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On The Articulations   


quiet, and twenty at most.

15. But if the clavicle be fractured in the opposite manner (which
does not readily happen), so that the fragment of bone connected
with the breast is depressed, while the piece connected with the
acromion is raised up and rides over other, this case does not require
much management, for if the shoulder and arm be let go, the
fragments of the bone will be adjusted to one another, and an ordinary
bandage will suffice, and the callus will be formed in the course of a
few days.

16. If the fracture be not thus, but if it incline either forward or
backward, it may be restored to its natural position, by raising the
shoulder with the arm as formerly described, and brought back to its
natural place, when the cure will be speedily accomplished. Most of
the varieties of displacement may be rectified by raising the arm
upward. When the upper bone is displaced laterally or downward, it
would favor the adaptation of the parts if the patient would lie on
his back, and if some elevated substance were placed between the
shoulder-blades, so that the breast may be depressed as much as
possible upon the two sides; and if, while another person raised the
arm extended along the sides, the physician, applying the palm of
the one hand to the head of the bone, would push it away, and with the
other would adjust the broken bones, he would thus reduce the parts
most readily to their natural position. But, as formerly stated, the
upper bone (sternal fragment?) is rarely depressed downward. In most
cases, after the bandages have been applied, that position is
beneficial in which the elbow is fixed to the same side, and the
shoulder is kept elevated; but in certain cases, the shoulder is to be
raised, as has been directed, and the elbow is to be brought forward
to the breast, and the hand laid on the acromion of the sound side. If
the patient has the resolution to lie in bed, something should be
placed so as to support the shoulder, and keep it as much elevated
as possible. But if he walk about, the arm should be slung in a shawl,
which embraces the point of the elbow, and is passed round the neck.

17. When the elbow-joint is displaced or dislocated to the side or
outward, while its sharp point (olecranon?) remains in the cavity of
the humerus, extension is to be made in a straight line, and the
projecting part is to be pushed backward and to the side.

18. In complete dislocations toward either side, extension is to
be made as in bandaging fracture of the arm; for thus the rounded part
of the elbow will not form an obstacle to it. Dislocation, for the
most part, takes place toward the sides (inwardly?). Reduction is to
be effected by separating (the bones) as much as possible, so that the
end (of the humerus) may not come in contact with the olecranon, and
it is to be carried up, and turned round, and not forced in a straight
line, and, at the same time, the opposite sides are to be pushed
together, and propelled into their proper place. It will further
assist if rotation of the fore-arm be made at the elbow, sometimes
turning it into a supine position, and sometimes into a prone. The
position for the treatment consists in keeping the hand a little
higher than the elbow, and the arm at the sides; then it may either be
suspended or laid at rest, for either position will answer; and nature
and the usage of common means will accomplish the cure, if the
callus does not form improperly: it is formed quickly. The treatment
is to be conducted with bandages according to the rule for bandaging
articulations, and the point of the elbow is to be included in the
bandage.

19. Dislocations at the elbow give rise to the most serious
consequences, such as fevers, pain, nausea, vomitings of pure bile,
and more especially when the humerus is displaced backward from

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