第 12 节
作者:没事找事      更新:2021-10-16 18:43      字数:9321
  shortened; but those of the fore…arm and hand are little inferior in
  size to the sound; for the reasons which have been stated; because the
  humerus is the bone nearest to the joint affected; and; on that
  account; it is shorter than natural; but the fore…arm is not equally
  affected by the accident; because the joint at which the bones of
  the arm and forearm are articulated remains in its natural
  condition; and the hand is still further distant than the fore…arm
  from the seat of the injury。 Such are the reasons why certain of the
  bones in this case increase in growth; and certain do not。 The
  laborious office of the hand contributes much to the development of
  the flesh in the fore…arm and hand; for whatever work is done by the
  hand; these weasel…armed persons strive to do no less effectually with
  the other hand than with the sound; for the arms do not support the
  weight of the body like the legs; and the work performed by them is
  light。 From exercise; then; the fleshy parts on the hand and
  fore…arm are not atrophied in weasel…armed persons; and by these means
  the arm; too; gains flesh。 But in dislocation inward at the hip…joint;
  whether from birth or from childhood; the fleshy parts; on that
  account; are much more atrophied than those of the hand; because the
  patients cannot exercise the leg。 Another proof will be given in the
  observations which will be presently stated; that these things are
  such as I things are such as I have represented。
  54。 When the head of the femur is dislocated outward; the limb in
  these cases; when compared with the other; appears shortened; and this
  is natural; for the head of the femur no longer rests on a bone as
  in dislocation inward; but along the side of a bone which naturally
  inclines to the side; and it is lodged in flesh of a pulpy and
  yielding nature; and on that account it appears more shortened。
  Inwardly; the thigh about the perineum appears more hollow and flabby;
  but externally the buttock is more rounded; from the head of the thigh
  having slipped outward; but the nates appear to be raised up; owing to
  the flesh there having yielded to the head of the thigh…bone; but
  the extremity of the thigh…bone; at the knee; appears to be turned
  inward; and the leg and foot in like manner; neither does it admit
  of flexion like the sound limb。 These; then; are the symptoms of
  dislocation outward。
  55。 When such a dislocation is not reduced in adults; the whole limb
  appears to be shortened; and in walking they cannot reach the ground
  with the heel; but they walk with the ball of the foot on the
  ground; and the points of their toes incline a little inward。 But
  the injured limb; in this case; can support the body much better
  than in dislocation inward; both because the head of the femur and the
  neck of its articular extremity; being naturally oblique; have
  formed a bed under a considerable portion of the hip; and because
  the extremity of the foot is not forcibly turned outward; but is
  nearly in a line with the body; and is even inclined more inwardly。
  When; then; the articular extremity of the femur has worn out a socket
  for itself in the flesh where it was lodged; and the flesh is
  lubricated; it ceases to be painful in the course of time; and when it
  becomes free from pain; they can walk without a staff; if so inclined;
  and they can support the body on the injured limb。 From usage then; in
  such cases; the fleshy parts are less enervated than in those which
  have been mentioned a little before; still; however; they lose their
  strength more or less; but in general there is more enervation when
  the dislocation is inward than when it is outward。 Some of them; then;
  cannot wear their shoes; owing to the unbending state of their leg;
  and some of them can。 But when this dislocation takes place in
  utero; and when the dislocation having occurred at any time before
  manhood; from violence; has not been replaced; or when from disease
  the articular extremity has started from its socket; and is
  displaced (for many such cases occur; and from some of them; if the
  femur become necrosed; obstinate suppurations requiring the use of
  tents are formed; and in certain of them the bone is laid bare);
  whether the bone become necrosed or not; the bone of the thigh is much
  shortened; and does not usually grow like the sound one; the bones;
  too; of the leg; become shorter than those of the other; but in a
  small degree; for the same reasons that were formerly stated; such
  persons can walk; some of them in the same fashion as adults having an
  unreduced dislocation; and some of them walk with the whole foot on
