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. IV. Of a DISLOCATION with a WOƲND.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Dislocatio cum Vulnere: and in English, a Dis∣location with a Wound.

II. The Prognosticks. A Dislocation or Luxation join'd with a Wound, is very dangerous; and if the Joint be either uncover∣ed, or a little thrust forth with∣out the Skin, it is for the most part mortal.

III. If it is reduc'd, the dan∣ger is greater, than if it is not: if it is not reduc'd, Inflamma∣tion will come upon it, some∣times Convulsions, and some∣times Death.

IV. Or there will be a filthy and Incurable Ʋlcer; which if by chance it is brought to Cicatrize at all; it will easily be dissolved, by reason of its softness.

V. If it is reduc'd, there will be extream danger of Convulsion, Gangrene, and of Death, which ge∣nerally follows it.

VI. Hippocrates, de Articulis Art. 4. Text. 16, 17. says, who∣so has the Bones of the Leg Luxa∣ted with a Wound, so that they hang forth of the Joint, whether inwardly or outwardly, they are not to be reduc'd; for if they be, and so remain, they shall Die, nor shall they Live many days; for few such pass the seventh day, by rea∣son of a mortal Convulsion; more∣over

a Gangrene does also happen: and these things you must know will certainly come to pass.

VII. This Danger, says Senner∣tus, Med. Pract. lib. 5. part. 6. cap. 2. is so much the greater, by how much the Member is greater, and the Nerves and Muscles about it are greater, and by how much the Wound is nearer the Joint.

VIII. For as much, as because of Distention of the Nerves and Muscles, Pains, Inflammations, Convulsions, acute Fevers, Gan∣grenes, and a Sphacelus may be induc'd: and therefore it is that Hippocrates, is against reducing of Luxated Bones, and their Bindings up; and orders us to use at the beginning only things which asswage Pain, and takes away Inflammation.

IX. And he is of Opinion, that no Bones can be safely reduc'd ex∣cept those of the Fingers, Hands, and Feet: And in a Finger, (in which there is the least of dan∣ger) the Luxation ought not to be replaced when there is an Inflammation, but either be∣fore it comes, or after it is as∣swaged.

X. But some fear these kinds of dangers only in the great Joints as, the Shoulder, Arm, Wrist, Thigh, Knee, Ancle; by reason of their strong Tendons, great Liga∣ments, and considerable Vessels.

XI. The Cure. If it may be reduc'd, it must be at first, before Inflammation: but you are to let the Patient and by-standers know the eminent danger, that the Artist may save his Credit, and his Art not be disparaged, if things should not succeed.

XII. This, says Scultetus, the Chirurgian must attempt the first, second, eighth, or ninth day, that he may not appear to be ignorant; first looking to the Inflammation, and Convulsion; and then to the Wound and Dislocation.

XIII. If the Joint is replaced, and an Inflammation or Convulsion should then happen; it must be thrust out of its place again, (if it can be done without vio∣lence.)

XIV. However, you must en∣deavour to abate the Inflammation, and then the Cure of the Wound must be ordered, applying to it Lenient Medicaments, as in a Fracture with a Wound; after which you must take Care of the Dislocation.

XV. But if they possess one place at one time, first respect the Dislo∣cation, then the Wound, applying over all, Sticticum Paracelsi: and see that the Member it self be so placed, that the Sick may lie in as much ease as is possible.

XVI. When the Joint or Bone cannot be reduc'd, care must be first taken for Ʋniversals and Diet: and the Part must be placed in a mean Figure, (without any extension or binding) either hanging from the Shoulder or Neck, or laid down in a Cap∣sula, or in a Junk or Trunk, that the Sick may feel as little Pain as may be.

XVII. And if vehement Pain is present, or Inflammation and Con∣vulsions may be feared to be near, or at hand, they ought to be prevented or hindred by such things as are anodyn, digestive, a little cooling and repellent.