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

OF FRACTURES. THE FIFTEENTH BOOKE. (Book 15)

CHAP. I. What a Fracture is, and what the differences thereof are.

A Fracture, in Galens opinion, is the solution of continuitie in a * 1.1 bone, which by the Greeks is called Catagma. There are many sorts of hurting or offending the bones: as the drawing them a-sunder, luxation, or putting them out of joynt; their unnaturall growing together, their cutting or dividing a-sunder; contusion, abscesse, putrefaction, rottennesse, laying bare the periostium being violated or lost; and lastly, that whereof we now treate, a Fracture. Again, the varieties of Fractures are almost infinite. For one is complete and perfect, another imperfect; one runnes long-wise, another transverse, another oblique; one while it is broken into great peeces, another while into little and small scales, which have eyther a blunt, or else a sharpe end, and pricke the adjacent bo∣dies of the muscles, nerves, veines or arteries. It somtimes happens, that the bone is not broken into splinters, that is, long-wayes, but together, and at once into two peeces overthwart, which Fracture is called Raphanedon, that is, after the maner of * 1.2 a Raddish.

A Fracture is made Caryedon, or like a nut, when as the bone flyes into many * 1.3 small peeces, severed each from other, as when a Nut is broken with a hammer or mallet upon an Anvile: Which fracture is also termed Alphitidon, by reason of the resemblance it hath to meale or floure; and such is often seene in fractures made by bullets, shot out of guns and such fiery engines. Contrary to these are those fra∣ctures which are called Schidacidon, as rent into splinters, or after the manner of * 1.4 a boord or peece of timber, that is, right-downe, and alongst the bone: and these fractures are eyther apparent to the eye, or else not apparent, and therefore called Capillarie, being so small, as that they cannot be perceived by the eye, unlesse you put inke upon them, and then shave them with your Scrapers. Sometimes the bone is only pressed downe by the stroke, sometimes on the contrarie it flyes up, as if it were vaulted. They call it attrition, when the bone is broken into many small fragments, and as it were scales or chips. The fragments of fractured bones are somtimes smooth and polished, otherwhiles unequall, and as it were sharpe and rough with little teeth, or prickes. Some fractures touch onely the surface of the bone, fetching off only a scale; othersome change not the site of fractured bones, but only cleaves them length-waies, without the plucking away of any fragment; othersome penetrate even to their marrow.

Furthermore some Fractures are simple and alone by themselves; othersome are accompanied with a troop of other affects and symptomes; as a wound, haemorrha∣gye, inflammation, gangrene, and the like. Hereunto you may also adde the diffe∣rences

drawne from the parts which the Fractures possesse; as from the head, ribs, limbs, joynts, and other members of the bodie. Adde also these which are taken from the habit of bodies, aged, young, full of ill humors, well tempered; almost all which have their proper and peculiar indications for curing. Now the causes * 1.5 of Fractures, are the too violent assaults or stroaks of all externall things, which may cut, bruise, breake, or shake: in this number of causes may also be reckoned fals from high places, and infinite other things, which would be long and tedious to reckon up.

CHAP. II. Of the signes of a Fracture.

WE may know by evident signes that a bone is broken: the first whereof, and most certaine, is, when by handling the part which * 1.6 we suspect to be broken, wee feele peeces of the bone severed a-sunder, and heare a certaine crackling of these peeces under our hands, caused by the attrition of the shattered bones. Another signe is taken from the impotencie of the part, which chiefly be∣wrayes * 1.7 its selfe, when both the bones, the legge, and brace-bones, the ell and wand are broken. For if onely the brace-bone or wand be broken, the Patient may goe on his legge, and stirre his arme: for the brace-bone serves for the sustaining of the muscles, and not of the bodie, as the legge bone doth. The third * 1.8 signe is drawne from the figure of the part changed besides nature: for it is there hollow, from whence the bone is flowne or gone, but gibbous or bunching out whither it is runne. Great paine in the interim torments the patient by reason of the wronged periostium, and that membrane which involves the marrow and the sympathie of the adjacent parts which are compressed or pricked.

CHAP. III. Of Prognosticks to be made in Fractures.

WEe must prognosticate in Fractures, whether they are to end in the de∣struction or welfare of the patient; or whether their cure shall be long or short, easie, or else difficult and dangerous; and lastly, what acci∣dents and symptomes may happen thereupon. Hee shall easily attaine to the knowledge of all these things, who is not onely well seene in the anatomicall description of the bones, but also in the temper, composition and com∣plexion of the whole bodie. Wherefore in the first place, I thinke good to admo∣nish the Surgeon of this, that in winter when all is stiffe with cold, by a little fall, or * 1.9 some such sleight occasion, the bones may be quickly and readily broken. For then the bones, being dryed by the drinesse of the ayre encompassing us, become more brittle; which everie one of the Vulgar usually observe to happen both in waxen and tallow candles: but when the season is moist, the bones are also more moist, and therefore more flexible and yeelding to the violence of the obvious and offen∣ding bodie. Wherefore also you may gather this to the framing of your Progno∣sticks, That bones by reason of their naturall drinesse are not so easily agglutinated * 1.10 and consolidated as flesh; though in Children, according to Galen, by reason of the abundance of their humiditie, the lost substance may bee repaired, according (as they terme it) to the first intention, that is, by restoring of the same kinde of sub∣stance or matter. But in others, about the Fractures a certaine hard substance usu∣ally concreats, of that nourishment of the broken bone which abounds, which glues together the fragments thereof, being fitly put together. This substance is then termed a Callus, and it is so hardened in time, that the bone thereafter in the

broken part is seene to be more firme and hard than it is in any other: therefore that usuall saying in Physicke is not without reason; That rest is necessarie for the uni∣ting of broken bones. For the Callus is easily dissolved, if they bee moved before their perfect and solid agglutination. The matter of a Callus ought to be indifferent and laudible in quantitie and qualitie, even as blood which flowes for the regenera∣tion of the lost flesh in wounds. It is fit, that there may be sufficient matter for such a Callus, that the part have a laudible temper, otherwise there either wil be no Callus, or certainly it wil grow more slowly. Fractures are far more easily repaired in yong * 1.11 bodies than in old: for in these there is plentie of the primigenious and radicall moisture, that is laudably holding and glutinous; and in the other there is store of watrish and excrementitious. By this you may easily conjecture, that you cannot certainely set downe a time necessarie for the generating a Callus: for in some it happens later, in some sooner: the cause of which varietie is also to be referred to the constitution of the yeare and region, the temper and diet of the Patient, and ma∣ner of Ligation. For, those Patients whose powers are weake, and blood watrish and thin, in these the generation of a Callus uses to be more slow: On the contrarie, * 1.12 strong powers hasten to agglutinate the bones, if there be plentie of grosse and vis∣cous matter; whereby it comes to passe, that meats of grosser nutriment are to bee used, and medicines applyed which may helpe forwards the endeavour of nature, as we shall declare hereafter. When the bones are broken neare unto the joynts, the motion afterwards uses to be more difficult, especially if the Callus, which is sub∣stituted, be somewhat thicke and bunching forth. But if, together with the violence * 1.13 and force of the Fracture, the joynts shall bee broken and bruised, the motion will not only bee lost, but the life brought in danger, by reason of the greatnesse of the inflammation, which usually happens in such affects, and the excesse of paine in a tendinous body. These fractures wherein both the bones of the arme or legge are broken, are more difficult to cure, than those which happen but to one of them. For they are handled & kept in their places with more difficulty, because that which * 1.14 remaines whole, serves the other for a rest or stay to which it may leane. Moreover, there is longer time required to substitute a Callus to a great bone, than to a little one. Againe these bones which are more rare and spongie, are sooner glued toge∣ther by the interposition of a Callus, than these which are dense and solid. A Cal∣lus sooner growes in sanguine, than in cholerick bodies. But broken bones cannot be so happily agglutinated, nor restored in any body, but that alwaies some asperi∣ty or unequall protuberancie may bee seene on that part where the Callus is genera∣ted. Wherfore the Surgeon ought to make artificiall Ligations, that the Callus may * 1.15 not stand out too far, nor sinke downe too low. That Fracture is least troublesome which is simple; on the contrarie, that is more troublesome which is made into splinters; but that is most troublesome and worst of all which is in small and sharp fragments, because there is danger of convulsion by pricking a nerve, or the peri∣ostium. Sometimes the fragments of a broken bone keep themselves in their due place: they also oft times fly forth thereof, so that one of them gets above another; which when it happens, you may perceive an inequality by the depression of the one part and the bunching forth of the other, as also paine by the pricking: besides also the member is made shorter than it was, and than the sound member on the op∣posite side is, and more swolne by the contraction of the muscles towards their originall. Wherefore when a bone is broken, if you perceive aniething so depres∣sed, * 1.16 presently putting your hand on both sides above and below, stretch forth the bone as forcibly as you can; for otherwise, the muscles and nerves, stretched and contracted, will never of their owne accord suffer the bones to be restored to their proper seat and themselves. This extension must bee performed in the first dayes, for afterwards there will happen inflammation: which being present, it is dange∣rous to draw the nerves and tendons too violently; for hence would ensue an im∣postume, convulsion, gangrene and mortification. Therefore Hippocrates forbids * 1.17 you to defer such extension untill the third, or fourth day. Fractures are thought dangerous, whose fragments are great, and fly out, especially in these bones which are filled with marrow on the inside. When broken or dislocated bones cannot be

restored to themselves and their naturall place, the part wasts for want of nourish∣ment; both for that the naturall site of the veines, arteries and nerves is perverted, as also because the part it selfe lyes immoveable, or scarce moveable: whereby it commeth to passe, that the spirits doe not freely flow thereto, as neyther the nutri∣tive juice commeth thither in sufficient plentie. When the dislocated or broken member is troubled with any great inflammation, it is doubtfull whether or no a * 1.18 convulsion will happen, if wee attempt to restore it, or the parts thereof to their seat: therefore it is better, if it may bee done, to deferre the reducing thereof so long, untill the humor which possesses the part be dissolved, the tumor abated, and the bitternesse of paine mitigated.

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 * 1.19 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 * 1.20 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 * 1.21 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 * 1.22 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 * 1.23 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,

a palsie and gangrene: all which sooner happen to strong and aged bodies, * 1.24 than to children, eunuches, women, youthes, and generally all moyst bodies, for that they are lesse hurt by violent extension and pulling, by reason of their native and much humiditie and softnesse. For thus skins of leather, moystened with any liquor, are easily retched and drawn out as one pleaseth: but such as are dry & hard, being lesse tractable, will sooner rend and teare, than stretch further out. Therefore the Surgeon shall use a meane in extending and drawing forth of members, as shall be most agreeable to the habits of the bodies. You may know the bone is set, and * 1.25 the setting performed as is fit, if the paine be asswaged; to wit, the fibres of the muscles, and the other parts being restored to their former site, and all compression, which the bones moved out of their places have made, being taken away; if, to your feeling there bee nothing bunching out, nor rugged, but the surface of the member remaine smooth and equall; and lastly, if the broken or dislocated mem∣ber compares with its opposite in the composure of the joynts, as the knees and ancles answer justly and equally in length and thicknesse. For which purpose it must not suffice the Surgeon to view it once, but even as often as he shall dresse it. For it may happen, that the bone which is well set, may by some chance, as by the * 1.26 Patients unconsiderate turning himselfe in his bed, or as it were a convulsive twitch∣ing of the members or joynts whilest he sleepes, the muscles of their owne accord contracting themselves towards their originals, that the member may againe fall out; and it will give manifest signes thereof by renewing the paine, by pressing or pricking the adjacent bodies: which paine will not cease, before it bee restored to its place: and hereof the Surgeon ought to have diligent care. For if, whilest the Callus is in growing, one bone ride over another, the bone it selfe will afterwards be so much the shorter, and consequently the whole member; so that if this errour shall happen in a broken legge, the Patient will halt ever after, to his great griefe, and the Surgeons shame. Wherefore the Patient shall take heed, as much as in him lyes, that he stirre not the broken member, before that the Callus be hardened. Such dili∣gent care needes not bee had in dislocations. For these once set, and artificially bound up, doe not afterwards so easily fall forth as broken bones.

