Part V ik

If che Shoulder be luxated co the ;.
The [bout- dev duxated | to she fore
Arm-pit, co wit, by extending the part
Shoulder,and drawing its head up and down, and forcing ic rnto its Cavicy: Ic differs only inthis, Thac in this kind of Luxation the fhoulder being drawn downwards mutt be driven to the hinder pare 5 but che Chirutgeon mutt have a diligenc care, left the head of the fhouldee in the action do fal down into the Arm> pit, which may 6edone ifthe Arm-pic be filled up with a bal or fome round ching of a juft bignefs 5 and chis Operation may be facilicaced by afecvant Handing at the back of the Pactene, and with a rope or ftrong and broad {wathe drawing upwards che fhoulder-blade, left that follow upon che ex- tenfion of che thoulder made by che Chirutgee on. The fhoulder being reduced, Medicines that do hinder Inflammation. and ftrengthen the relexe and fofc Ligaments muft be applied ; of which we made mention in the precedent parc concerning Fractures, and above Chap. 1. of Luxations in general: che moft convenient way of {wathing is if a bal made up of Linen or courfe flax, and dipe in convenient Medicines,be puc under che Arm- pic, that che bead ef the fhoulder recurn not thither; lecche firft {wache be here, afterwards lec it be rowled once or twice abouc the joynt ; bence lec ic be broughs co the fhoulder-blade, and again defcendto thejoynr: ac laft chat it may draw the Arm the more upwards, and keep ic fo, lec is cend co the neck on che other fide, and chere be bound, neither lec ic be loofened before the rhird of fourthday, unlefs an Inflammation command otherwife. But che fwathe being taken off, ox
| laid on, fome Ceroce muft be applied, viz. Dia-
palmaific be Summer, or if it be Winter, Bar- barum or Oxycroceum.
Laft of al, we muft not-pafs by here che Luxation of che cop of the : broad bone of the fhoulder-blade, af ; yibie ih: ie of which Hippocrates 2.de artic. | of the (boulder tex. 62. hath chefe words: But in } blades
i The loofening
Thirdly, becaufe that Spatha,| thofe in whom the top of the fhoul- |
which is put under the Shoulder hathnot around | der #s pulled off,the bone which is pulled off is (eet head, but acrofs picce of wood prefixt, which 1s | to flick out. But the bone is that which joyms toge- fentunder the Arm-pic. Fourthly, becaufethe ther the throat and fhoulder-blade, whenas in
Arm is not bound co the Ambi or Spatha,. but | this part the Nature of man i different from o-=.
only hes upon ic, but che {wathe which is caft ‘ther Creatures, Phyfitians therefore are wont to uponthe luxaced Arm on boch fides of the Arm)! be moft of al deceived im this wound, for when is made faft beneath to chat drawing Engine. the bone pulled off flicks forth, the upper part of For bievicy fake we omic many more waies of | thefhoulder appears low and hollow, that they reducing which prefenct themfelves every where in| wfe the means as if the fhoulder were fallen out; Authors ; and of chefé we have now reckoned up, | truly 1 bave known many Phyfitians in otber andachers, wemay fomumes ufechis, fom«umes things good enough, who whiles they endeavor that, as they areready andéc band; for ic is not | toreduce {uch jpoulders, thinking they were fallen fafe to deter che reducing long, cil more laborious | owe, bavecaufed much burt by troubling thems Inftcuments ace acquired, andbavenot gtrven over til they bave changed : ‘\tbew opinion, or thinking they bad reduced ibe
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Chap. ¥
Of a Luxation of the Elbow wid Radius,
joynt they knew not wbat they fhould do mores the Cure of thefer this, asto others of the like fort, a Cerote, Bolfters, Linen Clothes, and Swathing made after this manner: the bone flicking out muft be forced downwards, and on that part many Bolfters muft be laid, and they muft be preft down very wel, and the Arm mu(t be faftenedto the Ribs towards the upper part and keptfo 5 for by no means whatfoever can it bedone, thatthe bone pul?d off can come clofe and grow togethers yetwe mut wel know, and foretel alfo that thefe things are fafe, if you would bave it otberwifes because neither {mal nor great burt bappens to the Shoulder by this Wound, only the place becomes more deformed. F or vobenas neither this bone can be reftoredioits ancient feat, after the {ame manner as it was by ‘Nature, but it muft needs be t¥at it becomes lit tle or much firutting out at the upper part 5 nei~ ther doth any thing elfe return wholly into the fame ftate, which communicating and cobering with another bath been pul’d off fromitr ancient coberence.In a fev dates the pain at the top of the Shoulder ts affeoaged if tt be bound down righily,
a perverfion of the Arm; the Gaufes of a fub- Juxtacton are humors flowing to the Joynt,which by degrees do fil up che Cavities engraved borh in the lower part of the Shouldersbone, andalfo it che Eibow and Radiws, and do cbruft forth che Elbow or Radius out of cheir feat.
