De Medicina |
Translator: Walter George Spencer
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| 205 |
At in digitis totidem fere casus eademque signa sunt , quae in manibus . Sed in his extendendis no n aeque ui opus est , quo m et articuli breuiores et nerui minus ualidi sint . Super mensam tantummodo intendi debent , qui uel in priorem uel in posteriorem partem exciderunt ; tum i ma palma conpelli : at id , quod in latus elapsum est , digitis restitui .
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19 Now the fingers can be dislocated in almost as many ways as the hand and the signs are the same. But in stretching these less force is required, for the joints are shorter and the sinews less strong. They only need to be stretched out on a table, when the dislocation is forwards or backwards; then reduction is made with the palm of the hand; but when the displacement is to one side, by means of the surgeon's fingers. |
| 206 |
Cum de his dixerim , de is quoque , quae in cruribus sunt , uideri possum dixisse : siquidem etiam in hoc casu quaedam similitudo est femori et umero , tibiae et cubito , pedi et manui . Quaedam tamen separatim quoque de his dicenda sunt . Femur in omnes quattuor partes promouetur , saepissime in interiorem , deinde in exteriorem , raro admodum in priorem aut posteriorem . Si in interiorem partem prolapsum est , crus longius altero et ua tium est : extra enim pes ultimus spectat ; si in exteriorem , breuius uarumque fit , et pes intus inclinatur ; calx ingressu terram non contingi t , sed planta i ma; melius que id crus superiusque corpus quam in priore casu fert , minusque baculo eget . Si in priorem , crus extensum est , in cli narique non potest ; alteri cruri ad calcem par est : sed ima planta minus in priorem partem inclinatur ; dolorque in hoc casu praecipuus est , et maxime urina supprimitur . Vbi cum dolore inflammatio quieuit , commode ingrediuntur , totusque eorum pes inced it . Si in posteriorem , extendi non potest crus , breuiusque est ; ubi constitit , calx his quoque terram non contingit . Magnum autem femori periculum est , ne uel difficulter reponatur , uel repositum rursu s excidat . Quidam iterum semper excidere contendunt : sed Hippocrates et Diocles et Ph ylotimus et Nileus et Heraclides Tarentinus , clari admodum auctores , ex toto se restituisse memoriae prodiderunt : neque tot genera machinamentorum quoque ad extendendum in hoc casu femur Hippocrates , Andreas , Nileus , Nymphodorus , Protarchus , Heraclides , quidam quoque faber repperissent , si id frustra esset . Sed ut haec falsa opinio est , sic illud uerum est : cum ibi ualentissimi nerui musculique sint , si suum robur habent , uix admittere ; si non habent , postea non continer e . Temptandum igitur est : et si tenerum membrum est , satis est haben a alter a ab inguine , alter a a genu intendi ; si ualidius , melius adducent , qui easdem habenas ad bacula ualida deligarint ; cumque eorum fustium imas partes oppositae morae obiecerint , superiores ad se utraque manu traxerint . Etiamnum ualentius intenditur membrum super scamnum , cui ab utraque parte axes sunt , ad quos habenae illae deligantur ; qui , ut in torcularibus conuersi , rumpere quoque , si quis perseuerauerit , non solum extendere neruos et musculos possunt . Collocandus autem homo super id scamnum est aut pronus aut supinus aut in latus sic , ut semper ea pars superior sit , in quam os prolapsum est , et ea inferior , a qua recessit . Neruis extensis , si in priorem partem os uenit , rotundum aliquid super inguen ponendum , subitoque super id genu adducendum est eodem modo eademque de causa , qua idem in brachio fit : protinusque , si conplicari femur potest , intus est . In ceteris uero casibus , ubi ossa per uim paulum inter se recesserunt , medicus debet id , quod eminet , retro cogere ; minister contra inde coxam propellere . Reposito osse , nihil aliud curatio requirit , quam ut diutius is in lecto detineatur , ne , si motum adhuc neruis laxioribus femur fu erit , rursus erumpat .
