第 3 节
作者:没事找事      更新:2021-10-16 18:43      字数:9321
  11。 It deserves to be known how a shoulder which is subject to
  frequent dislocations should be treated。 For many persons owing to
  this accident have been obliged to abandon gymnastic exercises; though
  otherwise well qualified for them; and from the same misfortune have
  become inept in warlike practices; and have thus perished。 And this
  subject deserves to be noticed; because I have never known any
  physician treat the case properly; some abandon the attempt
  altogether; and others hold opinions and practice the very what is
  proper。 For physicians have burned the shoulders subject to
  dislocation; at the top of the shoulder; at the anterior part where
  the head of the humerus protrudes; and a little behind the top of
  the shoulder; these burnings; if the dislocation of the arm were
  upward; or forward; or backward; would have been properly performed;
  but now; when the dislocation is downward; they rather promote than
  prevent dislocations; for they shut out the head of the humerus from
  the free space above。 The cautery should be applied thus: taking
  hold with the hands of the skin at the armpit; it is to be drawn
  into the line; in which the head of the humerus is dislocated; and
  then the skin thus drawn aside is to be burnt to the opposite side。
  The burnings should be performed with irons; which are not thick nor
  much rounded; but of an oblong form (for thus they pass the more
  readily through); and they are to be pushed forward with the hand; the
  cauteries should be red…hot; that they may pass through as quickly
  as possible; for such as are thick pass through slowly; and occasion
  eschars of a greater breadth than convenient; and there is danger that
  the cicatrices may break into one another; which; although nothing
  very bad; is most unseemly; or awkward。 When you have burnt through;
  it will be sufficient; in most cases; to make eschars only in the
  lower part; but if there is no danger of the ulcers passing into one
  another; and there is a considerable piece of skin between them; a
  thin spatula is to be pushed through these holes which have been
  burned; while; at the same time; the skin is stretched; for
  otherwise the instrument could not pass through; but when you have
  passed it through you must let go the skin; and then between the two
  eschars you should form another eschar with a slender iron; and burn
  through until you come in contact with the spatula。 The following
  directions enable you to determine how much of the skin of the
  armpit should be grasped; all men have glands in the armpit greater or
  smaller; and also in many other parts of the body。 But I will treat in
  another work of the whole constitution of the glands; and explain what
  they are; what they signify; and what are their offices。 The glands;
  then; are not to be taken hold of; nor the parts internal to the
  glands; for this would be attended with great danger; as they are
  adjacent to the most important nerves。 But the greater part of the
  substances external to the glands are to be grasped; for there is no
  danger from them。 And this; also; it is proper to know; that if you
  raise the arm much; you will not be able to grasp any quantity of skin
  worth mentioning; for it is all taken up with the stretching; and also
  the nerves。 which by all means you must avoid wounding; become exposed
  and stretched in this position; but if you only raise the arm a
  little; you can grasp a large quantity of skin; and the nerves which
  you ought to guard against are left within; and at a distance from the
  operation。 Should not; then; the utmost pains be taken in the whole
  practice of the art to find out the proper attitude in every case?
  So much regarding the armpit; and these contractions will be
  sufficient; provided the eschars be properly placed。 Without the
  armpit there are only two places where one might place the eschars
  to obviate this affection; the one before and between the head of
  the humerus and the tendon at the armpit; and then the skin may be
  fairly burned through; but not to any great depth; for there is a
  large vein adjacent; and also nerves; neither of which must be touched
  with the heat。 But externally; one may form another eschar
  considerably above the tendon at the armpit; but a little below the
  head of the humerus; and the skin must be burned fairly through; but
  it must not be made very deep; for fire is inimical to the nerves。
  Through the whole treatment the sores are to be so treated; as to
  avoid all strong extension of the arm; and this is to be done
  moderately; and only as far as the dressing requires; for thus they
  will be less cooled (for it is of importance to cover up all sorts
  of burns if one would treat them mildly); and then the lips of them
  will be less turned aside; there will be less hemorrhage and fear of
  convulsions。 But when the sores have become clean; and are going on to
  cicatrization; then by all means the arm is to be bound to the side
  night and day; and even when the ulcers are completely healed; the arm
  must still be bound to the side for a long time; for thus more
  especially will cicatrization take place; and the wide space into
  which the humerus used to escape will become contracted。
  12。 When attempts to reduce a dislocated shoulder have failed; if
  the patient be still growing; the bone of the affected arm will not
  increase like the sound one; for although it does increase in so far
  it becomes shorter than the other; and those persons called
  weasel…armed; become so from two accidents; either from having met
  with this dislocation in utero; or from another accident; which will
  be described afterward。 But those who while they were children have
  had deep…seated suppurations about the head of the bone; all become
  weasel…armed; and this; it should be well known; will be the issue;
  whether the abscess be opened by an incision or cautery; or whether it
  break spontaneously。 Those who are thus affected from birth are
  quite able to use the arm yet neither can they raise the arm to the
  ear; by extending the elbow; but they do this much less efficiently
  than with the sound arm。 But in those who have had the shoulder
  dislocated after they were grown up; and when it has not been reduced;
  the top of the shoulder becomes much less fleshy; and the habit of
  body at that part is attenuated; but when they cease to have pain;
  whatever they attempt to perform by raising the elbow from the sides
  obliquely; they can no longer accomplish as formerly; but whatever
  acts are performed by carrying the arm around by the sides; either
  backward or forward; all those they can perform; for they can work
  with an auger or a saw; or with a hatchet; and can dig; by not raising
  the elbow too much; and do all other kinds of work which are done in
  similar attitudes。
  13。 In those cases where the acromion has been torn off; the bone
  which is thus separated appears prominent。 The bone is the bond of
  connection between the clavicle and scapula; for in this respect the
  constitution of man is different from that of other animals;
  physicians are particularly liable to be deceived in this accident
  (for as the separated bone protrudes; the top of the shoulder
  appears low and hollow); so that they make preparations as if for
  dislocation of the shoulder; for I have known many physicians;
  otherwise not inexpert at the art; who have done much mischief by
  attempting to reduce such shoulders; thus supposing it a case of
  dislocation; and they did not desist until they gave over mistake of
  supposing that they had reduced the shoulder。 The treatment; in
  these cases; is similar to that which is applicable in others of a
  like kind; namely; cerate; compresses; and suitable bandaging with
  linen cloths。 The projecting part must be pushed down; and the greater
  number of compresses are to be placed on it; and most compression is
  to be applied at that part; and the arm being fastened to the side
  is to be kept elevated; for thus the parts which had been torn asunder
  are brought into closest proximity with one another。 All this should
  be well known; and if you choose you may prognosticate safely that
  no impediment; small or great; will result from such an injury at
  the shoulder; only there will be a deformity in the place; for the
  bone cannot be properly restored to its natural situation; but there
  must necessarily be more or less tumefaction in the upper part。 For
  neither can any other bone be made exactly as it was; which having
  become incorporated with another bone; and having grown to it as an
  apophysis; has been torn from its natural situation。 If properly
  bandaged; the acromion becomes free of pain in a few days。
  14。 When a fractured clavicle is fairly broken across it is more
  easily treated; but when broken obliquely it is more difficult to
  manage。 Matters are different in these cases from what one would
  have supposed; for a bone fairly broken across can be more easily
  restored to its natural state; and with proper care the upper part may
  be brought down by means of suitable position and proper bandaging;
  and even if not properly set; the projecting part of the bone is not
  very sharp。 But in oblique fractures the case is similar to that of
  bones which have been torn away;