CHAP. V. Certain common precepts of the binding up of Fractures and Luxations.
IN every Fracture and Luxation, the depressed, hollow and extenuated parts, such as are neer unto the joints, ought to be filled up with boulsters, or clothes put about them, so to make the part equal, that so they may be equally and on every side pressed by the splints, and the bones more firmly contained in their seats. So when the knee is bound up, you must fill the ham or that cavity which is there, that so the ligation may be the better and speedilier performed. The same must be done under the arm-pits,* 1.1 above the heel, in the arm neer the wrist; and to conclude, in all other parts which have a conspicuous inequality by reason of some manifest cavi∣ty. When you have finished your binding, then enquire of the Patient, whether the member seem not to be bound too strait. For if he say that he is unable to endure it so hard bound, then must the binding be somewhat flackned.* 1.2 For, too strait binding causes pain, heat, defluxion, a gangrene, and lastly, a sphacel or mortification: but too loose is unprofitable, for that it doth not contain the parts in that state we desire. It is a sign of a just ligation that is neither too strait nor too loose, if the ensuing day the part be swoln with an oedematous tumor, caused by the blood pressed forth of the broken place; but of too strait ligation, if the part be hard swoln; and of too loose, if it be no whit swoln, as that which hath pressed no blood out of the affected part. Now if a hard tumor, caused by too strait binding, trouble the Patient, it must presently be loosed for fear of more grievous symptoms, and the part must be fomented with warm Hydraeleum, and another in∣different, yea verily, more loose ligature must be made instead thereof, as long as the pain and in∣flammation shall continue; in which time and for which cause, you shall lay nothing upon the part which is any thing burdensome. When the Patient begins to recover, for three or four dayes space, especially if you find him of a more compact habit and a strong man, the ligature must be kept firm and not loosed. If on the third day, and so untill the seventh, the spires or windings be found more loose, and the part affected more slender; then we must judge it to be for the better. For hence you may gather, that there is an expression and digestion of the humors, causing the tumor made by force of the ligation. Verily, broken bones fitly bound up, are better set, and more firmly agglutinated, which is the cause, why in the place of the fracture, the ligation must be made the straiter,* 1.3 in other places more loosly. If the fractured bone stand forth in any part, it must there be more straitly pressed with boulsters and splints. To conclude, the seventh day being past, we must bind the part more straitly then before: for that then inflamation, pain and the like accidents are not to be feared. But these things which we have hitherto spoken of, the three kinds of Ligatures, cannot take place in each fractured part of the body, as in the chaps, collar-bones, head, nose, ribs: For, seeing such parts are not round and long, a Ligature can∣not be wrapped about them, as it may on the arms, thighs, and legs, but only be put on their outsides.