The whole course of chirurgerie wherein is briefly set downe the causes, signes, prognostications & curations of all sorts of tumors, wounds, vlcers, fractures, dislocations & all other diseases, vsually practiced by chirurgions, according to the opinion of all our auncient doctours in chirurgerie. Compiled by Peter Lowe Scotchman, Arellian, Doctor in the Facultie of Chirurgerie in Paris, and chirurgian ordinarie to the most victorious and christian King of Fraunce and Nauarre. Whereunto is annexed the presages of diuine Hippocrates.

The third Chapter, of Dislocations.

CO.

Like as wee haue done in Fractures, so we will followe out in dislocations but for the better vnderstanding thereof, I woulde knowe of you, after how many fashions the boanes are ioyned together, before we come to the definition of the dis∣ease.

LO.

All boanes are ioyned generally two wayes, to witte, by Ar••thro••, that is, by articulation, and by Sym∣phis••, that is, by naturall vnion.

CO.

Howe many sortes are there of articulation?

LO.

There are two, to witte, Diarthrosis, that is, coniunction with mouement manifest to the sight, as legges, armes, feete and handes: Synarthrosis, is mouing more obscure to bee perceiued, as the teeth, the sutors of the head.

CO.

Howe many sorts are there of ma∣nifest mouinges?

LO.

Three, to witte, Enarthrosin, that is, when there is a great cauitie, that receiueth a long round∣nesse, as the thigh with the haunch: the second is Arthro∣dia, that is, when a superficiall cauitie receiueth a little su∣perficiall head of a boane, as the arme and shoulder with

the omoplat, the third is ginglimus, that is, when the boanes receiue one another, as in the connexion of the knee, and the cubitus with the arme.

CO.

Howe many sortes are there of obscure mouinges?

LO.

Galen saith, that there are three, to wit, suture, as the sutures of the head, the se∣cond is called gomphosis, that is, when the boane is infixed in like a nayle, as the teeth in the iawe boane: the thirde is called Harmonia, as the nose with the head, the boanes of the face which are ioyned together like a lyue.

CO.

You haue tolde sufficiently of articulation, nowe tell me of naturall vnion, and howe many wayes it is done.

LO.

Two wayes, eyther without mediation, but by succession of time grow∣eth together, as the nether iaw boane, which manifestly is distinguished in children, or else by mediation, and is done three wayes, to witte, the cartilage, as the boane pubis: se∣condly by the nerue or tendon, as the sternon and as illium are ioyned together: thirdly by flesh, as the teeth are faste∣ned. This, as also all the Anotomie is most perfectly de∣clared by Robert Achymutie Chirurgian of Edenburgh, sometime Chirurgian in the great Hospitall of Paris.

CO.

What is Dislocation?

LO.

It is an outgoing of the boane out of the naturall seate, which letteth the mouing.

CO.

Howe many differences are there of Dislocations?

LO.

Three, of the which the first is called complete, when the boane is altogether out of the place, the second is im∣complete, when the boane is not altogether, but a little out, the third is distortion, elongation or peruertion of the liga∣ment.

CO.

How many wayes is Dislocation complete done?

LO.

Foure wayes, before, behinde, outward and inward, some vp, some downe, but not oft seene.

CO.

Howe many differences hath incomplet?

LO.

It hath three, the first, that the ligament in the ioynt and about it is relaxed, as chaunceth in the haunch, the seconde, when the liga∣ment is forced by great violence, as the legge or foote in making a wrong or croked steppe: the thirde is, when by

little and little the ligament relaxeth & bringeth the boane after it, as chaunceth in the backe.

CO.

How many diffe∣rences hath the third, which is called distortion?

LO.

No difference, but onely the boane is made longer from the o∣ther.

CO.

Which are the causes of luxation?

LO.

Two, to witte, externe and interne.

CO.

Which are the ex∣terne?

LO.

Falles or stroakes▪ and too violent extending of the member violently again•••• the figure naturall.

CO.

Which are the interne?

LO.

Great aboundance of hu∣mor pituitous, gathered in the ioynture, which humecteth the ligamentes, and maketh them softe and humide, so the boane goeth out, or by the extenuation of the muscles a∣bout the ioynture.

CO.

Howe knowe you Dislocation?

LO.

By the extraordinarie tumor of the place, by the emptinesse of the place, where the boane was, by the priua∣tion of the moouing, accompanied with dolor.

CO.

By what iudgement or signe knowe you those that are easie and those that are difficill, and those which are incureable and mor∣tall?

LO.

I iudge by the kinde and diuersitie of the Dislocation, and bodie, as for example, the 〈◊〉〈◊〉 is easie to goe forth & to goe in, also the finger, in like manner mem∣bers leane, and where the nerues and ligamentes haue store of humiditie and moistnesse, the arme difficill to goe forth, and hard to put in againe, and in grosse, fatte and tender people, those with fracture and apostume are euill to heale, those are very difficill, that haue the sides broken, those which haue bene long out, are almost impossible, the two vppermost vertebres of the necke beeing out, letteth the spiration, and so the partie dieth within the space of three dayes.

CO.

What method vse you for the cure hereof.

LO.

The methode generall for all Dislocations hath foure intentions: the first is, to put the boane in his owne proper place, the extension of the member first made, with handes or machins: the second intention is to coatinue it in the place by good medicamentes and bandages as in

Fractures: the third is, to put the member in right situation: the fourth, to giue order to the accidentes, as by good dyet, purging, and bleeding if neede be, & reduce the Fracture, before the inflamation be come, otherwise stay, till it bee past, when it is neare whole, or the accidentes past, we shal vse thinges to corroborate and comfort the parte with cer∣taine simples sodde in wine, next, the emplaister oxycrosiū, or ad fracturas.

CO.

If the Dislocation chaunce with Frac∣ture, what is to be done?

LO.

First reduce the Dislocation, next the Fracture if it be possible, some reduce the Fracture, next the Dislocation, it being reduced and the Dislocation simple, foment with oyle of roses, whites of egges, and cloth wette in oxicrate, with splintes, putting it in good fi∣gure, with as little paine as may be. It must not be stirred, till the 7. day, except inflamation or some euill accident doe fall, at which time foment it with hot water, thereafter, the astringent as in Fractures, keepe good dyet, eate little for 4. or sixe dayes, till the inflamation be past. If the Disloca∣tion be composed with causes interne, as aboundance of humors, which looseth the ligamentes, wee vse astringent and drying medicines, if it be accompanied with dolor and inflamation, cure it, as yee haue heard, if feuer, vse good dyet, purgations and bleeding, in the ende of the cure cor∣roborate the parte with decoction of roses, wormewood and wine, thereafter the emplaister of oxycrosium.

Notes

• Lib de os••ibus
• Paul. lib. 6. c. 3.
• Celsus. lib. 8. cap. 20. Gal. com. aph. 2. et lib. 1. de articulis.
• Gal. de causis morborum ca. 2. & artis paruae cap. 58. com. a∣pho. 26. et lib. 1. de articulis. Celsus. lib. 8. cap. 11. com. a∣pho. 1. lib. 11. de officin medici.
• Paulus lib. 6.
• Celsus
• Cure.
• Celsus. lib. 8. cap. 2.
• Albucrasis. To.
• Guido. 2. doct. cap. 1. Hip. apho. 65. lib. 4. de artic. Hip. lib. citato. Celsus. lib. 8. cap. 2.