on the articulations-第19章

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be　understood　that　many　other　methods　are　more　powerful　than　it。　The
bladder　should　be　placed　between　the　thighs　uninflated；　so　that　it　may
be　carried　as　far　up　the　perineum　as　possible；　and　the　thighs
beginning　at　the　patella　are　to　be　bound　together　with　a　swathe；　as
far　up　as　the　middle　of　the　thigh；　and　then　a　brass　pipe　is　to　be
introduced　into　one　of　the　loose　feet　of　the　bladder；　and　air　forced
into　it；　the　patient　is　to　lie　on　his　side　with　the　injured　limb
uppermost。　This；　then；　is　the　preparation；　some；　however；　do　the　thing
worse　than　as　I　have　described；　for　they　do　not　bind　the　thighs
together　to　any　extent；　but　only　at　the　knees；　neither　do　they　make
extension；　whereas　extension　should　be　made；　and　yet　some　people　by
having　the　good　fortune　to　meet　with　a　favorable　case；　have
succeeded　in　making　reduction。　But　it　is　not　a　convenient　method　of
applying　force；　for　the　bladder；　when　inflated；　does　not　present　its
most　prominent　part　to　the　articular　extremity　of　the　femur；　which
is　the　place　that　ought　to　be　more　especially　pressed　outward；　but　its
middle；　which　probably　corresponds　with　the　middle　of　the　thigh；　or
still　lower　down；　for　the　thighs　are　naturally　curved；　being　fleshy；
and　in　contact　above；　and　becoming　smaller　downward；　so　that　the
natural　configuration　of　the　parts　forces　the　bladder　from　the　most
proper　place。　And　if　a　small　bladder　be　introduced；　its　power　will
be　small；　and　unable　to　overcome　the　resistance　of　the　articular　bone。
But　if　the　bladder　must　be　used；　the　thighs　are　to　be　bound　together
to　a　considerable　extent；　and　the　bladder　is　to　be　inflated　along　with
the　extension　of　the　body；　and　in　this　method　of　reduction　both　legs
are　to　be　bound　together　at　their　extremity。

　　78。　The　prime　object　of　the　physician　in　the　whole　art　of　medicine
should　be　to　cure　that　which　is　diseased；　and　if　this　can　be
accomplished　in　various　ways；　the　least　troublesome　should　be
selected；　for　this　is　more　becoming　a　good　man；　and　one　well　skilled
in　the　art；　who　does　not　covet　popular　coin　of　base　alloy。　With　regard
to　the　subject　now　on　hand；　the　following　are　domestic　means　of　making
extension　of　the　body；　so　that　it　is　easy　to　choose　from　among　the
things　at　hand：…In　the　first　place；　when　soft　and　supple　thongs　are
not　at　hand　for　ligatures；　either　iron　chains；　or　cords；　or　cables
of　ships；　are　to　be　wrapped　round　with　scarfs　or　pieces　of　woolen
rags；　especially　at　the　parts　of　them　which　are　to　be　applied；　and
in　this　state　they　are　to　be　used　as　bands。　In　the　second　place；　the
patient　is　to　be　comfortably　laid　on　the　strongest　and　largest　couch
that　is　at　hand；　and　the　feet　of　the　couch；　either　those　at　the
（patient's？）　head；　or　those　at　the　feet；　are　to　be　fastened　to　the
threshold；　either　within　or　without；　as　is　most　suitable；　and　a　square
piece　of　wood　is　to　be　laid　across；　and　extending　from　the　one　foot　to
the　other；　and　if　this　piece　of　wood　be　slender；　it　should　be　bound　to
the　feet　of　the　couch；　but；　not　withstanding；　if　it　be　thick；　there
will　be　no　necessity　for　this；　then　the　heads　of　the　ligatures；　both
of　those　at　the　head　and　those　at　the　feet；　are　to　be　fastened　to　a
pestle；　or　some　such　piece　of　wood；　difficult　to　reduce　at　either　end；
the　ligatures　should　run　along　the　line　of　the　body；　or　be　a　little
elevated　above　it；　and　it　should　be　stretched　proportionally　to　the
pestles；　so　that；　standing　erect；　the　one　may　be　fastened　to　the
threshold；　and　the　other　to　the　transverse　piece　of　wood。　Extension　is
then　to　be　made　by　bending　back　the　ends　of　the　pestles。　A　ladder；
having　strong　steps；　if　laid　below　the　bed；　will　serve　the　purpose
of　the　threshold　and　the　piece　of　wood　laid　along　（the　foot　of　the
couch？）；　as　the　pestles　can　be　fastened　to　the　steps　at　either　end；
and　when　drawn　back　they　thus　make　extension　of　the　ligatures。
Dislocation；　inward　or　forward；　may　be　reduced　in　the　following
manner：　a　ladder　is　to　be　fastened　in　the　ground；　and　the　man　is　to　be
seated　upon　it；　and　then　the　sound　leg　is　to　be　gently　stretched　along
and　bound　to　it；　wherever　it　is　found　convenient；　and　water　is　to　be
poured　into　an　earthen　vessel；　or　stones　put　into　a　hamper　and　slung
from　the　injured　leg；　so　as　to　effect　the　reduction。　Another　mode　of
reduction：　a　cross…beam　is　to　be　fastened　between　two　pillars　of
moderate　height；　and　at　one　part　of　the　cross…beam　there　should　be　a
protuberance　proportionate　to　the　size　of　the　nates；　and　having
bound　a　coverlet　round　the　patient's　breast；　he　is　to　be　seated　on　the
protuberant　part　of　the　cross…beam；　and　afterward　the　breast　is　to
be　fastened　to　the　pillar　by　some　broad　ligature；　then　some　one　is
to　hold　the　sound　leg　so　that　he　may　not　fall　off；　and　from　the
injured　limb　is　to　be　suspended　some　convenient　weight；　as　formerly
described。

