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.

The FIFTEENTH BOOK: Of FRACTURES. (Book 15)

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

* 1.1A Fracture, in Galens opinion, is the solution of continuity in a bone, which by the Greeks is called Catagma. There are many sorts of hurting or offending the bones: as the drawing them asunder, luxation, or putting them out of joint; their unna∣tural growing together, their cutting or dividing asunder; contusion, abscess, putrefaction, rottenness, laying bare the periosteum, being violated or lost; and lastly, that whereof we now treat, a Fracture. Again, the varieties of Fractures are almost infinite. For one is complete and perfect, another imperfect; one runs long-wise, another transverse, another oblique; one while it is broken into great pieces, another while into little and small scales, which have either a blunt, or else a sharp end, and prick the adjacent bodies of the muscles, nerves, veins or arteries. It sometimes happens, that the bone is not bro∣ken into splinters,* 1.2 that is, long-wayes, but together, and at once into two pieces overthwart, which Fracture is called Raphanedon, that is, after the manner of a Radish.

* 1.3A Fracture is made Caryedon, or like a nut, when as the bone flyes into many small pieces, seve∣red 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 meal or flour; and such is often seen in fractures made by bullets,* 1.4 shot out of guns and such fiery Engins. Contrary to these are those fractures which are called Schidacidon, as rent into splinters, or after the manner of a boord or piece of timber, that is, right-down, and alongst the bone: and these fractures are either apparent to the eye, or else not apparent, and therefore called Capillary, being so small, as that they cannot be perceived by the eye, unless you put ink upon them, and then shave them with your Scrapers. Sometimes the bone is only pressed down with the stroke; sometimes on the contrary it flies 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 some∣times smooth and polished, otherwhiles unequal, and as it were sharp and rough with little teeth, or pricks. Some fractures touch only the surface of the bone, fetching off only a scale; other∣some change not the site of fractured bones, but only cleaves them length-wayes, 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, haemorrhagy, inflammation, gangrene, and the like. Hereun∣to you may also adde the differences drawn from the parts which the Fractures possess; as from the head, ribs, limbs, joints, and other members of the body. Adde also these which are taken from the habit of bodies, aged, young, full of ill humours, well tempered; almost all which have their proper and peculiar indications for curing.* 1.5 Now the causes of Fractures, are the too vio∣lent assaults or stroaks of all external things, which may cut, bruise, break, or shake: in this num∣ber of causes may also be reckoned, falls from high places, and infinite other things, which would be long and tedious to reckon up.

CHAP. II. Of the signs of a Fracture.

* 1.6WE may know by evident signs that a bone is broken: the first whereof and most cer∣tain, is, when by handling the part which we suspect to be broken, we feel pieces of the bone severed asunder, and hear a certain crackling of these pieces under our hands,* 1.7 caused by the attrition of the shattered bones. Another sign is taken from the impotency of the part, which chiefly bewrayes it self, when both the bones, the leg, and brace-bones, the ell and wand are broken: For if only the brace-bone or wand be broken, the Patient may go on his leg,* 1.8 and stir his arm; for the Brace-bone serves for the sustaining of the muscles, and not of the body, as the leg-bone doth. The third sign is drawn from the figure of the part changed besides nature: for it is there hollow, from whence the bone is flown or gone, but gibbous or bunching out whither it is run. Great pain in the interim torments the Patient by reason of the wronged periosteum, and that membrane which involves the marrow and the sympathy of the ad∣jacent parts, which are compressed or pricked.

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

WE must prognosticate in Fractures whether they are to end in the destruction or wel∣fare of the Patient; or whether their cure shall be long or short, easie, or else difficult and dangerous; and lastly, what accidents and symptoms may happen there∣upon. He shall easily attain to the knowledge of all these things, who is not only well seen in the anatomical description of the bones, but also in the temper, composition, and complexion of the whole body. Wherefore in the first place, I think good to admonish the Surgeon of this,* 1.9 that in winter when all is stiffe with cold, by a little fall, or some such sleight occasion, the bones may be quickly and readily broken. For then the bones, being dried, by the dryness of the air encompassing us, become more brittle; which every 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 yielding to the violence of the obvious and of∣fending body. Wherefore also you may gather this to the framing of your Prognosticks,* 1.10 That bones by reason of their natural driness are not so easily agglutinated and consolidated as flesh; though in Children, according to Galen, by reason of the abundance of their humi∣dity, the lost substance may be repaired, according (as they term it) to the first intention, that is, by restoring of the same kind of substance or matter. But in others, about the Fractures, a certain hard substance usually concreats, of that nourishment of the broken bone which abounds, which glues together the fragments thereof, being fitly put together. This sub∣stance is then termed a Callus, and it is so hardened in time, that the bone thereafter in the broken part is seen to be more firm and hard than it is in any other; therefore that usual saying in Physick is not without reason; That rest is necessary for the uniting of broken bones. For the Callus is easily dissolved, if they be moved before their perfect and solid agglutination. The matter of a Callus ought to be indifferent and laudable in quantity and quality, even as blood which flowes for the regeneration of the lost flesh in wounds. It is fit, that there may be sufficient matter for such a Callus, that the part have a laudable temper, otherwise there either will be no Callus, or certainly it will grow more slowly.* 1.11 Fractures are far more easily re∣paired in young bodies than in old: for in these there is plenty of the primigenious and radi∣cal moisture, that is laudably holding and glutinous; and in the other there is store of watrish and excrementitious humors. By this you may easily conjecture, that you cannot certainly set down a time necessary for the generating a Callus: for in some it happens later, in some sooner: the cause of which variety is also to be referred to the constitution of the year and region, the temper and diet of the Patient, and manner of Ligation: For, those Patients whose powers are weak, and blood waterish and thin, in these the generation of a Callus uses to be more slowe: On the contrary, strong powers hasten to agglutinate the bones, if there be plenty of gross and viscous matter; whereby it comes to pass, that meats of grosser nutriment are to be used,* 1.12 and medicins applyed which may help forwards the endeavour of nature, as we shall declare here∣after. When the bones are broken near unto the joints, the motion afterwards uses to be more difficult, especially if the Callus, which is substituted, be somewhat thick and bunching forth. But if, together with the violence and force of the Fracture, the joints shall be broken and bruised, the motion will not only be lost, but the life brought in danger, by reason of the greatness of the inflammation, which usually happens in such affects, and the excess of pain in a tendinous body. These fractures wherein both the bones of the arm or leg are broken,* 1.13 are more difficult to cure, than those which happen but to one of them: For they are handled and kept in their places with more difficulty, because that which temains whole, serves the other for a rest or stay to which it may lean. Moreover, there is longer time required to sub∣stitute a Callus to a great bone, than to a little one. Again,* 1.14 these bones which are more rare and spongy, are sooner glued together by the interposition of a Callus, than these which are dense and solid. A Callus sooner growes in sanguin, than in cholerick bodies: But broken bones cannot be so happily agglutinated, nor restored in any body, but that alwayes some asperity or unequal protuberancy may be seen on that part where the Callus is generated:* 1.15 Wherefore the Surgeon ought to make artificial Ligations, that the Callus may not stand out too far, nor sink down too low. That Fracture is least troublesom which is simple; on the contrary, that is more troublesom 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 periosteum. 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 pain by the pricking: besides also the member is made shorter than it was, and than the sound member on the opposite side is, and more swoln by the contraction of the muscles towards their original. Wherefore when a bone is broken,* 1.16 if you perceive any thing so depressed, 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 own accord suffer the bones to be restored to their proper seat of themselves. This extension must be performed in the first dayes, for afterwards there

will happen inflammation: which being present, it is dangerous to draw the nerves and tendons too violently; for hence would ensue an impostume, convulsion, gangrene and mortification. Therefore Hippocrates forbids you to defer such extension untill the third,* 1.17 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 them∣selves and their natural place, the part wasts for want of nourishment; both for that the natural site of the veins, arteries and nerves, is perverted, as also because the part it self lies immovable, or scarce moveable: whereby it cometh to pass, that the spirits do not freely flow thereto, as nei∣ther the nutritive juice cometh thither in sufficient plenty.* 1.18 When the dislocated or broken mem∣ber is troubled with any great inflammation, it is doubtfull whether or no a convulsion will hap∣pen, if we attempt to restore it, or the parts thereof to their seat: therefore it is better, if it may be done, to defer the reducing thereof so long, untill the humour which possesses the part be dis∣solved, the tumor abated, and the bitterness of pain mitigated.

CHAP. IV. The general cure of broken and dislocated bones.

