DISLOCATION OF THE RIBS. 51 



Treatment. — The patient should be seated on a low stool, and the 

 surgeon standing in front, should press his thumbs, properly pro- 

 tected, upon the last molar teeth, at the same time elevating the chin 

 with the fingers. The condyles are thus extricated from their un- 

 natural position, and returned to their socket by the normal action 

 of the muscles, which produces an audible noise. In difficult cases, 

 greater leverage may be obtained by using two forks or strong pieces of 

 wood, connected by a string in such a way that it will elevate the chin, 

 whilst the ends are pressed against the teeth in place of the thumb. 

 When the resistance is great the eflbrts may be directed first to one 

 side at a time. 



After reduction, the chin should be confined by a bandage for a 

 week or ten days. 



DISLOCATION OF THE SPINE. 



This accident rarely happens unless connected with fracture; 

 although it has occasionally occurred in the cervical vertebrae. 



It may be produced by the muscular efforts of convulsion and 

 mania, but more frequently is the result of violence ; for instance, 

 falls from a height, crushing by wheels, hanging, &c. 



The chance of life is but small on account of injury done the spinal 

 marrow. The displacement is easily recognised by the deformity, 

 paralysis, &c. 



Dislocation of the atlas upon the dentata may occasion instant 

 death, by the intrusion of its dentate process into the spinal marrow. 

 Dislocations of the oblique processes simply may terminate with no 

 other inconvenience than contortion of the neck and restricted mo- 

 tion of the head. The action of the diaphragm may be suspended 

 by compression of the phrenic nerve. 



Dislocations of the bodies of vertebrse of the neck and back, are 

 almost necessarily accompanied by fracture. 



Treatment. — But little is to be expected. Great care is required 

 in extension and coaptation. In the neck, danger is to be appre- 

 hended from an attempt to reduce the deformity. Contusion of the 

 muscles may produce a deformity which may resemble dislocation. 



Subluxation or partial dislocation is more common ; and it may 

 terminate without permanent injury to the spinal marrow ; provided 

 the antiphlogistic system is pursued in all the details of rest, diet, 

 purging, cups, &;c. 



DISLOCATION OF THE RIBS. 



The vertebral extremity of the ribs can only be dislocated by 

 severe falls, or blows upon the back ; 'on account of its double 

 articulation, and its protection by the muscles of the back. The 

 sternal extremity is sometimes loosened from the cartilage by vio- 

 lent bending of the body backwards ; — great pain and difficulty of 



