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
teaches them to choose that which is most conformable to their present
circumstances。 For persons who have a sore on the foot； or leg； and
cannot rest upon the limb； all； even children； walk in this way； for
they turn the injured limb outward in walking； and they derive two
advantages therefrom； to supply two wants； the weight of the body is
not equally thrown upon the limb turned outward； as upon the one
turned inward； for neither is the weight in a line with it； but is
much more thrown upon the one under the body； for the weight is in a
straight line with it； both in walking and in the shifting of the
legs。 In this position one can most quickly turn the sound limb
under the body； by walking with the unsound limb outward； and the
sound inward。 In the case we are now treating of； it is well that
the body finds out the attitudes which are the easiest for itself。
Those persons； then； who have not attained their growth at the time
when they met with a dislocation which is not reduced； become maimed
in the thigh； the leg； and the foot； for neither do the bones grow
properly； but become shortened； and especially the bone of the
thigh； and the whole limb is emaciated； loses its muscularity； and
becomes enervated and thinner； both from the impediment at the
joint； and because the patient cannot use the limb； as it does not lie
in its natural position； for a certain amount of exercise will relieve
excessive enervation； and it will remedy in so far the deficiency of
growth in length。 Those persons； then； are most maimed who have
experienced the dislocation in utero； next those who have met with
it in infancy； and least of all； those who are full grown。 The mode of
walking adopted by adults has been already described； but those who
are children when this accident befalls them； generally lose the erect
position of the body； and crawl about miserably on the sound leg；
supporting themselves with the hand of the sound side resting on the
ground。 Some； also； who had attained manhood before they met with this
accident； have also lost the faculty of walking erect。 Those who
were children when they met with the accident； and have been
properly instructed； stand erect upon the sound leg； but carry about a
staff； which they apply under the armpit of the sound side； and some
use a staff in both arms； the unsound limb they bear up； and the
smaller the unsound limb； the greater facility have they in walking；
and their sound leg is no less strong than when both are sound。 The
fleshy parts of the limb are enervated in all such cases； but those
who have dislocation inward are more subject to this loss of
strength than； for the most part； those who have it outward。
53。 Some tell a story how the Amazonian women dislocate the joints
of their male children while mere infants； some at the knee； and
others at the hip…joint； that they may be maimed； and that the male
sex may not conspire against the female； and that they use them as
artisans to perform any sedentary work； such as that of a shoemaker or
brazier。 Whether these things be true or not I do not know； but this I
know； that matters would be such as is represented； provided their
children； while infants； were to have their joints dislocated。 The
consequences of dislocation inward at the hip…joint are much greater
than of dislocation outward at the hip…joint； but at the knee；
although there be some difference； it is less； but the mode of
either impediment is peculiar； their legs are more bandied when the
dislocation is outward； but those who have dislocation inward stand
erect on their feet with less freedom。 In like manner； when the
dislocation is at the anklejoint； if outward they become vari （their
toes are turned inward？）； but they can stand； but if the dislocation
be inward they become valgi （their toes are turned outward？）； but they
have less freedom of standing。 The proportional growth of their
bones is as follows： in those cases in which the bone of the leg is
dislocated； the bones of the feet grow very little； as being very near
the injury； but the bones of the leg increase in size； and with very
little defect； but the fleshy parts （muscles？） are wasted。 But when
the ankle…joint is in its natural state； but the knee is dislocated；
in these cases the bones of the leg do not grow in like manner； but
become shortened； as being nearest the seat of the injury； and the
bones of the feet also are atrophied； but not in the same
proportion； because； as was said a little while ago； the ankle…joint
is safe； and if they could use it； as in the case of club…foot； the
bones of the foot would be still less atrophied。 When the
dislocation takes place at the hip…joint； the bone of the thigh； in
this case； does not generally grow in like manner； as being the one
nearest the seat of the injury； but becomes shorter than the sound
one； but the growth of the bones of the leg is not arrested in like
manner； nor of those of the feet； for this reason； that there is no
displacement between the bones of the thigh and leg； nor between those
of the leg and foot； in those cases； however； the fleshy parts of
the whole limb are atrophied； but if they could make use of the
limb； the growth of the bones would be still more developed； as
formerly stated； only the thigh； although its flesh would be much less
wasted； would still be by no means so fleshy as the sound limb。 The
following observations are a proof of this： those persons who are
weasel…armed （galiancones） from birth； owing to dislocation of the
humerus； or when the accident has happened to them before they have
attained their full growth； such persons have the bone of the arm
shortened； but those of the fore…arm and hand are little inferior in
size to the sound； for the reasons which have been stated； because the
humerus is the bone nearest to the joint affected； and； on that
account； it is shorter than natural； but the fore…arm is not equally
affected by the accident； because the joint at which the bones of
the arm and forearm are articulated remains in its natural
condition； and the hand is still further distant than the fore…arm
from the seat of the injury。 Such are the reasons why certain of the
bones in this case increase in growth； and certain do not。 The
laborious office of the hand contributes much to the development of
the flesh in the fore…arm and hand； for whatever work is done by the
hand； these weasel…armed persons strive to do no less effectually with
the other hand than with the sound； for the arms do not support the
weight of the body like the legs； and the work performed by them is
light。 From exercise； then； the fleshy parts on the hand and
fore…arm are not atrophied in weasel…armed persons； and by these means
the arm； too； gains flesh。 But in dislocation inward at