The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. II. Sheweth the indications and generall precepts of fitting of Bandages and Ligatures.

THere are, in Hippocrates opinion, two indications of fitting Bandages or * 1.1 Ligatures; the one whereof is taken from the part affected; the other from the affect it selfe. From the part affected: so the legge, if you at any time binde it up, must bee bound long-waies; for if you binde it overthwart, the binding will loosen as soone as the patient beginnes to goe, and put forth his legge, for then the muscles take upon them another figure. On the contra∣rie the Arme or Elbow must be bound up, bending in and turned to the breast, for otherwise at the first bending, if it bee bound when it is stretched forth, the Liga∣ture will be slacked, for that (as we formerly said) the figure of the muscles is per∣verted. Now for this indication, let each one perswade himselfe thus much, That the part must be bound up in that figure, wherein wee would have it remaine.

Now for that indication which is drawne from the disease, if there be a hollow ulcer, sinuous and cuniculous, casting forth great store of Sanies, then must you be∣gin * 1.2 the ligature and binding from the bottome of the sinus, and end at the orifice of the ulcer; and this precept must you alwayes observe, whether the sinus be sealed in the top, bottome, middle, or sides of the ulcer. For thus the filth therein con∣tained shall bee emptied and cast forth, and the lippes of the ulcer too farre separa∣ted, shall bee joyned together; otherwise the contained filth will eate into all that lyes neare it, increase the ulcer, and make it uncurable by rotting the bones which lye under it with this acride sanies or filth. But some Ligatures are remedies * 1.3 of themselves, as those which performe their duties of themselves, and whereto the cure is committed, as are these which restore to their native unitie, those parts which are dis-joyned: others are not used for their owne sakes, but only to serve to hold fast such medicines as have a curative facultie. This kinde of Ligature is eyther yet a doing, and is termed by Hippoc. Deligatio operans; or else done and finished, * 1.4 and is called, Deligatio operata: for the first, that the Ligature may be well made, it is fit that it be close rowled together, and besides, that the Surgeon hold it stiffe and strait in his hand, and not carelesly, for so he shall binde up the member the better. Also he must in the binding observe, that the ends of the Rowler, and consequently their fastning may not fall to bee on the affected or grieved part; for it is better that they come above or below, or else on the side: besides also, he must have a spe∣ciall care that there be no knot tyed upon the same place, or upon the region of the backe, buttocks, sides, joynts, or backe part of the head, or to conclude in any other part upon which the Patient uses to leane, rest or lye. Also on that part where wee intend to sow or fasten the Rowlers, you must double in their ends, that so the fast∣ning or suture may be the stronger, otherwise how close soever they shall be wrap∣ped or rowled about the member, yet will they not remaine firme, especially if they be of a great breadth. For the second kinde of Ligature, to wit, that which is already done and finished; the Surgeon, the performer thereof, must consider to what end

it was done, and whether he hath performed it well and fitly, as also neatly and e∣legantly, * 1.5 to the satisfaction both of himselfe and the beholders. For it is the part of a skilfull Workeman everie where handsomely and rightly to performe that which may so be done.

In fractures and luxations & all dislocations of bones, as also in wounds and contusions, you must beginne your bandage with two or three windings or wraps about upon the place, and that (if you can) more straitly than in other places, that so the set bones may be the better kept in their places, and that the humors, if anie be alreadie fallen thither, may by this strait compression be pressed forth, as also to hinder and prevent the entrance in of any other which may bee readie to fall down. But in fractures (as those which never happen without contusion) the blood flowes, and is pressed forth of its proper vessels, as those which are violently battered and torne, which causes sugillation in the neighbouring flesh, which first lookes red, but afterwards black and blue by reason of the corruption of the blood poured forth under the skinne. Wherefore after these first windings, which I formerly mentioned, you must continue your rowling a great way from the broken or luxa∣ted part; he which does otherwise, will more and more draw the blood and humors into the affected part, and cause Impostumes, and other maligne accidents. Now the blood which flowes, goes but one way downwards, but that which is pressed is * 1.6 carried as it were in two pathes, to wit, from above downwards, and from belowe upwards. Yet you must have a care that you rather drive it backe into the body and bowels, than towards the extremities thereof, as being parts which are unca∣pable of so much matter, and not furnished with sufficient strength to suffer that burden, which threatens to fall upon it, without danger and the increase of prenatu∣rall accidents. But when this masse and burden of humors is thrust backe into the bodie, it is then ruled and kept from doing harme by the strength and benefit of the faculties remaining in the bowels and the native heat.

Notes

• * 1.1

  1. & 2. sect. lib. de fract.
• * 1.2

  We must al∣waies begin our ligatures at the bottome of a sinus.
• * 1.3

  Hipp. sent. 4. sect. 2. offic.
• * 1.4

  Initio 2. sect. off.
• * 1.5

  Ligatures must not bee only lightly, but also neatly perfor∣med.
• * 1.6

  Gal. com. ad sent. 25. sect. 1. lib. de fract.