Iamacquaintedwithoneforminwhichtheshoulder—jointisdislocated，namely，thatintothearmpit；Ihaveneverseenittakeplaceupwardnoroutward；andyetIdonotpositivelyaffirmwhetheritmightbedislocatedinthesedirectionsornot，althoughIhavesomethingwhichImightsayonthissubject。ButneitherhaveIeverseenwhatIconsideredtobeadislocationforward。Physicians，indeed，fancythatdislocationisveryapttooccurforward，andtheyaremoreparticularlydeceivedinthosepersonswhohavethefleshypartsaboutthejointandarmmuchemaciated；for，inallsuchcases，theheadofthearmappearstoprotrudeforward。AndI
inonecaseofthiskindhavingsaidthattherewasnodislocation，exposedmyselftocensurefromcertainphysiciansandcommonpeopleonthataccount，fortheyfanciedthatIalonewasignorantofwhateverybodyelsewasacquaintedwith，andIcouldnotconvincethembutwithdifficulty，thatthematterwasso。Butifonewillstripthepointoftheshoulderofthefleshyparts，andwherethemuscle（deltoid？）extends，andalsolaybarethetendonthatgoesfromthearmpitandclavicletothebreast（pectoralmuscle？），theheadofthehumeruswillappeartoprotrudestronglyforward，althoughnotdislocated，fortheheadofthehumerusnaturallyinclinesforward，buttherestoftheboneisturnedoutward。Thehumerusisconnectedobliquelywiththecavityofthescapula，whenthearmisstretchedalongthesides；butwhenthewholearmisstretchedforward，thentheheadofthehumerusisinalinewiththecavityofthehumerus，andnolongerappearstoprotrudeforward。Andwithregardtothevarietywearenowtreatingof，Ihaveneverseenacaseofdislocationforward；andyetIdonotspeakdecidedlyrespectingit，whethersuchadislocationmaytakeplaceornot。When，then，adislocationintothearmpittakesplace，seeingitisoffrequentoccurrence，manypersonsknowhowtoreduceit，foritisaneasythingtoteachallthemethodsbywhichphysicianseffectthereductions，andthebestmannerofapplyingthem。Thestrongestofthosemethodsshouldbeusedwhenthedifficultyofreductionisparticularlygreat。Thestrongestisthemethodtobelastdescribed。
2。Thosewhoaresubjecttofrequentdislocationsattheshoulder—joint，areforthemostpartcompetenttoeffectthereductionthemselves；for，havingintroducedtheknucklesoftheotherhandintothearmpit，theyforcethejointupward，andbringtheelbowtowardthebreast。Thephysicianmightreduceitinthesamemanner，ifhavingintroducedhisfingersintothearmpitontheinsideofthedislocatedjoint，hewouldforceitfromtheribs，pushinghisownheadagainsttheacromion，inordertomakecounter—pressure，andwithhiskneesappliedtothepatient’selbowpushingthearmtothesides。
Itwillbeofadvantageiftheoperatorhasstronghands，orthephysicianmaydoasdirectedwithhisheadandhands，whileanotherpersonbringstheelbowtowardthebreast。Reductionoftheshouldermayalsobeeffectedbycarryingthefore—armbackwardtothespine，andthenwiththeonehandgraspingitattheelbow，tobendthearmupward，andwiththeothertosupportitbehindatthearticulation。
Thismodeofreduction，andtheoneformerlydescribed，arenotnatural，andyetbyrotatingtheboneofthejoint，theyforceittoreturn。
3。Thosewhoattempttoperformreductionwiththeheel，operateinamannerwhichisanapproachtothenatural。Thepatientmustlieonthegrounduponhisback，whilethepersonwhoistoeffectthereductionisseatedonthegrounduponthesideofthedislocation；
thentheoperator，seizingwithhishandtheaffectedarm，istopullit，whilewithhisheelinthearmpithepushesinthecontrarydirection，therightheelbeingplacedintherightarmpit，andtheleftheelintheleftarmpit。Butaroundballofasuitablesizemustbeplacedinthehollowofthearmpit；themostconvenientareverysmallandhardballs，formedfromseveralpiecesofleathersewedtogether。Forwithoutsomethingofthekindtheheelcannotreachtotheheadofthehumerus，since，whenthearmisstretched，thearmpitbecomeshollow，thetendonsonbothsidesofthearmpitmakingcounter—contractionsoastoopposethereduction。Butanotherpersonshouldbeseatedontheothersideofthepatienttoholdthesoundshoulder，sothatthebodymaynotbedraggedalongwhenthearmoftheaffectedsideispulled；andthen，whentheballisplacedinthearmpit，asupplepieceofthongsufficientlybroadistobeplacedroundit，andsomepersontakingholdofitstwoendsistoseathimselfabovethepatient’sheadtomadecounter—extension，whileatthesametimehepusheswithhisfootagainsttheboneatthetopoftheshoulder。Theballshouldbeplacedasmuchontheinsideaspossible，upontheribs，andnotupontheheadofthehumerus。
4。Thereisanothermethodofreductionperformedbytheshoulderofapersonstanding。Thepersonoperatinginthisway，whoshouldbetallerthanthepatient，istotakeholdofhisarmandplacethesharppointofhisownshoulderinthepatient’sarmpit，andpushitinsothatitmaylodgethere，andhavingforhisobjectthatthepatientmaybesuspendedathisbackbythearmpit，hemustraisehimselfhigheronthisshoulderthantheother；andhemustbringthearmofthesuspendedpatientasquicklyaspossibletohisownbreast。Inthispositionheshouldshakethepatientwhenheraiseshimup，inorderthattherestofthebodymaybeacounterpoisetothearmwhichisthusheld。Butifthepatientbeverylight，alightchildshouldbesuspendedbehindalongwithhim。Thesemethodsofreductionareallofeasyapplicationinthepalestra，astheycanallbeperformedwithoutinstruments，buttheyalsobeusedelsewhere。
5。Thosewhoaccomplishthereductionbyforciblybendingitroundapestle，operateinamannerwhichisnearlynatural。Butthepestleshouldbewrappedinasoftshawl（forthusitwillbelessslippery），anditshouldbeforcedbetweentheribsandtheheadofthehumerus。Andifthepestlebeshort，thepatientshouldbeseateduponsomething，thathisarmcanwithdifficultypassabovethepestle。Butforthemostpartthepestleshouldbelonger，sothatthepatientwhenstandingmaybealmostsuspendeduponthepieceofwood。Andthenthearmandforearmshouldbestretchedalongthepestle，whilstsomepersonsecurestheoppositesideofthebodybythrowinghisarmsroundtheneck，neartheclavicle。
