretobeflattenedtowardtheleg，soft，strong，andhavingrings；androdsmadeofcornel，andofaproperlengthandthicknessaretobeadjustedtothem，soastokeepthepartsdistended；andstraps，attachedtobothextremities，aretobeinsertedintotherings，sothattheextremitiesbeingfixedintotherolls，mayeffectdistention。Treatment:—Pitchedcerate，inahotstate；theattitudes，positionofthefootandhip；regulateddiet。Theboneswhichhaveprotrudedthroughtheskinaretobereplacedthesameday，ornext；notonthefourthorfifth，butwhentheswellinghassubsided。Reductionistobeperformedwithlevers；

whenthebonedoesnotpresentanyplaceuponwhichthelevercanrest，aportionofthepartwhichpreventsthisistobesawedoff。

Butthedenudedpartswilldropoff，andthelimbbecomeshortened。

Part42

Dislocationsatthejointsaretoagreaterandlessextent。

Thosethataretoalessextentarethemosteasilyreduced；thosethataretoagreaterextentoccasionlesionsofthebones，oftheligaments，ofthejoints，ofthefleshyparts，andoftheattitudes。

Thethighandarmresembleoneanotherverymuchintheirdislocations。