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Hauing intreated heretofore of maladies which happen in the soft partes,* 1.1 as the skinne and flesh, heere wee will prosecute those which happen in hard and solide partes, as the boanes, and first of Fractures, what is then a Fracture?
It is a gene∣rall diuision or disscision, or solution of continuitie in the boane.
How many kindes of Fractures are there?
* 1.2Three, the first is ouertwart breaking, the second in length, and the third obliquely, in this kinde of Fracture the the pointes of the bones enter in the flesh, and causeth do∣lor, by the pricking of the flesh and nerues.
Are these kindes of Fractures simple or composed?* 1.3
Some∣time simple, otherwhiles composed with wound, inflama∣tion, gangren, dolor and such like.
Differ they not after another manner?
They differ according to the partes, where the Fracture is, as Fracture in the head, nose, backe, legges, fingers and such like.
Which are the causes of Fractures?* 1.4
Haly Abbas saith, & also Galen, that all outward thinges,* 1.5 that haue force to bruise, breake, cutte or cleaue, are sufficient to cause Fracture.
Which are the Signes of Fractures?
Auicen, Rasis & Celsus say,* 1.6 that by the sight and feeling the parte with the hande, thou shalt perceiue it vnequall,* 1.7 and also feele and heare a noyse in handling harder, & there shall be dolor in the part.
Which are the Iudgements of Fractures?
Frac∣tures in hard bo••••es and drie▪ as in olde folke are more dif∣ficill and longer in healing, then soft and humide in young people. Auicen saith, that Fractures in chollericke and old folke, are difficill, & in very olde folke impossible: Fractures of the ribbes with inflamation & spitting of bloud are most dangerous.* 1.8
Of all sorts of Fractures, which are easie to heale, & which difficill and dangerous?
All Fractures i•• the ribbes, which are simple, in the middest of the legges or armes and fingers made ouerthwart, are not dangerous.
All fractures neare the ioynts and in the heads of the bones are difficill, and the motion afterwards not good & those which presse inward, are worse, than those which go out. All fractures in the head how little so euer they be, are dā∣gerous:* 1.9 all fractures where they are many broken peces are dangerous, those with wound are difficill, because the bā∣dage cannot be done without dolor of the wounde Celsus saith that fractures in the thigh, are euill,* 1.10 because the mē∣ber remaineth alwaies shorter, all those that are eminēt, & have much marrow, are dangerous.
Are all frac∣tures healed in a certaine space?
Some are longer, some shorter, according to the greatnes, hardnes and drynes, fractures in the head are healed in 35. daies, in the thigh in 45. daies, in the legges and armer in 40. daies,* 1.11 the nose in 16. daies, the ribbes in 20. daies, in the iawes, the shoul∣der, clauicles, handes, feete, are healed in 20. daies, in the haunch and point of the shoulder in 40. daies, and likewise in other places, according to nature of the bone, the age, the aire and time of the yeare, and constitution of the body, the dyet, medicaments and gouernment of the sick, which things duely done do shorten the time of the cure.* 1.12 The defect of the aliment viscous is helped by fomē∣ting with hot water, the oft pessing and shifting it doth prolong the time as also straight ligatures, so in dede there is no ••imited, but some are longer, some shorter time in healing as we see by day experience.
