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On The Articulations   


may suit to push inward or outward with the lever; and the lever may
be either of a round or broad form, as may be judged proper; for
sometimes the one form and sometimes the other suits with the
articulation. This mode of applying the lever along with extension
is applicable in the reduction of all dislocations of the thigh. In
the case now on hand, a round lever is proper; but in dislocations
outward a flat lever will be the suitable one. By means of such
machines and of such powers, it appears to me that we need never
fail in reducing any dislocation at a joint.

73. And one might find out other modes of reduction for this
joint. If the large bench were to have raised on it two posts about
a foot (in diameter?), and of a suitable height, on each side near its
middle, and if a transverse piece of wood like the step of a ladder,
were inserted in the posts, then if the sound leg were carried through
between the posts, and the injured limb were brought over the
transverse piece of wood, which should be exactly adapted in height to
the joint which is dislocated (and it is an easy matter so to adjust
it, for the step of the ladder should be made a little higher than
required, and a convenient robe, folded several times, is to be laid
below the patient's body), then a piece of wood, of suitable breadth
and length, is to be laid below the limb, and it should reach from the
ankle to beyond the head of the thigh-bone, and should be bound
moderately tight to the limb. Then the limb being extended, either
by means of the pestle-like piece of wood (formerly described), or
by any of the other methods of extension, the limb which is carried
over the step with the piece of wood attached to it, is to be forced
downward, while somebody grasps the patient above the hip-joint. In
this manner the extension will carry the head of the thighbone above
the acetabulum, while the lever power that is exercised will push
the head of the thigh-bone into its natural seat. All the
above-mentioned powers are strong, and more than sufficient to rectify
the accident, if properly and skillfully applied. For, as formerly
stated, in most cases reduction may be effected by much weaker
extension, and an inferior apparatus.

74. If the head of the bone slip outward, extension and
counter-extension must be made as described, or in a similar manner.
But along with the extension a broad lever is to be used to force
the bone from without inward, the lever being placed at the nates or a
little farther up, and some person is to steady the patient's body, so
that it may not yield, either by grasping him at the buttocks with his
hands, or this may be effected by means of another similar lever,
adjusted to one of the grooves, while the patient has something laid
below him, and he is secured, and the dislocated thigh is to be turned
gently from within outward at the knee. Suspension will not answer
in this form of dislocation, for, in this instance, the arm of the
person suspended from him, would push the head of the thigh-bone
from the acetabulum. But one might use the piece of wood placed
below him as a lever, in such a manner as might suit with this mode of
dislocation; it must work from without. But what use is there for more
words? For if the extension be well and properly done, and if the
lever be properly used, what dislocation of the joint could occur,
that might not be thus reduced?

75. In dislocation of the thigh, backward, extension and
counter-extension should be made as has been described; and having
laid on the bench a cloth which has been folded several times, so that
the patient may lie soft, he is to be laid on his face, and
extension thus made, and, along with the extension, pressure is to
be made with a board, as in the case of humpback, the board being
placed on the region of the nates, and rather below than above the
hip-joint; and the hole made in the wall for the board should not be
direct over, but should be inclined a little downward, toward the

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