on the articulations-第12节

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shortened；　but　those　of　the　fore…arm　and　hand　are　little　inferior　in
size　to　the　sound；　for　the　reasons　which　have　been　stated；　because　the
humerus　is　the　bone　nearest　to　the　joint　affected；　and；　on　that
account；　it　is　shorter　than　natural；　but　the　fore…arm　is　not　equally
affected　by　the　accident；　because　the　joint　at　which　the　bones　of
the　arm　and　forearm　are　articulated　remains　in　its　natural
condition；　and　the　hand　is　still　further　distant　than　the　fore…arm
from　the　seat　of　the　injury。　Such　are　the　reasons　why　certain　of　the
bones　in　this　case　increase　in　growth；　and　certain　do　not。　The
laborious　office　of　the　hand　contributes　much　to　the　development　of
the　flesh　in　the　fore…arm　and　hand；　for　whatever　work　is　done　by　the
hand；　these　weasel…armed　persons　strive　to　do　no　less　effectually　with
the　other　hand　than　with　the　sound；　for　the　arms　do　not　support　the
weight　of　the　body　like　the　legs；　and　the　work　performed　by　them　is
light。　From　exercise；　then；　the　fleshy　parts　on　the　hand　and
fore…arm　are　not　atrophied　in　weasel…armed　persons；　and　by　these　means
the　arm；　too；　gains　flesh。　But　in　dislocation　inward　at　the　hip…joint；
whether　from　birth　or　from　childhood；　the　fleshy　parts；　on　that
account；　are　much　more　atrophied　than　those　of　the　hand；　because　the
patients　cannot　exercise　the　leg。　Another　proof　will　be　given　in　the
observations　which　will　be　presently　stated；　that　these　things　are
such　as　I　things　are　such　as　I　have　represented。

　　54。　When　the　head　of　the　femur　is　dislocated　outward；　the　limb　in
these　cases；　when　compared　with　the　other；　appears　shortened；　and　this
is　natural；　for　the　head　of　the　femur　no　longer　rests　on　a　bone　as
in　dislocation　inward；　but　along　the　side　of　a　bone　which　naturally
inclines　to　the　side；　and　it　is　lodged　in　flesh　of　a　pulpy　and
yielding　nature；　and　on　that　account　it　appears　more　shortened。
Inwardly；　the　thigh　about　the　perineum　appears　more　hollow　and　flabby；
but　externally　the　buttock　is　more　rounded；　from　the　head　of　the　thigh
having　slipped　outward；　but　the　nates　appear　to　be　raised　up；　owing　to
the　flesh　there　having　yielded　to　the　head　of　the　thigh…bone；　but
the　extremity　of　the　thigh…bone；　at　the　knee；　appears　to　be　turned
inward；　and　the　leg　and　foot　in　like　manner；　neither　does　it　admit
of　flexion　like　the　sound　limb。　These；　then；　are　the　symptoms　of
dislocation　outward。

　　55。　When　such　a　dislocation　is　not　reduced　in　adults；　the　whole　limb
appears　to　be　shortened；　and　in　walking　they　cannot　reach　the　ground
with　the　heel；　but　they　walk　with　the　ball　of　the　foot　on　the
ground；　and　the　points　of　their　toes　incline　a　little　inward。　But
the　injured　limb；　in　this　case；　can　support　the　body　much　better
than　in　dislocation　inward；　both　because　the　head　of　the　femur　and　the
neck　of　its　articular　extremity；　being　naturally　oblique；　have
formed　a　bed　under　a　considerable　portion　of　the　hip；　and　because
the　extremity　of　the　foot　is　not　forcibly　turned　outward；　but　is
nearly　in　a　line　with　the　body；　and　is　even　inclined　more　inwardly。
When；　then；　the　articular　extremity　of　the　femur　has　worn　out　a　socket
for　itself　in　the　flesh　where　it　was　lodged；　and　the　flesh　is
lubricated；　it　ceases　to　be　painful　in　the　course　of　time；　and　when　it
becomes　free　from　pain；　they　can　walk　without　a　staff；　if　so　inclined；
and　they　can　support　the　body　on　the　injured　limb。　From　usage　then；　in
such　cases；　the　fleshy　parts　are　less　enervated　than　in　those　which
have　been　mentioned　a　little　before；　still；　however；　they　lose　their
strength　more　or　less；　but　in　general　there　is　more　enervation　when
the　dislocation　is　inward　than　when　it　is　outward。　Some　of　them；　then；
cannot　wear　their　shoes；　owing　to　the　unbending　state　of　their　leg；
and　some　of　them　can。　But　when　this　dislocation　takes　place　in
utero；　and　when　the　dislocation　having　occurred　at　any　time　before
manhood；　from　violence；　has　not　been　replaced；　or　when　from　disease
the　articular　extremity　has　started　from　its　socket；　and　is
displaced　（for　many　such　cases　occur；　and　from　some　of　them；　if　the
femur　become　necrosed；　obstinate　suppurations　requiring　the　use　of
tents　are　formed；　and　in　certain　of　them　the　bone　is　laid　bare）；
whether　the　bone　become　necrosed　or　not；　the　bone　of　the　thigh　is　much
shortened；　and　does　not　usually　grow　like　the　sound　one；　the　bones；
too；　of　the　leg；　become　shorter　than　those　of　the　other；　but　in　a
small　degree；　for　the　same　reasons　that　were　formerly　stated；　such
persons　can　walk；　some　of　them　in　the　same　fashion　as　adults　having　an
unreduced　dislocation；　and　some　of　them　walk　with　the　whole　foot　on
the　ground；　but　limp　in　walking；　being　obliged　to　do　so　by　the
shortness　of　the　limb。　Such　is　the　result；　even　though　they　be
carefully　and　properly　trained　in　the　attitudes　before　they　have
strength　for　walking；　and　in　like　manner　also；　after　they　have
acquired　the　necessary　strength；　but　those　persons　require　the　most
care　who　were　very　young　when　they　met　with　the　accident；　for；　if
neglected　while　children；　the　limb　becomes　entirely　useless　and
atrophied。　The　fleshy　parts　of　the　entire　limb　are　more　wasted　than
those　of　the　sound　limb；　but　this　is　much　less　apt　to　happen　in
their　case　than　in　dislocation　inward；　owing　to　usage　and　exercise；　as
they　are　speedily　able　to　make　use　of　the　limb；　as　was　stated　a　little
before　with　regard　to　the　weasel…armed　（galiancones）。