6。Butthemethodwithaladderisanotherofthesamekind，andstillbetter，sincebyitthebodycanbemoresafelycounterpoisedonthisside；andthat，whileinthemethodwhichthepieceofwoodresemblingapestle，thereisdangerofthebodytumblingtoeitherside。Butsomeroundthingshouldbetieduponthestepoftheladderwhichmaybefittedtothearmpit，wherebytheheadofthebonemaybeforcedintoitsnaturalplace。
7。Thefollowing，however，isthestrongestofallthemethodsofreduction。Wemustgetapieceofwood，five，oratleastfourinchesbroad，twoinchesinthickness，orstillthinner，andtwocubitsinlength，oralittleless；anditsextremityatoneendshouldberounded，andmadeverynarrowandveryslenderthere，anditshouldhaveaslightlyprojectingedge（ambe）onitsroundextremity，notonthepartthatistobeappliedtotheside，buttotheheadofthehumerus，sothatitmaybeadjustedinthearmpitatthesidesundertheheadofthehumerus；andapieceofsoftshawlorclothshouldbegluedtotheendofthepieceofwood，soastogivethelesspainuponpressure。Thenhavingpushedtheheadofthispieceofwoodasfarinwardaspossiblebetweentheribsandtheheadofthehumerus，thewholearmistobestretchedalongthispieceofwood，andistobeboundroundatthearm，thefore—arm，andthewrist，sothatitmaybeparticularlywellsecured；butgreatpainsshouldbetakenthattheextremityofthispieceofwoodshouldbeintroducedasfaraspossibleintothearmpit，andthatitiscarriedpasttheheadofthehumerus。Thenacross—beamistobesecurelyfastenedbetweentwopillars，andafterwardthearmwiththepieceofwoodattachedtoitistobebroughtoverthiscross—beam，sothatthearmmaybeontheonesideofitandthebodyontheother，andthecross—beaminthearmpit；andthenthearmwiththepieceofwoodistobeforceddownontheonesideofthecross—beam，andtherestofthebodyontheother。Thecross—beamistobeboundsohighthattherestofthebodymayberaisedupontip—toes。Thisisbyfarthemostpowerfulmethodofeffectingreductionoftheshoulder；foronethusoperateswiththeleveruponthemostcorrectprinciples，providedonlythepieceofwoodbeplacedasmuchaspossiblewithintheheadofthehumerus，andthusalsothecounter—balancingweightswillbemostproperlyadjusted，andsafelyappliedtotheboneofthearm。Whereforerecentcasesinthiswaymaybereducedmorequicklythancouldbebelieved，beforeevenextensionwouldappeartobeapplied；andthisistheonlymodeofreductioncapableofreplacingolddislocations，andthisitwilleffect，unlessfleshhasalreadyfilledupthe（glenoid）cavity，andtheheadofthehumerushasformedasocketforitselfintheplacetowhichithasbeendisplaced；andeveninsuchanoldcaseofdislocation，itappearstomethatwecouldeffectreduction（forwhatobjectwouldaleverpowerproperlyappliednotitmove？），butitwouldnotremaininitsplace，butwouldbeagaindisplacedasformerly。Thesamethingmaybeeffectedbymeansoftheladder，bypreparingitinthesamemanner。Ifthedislocationberecent，alargeThessalianchairmaybesufficienttoaccomplishthispurpose；thewood，however，shouldbedressedupasdescribedbefore；butthepatientshouldbeseatedsidewaysonthechair，andthenthearm，withthepieceofwoodattachedtoit，istobebroughtoverthebackofthechair，andforceistobeappliedtothearm，withthewoodontheoneside，andthebodyontheotherside。Thesamemeansmaybeappliedwithadoubledoor。Oneshouldalwaysusewhathappenstobeathand。
8。Whereforeitshouldbeknownthatoneconstitutiondiffersmuchfromanotherastothefacilitywithwhichdislocationsinthemmaybereduced，andonearticularcavitydiffersmuchfromanother，theonebeingsoconstructedthatthebonereadilyleapsoutandanotherlessso；butthegreatestdifferenceregardsthebindingtogetherofthepartsbythenerves（ligaments？）whichareslackinsomeandtightinothers。Forthehumidityinthejointsofmenisconnectedwiththestateoftheligaments，whentheyareslackandyielding；foryoumayseemanypeoplewhoaresohumid（flabby？）thatwhentheychoosetheycandisarticulatetheirjointswithoutpain，andreducetheminlikemanner。Thehabitofthebodyalsooccasionsacertaindifference，forinthosewhoareinastateofembonpointandfleshythejointisrarelydislocated，butismoredifficulttoreduce；butwhentheyaremoreattenuatedandleanerthanusual，thentheyaresubjecttodislocationswhicharemoreeasilyreduced。Andthefollowingobservationisaproofthatmattersareso；forincattlethethighsaremostapttobedislocatedatthehip—joint，whentheyaremostparticularlylean，whichtheyareattheendofwinter，atwhichtimethentheyareparticularlysubjecttodislocations（ifI
maybeallowedtomakesuchanobservationwhiletreatingofamedicalsubject）；andthereforeHomerhaswellremarked，thatofallbeastsoxensufferthemostatthatseason，andespeciallythoseemployedattheplowasbeingworkedinthewinterseason。Inthem，therefore，dislocationshappenmostfrequently，asbeingatthattimemostparticularlyreducedinflesh。Andothercattlecancropthegrasswhenitisshort，buttheoxcannotdosountilitbecomeslong；
for，intheothers，theprojectionofthelipisslender，andsoistheupperlip，butintheoxtheprojectionofthelipisthick，andtheupperjawisthickandobtuse，andthereforetheyareincapableofseizingshortherbs。Butthesolidungulaashavingprominentteethinboththeirfrontjaws，cancropthegrassandgraspitwiththeirteethwhileshort，anddelightmoreinshortgrassthaninrank；
for，ingeneral，shortgrassisbetterandmoresubstantialthanrank，ashavingnotyetgivenoutitsfructification。Whereforethepoethasthefollowingline：
Aswhentohornedcattledearthevernalseasoncomes，*
becauserankgrassappearstobemostsoughtafterbythem。Butotherwiseintheox，thisjointisslackerthaninotheranimals，and，therefore，thisanimaldragshisfootinwalkingmorethananyother，andespeciallywhenlankandold。Forallthesereasonstheoxismostparticularlysubjecttodislocations；andIhavemadethemoreobservationsrespectinghim，astheyconfirmallthatwassaidbeforeonthissubject。Withregard，then，tothematteronhand，I
saythatdislocationsoccurmorereadily，andaremorespeedilyreducedinthosewhoareleanthaninthosewhoarefleshy；andinthosewhoarehumidandlankthereislessinflammationthaninsuchasaredryandfleshy，andtheyarelesscompactlyknithereafter，andthereismoremucositythanusualincasesnotattendedwithinflammation，andhencethejointsaremoreliabletoluxations；
