It is not always an easy matter to distinguish between a fracture and a dislocation. In certain forms of fracture, there is no crepitation or grating ot the ends of the bones to be detected, as the same violence which breaks the bone drives the fragments forcibly together, and causes them to become impacted, or fixed together. In fractures about the region of a joint, the crepitation would be a main symptom by which to distinguish this injury from dislocation. Where it is absent, it is almost impossible for a non-professional person to come to a decision as to the real nature of the accident. Should, how- ever, surgical assistance not be obtainable, the best plan to pursue will be to pull steadily at the injured limb until it resumes its shapt and length. By this means, if the bones be dislocated, it may be possible to reduce the dislocation, and if fractured, it may, by loosening the bones, cause the distinctive sound of crepitation, and other signs of fracture, to be dis- tinguished. Dislocation of the Jaw. — This may readily be detected by the imbecile appearance it gives the patient. The mouth is fixed wide open, and the saliva runs out at the corners. It is impossible to close the mouth, the patient making ineffectual efforts to articulate. Treatment. — The patient should be seated in a high- 826 MEDICINAL backed chair, or against a wall, in such a manner that his head may lean against the back of the chair, or the wall. The operator should then wrap a couple of napkins round his thumbs, one on each, and when by this means they are well protected, he should place them as far back along the jaw inside the mouth as he can reach. He should then press with his thumbs downward and backwards, and at the same time raise the chin with his fingers. The bone will return to its place with a snap. The advantage of having wrapped the thumbs well round with napkins will then be experienced; for the teeth come together very sharply, and, were the thumbs not well protected, bites of a severe character might be suffered. Another method pursued for the reduction 'Of this dislocation is to place a couple of corks between the back teeth, raising the chin, and making the corks act as a fulcrum between the jaws. Dislocation of the Shoulder Joint. — Th* may be distinguished by the evident lengthening of the arm and flat- tening of the shoulder. If compared with the other side there will be found a dent, or depression, just under the point of the shoulder. Frequently the round head of the arm-bone may be felt in the armpit. Treatment. — The patient should sit on the ground and lean his shoulder against a sofa or couch; the operator should mount the couch, and, having removed his boot, should place his foot gently on the patient's injured shoulder; at the same time he should raise the dislocated arm upwards, gently increasing the pressure made by his foot on the shoulder. By these means the bone may soon be felt to slip into the socket with a jerk. When this is effected, the arm should be gradu- ally restored to its original uosition, and there fastened by bandaging for about a week. Htp Joint. — This dislocation may be recognized by the deformity of the limb, the inability to stand on the injured extremity, and, perhaps, the head of the bone may be detected out of its place under the skin.

AI-modernized reading of the original text

It is not always an easy matter to distinguish between a fracture and a dislocation. In certain forms of fracture, there is no crepitation or grating ot the ends of the bones to be detected, as the same violence which breaks the bone drives the fragments forcibly together, and causes them to become impacted, or fixed together. In fractures about the region of a joint, the crepitation would be a main symptom by which to distinguish this injury from dislocation. Where it is absent, it is almost impossible for a non-professional person to come to a decision as to the real nature of the accident. Should, however, surgical assistance not be obtainable, the best plan to pursue will be to pull steadily at the injured limb until it resumes its shapt and length. By this means, if the bones be dislocated, it may be possible to reduce the dislocation, and if fractured, it may, by loosening the bones, cause the distinctive sound of crepitation, and other signs of fracture, to be distinguished. Dislocation of the Jaw. — This may readily be detected by the imbecile appearance it gives the patient. The mouth is fixed wide open, and the saliva runs out at the corners. It is impossible to close the mouth, the patient making ineffectual efforts to articulate. Treatment. — The patient should be seated in a high- backed chair, or against a wall, in such a manner that his head may lean against the back of the chair, or the wall. The operator should then wrap a couple of napkins round his thumbs, one on each, and when by this means they are well protected, he should place them as far back along the jaw inside the mouth as he can reach. He should then press with his thumbs downward and backwards, and at the same time raise the chin with his fingers. The bone will return to its place with a snap. The advantage of having wrapped the thumbs well round with napkins will then be experienced; for the teeth come together very sharply, and, were the thumbs not well protected, bites of a severe character might be suffered. Another method pursued for the reduction 'Of this dislocation is to place a couple of corks between the back teeth, raising the chin, and making the corks act as a fulcrum between the jaws. Dislocation of the Shoulder Joint. — This may be distinguished by the evident lengthening of the arm and flattening of the shoulder. If compared with the other side there will be found a dent, or depression, just under the point of the shoulder. Frequently the round head of the arm-bone may be felt in the armpit. Treatment. — The patient should sit on the ground and lean his shoulder against a sofa or couch; the operator should mount the couch, and, having removed his boot, should place his foot gently on the patient's injured shoulder; at the same time he should raise the dislocated arm upwards, gently increasing the pressure made by his foot on the shoulder. By these means the bone may soon be felt to slip into the socket with a jerk. When this is effected, the arm should be gradually restored to its original uosition, and there fastened by bandaging for about a week. Htp Joint. — This dislocation may be recognized by the deformity of the limb, the inability to stand on the injured extremity, and, perhaps, the head of the bone may be detected out of its place under the skin.

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