The second scope is, that the bones which shall be restored may bee firmely kept in their state and place. That shall be done by Bandages; as ligatures, boulsters, and other things, whereof hereafter we shall make particular mention. Hither tend pro∣per and fit medicines, to wit, applying of oyle of Roses with the whites of Egges, and the like repelling things; and then resolving medicines, as the present necessity shall require. It will be convenient, to moysten your rowlers and boulsters in oxy∣crate for this purpose, or else in Rose vinegar, if the Fracture be simple, or with red wine, or the like liquor warme (in Galens opinion) if a wound bee joyned to the * 1.27 fracture; and it will be fit to moysten fractures oftner in Summer: For so the part is strengthened, the defluxion being repelled, whereby the inflammation and paine are hindred. You must desist from humecting and watering the part when the symp∣tomes are past, lest you retard the generating of a Callus; for which you must la∣bour by these meanes which wee shall hereafter declare. To this purpose also con∣duces the rest and lying of the part in its proper figure and site accustomed in health, that so it may the longer remaine in the same place unstirred. Besides also, it is expedient then only to dresse the part, when it is needfull, & with those things that are requisite, shunning, as much as may be, inflammation and paine. That fi∣gure * 1.28 is thought the best, which is the middle, that is, which containes the muscles in their site, which is without paine; so that the Patient may long endure it with∣out labour or trouble. All these thing being performed, the Patient must be asked, Whether the member be bound up too strait? If hee answer, No, (unlesse perad∣venture a little upon the fracture or luxation, for there it is fit it should bee more straitly bound) then may you know that the binding is moderate. And this * 1.29 same first ligation is to bee kept in fractures without loosing for three or foure dayes space, unlesse peradventure paine urge you to the contrary. In dislocations the same binding may bee kept for seven or eight daies, unlesse by chance some symptome may happen, which may force us to open it before that time: for

the Surgeon must with all his art have a care to prohibite the happening of evill accidents and symptomes, which, how he may bring to passe, shall bee declared in the following Chapter.

CHAP. V. By what meanes you may performe the third intention in curing fractures and dislo∣cations, which is, the hindring and correction of accidents and symptomes.

THat we may attaine unto this third scope, it is requisite we handle as gen∣tly and without paine, as we may, the broken or dislocated member; * 1.30 we drive away the defluxion ready to fall downe upon the part by me∣dicines, repelling the humour, and strengthning the part; wee, by ap∣pointing a good diet, hinder the begetting of excrements in the bodie, and divert them by purging and phlebotomie. But if these accidents be already present, we must cure them according to the kinde and nature of each of them: for they are various. Amongst which is reckoned itching, which in the beginning torments the Patient: this ariseth from a collection and suppression of subacride vapours, * 1.31 arising from the blood, and other humors under the skin. Whence a light biting, which causeth a simple itch, or else a more grievous and acride one, from whence (in Galens opinion) proceeds a painefull itching. Wherefore such matter, as the * 1.32 cause, being evacuated, all itching ceaseth. But this cannot easily and freely be eva∣cuated and breathed out, because the pores of the part are shut up, and as it were oppressed with the burden of the emplaisters, boulsters, and ligatures, which are put about the part. Hereunto may be added, that the part its selfe doth not so per∣fectly performe and enjoy its wonted faculties and actions: by which it commeth to passe, that the heat thereof is more languide than may suffice to discusse the fuli∣ginous matter there collected. Wherefore it will be convenient to loose the liga∣tures * 1.33 everie third day, that, as by loosing their tyes, their sanious and fuliginous excrements, shut up under the skinne, may freely passe forth, lest in continuance they should fret and ulcerate it; as it happens to most of those who provide not for it by loosing their ligatures. Besides also, the part must bee long fomented with hote water alone, or else with a decoction of sage, chamomile, roses, and melilote made in wine and water: for long fomenting attenuates and evacuates, but shorter fils and mollifies, as it is delivered by Hippocrates. Also gentle fri∣ctions, performed with your hand, or a warme linnen cloath upwards, to the right side and left, and circularly to everie side, are good. But if the skinne be already ri∣sen into blisters, they must be cut, lest the matter contained thereunder may corrode and ulcerate the skinne: then must the skinne be annointed with some cooling and drying medicine; as, Ung. album Camphoratum Rhasis, Desiccativum rubrum, un∣guentum rosatum sine aceto; adding thereto the pouder of a rotten poste, or prepared Tutia, or the like. Other accidents more grievous than these, doe often happen, but * 1.34 we will treat of them hereafter. But if the scales of the bone underneath bee quite severed from the whole, then must they be presently taken forth, especially if they prick the muscles: But if the bone be broken into splinters, and so prominent out of the wounded flesh as that it cannot be restored into its seat, it must be cut off with your cutting mallets, or parrats beake, as occasion shall offer its selfe. In the interim, you must have a care that the part enjoy perspiration, and by change of place and rising, now and then it may be as it were ventilated: also you must see that it be not over-burdened, neyther too strait bound, otherwise it will be apt to inflammation. Thus much concerning fractures and dislocations in generall: now we must descend to particulars, beginning with a fracture of the Nose.

CHAP. VI. Of the Fracture of the Nose.

THe Nose is gristly in its lower part, but bony in the upper. Wherfore it * 1.35 suffers no fracture in the gristly part (unless peradventure a Sedes) but only a depression, distortion or contusion. But a fracture often happens to the bony part, & so great a depression to the in nerside, that unlesse it be pro∣vided for by diligent restoring it, the nose will become flat, or wrested aside, whence there will be difficulty of breathing. That this kinde of fracture may be restored, * 1.36 that bone which stands too farre out must be pressed downe; but that which is de∣prest, must be lifted up with a spatherne, or little sticke handsomely fashioned and wrapped about with cotten or a linnen ragge, so to avoyd paine. Therefore you shall hold the spatherne in one hand, and reduce and order it with the other. The bone being restored, directories or tents of a convenient bignesse shall be put into the nose; which tents shall bee made of sponge, or flaxe, or a peece of a beasts or sheeps lungs. For these things are soft, and doe not onely hinder the bones of the Nose that they fall no more, but also lift them up higher. And then the Nose shall be in some sort stayed with boulsters on each side, even untill the perfect agglutina∣tion of the bones, lest the figure and straitnesse should be vitiated and spoyled. I have oft times put golden, silver and leaden pipes into fractured noses, and fastned them with a thred to the Patients night cap, which, by one and the same means, kept the bones from being again deprest, gave the matter free passage forth, and no∣thing hindred the breathing. In the mean time we must see, that we do not presse the Nose with too strait binding, unlesse peradventure some other thing perswade; lest they become eyther too wide, too flat, or crooked. If any wound accom∣pany the fracture, that shall bee cured after the same manner, as the wounds of the head. The fracture restored, the following medicine, which hath a facultie to repell and represse the defluxion, to strengthen and keep the part in its due posture, and to dry up and waste the matter which hath alreadie fallen downe, shall bee apply∣ed to the Nose, and all the other dry parts.

℞. thuris, mastiches, boli armeniae, sanguinis draconis. an. ℥ss. aluminis rochae, * 1.37 resinae pini. an. ʒ ij. pulverisentur subtilissimè: Or else, ℞. farinae volatilis ℥ss. al∣buminum ovorum quantum sufficit, incorporentur simul, & fiat medicamentum.

Neither shall you use any other art to cure the cartilagineous part of the nose being fractured. Wherefore Hippocrates termes that solution of continuitie that * 1.38 there happens, A fracture, as if it were in a bone; because hee could finde no o∣ther name more fitly to expresse it: for a gristle, next to a bone, is the har∣dest of all the parts of our bodie. A Callus uses to grow in fractured noses, unlesse something hinder within the space of twelve or fifteene dayes.

CHAP. VII. Of the Fracture of the lower Jaw.

THe lower Jaw runnes into two, as it were, horns or tops: the one where∣of * 1.39 ends sharpe, and receives a tendon from the temporall muscle; the other ends blunt and round under the mammillarie processe, and it is there implanted in a small cavitie; it is joyned together in the mid∣dle of the chin by Symphysis, and is marrowie within. The Fracture, * 1.40 which happens thereto, is restored by putting your fingers into the Patients mouth, and pressing them on the inside and outside, that so the fractured bones put toge∣ther may be smoothed and united. But if they be broken wholly athwart, so that the bones lye over each other, extension must be made on both sides on contrary parts, upwards and downwards, whereby the bones may be composed and joy∣ned

more easily to one another. The teeth in the meane while, if they be eyther shaken or removed out of their sockets, must be restored to their former places, and tyed with a gold or silver wyar, or else an ordinary threed, to the next firme teeth, untill such time as they shall be fastened, and the bones perfectly knit by a Callus. To which purpose the ordered fragments of the fractured bone shall bee stayed, by putting a splint on the outside, made of such leather as shoe soales are made; the midst thereof being divided at the Chin, and of such length and breadth as may serve the Jaw: then you shall make ligation with a ligature two fingers broad, * 1.41 and of such length as shall be sufficient, divided at both the ends, and cut long-waies in the midst thereof; that so it may engirt the chin on both sides. Then there will be foure heads of such a ligature so divided at the ends; the two lower where∣of being brought to the crown of the head, shall bee there fastened and sowed to the Patients night-cap. The two upper drawne athwart shall likewise be sowed as artificially as may bee, to the cap in the nappe of the necke. It is a most certaine signe, that the Jaw is restored and well set, if the teeth fastened therein stand in their due ranke and order. The patient shall not lye downe upon his broken jaw, lest the fragments of the bones should againe fall out, and cause a greater defluxion. Unlesse inflammation, or some other grievous symptome, shall happen, it is strengthned with a Callus within twentie dayes; for that it is spongious, hollow, and full of marrow, especially in the midst thereof: yet sometimes, it heales more * 1.42 slowly, according as the temper of the patient is, which takes also place in other fractured bones. The agglutinating and repelling medicine, described in the for∣mer chapter, shall be used; as also others, as occasion shall offer it selfe. The Pa∣tient must be fed with liquid meats, which stand not in need of chewing, untill such time as the Callus shall grow hard, lest the scarce or ill-joyned fragments should fly insunder with the labour of chewing. Therefore shall hee bee nourished with water-grewell, ponadoes, cullasses, barley creames, gellies, brothes, reare egges, re∣staurative liquors, and other things of the like nature.

CHAP. VIII. Of the Fracture of the Clavicle or Collar-bone.

