On the Articulations (86-87)

When persons jumping from a height pitch on the heel, so as to occasion separation (diastasis) of the bones, ecchymosis of the veins, and contusion of the nerves; when these symptoms are very violent there is danger of sphacelus, and that the case may give trouble during life, for the bones are so constructed as

to slip from one another, and the nerves communicate together. And, indeed, in cases of fracture, either from an injury in the leg or thigh, or in paralysis of the nerves (tendons?) connected with these parts, or from neglect during confinement to bed, when the heel gets blackened the most serious consequences result therefrom. Sometimes, in addition to the sphacelus, there come on acute fevers accompanied with hiccup, aberration of intellect, and speedy death, with lividities of the large blood-vessels. With regard to the symptoms attending exacerbations, if the ecchymosed and blackened parts and those around be somewhat hard and red, and if along with the hardness there be lividity, mortification is to be apprehended; but if the parts be slightly livid, or even very livid, and the swelling diffused, or if greenish and soft, these appearances, in such cases, are all favorable. The treatment, if no fever be present, consists in the administration of hellebore, but otherwise (it is not to be given, but oxyglyky (decoction of honeycombs and vinegar) is to be given for drink, if required. Bandaging as in the other articulations: above all, more especially in contusions, the bandages should be numerous and softer than usual, but the compression should be less; most turns should be made around the heel. Position, like the bandaging, should be so regulated as not to determine to the heel. Splints are not to be used.

When the foot is dislocated, either alone or along with its epiphysis, the displacement is, for the most part, to the inside. If not reduced, in the course of time, the hip, the thigh, and the side of the leg opposite the dislocation, become atrophied. Reduction is the same as in the wrist, but the extension requires to be very powerful. Treatment, agreeably to the general rule for joints. Exacerbations do occur, but less frequently than in dislocations at the wrist, provided the parts get rest. While they remain at rest the diet should be restricted. Those which occur at birth, or during adolescence, follow the rule formerly stated.