Instruments of Reduction   

a great extent, unless you bring both limbs into the middle space
between them in making a comparison of them; and the foot and the
knee are inclined outward. If the dislocation has taken place from
birth, or during one’s growth, the thigh is shortened, the leg less
so, and the others according to the same rule; the fleshy parts are
atrophied, especially on the outside. Such persons are afraid to stand
erect, and crawl along on the sound limb; or, if compelled, they walk
with one or two staves, and bear up the affected limb; and the smaller
the limb so much the more do they walk. If the accident happens to
adults the bones remain of their proper size, but the flesh is wasted,
as formerly described; the patients walk in a wriggling manner, like
oxen; they are bent toward the flank, and the buttock on the uninjured
side is prominent; for the uninjured limb must necessarily come below
that it may support the body, whilst the other must be carried out
of the way, as it cannot support the body, like those who have an
ulcer in the foot. They poise the body by means of a staff on the
sound side, and grasp the affected limb with the hand above the knee
so as to carry the body in shifting from one place to another. If
the parts below the hip-joint be used, the bones below are less atrophied,
but the flesh more.


PART 21
The symptoms and attitudes in dislocation outward are the opposite,
and the knee and foot incline a little inward. When it is congenital,
or occurs during adolescence, the bones do not grow properly; according
to the same rule, the bone of the hip-joint is somewhat higher than
natural, and does not grow proportionally. In those who have frequent
dislocations outward, without inflammation, the limb is of a more
humid (flabby?) temperament than natural, like the thumb, for it is
the part most frequently dislocated, owing to its configuration; in
what persons the dislocation is to a greater or less extent; and in
what persons it is more difficultly or easily produced; in what there
is reason to hope that it can be speedily reduced, and in what not;
and the remedy for this; and in what cases the dislocation frequently
happens, and treatment of this. In 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