instruments of reduction-第4章

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taking　care
to　avoid　producing　pain；　for　deliquium　animi　may　occasion　death。　The
bone　of　the　thigh　in　such　a　case　came　away　on　the　eightieth　day；　but
the　leg　was　removed　on　the　twentieth　day。　The　bones　of　the　leg；　in　a
certain　case；　came　away　at　the　middle　of　the　sixtieth　day。　In　these
cases　the　separation　is　quick　or　slow；　according　to　the　compression
applied　by　the　physician。　When　the　compression　is　gently　applied　the
bones　do　not　drop　off　at　all；　neither　are　they　denuded　of　flesh；　but
the　gangrene　is　confined　in　the　more　superficial　parts。　The
treatment　of　such　cases　must　be　undertaken；　for　most　of　them　are
more　formidable　in　appearance　than　in　reality。　The　treatment　
should　be
mild；　but；　not　withstanding；　with　a　restricted　diet；　hemorrhages　and
cold　are　to　be　dreaded；　the　position；　so　as　that　the　limb　may　be
inclined　upward；　and　afterward；　on　account　of　the　purulent　abscess；
horizontally；　or　such　as　may　suit　with　it。　In　such　cases；　and　in
mortifications；　there　are　usually；　about　the　crisis；　hemorrhages　and
crisis；　hemorrhages　and　violent　diarrhoeas；　which；　however；　only
last　for　a　few　days；　the　patients　do　not　lose　their　appetite；
neither　are　they　feverish；　nor　should　they　be　put　upon　a　
reduced　diet。

　Part　36
Displacement　of　the　spine；　if　inward；　threatens　immediate　death；
attended　with　retention　of　urine　and　loss　of　sensibility。　
Outward；　the
accident　is　free　from　most　of　these　bad　effects；　much　more　so　than
where　there　is　merely　concussion　without　displacement；　the　effects
in　the　former　case　being　confined　to　the　spot　affected；　
whereas　in　the
latter　they　are　further　communicated　to　the　whole　body；　and　are　of　a
mortal　character。　In　like　manner；　when　the　ribs　are　
fractured；　whether
one　or　more；　provided　there　be　no　splinters；　there　is　rarely　fever；
spitting　of　blood；　and　sphacelus；　and　ordinary　treatment　without
evacuation　will　suffice；　provided　there　be　no　fever；…bandaging；
according　to　rule；　and　the　callus　forms　in　twenty　days；　the　
bone　being
of　a　porous　nature。　But　in　cases　of　contusion；　tubercles　form；　along
with　cough；　suppurating　sores；　and　sphacelus　of　the　ribs；　for　nerves
from　all　the　parts　run　along　each　rib。　In　many　of　these　cases
haemoptysis　and　empyema　also　take　place。　The　management　of　this　case
consists　in　careful　treatment；　bandaging　according　to　rule；　diet　at
first　restricted；　but　afterward　more　liberal；　quiet；　silence；
position；　bowels；　and　venereal　matters　regulated。　Even　when　there　is
no　spitting　of　blood；　these　contusions　are　more　painful　than
fractures；　and　are　more　subject　in　time　to　relapses；　and　when　any
mucous　collection　is　left　in　the　part；　it　makes　itself　be　felt　in
disorders　of　the　body。　Treatment：…burning；　when　the　bone　is
affected；　down　to　the　bone；　but　not　touching　the　bone　itself；　if　in
the　intercostal　space；　the　burning　must　not　extend　through　it；　nor
be　too　superficial。　In　sphacelus　of　the　ribs；　tents　are　to　be　tried；
all　other　particulars　will　be　stated　afterward：　but　they　should　be
learned　by　sight　rather　than　by　words；　namely；　food；　drink；　heat；
cold；　attitude；　medicines；　dry；　liquid；　red；　dark；　white；　sour；　for
the　ulcers；　and　so　with　regard　to　the　diet。

　Part　37
Displacements　（of　the　vertebrae）　from　a　fall　rarely　admit　of
being　rectified；　and　those　above　the　diaphragm　are　most　difficult　to
rectify。　When　the　accident　happens　to　children；　the　body　does　not
grow；　with　the　exception　of　the　legs；　the　arms；　and　head。　
Excurvation；
in　adults；　speedily　relieves　the　individual　from　the　disease　he　is
laboring　under；　but　in　time　it　renews　its　attack；　with　the　same
symptoms　as　in　children；　but　of　a　less　serious　nature。　Some
individuals　have　borne　this　affection　well；　and　have　turned　out　to
be　brawny　and　fat。　But　few　of　them　have　lived　to　the　age　of　sixty。
Lateral　curvatures　also　occur；　the　proximate　cause　of　which　is　the
attitudes　in　which　these　persons　lie。　These　cases　have　their
prognostics　accordingly。