* 1.19TO 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,* 1.20 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,* 1.21 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,* 1.22 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,* 1.23 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,* 1.24 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.* 1.25 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

once, but even as often as he shall dress it: For it may happen, that the bone which is well set,* 1.26 may by some chance, as by the Patients unconsiderate turning himself in his bed, or as it were a convulsive twitching of the members or joints whilest he sleeps, the muscles of their own ac∣cord contracting themselves towards their originals, that the member may again fall out; and it will give manifest signs thereof by renewing the pain, by pressing or pricking the adjacent bodies: which pain will not cease, before it be 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 self will afterwards be so much the shorter, and consequently the whole member; so that if this errour shall happen in a broken leg, the Patient will halt ever after, to his great grief, and the Surgeons shame: Wherefore the Patient shall take heed, as much as in him lies, that he stir not the broken member, before that the Callus be hardned. Such diligent care needs not be had in dislocations: For these once set, and artificially bound up, do not afterwards so easily fall forth as broken bones. The second scope is, that the bones which shall be restored may be firmly kept in their state and place: that shall be done by Bandages; as ligatures, boul∣sters, and other things, whereof hereafter we shall make particular mention: Hither tend pro∣per and fit medicins, to wit, applying of oil of Roses with the whites of Eggs, and the like re∣pelling things, and then resolving medicins, as the present necessity shall require. It will be convenient to moisten your rowlers and boulsters in Oxycrate for this purpose, or else in Rose-vinegar, if the Fracture be simple, or with red wine;* 1.27 or the like liquor warm (in Galens opi∣nion) if a wound be joined to the fracture; and it will be fit to moisten fractures oftner in Summer; For so the part is strengthened, the defluxion being repelled, whereby the inflamma∣tion and pain are hindered. You must desist from humecting and watering the part when the symptomes are past, lest you retard the generating of a Callus; for which you must labour by these means which we shall hereafter declare. To this purpose also conduces the rest and lying of the part in its proper figure and site accustomed in health, that so it may the longer re∣main in the same place unstirred: Besides also, it is expedient then only to dress the part, when it is needfull, and with those things which are requisite, shunning as much as may be, inflamma∣tion and pain. That figure is thought the best, which is the middle; that is,* 1.28 which contains the muscles in their site, which is without pain; so that the Patient may long endure it without la∣bour or trouble. All these things being performed, the Patient must be asked, whether the mem∣ber be bound up too strait? If he answer No, (unless peradventure a little upon the fracture or luxation, for there it is fit it should be more straitly bound) then may you know that the binding is moderate:* 1.29 And this same first ligation is to be kept in fractures without loosing for three or four dayes space, unless peradventure pain urge you to the contrary. In dislocations the same binding may be kept for seven or eight dayes, unless by chance some symptom may happen; which may force us to open it before that time: for the Surgeon must with all his art have a care to prohibit the happening of evil accidents and symptomes, which, how he may bring to pass, shall be declared in the following Chapter.

CHAP. V. By what means you may perform the third intention in curing Fractures and Dislocations, which is the hindring and correction of accidents and symptoms.

THat We may attain unto this third scope,* 1.30 it is requisite we handle as gently and without pain, as we may, the broken, or dislocated member; we drive away the defluxion ready to fall down upon the part, by medicins, repelling the humour, and strengthening the part; we, by appointing a good diet, hinder the begetting of ex∣crements in the body, and divert them by purging and phlebotomy: But if these accidents be already present, we must cure them, according to the kind and nature of each of them;* 1.31 for they are various: Amongst which is reckoned itching, which in the beginning torments the Patient: this ariseth from a collection and suppression of subacrid vapours, arising from the blood, and other humours under the skin: Whence a light biting, which causeth a sim∣ple itch, or else a more grievous and acrid one,* 1.32 from whence (in Galens opinion) proceeds a painfull itching. Wherefore such matter, as the cause, being evacuated, all itching ceaseth: But this cannot easily and freely be evacuated 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 it self doth not so per∣fectly perform and enjoy its wonted faculties and actions: by which it cometh to pass, that the heat thereof is more languid than may suffice to discuss the fuliginous matter there col∣lected. Wherefore it will be convenient to loose the ligatures every third day,* 1.33 that as by loosing their tyes, their sanious and fuliginous excrements, shut up under the skin, may freely pass 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 be long fomented with hot water alone, or else with a decoction, of sage, chamomil, roses, and melilot made in wine and water: for long fomenting attenuates and evacuates; but shorter fills and mollifies, as it is delivered by Hippocrates. Also gentle frictions, performed with your hand,* 1.34 or a warm lin∣nen cloth upwards, to the right side and left, and circularly to every side, are good. But if

the skin be already risen into blisters, they must be cut, lest the matter contained thereunder may corrode and ulcerate the skin: then must the skin be anointed with some cooling and drying medicin; as, ung. album Camphoratum Rhasis, Desiccativum rubrum, unguentum rosatum sine aceto; adding thereto the powder of a rotten poste, or prepared Tutia, or the like. Other accidents more grievous than these, do often happen, but we will treat of them hereafter: But if the scales of the bone underneath, be quite severed from the whole, then must they be presently taken forth, espe∣cially 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 cut∣ting mallets, or Parrats beak, as occasion shall offer its self: 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, neither too strait bound, otherwise it will be apt to inflammation. Thus much concerning fractures and dislo∣cations in generall: now we must descend to particulars, beginning with the fracture of the Nose.

CHAP. VI. Of the Fracture of the Nose.

* 1.35THe Nose is gristly in its lower part, but bony in the upper. Wherefore it suffers no fracture in the gristly part (unless peradventure a Sedes) but only a depression, distorti∣on or contusion. But a fracture often happens to the bony part, and so great a depressi∣on to the inner side, that unless it be provided for by diligent restoring it, the nose will become flat,* 1.36 or wrested aside, whence there will be difficulty of breathing. That this kind of fracture may be restored, that bone which stands too far out, must be pressed down; but that which is deprest, must be lifted up with a spathern, or little stick handsomely fashioned and wrapped about with cotten or a linnen rag, so to avoid pain: Therefore you shall hold the spathern in one hand. and reduce and order it with the other. The bone being restored, directories or tents of a convenient bigness shall be put into the nose; which tents shall be made of spunge, or flax, or a piece of a beasts or sheeps lungs: For these things are soft, and doe not only 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 per∣fect agglutination of the bones, lest the figure and straitness should be vitiated and spoiled. 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 nothing hindred the breathing. In the mean time we must see that we do not press the Nose with too strait binding, unless peradven∣ture some other thing perswade; lest they become either too wide, too flat, or crooked. If any wound accompany the fracture, that shall be cured after the same manner; as the wounds of the head. The fracture restored, the following medicin, which hath a faculty to repell and re∣press the defluxion, to strengthen and keep the part in its due posture, and to dry up and waste the matter which hath already fallen down, shall be applyed to the Nose, and all the other dry parts.* 1.37 ℞ thuris, mastiches, boli armeniae, sanguinis draconis, an. ℥ ss. aluminis rochae, resinae pini. an. ʒ ij. pulverisentur subtilissime: Or else, ℞ farinae volatilis ℥ ss. albuminum ovorum quantum sufficit, incor∣porentur simul, & fiat medicamentum.

Neither shall you use any other art to cure the cartilaginous part of the nose being fractu∣red:* 1.38 Wherefore Hippocrates terms that solution of continuity that there happens, A fracture, as if it were in a bone; because he could find no other name more fitly to express it: for a gristle, next to a bone, is the hardest of all the parts of our body. A Callus uses to grow in fractured Noses, unless something hinder within the space of twelve or fifteen dayes.

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

* 1.39THe lower Jaw runs into two, as it were, horns or tops: the one whereof ends sharp, and receives a tendon from the temporal muscle; the other ends blunt and round un∣der the mammillary process, and it is there implanted in a small cavity; it is joyned together in the middle of the chin by Symphysis, and is marrowy within: The Fracture, 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 together 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, where∣by the bones may be composed, and joined more easily to one another: The teeth in the mean while, if they be either shaken or removed out of their sockets, must be restored to their former places, and tyed with a gold or silver wyer, or else an ordinary thred, to the next firm teeth, untill such time as they shall be fastened, and the bones pefectly knit by a Callus: To which purpose, the ordered fragments of the fractured bone shall be stayed, by

putting a splint on the outside, made of such leather as shoe-soals are made;* 1.40 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, and of such length as shall be sufficient, divided at both the ends; and cut long-wayes in the midst thereof; that so it may engirt the chin on both sides. Then there will be four heads of such a ligature so divided at the ends; the two lower whereof being brought to the crown of the head, shall be there fastned, and sowed to the Patients night-cap. The two upper drawn athwart, shall likewise be sowed as artificially as may be, to the cap in the nape of the neck. It is a most certain sign, that the Jaw is re∣stored and well set, if the teeth fastened therein stand in their due rank and order. The Pa∣tient shall not lye down upon his broken Jaw, lest the fragments of the bones should again fall out, and cause a greater defluxion. Unless inflammation,* 1.41 or some other grievous symptom shall happen, it is strengthened with a Callus within twenty dayes; for that it is spongious, hollow, and full of marrow, especially in the midst thereof: yet sometimes, it heals more slowly, according as the temper of the Patient is, which takes also place in other fractured bones. The agglutina∣ting and repelling medicin, described in the former chapter, shall be used; as also others, as occasion shall offer it self. The Patient 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-jointed fragments should fly in sunder with the labour of chewing. Therefore shall he be nourished with water-grewel, ponadoes, cullasses, barley-creams, gellies, broths, rear-egs, restaurative 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 be,* 1.42 so must the cure and restoring thereof be performed: But howsoever this bone shall be broken, alwayes the end fasten∣ed to the shoulder and shoulder-blade, is lower than that which is joyned to the chest; for that the arm drawes it downwards. The collar-bone, if broken athwart, is more easily resto∣red and healed, than if it be cloven long-wayes: For, every bone broken athwart doth more easily return 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-wayes, is more difficultly joined and united to the ends and fragments; for those pieces, which were set, will be plucked asunder, even by the least motion of the arms; and that which was knit with the shoulder, will fall down to the lower part of the breast: The reason of which is, the collar-bone is not moved of its self, but consents in motion with the arm. In restoring this or any other fracture,* 1.43 you must have a care that the bones ride not one over another, neither be drawn nor depart too far in sunder: therefore it will be here convenient, that one servant draw the arm backwards, and another pull the shoulder towards him the contrary way; for so there will be made, as I may so term it, a coun∣ter-extension: While which is in doing, the Surgeon with his fingers shall restore the fracture, pressing down that which stood up too high, and lifting up that which is pressed down too low. Some, that they may more easily restore this kind of fracture,* 1.44 put a clew of yarn under the Patients arm-pit; so to fill up the cavity thereof: then they forcibly press the elbow to the ribs, and then force the bone into its former seat: But if it happen,* 1.45 that the ends of the broken bones shall be so deprest, that they cannot be drawn upwards by the forementioned means; then must the Patient be laid with his back, just between the shoulders, upon a pillow hard stuffed, or a tray turned with the bottom upwards, and covered with a rug or some such thing: Then the servant shall so long press down the Patients shoulders with his hands, untill the ends of the bones, lying hid and pressed down, fly out and shew themselves: Which being done, the Surgeon may easi∣ly restore or set the fractured bone. But if the bone be broken so into splinters that it cannot be restored, and any of the splinters prick and wound the flesh, and so cause difficulty of breath∣ing, you then must cut the skin even against them, and with your instrument lift up all the de∣pressed splinters, and cut off their sharp points; so to prevent all deadly accidents, which there∣upon may be feared. If there be any fragments, they, after they are set, shall be covered with a knitting medicin made of wheat flour, frankincense, bole armeniack, sanguis draconis, resina pini, made into powder, and mixed with the whites of eggs, putting upon it splints covered with soft, worn linnen rags; covered over likewise with the same medicin, and then three boulsters dipped in the same; two whereof shall be laid upon the sides; but the third and thickest upon the promi∣nent fracture, so to repress it and hold it in:* 1.46 For thus the fragments shall not be able to stir or lift themselves up further than they should, either to the right side or left. Now these boulsters must be of a convenient thickness 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 cross-wise, of a hands breadth, and some two ells and a half long, more or less, according to the Patients body. Now he shall be so rowled up, as it may draw his arm somewhat backwards, and in the interim his arm-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 himself bend his arm backwards, and set his hand upon his hip, as the Country Clowns use to do, when they play at leap-frog. But how great diligence soever you use in curing this sort of fracture,

