The Compleat Surgeon Part 39

The _Clavicle_ is oftner loosen'd from the _Acromion_ than from the _Sternum_; when it hath left the former the Arm cannot be lifted up; the _Acromion_ makes a Prominence, and the Clavicle descends downward, a Cavity appearing in its place. To reduce this Luxation, the Patient is to be laid upon some Convex Body put between his Shoulders; both which are to be press'd backward, to raise up the Clavicle: Afterward he is to be set in a Chair, that his Arm may be drawn backward, whilst the {300} Surgeon is employ'd in pressing the Clavicle and _Acromion_, to join 'em together.

_The Dressing and Bandage_

Are the same with those that we have already shewn, in treating of the Fracture of the Clavicle.

CHAP. IV.

_Of the Luxation of the _Vertebra's.

In the Luxation of the _Vertebra_'s of the Neck, the Head stands to one side, and the Face is swell'd and livid, with a difficulty of Respiration.

To reduce this Dislocation, the Patient is to be set upon a low Seat, an a.s.sistant leaning on his Shoulders, to keep his Body steady, whilst the Surgeon or Operator draws his Head upward, and turns it from one side to another: Then if the Accidents or Symptoms cease, the Cure is perform'd; so that Fomentations may be apply'd to the Part; and the Patient being laid in his Bed, must take care to avoid moving his Head.

When the _Vertebra_'s of the Back or Loins are luxated on the inside, a sinking of the Bone is soon perceiv'd; whereupon the Patient being laid on his Belly, the Extension is to be made with Napkins pa.s.s'd under the Arm-Pits, and upon the _Os Ileum_, whilst the Surgeon with {301} a strong Extension makes some Efforts on the Spine, endeavouring to draw back the _Vertebra_. If that be not sufficient, 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 may be taken out with a Pair of _Forceps_. Then the Wound is to be dress'd with Pledgets, a Plaister, and a Napkin, which must not be bound too close, for fear of pus.h.i.+ng back the Spine.

When the _Vertebra_ is luxated on the outside, a Prominence appears; so that to reduce this Dislocation, the Extension is to be made as before, the Patient lying in like manner upon his Belly; but in order to push back the _Vertebra_, two little Sticks trimm'd with Linnen-Cloth are to be prepar'd, and laid along the two sides of the Spine of the _Vertebra_; yet these Sticks ought to be thick enough to remain more elevated than the _Apophysis Spinosa_; and a large wooden Roller is to be often roll'd upon 'em, which by its turning backward and forward, may thrust the _Vertebra_'s inward; so that when all the _Vertebra_'s are of an equal height, the Reduction is finish'd. If the _Vertebra_'s are luxated on the side, the same Extensions are to be made, and the Prominence is to be push'd, to re-establish the _Vertebra_ in its place.

_The Dressing and Bandage._

The Dressing is prepar'd by laying two thin Plates of Lead on each side of the Spinous Process of the _Vertebra_, to maintain it in its Place, and a long Bolster over 'em. The {302} proper Bandage is the _Quadriga_, which hath been before describ'd, in treating of the Fractures of the Breast-Bone.

CHAP. V.

_Of the Luxation of the _Coccyx_ or Rump-Bone._

If the _Coccyx_ be sunk on the inside, it is to be rais'd with the Fore-finger of the Right-hand put into the _a.n.u.s_; and if the Luxation be on the outside, it may be gently thrust back again. An Account of its proper Dressing and Bandage hath been already given in the Fracture of the _Coccyx_.

CHAP. VI.

_Of the _Bunch_._

The _Bunch_ is nothing else but an exterior Luxation of the _Vertebra_'s, and for the Cure thereof, it wou'd be requisite to keep Emollients for a long time upon the _Vertebra_'s, to loosen the Ligaments, and to wear Iron-Bodice; which in compressing the _Vertebra_'s by little and little, might perhaps drive 'em back into their Natural Place.

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CHAP. VII.

