in as much as the anus is comprehended by it； and many turns of the
bandage are crowded there in a narrow space。 And in the method with
the girdle； the girdle cannot be so firmly girt around； but that the
turns of the bandage force the girdle to ascend； and hence of
necessity all the other bandages must be slackened。 He would seem to
me to come nearest his purpose； although after all he effects but
little； who would take a few turns round the girdle； few turns round
the girdle； but would use the bandage principally to secure the former
bandaging； for in this manner the bandages would be most secure； and
would mutually assist one another。 Every thing now almost has been
said which applies to fracture of the clavicle。 But this also should
be known； that in fractures of the clavicle； it is the part attached
to the breast which is uppermost； and that the piece attached to the
acromion is the lowermost。 The cause of this is； that for the most
part the breast can neither be depressed nor raised； there being but a
slight movement of the joint at the breast； for the sternum is
connected together on both sides with the spine。 The clavicle admits
of most motion at the joint of the shoulder； and this arises from
its connection with the acromion。 And； moreover； when broken； the part
which is connected with the sternum flies upward； and is not easily
forced downward； for it is naturally light； and there is more room for
it above than below。 But the shoulder； the arm； and the parts
connected with them； are easily moved from the sides and breast；
and； on that account； they admit of being considerably elevated and
depressed。 When； therefore； the clavicle is broken； the fragment
attached to the shoulder inclines downward； for it inclines much
more readily with the shoulder and arm downward than upward。 Matters
being as I have stated； they act imprudently who think to depress
the projecting end of the bone。 But it is clear that the under part
ought to be brought to the upper； for the former is the movable
part； and that which has been displaced from its natural position。
It is obvious； therefore； that there is no other way of applying force
to it （for the bandages no more force it to than they force it
from）； but if one will push the arm when at the sides as much as
possible upward； so that the shoulder may appear as sharp as possible；
it is clear that in this way it will be adjusted to the fragment of
the bone connected with the breast from which it was torn。 If one then
will apply a bandage； secundum artem； for the purpose of promoting a
speedy cure； and will reckon everything else of no value； except the
position as described； he will form a correct opinion of the case； and
will effect a cure in the speediest and most appropriate manner。 It is
of great importance； however； that the patient should lie in a
recumbent posture。 Fourteen days will be sufficient if he keep
quiet； and twenty at most。
15。 But if the clavicle be fractured in the opposite manner （which
does not readily happen）； so that the fragment of bone connected
with the breast is depressed； while the piece connected with the
acromion is raised up and rides over other； this case does not require
much management； for if the shoulder and arm be let go； the
fragments of the bone will be adjusted to one another； and an ordinary
bandage will suffice； and the callus will be formed in the course of a
few days。
16。 If the fracture be not thus； but if it incline either forward or
backward； it may be restored to its natural position； by raising the
shoulder with the arm as formerly described； and brought back to its
natural place； when the cure will be speedily accomplished。 Most of
the varieties of displacement may be rectified by raising the arm
upward。 When the upper bone is displaced laterally or downward； it
would favor the adaptation of the parts if the patient would lie on
his back； and if some elevated substance were placed between the
shoulder…blades； so that the breast may be depressed as much as
possible upon the two sides； and if； while another person raised the
arm extended along the sides； the physician； applying the palm of
the one hand to the head of the bone； would push it away； and with the
other would adjust the broken bones； he would thus reduce the parts
most readily to their natural position。 But； as formerly stated； the
upper bone （sternal fragment？） is rarely depressed downward。 In most
cases； after the bandages have been applied； that position is
beneficial in which the elbow is fixed to the same side； and the
shoulder is kept elevated； but in certain cases； the shoulder is to be
raised； as has been directed； and the elbow is to be brought forward
to the breast； and the hand laid on the acromion of the sound side。 If
the patient has the resolution to lie in bed； something should be
placed so as to support the shoulder； and keep it as much elevated
as possible。 But if he walk about； the arm should be slung in a shawl；
which embraces the point of the elbow； and is passed round the neck。
