The noble experyence of the vertuous handy warke of surgeri, practysyd [and] compyled by the moost experte mayster Iherome of Bruynswyke, borne in Straesborowe in Almayne ... Item there after he hath authorysed and done it to vnderstande thrugh the trewe sentences of the olde doctours and maysters very experte in the scyence of surgery, as Galienus, Ipocras, Auicenna, Gwydo, Haly abbas, Lancfrancus of mylen, Iamericus, Rogerius, Albucasis, Place[n]tinus, Brunus, Gwilhelmus de saliceto, [and] by many other maysters whose names be wryten in this same boke. ... Item yf ye fynde ony names of herbes or of other thynges wherof ye haue no knowlege, yt shall ye knowe playnly by the potecarys. Item here shall you fynde also for to make salues, plasters, powders, oyles, and drynkes for woundes. Item who so desyreth of this science ye playne knowlege let hym oftentymes rede this boke, and than he shall gette perfyte vnderstandynge of the noble surgery

¶ Dfall maner of fractures brekynge of bones in generall and howe they shall be ryghted and heled. Ca. lix. (Book 59)

OF the woūdes y^t happe neth in y^e softe mēbres I haue sayd / as of the skyn̄e / flesshe / vaynes synewes / vnto y^e bone So shall I wryte of y^e harder dele / or partes of y^e body. And of all y^t is cut w^t a sworde / & y^t the flesshe & the bone be throughe cut / that is called a woūde w^t the fracture or brekyng. & yf y^e bone be hurt w^t no cuttynge instrumēt / but w^t a clobbe / or staffe / stone / or fallynge / or cast / or by hym selfe / or by another / it is called a frac∣ture or brekynge of y^e bones. Sōtyme y^e bo ne breketh ouertwharte y^t in the fracture w^t the brekynge is no smal peces of the bone / & y^t comenly is called a fracture. & somtyme y^e bone is beten & hurte / & is vneuen brokē w^t splenters y^t one pece or many peces depteth from other / y^t is called frustralis / or y^e bone broken w^t peces. Somtyme it is not brokē ouertwhart / nor w^t peces / but it is rente in length / then it is called Apertura or rente. The token of y^e fracture or brekynge / yf it be in brede or in length / It is knowen wel ynoughe by the syght & by vnderstādynge / as haly abbas & Lāfrā. sayth / & can ye not se y^e fracture / ye shall know thrugh selynge w^t your hāde on y^e bone (as Rasis & Auicē. sayth) ¶ The payne of the bone as it is tow chyd / & the feblenes therof is a token of the fracture. And as ther is in y^e fracture splen∣tes or peces / then ye shall fele by the peces about y^e fracture & it wyl prycke in y^e flesshe & the pacyent feleth the pryckynge ouer the place of the fracture / & moost whā you tow che it with your hande. ¶ The fracture or rynyng that cometh in the length of y^e bone is worser to be knowen than the fracture y^t cometh ouertwharte y^e bone / but it is kno∣wen for y^e membre is greter and thycker / & that the pacient with y^e membre may not laboure as he hath done before tymes. That bone y^t is ouertwhart broken in. ii. peces y^t is more peryllous to bynde and to holde / than is the bone that is broken or rente in y^e length. Therfore as suche a fracture is he∣led it is altymes vneuē and croked / pryncy pally as the fracture is in a bone y^t standeth alone with none other standyng ther by / ly ke as the formest bone in the arme / and in y^e shynnes. ¶ The fracture by the ioyntes it is the heuyest & the worst to bynde / And yt can not well be bounden for there cometh often tymes grete payne in the meuynge / & hardneth the fracture with payne and mar rynge of the flesshe / And yf it haue moche moystnes it is euyll / bycause he can not be▪ holpē for the tyme y^e fayntnes must be fyrst amended. ¶ The fracture with a wounde hathe a sondry cure / & ye must make holes in the bande / through the whyche it may be heled where as nede is. ¶ Whan ony frac ture is longe vnbounde it is dredfull and y^e worse. ¶ And yf the fracture ware harde / than is it the worse to set to gyder / and ther fore it is nedefull to haue a greate stronge

byndyge / and the grete stronge byndynge is peryllous sor comynge onyhete & cram∣pe (as Auicenna sayth)

¶ To knowe in what tyme the bones may be heled / that is to knowe. The braynnan may be heled in. xl. dayes. The bone of the nose is heled in. xiiii. dayes. The rybbes in xx. dayes. and so forth it shall be sayd here∣after. But the age of a man taketh awaye suche comely tyme of helynge. Jamericus Auicenna / and haly abbas sayth / what is the cause that the tyme is longe or y^e bones be heled to gyder / It cometh often tymes y^t the bones be oftē tymes dressed / and moyst∣ned with warme water / and with often ty mes meuynge / and that ther is to lytell sly my blood / and throughe strayte byndynge it beletteth the membre to fede / & hyndreth hym of his helynge. And it is sayd that the swellynge of the membre wout grete payn after y^e byndynge / & slaketh the swellynge after the tyme of the settynge agayne of the bones that is a good token.