The Signs Diagnoftick.
It is eafily difcovered by the Sight and: Touch into what pare the Elbow is luxaced; for if it be | fallen co the fore part the Arm is ex-ended and | cannot be bencsin the fore parc there ts feen an un= ‘ufual Tumor, bucin che hinder pare an unufual Cavicy 5 chings contrary ro chefe do happen, if ic be luxaced tothe hinder pace 5 to wit, the Arm ig crooked, and can by no means be excended ; che | Tumor appears in che hinder pare,but che Caviry
inthe fore part. A Luxation tothe outward pare makes alfoa bunching out in the ourer party bue a bofom in the inner parc 3 but on'the contrary, if che Elbow be fallen to the inward part, there is ann erminenicy lets then fhould be tn the inward part; anda Cavity in the outer parr. ie
Ifche Radins foliow che Elbow, *tis known by
Thus much ‘Hippocrates 5 tee Galen ailoin his | the fame Signs; but it ic Only deparc from the EJs
Comment.
Chap 7. Of a Luxation of the Elbo ad Radius.
, bofom wich the Finger. |
bow wichout a Luxation, a gaping and difjoyning fhews it, the place is hollow, and ’cis eafie co finda
Prognofticks. : t. The Elbow as ic doth not eafily fal forth by
ae Elbow and ‘Radius are joyned with the j réaion of its ficm and faft coarciculation with che
lower head of the Shoulder. The Elbow by a Gynglymus, that is, by chac kind of Arciculation in whica the bones joyned cogether do miitually receive and are received by one another; for che Shoulder harh in ics Jower part two bofoms, the former or leffer of which réceives che outer procels of che Elbow; but che hindermoft or gréater 1s devored co the hinder procefs of che fame; but for receiving of che Radius che Shoulder hath alfo a peculiar head, called che outer head.
The Differences.
~ From which we may eafily colle, chat the El- bow may not only be wholly and perfeétly luxa- ted, but alfo may fuffer a fubluxation: néxt of all thac it may be luxiced intoal che four Differences of place, forwards,backwards,oucwatds, inwards; buc che Radius as fomecimes ic follows che El- bow luxaced intoany part, but fomecimes ftaies in its place ; fo fometimes it alone fals from che Elbow, withour any luxation of ic.
The Caufes.
As the Luxation of other pares proceeds from!
violent Cautes, fochis alfo; and indeed the Lux=
Shoulder, and its plenty and ftrength of Liga> eee fobeing fallen forth it is hardly refta- red. 2, The Eibow luxated unlefs it bé moft {peedia ly reduced,doth not only bring divers and dangeé |tousSyMptoms, co wie, amoft exceeding pain; Inflammation, Fevér, Convulfion, but fometimes alfo Deach.
3. Ofall Luxations which happén inthe Gib- bous parc of the Elbow, the moft dangerous and painful is chac which is co che hinder part. Palas fEgineta,de re medic. 1. 6.c. 115.
