第 15 节
作者:没事找事      更新:2021-10-16 18:43      字数:9322
  the most efficient method; and the one most conformable to art; is
  that by the lever; as formerly described when treating of bones
  which have been fractured and protruded; then the patient must be as
  quiet as possible; lie in a recumbent position; and observe a
  restricted regimen。 And it will be better also that he should get some
  gentle emetics。 The sore is to be treated with dressings for fresh
  wounds; which permit of allusions; or with the leaves of camomile;
  or with the applications for fractured bones of the head; but
  nothing very cold must be applied。 The first (most distant?) joints
  are least dangerous; but those still higher; are more so。 Reduction
  should be made the same day; or the next; but by no means on the third
  or fourth; for it is on the fourth day that exacerbations especially
  attack。 In those cases; then; where immediate reduction cannot be
  accomplished; we must wait until after the aforesaid days; for
  whatever you reduce within ten days; may be expected to induce
  spasm。 But if the spasm supervene on its being reduced; the joint
  should be quickly displaced; and bathed frequently with warm water;
  and the whole body should be kept in a warm; soft; and easy condition;
  and more especially about the joints; for the whole body should rather
  be in a bent than in an extended state。 Moreover; it is to be
  expected; that the articular extremities of the bones of the fingers
  will for this generally happens; if even the least degree of
  inflammation take place; so that if it were not that the physician
  would be exposed to censure; owing to the ignorance of the common
  people; no reduction should be made at all。 The reduction of the bones
  of joints which have protruded through the skin; is attended with
  the dangers which have been described。
  68。 When the articular bones of the fingers are fairly chopped
  off; these cases are mostly unattended with danger; unless deliquium
  come on in consequence of the injury; and ordinary treatment will be
  sufficient to such sores。 But when resection is made; not at the
  articulations; but at some other point in the bones; these cases
  also are free from danger; and are still more easily cured than the
  others; and the fractured bones of the fingers which protrude
  otherwise than at the joint admit of reduction without danger。
  Complete resections of bones at the joints; whether the foot; the
  hand; the leg; the ankle; the forearm; the wrist; for the most part;
  are not unattended with danger; unless one be cut off at once by
  deliquium animi; or if continual fever supervene on the fourth day。
  69。 With regard to the sphacelus of fleshy parts; it takes place
  in wounds where there are large blood…vessels; which have been
  strongly compressed; and in fractures of bones which have been bound
  too tight; and in other cases of immoderate constriction; when the
  parts which have been strangulated generally drop off; and the most of
  such patients recover; even when a portion of the thigh comes away; or
  of the arm; both bones and flesh; but less so in this case; and when
  the fore…arm and leg drop off; the patients readily recover。 In
  cases then; of fracture of the bones; when strangulation and
  blackening of the parts take place at first; the separation of the
  dead and living parts quickly occurs; and the parts speedily drop off;
  as the bones have already given way; but when the blackening
  (mortification) takes place while the bones are entire; the fleshy
  parts; in this case; also quickly die; but the bones are slow in
  separating at the boundary of the blackening; and where the bones
  are laid bare。 Those parts of the body which are below the
  boundaries of the blackening are to be removed at the joint; as soon
  as they are fairly dead and have lost their sensibility; care being
  taken not to wound any living part; for if the part which is cut off
  give pain; and if it prove not to be quite dead; there is great danger
  lest the patient may swoon away from the pain; and such swoonings
  often are immediately fatal。 I have known the thigh…bones; when
  denuded in this manner; drop off on the eightieth day; but in the case
  of this patient; the parts below were separated at the knee on the
  twentieth day; and; as I thought; too early; for it appeared to me
  that this should be done more guardedly。 In a case which I had of such
  blackening in the leg; the bones of the leg; as far as they were
  denuded; separated at its middle on the sixtieth day。 But the
  separation of denuded bones is quicker or slower; according to the
  mode of treatment; something; too; depends upon whether the
  compression be stronger or weaker; and whether the nerves; flesh;
  arteries; and veins are quicker or slower in becoming blackened and in
  dying; since; when the parts are not strongly compressed; the
  separation is more superficial; and does not go the length of laying
  the bones bare; and in some cases it is still more superficial; so
  as not even to expose the nerves。 For the reasons now stated; it is
  impossible to define accurately the time at which each of these
  cases will terminate。 The treatment of such cases; however; is to be
  readily undertaken; for they are more formidable to look at than to
  treat; and a mild treatment is sufficient in all such cases; for
  they come to a crisis of themselves; only the diet must be attended
  to; so that it may be as little calculated to create fever as
  possible; and the body is to be placed in the proper positions:
  these are; neither raised very high up; nor inclined much downward;
  but rather upward; until the separation be completed; for at that time
  there is most danger of hemorrhage; on this account; wounds should not
  be laid in a declining position; but the contrary。 But after a
  while; and when the sores have become clean; the same positions will
  no longer be appropriate; but a straight position; and one inclining
  downward; may be proper; and in the course of time; in some of these
  cases; abscesses form; and require bandages。 One may also expect
  that such patients will be attacked with dysentery; for dysentery
  usually supervenes in cases of mortification and of hemorrhage from
  wounds; it comes on generally when the blackening and hemorrhage
  have arrived at a crisis; and is profuse and intense; but does not
  last many days; neither is it of a fatal nature; for such patients
  do not usually lose their appetite; nor is it proper to put them on
  a restricted diet。
  70。 Dislocation inward at the hip…joint is to be reduced in the
  following manner: (it is a good; proper; and natural mode of
  reduction; and has something of display in it; if any one takes
  delight in such ostentatious modes of procedure)。 The patient is to be
  suspended by the feet from a cross…beam with a strong; soft; and broad
  cord; the feet are to be about four inches or less from one another;
  and a broad and soft leather collar connected with the cross…beam is
  to be put on above the knees; and the affected leg should be so
  extended as to moved be two inches longer than the other; the head
  should be about two cubits from the ground; or a little more or
  less; and the arms should be stretched along the sides; and bound with
  something soft; all these preparations should be made while he is
  lying on his back; so that he may be suspended for as short a time
  as possible。 But when the patient is suspended; a person properly
  instructed and not weak; having introduced his arm between his thighs;
  is to place his fore…arm between the perineum and the dislocated
  head of the os femoris; and then; having joined the other hand to
  the one thus passed through the thighs; he is to stand by the side
  of the suspended patient; and suddenly suspend and swing himself in
  the air as perpendicularly as possible。 This method comprises all
  the conditions which are natural; for the body being suspended by
  its weight; produces extension; and the person suspended from him;
  along with the extension; forces the head of the thigh…bone to rise up
  above the acetabulum; and at the same time he uses the bone of the
  fore…arm as a lever; and forces the os femoris to slip into its old
  seat。 The cords should be properly prepared; and care should be
  taken that the person suspended along with the patient have a
  sufficiently strong hold。
  71。 Wherefore; as formerly stated; men's constitutions differ much
  from one another as to the facility or difficulty with which
  dislocations are reduced; and the cause of this was also stated
  formerly in treating of the shoulder。 In some the thigh is reduced
  with no preparation; with slight extension; directed by the hands; and
  with slight movement; and in some the reduction is effected by bending
  the limb at the joint; and making rotation。 But much more frequently
  it does not yield to any ordinary apparatus; and therefore one
  should be acquainted with the most powerful means which can be applied
  in each case; and use whatever maybe judged most proper under all
  circumstances。 The modes of extension have been described in the
  former parts of the work; so that one may make use of whatever may
  happen to be at hand。 For; extension and counter…extension are to be
  made in the direction of the limb and the body; and if this be
  properly eff