for，inthemain，thearticulationsaremoresubjecttomucositiesinthosewhoareleanthaninthosewhoarefleshy；andthefleshofleanpersonswhohavenotbeenreducedbyapropercourseofdisciplineaboundsmorewithmucositythanthatoffatpersons。Butinthosecasesinwhichthemucosityisaccompaniedwithinflammation，theinflammationbinds（braces？）thejoint，andhencethosewhohavesmallcollectionsofmucositiesarenotverysubjecttodislocations，whichtheywouldbeifthemucosityhadnotbeenaccompaniedwithmoreorlessinflammation。
*ThereisnosuchlineintheworksofHomerastheyhavecomedowntous。
9。Incasesofdislocationthosepersonswhoarenotattackedwithinflammationofthesurroundingparts，canusetheshoulderimmediatelywithoutpain，anddonotthinkitnecessarytotakeanyprecautionswiththemselves；itisthereforethebusinessofthephysiciantowarnthembeforehandthatdislocationismorelikelytoreturninsuchcasesthanwhenthetendonshavebeeninflamed。Thisremarkappliestoallthearticulations，butparticularlytothoseoftheshoulderandknee，forthesearethejointsmostsubjecttoluxations。Butthosewhohaveinflammationoftheligamentscannotusetheshoulder，forthepainandthetensioninducedbytheinflammationpreventthem。Suchcasesaretobetreatedwithcerate，compresses，andplentyofbandages；butaballofsoftcleanwoolistobeintroducedintothearmpit，tofillupthehollowofit，thatitmaybeasupporttothebandaging，andmaintainthejointinsitu。Thearm，ingeneral，shouldbeinclinedupwardasmuchaspossible，forthusitwillbekeptatthegreatestpossibledistancefromtheplaceatwhichtheheadofthehumerusescaped。Andwhenyoubandagetheshoulderyoumustfastenthearmstothesideswithaband，whichistobecarriedroundthebody。Theshouldershouldberubbedgentlyandsoftly。Thephysicianoughttobeacquaintedwithmanythings，andamongotherswithfriction；forfromthesamenamethesameresultsarenotalwaysobtained；forfrictioncouldbraceajointwhenunseasonablyrelaxed，andrelaxitwhenunseasonablyhard；butwewilldefinewhatweknowrespectingfrictioninanotherplace。Theshoulder，then，insuchastate，shouldberubbedwithsofthands；
and，moreover，inagentlemanner，andthejointshouldbemovedabout，butnotroughly，soastoexcitepain。Thingsgetrestoredsometimesinagreaterspaceoftime，andsometimesinasmaller。
10。Adislocationmayberecognizedbythefollowingsymptoms：—Sincethepartsofaman’sbodyareproportionatetooneanother，asthearmsandthelegs，thesoundshouldalwaysbecomparedwiththeunsound，andtheunsoundwiththesound，notpayingregardtothejointsofotherindividuals（foroneperson’sjointsaremoreprominentthananother’s），butlookingtothoseofthepatient，toascertainwhetherthesoundjointbeunliketheunsound。Thisisaproperrule，andyetitmayleadtomucherror；andonthisaccountitisnotsufficienttoknowthisartintheory，butalsobyactualpractice；formanypersonsfrompain，orfromanyothercause，whentheirjointsarenotdislocated，cannotputthepartsintothesamepositionsasthesoundbodycanbeputinto；oneoughtthereforetoknowandbeacquaintedbeforehandwithsuchanattitude。Butinadislocatedjointtheheadofthehumerusappearslyingmuchmoreinthearmpitthanitisinthesoundjoint；andalso，above，atthetopoftheshoulder，thepartappearshollow，andtheacromionisprominent，owingtotheboneofthejointhavingsunkintothepartbelow；thereisasourceoferrorinthiscasealso，aswillbedescribedafterward，foritdeservestobedescribed；andalso，theelbowofthedislocatedarmisfartherremovedfromtheribsthanthatoftheother；butbyusingforceitmaybeapproximated，thoughwithconsiderablepain；andalsotheycannot，withtheelbowextended，raisethearmtotheear，astheycanthesoundarm，normoveitaboutasformerlyinthisdirectionandthat。These，then，arethesymptomsofdislocationattheshoulder。Themethodsofreductionandthetreatmentareasdescribed。
11。Itdeservestobeknownhowashoulderwhichissubjecttofrequentdislocationsshouldbetreated。Formanypersonsowingtothisaccidenthavebeenobligedtoabandongymnasticexercises，thoughotherwisewellqualifiedforthem；andfromthesamemisfortunehavebecomeineptinwarlikepractices，andhavethusperished。Andthissubjectdeservestobenoticed，becauseIhaveneverknownanyphysiciantreatthecaseproperly；someabandontheattemptaltogether，andothersholdopinionsandpracticetheverywhatisproper。Forphysicianshaveburnedtheshoulderssubjecttodislocation，atthetopoftheshoulder，attheanteriorpartwheretheheadofthehumerusprotrudes，andalittlebehindthetopoftheshoulder；theseburnings，ifthedislocationofthearmwereupward，orforward，orbackward，wouldhavebeenproperlyperformed；
butnow，whenthedislocationisdownward，theyratherpromotethanpreventdislocations，fortheyshutouttheheadofthehumerusfromthefreespaceabove。Thecauteryshouldbeappliedthus：takingholdwiththehandsoftheskinatthearmpit，itistobedrawnintotheline，inwhichtheheadofthehumerusisdislocated；andthentheskinthusdrawnasideistobeburnttotheoppositeside。
Theburningsshouldbeperformedwithirons，whicharenotthicknormuchrounded，butofanoblongform（forthustheypassthemorereadilythrough），andtheyaretobepushedforwardwiththehand；thecauteriesshouldbered—hot，thattheymaypassthroughasquicklyaspossible；forsuchasarethickpassthroughslowly，andoccasionescharsofagreaterbreadththanconvenient，andthereisdangerthatthecicatricesmaybreakintooneanother；which，althoughnothingverybad，ismostunseemly，orawkward。Whenyouhaveburntthrough，itwillbesufficient，inmostcases，tomakeescharsonlyinthelowerpart；butifthereisnodangeroftheulcerspassingintooneanother，andthereisaconsiderablepieceofskinbetweenthem，athinspatulaistobepushedthroughtheseholeswhichhavebeenburned，while，atthesametime，theskinisstretched，forotherwisetheinstrumentcouldnotpassthrough；butwhenyouhavepasseditthroughyoumustletgotheskin，andthenbetweenthetwoescharsyoushouldformanotherescharwithaslenderiron，andburnthroughuntilyoucomeincontactwiththespatula。