Of Medicine, in Eight Books

by Aulus Cornelius Celsus

Having treated of the humerus[(28)], what I said there may seem to suffice for the lower extremities; for there is some similitude in this case between the femur, and humerus, the tibia, and cubitus, the foot and hand. However something must be said in particular about these.

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.