on the articulations-第13章

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usually　supervenes　in　cases　of　mortification　and　of　hemorrhage　from
wounds；　it　comes　on　generally　when　the　blackening　and　hemorrhage
have　arrived　at　a　crisis；　and　is　profuse　and　intense；　but　does　not
last　many　days；　neither　is　it　of　a　fatal　nature；　for　such　patients
do　not　usually　lose　their　appetite；　nor　is　it　proper　to　put　them　on
a　restricted　diet。

　　70。　Dislocation　inward　at　the　hip…joint　is　to　be　reduced　in　the
following　manner：　（it　is　a　good；　proper；　and　natural　mode　of
reduction；　and　has　something　of　display　in　it；　if　any　one　takes
delight　in　such　ostentatious　modes　of　procedure）。　The　patient　is　to　be
suspended　by　the　feet　from　a　cross…beam　with　a　strong；　soft；　and　broad
cord；　the　feet　are　to　be　about　four　inches　or　less　from　one　another；
and　a　broad　and　soft　leather　collar　connected　with　the　cross…beam　is
to　be　put　on　above　the　knees；　and　the　affected　leg　should　be　so
extended　as　to　moved　be　two　inches　longer　than　the　other；　the　head
should　be　about　two　cubits　from　the　ground；　or　a　little　more　or
less；　and　the　arms　should　be　stretched　along　the　sides；　and　bound　with
something　soft；　all　these　preparations　should　be　made　while　he　is
lying　on　his　back；　so　that　he　may　be　suspended　for　as　short　a　time
as　possible。　But　when　the　patient　is　suspended；　a　person　properly
instructed　and　not　weak；　having　introduced　his　arm　between　his　thighs；
is　to　place　his　fore…arm　between　the　perineum　and　the　dislocated
head　of　the　os　femoris；　and　then；　having　joined　the　other　hand　to
the　one　thus　passed　through　the　thighs；　he　is　to　stand　by　the　side
of　the　suspended　patient；　and　suddenly　suspend　and　swing　himself　in
the　air　as　perpendicularly　as　possible。　This　method　comprises　all
the　conditions　which　are　natural；　for　the　body　being　suspended　by
its　weight；　produces　extension；　and　the　person　suspended　from　him；
along　with　the　extension；　forces　the　head　of　the　thigh…bone　to　rise　up
above　the　acetabulum；　and　at　the　same　time　he　uses　the　bone　of　the
fore…arm　as　a　lever；　and　forces　the　os　femoris　to　slip　into　its　old
seat。　The　cords　should　be　properly　prepared；　and　care　should　be
taken　that　the　person　suspended　along　with　the　patient　have　a
sufficiently　strong　hold。

　　71。　Wherefore；　as　formerly　stated；　men's　constitutions　differ　much
from　one　another　as　to　the　facility　or　difficulty　with　which
dislocations　are　reduced；　and　the　cause　of　this　was　also　stated
formerly　in　treating　of　the　shoulder。　In　some　the　thigh　is　reduced
with　no　preparation；　with　slight　extension；　directed　by　the　hands；　and
with　slight　movement；　and　in　some　the　reduction　is　effected　by　bending
the　limb　at　the　joint；　and　making　rotation。　But　much　more　frequently
it　does　not　yield　to　any　ordinary　apparatus；　and　therefore　one
should　be　acquainted　with　the　most　powerful　means　which　can　be　applied
in　each　case；　and　use　whatever　maybe　judged　most　proper　under　all
circumstances。　The　modes　of　extension　have　been　described　in　the
former　parts　of　the　work；　so　that　one　may　make　use　of　whatever　may
happen　to　be　at　hand。　For；　extension　and　counter…extension　are　to　be
made　in　the　direction　of　the　limb　and　the　body；　and　if　this　be
properly　effected；　the　head　of　the　thigh…bone　will　be　raised　above　its
ancient　seat；　and　if　thus　raised；　it　will　not　be　easy　to　prevent　it
from　settling　in　its　place；　so　that　any　ordinary　impulse　with　the
lever　and　adjustment　will　be　quite　sufficient；　but　some　apply
insufficient　extension；　and　hence　the　reduction　gives　much　trouble。
The　bands　then　should　be　fastened；　not　only　at　the　foot；　but　also
above　the　knee；　so　that　the　force　of　the　extension　may　not　be　expended
on　the　knee…joint　more　than　upon　the　hip…joint。　The　extension　in　the
direction　of　the　foot　is　to　be　thus　contrived。　But　the
counter…extension　is　not　only　to　be　managed　by　means　of　something
carried　round　the　chest　and　armpits；　but　also　by　a　long；　double；
strong；　and　supple　thong　applied　to　the　perineum；　and　carried　behind
along　the　spine；　and　in　front　along　the　collar…bone　and　fixed　to　the
point　from　which　counter…extension　is　made；　and　then　force　is　to　be　so
applied；　by　means　of　this　extension　and　counter…extension；　that　the
thong　at　the　perineum　may　not　pass　over　the　head　of　the　thigh…bone；
but　between　it　and　the　perineum；　and　during　the　extension　one　should
strike　the　head　of　the　femur　with　the　fist；　so　as　to　drive　it　outward。
And　when　the　patient　is　raised　up　by　the　stretching；　you　should　pass　a
hand　through　（between　the　legs？）　and　grasp　it　with　the　other　hand；
so　as　at　the　same　time　to　make　extension；　and　force　the　dislocated
limb　outward；　while　some　other　person　sitting　by　the　knee　quietly
directs　it　inward。

