fore…arm are not atrophied in weasel…armed persons； and by these means
the arm； too； gains flesh。 But in dislocation inward at the hip…joint；
whether from birth or from childhood； the fleshy parts； on that
account； are much more atrophied than those of the hand； because the
patients cannot exercise the leg。 Another proof will be given in the
observations which will be presently stated； that these things are
such as I things are such as I have represented。
54。 When the head of the femur is dislocated outward； the limb in
these cases； when compared with the other； appears shortened； and this
is natural； for the head of the femur no longer rests on a bone as
in dislocation inward； but along the side of a bone which naturally
inclines to the side； and it is lodged in flesh of a pulpy and
yielding nature； and on that account it appears more shortened。
Inwardly； the thigh about the perineum appears more hollow and flabby；
but externally the buttock is more rounded； from the head of the thigh
having slipped outward； but the nates appear to be raised up； owing to
the flesh there having yielded to the head of the thigh…bone； but
the extremity of the thigh…bone； at the knee； appears to be turned
inward； and the leg and foot in like manner； neither does it admit
of flexion like the sound limb。 These； then； are the symptoms of
dislocation outward。
55。 When such a dislocation is not reduced in adults； the whole limb
appears to be shortened； and in walking they cannot reach the ground
with the heel； but they walk with the ball of the foot on the
ground； and the points of their toes incline a little inward。 But
the injured limb； in this case； can support the body much better
than in dislocation inward； both because the head of the femur and the
neck of its articular extremity； being naturally oblique； have
formed a bed under a considerable portion of the hip； and because
the extremity of the foot is not forcibly turned outward； but is
nearly in a line with the body； and is even inclined more inwardly。
When； then； the articular extremity of the femur has worn out a socket
for itself in the flesh where it was lodged； and the flesh is
lubricated； it ceases to be painful in the course of time； and when it
becomes free from pain； they can walk without a staff； if so inclined；
and they can support the body on the injured limb。 From usage then； in
such cases； the fleshy parts are less enervated than in those which
have been mentioned a little before； still； however； they lose their
strength more or less； but in general there is more enervation when
the dislocation is inward than when it is outward。 Some of them； then；
cannot wear their shoes； owing to the unbending state of their leg；
and some of them can。 But when this dislocation takes place in
utero； and when the dislocation having occurred at any time before
manhood； from violence； has not been replaced； or when from disease
the articular extremity has started from its socket； and is
displaced （for many such cases occur； and from some of them； if the
femur become necrosed； obstinate suppurations requiring the use of
tents are formed； and in certain of them the bone is laid bare）；
whether the bone become necrosed or not； the bone of the thigh is much
shortened； and does not usually grow like the sound one； the bones；
too； of the leg； become shorter than those of the other； but in a
small degree； for the same reasons that were formerly stated； such
persons can walk； some of them in the same fashion as adults having an
unreduced dislocation； and some of them walk with the whole foot on
the ground； but limp in walking； being obliged to do so by the
shortness of the limb。 Such is the result； even though they be
carefully and properly trained in the attitudes before they have
strength for walking； and in like manner also； after they have
acquired the necessary strength； but those persons require the most
care who were very young when they met with the accident； for； if
neglected while children； the limb becomes entirely useless and
atrophied。 The fleshy parts of the entire limb are more wasted than
those of the sound limb； but this is much less apt to happen in
their case than in dislocation inward； owing to usage and exercise； as
they are speedily able to make use of the limb； as was stated a little
before with regard to the weasel…armed （galiancones）。
56。 There are persons who； from birth or from disease； have
dislocations outward of both the thighs； in them； then； the bones
are affected in like manner； but the fleshy parts in their case lose
their strength less； the legs； too； are plump and fleshy； except
that there is some little deficiency at the inside； and they are plump
because they have the equal use of both their legs； for in walking
they totter equally to this side that。 Their nates appear very
prominent； from the displacement of the bones of the joint。 But if
in their case the bones do not sphacelate （become carious？） and if
they do not become bent above the hip…joint； if nothing of this kind
happen to them； they become otherwise sufficiently healthy； but the
