第 2 节
作者:没事找事      更新:2021-10-16 18:43      字数:9322
  reduction of the shoulder; for one thus operates with the lever upon
  the most correct principles; provided only the piece of wood be placed
  as much as possible within the head of the humerus; and thus also
  the counter…balancing weights will be most properly adjusted; and
  safely applied to the bone of the arm。 Wherefore recent cases in
  this way may be reduced more quickly than could be believed; before
  even extension would appear to be applied; and this is the only mode
  of reduction capable of replacing old dislocations; and this it will
  effect; unless flesh has already filled up the (glenoid) cavity; and
  the head of the humerus has formed a socket for itself in the place to
  which it has been displaced; and even in such an old case of
  dislocation; it appears to me that we could effect reduction (for what
  object would a lever power properly applied not it move?); but it
  would not remain in its place; but would be again displaced as
  formerly。 The same thing may be effected by means of the ladder; by
  preparing it in the same manner。 If the dislocation be recent; a large
  Thessalian chair may be sufficient to accomplish this purpose; the
  wood; however; should be dressed up as described before; but the
  patient should be seated sideways on the chair; and then the arm; with
  the piece of wood attached to it; is to be brought over the back of
  the chair; and force is to be applied to the arm; with the wood on the
  one side; and the body on the other side。 The same means may be
  applied with a double door。 One should always use what happens to be
  at hand。
  8。 Wherefore it should be known that one constitution differs much
  from another as to the facility with which dislocations in them may be
  reduced; and one articular cavity differs much from another; the one
  being so constructed that the bone readily leaps out and another
  less so; but the greatest difference regards the binding together of
  the parts by the nerves (ligaments?) which are slack in some and tight
  in others。 For the humidity in the joints of men is connected with the
  state of the ligaments; when they are slack and yielding; for you
  may see many people who are so humid (flabby?) that when they choose
  they can disarticulate their joints without pain; and reduce them in
  like manner。 The habit of the body also occasions a certain
  difference; for in those who are in a state of embonpoint and fleshy
  the joint is rarely dislocated; but is more difficult to reduce; but
  when they are more attenuated and leaner than usual; then they are
  subject to dislocations which are more easily reduced。 And the
  following observation is a proof that matters are so; for in cattle
  the thighs are most apt to be dislocated at the hip…joint; when they
  are most particularly lean; which they are at the end of winter; at
  which time then they are particularly subject to dislocations (if I
  may be allowed to make such an observation while treating of a medical
  subject); and therefore Homer has well remarked; that of all beasts
  oxen suffer the most at that season; and especially those employed
  at the plow as being worked in the winter season。 In them;
  therefore; dislocations happen most frequently; as being at that
  time most particularly reduced in flesh。 And other cattle can crop the
  grass when it is short; but the ox cannot do so until it becomes long;
  for; in the others; the projection of the lip is slender; and so is
  the upper lip; but in the ox the projection of the lip is thick; and
  the upper jaw is thick and obtuse; and therefore they are incapable of
  seizing short herbs。 But the solidungula as having prominent teeth
  in both their front jaws; can crop the grass and grasp it with their
  teeth while short; and delight more in short grass than in rank;
  for; in general; short grass is better and more substantial than rank;
  as having not yet given out its fructification。 Wherefore the poet has
  the following line:
  As when to horned cattle dear the vernal season comes;*
  because rank grass appears to be most sought after by them。 But
  otherwise in the ox; this joint is slacker than in other animals; and;
  therefore; this animal drags his foot in walking more than any
  other; and especially when lank and old。 For all these reasons the
  ox is most particularly subject to dislocations; and I have made the
  more observations respecting him; as they confirm all that was said
  before on this subject。 With regard; then; to the matter on hand; I
  say that dislocations occur more readily; and are more speedily
  reduced in those who are lean than in those who are fleshy; and in
  those who are humid and lank there is less inflammation than in such
  as are dry and fleshy; and they are less compactly knit hereafter; and
  there is more mucosity than usual in cases not attended with
  inflammation; and hence the joints are more liable to luxations;
  for; in the main; the articulations are more subject to mucosities
  in those who are lean than in those who are fleshy; and the flesh of
  lean persons who have not been reduced by a proper course of
  discipline abounds more with mucosity than that of fat persons。 But in
  those cases in which the mucosity is accompanied with inflammation;
  the inflammation binds (braces?) the joint; and hence those who have
  small collections of mucosities are not very subject to
  dislocations; which they would be if the mucosity had not been
  accompanied with more or less inflammation。
  *There is no such line in the works of Homer as they have come down to
  us。
  9。 In cases of dislocation those persons who are not attacked with
  inflammation of the surrounding parts; can use the shoulder
  immediately without pain; and do not think it necessary to take any
  precautions with themselves; it is therefore the business of the
  physician to warn them beforehand that dislocation is more likely to
  return in such cases than when the tendons have been inflamed。 This
  remark applies to all the articulations; but particularly to those
  of the shoulder and knee; for these are the joints most subject to
  luxations。 But those who have inflammation of the ligaments cannot use
  the shoulder; for the pain and the tension induced by the inflammation
  prevent them。 Such cases are to be treated with cerate; compresses;
  and plenty of bandages; but a ball of soft clean wool is to be
  introduced into the armpit; to fill up the hollow of it; that it may
  be a support to the bandaging; and maintain the joint in situ。 The
  arm; in general; should be inclined upward as much as possible; for
  thus it will be kept at the greatest possible distance from the
  place at which the head of the humerus escaped。 And when you bandage
  the shoulder you must fasten the arms to the sides with a band;
  which is to be carried round the body。 The shoulder should be rubbed
  gently and softly。 The physician ought to be acquainted with many
  things; and among others with friction; for from the same name the
  same results are not always obtained; for friction could brace a joint
  when unseasonably relaxed; and relax it when unseasonably hard; but we
  will define what we know respecting friction in another place。 The
  shoulder; then; in such a state; should be rubbed with soft hands;
  and; moreover; in a gentle manner; and the joint should be moved
  about; but not roughly; so as to excite pain。 Things get restored
  sometimes in a greater space of time; and sometimes in a smaller。
  10。 A dislocation may be recognized by the following symptoms:…Since
  the parts of a man's body are proportionate to one another; as the
  arms and the legs; the sound should always be compared with the
  unsound; and the unsound with the sound; not paying regard to the
  joints of other individuals (for one person's joints are more
  prominent than another's); but looking to those of the patient; to
  ascertain whether the sound joint be unlike the unsound。 This is a
  proper rule; and yet it may lead to much error; and on this account it
  is not sufficient to know this art in theory; but also by actual
  practice; for many persons from pain; or from any other cause; when
  their joints are not dislocated; cannot put the parts into the same
  positions as the sound body can be put into; one ought therefore to
  know and be acquainted beforehand with such an attitude。 But in a
  dislocated joint the head of the humerus appears lying much more in
  the armpit than it is in the sound joint; and also; above; at the
  top of the shoulder; the part appears hollow; and the acromion is
  prominent; owing to the bone of the joint having sunk into the part
  below; there is a source of error in this case also; as will be
  described afterward; for it deserves to be described; and also; the
  elbow of the dislocated arm is farther removed from the ribs than that
  of the other; but by using force it may be approximated; though with
  considerable pain; and also they cannot; with the elbow extended;
  raise the arm to the ear; as they can the sound arm; nor move it about
  as formerly in this direction and that。 These; then; are the
  symptoms of dislocation at the shoulder。 The methods of reduction
  and the treatment are as described。
  11。 It deserves to be known how a shoulder which is subject to
  frequent dislocations should be treate