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20 Since I have described the above, I can be held also to have described displacements in the legs: for in this kind of accident also there is some similarity between the thigh and upper arm, between the tibia and ulna, between the foot and the hand. But there are also some special points to note about the legs. The thigh-bone may be moved out of place in all four directions, oftenest inwards, next outwards, very rarely forwards or backwards. If it has been dislocated inwards, the leg is longer than the other, and is bowed; for the point of the foot looks outwards; if outwards, the leg becomes shorter and knock-need, and the foot is inclined inwards; the heel in walking does not touch the ground, but only the extreme end of the sole; the leg in this case supports the rest of the body better and more uprightly than in the other and there is less need for a stick. If forwards, the leg is extended and cannot be bent; as far as the heel the injured leg is the length of the other one, but the extremity of the sole is less bent forward; and in this case there is marked pain, and very often the urine is suppressed. When the inflammation and pain have subsided, the patients walk fairly and the whole of their foot touches the ground. If backwards, the leg cannot be stretched out, and is shorter; when the patient is standing the heel in these cases too cannot touch the ground. But the great danger with regard to the thigh is that it is difficult to replace, or, after replacement, slips again out of position. Some hold that it always does so; but such renowned authorities as Hippocrates and Diocles and Phylotimus and Nileus and Heracles of Tarentum have related that they had completely restored such cases; nor would Hippocrates, Andreas, Nileus, Nymphodorus, Protarchus, Heraclides, and a certain smith as well, have invented so many sorts of instruments for making extension on the thigh after this accident, if it had been all of no use. But although that opinion is a false one, there is this truth in it: since the ligaments and muscles there are very strong, if they retain their strength they scarcely allow of replacement; if not, they do not keep in place afterwards. Replacement, then, is to be attempted; and if the limb is weak it is sufficient to stretch it by straps, one from the groin, another from the knee; if stronger, the assistants will have more purchase if they have knotted the straps around long poles; and if after pressing the lower ends of the poles against firm supports, they have drawn the upper ends towards themselves with both hands. Even more forcible pressure can be exerted by stretching the limb over a bench, at either end of which is a windlass to which the straps are attached; when these are rotated as in a winepress, it is possible, by continuing to do this, even to rupture the ligaments and muscles, and not merely to stretch them. Now the patient is to be laid upon this bench, on his face or back or side, so that that part is always the higher into which the bone has slipped, and that from which it has receded the lower. When the sinews have been stretched, if the bone comes forwards, some round object is placed over the groin and the patient's knee must be pulled back over it with a jerk, in the same way and for the same reason for which this was done in the case of the forearm; as soon as the thigh can be bent up, the bone is in place. In the other cases, when the bones under extension have receded a little from each other, the surgeon should force the projecting part back, whilst an assistant presses the hip in the opposite direction. When the bone is replaced nothing further need be done, but the patient must be kept in bed for a rather long time or the thigh may become displaced again on moving while the sinews are still relaxed. |
| 207 |
Genu uero et in exteriorem et interiorem et in posteriorem partem excidere notissimum est . In priorem non prolabi plerique scripserunt ; potestque id uero proximum esse , cum inde opposita patella ipsa quoque caput tibiae contineat . M eg es tamen eum , cui in priorem partem excidi sset, a se curatum esse memoriae prodidit . —In his casibus intendi nerui rationibus isdem , quas in femore rettuli , possunt . Et id quidem , quod in posteriorem partem excidit , eodem modo , rotundo aliquo super poplitem inposito adductoque eo crure , reconditur . Cetera uero manibus simul , dum ossa in diuersas partes * * * conpellentur .
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21 It is very well known that the knee is put out externally and internally and backwards. Many have written that it does not slip out forwards; and this may be very near the truth, for the knee-cap is there right in front and holds the head of the tibia in place. Meges, however, has recorded a case in which he replaced a knee which had slipped forwards. In cases affecting the knee-joint the sinews can be extended by the same means as I have described for the thigh. And when it has slipped out backwards, as described above, a round ball of some kind is placed on the ham, and when the leg is bent up over it, the knee slips back again. In the other cases it is to be replaced by the surgeon's hands while the bones are being drawn apart in opposite directions. |
| 208 |
Talus in omnes partes prolabitur . Vbi in interiorem partem excidit , ima pars pedis in exteriorem partem conuertitur ; ubi huic contrarius casus , contrarium etiam signum extat . Si in priorem partem erumpit , a posteriore latus neruos durus et insanus est : m an uque his opus est : si in posteriorem , calx paene conditur , pla nta maior fit . Reponitur autem is quoque per manus , prius in diuersa pede et crure d iductis. Et in hoc quoque casu diutius in lectulo perseuerandum est , ne is talus , qui totum corpus sustinet , parum confirmatis neruis ferendo oneri , cedat rursusque prorumpat . Calciamentis quoque humilioribus primo tempore utendum , ne uinctura talum ipsum laedat .
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22 The ankle can be dislocated in all fought directions. When it slips inwards, the sole of the foot is turned outwards; when outwards, the contrary sign is exhibited. If the ankle is dislocated forwards, the broad sinew behind is hard and tense, and in those cases manipulation is required; if backwards, the heel is almost hidden and the sole is elongated. But this is also replaced by manipulation, the foot and leg first being stretched in opposite directions. And after this kind of accident also, the patient should stay for a long while in because, lest the ankle, which sustains the whole weight of the body, should give way and again be displaced if the sinews have not gained strength enough for bearing the weight. At first low shoes should be worn, so that the ankle may not be injured by tight lacing. |