instruments of reduction-第3章

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case；　and　the　projecting　part　is　to　be　pressed　upon；　and
counter…pressure　made　on　the　opposite　side：　both　modes　being　
performed
at　the　same　time；　both　backward　and　laterally；　either　with　the　hands
on　a　table；　or　with　the　heel。　These　accidents　give　rise　to　serious
consequences　and　deformities；　but　in　time　the　parts　get　so　strong　as
to　admit　of　being　used。　The　treatment　consists　of　bandages
comprehending　the　hand　and　forearm；　and　splints　are　to　be　applied　as
far　as　the　fingers；　when　put　in　splints；　they　are　to　be　more
frequently　loosed　than　in　fractures；　and　more　copious　allusions　of
water　are　to　be　used。

　Part　18
In　congenital　dislocations　the　hand　becomes　shortened；　and　the
atrophy　of　the　flesh　is　generally　on　the　side　opposite　the
dislocation。　In　the　adult　the　bones　remain　of　their　proper　size。

　Part　19
The　symptoms　of　dislocation　of　the　finger　are　obvious；　and　need
not　be　described。　This　is　the　mode　of　reduction：…By　stretching　in　a
straight　line；　and　making　pressure　on　the　projecting　part；　and
counter…pressure；　at　the　opposite　side；　on　the　other。　The　proper
treatment　consists　in　the　application　of　bandages。　When　not　reduced；
the　parts　unite　by　callus　outside　of　the　joints。　In　congenital
dislocations；　and　in　those　which　occur　during　bones　below　the
dislocation　are　shortened；　and　the　flesh　is　wasted　principally　on
the　side　opposite　to　the　dislocation；　in　the　adult　the　bones　
remain　of
their　proper　size。

　Part　20
Dislocation　at　the　hip…joint　occurs　in　four　modes；　inward　most
frequently；　outward　next；　the　others　of　equal　frequency。　The
symptoms：…The　common；　a　comparison　with　the　sound　leg。　The　peculiar
symptoms　of　dislocations　inward；　the　head　of　the　bone　is　felt　at　the
perineum；　the　patient　cannot　bend　his　leg　as　formerly；　the　limb
appears　elongated；　and　to　a　great　extent；　unless　you　bring　both
limbs　into　the　middle　space　between　them　in　making　a　comparison　of
them；　and　the　foot　and　the　knee　are　inclined　outward。　If　the
dislocation　has　taken　place　from　birth；　or　during　one's　growth；　the
thigh　is　shortened；　the　leg　less　so；　and　the　others　according　to　the
same　rule；　the　fleshy　parts　are　atrophied；　especially　on　the
outside。　Such　persons　are　afraid　to　stand　erect；　and　crawl　along　on
the　sound　limb；　or；　if　compelled；　they　walk　with　one　or　two　staves；
and　bear　up　the　affected　limb；　and　the　smaller　the　limb　so　much　the
more　do　they　walk。　If　the　accident　happens　to　adults　the　bones
remain　of　their　proper　size；　but　the　flesh　is　wasted；　as　formerly
described；　the　patients　walk　in　a　wriggling　manner；　like　oxen；　they
are　bent　toward　the　flank；　and　the　buttock　on　the　uninjured　side　is
prominent；　for　the　uninjured　limb　must　necessarily　come　below　that
it　may　support　the　body；　whilst　the　other　must　be　carried　out　of　the
way；　as　it　cannot　support　the　body；　like　those　who　have　an　ulcer　in
the　foot。　They　poise　the　body　by　means　of　a　staff　on　the　sound　side；
and　grasp　the　affected　limb　with　the　hand　above　the　knee　so　as　to
carry　the　body　in　shifting　from　one　place　to　another。　If　the　parts
below　the　hip…joint　be　used；　the　bones　below　are　less　atrophied；　but
the　flesh　more。

　Part　21
The　symptoms　and　attitudes　in　dislocation　outward　are　the
opposite；　and　the　knee　and　foot　incline　a　little　inward。　When　it　is
congenital；　or　occurs　during　adolescence；　the　bones　do　not　grow
properly；　according　to　the　same　rule；　the　bone　of　the　hip…joint　is
somewhat　higher　than　natural；　and　does　not　grow　proportionally。　In
those　who　have　frequent　dislocations　outward；　without　inflammation；
the　limb　is　of　a　more　humid　（flabby？）　temperament　than　natural；　like
the　thumb；　for　it　is　the　part　most　frequently　dislocated；　
owing　to　its
configuration；　in　what　persons　the　dislocation　is　to　a　
greater　or　less
extent；　and　in　what　persons　it　is　more　difficultly　or　easily　
produced；
in　what　there　is　reason　to　hope　that　it　can　be　speedily　reduced；　and
in　what　not；　and　the　remedy　for　this；　and　in　what　cases　the
dislocation　frequently　happens；　and　treatment　of　this。　In
dislocation　outward　from　birth；　or　during　adolescence；　or　from
disease；　（and　it　happens　most　frequently　from　disease；　in　which　case
there　is　sometimes　exfoliation　of　the　bone；　but　even　where　
there　is　no
exfoliation）；　the　patients　experience　the　same　symptoms；　but　to　an
inferior　degree　to　those　in　dislocations　inward；　if　properly　managed
so　that　in　walking　they　can　put　the　whole　foot　to　the　ground　and
lean　to　either　side。　The　younger　the　patient　is；　the　greater　care
should　be　bestowed　on　him；　when　neglected；　the　case　gets　worse；　when
attended　to；　it　improves；　and；　although　there　be　atrophy　in　all
parts　of　the　limb；　it　is　to　a　less　extent。

