第 2 节
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没事找事 更新:2021-10-16 18:43 字数:9322
reduction of the shoulder; for one thus operates with the lever upon
the most correct principles; provided only the piece of wood be placed
as much as possible within the head of the humerus; and thus also
the counter…balancing weights will be most properly adjusted; and
safely applied to the bone of the arm。 Wherefore recent cases in
this way may be reduced more quickly than could be believed; before
even extension would appear to be applied; and this is the only mode
of reduction capable of replacing old dislocations; and this it will
effect; unless flesh has already filled up the (glenoid) cavity; and
the head of the humerus has formed a socket for itself in the place to
which it has been displaced; and even in such an old case of
dislocation; it appears to me that we could effect reduction (for what
object would a lever power properly applied not it move?); but it
would not remain in its place; but would be again displaced as
formerly。 The same thing may be effected by means of the ladder; by
preparing it in the same manner。 If the dislocation be recent; a large
Thessalian chair may be sufficient to accomplish this purpose; the
wood; however; should be dressed up as described before; but the
patient should be seated sideways on the chair; and then the arm; with
the piece of wood attached to it; is to be brought over the back of
the chair; and force is to be applied to the arm; with the wood on the
one side; and the body on the other side。 The same means may be
applied with a double door。 One should always use what happens to be
at hand。
8。 Wherefore it should be known that one constitution differs much
from another as to the facility with which dislocations in them may be
reduced; and one articular cavity differs much from another; the one
being so constructed that the bone readily leaps out and another
less so; but the greatest difference regards the binding together of
the parts by the nerves (ligaments?) which are slack in some and tight
in others。 For the humidity in the joints of men is connected with the
state of the ligaments; when they are slack and yielding; for you
may see many people who are so humid (flabby?) that when they choose
they can disarticulate their joints without pain; and reduce them in
like manner。 The habit of the body also occasions a certain
difference; for in those who are in a state of embonpoint and fleshy
the joint is rarely dislocated; but is more difficult to reduce; but
when they are more attenuated and leaner than usual; then they are
subject to dislocations which are more easily reduced。 And the
following observation is a proof that matters are so; for in cattle
the thighs are most apt to be dislocated at the hip…joint; when they
are most particularly lean; which they are at the end of winter; at
which time then they are particularly subject to dislocations (if I
may be allowed to make such an observation while treating of a medical
subject); and therefore Homer has well remarked; that of all beasts
oxen suffer the most at that season; and especially those employed
at the plow as being worked in the winter season。 In them;
therefore; dislocations happen most frequently; as being at that
time most particularly reduced in flesh。 And other cattle can crop the
grass when it is short; but the ox cannot do so until it becomes long;
for; in the others; the projection of the lip is slender; and so is
the upper lip; but in the ox the projection of the lip is thick; and
the upper jaw is thick and obtuse; and therefore they are incapable of
seizing short herbs。 But the solidungula as having prominent teeth
in both their front jaws; can crop the grass and grasp it with their
teeth while short; and delight more in short grass than in rank;
for; in general; short grass is better and more substantial than rank;
as having not yet given out its fructification。 Wherefore the poet has
the following line:
As when to horned cattle dear the vernal season comes;*
because rank grass appears to be most sought after by them。 But
otherwise in the ox; this joint is slacker than in other animals; and;
therefore; this animal drags his foot in walking more than any
other; and especially when lank and old。 For all these reasons the
ox is most particularly subject to dislocations; and I have made the
more observations respecting him; as they confirm all that was said
before on this subject。 With regard; then; to the matter on hand; I
say that dislocations occur more readily; and are more speedily
reduced in those who are lean than in those who are fleshy; and in
those who are humid and lank there is less inflammation than in such
as are dry and fleshy; and they are less compactly knit hereafter; and
there is more mucosity than usual in cases not attended with
inflammation; and hence the joints are more liable to luxations;
for; in the main; the articulations are more subject to mucosities
in those who are lean than in those who are fleshy; and the flesh of
lean persons who have not been reduced by a proper course of
discipline abounds more with mucosity than that of fat persons。 But in
those cases in which the mucosity is accompanied with inflammation;
the inflammation binds (braces?) the joint; and hence those who have
small collections of mucosities are not very subject to
dislocations; which they would be if the mucosity had not been
accompanied with more or less inflammation。
*There is no such line in the works of Homer as they have come down to
us。
9。 In cases of dislocation those persons who are not attacked with
inflammation of the surrounding parts; can use the shoulder
immediately without pain; and do not think it necessary to take any
precautions with themselves; it is therefore the business of the
physician to warn them beforehand that dislocation is more likely to
return in such cases than when the tendons have been inflamed。 This
remark applies to all the articulations; but particularly to those
of the shoulder and knee; for these are the joints most subject to
luxations。 But those who have inflammation of the ligaments cannot use
the shoulder; for the pain and the tension induced by the inflammation
prevent them。 Such cases are to be treated with cerate; compresses;
and plenty of bandages; but a ball of soft clean wool is to be
introduced into the armpit; to fill up the hollow of it; that it may
be a support to the bandaging; and maintain the joint in situ。 The
arm; in general; should be inclined upward as much as possible; for
thus it will be kept at the greatest possible distance from the
place at which the head of the humerus escaped。 And when you bandage
the shoulder you must fasten the arms to the sides with a band;
which is to be carried round the body。 The shoulder should be rubbed
gently and softly。 The physician ought to be acquainted with many
things; and among others with friction; for from the same name the
same results are not always obtained; for friction could brace a joint
when unseasonably relaxed; and relax it when unseasonably hard; but we
will define what we know respecting friction in another place。 The
shoulder; then; in such a state; should be rubbed with soft hands;
and; moreover; in a gentle manner; and the joint should be moved
about; but not roughly; so as to excite pain。 Things get restored
sometimes in a greater space of time; and sometimes in a smaller。
10。 A dislocation may be recognized by the following symptoms:…Since
the parts of a man's body are proportionate to one another; as the
arms and the legs; the sound should always be compared with the
unsound; and the unsound with the sound; not paying regard to the
joints of other individuals (for one person's joints are more
prominent than another's); but looking to those of the patient; to
ascertain whether the sound joint be unlike the unsound。 This is a
proper rule; and yet it may lead to much error; and on this account it
is not sufficient to know this art in theory; but also by actual
practice; for many persons from pain; or from any other cause; when
their joints are not dislocated; cannot put the parts into the same
positions as the sound body can be put into; one ought therefore to
know and be acquainted beforehand with such an attitude。 But in a
dislocated joint the head of the humerus appears lying much more in
the armpit than it is in the sound joint; and also; above; at the
top of the shoulder; the part appears hollow; and the acromion is
prominent; owing to the bone of the joint having sunk into the part
below; there is a source of error in this case also; as will be
described afterward; for it deserves to be described; and also; the
elbow of the dislocated arm is farther removed from the ribs than that
of the other; but by using force it may be approximated; though with
considerable pain; and also they cannot; with the elbow extended;
raise the arm to the ear; as they can the sound arm; nor move it about
as formerly in this direction and that。 These; then; are the
symptoms of dislocation at the shoulder。 The methods of reduction
and the treatment are as described。
11。 It deserves to be known how a shoulder which is subject to
frequent dislocations should be treate