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
feet。 This mode of reduction is particularly appropriate to this
variety of dislocation； and at the same time is very strong。 But
perhaps； instead of the board； it might be sufficient to have a person
sitting （on the seat of luxation ？）； or pressing with his hands； or
with his foot； and suddenly raising himself up； along with the
extension。 None of the other aforementioned modes of reduction are
natural in this form of dislocation。
76。 In dislocation forward； the same mode of extension should be
made； but a person who has very strong hands； and is well trained；
should place the palm of the one hand on the groin； and taking hold of
this hand with the other； is at the same time to push the dislocated
part downward； and at the same time to the fore part of the knee。 This
method of reduction is most especially conformable to this mode of
dislocation。 And the mode of suspension is also not far removed from
being natural； but the person suspended should be well trained； so
that his arm may not act as a lever upon the joint； but that the force
of the suspension may act about the middle of the perineum； and at the
os sacrum。
77。 Reduction by the bladder is also celebrated in dislocations at
this joint； and I have seen certain persons who； from ignorance；
attempted to reduce both dislocations outward and backward
therewith； not knowing that they were rather displacing than replacing
the parts； it is clear； however； that he who first invented this
method intended it for dislocation inward。 It is proper； then； to know
how the bladder should be used； if it is to be used； and it should
be understood that many other methods are more powerful than it。 The
bladder should be placed between the thighs uninflated； so that it may
be carried as far up the perineum as possible； and the thighs
beginning at the patella are to be bound together with a swathe； as
far up as the middle of the thigh； and then a brass pipe is to be
introduced into one of the loose feet of the bladder； and air forced
into it； the patient is to lie on his side with the injured limb
uppermost。 This； then； is the preparation； some； however； do the thing
worse than as I have described； for they do not bind the thighs
together to any extent； but only at the knees； neither do they make
extension； whereas extension should be made； and yet some people by
having the good fortune to meet with a favorable case； have
succeeded in making reduction。 But it is not a convenient method of
applying force； for the bladder； when inflated； does not present its
most prominent part to the articular extremity of the femur； which
is the place that ought to be more especially pressed outward； but its
middle； which probably corresponds with the middle of the thigh； or
still lower down； for the thighs are naturally curved； being fleshy；
and in contact above； and becoming smaller downward； so that the
natural configuration of the parts forces the bladder from the most
proper place。 And if a small bladder be introduced； its power will
be small； and unable to overcome the resistance of the articular bone。
But if the bladder must be used； the thighs are to be bound together
to a considerable extent； and the bladder is to be inflated along with
the extension of the body； and in this method of reduction both legs
are to be bound together at their extremity。
78。 The prime object of the physician in the whole art of medicine
should be to cure that which is diseased； and if this can be
accomplished in various ways； the least troublesome should be
selected； for this is more becoming a good man； and one well skilled
in the art； who does not covet popular coin of base alloy。 With regard
to the subject now on hand； the following are domestic means of making
extension of the body； so that it is easy to choose from among the
things at hand：…In the first place； when soft and supple thongs are
not at hand for ligatures； either iron chains； or cords； or cables
of ships； are to be wrapped round with scarfs or pieces of woolen
rags； especially at the parts of them which are to be applied； and
in this state they are to be used as bands。 In the second place； the
patient is to be comfortably laid on the strongest and largest couch
that is at hand； and the feet of the couch； either those at the
（patient's？） head； or those at the feet； are to be fastened to the
threshold； either within or without； as is most suitable； and a square
piece of wood is to be laid across； and extending from the one foot to
the other； and if this piece of wood be slender； it should be bound to
the feet of the couch； but； not withstanding； if it be thick； there
will be no necessity for this； then the heads of the ligatures； both
of those at the head and those at the feet； are to be fastened to a
pestle； or some such piece of wood； difficult to reduce at either end；
the ligatures should run along the line of the body； or be a little
elevated above it； and it should be stretched proportionally to the
pestles； so that； standing erect； the one may be fastened to the
threshold； and the other to the transverse piece of wood。 Extension is
then to be made by bending back the ends of the pestles。 A ladder；
having strong steps； if laid below the bed； will serve the purpose
of the threshold and the piece of wood laid along （the foot of the
couch？）； as the pestles can be fastened to the steps at either end；
and when drawn back they thus make extension of the ligatures。
Dislocation； inward or forward； may be reduced in the following
manner： a ladder is to be fastened in the ground； and the man is to be
seated upon it； and then the sound leg is to be gently stretched along
and bound to it； wherever it is found convenient； and water is to be
poured into an earthen vessel； or stones put into a hamper and slung
from the injured leg； so as to effect the reduction。 Another mode of
reduction： a cross…beam is to be fastened between two pillars of
moderate height； and at one part of the cross…beam there should be a
protuberance proportionate to the size of the nates； and having
bound a coverlet round the patient's breast； he is to be seated on the
protuberant part of the cross…beam； and afterward the breast is to
be fastened to the pillar by some broad ligature； then some one is
to hold the sound leg so that he may not fall off； and from the
injured limb is to be suspended some convenient weight； as formerly
described。
79。 It should be particularly known that the union of all bones
is； for the most part； by a head and socket （cotyle）； in some of these
the place （socket？） is cotyloid and oblong； and in some the socket
is glenoid （shallow？）。 In all dislocations reduction is to be
effected； if possible； immediately； while still warm； but otherwise；
as quickly as it can be done； for reduction will be a much easier
and quicker process to the operator； and a much less painful one to
the patient； if effected before swelling comes on。 But all the
joints when about to be reduced should be first softened； and gently
moved about； for； thus they are more easily reduced。 And； in all cases
of reduction at joints； the patient must be put on a spare diet； but
more especially in the case of the greatest joints； and those most
difficult to reduce； and less so in those which are very small and
easily reduced。
80。 If any joint of the fingers is dislocated； whether the first；
second； or the third； the same method of reduction is to be applied；
but the largest joints are the most difficult to reduce。 There are
four modes of displacement…either upward； downward； or to either side；
most commonly upward； and most rarely laterally； and in consequence of
violent motion。 On both sides of its articular cavity there is a
sort of raised border。 When the dislocation is upward or d