SECT. CX.—ON BONES WHICH HAVE NOT UNITED BY CALLUS.
Sometimes fractured bones remain without forming adhesions, beyond the natural period, either owing to their being often loosed, or from too frequent bathing of the part, or from having been moved unseasonably, or from the number of the bandages, or from atrophy of the whole body, by which means the limb becomes emaciated. Wherefore we must endeavour to remove all the other causes, but more especially the atrophy, partly by calefacient applications which attract nourishment to the place, and partly by supplying a sufficiency of food and baths, and whatever also is of a refreshing nature. Among the other symptoms which follow the formation of callus, the bandages then become stained with blood, although no wound be present, which probably takes place from the substance about the callus, when it unites, squeezing out the drops of blood which were distributed to the hollows of the bones.
Commentary. When the fractured portions do not adhere after a certain time, Celsus directs us to extend the limb, and rub the ends of the bone together, in order to convert them again into the state of a recent fracture, taking care, however, not to hurt the muscles and nerves. The part is then to be fomented, and the splints applied on the fifth day.
Rhases recommends calefacient liniments, friction, and nutritive food.
SECT. CXI.—ON LUXATIONS.
We proceed to the treatment of luxations, which naturally follows that of fractures. A luxation then (to give a definition of it) is a displacement of a member from its proper cavity to an unusual place, by which means the voluntary motion is impeded. We have no other differences of it to mention, except that some are to a greater and some to a less degree. When the bone of a member, therefore, is completely removed from its place, the accident is called by the common name of luxation, but when only moved a little, or brought only to the brim of the cavity, it is called a subluxation.
Commentary. Celsus gives several important remarks upon dislocations in general, but as most of them may more properly be brought under particular heads, we shall notice them here but briefly. He distinguishes dislocations into two classes; the first consisting of a separation of two bones naturally united, such as the scapula from the humerus, the radius from the ulna, the tibia from the fibula, the os calcis from the bones of the ankle, which last is of rare occurrence, and the second being a removal of the bone of a joint from its proper place. When a dislocation occurs, as he remarks, the finger discovers a cavity in the part, and inflammation and fever come on, followed sometimes by gangrene and convulsions. If not reduced, the limb wastes. In a person who is lean, humid, and has weak nerves (muscles?) the dislocation is most easily reduced, but is more difficult to retain. The inflammation is to be reduced by the application of wool dipped in vinegar; by abstinence, a spare diet, and drinking tepid water. Afterwards friction, exercise, and a more generous diet are to be allowed. (viii, 11.)
See many curious remarks on this subject in Galen’s Commentary on Hippocrates (de Articulis), and in Apollonii Citiensis Scholia in Hip. et Galen.; also Avicenna (iv, 5, 1); Haly Abbas (Pract. ix, 101); Rhases (Cont. xxix, 2.)
SECT. CXII.—ON THE LOWER JAW.
Beginning then again from the upper parts we shall treat of the lower jaw. For the upper being immoveable does not admit of dislocation; but the lower does not indeed readily admit of complete luxation, owing to its heads being firmly fixed to the upper jaw, but it often undergoes subluxation, for the muscles which are fixed to it being relaxed by the constant exercise of mastication and speaking, the jaw is readily slackened from the most common causes. For the term used by Hippocrates signifies slackened. In these cases the part returns to its natural place without trouble. With regard to the complete dislocation of the lower jaw, it will be sufficient to deliver Hippocrates’s account, being, at the same time, brief, complete and clear. He says thus: “The jaw seldom falls out of the joint, but it is often slackened in yawning, as many other irregular actions of muscles and tendons do this. When it falls out of the joint it is marked principally by these symptoms; the lower jaw projects forwards, and is inclined in an opposite direction to the luxation; and the coronoid process of the bone swells out near the upper jaw-bone, and it is with difficulty that they shut their jaws. In these cases the suitable mode of reduction is apparent. For somebody must hold the patient’s head, another grasps the lower jaw internally and externally with his fingers at the chin, while the patient yawns as much as he can conveniently; and we must first move the jaw with the hand hither and thither for a certain time, and order the man to relax the jaw and separate it; and then we must attend to perform three evolutions at the same time, we must move the jaw from its distorted shape to its natural; push the jaw backwards; and then shut the jaws close, and prevent yawning. This is the mode of reduction, and it cannot be performed by any other processes. Very little treatment will suffice afterwards. Having applied a waxed compress, it is to be secured with a loose bandage. But the surest process is to lay the man upon his back, and supporting his head upon well-stuffed pillows, that they may not yield, to get some person to hold the head of the patient. And if both ends of the jaw be dislocated, the treatment is the same, only the mouth cannot be so well shut, for then the jaw is more prominent, but less distorted from the teeth of the upper and lower jaws corresponding exactly together. Reduction is to be immediately performed, and the mode of it has been already described. If it cannot be restored, there may be danger of the life from continued fevers, torpor, and carus. For these muscles being altered and stretched in a preternatural manner produce carus. They frequently have evacuations by the belly, which are purely bilious, and small in quantity; and if they vomit, it is pure bile. These, for the most part, die on the tenth day.” This mode of reduction we have often practised, having first used fomentations of warm water and oil, by a sponge along the dislocated jaw, more especially when there is any difficulty in restoring it to its position. Wherefore, having placed the man upon the ground, we stand behind and operate in the manner described by Hippocrates.