　Part　22
When　there　is　a　dislocation　on　both　sides；　the　affections　of　the
bones　are　the　same；　the　flesh　is　well　developed；　except　within；　the
nates　protrude；　the　thighs　are　arched；　unless　there　be　sphacelus。　If
there　be　curvature　of　the　spine　above　the　hip…joint；　the　patients
enjoy　good　health；　but　the　body　does　not　grow；　with　the　exception　of
the　head。

　Part　23
The　symptoms　of　dislocation　backward　are：…The　parts　before
more　empty；　behind　they　protrude；　the　foot　straight；　flexion
impossible；　except　with　pain；　extension　least　of　all：　in　these　the
limb　is　shortened。　They　can　neither　extend　the　limb　at　the　
ham；　nor　at
the　groin；　unless　it　be　much　raised；　nor　can　they　bend　it。　The
uppermost　joint；　in　most　cases；　takes　the　lead：　this　is　common　in
joints；　nerves；　muscles；　intestines；　uteri；　and　other　parts。　
There　the
bone　of　the　hip…joint　is　carried　backward　to　the　nates；　and　on　that
account　it　is　shortened；　and　because　the　patient　cannot　
extend　it。　The
flesh　of　the　whole　leg　is　wasted　in　all　cases；　in　which　most；　and　to
what　extent；　has　been　already　stated。　Every　part　of　the　body　which
performs　its　functional　work　is　strong；　but；　not　withstanding；　if
inactive；　it　gets　into　a　bad　condition；　unless　its　inactivity　arise
from　fatigue；　fever；　or　inflammation。　And　in　dislocations　
outward；　the
limb　is　shortened；　because　the　bone　is　lodged　in　flesh　which　yields；
but；　not　withstanding；　in　dislocations　inward；　it　is　longer；　because
the　bone　is　lodged　on　a　projecting　bone。　Adults；　then；　who　have　this
dislocation　unreduced；　are　bent　at　the　groins　in　walking；　and　the
other　ham　is　flexed；　they　scarcely　reach　the　ground　with　the　ball　of
the　foot；　they　grasp　the　limb　with　the　hand；　and　walk　without　a
staff　if　they　choose；　if　the　staff　be　too　long；　their　foot　cannot
reach　the　grounds…if　they　wish　to　reach　the　ground；　they　must　use　a
short　staff。　There　is　wasting　of　the　flesh　in　cases　attended　with
pain；　and　the　inclination　of　the　leg　is　forward；　and　the　sound　leg
in　proportion。　In　congenital　cases；　or　when　in　adolescence；　or　from
disease；　the　bone　is　dislocated　（under　what　circumstances　will　be
explained　afterward）；　the　limb　is　particularly　impaired；　owing　to
the　nerves　and　joints　not　being　exercised；　and　the　knee　is　impaired
for　the　reasons　stated。　These　persons；　keeping　the　limb　bent；　walk
with　one　staff　or　two。　But　the　sound　limb　is　in　good　flesh　
from　usage。

　Part　24
In　dislocations　forward　the　symptoms　are　the　opposite：　a　vacuity
behind；　a　protuberance　before；　of　all　motions　they　can　least　perform
flexion；　and　extension　best；　the　foot　is　straight；　the　limb　is　of
the　proper　length　at　the　heel；　at　its　extremity　the　foot　a　little
turned　up；　they　are　especially　pained　at　first：　of　all　these
dislocations　retention　of　urine　occurs　most　frequently　in　this
variety；　because　the　bone　is　lodged　among　important　nerves。　The　fore
parts　are　stretched；　do　not　grow；　are　diseased；　and　are　obnoxious　to
premature　decay；　the　back　parts　are　wrinkled。　In　the　case　of　adults；
they　walk　erect；　resting　merely　on　the　heel；　and　this　they　do
decidedly　if　they　can　take　great　steps；　but　they　drag　it　along；　the
wasting　is　least　of　all　in　this　variety　of　dislocation；　
owing　to　their
being　able　to　use　the　limb；　but　the　wasting　is　most　behind。　The
whole　limb　being　straighter　than　natural　they　stand　in　need　
of　a　staff
on　the　affected　side。　When　the　dislocation　is　congenital；　or　has
occurred　during　adolescence；　if　properly　managed；　the　patient　has
the　use　of　the　limb　as　well　as　adults　（o