　　72。　It　has　been　formerly　stated　by　us　that　it　will　be　of
importance　for　any　person　who　practices　medicine　in　a　populous　city　to
get　prepared　a　quadrangular　board；　about　six　cubits　or　a　little　more
in　length；　and　about　two　cubits　in　breadth；　a　fathom　will　be
sufficient　thickness　for　it；　and　then　along　it　from　the　one　end　to　the
other；　an　excavation　must　be　made；　so　that　the　working　of　the　levers
may　not　be　higher　than　is　proper；　then　at　both　sides　we　are　to　raise
short；　strong；　and　strongly…fixed　posts；　having　axles；　and　in　the
middle　of　the　bench　five　or　six　long　grooves　are　to　be　scooped　out
about　four　inches　distant　from　one　another；　three　inches　will　be　a
sufficient　breadth　for　them；　and　the　depth　in　like　manner；　and
although　the　number　of　grooves　I　have　mentioned　will　be　sufficient；
there　is　nothing　to　prevent　their　being　made　all　over　the　bench。　And
the　bench　should　have　in　its　middle　a　pretty　deep　hole；　of　a　square
shape；　and　of　about　three　inches　in　size；　and　into　this　hole；　when
judged　necessary；　is　to　be　adjusted　a　corresponding　piece　of　wood；
rounded　above；　which；　at　the　proper　time；　is　to　be　adjusted　between
the　perineum　and　the　head　of　the　thigh…bone。　This　upright　piece　of
wood　prevents　the　body　from　yielding　to　the　force　dragging　downward　by
the　feet；　for　sometimes　this　piece　of　wood　serves　the　purpose　of
counter…extension　upward；　and　sometimes；　too；　when　extension　and
counter…extension　are　made；　this　piece　of　wood；　if　susceptible　of　some
motion　to　this　side　or　that；　will　serve　the　purpose　of　a　lever　for
pushing　the　head　of　the　thigh…bone　outward。　It　is　on　this　account　that
several　grooves　are　scooped　out　on　the　bench；　so　that　this　piece　of
wood；　being　erected　at　the　one　which　answers；　may　act　as　a　lever；
either　on　the　sides　of　the　articular　heads　of　bones；　or　may　make
pressure　direct　on　the　heads　along　with　the　extension；　according　as　it
may　suit　to　push　inward　or　outward　with　the　lever；　and　the　lever　may
be　either　of　a　round　or　broad　form；　as　may　be　judged　proper；　for
sometimes　the　one　form　and　sometimes　the　other　suits　with　the
articulation。　This　mode　of　applying　the　lever　along　with　extension
is　applicable　in　the　reduction　of　all　dislocations　of　the　thigh。　In
the　case　now　on　hand；　a　round　lever　is　proper；　but　in　dislocations
outward　a　flat　lever　will　be　the　suitable　one。　By　means　of　such
machines　and　of　such　powers；　it　appears　to　me　that　we　need　never
fail　in　reducing　any　dislocation　at　a　joint。