4. When che Bone of che Elbow is divided from che other Bone, it 1s not eafily reftored; for neither docwo bones, which are joyned together, when chey once gape, eafily return to their ancie enc place; bucicmuft needs be, chat the Bones being fo divided, she parc becomes fwelled, and the bones are quickly compaft with a Callus.
The (ure, 4 The Elbow being imperfectly luxaced (Cor fub- luxaced)co che}fote pare is moft eafily reftored by
moderate extenfion and only bending of the Arm, | buc a perfect Luxatyon is harder co be reduced and
a
~a68n |
EE etal
ation of she Elbow tothe fore pace ( for the moft | requires greacer provifion; for firft chere muft be prcc ) 3s froma violent and fudden extenfion of | excenfion made and that obliquely (¢ left che high the Atm; coche hinder part,froma violent bende | brow of the Elbow burt che head of the Shoaiidery mg of the Atm, and outwardly or inwardly, from | by cwo Servants, oné of which .muft draw che top’
| ; of
esi
Eom anh TSA REEMA SI ee SS
of che-Shoulder upwards, but the other che El-
een Anan A
2682. Book V. Of Prattical Phy ick.
bow downwards, either with their Hands only, orifneed be with Reins; chenfome cound bo- dy muft be placed by the brawny pare 5 over which afcerwaids the Chirurgeon bending his Arm, and fuddenly forcing the Elbow to the bin- der parts,may reftore it 1nc0 its place.
Hippocrates 3. de frattu. affirms chathe hath fomcimes cured the Elbow luxacedto the hinder part, only by a fudden and continued extenfion of the Arm; which ifsc fufficenot, convemenct ex- tenfion being made the Elbow muft be driven 1n- wards.
The Elbow fallen forth to the outer or inner partis moft eafily reduced, if extenfion being made, icbe forced from thac patéinto which ic 1s fallen, into che contrary.
The {ame manner of reducing is co be obferved
in replacing the Radius, ific hath. followed | - the Luxation of the Elbow; buc if it be only |
departced from it, ic muft be preft wich the prominenc parcs of che Hands, and the Arm muft be reduced co the nacural figure; it being te- duced convenient Medicines muft be applied, and ac muft be bound up fitly, as was {aid in general before,c. 7
Chap. 8. Of a Luxation of the Fland and its Fingers.
Ere by the name of Hand we underftand
the Wrift, and After-wrift.; buc che Weift
is joyhed wich che Elbow bone and ‘Radius by a Diarthrofis, whenas there isa manifeft motion 5 but wich the After- wrift, whenas there isno ma~ nifeft motion, by a Synartbrofis or doubtful arci- culation; the Metacarpium or Afcet-wrift is gzoyned again with the bones of che Fingers by a Diarthrofis, becaufe che round heads of che tour bones of the After-wrift do confpicuoufly enter the fuperficies of che firft bones of che Fingers, lightly hollowed; and after chis manner alto, the bones of the Fingers chemfelves are joyned one to
another. 3 The Differences.
Whence we may eafily collect, thatthe Wrift may be luxaredincoall four parts, to wit, che fore, the hinder, and co che fides : all che bones of the After-wrift indeed are luxaced inwards and outwards, but the falling of the cwo middle bones co the fidesis hindred by che two excceam bones that have re{pect co the liccle and Fore-finger, che which two only may fall forchtochat fide which 1s freefrom bordering bones. The bones of che Fingers again are |uxated four waies, cOWIt, in- wardly, outwardly, and co ope fides.
I be (aujes. The Caufe of che Luxation of the Writ, Afcere |
Se Ng ae eee ee NAT j woilt, and Fingers, as of other Juxations, is fome
Pare V1. i
violenc Motion, Blow, Fall, Perverfion, and Cons | Corfion, Signs Diagnoftick. The Signs of all parts of che Hands luxated are
almoft common; tor whether the bones of che | Weift, Atcer-wrift, or Fingers be luxated to thé ‘fore part, a Tumor appears ac thac place in che fore pare, and che Fingers cannot be bene. | Ifchey befallencoche hinder parc, a Tumor alfo is perceived in che hinder part, aud che Fin~ | gers by realon of the compreffion of the Tendons and Nerves going to chem cannot be excended.
