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On The Articulations   


the hands upon a table, or with the heel. These accidents give rise to
serious consequences and deformities; but in the course of time the
part gets strong, and admits of being used. The cure is with bandages,
which ought to embrace both the hand and fore-arm; and splints are
to be applied as far as the fingers; and when they are used they
should be more frequently unloosed than infractures, and more
copious affusions of water should be used.

28. In congenital dislocations (at the wrist) the hand becomes
shortened, and the atrophy of the flesh occurs, for the most part,
on the side opposite to the dislocation. In an adult the bones
remain of their natural size.

29. Dislocation at the joint of a finger is easily recognized.
Reduction is to be effected by making extension in a straight line,
and applying pressure on the projecting bone, and counter-pressure
on the opposite side of the other. The treatment is with bandages.
When not reduced, callus is formed outside of the joint. When the
dislocation takes place at birth, during adolescence the bones below
the dislocation are shortened, and the flesh is wasted rather on the
opposite than on the same side with the dislocation. When it occurs in
an adult the bones remain of their proper size.

30. The jaw-bone, in few cases, is completely dislocated, for the
zygomatic process formed from the upper jaw-bone (malar?) and the bone
behind the ear (temporal?) shuts up the heads of the under jaw,
being above the one (condyloid process?), and below the other
(coronoid process?). Of these extremities of the lower jaw, the one,
from its length, is not much exposed to accidents, while the other,
the coronoid, is more prominent than the zygoma, and from both these
heads nervous tendons arise, with which the muscles called temporal
and masseter are connected; they have got these names from their
actions and connections; for in eating, speaking, and the other
functional uses of the mouth, the upper jaw is at rest, as being
connected with the head by synarthrosis, and not by diarthrosis
(enarthrosis?): but the lower jaw has motion, for it is connected with
the upper jaw and the head by enarthrosis. Wherefore, in convulsions
and tetanus, the first symptom manifested is rigidity of the lower
jaw; and the reason why wounds in the temporal region are fatal and
induce coma, will be stated in another place. These are the reasons
why complete dislocation does not readily take place, and this is
another reason, because there is seldom a necessity for swallowing
so large pieces of food as would make a man gape more than he easily
can, and dislocation could not take place in any other position than
in great gaping, by which the jaw is displaced to either side. This
circumstance, however, contributes to dislocation there; of nerves
(ligaments?) and muscles around joints, or connected with joints, such
as are frequently moved in using the member are the most yielding to
extension, in the same manner as well-dressed hides yield the most.
With regard, then, to the matter on hand, the jaw-bone is rarely
dislocated, but is frequently slackened (partially displaced?) in
gaping, in the same manner as many other derangements of muscles and
tendons arise. Dislocation is particularly recognized by these
symptoms: the lower jaw protrudes forward, there is displacement to
the opposite side, the coronoid process appears more prominent than
natural on the upper jaw, and the patient cannot shut his lower jaw
but with difficulty. The mode of reduction which will apply in such
cases is obvious: one person must secure the patient's head, and
another, taking hold of the lower jaw with his fingers within and
without at the chin, while the patient gapes as much as he can,
first moves the lower jaw about for a time, pushing it to this side
and that with the hand, and directing the patient himself to relax the
jaw, to move it about, and yield as much as possible; then all of a
sudden the operator must open the mouth, while he attends at the

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