17。 When the elbow…joint is displaced or dislocated to the side or
outward； while its sharp point （olecranon？） remains in the cavity of
the humerus； extension is to be made in a straight line； and the
projecting part is to be pushed backward and to the side。
18。 In complete dislocations toward either side； extension is to
be made as in bandaging fracture of the arm； for thus the rounded part
of the elbow will not form an obstacle to it。 Dislocation； for the
most part； takes place toward the sides （inwardly？）。 Reduction is to
be effected by separating （the bones） as much as possible； so that the
end （of the humerus） may not come in contact with the olecranon； and
it is to be carried up； and turned round； and not forced in a straight
line； and； at the same time； the opposite sides are to be pushed
together； and propelled into their proper place。 It will further
assist if rotation of the fore…arm be made at the elbow； sometimes
turning it into a supine position； and sometimes into a prone。 The
position for the treatment consists in keeping the hand a little
higher than the elbow； and the arm at the sides； then it may either be
suspended or laid at rest； for either position will answer； and nature
and the usage of common means will accomplish the cure； if the
callus does not form improperly： it is formed quickly。 The treatment
is to be conducted with bandages according to the rule for bandaging
articulations； and the point of the elbow is to be included in the
bandage。
19。 Dislocations at the elbow give rise to the most serious
consequences； such as fevers； pain； nausea； vomitings of pure bile；
and more especially when the humerus is displaced backward from
pressure on the nerve； which occasions numbness； next to it is the
dislocation forward； the treatment is the same； reduction in
dislocation backward is by extension and adaptation； the symptom of
this variety…loss of the power of extension； of dislocation
forward…loss of the power of flexion； and in this case reduction is to
be accomplished by placing a hard ball （in the bend of the elbow）； and
bending the fore…arm about it； along with sudden extension。
20。 Diastasis of the bones may be recognized by examining the part
where the vein that runs along the arm divides。
21。 In those cases callus is quickly formed。 In congenital
dislocations the bones below the seat of the injury are shorter than
natural； and； mostly； those nearest to the place； namely； the bones of
the fore…arm； next those of the hand； and； third； those of the
fingers。 The arm and shoulder are stronger； owing to the nourishment
which they receive； and the other arm； from the additional work
which it has to perform； is still more strong。 Wasting of the flesh
takes place on the inside if the dislocation be on the outside； or
otherwise； on the side opposite the dislocation。
22。 When the elbow is dislocated either inward or outward； extension
is to be made with the fore…arm at a right angle to the arm； the
arm； suspended by means of a shawl passed through the armpit； and a
weight attached to the extremity of the elbow； or force may be applied
with the hands； when the articular extremity has been cleared； the
displaced parts are to be rectified with the palms of the hand； as
in dislocations of the hands。 It is to be bandaged； suspended in a
sling； and placed while in this attitude。
23。 Dislocations backward are to be rectified by the palms of the
hands； along with sudden extension； the two acts are to be performed
together； as in other cases of the kind。 But in dislocation forward
the arm is to be bent around a ball of cloth of proper size； and at
the same time replaced。
24。 But if the displacement be on the other side； both these
operations are to be performed in effecting the adjustment。 For
conducting the treatment； the position and bandaging are the same as
in the other cases。 But all these cases may be reduced by ordinary
distention。
25。 Of the methods of reduction； some operate by raising up the
part； some by extension； and some by rotation： the last consists in
rapidly turning the fore…arm to this side and that。
26。 The joint of the hand is dislocated either inward or outward；
most frequently inward。 The symptoms are easily recognized： if inward；
the patient cannot at all bend his fingers； and if outward； he
cannot extend them。 With regard to the reduction；…by placing the
fingers above a table； extension and counter…extension are to be
made by other persons； while with the palm or heel of the hand on
the projecting bone one pushes forward； and another from behind on the
other bone； some soft substance is to be applied to it； and the arm is
to be turned to the prone position if the dislocation was forward； but
to the supine； if backward。 The treatment is to be conducted with
bandages。
27。 The whole hand is dislocated either inward or outward； or to
this side or that； but more especially inward； and sometimes the
epiphysis is displaced； and sometimes the other of these bones is
separated。 In these cases strong extension is to be applied； and
pressure is to be made on the projecting bon