would believe。 However； they are to be fairly mastered only by time；
and not until the body has grown up in the natural shape； when
recourse is had to a shoe； the most suitable are the buskins； which
derive their name from being used in traveling through mud； for this
sort of shoe does not yield to the foot； but the foot yields to it。
A shoe shaped like the Cretan is also suitable。
63。 In cases of complete dislocation at the ankle…joint； complicated
with an external wound； whether the displacement be inward or outward；
you are not to reduce the parts； but let any other physician reduce
them if he choose。 For this you should know for certain； that the
patient will die if the parts are allowed to remain reduced； and
that he will not survive more than a few days； for few of them pass
the seventh day； being cut off by convulsions； and sometimes the leg
and foot are seized with gangrene。 It should be well known that such
will be the results； and it does not appear to me that hellebore
will do any good； though administered the same day； and the draught
repeated； and yet it is the most likely means； if any such there be；
but I am of opinion that not even it will be of service。 But if not
reduced； nor any attempts at first made to reduce them； most of such
cases recover。 The leg and foot are to be arranged as the patient
wishes； only they must not be put in a dependent position； nor moved
about； and they are to be treated with pitched cerate； a few
compresses dipped in wine； and not very cold； for cold in such cases
induces convulsions； the leaves also of beet； or of colt's foot； of
any such； when boiled in dark…colored austere wine； form a suitable
application to the wound and the surrounding parts； and the wound
may further be anointed with cerate in a tepid state。 But if it be the
winter season； the part is to be covered with unscoured wool； which is
to be sprinkled from above with tepid wine and oil； but on no
account is either bandage or compress to be applied； for this should
be known most especially； that whatever compresses； or is heavy；
does mischief in such cases。 And certain of the dressings used to
recent wounds are suitable in such cases； and wool may be laid upon
the sore； and sprinkled with wine； and allowed to remain for a
considerable time； but those dressings for recent wounds which only
last for a few days； and into which resin enters as an ingredient；
do not agree with them； for the cleansing of the sores is a slow
process； and the sore has a copious discharge for a long time。 Certain
of these cases it may be advantageous to bandage。 It ought also to
be well understood； that the patient must necessarily be much maimed
and deformed； for the foot is retracted outward； and the bones which
have been displaced outward protrude： these bones； in fact； not
being generally laid bare； unless to a small extent； neither do they
exfoliate； but they heal by thin and feeble cicatrices； provided the
patient keeps quiet for a length of time； but otherwise there is
danger that a small ulcer may remain incurable。 And yet in the case we
are treating of； those who are thus treated are saved； whereas； when
the parts are reduced and allowed to remain in place； the patients
die。
64。 The same rule applies to dislocations at the wrist； attended
with a wound and projection of the bone； whether the bones of the
arm be displaced inward or outward。 For this should be well
understood； that the patient will die in the course of a few days；
by the same mode of death as formerly described； if the bone be
reduced； and allowed to remain so。 But in those cases in which they
are not reduced； nor any attempt made to reduce them； the patients；
for the most part； recover； and the same mode of treatment as has been
described will be applicable； but the deformity and impediment of
the limb must necessarily be great； and the fingers of the hand will
be weak and useless； for if the bones have slipped inward； they cannot
bend the fingers； or if outward； they cannot extend them。
65。 When the os tibiae； having made a wound at the knee； has
protruded through the skin； whether the dislocation be outward or
inward； in such a case； if the bone be reduced； death will be even
more speedy than in the other cases； although speedy also in them。 But
the only hope of recovery is if you treat them without reduction。
These cases are more dangerous than the others； as being so much
higher up； as being so much stronger joints； and displaced from
bones which are so much stronger。 But if the os femoris form a wound
at the knee； and slip through it； provided it be reduced and left
so； it will occasion a still more violent and speedy death than in the
cases formerly described； but if not reduced； it will be much more
dangerous than those cases mentioned before； and yet this is the
only hope of recovery。
66。 The same rule applies to the elbow…joint； and with regard to the
bones of the fore…arm and arm。 For when these bones protrude through a
wound which they have made in the skin； all cases in which they are