IN the precedent Chapter ye haue heard, what fracture is with the causes, signes, and Iudgments now remayneth the cure, for the which ye must consider first if there be in∣flammation, to differ the reduction▪ till it be past, for to a∣uoyd great accidēts, than we must haue a quātity of whites of eggs & oyle of Roses beaten together cloth, cōpresses,* 1.13
bandes, fe••ules, machins, lacs, oxycrate, men to help thee, with other things necessary for the purpose, hauing al these in readines, there remaineth yet fiue pointes, the first is in extension of the member which is done,* 1.14 by laying it on a bench or other place proper, the sick being well situated, there must be two persons to hold the member fractured, the one at the nether part, the other at the vpper part, of the which one draweth vp an other down, to make the ex∣tension, if the hands bee not suffitient to do this, wee take cords or strong cloth and bind fast the member one to the vpper part, an other to the nether, which shalbe drawne by two men contrarie as ye haue heard.* 1.15 For the same pur∣pose ye may vse glossocomes, if great force bee needefull, beware of extensiō, chiefly in dry bodies, for feare of dolor feuer and conuulsion. The second intentision after the ex∣tensiō is made, thou shalt take the mēber softly with thy hands & reduce the bones in situation naturall, then lose the machins that the muscles may go to their owne natu∣rall.* 1.16 The third intension is to binde it well to hold it in the estate vnmouing & it is done by medicament•• & bandage, we apply for the first time an emplastrū astringēt or defen∣siue,* 1.17 made of bol, frie flower whites of egs & oyle of roses, it shalbe best to rub the māber with cerat galen, oyle of ro∣ses, mirtill or mastick before the applicatiō of the astringēt, the cloth must be wet in oxycrate & the bands also. Ther∣after bind the member, of the which our auntient vsed on∣ly two kindes to wit the vnder band,* 1.18 which Hipp. calleth Hypodesmedy, & the vpper band which he calleth Hypo∣desmos. The nether band is deuided into 2. or 3. the first is short beginning right on the fracture wearing vpward to¦ward the knee, if the fracture be in the legge, the volutiōs must be close together, this kind of bādage letteth the flux¦ion on the member hurt. The second band, which must be longer shall begin in the same fashion,* 1.19 making 2. or 3. cir∣cumuolutions on the fracture, cōducing downwards, this bandage maketh expression of the blood which was fallē
on the fracture, let the volutions be further asunder, being low ye shall weare vp againe, and end at the other ioynt. The third band shall begin at the nether ioynt & passe vp∣ward on the fracture to the other ioynt and there end with the rest, the band must be of clean cloth thin, soft without seame or hem, of length according to the member,* 1.20 & the breadth of 3. or 4. fingers, reasonable strong, that they be neither too straight, nor too slacketh boūd, the straight ma∣keth dolor and inflammation and letteth the vitall spirrit, likewise the too loose binding,* 1.21 holdeth the bones toge∣ther, so there must be mediocritie in that matter. The bād being gouerned in such fashion, ye must consider, that the leggs, thighes & armes are smaler in the nether parts, than the higher, therefore we must put double clothes to pro∣portiō the member, to make the small partes equall with the rest & also that our splints that are made of cards, wod or white Iron, be holden faster by the vpper hand. There must be 3. splents made hollow,* 1.22 the first which is biggest shall embrace all the vnder part of the fracture, as funda∣mēt, thother 2. shalbe put on both sides a litle space one frō an other, these 3. splents,* 1.23 being placed on the vnder band do hold them fast, and also keepeth the bone steadie from mouing, they must not be put to afore the 7. day, also they must be narrow at the lower end according to the mēber, broad and strong on the place fractured, with a little cot∣ton or woll. Our ordinarie practise is to vse them the first day, if there be no inflammation, and being done,* 1.24 we ap∣ply the two vpper bands on them, called Epidesmons, the first shall begin in their inner side of the nether ioynte, and turne vpward to the vpper parte of the member. The seconde shall begyn in the vppermost part,* 1.25 in the out side, turning inwardes, so the one shall goe contrarie to the other in forme of St. Andrewes Crosse as saith Cel∣sus. The member bound in this fashion and situated accordinge to the situation of the veines, arters,* 1.26 nerues and muscles as sayth Galen, the nexte we must take a