_Of the Luxation of the Ribs._

The Ribs are luxated either on the outside, or on the inside: If they be dislocated on the inside, a Cavity is perceiv'd near the _Vertebra_'s, the Patient drawing his Breath with Pain, and not being able to bend his Body.

When the Luxation is on the outside, and happens in the upper Ribs, the Patient's Hands are to be hoisted upon the top of a Door, to raise up the Ribs, whilst the Surgeon presseth the Prominence of the Rib to restore it to its place.

When the lower Ribs are luxated, the Patient must be oblig'd to stoop, laying his Hands upon his Knees, and the Prominence of the Bone is to be thrust back.

If a Rib be luxated on the inside, an Incision is to be made to draw it out with the Fingers.

_The Dressing and Bandage_

Are the same with those that are us'd in the Fracture of the Ribs.

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CHAP. VIII.

_Of the Sinking of the _Xiphoides_, or Sword-like Cartilage_.

To raise up the _Xiphoid_ Cartilage, it must be fomented before for some time with Oil of Turpentine, or other Fomentations, made with Aromaticks; then the Patient is to be laid upon his Back, with a Convex Body underneath, and the Shoulders, and Sides of the Breast are to be press'd, to lift up the Cartilage. When this Operation is not sufficient, dry Cupping-Gla.s.ses are usually apply'd, till the Part be elevated, and a strengthening Plaister is afterward laid upon it.

CHAP. IX.

_Of the Luxation of the _Humerus_, or Arm-Bone_.

The Head of the _Humerus_ generally falls under the Arm-Pit, so that the luxated Arm becomes longer than the other, the _Acromion_ appears pointed on the outside; the Elbow starts from the Ribs, and cannot be mov'd without great Pain. To reduce this Bone, the {305} Patient is to be set upon a low Seat, or else on the Ground, whilst some Person supports his Body with a Napkin: In the mean time the Surgeon is to lay hold on the upper-part of the _Humerus_, a Servant kneeling behind him, who is to hold the Patient's Arm above the Elbow, which is to pa.s.s between the Surgeon's Legs, and is to be drawn down by the a.s.sistant as much as is possible, whilst the Surgeon in like manner draws the Arm, to remove the Head of the Bone out of the place where it was stopt; insomuch that the Bone sometimes makes a Noise in re-entring its Cavity.

Or else the Patient's Arm may be laid upon the Shoulder of a taller Man than himself, who is strongly to draw the luxated Arm upon the Fore-part of his Breast; during which time, the Operator is to push the Head of the _Humerus_, to cause it to re-enter its Cavity.

Otherwise the Patient may lie on the Ground, a Tennis-Ball being put under his Arm-Pit, which a Servant is to draw strongly with a Handkerchief pa.s.s'd under the Shoulder, whilst another a.s.sistant stands behind the Patient, to thrust down the Shoulder with his Foot; at the same time the Surgeon sitting between the Patient's Legs, is to push strongly with his Heel the Ball that lies under the Arm-hole.

Or else, a thick Battoon or Leaver may be laid on the Shoulders of two Men, after a Tennis-Ball hath been nail'd on the middle of it; otherwise a Bunch may be made therein, and cover'd with Linnen-Cloth; two Wooden Pins being also fixt on each side of the Ball: {306} Then the Patient's Arm-Pit is to be set between those two Pins, and upon the Ball, where he is to remain hanging, whilst his Arm is pull'd down by main force. The same thing may be done by laying the Patient's Arm-Pit upon a Door, or else upon the Round of a Ladder.

_The Dressing and Bandage_

A little Ball of Linnen is to be laid under the Arm-Pit, and underneath a Bolster with four Heads, which are cross'd upon the Shoulder; as also a Bolster under the sound Arm-Hole, that it may not be gall'd by the Bandage _Spica_, the Nature of which we have shewn in treating of the Fracture of the Clavicle.

CHAP. X.

_Of the Luxation of the Elbow._