第 14 节
作者:没事找事      更新:2021-10-16 18:43      字数:9322
  all; and yet these bones admit of being displaced to a greater or less
  extent; and the thigh is more subject to these differences than the
  arm。
  62。 Wherefore; then; some of these congenital displacements; if to a
  small extent; may be reduced to their natural condition; and
  especially those at the ankle…joint。 Most cases of congenital
  club…foot are remediable; unless the declination be very great; or
  when the affection occurs at an advanced period of youth。 The best
  plan; then; is to treat such cases at as early a period as possible;
  before the deficiency of the bones of the foot is very great; and
  before there is any great wasting of the flesh of the leg。 There is
  more than one variety of club…foot; the most of them being not
  complete dislocations; but impairments connected with the habitual
  maintenance of the limb in a certain position。 In conducting the
  treatment; attention must be paid to the following points: to push
  back and rectify the bone of the leg at the ankle from without inward;
  and to make counter…pressure on the bone of the heel in an outward
  direction; so as to bring it bring it into line; in order that the
  displaced bones may meet at the middle and side of the foot; and the
  mass of the toes; with the great toe; are to be inclined inward; and
  retained so; and the parts are to be secured; with cerate containing a
  full proportion of resin; with compresses; and soft bandages
  insufficient quantity; but not applied too tight; and the turns of the
  bandages should be in the same direction as the rectifying of the foot
  with the hand; so that the foot may appear to incline a little
  outward。 And a sole made of leather not very hard; or of lead; is to
  be bound on; and it is not to be applied to the skin but when you
  are about to make the last turns of the bandages。 And when it is all
  bandaged; you must attach the end of one of the bandages that are used
  to the bandages applied to the inferior part of the foot on the line
  of the little toe; and then this bandage is to be rolled upward in
  what is considered to be a sufficient degree; to above the calf of the
  leg; so that it may remain firm when thus arranged。 In a word; as if
  moulding a wax model; you must bring to their natural position the
  parts which were abnormally displaced and contracted together; so
  rectifying them with your hands; and with the bandaging in like
  manner; as to bring them into their position; not by force; but
  gently; and the bandages are to be stitched so as to suit the position
  in which the limb is to be placed; for different modes of the
  deformity require different positions。 And a small shoe made of lead
  is to be bound on externally to the bandaging; having the same shape
  as the Chian slippers had。 But there is no necessity for it if the
  parts be properly adjusted with the hands; properly secured with the
  bandages; and properly disposed of afterward。 This; then; is the
  mode of cure; and it neither requires cutting; burning; nor any
  other complex means; for such cases yield sooner to treatment than one
  would believe。 However; they are to be fairly mastered only by time;
  and not until the body has grown up in the natural shape; when
  recourse is had to a shoe; the most suitable are the buskins; which
  derive their name from being used in traveling through mud; for this
  sort of shoe does not yield to the foot; but the foot yields to it。
  A shoe shaped like the Cretan is also suitable。
  63。 In cases of complete dislocation at the ankle…joint; complicated
  with an external wound; whether the displacement be inward or outward;
  you are not to reduce the parts; but let any other physician reduce
  them if he choose。 For this you should know for certain; that the
  patient will die if the parts are allowed to remain reduced; and
  that he will not survive more than a few days; for few of them pass
  the seventh day; being cut off by convulsions; and sometimes the leg
  and foot are seized with gangrene。 It should be well known that such
  will be the results; and it does not appear to me that hellebore
  will do any good; though administered the same day; and the draught
  repeated; and yet it is the most likely means; if any such there be;
  but I am of opinion that not even it will be of service。 But if not
  reduced; nor any attempts at first made to reduce them; most of such
  cases recover。 The leg and foot are to be arranged as the patient
  wishes; only they must not be put in a dependent position; nor moved
  about; and they are to be treated with pitched cerate; a few
  compresses dipped in wine; and not very cold; for cold in such cases
