on the articulations-第13部分

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shifting　of　the　feet　in　walking；　the　body　cannot　be　supported　on　the
unsound　be　supported　on　the　unsound　limb；　unless　it　be　pressed　to
the　ground　by　the　hand；…the　end　of　the　femur　not　being　placed　properly
under　the　body；　but　having　slipped　backward　to　the　nates；　and　if　he
should　try　to　rest　the　weight　of　his　body　for　a　little；　upon　the　foot；
without　any　other　support；　he　would　fall　backward；　for　there　would
be　a　great　inclination　in　this　direction；　from　the　hips　having
protruded　backward　far　beyond　the　line　of　the　foot；　and　the　spine
inclining　toward　the　hips。　Such　persons　can　walk；　indeed；　without　a
staff；　if　so　accustomed；　for　because　the　sole　of　the　foot　is　in　its
old　line；　and　is　not　inclined　outward；　they　do　not　require　anything　to
balance　them。　Such；　however；　as；　instead　of　grasping　the　thigh；　prefer
resting　their　weight　upon　a　staff　introduced　into　the　armpit　of　the
affected　side；　these；　if　they　use　a　longer　staff；　will　walk；　indeed；
more　erect；　but　will　not　be　able　to　reach　the　ground　with　the　foot；　or
if　they　wish　to　rest　upon　the　foot；　they　must　take　a　shorter　staff；
and　will　require　to　bend　the　body　at　the　groins。　The　wasting　of　the
fleshy　parts　is　analogous　to　what　happens　in　the　cases　formerly
described；　for　the　wasting　is　greatest　in　those　cases　in　which　the
patients　keep　the　limb　up；　and　do　not　exercise　it；　whilst　those　who
practice　walking；　have　the　least　atrophy。　The　sound　leg；　however；　is
not　benefited；　but　is　rather　rendered　more　deformed；　if　the　injured
limb　be　applied　to　the　ground；　for　it　is　forced　to　cooperate　with
the　other；　being　protruded　at　the　hip；　and　bent　at　the　ham。　But　if　the
patient　does　not　use　the　injured　limb　by　applying　it　to　the　ground；
but　carries　it　up；　and　rests　upon　a　staff；　the　sound　leg　thereby　gains
strength；　for　it　is　employed　in　its　natural　position；　and　further；　the
exercise　gives　it　strength。　But　it　may　be　said；　these　things　are
foreign　to　medicine；　for　what　is　the　use　of　enlarging　upon　cases　which
are　already　past　remedy？　This　is　far　from　being　the　case；　for　it
belongs　to　the　knowledge　of　medicine　to　be　acquainted　also　with　these；
and　they　cannot　possibly　be　separated　from　one　another；　for　to　such　as
are　curable；　means　are　to　be　used　to　prevent　them　from　becoming
incurable；　studying　how　they　may　best　be　prevented　from　getting　into
an　incurable　state。　And　incurable　cases　should　be　known；　that　they　may
not　be　aggravated　by　useless　applications；　and　splendid　and　creditable
prognostics　are　made　by　knowing　where；　how；　and　when　every　case　will
terminate；　and　whether　it　will　be　converted　into　a　curable　or　an
incurable　disease。　When　then；　from　birth；　or　during　one's　youth；
this　dislocation　backward　occurs；　and　is　not　reduced；　whether　it　be
connected　with　violence　or　disease　（for　many　such　dislocations　occur
in　diseases；　but　the　nature　of　the　diseases　in　which　dislocations　take
place；　will　be　described　afterward）；　if；　then；　the　dislocated　limb
be　not　reduced；　the　bone　of　the　thigh　becomes　shortened；　the　whole
limb　is　impaired；　is　arrested　in　its　growth；　and　loses　its　flesh
from　want　of　use；　the　articulation　at　the　ham　is　also　impaired；　for
the　nerves　（ligaments？）　become　stretched；　from　cases　formerly
stated；　wherefore　those　who　have　this　dislocation；　cannot　make
extension　at　the　knee…joint。　In　a　word；　all　parts　of　the　body　which
were　made　for　active　use；　if　moderately　used　and　exercised　at　the
labor　to　which　they　are　habituated；　become　healthy；　increase　in
bulk；　and　bear　their　age　well；　but　when　not　used；　and　when　left
without　exercise；　they　become　diseased；　their　growth　is　arrested；
and　they　soon　become　old。　Among　these　parts　the　joints　and　nerves
（ligaments？）；　if　not　used；　are　not　the　least　liable　to　be　so　affected；
they　are　impaired；　then；　for　the　reasons　we　have　stated；　more　in
this　variety　of　dislocation　than　in　the　others；　for　the　whole　limb
is　wasted；　both　in　its　bones　and　in　its　fleshy　parts。　Such　persons；
then；　when　they　attain　their　full　growth；　keep　the　limb　raised　and
flexed；　rest　the　weight　of　the　body　on　the　other　leg；　and　support
themselves　with　a　staff；　some　with　one；　and　others　with　two。

　　59。　In　dislocations　of　the　head　of　the　thigh…bone　forward　（they
are　of　rare　occurrence）；　the　patients　cannot　extend　the　leg
completely；　but　least　of　all　can　they　bend　it　at　the　groin；　they　are
pained；　also；　if　forced　to　bend　the　limb　at　the　ham。　The　length　of　the
leg；　if　compared　at　the　heel；　is　the　same　as　that　of　the　other；　but
the　extremity　of　the　foot　inclines　less　to　project　forward。　But　the
whole　limb　has　its　natural　direction；　and　inclines　neither　to　this
side　nor　to　that。　These　cases　are　particularly　attended　with　severe
pain；　and　they　are　more　apt　to　be　accompanied　with　retention　of
urine　at　first　than　any　of　the　other　dislocations；　for　the　head　of　the
thigh…bone　is　lodged　very　near　to　important　nerves。　And　the　region
of　the　groin　appears　swelled　out　and　stretched；　while　that　of　the
nates　is　more　wrinkled　and　flabby。　The　symptoms　now　stated　are　those
which　attend　this　dislocation　of　the　thigh…bone。