AS the nature and kinde of the fractured Clavicle shall bee, so must the cure and restoring thereof bee performed. But howsoever this bone * 1.43 shall be broken, alwaies the end fastened to the shoulder and shoulder-blade, is lower than that which is joyned to the chest; for that the arme drawes it downe-wards. The collar-bone, if broken athwart, is more easily restored and healed, than if it be cloven long-wayes. For, everie bone bro∣ken athwart doth more easily returne into its former state or seat, whiles you lift it up on this or that side with your fingers. But that which is broken schidacidon, or into splinters, or long-waies, is more difficultly joyned and united to the ends and fragments: for those peeces, which were set, will be plucked asunder, even by the least motion of the armes; and that which was knit with the shoulder, will fall downe to the lower part of the breast. The reason of which is, the Collar-bone is not moved of its selfe, but consents in motion with the arme. In restoring this or * 1.44 any other fracture, you must have a care that the bones ride not one over another, neyther be drawn nor depart too far in sunder: therfore it will be here convenient, that one servant draw the arme backwards, and another pull the shoulder towards him the contrarie way; for so there will be made, as I may so terme it, a counter-extension. While which is in doing, the Surgeon with his fingers shall restore the fracture, pressing downe that which stood up too high, and lifting up that which is pressed downe too low. Some, that they may more easily restore this kinde of * 1.45 fracture, put a clew of yarne under the Patients arme-pit; so to fill up the cavity thereof: then they forcibly presse the elbow to the ribs, and then force the bone into its former seat. But if it happen, that the ends of the broken bones shall bee so * 1.46

deprest, that they cannot be drawn upwards by the forementioned means: then must the Patient be layd with his backe, just betweene the shoulders, upon a pillow hard stuffed, or a tray turned with the bottome upwards, and covered with a rugge or some such thing. Then the servant shall so long presse downe the Patients shoul∣ders with his hands, untill the ends of the bones, lying hid and pressed downe, fly out and shew themselves. Which being done, the Surgeon may easily restore or set the fractured bone. But if the bone be broken so into splinters that it cannot bee re∣stored, and any of the splinters pricke and wound the flesh, and so cause difficultie of breathing, you then must cut the skinne even against them, and with your instru∣ment lift up all the depressed splinters, and cut off their sharp points; so to prevent all deadly accidents, which thereupon may bee feared. If there be many frag∣ments, they, after they are set, shall be covered with a knitting medicine made of wheat floure, frankincense, bole armenicke, sanguis draconis, resina pini, made into powder, and mixed with the whites of egges, putting upon it splints, covered with * 1.47 soft worne linnen raggs; covered over likewise with the same medicine, and then three boulsters dipped in the same; two whereof shall be layd upon the sides, but the third and thickest upon the prominent fracture, so to represse it and hold it in. For thus the fragments shall not be able to stirre or lift themselves up further than they should, eyther to the rightside or left. Now these Boulsters must be of a con∣venient thicknesse and breadth, sufficient to fill up the cavities which are above and below that bone. Then shall you make fit ligation with a rowler, having a double head cast crosse-wise, of a hands breadth, and some two ells and a halfe long, more or less, according to the Patients bodie. Now hee shall be so rowled up, as it may draw his arme somewhat backwards, and in the interim his arme-pits shall be filled with boulsters, especially that next the broken bone; for so the Patient may more easily suffer the binding. Also you shall wish the Patient, that he of himselfe bend his arme backewards, and set his hand upon his hip, as the Countrey Clownes use to doe, when they play at leap-frogge. But how great diligence soever you use * 1.48 in curing this sort of fracture, yet can it scarce be so performed, but that there will some deformity remaine in the part: for that a ligature cannot be rowled about the collar-bone, as it may about a legge or an arme. A Callus oft times growes on this bone, within the space of twenty daies, because it is rare and spongious.

CHAP. IX. Of the fracture of the shoulder-blade.

THe Greeks call that Omoplata, which the Latines terme Scapula, or Scapu∣lae * 1.49 patella, that is, the shoulder-blade. It is fastened on the backe to the ribs, nowle, the Vertebrae of the chest and necke; but not by articulation, but only by the interposition of muscles, of which wee have spoken in our Anatomie. But on the forepart it is articulated after the manner of other bones with the collar-bone, the shoulder, or arme-bone: for with its processe, which re∣presents a pricke or thorne, and by some, for that it is more long and prominent, is called Acromion, (that is, as you would say, the top or spire of the said shoulder-blade) it receives the Collar-bone. Therefore some Anatomists, according to Hip∣pocrates as they suppose, call all this articulation of the Collar-bone with the hollowed processe of the shoulder-blade, Acromion. There is another processe of the said Blade-bone, called Cervix om••platae, or the necke of the Shoulder-blade: this truely is very short, but ending in a broad and sinuated head, provided for the receiving of the Shoulder or arme-bone. Not farre from this processe is another, called Coracoides, for that the end thereof is crooked like a Crowes beake. This keeps the shoulder bone in its place, and conduces to the strength of that part. The shoulder-blade may be fractured in any part thereof, that is, eyther on the ridge, * 1.50 which runnes like a hill, alongst the midst thereof, for its safety, as wee see in the Vertebrae of the backe. So also in the broader part thereof it may bee thrust in and

deprest; and also in that articulation, whereby the top of the shoulder is knit to it. According to this variety of these fractured parts, the happening accidents are more grievous or gentle.

Wee know the spine or ridge of the Shoulder-blade to be broken, when a dolo∣rificke inequalitie is perceived by touching or feeling it. But you may know, that the broader or thinner part thereof is depressed, if you feele a cavity, and a prick∣ing paine molest the part, and if a numnesse trouble the arme, being stretched forth. The fragments, if they yet sticke to their bone, and doe not pricke the flesh, * 1.51 must be restored to their state and place, and there kept with agglutinative medi∣cines, and such as generate a Callus, as also with boulsters and rowlers fitted to the place. But if they doe not adhere to the bone, or pricke the flesh lying under them, then must you make incision in the flesh over against them, that so you may take them out with your Crowes beake. But although they stirre up and downe, yet if they still adhere to the periostium and ligaments, (if so be that they trouble not the muscles by pricking them) then must they not bee taken forth: for I have oftner than once observed, that they have within some short time after growne to the ad∣jacent bones. But if they, being wholly separated, doe not so much as adhere to the periostium, then must they necessarily be plucked away; otherwise within some short space after, they will be driven forth by the strength of nature, for that they participate not any more in life with the whole. For that which is quicke, saith Hippocrates, uses to expell that which is dead farre from it. The truth whereof was * 1.52 manifested in the Marques of Villars, who at the battell of Dreux was wounded in his shoulder with a pistoll bullet, certaine splinters of the broken bone were plucked forth with the peeces of his harnesse, and of the leaden bullet; and within some short space after, the wound was cicatrized, and fully and perfectly healed. But more than seven yeares after, a defluxion and inflammation arising in that place by reason of his labour in armes, and the heavinesse of his armour at the battell of Mont-contour, the wound broke open againe; so that many shivers of the bone, * 1.53 with the residue of the leaden bullet, came forth of themselves. But if the fracture shall happen in the necke of the shoulder blade or dearticulation of the shoulder, there is scarce any hope of recovery; as I have observed in Anthony of Burbon, King of Navarre; Francis of Lorraine, Duke of Guise; the Count Rhingrave Phi∣libert, and many other in these late civill warrs. For there are many large vessels a∣bout this dearticulation, to wit, the axillary veine and arterie, the nerves arising from the Vertebrae of the necke, which are thence disseminated into all the muscles of the arme. Besides, also inflammation and putrefaction arising there are easily communicated by reason of their neighbour-hood to the heart and other princi∣pall parts, whence grievous symptomes, and oft times death it selfe, ensues.

CHAP. X. Of the fracture and depression of the Sternon, or Breast-bone.

THe Sternum is sometimes broken, otherwiles onely thrust in without a fracture. The inequality perceivable by your feeling, shews a fracture, * 1.54 as also the going in with a thrust with your finger, and the sound or noise of the bones crackling under your fingers. But a manifest cavity in the part, a cough, spitting of blood, and difficultie of breathing by compression of the * 1.55 membrane investing the ribs and the lungs, argue the depression thereof. For the restoring of this bone, whether broken or deprest, the patient must be layd on his * 1.56 backe, with a cushion stuffed with tow or hay under the vertebrae of the backe, as we set downe in the setting of the Collar-bone. Then a servant shall lye strongly with both his hands on his shoulders, as if he would presse them downe, whilst the Surgeon, in the meane time pressing the ribs on each side, shall restore and set the bone with his hand; and then the formerly described medicines shall bee applyed for to hinder inflammation, and asswage paine; boulsters shall bee fitted thereto,

and a ligature shall bee made crosse-wayes above the shoulders, but that not too strait, lest it hinder the Patients breathing. I by these meanes, at the appointment * 1.57 of Anthony of Burbon King of Navarre, cured Anthony Benand a Knight of the Order, who had his breast-plate bended and driven in, with an iron bullet shot out of a Field-Peece, as also his sternum together therewith, and he fell down as dead with the blow; he did spit blood for three months after I had set the bone: yet for all this he lives at this day in perfect health.

CHAP. XI. Of the fracture of the ribs.

THe true ribs, for that they are bonie, may be broken in any part of them. But the bastard ribs cannot be truly broken unlesse at the backe bone, * 1.58 because they are onely bonie in that part, but gristly of the foreside to∣wards the breast-bone; wherefore there they can only be folded or croo∣ked in. These which are subject to fractures, may be broken inwards and outwards. But oft times it comes to passe, that they are not absolutely broken, but cleft into splinters, and that sometimes inwards, but not outwards. Thus the fissure doth oft-times not exceede the middle substance of the rib; but sometimes it so breakes through it all, that the fragments and splinters do prick and wound the membrane, which invests and lines them on the inside, and then there is great danger. But when the fracture is simple without a wound, compression, puncture of the mem∣brane, and lastly, without any other symptome; then the danger is lesse. There∣fore Hippocrates wisheth, that these, who are thus affected, fill themselves more free∣ly * 1.59 with meat; for that moderate repletion of the belly, is (as it were) a certaine prop or stay for the ribs, keeping them well in their place and state: which rule chiefly takes place in fractures of the bastard ribs. For such as have them broken, usually feele themselves better after, than before meat. For emptinesse of meat, or of the stomack, makes a suspension of the ribs, as not underpropped by the meat. Now that fracture which is outwardly, is farre more easie to heale, than that which * 1.60 is inwardly; for that this pricketh the membrane or Pleura, and causeth inflamma∣tion, which may easily end in an Empyema. Adde hereunto, that this is not so easi∣ly to be handled or dealt withall, as the other: whereby it commeth to passe, that it cannot be so easily restored; for that these things cannot bee so fully and freely performed in this kinde of fracture, which are necessary to the setting of the bone, as to draw it out, hold it and joyne it together. It is therefore healed within twenty dayes, if nothing else hinder. The signes of fractured ribs are not obscure; for by * 1.61 feeling the grieved part with your fingers, you may easily perceive the fracture by the inequalitie of the bones, and their noyse or crackling, especially, if they bee quite broke asunder. But if a rib be broken on the inside, a pricking paine, far more grievous than in a Pleurisie, troubles the Patient; because the sharp splinters pricke the Costall membrane: whence great difficulty in breathing, a cough and spitting of blood ensue. For blood, flowing from the vessels broken by the vio∣lence * 1.62 of the thing causing the fracture, is (as it were) sucked up by the lungs, and so by a dry cough carried into the weazond, and at length spit out of the mouth. Some, to pull up the bone that is quite broken and deprest, apply a cupping glasse, and that is ill done: for there is caused greater attraction of humors, and excesse of paine by the pressure and contraction of the adjacent parts, by the cupping-glasse; wherefore Hippocrates also forbids it. Therefore it is better to endeavour to re∣store * 1.63 it after this following manner. Let the Patient lye upon his sound fide, and let there be layd upon the fractured side an emplaister made of Turpentine, rosin, black pitch, wheat floure, mastick and aloes, and spread upon a strong and new cloath. When it hath stucke there some time, then plucke it suddenly with great violence from below upwards: for so the rib will follow together therewith, and bee plucked and drawne upwards. It is not sufficient to have done this once, but you

must doe it often, untill such time as the Patient shall finde himselfe better, and to breathe more easily. There will be much more hope of restitution, if, whilest the Surgeon doe this diligently, the Patient forbeare coughing, and hold his breath. Otherwise, if necessitie urge, as if sharpe splinters with most bitter tormen∣ting paine pricke the Costall membrane overspred with many nerves, veines, and arteries, which run under the ribs, whence difficultie of breathing, spitting of blood, a cough and fever ensue; then the only way to deliver the Patient from danger of imminent death, is, to make incision on the part, where the rib is broken, that so laying it bare, you may discerne the pricking fragments, and take them out with your instrument, or else cut them off. And if you make a great wound by incision, then shall you few it up, and cure it according to the common rules of curing wounds. Now Diet, Phlebotomie and Purgation, which (as Hippocrates saith) * 1.64 are not very needfull in a simple fracture, for that there are no symptomes, which may require such remedies; yet, they, by reason of the complicated symptomes, as a convulsion, feaver, Empyema, and the like, must here be prescribed, by the ad∣vice of the Physician which over-sees the cure. A Cerate, and other remedies fit∣ting the occasion, shall be applyed to the grieved part: no other ligatures can be u∣sed, than such as are fit to hold fast and stay the locall medicines. There is no o∣ther rule of site and lying, than such as is taken from the will and content of the Patient.

CHAP. XII. Of certaine preternaturall affects which ensue upon broken ribs.

