SURGERY. 
cesses advance beyond the eminentiae arti- 
culares. In tliis Case the mouth remains 
open, and cannot be sliiit ; tliere is pain ; 
impaired and almost destroyed articula- 
tion and deglutition, &c. One or both 
condyles may be displaced. To reduce it, 
the thumbs well covered should be intro- 
duced as far backward as possible along the 
grinding teeth. The surgeon then elevates 
the front of the bone witli his fingers, and 
the palms of his hands, while he depresses 
the condyles with his thumbs ; and the latter 
prominences are thus forced back into the 
glenoid cavities of the temporal bones. 
Dislocations of the head and vertebrm 
are probably imaginary occurrences, as we 
know hitherto of no well attested example 
of their occurrence. 
Tin os humeri is probably luxated more 
frequently than any other bone. It may be 
displaced downwards, forwards, and back- 
wards. In all these cases a vacancy is dis- 
tinguishable under the acromion, in conse- 
quence of the absence of the head of the 
humerus from the glenoid cavity of the 
scaprda. The head of the bone foms a 
preternatural tumour in some situation. The 
elbow cannot be carried close to the chest, 
nor can the limb be elevated, without ex- 
treme pain, to a line with the acromion. 
Great pain is’ caused by the pressure of the 
head of the bone in its unnatural position, 
particularly when it lies in the axilla. Our 
object is to dislodge the head of the os bra- 
chii from its unnatural situation, in order to 
bring it on a level with the glenoid cavity of 
the scapula. To accomplish this puipose, ex- 
tension must be made ; that is, the limb must 
be drawn forcibly outwards ; and the bone 
itself should be made to operate as a lever, 
which can be best effected by the surgeon's 
knee placed under it towards the head, 
while he depresses the elbow at the proper 
time, so as to raise the head towards the 
glenoid cavity. The patient’s body should 
be fixed by placing a broad towel round the 
chest, and tying it to some immoveable 
point. The extension should be gradual, 
and kept up unremittingly, which cap be 
best effected by means of pullies. Tiis 
elbow should be bent, and the extending 
power applied just above the condyles of 
the humerus. When the surgeon finds that 
thehead'of the bone is drawn out of its 
unnatural position, he may allow the exten- 
sion to be remitted, and depress the elbow. 
The arm should afterwards be kept quietly 
in a sling, a piece of soap plaister, and a 
spica bandage being applied to the shoulder. 
Elboiv, Dislocations at this joint are very 
difficult to discover, from the swelling which 
comes on so quickly. The radius may be 
displaced forwards ; and here the flexion 
of the elbow is almost entirely destroyed. 
The nina may at the same time be driven 
backward? : it may also be pushed inwards, 
80 as to occupy the place of the radius. 
All these are easily reduced, when they are 
ascertained. Leeches and cold washes 
should be employed afterwards. 
Wrist. The distortion consequent on a 
displacement of the carpus is so consider- 
able, that the nature of the case is rendered 
immediately obvious. The reduction is 
easy ; and after it has been accomplished, 
tlie hand and fore-arm should be bound on 
a splint, and supported by a sling. 
Thigh. The os feraoris may be displaced 
downwards and inwards, so that the head 
rests on the obturator foramen ; upwards 
and outwards, when the head is towards 
the sacro-iscliiatic foramen, and the tro- 
chanter forwards; and upwards and for- 
wards, so that the head rests upon the os 
pubis. In the first case the toes are turned 
out, and tlie limb elongated. In the se- 
cond, the limb is shortened, the foot turned 
inwards, and the buttock more prominent. 
Great pain is excited by attempting to 
move the limb in all cases of luxation, and 
a vacuity is discernible in the natural siin- 
ation of the head of the bone. The patient 
should be placed on the side opposite to the 
accident, and liis pelvis should be fixed by 
means of a sheet passed under the perine- 
um. Extension may be made by fixing a 
broad towel, or the pullies, just above the 
condyles. When the head of the bone is 
on the dorsum ilii, the extension is to be 
continued until it has been brought to the 
acetabulum, into which the surgeon must 
guide it. In the dislocation on the obtura- 
tor foramen, we should make a lever of the 
bone by passing a towel under the thigh, 
near tlie trochanter, and elevating it after 
a slight extension has been made, the con- 
dyles being at the same time depressed. 
The patella may be dislocated either in-, 
wards or outwards. Its reduction is very 
easy when the muscles inserted into it have 
been relaxed. 
The knee hardly admits of complete lux- 
ation without sucli injury of the parts as 
would render the loss of the limb necessary. 
The nature of the accident must be obvioiw 
from the altered figure of the parts, and re- 
placement is perfectly easy. Inflammation 
must be guarded against afterwards. 