Thefollowingdirectionsenableyoutodeterminehowmuchoftheskinofthearmpitshouldbegrasped；allmenhaveglandsinthearmpitgreaterorsmaller，andalsoinmanyotherpartsofthebody。ButIwilltreatinanotherworkofthewholeconstitutionoftheglands，andexplainwhattheyare，whattheysignify，andwhataretheiroffices。Theglands，then，arenottobetakenholdof，northepartsinternaltotheglands；forthiswouldbeattendedwithgreatdanger，astheyareadjacenttothemostimportantnerves。Butthegreaterpartofthesubstancesexternaltotheglandsaretobegrasped，forthereisnodangerfromthem。Andthis，also，itispropertoknow，thatifyouraisethearmmuch，youwillnotbeabletograspanyquantityofskinworthmentioning，foritisalltakenupwiththestretching；andalsothenerves。whichbyallmeansyoumustavoidwounding，becomeexposedandstretchedinthisposition；butifyouonlyraisethearmalittle，youcangraspalargequantityofskin，andthenerveswhichyououghttoguardagainstareleftwithin，andatadistancefromtheoperation。Shouldnot，then，theutmostpainsbetakeninthewholepracticeofthearttofindouttheproperattitudeineverycase？
Somuchregardingthearmpit，andthesecontractionswillbesufficient，providedtheescharsbeproperlyplaced。Withoutthearmpitthereareonlytwoplaceswhereonemightplacetheescharstoobviatethisaffection；theonebeforeandbetweentheheadofthehumerusandthetendonatthearmpit；andthentheskinmaybefairlyburnedthrough，butnottoanygreatdepth，forthereisalargeveinadjacent，andalsonerves，neitherofwhichmustbetouchedwiththeheat。Butexternally，onemayformanotherescharconsiderablyabovethetendonatthearmpit，butalittlebelowtheheadofthehumerus；andtheskinmustbeburnedfairlythrough，butitmustnotbemadeverydeep，forfireisinimicaltothenerves。
Throughthewholetreatmentthesoresaretobesotreated，astoavoidallstrongextensionofthearm，andthisistobedonemoderately，andonlyasfarasthedressingrequires；forthustheywillbelesscooled（foritisofimportancetocoverupallsortsofburnsifonewouldtreatthemmildly），andthenthelipsofthemwillbelessturnedaside；therewillbelesshemorrhageandfearofconvulsions。Butwhenthesoreshavebecomeclean，andaregoingontocicatrization，thenbyallmeansthearmistobeboundtothesidenightandday；andevenwhentheulcersarecompletelyhealed，thearmmuststillbeboundtothesideforalongtime；forthusmoreespeciallywillcicatrizationtakeplace，andthewidespaceintowhichthehumerususedtoescapewillbecomecontracted。
12。Whenattemptstoreduceadislocatedshoulderhavefailed，ifthepatientbestillgrowing，theboneoftheaffectedarmwillnotincreaselikethesoundone，foralthoughitdoesincreaseinsofaritbecomesshorterthantheother；andthosepersonscalledweasel—armed，becomesofromtwoaccidents，eitherfromhavingmetwiththisdislocationinutero，orfromanotheraccident，whichwillbedescribedafterward。Butthosewhowhiletheywerechildrenhavehaddeep—seatedsuppurationsabouttheheadofthebone，allbecomeweasel—armed；andthis，itshouldbewellknown，willbetheissue，whethertheabscessbeopenedbyanincisionorcautery，orwhetheritbreakspontaneously。Thosewhoarethusaffectedfrombirtharequiteabletousethearmyetneithercantheyraisethearmtotheear，byextendingtheelbow，buttheydothismuchlessefficientlythanwiththesoundarm。Butinthosewhohavehadtheshoulderdislocatedaftertheyweregrownup，andwhenithasnotbeenreduced，thetopoftheshoulderbecomesmuchlessfleshy，andthehabitofbodyatthatpartisattenuated；butwhentheyceasetohavepain，whatevertheyattempttoperformbyraisingtheelbowfromthesidesobliquely，theycannolongeraccomplishasformerly；butwhateveractsareperformedbycarryingthearmaroundbythesides，eitherbackwardorforward，allthosetheycanperform；fortheycanworkwithanaugerorasaw，orwithahatchet，andcandig，bynotraisingtheelbowtoomuch，anddoallotherkindsofworkwhicharedoneinsimilarattitudes。
13。Inthosecaseswheretheacromionhasbeentornoff，thebonewhichisthusseparatedappearsprominent。Theboneisthebondofconnectionbetweentheclavicleandscapula，forinthisrespecttheconstitutionofmanisdifferentfromthatofotheranimals；
physiciansareparticularlyliabletobedeceivedinthisaccident（forastheseparatedboneprotrudes，thetopoftheshoulderappearslowandhollow），sothattheymakepreparationsasiffordislocationoftheshoulder；forIhaveknownmanyphysicians，otherwisenotinexpertattheart，whohavedonemuchmischiefbyattemptingtoreducesuchshoulders，thussupposingitacaseofdislocation；andtheydidnotdesistuntiltheygaveovermistakeofsupposingthattheyhadreducedtheshoulder。Thetreatment，inthesecases，issimilartothatwhichisapplicableinothersofalikekind，namely，cerate，compresses，andsuitablebandagingwithlinencloths。Theprojectingpartmustbepusheddown，andthegreaternumberofcompressesaretobeplacedonit，andmostcompressionistobeappliedatthatpart，andthearmbeingfastenedtothesideistobekeptelevated；forthusthepartswhichhadbeentornasunderarebroughtintoclosestproximitywithoneanother。Allthisshouldbewellknown，andifyouchooseyoumayprognosticatesafelythatnoimpediment，smallorgreat，willresultfromsuchaninjuryattheshoulder，onlytherewillbeadeformityintheplace，forthebonecannotbeproperlyrestoredtoitsnaturalsituation，buttheremustnecessarilybemoreorlesstumefactionintheupperpart。Forneithercananyotherbonebemadeexactlyasitwas，whichhavingbecomeincorporatedwithanotherbone，andhavinggrowntoitasanapophysis，hasbeentornfromitsnaturalsituation。Ifproperlybandaged，theacromionbecomesfreeofpaininafewdays。
