on the articulations-第14部分

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denuded　in　this　manner；　drop　off　on　the　eightieth　day；　but　in　the　case
of　this　patient；　the　parts　below　were　separated　at　the　knee　on　the
twentieth　day；　and；　as　I　thought；　too　early；　for　it　appeared　to　me
that　this　should　be　done　more　guardedly。　In　a　case　which　I　had　of　such
blackening　in　the　leg；　the　bones　of　the　leg；　as　far　as　they　were
denuded；　separated　at　its　middle　on　the　sixtieth　day。　But　the
separation　of　denuded　bones　is　quicker　or　slower；　according　to　the
mode　of　treatment；　something；　too；　depends　upon　whether　the
compression　be　stronger　or　weaker；　and　whether　the　nerves；　flesh；
arteries；　and　veins　are　quicker　or　slower　in　becoming　blackened　and　in
dying；　since；　when　the　parts　are　not　strongly　compressed；　the
separation　is　more　superficial；　and　does　not　go　the　length　of　laying
the　bones　bare；　and　in　some　cases　it　is　still　more　superficial；　so
as　not　even　to　expose　the　nerves。　For　the　reasons　now　stated；　it　is
impossible　to　define　accurately　the　time　at　which　each　of　these
cases　will　terminate。　The　treatment　of　such　cases；　however；　is　to　be
readily　undertaken；　for　they　are　more　formidable　to　look　at　than　to
treat；　and　a　mild　treatment　is　sufficient　in　all　such　cases；　for
they　come　to　a　crisis　of　themselves；　only　the　diet　must　be　attended
to；　so　that　it　may　be　as　little　calculated　to　create　fever　as
possible；　and　the　body　is　to　be　placed　in　the　proper　positions：
these　are；　neither　raised　very　high　up；　nor　inclined　much　downward；
but　rather　upward；　until　the　separation　be　completed；　for　at　that　time
there　is　most　danger　of　hemorrhage；　on　this　account；　wounds　should　not
be　laid　in　a　declining　position；　but　the　contrary。　But　after　a
while；　and　when　the　sores　have　become　clean；　the　same　positions　will
no　longer　be　appropriate；　but　a　straight　position；　and　one　inclining
downward；　may　be　proper；　and　in　the　course　of　time；　in　some　of　these
cases；　abscesses　form；　and　require　bandages。　One　may　also　expect
that　such　patients　will　be　attacked　with　dysentery；　for　dysentery
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