MAny symptomes ensue upon fractured and contused ribs: but amongst the rest, there are two which are not common, whereof we will treate in this place. The first is, the inflation, or rising up of the contused flesh, which also ensues upon light affects of the bone, which have bin neglected at the beginning. But the flesh is not meerly puffed up of its selfe, but also with a certaine phlegmatick, glutinous and viscous humour gathering thereinto. The cause hereof is, the weaknesse of the digestive facultie of the part, occasioned by the stroake and distemper; which therefore cannot assimulate the * 1.65 nourishment flowing more plentifully than it was wont, eyther drawne thither by means of the pain, or sent thither by a blinde violence of nature, stirred thereto by a desire of its own preservation. Wherfore this halfe crude humor remaining there, raiseth much flatuling from its selfe, or else wrought upon by the weaker heat, it is resolved into cloudy vapours; whence it commeth to passe, that the flesh is swolne up in that place, and the skinne on the contrary growes soft, as if it were blowne * 1.66 up with a quill. Therefore laying your hand thereon, you may heare the noyse of the winde going forth thereof, and see a cavity left in the part, as it is usually seene in oedematous tumors. Unlesse you remedie this inflation, there will ensue an in∣flammation, fever, abscesse, difficulty of breathing; and lastly, that second kinde of affect, whereof we have determined to treat in this Chapter, to wit, the putrefacti∣on, corruption, or blasting of the ribs. An abscesse, and the separation of the flesh from the bone, is the cause hereof: for hence it commeth to passe, that the bone, despoyled of its naturall and fleshly cloathing wherewith it was cherished, is easily offended by the touch of the entring ayre, which it never formerly felt, and so at length it becommeth (as it were) blasted: which when it happens, they spit up filth, and so fall into a consumption, and at length dye. To withstand all these inconve∣niencies, you must, as speedily as you can, restore the fractured bones by the for∣merly * 1.67 delivered meanes. And then this mucous tumor must be resolved by proper heating and discussing medicines, and kept downe by boulsters and rowlers; that so the flesh may touch the bone, and cover it as it usually did. But the ligature shall not be made so strait, as to hinder the ribs from their wonted motion in expiration and inspiration. If the tumor degenerate into an Abscesse, it shalbe speedily opened,

lest the matter, kept in too long, corrupt the bone which lyes under it, by the con∣tagion of its putrefaction. The Ulcer being opened, the matter shall bee evacuated by putting a pipe into the ulcer; the end whereof shalbe bound about with a thred, lest it fall into the capacity of the chest, and that it may bee drawne forth at your pleasure.

CHAP. XIII. Of the fracture of the Vertebrae, or Rack-bones of the backe, and of their processes.

THe Vertebrae are some-whiles broken, otherwhiles bruised, or strained * 1.68 on the inside, wherby it commeth to passe, that the membranes which invest the spinall marrow, as also the spinall marrow its selfe, are com∣pressed and straitened, which cause many maligne accidents; which, whether they be curable or not, may be certainly foretold by their magnitude. A∣mongst these symptomes, are the stupidity, or numnesse and palsie of the armes, legges, fundament and bladder, which diminish, or else take away from them the facultie of sense and motion; so that their urine and excrements come from them a∣gainst their wils and knowledge, or else are wholly supprest. Which when they happen (saith Hippocrates) you may fore-tell that death is at hand, by reason that * 1.69 the spinall marrow is hurt. Having made such a prognosticke, you may make an * 1.70 incision, so to take forth the splinters of the broken vertebrae, which, driven in, presse the spinall marrow, and the nerves thereof. If you cannot doe this, at least you shall apply such medicines as may asswage paine, and hinder inflammation; and then the broken bones shall be restored to their places, and contained therein by those meanes which we shall mention when we come to treat of the luxation of the spine. But if that the processes onely of the vertebrae be broken, the fragments * 1.71 shall be put in their places, unlesse they bee quite severed from their periostium. But if they bee severed, you shall open the skinne and take them forth, and then dresse the wound as is fit. Wee understand, that onely the processes of the vertebrae are * 1.72 broken, if, in the absence of the fore-mentioned symptomes of numnes and the pal∣sey, you, laying your finger upon the grieved part, feele something, as a bony frag∣ment, shaking and moving thereunder, with a certaine crackling noyse, and cavitie, and depression; and then, if when the Patient holds downe his head, and bends his backe, hee feele farre more paine, than when hee stands up straight on his feete. For in stooping, the skinne of the backe is somewhat stretched forth, and extended, and also forced upon the sharpe Splinters of the fragments, whence proceedes a dolorificke solution of continuitie, and a pricking: in stan∣ding straight up, on the contrary, the stretched skinne is relaxed, and consequent∣ly lesse molested by the sharpe fragments. The fractured processes of the verte∣brae easily heale, unlesse they bee associated with some other more grievous symp∣tome which may hinder; such as is a certaine great contusion, and the like. For, as wee formerly sayd out of Hippocrates, All rare and spongie bones are knit by a Callus within a few dayes.

CHAP. XIV. Of the fracture of the holy-bone.

ALso the Holy-bone in a certaine part thereof, which may be easily hea∣led, may be broken by the blow of bruising things, as by a bullet shot * 1.73 out of a musket, as I have observed in many. But if the fracture violate, together with the vertebrae thereof, the spinall marrow contained therein, then the Patient can scarce scape death, for the reasons shewed in the former Chapter.

CHAP. XV. Of the fracture of the Rumpe.

THe Rumpe is composed of foure bones: the first whereof hath a cavitie, * 1.74 wherein it receives the lowest vertebrae of the Holy-bone: the other three are joyned together by Symphysis or Coalition; at the end of these hangs a certaine small gristle. The fracture of these bones shall be cu∣red by putting your finger into the Patients fundament, and so thrusting it even to * 1.75 the fractured place. For, thus you may thrust the fragment forth, and fit and re∣store it to the rest of the bones by your other hand lying upon the backe. But that it may be the sooner healed, it is fit the Patient keep his bed, during all the time of the cure. But if there be a necessitie to rise, hee shall so sit in a perforated seat, that there may bee nothing which may presse the broken part; and fitting remedies for healing fractures shall be applyed, as occasion shall offer its selfe.

CHAP. XVI. Of the fracture of the Hip, or Os Ilium.

THe Hip consists of three bones: The first is named Os Ilium, the Haunch-bone; * 1.76 the other, Os Ischion, the Huckle bone; the third, Os pubis, the Share-bone. These three bones in men of full growth, are so fast knit and joyned together, that they can by no meanes be separated; but in children they may be separated without much adoe. This bone may be broken in any part thereof, either by a stroake, or by a fall from high upon any hard bodie. You shall know the fracture by the same kinde of signes, as you know others, to wit, * 1.77 paine, pricking, a depressed cavitie, and inequalitie, and also a numnesse of the legge of the same side. The splinters of the bones (if quite broke off) must by making in∣cision * 1.78 be taken away at the first dressing: in performance of which operation, you must have a care, that you hurt not with your instrument the heads of the muscles, nor any vessels, especially which are great; nor lastly, that large nerve which is sent into the muscles of the thigh and legge. On the contrary, such fragments as are not broken or severed from their periostium, shall bee smoothed and set in order with your fingers, as is fitting. Other things shall be done according as art and necessity shall perswade and require.

CHAP. XVII. Of a fracture of the Shoulder, or Arme-bone.

THe Arme-bone is round, hollow, full of marrow, rising up with an indif∣ferent * 1.79 necke, and ending on the upper part into somewhat a thick head. On the lower part it hath two processes, the one before, the other be∣hinde: between which there is (as it were) an halfe circle, or the cavity of a pulley, each end whereof leads into its cavitie, of which one is interior, ano∣ther exterior; that by these (as it were) hollow stops, the bending and extension of the arme might bee limited: lest that the bone of the cubite, if the circle should have beene perfect, sliding equally this way and that way, might, by its turning, have gone quite round, as a rope runnes in a pulley; which thing would much have confused the motion of the Cubite. For so the extension, or bending it backe, would have beene equall to the necessarie bending it inwards. It is very expedient that a Surgeon know these things, that so hee may the better know how to restore the fractures and luxations of this part. If one of the fragments of this broken * 1.80 bone shall lye much over the other, and the patient have a good strong bodie, then the arme shall be much extended, the Patient being so set upon a lowe seat, that he may not rise, when the fracture shall bee a-setting, and so hinder the begunne worke; and also, that so the Surgeon may the more easily performe his operation upon the Patient seated under him: yet Hippocrates, regarding another thing, would have the Patient to sit higher. But you must have a care, that the shoulder-bone it selfe be drawne directly down-wards, and the cubit so bended as when you put it into a scarfe. For if any one set this bone, lifting the arme upwards, or other-wise extending it, then must it be kept in that posture: for otherwise, if the figure be changed, the setting will quickly bee spoyled, when as you come to put the arme in a scarfe. Wherefore the Surgeon must diligently and carefully observe, * 1.81 that in setting a broken arme, hee put it in such a posture, that resting on the breast, it looke downe towards the girdle. You must have a care in laying the splints, and rowling your ligatures, that they hurt not, nor presse too hard upon the joynts. For, in the opinion of Hippocrates, by the pressure of parts which are nervous, * 1.82 fleshlesse, and consequently endued with exquisite sense, by the splints there is danger of most grievous paine, inflammation, denudation both of the bone and nerve; but chiefly, if such compression hurt the inner part, towards which the arme is bended: wherefore the splints made for this place must bee the shorter. There∣fore, after the Arme-bone is set, the arme shall bee layd upon the breast in a right angle, and there bound up in a scarfe, lest that the Patient, when he hath neede to stirre, spoyle and undoe the setting, and figure of the broken bone. But the arme * 1.83 must be kept in quiet, untill such time as the fragments shall bee confirmed with a Callus, which usually is in fortie dayes, sooner or later, according to the different constitutions of bodies.

CHAP. XVIII. Of the fracture of the Cubit, or the Ell and Wand.

IT sometimes happeneth, that the Cubite and Wand are broken to∣gether * 1.84 and at once, and otherwhiles that but the one of them is fractured. Now they are broken eyther in their midst or ends; their ends (I say) which are eyther towards the elbow, or else towards the wrest. That fracture is worst of all, wherein both the bones are broken, for then the member is made wholly impotent to per∣forme any sort of action, and the cure is also more difficult; for the member can∣not so easily be contained in its state: for that bone which remaines whole, serves

for a stay to the arme, and hinders the muscles from being drawn backe, which u∣sually draw backe and shrinke up themselves, whensoever both bones are broken. Hence it is, that that fracture is judged the worst, wherein the Cubir or Ell bone is broken. But that is easiest of all, wherein onely the Wand is broken, for so the * 1.85 fractured part is sustained by the Ell-bone: When both the bones are broken, there must bee made a stronger extension, for that the muscles are the more contracted. Therefore, whensoever eyther of them remaines whole, it doth more service in sustaining the other, than any eyther ligatures of splints, for that it keeps the mus∣cles right in their places. Wherefore, after the bones shal be set and rowled up with ligatures and splints, the arme must bee so carried up in a scarfe put about the necke, that the hand may not be much higher than the elbow, lest the blood and other humors may fall downe thereinto. But the hand shall be set in that posture which is betweene prone and supine, for so the Wand shall lye directly under the Ell, as we have read it observed by Hippocrates. The reason is, for that by a supine figure * 1.86 or situation, both the bone and muscles are perverted: for first, for the bone, the Apo∣physis, styloides and Olecranum of the Cubit, ought to be in an equall plaine, and to be seated each against other; which is not so in a supine figure, as wherein the Processus styloides of the Cubit is set against the inner processe of the arme bone. But in muscles, for that, like as the insertion and site of the head of a muscle is, such also is the site of the belly thereof, and lastly, such the insertion of the tayle thereof; but by a supine figure, the muscles arising from the inner processe of the arme bone and bending the cubit, shall have their tayle placed in an higher and more exteriour site. In the interim, you must not omit, but that the Patients arme may, with as little paine as possibly you can, be bended and extended now and then, lest by the too long rest of the tyed up part, and the intermission of its proper fun∣ction, the bones of the joynt may be sowdred together by the interposition, and as it were glue of the defluxion which fals abundantly into the joynt of the Ell-bow, and neighbouring parts, whence the stiffenesse and unmoveablenesse thereof, as if there were a Callus growne there: from whence it may happen, that the arme thereafter may neither be bended, nor extended, which I have observed to have happened to many. Whereof also Galen makes mention, and cals this kinde of * 1.87 vitiated conformation Ancyle and Ancylosis. If a wound also associate a fracture of the arme, then see, that you put about it plates of Latin, or Past-bord, and make a convenient Ligature, and that the fragments of the bones be kept in the same state wherein they were set and restored. Moreover, let him lay his arme upon a soft pil∣low or cushion, as the following Figure shewes you.