14。Whenafracturedclavicleisfairlybrokenacrossitismoreeasilytreated，butwhenbrokenobliquelyitismoredifficulttomanage。Mattersaredifferentinthesecasesfromwhatonewouldhavesupposed；forabonefairlybrokenacrosscanbemoreeasilyrestoredtoitsnaturalstate，andwithpropercaretheupperpartmaybebroughtdownbymeansofsuitablepositionandproperbandaging，andevenifnotproperlyset，theprojectingpartoftheboneisnotverysharp。Butinobliquefracturesthecaseissimilartothatofboneswhichhavebeentornaway，asformerlydescribed；fortheydonotadmitofbeingrestoredtotheirplace，andtheprominenceoftheboneisverysharp。Forthemostpart，then，itshouldbeknown，noharmresultstotheshoulderortotherestofthebodyfromfractureoftheclavicle，unlessitsphacelate，andthisrarelyhappens。Adeformity，however，mayarisefromfractureoftheclavicle，andinthesecasesitisverygreatatfirst，butbyandbyitbecomesless。Afracturedclavicle，likeallotherspongybones，getsspeedilyunited；forallsuchbonesformcallusinashorttime。When，then，afracturehasrecentlytakenplace，thepatientsattachmuchimportancetoit，assupposingthemischiefgreaterthanitreallyis，andthephysiciansbestowgreatpainsinorderthatitmaybeproperlybandaged；butinalittletimethepatients，havingnopain，norfindinganyimpedimenttotheirwalkingoreating，becomenegligent；andthephysiciansfindingtheycannotmakethepartslookwell，takethemselvesoff，andarenotsorryattheneglectofthepatients，andinthemeantimethecallusisquicklyformed。Themethodofdressingwhichismostappropriate，issimilartothatusedinordinarycases，consistingofcerate，compresses，andbandages；anditshouldbemostespeciallyknowninthisoperation，thatmostcompressesshouldbeplacedontheprojectingbone，andthatthegreatestpressureshouldbemadethere。Therearecertainphysicianswhomakeashowofsuperiorskillbybindingaheavypieceofleadonthepartinordertodepresstheprojectingbone；butthismodeoftreatmentdoesnotapplytotheclavicle，foritisimpossibletodepresstheprojectingparttoanyextentworthmentioning。Thereareotherswho，knowingthefactthatthebandagesareapttoslipoff，andthattheydonotkeeptheprojectingpartsintheirplace，applycompressesandbandagesliketheothers，andthenhavinggirtthepatientwithagirdle，whereitisusuallyappliedwithmosteffect，theymakeaheapofthecompressesuponofthecompressesupontheprojectingbonewhentheyapplythem，andhavingfastenedtheheadofthebandagetothegirdleinfront，theyapplyitsoastobringtheturnsofitintothelineoftheclavicle，carryingthemtotheback，andthenbringingthemaroundthegirdletheycarrythemtotheforepartandagainbackward。Thereareotherswhodonotapplythebandageroundthegirdle，butcarrytheroundsofitbytheperineumandanus，andalongthespine，soastocompressthefracture。Toaninexperiencedpersonthesemethodswillappearnotfarfromnatural，butwhentied，theywillbefoundofnoservice；fortheydonotremainfirmanylengthoftime，evenifthepatientkeephisbed，althoughinthispositiontheyanswerbest；andyetevenwhenlyinginbed，shouldhebendhisleg，orshouldhistrunkbebent，allthewillbedisplaced；and，moreover，thebandagingisinconvenient，inasmuchastheanusiscomprehendedbyit，andmanyturnsofthebandagearecrowdedthereinanarrowspace。Andinthemethodwiththegirdle，thegirdlecannotbesofirmlygirtaround，butthattheturnsofthebandageforcethegirdletoascend，andhenceofnecessityalltheotherbandagesmustbeslackened。Hewouldseemtometocomenearesthispurpose，althoughafterallheeffectsbutlittle，whowouldtakeafewturnsroundthegirdle，fewturnsroundthegirdle，butwouldusethebandageprincipallytosecuretheformerbandaging；forinthismannerthebandageswouldbemostsecure，andwouldmutuallyassistoneanother。Everythingnowalmosthasbeensaidwhichappliestofractureoftheclavicle。Butthisalsoshouldbeknown，thatinfracturesoftheclavicle，itisthepartattachedtothebreastwhichisuppermost，andthatthepieceattachedtotheacromionisthelowermost。Thecauseofthisis，thatforthemostpartthebreastcanneitherbedepressednorraised，therebeingbutaslightmovementofthejointatthebreast，forthesternumisconnectedtogetheronbothsideswiththespine。Theclavicleadmitsofmostmotionatthejointoftheshoulder，andthisarisesfromitsconnectionwiththeacromion。And，moreover，whenbroken，thepartwhichisconnectedwiththesternumfliesupward，andisnoteasilyforceddownward；foritisnaturallylight，andthereismoreroomforitabovethanbelow。Buttheshoulder，thearm，andthepartsconnectedwiththem，areeasilymovedfromthesidesandbreast，and，onthataccount，theyadmitofbeingconsiderablyelevatedanddepressed。When，therefore，theclavicleisbroken，thefragmentattachedtotheshoulderinclinesdownward，foritinclinesmuchmorereadilywiththeshoulderandarmdownwardthanupward。MattersbeingasIhavestated，theyactimprudentlywhothinktodepresstheprojectingendofthebone。Butitisclearthattheunderpartoughttobebroughttotheupper，fortheformeristhemovablepart，andthatwhichhasbeendisplacedfromitsnaturalposition。
Itisobvious，therefore，thatthereisnootherwayofapplyingforcetoit（forthebandagesnomoreforceittothantheyforceitfrom）；butifonewillpushthearmwhenatthesidesasmuchaspossibleupward，sothattheshouldermayappearassharpaspossible，itisclearthatinthiswayitwillbeadjustedtothefragmentoftheboneconnectedwiththebreastfromwhichitwastorn。Ifonethenwillapplyabandage，secundumartem，forthepurposeofpromotingaspeedycure，andwillreckoneverythingelseofnovalue，exceptthepositionasdescribed，hewillformacorrectopinionofthecase，andwilleffectacureinthespeediestandmostappropriatemanner。Itisofgreatimportance，however，thatthepatientshouldlieinarecumbentposture。Fourteendayswillbesufficientifhekeepquiet，andtwentyatmost。
15。Butiftheclaviclebefracturedintheoppositemanner（whichdoesnotreadilyhappen），sothatthefragmentofboneconnectedwiththebreastisdepressed，whilethepiececonnectedwiththeacromionisraisedupandridesoverother，thiscasedoesnotrequiremuchmanagement，foriftheshoulderandarmbeletgo，thefragmentsofthebonewillbeadjustedtooneanother，andanordinarybandagewillsuffice，andthecalluswillbeformedinthecourseofafewdays。
