Of Medicine, in Eight Books

by Aulus Cornelius Celsus

CHAP. XV. OF A LUXATION OF THE HUMERUS.

The humerus slips sometimes into the axilla, sometimes forward. If it has fallen into the arm-pit, the cubitus recedes from the body, and cannot be brought upward with the humerus to the ear of the same side; also that arm is longer than the other: if forward, the upper part of the fore-arm is extended, but not to its full length; and the cubitus is moved with more difficulty forward than backward.

Therefore if the humerus has fallen into the arm-pit, and the patient be young, or of a lax habit, so that the ligaments are weak, it is sufficient to place him in a seat; and to order one assistant to draw back gently the head of the broad bone of the scapula, and another to extend the fore-arm; while the physician himself sitting behind, with his knee under the patient’s arm-pit, forces the humerus upwards, and at the same time presses the scapula with one hand, while he pushes the cubit to the side with the other.

But if the patient be of a large stature, or the ligaments more robust, a wooden spatha is necessary of the thickness of two fingers, and so long as to reach from the arm-pit to the fingers. In the top of it, is a small round head a little hollowed; that it may receive some part of the head of the humerus; and in three places at due distances there are two holes made for the admission of soft straps. This spatha being wrapt up in a roller, that it may hurt the less, is applied from the fore-arm to the arm pit, in such a manner, that the head of it is put under the axilla; then it is tied to the arm by its straps, in one place a little below the head of the humerus, another a little above the elbow, and the third above the hand; to which purpose the distances of the holes are then also to be adapted. The arm being thus tied up is put over a step of a ladder, so high, that the patient cannot stand upon the ground; and at the same time his body is suffered to sink on one side, and his arm kept extended on the other; the effect is, that the head of the humerus, being impelled by the head of the spatha, is forced into its place, sometimes with a crack, sometimes without it. It appears from Hippocrates alone, that there are many other methods; but none of them has been more approved by experience than this.

But if the humerus is luxated forward, the patient must be laid on his back, and a roller, or strap put round the middle of the arm-pit, and the ends of it delivered to one assistant behind the patient’s head, and his fore-arm to another; then the first must be ordered to extend the strap, and the other the fore-arm; and the physician must thrust back the patient’s head with his left hand, and with his right raise the cubitus together with the humerus, and force the bone into its place; which in this case is more easily reduced than in the former.

When the humerus is replaced, wool must be put under the arm-pit; that if the bone was in the interior part, it may prevent its returning; if forward, that it may however be more conveniently rolled up. Then the roller being first carried under the arm-pit, ought to surround the head of the bone, and passing over the breast to the other arm-pit, and from that to the scapulæ, and back again to the head of the luxated humerus, it must be carried round in this manner several times, till the head of the humerus be well secured. The humerus being thus bound up is better fixed, if it be drawn close to the side, and tied down to it with a roller.

CHAP. XVI. OF A LUXATION OF THE CUBITUS.

From what has been said in the first part of this book, it may be understood, that three bones meet together at the elbow, the humerus, radius, and cubitus. If the cubitus, which is fixed to the humerus, separates from it, the radius, which is contiguous to it, is sometimes dislocated, and sometimes remains firm. Now the cubitus may be luxated in all the four different ways. If it be displaced forward, the fore-arm is extended, and cannot be bent; if backward, the fore-arm is bent, cannot be extended, and is shorter than the other; sometimes it brings on a fever and bilious vomiting; if externally, or internally, the fore-arm is stretched, but is a little bent to that part, from whence the bone has receded.

Whatever species it be, the method of reduction is the same (and not only in the cubitus, but in all the larger limbs, which are joined in the articulation by a long process) to extend both limbs different ways, till there be a void space between the bones; and then to thrust the luxated bone from that side, into which it has prolapsed, to the contrary. However the methods of extension are various according to the strength of the ligaments, and the position of the luxated bones. And sometimes the hands alone are used, sometimes other means.