on the articulations-第15部分

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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　at　the　same　time　to　push　the　dislocated
part　downward；　and　at　the　same　time　to　the　fore　part　of　the　knee。　This
method　of　reduction　is　most　especially　conformable　to　this　mode　of
dislocation。　And　the　mode　of　suspension　is　also　not　far　removed　from
being　natural；　but　the　person　suspended　should　be　well　trained；　so
that　his　arm　may　not　act　as　a　lever　upon　the　joint；　but　that　the　force
of　the　suspension　may　act　about　the　middle　of　the　perineum；　and　at　the
os　sacrum。

　　77。　Reduction　by　the　bladder　is　also　celebrated　in　dislocations　at
this　joint；　and　I　have　seen　certain　persons　who；　from　ignorance；
attempted　to　reduce　both　dislocations　outward　and　backward
therewith；　not　knowing　that　they　were　rather　displacing　than　replacing
the　parts；　it　is　clear；　however；　that　he　who　first　invented　this
method　intended　it　for　dislocation　inward。　It　is　proper；　then；　to　know
how　the　bladder　should　be　used；　if　it　is　to　be　used；　and　it　should
be　understood　that　many　other　methods　are　more　powerful　than　it。　The
bladder　should　be　placed　between　the　thighs　uninflated；　so　that　it　may
be　carried　as　far　up　the　perineum　as　possible；　and　the　thighs
beginning　at　the　patella　are　to　be　bound　together　with　a　swathe；　as
far　up　as　the　middle　of　the　thigh；　and　then　a　brass　pipe　is　to　be
introduced　into　one　of　the　loose　feet　of　the　bladder；　and　air　forced
into　it；　the　patient　is　to　lie　on　his　side　with　the　injured　limb
uppermost。　This；　then；　is　the　preparation；　some；　however；　do　the　thing
worse　than　as　I　have　described；　for　they　do　not　bind　the　thighs
together　to　any　extent；　but　only　at　the　knees；　neither　do　they　make
extension；　whereas　extension　should　be　made；　and　yet　some　people　by
having　the　good　fortune　to　meet　with　a　favorable　case；　have
succeeded　in　making　reduction。　But　it　is　not　a　convenient　method　of
applying　force；　for　the　bladder；　when　inflated；　does　not　present　its
most　prominent　part　to　the　articular　extremity　of　the　femur；　which
is　the　place　that　ought　to　be　more　especially　pressed　outward；　but　its
middle；　which　probably　corresponds　with　the　middle　of　the　thigh；　or
still　lower　down；　for　the　thighs　are　naturally　curved；　being　fleshy；
and　in　contact　above；　and　becoming　smaller　downward；　so　that　the
natural　configuration　of　the　parts　forces　the　bladder　from　the　most
proper　place。　And　if　a　small　bladder　be　introduced；　its　power　will
be　small；　and　unable　to　overcome　the　resistance　of　the　articular　bone。
But　if　the　bladder　must　be　used；　the　thighs　are　to　be　bound　together
to　a　considerable　extent；　and　the　bladder　is　to　be　inflated　along　with
the　extension　of　the　body；　and　in　this　method　of　reduction　both　legs
are　to　be　bound　together　at　their　extremity。

