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

CHAP. XX. Of the fracture of a Thigh.

IT is a hard thing to bring the fragments of the broken thigh together to be set, by reason of the large and strong muscles of that part; which whilest they are drawne backe towards their originall, by a motion both naturall and convulsive, they carry together with them the frag∣ment of the bone, whereinto they are inserted. Therefore, when as * 1.1 the fracture of this bone shall be restored, the Patient must lye upon his back with his legge stretched forth, and the Surgeon must strongly and with great force extend the thigh; but if he alone shall not be able sufficiently to extend it, he shall imploy two other strong attendants, by whose joynt-helpe the fragments may be fitted and set each against other. For this purpose, when as the strength of the hand was not sufficient, the Ancients used an Instrument, called a Glossocomium, whereof this is the figure.

[illustration]

The figure of a Glossocomium, or Extender.

In stead of this Glossocomium, you may make use of my pulley; for Hippocrates * 1.2 in this bone when it is broken, doth approve of extension so great, that although by the greatnesse of the extension the ends of the fragments be somewhat distant a-sunder, an emptie space being left betweene; yet notwithstanding would hee have ligature made. For it is not here as it is in the extensions of other bones, whereas the casting about of Ligatures keeps the muscles unmoveable: but here, in the ex∣tended thighes, the deligation is not of such force, as that it may stay and keepe the bones and muscles in that state, wherein the Surgeon hath placed them. For, seeing that the muscles of the thigh are large and strong, they overcome the ligation, and are not kept under by it. The Surgeon, in setting it, shall also consider, that the thigh-bone is hollowed on the inner side, but gibbous on the outside, therefore it must be set in its native figure. Otherwise, if anie, unmindefull of this considera∣tion, * 1.3 would have it straight, he shall make his Patient halt all his life after: where∣fore this inner and native hollownesse must be filled up and preserved by putting in a compresse or boulster, spread over with unguentum rosatum, or the like glutinous thing that it may not fall off: for thus also the ligation shall the more faithfully keep the fragments of the bone in their places. Moreover, compresses shall be appli∣ed * 1.4 to the more slender and lesse protuberating parts of the thigh, as those which are next the ham and knee, that so the whole ligation may be alike, and consequently the more firme. Now ligatures, as we formerly noted, are ordained for three things. The first is, that the bones may bee kept in that state wherein they were set, untill they be strengthened by a Callus. The second is, to hinder defluxion, which easily fals into the broken and luxated parts, both by reason of paine, as also by weak∣nesse. The third is, to stay and hold fast the splints and medicines which are appli∣ed. Inflammation is hindred by repressing and hindring the blood and other hu∣mours, ready to flow downe, from entring into the part, and by pressing those humors, which are preternaturally contained in the part, into the neighbouring parts above and below. Wherefore there must no small care be had of preparing ligatures, to wit, that they bee made of choyce and well woven cloth, yet not course or rough; and let them be of such length and breadth, as the Surgeon, per∣swaded by an artificiall conjecture, shal judge to be fit for the thicknesse and length of the member, and greatnesse of the fracture: for ligatures ought to be of breadth to involve and cover all the fractured part, and a great part of that which is sound. But seeing that in my Booke of Bandages, I have seemed chiefly to set downe and approve the manner of binding used by Hippocrates, now I * 1.5 thinke good here in this place to describe that which is in common use amongst our Surgeons.

Our Surgeons therefore at this day require three Ligatures for fractures, the first whereof they presently cast upon the hurt part, whether broken or dislocated, or onely strained, making the first wrappings upon it; so that they most and straitliest binde it there, but lesse and more loosely on both sides thereof. Such circumvoluti∣ons, or wrappings, are drawne upwards, and there ended. They must bee rowled * 1.6 thicke, and not wide; for so if they presently follow, and lye one upon another, they will hold the bones more firmely, and more farre and wide presse forth and re∣presse the superfluous blood from the sound part. They presently in like sort cast the second ligature upon the verie fracture, giving it two wraps, then going down-wards; yet so, as that they are opener or wider, and farther distant each from other, and not so close together, as the circumvolutions of the first ligature; that so they may presse the humors the lesse to the extremities of the part, as those which can∣not receive and beare, without inflammation and danger of a gangrene, such abun∣dance of humors, for that they are not sufficiently spatious, as also more remote from the fountaine of native heat, which is greater in the center than in the circum∣ference. At the lower end of the hurt part the circumvolutions either end, or else are twined thence backe againe. They cast on the third ligature in that lower end * 1.7 of the hurt part, and rowle it smoothly and gently upwards, the windings being made contrarie to the windings of the first and second ligatures; that they may so draw backe into their naturall state the muscles, which peradventure have beene drawne aside by the force of the former wrappings. These ligations finished, they apply three splints of past-bord, or some such matter; the first below the fracture, and that truly more broad, and of sufficient length; and then two others, one on each side, distant each from other some fingers breadth, to the end to keep the bone that it doe not stirre to this side or that, being wrapped about with Tow or Cot∣ton. Then they thinke of placing or laying the part, to which purpose they pro∣pound * 1.8 to themselves three scopes. The first is, that the part may lye soft; the second, smooth, or even; the third, somewhat high. The hurt part ought truely to lye soft, for that hard lying presses it, and causes paine and inflammation; which whiles the Patient cannot patiently endure, he is forced to change his place, whilst he everie way seeks ease for his paine: and thus he now and then moves the fractured part, which ought to be kept quiet without any motion. It must lye smooth or even, because an unequall or uneven site distorts or draws awry the part, whilst one por∣tion of the hurt part is borne up, and sustained by that which lyes under it; but the other hanging downe hath nothing thereunder, whereupon it may rest. Therefore Hippocrates bids us diligently to take heed, that the heele doe not hang downe, * 1.9 nor the foot remaine without a pillow, for hence paine and a troublesome deflu∣xion of humors is to be feared. But the part ought to lye somewhat high, that the defluxion may bee hindred, which is easily stirred up by a prone and declining site: for if the foote shall be placed in a lower figure, the blood which flowes thither from the legge, will cause inflammation. But on the contrarie, if it bee higher, no∣thing can flow downe thereinto. Therefore absolutely not only the foote, but also the thigh and legge, are to be placed higher than the rest of the bodie: yet, keep∣ing such a meane, that the part may not be too much distended, as Hippocrates ad∣monisheth * 1.10 us. In the meane time, this hurt legge or side, ought to bee of equall length with the sound, and for that purpose it must bee stayed on both sides with Junks, as we shall shew you hereafter, when we come to speak of a broken legge. The bandage being performed as we have said, the following night, and the next day the Patient feels the member more straitly bound, than when it was first wrap∣ped; yea, verily the knee is lifted up into a soft tumor by the expression of the hu∣mor from the wounded part: but on the contrarie, the ensuing day the ligation is slackned and relaxed, some portion of the humor contained in the part being dige∣sted. Also the next day all things are perceived more loose, there being made a lar∣ger resolution of the humor. Then therefore the Bandages must be loosed, and that * 1.11 not only, lest that the fragments of the bones should fall forth of their place, but al∣so that we may gratifie the Patient by that alteration or change of place, and besides that wee may avoyde itching, which usually happens to parts too long bound up,

