A Treatise on Fractures, Luxations, and Other Affections of the BonesDesault, P.-J. (Pierre-Joseph)
Science
A Treatise on Fractures, Luxations, and Other Affections of the Bones
Desault, P.-J. (Pierre-Joseph)
Dislocations; Fractures; Surgery
17. The body passes from one place to another, on the least motion,
and sometimes, as Bell observes, the patient, on changing his position
during sleep, is awakened by severe pain, in consequence of the foreign
body being moved by this change. It happens, in certain cases, that it
disappears, and lies concealed for some time, in the back part of the
joint. During this period the joint performs all its functions with
freedom and ease. Desault made this remark, in the case of a captain of
dragoons, from whom, for the first time in his practice, he extracted
one of these bodies, and who, for six months previously, had been able
to perform all the motions of the joint freely, without pain. This
person, experiencing no uneasiness, considered himself perfectly cured,
when the body suddenly reappeared, in consequence of a hasty extension
of the leg.
18. If the body, when projecting under the integuments, be gently
compressed, it yields to the pressure, changes its situation, and,
according to the impression it has received, moves either to the
internal or the external side of the joint, or reciprocally from one
side to the other, passing also behind the rotula, behind the inferior
ligament, or sometimes behind the tendon of the extensor muscles. In
these alternate displacements, it may in some cases be turned round,
in such a manner that its anterior surface will take the place of its
posterior one, and then resume its primitive situation. Desault met
with an instance, in which the patient himself was in the habit of
turning the body round in this manner.
19. Bell, in conformity to the distinction of articular concretions
into cellular and solid, attributes to each division its peculiar
signs. In the first case, the pains, being rather obtuse than sharp,
are constant; in the second, they are extremely acute, but disappear
and return at intervals. Supposing the division to be a real one, cases
of the last description certainly occur much more frequently than those
of the first.
§ V.
OF THE TREATMENT.
20. From what has been said it follows, 1st, that these cartilages
floating through the joints, do mischief mechanically (14), by coming
into contact with the articular surfaces: 2dly, that to obviate this
mischief, it is necessary either to prevent their contact, by fixing
the bodies in a spacious part of the joint, and thus doing constantly
what nature does on certain occasions, or to extract them through an
opening made into the articular cavity.
21. Hence, art can have recourse to but two methods of cure, all hope
of discussing these tumours by external applications being, as Bell
observes, entirely extinguished.
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