yet can it scarce be so performed,* 1.47 but that there will some deformity remain in the part: for that a ligature cannot be rowled about the collar-bone, as it may about a leg or an arm. A Callus oft-times growes on this bone, within the space of twenty dayes, because it is rare and spongious.

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

* 1.48THe Greeks call that Omoplata, which the Latines tearm Scapula, or Scapulae patella, that is, the shoulder-blade. It is fastned on the back to the ribs, nowle, the Vertebrae of the chest and neck; but not by articulation, but only by the interposition of muscles, of which we have spoken in our Anatomy: But on the forepart it is articulated after the manner of other bones, with the collar-bone, the shoulder, or arm-bone: for with its process, which represents a prick or thorn, 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. There∣fore some Anatomists, according to Hippocrates, as they suppose, call all this articulation of the collar-bone with the hollowed process of the shoulder-blade, Acromion. There is another pro∣cess of the said Blade-bone, called Cervix omoplatae, or the neck of the shoulder-blade; this truely is very short, but ending in a broad insinuated head, provided for the receiving of the shoulder or arm-bone. Not far from this process is another, called Coracoides, for that the end thereof is crooked like a Crows beak. This keeps the shoulder-bone in its place, and conduces to the strength of that part.* 1.49 The shoulder-blade may be fractured in any part thereof, that is, either on the ridge, which runs like a hill, alongst the midst thereof for its safety, as we see in the ver∣tebrae of the back: So also in the broader part thereof, it may be 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.

We know the spine or ridge of the shoulder-blade to be broken, when a dolorifick inequality is perceived, by touching or feeling it: But you may know, that the broader or thinner part there∣of, is depressed, if you feel a cavity, and a pricking pain molest the part, and if a numness trouble the arm,* 1.50 being stretched forth. The fragments, if they yet stick to their bones and do not prick the flesh, must be restored to their state and place, and there kept with agglutinative medicines, and such as generate a Callus, as also with boulsters and rowlers fitted to the place: But if they do not adhere to the bone, or prick 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 Crows beak: But although they stir up and down, yet if they still adhere to the periosteum and ligaments, (if so be that they trouble not the muscles by pricking them) then must they not be taken forth: for I have oftner than once observed, that they have within some short time after grown to the adjacent bones. But if they, being wholly separated, do not so much as adhere to the periosteum, then must they necessarily be plucked away; otherwise within some short space after, they will be driven forth by the strength of nature,* 1.51 for that they participate not any more in life with the whole: For that which is quick, saith Hippocrates, uses to expell that which is dead far from it. The truth whereof was manifested in the Marquess of Villars, who at the battell of Dreux, was wounded in his shoul∣der with a Pistoll-bullet, certain splinters of the broken bone were plucked forth with the pieces of his harness, and of the leaden bullet; and within some short space after, the wound was cica∣trized,* 1.52 and fully and perfectly healed: But more than seven years after, a defluxion and inflam∣mation arising in that place by reason of his labour in arms, and the heaviness of his Armour at the Battell of Mont-contour, the wound broke open again; so that many shivers of the bone, with the residue of the leaden bullet, came forth of themselves. But if the fracture shall happen in the neck 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 Lorrain, Duke of Guise;* 1.53 the Count Rhingrave Philibert, and many other in these late civil Wars: For there are many large vessels about this dearticulation, to wit, the axillary vein and artery, the nerves ari∣sing from the Vertebrae of the neck, which are thence disseminated into all the muscles of the arm. Besides, also inflammation and putrefaction arising there, are easily communicated by reason of their neighbourhood to the heart and other principal parts, whence grievous symptoms, and oft-times death it self ensues.

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

* 1.54THe Sternum is sometimes broken, other whiles only thrust in without a fracture. The in∣equality perceivable by your feeling, shewes a fracture, 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 bloud, and difficulty of breathing by compressi∣on of the membrane investing the ribs and the lungs, argue the depression thereof. For the re∣storing of this bone, whether broken or deprest, the Patient must be laid on his back with a cushion stuffed with tow or hay under the vertebrae of the back, as we set down in the setting of

the collar-bone: Then a servant shall lie strongly with both his hands on his shoulders, as if he would press them down, whilest the Surgeon, in the mean time pressing the ribs on each side, shall restore and set the bone with his hand; and then the formerly described medicines shall be ap∣plyed for to hinder inflammation, and asswage pain; Boulsters shall be fitted thereto, and a liga∣ture shall be made crosse-wayes above the shoulders; but that not too strait, lest it hinder the Patients breathing. I by these means, at the appointment of Anthony of Burbon King of Navar,* 1.55 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-piece, as also his sternum together therewith, and he fell down as dead with the blow; he did spit bloud for three moneths after I had set the bone, yet for all this he lives at this dsy in perfect health.

CHAP. XI. Of the fracture of the Ribs.

THe true ribs, for that they are bony, may be broken in any part of them;* 1.56 But the bastard ribs cannot be truly broken, unless at the back-bone, because they are only bony in that part, but gristly on the foreside toward the breast-bone; wherefore there they can only be folded or crooked in. These which are subject to fractures, may be broken inwards and outwards. But oft-times it comes to pass, that they are not absolutely broken, but cleft into splinters, and that sometimes inwards, but not outwards. Thus the fissure doth oft-times not ex∣ceed the middle substance of the rib; but sometimes it so breaks through it all, that the fragments and splinters doe 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 membrane, and lastly, without any other symptome; then the danger is less: Therefore Hippocrates wisheth, that those, who are thus affected,* 1.57 fill themselves more freely with meat; for that moderate repletion of the belly, is (as it were) a certain 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 feel themselves better after, than before meat. For emptiness of meat, or of the stomach, makes a suspension of the ribs, as not underpropped by the meat. Now that fracture which is outwardly, is far more easie to heal,* 1.58 than that which is inwardly; for that this pricketh the membrane or Pleura, and causeth inflammation, which may easily end in an Empyema. Adde hereunto, that this is not so easily to be handled or dealt withall, as the other: whereby it cometh to pass, that it cannot be so easily restored; for that these things cannot be 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 join it together. It is therefore healed with∣in twenty dayes, if nothing else hinder. The signs of fractured ribs are not obscure;* 1.59 for by feel∣ing the grieved part with your fingers, you may easily perceive the fracture by the inequality of the bones, and their noise or crackling, especially if they be quite broke asunder.* 1.60 But if a rib be broken on the inside, a pricking pain, far more grievous than in a plurisie, troubles the Patient; because the sharp splinters prick the Costall membrane: whence great difficulty in breathing, a cough, and spitting of bloud ensue. For bloud, flowing from the vessels broken by the violenee of the thing causing the fracture, is (as it were) sucked up by the lungs, and so by a dry cough carryed 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-glass, and that is ill done; for there is caused grea∣ter attraction of humours, and excess of pain by the pressure and contraction of the adjacent parts, by the Cupping-glass; wherefore Hippocrates also forbids it:* 1.61 Therefore it is better to en∣deavour to restore it after this following manner. Let the Patient lye upon his sound side, and let there be laid upon the fractured side an emplaister made of Turpentine, Rosin, black Pitch, Wheat flour, Mastick, and Aloes, and spread upon a strong and new cloth. When it hath stuck there some time, then pluck it suddenly with great violence from below upwards; for so the rib will follow together therewith, and be plucked and drawn upwards. It is not sufficient to have done this once, but you must do it often, untill such time as the Patient shall finde himself better, and to breath more easily. There will be much more hope of restitution, if, whilest the Surgeon do this diligently, the Patient forbear coughing, and hold his breath: Otherwise, if necessity urge, as if sharp splinters with most bitter tormenting pain prick the Costall membrane, overspread with many nerves, veins, and arteries, which run under the ribs, whence difficulty of breathing, spitting of bloud, a cough and feaver 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 discern 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 sew it up, and cure it according to the common rules of curing wounds. Now diet, phlebotomy, and purgation,* 1.62 which (as Hippocrates saith) are not very needfull in a simple fracture, for that there are no sym∣ptomes which may require such remedies; yet they, by reason of the complicated symptoms, as a convulsion, feaver, Empyema, and the like, must here be prescribed by the advice of the Physician which oversees the cure. A Cerate, and other remedies fitting the occasion, shall be applyed to the grieved part: no other ligatures can be used, than such as are fit to hold fast and stay the local medicins. There is no other Rule of site and lying, than such as is taken from the will and content of the Patient.

CHAP. XII. Of certain preternatural affects which ensue upon broken Ribs.