by reason of the suppression of acride and fuliginous excrements, which use to be gathered in great quantitie in a part at rest and bound up, both from the excremen∣titious humors, wherewith the part is moistened, and the alimentarie humors in a part which is idle and at quiet; by reason the difflation and transpiration are hin∣dred by want of exercise, and the pores of the skinne shut up by the abundance of the ligatures: so that by the suppression thereof, many have not only an itching, but also, the skinne being broke by the acrimonie of these, as well vapours as hu∣mors, which are kept shut and pent up, have ulcers breake forth. Therefore when such accidents shall be feared, the part shall so long be fomented with warme water and oyle, as you shall thinke fit: for, such fomenting asswageth paine, relaxeth that which was too much straitened by the binding, and amends the refrigeration of the part, caused by the repercussion and expression of the blood and spirits, the na∣tive and internall heat being by this meanes revived. If, together with the tumor, there be a contusion and sugillation, it must bee the longer fomented, that the ex∣crementitious humor residing in the part may be digested. But if this quantitie of time shall not suffice, then must you use stronger digestives: yet have a care you use them not too long; for so you should hinder the generation of a Callus. There∣fore that saying of Hippocrates must here be remembred, which saith, That a weak fomentation, and the short time of using one doth attract, but not discusse; but a * 1.12 longer and stronger wastes the flesh. Besides also, you must have regard to the tem∣per and habit of the Patient; for fomentations, used to plethorick bodies, draw su∣perfluous humors to the part. The Ancients bid, that the ligatures be loosed everie third day, untill their seventh day; but after the seventh, on everie seventh day: but hereof nothing can be certainly and perpetually decreed. For, according to the accidents the Patients must be dressed sooner or later, more often or seldome, renuing the ligatures, and the rest of the dressing. Therefore, if no symptome urge, I would have none of these things, which are done to the Patient at the first dressing, to be moved, unlesse as slowly and seldome as you may. For you hinder the knitting of the bone, if you never so little move the ends of the fragments thereof: for, as you see wood is joyned together by glue, and pewter with sowder; so the fragments of bones are, by the providence of nature, glued and sowdred together by a Callus. Wherefore broken bones have very much need of rest, to the generating of * 1.13 a Callus; otherwise, the matter thereof flowing downe, quickly flowes away, and nothing is done. You may much helpe forwards the generation of a Callus, which is begunne about the thirteenth or fifteenth day, by applying an emplaister made with the white of an egge, having the powder of red rose leaves, and wheat floure mixed therewith, and other Catagmatick plaisters, which shall hereafter be descri∣bed in speaking of the fracture of a legge.

Notes

• * 1.1

  Why the bone of the thigh is more difficultly set.
• * 1.2

  Sent. 67. & 68. sect. 2. de fract.
• * 1.3

  The naturall and internall crookednesse must be preser∣ved in setting the bone.
• * 1.4

  The part to bee bound up, must be made plaine either by na∣ture or art.
• * 1.5

  The manner of binding used by Surgeons at this day.
• * 1.6

  Why the win∣dings of the up∣per ligatures must be thicker and straiter than the lower.
• * 1.7

  Why the third ligature must bee rowled con∣trary to the two first.
• * 1.8

  The Surgeon must be minde∣full of three things in pla∣cing the mem∣ber.
• * 1.9

  Sect. 2. de fract.
• * 1.10

  Sent. 33. & 56. sect. 2. de fract.
• * 1.11

  When the first ligation must be loosed.
• * 1.12

  Sent. 15. sect. 3. 〈◊〉〈◊〉 offic.
• * 1.13

  Rest necessary for the knitting of set bones.