therefore； the distortion usually takes place； if not properly
treated； but indeed； all the other bones are usually distorted
during treatment for fracture to that side to which they naturally
incline。 When； therefore； anything of this kind is suspected； the
arm is to be encircled in a broad shawl； which is to be carried
round the breast； and when the patient goes to rest； a compress of
many folds； or some such thing； is to be folded and placed between the
elbow and the side； for thus the bending of the bone will be
rectified； but care must be taken lest it be inclined too much
inwards。
9。 The human foot is composed of several small bones like the
hand。 These bones therefore are scarcely ever broken； unless the
skin at the same time be wounded by some sharp and heavy body。 The
treatment of stich injuries； therefore； will be delivered under the
head of wounds。 But if any bone be moved from its place； or a joint of
the toes be luxated； or any of the bones of the part called the tarsus
be displaced； it must be forced back again to its place as described
with regard to the hand； and is to be treated with cerate； compresses；
and bandages； like the fractures； with the exception of the splints；
and is to be secured tightly in the same way； and the bandages renewed
on the third day； and the patient thus bandaged should return the same
answers as in fractures； as to the bandages feeling tight or slack。
All these bones recover perfectly in twenty days； except those that
are connected with the bones of the leg； and are in a line with
them。 It is advantageous to lie in bed during the whole of this
time； but the patients； thinking light of the complaint； have not
perseverance to do this； and they walk about before they get well；
wherefore many of these do not make a perfect recovery。 And often
the pain puts them in mind of the injury； and deservedly； for the feet
sustain the weight of the whole body。 When； therefore； they walk about
before they are whole； the joints which have been luxated are cured
incompletely； and； on that account； while walking about； they have
pains in the leg from time to time。
10。 But those bones which are connected with the bones of the leg
are larger than the others； and the cure of them when luxuated is more
protracted。 The mode of treatment then is the same； but we must use
more bandages and more splints； and the bandage is to be carried round
to this side and to that； and pressure is to be made as in the other
cases； particularly at the seat of the luxation； and the first circles
of the bandages are to be made there。 And at each time the bandages
are taken off； much hot water is to be used； for in all injuries at
joints the affusion of hot water in large quantity is to be had
recourse to。 And the same symptoms of compression and relaxation
should manifest themselves in the same times； as in the cases formerly
treated of； and the subsequent bandagings should be conducted in
like manner。 These cases get completely well for the most part in
forty days； if the patients have resolution to keep their bed； but
if not； they are subjected to the complaints formerly described； or
still worse。
11。 In persons who jumping from any high object pitch upon their
heel with great force； the bones are separated； and the veins pour
forth their contents； owing to the contusion of the flesh
surrounding the bone； and hence a swelling and much pain supervene。
For this bone （os calcis） is not a small one； protrudes beyond the
line of the leg； and is connected with important veins and tendons；
for the back tendon of the leg is inserted into this bone。 Such
cases are to be treated with cerate； and with compresses and bandages；
and hot water is to be used in large quantity； and they require many
bandages； which ought to be particularly good and appropriate。 And
if the patient happen to have a tender skin about the heel； nothing is
to be done to it； but if； as some have it； the skin be thick and
hardened； it is to be pared down smoothly and thinned； but without
wounding it。 It is not everybody who can apply the bandage properly in
such cases； for if one shall bind the parts； as in other accidents
about the ankle； sometimes bringing a fold round the foot and
sometimes round the tendon； these turns leave out the heel； which is
the seat of the contusion； and thus there is danger that the os calcis
may sphacelate； and if this should take place； the impediment may
endure for life and also in all the other cases of sphacelus； not
proceeding from such a cause as this； as when； from being carelessly
allowed to lie in a certain position during confinement to bed； the
heel becomes black； or when a serious wound has occurred in the leg
and it is long of healing； and is connected with the heel； or when the
same thing happens in the thigh； or when in any disease a protracted
decubitus takes place on the back； in all such cases the sores are
inveterate； troublesome； and frequently break out again； unless
particular attention be paid to the cure； along with much rest； as
in all the cases attended with sphacelus。 And cases of sphacelus