MAny symptoms ensue upon fractured and contused ribs; but amongst the rest, there are two which are not common, whereof we will treat in this place. The first is, the infla∣tion, or rising up of the contused flesh, which also ensues upon light affects of the bone, which have been neglected at the beginning. But the flesh is not meerly puffed up of it self, but also within a certain phlegmatick, glutinous and viscous humour gathering thereinto. The cause hereof is,* 1.63 the weakness of the digestive faculty of the part, occasioned by the stroak and distemper; which therefore cannot affimilate the nourishment flowing more plentifully than it was wont, either drawn thither by means of the pain, or sent thither by a blinde violence of nature, stirred thereto by a desire of its own preservation. Wherefore this half crude humor remaining there, raiseth much flatuling from its self, or else wrought upon by the weaker heat, it is resolved into cloudy vapours; whence it cometh to pass, that the flesh is swoln up in that place,* 1.64 and the skin on the contrary grows soft, as if it were blown up with a quill: Therefore laying your hand thereon, you may hear the noise of the winde going forth thereof, and see a cavity left in the part, as it is usually seen in oedematous tumors. Unless you remedy this inflati∣on, there will ensue an inflammation, feaver, abscess, difficulty of breathing; and lastly, that se∣cond kinde of affect whereof we have determined to treat in this Chapter, to wit, the putre∣faction, corruption, or blasting of the ribs. An abscess, and the separation of the flesh from the bone is the cause hereof: for hence it cometh to pass, that the bone, despoiled of its natural and fleshly cloathing wherewith it was cherished, is easily offended by the touch of the entring air, which it never formerly felt, and so at length it becometh (as it were) blasted: which when it happens,* 1.65 they spit up filth, and so fall into a consumption, and at length dye. To withstand all these inconveniencies, you must as speedily as you can, restore the fractured bones by the former delivered means; And then this mucous tumor must be resolved by proper heating and discussing medicins, and kept down by boulsters and rowlers; that so the flesh may touch the bone, and co∣ver 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 abscess, it shall be speedily opened, lest the matter, kept in too long, corrupt the bone which lyes under it, by the contagion of its putrefaction. The Ulcer being opened, the matter shall be evacuated by putting a Pipe into the Ulcer; the end whereof shall be bound about with a thred, lest it fall into the capacity of the chest, and that it may be drawn forth at your pleasure.

CHAP. XIII. Of the Fracture of the Vertebrae, or rack Bones of the Back, and of their Processes.

* 1.66THe Vertebrae are somewhiles broken, otherwhiles bruised, or strained on the inside, whereby it cometh to pass, that the membranes which invest the spinal marrow, as also the spinal marrow it self, are compressed and straitned, which cause many malign acci∣dents; which, whether they be curable or not, may be certainly foretold by their magnitude. Amongst these symptoms, are the stupidity, or numness and palsie of the arms, legs, fundament, and bladder, which diminish, or else take away from them the faculty of sense and motion; so that their urine and excrements come from them against their wills and knowledge, or else are wholly supprest.* 1.67 Which when they happen (saith Hippocrates) you may foretell that death is at hand, by reason that the spinal marrow is hurt. Having made such a prognostick, you may make an in∣cision, so to take forth the splinters of the broken vertebrae, which driven in, press the spinal mar∣row, and the nerves thereof. If you cannot do this, at least you shall apply such medicins as may asswage pain, and hinder inflammation; and then the broken bones shall be restored to their places, and contained therein by those means which we shall mention, when we come to treat of the luxation of the spine.* 1.68 But if that the Processes only of the Vertebrae be broken, the fragments shall be put in their places, unless they be quite severed from their Periosteum. But if they be severed,* 1.69 you shall open the skin and take them forth, and then dress the wound as is fit. We un∣derstand that only the processes of the Vertebrae are broken, if in the absence of the forementioned symptoms of numness and the palsie, you laying your finger upon the grieved part, feel some∣thing, as a bony fragment, shaking and moving thereunder, with a certain crackling noise, cavity, and depression; and then, if when the Patient holds down his head, and bends his back, he feel far more pain, than when he stands up straight on his feet: For in stooping, the skin of the back is somewhat stretched forth and extended, and also forced upon the sharp splinters of the fragments, whence proceeds a dolorifick solution of continuity, and a pricking: in standing streight up, on the contrary, the stretched skin is relaxed, and consequently less molested by the sharp fragments. The fractured processes of the Vertebrae easily heal, unless they be associated with some other more grievous symptom which may hinder; such as is a certain great contusion, and the like: For as we formerly said out of Hippocrates, all rare and spongy 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 certain part thereof, which may be easily healed,* 1.70 may be broken by the blow of bruising things, as by a bullet shot out of a musket, as I have observed in many: But if the fracture violate, together with the Vertebrae thereof, the spinal marrow contained therein, then the Patient can scarce scape death, for the reasons shewed in the for∣mer Chapter.

CHAP. XV. Of the Fracture of the Rump.

THe Rump is composed of four bones; the first whereof hath a cavity,* 1.71 wherein it re∣ceives the lowest Vertebrae of the holy bone; the other three are joined together by Symphisis or Coalition; at the end of these hangs a certain small gristle.* 1.72 The fracture of these bones shall be cured by putting your finger into the Patients fundament, and so thrusting it even to the fractured place: For, thus you may thrust the fragment forth, and fit and restore it to the rest of the bones by your other hand lying upon the back: 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 ne∣cessity to rise, he shall so sit in a perforated seat, that there may be nothing which may press the broken part; and fitting remedies for healing fractures shall be applyed as occasion shall offer it self.

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; the other,* 1.73 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 joined together, that they can by no means be separated; but in children they may be separated without much ado. This bone may be bro∣ken in any part thereof, either by a stroak, or by a fall from high upon any hard body.* 1.74 You shall know the fracture by the same kind of signs, as you know others, to wit, pain, pricking, a depres∣sed cavity, and inequality, and also a numness of the leg of the same side.* 1.75 The splinters of the bones (if quite broke off) must by making incision, be taken away at the first dressing; in per∣formance 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 leg. On the contrary, such fragments as are not broken or severed from their periosteum, shall be 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 Arm-bone.

THe Arm-bone is round, hollow, full of marrow, rising up with an indifferent neck,* 1.76 and ending on the upper part into somewhat a thick head. On the lower part it hath two processes, the one before, the other behinde; between which there is (as it were) an half-circle, or the cavity of a pulley, each end whereof leads into its cavity, of which one is interior, another exterior; that by these (as it were) hollow stops, the bending and extension of the arm might be limited, lest that the bone of the cubit, if the circle should have been per∣fect, sliding equally this way and that way, might, by its turning, have gone quite round, as a rope runs in a pulley; which thing would much have confused the motion of the cubit: For so the extension, or bending it back, would have been equal to the necessary bending it inwards. It is very expedient that a Surgeon know these things, that so he may the better know how to restore the fractures and luxations of this part.* 1.77 If one of the fragments of this broken bone shall lye much over the other, and the Patient have a good strong body, then the arm shall be much extended, the Patient being so set upon a low seat, that he may not rise when the fracture shall be a setting, and so hinder the begun work; and also, that so the Surgeon may the more easily perform 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 self be drawn directly downwards, and the cubit so bended, as when you put it into a scarf. For if any one set this bone, lifting the arm upwards, or otherwise extending it, then must it be kept in that posture; for otherwise, if the figure be changed, the setting will quickly be spoiled, when as you come to put the arm in a scarf: Wherefore the Surgeon must diligently and carefully

observe,* 1.78 that in setting a broken arm, he put it in such a posture, that resting on the breast, it look down towards the girdle. You must have a care in laying the splints, and rowling your li∣gatures, that they hurt not, nor press too hard upon the joints. For, in the opinion of Hippocrates, by the pressure of parts which are nervous, fleshless, and consequently endued with exquisite sense; by the splints there is danger of most grievous pain, inflammation, denudation both of the bone and nerve; but chiefly, if such compression hurt the inner part, towards which the arm is bended; wherefore the splints made for this place must be the shorter: Therefore after the arm-bone is set, the arm shall be laid upon the breast in a right angle, and there bound up in a scarf, lest that the Patient, when he hath need to stir, spoil and undo the setting, and figure of the broken bone:* 1.79 But the arm must be kept in quiet, untill such time as the fragments shall be confirmed with a Callus, which usually is in forty dayes, sooner or later, according to the diffe∣rent constitutions of bodies.

CHAP. XVII. Of the Fracture of the Cubit, or the Ell and Wand.

* 1.80IT sometimes happeneth, that the cubit and wand are broken together and at once, and other∣whiles that but the one of them is fractured. Now they are broken either in their midst or ends; their ends (I say) which are either towards the elbow, or else towards the wrist. That fracture is worst of all, wherein both the bones are broken, for then the member is made wholly impotent to perform any sort of action, and the cure is also more difficult; for the mem∣ber cannot so easily be contained in its state: for that bone which remains whole, serves for a stay to the arm, and hinders the muscles from being drawn back, which usually draw back and shrink up themselves, whensoever both bones are broken: Hence it is, that that fracture is judged the worst,* 1.81 wherein the cubit or ell-bone is broken; But that is easiest of all, wherein only the wand is broken, for so the fractured part is sustained by the ell-bone: when both the bones are broken, there must be made a stronger extension, for that the muscles are the more con∣tracted: Therefore, whensoever either of them remains whole, it doth more service in sustaining the other, then any either ligatures or splints, for that it keeps the muscles right in their places: Wherefore, after the bones shall be set and rowled up with ligatures and splints, the arm must be so carryed up in a scarf put about the neck, that the hand may not be much higher than the elbow, lest the blood and other humours may fall down thereinto: But the hand shall be set in that posture which is between prone and supine, for so the wand shall lye directly under the ell,* 1.82 as we have read it observed by Hippocrates: The reason is, for that by a supine figure or situa∣tion, both the bone and muscles are perverted: for first, for the bone, the Apophysis, styloides and Olecranum of the cubit, ought to be in an equal plain, 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 process of the arm-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 tail thereof; but by a supine figure, the muscles arising from the inner process of the arm-bone, and bending the cubit, shall have the tail placed in an higher and more exteriour site. In the interim, you must not omit, but that the Patients arm

[illustration]

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

may, with as little pain as possible you can, be bended and extended now and then, lest by the too long rest of the tyed up part, and the in∣termission of its proper function, the bones of the joint may be sowdred together by the interposition, and as it were glue of the defluxion which falls abundantly into the joint of the el∣bow, and neighbouring parts, whence the stifness & unmoveableness there∣of, as if there were a Callus grown there: from whence it may happen that the arm thereafter may neither be bended, nor extended, which I have observed to have happened to many:* 1.83 Whereof also Galen makes mention, and calls this kind of vitiated con∣formation Ancyle and Ancylosis. If a wound also associate a fracture of the arm, then see that you put about it Plates of Latin, or Past-board, and make a convenient ligature, and that the fragments of the bones be kept in the same state wherein they were set and resto∣red: Moreover, let him lay his arm upon a soft pillow, or cushion, as the precedent figure shewes you.

