, or when his attention is diverted from the injured
part, to carry out the manipulations necessary to restore the bone to
its normal position.

The appropriate manoeuvres for disengaging the head of the bone from
tendons, ligaments, or bony processes with which it may be entangled,
will be suggested by a consideration of the anatomy of the particular
joint involved, and will be described with individual dislocations.

In reducing a dislocation, no amount of physical force will compensate
for a want of anatomical knowledge. All tugging, twisting, or
wrenching movements are to be avoided, as they are liable to cause
damage to blood vessels, nerves, or other soft parts, or even--and
especially in old people--to fracture one of the bones concerned.

After reduction, great benefit is gained by the systematic use of
_massage_ and movement. Before any restraining apparatus is applied
the whole region should be gently stroked in a centrifugal direction
for fifteen or twenty minutes; and this is to be repeated daily, each
sitting lasting for about twenty minutes. From the first day onward,
movement of the joint is carried out in every direction, except that
which tends to bring the head of the bone against the injured part of
the capsule; and the patient is encouraged to move the joint as early
as possible. The appropriate apparatus and the period during which it
should be worn will be considered with the individual dislocations.

_Operation in Simple Dislocations._--In a limited number of cases,
even with the aid of an anaesthetic, reduction by manipulation is found
to be impossible. Resort must then be had to operation, which is a
comparatively safe and satisfactory proceeding, although often
difficult. It may happen in rare instances that the undoing of the
displacement is only possible after the removal of a portion of one or
other of the bones.

#Compound Dislocations.#--Compound dislocations are usually the result
of extreme violence produced by machinery or railway accidents, or by
a fall from a height. In the majority of cases they are complicated by
fracture of one or more of the constituent bones of the joint, as well
as by laceration of muscles, tendons, and blood vessels. In the region
of the ankle, wrist, and joints of the thumb, however, compound
dislocation is sometimes met with uncomplicated by other lesions. The
great risk is infection, which may result in serious impairment of the
usefulness of the joint