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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
dislocation the method of extension formerly described； for the
application of the bandages in the case of fracture of the arm； but
when extension is made； the parts are to be adjusted； as has been also
described above。
43。 But if the arm be dislocated backward （but this very rarely
happens； and it is the most painful of all； and the most subject to
bilious fevers of the continual type； which prove fatal in the
course of a few days）； in such a case the patient cannot extend the
arm。 If you are quickly present； by forcible extension the parts may
return to their place of their own accord； but if fever have
previously come on； you must no longer attempt reduction； for the pain
will be rendered more intense by any such violent attempt。 In a
word； no joint whatever should be reduced during the prevalence of
fever； and least of all the elbow…joint。
44。 There are also other troublesome injuries connected with the
elbow…joint； for example； the thicker bone （radius？） is sometime
partially displaced from the other； and the patient can neither
perform extension nor flexion properly。 This accident becomes
obvious upon examination with the hand at the bend of the arm near the
division of the vein that runs up the muscle。 In such a case it is not
easy to reduce the parts to their natural state； nor is it easy； in
the separation of any two bones united by symphysis； to restore them
to their natural state； for there will necessarily be a swelling at
the seat of the diastasis。 The method of bandaging a joint has been
already described in treating of the application of bandages to the
ankle。
45。 In certain cases the process of the ulna （olecranon？） behind the
humerus is broken； sometimes its cartilaginous part； which gives
origin to the posterior tendon of the arm； and sometimes its fore
part； at the base of the anterior coronoid process； and when this
displacement takes place； it is apt to be attended with malignant
fever。 The joint； however； remains in place； for its whole base
protrudes at that point。 But when the displacement takes place where
its head overtops the arm； the joint becomes looser if the bone be
fairly broken across。 To speak in general terms； all cases of
fractured bones are less dangerous than those in which the bones are
not broken； but the veins and important nerves （tendons？） situated
in these places are contused； for the risk of death is more
immediate in the latter class of cases than in the former； if
continual fever come on。 But fractures of this nature seldom occur。
46。 It sometimes happens that the head of the humerus is fractured
at its epiphysis； and this； although it may appear to be a much more
troublesome accident； is in fact a much milder one than the other
injuries at the joint。
47。 The treatment especially befitting each particular dislocation
has been described； and it has been laid down as a rule； that
immediate reduction is of the utmost advantage； owing to the rapid
manner in which inflammation of the tendons supervenes。 For even
when the luxated parts are immediately reduced； the tendons usually
become stiffened； and for a considerable time prevent extension and
flexion from being performed to the ordinary extent。 are to be treated
in a similar way； whether the extremity of the articulating bone be
snapped off； whether the bones be separated； or whether they be
dislocated； for they are all to be treated with plenty of bandages；
compresses； and cerate； like other fractures。 The position of the
joint in all these cases should be the same； as when a fractured arm
or fore…arm has been bound up。 For this is the most common position in
all dislocations； displacements； and fractures； and it is the most
convenient for the subsequent movements； whether of extension or
flexion； as being the intermediate stage between both。 And this is the
position in which the patient can most conveniently carry or suspend
his arm in a sling。 And besides； if the joint is to be stiffened by
callus； it were better that this should not take place when the arm is
exte