on the articulations-第15章

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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。　In　dislocations　of　the　head　of　the　thigh…bone　forward　（they
are　of　rare　occurrence）；　the　patients　cannot　extend　the　leg
completely；　but　least　of　all　can　they　bend　it　at　the　groin；　they　are
pained；　also；　if　forced　to　bend　the　limb　at　the　ham。　The　length　of　the
leg；　if　compared　at　the　heel；　is　the　same　as　that　of　the　other；　but
the　extremity　of　the　foot　inclines　less　to　project　forward。　But　the
whole　limb　has　its　natural　direction；　and　inclines　neither　to　this
side　nor　to　that。　These　cases　are　particularly　attended　with　severe
pain；　and　they　are　more　apt　to　be　accompanied　with　retention　of
urine　at　first　than　any　of　the　other　dislocations；　for　the　head　of　the
thigh…bone　is　lodged　very　near　to　important　nerves。　And　the　region
of　the　groin　appears　swelled　out　and　stretched；　while　that　of　the
nates　is　more　wrinkled　and　flabby。　The　symptoms　now　stated　are　those
which　attend　this　dislocation　of　the　thigh…bone。

　　60。　When　persons　have　attained　their　full　growth　before　meeting　with
this　dislocation；　and　when　it　has　not　been　reduced；　upon　the
subsidence　of　the　pain；　and　when　the　bone　of　the　joint　has　been
accustomed　to　be　rotated　in　the　place　where　it　is　lodged；　these
persons　can　walk　almost　erect　without　a　staff；　and　with　the　injured
leg　almost　quite　straight；　as　it　does　not　admit　of　easy　flexion　at　the
groin　and　the　ham；　owing；　then；　to　this　want　of　flexion　at　the
groin；　they　keep　the　limb　more　straight　in　walking　than　they　do　the
sound　one。　And　sometimes　they　drag　the　foot　along　the　ground；　as　not
being　able　to　bend　the　upper　part　of　the　limb；　and　they　walk　with
the　whole　foot　on　the　ground；　for　in　walking　they　rest　no　less　on
the　heel　than　on　the　fore　part　of　the　foot；　and　if　they　could　take
great　steps；　they　would　rest　entirely　on　the　heel　in　walking；　for
persons　whose　limbs　are　sound；　the　greater　the　steps　they　take　in
walking；　rest　so　much　the　more　on　the　heel；　while　they　are　putting
down　the　one　foot　and　raising　the　opposite。　In　this　form　of
dislocation；　persons　rest　their　weight　more　on　the　heel　than　on　the
anterior　part　of　the　foot；　for　the　fore　part　of　the　foot　cannot　be
bent　forward　equally　well　when　the　rest　of　the　limb　is　extended　as
when　it　is　in　a　state　of　flexion；　neither；　again；　can　the　foot　be
arched　to　the　same　degree　the　limb　is　bent　as　when　it　is　extended。　The
natural　state　of　matters　is　such　as　has　been　now　described；　and　in
an　unreduced　dislocation；　persons　walk　in　the　manner　described；　for
the　reasons　which　have　been　stated。　The　limb；　moreover；　is　less　fleshy
than　the　other；　at　the　nates；　the　calf　of　the　leg；　and　the　whole　of
its　posterior　part。　When　this　dislocation　occurs　in　infancy；　and　is
not　reduced；　or　when　it　is　congenital；　in　these　cases　the　bone　of
the　thigh　is　more　atrophied　than　those　of　the　leg　and　foot；　but　the
atrophy　of　the　thigh…bone　is　least　of　all　in　this　form　of　dislocation。
The　fleshy　parts；　however；　are　everywhere　attenuated；　more
especially　behind；　as　has　been　stated　above。　If　properly　trained；　such
persons；　when　they　grow　up；　can　use　the　limb；　which　is　only　a　little
shorter　than　the　other；　and　yet　they　support　themselves　on　a　staff
at　the　affected　side。　For；　not　being　able　to　use　properly　the　ball
of　the　foot　without　the　heel；　nor　to　put　it　down　as　some　can　in　the
other　varieties　of　dislocation　（the　cause　of　which　has　been　just　now
stated）；　on　this　account　they　require　a　staff。　But　those　who　are
neglected；　and　are　not　in　the　practice　of　putting　their　foot　to　the
ground；　but　keep　the　limb　up；　have　the　bones　more　atrophied　than　those
who　use　the　limb；　and；　at　the　articulations；　the　limb　is　more　maimed
in　the　direct　line　than　in　the　other　forms　of　dislocation。