　　79。　It　should　be　particularly　known　that　the　union　of　all　bones
is；　for　the　most　part；　by　a　head　and　socket　（cotyle）；　in　some　of　these
the　place　（socket？）　is　cotyloid　and　oblong；　and　in　some　the　socket
is　glenoid　（shallow？）。　In　all　dislocations　reduction　is　to　be
effected；　if　possible；　immediately；　while　still　warm；　but　otherwise；
as　quickly　as　it　can　be　done；　for　reduction　will　be　a　much　easier
and　quicker　process　to　the　operator；　and　a　much　less　painful　one　to
the　patient；　if　effected　before　swelling　comes　on。　But　all　the
joints　when　about　to　be　reduced　should　be　first　softened；　and　gently
moved　about；　for；　thus　they　are　more　easily　reduced。　And；　in　all　cases
of　reduction　at　joints；　the　patient　must　be　put　on　a　spare　diet；　but
more　especially　in　the　case　of　the　greatest　joints；　and　those　most
difficult　to　reduce；　and　less　so　in　those　which　are　very　small　and
easily　reduced。

　　80。　If　any　joint　of　the　fingers　is　dislocated；　whether　the　first；
second；　or　the　third；　the　same　method　of　reduction　is　to　be　applied；
but　the　largest　joints　are　the　most　difficult　to　reduce。　There　are
four　modes　of　displacement…either　upward；　downward；　or　to　either　side；
most　commonly　upward；　and　most　rarely　laterally；　and　in　consequence　of
violent　motion。　On　both　sides　of　its　articular　cavity　there　is　a
sort　of　raised　border。　When　the　dislocation　is　upward　or　downward；
owing　to　the　articular　cavity　having　smoother　edges　there　than　at
the　sides；　if　the　joint　of　it　be　dislocated；　it　is　more　easily
reduced。　This　is　the　mode　of　reduction：…The　end　of　the　finger　is　to　be
wrapped　round　with　a　fillet；　or　something　such；　that；　when　you　lay
hold　of　it　and　make　extension；　it　will　not　slip；　and　when　this　is
done；　some　person　is　to　grasp　the　arm　at　the　wrist；　and　another　is
to　take　hold　of　the　finger　which　is　wrapped　in　the　fillet；　and　then
each　is　to　make　considerable　extension　toward　himself；　and　at　the　same
time　the　projecting　bone　is　to　be　pushed　into　its　place。　But；　if　the
dislocation　be　lateral；　the　same　mode　of　reduction　is　to　be　used；
but　when　you　think　that　the　extremity　of　the　bone　has　cleared　the　rim；
at　the　same　time　that　extension　is　made；　the　bone　is　to　be　pushed
direct　into　its　place；　while　another　person　on　the　other　side　of　the
finger　is　to　take　care　and　make　counter…pressure；　so　that　it　may　not
again　slip　out　there。　The　twisted　nooses　formed　from　palm…shoots　are
convenient　for　effecting　reduction；　if　you　will　make　extension　and
counter…extension　by　holding　the　twisted　string　in　the　one　hand　and
the　wrist　in　the　other。　When　reduced；　you　must　bind　the　part　as
quickly　as　possible　with　bandages；　these　are　to　be　very　slender　and
waxed　with　cerate；　neither　very　soft　nor　very　hard；　but　of　middle
consistence；　for　that　which　is　hard　drops　off　from　the　finger；　while
that　which　is　soft　and　liquid　is　melted　and　lost　by　the　increased　heat
of　the　finger。　The　bandage　is　to　be　loosed　on　the　third　or　fourth　day；
but　on　the　whole；　if　inflamed；　it　is　to　be　the　more　frequently　loosed；
and　if　otherwise；　more　rarely；　this　I　say　respecting　all　the　joints。
The　articulation　of　a　finger　is　restored　in　fourteen　days。　The
treatment　of　the　fingers　and　of　the　toes　is　the　same。

　　81。　After　all　reductions　of　joints　the　patient　should　be　confined　to
a　restricted　diet　and　abstinence　until　the　seventh　day；　and　if　there
be　inflammation；　the　bandages　are　to