on the articulations-第13章

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strength　than；　for　the　most　part；　those　who　have　it　outward。

　　53。　Some　tell　a　story　how　the　Amazonian　women　dislocate　the　joints
of　their　male　children　while　mere　infants；　some　at　the　knee；　and
others　at　the　hip…joint；　that　they　may　be　maimed；　and　that　the　male
sex　may　not　conspire　against　the　female；　and　that　they　use　them　as
artisans　to　perform　any　sedentary　work；　such　as　that　of　a　shoemaker　or
brazier。　Whether　these　things　be　true　or　not　I　do　not　know；　but　this　I
know；　that　matters　would　be　such　as　is　represented；　provided　their
children；　while　infants；　were　to　have　their　joints　dislocated。　The
consequences　of　dislocation　inward　at　the　hip…joint　are　much　greater
than　of　dislocation　outward　at　the　hip…joint；　but　at　the　knee；
although　there　be　some　difference；　it　is　less；　but　the　mode　of
either　impediment　is　peculiar；　their　legs　are　more　bandied　when　the
dislocation　is　outward；　but　those　who　have　dislocation　inward　stand
erect　on　their　feet　with　less　freedom。　In　like　manner；　when　the
dislocation　is　at　the　anklejoint；　if　outward　they　become　vari　（their
toes　are　turned　inward？）；　but　they　can　stand；　but　if　the　dislocation
be　inward　they　become　valgi　（their　toes　are　turned　outward？）；　but　they
have　less　freedom　of　standing。　The　proportional　growth　of　their
bones　is　as　follows：　in　those　cases　in　which　the　bone　of　the　leg　is
dislocated；　the　bones　of　the　feet　grow　very　little；　as　being　very　near
the　injury；　but　the　bones　of　the　leg　increase　in　size；　and　with　very
little　defect；　but　the　fleshy　parts　（muscles？）　are　wasted。　But　when
the　ankle…joint　is　in　its　natural　state；　but　the　knee　is　dislocated；
in　these　cases　the　bones　of　the　leg　do　not　grow　in　like　manner；　but
become　shortened；　as　being　nearest　the　seat　of　the　injury；　and　the
bones　of　the　feet　also　are　atrophied；　but　not　in　the　same
proportion；　because；　as　was　said　a　little　while　ago；　the　ankle…joint
is　safe；　and　if　they　could　use　it；　as　in　the　case　of　club…foot；　the
bones　of　the　foot　would　be　still　less　atrophied。　When　the
dislocation　takes　place　at　the　hip…joint；　the　bone　of　the　thigh；　in
this　case；　does　not　generally　grow　in　like　manner；　as　being　the　one
nearest　the　seat　of　the　injury；　but　becomes　shorter　than　the　sound
one；　but　the　growth　of　the　bones　of　the　leg　is　not　arrested　in　like
manner；　nor　of　those　of　the　feet；　for　this　reason；　that　there　is　no
displacement　between　the　bones　of　the　thigh　and　leg；　nor　between　those
of　the　leg　and　foot；　in　those　cases；　however；　the　fleshy　parts　of
the　whole　limb　are　atrophied；　but　if　they　could　make　use　of　the
limb；　the　growth　of　the　bones　would　be　still　more　developed；　as
formerly　stated；　only　the　thigh；　although　its　flesh　would　be　much　less
wasted；　would　still　be　by　no　means　so　fleshy　as　the　sound　limb。　The
following　observations　are　a　proof　of　this：　those　persons　who　are
weasel…armed　（galiancones）　from　birth；　owing　to　dislocation　of　the
humerus；　or　when　the　accident　has　happened　to　them　before　they　have
attained　their　full　growth；　such　persons　have　the　bone　of　the　arm
shortened；　but　those　of　the　fore…arm　and　hand　are　little　inferior　in
size　to　the　sound；　for　the　reasons　which　have　been　stated；　because　the
humerus　is　the　bone　nearest　to　the　joint　affected；　and；　on　that
account；　it　is　shorter　than　natural；　but　the　fore…arm　is　not　equally
affected　by　the　accident；　because　the　joint　at　which　the　bones　of
the　arm　and　forearm　are　articulated　remains　in　its　natural
condition；　and　the　hand　is　still　further　distant　than　the　fore…arm
from　the　seat　of　the　injury。　Such　are　the　reasons　why　certain　of　the
bones　in　this　case　increase　in　growth；　and　certain　do　not。　The
laborious　office　of　the　hand　contributes　much　to　the　development　of
the　flesh　in　the　fore…arm　and　hand；　for　whatever　work　is　done　by　the
hand；　these　weasel…armed　persons　strive　to　do　no　less　effectually　with
the　other　hand　than　with　the　sound；　for　the　arms　do　not　support　the
weight　of　the　body　like　the　legs；　and　the　work　performed　by　them　is
light。　From　exercise；　then；　the　fleshy　parts　on　the　hand　and
fore…arm　are　not　atrophied　in　weasel…armed　persons；　and　by　these　means
the　arm；　too；　gains　flesh。　But　in　dislocation　inward　at　the　hip…joint；
whether　from　birth　or　from　childhood；　the　fleshy　parts；　on　that
account；　are　much　more　atrophied　than　those　of　the　hand；　because　the
patients　cannot　exercise　the　leg。　Another　proof　will　be　given　in　the
observations　which　will　be　presently　stated；　that　these　things　are
such　as　I　things　are　such　as　I　have　represented。

