1 72. It has been formerly stated by us that it will be of importance for any person who practices medicine in a populous city to get prepared a quadrangular board, about six cubits or a little more in length, and about two cubits in breadth; a fathom will be sufficient thickness for it; and then along it from the one end to the other, an excavation must be made, so that the working of the levers may not be higher than is proper; then at both sides we are to raise short, strong, and strongly-fixed posts, having axles; and in the middle of the bench five or six long grooves are to be scooped out about four inches distant from one another, three inches will be a sufficient breadth for them, and the depth in like manner; and although the number of grooves I have mentioned will be sufficient, there is nothing to prevent their being made all over the bench. And the bench should have in its middle a pretty deep hole, of a square shape, and of about three inches in size; and into this hole, when judged necessary, is to be adjusted a corresponding piece of wood, rounded above, which, at the proper time, is to be adjusted between the perineum and the head of the thigh-bone. This upright piece of wood prevents the body from yielding to the force dragging downward by the feet; for sometimes this piece of wood serves the purpose of counter-extension upward; and sometimes, too, when extension and counter-extension are made, this piece of wood, if susceptible of some motion to this side or that, will serve the purpose of a lever for pushing the head of the thigh-bone outward. It is on this account that several grooves are scooped out on the bench, so that this piece of wood, being erected at the one which answers, may act as a lever, either on the sides of the articular heads of bones, or may make pressure direct on the heads along with the extension, according as it may suit to push inward or outward with the lever; and the lever may be either of a round or broad form, as may be judged proper; for sometimes the one form and sometimes the other suits with the articulation. This mode of applying the lever along with extension is applicable in the reduction of all dislocations of the thigh. In the case now on hand, a round lever is proper; but in dislocations outward a flat lever will be the suitable one. By means of such machines and of such powers, it appears to me that we need never fail in reducing any dislocation at a joint. 73. And one might find out other modes of reduction for this joint. If the large bench were to have raised on it two posts about a foot (in diameter ?), and of a suitable height, on each side near its middle, and if a transverse piece of wood like the step of a ladder, were inserted in the 1 The drawings of the scamnum Hippocratis, as given by us from Vidus Vidius and Littré, will render this description quite intelligble. It is thus described by Celsus: "Etiamnum valentius intenditur membram super scamnum, cui ab utraque parte axes sunt, ad quos habenæ illæ deligantur: qui, ut in torcularibus, conversi, rumpere quoque, si perseveraverit, non solum extendere, nervos et musculos possunt." (viii., 20.) See the Plates. posts, then if the sound leg were carried through between the posts, and the injured limb were brought over the transverse piece of wood, which should be exactly adapted in height to the joint which is dislocated, (and it is an easy matter so to adjust it, for the step of the ladder should be made a little higher than required, and a convenient robe, folded several times, is to be laid below the patient's body), then a piece of wood, of suitable breadth and length, is to be laid below the limb, and it should reach from the ankle to beyond the head of the thigh-bone, and should be bound moderately tight to the limb. Then the limb being extended, either by means of the pestle-like piece of wood (formerly described), or by any of the other methods of extension, the limb which is carried over the step with the piece of wood attached to it, is to be forced downward, while somebody grasps the patient above the hip-joint. In this manner the extension will carry the head of the thigh-bone above the acetabulum, while the lever power that is exercised will push the head of the thighbone into its natural seat. All the above-mentioned powers are strong, and more than sufficient to rectify the accident, if properly and skillfully applied. For, as formerly stated, in most cases reduction may be effected by nach weaker extension, and an inferior apparatus. 