Of Medicine, in Eight Books

by Aulus Cornelius Celsus

But the lower jaw and the vertebræ, and all the joints, though they be secured by strong ligaments, are luxated by the force of a blow, or when the ligaments are either ruptured, or some way weakened; and more easily in children or lads, than in those that are more robust. And they slip out forward and backward, and inward and outward; some of them in all these ways, others in particular ways. And there are some general signs belonging to all, others peculiar to each one: for there is always a tumour in that part, to which the bone is propelled, and a cavity in that from whence it recedes. Now these marks are common to them all; the others peculiar to the several bones will be mentioned, when I speak of each case distinctly.

But though all the articulations may be dislocated, they cannot be all replaced; for the head is never reduced, nor a vertebra in the spine, nor a jaw-bone, which being out on both sides, has raised an inflammation before it could be returned. Again, those that slip out from the fault of the ligaments, when they are forced into their places, give way again. And those that have been dislocated in childhood, and have not been reduced, grow less than the rest: and the flesh of all these that are not in their place, is decayed, and more so in the member nearest to it, than in one beyond it. For instance, if the humerus is not in its place, the arm wastes more than the fore-arm, and that more than the hand. Then according to the situations, and the nature of the accidents, there is left either more or less use of the limb; and the more use remains of it, the less it is wasted.

Now whatever is dislocated should be reduced before an inflammation begin. If that has already seized it, till it cease, it must not be meddled with; after its removal, trial must be made in such limbs as are reducible. A great deal depends upon the habit both of the body and the ligaments: for if the body be slender, or humid, or if the ligaments be weak, the bone is more quickly reduced; but it is both more liable to dislocation, and is less firmly held after it is reduced[(24)]. Bodies of the contrary qualities hold it faster in its place; but when once forced out, admit of its return with difficulty. It is proper to alleviate the inflammation by applying sordid wool squeezed out of vinegar; and if the misfortune be in a strong articulation, to abstain from food for three, and sometimes even five days; to drink warm water till the thirst be gone; to observe these rules more strictly in luxations of those bones, that are held by strong large muscles; and much more so if a fever has ensued; on the fifth day to foment with hot water; and taking away the wool, to apply cerate made of Cyprine oil, with the addition of nitre, till the inflammation be entirely removed. Then it is proper to use friction to the limb; to take food of good juices, wine in moderate quantity; and by this time, to make some use of the limb: because motion, as it is extremely hurtful in pain, so it is very salutary when the pain is removed. These observations are general; I shall now treat of the particular cases.

CHAP. XII. OF A LUXATED MAXILLA.

In a dislocation of the lower jaw it is pushed forward, but sometimes on one side, sometimes on both. If on one side, it inclines together with the chin to the contrary side, the teeth do not answer to each other, but the canine teeth below are opposite to the incisores: if on both sides, the chin leaves its place, and is protruded to the external part; and the lower teeth come farther out than the upper; and the muscles of the temples appear tense. The patient, as soon as possible, must be placed in a seat in such a manner, that an assistant may secure his head behind; or he may be seated near a wall, putting a hard leather cushion between the wall and his head, and let his head be pressed upon the cushion by an assistant, that it may be kept the steadier; then the thumbs of the physician being wrapped up with linen cloths, or rollers, that they may not slip, must be introduced into his mouth; and the fingers must be applied externally. When the maxilla is firmly grasped, if the luxation be on one side, the chin must be shaken, and brought towards the throat; then at the same time his head must be held, and the chin being raised, the maxilla forced into its place, and the mouth shut; and all this must be done almost in the same instant. But if the luxation be on both sides, the same method must be taken; but the jaw-bone must be forced back equally on both sides. When the bone is replaced, if the case was attended with a pain of the eyes and neck, blood must be taken from the arm. And as liquid food at first is proper for all persons, whose bones have been dislocated, so particularly in this circumstance; where even frequent speaking, by the motion of the mouth, hurts the nerves of the temples[(25)].

CHAP. XIII. OF A LUXATION OF THE HEAD.

In the first part of this book, I have already observed, that the head is secured upon the neck by two processes received into two depressions of the upper vertebra. These processes are sometimes dislocated toward the posterior part; the consequence of which is, that the nerves below the occiput are extended, the chin is fixed upon the breast, and the patient can neither drink, nor speak, and sometimes discharges his semen involuntarily. Such patients die very quickly. I judged it necessary to mention this case, not because there is any cure for it; but that it might be known by its symptoms, and if any should lose a friend in this way, they might not think it was for want of a physician.

CHAP. XIV. OF A LUXATION IN THE SPINE.

The same misfortune attends those, whose vertebræ of the spine are luxated. For this cannot happen, unless both the medulla, which passes through the middle, and the two membranes, that go through the two processes on the sides, as also the ligaments, that secure them, be ruptured. They are dislocated both backward, and forward; both above and below the transverse septum. As they slip the one way or the other, there will be either a swelling or a cavity behind. If this happens above the septum, the hands become paralytick, a vomiting or convulsions follow, the breath is oppressed, and a violent pain and deafness ensue. If below the septum, the thighs are paralytick, the urine is suppressed, and sometimes it even flows involuntarily. Though a person does not in such cases die so quickly as where the head is luxated, yet it commonly happens within three days; for what Hippocrates has directed in a vertebra luxated externally, that the patient must be laid prone, and extended, and then a person ought to stand upon him with his heel and force it in, must be understood of those, that are but partially displaced, not of these, that are entirely luxated; for sometimes a weakness of the ligaments causes a vertebra to protuberate forwards, though it be not dislocated: this is not mortal. But it is not possible to force it back from the internal part. If any vertebra be reduced from the external side, it generally returns again, unless, which is very rare, the tone of the nerves be restored[(26)].