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