dislocation outward from birth； or during adolescence； or from
disease； （and it happens most frequently from disease； in which case
there is sometimes exfoliation of the bone； but even where
there is no
exfoliation）； the patients experience the same symptoms； but to an
inferior degree to those in dislocations inward； if properly managed
so that in walking they can put the whole foot to the ground and
lean to either side。 The younger the patient is； the greater care
should be bestowed on him； when neglected； the case gets worse； when
attended to； it improves； and； although there be atrophy in all
parts of the limb； it is to a less extent。
Part 22
When there is a dislocation on both sides； the affections of the
bones are the same； the flesh is well developed； except within； the
nates protrude； the thighs are arched； unless there be sphacelus。 If
there be curvature of the spine above the hip…joint； the patients
enjoy good health； but the body does not grow； with the exception of
the head。
Part 23
The symptoms of dislocation backward are：…The parts before
more empty； behind they protrude； the foot straight； flexion
impossible； except with pain； extension least of all： in these the
limb is shortened。 They can neither extend the limb at the
ham； nor at
the groin； unless it be much raised； nor can they bend it。 The
uppermost joint； in most cases； takes the lead： this is common in
joints； nerves； muscles； intestines； uteri； and other parts。
There the
bone of the hip…joint is carried backward to the nates； and on that
account it is shortened； and because the patient cannot
extend it。 The
flesh of the whole leg is wasted in all cases； in which most； and to
what extent； has been already stated。 Every part of the body which
performs its functional work is strong； but； not withstanding； if
inactive； it gets into a bad condition； unless its inactivity arise
from fatigue； fever； or inflammation。 And in dislocations
outward； the
limb is shortened； because the bone is lodged in flesh which yields；
but； not withstanding； in dislocations inward； it is longer； because
the bone is lodged on a projecting bone。 Adults； then； who have this
dislocation unreduced； are bent at the groins in walking； and the
other ham is flexed； they scarcely reach the ground with the ball of
the foot； they grasp the limb with the hand； and walk without a
staff if they choose； if the staff be too long； their foot cannot
reach the grounds…if they wish to reach the ground； they must use a
short staff。 There is wasting of the flesh in cases attended with
pain； and the inclination of the leg is forward； and the sound leg
in proportion。 In congenital cases； or when in adolescence； or from
disease； the bone is dislocated （under what circumstances will be
explained afterward）； the limb is particularly impaired； owing to
the nerves and joints not being exercised； and the knee is impaired
for the reasons stated。 These persons； keeping the limb bent； walk
with one staff or two。 But the sound limb is in good flesh
from usage。
Part 24
In dislocations forward the symptoms are the opposite： a vacuity
behind； a protuberance before； of all motions they can least perform
flexion； and extension best； the foot is straight； the limb is of
the proper length at the heel； at its extremity the foot a little
turned up； they are especially pained at first： of all these
dislocations retention of urine occurs most frequently in this
variety； because the bone is lodged among important nerves。 The fore
parts are stretched； do not grow； are diseased； and are obnoxious to
premature decay； the back parts are wrinkled。 In the case of adults；
they walk erect； resting merely on the heel； and this they do
decidedly if they can take great steps； but they drag it along； the
wasting is least of all in this variety of dislocation；
owing to their
being able to use the limb； but the wasting is most behind。 The
whole limb being straighter than natural they stand in need
of a staff
on the affected side。 When the dislocation is congenital； or has
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