are already past remedy？ This is far from being the case； for it
belongs to the knowledge of medicine to be acquainted also with these；
and they cannot possibly be separated from one another； for to such as
are curable； means are to be used to prevent them from becoming
incurable； studying how they may best be prevented from getting into
an incurable state。 And incurable cases should be known； that they may
not be aggravated by useless applications； and splendid and creditable
prognostics are made by knowing where； how； and when every case will
terminate； and whether it will be converted into a curable or an
incurable disease。 When then； from birth； or during one's youth；
this dislocation backward occurs； and is not reduced； whether it be
connected with violence or disease （for many such dislocations occur
in diseases； but the nature of the diseases in which dislocations take
place； will be described afterward）； if； then； the dislocated limb
be not reduced； the bone of the thigh becomes shortened； the whole
limb is impaired； is arrested in its growth； and loses its flesh
from want of use； the articulation at the ham is also impaired； for
the nerves （ligaments？） become stretched； from cases formerly
stated； wherefore those who have this dislocation； cannot make
extension at the knee…joint。 In a word； all parts of the body which
were made for active use； if moderately used and exercised at the
labor to which they are habituated； become healthy； increase in
bulk； and bear their age well； but when not used； and when left
without exercise； they become diseased； their growth is arrested；
and they soon become old。 Among these parts the joints and nerves
（ligaments？）； if not used； are not the least liable to be so affected；
they are impaired； then； for the reasons we have stated； more in
this variety of dislocation than in the others； for the whole limb
is wasted； both in its bones and in its fleshy parts。 Such persons；
then； when they attain their full growth； keep the limb raised and
flexed； rest the weight of the body on the other leg； and support
themselves with a staff； some with one； and others with two。
59。 In dislocations of the head of the thigh…bone forward （they
are of rare occurrence）； the patients cannot extend the leg
completely； but least of all can they bend it at the groin； they are
pained； also； if forced to bend the limb at the ham。 The length of the
leg； if compared at the heel； is the same as that of the other； but
the extremity of the foot inclines less to project forward。 But the
whole limb has its natural direction； and inclines neither to this
side nor to that。 These cases are particularly attended with severe
pain； and they are more apt to be accompanied with retention of
urine at first than any of the other dislocations； for the head of the
thigh…bone is lodged very near to important nerves。 And the region
of the groin appears swelled out and stretched； while that of the
nates is more wrinkled and flabby。 The symptoms now stated are those
which attend this dislocation of the thigh…bone。
60。 When persons have attained their full growth before meeting with
this dislocation； and when it has not been reduced； upon the
subsidence of the pain； and when the bone of the joint has been
accustomed to be rotated in the place where it is lodged； these
persons can walk almost erect without a staff； and with the injured
leg almost quite straight； as it does not admit of easy flexion at the
groin and the ham； owing； then； to this want of flexion at the
groin； they keep the limb more straight in walking than they do the
sound one。 And sometimes they drag the foot along the ground； as not
being able to bend the upper part of the limb； and they walk with
the whole foot on the ground； for in walking they rest no less on
the heel than on the fore part of the foot； and if they could take
great steps； they would rest entirely on the heel in walking； for
persons whose limbs are sound； the greater the steps they take in
walking； rest so much the more on the heel； while they are putting
down the one foot and raising the opposite。 In this form of
dislocation； persons rest their weight more on the heel than on the
anterior part of the foot； for the fore part of the foot cannot be
bent forward equally well when the rest of the limb is extended as
when it is in a state of flexion； neither； again； can the foot be
arched to the same degree the limb is bent as when it is extended。 The
natural state of matters is such as has been now described； and in
an unreduced dislocation； persons walk in the manner described； for
the reasons which have been stated。 The limb； moreover； is less fleshy
than the other； at the nates； the calf of the leg； and the whole of
its posterior part。 When this dislocation occurs in infancy； and is
not reduced； or when it is congenital； in these cases the bone of
the thigh is more atrophied than those of the leg and foot； but the
atrophy of the thigh…bone is least of all in this form of dislocation。
The fleshy parts； however； are everywhere attenuated； more
