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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 choose； it may be done thus： instead of the naves； lay a
moderate…sized beam under the couch； and then having fastened pieces
of wood in this beam； both before and behind the head； make
counter…extension by means of thongs； or place windlasses at this
extremity and that； and make extension by means of them。 There are
many other methods of making extension。 But the best thing is； for any
physician who practices in a large city； to have prepared a proper
wooden machine； with all the mechanical powers applicable in cases
of fractures and dislocation； either for making extension； or acting
as a lever。 For this purpose it will be sufficient to possess a
board in length； breadth； and thickness； resembling the quadrangular
threshing…boards made of oak。
14。 When you have made proper extension； it is easy reduce the
joint； for the displaced bone is thus raised into a line with the
other。 And the bones are to be adjusted with the palms of the hands；
pressing upon the projecting bone with the one； and making
counter…pressure below the ankle with the other。 When you have
replaced the bones； you must apply the bandages while the parts are
upon the stretch； if you possibly can； but if prevented by the thongs；
you must loose them； and make counter…extension until you get the
bandages applied。 The bandage is to be applied in the manner
formerly described； the heads of the bandages being placed on the
projecting part； and the first turns made in like manner； and so
also with regard to the number of compresses and the compression；
and turns of the bandages are to be brought frequently round on this
and on that side of the ankle。 But this joint must be bound more tight
at the first dressing than in the case of the hand。 But when you
have applied the bandage； you must place the bandaged part somewhat
higher than the rest of the body； and in such a position that the foot
may hang as little as possible。 The attenuation of the body is to be
made proportionate to the magnitude of the luxation； for one
luxation is to be a small； and another to a great extent。 But in
general we must reduce more； and for a longer time； in injuries
about the legs； than in those about the hands； for the former parts
are larger and thicker than the latter； and it is necessary that the
body should be kept in a state of rest； and in a recumbent position。
There is nothing to prevent or require the limb to be bandaged anew on
the third day。 And all the treatment otherwise is to be conducted in
like manner； as in the preceding cases。 And if the patient have
resolution to lie quiet； forty days will be sufficient for this
purpose； if only the bones be properly reduced； but if he will not lie
quiet； he will not be able to use the limb with ease； and he will find
it necessary to wear a bandage for a long time。 When the bones are not
properly replaced； but there has been some defect in this respect； the
hip； the thigh； and the leg become wasted； and if the dislocation be
inward； the external part of the thigh is wasted； and vice versa。
But for the most part the dislocation is inward。
15。 And when both bones of the leg are broken without a wound of the
skin； stronger extension is required。 We may make extension by some of
the methods formerly described； provided the bones ride over one
another to a considerable degree。 But extension by men is also
sufficient； and for the most part two strong men will suffice； by
making extension and counterextension。 Extension must naturally be
made straight in a line with the leg and thigh； whether on account
of a fracture of the bones of the leg or of the thigh。 And in both
cases they are to be bandaged while in a state of extension； for the
same position does not suit with the leg and the arm。 For when the
fractured bones of the arm or fore…arm are bandaged； the fore…arm is
suspended in a sling； and if you bind them up while extended； the
figures of the fleshy parts will be changed in bending the arm at
the elbow； for the elbow cannot be kept long extended； since persons
are not in the custom of keeping the joint long in this form； but in a
bent position； and persons who have been wounded in the arm； and are
still able to walk about； require to have the arm bent at the
elbow…joint。 But the leg； both in walking and standing； is
habitually extended； either completely or nearly so； and is usually in
a depending position from its construction； and in order that it may
bear the weight of the rest of the body。 Wherefore it readily bears to
be extended when necessary； and even when in bed the limb is often
in this position。 And when wounded； necessity subdues the
understanding； since the patients become incapable of raising
themselves up； so that they neither think of bending the limb nor of
getting up erect； but remain lying in the same position。 For these
reasons； neither the same position nor the same mode of bandaging
applies to the arm and to the leg。 If； then； extension by means of men
be sufficient； we should not have recourse to a