第 9 节
作者:
没事找事 更新:2021-10-16 18:43 字数:9322
generation; and the loose portion of the rectum; are situated there。
From this; to the attachment of the diaphragm; the spine inclines
inward; and this portion alone; from the internal parts; gives
origin to muscles; which are called psoae。 From this to the great
vertebra (seventh cervical?) which is above the tops of the shoulders;
it is convex behind lengthways; but it is more in appearance than it
really is; for the spinous processes are highest in the middle; and
less so above and below。 The region of the neck is convex before。
46。 In cases of displacement backward along the vertebrae; it does
not often happen; in fact; it is very rare; that one or more vertebrae
are torn from one another and displaced。 For such injuries do not
readily occur; as the spine could not easily be displaced backward but
by a severe injury on the fore part through the belly (which would
prove fatal); or if a person falling from a height should pitch on the
nates; or shoulders (and even in this case he would die; but not
immediately); and it also would not readily happen that such a
displacement could take place forward; unless some very heavy weight
should fall upon it behind; for each of the posterior spinal processes
is so constructed; that it would sooner be broken than undergo any
great inclination forward from a force which would have to overcome
the ligaments and the articulations mutually connecting them。 And
the spinal marrow would suffer; if from the displacement of a vertebra
it were to be bent even to a small extent; for the displaced
vertebra would compress the spinal marrow; if it did not break it; and
if compressed and strangled; it would induce insensibility of many
great and important parts; so that the physician need not give himself
any concern about rectifying the displacement of the vertebra;
accompanied; as it is; by many other ill consequences of a serious
nature。 It is evident; then; that such a case could not be reduced
either by succussion or by any other method; unless one were to cut
open the patient; and then; having introduced the hand into one of the
great cavities; were to push outward from within; which one might do
on the dead body; but not at all on the living。 Wherefore; then; do
I write all this? Because certain persons fancy that they have cured
patients in whom the vertebra had undergone complete dislocation
forward。 Some; indeed; suppose that this is the easiest of all these
dislocations to be recovered from; and that such cases do not stand in
need of reduction; but get well spontaneously。 Many are ignorant;
and profit by their ignorance; for they obtain credit from those about
them。 These are deceived in this way; for they suppose the spinous
processes to be the vertebrae themselves; because every one of them
appears round to the touch; not knowing that these bones are processes
from the vertebrae; as formerly stated; but the vertebrae are at a
considerable distance before them; for of all animals; man; in
proportion to his bulk; has the belly (internal cavity?) the narrowest
from behind to before; especially at the breast。 When; therefore;
any of these processes are severely fractured; whether one or more;
the part there appears lower than on either side; and for that
reason they are deceived; supposing that the vertebrae are displaced
inward。 And the patient contribute also to deceive them; for if they
attempt to put themselves into a bent position; they are pained;
from the skin being stretched at the seat of the injury; and at the
same time the fragments of the bones wound the skin still more; but if
they bend forward; they feel easier; for the skin at the wound is thus
relaxed; and the bones are less disposed to hurt them; and if touched;
they shrink and bend forward; and the part which is touched appears
empty and soft。 All the circumstances now mentioned contribute to
deceive the physician。 Such patients speedily get well without any bad
effects; for callus readily forms in all such bones as are porous。
47。 There are many varieties of curvature of the spine even in
persons who are in good health; for it takes place from natural
conformation and from habit; and the spine is liable to be bent from
old age; and from pains。 Gibbosities (or projections backward) from
falls generally take place when one pitches on the nates; or falls
on the shoulders。 In this case some one of the vertebrae must
necessarily appear higher than natural; and those on either side to
a less degree; but yet no one generally has started out of the line of
the others; but every one has yielded a little; so that a considerable
extent of them is curved。 On this account the spinal marrow easily
bears such distortions; because they are of a circular shape; and
not angular。 The apparatus for the reduction in this case must be
managed in the following manner: a strong and broad board; having an
oblong furrow in it; is to be fastened in the ground; or; in place
of the board; we may scoop out an oblong furrow in the wall; about a
cubit above the floor; or at any suitable height; and then something
like an oaken bench; of a quadrangular shape; is to be laid along (the
wall?) at a distance from the wall; which will admit of persons to
pass round if necessary; and the bench is to be covered with robes; or
anything else which is soft; but does not yield much; and the
patient is to be stoved with vapor; if necessary; or bathed with
much hot water; and then he is to be stretched along the board on
his face; with his arms laid along and bound to his body; the
middle; then; of a thong which is soft; sufficiently broad and long;
and composed of two cross straps of leather; is to be twice carried
along the middle of the patient's breast; as near the armpits as
possible; then what is over of the thongs at the armpits is to be
carried round the shoulders; and afterward the ends of the thong are
to be fastened to a piece of wood resembling a pestle; they are to
be adapted to the length of the bench laid below the patient; and so
that the pestle…like piece of wood resting against this bench may make
extension。 Another such band is to be applied above the knees and
the ankles; and the ends of the thongs fastened to a similar piece
of wood; and another thong; broad; soft; and strong; in the form of
a swathe; having breadth and length sufficient; is to be bound tightly
round the loins; as near the hips as possible; and then what remains
of this swathelike thong; with the ends of the thongs; must be
fastened to the piece of wood placed at the patient's feet; and
extension in this fashion is to be made upward and downward; equally
and at the same time; in a straight line。 For extension thus made
could do no harm; if properly performed; unless one sought to do
mischief purposely。 But the physicians; or some person who is
strong; and not uninstructed; should apply the palm of one hand to the
hump; and then; having laid the other hand upon the former; he
should make pressure; attending whether this force should be applied
directly downward; or toward the head; or toward the hips。 This method
of applying force is particularly safe; and it is also safe for a
person to sit upon the hump while extension is made; and raising
himself up; to let himself fall again upon the patient。 And there is
nothing to prevent a person from placing a foot on the hump; and
supporting his weight on it; and making gentle pressure; one of the
men who is practiced in the palestra would be a proper person for
doing this in a suitable manner。 But the most powerful of the
mechanical means is this: if the hole in the wall; or in the piece
of wood fastened into the ground; be made as much below the man's back
as may be judged proper; and if a board; made of limetree; or any
other wood; and not too narrow; be put into the hole; then a rag;
folded several times or a small leather cushion; should be laid on the
hump; nothing large; however; should be laid on the back; but just
as much as may prevent the board from giving unnecessary pain by its
hardness; but the hump should be as much as possible on a line with
the hole made in the wall; so that the board introduced into it may
make pressure more especially at that especially at that spot。 When
matters are thus adjusted; one person; or two if necessary; must press
down the end of the board; whilst others at the same time make
extension and counter…extension as along the body; as formerly
described。 Extension may also be made with axles; which may either
be fastened in the ground beside the bench; or the post of the axles
may be attached to the bench itself; if you will make them
perpendicular and overtopping (the bench?) a little at both ends; or
at either end of the bench。 These powers are easily regulated; so as
to be made stronger or weaker; and they are of such force; that if one
were to have recourse to them for a mischievous purpose; and not as
a remedy; they would operate strongly in this way also; for by
making merely extension and counter…extension longitudinally;
without any additional force; one might make sufficient extension; and
if; without making extension at all; one were only to press down
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