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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； either of articular bones or of pieces of bones； when
not high up in the body； but about the foot or the hand； is
generally followed by recovery； unless the patient die at once from
deliquium animi。 Treatment：…As in injuries of the head； warmth。
Part 35
Sphacelus of the fleshy parts is produced by the tight
compression of bleeding wounds； and by pressure in the fractures of
bones； and by blackening； arising from bandages。 And in
those cases in
which a portion of the thigh or arm； both the bones and the
flesh drop
off； many recover； the case being less dangerous than many others。
In cases； then； connected with fracture of the bones； the separation
of the flesh quickly takes place； but the separation of the bone； at
the boundary of its denuded part； is slower in taking place。 But the
parts below the seat of the injury； and the sound portion of
the body；
are to be previously taken away （for they die previously）；
taking care
to avoid producing pain； for deliquium animi may occasion death。 The
bone of the thigh in such a case came away on the eightieth day； but
the leg was removed on the twentieth day。 The bones of the leg； in a
certain case； came away at the middle of the sixtieth day。 In these
cases the separation is quick or slow； according to the compression
applied by the physician。 When the compression is gently applied the
bones do not drop off at all； neither are they denuded of flesh； but
the gangrene is confined in the more superficial parts。 The
treatment of such cases must be undertaken； for most of them are
more formidable in appearance than in reality。 The treatment
should be
mild； but； not withstanding； with a restricted diet； hemorrhages and
cold are to be dreaded； the position； so as that the limb may be
inclined upward； and afterward； on account of the purulent abscess；
horizontally； or such as may suit with it。 In such cases； and in
mortifications； there are usually； about the crisis； hemorrhages and
crisis； hemorrhages and violent diarrhoeas； which； however； only
last for a few days； the patients do not lose their appetite；
neither are they feverish； nor should they be put upon a
reduced diet。
Part 36
Displacement of the spine； if inward； threatens immediate death；
attended with retention of urine and loss of sensibility。
Outward； the
accident is free from most of these bad effects； much more so than
where there is merely concussion without displacement； the effects
in the former case being confined to the spot affected；
whereas in the
latter they are further communicated to the whole body； and are of a
mortal character。 In like manner； when the ribs are
fractured； whether
one or more； provided there be no splinters； there is rarely fever；
spitting of blood； and sphacelus； and ordinary treatment without
evacuation will suffice； provided there be no fever；…bandaging；
according to rule； and the callus forms in twenty days； the
bone being
of a porous nature。 But in cases of contusion； tubercles form； along
with cough； suppurating sores； and sphacelus of the ribs； for nerves
from all the parts run along each rib。 In many of these cases
haemoptysis and empyema also take place。 The management of this case
consists in careful treatment； bandaging according to rule； diet at
first restricted； but afterward more liberal； quiet； silence；
position； bowels； and venereal matters regulated。 Even when there is
no spitting of blood； these contusions are more painful than
fractures； and are more subject in time to relapses； and when any
mucous collection is left in the part； it makes itself be felt in
disorders of the body。 Treatment：…burning； when the bone is
affected； down to the bone； but not touching the bone itself； if in
the intercostal space； the burning must not extend through it； nor
be too superficial。 In sphacelus of the ribs； tents are to be tried；
all other particulars will be stated afterward： but they should be
learned by sight rather than by words； namely； food； drink； heat；
cold； attitude； medicines