  the ground; but limp in walking; being obliged to do so by the
  shortness of the limb。 Such is the result; even though they be
  carefully and properly trained in the attitudes before they have
  strength for walking; and in like manner also; after they have
  acquired the necessary strength; but those persons require the most
  care who were very young when they met with the accident; for; if
  neglected while children; the limb becomes entirely useless and
  atrophied。 The fleshy parts of the entire limb are more wasted than
  those of the sound limb; but this is much less apt to happen in
  their case than in dislocation inward; owing to usage and exercise; as
  they are speedily able to make use of the limb; as was stated a little
  before with regard to the weasel…armed (galiancones)。
  56。 There are persons who; from birth or from disease; have
  dislocations outward of both the thighs; in them; then; the bones
  are affected in like manner; but the fleshy parts in their case lose
  their strength less; the legs; too; are plump and fleshy; except
  that there is some little deficiency at the inside; and they are plump
  because they have the equal use of both their legs; for in walking
  they totter equally to this side that。 Their nates appear very
  prominent; from the displacement of the bones of the joint。 But if
  in their case the bones do not sphacelate (become carious?) and if
  they do not become bent above the hip…joint; if nothing of this kind
  happen to them; they become otherwise sufficiently healthy; but the
  growth of all the rest of the body; with the exception of the head; is
  arrested。
  57。 In dislocations of the head of the femur backward; which
  rarely occur; the patient cannot extend the leg; either at the
  dislocated joint; or at the ham; to any extent; and of all the
  dislocations; this is the variety in which the patients have the least
  power of making extension at the groin and the ham。 But; moreover;
  this also should be known (for it is a valuable piece of knowledge;
  and of much importance; and yet most yet most people are ignorant of
  it); that persons in health cannot extend the joint at the ham; if
  they do not extend the joint at the groin at the same time; unless
  they raise the foot very high; for in this way they could do it;
  neither also could they bend the joint at the ham; but with much
  greater difficulty; if they do not bend the joint at the groin at
  the same time。 There are many other things in the body which have
  similar connections; both with regard to the contractions of nerves
  (ligaments?); and the positions of muscles; and many of them more
  worthy of being known than is generally supposed; and with regard to
  the nature of the intestine and that of the whole internal cavity; and
  with regard to the displacements and contractions of the uterus; but
  all these things will be treated of elsewhere; in a work akin to the
  present one。 But with regard to the matter on hand; they cannot make
  extension; as has been already stated; and the limb appears shortened;
  for two reasons…first; because it cannot be extended; and also because
  the bone has slipped into the flesh of the nates; for the head and
  neck of the femur; in this dislocation; are carried downward from
  their natural situation; to the outside of the nates。 But yet they can
  bend the limb; unless prevented by pain; and the leg and foot appear
  pretty straight; and not much inclined toward either side; but at
  the groin the flesh; when felt; appears looser; from the bone of the
  joint having slipped to the other side; but at the nates the head of
  the femur may be felt to be more prominent than natural。 Such are
  the symptoms accompanying dislocation of the thigh backward。
  58。 When this dislocation occurs in an adult; and is not reduced; he
  can walk; indeed; after a time; and when the pain has abated; and when
  he has been accustomed to rotate the articular bone in the flesh; he
  finds it necessary; however; to make strong flexion at the groin in
  walking; for two reasons; both because the limb; for the causes
  already stated; becomes much shorter; and he is far from touching
  the ground with his heel; and he can barely reach it with the ball
  of his foot; and not even thus; unless he bend himself at the
  groins; and also bend with the other leg at the ham。 And in this case;
  he is under the necessity of supporting the upper part of the thigh
  with his hand at each step: this also contributes; in a certain
  degree; to make him bend the body at the groins; for; during the
  shifting of the feet in walking; the body cannot be supported on the
  unsound be supported on