denuded in this manner； drop off on the eightieth day； but in the case
of this patient； the parts below were separated at the knee on the
twentieth day； and； as I thought； too early； for it appeared to me
that this should be done more guardedly。 In a case which I had of such
blackening in the leg； the bones of the leg； as far as they were
denuded； separated at its middle on the sixtieth day。 But the
separation of denuded bones is quicker or slower； according to the
mode of treatment； something； too； depends upon whether the
compression be stronger or weaker； and whether the nerves； flesh；
arteries； and veins are quicker or slower in becoming blackened and in
dying； since； when the parts are not strongly compressed； the
separation is more superficial； and does not go the length of laying
the bones bare； and in some cases it is still more superficial； so
as not even to expose the nerves。 For the reasons now stated； it is
impossible to define accurately the time at which each of these
cases will terminate。 The treatment of such cases； however； is to be
readily undertaken； for they are more formidable to look at than to
treat； and a mild treatment is sufficient in all such cases； for
they come to a crisis of themselves； only the diet must be attended
to； so that it may be as little calculated to create fever as
possible； and the body is to be placed in the proper positions：
these are； neither raised very high up； nor inclined much downward；
but rather upward； until the separation be completed； for at that time
there is most danger of hemorrhage； on this account； wounds should not
be laid in a declining position； but the contrary。 But after a
while； and when the sores have become clean； the same positions will
no longer be appropriate； but a straight position； and one inclining
downward； may be proper； and in the course of time； in some of these
cases； abscesses form； and require bandages。 One may also expect
that such patients will be attacked with dysentery； for dysentery
usually supervenes in cases of mortification and of hemorrhage from
wounds； it comes on generally when the blackening and hemorrhage
have arrived at a crisis； and is profuse and intense； but does not
last many days； neither is it of a fatal nature； for such patients
do not usually lose their appetite； nor is it proper to put them on
a restricted diet。
70。 Dislocation inward at the hip…joint is to be reduced in the
following manner： （it is a good； proper； and natural mode of
reduction； and has something of display in it； if any one takes
delight in such ostentatious modes of procedure）。 The patient is to be
suspended by the feet from a cross…beam with a strong； soft； and broad
cord； the feet are to be about four inches or less from one another；
and a broad and soft leather collar connected with the cross…beam is
to be put on above the knees； and the affected leg should be so
extended as to moved be two inches longer than the other； the head
should be about two cubits from the ground； or a little more or
less； and the arms should be stretched along the sides； and bound with
something soft； all these preparations should be made while he is
lying on his back； so that he may be suspended for as short a time
as possible。 But when the patient is suspended； a person properly
instructed and not weak； having introduced his arm between his thighs；
is to place his fore…arm between the perineum and the dislocated
head of the os femoris； and then； having joined the other hand to
the one thus passed through the thighs； he is to stand by the side
of the suspended patient； and suddenly suspend and swing himself in
the air as perpendicularly as possible。 This method comprises all
the conditions which are natural； for the body being suspended by
its weight； produces extension； and the person suspended from him；
along with the extension； forces the head of the thigh…bone to rise up
above the acetabulum； and at the same time he uses the bone of the
fore…arm as a lever； and forces the os femoris to slip into its old
seat。 The cords should be properly prepared； and care should be
taken that the person suspended along with the patient have a
sufficiently strong hold。
71。 Wherefore； as formerly stated； men's constitutions differ much
from one another as to the facility or difficulty with which
dislocations are reduced； and the cause of this was also stated
formerly in treating of the shoulder。 In some the thigh is reduced
with no preparation； with slight extension； directed by the hands； and
with slight movement； and in some the reduction is effected by bending
the limb at the joint； and making rotation。 But much more frequently
it does not yield to any ordinary apparatus； and therefore one
should be acquainted with the most powerful means which can be applied
in each case； and use whatever maybe judged most proper under all
circumstances。 The modes of extension have been described in the
former parts of the work； so that one may make use of whatever may
happen to be at hand。 For； extension and counter…extension are to be
