on the articulations-第12章

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used；　and　they　should　be　put　on　moderately　firm；　so　that　the　patient
will　say　that　they　are　neither　too　tight　nor　loose；　and　the
bandaging　should　commence　at　the　seat　of　the　injury；　and　be　made
more　particularly　tight　there；　and　the　bandaging　should　be　conducted
as　is　done　with　a　double…headed　roller；　so　that　the　skin　about　the
ribs　may　not　be　ruffled；　but　may　lie　smooth；　and　the　bandaging
should　be　renewed　every　day；　or　every　alternate　day。　It　is　better　also
to　open　the　bowels　with　some　gentle　medicine；　so　as　just　to　produce　an
evacuation　of　the　food；　and　the　diet　is　to　be　restricted　for　ten　days；
and　then　the　body　is　to　be　recruited　and　filled　up；　while　you　are　upon
the　reducing　system；　the　bandaging　should　be　tighter；　but　when　you　are
making　him　up　again；　it　must　be　looser；　and；　if　he　spit　blood　from　the
commencement；　the　treatment　and　bandaging　should　be　continued　for
forty　days；　but　if　there　be　no　haemoptysis；　treatment　for　twenty
days　will　generally　be　sufficient；　but　the　length　of　time　must　be
regulated　by　the　magnitude　of　the　injury。　When　such　contusions　are
neglected；　if　no　greater　mischief　result　there　from；　at　all　events　the
bruised　part　has　its　flesh　more　pulpy　than　it　had　formerly。　When；
therefore；　any　such　thing　is　left　behind；　and　is　not　properly
dissipated　by　the　treatment；　it　will　be　worse　if　the　mucosity　be
lodged　near　the　bone；　for　the　flesh　no　longer　adheres　to　the　bone　as
formerly；　the　bone　becomes　diseased；　and　chronic　sloughings　of　the
bone　in　many　cases　arise　from　such　causes。　But　if　the　mischief　be
not　upon　the　bone；　but　it　is　the　flesh　itself　which　is　pulpy；　relapses
and　pains　will　return　from　time　to　time；　if　there　happen　to　be　any
disorder　in　the　body；　wherefore　proper　bandaging；　and　for　a
considerable　time；　must　be　had　recourse　to；　until　the　extravasated
blood　forming　in　the　bruise　be　dried　up　and　absorbed；　and　the　part
be　made　up　with　sound　flesh；　and　the　flesh　adhere　to　the　bone。　The
best　cure　is　the　cautery　in　those　cases　which；　from　neglect；　have
become　chronic；　and　the　place　turns　painful；　and　the　flesh　is　pulpy。
And　when　the　flesh　itself　is　pulpy；　the　burning　should　be　carried　as
far　as　the　bone；　but　the　bone　itself　should　not　be　heated；　but　if　it
be　in　the　intercostal　space；　you　need　not　make　the　burning　so
superficial；　only　you　must　take　care　not　to　burn　quite　through。　But　if
the　contusion　appear　to　be　at　the　bone；　if　it　be　still　recent；　and　the
bone　has　not　yet　become　necrosed；　if　it　be　very　small；　it　is　to　be
burned　as　has　been　described；　but　if　the　rising　along　the　bone　be
oblong；　several　eschars　are　to　be　burned　over　it。　Necrosis　of　the
rib　will　be　described　along　with　the　treatment　of　suppurating　sores。

　　51。　There　are　four　modes　of　dislocation　at　the　hip…joint：　of　which
modes；　dislocation　inward　takes　place　most　frequently；　outward；　the
most　frequently　of　all　the　other　modes；　and　it　sometimes　takes　place
backward　and　forward；　but　seldom。　When；　therefore；　dislocation　takes
place　inward；　the　leg　appears　longer　than　natural；　when　compared
with　the　other　leg；　for　two　reasons　truly；　for　the　bone　which
articulates　with　the　hip…joint　is　carried　from　above　down　to　the
ischium　where　it　rises　up　to　the　pubes；　upon　it；　then；　the　head　of　the
femur　rests；　and　the　neck　of　the　femur　is　lodged　in　the　cotyloid
foramen　（foramen　thyroideum？）。　The　buttock　appears　hollow
externally；　from　the　head　of　the　thighbone　having　shifted　inward；
and　the　extremity　of　the　femur　at　the　knee　is　turned　outward；　and
the　leg　and　foot　in　like　manner。　The　foot　then　being　turned　outward；
physicians；　from　ignorance；　bring　the　sound　leg　to　it　and　not　it　to
the　sound　leg；　on　this　account；　the　injured　limb　appears　to　be　much
longer　than　the　sound　one；　and　in　many　other　cases　similar
circumstances　lead　to　error　in　judgment。　Neither　does　the　limb　at
the　groin　admit　of　flexion　as　in　the　sound　limb；　and　the　head　of　the
bone　is　felt　at　the　perineum　too　prominent。　These；　then；　are　the
symptoms　attending　dislocation　of　the　thigh　inward。

