CHAP. IV. The generall cure of broken and dislocated bones.
TO cure a broken and dislocated bone, is to restore it to its former figure and site. For the performance whereof, the Surgeon must propose three things to himselfe: The first is, to restore the bone to its place: The se∣cond * 1.1 is, that he containe or stay it being so restored: The third is, that he hinder the increase of maligne symptomes and accidents; or else if they doe happen, that then he temper and correct their present malignitie. Such accidents are paine, inflammation, a feaver, abscesse, gangrene and sphacell. For the first in∣tention, you may easily restore broken or dislocated bone, if presently, as soon as the mischance is got, or else the same day, you endeavour to restore it: for the bitternesse of paine or inflammation, which may trouble the patient, is not as yet verie great, neyther is the contraction of the muscles upwards as yet very much or stubborne. Therefore first of all, the Patient with his whole bodie, but * 1.2 especially with the broken or dislocated part, as also the Surgeon, must bee in some place which hath good and sufficient light. Then let trusty and skilfull atten∣dants be there, good ligatures, and also, if need so require, good engines. His friends which are present, let them see and hold their peace, neyther say, nor do any thing which may hinder the Worke of the Surgeon. Then putting one hand above, that is, towards the center of the body, and the other below, as neare as hee can to the part affected, let him stretch forth the member: for if you lay your hand any di∣stance from the part affected, you wil hurt the sound part by too much compression, neyther will you much avayle your selfe by stretching it at such a distance. But if you only endeavour below with your hand or ligature, assisting to make extension * 1.3 thereof, it will be dangerous if there bee nothing above which may withstand or hold, lest that you draw the whole bodie to you. This being done, according as I have delivered, it is fit the Surgeon make a right or straight extension of the part affected: for when the bone is eyther broken or out of joynt, there is a contraction of the muscles towards their originall, and consequently of the bones by them, as it is observed by Galen. Wherefore it is impossible to restore the bones to their * 1.4 former seat, without the extension of the muscles. But the part being thus exten∣ded, the broken bones will sooner and more easily be restored to their former seate. Which being restored, you shall presently with your hand presse it downe, if there be any thing that bunches or stands out. And lastly, you shall binde it up, by apply∣ing boulsters and splints as shall bee fit. But if the bone bee dislocated or forth of joynt, then presently after the extension thereof, it will be requisite to bend it som∣what about, and so to draw it in. The Surgeon is sometimes forced to use engines * 1.5 for this worke, especially if the luxation be inveterate, if the broken or luxated bones be great; and that in strong and rustick bodies, and such as have large joynts: for that then there is need of greater strength, than is in the hand of the Surgeon alone. For, by how much the muscles of the Patient are the stronger, by so much will they bee contracted more powerfully upwards towards their originals. Yet have a care that you extend them not too violently, lest by rending and breaking a-sunder the muscles and nerves, you cause the forementioned symptomes, paine, con∣vulsion,