Part 38
The rule for the reduction and adjustment:-The axle, the lever, the
wedge, pressure above; the axle to separate, the lever to push aside.
Reduction and adjustment are to be accomplished by forcible extension,
the parts being placed in such a position as will facilitate the conveying
of the displaced bone over the extremity of the bone from which it
was displaced: this is to be accomplished either with the hands, or
by suspension, or axles, or turned round something. With the hands
this is to be effected properly, according to the structure of the
parts. In the case of the wrist and elbow, the parts are to be forced
asunder, at the wrist in the line of the elbow, and the elbow with
the fore-arm at a right angle with the arm, as when it is suspended
in a sling. When we want to separate the protruding bones, and force
them into place, in the case of the fingers, the toes, or the wrist,
the proper separation may be made by hands, while the projecting part
is forced into its place by pressing down with the heel or the palm
of the hand upon some resisting object, while something moderately
soft is laid under the projecting part, but nothing
[p. 295]such under the
other, and then pressure is to be made backward and downward, whether
the dislocation be inward or outward. In lateral displacement, pressure
and counter-pressure must be made on the opposite sides. Displacements
forward can be reduced neither by sneezing, nor coughing, nor by the
injection of air, nor by the cupping-instrument; and if anything can
do good in such a case, it is extension. People are deceived in fractures
of the spinal processes, the pain of which causing the patient to
stoop forward, the case is taken for dislocation inward; these fractures
heal speedily and easily. Dislocation outward is to be remedied by
succussion, when high up, toward the feet; and when situated low down,
in the contrary direction; the part is to be pressed back into its
place, either with the foot or a board. Dislocations to either side,
if they admit of any remedy, are to be treated by extension, and suitable
attitudes, with regimen. The whole apparatus should be broad, soft,
and strong; or otherwise, they should be wrapped in rags; before being
used, they should all be prepared proportionately to the length, height,
and breadth. In applying extension to the thigh, for example, the
bands should be fastened at the ankle and above the knee, these stretching
in the same direction, another band to be passed by the loins, and
around the armpits, and by the perineum and thigh, one end passing
up the breast and the other along the back, these all stretching in
the same direction and being fastened either to a piece of wood resembling
a pestle or to an axle. When this is done on a couch, either of its
feet is to be fastened to the threshold, and a strong block of wood
is to be laid across the other, and the pieces of wood resembling
a pestle are to be raised on these, to make extension and counter-extension;
the naves of a wheel are to be fastened in the floor, or a ladder
is to be adjusted, so that extension may be made in both directions.
The thing commonly used is a bench six cubits long, two cubits broad,
one fathom in thickness, having two low axles at this end and that,
and having at its middle two moderate sized pillars, to which is to
be adjusted a transverse piece of wood like the step of a ladder,
which is to receive the piece of wood tied below the limb, as is done
in dislocation at the shoulder; and the bench is to have
[p. 296]excavations
like trays, smooth, four inches in breadth and depth, and at such
an interval as to leave room for the lever used to reduce the limb.
In the middle of the bench a square hole is to be scooped out to receive
a small pillar, which, being adjusted to the perineum, will obviate
the tendency of the body to slip downward, and being rather loose
may act somewhat as a lever. In certain occasions a piece of wood
is required, which is inserted into a hole scooped out of the wall;
the other end of it is then to be pressed down, something moderately
soft being placed under it.