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On The Articulations   


same time to three positions: for the lower jaw is to be moved from
the place to which it is dislocated to its natural position; it is
to be pushed backward, and along with these the jaws are to be brought
together and kept shut. This is the method of reduction, and it cannot
be performed in any other way. A short treatment suffices, a waxed
compress is to be laid on, and bound with a loose bandage. It is safer
to operate with the patient laid on his back, and his head supported
on a leather cushion well filled, so that it may yield as little as
possible, but some person must hold the patient's head.

31. When the jaw is dislocated on both sides, the treatment is the
same. The patients are less able to shut the mouth than in the
former variety; and the jaw protrudes farther in this case, but is not
distorted; the absence of distortion may be recognized by comparing
the corresponding rows of the teeth in the upper and lower jaws. In
such cases reduction should be performed as quickly as possible; the
method of reduction has been described above. If not reduced, the
patient's life will be in danger from continual fevers, coma
attended with stupor (for these muscles, when disordered and stretched
preternaturally, induce coma); and there is usually diarrhea
attended with billous, unmixed, and scanty dejections; and the
vomitings, if any, consist of pure bile, and the patients commonly die
on the tenth day.

32. In fracture of the lower jaw, when the bone is not fairly broken
across, and is still partially retained, but displaced, it should be
adjusted by introducing the fingers at the side of the tongue, and
making suitable counter-pressure on the outside; and if the teeth at
the wound be distorted and loosened, when the bone is adjusted, they
should be connected together, not only two, but more of them, with a
gold thread, if possible, but otherwise, with a linen thread, until
the bone be consolidated, and then the part is to be dressed with
cerate, a few compresses, and a few bandages, which should not be very
tight, but rather loose. For it should be well known that in
fracture of the jaw, dressing with bandages, if properly performed, is
of little advantage, but occasions great mischief if improperly
done. Frequent examinations should be made about the tongue, and
prolonged pressure should be applied with the fingers, in order to
rectify the displaced bone. It would be best if one could do so
constantly, but that is impossible.

33. But if the bone be fairly broken across (this, however, rarely
happens), it is to be set in the manner now described. When
adjusted, the teeth are to be fastened together as formerly described,
for this will contribute much toward keeping the parts at rest,
especially if properly fastened, and the ends of the thread secured
with knots. But it is not easy to describe exactly in writing the
whole manipulation of the case; but the reader must figure the thing
to himself from the description given. Then one must take a piece of
Carthaginian leather; if the patient be a younger person, it will be
sufficient to use the outer skin, but if an adult the whole
thickness of the hide will be required; it is to be cut to the breadth
of about three inches, or as much as will be required, and having
smeared the jaw with a little gum (for thus it sticks more
pleasantly), the end of the skin is to be fastened with the glue
near the fractured part of the jaw, at the distance of an inch or a
little more, from the wound. This piece is to be applied below the
jaw; but the thong should have a cut in it, in the direction of the
chin, so that it may go over the sharp point of the chin. Another
piece of thong like this, or somewhat broader, is to be glued to the
upper part of the jaw, at about the same distance from the wound as
the other thong; this thong should be so cut as to encircle the ear.
The thongs should be sharp-pointed at the part where they unite, and
in gluing them, the flesh of the thong should be turned to the

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