The workes of that famous chirurgion Ambrose Parey translated out of Latin and compared with the French. by Tho: Johnson. Whereunto are added three tractates our of Adrianus Spigelius of the veines, arteries, & nerves, with large figures. Also a table of the bookes and chapters.

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 be kept firm and ratified;* 1.1 that ligation must be made upon the wound; otherwise the wounded part will pre∣sently lift it self up into a great tumor, receiving the humors pressed thither by the force of the ligation made on this and that side, above and below, whence ensue many malign symptoms: You may make tryall hereof upon a sound fleshy part;* 1.2 for if you binde it above and below, not touching that which is in the midst, it will be lifted up into a great tumor, and change the flourishing and native colour, into a livid or blackish hue, by reason of the flowing and abundance of the humors pressed forth on every side from the neighbour∣ing parts. Therefore such things will happen much the rather in a wounded or ulcerated part: But for this cause, the ulcer will remain unsuppurated 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 thereof, burns and corrupts them, and so much the more, if they be rare and soft.* 1.3 These will be the signs of such corruption of the bones; if a greater quantity, and that more filthy sanies, flow from the Ulcer, than was accusto∣med, or the nature of a simple ulcer requires; if the lips of the ulcer be inverted; if the flesh be more soft and flaccid about them; if a sorrowfull sense of a beating, and also deep pain torment the Patient by fits; if, by searching with your probe, you perceive the bone to be spoiled of its pe∣riosteum; and lastly, if you finde it scaly and rough; or also, if your probe be put down somewhat hard, it run into the substance of the bone: But we have treated sufficiently hereof in our par∣ticular Treatise of the rottenness of the bones; But certainly such rottenness will never happen to the bone, if the hurt part be bound up, as is is fit, and according to art. Wherefore I judge it not amiss again to admonish the Surgeon of this, that as far as the thing shall suffer,* 1.4 he make his rowl∣ings upon the wound; unless by chance there be such excessive pain and great inflammation, that, through occasion of such symptoms 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 weak, nor too much worn, being twice or thrice doubled, and which may serve to compass 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 stir the fragments of the bones (which once set ought to be kept unmoved) as often as the wound comes to be dressed. For, broken bones do not require such frequent dressing, as wounds and ulcers do: By this it appears, that as want of bind∣ing, and too much loosness in absence of pain and a phlegmon, so also too strait ligation, when pain is present, brings a phlegmon and abscess 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 reiterate these things, because you shall as yet find many, who follow the practise of Paulus, and make many circumvolutions here and there, above and below the wound, which pre∣sently they carry cross-wise:* 1.5 But this cross or lattice-like kind of ligation is wholly to be disliked, and that only to be used which we have described, according to the mind of Hippocrates. Now it is time that I return to the former history of my mishap, and declare what was done to me after that first dressing, which I have formerly mentioned.

Notes

• * 1.1

  That the liga∣tion must be most strait upon the wound.
• * 1.2

  What symp∣toms ensue the want of bind∣ing upon the wounded part.
• * 1.3

  Signs of the corruption of the bones.
• * 1.4

  When the wounded part must be omit∣ted in liga∣tion.
• * 1.5

  Lattice-like binding to be shunned.