[p. 275]second, or the third, the same method of reduction is to be applied, but the largest joints are the most difficult to reduce. There are four modes of displacement-either upward, downward, or to either side; most commonly upward, and most rarely laterally, and in consequence of violent motion. On both sides of its articular cavity there is a sort of raised border. When the dislocation is upward or downward, owing to the articular cavity having smoother edges there than at the sides, if the joint of it be dislocated, it is more easily reduced. This is the mode of reduction:-The end of the finger is to be wrapped round with a fillet, or something such, that, when you lay hold of it and make extension, it will not slip; and when this is done, some person is to grasp the arm at the wrist, and another is to take hold of the finger which is wrapped in the fillet, and then each is to make considerable extension toward himself, and at the same time the projecting bone is to be pushed into its place. But, if the dislocation be lateral, the same mode of reduction is to be used; but when you think that the extremity of the bone has cleared the rim, at the same time that extension is made, the bone is to be pushed direct into its place, while another person on the other side of the finger is to take care and make counter-pressure, so that it may not again slip out there. The twisted nooses formed from palm-shoots are convenient for effecting reduction, if you will make extension and counter-extension by holding the twisted string in the one hand and the wrist in the other. When reduced, you must bind the part as quickly as possible with bandages; these are to be very slender and waxed with cerate, neither very soft nor very hard, but of middle consistence; for that which is hard drops off from the finger, while that which is soft and liquid is melted and lost by the increased heat of the finger. The bandage is to be loosed on the third or fourth day; but on the whole, if inflamed, it is to be the more frequently loosed, and if otherwise, more rarely; this I say respecting all the joints. The articulation of a finger is restored in fourteen days. The treatment of the fingers and of the toes is the same.
Part 81
After all reductions of joints the patient should be confined to a restricted diet and abstinence until the seventh day;
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