CHAP. XIX. Of the fracture of a Hand.

THe Bones of the Wrist, and After-wrist, may be broken: but, in Hippocrates opinion,* 1.84 chiefly by that kinde of fracture which is called a Sedes; now if they shall happen to be broken, this shall be the manner of restoring them:* 1.85 Let the Patient lay forth his hand upon some even and smooth table; then let your servant stretch forth the broken bones, and the work-master restore them thus extended, and put them in their proper seats. But being resto∣red, they must be kept in their places by such remedies as are used in other fractures; to wit, cerates, compresses, linnen cloths, and splints. Now the fractured 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 Workman: But these bones, seeing they are of a rare and spongy nature, are in a short time and easily strengthened, or knit by a Callus.* 1.86 These things being done, the hollowness or palm 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 them∣selves 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, whereby we take hold of any thing. The case stands otherwise with the fractured Toes; for they shall be kept streight and even out, lest they should hinder our going or standing.

CHAP. XX. Of the Fracture of the Thigh.

IT is a hard thing to bring the fragments of the broken thigh together to be set,* 1.87 by reason of the large and strong muscles of that part; which whilest they are drawn back towards their original, by a motion both natural and convulsive, they carry together with them the frag∣ment of the bone, whereinto they are inserted: Therefore, when as the fracture of this bone shall be restored, the Patient must lie upon his back with his leg stretched forth, and the Surgeon must strongly and with great force extend the thigh; but if he alone shall not be able sufficient∣ly to extend it, he shall imploy two other strong attendants, by whose joint-help 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.

Instead of this Glosso∣comium,* 1.88 you may make use of my Pulley; for Hippocrates, in this bone when it is broken, doth approve of extension so much, that although by the greatness of the ex∣tension the ends of the fragments be somewhat distant asunder, an emp∣ty space being left be∣tween; yet notwith∣standing would he have a ligature made: For it is not here as it is in the extensions of other bones, whereas the cast∣ing about of Ligatures keeps the muscles un∣moveable: but here, in the extended thighs, the deligation is not of such force, as that it may stay and keep 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:* 1.89 Other∣wise, if any, unmindfull of this consideration, would have it straight, he shall make his Patient halt all his life after: wherefore this inner and native hollowness must be filled up and preserved by putting in a compress 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 frag∣ments of the bone in their places. Moreover,* 1.90 Compresses shall be applyed to the more slender and less 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 firm. Now ligatures, as we formerly noted, are ordained for three things: The first is, that the bones may be kept in that state where∣in they were set, untill they be strengthened by a Callus: The second is, to hinder defluxion, which

easily falls into the broken and luxated parts, both by reason of pain, as also by weakness: The third is, to stay and hold fast the splints and medicins which are applyed. Inflamation is hindred by repressing and hindring the blood and other humours, ready to flow down, from entring into the part, and by pressing those humours, 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 be made of choice and well woven cloth, yet not course or rough; and let them be of such length and breadth, as the Surgeon, perswaded by an artificial conjecture, shall judge to be fit for the thickness and length of the member, and greatness 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 Book of Bandages, I have seemed chiefly to set down and approve the manner of binding used by Hippocrates, now I think good here in this place to describe that which is in common use amongst our Surgeons.* 1.91 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 only strained, making the first wrappings upon it; so that they most and straitliest bind it there, but less and more loosly on both sides thereof: Such circumvo∣lutions,* 1.92 or wrapp••ngs, are drawn upwards, and there ended. They must be rowled thick, and not wide; for so if they presently follow, and lye one upon another, they will hold the bones more firmly, and more far and wide press forth and repress the superfluous blood from the sound part. They presently in like sort cast the second ligature upon the very fracture, giving it two wraps, then going downwards; 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 press the humors the less to the extremities of the part, as those which cannot receive and bear, without inflammation and danger of a gangrene, such abundance of humours, for that they are not sufficiently spacious; as also more remote from the fountain of native heat, which is greater in the center than in the circumference. At the lower end of the hurt part the circumvolutions either end,* 1.93 or else are twined thence back again: They cast on the third ligature in that lower end of the hurt part, and rowl it smoothly and gently upwards, the windings being made contrary to the windings of the first and second ligatures; that they may so draw back into their natural state the muscles, which peradventure have been drawn aside by the force of the former wrap∣pings. These ligations finished, they apply three splints of past-board, or some such matter; the first below the fracture, and that truely 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 do not stir to this side or that, being wrapped about with Tow or Cotton: Then they think of placing or laying the part,* 1.94 to which purpose they propound 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 pain and inflammation; which whiles the Patient cannot patiently endure, he is forced to change his place, whilest he every way seeks ease for his pain; and thus he now and then moves the fractured part, which ought to be kept quiet without any motion. It must lie smooth or even, because an unequal or uneven site distorts or draws awry the part, whilest one portion of the hurt part is born up, and sustained by that which lyes under it; but the other hanging down hath nothing thereunder, whereupon it may rest:* 1.95 Therefore Hippocrates bids us diligently to take heed that the heel do not hang down, nor the foot remain without a pillow, for hence pain and defluxion of humors is to be feared. But the part ought to lye somewhat high, that the defluxion may be hindred, which is easily stirred up by a prone and declining site: for if the foot shall be placed in a lower figure, the blood which flowes thither from the leg, will cause inflammation. But on the contrary, if it be higher, nothing can flow down thereinto: Therefore absolutely not only the foot, but also the thigh and leg, are to be placed higher than the rest of the body: yet keeping such a mean,* 1.96 that the part may not be too much distended, as Hippocrates admonisheth us. In the mean time, this hurt leg or side, ought to be of equal length with the sound, and for that purpose it must be stayed on both sides with Junks, as we shall shew you hereafter, when we come to speak of a broken leg. 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 wrapped; yea, verily the knee is lifted up into a soft tumor by the expression of the humor from the wounded part: but on the contrary, the ensuing day the ligation is slackened and relaxed, some portion of the humor contained in the part being digested. Also the next day all things are perceived more loose,* 1.97 there being made a larger resolution of the humor: Then therefore the bandages must be loosed, and that not only, lest that the fragments of the bones should fall forth of their place, but also that we may gratifie the Patient by that alteration or change of place, and besides that we may avoid itching, which usually happens to parts too long bound up, by reason of the suppression of acrid and fuliginous excrements, which use to be gathered in great quantity in a part at rest and bound up, both from the excrementitious humors, wherewith the part is moiste∣ned, and the alimentary humors, in a part which is idle and at quiet; by reason the difflation and transpiration are hindred by want of exercise, and the pores of the skin shut up by the abun∣dance of the ligatures: so that by the suppression thereof, many have not only an itching, but also the skin being broke by the acrimony of these, as well vapours as humors, which are kept shut and pent up, have ulcers break forth: Therefore when such accidents shall be feared, the part shall so long be fomented with warm water and oil, as you shall think fit: for, such fo∣menting

asswageth pain, relaxeth that which was too much straitned by the binding, and amends the refrigeration of the part, caused by the repercussion and expression of the blood and spirits, the native and internal heat being by this means revived. If, together with the tumor, there be a con∣tusion and sugillation, it must be the longer fomented, that the excrementitious humor residing in the part may be digested. But if this quantity 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. Therefore 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 discuss; but a longer and stronger wastes the flesh: Besides also you must have regard to the temper and habit of the Pa∣tient; for fomentations used to plethorick bodies, draw superfluous humours to the part.* 1.98 The An∣cients bid, that the ligatures be loosed every third day untill their seventh day; but after the se∣venth, on every 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 seldom; renewing the ligatures, and the rest of the dressing: Therefore, if no symptom urge, I would have none of these things, which are done to the Patient at the first dressing, to be moved, unless as slowly and seldom 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 joined together by glue, and pewter with sowder; so the fragments of bones are, by a providence of nature, glued and sowdred together by a Callus. Wherefore broken bones have very much need of rest,* 1.99 to the generating of a Callus; otherwise, the matter thereof flowing down, quickly flowes away, and nothing is done. You may much help forwards the generation of a Callus, which is begun about the thirteenth or fifteenth day, by applying an emplaister made with the white of an egg, having the powder of red rose-leaves, and wheat-flour mixed therewith, and catagmatick plaisters, which shall hereafter be described in speaking of the fracture of a Leg.

