Part 46
In cases of displacement backward along the vertebrae, it does not
often happen, in fact, it is very rare, that one or more vertebrae
are torn from one another and displaced. For such injuries do not
readily occur, as the spine could not easily be displaced backward
but by a severe injury on the fore part through the belly (which would
prove fatal), or if a person falling from a height should pitch on
the nates, or shoulders (and even in this case he would die, but not
immediately); and it also would not readily happen that such a displacement
could take place
[p. 242]forward, unless some very heavy weight should fall
upon it behind; for each of the posterior spinal processes is so constructed,
that it would sooner be broken than undergo any great inclination
forward from a force which would have to overcome the ligaments and
the articulations mutually connecting them. And the spinal marrow
would suffer, if from the displacement of a vertebra it were to be
bent even to a small extent; for the displaced vertebra would compress
the spinal marrow, if it did not break it; and if compressed and strangled,
it would induce insensibility of many great and important parts, so
that the physician need not give himself any concern about rectifying
the displacement of the vertebra, accompanied, as it is, by many other
ill consequences of a serious nature. It is evident, then, that such
a case could not be reduced either by succussion or by any other method,
unless one were to cut open the patient, and then, having introduced
the hand into one of the great cavities, were to push outward from
within, which one might do on the dead body, but not at all on the
living. Wherefore, then, do I write all this? Because certain persons
fancy that they have cured patients in whom the vertebra had undergone
complete dislocation forward. Some, indeed, suppose that this is the
easiest of all these dislocations to be recovered from, and that such
cases do not stand in need of reduction, but get well spontaneously.
Many are ignorant, and profit by their ignorance, for they obtain
credit from those about them. These are deceived in this way, for
they suppose the spinous processes to be the vertebrae themselves,
because every one of them appears round to the touch, not knowing
that these bones are processes from the vertebrae, as formerly stated;
but the vertebrae are at a considerable distance before them; for
of all animals, man, in proportion to his bulk, has the belly (
internal
cavity?) the narrowest from behind to before, especially at the breast.
When, therefore, any of these processes are severely fractured, whether
one or more, the part there appears lower than on either side, and
for that reason they are deceived, supposing that the vertebrae are
displaced inward. And the attitudes of the patient contribute also to deceive them;
for if they attempt to put themselves into a bent position, they
[p. 243]are
pained, from the skin being stretched at the seat of the injury, and
at the same time the fragments of the bones wound the skin still more;
but if they bend forward, they feel easier, for the skin at the wound
is thus relaxed, and the bones are less disposed to hurt them; and
if touched, they shrink and bend forward, and the part which is touched
appears empty and soft. All the circumstances now mentioned contribute
to deceive the physician. Such patients speedily get well without
any bad effects, for callus readily forms in all such bones as are
porous.
