第 17 节
作者:没事找事      更新:2021-10-16 18:43      字数:9322
  be understood that many other methods are more powerful than it。 The
  bladder should be placed between the thighs uninflated; so that it may
  be carried as far up the perineum as possible; and the thighs
  beginning at the patella are to be bound together with a swathe; as
  far up as the middle of the thigh; and then a brass pipe is to be
  introduced into one of the loose feet of the bladder; and air forced
  into it; the patient is to lie on his side with the injured limb
  uppermost。 This; then; is the preparation; some; however; do the thing
  worse than as I have described; for they do not bind the thighs
  together to any extent; but only at the knees; neither do they make
  extension; whereas extension should be made; and yet some people by
  having the good fortune to meet with a favorable case; have
  succeeded in making reduction。 But it is not a convenient method of
  applying force; for the bladder; when inflated; does not present its
  most prominent part to the articular extremity of the femur; which
  is the place that ought to be more especially pressed outward; but its
  middle; which probably corresponds with the middle of the thigh; or
  still lower down; for the thighs are naturally curved; being fleshy;
  and in contact above; and becoming smaller downward; so that the
  natural configuration of the parts forces the bladder from the most
  proper place。 And if a small bladder be introduced; its power will
  be small; and unable to overcome the resistance of the articular bone。
  But if the bladder must be used; the thighs are to be bound together
  to a considerable extent; and the bladder is to be inflated along with
  the extension of the body; and in this method of reduction both legs
  are to be bound together at their extremity。
  78。 The prime object of the physician in the whole art of medicine
  should be to cure that which is diseased; and if this can be
  accomplished in various ways; the least troublesome should be
  selected; for this is more becoming a good man; and one well skilled
  in the art; who does not covet popular coin of base alloy。 With regard
  to the subject now on hand; the following are domestic means of making
  extension of the body; so that it is easy to choose from among the
  things at hand:…In the first place; when soft and supple thongs are
  not at hand for ligatures; either iron chains; or cords; or cables
  of ships; are to be wrapped round with scarfs or pieces of woolen
  rags; especially at the parts of them which are to be applied; and
  in this state they are to be used as bands。 In the second place; the
  patient is to be comfortably laid on the strongest and largest couch
  that is at hand; and the feet of the couch; either those at the
  (patient's?) head; or those at the feet; are to be fastened to the
  threshold; either within or without; as is most suitable; and a square
  piece of wood is to be laid across; and extending from the one foot to
  the other; and if this piece of wood be slender; it should be bound to
  the feet of the couch; but; not withstanding; if it be thick; there
  will be no necessity for this; then the heads of the ligatures; both
  of those at the head and those at the feet; are to be fastened to a
  pestle; or some such piece of wood; difficult to reduce at either end;
  the ligatures should run along the line of the body; or be a little
  elevated above it; and it should be stretched proportionally to the
  pestles; so that; standing erect; the one may be fastened to the
  threshold; and the other to the transverse piece of wood。 Extension is
  then to be made by bending back the ends of the pestles。 A ladder;
  having strong steps; if laid below the bed; will serve the purpose
  of the threshold and the piece of wood laid along (the foot of the
  couch?); as the pestles can be fastened to the steps at either end;
  and when drawn back they thus make extension of the ligatures。
  Dislocation; inward or forward; may be reduced in the following
  manner: a ladder is to be fastened in the ground; and the man is to be
  seated upon it; and then the sound leg is to be gently stretched along
  and bound to it; wherever it is found convenient; and water is to be
  poured into an earthen vessel; or stones put into a hamper and slung
  from the injured leg; so as to effect the reduction。 Another mode of
  reduction: a cross…beam is to be fastened between two pillars of
  moderate height; and at one part of the cross…beam there should be a
  protuberance proportionate to the size of the nates; and having
  bound a coverlet round the patient's breast; he is to be seated on the
  protuberant part of the cross…beam; and afterward the breast is to
