第 3 节
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没事找事 更新:2021-10-16 18:43 字数:9321
11。 It deserves to be known how a shoulder which is subject to
frequent dislocations should be treated。 For many persons owing to
this accident have been obliged to abandon gymnastic exercises; though
otherwise well qualified for them; and from the same misfortune have
become inept in warlike practices; and have thus perished。 And this
subject deserves to be noticed; because I have never known any
physician treat the case properly; some abandon the attempt
altogether; and others hold opinions and practice the very what is
proper。 For physicians have burned the shoulders subject to
dislocation; at the top of the shoulder; at the anterior part where
the head of the humerus protrudes; and a little behind the top of
the shoulder; these burnings; if the dislocation of the arm were
upward; or forward; or backward; would have been properly performed;
but now; when the dislocation is downward; they rather promote than
prevent dislocations; for they shut out the head of the humerus from
the free space above。 The cautery should be applied thus: taking
hold with the hands of the skin at the armpit; it is to be drawn
into the line; in which the head of the humerus is dislocated; and
then the skin thus drawn aside is to be burnt to the opposite side。
The burnings should be performed with irons; which are not thick nor
much rounded; but of an oblong form (for thus they pass the more
readily through); and they are to be pushed forward with the hand; the
cauteries should be red…hot; that they may pass through as quickly
as possible; for such as are thick pass through slowly; and occasion
eschars of a greater breadth than convenient; and there is danger that
the cicatrices may break into one another; which; although nothing
very bad; is most unseemly; or awkward。 When you have burnt through;
it will be sufficient; in most cases; to make eschars only in the
lower part; but if there is no danger of the ulcers passing into one
another; and there is a considerable piece of skin between them; a
thin spatula is to be pushed through these holes which have been
burned; while; at the same time; the skin is stretched; for
otherwise the instrument could not pass through; but when you have
passed it through you must let go the skin; and then between the two
eschars you should form another eschar with a slender iron; and burn
through until you come in contact with the spatula。 The following
directions enable you to determine how much of the skin of the
armpit should be grasped; all men have glands in the armpit greater or
smaller; and also in many other parts of the body。 But I will treat in
another work of the whole constitution of the glands; and explain what
they are; what they signify; and what are their offices。 The glands;
then; are not to be taken hold of; nor the parts internal to the
glands; for this would be attended with great danger; as they are
adjacent to the most important nerves。 But the greater part of the
substances external to the glands are to be grasped; for there is no
danger from them。 And this; also; it is proper to know; that if you
raise the arm much; you will not be able to grasp any quantity of skin
worth mentioning; for it is all taken up with the stretching; and also
the nerves。 which by all means you must avoid wounding; become exposed
and stretched in this position; but if you only raise the arm a
little; you can grasp a large quantity of skin; and the nerves which
you ought to guard against are left within; and at a distance from the
operation。 Should not; then; the utmost pains be taken in the whole
practice of the art to find out the proper attitude in every case?
So much regarding the armpit; and these contractions will be
sufficient; provided the eschars be properly placed。 Without the
armpit there are only two places where one might place the eschars
to obviate this affection; the one before and between the head of
the humerus and the tendon at the armpit; and then the skin may be
fairly burned through; but not to any great depth; for there is a
large vein adjacent; and also nerves; neither of which must be touched
with the heat。 But externally; one may form another eschar
considerably above the tendon at the armpit; but a little below the
head of the humerus; and the skin must be burned fairly through; but
it must not be made very deep; for fire is inimical to the nerves。
Through the whole treatment the sores are to be so treated; as to
avoid all strong extension of the arm; and this is to be done
moderately; and only as far as the dressing requires; for thus they
will be less cooled (for it is of importance to cover up all sorts
of burns if one would treat them mildly); and then the lips of them
will be less turned aside; there will be less hemorrhage and fear of
convulsions。 But when the sores have become clean; and are going on to
cicatrization; then by all means the arm is to be bound to the side
night and day; and even when the ulcers are completely healed; the arm
must still be bound to the side for a long time; for thus more
especially will cicatrization take place; and the wide space into
which the humerus used to escape will become contracted。
12。 When attempts to reduce a dislocated shoulder have failed; if
the patient be still growing; the bone of the affected arm will not
increase like the sound one; for although it does increase in so far
it becomes shorter than the other; and those persons called
weasel…armed; become so from two accidents; either from having met
with this dislocation in utero; or from another accident; which will
be described afterward。 But those who while they were children have
had deep…seated suppurations about the head of the bone; all become
weasel…armed; and this; it should be well known; will be the issue;
whether the abscess be opened by an incision or cautery; or whether it
break spontaneously。 Those who are thus affected from birth are
quite able to use the arm yet neither can they raise the arm to the
ear; by extending the elbow; but they do this much less efficiently
than with the sound arm。 But in those who have had the shoulder
dislocated after they were grown up; and when it has not been reduced;
the top of the shoulder becomes much less fleshy; and the habit of
body at that part is attenuated; but when they cease to have pain;
whatever they attempt to perform by raising the elbow from the sides
obliquely; they can no longer accomplish as formerly; but whatever
acts are performed by carrying the arm around by the sides; either
backward or forward; all those they can perform; for they can work
with an auger or a saw; or with a hatchet; and can dig; by not raising
the elbow too much; and do all other kinds of work which are done in
similar attitudes。
13。 In those cases where the acromion has been torn off; the bone
which is thus separated appears prominent。 The bone is the bond of
connection between the clavicle and scapula; for in this respect the
constitution of man is different from that of other animals;
physicians are particularly liable to be deceived in this accident
(for as the separated bone protrudes; the top of the shoulder
appears low and hollow); so that they make preparations as if for
dislocation of the shoulder; for I have known many physicians;
otherwise not inexpert at the art; who have done much mischief by
attempting to reduce such shoulders; thus supposing it a case of
dislocation; and they did not desist until they gave over mistake of
supposing that they had reduced the shoulder。 The treatment; in
these cases; is similar to that which is applicable in others of a
like kind; namely; cerate; compresses; and suitable bandaging with
linen cloths。 The projecting part must be pushed down; and the greater
number of compresses are to be placed on it; and most compression is
to be applied at that part; and the arm being fastened to the side
is to be kept elevated; for thus the parts which had been torn asunder
are brought into closest proximity with one another。 All this should
be well known; and if you choose you may prognosticate safely that
no impediment; small or great; will result from such an injury at
the shoulder; only there will be a deformity in the place; for the
bone cannot be properly restored to its natural situation; but there
must necessarily be more or less tumefaction in the upper part。 For
neither can any other bone be made exactly as it was; which having
become incorporated with another bone; and having grown to it as an
apophysis; has been torn from its natural situation。 If properly
bandaged; the acromion becomes free of pain in a few days。
14。 When a fractured clavicle is fairly broken across it is more
easily treated; but when broken obliquely it is more difficult to
manage。 Matters are different in these cases from what one would
have supposed; for a bone fairly broken across can be more easily
restored to its natural state; and with proper care the upper part may
be brought down by means of suitable position and proper bandaging;
and even if not properly set; the projecting part of the bone is not
very sharp。 But in oblique fractures the case is similar to that of
bones which have been torn away;