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. XXIV. Of a DISLOCATION of the KNEE, or BONES of the LEG.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Dislocatio Ossis, pl. Ossium Cruris; and in English, A Dislocation of the Bone, or Bones of the Leg. It is also called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Dislocatio Genu; and in English, A Dislocation of the Knee.

II. The Thigh-Bone in its lower part has two eminent Apophyses, tending to the hinder part, with a Cavity in the middle, which receives the Apophysis of the Tibia; which Apophysis is tied to that Sinus, by a Ligament arising from the Vertex of that Head: and the Apophyses of the Os Femoris are received by the Cavities (which are not deep, but shalllow ones) of the Os Tibiae: this Articulation is loose, and is of that kind which we call Ginglymus; the fore-part of which is called the Knee, and the hindermost the Ham.

III. This Joint is guarded on the fore-part by the great and large Muscles, which running to, and beyond the Patella, join it to the Tibia, and bind it down upon the Articulation: and on the hinder-part, it is guarded with the two Ham-strings so called, viz. the Tendon of the Biceps outwardly; and of the Sartorius gracilis, Se∣mimembranosus, and Seminervo∣sus, inwardly: between which, thro' a little Cavity made for that purpose, all the Great Ves∣sels have their passage to the Legs.

IV. Now this Joint being thus strengthned, does scarcely admit of of any Luxation forwards, (for that the opposition of the Patella does hinder it) unless the Cause or Force is exceeding violent: but there may be a perfect Luxation, either inwards or outwards, which are often seen; and some∣times backwards, but that is very rare: as also a Subluxation, according to the variety of Causes.

V. The Causes. If it be caused by Falls from high places, ve∣hement Blows, Jumping, hard Running, strong Extension, Con∣traction,

or Distortion of the Leg.

VI. It may also be subluxated, thro' the afflux of Humors, as in the Rickets in Children, (which I once saw) and in the Kings-Evil in elder People; also in an Oedema, of which I knew a Patient to dye.

VII. The Signs. A Luxation in this Part is known by Sight and Touch, because it is almost a fleshless Part: there appears a Bunching-out of the side to which the Bone is fallen, and a hollowness in the place from whence it is fallen; the figure is depraved, and the mo∣tion is weakned and abolished; for the Thigh is extended, and and cannot be bent.

VIII. The Prognosticks. If it is compared with the Elbow, the Knee is oftner dislocated, and more easily reduced: it also less dan∣gerous, nor does an Inflammation easily happen, because the Re∣duction is without any great force.

IX. The Cure. The Luxation, either inwards or outwards, it easy to be restored by a moderate Ex∣tension, either with Hands in a new Luxation, and in Child's Body: or with Swaths or Bands in a Luxation not so recent, and in a stronger Body; forcing the Bones with the Hand, into the part from whence they fell.

X. A Luxation backwards is restored by placing the Sick to lean over a Bench, and putting a Linnen Ball into the hollow of the Ham, where the Bone sticks forth; and then strongly forcing the Bone forwards, whil'st another takes hold of the lame Leg, and on a sudden so bends it, as to make the Heel touch the Buttock; so will you hear it snap, when it enters into its place.

XI. Or thus. If the Tibia is luxated Sideways; one Attendant must draw the Thigh upwards, and another must in the mean season draw the Leg below the Knee down towards the Foot; and the Artist the mean while must force the Bone the contrary way: in a grown Person, and a perfect Luxation, there will be need of Swaths, Bands, or Girts; or the use of Engines, to make a suffi∣cient Extension.

XII. If the Luxation is Back∣wards, the Patient is to be laid upon his Belly; then Extension is to be made, and the whil'st the Artist is to bend his Leg, by making the Heel approach to the top of the Thigh, or But∣tock.

XIII. These things being done, Embrocate the Joint and Parts affected; and apply Astringent Medicaments in the Ham, with Compress and good Bandage.

XIV. You must prepare a Swath four Yards long, and two Inches broad, rowled up to the middle, with two Heads: then a circum∣volution is to be made above the Knee, and the Letter X is to be formed underneath; then ma∣king a circumvolution above it, the Swath is to be carried up again over the Knee; which is to be rowled about, and cross'd again underneath, 'til the Knee is perfectly cured.

XV. If it is a Sublaxation, it is Cured by a very little Extension; upon which, the Bone is to be forced back to the Part from whence it is somewhat removed.