¶ Item Galienus and Auicenna sayth to this fracture is. iiii. dyuers maners of he∣lynge and byndynge / The fyrst the broken bone to be made euen / The other set togy∣der agayne y^e bone that is made euen. The iii. is the byndynge w^t the hole / The. iiii. to amende y^e yll accidēte. And in y^e fyrst I wyl gyue you that whiche is nedful to this wor¦ke / fyrst se that all thynge be redy to the set∣tynge in agayne. The other lernynge is to haue a comely place / & a comely seruaunt. The. iii. is the white of an egge / so moche as it is Inough / & oyle of roses / and depte therin a cloth / after the gretnes of y^e mēbre. The. iiii. thre bandes longe and brode after the mēbre. The. v. is towe that is softe and wel heccled / depte in acicrata & wrōge out agayne (As Ra. ••sayleth) The. vi. splētes y^t beeuē & smote / made of box or harde wood or of horne / or of yron / or of lether after the mēbre thre fyngers brode ouer y^e fracture / and more yf nede be / as albucaiis sayth / & that it touche thout uor hurteth the ioyntes in the myddes thycker then in y^e endes / and therof shall be layde as many as nede is / & that may goo aborte y^e mēbre couered with clothes wasshed in the whyte of an egge.

¶ The. vii. yf it be nede ye shall haue pypes with small cordes to hynde so moche as ne∣deth after the lengthe of the membre / y^e splētes shall be boun de with the cordes & with the pypes / and bynde it reasonably / & after drawe thorowe the pypes small styckes so that y^e pypes t•…•…e not / & that y^e dyndynge lose not. ¶ The. viii. that ye haue suspenio∣riū or canabulū therin y^e mēbre ryght and surely is be set ¶ The. ix. y^e bedde there as y^e pacyent lyeth yt it be nede / it muste haue a hole wherthrugh he may do his draught and therfore he shal haue a corde hangynge aboue the bed / wher w^t he may tourne selfe. The other lernynge is of y^e maky•…•… euen with. ii. seruauntes / wher of the one shall holde & drawe the mēbre at one ende. and the other seruaūt shall holde, & drawe at the other ende vpryght that it breke not / and yf they maye not drawe it alyke with theyr handes / & the broken mēbre stretche out / ye shall take a gyrdell made therfore / or ony other thynge (As Ipocras sayd) but it were very good to haue a vyce made ther¦fore / that the bone myght be preserued tyll the mēbre be bonnde / and the facyon of this same vyce standeth here in pycture

[illustration]

¶ The. iii. lernynge that the holdynger of y^e membre whiche is with byndynge and ga derynge togyder / it shall be done softely w^t out ony payne. Galienus sayth / they that bynde / shall chose the beste maner that ther to belongeth that the lesser payne maye be / for not hynge marreth so sooue the membre 〈◊〉〈◊〉 the payne dothe comynge of the strayte vyndynge / and vnreasonable handelynde / Therfore marke well (that Guydo sayth) And in lyke wyse I also haue sene many mē bres that hath bene euyll gnyded with esti omena & rottynge / Therof Rasys gyueth warnynge to the surgean for the byndynge that is lose bounde it holdeth not the bone / and the harde byndynge bryngeth payne / and letteth foode to come to the membres / and the byndynge vp must be as the pacyēt may suffre withease (as Rasys sayth).

Ipocras cōmaundeth to take. iii. bandes. And the fyrst bande goynge vpwarde from the fracture whyche letteth the comynge downe of the matter. The other bande is from the same place goynge downewarde and that thresteth the matter out / and the∣se twoo bandes kepeth to gyder the broken bone / and defendeth that none impostuma cyon come therto / but that is not ynowe / for y^e thyrde bande must be put therto / whi che is bounde for the kepe the plumacyoles to close it withall. Galienus cōmaundeth to take Acerotum / wherfore nowe is takē oyle of roses. Also Rasys counsayleth that the fracture at the fyrste begynnynge shall not be boūde to fast tyll the. vii. daye. And on the. vii. daye. it shall be bounde metely strayte / and in the fyrste and the laste ende bynde it not to faste for fere of impostuma∣cyon. ¶ The. iiii. lernynge is that in the be gynnyng shall be layde good euen splentes or other thynges in theyr stede / not for to strayne y^e membre / but alonely for to kepe it vnto the seuenth day ende / for feare that ••o impostnmacyon come therto / than shall yo••••ay theron good stronge splentes / that y^e membre may be holde fast / and at y^e fyrst tyme I take the goode splentes / and bynde them som what lose / that no swellynge nor impostumacyon come therto / And also do so to the last tyll it be well strengthed / and be not hasty to take of the splentes (as Aup cenna sayth in his boke of Sargery.