napkin and row a little straw in euery end of it, sow it to∣gether and lay the member in the midst of it, binde it with little cords or ••ibban, situate it right, soft and high, so con∣tinue it 3. daies, if no accidents happen, renue it againe in 3. daies, but if the fracture be simple we remoue it not be∣fore the 7. day or longer.* 1.27 The seeuenth day past, renue it euery 7. day or 12. or 20. day if other accedēts do not hap∣pen as saith Hipp. defensiues in the superior partes at least in the beginning, also fomēt it with warme water for that reuoketh the blod, cōforteth the part & humecteth it with a pleasant humiditie. The fourth precept is in generation of callositie,* 1.28 first they shal eate meat of good suc to ingēder good blood, yet somewhat straight till the 10. day be past abstaine from strong drink, for in that time the inflamma∣tion and feuer do passe, eate veale, m••tton, and kidde, vse medicamentes emplastricks that heate moderatly, also an emplaster or cataplasme of whites of egges fine flower & Rosess till the 20. or 25▪ day be past thou maist know whē the call is making,* 1.29 if in tying the first band it seemeth bloo∣die and not wounded, it sheweth the call to bee making then to fortifie the same we vse euery three dayes to washe the member with decoction of Roses, and mosse of the oake tree, putting to it a little oxcrosi••m, or de althea, if in this time it itch, as oft happeneth foment it with water and salt and vse fomentations of hot water and emplasters of pitch to reuoke and draw the aliment to breede the caule. If the call be too great we bind a cake of lead on it, or some medicament that digesteth as counselleth Galen;* 1.30 all em∣plastick substānce that healeth moderately. The fift pre∣cept in correction of the accidentes for sometime there is wounde with the fracture and then it must bee banded more slack, vsing moe bandes and no splentes, also more straight dyet.* 1.31 If eyther phlegmon Contusion or Gangren cure them as ye haue heard in their Chapter. If the be not proportionably, it must bee amended by breaking, which must
be done afore it be hard, otherwise it breaketh in some o∣th••r parte: to doe the same, it must be fomented the space of 15 dayes, with hennes, goose or cockes grease, fomen∣tations and cataplasmes that haue force to soften the calle, as this: take vnguent de althea and agrippa of each onc. se. olei camomelini, lillies and laurell, axungiae gallinae anseris and fresh butter, of euery one onc. 1. with a little waxe, so being softened, it separateth easily, sometime it requireth a little force to doe it. Auicen & Guido write in diuers ma∣ners to doe this, which I counsell no man to trie,* 1.32 for better it is to suffer a little deformitie of a parte, then losse of the whole bodie, to witte, death, which often happeneth. As for the curation of Fractures in the head, looke Hippoc. de vulneribus capitis & Galen 6. meth. cap. 6. et Celsus lib. 8. cap. 3. & 4. et Paulus libro sexto, cap. 90.
Like as wee haue done in Fractures, so we will followe out in dislocations but for the better vnderstanding thereof, I woulde knowe of you, after how many fashions the boanes are ioyned together, before we come to the definition of the dis∣ease.
All boanes are ioyned generally two wayes, to witte, by Ar••thro••, that is, by articulation, and by Sym∣phis••, that is, by naturall vnion.
Howe many sortes are there of articulation?
There are two, to witte, Diarthrosis, that is, coniunction with mouement manifest to the sight, as legges, armes, feete and handes: Synarthrosis, is mouing more obscure to bee perceiued, as the teeth, the sutors of the head.
Howe many sorts are there of ma∣nifest mouinges?
Three, to witte, Enarthrosin, that is, when there is a great cauitie, that receiueth a long round∣nesse, as the thigh with the haunch: the second is Arthro∣dia, that is, when a superficiall cauitie receiueth a little su∣perficiall head of a boane, as the arme and shoulder with
the omoplat, the third is ginglimus, that is, when the boanes receiue one another, as in the connexion of the knee, and the cubitus with the arme.
Howe many sortes are there of obscure mouinges?* 1.33
Galen saith, that there are three, to wit, suture, as the sutures of the head, the se∣cond is called gomphosis, that is, when the boane is infixed in like a nayle, as the teeth in the iawe boane: the thirde is called Harmonia, as the nose with the head, the boanes of the face which are ioyned together like a lyue.
You haue tolde sufficiently of articulation, nowe tell me of naturall vnion, and howe many wayes it is done.
Two wayes, eyther without mediation, but by succession of time grow∣eth together, as the nether iaw boane, which manifestly is distinguished in children, or else by mediation, and is done three wayes, to witte, the cartilage, as the boane pubis: se∣condly by the nerue or tendon, as the sternon and as illium are ioyned together: thirdly by flesh, as the teeth are faste∣ned. This, as also all the Anotomie is most perfectly de∣clared by Robert Achymutie Chirurgian of Edenburgh, sometime Chirurgian in the great Hospitall of Paris.
* 1.34What is Dislocation?
It is an outgoing of the boane out of the naturall seate, which letteth the mouing.
Howe many differences are there of Dislocations?
Three, of the which the first is called complete, when the boane is altogether out of the place, the second is im∣complete, when the boane is not altogether, but a little out, the third is distortion, elongation or peruertion of the liga∣ment.
How many wayes is Dislocation complete done?
