separated。 In these cases strong extension is to be applied； and
pressure is to be made on the projecting bone； and counter…pressure on
the opposite side； both at the same time； behind and at the side； with
the hands upon a table； or with the heel。 These accidents give rise to
serious consequences and deformities； but in the course of time the
part gets strong； and admits of being used。 The cure is with bandages；
which ought to embrace both the hand and fore…arm； and splints are
to be applied as far as the fingers； and when they are used they
should be more frequently unloosed than infractures； and more
copious affusions of water should be used。
28。 In congenital dislocations （at the wrist） the hand becomes
shortened； and the atrophy of the flesh occurs； for the most part；
on the side opposite to the dislocation。 In an adult the bones
remain of their natural size。
29。 Dislocation at the joint of a finger is easily recognized。
Reduction is to be effected by making extension in a straight line；
and applying pressure on the projecting bone； and counter…pressure
on the opposite side of the other。 The treatment is with bandages。
When not reduced； callus is formed outside of the joint。 When the
dislocation takes place at birth； during adolescence the bones below
the dislocation are shortened； and the flesh is wasted rather on the
opposite than on the same side with the dislocation。 When it occurs in
an adult the bones remain of their proper size。
30。 The jaw…bone； in few cases； is completely dislocated； for the
zygomatic process formed from the upper jaw…bone （malar？） and the bone
behind the ear （temporal？） shuts up the heads of the under jaw；
being above the one （condyloid process？）； and below the other
（coronoid process？）。 Of these extremities of the lower jaw； the one；
from its length； is not much exposed to accidents； while the other；
the coronoid； is more prominent than the zygoma； and from both these
heads nervous tendons arise； with which the muscles called temporal
and masseter are connected； they have got these names from their
actions and connections； for in eating； speaking； and the other
functional uses of the mouth； the upper jaw is at rest； as being
connected with the head by synarthrosis； and not by diarthrosis
（enarthrosis？）： but the lower jaw has motion； for it is connected with
the upper jaw and the head by enarthrosis。 Wherefore； in convulsions
and tetanus； the first symptom manifested is rigidity of the lower
jaw； and the reason why wounds in the temporal region are fatal and
induce coma； will be stated in another place。 These are the reasons
why complete dislocation does not readily take place； and this is
another reason； because there is seldom a necessity for swallowing
so large pieces of food as would make a man gape more than he easily
can； and dislocation could not take place in any other position than
in great gaping； by which the jaw is displaced to either side。 This
circumstance； however； contributes to dislocation there； of nerves
（ligaments？） and muscles around joints； or connected with joints； such
as are frequently moved in using the member are the most yielding to
extension； in the same manner as well…dressed hides yield the most。
With regard； then； to the matter on hand； the jaw…bone is rarely
dislocated； but is frequently slackened （partially displaced？） in
gaping； in the same manner as many other derangements of muscles and
tendons arise。 Dislocation is particularly recognized by these
symptoms： the lower jaw protrudes forward； there is displacement to
the opposite side； the coronoid process appears more prominent than
natural on the upper jaw； and the patient cannot shut his lower jaw
but with difficulty。 The mode of reduction which will apply in such
cases is obvious： one person must secure the patient's head； and
another； taking hold of the lower jaw with his fingers within and
without at the chin； while the patient gapes as much as he can；
first moves the lower jaw about for a time； pushing it to this side
and that with the hand； and directing the patient himself to relax the
jaw； to move it about； and yield as much as possible； then all of a
sudden the operator must open the mouth； while he attends at the
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
patient's skin； for in this way it will be more tenacious； then we
must stretch this thong； but still more so the one at the chin； in
order to prevent the fragments of the jaw from riding over each other；
and the thongs are to be fastened at the vertex； and then a bandage is
to be bound round the forehead； and a proper apparatus is to be put
over all； to prevent the bandages from being displaced。 The patient
should lie upon the sound side of the jaw； not resting upon the jaw；
but upon the head。 He is to be kept on a spare diet for ten days；
and then nourished without delay。 If there be no inflammation during
the first days； the jaw is consolidated in twenty days； for callus
quickly forms in this； as in all the other porous bones； provided
there be no sphacelus （exfoliation？）。 But much remains to be said on
the sphacelus of bones in another place。 This method of distention
with glued substances is mild； of easy application； and is useful
for many dislocations in many parts of the body。 Those physicians
who have not judgment combined with their dexterity； expose themselves
in fractures of the jaws； as in other cases； for they apply a
variety of bandages to a fractured jaw…bone； sometimes properly； and
sometimes improperly。 For all such bandaging of a fractured jawbone
has a tendency rather to derange the bones connected with the
fracture； than to bring them into their natural position。
34。 But if the lower jaw be disjointed at its symphysis in the
chin （there is but one symphysis in the lower jaw； but there are
several in the upper； but I am unwilling to digress from the
subject； as these matters will have to be touched upon in other
kinds of disease）…if； then； the symphysis be separated at the chin； it
is the work which anybody can perform； to rectify it； for the part
which protrudes is to be pushed inward by pressure with the fingers；
and the part that inclines inward is to forced outward by pushing with