16。Ifthefracturebenotthus，butifitinclineeitherforwardorbackward，itmayberestoredtoitsnaturalposition，byraisingtheshoulderwiththearmasformerlydescribed，andbroughtbacktoitsnaturalplace，whenthecurewillbespeedilyaccomplished。Mostofthevarietiesofdisplacementmayberectifiedbyraisingthearmupward。Whentheupperboneisdisplacedlaterallyordownward，itwouldfavortheadaptationofthepartsifthepatientwouldlieonhisback，andifsomeelevatedsubstancewereplacedbetweentheshoulder—blades，sothatthebreastmaybedepressedasmuchaspossibleuponthetwosides；andif，whileanotherpersonraisedthearmextendedalongthesides，thephysician，applyingthepalmoftheonehandtotheheadofthebone，wouldpushitaway，andwiththeotherwouldadjustthebrokenbones，hewouldthusreducethepartsmostreadilytotheirnaturalposition。But，asformerlystated，theupperbone（sternalfragment？）israrelydepresseddownward。Inmostcases，afterthebandageshavebeenapplied，thatpositionisbeneficialinwhichtheelbowisfixedtothesameside，andtheshoulderiskeptelevated；butincertaincases，theshoulderistoberaised，ashasbeendirected，andtheelbowistobebroughtforwardtothebreast，andthehandlaidontheacromionofthesoundside。Ifthepatienthastheresolutiontolieinbed，somethingshouldbeplacedsoastosupporttheshoulder，andkeepitasmuchelevatedaspossible。Butifhewalkabout，thearmshouldbeslunginashawl，whichembracesthepointoftheelbow，andispassedroundtheneck。
17。Whentheelbow—jointisdisplacedordislocatedtothesideoroutward，whileitssharppoint（olecranon？）remainsinthecavityofthehumerus，extensionistobemadeinastraightline，andtheprojectingpartistobepushedbackwardandtotheside。
18。Incompletedislocationstowardeitherside，extensionistobemadeasinbandagingfractureofthearm；forthustheroundedpartoftheelbowwillnotformanobstacletoit。Dislocation，forthemostpart，takesplacetowardthesides（inwardly？）。Reductionistobeeffectedbyseparating（thebones）asmuchaspossible，sothattheend（ofthehumerus）maynotcomeincontactwiththeolecranon，anditistobecarriedup，andturnedround，andnotforcedinastraightline，and，atthesametime，theoppositesidesaretobepushedtogether，andpropelledintotheirproperplace。Itwillfurtherassistifrotationofthefore—armbemadeattheelbow，sometimesturningitintoasupineposition，andsometimesintoaprone。Thepositionforthetreatmentconsistsinkeepingthehandalittlehigherthantheelbow，andthearmatthesides；thenitmayeitherbesuspendedorlaidatrest，foreitherpositionwillanswer；andnatureandtheusageofcommonmeanswillaccomplishthecure，ifthecallusdoesnotformimproperly：itisformedquickly。Thetreatmentistobeconductedwithbandagesaccordingtotheruleforbandagingarticulations，andthepointoftheelbowistobeincludedinthebandage。
19。Dislocationsattheelbowgiverisetothemostseriousconsequences，suchasfevers，pain，nausea，vomitingsofpurebile，andmoreespeciallywhenthehumerusisdisplacedbackwardfrompressureonthenerve，whichoccasionsnumbness；nexttoitisthedislocationforward；thetreatmentisthesame；reductionindislocationbackwardisbyextensionandadaptation；thesymptomofthisvariety—lossofthepowerofextension；ofdislocationforward—lossofthepowerofflexion，andinthiscasereductionistobeaccomplishedbyplacingahardball（inthebendoftheelbow），andbendingthefore—armaboutit，alongwithsuddenextension。
20。Diastasisofthebonesmayberecognizedbyexaminingthepartwheretheveinthatrunsalongthearmdivides。
21。Inthosecasescallusisquicklyformed。Incongenitaldislocationsthebonesbelowtheseatoftheinjuryareshorterthannatural，and，mostly，thosenearesttotheplace；namely，thebonesofthefore—arm，nextthoseofthehand；and，third，thoseofthefingers。Thearmandshoulderarestronger，owingtothenourishmentwhichtheyreceive，andtheotherarm，fromtheadditionalworkwhichithastoperform，isstillmorestrong。Wastingofthefleshtakesplaceontheinsideifthedislocationbeontheoutside；orotherwise，onthesideoppositethedislocation。
22。Whentheelbowisdislocatedeitherinwardoroutward，extensionistobemadewiththefore—armatarightangletothearm；thearm，suspendedbymeansofashawlpassedthroughthearmpit，andaweightattachedtotheextremityoftheelbow；orforcemaybeappliedwiththehands；whenthearticularextremityhasbeencleared，thedisplacedpartsaretoberectifiedwiththepalmsofthehand，asindislocationsofthehands。Itistobebandaged，suspendedinasling，andplacedwhileinthisattitude。
23。Dislocationsbackwardaretoberectifiedbythepalmsofthehands，alongwithsuddenextension；thetwoactsaretobeperformedtogether，asinothercasesofthekind。Butindislocationforwardthearmistobebentaroundaballofclothofpropersize，andatthesametimereplaced。
24。Butifthedisplacementbeontheotherside，boththeseoperationsaretobeperformedineffectingtheadjustment。Forconductingthetreatment，thepositionandbandagingarethesameasintheothercases。Butallthesecasesmaybereducedbyordinarydistention。
25。Ofthemethodsofreduction，someoperatebyraisingupthepart，somebyextension，andsomebyrotation：thelastconsistsinrapidlyturningthefore—armtothissideandthat。
26。Thejointofthehandisdislocatedeitherinwardoroutward，mostfrequentlyinward。Thesymptomsareeasilyrecognized：ifinward，thepatientcannotatallbendhisfingers；andifoutward，hecannotextendthem。Withregardtothereduction，—byplacingthefingersaboveatable，extensionandcounter—extensionaretobemadebyotherpersons，whilewiththepalmorheelofthehandontheprojectingboneonepushesforward，andanotherfrombehindontheotherbone；somesoftsubstanceistobeappliedtoit，andthearmistobeturnedtothepronepositionifthedislocationwasforward，buttothesupine，ifbackward。Thetreatmentistobeconductedwithbandages。
27。Thewholehandisdislocatedeitherinwardoroutward，ortothissideorthat，butmoreespeciallyinward；andsometimestheepiphysisisdisplaced，andsometimestheotherofthesebonesisseparated。Inthesecasesstrongextensionistobeapplied，andpressureistobemadeontheprojectingbone，andcounter—pressureontheoppositeside，bothatthesametime，behindandattheside，withthehandsuponatable，orwiththeheel。Theseaccidentsgiverisetoseriousconsequencesanddeformities；butinthecourseoftimethepartgetsstrong，andadmitsofbeingused。Thecureiswithbandages，whichoughttoembraceboththehandandfore—arm；andsplintsaretobeappliedasfarasthefingers；andwhentheyareusedtheyshouldbemorefrequentlyunloosedthaninfractures，andmorecopiousaffusionsofwatershouldbeused。
