Persons who,in jumping from a height,have pitched on the heel,so as to occasion diastasis (separation)of the bones,ecchymosis of the veins,and contusion of the nerves,-when these symptoms are very violent,there is danger that the parts may sphacelate,and give trouble to the patient during the remainder of his life;for these bones are so constructed as to slip past one another,and the nerves communicate together.And,likewise in cases of fracture,either from an injury in the leg or thigh,or in paralysis of the nerves connected with these parts,or,when in any other case of confinement to bed the heel,from neglect,becomes blackened,in all these cases serious effects result therefrom.Sometimes,in addition to the sphacelus,very acute fevers supervene,attended with hiccup,tumors,aberration of intellect,and speedy death,along with lividity of the large bloodvessels,and gangrene.The symptoms of the exacerbations are these:if the ecchymosis,the blackened parts,and those around them,be somewhat hard and red,and if lividity be combined with the hardness,there is danger of mortification;but,not withstanding,if the parts are sublivid,or even very livid and diffused,or greenish and soft,these symptoms,in all such cases,are favorable.The treatment consists in the administration of hellebore,if they be free from fever,but otherwise,they are to have oxyglyky for drink,if required.Bandaging,-agreeably to the rule in other joints;but this is to be attended to also,-the bandages should be numerous,and softer than usual;compression less;more water than usual to be used in the allusions;to be applied especially to the heel.The same object should be sought after in the position as in the bandaging,namely,that the humors may not be determined to the heel;the limb to be well laid should have the heel higher than the knee.Splints not to be used.
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