connected with this cause； in addition to other inconveniences； are
attended with great danger to the whole body。 For they are apt to be
attended with very acute fevers； of the continual type； accompanied
with tremblings； hiccup； aberration of intellect； and which prove
fatal within a few days： and there may be lividities of bloody
veins； with nausea； and gangrene from pressure； these diseases may
occur； besides the sphacelus。 Those which have been described are
the most violent contusion； but in general the contusions are mild；
and no great care is required with regard to the treatment； and yet it
must be conducted properly。 But when the contusion appears to be
severe； we must do as described above； making many turns of the
bandage around the heel； sometimes carrying it to the extremity of the
foot； sometimes to the middle； and sometimes around the leg； and； in
addition； all the surrounding parts are to be bandaged in this
direction and that； as formerly described； and the compression
should not be made strong； but we should make use of many bandages；
and it is better also to administer hellebore the same day or on the
morrow； and the bandages should be removed on the third day and
reapplied。 And these are the symptoms by which we discover whether the
case will get worse or not： when the extravasated blood； the
lividities； and the surrounding parts become red and hard； there is
danger of an exacerbation。 But if there be no fever； we must give
emetics； as has been said； and administer the other remedies which are
applicable when the fever is not of a continual type； but if continual
fever be present； we must not give strong medicines； but enjoin
abstinence from solid food and soups； and give water for drink； and
not allow wine but oxyglyky （a composition from vinegar and honey？）。
But if the case be not going to get worse； the ecchymosed and livid
parts； and those surrounding them become greenish and not hard； for
this is a satisfactory proof in all cases of ecchymosis； that they are
not to get worse； but when lividity is complicated with hardness；
there is danger that the part may become blackened。 And we must so
manage the foot as that it may be generally raised a little higher
than the rest of the body。 Such a patient will get well in sixty
days if he keep quiet。
12。 The leg consists of two bones； of which the one is much more
slender than the other at one part； but not much more slender at
another。 These are connected together at the foot； and form a common
epiphysis； but they are not united together along the line of the leg；
and at the thigh they are united together and form an epiphysis； and
this epiphysis has a diaphysis； but the other bone in a line with
the little toe is a little longer。 Such is the nature of the bones
of the leg。
13。 Sometimes the bones connected with the foot are displaced；
sometimes both bones with their epiphysis； sometimes the whole
epiphysis is slightly moved； and sometimes the other bone。 These cases
are less troublesome than the same accidents at the wrist； if the
patients will have resolution to give them rest。 The mode of treatment
is the same as that of the other； for the reduction is to be made；
as of the other； by means of extension； but greater force is required；
as the parts of the body concerned are stronger in this case。 But； for
the most part； two men will be sufficient； by making extension in
opposite directions； but； not withstanding； if they are not
sufficiently strong； it is easy to make more powerful extension in the
following way： having fixed in the ground either the nave of a
wheel； or any such object； something soft is to be bound round the
foot； and then some broad thongs of ox…skin being brought round it；
the heads of the thongs are to be fastened to a pestle or any other
piece of wood； the end of which is to be inserted into the nave； and
it； the pestle； is to be pulled away； while other persons make
counter…extension by grasping the shoulders and the ham。 It is also
sometimes necessary to secure the upper extremity otherwise； this if
you desire to effect； fasten deeply in the ground a round； smooth
piece of wood； and place the upper extremity of the piece of wood at
the perineum； so that it may prevent the body from yielding to the
pulling at the foot； and； moreover； to prevent the leg while
stretched； from inclining downward； some person seated at his side
should push back the hip； so that the body may not turn round with the
pulling； and for this purpose； if you think fit； pieces of wood may be
fastened about the armpits on each side； and they are to be
stretched by the hands； and thus secured； while another person takes
hold of the limb at the knee； and aids in thus making
counter…extension。 Or thus； if you prefer it： having bound other
thongs of leather about the limb； either at the knee； or around the
thigh； and having fastened another nave of a wheel in the ground above
the head； and adjusted the thongs piece of wood adapted to the nave；
extension may thus be made in the opposite direction to the feet。 Or
if you cho