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occurred during adolescence； if properly managed； the patient has
the use of the limb as well as adults （otherwise？） have of
it。 But； if
neglected； it is shortened and extended； for in such cases the joint
is generally in a straight position。 The diminution of the bones；
and wasting of the fleshy parts； are analogous。
Part 25
In reduction…the extension of the thigh is to be powerful； and
the adjustment what is common in all such cases； with the hands； or
a board； or a lever； which； in dislocations inward； should be round；
and in dislocations outward； flat； but it is mostly applicable in
dislocations outward。 Dislocations inward are to be remedied by
means of bladders； extending to the bare part of the thigh；
along with
extension and binding together of the limbs。 The patient may be
suspended； with his feet a little separated from one
another； and then
a person inserting his arm within the affected limb； is to suspend
himself from it； and perform extension and readjustment at the same
time； and this method is sufficient in dislocations forward and the
others； but least of all in dislocations backward。 A board fastened
under the limb； like the board fastened below the arm in
dislocations at the shoulder； answers in dislocations
inward； but less
so in the other varieties。 Along with extension you will use
pressure either with the foot； the hand； or a board； especially in
dislocations forward and backward。
Part 26
Dislocations at the knee are of a milder character than those of
the elbow； owing to the compactness and regularity of the joint； and
hence it is more readily dislocated and reduced。 Dislocation
generally
takes place inward； but also outward and backward。 The methods of
reduction are…by circumflexion； or by rapid excalcitration； or by
rolling a fillet into a ball； placing it in the ham； and then
letting the patient's body suddenly drop down on his knees： this
mode applies best in dislocations backward。 Dislocations backward；
like those of the elbows； may also be reduced by moderate extension。
Lateral dislocations may be reduced by circumflexion or
excalcitration； or by extension （but this is most applicable in
dislocation backward）； but also by moderate extension。 The
adjustment is what is common in all。 If not reduced； in dislocations
backward； they cannot bend the leg and thigh upon one another； but
neither can they do this in the others except to a small extent； and
the fore parts of the thigh and leg are wasted。 In
dislocations inward
they are bandy…legged； and the external parts are atrophied。 But； in
dislocations outward； they incline more outward； but are less lame；
for the body is supported on the thicker bone； and the inner
parts are
wasted。 The consequences of a congenital dislocation； or one
occurring
during adolescence； are analogous to the rule formerly laid down。
Part 27
Dislocations at the ankle…joint require strong extension； either
with the hands or some such means； and adjustment； which at the same
time effects both acts； this is common in all cases。
Part 28
Dislocations of the bones of the foot are to be treated like
those of the hand。
Part 29
Dislocations of the bones connected with the leg； if not
reduced； whether occurring at birth or during adolescence； are of
the same character as those in the hand。
Part 30
Persons who； in jumping from a height； have pitched on the heel；
so as to occasion diastasis （separation） of the bones； ecchymosis of
the veins； and contusion of the nerves；…when these symptoms are very
violent； there is danger that the parts may sphacelate； and give
trouble to the patient during the remainder of his life； for these
bones are so constructed as to slip past one another； and the nerves
communicate together。 And； likewise in cases of fracture； either
from an injury in the leg or thigh； or in paralysis of the nerves
connected with these parts； or； when in any other case of
confinement to bed the heel； from neglect； becomes blackened； in all
these cases serious effects result therefrom。 Sometimes； in addition
to the sphacelus； very acute fevers supervene； attended with hiccup；
tumors； aberration of intellect； and speedy death； along
with lividity
of the large bloodvessels； and gangrene。 The symptoms of the
exacerbations are these： if the ecchymosis； the blackened parts； and
those around them； be somewhat hard and red； and if lividity be
combined with the hardness； there is danger of
mortification； but； not
withstanding； if the parts are sublivid； or even very livid and
diffused； or greenish and soft； these symptoms； in all such
cases； are
favorable。 The treatment consists in the administration of
hellebore； if they be free from fever； but otherwise； they
are to have
oxyglyky for drink； if required。 Bandaging；…agreeably to the rule in
other joints； but this is to be attended to also；…the bandages
should be numerous； and softer than usual； compression less； more
water than usual to be used in the allusions； to be applied
especially
to the heel。 The same object should be sought after in the
position as
in the bandaging； namely； that the humors may not be
determined to the
heel； the limb to be well laid should have the heel higher than the
knee。 Splints not to be used。
Part 31
When the foot is dislocated； either alone； or with the
epiphysis； the displacement is more apt to be inward。 If not
reduced； in the course of time the parts of the hips； thigh； and
leg； opposite the dislocation； become attenuated。 Reduction：…As in
dislocation at the wrist； but the extension requires to be very
powerful。 Treatment：…Agreeably to the rule laid down for the other
joints。 Less apt to be followed by serious consequences than the
wrist； if kept quiet。 Diet restricted； as being in an inactive
state。 Those occurring at birth； or during adolescence； observe the
rule formerly stated。
Part 32
With regard to slight congenital dislocations； some of them
can be rectified； especially club…foot。 There is more than
one variety
of club…foot。 The treatment consists in modeling the foot
like a piece
of wax； applying resinous cerate； and numerous bandages； or
a sole； or
a piece of lead is to be bound on； but not upon the bare skin； the
adjustment and attitudes to correspond。
Part 33
If the dislocated bones cause a wound in the skin； and protrude；
it is better to let them alone； provided only they are not allowed
to hang； nor are compressed。 The treatment consists in applying
pitched cerate； or compresses dipped in hot wine （for cold is bad in
all such cases）； and certain leaves； but in winter unwashed wool may
be applied as a cover to the part； neither cataplasms nor bandaging；
restricted diet。 Cold； great weight； compression； violence；
restricted
position； all such are to be accounted as fatal measures。
When treated
moderately （they escape）； maimed and deformed； for； if the
dislocation
be at the ankle； the foot is drawn upward； and； if elsewhere；
according to the same rule。 The bones do not readily exfoliate； for
only small portions of them are denuded； and they heal by narrow
cicatrices。 The danger is greatest in the greatest joints； and those
highest up。 The only chance of recovery is； if they are not reduced；
except at the fingers and hand； and in these cases the danger should
be announced beforehand。 Attempts at reduction to be made on
the first
or second day； or； if not accomplished then； on the tenth；
by no means
on the fourth。 Reduction by levers。 Treatment：…As in injuries of the
bones of the head； and the part is to be kept hot； and it is
better to
give hellebore immediately after the parts have been reduced。 With
regard to the other bones； it should be well known； that； if
replaced；
death will be the consequence； the more surely and expeditiously；
the greater the articulation； and the more high its situation。
Dislocation of the foot is attended with spasm （tetanus） and
gangrene；
and if； upon its being replaced； any of these symptoms come on； the
chance of recovery； if there be any chance； is in displacing it
anew； for spasms do not arise from relaxation； but from
tension of the
parts。
Part 34
Excision；