　　73。　And　one　might　find　out　other　modes　of　reduction　for　this
joint。　If　the　large　bench　were　to　have　raised　on　it　two　posts　about
a　foot　（in　diameter？）；　and　of　a　suitable　height；　on　each　side　near　its
middle；　and　if　a　transverse　piece　of　wood　like　the　step　of　a　ladder；
were　inserted　in　the　posts；　then　if　the　sound　leg　were　carried　through
between　the　posts；　and　the　injured　limb　were　brought　over　the
transverse　piece　of　wood；　which　should　be　exactly　adapted　in　height　to
the　joint　which　is　dislocated　（and　it　is　an　easy　matter　so　to　adjust
it；　for　the　step　of　the　ladder　should　be　made　a　little　higher　than
required；　and　a　convenient　robe；　folded　several　times；　is　to　be　laid
below　the　patient's　body）；　then　a　piece　of　wood；　of　suitable　breadth
and　length；　is　to　be　laid　below　the　limb；　and　it　should　reach　from　the
ankle　to　beyond　the　head　of　the　thigh…bone；　and　should　be　bound
moderately　tight　to　the　limb。　Then　the　limb　being　extended；　either
by　means　of　the　pestle…like　piece　of　wood　（formerly　described）；　or
by　any　of　the　other　methods　of　extension；　the　limb　which　is　carried
over　the　step　with　the　piece　of　wood　attached　to　it；　is　to　be　forced
downward；　while　somebody　grasps　the　patient　above　the　hip…joint。　In
this　manner　the　extension　will　carry　the　head　of　the　thighbone　above
the　acetabulum；　while　the　lever　power　that　is　exercised　will　push
the　head　of　the　thigh…bone　into　its　natural　seat。　All　the
above…mentioned　powers　are　strong；　and　more　than　sufficient　to　rectify
the　accident；　if　properly　and　skillfully　applied。　For；　as　formerly
stated；　in　most　cases　reduction　may　be　effected　by　much　weaker
extension；　and　an　inferior　apparatus。

　　74。　If　the　head　of　the　bone　slip　outward；　extension　and
counter…extension　must　be　made　as　described；　or　in　a　similar　manner。
But　along　with　the　extension　a　broad　lever　is　to　be　used　to　force
the　bone　from　without　inward；　the　lever　being　placed　at　the　nates　or　a
little　farther　up；　and　some　person　is　to　steady　the　patient's　body；　so
that　it　may　not　yield；　either　by　grasping　him　at　the　buttocks　with　his
hands；　or　this　may　be　effected　by　means　of　another　similar　lever；
adjusted　to　one　of　the　grooves；　while　the　patient　has　something　laid
below　him；　and　he　is　secured；　and　the　dislocated　thigh　is　to　be　turned
gently　from　within　outward　at　the　knee。　Suspension　will　not　answer
in　this　form　of　dislocation；　for；　in　this　instance；　the　arm　of　the
person　suspended　from　him；　would　push　the　head　of　the　thigh…bone
from　the　acetabulum。　But　one　might　use　the　piece　of　wood　placed
below　him　as　a　lever；　in　such　a　manner　as　might　suit　with　this　mode　of
dislocation；　it　must　work　from　without。　But　what　use　is　there　for　more
words？　For　if　the　extension　be　well　and　properly　done；　and　if　the
lever　be　properly　used；　what　dislocation　of　the　joint　could　occur；
that　might　not　be　thus　reduced？

　　75。　In　dislocation　of　the　thigh；　backward；　extension　and
counter…extension　should　be　made　as　has　been　described；　and　having
laid　on　the　bench　a　cloth　which　has　been　folded　several　times；　so　that
the　patient　may　lie　soft；　he　is　to　be　laid　on　his　face；　and
extension　thus　made；　and；　along　with　the　extension；　pressure　is　to
be　made　with　a　board；　as　in　the　case　of　humpback；　the　board　being
placed　on　the　region　of　the　nates；　and　rather　below　than　above　the
hip…joint；　and　the　hole　made　in　the　wall　for　the　board　should　not　be
direct　over；　but　should　be　inclined　a　little　downward；　toward　the
feet。　This　mode　of　reduction　is　particularly　appropriate　to　this
variety　of　dislocation；　and　at　the　same　time　is　very　strong。　But
perhaps；　instead　of　the　board；　it　might　be　sufficient　to　have　a　person
sitting　（on　the　seat　of　luxation　？）；　or　pressing　with　his　hands；　or
with　his　foot；　and　suddenly　raising　himself　up；　along　with　the
extension。　None　of　the　other　aforementioned　modes　of　reduction　are
natural　in　this　form　of　dislocation。

　　76。　In　dislocation　forward；　the　same　mode　of　extension　should　be
made；　but　a　person　who　has　very　strong　hands；　and　is　well　trained；
should　place　the　palm　of　the　one　hand　on　the　groin；　and　taking　hold　of
this　hand　with　the　other；　is　a