on the articulations-第14章

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atrophied。　The　fleshy　parts　of　the　entire　limb　are　more　wasted　than
those　of　the　sound　limb；　but　this　is　much　less　apt　to　happen　in
their　case　than　in　dislocation　inward；　owing　to　usage　and　exercise；　as
they　are　speedily　able　to　make　use　of　the　limb；　as　was　stated　a　little
before　with　regard　to　the　weasel…armed　（galiancones）。

　　56。　There　are　persons　who；　from　birth　or　from　disease；　have
dislocations　outward　of　both　the　thighs；　in　them；　then；　the　bones
are　affected　in　like　manner；　but　the　fleshy　parts　in　their　case　lose
their　strength　less；　the　legs；　too；　are　plump　and　fleshy；　except
that　there　is　some　little　deficiency　at　the　inside；　and　they　are　plump
because　they　have　the　equal　use　of　both　their　legs；　for　in　walking
they　totter　equally　to　this　side　that。　Their　nates　appear　very
prominent；　from　the　displacement　of　the　bones　of　the　joint。　But　if
in　their　case　the　bones　do　not　sphacelate　（become　carious？）　and　if
they　do　not　become　bent　above　the　hip…joint；　if　nothing　of　this　kind
happen　to　them；　they　become　otherwise　sufficiently　healthy；　but　the
growth　of　all　the　rest　of　the　body；　with　the　exception　of　the　head；　is
arrested。

　　57。　In　dislocations　of　the　head　of　the　femur　backward；　which
rarely　occur；　the　patient　cannot　extend　the　leg；　either　at　the
dislocated　joint；　or　at　the　ham；　to　any　extent；　and　of　all　the
dislocations；　this　is　the　variety　in　which　the　patients　have　the　least
power　of　making　extension　at　the　groin　and　the　ham。　But；　moreover；
this　also　should　be　known　（for　it　is　a　valuable　piece　of　knowledge；
and　of　much　importance；　and　yet　most　yet　most　people　are　ignorant　of
it）；　that　persons　in　health　cannot　extend　the　joint　at　the　ham；　if
they　do　not　extend　the　joint　at　the　groin　at　the　same　time；　unless
they　raise　the　foot　very　high；　for　in　this　way　they　could　do　it；
neither　also　could　they　bend　the　joint　at　the　ham；　but　with　much
greater　difficulty；　if　they　do　not　bend　the　joint　at　the　groin　at
the　same　time。　There　are　many　other　things　in　the　body　which　have
similar　connections；　both　with　regard　to　the　contractions　of　nerves
（ligaments？）；　and　the　positions　of　muscles；　and　many　of　them　more
worthy　of　being　known　than　is　generally　supposed；　and　with　regard　to
the　nature　of　the　intestine　and　that　of　the　whole　internal　cavity；　and
with　regard　to　the　displacements　and　contractions　of　the　uterus；　but
all　these　things　will　be　treated　of　elsewhere；　in　a　work　akin　to　the
present　one。　But　with　regard　to　the　matter　on　hand；　they　cannot　make
extension；　as　has　been　already　stated；　and　the　limb　appears　shortened；
for　two　reasons…first；　because　it　cannot　be　extended；　and　also　because
the　bone　has　slipped　into　the　flesh　of　the　nates；　for　the　head　and
neck　of　the　femur；　in　this　dislocation；　are　carried　downward　from
their　natural　situation；　to　the　outside　of　the　nates。　But　yet　they　can
bend　the　limb；　unless　prevented　by　pain；　and　the　leg　and　foot　appear
pretty　straight；　and　not　much　inclined　toward　either　side；　but　at
the　groin　the　flesh；　when　felt；　appears　looser；　from　the　bone　of　the
joint　having　slipped　to　the　other　side；　but　at　the　nates　the　head　of
the　femur　may　be　felt　to　be　more　prominent　than　natural。　Such　are
the　symptoms　accompanying　dislocation　of　the　thigh　backward。