28。Incongenitaldislocations（atthewrist）thehandbecomesshortened，andtheatrophyofthefleshoccurs，forthemostpart，onthesideoppositetothedislocation。Inanadultthebonesremainoftheirnaturalsize。
29。Dislocationatthejointofafingeriseasilyrecognized。
Reductionistobeeffectedbymakingextensioninastraightline，andapplyingpressureontheprojectingbone，andcounter—pressureontheoppositesideoftheother。Thetreatmentiswithbandages。
Whennotreduced，callusisformedoutsideofthejoint。Whenthedislocationtakesplaceatbirth，duringadolescencethebonesbelowthedislocationareshortened，andthefleshiswastedratherontheoppositethanonthesamesidewiththedislocation。Whenitoccursinanadultthebonesremainoftheirpropersize。
30。Thejaw—bone，infewcases，iscompletelydislocated，forthezygomaticprocessformedfromtheupperjaw—bone（malar？）andthebonebehindtheear（temporal？）shutsuptheheadsoftheunderjaw，beingabovetheone（condyloidprocess？），andbelowtheother（coronoidprocess？）。Oftheseextremitiesofthelowerjaw，theone，fromitslength，isnotmuchexposedtoaccidents，whiletheother，thecoronoid，ismoreprominentthanthezygoma，andfromboththeseheadsnervoustendonsarise，withwhichthemusclescalledtemporalandmasseterareconnected；theyhavegotthesenamesfromtheiractionsandconnections；forineating，speaking，andtheotherfunctionalusesofthemouth，theupperjawisatrest，asbeingconnectedwiththeheadbysynarthrosis，andnotbydiarthrosis（enarthrosis？）：butthelowerjawhasmotion，foritisconnectedwiththeupperjawandtheheadbyenarthrosis。Wherefore，inconvulsionsandtetanus，thefirstsymptommanifestedisrigidityofthelowerjaw；andthereasonwhywoundsinthetemporalregionarefatalandinducecoma，willbestatedinanotherplace。Thesearethereasonswhycompletedislocationdoesnotreadilytakeplace，andthisisanotherreason，becausethereisseldomanecessityforswallowingsolargepiecesoffoodaswouldmakeamangapemorethanheeasilycan，anddislocationcouldnottakeplaceinanyotherpositionthaningreatgaping，bywhichthejawisdisplacedtoeitherside。Thiscircumstance，however，contributestodislocationthere；ofnerves（ligaments？）andmusclesaroundjoints，orconnectedwithjoints，suchasarefrequentlymovedinusingthememberarethemostyieldingtoextension，inthesamemanneraswell—dressedhidesyieldthemost。
Withregard，then，tothematteronhand，thejaw—boneisrarelydislocated，butisfrequentlyslackened（partiallydisplaced？）ingaping，inthesamemannerasmanyotherderangementsofmusclesandtendonsarise。Dislocationisparticularlyrecognizedbythesesymptoms：thelowerjawprotrudesforward，thereisdisplacementtotheoppositeside，thecoronoidprocessappearsmoreprominentthannaturalontheupperjaw，andthepatientcannotshuthislowerjawbutwithdifficulty。Themodeofreductionwhichwillapplyinsuchcasesisobvious：onepersonmustsecurethepatient’shead，andanother，takingholdofthelowerjawwithhisfingerswithinandwithoutatthechin，whilethepatientgapesasmuchashecan，firstmovesthelowerjawaboutforatime，pushingittothissideandthatwiththehand，anddirectingthepatienthimselftorelaxthejaw，tomoveitabout，andyieldasmuchaspossible；thenallofasuddentheoperatormustopenthemouth，whileheattendsatthesametimetothreepositions：forthelowerjawistobemovedfromtheplacetowhichitisdislocatedtoitsnaturalposition；itistobepushedbackward，andalongwiththesethejawsaretobebroughttogetherandkeptshut。Thisisthemethodofreduction，anditcannotbeperformedinanyotherway。Ashorttreatmentsuffices，awaxedcompressistobelaidon，andboundwithaloosebandage。Itissafertooperatewiththepatientlaidonhisback，andhisheadsupportedonaleathercushionwellfilled，sothatitmayyieldaslittleaspossible，butsomepersonmustholdthepatient’shead。
31。Whenthejawisdislocatedonbothsides，thetreatmentisthesame。Thepatientsarelessabletoshutthemouththanintheformervariety；andthejawprotrudesfartherinthiscase，butisnotdistorted；theabsenceofdistortionmayberecognizedbycomparingthecorrespondingrowsoftheteethintheupperandlowerjaws。Insuchcasesreductionshouldbeperformedasquicklyaspossible；themethodofreductionhasbeendescribedabove。Ifnotreduced，thepatient’slifewillbeindangerfromcontinualfevers，comaattendedwithstupor（forthesemuscles，whendisorderedandstretchedpreternaturally，inducecoma）；andthereisusuallydiarrheaattendedwithbillous，unmixed，andscantydejections；andthevomitings，ifany，consistofpurebile，andthepatientscommonlydieonthetenthday。
32。Infractureofthelowerjaw，whentheboneisnotfairlybrokenacross，andisstillpartiallyretained，butdisplaced，itshouldbeadjustedbyintroducingthefingersatthesideofthetongue，andmakingsuitablecounter—pressureontheoutside；andiftheteethatthewoundbedistortedandloosened，whentheboneisadjusted，theyshouldbeconnectedtogether，notonlytwo，butmoreofthem，withagoldthread，ifpossible，butotherwise，withalinenthread，untilthebonebeconsolidated，andthenthepartistobedressedwithcerate，afewcompresses，andafewbandages，whichshouldnotbeverytight，butratherloose。Foritshouldbewellknownthatinfractureofthejaw，dressingwithbandages，ifproperlyperformed，isoflittleadvantage，butoccasionsgreatmischiefifimproperlydone。Frequentexaminationsshouldbemadeaboutthetongue，andprolongedpressureshouldbeappliedwiththefingers，inordertorectifythedisplacedbone。Itwouldbebestifonecoulddosoconstantly，butthatisimpossible。