4. If the head of the bone slip outward, extension and counterextension must be made as described, or in a similar manner. But along with the extension a broad lever is to be used to force the bone from without inward, the lever being placed at the nates or a little farther up, and some person is to steady the patient's body, so that it may not yield, either by grasping him at the buttock with his hands, or this may be effected by means of another similar lever, adjusted to one of the grooves, while the patient has something laid below him, and he is secured, and the dislocated thigh is to be turned gently from within outward at the knee. Suspension will not answer in this form of dislocation, for, in this instance, the arm of the person suspended from him, would push the head of the thighbone from the acetabulum. But one might use the piece of wood placed below him as a lever, in such a manner as might suit with this mode of dislocation; it must work from without. But what use is there for more words? For if the extension be well and properly done, and if the lever be properly used, what dislocation of the joint could occur, that might not be thus reduced?1 75. In dislocation of the thigh, backward, extension and counterextension should be made as has been described; and having laid on the bench a cloth which has been folded several times, so that the patient may lie soft, he is to be laid on his face, and extension thus made, and, along with the extension, pressure is to be made with a board, as in the case of humpback, the board being placed on the region of the nates, and See the Plate at the end of the volume. transverse pi the joint w 72. It has been formerly stated by us that it will be of im, through bet any person who practices medicine in a populous city to get quadrangular board, about six cubits or a little more in lengti. for the step of and a conve at ent's body), the and below the 1 of the thigh Then the lim of wood (form two cubits in breadth; a fathom will be sufficient thickness then along it from the one end to the other, an excavation mi so that the working of the levers may not be higher than is at both sides we are to raise short, strong, and strongly-fixed axles; and in the middle of the bench five or six long groo scooped out about four inches distant from one another, thr be a sufficient breadth for them, and the depth in like although the number of grooves I have mentioned will be su is nothing to prevent their being made all over the ben, the limb wh bench should have in its middle a pretty deep hole, of a squ of about three inches in size; and into this hole, when jud ve the hip-joint. is to be adjusted a corresponding piece of wood, rounded aligh-bone abov the proper time, is to be adjusted between the perineum ar the thigh-bone. This upright piece of wood prevents tel to it, is to be will push the h e-mentioned po yielding to the force dragging downward by the feet; for accident, if prop piece of wood serves the purpose of counter-extension upw most cases reduction times, too, when extension and counter-extension are mador apparatus. wood, if susceptible of some motion to this side or that. outward, extensi purpose of a lever for pushing the head of the thigh-bor" in a similar man is on this account that several grooves are scooped out o used to force the b as a lever, either on the sides of the articular heads of bor so that it may not that this piece of wood, being erected at the one which ates or a little furth pressure direct on the heads along with the extension, acc hands, or this ma suit to push inward or outward with the lever; and the levee to one of the gro a round or broad form, as may be judged proper; for somet and he is secured, an and sometimes the other suits with the articulation. Thin outward at the ing the lever along with extension is applicable in the dislocation, for, in th be dislocations of the thigh. In the case now on hand, proper; but in dislocations outward a flat lever will would push the he might use the piece By means of such machines and of such powers, it appner as might suit wi need never fail in reducing any dislocation at a joint. out. But what use is and properly done, a If the large bench were to have raised on it two pos of the joint could occ diameter ?), and of a suitable height, on each side near a transverse piece of wood like the step of a ladder, W. backward, extension 1 The drawings of the scamnum Hippocratis, as given by and Littré, will render this description quite intelligble. I Celsus: "Etiamnum valentius intenditur membram super sc que parte axes sunt, ad quos habenæ illæ deligant versi, rumpere quoque, si perseveraverit, non s possunt." (viii., 20.) See the Plates. en described; and hav several times, so t face, and extension ti s to be made with a aced on the remor of "end of the ** 149 evere-arrusi through between the posts, and ent over the transverse piece of wood, when 2 le it to the joint which is discocated, just t. for the step of the ladder stondi Lan Suresi, and a convenient robe, fouesi the patient's body), then a piece of wood, to be and below the limb, and it should the head of the thigh bone, and snowad Then the limb being extendesi, -te de Dance of wood (formerly described), or f extension, the limb which is carried over : wsi attached to it, is to be forced downward, hat ent above the