reduced prove fatal； but if not reduced； there is a chance of
recovery； but to those that survive there is certain impediment。 And
if in any instance the bones of the upper articulations
（shoulder…joint？）； should be dislocated； and project through a wound
which they have made in the skin； these； if reduced； are followed by
more speedy death； and if not reduced； they are more dangerous than
the others。 But the mode of treatment which appears to me most
suitable has been already described。
67。 When the joints of the toes or hands are dislocated； and the
bones protrude through a wound which they have made； and when there is
no fracture of the bone； but merely displacement of the joint； in
these cases； if the reduction be made and allowed to remain； there
is some danger of spasms （tetanus？） if not properly treated； and yet
it may be worth while to reduce them； having warned the patient
beforehand that much caution and care will be required。 The easiest；
the most efficient method； and the one most conformable to art； is
that by the lever； as formerly described when treating of bones
which have been fractured and protruded； then the patient must be as
quiet as possible； lie in a recumbent position； and observe a
restricted regimen。 And it will be better also that he should get some
gentle emetics。 The sore is to be treated with dressings for fresh
wounds； which permit of allusions； or with the leaves of camomile；
or with the applications for fractured bones of the head； but
nothing very cold must be applied。 The first （most distant？） joints
are least dangerous； but those still higher； are more so。 Reduction
should be made the same day； or the next； but by no means on the third
or fourth； for it is on the fourth day that exacerbations especially
attack。 In those cases； then； where immediate reduction cannot be
accomplished； we must wait until after the aforesaid days； for
whatever you reduce within ten days； may be expected to induce
spasm。 But if the spasm supervene on its being reduced； the joint
should be quickly displaced； and bathed frequently with warm water；
and the whole body should be kept in a warm； soft； and easy condition；
and more especially about the joints； for the whole body should rather
be in a bent than in an extended state。 Moreover； it is to be
expected； that the articular extremities of the bones of the fingers
will for this generally happens； if even the least degree of
inflammation take place； so that if it were not that the physician
would be exposed to censure； owing to the ignorance of the common
people； no reduction should be made at all。 The reduction of the bones
of joints which have protruded through the skin； is attended with
the dangers which have been described。
68。 When the articular bones of the fingers are fairly chopped
off； these cases are mostly unattended with danger； unless deliquium
come on in consequence of the injury； and ordinary treatment will be
sufficient to such sores。 But when resection is made； not at the
articulations； but at some other point in the bones； these cases
also are free from danger； and are still more easily cured than the
others； and the fractured bones of the fingers which protrude
otherwise than at the joint admit of reduction without danger。
Complete resections of bones at the joints； whether the foot； the
hand； the leg； the ankle； the forearm； the wrist； for the most part；
are not unattended with danger； unless one be cut off at once by
deliquium animi； or if continual fever supervene on the fourth day。
69。 With regard to the sphacelus of fleshy parts； it takes place
in wounds where there are large blood…vessels； which have been
strongly compressed； and in fractures of bones which have been bound
too tight； and in other cases of immoderate constriction； when the
parts which have been strangulated generally drop off； and the most of
such patients recover； even when a portion of the thigh comes away； or
of the arm； both bones and flesh； but less so in this case； and when
the fore…arm and leg drop off； the patients readily recover。 In
cases then； of fracture of the bones； when strangulation and
blackening of the parts take place at first； the separation of the
dead and living parts quickly occurs； and the parts speedily drop off；
as the bones have already given way； but when the blackening
（mortification） takes place while the bones are entire； the fleshy
parts； in this case； also quickly die； but the bones are slow in
separating at the boundary of the blackening； and where the bones
are laid bare。 Those parts of the body which are below the
boundaries of the blackening are to be removed at the joint； as soon
as they are fairly dead and have lost their sensibility； care being
taken not to wound any living part； for if the part which is cut off
give pain； and if it prove not to be quite dead； there is great danger
lest the patient may swoon away from the pain； and such swoonings
often are immediately fatal。 I have known the thigh…bones； when
denuded in this manner； drop off on the eightieth day； but in the case
of this patient； the parts below were separate