[illustration]

The figure of a fractured Arme, with a wound bound up, and seated, as is fit.

CHAP. XIX. Of the fracture of a Hand.

THe bones of the Wrest, and After-wrest, may bee broken: but, * 1.88 in Hippocrates opinion, chiefly by that kind of fracture which is cal∣led a Sedes; now if they shal happen to be broken, this shal be the maner of restoring them. Let the Patient lay forth his hand upon some even * 1.89 and smooth table, then let your servant stretch forth the broken bones, & the work-master restore them thus extended, and put them in their proper seats. But being re∣stored, they must be kept in their places by such remedies as are used in other fra∣ctures; to wit, cerates, compresses, linnen clothes, and splints. Now the fractu∣red fingers shall be tyed or bound to their neighbours, that so they may the more easily, as bound to a stake, be kept in that state wherein they have been put by the hand of the Workeman. But these bones, seeing they are of a rare and spongie na∣ture, are in a short time and easily strengthened, or knit by a Callus. These things * 1.90 being done, the hollownesse or palme of the hand shall be filled with a Tennis ball, for thus the broken bones shall not only be more easily kept in their places, but also the fingers themselves shall be kept in a middle posture, that is, not wholly open, nor quite shut. If they be kept in any other figure, the ensuing Callus will either deprave or quite abolish that action of the hand, wherby we take hold of any thing. The case stands otherwise with the fractured Toes; for they shall bee kept straight and even out, lest they should hinder our going or standing.

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 * 1.91 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 * 1.92 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, * 1.93 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 * 1.94 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 * 1.95 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 * 1.96 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 * 1.97 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 * 1.98 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, * 1.99 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 * 1.100 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 * 1.101 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 * 1.102 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 * 1.103 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.

CHAP. XXI. Of the fracture of the Thigh nigh to the joynt, or the upper or lower head of the bone.

A Fracture sometimes happens at the joynt of the hip in the neck of the thigh-bone, as I once observed in an honest matron. I being called to * 1.104 her, when I had observed the hurt Thigh to be shorter than the whole, with the outward prominencie of the Ischium, which at the first sight I supposed to proceede from the head of the thigh bone, I presently per∣swaded my selfe it was a dislocation and no fracture; I then therefore extended the bone, and forced (as I thought) the head thereof into its cavitie. The equalitie of both the legges in bignesse which followed upon this extension, encreased my per∣swasion that it was a dislocation. The next day I visited her the second time, and found her in great paine, her hurt legge the shorter, and her foot wrested inwards.

Then I loosed all her ligatures, and perceived such a prominencie as I did former∣ly. Wherefore I ende voured againe to force in the head of the bone, as I formerly did. But as I was busied therein, I heard a little crackling, and also I considered, that there was no cavitie nor depression in the joynt, by which signes I certainly perswaded my selfe, that the bone was broken, and not dislocated. Neyther only such kinde of Fractures, but also the separation of the appendix or head of this bone from its place, may induce one to thinke it a dislocation; which thing hath some∣times deceived some heedlesse Surgeons, who have not dreamt of the divulsion or * 1.105 separation of the appendix from the top of the Thigh-bone, but have judged it only a dislocation. Then therefore (that I may returne to my former narration) I set the bone, and joyned the fragments together, layd thereupon splints with com∣presses, made ligations with a rowler, having two heads wrapped about the joynt, and the bodie crosse-wise, and I defended her foote with a Case, that none of the clothes might presse it. I fastened a rope to a poste, and so let it come downe into the midst of the bed, and tyed many knots thereon, for the better taking hold and lifting up her selfe; the which thing you must alwaies doe in fractures and disloca∣tions of the thigh and legge, that so your Patients may have some stay, whereby they may succour themselves with their hands, as oft as they desire to rise, or lift themselves up in their beds, or goe to stoole; as also, that they may give per∣spiration, and as it were ventilation to the loynes, buttocks, rumpe, and other parts, compressed and wearied with long lying, for want wherof they are molested with heat and paine; whence ulcers arise, which oft-times torment the Patient with such tormenting heate and paine, that he is even consumed by a fever, watchings, and want of rest. This opportunitie of raising the bodie out of the bed, is by so * 1.106 much the more needfull in this place, by how much the fracture is nearer the joynt: for there it is more dangerous than in the midst of the thigh, and consequently more difficult to dresse and heale, for that the part is bloodlesse, and by reason of the multitude of the nerves, tendons and ligaments, which are obnoxious to many maligne symptomes. But the Surgeon must have diligent care in this kinde of fra∣cture, and must looke often that the bone, which is set, doe not fall forth againe, which easily happens here by any light stirring of the bodie, & the like occasion, for that the thigh hath but one onely bone. Therefore, as oft as the Bandages shal be loosed, and the fracture dressed, hee shall attentively view the figure of the bone, and the magnitude of the affected part, comparing it with the sound; for the set and composed fragments of the broken bone, can scarce fall asunder, but that the one must lye upon the other. But before it be knit, the part must be extended and resto∣red to its state, that so the Patient may not halt during the residue of his life. For I have read it written in Avicen, that scarce any doe so well recover a fractured * 1.107 thigh, that they doe not halt thereof: therefore the Patient must be carefull, that hee move himselfe, or his bodie, as little as hee can. Many of the Ancients have set downe the time of the consolidation of this bone to bee fiftie dayes: but (as I formerly sayd) there can bee no certaine or determinate time here∣of. But in what time soever this bone shall bee knit, the Patient must not * 1.108 stand or goe thereon presently upon it; for that there remaines a weakenesse in the part a long time after, so that the Patients are forced to use Crutches to goe with∣all, in the meane space while they recover more strength.

CHAP. XXII. Of the Fracture of the Patella, or whirle-bone of the Knee.

THe Whirle-bone of the knee is oft times contused, but not so frequently broken: yet when that happens, it goes into two or three peeces, some∣times * 1.109 long-wise, sometimes athwart. Sometimes it is broken in the midst, and some-whiles shivered into many splinters, and all these ey∣ther with, or without a wound. The signes are, impotencie in going, a hollownesse * 1.110 in that place, and a sensible separation of the fragments of the hurt part, and the crackling of these parts under your hand. It is set after this manner; Wish the Pa∣tient * 1.111 to stretch forth his legge, yea, hee must keepe it extended all the while, untill it be knit; and therefore left hee should bend it unawares, the hollownesse of the Ham shall be filled with a boulster: for by bending of the knee, the set fragments of the whirle-bone would againe fly in sunder. This being done, the fragments shall by the hand of the Surgeon be set as is fitting, and be kept so set by the appli∣cation of convenient remedies, making ligatures, and applying Junks, as wee said must be done in a fracture of the Thigh-bone. And lastly, you must observe and doe in this, as in the fracture of a legge. For the Prognostick, this I affirme, That I have seene none of those who have had this bone fractured, who have not hal∣ted during the rest of their lives. The cause hereof is, the knitting by the concre∣tion of a Callus hinders the free bending of the knee; going, especially on even * 1.112 ground is more easie to the Patient, but an ascent is farre more difficult, and abso∣lutely painfull. The Patient must necessarily for this kinde of fracture lye or keep his bed, at the least for forty dayes.

CHAP. XXIII. Of a broken Legge.

THis kinde of Fracture is cured after the same manner as that of the arme or cubit. Hippocrates admonisheth us, that the Tibia, or Leg-bone is * 1.113 more dangerous to be broken, and more difficult and slow to be healed than the Fibula, or Shin-bone; because that is the thicker, and as it were the upholder of the whole bulke of the bodie: but this other is but as it were a cer∣taine additament or assistant, provided for the staying or bearing up of the mus∣cles of the legge, by which the foot is moved. The legge bone being only broken, the signes thereof are perceived onely in the inner part of the legge; for that the Shin-bone being whole, suffers it not to throw or cast forth its selfe. On the con∣trarie, when the Shin-bone onely is broken, the signes thereof appeare only in the externall part of the legge; because the legge bone, being opposed thereto, doth not suffer it to cast in its selfe, and with its fragments to turne inwards. But when both the bones are broken, the signes of the fracture may equally appeare both * 1.114 here and there. But when only one of these bones are broken, the fracture is farre more easie to dresse and heale, because that which remaines whole, is a much more firme stay to that which is hurt, than any splints can bee. But that I may the bet∣ter instruct and make readie the Surgeon for the restoring of this fracture, I will il∣lustrate the matter by an example from my selfe. John Nestor, Doctor of Physick, Richard Hubert, and I, went together to visit a Patient at the Place of the Frier * 1.115 Minorites. Wherefore, intending to passe over the Seine within sight of the place, I endeavoured to make my horse take boat, and therefore switched him over the buttocks. The Jade, madded herewith, so strucke at me with his heels, that he brake both the bones of my left legge, some foure fingers breadth above my ankle. Then I, fearing some worse mischiefe, and lest the Jade should double his blow, flew back; and as I fled backe, the broken bones flew in sunder; and breaking through the flesh,

stocking and boote, shewed themselves, whereby I felt as much paine, as it is credi∣ble a man was able to endure. Wherefore I was presently carried into the boate, that so I might be carried to the other side of the water to be dressed: but the stir∣ring of the boat as they rowed, almost killed me with bitternesse of paine, for that the sharpe fragments of the bones were rubbed against the flesh which lay next them. Being ferried over, as I was conveyed into the next houses, my pain was much encreased, whilest lifted by the hands of divers persons, one while up, another downe, sometimes to the left side, otherwhiles to the right with my whole bodie, and all the parts thereof. When at the length, I was layd upon a bed, I was some-what freed from the bitternesse of my paine, and had time to wipe off the sweat, which ranne downe over all my bodie. Then was I dressed with such a medicine, as the time and place would affoord; we composed it of the white of an egge, wheat floure, soote of a chimney, and melted butter. For the rest, I intreated Richard * 1.116 Hubert, that he would handle me, as if he knew mee not, neither that, moved for love of mee, he should remit any thing of the severitie of art, but chiefly, that hee * 1.117 would stretch my foot straight out, and if the wound were not sufficiently wide, that hee would enlarge it with his incision knife, that so hee might the more easily set the broken bones in their due place; that hee would with his fingers (whose judgement is farre more certaine than the best made instruments) search, whether the splinters which were in the wound were quite severed from the bone, and ther∣fore to be taken forth; that he would with his hand presse forth the blood, and the clods of blood which were in a great quantitie concrete at the mouth of the wound; that he would bind up and place my legge in that site and manner, as he thought best: which is, that he should have three rowlers in a readinesse; the first whereof he should cast directly upon the wound, so that he should beginne his liga∣tion at the wound: also he should put splints about it; some three, but others two fingers breadth, of the length of halfe a foote, somewhat depressed and hollowed, whereby they might be the more easily put about the legge, more straitly at their ends, and a fingers distance each from other, which at the last he should binde with fillets, like those wherewith Women use to binde up their haire; yet so, that the binding might be more strait upon the wound: and that he would fill the cavitie of the ham, and of the ancles, with boulsters made of flaxe wrapped in linnen clothes: that he would fortifie the sides of my legge with Junkes made of bents or little stickes, and lined with linnen cloth, stretched from my heele to my groine, and bound over in foure places; so that the strait figure of the legge might scarcely bee perverted by any force: that he would gently, and smoothly lift up my legge to an indifferent height: and lastly, that he should arme it from the violence of exter∣nall injuries, by putting it in a boxe or case. But you must note, that the fit placing or laying of the legge is a matter of such moment, that if any errour be here com∣mitted, it will cause no lesse than lamenesse. For if it be lifted up higher than is fit, the Callus will be hollow on the foreside; if lower, then it will be gibbous or bunch∣ing forth. Neither also doe they commit a small errour, who doe not fill up the cavities at the ancles after the forementioned manner: for, hereupon the heele will be much afflicted, whilest it is forced to sustaine a tedious and painefull compres∣sion, which at length brings a hot distemper, because the spirits cannot freely flow thereto; which I, finding by experience, not knowing the cause, wished them ever now and then to lift up my heele, wherby it might enjoy the benefit of perspiration, and the spirits have free entrance thereinto, & the contained vapours passing forth. To conclude, my hurt legge was layd upon a cushion after the manner you see here described.