  induces convulsions; the leaves also of beet; or of colt's foot; of
  any such; when boiled in dark…colored austere wine; form a suitable
  application to the wound and the surrounding parts; and the wound
  may further be anointed with cerate in a tepid state。 But if it be the
  winter season; the part is to be covered with unscoured wool; which is
  to be sprinkled from above with tepid wine and oil; but on no
  account is either bandage or compress to be applied; for this should
  be known most especially; that whatever compresses; or is heavy;
  does mischief in such cases。 And certain of the dressings used to
  recent wounds are suitable in such cases; and wool may be laid upon
  the sore; and sprinkled with wine; and allowed to remain for a
  considerable time; but those dressings for recent wounds which only
  last for a few days; and into which resin enters as an ingredient;
  do not agree with them; for the cleansing of the sores is a slow
  process; and the sore has a copious discharge for a long time。 Certain
  of these cases it may be advantageous to bandage。 It ought also to
  be well understood; that the patient must necessarily be much maimed
  and deformed; for the foot is retracted outward; and the bones which
  have been displaced outward protrude: these bones; in fact; not
  being generally laid bare; unless to a small extent; neither do they
  exfoliate; but they heal by thin and feeble cicatrices; provided the
  patient keeps quiet for a length of time; but otherwise there is
  danger that a small ulcer may remain incurable。 And yet in the case we
  are treating of; those who are thus treated are saved; whereas; when
  the parts are reduced and allowed to remain in place; the patients
  die。
  64。 The same rule applies to dislocations at the wrist; attended
  with a wound and projection of the bone; whether the bones of the
  arm be displaced inward or outward。 For this should be well
  understood; that the patient will die in the course of a few days;
  by the same mode of death as formerly described; if the bone be
  reduced; and allowed to remain so。 But in those cases in which they
  are not reduced; nor any attempt made to reduce them; the patients;
  for the most part; recover; and the same mode of treatment as has been
  described will be applicable; but the deformity and impediment of
  the limb must necessarily be great; and the fingers of the hand will
  be weak and useless; for if the bones have slipped inward; they cannot
  bend the fingers; or if outward; they cannot extend them。
  65。 When the os tibiae; having made a wound at the knee; has
  protruded through the skin; whether the dislocation be outward or
  inward; in such a case; if the bone be reduced; death will be even
  more speedy than in the other cases; although speedy also in them。 But
  the only hope of recovery is if you treat them without reduction。
  These cases are more dangerous than the others; as being so much
  higher up; as being so much stronger joints; and displaced from
  bones which are so much stronger。 But if the os femoris form a wound
  at the knee; and slip through it; provided it be reduced and left
  so; it will occasion a still more violent and speedy death than in the
  cases formerly described; but if not reduced; it will be much more
  dangerous than those cases mentioned before; and yet this is the
  only hope of recovery。
  66。 The same rule applies to the elbow…joint; and with regard to the
  bones of the fore…arm and arm。 For when these bones protrude through a
  wound which they have made in the skin; all cases in which they are
  reduced prove fatal; but if not reduced; there is a chance of
  recovery; but to those that survive there is certain impediment。 And
  if in any instance the bones of the upper articulations
  (shoulder…joint?); should be dislocated; and project through a wound
  which they have made in the skin; these; if reduced; are followed by
  more speedy death; and if not reduced; they are more dangerous than
  the others。 But the mode of treatment which appears to me most
  suitable has been already described。
  67。 When the joints of the toes or hands are dislocated; and the
  bones protrude through a wound which they have made; and when there is
  no fracture of the bone; but merely displacement of the joint; in
  these cases; if the reduction be made and allowed to remain; there
  is some danger of spasms (tetanus?) if not properly treated; and yet
  it may be worth while to reduce them; having warned the patient
  beforehand that much caution and care will be required。 The easiest;
  the most efficient method; and the one most conformable to art; is
  that by the lever; as formerly described