　　58。　When　this　dislocation　occurs　in　an　adult；　and　is　not　reduced；　he
can　walk；　indeed；　after　a　time；　and　when　the　pain　has　abated；　and　when
he　has　been　accustomed　to　rotate　the　articular　bone　in　the　flesh；　he
finds　it　necessary；　however；　to　make　strong　flexion　at　the　groin　in
walking；　for　two　reasons；　both　because　the　limb；　for　the　causes
already　stated；　becomes　much　shorter；　and　he　is　far　from　touching
the　ground　with　his　heel；　and　he　can　barely　reach　it　with　the　ball
of　his　foot；　and　not　even　thus；　unless　he　bend　himself　at　the
groins；　and　also　bend　with　the　other　leg　at　the　ham。　And　in　this　case；
he　is　under　the　necessity　of　supporting　the　upper　part　of　the　thigh
with　his　hand　at　each　step：　this　also　contributes；　in　a　certain
degree；　to　make　him　bend　the　body　at　the　groins；　for；　during　the
shifting　of　the　feet　in　walking；　the　body　cannot　be　supported　on　the
unsound　be　supported　on　the　unsound　limb；　unless　it　be　pressed　to
the　ground　by　the　hand；…the　end　of　the　femur　not　being　placed　properly
under　the　body；　but　having　slipped　backward　to　the　nates；　and　if　he
should　try　to　rest　the　weight　of　his　body　for　a　little；　upon　the　foot；
without　any　other　support；　he　would　fall　backward；　for　there　would
be　a　great　inclination　in　this　direction；　from　the　hips　having
protruded　backward　far　beyond　the　line　of　the　foot；　and　the　spine
inclining　toward　the　hips。　Such　persons　can　walk；　indeed；　without　a
staff；　if　so　accustomed；　for　because　the　sole　of　the　foot　is　in　its
old　line；　and　is　not　inclined　outward；　they　do　not　require　anything　to
balance　them。　Such；　however；　as；　instead　of　grasping　the　thigh；　prefer
resting　their　weight　upon　a　staff　introduced　into　the　armpit　of　the
affected　side；　these；　if　they　use　a　longer　staff；　will　walk；　indeed；
more　erect；　but　will　not　be　able　to　reach　the　ground　with　the　foot；　or
if　they　wish　to　rest　upon　the　foot；　they　must　take　a　shorter　staff；
and　will　require　to　bend　the　body　at　the　groins。　The　wasting　of　the
fleshy　parts　is　analogous　to　what　happens　in　the　cases　formerly
described；　for　the　wasting　is　greatest　in　those　cases　in　which　the
patients　keep　the　limb　up；　and　do　not　exercise　it；　whilst　those　who
practice　walking；　have　the　least　atrophy。　The　sound　leg；　however；　is
not　benefited；　but　is　rather　rendered　more　deformed；　if　the　injured
limb　be　applied　to　the　ground；　for　it　is　forced　to　cooperate　with
the　other；　being　protruded　at　the　hip；　and　bent　at　the　ham。　But　if　the
patient　does　not　use　the　injured　limb　by　applying　it　to　the　ground；
but　carries　it　up；　and　rests　upon　a　staff；　the　sound　leg　thereby　gains
strength；　for　it　is　employed　in　its　natural　position；　and　further；　the
exercise　gives　it　strength。　But　it　may　be　said；　these　things　are
foreign　to　medicine；　for　what　is　the　use　of　enlarging　upon　cases　which
are　already　past　remedy？　This　is　far　from　being　the　case；　for　it
belongs　to　the　knowledge　of　medicine　to　be　acquainted　also　with　these；
and　they　cannot　possibly　be　separated　from　one　another；　for　to　such　as
are　curable；　means　are　to　be　used　to　prevent　them　from　becoming
incurable；　studying　how　they　may　best　be　prevented　from　getting　into
an　incurable　state。　And　incurable　cases　should　be　known；　that　they　may
not　be　aggravated　by　useless　applications；　and　splendid　and　creditable
prognostics　are　made　by　knowing　where；　how；　and　when　every　case　will
terminate；　and　whether　it　will　be　converted　into　a　curable　or　an
incurable　disease。　When　then；　from　birth；　or　during　one's　youth；
this　dislocation　backward　occurs；　and　is　not　reduced；　whether　it　be
connected　with　violence　or　disease　（for　many　such　dislocations　occur
in　diseases；　but　the　nature　of　the　diseases　in　which　dislocations　take
place；　will　be　described　afterward）；　if；　then；　the　dislocated　limb
be　not　reduced；　the　bone　of　the　thigh　becomes　shortened；　the　whole
limb　is　impaired；　is　arrested　in　its　growth；　and　loses　its　flesh
from　want　of　use；　the　articulation　at　the　ham　is　also　impaired；　for
the　nerves　（ligaments？）　become　stretched；　from　cases　formerly
stated；　wherefore　those　who　have　this　dislocation；　cannot　make
extension　at　the　knee…joint。　In　a　word；　all　parts　of　the　body　which
were　made　for　active　use；　if　moderately　used　and　exercised　at　the
labor　to　which　they　are　habituated；　become　healthy；　increase　in
bulk；　and　bear　their　age　well；　but　when　not　used；　and　when　left
without　exercise；　they　become　diseased；　their　growth　is　arrested；
and　they　soon　become　old。　Among　these　parts　the　joints　and　nerves
（ligaments？）；　if　not　used；　are　not　the　least　liable　to　be　so　affected；
they　are　impaired；　then；　for　the　reasons　we　have　stated；　more　in
this　variety　of　dislocation　than　in　the　others；　for　the　whole　limb
is　wasted；　both　in　its　bones　and　in　its　fleshy　parts。　Such　persons；
then；　when　they　attain　their　full　growth；　keep　the　limb　raised　and
flexed；　rest　the　weight　of　the　body　on　the　other　leg；　and　support
themselves　with　a　staff；　some　with　one；　and　others　with　two。

　　59