[illustration]

The figure of a Legge fractured with a wound, and bound up.

CHAP. XXIV. Of some things to be observed in Ligation, when a fracture is associated with a wound.

THis, taken out of the doctrine of the Ancients, ought to bee kept firme and ratified, That Ligation must bee made upon the wound; otherwise * 1.118 the wounded part will presently lift it selfe up into a great tumor, re∣ceiving the humors pressed thither by the force of the Ligation made on this and that side, above and bolow, whence ensue many maligne symptomes. You may make triall hereof upon a sound fleshie part; for if you binde it above and * 1.119 below, not touching that which is in the midst, it will be lifted up into a great tu∣mor, and change the flourishing and native colour into a livide or blackish hue, by reason of the flowing and abundance of the humors pressed forth on everie side from the neighbouring parts. Therefore such things will happen much the rather in a wounded or ulcerated part. But for this cause, the ulcer will remaine unsuppu∣rated and weeping, crude and liquid sanies flowing there-hence, like unto that which usually flowes from inflamed eyes. Such sanies, if it fall upon the bones, and make any stay there, it, with the touch therof, burnes and corrupts them, and so much the more, if they be rare and soft. These will bee the signes of such corruption of * 1.120 the bones; if a greater quantitie, and that more filthie sanies, flow from the ulcer, than was accustomed, or the nature of a simple ulcer requires; if the lippes of the ulcer be inverted; if the flesh be more soft and flaccid about them; if a sorrowfull sense of a beating, and also deepe paine torment the Patient by fitts; if, by search∣ing with your Probe, you perceive the bone to be spoyled of its periostium; and lastly, if you finde it scaily and rough, or also if your Probe bee put downe some-what hard, it runne into the substance of the bone. But we have treated sufficient∣ly hereof in our particular Treatise of the rottennesse of the bones. But certainely such rottennesse will never happen to the bone, if the hurt part be bound up, as is fit, and according to art. Wherefore I judge it not amisse, againe to admonish the Surgeon of this, That as farre as the thing shall suffer, hee make his rowlings upon * 1.121 the wound; unlesse by chance there be such excessive paine and great inflammation, that, through occasion of such symptomes and accidents, he be diverted from this proper and legitimate cure of the disease. Therefore then, because nothing more can be done, let him only doe this, which may be done without offence; that is, let him supply the defect of ligation and rowlers, with a linnen cloth, not too weake, nor too much worne, being twice or thrice doubled, and which may serve to com∣passe the wound and neighbouring parts once about: let him sew the edges there∣of at the sides of the wound, lest he be forced to stirre the fragments of the bones (which once set ought to be kept unmoved) as often as the wound comes to be dres∣sed. For, broken bones doe not require such frequent dressing, as wounds and ulcers doe. By this it appeares, that as want of binding, and too much loosenesse in ab∣sence

of paine and a Phlegmon, so also too strait ligation, when paine is present, brings a Phlegmon and Abscesse to the wound. Therefore let all things here, ac∣cording to the forementioned rules and circumstances, be indifferent. I have for this purpose thought good to re••terate these things, because you shall as yet finde many, who follow the practice of Paulus, and make many circumvolutions here and there, above and below the wound, which presently they carrie crosse-wise. But this crosse or lattice-like kinde of ligation is wholly to be disliked, and that * 1.122 onely to be used which we have described, according to the minde of Hippocra∣tes. Now it is time, that I returne to the former historie of my mishap, and declare what was done to me after that first dressing, which I have formerly mentioned.

CHAP. XXV. What was used to the Authors Legge after the first dressing.

I Being brought home to mine owne house in Paris in the after-noone, they tooke from me, out of the Basilica of the left arme, some sixe ounces of blood. And then at the second dressing the lippes or edges of the wound and places thereabout were an∣nointed with unguentum rosatum, which, by a joynt consent of * 1.123 the Ancients, is much commended in the beginnings of fra∣ctures: for it will asswage paine, and hinder inflammation, by repelling the humors farre from the wounded part: for it is cold, astringent and repelling, as the composition thereof shewes; for it is made ex oleo omphacino, aqua rosacea, pauco aceto & cera alba. Therefore I used this oyntment for sixe dayes; I dipped the compresses and rowlers somewhiles in oxycrate, otherwhiles in thick and astringent red wine, for the strengthning of the part, and repressing the hu∣mors; * 1.124 which two things wee must have a care of in Hippocrates opinion, in fra∣ctures especially with a wound. Wherfore if at any time the compresses or rowlers seemed to dry, I now and then moystened them with the oxycrate, or rose vineger: for, by their too much drinesse, paine and inflammation happen; and if they binde the part somewhat more strait, they hurt it also by their hardnesse. You shall see many surgeons, who in this kinde of affect, from the beginning to the end, use on∣ly astringent and emplastick medicines, wholly contrary to the methode set down by Hippocrates, and commended by Galen. For, by the continued use of such things, the pores and breathing places of the skinne are shut up; whence the fuligi∣nous excrement being supprest, the externall heat is increased, and itching caused, and at length an ulcer by the fretting of the acride and serous humor long supprest. Whereby you may learne, that astringent and emplastick medicines must not bee used above sixe daies. In stead hereof you shall use the emplaisters, which I shall presently describe. In the beginning of my disease I used so spare a diet, that for nine daies, I ate nothing each day, but twelve stewed prunes, and sixe morsels of bread, and dranke a Paris pinte of sugred water, of which water this was the com∣position.

℞. sacc. albis. ℥ xii. aquae font. lb xii. cinam. ʒ iii. bulliant simul secundum artem: * 1.125 Otherwhiles I used syrup of maydens hair with boyled water: Otherwhiles, the di∣vine drinke (as they terme it) whereof this is the composition. ℞. aquaecoctae lb. vi. sacc. albis. ℥ iiii. succ. lim. ℥ i. agitentur & transvasentur saepius in vasis vitreis. I was purged when neede required with a bole of Cassia with Rubarbe. I used also sup∣positories of Castle soape to make me goe to stoole; for, if at any time I wanted due evacuation, a preternaturall heat presently seized upon my kidneyes. With this, though exquisite manner of diet, I could not prevaile, but that a fever tooke mee upon the eleventh day of my disease, and a defluxion, which turned into an Ab∣scesse, long flowing with much matter. I thinke the occasion hereof was some por∣tion * 1.126 of the humor supprest in the bottome of the wound; as also by too loose binding, by reason that I could not endure just or more strait binding; and lastly,

scales or shivers of bones quite broke off, and therefore unapt to be agglutinated: for these therefore putrefying, drew by consent the proper nourishment of the part into putrefaction, and by the putredinous heat thence arising, did plentifully ad∣minister the materiall and efficient cause to the defluxion and inflammation. I was moved to thinke they were scales, severed from their bone, by the thin and crude sanies flowing from the wound, the much swolne sides of the wound, and the * 1.127 more loose and spongie flesh thereabouts. To these causes, this also did accrew, one night amongst the rest, as I slept, the muscles so contracted themselves by a vio∣lent motion, that they drew my whole Legge upwards; so that the bones, by the vehemency of the convulsion, were displaced, and pressed the sides of the wound; neyther could they be perfectly composed or set, unlesse by a new extension and impulsion, which was much more painefull to mee than the former. My fever, when it had lasted with me seven dayes, at length enjoyed a Crisis and end, partly by the eruption of matter, and partly by sweat, flowing from me in a plenteous manner.

CHAP. XXVI. What may be the cause of the convulsive twitching of broken members.

THis contraction, and (as it were) convulsive twitching, usually happens to fractured members in the time of sleepe. I thinke the cause thereof is, for that the native heat withdraws its selfe while we sleepe, into the * 1.128 center of the body; whereby it commeth to passe, that the extreme parts grow colde. In the meane while, nature, by its accustomed providence, sends spirits to the suply of the hurt part. But because they are not received of the part evill affected and unapt thereto, they betake themselves together, and suddenly, ac∣cording to their wonted celerity, thither from whence they came, the muscles fol∣low their motion: with the muscles, the bones, whereinto they are inserted, are together drawne; whereby it comes to passe, that they are againe displaced, and with great torment of paine, fall from their former seate. This contraction of the muscles is towards their originall.

CHAP. XXVII. Certaine Documents concerning the parts, whereon the Patient must necessarily rest, whilest he lyes in his bed.

THose who have their Legge or the like bone broken, because they are hin∣dered by the bitternesse of paine, and also wish for their cure or con∣solidation, * 1.129 are forced to keep themselves without stirring, and upon their backes in their beds for a long time together. In the meane space, the parts whereupon they must necessarily lye, as the heele, backe, holy-bone, rumpe, the muscles of the broken thigh or legge remaine stretched forth and unmoveable, set at libertie from their usuall functions. Whereby it comes to passe, that all their strength decayes, and growes dull by little and little. Moreover also, by the sup∣pression of the fuliginous and acride excrements, and want of perspiration, they grow preternaturally hote; whence defluxion, an abscesse and ulcer, happen to them, but principally to the holy-bone, the rumpe and heele: to the former, for that * 1.130 they are defended with small store of flesh; to the latter, for that it is of more ex∣quisite sense. Now the ulcers of these parts are difficulty healed, yea, and oft-times they cause a gangrene in the flesh, and a rottennesse and mortification in the bones there-under, and for the most part a continued fever, delirium, convulsion, and (by that sympathie which generally accompanies such affects) a hicketing. For the heele and stomacke are two very nervous parts, the latter in the whole bodie

thereof, and by a large portion of the nerves of the sixth conjugation; but the o∣ther by the great tendon passing under it, the which is produced by the meeting, and as it were growing together of the three muscles of the calfe of the legge. All which are deadly, both by dissipation of the native heat by the feverish, and that which is preternaturall; as also by the infection of the noble parts, whose use the life cannot want, by carrion-like vapours. When as I considered all these things with my selfe, and (become more skilfull by the example of others) understood how dangerous they were, I wished them now and then to lift my heele up out of * 1.131 the bed; and taking hold of the rope which hung over my head, I heaved up my selfe, that so the parts, pressed with continuall lying, might transpire, and be venti∣lated. Moreover also I rested these parts upon a round cushion, being open in the middle, and stuffed with soft feathers, and layd under my rumpe and heele, that they might be refreshed by the benefit and gentle breathing of the ayre: and I did oft-times apply linnen clothes, spred over with unguentum rosatum, for the asswa∣ging of the paine and heat. Besides also, I devised a Casse of Lattin, wherein the * 1.132 broken legge being layd, is kept in its place, farre more surely and certainely than by anie Junks; and moreover also, it may all be moved to and againe at the Patients pleasure. This Casse will also hinder the heele from lying with all its bodie and weight upon the bed, putting a soft and thicke boulster under the calfe, in that place where the Casse is hollow: besides also, it armes and defends it against the falling downe and weight of the bed-clothes, having a little arch made over and above, of the same matter. All which shall bee made manifest unto you by the following figure.

[illustration]

The figure of a Casse.

A A. Shew the bottome or belly of the Casse.

B B. The wings or sides to be opened and shut at pleasure:

C. The end of the wings, whereto the sole or arch is fitted.

D D. The Arch.

E E. The Sole.

F F. An open space, whereat the heele hangs forth of the Casse.

Now it remaines, that I tell you what remedies I applyed to the Abscesse which happened upon my wound. When therefore I perceived an Abscesse to breed, I composed a suppurative medicine of the yoalks of egges, common oyle, turpentine, * 1.133

and a little wheat floure, and I used it untill it was opened: then to cleanse it I used this following remedie.

