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On The Articulations   


last for a few days, and into which resin enters as an ingredient,
do not agree with them; for the cleansing of the sores is a slow
process, and the sore has a copious discharge for a long time. Certain
of these cases it may be advantageous to bandage. It ought also to
be well understood, that the patient must necessarily be much maimed
and deformed, for the foot is retracted outward, and the bones which
have been displaced outward protrude: these bones, in fact, not
being generally laid bare, unless to a small extent; neither do they
exfoliate, but they heal by thin and feeble cicatrices, provided the
patient keeps quiet for a length of time; but otherwise there is
danger that a small ulcer may remain incurable. And yet in the case we
are treating of, those who are thus treated are saved; whereas, when
the parts are reduced and allowed to remain in place, the patients
die.

64. The same rule applies to dislocations at the wrist, attended
with a wound and projection of the bone, whether the bones of the
arm be displaced inward or outward. For this should be well
understood, that the patient will die in the course of a few days,
by the same mode of death as formerly described, if the bone be
reduced, and allowed to remain so. But in those cases in which they
are not reduced, nor any attempt made to reduce them, the patients,
for the most part, recover; and the same mode of treatment as has been
described will be applicable; but the deformity and impediment of
the limb must necessarily be great, and the fingers of the hand will
be weak and useless; for if the bones have slipped inward, they cannot
bend the fingers, or if outward, they cannot extend them.

65. When the os tibiae, having made a wound at the knee, has
protruded through the skin, whether the dislocation be outward or
inward, in such a case, if the bone be reduced, death will be even
more speedy than in the other cases, although speedy also in them. But
the only hope of recovery is if you treat them without reduction.
These cases are more dangerous than the others, as being so much
higher up, as being so much stronger joints, and displaced from
bones which are so much stronger. But if the os femoris form a wound
at the knee, and slip through it, provided it be reduced and left
so, it will occasion a still more violent and speedy death than in the
cases formerly described; but if not reduced, it will be much more
dangerous than those cases mentioned before, and yet this is the
only hope of recovery.

66. The same rule applies to the elbow-joint, and with regard to the
bones of the fore-arm and arm. For when these bones protrude through a
wound which they have made in the skin, all cases in which they are
reduced prove fatal; but if not reduced, there is a chance of
recovery; but to those that survive there is certain impediment. And
if in any instance the bones of the upper articulations
(shoulder-joint?), should be dislocated, and project through a wound
which they have made in the skin, these, if reduced, are followed by
more speedy death; and if not reduced, they are more dangerous than
the others. But the mode of treatment which appears to me most
suitable has been already described.

67. When the joints of the toes or hands are dislocated, and the
bones protrude through a wound which they have made, and when there is
no fracture of the bone, but merely displacement of the joint, in
these cases, if the reduction be made and allowed to remain, there
is some danger of spasms (tetanus?) if not properly treated, and yet
it may be worth while to reduce them, having warned the patient
beforehand that much caution and care will be required. The easiest,
the most efficient method, and the one most conformable to art, is
that by the lever, as formerly described when treating of bones
which have been fractured and protruded; then the patient must be as

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