第 11 节
作者:没事找事      更新:2021-10-16 18:43      字数:9322
  And when the flesh itself is pulpy; the burning should be carried as
  far as the bone; but the bone itself should not be heated; but if it
  be in the intercostal space; you need not make the burning so
  superficial; only you must take care not to burn quite through。 But if
  the contusion appear to be at the bone; if it be still recent; and the
  bone has not yet become necrosed; if it be very small; it is to be
  burned as has been described; but if the rising along the bone be
  oblong; several eschars are to be burned over it。 Necrosis of the
  rib will be described along with the treatment of suppurating sores。
  51。 There are four modes of dislocation at the hip…joint: of which
  modes; dislocation inward takes place most frequently; outward; the
  most frequently of all the other modes; and it sometimes takes place
  backward and forward; but seldom。 When; therefore; dislocation takes
  place inward; the leg appears longer than natural; when compared
  with the other leg; for two reasons truly; for the bone which
  articulates with the hip…joint is carried from above down to the
  ischium where it rises up to the pubes; upon it; then; the head of the
  femur rests; and the neck of the femur is lodged in the cotyloid
  foramen (foramen thyroideum?)。 The buttock appears hollow
  externally; from the head of the thighbone having shifted inward;
  and the extremity of the femur at the knee is turned outward; and
  the leg and foot in like manner。 The foot then being turned outward;
  physicians; from ignorance; bring the sound leg to it and not it to
  the sound leg; on this account; the injured limb appears to be much
  longer than the sound one; and in many other cases similar
  circumstances lead to error in judgment。 Neither does the limb at
  the groin admit of flexion as in the sound limb; and the head of the
  bone is felt at the perineum too prominent。 These; then; are the
  symptoms attending dislocation of the thigh inward。
  52。 When; then; a dislocation has not been reduced; but has been
  misunderstood or neglected; the leg; in walking; is rolled about as is
  the case with oxen; and the weight of the body is mostly supported
  on the sound leg; and the limb at the flank; and the joint where the
  dislocation has occurred is necessarily hollow and bent; while on
  the sound side the buttock is necessarily rounded。 For if one should
  walk with the foot of the sound leg turned outward; the weight of
  the body would be thrown upon the injured limb; but the injured limb
  could not carry it; for how could it? One; then; is forced in
  walking to turn the leg inward; and not outward; for thus the sound
  leg best supports its own half of the body; and also that of the
  injured side。 But being hollow at the flank and the hip…joint; they
  appear small in stature; and are forced to rest on a staff at the side
  of the sound leg。 For they require the support of a staff there; since
  the nates inclines to this side; and the weight of the body is carried
  to it。 They are forced also to stoop; for they are obliged to rest the
  hand on the side of the thigh against the affected limb; for the
  limb which is injured cannot support the body in changing the legs;
  unless it be held when it is applied to the ground。 They who have
  got an unreduced dislocation inward are forced to put themselves
  into these attitudes; and this from no premeditation on their part how
  they should assume the easiest position; but the impediment itself
  teaches them to choose that which is most conformable to their present
  circumstances。 For persons who have a sore on the foot; or leg; and
  cannot rest upon the limb; all; even children; walk in this way; for
  they turn the injured limb outward in walking; and they derive two
  advantages therefrom; to supply two wants; the weight of the body is
  not equally thrown upon the limb turned outward; as upon the one
  turned inward; for neither is the weight in a line with it; but is
  much more thrown upon the one under the body; for the weight is in a
  straight line with it; both in walking and in the shifting of the
  legs。 In this position one can most quickly turn the sound limb
  under the body; by walking with the unsound limb outward; and the
  sound inward。 In the case we are now treating of; it is well that
  the body finds out the attitudes which are the easiest for itself。
  Those persons; then; who have not attained their growth at the time
  when they met with a dislocation which is not reduced; become maimed
  in the thigh; the leg; and the foot; for neither do the bones grow
  properly; but become shortened; and especially the bone of the