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

A Fracture sometimes happens at the joint of the hip in the neck of the thigh-bone,* 1.100 as I once observed in an honest matron. I being called to her, when I had observed the hurt thigh to be shorter than the whole, with the outward prominency of the Ischium, which at the first sight I supposed to proceed from the head of the thigh-bone, I presently perswaded my self it was a dislocation and no fracture; I then therefore extended the bone, and forced (as I thought) the head thereof into its cavity. The equality of both the legs in bigness which followed upon this extension, encreased my perswasion that it was a dislocation. The next day I visited her the second time, and found her in great pain, her hurt leg the shorter, and her foot wrested inwards. Then I loosed all her ligatures, and perceived such a prominency as I did formerly: Where∣fore I endeavoured again 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 cavity nor depression in the joint, by which signs I certainly perswaded my self, that the bone was broken; and not dislocated. Neither only such kind of fractures,* 1.101 but also the separation of the appendix or head of this bone from its place, may induce one to think it a dislocation; which thing hath some∣times deceived some heedless Surgeons, who have not dreamt of the divulsion or separation of the appendix from the top of the thigh-bone, but have judged it only a dislocation. Then there∣fore (that I may return to my former narration) I set the bone, and joined the fragments toge∣ther, laid thereupon splints with compresses, made ligations with a rowler, having two heads wrapped about the joint, and the body cross-wise, and I defended her foot with a case, that none of the cloths might press it: I fastned a rope to a poste, and so let it come down into the midst of the bed, and tyed many knots thereon, for the better taking hold and lifting up her self; the which thing you must alwayes doe in fractures and dislocations of the thigh and leg, 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 go to stool; as also, that they may give perspiration, and as it were ventilation to the loins, buttocks, rump, and other parts, compressed and wearied with long lying, for want whereof they are molested with heat and pain, whence ulcers arise, which oft-times torment the Patient with such tormenting heat and pain, that he is even consumed by a feaver, watchings, and want of rest.* 1.102 This opportunity of raising the body out of the bed, is by so much the more needfull in this place, by how much the fracture is nearer the joint; for there it is more dangerous than in the midst of the thigh, and conse∣quently more difficult to dress and heal, for that the part is bloodless, and by reason of the multi∣tudes of the nerves, tendons and ligaments, which are obnoxious to many malign symptoms: But the Surgeon must have diligent care in this kind of fracture, and must look often that the bone, which is set, doe not fall forth again, which easily happens here by any light stirring of the body, and the like occasion, for that the thigh hath but one only bone: Therefore, as oft as the Bandages shall be loosed, and the fracture dressed, he 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 frag∣ments 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 restored to its state, that so the Patient may

not halt during the residue of his life:* 1.103 For I have read it written in Avicen, that scarce any do so well recover a fractured thigh, that they do not halt thereof; therefore the Patient must be carefull, that he move himself, or his body as little as he can. Many of the Ancients have set down the time of the consolidation of this bone to be fifty dayes:* 1.104 but (as I formerly said) there can be no certain or determinate time hereof; But in what time soever this bone shall be knit, the Patient must not stand or go thereon presently upon it; for that there remains a weakness in the part a long time after, so that the Patients are forced to use crutches to go withall, in the mean space while they recover more strength.

CHAP. XXII. Of the fracture of the Patella, or Whirle-bone of the knee.

* 1.105THe whirle-bone of the knee is oft-times contused, but not so frequently broken; yet when that happens, it goes into two or three pieces, sometimes long-wise, sometimes athwart; Sometimes it is broken in the midst, and some whiles shivered into many splinters, and all these either with,* 1.106 or without a wound. The signs are, impotency in going, a hollowness in that place, and a sensible separation of the fragments of the hurt part, and the crackling of these parts under your hand.* 1.107 It is set after this manner; wish the Patient to stretch forth his leg, yea, he must keep it extended all the while, untill it be knit; and therefore lest he should bend it unawares, the hollowness of the ham shall be filled with a boulster; for by bending of the knee, the set frag∣ments of the whirl-bone would again 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 application of convenient reme∣dies, making ligatures, and applying junks, as we said must be done in the fracture of the thigh-bone. And lastly, you must observe and do in this as in the fracture of a leg. For the prognostick this I affirm, that I have seen none of those who have had this bone fractured, who have not halted during the rest of their lives.* 1.108 The cause hereof is, the knitting by the concretion of a Callus hinders the free bending of the knee; going, especially on even ground, is more easie to the Patient, but an ascent is far more difficult, and absolutely 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 Leg.

* 1.109THis kind of fracture is cured after the same manner as that of the arm or cubit. Hippocrates admonisheth us, that the Tibia, or leg-bone is 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 bulk of the body; but this other is but as it were a certain additament or assistant, provided for the staying or bearing up of the muscles of the leg, by which the foot is moved. The leg-bone being only broken, the signs thereof are per∣ceived only in the inner part of the leg; for that the shin-bone being whole, suffers it not to throw or cast forth it self: On the contrary, when the shin-bone only is broken, the signs thereof appear only in the external part of the leg; because the leg-bone, being opposed there∣to,* 1.110 doth not suffer it to cast in its self, and with its fragments to turn inwards: But when both the bones are broken, the signs of the fracture may equally appear both here and there. But when only one of these bones are broken, the fracture is far more easie to dress and heal, be∣cause that which remains whole, is a much more firm stay to that which is hurt, than any splints can be. But that I may the better instruct and make ready the Surgeon for the restoring of this fracture,* 1.111 I will illustrate the matter by an example from my self. John Nestor, Doctor of Physick, Richard Hubert, and I, went together to visit a Patient at the place of the Frier Mino∣rites. Wherefore, intending to pass over the Sein within sight of the place, I endeavoured to make my horse take boat, and therefore switched him over the buttocks: The Jade, madded here∣with, so struck at me with his heels, that he brake both the bones of my left leg, some four fin∣gers breadth above my ankle: Then I, fearing some worse mischief, and lest the Jade should double his blow, flew back; and as I fled back, the broken bones flew in sunder; and breaking through the flesh, stocking, and boot, shewed themselves, whereby I felt as much pain, as it is credible a man was able to endure; Wherefore I was presently carried into the boat, that so I might be car∣ryed to the other side of the water to be dressed; but the stirring of the boat as they rowed, almost killed me with bitterness of pain, for that the sharp 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 increased, whilest lifted by the hands of divers persons, one while up, another down, sometimes to the left side, other whiles to the right with my whole body, and all the parts there∣of. When at the length I was laid upon a bed, I was somewhat freed from the bitterness of my pain,* 1.112 and had time to wipe off the sweat, which ran down over all my body. Then was I dressed with such a medicine, as the time and place would afford, we composed it of the white of an egge, wheat-flour, soot of a chimny, and melted butter. For the rest, I entreated Richard Hubert, that he would handle me, as if he knew me not, neither that moved for love of me, he should remit

any thing of the severity of art, but chiefly, that he would stretch my foot straight out,* 1.113 and if the wound were not sufficiently wide, that he would inlarge it with his incision-knife, that so he might the more easily set the broken bones in their due place; that he would with his fingers (whose judgement is far more certain than the best made instruments) search, whether the splinters which were in the wound were quite severed from the bone, and therefore to be taken forth; that he would with his hand press forth the blood, and the clods of blood which were in a great quantity concrete at the mouth of the wound; that he would bind up and place my leg in that site and man∣ner as he thought best; which is, that he would have three rowlers in a readiness, the first where∣of he should cast directly upon the wound, so that he should begin his ligation at the wound: also he should put splints about it; some three, but others two fingers breadth, of the length of half a foot, somewhat depressed and hollowed, whereby they might be the more easily put about the leg, more straitly at their ends, and a fingers distance each from other, which at the last he should bind with fillets, like those wherewith women use to binde up their hair; yet so that the binding might be more strait upon the wound; and that he would fill the cavity of the ham, and of the ancles with boulsters made of flax wrapped in linnen clothes: that he would fortifie the sides of my leg with Junks made of bents or little sticks, and lined with linnen cloth, stretched from my heel to my groin, and bound over in four places; so that the straight figure of the leg might scarcely be perverted by any force: that he would gently, and smoothly, lift up my leg to an in∣different

[illustration]

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

height: and lastly, that he should arm it from the violence of external inju∣ries, by putting it in a box or case. But you must note, that the fit placing or laying of the leg is a matter of such moment, that ••f any error be here committed, it will cause no less than lameness: 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 bunching forth. Nei∣ther also do they commit a small error, who do not fill up the cavities at the ancles after the afore-mentioned manner: for, hereupon the heel will be much afflicted, whilest it is forced to sustain a tedious and painfull compression, which at length brings a hot distemper, because the spirits cannot freely flow there∣to; which I finding by experience, not knowing the cause, wished them ever now and then to lift up my heel, whereby it might enjoy the benefit of perspiration, and the spirits have free en∣trance thereinto, and the contained vapours passing forth. To conclude, my hurt leg was laid upon a cushion, after the manner you see here described.

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;* 1.114 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;* 1.115 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.* 1.116 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,* 1.117 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:* 1.118 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.

