of the flesh； and prevents the limb from being properly laid； and
if； moreover； it be denuded of flesh； such a piece of bone should be
taken off。 With regard to the others； it is not of much consequence
whether they be sawed off or not。 For it should be known for
certain； that such bones as are completely deprived of flesh； and have
become dried； all separate completely。 Those which are about to
exfollate should not be sawn off。 Those that will separate
completely must be judged of from the symptoms that have been laid
down。
34。 Such cases are to be treated with compresses and vinous
applications； as formerly laid down regarding bones which will
separate。 We must avoid wetting it at the beginning with anything
cold； for there is danger of febrile rigors； and also of
convulsions； for convulsions are induced by cold things； and also
sometimes by wounds。 It is proper to know that the members are
necessarily shortened in those cases in which the bones have been
broken； and have healed the one across the other； and in those cases
in which the whole circle of the bone has become detached。
35。 Those cases in which the bone of the thigh； or of the arm；
protrudes； do not easily recover。 For the bones are large； and contain
much marrow； and many important nerves； muscles； and veins are wounded
at the same time。 And if you reduce them； convulsions usually
supervene； and； if not reduced； acute bilious fevers come on； with
singultus and mortification。 The chances of recovery are not fewer
in those cases in which the parts have not been reduced； nor any
attempts made at reduction。 Still more recover in those cases in which
the lower； than those in which the upper part of the bone protrudes；
and some will recover when reduction has been made； but very rarely
indeed。 For modes of treatment and peculiarity of constitution make
a great difference as to the capability of enduring such an injury。
And it makes a great difference if the bones of the arm and of the
thigh protrude to the inside； for there are many and important vessels
situated there； some of which； if wounded； will prove fatal； there are
such also on the outside； but of less importance。 In wounds of this
sort； then； one ought not to be ignorant of the dangers； and should
prognosticate them in due time。 But if you are compelled to have
recourse to reduction； and hope to succeed； and if the bones do not
cross one another much； and if the muscles are not contracted （for
they usually are contracted）； the lever in such cases may be
advantageously employed。
36。 Having effected the reduction； you must give an emollient
draught of hellebore the same day； provided it has been reduced on the
day of the accident； but otherwise it should not be attempted。 The
wound should be treated with the same things as are used in
fractures of the bones of the head； and nothing cold should be
applied； the patient should be restricted from food altogether； and if
naturally of a bilious constitution； he should have for a diet a
little fragrant oxyglyky sprinkled on water； but if he is not bilious；
he should have water for drink； and if fever of the continual type
come on； he is to be confined to this regimen for fourteen days at
least； but if he be free of fever； for only seven days； and then you
must bring him back by degrees to a common diet。 To those cases in
which the bones have not been reduced； a similar course of medicine
should be administered； along with the same treatment of the sores and
regimen； and in like manner the suspended part of the body should
not be stretched； but should rather be contracted； so as to relax
the parts about the wound。 The separation of the bones is
protracted； as also was formerly stated。 But one should try to
escape from such cases； provided one can do so honourably； for the
hopes of recovery are small； and the dangers many； and if the
physician do not reduce the fractured bones he will be looked upon
as upon as unskillful； while by reducing them he will bring the
patient nearer to death than to recovery。
37。 Luxations and subluxations at the knee are much milder accidents
than subluxations and luxations at the elbow。 For the knee…joint； in
proportion to its size； is more compact than that of the arm； and
has a more even conformation； and is rounded； while the joint of the
arm is large； and has many cavities。 And in addition； the bones of the
leg are nearly of the same length； for the external one overtops the
other to so small an extent as hardly to deserve being mentioned；
and therefore affords no great resistance； although the external nerve
（ligament？） at the ham arises from it； but the bones of the fore…arm
are unequal； and the shorter is considerably thicker than the other；
and the more slender （ulna？） protrudes； and passes up above the joint；
and to it （the olecranon？） are attached the nerves （ligaments？）
which go downward to the junction of the bones； and the slender bone
（ulna？） has more to do with the insertion of the ligaments in the
arm than the thick bone （radius？）。 The configuration then of the