* 1.35Foure wayes, before, behinde, outward and inward, some vp, some downe, but not oft seene.
Howe many differences hath incomplet?
It hath three, the first, that the ligament in the ioynt and about it is relaxed, as chaunceth in the haunch, the seconde, when the liga∣ment is forced by great violence, as the legge or foote in making a wrong or croked steppe: the thirde is, when by
little and little the ligament relaxeth & bringeth the boane after it, as chaunceth in the backe.
How many diffe∣rences hath the third, which is called distortion?
No difference, but onely the boane is made longer from the o∣ther.
Which are the causes of luxation?
Two, to witte, externe and interne.
Which are the ex∣terne?
Falles or stroakes▪ and too violent extending of the member violently again•••• the figure naturall.* 1.36
Which are the interne?
Great aboundance of hu∣mor pituitous, gathered in the ioynture, which humecteth the ligamentes, and maketh them softe and humide, so the boane goeth out, or by the extenuation of the muscles a∣bout the ioynture.
Howe knowe you Dislocation?
By the extraordinarie tumor of the place, by the emptinesse of the place, where the boane was, by the priua∣tion of the moouing, accompanied with dolor.
By what iudgement or signe knowe you those that are easie and those that are difficill, and those which are incureable and mor∣tall?
I iudge by the kinde and diuersitie of the Dislocation, and bodie, as for example, the 〈◊〉〈◊〉 is easie to goe forth & to goe in, also the finger, in like manner mem∣bers leane, and where the nerues and ligamentes haue store of humiditie and moistnesse, the arme difficill to goe forth, and hard to put in againe, and in grosse, fatte and tender people, those with fracture and apostume are euill to heale, those are very difficill, that haue the sides broken,* 1.37 those which haue bene long out, are almost impossible, the two vppermost vertebres of the necke beeing out,* 1.38 letteth the spiration, and so the partie dieth within the space of three dayes.
What method vse you for the cure hereof.* 1.39
The methode generall for all Dislocations hath foure intentions: the first is, to put the boane in his owne proper place, the extension of the member first made, with handes or machins: the second intention is to coatinue it in the place by good medicamentes and bandages as in
Fractures: the third is, to put the member in right situation: the fourth, to giue order to the accidentes, as by good dyet, purging,* 1.40 and bleeding if neede be, & reduce the Fracture, before the inflamation be come, otherwise stay, till it bee past, when it is neare whole, or the accidentes past, we shal vse thinges to corroborate and comfort the parte with cer∣taine simples sodde in wine, next, the emplaister oxycrosiū, or ad fracturas.* 1.41
If the Dislocation chaunce with Frac∣ture, what is to be done?
First reduce the Dislocation, next the Fracture if it be possible, some reduce the Fracture, next the Dislocation, it being reduced and the Dislocation simple, foment with oyle of roses, whites of egges, and cloth wette in oxicrate,* 1.42 with splintes, putting it in good fi∣gure, with as little paine as may be. It must not be stirred, till the 7. day, except inflamation or some euill accident doe fall, at which time foment it with hot water, thereafter, the astringent as in Fractures, keepe good dyet, eate little for 4. or sixe dayes, till the inflamation be past. If the Disloca∣tion be composed with causes interne, as aboundance of humors, which looseth the ligamentes, wee vse astringent and drying medicines, if it be accompanied with dolor and inflamation, cure it, as yee haue heard, if feuer, vse good dyet, purgations and bleeding, in the ende of the cure cor∣roborate the parte with decoction of roses, wormewood and wine, thereafter the emplaister of oxycrosium.
