LUX 



rrom tlie fcapTioides andcuboides. The tranfverfe dirfftion 

 of the articulation formed by thefe four bones, fuggefted to 

 Chopart the ingenious idea of amputating only a part of 

 the foot. Bat thefe luxations, lefs dangerous than the 

 others, can be occafioned only by a violent eftort in which the 

 anterior part of the foot is lixed, as happened in the two 

 cafes related by J. L. Petit, the foot being fadencd in an iron 

 grate, wlii'.ft the body was drawn backwards. The aftra- 

 galus and os calcis may, under thefe cinuimftanccs, be luxa- 

 ted, but particularly the former, the head of which Aides 

 from below upwards, in the cavity of the potterior face of 

 the fcaphoides, and forms a tumour on tlie back of the 

 foot. The inflammatory fwelling renders it often difficult 

 to afcertain this luxation. It is not eafily reduced, even 

 fiwrtly after it has taken place. Boycr fniled in a cafe of 

 this kind in which the head of the aftragalus was luxated 

 upwards and inwards by a fall from a horfe ; but in fome 

 time the perfon felt no inconvenience from the aiTeiilion, he 

 could walk witliout pain or lamenefs, and nothing remained 

 bnt the deformity occafioned bv the tumour. 



The other bones of the tarfus and metatarfus are too 

 flrongly tied together to admit of luxation. The phalanges 

 of the toes cannot be luxated by external violence, on ac- 

 count of their fhortnefs. However, the polTibility of luxa- 

 tion of the firft phalanx of the great toe from the firft bone 

 of the metatarfus may be eafily conceived. See Boyer on 

 the Bones, vol. ii. 



Compound Luxations. — We (hall conclude the prefent ar- 

 ticle with a few remarks on the treatment of compound 

 diflocations. The luxation of a large joint, bein*^ conjoined 

 with an external wound, leading into the capfular ligament, 

 is a circumftance that has a particular tendency to increafe 

 the dinger of the accident. In many cafes we fee injuries 

 of this defcri])tion followed by violent and extenfive inflam- 

 mation, abfceffes and floughing, fever, delirium, and death. 

 When the patient is advanced in years, is much debilitated, 

 or of an unhealthy irritable conftitution, compound luxa- 

 tionsl efpccially if attended with much contufion and other 

 injury of the foft parts, and wrongly treated, very often 

 have a fatal termination. This, however, is not the general 

 event of thele cafes, and whatever may have happened in 

 former times, we now know, that in the prefent improved 

 Itate of furgerv fuch accidents moftly admit of cure. We 

 would not, however, by any means inlinuate cenfure againft 

 every inllance of amputation performed in thefe cafes : we 

 know that fuch operation is occalionally mdilpenfable imme- 

 diately when the accident is ieen, and we are equally aware, 

 that it may become neceflary in a future llage, when extenfive 

 abfceffes or (longhing, joined with threatening conftitutional 

 fvmptoms, have occurred. Our only delign is to recommend 

 the endeavour to cure the generality of compound luxations. 

 But if a cafe were to prefent itfelf, attended with very 

 great contufion and laceration of the foft parts, w'e Ihould 

 be as earnelt advocates for amputation as any praftitioners. 



The treatment of a compound diflocation requires the re- 

 duction to be effefted without delay, and with as little vio- 

 lence and difturbance as poiTible. The limb is then to be 

 placed in fplints, with the requifite pads, eightecn-tailed 

 handage, &c. The wound is to be freed from any dirt or ex- 

 trane«us matter, and its lips accurately brought into contaft 

 with llrips of adhefive pialler. The joint is to be covered 

 ■with linen w'et with the faturnine lotion, the bandage is to 

 . be loofeiy laid down, and the fphnts faflenod on with their 

 proper ftraps or pieces of tape, and the limb is to be kept 

 perfedtly at re!t in an eligible pollure. The patient, if 

 ftrong and young, is to be bkd. This laft praftice may be 

 more freelv adopted in the country than in London, or large 



Voi.. XXI. 



