Instruments of Reduction   

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