on the articulations-第15部分

按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！


the　most　efficient　method；　and　the　one　most　conformable　to　art；　is
that　by　the　lever；　as　formerly　described　when　treating　of　bones
which　have　been　fractured　and　protruded；　then　the　patient　must　be　as
quiet　as　possible；　lie　in　a　recumbent　position；　and　observe　a
restricted　regimen。　And　it　will　be　better　also　that　he　should　get　some
gentle　emetics。　The　sore　is　to　be　treated　with　dressings　for　fresh
wounds；　which　permit　of　allusions；　or　with　the　leaves　of　camomile；
or　with　the　applications　for　fractured　bones　of　the　head；　but
nothing　very　cold　must　be　applied。　The　first　（most　distant？）　joints
are　least　dangerous；　but　those　still　higher；　are　more　so。　Reduction
should　be　made　the　same　day；　or　the　next；　but　by　no　means　on　the　third
or　fourth；　for　it　is　on　the　fourth　day　that　exacerbations　especially
attack。　In　those　cases；　then；　where　immediate　reduction　cannot　be
accomplished；　we　must　wait　until　after　the　aforesaid　days；　for
whatever　you　reduce　within　ten　days；　may　be　expected　to　induce
spasm。　But　if　the　spasm　supervene　on　its　being　reduced；　the　joint
should　be　quickly　displaced；　and　bathed　frequently　with　warm　water；
and　the　whole　body　should　be　kept　in　a　warm；　soft；　and　easy　condition；
and　more　especially　about　the　joints；　for　the　whole　body　should　rather
be　in　a　bent　than　in　an　extended　state。　Moreover；　it　is　to　be
expected；　that　the　articular　extremities　of　the　bones　of　the　fingers
will　for　this　generally　happens；　if　even　the　least　degree　of
inflammation　take　place；　so　that　if　it　were　not　that　the　physician
would　be　exposed　to　censure；　owing　to　the　ignorance　of　the　common
people；　no　reduction　should　be　made　at　all。　The　reduction　of　the　bones
of　joints　which　have　protruded　through　the　skin；　is　attended　with
the　dangers　which　have　been　described。

　　68。　When　the　articular　bones　of　the　fingers　are　fairly　chopped
off；　these　cases　are　mostly　unattended　with　danger；　unless　deliquium
come　on　in　consequence　of　the　injury；　and　ordinary　treatment　will　be
sufficient　to　such　sores。　But　when　resection　is　made；　not　at　the
articulations；　but　at　some　other　point　in　the　bones；　these　cases
also　are　free　from　danger；　and　are　still　more　easily　cured　than　the
others；　and　the　fractured　bones　of　the　fingers　which　protrude
otherwise　than　at　the　joint　admit　of　reduction　without　danger。
Complete　resections　of　bones　at　the　joints；　whether　the　foot；　the
hand；　the　leg；　the　ankle；　the　forearm；　the　wrist；　for　the　most　part；
are　not　unattended　with　danger；　unless　one　be　cut　off　at　once　by
deliquium　animi；　or　if　continual　fever　supervene　on　the　fourth　day。

　　69。　With　regard　to　the　sphacelus　of　fleshy　parts；　it　takes　place
in　wounds　where　there　are　large　blood…vessels；　which　have　been
strongly　compressed；　and　in　fractures　of　bones　which　have　been　bound
too　tight；　and　in　other　cases　of　immoderate　constriction；　when　the
parts　which　have　been　strangulated　generally　drop　off；　and　the　most　of
such　patients　recover；　even　when　a　portion　of　the　thigh　comes　away；　or
of　the　arm；　both　bones　and　flesh；　but　less　so　in　this　case；　and　when
the　fore…arm　and　leg　drop　off；　the　patients　readily　recover。　In
cases　then；　of　fracture　of　the　bones；　when　strangulation　and
blackening　of　the　parts　take　place　at　first；　the　separation　of　the
dead　and　living　parts　quickly　occurs；　and　the　parts　speedily　drop　off；
as　the　bones　have　already　given　way；　but　when　the　blackening
（mortification）　takes　place　while　the　bones　are　entire；　the　fleshy
parts；　in　this　case；　also　quickly　die；　but　the　bones　are　slow　in
separating　at　the　boundary　of　the　blackening；　and　where　the　bones
are　laid　bare。　Those　parts　of　the　body　which　are　below　the
boundaries　of　the　blackening　are　to　be　removed　at　the　joint；　as　soon
as　they　are　fairly　dead　and　have　lost　their　sensibility；　care　being
taken　not　to　wound　any　living　part；　for　if　the　part　which　is　cut　off
give　pain；　and　if　it　prove　not　to　be　quite　dead；　there　is　great　danger
lest　the　patient　may　swoon　away　from　the　pain；　and　such　swoonings
often　are　immediately　fatal。　I　have　known　the　thigh…bones；　when
denuded　in　this　manner；　drop　off　on　the　eightieth　day；　but　in　the　case
of　this　patient；　the　parts　below　were　separated　at　the　knee　on　the
twentieth　day；　and；　as　I　thought；　too　early；　for　it　appeared　to　me
that　this　should　be　done　more　guardedly。　In　a　case　which　I　had　of　such
blackening　in　the　leg；　the　bones　of　the　leg；　as　far　as　they　were
denuded；　separated　at　its　middle　on　the　sixtieth　day。　But　the
separation　of　denuded　bones　is　quicker　or　slower；　according　to　the
mode　of　treatment；　something；　too；　depends　upon　whether　the
compression　be　stronger　or　weaker；　and　whether　the　nerves；　flesh；
arteries；　and　veins　are　quicker　or　slower　in　becoming　blackened　and　in
dying；　since；　when　the　parts　are　not　strongly　compressed；　the
separation　is　more　superficial；　and　does　not　go　the　length　of　laying
the　bones　bare；　and　in　some　cases　it　is　still　more　superficial；　so
as　not　even　to　expose　the　nerves。　For　the　reasons　now　stated；　it　is
impossible　to　define　accurately　the　time　at　which　each　of　these
cases　will　terminate。　The　treatment　of　such　cases；　however；　is　to　be
readily　undertaken；　for　they　are　more　formidable　to　look　at　than　to
treat；　and　a　mild　treatment　is　sufficient　in　all　such　cases；　for
they　come　to　a　crisis　of　themselves；　only　the　diet　must　be　attended
to；　so　that　it　may　be　as　little　calculated　to　create　fever　as
possible；　and　the　body　is　to　be　placed　in　the　proper　positions：
these　are；　neither　raised　very　high　up；　nor　inclined　much　downward；
but　rather　upward；　until　the　separation　be　completed；　for　at　that　time
there　is　most　danger　of　hemorrhage；　on　this　account；　wounds　should　not
be　laid　in　a　declining　position；　but　the　contrary。　But　after　a
while；　and　when　the　sores　have　become　clean；　the　same　positions　will
no　longer　be　appropriate；　but　a　straight　position；　and　one　inclining
downward；　may　be　proper；　and　in　the　course　of　time；　in　some　of　these
cases；　abscesses　form；　and　require　bandages。　One　may　also　expect
that　such　patients　will　be　attacked　with　dysentery；　for　dysentery
usually　supervenes　in　cases　of　mortification　and　of　hemorrhage　from
wounds；　it　comes　on　generally　when　the　blackening　and　hemorrhage
have　arrived　at　a　crisis；　and　is　profuse　and　intense；　but　does　not
last　many　days；　neither　is　it　of　a　fatal　nature；　for　such　patients
do　not　usually　lose　their　appetite；　nor　is　it　proper　to　put　them　on
a　restricted　diet。

