CHAP. IV. The general cure of broken and dislocated bones.
* 1.1TO 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 himself: The first is, to restore the bone to its place: The second is, that he contain or stay it being so re∣stored: The third is, that he hinder the increase of malign symptoms and accidents; or else if they do happen, that then he temper and correct their present malignity: Such accidents are pain, inflammation, a feaver, abscess, gangrene and sphacell. For the first intention, you may easily restore a 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 bitterness of pain or inflammation, which may trouble the Patient, is not as yet very great; neither is the contraction of the muscles up∣wards,* 1.2 as yet very much or stubborn: Therefore first of all, the Patient with his whole body, but espeeially with the broken or dislocated part, as also the Surgeon, must be in some place which hath good and sufficient light: Then let trusty and skilfull attendants be there, good ligatures, and also, if need so require, good engins. His friends which are present, let them see and hold their peace, neither say nor do any thing which may hinder the work of the Surgeon: Then putting one hand above, that is, towards the center of the body, and the other below, as neer as he can to the part affected, let him stretch forth the member: for if you lay your hand any distance from the part affected, you will hurt the sound part by too much compression,* 1.3 neither will you much avail your self by stretching it at such a distance: But if you only endeavour below with your hand or ligature, assisting to make extension thereof, it will be dangerous if there be nothing above which may withstand or hold, lest that you draw the whole body to you: This being done according as I have delivered, it is fit the Surgeon make a right or streight extension of the part affected: for when the bone is either broken or out of joint, there is contraction of the muscles towards their original, and con∣sequently of the bones by them,* 1.4 as it is observed by Galen: Wherefore it is impossible to re∣store the bones to their former seat, without the extension of the muscles: But the part being thus extended, the broken bones will sooner and more easily be restored to their former seat; Which being restored, you shall presently with your hand press it down, if there be any thing that bunches or stands out. And lastly you shall binde it up, by applying boulsters and splints as shall be fit. But if the bone be dislocated or forth of joint, then presently after the exten∣sion thereof,* 1.5 it will be requisite to bend it somewhat about, and so to draw it in. The Surgeon is sometimes forced to use engins for this work, 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 joints: 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 be contracted more powerfully upwards towards their originals: Yet have a care that you extend them not too violently, lest by rending and breaking asunder the muscles and nerves, you cause the forementioned symptoms,* 1.6 pain, convulsion, a palsie and gangrene: all which sooner happen to strong and aged bodies, than to children, evnuches, women, youths, and generally all moist bodies, for that they are less hurt by violent extension and pulling, by reason of their na∣tive and much humidity and softness. For thus skins of leather, moistened with any liquor, are easily retched, and drawn out as one pleaseth: but such as are dry and hard, being less tractable, will sooner rend and tear, than stretch further out. Therefore the Surgeon shall use a mean in extending and drawing forth of members, as shall be most agreeable to the habits of the bodies.* 1.7 You may know the bone is set, and the setting performed as is fit, if the pain 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 be nothing bunching out, nor rugged, but the surface of the membrane remain smooth and equal; and lastly, if the broken or dislocated member compares with its opposite in the composure of the joints, and knees, as the ankles answer justly and equally in length and thickness. For which purpose it must not suffice the Surgeon to view it