L U X 



hofpitaN. Purging, however, mufl never be omitted, and 

 an anodyne, the firft night or two, will be highly proper. 

 Saline draughts, antimonials, and a low regimen, arc alfo 

 indicated during the firfl; few days of the fympto.matic fever 

 which commonly follows fo ferious an accident. 



If the cafe takes a favourable courfe, theconditutional in- 

 difpofition will not be exceflive, nor will the pain and inflai^- 

 mation of the limb be immoderate. Sometimes the wound 

 even unites, more or lefs, without fuppuration, a circum- 

 ftance of the higheft importance, as tending more than any 

 thing to leden the danger, by changing the cafe, as it were, 

 from a compound into a fimple one. In other cafes, the 

 wound is not united, but the inflammation and fuppuration 

 are not violent or extenfive, and there is every reafon to ex- 

 pcA ultimate fuccefs. When the wound is difpofed to unite 

 favourably, lint and adhefive platter are the bcft drcflings. 

 In other inftanccs, while the fuppuration is at all copious, or 

 the inflammation high or extenfive, emollient poultices are 

 moft eligible. 



■When the fymptomatic fever and firft inflammatory fymp- 

 toms are over, and there is much difcharge, attended with 

 marks of approaching weaking, the patient is to be allowed 

 more food, and be diredted to take bark, cordials, porter, 

 wine, &c. If his nights are reftleis, he muft have opiates ; 

 and, in Ihort, all fuch medicines as his particular complainU 

 may require, are to be prefcribed. 



When the inflammation of a compound diflocation is 

 violent or extenfive, general bleeding, and the ufe of leeches, 

 are the moft eff'edual means of counterafting the mif- 

 chief. 



In certain cafes, the moft Ikilful treatment is unavailing. 

 The joint and limb become affected with confiderable pain and 

 fwelling ; the fever runs high ; delirium comes on ; and the 

 patient may even perilh from the violence of the firft fymp- 

 toms, the limb being generally at the fame time attacked' with 

 gangrene. If thefe firft dangers are avoided, the wound may 

 not heal favourably; the inflammation may be extenfive ; large 

 abfcefles under the fafcix may be formed ; and the heftical 

 fymptoms and iinking ftate of the patient may make the 

 only chance of recovery depend upon amputation. But 

 even this operation is fometimes deferred till too late, and 

 the patient muft be left to his mifcrable fate. 



Wiioever gives the fmallcft reflection to the nature of 

 compound fractures, will perceive, that it is often a matter 

 of the laft importance to make a right decifion at the very 

 beginning, whether amputation fliould be immediately done, 

 or whether an attempt to fave the limb ought to be made. 

 In fome inftanccs, the patient's fole chance depends upon 

 the operation being performed at once without the leall 

 delay, and the opportunity of doing it never returns. 



Thus, when great inflammation and a rapid raortitlcatioii 

 of the limb follow the accident, the patient may die before 

 the floughing has fliewn the leaft inclination to ftop. 



But, befides this firft critical period, the furgeoti often has 

 to exercife a nice degree of judgment in a future ftage of the 

 cafe ; we mean when the fuppuration is copious, and the 

 health much impaired. Here the praftitioner may err in 

 taking off a limb that might be laved ; or he may commit 

 a vv'orfe fault, and make the patient lofe his life in a fruitlefs 

 attempt to fave the member. No precepts can form the 

 right praditioner in this delicate part of furgery ; genius 

 alone cannot do it ; we would add, mere experience, how- 

 ever great, cannot do it : the opportunity oif making obfer- 

 vations, and the talent of profiting by them, are here the 

 things which make the confuniniate furgeon. 



LUXEMBOURG, FRANClsHEN-RYBEMoNT-MOnENCY, 



Duheof, \n Biogral'by, a celebrated rrench general, fon of the 

 4 S cou«t 