33。Butifthebonebefairlybrokenacross（this，however，rarelyhappens），itistobesetinthemannernowdescribed。Whenadjusted，theteetharetobefastenedtogetherasformerlydescribed，forthiswillcontributemuchtowardkeepingthepartsatrest，especiallyifproperlyfastened，andtheendsofthethreadsecuredwithknots。Butitisnoteasytodescribeexactlyinwritingthewholemanipulationofthecase；butthereadermustfigurethethingtohimselffromthedescriptiongiven。ThenonemusttakeapieceofCarthaginianleather；ifthepatientbeayoungerperson，itwillbesufficienttousetheouterskin，butifanadultthewholethicknessofthehidewillberequired；itistobecuttothebreadthofaboutthreeinches，orasmuchaswillberequired，andhavingsmearedthejawwithalittlegum（forthusitsticksmorepleasantly），theendoftheskinistobefastenedwiththegluenearthefracturedpartofthejaw，atthedistanceofaninchoralittlemore，fromthewound。Thispieceistobeappliedbelowthejaw；butthethongshouldhaveacutinit，inthedirectionofthechin，sothatitmaygooverthesharppointofthechin。Anotherpieceofthonglikethis，orsomewhatbroader，istobegluedtotheupperpartofthejaw，ataboutthesamedistancefromthewoundastheotherthong；thisthongshouldbesocutastoencircletheear。
Thethongsshouldbesharp—pointedatthepartwheretheyunite，andingluingthem，thefleshofthethongshouldbeturnedtothepatient’sskin，forinthiswayitwillbemoretenacious；thenwemuststretchthisthong，butstillmoresotheoneatthechin，inordertopreventthefragmentsofthejawfromridingovereachother，andthethongsaretobefastenedatthevertex，andthenabandageistobeboundroundtheforehead，andaproperapparatusistobeputoverall，topreventthebandagesfrombeingdisplaced。Thepatientshouldlieuponthesoundsideofthejaw，notrestinguponthejaw，butuponthehead。Heistobekeptonasparedietfortendays，andthennourishedwithoutdelay。Iftherebenoinflammationduringthefirstdays，thejawisconsolidatedintwentydays；forcallusquicklyformsinthis，asinalltheotherporousbones，providedtherebenosphacelus（exfoliation？）。Butmuchremainstobesaidonthesphacelusofbonesinanotherplace。Thismethodofdistentionwithgluedsubstancesismild，ofeasyapplication，andisusefulformanydislocationsinmanypartsofthebody。Thosephysicianswhohavenotjudgmentcombinedwiththeirdexterity，exposethemselvesinfracturesofthejaws，asinothercases，fortheyapplyavarietyofbandagestoafracturedjaw—bone，sometimesproperly，andsometimesimproperly。Forallsuchbandagingofafracturedjawbonehasatendencyrathertoderangethebonesconnectedwiththefracture，thantobringthemintotheirnaturalposition。
34。Butifthelowerjawbedisjointedatitssymphysisinthechin（thereisbutonesymphysisinthelowerjaw，butthereareseveralintheupper；butIamunwillingtodigressfromthesubject，asthesematterswillhavetobetoucheduponinotherkindsofdisease）—if，then，thesymphysisbeseparatedatthechin，itistheworkwhichanybodycanperform，torectifyit；forthepartwhichprotrudesistobepushedinwardbypressurewiththefingers，andthepartthatinclinesinwardistoforcedoutwardbypushingwiththefingersfromwithin。Itisafterhavingappliedextensiontoseparatethefragmentsthatthisistobedone，fortheywillthusbemoreeasilyrestoredtotheirnaturalposition，thanifoneshouldbringthemtogetherbyusingforce。Thisispropertobeknownasapplyingtoallsuchcases。Whenyouhavesettheparts，youmustfastentheteethonbothsidestooneanother，asformerlydirected。Thetreatmentistobeaccomplishedwithcerate，afewcompresses，andbandages。Thispart，inparticular，requiresashortbutcomplex（？）bandaging，foritisnearlycylindrical，thoughnotexactlyso；buttheturnofthebandageistobemade，iftherightjawwasdislocated，totherighthand（thatissaidtobetotherighthandwhentherighthandconductsthebandaging）；butiftheotherjawbetheseatofthedislocation，thebandagingistobemadeintheotherdirection。Andifmattersbeproperlyadjusted，andthepatientkeepquiet，therewillbeaspeedyrecovery，andtheteethwillbeuninjured；butifnot，therecoverywillbemoreprotracted，theteethwillbedistorted，willgivetrouble，andbecomeuseless。
35。Offracturesofthenosetherearemorethanonevariety，butthosewho，withoutjudgment，delightinfinebandagings，domuchmischief，mostespeciallyininjuriesaboutthenose。Forthisisthemostcomplexofalltheformsofbandaging，havingmostoftheturnsofthebandagecalled\"ascia，\"andrhomboidalintervalsanduncoveredspacesoftheskin。Ashasbeensaid，thosewhopracticemanipulationwithoutjudgmentarefondofmeetingwithacaseoffracturednose，thattheymayapplythebandage。Foradayortwo，then，thephysiciangloriesinhisperformance，andthepatientwhohasbeenbandagediswellpleased，butspeedilythepatientcomplainsoftheincumbranceofthebandage，andthephysicianissatisfied，becausehehashadanopportunityofshowinghisskillinapplyingacomplexbandagetothenose。Suchabandagingdoeseverythingtheveryreverseofwhatisproper；for，inthefirstplace，thosewhohavetheirnoseflattenedbythefracture，willclearlyhavethepartrenderedstillmoreflat，ifpressureabovebeappliedtoit；andfurther，thosecasesinwhichthenoseisdistortedtoeitherside，whetheratthecartilageorhigherup，willevidentlyderivenobenefitfrombandagingaboveit，butwillratherbeinjured；foritwillnotadmitofhavingcompressesproperlyarrangedoneithersideofthenose，andindeed，personsapplyingthisbandagedonotseektodothis。
36。Thisbandagingwouldappeartometoanswerbestwhentheskinsurroundingtheboneiscontusedonitsridgenearthemiddle，oriftheboneitselfhavesustainedsomeinjury，butnotagreatone，insuchcases，redundantcallusformsinthenose，andthepartbecomesalittletooprominent；andyet，eveninthesecases，thebandagingneednotrequiremuchtrouble，if，indeed，anybandagebeappliedatall；
foritisenoughifonelayawaxedcompressonthecontusion，andthenapplythedouble—headedbandage，thustakingoneturnwithit。
Thebestapplicationtosuchaccidentsisasmallcataplasmofwheatenflour，washed，andmixedupintoaviscidmass。Iftheflourbemadefromgoodwheat，andifitbeglutinous，itshouldbeusedaloneforallsuchcases，butifitbenotveryglutinous，alittleofthemannaoffrankincense，wellpulverized，istobemoistenedwithwater，andtheflouristobemixedupwithit，oraverylittlegummaybemixedinlikemanner。