made in the direction of the limb and the body； and if this be
properly effected； the head of the thigh…bone will be raised above its
ancient seat； and if thus raised； it will not be easy to prevent it
from settling in its place； so that any ordinary impulse with the
lever and adjustment will be quite sufficient； but some apply
insufficient extension； and hence the reduction gives much trouble。
The bands then should be fastened； not only at the foot； but also
above the knee； so that the force of the extension may not be expended
on the knee…joint more than upon the hip…joint。 The extension in the
direction of the foot is to be thus contrived。 But the
counter…extension is not only to be managed by means of something
carried round the chest and armpits； but also by a long； double；
strong； and supple thong applied to the perineum； and carried behind
along the spine； and in front along the collar…bone and fixed to the
point from which counter…extension is made； and then force is to be so
applied； by means of this extension and counter…extension； that the
thong at the perineum may not pass over the head of the thigh…bone；
but between it and the perineum； and during the extension one should
strike the head of the femur with the fist； so as to drive it outward。
And when the patient is raised up by the stretching； you should pass a
hand through （between the legs？） and grasp it with the other hand；
so as at the same time to make extension； and force the dislocated
limb outward； while some other person sitting by the knee quietly
directs it inward。
72。 It has been formerly stated by us that it will be of
importance for any person who practices medicine in a populous city to
get prepared a quadrangular board； about six cubits or a little more
in length； and about two cubits in breadth； a fathom will be
sufficient thickness for it； and then along it from the one end to the
other； an excavation must be made； so that the working of the levers
may not be higher than is proper； then at both sides we are to raise
short； strong； and strongly…fixed posts； having axles； and in the
middle of the bench five or six long grooves are to be scooped out
about four inches distant from one another； three inches will be a
sufficient breadth for them； and the depth in like manner； and
although the number of grooves I have mentioned will be sufficient；
there is nothing to prevent their being made all over the bench。 And
the bench should have in its middle a pretty deep hole； of a square
shape； and of about three inches in size； and into this hole； when
judged necessary； is to be adjusted a corresponding piece of wood；
rounded above； which； at the proper time； is to be adjusted between
the perineum and the head of the thigh…bone。 This upright piece of
wood prevents the body from yielding to the force dragging downward by
the feet； for sometimes this piece of wood serves the purpose of
counter…extension upward； and sometimes； too； when extension and
counter…extension are made； this piece of wood； if susceptible of some
motion to this side or that； will serve the purpose of a lever for
pushing the head of the thigh…bone outward。 It is on this account that
several grooves are scooped out on the bench； so that this piece of
wood； being erected at the one which answers； may act as a lever；
either on the sides of the articular heads of bones； or may make
pressure direct on the heads along with the extension； according as it
may suit to push inward or outward with the lever； and the lever may
be either of a round or broad form； as may be judged proper； for
sometimes the one form and sometimes the other suits with the
articulation。 This mode of applying the lever along with extension
is applicable in the reduction of all dislocations of the thigh。 In
the case now on hand； a round lever is proper； but in dislocations
outward a flat lever will be the suitable one。 By means of such
machines and of such powers； it appears to me that we need never
fail in reducing any dislocation at a joint。
73。 And one might find out other modes of reduction for this
joint。 If the large bench were to have raised on it two posts about
a foot （in diameter？）； and of a suitable height； on each side near its
middle； and if a transverse piece of wood like the step of a ladder；
were inserted in the posts； then if the sound leg were carried through
between the posts； and the injured limb were brought over the
transverse piece of wood； which should be exactly adapted in height to
the joint which is dislocated （and it is an easy matter so to adjust
it； for the step of the ladder should be made a little higher than
required； and a convenient robe； folded several times； is to be laid
below the patient's body）； then a piece of wood； of suitable breadth
and length； is to be laid below the limb； and it should reach from the
ankle to beyond the head of the thigh…bone； and should be bound
moderately tight to the limb。 Then the limb being extended； either
by means of the pestle…like piece of wood （formerly described）； or
by any of the other methods of extension； the limb which is carried
over the