on the articulations-第16部分

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violent　motion。　On　both　sides　of　its　articular　cavity　there　is　a
sort　of　raised　border。　When　the　dislocation　is　upward　or　downward；
owing　to　the　articular　cavity　having　smoother　edges　there　than　at
the　sides；　if　the　joint　of　it　be　dislocated；　it　is　more　easily
reduced。　This　is　the　mode　of　reduction：…The　end　of　the　finger　is　to　be
wrapped　round　with　a　fillet；　or　something　such；　that；　when　you　lay
hold　of　it　and　make　extension；　it　will　not　slip；　and　when　this　is
done；　some　person　is　to　grasp　the　arm　at　the　wrist；　and　another　is
to　take　hold　of　the　finger　which　is　wrapped　in　the　fillet；　and　then
each　is　to　make　considerable　extension　toward　himself；　and　at　the　same
time　the　projecting　bone　is　to　be　pushed　into　its　place。　But；　if　the
dislocation　be　lateral；　the　same　mode　of　reduction　is　to　be　used；
but　when　you　think　that　the　extremity　of　the　bone　has　cleared　the　rim；
at　the　same　time　that　extension　is　made；　the　bone　is　to　be　pushed
direct　into　its　place；　while　another　person　on　the　other　side　of　the
finger　is　to　take　care　and　make　counter…pressure；　so　that　it　may　not
again　slip　out　there。　The　twisted　nooses　formed　from　palm…shoots　are
convenient　for　effecting　reduction；　if　you　will　make　extension　and
counter…extension　by　holding　the　twisted　string　in　the　one　hand　and
the　wrist　in　the　other。　When　reduced；　you　must　bind　the　part　as
quickly　as　possible　with　bandages；　these　are　to　be　very　slender　and
waxed　with　cerate；　neither　very　soft　nor　very　hard；　but　of　middle
consistence；　for　that　which　is　hard　drops　off　from　the　finger；　while
that　which　is　soft　and　liquid　is　melted　and　lost　by　the　increased　heat
of　the　finger。　The　bandage　is　to　be　loosed　on　the　third　or　fourth　day；
but　on　the　whole；　if　inflamed；　it　is　to　be　the　more　frequently　loosed；
and　if　otherwise；　more　rarely；　this　I　say　respecting　all　the　joints。
The　articulation　of　a　finger　is　restored　in　fourteen　days。　The
treatment　of　the　fingers　and　of　the　toes　is　the　same。

　　81。　After　all　reductions　of　joints　the　patient　should　be　confined　to
a　restricted　diet　and　abstinence　until　the　seventh　day；　and　if　there
be　inflammation；　the　bandages　are　to　be　the　more　frequently　loosed；
but　otherwise；　less　frequently；　and　the　pained　joint　is　to　be　kept
constantly　in　a　state　of　rest；　and　is　to　be　laid　in　the　most
convenient　position　possible。

　　82。　Accidents　at　the　knee　are　more　mild　than　at　the　elbow；　from
its　being　compact；　regular；　and　elegant　in　its　construction；　and；
therefore；　it　is　more　readily　dislocated　and　reduced。　It　is　most
frequently　dislocated　inward；　but　also　outward　and　backward。　The　modes
of　reduction　are　these：　by　flexion　at　the　knee；　or　by　sudden
calcitration；　or　having　rolled　a　swathe　into　a　ball；　and　fixed　it　in
the　ham；　the　patient's　body　is　to　be　suddenly　dropped　on　its　bended
knees。　Dislocation　backward；　also；　as　in　the　case　of　the　elbow；　may　be
reduced　by　moderate　extension；　and　to　either　side；　either　by　flexion
or　calcitration；　but　also　by　moderate　extension。　The　adjustment　is　the
same　in　all　cases。　In　dislocations　backward　which　are　not　reduced；　the
patient　cannot　bend　the　joint；　but　neither　can　he；　to　any　great
extent；　in　the　other　varieties；　the　thigh　and　leg　are　wasted　in　front；
but　if　inward　the　patients　become　bow…legged；　and　the　external　parts
are　wasted；　but　if　outward　they　become　more　bandy…legged；　but　the
impediment　is　less；　for　the　body　is　supported　on　the　larger　of　the
bones；　and　the　inner　parts　are　wasted。　When　these　accidents　happen
at　birth　or　during　adolescence；　they　follow　the　rule　formerly　stated。

