on fractures-第10章

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situated　there；　some　of　which；　if　wounded；　will　prove　fatal；　there　are
such　also　on　the　outside；　but　of　less　importance。　In　wounds　of　this
sort；　then；　one　ought　not　to　be　ignorant　of　the　dangers；　and　should
prognosticate　them　in　due　time。　But　if　you　are　compelled　to　have
recourse　to　reduction；　and　hope　to　succeed；　and　if　the　bones　do　not
cross　one　another　much；　and　if　the　muscles　are　not　contracted　（for
they　usually　are　contracted）；　the　lever　in　such　cases　may　be
advantageously　employed。
　　36。　Having　effected　the　reduction；　you　must　give　an　emollient
draught　of　hellebore　the　same　day；　provided　it　has　been　reduced　on　the
day　of　the　accident；　but　otherwise　it　should　not　be　attempted。　The
wound　should　be　treated　with　the　same　things　as　are　used　in
fractures　of　the　bones　of　the　head；　and　nothing　cold　should　be
applied；　the　patient　should　be　restricted　from　food　altogether；　and　if
naturally　of　a　bilious　constitution；　he　should　have　for　a　diet　a
little　fragrant　oxyglyky　sprinkled　on　water；　but　if　he　is　not　bilious；
he　should　have　water　for　drink；　and　if　fever　of　the　continual　type
come　on；　he　is　to　be　confined　to　this　regimen　for　fourteen　days　at
least；　but　if　he　be　free　of　fever；　for　only　seven　days；　and　then　you
must　bring　him　back　by　degrees　to　a　common　diet。　To　those　cases　in
which　the　bones　have　not　been　reduced；　a　similar　course　of　medicine
should　be　administered；　along　with　the　same　treatment　of　the　sores　and
regimen；　and　in　like　manner　the　suspended　part　of　the　body　should
not　be　stretched；　but　should　rather　be　contracted；　so　as　to　relax
the　parts　about　the　wound。　The　separation　of　the　bones　is
protracted；　as　also　was　formerly　stated。　But　one　should　try　to
escape　from　such　cases；　provided　one　can　do　so　honourably；　for　the
hopes　of　recovery　are　small；　and　the　dangers　many；　and　if　the
physician　do　not　reduce　the　fractured　bones　he　will　be　looked　upon
as　upon　as　unskillful；　while　by　reducing　them　he　will　bring　the
patient　nearer　to　death　than　to　recovery。
　　37。　Luxations　and　subluxations　at　the　knee　are　much　milder　accidents
than　subluxations　and　luxations　at　the　elbow。　For　the　knee…joint；　in
proportion　to　its　size；　is　more　compact　than　that　of　the　arm；　and
has　a　more　even　conformation；　and　is　rounded；　while　the　joint　of　the
arm　is　large；　and　has　many　cavities。　And　in　addition；　the　bones　of　the
leg　are　nearly　of　the　same　length；　for　the　external　one　overtops　the
other　to　so　small　an　extent　as　hardly　to　deserve　being　mentioned；
and　therefore　affords　no　great　resistance；　although　the　external　nerve
（ligament？）　at　the　ham　arises　from　it；　but　the　bones　of　the　fore…arm
are　unequal；　and　the　shorter　is　considerably　thicker　than　the　other；
and　the　more　slender　（ulna？）　protrudes；　and　passes　up　above　the　joint；
and　to　it　（the　olecranon？）　are　attached　the　nerves　（ligaments？）
which　go　downward　to　the　junction　of　the　bones；　and　the　slender　bone
（ulna？）　has　more　to　do　with　the　insertion　of　the　ligaments　in　the
arm　than　the　thick　bone　（radius？）。　The　configuration　then　of　the
articulations；　and　of　the　bones　of　the　elbow；　is　such　as　I　have
described。　Owing　to　their　configuration；　the　bones　at　the　knee　are
indeed　frequently　dislocated；　but　they　are　easily　reduced；　for　no
great　inflammation　follows；　nor　any　constriction　of　the　joint。　They
are　displaced　for　the　most　part　to　the　inside；　sometimes　to　the
outside；　and　occasionally　into　the　ham。　The　reduction　in　all　these
cases　is　not　difficult；　but　in　the　dislocations　inward　and　outward；
the　patient　should　be　placed　on　a　low　seat；　and　the　thigh　should　be
elevated；　but　not　much。　Moderate　extension　for　the　most　part
sufficeth；　extension　being　made　at　the　leg；　and　counter…extension　at
the　thigh。
　　38。　Dislocations　at　the　elbow　are　more　troublesome　than　those　at　the
knee；　and；　owing　to　the　inflammation　which　comes　on；　and　the
configuration　of　the　joint；　are　more　difficult　to　reduce　if　the
bones　are　not　immediately　replaced。　For　the　bones　at　the　elbow　are
less　subject　to　dislocation　than　those　of　the　knee；　but　are　more