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

I Being brought home to mine own house in Paris in the afternoon, they took from me, out of the Basilica of the left arm, some six ounces of blood: And then at the second dressing the lips or edges of the wound and places thereabout were anointed with unguentum rosatum,* 1.119 which by a joint consent of the Ancients, is such commended in the beginnings of fractures; for it will asswage pain, and hinder inflammation, by repelling the humours far from the wounded part: for it is cold, astringent and repelling, as the composition thereof shews; for it is made ex oleo omphacino, aquâ rosaceâ, pauco aceto, & cera alba. Therefore I used this ointment for six dayes; I dipped the compresses and rowlers somewhiles in Oxycrate, otherwhiles in thick and astringent red wine, for the strengthening of the part, and repressing the humors, which two things we must have a care of in Hippocrates opinion,* 1.120 in fractures especially with a wound: Wherefore if at any time the compresses or rowlers seemed to dry, I now and then moistened them with the Oxycrate or rose-vinegar: for, by their too much dryness, pain and inflammation happen; and if they binde the part somewhat more strait, they hurt it also by their hardness. You shall see many Surgeons, who in this kind of affect, from the beginning to the end, use only astringent and emplastick medicins, wholly contrary to the method set down by Hippocrates, and commended by Galen: For, by the continued use of such things, the pores and breathing-places of the skin are shut up; whence the fuliginous excrement being supprest, the externall heat is increased, and itching caused, and at length an ulcer by the fretting of the acrid and serous humour long supprest: Whereby you may learn, that astringent and emplastick medicins must not be used above six dayes: Instead 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 dayes I ate nothing each day, but twelve stewed Prunes, and six morsels of bread, and drank a Paris pinte of sugred water, of which water this was the composition.* 1.121 ℞. sacc. albis. ℥ xij. aquae font. lb xij. cinam. ʒ iij. bulliant simul secundum artem: Otherwhiles I used syrup of maidens-hair with boiled water: Otherwhiles, the divine drink (as they term it) whereof this is the composition. ℞. aquae coctae lb vj. sacc. albis. ℥ iv. succ. lim. ℥ j. agitentur & transvasentur saepius in vasis vitreis: I was purged when need required with a bole of Cassia with Rubarb: I used also suppositories of Castle-soap to make me go to stool; for, if at any time I wanted due evacuation, a preternatural heat presently seised upon my kidnies:* 1.122 With this, though exquisite manner of diet, I could not prevail, but that a feaver took me upon the eleventh day of my disease, and a defluxion, which turned into an abscess, long flowing with much matter: I think the occasion hereof was some portion of the humor supprest in the bottom 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 nourish∣ment of the part into putrefaction, and by the putredinous heat thence arising, did plentifully ad∣minister the material and efficient cause to the defluxion and inflammation.* 1.123 I was moved to think they were scales severed from their bone, by the thin and crude sanies flowing from the wound, the much swoln sides of the wound, and the more loose and spongy flesh thereabouts. To these causes, this also did accrew, one night amongst the rest, as I slept, the muscles so contracted themselves by a violent motion, that they drew my whole leg upwards; so that the bones, by the vehemency of the convulsion, were displaced, and pressed the sides of the wound; neither could they be perfectly composed or set, unless by a new extension and impulsion, which was much more painfull to me than the former. My feaver when it had lasted 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,* 1.124 usually happens to fractured members in the time of sleep. I think the cause thereof is, for that the native heat withdraws its self while we sleep, into the center of the body; whereby it cometh to pass, that the extream parts grow cold. In the mean while, nature, by its accustomed providence, sends spirits to the supply of the hurt part: But because they are not received of the part evill affected and unapt thereto, they betake themselves together, and suddenly, according to their wonted celerity, thither from whence they came, the muscles follow their motion; with the muscles, the bones whereinto they are inserted, are together drawn; whereby it comes to pass, that they are again displaced, and with great torment of pain, fall from their former seat. This contraction of the muscles is towards their original.

CHAP. XXVII. Certain documents concerning the parts, whereon the Patient must necessarily rest, whilest he lies in his bed.

THose who have their leg or the like bone broken,* 1.125 because they are hindred by the bitter∣ness of pain, and also wish for their cure or consolidation, are forced to keep them∣selves without stirring, and upon their backs in their beds for a long time together. In the mean space, the parts whereupon they must necessarily lye, as the heel, back, holy-bone, rump, the muscles of the broken thigh or leg, remain stretched forth and unmoveable, set at liberty from their usual functions: Whereby it comes to pass, that all their strength decayes, and growes dull by little and little: Moreover also,* 1.126 by the suppression of the fuliginous and acrid excrements, and want of perspiration, they grow preternaturally hot; whence defluxion, an abscess and ulcer, happen to them, but principally to the holy-bone, the rump, and heel: to the former, for that they are defended with small store of flesh; to the latter, for that it is of more exquisite sense. Now the ulcers of these parts are difficultly healed, yea, and oft-times they cause a gangrene in the flesh, and a rottenness and mortification in the bones thereunder, and for the

[illustration]

The figure of a Casse.

AA. Shews the bottom or belly of the Casse. BB. The wings or sides to be opened and shut at pleasure. C. The end of the wings, whereto the sole or arch is fitted. DD. The Arch. EE. The sole. FF. An open space, whereat the heel hangs forth of the Casse.

most part a con∣tinued feaver, de∣lirium, convulsion and (by that sym∣pathy which ge∣nerally accompa∣nies such affects) a hicketing: For the heel and sto∣mach are two ve∣ry nervous parts, the latter in the whole body ther∣of, and by a large portion of the nerves of the sixt conjugation; but the other by the great tendon pas∣sing under it, the which is produ∣ced by the meet∣ing, and as it were growing together of the three mus∣cles of the calf of the leg. All which are deadly, both by dissipation of the native heat by the feaverish, and that which is preternatural; as also by the infection of the noble parts, whose use the life cannot want, by carrion-like vapours.* 1.127 When as I con∣sidered all these things with my self, and (become more skilfull by the example of others) un∣derstood how dangerous they were, I wished them now and then to lift my heel out of the bed; and taking hold of the rope which hung over my head, I heaved up my self, that so the parts, pres∣sed with continual lying, might transpire, and be ventilated. Moreover also I rested these parts upon a round cushion, being open in the middle, and stuffed with soft feathers, and laid under my

rump and heel, that they might be refreshed by the benefit and gentle breathing of the air: and I did oft-times apply linnen cloathes spred over with unguentum rosatum, for the asswaging of the pain and heat:* 1.128 Besides also, I devised a Casse of Lattin, wherein the broken leg being laid, is kept in its place, far more surely and certainly than by any Junks; and moreover also, it may all be moved to and again at the Patients pleasure. This Cass will also hinder the heel from lying with all its body and weight upon the bed, putting a soft and thick boulster under the calf, in that place where the Cass is hollow: besides also, it arms and defends it against the falling down and weight of the bed clothes, having a little arch made over and above of the same matter: All which shall be made manifest unto you by the precedent figure. Now it remains, that I tell you what reme∣dies I applyed to the abscess which happened upon my wound.* 1.129 When therefore I perceived an abscess to breed, I composed a suppurative medicine of the yolks of eggs, common oyl, turpen∣tine,* 1.130 and a little wheat flower, and I used it until it was opened; then to cleanse it I used this fol∣lowing remedy. ℞. syrupi rosati & terebinth. venetae, an. ℥ ii. pulveris radicis ireos florentiae, aloes, mastiches, farinae hordei, an. ʒ ss. incorporentur omnia simul, & fiat mundificativum: but I had a care that the place whereat I conjectured the quite severed scales of the bones must break forth, should be filled with tents made of sponge or flax, that so, by this means, I might keep the ulcer open at my pleasure:* 1.131 But I put into the bottom of the ulcer catagmatick and cephalick powders, with a little burnt alum, to procure the egress of the formerly mentioned scales: These at length cast forth, I cicatrized the ulcer with burnt alum; For, this having a drying and astringent faculry, con∣firms and hardens the flesh, which is loose and spongy, and flowing with liquid sanies, and helps forward natures endeavour in cicatrization. For, the fragments of the bones, they, by reason of their natural driness and hardness, cannot be joyned and knit together by themselves without a medium: but they need a certain substance, which, thickning and concreting at their ends, doth at length glue them together,* 1.132 and (as it were) fasten them with soder. This substance hath its mat∣ter of the proper substance and marrow of the bones; but the former from the native hear, and emplastick medicines, which moderately heat: For, on the contrary, these medicines, which, by their too much heat, do discuss and attenuate, do (as it were) melt and dissolve the matter of the Callus, and so hinder the knitting: 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 plasters.* 1.133 ℞. olei myrtil. & rosarum omphac. an. lb. ss. rad. altheae lb. ij. rad. fraxini, & fol. ejusdem, rad. consolidae majoris & fol. ejusdem, fol. salicis, an. m. j. fiat decoctio in sufficiente quantitate vini nigri, & aquae fabrorum, ad medietatis consumptionem, adde in colaturâ pul∣veris myrrhae & thuris an. ℥ ss. adipis hirci, lb. ss. terebinth. lotae ℥ iv. mastiches ʒ iij. lithargyri auri & argenti, an. ℥ ij. boli armeniae, & terrae sigillatae, an. ℥. i. ss. minii ʒ. vi. cerae albae quantum sufficit: fiat emplastrum, ut artis est. In stead hereof you may use the black emplaster, whereof this is the de∣scription.* 1.134 ℞. lithargyri auri lb. j. olei & aceti lb ij. coquantur simul lento igne donec nigrum & splen∣dens reddatur emplastrum, & non adhaereat digitis. Or else, ℞. olei rosat. & myrtill. an. ℥. ij. nucum cupressi, boli armen. sanguinis drac. pulverisatorum an. ℥. ss. emplastri diachalcitheos ℥. iv. liquefaciant simul & fiat emplastrum secundum artem.* 1.135 In defect of these, you may use a Cere-cloth, or tela Gual∣teri, whereof this is the description. ℞. pulveris thuris, farinae volatilis, mastiches, boli arm. resinae pini, nucum cupressi, rubiae tinctorum, an. ℥ ij. sevi arietini & cerae albae an lb ss. fiat emplastrum: into which (whilest it is hot) dip a warm linnen cloth, for the forementioned use. Emplastrum Dia∣calcitheos, by the common consent of all the Ancients, is much commended for fractures; but it must undergo different preparations, according to the condition of the time; for in the Summer it must be dissolved in the juice of Plantain and Night-shade, lest it should heat more than is fit. It is convenient, in the interim, to have regard to the temper of the affected bodies; for neither are the bodies of children to be so much dried as these of old men: otherwise if such drying medi∣cines should be applied to young bodies as to old, the matter of the Callus would be dissolved, it would be so far from concreting; wherefore the Surgeon must take great heed in the choice of his medicines;* 1.136 For, oftentimes remedies, good of themselves, are by use made not good, because they are used and applyed without judgment; which is the cause that oft-times pernicious acci∣dents 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 means we may know the Callus is a breeding.

