Chapter XXVIII: Preface (6)

The femur is protruded in all the four ways; most frequently to the internal part, next externally, very rarely forward, or backward. If it be luxated internally, the leg is longer and turned round externally more than the other; for the toes point outward. If to the external part, it is shorter and bowed inward, and the foot turns the same way; the heel in walking does not touch the ground, but the person rests upon the extremity of the sole of the foot; and in this case, the leg sustains the superior part of the body better than in the former, and less needs the help of a staff. If forward, the leg cannot be bent, and being extended is as long at the heel as the other: but the toes are turned less inward; also the pain is most violent in this case; and the urine very liable to be suppressed: when the inflammation together with the pain have ceased, such patients walk pretty well, and their foot is straight. If the luxation be backward, the leg cannot be extended; and is shorter; also in standing, the heel does not reach the ground.

But there is a great danger attending the femur, that it be either difficult to reduce, or slip out again after it is replaced: some affirm it always comes out again; but Hippocrates, and Diocles, and Philotimus, and Nileus, and Heraclides the Tarentine, very celebrated authors, have affirmed, that they have made a perfect cure. Neither would Hippocrates, Andreas, Nileus, Nymphodorus, Protarchus, Heraclides, and a certain artificer too, have contrived so great a variety of machines for extending the femur in this case, if it were to no purpose. But as this is a false opinion, so on the other hand it is true, that the ligaments and muscles there being very strong, if they retain their natural firmness, they will hardly admit of a reduction; if they do not, they do not hold it fast, when reduced.

Therefore trial must be made, and if the limb be but tender, it is sufficient to make an extension by one strap at the groin, and another at the knee; if it be muscular, the extension will be better made by tying these straps to strong sticks; and then putting the lower ends of the sticks against a fulcrum, and pulling the upper ends with both hands. The extension of the limb is still more strong upon a bench, that has axes at both ends, to which these straps are tied; which being turned as in a wine-press, by persevering, they will not only extend, but even break the ligaments and muscles. Now the patient must be laid upon this bench, either prone or supine, or on one side, so that the part, into which the bone has slipped, be always uppermost, and that, from which it has receded, lowermost. When the ligaments are extended, if the bone is luxated forward, some round body must be put upon the groin; and the knee must suddenly be drawn towards the body, in the same manner, and for the same reason, as is done in the arm; and if the femur gives way to the flexion, it is reduced.

But in the other cases, where the bones have receded a little from each other, the physician ought to force back the prominent part; and an assistant to push the hip in a contrary direction. When the bone is reduced, there is nothing different required in the treatment, except confining the patient longer to his bed; lest if the femur be moved, while the ligaments are too lax, it may slip out again. However it may be secured by keeping the middle or upper part of the joint in some canaliculus(29).

CHAP. XXI.

OF A LUXATION OF THE KNEE.

It is very well known, that the knee slips inward, outward, and backward. Most authors have written, that it is not displaced forward. And that may appear very probable; as in that place the patella is opposed to it, and likewise keeps in the head of the tibia. But Meges has given an instance of a person cured by him, where the luxation was forward.

In these cases the ligaments may be extended by the same means, which I recited in the femur. And where the bone is luxated backward, it is reduced in the same manner, by some round body applied to the ham, and drawing up the leg. In the other cases the hands are only to be used, and then the bones are at the same time forced different ways.

CHAP. XXII.

OF A LUXATED ANCLE.

The ancle is luxated in all directions. When it is inward, the sole of the foot is turned outward. When the contrary case to this happens, there is also the contrary symptom. But if it be luxated forward, the broad tendon behind is hard, and tense; and the foot turns downward. If backward, the heel is almost hid, and the sole of the foot is enlarged. This luxation is reduced by the hands; the foot and leg being first extended different ways. And in this case also the patient must be kept longer in bed; lest the ancle, which sustains the whole body, yield beneath its load, and be forced out again before the ligaments have recovered their strength. And at first low shoes must be used, lest the binding hurt the ancle.

CHAP. XXIII.

OF LUXATIONS IN THE SOLES OF THE FEET.

The bones in the soles of the feet are luxated in the same manner as those in the hands; and are reduced by the same methods; only it is necessary to put a roller round the heel; lest as the middle part and extremity of the sole require to be bound, the ancle being left free, may receive the redundant matter, and thus come to suppuration.

CHAP. XXIV.

OF LUXATED TOES.

In the toes there is nothing else required, than what has been directed before in the fingers.

CHAP. XXV.

OF LUXATIONS ATTENDED WITH A WOUND.

These are the methods to be taken, when the bones have been displaced without a wound; but they are often dislocated, and the part wounded at the same time; and here the danger is great, and so much the greater, as the limb is larger, and the ligaments, or muscles that hold it, stronger; and therefore, from the arm and thigh bones there is danger of death: and if the bones are reduced, there is no hope; and yet when they are not replaced, there is also some danger. In both, the event is the more to be feared, the nearer the wound is to the articulation. For Hippocrates has asserted, that no bone could in this case be safely reduced, except the fingers and toes, and the bones of the feet and hands; and that even here great caution must be used, lest it suddenly destroy the patient. Some have reduced both arms and legs; and to prevent gangrenes and convulsions (which in such cases often terminate in speedy death) they let blood from the arm. But not even a finger (where, as the malady, so also the danger is least) ought to be reduced, either while there is an inflammation, or afterwards, when the bones have continued long luxated. And farther, if after the reduction of the bone, convulsions come on, it must be immediately put out again.

Now every member that is at once wounded and dislocated, and continues unreduced, ought to lie in the posture easiest to the patient; provided it neither be moved nor hang down. In every case of this kind the cure is much promoted by long fasting; and then the use of those methods prescribed before. In fractured bones, where there is a wound, if the naked bone project, it will always prevent its healing; therefore, the prominent part must be cut away, and dry lint applied, and medicines not greasy; till the greatest degree of soundness attainable in such a case be restored; for it both leaves a weakness behind it, and the part is covered with a thin cicatrix, which must of necessity be ever after greatly exposed to injuries.

NOTES

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