Instruments of Reduction   

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.