But if a Luxacion be made co the fides, a Tu= mot appears in chac part into which che fall 1s: ‘made; andadepreffion into chat from which che
Joync as fallen.
The Prognoftick
| The Luxation of thefe parts 1s not dangerous, whenas they may eafily be reftored into cheit
place. The Cure
The bones of the Wrift, mto what part foever they be luxared,may be without any extenfion ae all reduced inco their place, after chis manner ; ler che Hand of che Patienc be placed upon a Board or Table, and that withthe palm downward if che luxacion be co the hinder parts; but with che back downwards, if icbecoche fore parcs; after= wards let che Chirurgeon moft ftrongly force the luxated Joync tothe contrary part, either with che palm of his Hand in more tender bodies 5 of wich his Heel, in bodies chat are ftronger.
The fame cule is obferved in replacing the bones of the Afcer-wrift and Fingers, except thac fome fervant holding with one Hand che Fingers, wich che other Hand che Arm;dorh make a light extens fion ; the bones being reduced, Medicines that bin- deran Inflammation and ftrengthen the Joynis muft be applied, and the part muft be convenient ly bound up and placed.
Chap. 9. Of 4 Luxation of the Thigh.
op BS Thigh-bone, the longeft and greaceft in
che Body of Man, ac itsupper parc wich its”
head fufficiencly great, chick, and exactly half Globous, is not only moft exadly halt joyned by an Enartbrofis to the bofom ot the Hip fufiici ently large and deep'to receive thishead, burcalio is moft ftrongly united co it by a moft firm Liga- ment arifing from che bofom of the Hip, and im planted into the narrow bofom of che head of che Thigh,to cheend thar the Thigh might by fo much che eafier and more readily be bowed, extended, moved co the fides, and turned about, and not ea= fily flip torch. The
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Sa a eres
[bility of che Groyn they ufe che whol Thigh mare ftraight in going, than when it was found: fom times alfo chey draw their foot upon the ground;
are the fame as of the Luxation of the Shoulder, | whenas chey cannot eafily bend the upper fune ko wit, excernal andviolenc, a fal, a blow, or | dtures which are ac the Groynand Knee,alchough
{ome other violent and indecent excenfion and di- | they walk upon the whol foot; buc-in thole at
ftorfion of the Thighs buc che cautes of an im- whofe cender age this joynt fallen forch is not -re2
perfect Luxation are che humors flowing to this} ftored;‘cheir Thigh-boneis more diminifhed than
joynt, and by degrees chrufting it out of irs | that of che Leg or Foor, but the Thigh is little dis
feat. °°" | minifhed, only che fleth every where is abated; e= The Differences. | {pecially ac che hinder pace.
