On the Articulations (26-30)

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.

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 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.

In congenital dislocations (at the wrist) the hand becomes

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.

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