SEeing that embalming of the dead is an auncient cu∣stome, as appeareth by the olde and newe Testament, and also prophane histories, & that the same is vsed in these our dayes, aswell of Christians as infidelles, I will shew the vsuall maner of it, vsed in this our time. First we lay the bo∣dy o•• a table, and make incision from the clauicles to the
os pubis, next lift the sternon, as also the musces of the inferior bellie, taking out all which is contayned therein as also the braynes, hauing first opened the panne with a saw, which all shall be presently buryed in the earth, sauing the heart, which shall be embalmed eyther with the bodie, or alone in a box of lead, as the friendes shall thinke good, ••hereafter, thou shalt make long deepe in∣cisions in the armes, thighes, buttocks and legges and other fleshie partes, chiefly where there are veines and arters, to the end they may the better auoyde, which thing being done, thou shalt diligently wash the three venters, as also the partes incised with stronge vineger, wherein hath been sodden Worme-wood, Allom and Salt, thereafter with Aqui••itae, or fine spirite of Wine doe the lyke, then dry all well with Lynnen clothes or sponges and fill vp the three bellies with pouders and a fewe flockes and sow them vp againe the incision shall be filled onely with the pouders and sowed vp likewise, the pouders are commonly of Roses, Camomill, Meli∣ot, Mint, Worme-wood, Sage, Lauendar, Rosemary, Marioram, Time, Cipres, Gentian, Iris of Florence, all being dryee and beaten to fine pouder, and mixed with Nutmeggs, Cloues Cinamon, Pepper, Bengewin, Aloes and Mirre. Some vse onely for this purpose a fewe the most common of those hearbes, with a little quick lime, ashes of beane stalkes, and of the Oake tree: thereafter enroll the Corps in a cered cloth, and tie him in all parts, with small cords, and put it in a coffer of lead well clo∣sed, This is the common way to preserue dead bodies eyther vnder or aboue the earth for a certaine time, but if thou wouldest embalme them to continue Fourescoore yeares, or more thou shalt finde an easie and perfit waye to performe the same in the poore mans Guide.
Paul lib. 6. cap. ••9. Galen. com. 1 aph. et lib. 1. de fracturis.
Gal. lib 6. meth cap 5. et Celsus. lib. 8. cap. 7. Hip. 6. cap. 5.
Difference.
Cause.
Gal. de fracturis Haly Abbas serm. 8. com 9. aphorism.
Signes.
Celsus. lib. 8. cap. 10. Auicen. tract. 2. cap. 1. Gal. 6. meth. c. 5
Cure.
Celsus lib. 8. ca 10
Hip. de vulne∣ribus cap. Hip. ibedem.
Hip. aph. 6. et ••. et lib. 2. de frac¦tur. Arhors. 6 5. Cel¦sus lib. 8. ca. 7.
Auic. tract. 2. cap 9. Paul. lib. 4. et 6 cap. 110. Com. aph. 42. et lib. 1. de frac¦tur.
Gal. 6. meth. ca cap. 5.
Soranus.
Hip. li de frac∣turis com aph. 12. et lib. 1. de articules et 6. meth. cap. 5. Cel. li. 8. ca. 10.
Hip. aph. 21. et lib. 1. de fractu.
Aph. 26. et lib. 2. de officina medici et lib. 1 de fractrris.
Aph. 12. et 37 ••ib. 3. de offic. medici.
Com. aph. 13. et lib. 1. de frac Cel lib 8. cap. 10. Com. ca. 13.
Gal. 5. de offic. medici et Cel∣sus lib. citato.
Hip. aPh. 19. et 26. lib 2. de o∣fic. medici et com. apho. 21 ec lib. 1. fractu∣ris
Aph. 41. lib. 1 de fracturis.
Hip. lib. 1. de fracturis.
Aph 1. et 2. etli. 3. de officina medici
Lib 8. cap. 10. et Hip. lib. 1 de fracturis.
Lib. 6. met. ca. 5.
Aph. 39. et l••b▪ 1. de fract et a∣pho. 4. ibidē.
Hip aph. 45▪ et 46. et lib. 1. de fracturis.
Paul. lib. 9. cap 110.
Lib. 6. meth. cap. 5.
Cel. lib. 8. ca 10
Brunus. Albuc.
Lib de os••ibus
Paul. lib. 6. c. 3.
Celsus. lib. 8. cap. 20. Gal. com. aph. 2. et lib. 1. de articulis.
Gal. de causis morborum ca. 2. & artis paruae cap. 58. com. a∣pho. 26. et lib. 1. de articulis. Celsus. lib. 8. cap. 11. com. a∣pho. 1. lib. 11. de officin medici.
Paulus lib. 6.
Celsus
Cure.
Celsus. lib. 8. cap. 2.
Albucrasis. To.
Guido. 2. doct. cap. 1. Hip. apho. 65. lib. 4. de artic. Hip. lib. citato. Celsus. lib. 8. cap. 2.