第 5 节
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没事找事 更新:2021-10-16 18:43 字数:9322
position for the treatment consists in keeping the hand a little
higher than the elbow; and the arm at the sides; then it may either be
suspended or laid at rest; for either position will answer; and nature
and the usage of common means will accomplish the cure; if the
callus does not form improperly: it is formed quickly。 The treatment
is to be conducted with bandages according to the rule for bandaging
articulations; and the point of the elbow is to be included in the
bandage。
19。 Dislocations at the elbow give rise to the most serious
consequences; such as fevers; pain; nausea; vomitings of pure bile;
and more especially when the humerus is displaced backward from
pressure on the nerve; which occasions numbness; next to it is the
dislocation forward; the treatment is the same; reduction in
dislocation backward is by extension and adaptation; the symptom of
this variety…loss of the power of extension; of dislocation
forward…loss of the power of flexion; and in this case reduction is to
be accomplished by placing a hard ball (in the bend of the elbow); and
bending the fore…arm about it; along with sudden extension。
20。 Diastasis of the bones may be recognized by examining the part
where the vein that runs along the arm divides。
21。 In those cases callus is quickly formed。 In congenital
dislocations the bones below the seat of the injury are shorter than
natural; and; mostly; those nearest to the place; namely; the bones of
the fore…arm; next those of the hand; and; third; those of the
fingers。 The arm and shoulder are stronger; owing to the nourishment
which they receive; and the other arm; from the additional work
which it has to perform; is still more strong。 Wasting of the flesh
takes place on the inside if the dislocation be on the outside; or
otherwise; on the side opposite the dislocation。
22。 When the elbow is dislocated either inward or outward; extension
is to be made with the fore…arm at a right angle to the arm; the
arm; suspended by means of a shawl passed through the armpit; and a
weight attached to the extremity of the elbow; or force may be applied
with the hands; when the articular extremity has been cleared; the
displaced parts are to be rectified with the palms of the hand; as
in dislocations of the hands。 It is to be bandaged; suspended in a
sling; and placed while in this attitude。
23。 Dislocations backward are to be rectified by the palms of the
hands; along with sudden extension; the two acts are to be performed
together; as in other cases of the kind。 But in dislocation forward
the arm is to be bent around a ball of cloth of proper size; and at
the same time replaced。
24。 But if the displacement be on the other side; both these
operations are to be performed in effecting the adjustment。 For
conducting the treatment; the position and bandaging are the same as
in the other cases。 But all these cases may be reduced by ordinary
distention。
25。 Of the methods of reduction; some operate by raising up the
part; some by extension; and some by rotation: the last consists in
rapidly turning the fore…arm to this side and that。
26。 The joint of the hand is dislocated either inward or outward;
most frequently inward。 The symptoms are easily recognized: if inward;
the patient cannot at all bend his fingers; and if outward; he
cannot extend them。 With regard to the reduction;…by placing the
fingers above a table; extension and counter…extension are to be
made by other persons; while with the palm or heel of the hand on
the projecting bone one pushes forward; and another from behind on the
other bone; some soft substance is to be applied to it; and the arm is
to be turned to the prone position if the dislocation was forward; but
to the supine; if backward。 The treatment is to be conducted with
bandages。
27。 The whole hand is dislocated either inward or outward; or to
this side or that; but more especially inward; and sometimes the
epiphysis is displaced; and sometimes the other of these bones is
separated。 In these cases strong extension is to be applied; and
pressure is to be made on the projecting bone; and counter…pressure on
the opposite side; both at the same time; behind and at the side; with
the hands upon a table; or with the heel。 These accidents give rise to
serious consequences and deformities; but in the course of time the
part gets strong; and admits of being used。 The cure is with bandages;
which ought to embrace both the hand and fore…arm; and splints are
to be applied as far as the fingers; and when they are used they
should be more frequently unloosed than infractures; and more
copious affusions of water should be used。
28。 In congenital dislocations (at the wrist) the hand becomes
shortened; and the atrophy of the flesh occurs; for the most part;
on the side opposite to the dislocation。 In an adult the bones
remain of their natural size。
29。 Dislocation at the joint of a finger is easily recognized。
Reduction is to be effected by making extension in a straight line;
and applying pressure on the projecting bone; and counter…pressure
on the opposite side of the other。 The treatment is with bandages。
When not reduced; callus is formed outside of the joint。 When the
dislocation takes place at birth; during adolescence the bones below
the dislocation are shortened; and the flesh is wasted rather on the
opposite than on the same side with the dislocation。 When it occurs in
an adult the bones remain of their proper size。
30。 The jaw…bone; in few cases; is completely dislocated; for the
zygomatic process formed from the upper jaw…bone (malar?) and the bone
behind the ear (temporal?) shuts up the heads of the under jaw;
being above the one (condyloid process?); and below the other
(coronoid process?)。 Of these extremities of the lower jaw; the one;
from its length; is not much exposed to accidents; while the other;
the coronoid; is more prominent than the zygoma; and from both these
heads nervous tendons arise; with which the muscles called temporal
and masseter are connected; they have got these names from their
actions and connections; for in eating; speaking; and the other
functional uses of the mouth; the upper jaw is at rest; as being
connected with the head by synarthrosis; and not by diarthrosis
(enarthrosis?): but the lower jaw has motion; for it is connected with
the upper jaw and the head by enarthrosis。 Wherefore; in convulsions
and tetanus; the first symptom manifested is rigidity of the lower
jaw; and the reason why wounds in the temporal region are fatal and
induce coma; will be stated in another place。 These are the reasons
why complete dislocation does not readily take place; and this is
another reason; because there is seldom a necessity for swallowing
so large pieces of food as would make a man gape more than he easily
can; and dislocation could not take place in any other position than
in great gaping; by which the jaw is displaced to either side。 This
circumstance; however; contributes to dislocation there; of nerves
(ligaments?) and muscles around joints; or connected with joints; such
as are frequently moved in using the member are the most yielding to
extension; in the same manner as well…dressed hides yield the most。
With regard; then; to the matter on hand; the jaw…bone is rarely
dislocated; but is frequently slackened (partially displaced?) in
gaping; in the same manner as many other derangements of muscles and
tendons arise。 Dislocation is particularly recognized by these
symptoms: the lower jaw protrudes forward; there is displacement to
the opposite side; the coronoid process appears more prominent than
natural on the upper jaw; and the patient cannot shut his lower jaw
but with difficulty。 The mode of reduction which will apply in such
cases is obvious: one person must secure the patient's head; and
another; taking hold of the lower jaw with his fingers within and
without at the chin; while the patient gapes as much as he can;
first moves the lower jaw about for a time; pushing it to this side
and that with the hand; and directing the patient himself to relax the
jaw; to move it about; and yield as much as possible; then all of a
sudden the operator must open the mouth; while he attends at the
same time to three positions: for the lower jaw is to be moved from
the place to which it is dislocated to its natural position; it is
to be pushed backward; and along with these the jaws are to be brought
together and kept shut。 This is the method of reduction; and it cannot
be performed in any other way。 A short treatment suffices; a waxed
compress is to be laid on; and bound with a loose bandage。 It is safer
to operate with the patient laid on his back; and his head supported
on a leather cushion well filled; so that it may yield as little as
possible; but some person must hold the patient's head。
31。 When the jaw is dislocated on both sides; the treatment is the
same。 The patients are less able to shut the mouth than in the
former variety; and the jaw protrudes farther in this case; but is not
distorted; the absence of distortion may be recognized by comparing
the corresponding rows of the teeth in the upper a