　　61。　In　a　word；　luxations　and　subluxations　take　place　in　different
degrees；　being　sometimes　greater　and　sometimes　less；　and　those　cases
in　which　the　bone　has　slipped　or　been　displaced　to　a　much　greater
extent；　are　in　general　more　difficult　to　rectify　than　otherwise；　and
if　not　reduced；　such　cases　have　greater　and　more　striking　impairment
and　lesion　of　the　bones；　fleshy　parts；　and　attitudes；　but　when　the
bone　has　slipped；　or　been　displaced　to　a　less　extent；　it　is　easier
to　reduce　such　cases　than　the　other；　and　if　the　attempts　at
reduction　have　failed；　or　have　been　neglected；　the　impairment　in
such　cases　is　less；　and　proves　less　injurious　than　in　the　cases　just
mentioned。　The　other　joints　present　great　differences　as　to　the　extent
of　the　displacements　which　they　are　subject　to。　But　the　heads　of　the
femur　and　humerus　are　very　similar　to　one　another　as　to　their
dislocations。　For　the　heads　of　the　bones　are　rounded　and　smooth；　and
the　sockets　which　receive　the　heads　are　also　circular；　and　adapted
to　the　heads；　they　do　not　admit　then　of　being　dislocated　in　any
intermediate　degree；　but；　not　withstanding；　from　their　rounded
shape；　the　bones　slip　either　outward　or　inward。　In　the　case　we　are　now
treating　of；　then；　there　is　either　a　complete　dislocation　or　none　at
all；　and　yet　these　bones　admit　of　being　displaced　to　a　greater　or　less
extent；　and　the　thigh　is　more　subject　to　these　differences　than　the
arm。

　　62。　Wherefore；　then；　some　of　these　congenital　displacements；　if　to　a
small　extent；　may　be　reduced　to　their　natural　condition；　and
especially　those　at　the　ankle…joint。　Most　cases　of　congenital
club…foot　are　remediable；　unless　the　declination　be　very　great；　or
when　the　affection　occurs　at　an　advanced　period　of　youth。　The　best
plan；　then；　is　to　treat　such　cases　at　as　early　a　period　as　possible；
before　the　deficiency　of　the　bones　of　the　foot　is　very　great；　and
before　there　is　any　great　wasting　of　the　flesh　of　the　leg。　There　is
more　than　one　variety　of　club…foot；　the　most　of　them　being　not
complete　dislocations；　but　impairments　connected　with　the　habitual
maintenance　of　the　limb　in　a　certain　position。　In　conducting　the
treatment；　attention　must　be　paid　to　the　following　points：　to　push
back　and　rectify　the　bone　of　the　leg　at　the　ankle　from　without　inward；
and　to　make　counter…pressure　on　the　bone　of　the　heel　in　an　outward
direction；　so　as　to　bring　it　bring　it　into　line；　in　order　that　the
displaced　bones　may　meet　at　the　middle　and　side　of　the　foot；　and　the
mass　of　the　toes；　with　the　great　toe；　are　to　be　inclined　inward；　and
retained　so；　and　the　parts　are　to　be　secured；　with　cerate　containing　a
full　proportion　of　resin；　with　compresses；　and　soft　bandages
insufficient　quantity；　but　not　applied　too　tight；　and　the　turns　of　the
bandages　should　be　in　the　same　direction　as　the　rectifying　of　the　foot
with　the　hand；　so　that　the　foot　may　appear　to　incline　a　little
outward。　And　a　sole　made　of　leather　not　very　hard；　or　of　lead；　is　to
be　bound　on；　and　it　is　not　to　be　applied　to　the　skin　but　when　you
are　about　to　make　the　last　turns　of　the　bandages。　And　when　it　is　all
bandaged；　you　must　attach　the　end　of　one　of　the　bandages　that　are　used
to　the　bandages　applied　to　the　inferior　part　of　the　foot　on　the　line
of　the　little　toe；　and　then　this　bandage　is　to　be　rolled　upward　in
what　is　considered　to　be　a　sufficient　degree；　to　above　the　calf　of　the
leg；　so　that　it　may　remain　firm　when　thus　arranged。　In　a　word；　as　if
moulding　a　wax　model；　you　must　bring　to　their　natural　position　the
parts　which　were　abnormally　displaced　and　contracted　together；　so
rectifying　them　with　your　hands；　and　with　the　bandaging　in　like
manner；　as　to　bring　them　into　their　position；　not　by　force；　but
gently；　and　the　bandages　are　to　be　stitched　so　as　to　suit　the　position
in　which　the　limb　is　to　be　placed；　for　different　modes　of　the
deformity　require　different　positions。　And　a　small　shoe　made　of　lead
is　to　be　bound　on　externally　to　the　bandaging；　having　the　same　shape
as　the　Chian　slippers　had。　But　there　is　no　necessity　for　it　if　the
parts　be　properly　adjusted　with　the　hands；　properly　secured　with　the
bandages；　and　properly　disposed　of　afterward。　This；　then；　is　the
mode　of　cure；　and　it　neither　requires　cutting；　burning；　nor　any
other　complex　means；　for　such　cases　yield　sooner　to　treatment　than　one
would　believe。　However；　they　are　to　be　fairly　mastered　on