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On The Articulations   


lodged near the bone, for the flesh no longer adheres to the bone as
formerly, the bone becomes diseased, and chronic sloughings of the
bone in many cases arise from such causes. But if the mischief be
not upon the bone, but it is the flesh itself which is pulpy, relapses
and pains will return from time to time, if there happen to be any
disorder in the body; wherefore proper bandaging, and for a
considerable time, must be had recourse to, until the extravasated
blood forming in the bruise be dried up and absorbed, and the part
be made up with sound flesh, and the flesh adhere to the bone. The
best cure is the cautery in those cases which, from neglect, have
become chronic, and the place turns painful, and the flesh is pulpy.
And when the flesh itself is pulpy, the burning should be carried as
far as the bone, but the bone itself should not be heated; but if it
be in the intercostal space, you need not make the burning so
superficial, only you must take care not to burn quite through. But if
the contusion appear to be at the bone, if it be still recent, and the
bone has not yet become necrosed, if it be very small, it is to be
burned as has been described; but if the rising along the bone be
oblong, several eschars are to be burned over it. Necrosis of the
rib will be described along with the treatment of suppurating sores.

51. There are four modes of dislocation at the hip-joint: of which
modes, dislocation inward takes place most frequently, outward, the
most frequently of all the other modes; and it sometimes takes place
backward and forward, but seldom. When, therefore, dislocation takes
place inward, the leg appears longer than natural, when compared
with the other leg, for two reasons truly; for the bone which
articulates with the hip-joint is carried from above down to the
ischium where it rises up to the pubes, upon it, then, the head of the
femur rests, and the neck of the femur is lodged in the cotyloid
foramen (foramen thyroideum?). The buttock appears hollow
externally, from the head of the thighbone having shifted inward,
and the extremity of the femur at the knee is turned outward, and
the leg and foot in like manner. The foot then being turned outward,
physicians, from ignorance, bring the sound leg to it and not it to
the sound leg; on this account, the injured limb appears to be much
longer than the sound one, and in many other cases similar
circumstances lead to error in judgment. Neither does the limb at
the groin admit of flexion as in the sound limb, and the head of the
bone is felt at the perineum too prominent. These, then, are the
symptoms attending dislocation of the thigh inward.

52. When, then, a dislocation has not been reduced, but has been
misunderstood or neglected, the leg, in walking, is rolled about as is
the case with oxen, and the weight of the body is mostly supported
on the sound leg, and the limb at the flank, and the joint where the
dislocation has occurred is necessarily hollow and bent, while on
the sound side the buttock is necessarily rounded. For if one should
walk with the foot of the sound leg turned outward, the weight of
the body would be thrown upon the injured limb, but the injured limb
could not carry it, for how could it? One, then, is forced in
walking to turn the leg inward, and not outward, for thus the sound
leg best supports its own half of the body, and also that of the
injured side. But being hollow at the flank and the hip-joint, they
appear small in stature, and are forced to rest on a staff at the side
of the sound leg. For they require the support of a staff there, since
the nates inclines to this side, and the weight of the body is carried
to it. They are forced also to stoop, for they are obliged to rest the
hand on the side of the thigh against the affected limb; for the
limb which is injured cannot support the body in changing the legs,
unless it be held when it is applied to the ground. They who have
got an unreduced dislocation inward are forced to put themselves
into these attitudes, and this from no premeditation on their part how
they should assume the easiest position, but the impediment itself

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