　　83。　Dislocations　at　the　ankle…joints　require　strong　extension；
either　with　the　hands　or　some　such　means；　and　adjustment；　which　at　the
same　time　effects　both　purposes；　as　is　common　in　all　cases。

　　84。　Injuries　of　the　foot　are　to　be　remedied　like　those　of　the　hand。

　　85。　The　bones　connected　with　the　leg；　and　which　are　dislocated；
either　at　birth　or　during　adolescence；　follow　the　same　course　as　those
in　the　hand。

　　86。　When　persons　jumping　from　a　height　pitch　on　the　heel；　so　as　to
occasion　separation　（diastasis）　of　the　bones；　ecchymosis　of　the　veins；
and　contusion　of　the　nerves；　when　these　symptoms　are　very　violent
there　is　danger　of　sphacelus；　and　that　the　case　may　give　trouble
during　life；　for　the　bones　are　so　constructed　as　to　slip　from　one
another；　and　the　nerves　communicate　together。　And；　indeed；　in　cases　of
fracture；　either　from　an　injury　in　the　leg　or　thigh；　or　in　paralysis
of　the　nerves　（tendons？）　connected　with　these　parts；　or　from　neglect
during　confinement　to　bed；　when　the　heel　gets　blackened　the　most
serious　consequences　result　therefrom。　Sometimes；　in　addition　to　the
sphacelus；　there　come　on　acute　fevers　accompanied　with　hiccup；
aberration　of　intellect；　and　speedy　death；　with　lividities　of　the
large　blood…vessels。　With　regard　to　the　symptoms　attending
exacerbations；　if　the　ecchymosed　and　blackened　parts　and　those
around　be　somewhat　hard　and　red；　and　if　along　with　the　hardness
there　be　lividity；　mortification　is　to　be　apprehended；　but　if　the
parts　be　slightly　livid；　or　even　very　livid；　and　the　swelling
diffused；　or　if　greenish　and　soft；　these　appearances；　in　such　cases；
are　all　favorable。　The　treatment；　if　no　fever　be　present；　consists
in　the　administration　of　hellebore；　but　otherwise　（it　is　not　to　be
given；　but　oxyglyky　（decoction　of　honeycombs　and　vinegar）　is　to　be
given　for　drink；　if　required。　Bandaging　as　in　the　other　articulations：
above　all；　more　especially　in　contusions；　the　bandages　should　be
numerous　and　softer　than　usual；　but　the　compression　should　be　less；
most　turns　should　be　made　around　the　heel。　Position；　like　the
bandaging；　should　be　so　regulated　as　not　to　determine　to　the　heel。
Splints　are　not　to　be　used。

　　87。　When　the　foot　is　dislocated；　either　alone　or　along　with　its
epiphysis；　the　displacement　is；　for　the　most　part；　to　the　inside。　If
not　reduced；　in　the　course　of　time；　the　hip；　the　thigh；　and　the　side
of　the　leg　opposite　the　dislocation；　become　atrophied。　Reduction　is
the　same　as　in　the　wrist；　but　the　extension　requires　to　be　very
powerful。　Treatment；　agreeably　to　the　general　rule　for　joints。
Exacerbations　do　occur；　but　less　frequently　than　in　dislocations　at
the　wrist；　provided　the　parts　get　rest。　While　they　remain　at　rest
the　diet　should　be　restricted。　Those　which　occur　at　birth；　or　during
adolescence；　follow　the　rule　formerly　stated。



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