　　60。　When　persons　have　attained　their　full　growth　before　meeting　with
this　dislocation；　and　when　it　has　not　been　reduced；　upon　the
subsidence　of　the　pain；　and　when　the　bone　of　the　joint　has　been
accustomed　to　be　rotated　in　the　place　where　it　is　lodged；　these
persons　can　walk　almost　erect　without　a　staff；　and　with　the　injured
leg　almost　quite　straight；　as　it　does　not　admit　of　easy　flexion　at　the
groin　and　the　ham；　owing；　then；　to　this　want　of　flexion　at　the
groin；　they　keep　the　limb　more　straight　in　walking　than　they　do　the
sound　one。　And　sometimes　they　drag　the　foot　along　the　ground；　as　not
being　able　to　bend　the　upper　part　of　the　limb；　and　they　walk　with
the　whole　foot　on　the　ground；　for　in　walking　they　rest　no　less　on
the　heel　than　on　the　fore　part　of　the　foot；　and　if　they　could　take
great　steps；　they　would　rest　entirely　on　the　heel　in　walking；　for
persons　whose　limbs　are　sound；　the　greater　the　steps　they　take　in
walking；　rest　so　much　the　more　on　the　heel；　while　they　are　putting
down　the　one　foot　and　raising　the　opposite。　In　this　form　of
dislocation；　persons　rest　their　weight　more　on　the　heel　than　on　the
anterior　part　of　the　foot；　for　the　fore　part　of　the　foot　cannot　be
bent　forward　equally　well　when　the　rest　of　the　limb　is　extended　as
when　it　is　in　a　state　of　flexion；　neither；　again；　can　the　foot　be
arched　to　the　same　degree　the　limb　is　bent　as　when　it　is　extended。　The
natural　state　of　matters　is　such　as　has　been　now　described；　and　in
an　unreduced　dislocation；　persons　walk　in　the　manner　described；　for
the　reasons　which　have　been　stated。　The　limb；　moreover；　is　less　fleshy
than　the　other；　at　the　nates；　the　calf　of　the　leg；　and　the　whole　of
its　posterior　part。　When　this　dislocation　occurs　in　infancy；　and　is
not　reduced；　or　when　it　is　congenital；　in　these　cases　the　bone　of
the　thigh　is　more　atrophied　than　those　of　the　leg　and　foot；　but　the
atrophy　of　the　thigh…bone　is　least　of　all　in　this　form　of　dislocation。
The　fleshy　parts；　however；　are　everywhere　attenuated；　more
especially　behind；　as　has　been　stated　above。　If　properly　trained；　such
persons；　when　they　grow　up；　can　use　the　limb；　which　is　only　a　little
shorter　than　the　other；　and　yet　they　support　themselves　on　a　staff
at　the　affected　side。　For；　not　being　able　to　use　properly　the　ball
of　the　foot　without　the　heel；　nor　to　put　it　down　as　some　can　in　the
other　varieties　of　dislocation　（the　cause　of　which　has　been　just　now
stated）；　on　this　account　they　require　a　staff。　But　those　who　are
neglected；　and　are　not　in　the　practice　of　putting　their　foot　to　the
ground；　but　keep　the　limb　up；　have　the　bones　more　atrophied　than　those
who　use　the　limb；　and；　at　the　articulations；　the　limb　is　more　maimed
in　the　direct　line　than　in　the　other　forms　of　dislocation。

　　61。　In　a　word；　luxations　and　subluxations　take　place　in　different
degrees；　being　sometimes　greater　and　sometimes　less；　and　those　cases
in　which　the　bone　has　slipped　or　been　displaced　to　a　much　greater
extent；　are　in　general　more　difficult　to　rectify　than　otherwise；　and
if　not　reduced；　such　cases　have　greater　and　more　striking　impairment
and　lesion　of　the　bones；　fleshy　parts；　and　attitudes；　but　when　the
bone　has　slipped；　or　been　displaced　to　a　less　extent；　it　is　easier
to　reduce　such　cases　than　the　other；　and　if　the　attempts　at
reduction　have　failed；　or　have　been　neglected；　the　impairment　in
such　cases　is　less；　and　proves　less　injurious　than　in　the　cases　just
mentioned。　The　other　joints　present　great　differences　as　to　the　extent
of　the　displacements　which　they　are　subject　to。　But　the　heads　of　the
femur　and　humerus　are　very　similar　to　one　another　as　to　their
dislocations。　For　the　heads　of　the　bones　are　rounded　and　smooth；　and
the　sockets　which　receive　the　heads　are　also　circular；　and　adapted
to　the　heads；　they　do　not　admit　then　of　being　dislocated　in　any
intermediate　degree；　but；　not　withstanding；　from　their　rounded
shape；　the　bones　slip　either　outward　or　inward。　In　the　case　we　are　now
treating　of；　then；　there　is　either　a　complete　dislocation　or　none　at
all；　and　yet　these　bones　admit　of　being　displaced　to　a　greater　or　less
extent；　and　the　thigh　is　more　subject　t