  thigh; and the whole limb is emaciated; loses its muscularity; and
  becomes enervated and thinner; both from the impediment at the
  joint; and because the patient cannot use the limb; as it does not lie
  in its natural position; for a certain amount of exercise will relieve
  excessive enervation; and it will remedy in so far the deficiency of
  growth in length。 Those persons; then; are most maimed who have
  experienced the dislocation in utero; next those who have met with
  it in infancy; and least of all; those who are full grown。 The mode of
  walking adopted by adults has been already described; but those who
  are children when this accident befalls them; generally lose the erect
  position of the body; and crawl about miserably on the sound leg;
  supporting themselves with the hand of the sound side resting on the
  ground。 Some; also; who had attained manhood before they met with this
  accident; have also lost the faculty of walking erect。 Those who
  were children when they met with the accident; and have been
  properly instructed; stand erect upon the sound leg; but carry about a
  staff; which they apply under the armpit of the sound side; and some
  use a staff in both arms; the unsound limb they bear up; and the
  smaller the unsound limb; the greater facility have they in walking;
  and their sound leg is no less strong than when both are sound。 The
  fleshy parts of the limb are enervated in all such cases; but those
  who have dislocation inward are more subject to this loss of
  strength than; for the most part; those who have it outward。
  53。 Some tell a story how the Amazonian women dislocate the joints
  of their male children while mere infants; some at the knee; and
  others at the hip…joint; that they may be maimed; and that the male
  sex may not conspire against the female; and that they use them as
  artisans to perform any sedentary work; such as that of a shoemaker or
  brazier。 Whether these things be true or not I do not know; but this I
  know; that matters would be such as is represented; provided their
  children; while infants; were to have their joints dislocated。 The
  consequences of dislocation inward at the hip…joint are much greater
  than of dislocation outward at the hip…joint; but at the knee;
  although there be some difference; it is less; but the mode of
  either impediment is peculiar; their legs are more bandied when the
  dislocation is outward; but those who have dislocation inward stand
  erect on their feet with less freedom。 In like manner; when the
  dislocation is at the anklejoint; if outward they become vari (their
  toes are turned inward?); but they can stand; but if the dislocation
  be inward they become valgi (their toes are turned outward?); but they
  have less freedom of standing。 The proportional growth of their
  bones is as follows: in those cases in which the bone of the leg is
  dislocated; the bones of the feet grow very little; as being very near
  the injury; but the bones of the leg increase in size; and with very
  little defect; but the fleshy parts (muscles?) are wasted。 But when
  the ankle…joint is in its natural state; but the knee is dislocated;
  in these cases the bones of the leg do not grow in like manner; but
  become shortened; as being nearest the seat of the injury; and the
  bones of the feet also are atrophied; but not in the same
  proportion; because; as was said a little while ago; the ankle…joint
  is safe; and if they could use it; as in the case of club…foot; the
  bones of the foot would be still less atrophied。 When the
  dislocation takes place at the hip…joint; the bone of the thigh; in
  this case; does not generally grow in like manner; as being the one
  nearest the seat of the injury; but becomes shorter than the sound
  one; but the growth of the bones of the leg is not arrested in like
  manner; nor of those of the feet; for this reason; that there is no
  displacement between the bones of the thigh and leg; nor between those
  of the leg and foot; in those cases; however; the fleshy parts of
  the whole limb are atrophied; but if they could make use of the
  limb; the growth of the bones would be still more developed; as
  formerly stated; only the thigh; although its flesh would be much less
  wasted; would still be by no means so fleshy as the sound limb。 The
  following observations are a proof of this: those persons who are
  weasel…armed (galiancones) from birth; owing to dislocation of the
  humerus; or when the accident has happened to them before they have
  attained their full growth; such persons have the bone of the arm
  shortened; but those of the fore…arm and hand are little inferior in
  size to the sound; for the reasons which have been