第 14 节
作者:
没事找事 更新:2021-10-16 18:43 字数:9322
all; and yet these bones admit of being displaced to a greater or less
extent; and the thigh is more subject to these differences than the
arm。
62。 Wherefore; then; some of these congenital displacements; if to a
small extent; may be reduced to their natural condition; and
especially those at the ankle…joint。 Most cases of congenital
club…foot are remediable; unless the declination be very great; or
when the affection occurs at an advanced period of youth。 The best
plan; then; is to treat such cases at as early a period as possible;
before the deficiency of the bones of the foot is very great; and
before there is any great wasting of the flesh of the leg。 There is
more than one variety of club…foot; the most of them being not
complete dislocations; but impairments connected with the habitual
maintenance of the limb in a certain position。 In conducting the
treatment; attention must be paid to the following points: to push
back and rectify the bone of the leg at the ankle from without inward;
and to make counter…pressure on the bone of the heel in an outward
direction; so as to bring it bring it into line; in order that the
displaced bones may meet at the middle and side of the foot; and the
mass of the toes; with the great toe; are to be inclined inward; and
retained so; and the parts are to be secured; with cerate containing a
full proportion of resin; with compresses; and soft bandages
insufficient quantity; but not applied too tight; and the turns of the
bandages should be in the same direction as the rectifying of the foot
with the hand; so that the foot may appear to incline a little
outward。 And a sole made of leather not very hard; or of lead; is to
be bound on; and it is not to be applied to the skin but when you
are about to make the last turns of the bandages。 And when it is all
bandaged; you must attach the end of one of the bandages that are used
to the bandages applied to the inferior part of the foot on the line
of the little toe; and then this bandage is to be rolled upward in
what is considered to be a sufficient degree; to above the calf of the
leg; so that it may remain firm when thus arranged。 In a word; as if
moulding a wax model; you must bring to their natural position the
parts which were abnormally displaced and contracted together; so
rectifying them with your hands; and with the bandaging in like
manner; as to bring them into their position; not by force; but
gently; and the bandages are to be stitched so as to suit the position
in which the limb is to be placed; for different modes of the
deformity require different positions。 And a small shoe made of lead
is to be bound on externally to the bandaging; having the same shape
as the Chian slippers had。 But there is no necessity for it if the
parts be properly adjusted with the hands; properly secured with the
bandages; and properly disposed of afterward。 This; then; is the
mode of cure; and it neither requires cutting; burning; nor any
other complex means; for such cases yield sooner to treatment than one
would believe。 However; they are to be fairly mastered only by time;
and not until the body has grown up in the natural shape; when
recourse is had to a shoe; the most suitable are the buskins; which
derive their name from being used in traveling through mud; for this
sort of shoe does not yield to the foot; but the foot yields to it。
A shoe shaped like the Cretan is also suitable。
63。 In cases of complete dislocation at the ankle…joint; complicated
with an external wound; whether the displacement be inward or outward;
you are not to reduce the parts; but let any other physician reduce
them if he choose。 For this you should know for certain; that the
patient will die if the parts are allowed to remain reduced; and
that he will not survive more than a few days; for few of them pass
the seventh day; being cut off by convulsions; and sometimes the leg
and foot are seized with gangrene。 It should be well known that such
will be the results; and it does not appear to me that hellebore
will do any good; though administered the same day; and the draught
repeated; and yet it is the most likely means; if any such there be;
but I am of opinion that not even it will be of service。 But if not
reduced; nor any attempts at first made to reduce them; most of such
cases recover。 The leg and foot are to be arranged as the patient
wishes; only they must not be put in a dependent position; nor moved
about; and they are to be treated with pitched cerate; a few
compresses dipped in wine; and not very cold; for cold in such cases
induces convulsions; the leaves also of beet; or of colt's foot; of
any such; when boiled in dark…colored austere wine; form a suitable
application to the wound and the surrounding parts; and the wound
may further be anointed with cerate in a tepid state。 But if it be the
winter season; the part is to be covered with unscoured wool; which is
to be sprinkled from above with tepid wine and oil; but on no
account is either bandage or compress to be applied; for this should
be known most especially; that whatever compresses; or is heavy;
does mischief in such cases。 And certain of the dressings used to
recent wounds are suitable in such cases; and wool may be laid upon
the sore; and sprinkled with wine; and allowed to remain for a
considerable time; but those dressings for recent wounds which only
last for a few days; and into which resin enters as an ingredient;
do not agree with them; for the cleansing of the sores is a slow
process; and the sore has a copious discharge for a long time。 Certain
of these cases it may be advantageous to bandage。 It ought also to
be well understood; that the patient must necessarily be much maimed
and deformed; for the foot is retracted outward; and the bones which
have been displaced outward protrude: these bones; in fact; not
being generally laid bare; unless to a small extent; neither do they
exfoliate; but they heal by thin and feeble cicatrices; provided the
patient keeps quiet for a length of time; but otherwise there is
danger that a small ulcer may remain incurable。 And yet in the case we
are treating of; those who are thus treated are saved; whereas; when
the parts are reduced and allowed to remain in place; the patients
die。
64。 The same rule applies to dislocations at the wrist; attended
with a wound and projection of the bone; whether the bones of the
arm be displaced inward or outward。 For this should be well
understood; that the patient will die in the course of a few days;
by the same mode of death as formerly described; if the bone be
reduced; and allowed to remain so。 But in those cases in which they
are not reduced; nor any attempt made to reduce them; the patients;
for the most part; recover; and the same mode of treatment as has been
described will be applicable; but the deformity and impediment of
the limb must necessarily be great; and the fingers of the hand will
be weak and useless; for if the bones have slipped inward; they cannot
bend the fingers; or if outward; they cannot extend them。
65。 When the os tibiae; having made a wound at the knee; has
protruded through the skin; whether the dislocation be outward or
inward; in such a case; if the bone be reduced; death will be even
more speedy than in the other cases; although speedy also in them。 But
the only hope of recovery is if you treat them without reduction。
These cases are more dangerous than the others; as being so much
higher up; as being so much stronger joints; and displaced from
bones which are so much stronger。 But if the os femoris form a wound
at the knee; and slip through it; provided it be reduced and left
so; it will occasion a still more violent and speedy death than in the
cases formerly described; but if not reduced; it will be much more
dangerous than those cases mentioned before; and yet this is the
only hope of recovery。
66。 The same rule applies to the elbow…joint; and with regard to the
bones of the fore…arm and arm。 For when these bones protrude through a
wound which they have made in the skin; all cases in which they are
reduced prove fatal; but if not reduced; there is a chance of
recovery; but to those that survive there is certain impediment。 And
if in any instance the bones of the upper articulations
(shoulder…joint?); should be dislocated; and project through a wound
which they have made in the skin; these; if reduced; are followed by
more speedy death; and if not reduced; they are more dangerous than
the others。 But the mode of treatment which appears to me most
suitable has been already described。
67。 When the joints of the toes or hands are dislocated; and the
bones protrude through a wound which they have made; and when there is
no fracture of the bone; but merely displacement of the joint; in
these cases; if the reduction be made and allowed to remain; there
is some danger of spasms (tetanus?) if not properly treated; and yet
it may be worth while to reduce them; having warned the patient
beforehand that much caution and care will be required。 The easiest;
the most efficient method; and the one most conformable to art; is
that by the lever; as formerly described