  be fastened to the pillar by some broad ligature; then some one is
  to hold the sound leg so that he may not fall off; and from the
  injured limb is to be suspended some convenient weight; as formerly
  described。
  79。 It should be particularly known that the union of all bones
  is; for the most part; by a head and socket (cotyle); in some of these
  the place (socket?) is cotyloid and oblong; and in some the socket
  is glenoid (shallow?)。 In all dislocations reduction is to be
  effected; if possible; immediately; while still warm; but otherwise;
  as quickly as it can be done; for reduction will be a much easier
  and quicker process to the operator; and a much less painful one to
  the patient; if effected before swelling comes on。 But all the
  joints when about to be reduced should be first softened; and gently
  moved about; for; thus they are more easily reduced。 And; in all cases
  of reduction at joints; the patient must be put on a spare diet; but
  more especially in the case of the greatest joints; and those most
  difficult to reduce; and less so in those which are very small and
  easily reduced。
  80。 If any joint of the fingers is dislocated; whether the first;
  second; or the third; the same method of reduction is to be applied;
  but the largest joints are the most difficult to reduce。 There are
  four modes of displacement…either upward; downward; or to either side;
  most commonly upward; and most rarely laterally; and in consequence of
  violent motion。 On both sides of its articular cavity there is a
  sort of raised border。 When the dislocation is upward or downward;
  owing to the articular cavity having smoother edges there than at
  the sides; if the joint of it be dislocated; it is more easily
  reduced。 This is the mode of reduction:…The end of the finger is to be
  wrapped round with a fillet; or something such; that; when you lay
  hold of it and make extension; it will not slip; and when this is
  done; some person is to grasp the arm at the wrist; and another is
  to take hold of the finger which is wrapped in the fillet; and then
  each is to make considerable extension toward himself; and at the same
  time the projecting bone is to be pushed into its place。 But; if the
  dislocation be lateral; the same mode of reduction is to be used;
  but when you think that the extremity of the bone has cleared the rim;
  at the same time that extension is made; the bone is to be pushed
  direct into its place; while another person on the other side of the
  finger is to take care and make counter…pressure; so that it may not
  again slip out there。 The twisted nooses formed from palm…shoots are
  convenient for effecting reduction; if you will make extension and
  counter…extension by holding the twisted string in the one hand and
  the wrist in the other。 When reduced; you must bind the part as
  quickly as possible with bandages; these are to be very slender and
  waxed with cerate; neither very soft nor very hard; but of middle
  consistence; for that which is hard drops off from the finger; while
  that which is soft and liquid is melted and lost by the increased heat
  of the finger。 The bandage is to be loosed on the third or fourth day;
  but on the whole; if inflamed; it is to be the more frequently loosed;
  and if otherwise; more rarely; this I say respecting all the joints。
  The articulation of a finger is restored in fourteen days。 The
  treatment of the fingers and of the toes is the same。
  81。 After all reductions of joints the patient should be confined to
  a restricted diet and abstinence until the seventh day; and if there
  be inflammation; the bandages are to be the more frequently loosed;
  but otherwise; less frequently; and the pained joint is to be kept
  constantly in a state of rest; and is to be laid in the most
  convenient position possible。
  82。 Accidents at the knee are more mild than at the elbow; from
  its being compact; regular; and elegant in its construction; and;
  therefore; it is more readily dislocated and reduced。 It is most
  frequently dislocated inward; but also outward and backward。 The modes
  of reduction are these: by flexion at the knee; or by sudden
  calcitration; or having rolled a swathe into a ball; and fixed it in
  the ham; the patient's body is to be suddenly dropped on its bended
  knees。 Dislocation backward; also; as in the case of the elbow; may be
  reduced by moderate extension; and to either side; either by flexion
  or calcitration; but also by moderate extension。 The adjustment is the
  same in all cases。 In dislocations backward which are not reduced; the
  patient cannot bend the joint; but neither can he; to any great
  exten