difficult　to　reduce　and　keep　in　their　position；　and　are　more　apt　to
become　inflamed　and　ankylosed。
　　39。　For　the　most　part　the　displacements　of　these　bones　are　small；
sometimes　toward　the　ribs；　and　sometimes　to　the　outside；　and　the　whole
articulation　is　not　displaced；　but　that　part　of　the　humerus　remains　in
place　which　is　articulated　with　the　cavity　of　the　bone　of　the
forearm　that　has　a　protuberance　（ulna？）。　Such　dislocations；　to
whatever　side；　are　easily　reduced；　and　the　extension　is　to　be　made
in　the　line　of　the　arm；　one　person　making　extension　at　the　wrist；
and　another　grasping　the　armpit；　while　a　third；　applying　the　palm　of
his　hand　to　the　part　of　the　joint　which　is　displaced；　pushes　it　inward
ward；　and　at　the　same　time　makes　counterpressure　on　the　opposite
side　near　the　joint　with　the　other　hand。
　　40。　The　end　of　the　humerus　at　the　；elbow　gets　displaced
（subluxated？）　by　leaving　the　cavity　of　the　ulna。　Such　luxations
readily　yield　to　reduction；　if　applied　before　the　parts　get
inflamed。　The　displacement　for　the　most　part　is　to　the　inside；　but
sometimes　to　the　outside；　and　they　are　readily　recognized　by　the　shape
of　the　limb。　And　often　such　luxations　are　reduced　without　any　powerful
extension。　In　dislocations　inward；　the　joint　is　to　be　pushed　into
its　place；　while　the　fore…arm　is　brought　round　to　a　state　of
pronation。　Such　are　most　of　the　dislocations　at　the　elbow。
　　41。　But　if　the　articular　extremity　of　the　humerus　be　carried　to
either　side　above　the　bone　of　the　fore…arm；　which　is　prominent；　into
the　hollow　of　the　arm　（？）；　this　rarely　happens；　but　if　it　does　happen；
extension　in　the　straight　line　is　not　so　proper　under　such
circumstances；　for　in　such　a　mode　of　extension；　the　process　of　the
ulna　（olecranon？）　prevents　the　bone　of　the　arm　（humerus？）　from　passing
over　it。　In　dislocations　of　this　kind；　extension　should　be　made　in　the
manner　described　when　treating　of　the　bandaging　of　fractured　bones
of　the　arm；　extension　being　made　upward　at　the　armpit；　while　the　parts
at　the　elbow　are　pushed　downward；　for　in　this　manner　can　the　humerus
be　most　readily　raised　above　its　cavity；　and　when　so　raised；　the
reduction　is　easy　with　the　palms　of　the　hand；　the　one　being　applied　so
as　to　make　pressure　on　the　protuberant　part　of　the　arm；　and　the
other　making　counter…pressure；　so　as　to　push　the　bone　of　the
fore…arm　into　the　joint。　This　method　answers　with　both　cases。　And
perhaps　this　is　the　most　suitable　mode　of　reduction　in　such　a　case
of　dislocation。　The　parts　may　be　reduced　by　extension　in　a　straight
line；　but　less　readily　than　thus。
　　42。　If　the　arm　be　dislocated　forward…　this　rarely　happens；　indeed；
but　what　would　a　sudden　shock　not　displace？　for　many　other　things
are　removed　from　their　proper　place；　notwithstanding　a　great
obstacle；…　in　such　a　violent　displacement　the　part　（olecranon？）
which　passes　above　the　prominent　part　of　the　bones　is　large；　and　the
stretching　of　the　nerves　（ligaments？）　is　intense；　and　yet　the　parts
have　been　so　dislocated　in　certain　cases。　The　following　is　the　symptom
of　such　a　displacement：　the　arm　cannot　be　bent　in　the　least　degree
at　the　elbow；　and　upon　feeling　the　joint　the　nature　of　the　accident
becomes　obvious。　If；　then；　it　is　not　speedily　reduced；　strong　and
violent　inflammation；　attended　with　fever；　will　come　on；　but　if　one
happen　to　be　on　the　spot　at　the　time　it　is　easily　reduced。　A　piece
of　hard　linen　cloth　（or　a　piece　of　hard　linen；　not　very　large；
rolled　up　in　a　ball；　will　be　sufficient）　is　to　be　placed　across　the
bend　of　the　elbow；　and　the　arm　is　then　to　be　suddenly　bent　at　the
elbow；　and　the　hand　brought　up　to　the　shoulder。　This　mode　of　reduction
is　sufficient　in　such　displacements；　and　extension　in　the　straight
line　can　rectify　this　manner　of　dislocation；　but　we　must　use　at　the
same　time　the　palms　of　the　hands；　applying　the　one　to　the　projecting
part　of　the　humerus　at　the　bend　of　the　arm　for　the　purpose　of
pushing　it　back；　and　applying　the　other　below　to　the　sharp　extremity
of　the　elbow；　to　make　counter…pressure；　and　incline　the　parts　into　the
straight　line。　And　one　may　use　with　advantage　in　this　form　of
dislocation　the　method　of　extension　formerly