　　52。　When；　then；　a　dislocation　has　not　been　reduced；　but　has　been
misunderstood　or　neglected；　the　leg；　in　walking；　is　rolled　about　as　is
the　case　with　oxen；　and　the　weight　of　the　body　is　mostly　supported
on　the　sound　leg；　and　the　limb　at　the　flank；　and　the　joint　where　the
dislocation　has　occurred　is　necessarily　hollow　and　bent；　while　on
the　sound　side　the　buttock　is　necessarily　rounded。　For　if　one　should
walk　with　the　foot　of　the　sound　leg　turned　outward；　the　weight　of
the　body　would　be　thrown　upon　the　injured　limb；　but　the　injured　limb
could　not　carry　it；　for　how　could　it？　One；　then；　is　forced　in
walking　to　turn　the　leg　inward；　and　not　outward；　for　thus　the　sound
leg　best　supports　its　own　half　of　the　body；　and　also　that　of　the
injured　side。　But　being　hollow　at　the　flank　and　the　hip…joint；　they
appear　small　in　stature；　and　are　forced　to　rest　on　a　staff　at　the　side
of　the　sound　leg。　For　they　require　the　support　of　a　staff　there；　since
the　nates　inclines　to　this　side；　and　the　weight　of　the　body　is　carried
to　it。　They　are　forced　also　to　stoop；　for　they　are　obliged　to　rest　the
hand　on　the　side　of　the　thigh　against　the　affected　limb；　for　the
limb　which　is　injured　cannot　support　the　body　in　changing　the　legs；
unless　it　be　held　when　it　is　applied　to　the　ground。　They　who　have
got　an　unreduced　dislocation　inward　are　forced　to　put　themselves
into　these　attitudes；　and　this　from　no　premeditation　on　their　part　how
they　should　assume　the　easiest　position；　but　the　impediment　itself
teaches　them　to　choose　that　which　is　most　conformable　to　their　present
circumstances。　For　persons　who　have　a　sore　on　the　foot；　or　leg；　and
cannot　rest　upon　the　limb；　all；　even　children；　walk　in　this　way；　for
they　turn　the　injured　limb　outward　in　walking；　and　they　derive　two
advantages　therefrom；　to　supply　two　wants；　the　weight　of　the　body　is
not　equally　thrown　upon　the　limb　turned　outward；　as　upon　the　one
turned　inward；　for　neither　is　the　weight　in　a　line　with　it；　but　is
much　more　thrown　upon　the　one　under　the　body；　for　the　weight　is　in　a
straight　line　with　it；　both　in　walking　and　in　the　shifting　of　the
legs。　In　this　position　one　can　most　quickly　turn　the　sound　limb
under　the　body；　by　walking　with　the　unsound　limb　outward；　and　the
sound　inward。　In　the　case　we　are　now　treating　of；　it　is　well　that
the　body　finds　out　the　attitudes　which　are　the　easiest　for　itself。
Those　persons；　then；　who　have　not　attained　their　growth　at　the　time
when　they　met　with　a　dislocation　which　is　not　reduced；　become　maimed
in　the　thigh；　the　leg；　and　the　foot；　for　neither　do　the　bones　grow
properly；　but　become　shortened；　and　especially　the　bone　of　the
thigh；　and　the　whole　limb　is　emaciated；　loses　its　muscularity；　and
becomes　enervated　and　thinner；　both　from　the　impediment　at　the
joint；　and　because　the　patient　cannot　use　the　limb；　as　it　does　not　lie
in　its　natural　position；　for　a　certain　amount　of　exercise　will　relieve
excessive　enervation；　and　it　will　remedy　in　so　far　the　deficiency　of
growth　in　length。　Those　persons；　then；　are　most　maimed　who　have
experienced　the　dislocation　in　utero；　next　those　who　have　met　with
it　in　infancy；　and　least　of　all；　those　who　are　full　grown。　The　mode　of
walking　adopted　by　adults　has　been　already　described；　but　those　who
are　children　when　this　accident　befalls　them；　generally　lose　the　erect
position　of　the　body；　and　crawl　about　miserably　on　the　sound　leg；
supporting　themselves　with　the　hand　of　the　sound　side　resting　on　the
ground。　Some；　also；　who　had　attained　manhood　before　they　met　with　this
accident；　have　also　lost　the　faculty　of　walking　erect。　Those　who
were　children　when　they　met　with　the　accident；　and　have　been
properly　instructed；　stand　erect　upon　the　sound　leg；　but　carry　about　a
staff；　which　they　apply　under　the　armpit　of　the　sound　side；　and　some
use　a　staff　in　both　arms；　the　unsound　limb　they　bear　up；　and　the
smaller　the　unsound　limb；　the　greater　facility　have　they　in　walking；
and　their　sound　leg　is　no　less　strong　than　when　both　are　sound。　The
fleshy　parts　of　the　limb　are　enervated　in　all　such　cases；　but　those
who　have　dislocation　inward　are　more　subject　to　this　loss　of
strength　than；　for　the　most　part；　those　who　ha