growth of all the rest of the body； with the exception of the head； is
arrested。
57。 In dislocations of the head of the femur backward； which
rarely occur； the patient cannot extend the leg； either at the
dislocated joint； or at the ham； to any extent； and of all the
dislocations； this is the variety in which the patients have the least
power of making extension at the groin and the ham。 But； moreover；
this also should be known （for it is a valuable piece of knowledge；
and of much importance； and yet most yet most people are ignorant of
it）； that persons in health cannot extend the joint at the ham； if
they do not extend the joint at the groin at the same time； unless
they raise the foot very high； for in this way they could do it；
neither also could they bend the joint at the ham； but with much
greater difficulty； if they do not bend the joint at the groin at
the same time。 There are many other things in the body which have
similar connections； both with regard to the contractions of nerves
（ligaments？）； and the positions of muscles； and many of them more
worthy of being known than is generally supposed； and with regard to
the nature of the intestine and that of the whole internal cavity； and
with regard to the displacements and contractions of the uterus； but
all these things will be treated of elsewhere； in a work akin to the
present one。 But with regard to the matter on hand； they cannot make
extension； as has been already stated； and the limb appears shortened；
for two reasons…first； because it cannot be extended； and also because
the bone has slipped into the flesh of the nates； for the head and
neck of the femur； in this dislocation； are carried downward from
their natural situation； to the outside of the nates。 But yet they can
bend the limb； unless prevented by pain； and the leg and foot appear
pretty straight； and not much inclined toward either side； but at
the groin the flesh； when felt； appears looser； from the bone of the
joint having slipped to the other side； but at the nates the head of
the femur may be felt to be more prominent than natural。 Such are
the symptoms accompanying dislocation of the thigh backward。
58。 When this dislocation occurs in an adult； and is not reduced； he
can walk； indeed； after a time； and when the pain has abated； and when
he has been accustomed to rotate the articular bone in the flesh； he
finds it necessary； however； to make strong flexion at the groin in
walking； for two reasons； both because the limb； for the causes
already stated； becomes much shorter； and he is far from touching
the ground with his heel； and he can barely reach it with the ball
of his foot； and not even thus； unless he bend himself at the
groins； and also bend with the other leg at the ham。 And in this case；
he is under the necessity of supporting the upper part of the thigh
with his hand at each step： this also contributes； in a certain
degree； to make him bend the body at the groins； for； during the
shifting of the feet in walking； the body cannot be supported on the
unsound be supported on the unsound limb； unless it be pressed to
the ground by the hand；…the end of the femur not being placed properly
under the body； but having slipped backward to the nates； and if he
should try to rest the weight of his body for a little； upon the foot；
without any other support； he would fall backward； for there would
be a great inclination in this direction； from the hips having
protruded backward far beyond the line of the foot； and the spine
inclining toward the hips。 Such persons can walk； indeed； without a
staff； if so accustomed； for because the sole of the foot is in its
old line； and is not inclined outward； they do not require anything to
balance them。 Such； however； as； instead of grasping the thigh； prefer
resting their weight upon a staff introduced into the armpit of the
affected side； these； if they use a longer staff； will walk； indeed；
more erect； but will not be able to reach the ground with the foot； or
if they wish to rest upon the foot； they must take a shorter staff；
and will require to bend the body at the groins。 The wasting of the
fleshy parts is analogous to what happens in the cases formerly
described； for the wasting is greatest in those cases in which the
patients keep the limb up； and do not exercise it； whilst those who
practice walking； have the least atrophy。 The sound leg； however； is
not benefited； but is rather rendered more deformed； if the injured
limb be applied to the ground； for it is forced to cooperate with
the other； being protruded at the hip； and bent at the ham。 But if the
patient does not use the injured limb by applying it to the ground；
but carries it up； and rests upon a staff； the sound leg thereby gains
strength； for it is employed in its natural position； and further； the
exercise gives it strength。 But it may be said； these things are
foreign to medicine； for what is the use of enlarging upon cases which
are already past remedy？ This is far from being the case； for it
belongs to the knowledge of medicine to be acquainted also