LUXATION OF THE FOOT, COMPLICATED WITH AN ESCAPE OF THE ASTRAGULUS, THROUGH THE CAPSULE AND THE LACERATED INTEGUMENTS. 17. When, in a luxation of the foot, the integuments, capsule, and ligaments are so lacerated, as to suffer the astragulus to escape, it would oftentimes be imprudent to attempt its reduction, as was done in the preceding cases. The violence already done to the parts around the joint is excessive; but this would be increased by the extension, and other efforts necessary in reduction. Whatever care might be taken, it would be difficult to prevent a vast swelling, long continued pains, and perhaps even a caries of the bone exposed to the air, with all those sufferings and dangers, to which such an accident gives origin. In such a case all the bones of the foot have been known to become carious, a state of things, which calls for the ultimate resources of art, and draws after it a train of evils, which it is always of the utmost importance to prevent. 18. What means are then to be employed? Two expedients only remain. 1st, the amputation of the foot; 2dly, the extirpation of the astragulus. The first is a cruel resource, which should never be adopted but in the last extremity, because it deprives the patient of a portion of himself, necessary to the performance of his functions. But the measure is forbidden by a reason still more powerful. Amidst the general disorder of the system, the severe pains experienced by the patient, the convulsions, and the delirium which oftentimes exists, what ground has the surgeon to hope for success? Will not the operation add to the number of these alarming appearances? Will it not aggravate them? May it not render them fatal? Both reason and experience reply in the affirmative.