第 15 节
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没事找事 更新:2021-10-16 18:43 字数:9322
the most efficient method; and the one most conformable to art; is
that by the lever; as formerly described when treating of bones
which have been fractured and protruded; then the patient must be as
quiet as possible; lie in a recumbent position; and observe a
restricted regimen。 And it will be better also that he should get some
gentle emetics。 The sore is to be treated with dressings for fresh
wounds; which permit of allusions; or with the leaves of camomile;
or with the applications for fractured bones of the head; but
nothing very cold must be applied。 The first (most distant?) joints
are least dangerous; but those still higher; are more so。 Reduction
should be made the same day; or the next; but by no means on the third
or fourth; for it is on the fourth day that exacerbations especially
attack。 In those cases; then; where immediate reduction cannot be
accomplished; we must wait until after the aforesaid days; for
whatever you reduce within ten days; may be expected to induce
spasm。 But if the spasm supervene on its being reduced; the joint
should be quickly displaced; and bathed frequently with warm water;
and the whole body should be kept in a warm; soft; and easy condition;
and more especially about the joints; for the whole body should rather
be in a bent than in an extended state。 Moreover; it is to be
expected; that the articular extremities of the bones of the fingers
will for this generally happens; if even the least degree of
inflammation take place; so that if it were not that the physician
would be exposed to censure; owing to the ignorance of the common
people; no reduction should be made at all。 The reduction of the bones
of joints which have protruded through the skin; is attended with
the dangers which have been described。
68。 When the articular bones of the fingers are fairly chopped
off; these cases are mostly unattended with danger; unless deliquium
come on in consequence of the injury; and ordinary treatment will be
sufficient to such sores。 But when resection is made; not at the
articulations; but at some other point in the bones; these cases
also are free from danger; and are still more easily cured than the
others; and the fractured bones of the fingers which protrude
otherwise than at the joint admit of reduction without danger。
Complete resections of bones at the joints; whether the foot; the
hand; the leg; the ankle; the forearm; the wrist; for the most part;
are not unattended with danger; unless one be cut off at once by
deliquium animi; or if continual fever supervene on the fourth day。
69。 With regard to the sphacelus of fleshy parts; it takes place
in wounds where there are large blood…vessels; which have been
strongly compressed; and in fractures of bones which have been bound
too tight; and in other cases of immoderate constriction; when the
parts which have been strangulated generally drop off; and the most of
such patients recover; even when a portion of the thigh comes away; or
of the arm; both bones and flesh; but less so in this case; and when
the fore…arm and leg drop off; the patients readily recover。 In
cases then; of fracture of the bones; when strangulation and
blackening of the parts take place at first; the separation of the
dead and living parts quickly occurs; and the parts speedily drop off;
as the bones have already given way; but when the blackening
(mortification) takes place while the bones are entire; the fleshy
parts; in this case; also quickly die; but the bones are slow in
separating at the boundary of the blackening; and where the bones
are laid bare。 Those parts of the body which are below the
boundaries of the blackening are to be removed at the joint; as soon
as they are fairly dead and have lost their sensibility; care being
taken not to wound any living part; for if the part which is cut off
give pain; and if it prove not to be quite dead; there is great danger
lest the patient may swoon away from the pain; and such swoonings
often are immediately fatal。 I have known the thigh…bones; when
denuded in this manner; drop off on the eightieth day; but in the case
of this patient; the parts below were separated at the knee on the
twentieth day; and; as I thought; too early; for it appeared to me
that this should be done more guardedly。 In a case which I had of such
blackening in the leg; the bones of the leg; as far as they were
denuded; separated at its middle on the sixtieth day。 But the
separation of denuded bones is quicker or slower; according to the
mode of treatment; something; too; depends upon whether the
compression be stronger or weaker; and whether the nerves; flesh;
arteries; and veins are quicker or slower in becoming blackened and in
dying; since; when the parts are not strongly compressed; the
separation is more superficial; and does not go the length of laying
the bones bare; and in some cases it is still more superficial; so
as not even to expose the nerves。 For the reasons now stated; it is
impossible to define accurately the time at which each of these
cases will terminate。 The treatment of such cases; however; is to be
readily undertaken; for they are more formidable to look at than to
treat; and a mild treatment is sufficient in all such cases; for
they come to a crisis of themselves; only the diet must be attended
to; so that it may be as little calculated to create fever as
possible; and the body is to be placed in the proper positions:
these are; neither raised very high up; nor inclined much downward;
but rather upward; until the separation be completed; for at that time
there is most danger of hemorrhage; on this account; wounds should not
be laid in a declining position; but the contrary。 But after a
while; and when the sores have become clean; the same positions will
no longer be appropriate; but a straight position; and one inclining
downward; may be proper; and in the course of time; in some of these
cases; abscesses form; and require bandages。 One may also expect
that such patients will be attacked with dysentery; for dysentery
usually supervenes in cases of mortification and of hemorrhage from
wounds; it comes on generally when the blackening and hemorrhage
have arrived at a crisis; and is profuse and intense; but does not
last many days; neither is it of a fatal nature; for such patients
do not usually lose their appetite; nor is it proper to put them on
a restricted diet。
70。 Dislocation inward at the hip…joint is to be reduced in the
following manner: (it is a good; proper; and natural mode of
reduction; and has something of display in it; if any one takes
delight in such ostentatious modes of procedure)。 The patient is to be
suspended by the feet from a cross…beam with a strong; soft; and broad
cord; the feet are to be about four inches or less from one another;
and a broad and soft leather collar connected with the cross…beam is
to be put on above the knees; and the affected leg should be so
extended as to moved be two inches longer than the other; the head
should be about two cubits from the ground; or a little more or
less; and the arms should be stretched along the sides; and bound with
something soft; all these preparations should be made while he is
lying on his back; so that he may be suspended for as short a time
as possible。 But when the patient is suspended; a person properly
instructed and not weak; having introduced his arm between his thighs;
is to place his fore…arm between the perineum and the dislocated
head of the os femoris; and then; having joined the other hand to
the one thus passed through the thighs; he is to stand by the side
of the suspended patient; and suddenly suspend and swing himself in
the air as perpendicularly as possible。 This method comprises all
the conditions which are natural; for the body being suspended by
its weight; produces extension; and the person suspended from him;
along with the extension; forces the head of the thigh…bone to rise up
above the acetabulum; and at the same time he uses the bone of the
fore…arm as a lever; and forces the os femoris to slip into its old
seat。 The cords should be properly prepared; and care should be
taken that the person suspended along with the patient have a
sufficiently strong hold。
71。 Wherefore; as formerly stated; men's constitutions differ much
from one another as to the facility or difficulty with which
dislocations are reduced; and the cause of this was also stated
formerly in treating of the shoulder。 In some the thigh is reduced
with no preparation; with slight extension; directed by the hands; and
with slight movement; and in some the reduction is effected by bending
the limb at the joint; and making rotation。 But much more frequently
it does not yield to any ordinary apparatus; and therefore one
should be acquainted with the most powerful means which can be applied
in each case; and use whatever maybe judged most proper under all
circumstances。 The modes of extension have been described in the
former parts of the work; so that one may make use of whatever may
happen to be at hand。 For; extension and counter…extension are to be
made in the direction of the limb and the body; and if this be
properly eff