1: | lithe Thigh-bone be luxated coche
But chis joynt fals forth co four parts, che for- me ed es ) binder parr, there are contrary figns mer, hinder, but feldom, whenas che brow of the| “” #”"- to thole mentioned, co wir, The Cavity in this pare is higher ;) co che outer and! Head of the Thigh being fallen to rhe Butcocks ig
‘anward parc moft often, whenas ac that place the | difcovered by a Tumor about chole parts, boih by brow is lower; and fomtimes the Thigh admits of | che fight and touch: the Groyns on the concrar¢ a Subluxation from an incernal caufe 5 whence appear more loofe; theaftected Thigh by reafon when Paulus Hgineta, lib. 6. de remed. c.118. of the compreffion and diftenfion of che Mufcles writes chat che Arciculacion of the Hip doth Only compafling the head of che Thigh cannac be ex:en-
The Caufes. The Caufes of a perfect Luxation of che Thigh
- fuffera Luxation and not a Subluxation, that is dedy and ’tis tendered fhoxter chan che found éne ¥
to be underftood of that only which is from an’ the heeldothnot touch the ground, whence the external and violent caufe 5 for we fee ofcentimes Patients canneither ftand nor go, but fal heads thac by a flux of humors fome have the Ligaments longbackwards, becaufe the body flides co thae in the Thigh relaxt and mollefied, chac they can- | part, and che head of the Vhigh being out of ixg not retain che head of the Thigh-bone firmly in proper place is not directly oppofed co under= ats Cavity, whence follows a certain Subluxa- | propthe body 3 yee che man may bend his Thiph rion. |1f hebe nov hindered by pains for whenas the Signs Diagnoftick | head of the Thighs is by force with ics whol neck
| expelled into the great’ Mufcle of che Buctocks; lithe Thigh be !uxated cothe fore} whicti extends this Articulation, this Mufcle ads
the Diagno- | pace, a Tumor appears avout the) mictting che head ofthe Thigh fallen forth is moft
tes Groins, whenas the head of the) of al tormented, whenas cis diftended and preft | ated torve | Thigh leans toche Pubes 3 the Buc= | under ic, and of neceflicy mutt be feized on by an fore part. tocks on che contrary, by reafon of the! Inflammation 5 bucin procefs of ime, when chis
* Mufcles contracted with the Thigh co the Pubes, feem wrinkled ; the Urine is fuppreft by reafon of che compreflion of che bladder by rhe head of the Thigh, che external Thigh can nether be bent tior brought co the Groin, whenas the head of che Thigh isin the very bending place; the man is al{o in pain if hebe. forced to bend his Kee, by reafon of the former Mulcle, which ari- fech from che bone which belongechcothe Loyns; for that is compreft, and being retche as jift up by | forch is not reftored, when che pain is ceafed, and the head of the Thigh, and whenas ic can be nol che joy ut accuftomed to be turned in the fleth, the furcher extended, it refifts; orherwife it equals | man indeed may walk, yet he is forced co bow ve= i0 length che whol found Thigh co the Heel; for ry much towards che Gtoyn when he walks, and the Thigh going forth of its Cavicy comes co the! chat for cwo reafons, Becaufe the Thigh is render- fore part and a Jiccle lower, by which ic comes to\ ed much fhorter, and the heel is far off from tou= pafs chat che Thigh bure equals the lengch of che ching the ground ; for ifhe cry never fo nsich co found one; which efpecially fals out fo ae ehe| ftand on chat foot, leaning upon no othec thing; Hee]; che Toes of che Foot cannot eafily be ex- | he wil every where fal backwards; but if intene tended, norturned tothe gtound, whence in wale | der age chis joynt luxated after chismanner be noe king che Patient is compelled co tread only on che reduced, the Thigh-bone is made fhort, and the Heel. But inthem who at ftrong age have this | whol Thigh is {poiled, and is lefs incceafed, and joynt fallen forth into this pare, and not reftored; | made flenderer, being tor no ufe.
If che T high be luxaced to the outer parc, i¢ 1f known by chefe figns; Be- tweenche Anus and Cod.there is {een a | Cavity and Jeannefs; onthe contrary
in
Muicle is freed from an Inflammation , and cond tracts a certain glutinous bumor, chac part of ic which couchech rhe joyne. grows toa Callus, and the Kuee is bent without any pain; moreover the head of che Thigh being luxaced co the hindee parc, the Thigh and Foot appear moderately ftraight, and donot incline much one way noc other.
Bur when in ripe age the Thigh-bone fallen
To thé is fallen, can forthwith go uprighe without a ftaff, | outer and wholly upright ; for by ceafon of the inflexi-
Of a Luxation of the Thigh. deol 7 gees
i vi
Semel ROS Soa aes SERN Rs SO TRIMS
ae a
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a
2684 Book
et
Of Prattical Phy/ick.
yer
Ss 38 serene tee