hip-joint. In this manner of the thigh-bone above the acetabulum, terised will push the head of the thighthe above-mentioned powers are strong, Iv the accident, if properiv and skillfully tiei, in most cases reduction may be effected at 1 an inferior apparatus. .1.. bone slip outward, extension and counterred, or in a similar manner. But along rs to be used to force the bone from without at the nates or a little farther up, and some t's body, so that it may not yield, either by with his hands, or this may be effected by -. aljusted to one of the grooves, while the him, and he is secured, and the dislocated fm within outward at the knee. Suspen n of dislocation, for, in this instance, the - him, would push the head of the thight one might use the piece of wood placed a manner as might suit with this mode of without. But what use is there for more -well and properly done, and if the lever on of the joint could occur, that might zh, backward, extension and vanterbeen described; and laring on the dded several times, so tout the job26 • face, and exterson to is made, ani, is to be made with a warm in the - placed on thereon a un mes LHŮ ler, when extremity ily pressed middle of ved, being rd, so that m the most wer will be bone. But ner to a con he extension to be bound t of medicine › accomplished 3d; for this is art, who does subject now on on of the body, ad:-In the first ligatures, either pped round with f them which are is bands. In the the strongest and ich, either those at stened to the thresnd a square piece of e foot to the other; and to the feet of the ty for this; then the those at the feet, are ood, at either end; the or be a little elevated to the pestles, so that, reshold, and the other to be made by bending rong steps, if laid below and the piece of wood can be fastened to the thus make extension of les, or strong staffs. Celsus em. (viii., 20.) rather below than above the hip-joint; and the hole made in the wall for the board should not be direct over, but should be inclined a little downward, toward the feet. This mode of reduction is particularly appropriate to this variety of dislocation, and at the same time is very strong. But perhaps, instead of the board, it might be sufficient to have a person sitting (on the seat of luxation ?), or pressing with his hands, or with his foot, and suddenly raising himself up, along with the extension. None of the other afore-mentioned modes of reduction are natural in this form of dislocation. 76. In dislocation forward, the same mode of extension should be made; but a person who has very strong hands, and is well trained, should place the palm of the one hand on the groin, and taking hold of this hand with the other, is at the same time to push the dislocated part downward, and at the same time to the fore part of the knee. This method of reduction is most especially conformable to this mode of dislocation. And the mode of suspension is also not far removed from being natural, but the person suspended should be well trained, so that his arm may not act as a lever upon the joint, but that the force of the suspension may act about the middle of the perineum, and at the os sacrum. 77. Reduction by the bladder is also celebrated in dislocations at this joint, and I have seen certain persons who, from ignorance, attempted to reduce both dislocations outward and backward therewith, not knowing that they were rather displacing than replacing the parts; it is clear, however, that he who first invented this method intended it for dislocation inward. It is proper, then, to know how the bladder should be used, if it is to be used, and it should be understood that many other methods are more powerful than it. The bladder should be placed between the thighs uninflated, so that it may be carried as far up the perineum as possible, and the thighs beginning at the patella are to be bound together with a swathe, as far up as the middle of the thigh, and then a brass pipe is to be introduced into one of the loose feet of the bladder,' and air forced into it, the patient is to lie on his side with the injured limb uppermost. This, then, is the preparation; some, however, do the thing worse than as I have described, for they do not bind the thighs together to any extent, but only at the knees, neither do they make extension, whereas extension should be made, and yet some people by having the good fortune to meet with a favorable case, have succeeded in making reduction. But 'By "feet" is meant corners, I suppose. Dietz gives the following note on this passage: "Pedes utris quatuor anguli dicuntur, capræ pedum reliquiæ. Sæpius in Hispania vinum hujusmodi utribus inclusum, qui pleni tumidique capræ formam referunt, a mulionibus transvehi cognovi iisque mulis impositis loco clitelJarum usus sum viator." (Ed. Dietz, tom. i., p. 30,) In like manner, "pes veli" means "the lower corner of a sail." See Catullus, iv., 19; and Facciolati's Lexicon, under Pes. |