℞. syrupi rosati & terebinth. venetae, an. ℥ii. pulveris radicis ireos florentiae, aloes, * 1.134 mastiches, farinae hordei, an. ʒss. incorporentur omnia simul & fiat mundificativum: but I had a care, that the place, whereat I conjectured the quite severed scales of the bones must breake forth, should be filled with tents made of sponge or flaxe, that so, by this meanes, I might keep the ulcer open at my pleasure. But I put into the * 1.135 bottome of the ulcer catagmatick and cephalicke powders, with a little burnt A∣lum to procure the egresse of the formerly mentioned scales. These at length cast forth, I cicatrized the ulcer with burnt Alum. For, this having a drying and astrin∣gent facultie, confirmes and hardens the flesh, which is loose and spongie, and flow∣ing with liquid sanies, and helps forwards natures endeavour in cicatrization. For, the fragments of the bones, they, by reason of their naturall drinesse and hardness, cannot be joyned and knit together by themselves without a medium: but they need a certaine substance, which, thickning and concreting at their ends, doth at length * 1.136 glue them together, and (as it were) fasten them with soder. This substance hath its matter of the proper substance and marrow of the bones; but the forme from the native heat, and emplastick medicines, which moderately heat. For, on the con∣trarie, these medicines, which, by their too much heat, doe discusse and attenuate, doe (as it were) melt and dissolve the matter of the Callus, and so hinder the knit∣ting. Wherefore for this purpose, I would wish you to make use of the following emplasters, of whose efficacie I have had experience: for, hence they are called knitting or consolidating plaisters.

℞. olei myrtill. & rosarum omphac. an. lb. ss. rad. altheae lb. ii. rad. fraxini, & fol. cjusdem, rad. consolidae majoris & fol. ejusdem, fol. salicis an. m. i. fiat decoctio in suffi∣cienti * 1.137 quantitate vini nigri, & aquaefabrorum, ad medi••tatis consumptionem, adde in co∣latura pulveris myrrhae & thuris an. ℥ss. adipis hirci lb. ss. terebinth. lotae ℥iiii. mesti∣ches ʒiii. lithargyri auri & argenti an. ℥ii. boli armeni••, & terrae sigillata, an. ℥i. ss. minii ʒvi. cerae albae quantum sufficit, fiat emplastrum, ut artis est. In stead hereof you may use the blacke emplaister, where of this is the description.

℞. lithargyri auri lb. i. olei & aceti lb. ii. coquantur simul lento igne donec nigrum & * 1.138 splendens reddatur emplastrum, & non adhaereat digitis. Or else, ℞. olei rosat. & myr∣till. an. ℥ii. nucum cupressi, boli armen. sanguinis drac. pulverisatorum an. ℥. ss. emplastri diachalciteos ℥iiii. liquefaciant simul, & fiat emplastrum secundum artem. In defect of these, you may use a Cere-cloth, or tela Gualteri, whereof this is the description.

℞. pulveris thuris, farinae volatilis, mastiches, boli arm. resinae pini, nucum cupressi, rubiae tinctorum, an. ℥ii. sevi arietini & cerae albae an. lb. ss. fiat emplastrum: into which * 1.139 (whilest it is hote) dip a warme linnen cloth, for the forementioned use. Emplastrum Diacalcithios, by the common consent of all the Ancients, is much commended for fractures: but it must undergoe different preparations, according to the condition of the time, for in summer it must be dissolved in the juice of plantaine and night-shade, lest it should heat more than is fit. It is convenient, in the interim, to have re∣gard to the temper of the affected bodies; for neyther are the bodies of children to be so much dried as these of old men: otherwise, if such drying medicines should be applyed to yong bodies as to old, the matter of the Callus would be dissolved, it would be so farre from concreting; wherefore the Surgeon must take great heede in the choyce of his medicines. For, often times remedies, good of themselves, are by use made not good, because they are used and applyed without judgment: which * 1.140 is the cause that oft times pernicious accidents happen, or else the Callus becomes more soft, hard, slender, crooked, or lastly concretes more slowly by the great error, and to the great shame of the Surgeon.

CHAP. XXVIII. By what meanes we may know the Callus is a breeding.

THen I knew that my legge begunne to knit, when as lesse matter than was * 1.141 usuall came from the ulcer, when the paine slackened, and lastly; when as the convulsive twitchings ceased; which caused me to judge it fit to dresse it seldomer than I was used to doe. For, by the frequent detersion in dressing an ulcer, whilst a Callus is breeding, the matters whereof it is to be made, are drawne away and spent, which are (as they terme them) Ros, Cambium, and Glu∣ten, which are the proper and genuine nourishments both of the bony, as also of the fleshie substance. I by other signes also conjectured the breeding of the Callus, to wit, by the sweating of a certaine dewie blood out of the edges and pores of the wound, which gently dyed and bedewed the boulsters and ligatures, proceeding from the effluxe of the subtler and gentler portion of that matter, which plenteous∣ly flowed downe for the breeding of a Callus. As also, by a tickling and pleasing sense of a certaine vapour, continually creeping, with a moderate and gentle heate, from the upper parts even to the place of the wound. Wherfore thence forwards * 1.142 I somewhat loosened the ligation, lest, by keeping it too strait, I should hinder from entring to the fragments of the bones, the matter of the Callus, which is a portion of the blood, temperate in qualitie, and moderate in quantie. Then therefore I thought good, to use nourishments fit to generate more grosse, thicke and tenacious blood, and sufficient for generating a Callus; such as are the extremities, tendinous * 1.143 and gristly parts of beasts, as the heads, feete, legges and eares of Hoggs, Oxen, Sheepe, Kids; all which I boyled with Rice, French Barley, and the like, using somewhiles one, somwhiles another, to please my stomack & palate. I also somtimes fed upon frumity, or wheat sodden in Capon broth with the yoalks of egges; I drank red, thicke and astringent wine, indifferently tempered with water. For my second course, I ate chesnuts and medlars: neyther doe I without some reason, thus parti∣cularize my diet: for that grosse nourishments, especially if they be friable and fra∣gile, as beefe is, are alike hurtfull (for as much as pertaines to the generating of a Callus) as light meats are. For that makes the Callus too dry, these too tender. Wher∣fore Galen pronounces these meats only fit for generating a Callus, which are ney∣ther * 1.144 fragile nor friable, neither serous and thin, nor too dry; but indifferent grosse, and also viscide, fat and tough. These meats, digested by the stomacke into Chilus; are sent into the guts, and from hence, by the mesaraick veines, into the Gate-veine, and the hollow part of the Liver, thence into the Hollow-veine, and so into the Veines dispersed over all the bodie and the parts thereof. There are also some of these veines which carrie blood into the bones; but in the large cavities of the bones is marrow contained, as in the small a certaine marrowie substance, propor∣tionable thereto, being their proper nourishment. The generation of marrow is from the grosser portion of the blood; which flowes into the greater cavities of the bones by larger veines and arteries, but into the lesse by lesser, which end in their pores and small passages. For, in large bones you may observe large and apparent passages, by which the veines and arteries enter for the forementioned use. By the same waies the nerves also insinuate themselves, from whence proceedes a mem∣brane which involves the marrow of the bones, the which by that means is endued with most exquisite sense, as experience teacheth; which is the cause that makes ma∣ny * 1.145 beleeve, that the marrow hath sense of feeling, because the membranes thereof being hurt cause most bitter paine. Therefore out of the marrow and the proper substance of the bone, there sweats a certaine grosse and terrestriall juice, whereof, by the power of the assimilating facultie, which serves in stead of the formative, a Callus growes and knits. Simple fractures of the legge are usually knit in fi••tle daies; * 1.146 but through the occasion of the wound and the scales quite broke off, and other ac∣cidents which befell mee, it was three whole months before the fragments of the bones were perfectly knit, and it was also another month, before I could goe upon

my legge without the helpe of a Crutch. Going was painefull to me for some few daies, because the Callus had taken up some place of the muscles: for, before my former freedome of motion could returne againe to the broken and knit part, it was necessaire, that the Tendons and Membranes should separate themselves by little and little from the scarre. In the performance of all these things, I had the diligent and faithfull assistance amongst the Surgeons, to omit Physitians, of Anthonie Portall, the Kings Surgeon.

CHAP. XXIX. Of those things which may hinder the generation of a Callus, and how to correct the faults thereof, if it be ill formed.

HAving already spoken of the signes of a Callus beginning to concrete, of its generation and the manner thereof: it now remaines, that wee treat of those things which hinder the generation thereof; and what on the contrarie helpe forwards the conformation and concretion thereof. Now these things which either wholly hinder, or else retarde the generation of a Callus, have a strong and powerfull discussive and attenuating * 1.147 facultie; or else they are unctuous, oyly and moist. For, by such the juice, wherof the Callus ought to be, is eyther melted and consumed, or else growes soft, and is relaxed. But on the contrarie, those things which helpe forwards a Callus must bee drying, incrassating, thickening, hardening and emplasticke, moderately hot and * 1.148 astringent. But for moist and relaxing medicines, they ought to have no place here, unlesse when it happens that the Callus is ill formed, that is, too thicke, or crooked, or otherwise ill shapen, whereby it may be wasted and broken, so to bee restored a∣gaine after a better manner. Yet notwithstanding, such things are not to be attemp∣ted, unlesse when the Callus is yet greene, and so depraved, that the fault therof doth very much pervert the native conformation of the part, and exceedingly offend the action. Then therefore in such a case, the place must be fomented with a decoction of a sheeps head and guts, wherein shall be boyled the roots of Marsh-mallowes, of Brionie, the seeds of Line, of Faenugreeke, Pigeons dung, Bay-berries, and the like. You shall also use this following oyntment and plaister.

℞. unguenti de Althaea ℥iiii. olei liliorum, & axungiae anseris an. ℥i. aquae vitae pa∣rum, liquefiant simul, fiat linimentum quo liniatur pars. Then apply this following emplaister.

℞. emplast. de Vigo cum mercurio, cerati oesypati descriptione Philagrii, an. ℥iii. olei anethini & liliorum an. ℥i. liquefiant omnia simul, fiat emplastrum; let it bee spred upon leather for the foresaid use. When by this meanes the Callus shall seeme to be sufficiently mollified, it shal be broken, and the bones restored to their naturall state, and the cure of the fracture to be followed as at the beginning. If the Callus be be∣come too hard through age, it is better not to break it, but to let it alone, lest some * 1.149 worse accident befall the Patient. For it may so fall out, that by your labouring to breake it, the bone may breake in some other part, before it break in that which is knit by the Callus. Therefore the discreet Patient had rather live lame, than for es∣chewing it, to undergoe the hazzard of his life. If the Callus be too grosse, it shalbe diminished (if it be as yet fresh) with emollient, resolving, and powerfully astrin∣gent medicines, which have force to dissolve, dry and exhaust. It will also bee good strongly to rubb the Callus with oyle of Bayes, wherein Salt-peter, or some other kinde of Salt hath been dissolved, then wrapped about with a Rowler, to binde it ve∣ry straitly, putting a leaden plate thereon, whereby the flowing downe of the nou∣rishing humor into the part, may be forbidden; that thus by little and little the Cal∣lus may decay and diminish. If on the contrarie, it any waies happen, that the Callus * 1.150 be more thin and slender, or grows more slowly, for that it is too straitly bound, or because the idle part is longer kept in quiet than is fit, without exercising of its pro∣per function (which cause is to be reckoned amongst the chiefe causes of the leane∣ness,

even for this reason, for that exercise stirres up the native heat of the part, the worker of digestion and nutrition) or else for that they feed upon such nourishments as offend in quality, or quantity, or both, or for that the ligature used to the part is too often loosed, or because the part its selfe is too hastily and before the time put to undergoe solid offices and motions. According to the variety of causes, medi∣cines shall bee applyed. For if the ligature of the part bee too strait, it shall bee loo∣sed, * 1.151 yea verily the fractured place, the ligature being taken away, shall be quite freed from ligation, and a new kind of ligature must bee made, which must be row∣led downe from the roote of the vessels, that is, from the armepitts, if the arme; or from the groine, if the legge be broken, to the fracture: yet so, as that you may leave it untouched or taken in, for thus the blood is pressed from the fountain and spring, and forced into the affected part, by a way quite contrary to that, whereby we have formerly taught in feare of inflammation, to hinder it from entrance into the affe∣cted part. Also gentle frictions and fomentations with warme water may be profita∣bly made, from which you must then disist when the part shall begin to grow hot and swell. If any too long continue these frictions and fomentations, hee shall re∣solve * 1.152 that which he hath drawne thither. For this we have often times observed, that frictions & fomentations have contrary effects, according to the shortness and con∣tinuance of time. Pications wil also conduce to this purpose, and other things which customarily are used to members troubled with an atrophi••, or want of nourishment.