　　78。　The　prime　object　of　the　physician　in　the　whole　art　of　medicine
should　be　to　cure　that　which　is　diseased；　and　if　this　can　be
accomplished　in　various　ways；　the　least　troublesome　should　be
selected；　for　this　is　more　becoming　a　good　man；　and　one　well　skilled
in　the　art；　who　does　not　covet　popular　coin　of　base　alloy。　With　regard
to　the　subject　now　on　hand；　the　following　are　domestic　means　of　making
extension　of　the　body；　so　that　it　is　easy　to　choose　from　among　the
things　at　hand：…In　the　first　place；　when　soft　and　supple　thongs　are
not　at　hand　for　ligatures；　either　iron　chains；　or　cords；　or　cables
of　ships；　are　to　be　wrapped　round　with　scarfs　or　pieces　of　woolen
rags；　especially　at　the　parts　of　them　which　are　to　be　applied；　and
in　this　state　they　are　to　be　used　as　bands。　In　the　second　place；　the
patient　is　to　be　comfortably　laid　on　the　strongest　and　largest　couch
that　is　at　hand；　and　the　feet　of　the　couch；　either　those　at　the
（patient's？）　head；　or　those　at　the　feet；　are　to　be　fastened　to　the
threshold；　either　within　or　without；　as　is　most　suitable；　and　a　square
piece　of　wood　is　to　be　laid　across；　and　extending　from　the　one　foot　to
the　other；　and　if　this　piece　of　wood　be　slender；　it　should　be　bound　to
the　feet　of　the　couch；　but；　not　withstanding；　if　it　be　thick；　there
will　be　no　necessity　for　this；　then　the　heads　of　the　ligatures；　both
of　those　at　the　head　and　those　at　the　feet；　are　to　be　fastened　to　a
pestle；　or　some　such　piece　of　wood；　difficult　to　reduce　at　either　end；
the　ligatures　should　run　along　the　line　of　the　body；　or　be　a　little
elevated　above　it；　and　it　should　be　stretched　proportionally　to　the
pestles；　so　that；　standing　erect；　the　one　may　be　fastened　to　the
threshold；　and　the　other　to　the　transverse　piece　of　wood。　Extension　is
then　to　be　made　by　bending　back　the　ends　of　the　pestles。　A　ladder；
having　strong　steps；　if　laid　below　the　bed；　will　serve　the　purpose
of　the　threshold　and　the　piece　of　wood　laid　along　（the　foot　of　the
couch？）；　as　the　pestles　can　be　fastened　to　the　steps　at　either　end；
and　when　drawn　back　they　thus　make　extension　of　the　ligatures。
Dislocation；　inward　or　forward；　may　be　reduced　in　the　following
manner：　a　ladder　is　to　be　fastened　in　the　ground；　and　the　man　is　to　be
seated　upon　it；　and　then　the　sound　leg　is　to　be　gently　stretched　along
and　bound　to　it；　wherever　it　is　found　convenient；　and　water　is　to　be
poured　into　an　earthen　vessel；　or　stones　put　into　a　hamper　and　slung
from　the　injured　leg；　so　as　to　effect　the　reduction。　Another　mode　of
reduction：　a　cross…beam　is　to　be　fastened　between　two　pillars　of
moderate　height；　and　at　one　part　of　the　cross…beam　there　should　be　a
protuberance　proportionate　to　the　size　of　the　nates；　and　having
bound　a　coverlet　round　the　patient's　breast；　he　is　to　be　seated　on　the
protuberant　part　of　the　cross…beam；　and　afterward　the　breast　is　to
be　fastened　to　the　pillar　by　some　broad　ligature；　then　some　one　is
to　hold　the　sound　leg　so　that　he　may　not　fall　off；　and　from　the
injured　limb　is　to　be　suspended　some　convenient　weight；　as　formerly
described。

　　79。　It　should　be　particularly　known　that　the　union　of　all　bones
is；　for　the　most　part；　by　a　head　and　socket　（cotyle）；　in　some　of　these
the　place　（socket？）　is　cotyloid　and　oblong；　and　in　some　the　socket
is　glenoid　（shallow？）。　In　all　dislocations　reduction　is　to　be
effected；　if　possible；　immediately；　while　still　warm；　but　otherwise；
as　quickly　as　it　can　be　done；　for　reduction　will　be　a　much　easier
and　quicker　process　to　the　operator；　and　a　much　less　painful　one　to
the　patient；　if　effected　before　swelling　comes　on。　But　all　the
joints　when　about　to　be　reduced　should　be　first　softened；　and　gently
moved　about；　for；　thus　they　are　more　easily　reduced。　And；　in　all　cases
of　reduction　at　joints；　the　patient　must　be　put　on　a　spare　diet；　but
more　especially　in　the　case　of　the　greatest　joints；　and　those　most
difficult　to　reduce；　and　less　so　in　those　which　are　very　small　and
easily　reduced。

　　80。　If　any　joint　of　the　fingers　is　dislocated；　whether　the　first；
second；　or　the　third；　the　same　method　of　reduction　is　to　be　applied；
but　the　largest　joints　are　the　most　difficult　to　reduce。　There　are
four　modes　of　displacement…either　upward；　downward；　or　to　either　side；
most　commonly　upward；　and　most　rarely　laterally；　and　in　consequence　of
violent　motion。　On　both　sides　of　its　articular　cavity　there　is　a
sort　of　raised　border。　When　the　dislocation　is　upward　or　d