Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. XIII. Of a DSLOCATION of the BACK-BONES.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Dislo∣catio, seu Luxatio Ossium, vel Vertebrarum Dorsi; and in Eng∣lish, A Dislocation of the Ver∣tebrae, or Bones of the Back.

II. Those Vertebrae which gene∣rally make up the Back-Bone, are those of the Thorax, and Loins: the Vertebrae of the Thorax are for the most part twelve, to which so many Ribs of a side answer; there are seldom thir∣teen of each, but more seldom eleven: and the Vertebrae of the Loins are always five.

III. Their Spines or hinder Processes, are not divided, as those in the Neck: the transverse are short and blunt, each having a shallow Sinus, for the inar∣ticulation of the Ribs, but are not perforated as those of the Neek; the oblique Processes, which are two ascending, and two descending, serve for the Articulation of one Vertebra with another.

IV. The descending are a little hollowed, and receive the protu∣berant Heads of the ascending Processes of the next Vertebrae below them, successively: and the forepart of their bodies, next to the cavity of the Thorax, are round or convex; the hinder part lunated, or concave; and on each side they have a smooth Sinus, for the reception of the heads of the Ribs: for into these Sinus's they are received, as well as into those of the transverse Processes.

V. This Luxation may be made either inwards or outwards, or to the right or left sides.

VI. The Signs. The Disloca∣tion is inwards, when there is a sinking of the Bone inwards, or a depressed cavity in the Spine, it is outwards, when there is a Bunch or Sticking-out on the Back; and it is to the right or left side, when they obliquely bunch out to either side, or the Patient is crooked, leaning to one side.

VII. The Causes. It is caused

either by external Force, from Falls, Blows; or too much, and long, and often Stooping one way: or from Internal Humors, of which in the next Chapter.

VIII. The Prognosticks. The Vertebrae cannot be thrust in with∣out a great deal of violence; because it cannot be without breaking of the Ligaments, for that they will rather break, than suffer so great extension.

IX. Paraeus, lib. 15. cap. 11. says, that such a Dislocation is mortal; because the Spinal Marrow is exceedingly violated by too strait compression; whence comes loss of sense in the Members lying under: and a Paralysis of those Parts, which receive branches of Nerves from the Conjugations or Pairs of Nerves, from the Vertebrae lying below the Dislocation.

X. The Cure. Where the Dislo∣cation is inwards, the Patient is to be laid upon his Belly; and the Extension is to be made with Napkins put under the Armpits; and upon the Os Ileon: the Artist in the mean season endea∣vouring to draw the Vertebra back again.

XI. If this is not sufficient, Fabricius Hildanus, Cent. 5. Observ. 59. prescribes a Cure by Cutting. An Incision is to be made upon the Apophysis Spinosa of the Vertebra: so that after having laid open this Process of the Bone, it is to be taken hold of with a pair of Forceps, and pulled up again.

XII. Then the Wound is to be drest with Pledgets, and a Pla∣ster, and bound about with a Napkin; and it to be treated and cured as a green Wound: but it is not to be bound too hard, for fear of pressing down again the Spine.

XIII. If the Luxation is out∣wards, it is not so dangerous yet it is seldom cured, or not without great difficulty: to reduce this, the Extension must be made as be∣fore, the Patient lying in like manner upon his Belly: but in order to thrust back the Verte∣bra, two little Sticks armed with Linnen Cloth or Rags, are to be prepared, and laid along the two sides of the Spine of the Verte∣bra: but these Sticks ought to be so thick, as to be higher than the Apophysis Spinosa: then a large Wooden Rowler is to be often rowled upon them, which by its often turning or rowling backwards and forwards, may thrust or force the Vertebrae in∣ward: thus when all the Verte∣brae are of an equal height, the Reduction is finished.

XIV. If the Vertebrae are lu∣xated sideways, the same Extensions are to be made; and the Promi∣nence is to be thrust the con∣trary way, to be put in its right place again.

XV. If the way of Extension at Sect. 10. above, be not sufficient, and Mens Arms are not of force enough; you must then do it by the help of Hippocrates his Table, which we have described in Lib. 6. Cap. 2. Sect. 34. ad 47. where you have the way and manner of doing the Work, the which you may imitate upon occasion.

XVI. As to the Dresing, two thin Plates of Lead are to be laid

on either side of the Spinous processes of the Vertebrae, to maintain and keep it in its place, and a long Bolster is to be put over them, after which you are to bind it up with Swaths, after the manner we have taught in binding up the fractured Ster∣non.