on the articulations-第4部分

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very　sharp。　But　in　oblique　fractures　the　case　is　similar　to　that　of
bones　which　have　been　torn　away；　as　formerly　described；　for　they　do
not　admit　of　being　restored　to　their　place；　and　the　prominence　of
the　bone　is　very　sharp。　For　the　most　part；　then；　it　should　be　known；
no　harm　results　to　the　shoulder　or　to　the　rest　of　the　body　from
fracture　of　the　clavicle；　unless　it　sphacelate；　and　this　rarely
happens。　A　deformity；　however；　may　arise　from　fracture　of　the
clavicle；　and　in　these　cases　it　is　very　great　at　first；　but　by　and
by　it　becomes　less。　A　fractured　clavicle；　like　all　other　spongy　bones；
gets　speedily　united；　for　all　such　bones　form　callus　in　a　short
time。　When；　then；　a　fracture　has　recently　taken　place；　the　patients
attach　much　importance　to　it；　as　supposing　the　mischief　greater　than
it　really　is；　and　the　physicians　bestow　great　pains　in　order　that　it
may　be　properly　bandaged；　but　in　a　little　time　the　patients；　having　no
pain；　nor　finding　any　impediment　to　their　walking　or　eating；　become
negligent；　and　the　physicians　finding　they　cannot　make　the　parts
look　well；　take　themselves　off；　and　are　not　sorry　at　the　neglect　of
the　patients；　and　in　the　meantime　the　callus　is　quickly　formed。　The
method　of　dressing　which　is　most　appropriate；　is　similar　to　that
used　in　ordinary　cases；　consisting　of　cerate；　compresses；　and
bandages；　and　it　should　be　most　especially　known　in　this　operation；
that　most　compresses　should　be　placed　on　the　projecting　bone；　and　that
the　greatest　pressure　should　be　made　there。　There　are　certain
physicians　who　make　a　show　of　superior　skill　by　binding　a　heavy
piece　of　lead　on　the　part　in　order　to　depress　the　projecting　bone；　but
this　mode　of　treatment　does　not　apply　to　the　clavicle；　for　it　is
impossible　to　depress　the　projecting　part　to　any　extent　worth
mentioning。　There　are　others　who；　knowing　the　fact　that　the　bandages
are　apt　to　slip　off；　and　that　they　do　not　keep　the　projecting　parts　in
their　place；　apply　compresses　and　bandages　like　the　others；　and　then
having　girt　the　patient　with　a　girdle；　where　it　is　usually　applied
with　most　effect；　they　make　a　heap　of　the　compresses　upon　of　the
compresses　upon　the　projecting　bone　when　they　apply　them；　and　having
fastened　the　head　of　the　bandage　to　the　girdle　in　front；　they　apply　it
so　as　to　bring　the　turns　of　it　into　the　line　of　the　clavicle；　carrying
them　to　the　back；　and　then　bringing　them　around　the　girdle　they
carry　them　to　the　fore　part　and　again　backward。　There　are　others　who
do　not　apply　the　bandage　round　the　girdle；　but　carry　the　rounds　of
it　by　the　perineum　and　anus；　and　along　the　spine；　so　as　to　compress
the　fracture。　To　an　inexperienced　person　these　methods　will　appear　not
far　from　natural；　but　when　tied；　they　will　be　found　of　no　service；　for
they　do　not　remain　firm　any　length　of　time；　even　if　the　patient　keep
his　bed；　although　in　this　position　they　answer　best；　and　yet　even　when
lying　in　bed；　should　he　bend　his　leg；　or　should　his　trunk　be　bent；　all
the　will　be　displaced；　and；　moreover；　the　bandaging　is　inconvenient；
in　as　much　as　the　anus　is　comprehended　by　it；　and　many　turns　of　the
bandage　are　crowded　there　in　a　narrow　space。　And　in　the　method　with
the　girdle；　the　girdle　cannot　be　so　firmly　girt　around；　but　that　the
turns　of　the　bandage　force　the　girdle　to　ascend；　and　hence　of
necessity　all　the　other　bandages　must　be　slackened。　He　would　seem　to
me　to　come　nearest　his　purpose；　although　after　all　he　effects　but
little；　who　would　take　a　few　turns　round　the　girdle；　few　turns　round
the　girdle；　but　would　use　the　bandage　principally　to　secure　the　former
bandaging；　for　in　this　manner　the　bandages　would　be　most　secure；　and
would　mutually　assist　one　another。　Every　thing　now　almost　has　been
said　which　applies　to　fracture　of　the　clavicle。　But　this　also　should
be　known；　that　in　fractures　of　the　clavicle；　it　is　the　part　attached
to　the　breast　which　is　uppermost；　and　that　the　piece　attached　to　the
acromion　is　the　lowermost。　The　cause　of　this　is；　that　for　the　most
part　the　breast　can　neither　be　depressed　nor　raised；　there　being　but　a
slight　movement　of　the　joint　at　the　breast；　for　the　sternum　is
connected　together　on　both　sides　with　the　spine。　The　clavicle　admits
of　most　motion　at　the　joint　of　the　shoulder；　and　this　arises　from
its　connection　with　the　acromion。　And；　moreover；　when　broken；　the　part
which　is　connected　with　the　sternum　flies　upward；　and　is　not　easily
forced　downward；　for　it　is　naturally　light；　and　there　is　more　room　for
it　above　than　below。　But　the　shoulder；　the　arm；　and　the　parts
connected　with　them；　are　easily　moved　from　the　sides　and　breast；
and；　on　that　account；　they　admit　of　being　considerably　elevated　and
depressed。　When；　therefore；　the　clavicle　is　broken；　the　fragment
attached　to　the　shoulder　inclines　downward；　for　it　inclines　much
more　readily　with　the　shoulder　and　arm　downward　than　upward。　Matters
being　as　I　have　stated；　they　act　imprudently　who　think　to　depress
the　projecting　end　of　the　bone。　But　it　is　clear　that　the　under　part
ought　to　be　brought　to　the　upper；　for　the　former　is　the　movable
part；　and　that　which　has　been　displaced　from　its　natural　position。
It　is　obvious；　therefore；　that　there　is　no　other　way　of　applying　force
to　it　（for　the　bandages　no　more　force　it　to　than　they　force　it
from）；　but　if　one　will　push　the　arm　when　at　the　sides　as　much　as
possible　upward；　so　that　the　shoulder　may　appear　as　sharp　as　possible；
it　is　clear　that　in　this　way　it　will　be　adjusted　to　the　fragment　of
the　bone　connected　with　the　breast　from　which　it　was　torn。　If　one　then
will　apply　a　bandage；　secundum　artem；　for　the　purpose　of　promoting　a
speedy　cure；　and　will　reckon　everything　else　of　no　value；　except　the
position　as　described；　he　will　form　a　correct　opinion　of　the　case；　and
will　effect　a　cure　in　the　speediest　and　most　appropriate　manner。　It　is
of　great　importance；　however；　that　the　patient　should　lie　in　a
recumbent　posture。　Fourteen　days　will　be　sufficient　if　he　keep
quiet；　and　twenty　at　most。

