第 13 节
作者:没事找事      更新:2021-10-16 18:43      字数:9322
  shifting of the feet in walking; the body cannot be supported on the
  unsound be supported on the unsound limb; unless it be pressed to
  the ground by the hand;…the end of the femur not being placed properly
  under the body; but having slipped backward to the nates; and if he
  should try to rest the weight of his body for a little; upon the foot;
  without any other support; he would fall backward; for there would
  be a great inclination in this direction; from the hips having
  protruded backward far beyond the line of the foot; and the spine
  inclining toward the hips。 Such persons can walk; indeed; without a
  staff; if so accustomed; for because the sole of the foot is in its
  old line; and is not inclined outward; they do not require anything to
  balance them。 Such; however; as; instead of grasping the thigh; prefer
  resting their weight upon a staff introduced into the armpit of the
  affected side; these; if they use a longer staff; will walk; indeed;
  more erect; but will not be able to reach the ground with the foot; or
  if they wish to rest upon the foot; they must take a shorter staff;
  and will require to bend the body at the groins。 The wasting of the
  fleshy parts is analogous to what happens in the cases formerly
  described; for the wasting is greatest in those cases in which the
  patients keep the limb up; and do not exercise it; whilst those who
  practice walking; have the least atrophy。 The sound leg; however; is
  not benefited; but is rather rendered more deformed; if the injured
  limb be applied to the ground; for it is forced to cooperate with
  the other; being protruded at the hip; and bent at the ham。 But if the
  patient does not use the injured limb by applying it to the ground;
  but carries it up; and rests upon a staff; the sound leg thereby gains
  strength; for it is employed in its natural position; and further; the
  exercise gives it strength。 But it may be said; these things are
  foreign to medicine; for what is the use of enlarging upon cases which
  are already past remedy? This is far from being the case; for it
  belongs to the knowledge of medicine to be acquainted also with these;
  and they cannot possibly be separated from one another; for to such as
  are curable; means are to be used to prevent them from becoming
  incurable; studying how they may best be prevented from getting into
  an incurable state。 And incurable cases should be known; that they may
  not be aggravated by useless applications; and splendid and creditable
  prognostics are made by knowing where; how; and when every case will
  terminate; and whether it will be converted into a curable or an
  incurable disease。 When then; from birth; or during one's youth;
  this dislocation backward occurs; and is not reduced; whether it be
  connected with violence or disease (for many such dislocations occur
  in diseases; but the nature of the diseases in which dislocations take
  place; will be described afterward); if; then; the dislocated limb
  be not reduced; the bone of the thigh becomes shortened; the whole
  limb is impaired; is arrested in its growth; and loses its flesh
  from want of use; the articulation at the ham is also impaired; for
  the nerves (ligaments?) become stretched; from cases formerly
  stated; wherefore those who have this dislocation; cannot make
  extension at the knee…joint。 In a word; all parts of the body which
  were made for active use; if moderately used and exercised at the
  labor to which they are habituated; become healthy; increase in
  bulk; and bear their age well; but when not used; and when left
  without exercise; they become diseased; their growth is arrested;
  and they soon become old。 Among these parts the joints and nerves
  (ligaments?); if not used; are not the least liable to be so affected;
  they are impaired; then; for the reasons we have stated; more in
  this variety of dislocation than in the others; for the whole limb
  is wasted; both in its bones and in its fleshy parts。 Such persons;
  then; when they attain their full growth; keep the limb raised and
  flexed; rest the weight of the body on the other leg; and support
  themselves with a staff; some with one; and others with two。
  59。 In dislocations of the head of the thigh…bone forward (they
  are of rare occurrence); the patients cannot extend the leg
  completely; but least of all can they bend it at the groin; they are
  pained; also; if forced to bend the limb at the ham。 The length of the
  leg; if compared at the heel; is the same as that of the other; but
  the extremity of the foot inclines less to project forward。 But the
  whole limb has its natural direction; and inclines neither to this