　　54。　When　the　head　of　the　femur　is　dislocated　outward；　the　limb　in
these　cases；　when　compared　with　the　other；　appears　shortened；　and　this
is　natural；　for　the　head　of　the　femur　no　longer　rests　on　a　bone　as
in　dislocation　inward；　but　along　the　side　of　a　bone　which　naturally
inclines　to　the　side；　and　it　is　lodged　in　flesh　of　a　pulpy　and
yielding　nature；　and　on　that　account　it　appears　more　shortened。
Inwardly；　the　thigh　about　the　perineum　appears　more　hollow　and　flabby；
but　externally　the　buttock　is　more　rounded；　from　the　head　of　the　thigh
having　slipped　outward；　but　the　nates　appear　to　be　raised　up；　owing　to
the　flesh　there　having　yielded　to　the　head　of　the　thigh…bone；　but
the　extremity　of　the　thigh…bone；　at　the　knee；　appears　to　be　turned
inward；　and　the　leg　and　foot　in　like　manner；　neither　does　it　admit
of　flexion　like　the　sound　limb。　These；　then；　are　the　symptoms　of
dislocation　outward。

　　55。　When　such　a　dislocation　is　not　reduced　in　adults；　the　whole　limb
appears　to　be　shortened；　and　in　walking　they　cannot　reach　the　ground
with　the　heel；　but　they　walk　with　the　ball　of　the　foot　on　the
ground；　and　the　points　of　their　toes　incline　a　little　inward。　But
the　injured　limb；　in　this　case；　can　support　the　body　much　better
than　in　dislocation　inward；　both　because　the　head　of　the　femur　and　the
neck　of　its　articular　extremity；　being　naturally　oblique；　have
formed　a　bed　under　a　considerable　portion　of　the　hip；　and　because
the　extremity　of　the　foot　is　not　forcibly　turned　outward；　but　is
nearly　in　a　line　with　the　body；　and　is　even　inclined　more　inwardly。
When；　then；　the　articular　extremity　of　the　femur　has　worn　out　a　socket
for　itself　in　the　flesh　where　it　was　lodged；　and　the　flesh　is
lubricated；　it　ceases　to　be　painful　in　the　course　of　time；　and　when　it
becomes　free　from　pain；　they　can　walk　without　a　staff；　if　so　inclined；
and　they　can　support　the　body　on　the　injured　limb。　From　usage　then；　in
such　cases；　the　fleshy　parts　are　less　enervated　than　in　those　which
have　been　mentioned　a　little　before；　still；　however；　they　lose　their
strength　more　or　less；　but　in　general　there　is　more　enervation　when
the　dislocation　is　inward　than　when　it　is　outward。　Some　of　them；　then；
cannot　wear　their　shoes；　owing　to　the　unbending　state　of　their　leg；
and　some　of　them　can。　But　when　this　dislocation　takes　place　in
utero；　and　when　the　dislocation　having　occurred　at　any　time　before
manhood；　from　violence；　has　not　been　replaced；　or　when　from　disease
the　articular　extremity　has　started　from　its　socket；　and　is
displaced　（for　many　such　cases　occur；　and　from　some　of　them；　if　the
femur　become　necrosed；　obstinate　suppurations　requiring　the　use　of
tents　are　formed；　and　in　certain　of　them　the　bone　is　laid　bare）；
whether　the　bone　become　necrosed　or　not；　the　bone　of　the　thigh　is　much
shortened；　and　does　not　usually　grow　like　the　sound　one；　the　bones；
too；　of　the　leg；　become　shorter　than　those　of　the　other；　but　in　a
small　degree；　for　the　same　reasons　that　were　formerly　stated；　such
persons　can　walk；　some　of　them　in　the　same　fashion　as　adults　having　an
unreduced　dislocation；　and　some　of　them　walk　with　the　whole　foot　on
the　ground；　but　limp　in　walking；　being　obliged　to　do　so　by　the
shortness　of　the　limb。　Such　is　the　result；　even　though　they　be
carefully　and　properly　trained　in　the　attitudes　before　they　have
strength　for　walking；　and　in　like　manner　also；　after　they　have
acquired　the　necessary　strength；　but　those　persons　require　the　most
care　who　were　very　young　when　they　met　with　the　accident；　for；　if
neglected　while　children；　the　limb　becomes　entirely　useless　and
atrophied。　The　fleshy　parts　of　the　entire　limb　are　more　wasted　than
those　of　the　sound　limb；　but　this　is　muc