　　15。　But　if　the　clavicle　be　fractured　in　the　opposite　manner　（which
does　not　readily　happen）；　so　that　the　fragment　of　bone　connected
with　the　breast　is　depressed；　while　the　piece　connected　with　the
acromion　is　raised　up　and　rides　over　other；　this　case　does　not　require
much　management；　for　if　the　shoulder　and　arm　be　let　go；　the
fragments　of　the　bone　will　be　adjusted　to　one　another；　and　an　ordinary
bandage　will　suffice；　and　the　callus　will　be　formed　in　the　course　of　a
few　days。

　　16。　If　the　fracture　be　not　thus；　but　if　it　incline　either　forward　or
backward；　it　may　be　restored　to　its　natural　position；　by　raising　the
shoulder　with　the　arm　as　formerly　described；　and　brought　back　to　its
natural　place；　when　the　cure　will　be　speedily　accomplished。　Most　of
the　varieties　of　displacement　may　be　rectified　by　raising　the　arm
upward。　When　the　upper　bone　is　displaced　laterally　or　downward；　it
would　favor　the　adaptation　of　the　parts　if　the　patient　would　lie　on
his　back；　and　if　some　elevated　substance　were　placed　between　the
shoulder…blades；　so　that　the　breast　may　be　depressed　as　much　as
possible　upon　the　two　sides；　and　if；　while　another　person　raised　the
arm　extended　along　the　sides；　the　physician；　applying　the　palm　of
the　one　hand　to　the　head　of　the　bone；　would　push　it　away；　and　with　the
other　would　adjust　the　broken　bones；　he　would　thus　reduce　the　parts
most　readily　to　their　natural　position。　But；　as　formerly　stated；　the
upper　bone　（sternal　fragment？）　is　rarely　depressed　downward。　In　most
cases；　after　the　bandages　have　been　applied；　that　position　is
beneficial　in　which　the　elbow　is　fixed　to　the　same　side；　and　the
shoulder　is　kept　elevated；　but　in　certain　cases；　the　shoulder　is　to　be
raised；　as　has　been　directed；　and　the　elbow　is　to　be　brought　forward
to　the　breast；　and　the　hand　laid　on　the　acromion　of　the　sound　side。　If
the　patient　has　the　resolution　to　lie　in　bed；　something　should　be
placed　so　as　to　support　the　shoulder；　and　keep　it　as　much　elevated
as　possible。　But　if　he　walk　about；　the　arm　should　be　slung　in　a　shawl；
which　embraces　the　point　of　the　elbow；　and　is　passed　round　the　neck。

　　17。　When　the　elbow…joint　is　displaced　or　dislocated　to　the　side　or
outward；　while　its　sharp　point　（olecranon？）　remains　in　the　cavity　of
the　humerus；　extension　is　to　be　made　in　a　straight　line；　and　the
projecting　part　is　to　be　pushed　backward　and　to　the　side。

　　18。　In　complete　dislocations　toward　either　side；　extension　is　to
be　made　as　in　bandaging　fracture　of　the　arm；　for　thus　the　rounded　part
of　the　elbow　will　not　form　an　obstacle　to　it。　Dislocation；　for　the
most　part；　takes　place　toward　the　sides　（inwardly？）。　Reduction　is　to
be　effected　by　separating　（the　bones）　as　much　as　possible；　so　that　the
end　（of　the　humerus）　may　not　come　in　contact　with　the　olecranon；　and
it　is　to　be　carried　up；　and　turned　round；　and　not　forced　in　a　straight
line；　and；　at　the　same　time；　the　opposite　sides　are　to　be　pushed
together；　and　propelled　into　their　proper　place。　It　will　further
assist　if　rotation　of　the　fore…arm　be　made　at　the　elbow；　sometimes
turning　it　into　a　supine　position；　and　sometimes　into　a　prone。　The
position　for　the　treatment　consists　in　keeping　the　hand　a　little
higher　than