especially behind； as has been stated above。 If properly trained； such
persons； when they grow up； can use the limb； which is only a little
shorter than the other； and yet they support themselves on a staff
at the affected side。 For； not being able to use properly the ball
of the foot without the heel； nor to put it down as some can in the
other varieties of dislocation （the cause of which has been just now
stated）； on this account they require a staff。 But those who are
neglected； and are not in the practice of putting their foot to the
ground； but keep the limb up； have the bones more atrophied than those
who use the limb； and； at the articulations； the limb is more maimed
in the direct line than in the other forms of dislocation。
61。 In a word； luxations and subluxations take place in different
degrees； being sometimes greater and sometimes less； and those cases
in which the bone has slipped or been displaced to a much greater
extent； are in general more difficult to rectify than otherwise； and
if not reduced； such cases have greater and more striking impairment
and lesion of the bones； fleshy parts； and attitudes； but when the
bone has slipped； or been displaced to a less extent； it is easier
to reduce such cases than the other； and if the attempts at
reduction have failed； or have been neglected； the impairment in
such cases is less； and proves less injurious than in the cases just
mentioned。 The other joints present great differences as to the extent
of the displacements which they are subject to。 But the heads of the
femur and humerus are very similar to one another as to their
dislocations。 For the heads of the bones are rounded and smooth； and
the sockets which receive the heads are also circular； and adapted
to the heads； they do not admit then of being dislocated in any
intermediate degree； but； not withstanding； from their rounded
shape； the bones slip either outward or inward。 In the case we are now
treating of； then； there is either a complete dislocation or none at
all； and yet these bones admit of being displaced to a greater or less
extent； and the thigh is more subject to these differences than the
arm。
62。 Wherefore； then； some of these congenital displacements； if to a
small extent； may be reduced to their natural condition； and
especially those at the ankle…joint。 Most cases of congenital
club…foot are remediable； unless the declination be very great； or
when the affection occurs at an advanced period of youth。 The best
plan； then； is to treat such cases at as early a period as possible；
before the deficiency of the bones of the foot is very great； and
before there is any great wasting of the flesh of the leg。 There is
more than one variety of club…foot； the most of them being not
complete dislocations； but impairments connected with the habitual
maintenance of the limb in a certain position。 In conducting the
treatment； attention must be paid to the following points： to push
back and rectify the bone of the leg at the ankle from without inward；
and to make counter…pressure on the bone of the heel in an outward
direction； so as to bring it bring it into line； in order that the
displaced bones may meet at the middle and side of the foot； and the
mass of the toes； with the great toe； are to be inclined inward； and
retained so； and the parts are to be secured； with cerate containing a
full proportion of resin； with compresses； and soft bandages
insufficient quantity； but not applied too tight； and the turns of the
bandages should be in the same direction as the rectifying of the foot
with the hand； so that the foot may appear to incline a little
outward。 And a sole made of leather not very hard； or of lead； is to
be bound on； and it is not to be applied to the skin but when you
are about to make the last turns of the bandages。 And when it is all
bandaged； you must attach the end of one of the bandages that are used
to the bandages applied to the inferior part of the foot on the line
of the little toe； and then this bandage is to be rolled upward in
what is considered to be a sufficient degree； to above the calf of the
leg； so that it may remain firm when thus arranged。 In a word； as if
moulding a wax model； you must bring to their natural position the
parts which were abnormally displaced and contracted together； so
rectifying them with your hands； and with the bandaging in like
manner； as to bring them into their position； not by force； but
gently； and the bandages are to be stitched so as to suit the position
in which the limb is to be placed； for different modes of the
deformity require different positions。 And a small shoe made of lead
is to be bound on externally to the bandaging； having the same shape
as the Chian slippers had。 But there is no necessity for it if the
parts be properly adjusted with the hands； properly secured with the
bandages； and properly disposed of afterward。 This； then； is the
mode of cure； and it neither requires cutting； burning； nor any
other complex means； for such cases yield sooner to treatment than one
would believe。 However； they are to be fairly mastered only by