  side nor to that。 These cases are particularly attended with severe
  pain; and they are more apt to be accompanied with retention of
  urine at first than any of the other dislocations; for the head of the
  thigh…bone is lodged very near to important nerves。 And the region
  of the groin appears swelled out and stretched; while that of the
  nates is more wrinkled and flabby。 The symptoms now stated are those
  which attend this dislocation of the thigh…bone。
  60。 When persons have attained their full growth before meeting with
  this dislocation; and when it has not been reduced; upon the
  subsidence of the pain; and when the bone of the joint has been
  accustomed to be rotated in the place where it is lodged; these
  persons can walk almost erect without a staff; and with the injured
  leg almost quite straight; as it does not admit of easy flexion at the
  groin and the ham; owing; then; to this want of flexion at the
  groin; they keep the limb more straight in walking than they do the
  sound one。 And sometimes they drag the foot along the ground; as not
  being able to bend the upper part of the limb; and they walk with
  the whole foot on the ground; for in walking they rest no less on
  the heel than on the fore part of the foot; and if they could take
  great steps; they would rest entirely on the heel in walking; for
  persons whose limbs are sound; the greater the steps they take in
  walking; rest so much the more on the heel; while they are putting
  down the one foot and raising the opposite。 In this form of
  dislocation; persons rest their weight more on the heel than on the
  anterior part of the foot; for the fore part of the foot cannot be
  bent forward equally well when the rest of the limb is extended as
  when it is in a state of flexion; neither; again; can the foot be
  arched to the same degree the limb is bent as when it is extended。 The
  natural state of matters is such as has been now described; and in
  an unreduced dislocation; persons walk in the manner described; for
  the reasons which have been stated。 The limb; moreover; is less fleshy
  than the other; at the nates; the calf of the leg; and the whole of
  its posterior part。 When this dislocation occurs in infancy; and is
  not reduced; or when it is congenital; in these cases the bone of
  the thigh is more atrophied than those of the leg and foot; but the
  atrophy of the thigh…bone is least of all in this form of dislocation。
  The fleshy parts; however; are everywhere attenuated; more
  especially behind; as has been stated above。 If properly trained; such
  persons; when they grow up; can use the limb; which is only a little
  shorter than the other; and yet they support themselves on a staff
  at the affected side。 For; not being able to use properly the ball
  of the foot without the heel; nor to put it down as some can in the
  other varieties of dislocation (the cause of which has been just now
  stated); on this account they require a staff。 But those who are
  neglected; and are not in the practice of putting their foot to the
  ground; but keep the limb up; have the bones more atrophied than those
  who use the limb; and; at the articulations; the limb is more maimed
  in the direct line than in the other forms of dislocation。
  61。 In a word; luxations and subluxations take place in different
  degrees; being sometimes greater and sometimes less; and those cases
  in which the bone has slipped or been displaced to a much greater
  extent; are in general more difficult to rectify than otherwise; and
  if not reduced; such cases have greater and more striking impairment
  and lesion of the bones; fleshy parts; and attitudes; but when the
  bone has slipped; or been displaced to a less extent; it is easier
  to reduce such cases than the other; and if the attempts at
  reduction have failed; or have been neglected; the impairment in
  such cases is less; and proves less injurious than in the cases just
  mentioned。 The other joints present great differences as to the extent
  of the displacements which they are subject to。 But the heads of the
  femur and humerus are very similar to one another as to their
  dislocations。 For the heads of the bones are rounded and smooth; and
  the sockets which receive the heads are also circular; and adapted
  to the heads; they do not admit then of being dislocated in any
  intermediate degree; but; not withstanding; from their rounded
  shape; the bones slip either outward or inward。 In the case we are now
  treating of; then; there is either a complete dislocation or none at
  all; and yet these bones admit of being displaced to a greater or less
  extent; and the thigh is more subject t