articulations； and of the bones of the elbow； is such as I have
described。 Owing to their configuration； the bones at the knee are
indeed frequently dislocated； but they are easily reduced； for no
great inflammation follows； nor any constriction of the joint。 They
are displaced for the most part to the inside； sometimes to the
outside； and occasionally into the ham。 The reduction in all these
cases is not difficult； but in the dislocations inward and outward；
the patient should be placed on a low seat； and the thigh should be
elevated； but not much。 Moderate extension for the most part
sufficeth； extension being made at the leg； and counter…extension at
the thigh。
38。 Dislocations at the elbow are more troublesome than those at the
knee； and； owing to the inflammation which comes on； and the
configuration of the joint； are more difficult to reduce if the
bones are not immediately replaced。 For the bones at the elbow are
less subject to dislocation than those of the knee； but are more
difficult to reduce and keep in their position； and are more apt to
become inflamed and ankylosed。
39。 For the most part the displacements of these bones are small；
sometimes toward the ribs； and sometimes to the outside； and the whole
articulation is not displaced； but that part of the humerus remains in
place which is articulated with the cavity of the bone of the
forearm that has a protuberance （ulna？）。 Such dislocations； to
whatever side； are easily reduced； and the extension is to be made
in the line of the arm； one person making extension at the wrist；
and another grasping the armpit； while a third； applying the palm of
his hand to the part of the joint which is displaced； pushes it inward
ward； and at the same time makes counterpressure on the opposite
side near the joint with the other hand。
40。 The end of the humerus at the ；elbow gets displaced
（subluxated？） by leaving the cavity of the ulna。 Such luxations
readily yield to reduction； if applied before the parts get
inflamed。 The displacement for the most part is to the inside； but
sometimes to the outside； and they are readily recognized by the shape
of the limb。 And often such luxations are reduced without any powerful
extension。 In dislocations inward； the joint is to be pushed into
its place； while the fore…arm is brought round to a state of
pronation。 Such are most of the dislocations at the elbow。
41。 But if the articular extremity of the humerus be carried to
either side above the bone of the fore…arm； which is prominent； into
the hollow of the arm （？）； this rarely happens； but if it does happen；
extension in the straight line is not so proper under such
circumstances； for in such a mode of extension； the process of the
ulna （olecranon？） prevents the bone of the arm （humerus？） from passing
over it。 In dislocations of this kind； extension should be made in the
manner described when treating of the bandaging of fractured bones
of the arm； extension being made upward at the armpit； while the parts
at the elbow are pushed downward； for in this manner can the humerus
be most readily raised above its cavity； and when so raised； the
reduction is easy with the palms of the hand； the one being applied so
as to make pressure on the protuberant part of the arm； and the
other making counter…pressure； so as to push the bone of the
fore…arm into the joint。 This method answers with both cases。 And
perhaps this is the most suitable mode of reduction in such a case
of dislocation。 The parts may be reduced by extension in a straight
line； but less readily than thus。
42。 If the arm be dislocated forward… this rarely happens； indeed；
but what would a sudden shock not displace？ for many other things
are removed from their proper place； notwithstanding a great
obstacle；… in such a violent displacement the part （olecranon？）
which passes above the prominent part of the bones is large； and the
stretching of the nerves （ligaments？） is intense； and yet the parts
have been so dislocated in certain cases。 The following is the symptom
of such a displacement： the arm cannot be bent in the least degree
at the elbow； and upon feeling the joint the nature of the accident
becomes obvious。 If； then； it is not speedily reduced； strong and
violent inflammation； attended with fever； will come on； but if one
happen to be on the spot at the time it is easily reduced。 A piece
of hard linen cloth （or a piece of hard linen； not very large；
rolled up in a ball； will be sufficient） is to be placed across the
bend of the elbow； and the arm is then to be suddenly bent at the
elbow； and the hand brought up to the shoulder。 This mode of reduction
is sufficient in such displacements； and extension in the straight
line can rectify this manner of dislocation； but we must use at the
same time the palms of the hands； applying the one to the projecting
part of the humerus at the bend of the arm for the purpose of
pushing it back； and applying the other below to the sharp extremity
of the elbow； to make counter…pressure； and incline the parts into the
straight line。 And one may use with advantage in this form of
dislocati