Fragment from the treatise Galen. Commentary on Hippocrates’ On Joints, IV. (Ιπποκρατουσ το περι αρθρων βιβλιον και Γαληνου εισ αυτο υπομνημα τεταρτον, ca. 177-180). The treatise represents the prototype of the first scientific article devoted to ligamentum capitis femoris (LCF), its anatomy, topography, function, changes in painful conditions and injuries, as well as the first documented method of conservative treatment of its pathology. See our commentary at the link: 177-180bGalen [Rus], and 2020ArkhipovSV_ProlyginaIV.
Quote.
[Grc]
Ιπποκρατουσ το περι αρθρων βιβλιον και Γαληνου εισ αυτο υπομνημα τεταρτον. Κεφ. μʹ. Μηρού δέ ολίσθημα κατ' ισχίον ώδε χρή έμβάλλειν, ήν ές τὸ εϊσω μέρος ώλισθήκη. (original source: 1829KühnCG,
pp. 731-736)
[Lat]
Hippocratis de articulis libеr et Galeni in eum commentarius quartus. Cap. XL. Ubi femur a coxa
elabatur, si in interiorem partein venerit, hac via restituendum est. (original source:
1829KühnCG, pp. 731-736)
Translation
[Eng]
Commentary on Hippocrates’ On Joints, IV. Chapter 40. On how to reduce a hip dislocation when it is displaced
inward.
If the femur comes out of the hip joint and is displaced inward, it must be returned to its place. Hippocrates was blamed for setting the thigh back because it was immediately displaced; and the first to do this was Ctesias of Cnidus, his relative - for he too was descended from the family of the Asclepiades - and after Ctesias some others. Since the judgment on all these things can be of two kinds: first, when someone is an eyewitness of the matter under investigation, and secondly, when someone, without waiting for long experience, by means of the demonstrative method discovers something from the nature of the matter, therefore we will turn to both kinds of judgment. And behold, the nature of this thing is this. In this joint, the ligament [of the femoral head] is extremely strong, rounded and hidden in it, connecting the top of the femoral head with the deepest inner part of the acetabulum. Therefore, without even seeing the ligament itself, but based only on this reasoning, we can understand that it is short: since the hip always rotates - as Hippocrates said: «it rotates in the pelvic bone» - and never leaves the acetabulum, the ligament ought to be very short. And so, it is the ligament that prevents the hip from being dislocated, at least while it is in its natural state. And not only can the ligament rupture, but also, due to the abundance of fluid that has unnaturally accumulated in the cavity [joint], become so sprain (stretched) that it sometimes allows the femur to dislocate from its natural place. And if, due to a rupture of the ligament, the hip is dislocated, then even with immediate setting it will not be able to remain in its place. Since the acetabulum is sloping and <to this is added> the great weight of the entire leg, the hip will easily immediately come out of place if someone tries to walk a little faster or step over something under his feet. Thus, if someone were to make small movements with the thigh on a level surface, it could always maintain its natural position, but this is apparently impossible. For even if a person could do nothing else, he would certainly be forced to lift his legs to enter the bath. This is how the nature of things teaches us that with a torn ligament, the re-set hip cannot remain in its place. It should also be added that on the outside of the knee joint there are several tendon ligaments and in the hip joint there is only this ligament, since neither anything of this kind, nor any muscles support the joint from the outside. For muscles also contribute greatly to the fact that joints do not dislocate so easily, especially when the muscles are strong and tense. Thus, in athletes and those who endure the strongest blows, falls, stretches and twists of the joints during wrestling, the limbs do not dislocate, because they are supported on all sides by strong and large muscles. And Hippocrates himself said at the beginning of this book that even in bulls it is the hip that get dislocated when they grow old and lose weight, because when the ligament of the hip is torn, the thigh cannot remain in the joint in its place even in after setting, the thing that especially applies to the emaciated [animals]. Next, let's look at what can happen if the ligament, weakened due to the abundance of fluid [in the joint], allows the hip to dislocate, but then it is re-set. It seems to me that it is quite obvious that in the presence of fluid the joint will dislocate again, and when it dries up, it will regain its natural strength. And the fact that dislocation of the hip can happen due to the fluid can be learned from Hippocrates himself, who writes in the “Aphorisms” thus: "Whoever, due to the chronic sciatica, has the femoral head dislocated and re-set again, will have an accumulation of mucus formed there". And when mucus builds up in the joint, then the ligament softens and weakens as a result. And it does not matter whether you call it a ligament (σύνδεσμον) or a connecting sinew (νεῦρον συνδετικόν). For those ligaments that have a rounded shape like tendons are usually called connecting sinews by the anatomists. And we have already righted this kind of hip dislocation twice, and it did not dislocate again. Drying medications should be applied over the joint for a long time until the connective sinew is dry enough to stop stretching together with the thigh bone extending beyond the edge of the acetabulum and keep it in its natural position. And that the hip sometimes remains set, there is a most reliable witness, Heraclides of Tarentum, a man who did not lie for the sake of the teaching of [his] school, as many of the dogmatists would have done, and was not ignorant of [medical] art, but, like no other, devoted much time to medical practice. Let us listen to his words, which he wrote in the fourth book of "On External Therapy." He says literally the following: «Those who believe that the hip does not remain set because the ligament (νεῦρον) connecting the femur to the acetabulum is torn, do not know things of general knowledge, when expressing their negation. For neither Hippocrates nor Diocles would have described the reductions, and neither would Phylotimus, Evenor, Nileus, Molpis, Nymphodorus and some others. And we have achieved this goal [reduction] in two children, although in adults the joint is dislocated again more often. This case should be judged not from hearsay, but since the thigh sometimes remains [set], it must be assumed that this ligament does not always rupture, but that it stretches and contracts again, for the study [of this question] is useful, but not in all cases». Heraclides added these words at the end of the argument in defense of his empirical school. And the empiricists have this proposition: it is useless to investigate the cause of those things that can be clearly observed and from which we can immediately derive benefit for the [medical] art. But even after Heraclides, many other younger doctors noted that the hip they had set remained so forever. (original source: 2020ArkhipovSV_ProlyginaIV, + machine translation into English from our article 2019АрхиповСВ_ПролыгинаИВ based on the Greek text from by 1829KühnCG and minor edits).
External links
Kühn CG. Clavdii Galeni Opera omnia. Editionem cvravit D. Carolvs Gottlob Kühn, professor physiologiae et pathologiae in literarvm vniversitate Lipsiensi pvblicvs ordinarivs etc. Vol. XVIII. Pars I. Lipsiae: Prostat in officina libraria Car. Cnoblochii, 1829. [archive.org, babel.hathitrust.org]
Arkhipov SV, Prolygina IV. Ancient Textual Sources on Ligamentum Teres: Context and Transmission. MLTJ. 2020;10(3):536-546. [mltj.online , mltj.online(PDF) , researchgate.net]
Архипов СВ, Пролыгина ИВ. Гален о вывихе бедра и связке головки бедренной кости. Opera medica historica. Труды по истории медицины. Альманах РОИМ. 2019;4:89-96. [Arkhipov S.V., Prolygina I.V. Galen o vyvikhe bedra i svyazke golovki bedrennoi kosti. Opera medica historica. Trudy po istorii meditsiny. Al'manakh ROIM. 2019;4:89-96. (In Russ.)] [researchgate.net ; kias.rfbr]
Authors & Affiliations
Galen (Κλαύδιος Γαληνός, Aelius Galenus, Claudius Galenus, Γαληνός ὁ Περγαμηός, Galenus Pergamenus, Galen of Pergamon; 129–210/217) was a Roman and Greek physician, surgeon, anatomist, and philosopher. [wikipedia.org]
 |
| Galen Engraver Georg Paul Busch (18th cent.); original in the wikipedia.org collection (CC0 – Public Domain, no changes). |
Keywords
ligamentum capitis femoris, ligamentum teres, ligament
of head of femur, anatomy, synonym, role, properties, attachment, treatment, pathology, damage, Galen
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
Comments
Post a Comment