　Part　38
The　rule　for　the　reduction　and　adjustment：…The　axle；　the
lever；　the　wedge；　pressure　above；　the　axle　to　separate；　the　lever　to
push　aside。　Reduction　and　adjustment　are　to　be　accomplished　by
forcible　extension；　the　parts　being　placed　in　such　a　position　as
will　facilitate　the　conveying　of　the　displaced　bone　over　the　
extremity
of　the　bone　from　which　it　was　displaced：　this　is　to　be　accomplished
either　with　the　hands；　or　by　suspension；　or　axles；　or　turned　round
something。　With　the　hands　this　is　to　be　effected　properly；　according
to　the　structure　of　the　parts。　In　the　case　of　the　wrist　and　
elbow；　the
parts　are　to　be　forced　asunder；　at　the　wrist　in　the　line　of　
the　elbow；
and　the　elbow　with　the　fore…arm　at　a　right　angle　with　the　
arm；　as　when
it　is　suspended　in　a　sling。　When　we　want　to　separate　the　protruding
bones；　and　force　them　into　place；　in　the　case　of　the　fingers；　the
toes；　or　the　wrist；　the　proper　separation　may　be　made　by　hands；
while　the　projecting　part　is　forced　into　its　place　by　pressing　down
with　the　heel　or　the　palm　of　the　hand　upon　some　resisting　object；
while　something　moderately　soft　is　laid　under　the　projecting　
part；　but
nothing　such　under　the　other；　and　then　pressure　is　to　be　
made　backward
and　downward；　whether　the　dislocation　be　inward　or　outward。　
In　lateral
displacement；　pressure　and　counter…pressure　must　be　made　on　the
opposite　sides。　Displacements　forward　can　be　reduced　neither　by
sneezing；　nor　coughing；　nor　by　the　injection　of　air；　nor　by　the
cupping…instrument；　and　if　anything　can　do　good　in　such　a　case；　it
is　extension。　People　are　deceived　in　fractures　of　the　spinal
processes；　the　pain　of　which　causing　the　patient　to　stoop　
forward；　the
case　is　taken　for　dislocation　inward；　these　fractures　heal　speedily
and　easily。　Dislocation　outward　is　to　be　remedied　by　succussion；
when　high　up；　toward　the　feet；　and　when　situated　low　down；　in　the
contrary　direction；　the　part　is　to　be　pressed　back　into　its　place；
either　with　the　foot　or　a　board。　Dislocations　to　either　side；　if
they　admit　of　any　remedy；　are　to　be　treated　by　extension；　
and　suitable
attitudes；　with　regimen。　The　whole　apparatus　should　be　broad；　soft；
and　strong；　or　otherwise；　they　should　be　wrapped　in　rags；　
before　being
used；　they　should　all　be　prepared　proportionately　to　the　length；
height；　and　breadth。　In　applying　extension　to　the　thigh；　for
example；　the　bands　should　be　fastened　at　the　ankle　and　above　
the　knee；
these　stretching　in　the　same　direction；　another　band　to　be　passed　by
the　loins；　and　around　the　armpits；　and　by　the　perineum　and　thigh；
one　end　passing　up　the　breast　and　the　other　along　the　back；　these
all　stretching　in　the　same　direction　and　being　fastened　either　to　a
piece　of　wood　resembling　a　pestle　or　to　an　axle。　When　this　is　done
on　a　couch；　either　of　its　feet　is　to　be　fastened　to　the　
threshold；　and
a　strong　block　of　wood　is　to　be　laid　across　the　other；　and　the
pieces　of　wood　resembling　a　pestle　are　to　be　raised　on　these；　to
make　extension　and　counter…extension；　the　naves　of　a　wheel　are　to　be
fastened　in　the　floor；　or　a　ladder　is　to　be　adjusted；　so　that
extension　may　be　made　in　both　directions。　The　thing　commonly　
used　is　a
bench　six　cubits　long；　two　cubits　broad；　one　fathom　in　thickness；
having　two　low　axles　at　this　end　and　that；　and　having　at　its　middle
two　moderate　sized　pillars；　to　which　is　to　be　adjusted　a　transverse
piece　of　wood　like　the　step　of　a　ladder；　which　is　to　receive　
the　piece
of　wood　tied　below　the　limb；　as　is　done　in　dislocation　at　the
shoulder；　and　the　bench　is　to　have　excavations　like　trays；　smooth；
four　inches　in　breadth　and　depth；　and　at　such　an　interval　as　to
leave　room　for　the　lever　used　to　reduce　the　limb。　In　the　
middle　of　the
bench　a　square　hole　is　to　be　scooped　out　to　receive　a　small　pillar；
which；　being　adjusted　to　the　perineum；　will　obviate　the　tendency　of
the　body　to　slip　downward；　and　being　rather　loose　may　act　somewhat
as　a　lever。　In　certain　occasions　a　piece　of　wood　is　
required；　which　is
inserted　into　a　hole　scooped　out　of　the　wall；　the　other　end　of　it　is
then　to　be　pressed　down；　something　moderately　soft　being　placed
under　it。

