第 16 节
作者:
没事找事 更新:2021-10-16 18:43 字数:9322
made in the direction of the limb and the body; and if this be
properly effected; the head of the thigh…bone will be raised above its
ancient seat; and if thus raised; it will not be easy to prevent it
from settling in its place; so that any ordinary impulse with the
lever and adjustment will be quite sufficient; but some apply
insufficient extension; and hence the reduction gives much trouble。
The bands then should be fastened; not only at the foot; but also
above the knee; so that the force of the extension may not be expended
on the knee…joint more than upon the hip…joint。 The extension in the
direction of the foot is to be thus contrived。 But the
counter…extension is not only to be managed by means of something
carried round the chest and armpits; but also by a long; double;
strong; and supple thong applied to the perineum; and carried behind
along the spine; and in front along the collar…bone and fixed to the
point from which counter…extension is made; and then force is to be so
applied; by means of this extension and counter…extension; that the
thong at the perineum may not pass over the head of the thigh…bone;
but between it and the perineum; and during the extension one should
strike the head of the femur with the fist; so as to drive it outward。
And when the patient is raised up by the stretching; you should pass a
hand through (between the legs?) and grasp it with the other hand;
so as at the same time to make extension; and force the dislocated
limb outward; while some other person sitting by the knee quietly
directs it inward。
72。 It has been formerly stated by us that it will be of
importance for any person who practices medicine in a populous city to
get prepared a quadrangular board; about six cubits or a little more
in length; and about two cubits in breadth; a fathom will be
sufficient thickness for it; and then along it from the one end to the
other; an excavation must be made; so that the working of the levers
may not be higher than is proper; then at both sides we are to raise
short; strong; and strongly…fixed posts; having axles; and in the
middle of the bench five or six long grooves are to be scooped out
about four inches distant from one another; three inches will be a
sufficient breadth for them; and the depth in like manner; and
although the number of grooves I have mentioned will be sufficient;
there is nothing to prevent their being made all over the bench。 And
the bench should have in its middle a pretty deep hole; of a square
shape; and of about three inches in size; and into this hole; when
judged necessary; is to be adjusted a corresponding piece of wood;
rounded above; which; at the proper time; is to be adjusted between
the perineum and the head of the thigh…bone。 This upright piece of
wood prevents the body from yielding to the force dragging downward by
the feet; for sometimes this piece of wood serves the purpose of
counter…extension upward; and sometimes; too; when extension and
counter…extension are made; this piece of wood; if susceptible of some
motion to this side or that; will serve the purpose of a lever for
pushing the head of the thigh…bone outward。 It is on this account that
several grooves are scooped out on the bench; so that this piece of
wood; being erected at the one which answers; may act as a lever;
either on the sides of the articular heads of bones; or may make
pressure direct on the heads along with the extension; according as it
may suit to push inward or outward with the lever; and the lever may
be either of a round or broad form; as may be judged proper; for
sometimes the one form and sometimes the other suits with the
articulation。 This mode of applying the lever along with extension
is applicable in the reduction of all dislocations of the thigh。 In
the case now on hand; a round lever is proper; but in dislocations
outward a flat lever will be the suitable one。 By means of such
machines and of such powers; it appears to me that we need never
fail in reducing any dislocation at a joint。
73。 And one might find out other modes of reduction for this
joint。 If the large bench were to have raised on it two posts about
a foot (in diameter?); and of a suitable height; on each side near its
middle; and if a transverse piece of wood like the step of a ladder;
were inserted in the posts; then if the sound leg were carried through
between the posts; and the injured limb were brought over the
transverse piece of wood; which should be exactly adapted in height to
the joint which is dislocated (and it is an easy matter so to adjust
it; for the step of the ladder should be made a little higher than
required; and a convenient robe; folded several times; is to be laid
below the patient's body); then a piece of wood; of suitable breadth
and length; is to be laid below the limb; and it should reach from the
ankle to beyond the head of the thigh…bone; and should be bound
moderately tight to the limb。 Then the limb being extended; either
by means of the pestle…like piece of wood (formerly described); or
by any of the other methods of extension; the limb which is carried
over the step with the piece of wood attached to it; is to be forced
downward; while somebody grasps the patient above the hip…joint。 In
this manner the extension will carry the head of the thighbone above
the acetabulum; while the lever power that is exercised will push
the head of the thigh…bone into its natural seat。 All the
above…mentioned powers are strong; and more than sufficient to rectify
the accident; if properly and skillfully applied。 For; as formerly
stated; in most cases reduction may be effected by much weaker
extension; and an inferior apparatus。
74。 If the head of the bone slip outward; extension and
counter…extension must be made as described; or in a similar manner。
But along with the extension a broad lever is to be used to force
the bone from without inward; the lever being placed at the nates or a
little farther up; and some person is to steady the patient's body; so
that it may not yield; either by grasping him at the buttocks with his
hands; or this may be effected by means of another similar lever;
adjusted to one of the grooves; while the patient has something laid
below him; and he is secured; and the dislocated thigh is to be turned
gently from within outward at the knee。 Suspension will not answer
in this form of dislocation; for; in this instance; the arm of the
person suspended from him; would push the head of the thigh…bone
from the acetabulum。 But one might use the piece of wood placed
below him as a lever; in such a manner as might suit with this mode of
dislocation; it must work from without。 But what use is there for more
words? For if the extension be well and properly done; and if the
lever be properly used; what dislocation of the joint could occur;
that might not be thus reduced?
75。 In dislocation of the thigh; backward; extension and
counter…extension should be made as has been described; and having
laid on the bench a cloth which has been folded several times; so that
the patient may lie soft; he is to be laid on his face; and
extension thus made; and; along with the extension; pressure is to
be made with a board; as in the case of humpback; the board being
placed on the region of the nates; and rather below than above the
hip…joint; and the hole made in the wall for the board should not be
direct over; but should be inclined a little downward; toward the
feet。 This mode of reduction is particularly appropriate to this
variety of dislocation; and at the same time is very strong。 But
perhaps; instead of the board; it might be sufficient to have a person
sitting (on the seat of luxation ?); or pressing with his hands; or
with his foot; and suddenly raising himself up; along with the
extension。 None of the other aforementioned modes of reduction are
natural in this form of dislocation。
76。 In dislocation forward; the same mode of extension should be
made; but a person who has very strong hands; and is well trained;
should place the palm of the one hand on the groin; and taking hold of
this hand with the other; is at the same time to push the dislocated
part downward; and at the same time to the fore part of the knee。 This
method of reduction is most especially conformable to this mode of
dislocation。 And the mode of suspension is also not far removed from
being natural; but the person suspended should be well trained; so
that his arm may not act as a lever upon the joint; but that the force
of the suspension may act about the middle of the perineum; and at the
os sacrum。
77。 Reduction by the bladder is also celebrated in dislocations at
this joint; and I have seen certain persons who; from ignorance;
attempted to reduce both dislocations outward and backward
therewith; not knowing that they were rather displacing than replacing
the parts; it is clear; however; that he who first invented this
method intended it for dislocation inward。 It is proper; then; to know
how the bladder should be used; if it is to be used; and it should
be understood that many other methods are more powerful than it。 The
bladder should be placed between the thi