　　70。　Dislocation　inward　at　the　hip…joint　is　to　be　reduced　in　the
following　manner：　（it　is　a　good；　proper；　and　natural　mode　of
reduction；　and　has　something　of　display　in　it；　if　any　one　takes
delight　in　such　ostentatious　modes　of　procedure）。　The　patient　is　to　be
suspended　by　the　feet　from　a　cross…beam　with　a　strong；　soft；　and　broad
cord；　the　feet　are　to　be　about　four　inches　or　less　from　one　another；
and　a　broad　and　soft　leather　collar　connected　with　the　cross…beam　is
to　be　put　on　above　the　knees；　and　the　affected　leg　should　be　so
extended　as　to　moved　be　two　inches　longer　than　the　other；　the　head
should　be　about　two　cubits　from　the　ground；　or　a　little　more　or
less；　and　the　arms　should　be　stretched　along　the　sides；　and　bound　with
something　soft；　all　these　preparations　should　be　made　while　he　is
lying　on　his　back；　so　that　he　may　be　suspended　for　as　short　a　time
as　possible。　But　when　the　patient　is　suspended；　a　person　properly
instructed　and　not　weak；　having　introduced　his　arm　between　his　thighs；
is　to　place　his　fore…arm　between　the　perineum　and　the　dislocated
head　of　the　os　femoris；　and　then；　having　joined　the　other　hand　to
the　one　thus　passed　through　the　thighs；　he　is　to　stand　by　the　side
of　the　suspended　patient；　and　suddenly　suspend　and　swing　himself　in
the　air　as　perpendicularly　as　possible。　This　method　comprises　all
the　conditions　which　are　natural；　for　the　body　being　suspended　by
its　weight；　produces　extension；　and　the　person　suspended　from　him；
along　with　the　extension；　forces　the　head　of　the　thigh…bone　to　rise　up
above　the　acetabulum；　and　at　the　same　time　he　uses　the　bone　of　the
fore…arm　as　a　lever；　and　forces　the　os　femoris　to　slip　into　its　old
seat。　The　cords　should　be　properly　prepared；　and　care　should　be
taken　that　the　person　suspended　along　with　the　patient　have　a
sufficiently　strong　hold。

　　71。　Wherefore；　as　formerly　stated；　men's　constitutions　differ　much
from　one　another　as　to　the　facility　or　difficulty　with　which
dislocations　are　reduced；　and　the　cause　of　this　was　also　stated
formerly　in　treating　of　the　shoulder。　In　some　the　thigh　is　reduced
with　no　preparation；　with　slight　extension；　directed　by　the　hands；　and
with　slight　movement；　and　in　some　the　reduction　is　effected　by　bending
the　limb　at　the　joint；　and　making　rotation。　But　much　more　frequently
it　does　not　yield　to　any　ordinary　apparatus；　and　therefore　one
should　be　acquainted　with　the　most　powerful　means　which　can　be　applied
in　each　case；　and　use　whatever　maybe　judged　most　proper　under　all
circumstances。　The　modes　of　extension　have　been　described　in　the
former　parts　of　the　work；　so　that　one　may　make　use　of　whatever　may
happen　to　be　at　hand。　For；　extension　and　counter…extension　are　to　be
made　in　the　direction　of　the　limb　and　the　body；　and　if　this　be
properly　eff