　Part　39
In　those　cases　where　the　bone　of　the　palate　has　exfoliated；
the　nose　sinks　in　its　middle。　In　contusions　of　the　head　without　a
wound；　either　from　a　fall；　a　fracture；　or　pressure；　in　certain　of
these　cases　acrid　humors　descend　from　the　head　to　the　
throat；　and　from
the　wound　in　the　head　to　the　liver　and　thigh。

　Part　40
The　symptoms　of　subluxations　and　luxations；　and　where；　and
how；　and　how　much　these　differ　from　one　another。　And　the　cases　in
which　the　articular　cavity　has　been　broke　off；　and　in　which　the
ligament　has　been　torn；　and　in　which　the　epiphysis　has　broken　in
which；　and　how；　when　the　limb　consists　of　two　bones；　one　or　both　are
broken：　in　consequence　of　these　the　dangers；　chances　in　
which　bad；　and
when　the　injuries　will　result　in　death；　and　when　in　recovery。　What
cases　are　to　be　reduced　or　attempted；　and　when；　and　which；　and　when
not；　the　hopes　and　dangers　in　these　cases。　Which　and　when　congenital
dislocations　are　to　be　undertaken：　the　parts　in　a　state　of　
growth；　the
parts　fully　grown；　and　why　sooner；　or　slower：　and　why　a　part　becomes
maimed；　and　how；　and　how　not：　and　why　a　certain　part　is　
atrophied；　and
where；　and　how；　and　in　what　cases　to　a　less　extent。　And　why
fractured　parts　unite　sooner　or　slower；　how　distortions　and
callosities　form；　and　the　remedy　for　them。　In　what　cases　there　are
external　wounds；　either　at　first　or　afterwards：　in　what　fractures
the　bones　are　shortened；　and　in　what　not：　in　what　cases　the
fractured　bones　protrude；　and　when　they　protrude　most：　in　what　cases
dislocated　bones　protrude。　That　physicians　are　deceived；　and　by　what
means；　in　what　they　see；　and　in　what　they　devise；　regarding
affections；　and　regarding　cures。　Established　rules　with　regard　to
bandaging：　preparation；　presentation　of　the　part；　extension；
adjustment；　friction；　bandaging；　suspension　and　placing　of　the　limb；
attitude；　seasons；　diet。　The　more　porous　parts　heal　fastest；　and
vice　versa。　Distortions；　where　the　bones　are　crooked。　Flesh　and
tendons　wasted　on　the　side　of　the　dislocation。　The　force　used　in
reduction　to　be　applied　at　as　great　a　distance　as　possible　from　the
seat　of　the　displacement。　Of　nerves　（ligaments？）；　those　which　are　in
motion　and　in　humidity　（flabby？）　are　of　a　yielding　nature；　those
that　are　not；　less　so。　In　every　dislocation　the　most　speedy
reduction　is　best。　Reduction　not　to　be　made　while　the　patient　is　in
a　febrile　state；　nor　on　the　fourth　or　fifth　day；　and　least　of　all；
in　those　of　the　elbow；　and　all　cases　which　induce　torpor；　the
soonest　the　best；　provided　the　inflammatory　stage　be　avoided。　Parts
torn　asunder；　whether　nerves；　or　cartilages；　or　epiphyses；　or　parts
separated　at　symphyses；　cannot　possibly　be　restored　to　their　former
state；　but　callus　is　quickly　formed　in　most　cases；　yet　the　use　of
the　limb　is　preserved。　Of　luxations；　those　nearest　the　
extremities　are
least　dangerous。　Those　joints　which　are　most　easily　
dislocated　are　the
least　subject　to　inflammation。　Those　which　have　been　least　inflamed；
and　have　not　been　subjected　to　after…treatment；　are　most　liable　to
be　dislocated　anew。　Extension　should　be　made　in　the　positi