¶ The. v. lernyng and doctryne is of the ty me of chaūgynge or byndynge / or dressyng The chaungynge shall not be done before the. x. xv. or. xx. day / pryncypally as y^e byn¦dynge is dressyd with the oyle aforesayde / And yf the fracture be not well and ryghte set / or ony stronge accydente cometh therin the sooner it must be dressed. And yf ye dres se the byndynge with the powder as I shal lerne you / so leue the byndynge theron y^e. ix. or. x. day. and longe abydyng in 〈◊〉〈◊〉 a byndynge wichout chaungyng it is euy•••• (as Rasys sayth) But yf ye were in feare y^t it is not wel and ryght set / thā may ye chan̄¦ge the byndynge in. vii. dayes. and somty∣me sooner. and ye shall somtyme chaunge y^e byndyng. in. x. dayes. for cause than is yet there not come the porus. and is than ther ony vneuen than make it euen y^t it not pryc kyth nor stytchyd in the fracture.

¶ If payne / or impostumacyon / or other yll accydentes cometh therto / than may ye chaunge it at the. iii. daye. But in other cau sys shall it not be chaunged nor losyd vp be fore the. vii. daye. but yf y^e matter must be clensyd than ye may the sooner chaunge the byndynge and dressynge of the same.

¶ The. vi. doctryne and lernynge is this

•…•…itacyons of the porus / & it growe that the•…•… •…•…day / and when it is comen ye shall strength hym with meete and drynke / and Galienus sayth the body f••de w^t meet wher in is grete moystnes / therof cometh not one¦ly good / but also 〈◊〉〈◊〉 my moystnes / & therof and therout cometh that couglutu 〈◊〉〈◊〉 that is he lynge to gyder (as A uicēna sayth lyke asrys rappe where / sodden heedes / & feetes of beestes / and refrayne wyne. He shall be ware hym for all thynges that bren neth the blood / as stronge wyne / garlyke / onyons / mustatde / and well smellynge spy¦ces. And Rasys sayth / in the begynnynge shall he chaūge his rulynge / in drynkynge no wyne / and in goyng to chambre / and in lettynge blood / and ther w^t shall be letteth the impostumacyon. and as he is sure of the impostume than may he returne agayne to his olde rule. In the fyrst retourne agayn to the makynge euen of the bones with dra¦wynge out the membre streyght / and ••y••••e vp the bone that is pressed downe / & threste downe y^e other bone that standeth on hyght and do it without payne / vnto the tyme the bones be knyt togyder in hys ryght place. The other lernynge is to be done w^t a good byndynge as many mayster sayth / and som bynde the fracture euen w^t out splentes vnto the fyfthe or syxte day / som layeth with plu macyoles of clowtes (as mayster Petrus) som of tow (as Theodoric••) and they bynde ther vpon the splentes / and these bothe doth h•…•…me / for the plumacyoles sholde be soma¦ny that there sholde be no faste byndynge and in a slyppe myght the membre be hurte And Euydo foloweth after y^e sayd lernyng And at the fyrst do that y^e payne may be put away and kepynge also the membre. The seconde in kepynge that the porus or cōglu¦tinatiuum groweth about the fracture.

The thyrde / that in kepynge the membre shal be stretched & brought agayn in his ol∣de workynge. ¶ Also ther is. iiii. maners for to hele & bynde this fracture. The fyrst as the fracture is ouert wharte / and yf ther be no small peces of bones to take out / than shall the fracture and wounded membre be stretche dout and holdē by your seruaun¦tes and to set ryght the brokē bones and do after the rule as I shall lerne you / yf there be ony small ••••eces departed fro the bone y^e stycke in the flesshe and is hangynge on the bone set them in theyr fyrst place and bynde them well togyder / make the small bones in the muscles payne and cause them to folo¦we the impostumacyon / than it is nede to cut the flesshe on that place and take out the lose bones and than to make y^e mēbre hole as I shall lerne you / yf the flesshe be brused with the fracture of the bone / then shall the bone be bounde with oyle of roses and shall lay on the powder of myrtylle beryes / and ouer the oyle and powder yeshallay a cloth depte in the whyte of egges & oyle of roses & bynde it softely / If y^e fracture be without payne / and without small peces of bones & is well streyghtened / so shall you bynde it with a longe brode bande after y^e dretnes of y^e membre without beynge longe of doyng And your seruaunt must holde the membre whyle y^e clowtes be layde bytwene (as Ga∣lienus is wonte to do▪ the clowtes may not be to cowrse for y^t letteth the good byndyng and the same clowtes sholde be depte in the whyte of egges medled in oyle of roses / and begyn to bynde vp y^e fracture w^t the ban••e going vp and downe / and let y^e bande goe ynoughe on the hole part / and vpon the frac¦ture bynde euen without paine / and vpon y^e bande shall be layde. ii. dowble 〈◊〉〈◊〉 depte and wronge out agayne / and shall co¦uer