　　56。　There　are　persons　who；　from　birth　or　from　disease；　have
dislocations　outward　of　both　the　thighs；　in　them；　then；　the　bones
are　affected　in　like　manner；　but　the　fleshy　parts　in　their　case　lose
their　strength　less；　the　legs；　too；　are　plump　and　fleshy；　except
that　there　is　some　little　deficiency　at　the　inside；　and　they　are　plump
because　they　have　the　equal　use　of　both　their　legs；　for　in　walking
they　totter　equally　to　this　side　that。　Their　nates　appear　very
prominent；　from　the　displacement　of　the　bones　of　the　joint。　But　if
in　their　case　the　bones　do　not　sphacelate　（become　carious？）　and　if
they　do　not　become　bent　above　the　hip…joint；　if　nothing　of　this　kind
happen　to　them；　they　become　otherwise　sufficiently　healthy；　but　the
growth　of　all　the　rest　of　the　body；　with　the　exception　of　the　head；　is
arrested。

　　57。　In　dislocations　of　the　head　of　the　femur　backward；　which
rarely　occur；　the　patient　cannot　extend　the　leg；　either　at　the
dislocated　joint；　or　at　the　ham；　to　any　extent；　and　of　all　the
dislocations；　this　is　the　variety　in　which　the　patients　have　the　least
power　of　making　extension　at　the　groin　and　the　ham。　But；　moreover；
this　also　should　be　known　（for　it　is　a　valuable　piece　of　knowledge；
and　of　much　importance；　and　yet　most　yet　most　people　are　ignorant　of
it）；　that　persons　in　health　cannot　extend　the　joint　at　the　ham；　if
they　do　not　extend　the　joint　at　the　groin　at　the　same　time；　unless
they　raise　the　foot　very　high；　for　in　this　way　they　could　do　it；
neither　also　could　they　bend　the　joint　at　the　ham；　but　with　much
greater　difficulty；　if　they　do　not　bend　the　joint　at　the　groin　at
the　same　time。　There　are　many　other　things　in　the　body　which　have
similar　connections；　both　with　regard　to　the　contractions　of　nerves
（ligaments？）；　and　the　positions　of　muscles；　and　many　of　them　more
worthy　of　being　known　than　is　generally　supposed；　and　with　regard　to
the　nature　of　the　intestine　and　that　of　the　whole　internal　cavity；　and
with　regard　to　the　displacements　and　contractions　of　the　uterus；　but
all　these　things　will　be　treated　of　elsewhere；　in　a　work　akin　to　the
present　one。　But　with　regard　to　the　matter　on　hand；　they　cannot　make
extension；　as　has　been　already　stated；　and　the　limb　appears　shortened；
for　two　reasons…first；　because　it　cannot　be　extended；　and　also　because
the　bone　has　slipped　into　the　flesh　of　the　nates；　for　the　head　and
neck　of　the　femur；　in　this　dislocation；　are　carried　downward　from
their　natural　situation；　to　the　outside　of　the　nates。　But　yet　they　can
bend　the　limb；　unless　prevented　by　pain；　and　the　leg　and　foot　appear
pretty　straight；　and　not　much　inclined　toward　either　side；　but　at
the　groin　the　flesh；　when　felt；　appears　looser；　from　the　bone　of　the
joint　having　slipped　to　the　other　side；　but　at　the　nates　the　head　of
the　femur　may　be　felt　to　be　more　prominent　than　natural。　Such　are
the　symptoms　accompanying　dislocation　of　the　thigh　backward。

　　58。　When　this　dislocation　occurs　in　an　adult；　and　is　not　reduced；　he
can　walk；　indeed；　after　a　time；　and　when　the　pain　has　abated；　and　when
he　has　been　accustomed　to　rotate　the　articular　bone　in　the　flesh；　he
finds　it　necessary；　however；　to　make　strong　flexion　at　the　groin　in
walking；　for　two　reasons；　both　because　the　limb；　for　the　causes
already　stated；　becomes　much　shorter；　and　he　is　far　from　touching
the　ground　with　his　heel；　and　he　can　barely　reach　it　with　the　ball
of　his　foot；　and　not　even　thus；　unless　he　bend　himself　at　the
groins；　and　also　bend　with　the　other　leg　at　the　ham。　And　in　this　case；
he　is　under　the　necessity　of　supporting　the　upper　part　of　the　thigh
with　his　hand　at　each　step：　this　also　contributes；　in　a　certain
degree；　to　make　him　bend　the　body　at　the　groins；　for；　during　the
shifting　of　the　feet　in　walking；　the　body　cannot　be　supported　on　the
unsound　be　supported　on