CHAP. XXX. Of fomentations which be used to broken bones.

DIvers fomentations are used to broken bones for severall causes. When * 1.153 we use warme water for a fomentation, wee meane that, which is just between hot and cold, that is, which feeles luke warme to the hand of the Physitian and Patient. A fomentation of such water used for * 1.154 some short space doth moderately heat, attenuate and prepare for re∣solution, the humor which is in the surface of the bodie; it drawes blood and an ali∣mentarie humor to the part labouring of an Atrophia; it asswages paine, relaxes that which is too much extended, and moderately heats the member refrigerated through occasion of too strait binding, or by any other means. On the contrarie, too hot fomenting cools by accident, digesting and discussing the hot humor which was contained in the member. We meane a short time is spent in fomenting, when the * 1.155 part begins to grow red and swell; a just space, when the part is manifestly red and swolne: but we conjecture, that much or too much time is spent thereon, if the red∣nesse, which formerly appeared, goe away, and the tumor, which lifted up the part, subside. Also in fomenting, you must have regard to the bodie whereto it is used. For if it be plethorick, an indifferent fomentation will distend the part with plenty * 1.156 of superfluous humors; but if it be leane and spare, it will make the part more fleshie and succulent. Now it remaines, that we say somewhat of the fracture of the bones of the feet.

CHAP. XXXI. Of the fracture of the bones of the feet.

THe bones of the Instep, back and toes of the feet, may bee fractured as the * 1.157 bones of the hands may. Wherefore these shall bee cured like them, but that the bones of the Toes must not be kept in a crooked posture, as the bones of the fingers must, lest their action should perish or bee depraved. For as we use our legges to walk, so we use our feet to stand-Besides also the Patient shall keep his bed untill they be knit.

The end of the fifteenth Booke.

Notes

• * 1.1

  Lib. 6. method.
• * 1.2

  What it is for a bone to be bro∣ken Raphanedon.
• * 1.3

  What Caryedon, or Alphitidon.
• * 1.4

  What Schidaci∣don.
• * 1.5

  The causes of fractures.
• * 1.6

  The first signe of a broken bone.
• * 1.7

  Another.
• * 1.8

  A third.
• * 1.9

  Why bones are more brittle in frostie weather.
• * 1.10

  Why the solu∣tion of conti∣nuity in bones is not so easily repaired. Gal. in arte par.
• * 1.11

  Why bones soo∣ner knitin yong bodies.
• * 1.12

  Meats of grosse and tough nou∣rishment con∣duce to the ge∣neration of a Callus.
• * 1.13

  Fractures at joynts dan∣gerous.
• * 1.14

  Hipp. sect. 18. & 19. sect. i. de fracturis.
• * 1.15

  Ligations con∣duce to the handsomnes of a Callus.
• * 1.16

  Extension must presently bee made after the bone is broken.
• * 1.17

  Sent. 36. sect. 3. de fract.
• * 1.18

  In inflammati∣ons the resto∣ring of the bone must not bee at∣tempted.
• * 1.19

  Three things to be performed in curing bro∣ken and disloca∣ted bones.
• * 1.20

  How to put the bones in their places.
• * 1.21

  Hipp. sent. 60. sect. 2. de fract.
• * 1.22

  Adsent. 1. sect. 1. de fract.
• * 1.23

  When instru∣ments or en∣gins are neces∣sary.
• * 1.24

  What bodies are sooner hurt by violent ex∣tension.
• * 1.25

  Signes of a bone well set.
• * 1.26

  Causes and signes of the re∣lapse of a set bone.
• * 1.27

  Ad sent. 21. sect. 1. de fract.
• * 1.28

  What the mid∣dle figure is, and why best.
• * 1.29

  Fit time for loosing of Liga∣tures in fra∣ctures and dis∣locations.
• * 1.30

  Foure choice meanes to hin∣der accidents.
• * 1.31

  The causes and differences of itching.
• * 1.32

  Ad sent. 4. sect. 1. de fract.
• * 1.33

  Remedies a∣gainst the itch∣ing.
• * 1.34

  Hipp. sent. 46. sect. 3. de fract.
• * 1.35

  Hipp. sent. 46. sect. 2. de art.
• * 1.36

  How to reduce the nose into its naturall figure.
• * 1.37

  A fit astringent and drying medicine.
• * 1.38

  Sent. 47. sect. 〈◊〉〈◊〉. de art. & Gal. in Com.
• * 1.39

  A description of the lower Jaw.
• * 1.40

  The manner of restoring a bro∣ken Jaw.
• * 1.41

  The description of a fit ligature for the under Jaw.
• * 1.42

  In what time it may be healed.
• * 1.43

  Hipp. sect. 63. sect. 1. de art.
• * 1.44

  How to restore the fractured Clavicle. The first way.
• * 1.45

  The second way.
• * 1.46

  The third way.
• * 1.47

  How to binde up the fractured clavicle.
• * 1.48

  It is a difficult matter perfect∣ly to restore a fractured cla∣vicle.
• * 1.49

  An anatomicall description of the shoulder-blade.
• * 1.50

  How many waies the shoul∣der-blade may be broken.
• * 1.51

  The cure.
• * 1.52

  Lib. de vuln. Capitis. A historie.
• * 1.53

  Nature of its owne accord makes it selfe way to cast forth strange bodies and matters. Why a fracture in the joynt of the shoulder is deadly.
• * 1.54

  Signes that the sternum is bro∣ken.
• * 1.55

  Signes that it is deprest.
• * 1.56

  The cure.
• * 1.57

  A historie.
• * 1.58

  In what place the short ribs may be broken.
• * 1.59

  Sent. 56. sect. 3. de art.
• * 1.60

  Why an inter∣nall fracture of the ribs is deadly.
• * 1.61

  The signes.
• * 1.62

  The cause of spitting blood when the ribs are broken.
• * 1.63

  Sent. 51. sect. 3. de art. Paulus lib. 6. cap. 96. Avicen. 4. The cure.
• * 1.64

  A simple frac∣ture may be cu∣red onely by Surgerie.
• * 1.65

  The cause.
• * 1.66

  The signes.
• * 1.67

  The cure.
• * 1.68

  The affects of the vertebrae.
• * 1.69

  Sect. 2. Prorh.
• * 1.70

  The cure of fractured Ver∣tebrae.
• * 1.71

  The cure of the processes.
• * 1.72

  Signes that on∣ly the processes are fractured.
• * 1.73

  What fracture of the Holy-bone curable and what not.
• * 1.74

  The descripti∣on of the rump.
• * 1.75

  The cure.
• * 1.76

  The description of the Hip.
• * 1.77

  The signes.
• * 1.78

  The cure.
• * 1.79

  The descripti∣on of the arme or shoulder-bone.
• * 1.80

  The cure.
• * 1.81

  How the arme must be placed when the bone is set.
• * 1.82

  Sect. 3. offic. sect. 1. de fract.
• * 1.83

  In what time it will knit.
• * 1.84

  The difference▪
• * 1.85

  The cure.
• * 1.86

  Sent. 3. sect. 1. de fract.
• * 1.87

  Com. in lib. de art.
• * 1.88

  Sect. 〈◊〉〈◊〉. de fract. sent. 9.
• * 1.89

  The cure.
• * 1.90

  To what pur∣pose the carry∣ing of a bail in a fractured hand serves.
• * 1.91

  Why the bone of the thigh is more difficultly set.
• * 1.92

  Sent. 67. & 68. sect. 2. de fract.
• * 1.93

  The naturall and internall crookednesse must be preser∣ved in setting the bone.
• * 1.94

  The part to bee bound up, must be made plaine either by na∣ture or art.
• * 1.95

  The manner of binding used by Surgeons at this day.
• * 1.96

  Why the win∣dings of the up∣per ligatures must be thicker and straiter than the lower.
• * 1.97

  Why the third ligature must bee rowled con∣trary to the two first.
• * 1.98

  The Surgeon must be minde∣full of three things in pla∣cing the mem∣ber.
• * 1.99

  Sect. 2. de fract.
• * 1.100

  Sent. 33. & 56. sect. 2. de fract.
• * 1.101

  When the first ligation must be loosed.
• * 1.102

  Sent. 15. sect. 3. 〈◊〉〈◊〉 offic.
• * 1.103

  Rest necessary for the knitting of set bones.
• * 1.104

  A historie.
• * 1.105

  Another fra∣cture of the thigh, resem∣bling a luxa∣tion.
• * 1.106

  Why the fra∣cture of a bon. neare a joynt is more dange∣rous.
• * 1.107

  Lib. 3. sen. 6. tract. 1. c. 14.
• * 1.108

  In what space the thigh bone may be knit.
• * 1.109

  The differen∣ces.
• * 1.110

  Signes.
• * 1.111

  Cure.
• * 1.112

  Why those halt who have had this bonefra∣ctured.
• * 1.113

  Sent. 65. sect. 2. de fract.
• * 1.114

  Signes that both the bones are broken.
• * 1.115

  A historie.
• * 1.116

  A soone made medicine.
• * 1.117

  What to doe when the legge is broken.
• * 1.118

  That the liga∣tion must be most strait upon the wound.
• * 1.119

  What symp∣tomes ensue the want of binding upon the woun∣ded part.
• * 1.120

  Signes of the corruption of the bones.
• * 1.121

  When the wounded part must be omit∣ted in ligation.
• * 1.122

  Lattice like binding to be shunned.
• * 1.123

  Vnguentum rosa∣tum, wherefore good in fra∣ctures.
• * 1.124

  You must have a care, that the compresses and rowlers grow not hard by drinesse.
• * 1.125

  The description of a sugred water.
• * 1.126

  The causes of a fever and ab∣scesse, ensuing upon a fracture.
• * 1.127

  Signes of scales severed from their bones.
• * 1.128

  Why the ex∣treme parts are cold when we sleepe.
• * 1.129

  The naturall fa∣culties languish in the parts by idlenesse, but are strengthe∣ned by action.
• * 1.130

  How, and what ulcers happen upon the fra∣cture of the legge, to the rumpe & heele.
• * 1.131

  Remedies for the prevention of the foresaid ulcers.
• * 1.132

  The use of a Lattin Casse.
• * 1.133

  A suppuratis 〈◊〉〈◊〉 medicine.
• * 1.134

  A d••te: ••ive.
• * 1.135

  Catagmatick powders have power to cast forth the scales of bones.
• * 1.136

  The causes both efficient and materiall of a Callus.
• * 1.137

  Medicines con∣ducing to the generation of a Callus.
• * 1.138

  The black plaister.
• * 1.139

  The descripti∣on of a Spa••a∣drapum or cere-cloth.
• * 1.140

  Medicines good of them∣selves, not good by event.
• * 1.141

  When the Cal∣lus is breeding the ulcer must be seldome drest.
• * 1.142

  Hipp. sent. 43. sect. 1. de fract.
• * 1.143

  Meats fit for generating a Callus.
• * 1.144

  Lib. 6. meth. cap. 〈◊〉〈◊〉▪
• * 1.145

  Why the mar∣row may seeme to have sense of feeling.
• * 1.146

  In what space the legge is usually knit.
• * 1.147

  Discussing and unctuous medi∣cines hinder the generation of a Callus.
• * 1.148

  What helps forward the ge∣neration thereof.
• * 1.149

  What Callus must not be broken, though distorte, or otherwise ill conformed.
• * 1.150

  The causes of too slender a Callus.
• * 1.151

  Remedies therefore.
• * 1.152

  When we must desist from fo∣menting and frictions.
• * 1.153

  Warme water.
• * 1.154

  The effects thereof.
• * 1.155

  Notes of short, just, and too long fomenting.
• * 1.156

  Fomentations hurt plethorick bodies.
• * 1.157

  Why the fractu∣red bones of the foot must be kept in a strait postur••.