the hole membre and that the endes of y^e splentes hurte not the membre / & sowe then the clothe about and thervpon lay the splen¦tes made of wood or of ledder & then bynde it w^t pypes / then shall the pacyent be layde in a styl place where he may haue rest / and yf it be nedefull ye shall let y^e pacyent blood the other day / and gyue hym a laxatyue in the fyrst dayes / and the byndynge shall not be chanuged in. x. or. xv. dayes / without were ony euyll accydent comynge therto / or that the fracture be not set well to gyder as is afore sayde / and after the. iii. and. iiii. day y^e fracture shall be dressed / and bounde as it was before. And yf the tyme be hote & there come a swellynge / or impostumacyō or ony other / ye shall occupy the oyle afore∣sayd / and yf he be sure of the euyll accedent than shall ye make this powder / wherof I haue often sene grete profyte come.

¶ A powder.

Take bol•• armen•• / ambra or walderote / of eche. iiii. ounces / small barlye mele. vi. ounces / medled all to gyder. And I was wonte to do therto walstone. iii. ounces / & they be brought out of Zwytselonde / or ex •…•…uincia Heluetiarum.

[illustration]

Nota ¶ I haue 〈◊〉〈◊〉 & her de a surge an made his booste to hele in. viii. dayes a parsoue that hathe broken his legge or arme. And thys to pro¦ue a dogges legge was broken / than med∣led he this powder afor sayd with y^e whyte of an egge / and layde it on te dogges legge and splented it / and as y^e. viii. dayes were past / than toke he the splentes of / and the dogges legge was hole. Terfore this is my counsayle to take this store for this cu∣re. that powder hathe such nature / yf there come ony swellynge to the bone at the fyrst tyme so gothe the swellynge shortly awaye with the sayd powder. The other maner is that after the. xii. or. xv. daies as porus be∣gynue to come / that is to knowe whan the payne is gone / and ther come none impostu¦macyon / and y^e membre is of good colour / than shall ye take of the bande / and wasshe the membre in warme water & lay thervpō a clothe stryken / and bynde it with all the bandes and splentes a foresayd / and bynde it som what faster. The fracture shalbe sal∣ued and dressed the. vii. or. ix. day. or more vnto the tyme that the bone be well bounde with that porus that is well knowē by me uynge and by the vnswellynge. The. iii. maner is that the membre shall be wasshed all thre dayes with good wyne wherein is sodden roses / wormode or abscintium in 〈◊〉〈◊〉 tyne / oken woode / and bounde with 〈◊〉〈◊〉 dept in y^e same wyne and pressyd out 〈◊〉〈◊〉 and bounde with. iii. or. iiii. splentes / 〈◊〉〈◊〉 shall the membre be brought by lytell and lytell to his olde workynge / and at the last shall the membre be made softe with Dyal the a / or oxcicrocium. ¶ The fourth maner is when the accydente is comynge / lyke yf ther were payne or impostumacyon / and yf the payne or impostumacyon be grete / that take away or it be boūde w^t the longe band that ther to belongeth. And yf it were well bounde after his belongynge / and ther com an impostumacyō or an vnreasonable pay∣ne / ther with is the surgean cōpelled y^e mē∣bre to open and to vnbynde / and to amende the accydent / and to helpe the nature. And that membre shall bestyll vnboundetyll y^e tyme the accydent and payne be takē away

Therfore must ye take away the payne (as 〈◊〉〈◊〉 sayth) w^t the saluyng of warme oyle of roses. Or (as Guido sayth) w^t wolle depte in oyle of roses / & venegre / and layde ther ouer. And yf ther com scabbes or itchyn¦ge / than lose y^e byndynge / and make y^e bone moyst with warme water wherin is soddē a lytel salt & that membre ther w^t embroced and droppe with the water from aboue on the membre Or salue the membre with vn guentum album / or populeum as is afore sayth. When all the accydentes is taken away thā tourne agayne to the byndyng of the membre. ¶ If ther be a wounde where in be smal peces of bones they must be takē out / and hele the woūde as I haue sayd in the chaptre of broken bones. And after goo to the helynge as is afore sayd. As the mat∣ter cometh out / make an hole in the bande / wher through the wounde may be clensed.