* 1.137THen I knew that my leg begun to knit, when as less matter than was usual came from the ulcer, when the pain slackned, and lastly, when as the convulsive twitchings ceased; which caused me to judge it fit to dress it seldomer than I was used to do: For, by the frequent detersion in dressing an ulcer, whilest a Callus is breeding, the matters whereof it is to be made, are drawn away and spent, which are (as they term them) Ros, Cambium, and Gluten, which are the proper and genuine nourishments both of the bony, as also of the fleshy substance. I by other signs also conjectured the breeding of the Callus, to wit, by the sweating of a certain dewie blood out of the edges and pores of the wound, which gently died and bedewed the boul∣sters and ligatures,* 1.138 proceeding from the efflux of the subtler and gentler portion of that matter, which plenteously flowed down for the breeding of a Callus. As also by a tickling and pleasing

sense of a certain vapour continually creeping, with a moderate and gentle heat, from the upper parts even to the place of the wound: Wherefore thenceforwards I somewhat loosened the liga∣tion, 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 bloud, temperate in quality, and moderate in quan∣tity: Then therefore I thought good, to use nourishments fit to generate more gross, thick,* 1.139 and tenacious bloud, and sufficient for generating a Callus; such as are the extremities, tendinous, and grisly parts of beasts, as the heads, feet, legs, and ears of Hogs, Oxen, Sheep, Kids; all which I boiled with Rice, French Barley, and the like, using somewhiles one, somewhiles another, to please my stomach and palate. I also sometimes fed upon frumity, or wheat sodden in Capon broth with the yolks of eggs; I drank red, thick and astringent wine, indifferently tempered with water. For my second course, I ate chesnuts and medlars: neither do I without some reason, thus particularize my diet; for that gross nourishments, especially if they be friable and fragil, as Beef is, are alike hurtful (for as much as pertains to the generating of a Callus) as light meats are; For that makes the Callus too dry, these too tender.* 1.140 Wherefore Galen pronounces these meats onely fit for generating a Callus, which are neither fragil, nor friable, neither serous and thin, nor too dry; but indifferent gross, and also viscid, fat and tough. These meats, digested by the stomach into chylus, are sent into the guts, and from hence, by the mesaraick veins, into the gate-vein, and the hollow part of the Liver, thence into the hollow vein, and so into the veins dispersed over all the body and parts thereof. There are also some of these veins which carry bloud into the bones; but in the large cavities of the bones is marrow contained, as in the small, a certain mar∣rowy substance, proportionable thereto, being their proper nourishment. The generation of marrow is from the grosser portion of the bloud, which flows into the greater cavities of the bones by larger veins and arteries, but into the less by lesser, which end in their pores and small passages: For, in large bones you may observe large and apparent passages, by which the veins and arteries enter for the forementioned use:* 1.141 By the same ways the nerves also insinuate them∣selves, from whence proceeds a membrane 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 many believe, that the marrow hath sense of feeling, because the membranes thereof being hurt cause most bitter pain: Therefore out of the marrow and the proper substance of the bone, there sweats a certain gross and terrestrial juice, whereof, by the power of the assimilating faculty, which serves in stead of the formative, a Callus grows and knits.* 1.142 Simple fractures of the leg are usually knit in fifty days; but through the occasion of the wound and the scales quite broke off, and other accidents which befel me, it was three whole months before the fragments of the bones were perfectly knit; and it was also another month, before I could go upon my leg with∣out the help of a crutch. Going was painful to me for some few days, because the Callus had ta∣ken up some place of the muscles: for, before my former freedom of motion could return again to the broken and knit part, it was necessary that the tendons and membranes should separate themselves by little and little from the scar. In the performance of all these things, I had the di∣ligent and faithful assistance amongst the Surgeons, to omit Physitians, of Anthony Portal 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 signs of a Callus beginning to concrete, of its generation and the manner thereof: it now remains, that we treat of those things which hinder the ge∣neration thereof; and what on the contrary help forwards the conformation and concre∣tion thereof. Now these things which either wholly hinder,* 1.143 or else retard the generation of a Callus, have a strong and powerful discussive and attenuating faculty: or else they are unctuous, oily, and moist: For by such, the juice, whereof the Callus ought to be, is either melted and con∣sumed, or else grows soft, and is relaxed. But on the contrary, those things which help forwards a Callus, must be drying, incrassating, thickening, hardning, and emplastick, moderately hot and a∣stringent: But for moist and relaxing medicines, they ought to have no place here, unless when it happens that the Callus is ill formed, that is, too thick, or crooked, or otherwise ill shapen, where∣by it may be wasted and broken, so to be restored again after a better manner. Yet notwithstand∣ing, such things are not to be attempted, unless when the Callus is yet green, and so depraved, that the fault thereof doth very much pervert the native conformation of the part, and exceedingly of∣fend 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 boiled the roots of Marsh-mallows, of Briony, the seeds of Line, of Faenugreek, Pigeons dung, Bay-berries, and the like. You shall also use this following ointment and plaster. ℞. Ʋnguenti de Althaeâ ℥. iv. olei liliorum, & axungiae anseris, an. ℥ j. aquae vitae parum, liquefiant fimul, fiat linimentum, quo lineatur pars. Then apply this following empla∣ster. ℞. Emplast. de Vigo cum Mercurio, cerati oesypati, descriptione Phylagrii, an ℥ iij. olei anethini & liliorum, an ℥ j. liquefiant omnia simul, fiat emplastrum; let it be spread upon leather for the afore∣said use. When by this means the Callus shall seem to be sufficiently mollified, it shall be broken, and the bones restored to their natural state, and the cure of the fracture to be followed as at the

beginning.* 1.144 If the Callus be become too hard through age, it is better not to break it, but to let it alone, lest some worse accident befal the Patient: For it may so fall out, that by your labouring to break it, the bone may break 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 eschewing it, to undergo the hazzard of his life. If the Callus be too gross, it shall be diminished (if it be as yet fresh) with e∣mollient, resolving, and powerfully astringent medicines, which have force to dissolve, dry and exhaust. It will also be good strongly to rub the Callus with oyl of Bays, wherein Salt-petre, or some other kind of Salt hath been dissolved; then wrapped about with a rowler to binde it very straitly, putting a leaden plate thereon, whereby the flowing down of the nourishing humour into the part, may be forbidden; that thus by little and little the Callus may decay and diminish. If on the contrary,* 1.145 it any ways happen that the Callus be more thin and slender, and 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 proper function, (which cause is to be reckoned amongst the chief causes of the leanness, even for this reason, for that exercise stirs up the native heat of the part, the wor∣ker of digestion and nutrition) or else for that they feed upon such nourishments as offend in qua∣lity, or quantity, or both; or for that the ligature used to the part, is too often loosed, or because the part it self is too hastily, and before the time put to undergo solid offices and motions. Accor∣ding to the variety of causes,* 1.146 medicines shall be applyed; For if the ligature of the part be too strait, it shall be loosed, yea verily the fractured place, the ligature being taken away, shall be quite freed from ligation, and a new kind of ligature must be made, which must be rowled down from the root of the vessels, that is, from the arm-pits, if the arm; or from the groin, if the leg be broken, to the fracture; yet so, as that you may leave it untouched or taken in, for thus the bloud 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 fear of inflamation, to hinder it from entrance into the affected part: Also gentle frictions and fomentations with warm water may be profitably made,* 1.147 from which you must then desist, when the part shall begin to grow hot and swell. If any too long continue these frictions and fomentations, he shall resolve that which he hath drawn thither: For this we have oftentimes observed, that frictions and fomentations have contrary effects, according to the shortness and continuance of time. Pications will also conduce to this purpose, and other things which customarily are used to members troubled with an atrophia, or want of nourishment.

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

* 1.148DIvers fomentations are used to broken bones for several causes. When we use warm water for a fomentation, we mean that, which is just between hot and cold, that is, which feels lukewarm to the hand of the Physitian and Patient. A fomentation of such water used for some short space doth moderately heat, attenuate, and prepare for resolution, the humour which is in the surface of the body, it draws bloud and an alimentary humour to the part labouring of an atrophia; it asswages pain, 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 contrary, too hot fomenting cools by accident, digesting and discussing the hot humour which was contained in the member. We mean a short time is spent in fomenting, when the part begins to grow red and swell;* 1.149 a just space, when the part is manifestly red and swoln: but we conjecture, that much or too much time is spent thereon, if the redness which formerly appeared, go away, and the tumour which lifted up the part, subside. Also in fomenting, you must have regard to the body whereto it is used: For if it be plethorick, an indifferent fomentation will distend the part with plenty of superfluous humours; but if it be lean and spare, it will make the part more fleshy and succulent. Now it remains, that we say somewhat of the fracture of the bones of the feet.

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

* 1.150THe bones of the instep, back and toes of the feet, may be fractured as the bones of the hands may: Wherefore these shall be 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 be depraved; For as we use our legs to walk, so we use our feet to stand: Besides also the Patient shall keep his bed until they be knit.

The end of the fifteenth Book.

Notes

• * 1.1

  Lib. 6. method.
• * 1.2

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

  What Carye∣don, or Alphiti∣don.
• * 1.4

  What Schidaci∣don.
• * 1.5

  The causes of Fractures.
• * 1.6

  The first sign of a broken bone.
• * 1.7

  Another.
• * 1.8

  A third.
• * 1.9

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

  Why the so∣lution of con∣tinuity in bones is not so easily repaired. Gal. in arte par.
• * 1.11

  Why bones sooner knit in young bodies.
• * 1.12

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

  Fractures at joint dange∣rous.
• * 1.14

  Hipp. sect. 18. & 19. sect. 1. de fracturis.
• * 1.15

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

  Extention must presently be made after the bone is broken.
• * 1.17

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

  In inflamma∣tions, the re∣storing of the bone must not be attempted.
• * 1.19

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

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

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

  Ad sent. 1. sect. 1. de fract.
• * 1.23

  When instru∣ments or engins are necessary.
• * 1.24

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

  Signs of a bone well set.
• * 1.26

  Causes and signs of the relapse 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 Li∣gatures in fractures and dislocations.
• * 1.30

  Four choice means to hin∣der accidents.
• * 1.31

  The causes and differences of itching.
• * 1.32

  Ad. sen. 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 natural fi∣gure.
• * 1.37

  A fit astringent and drying medicin.
• * 1.38

  Sent. 47. sect 2. de art. & Gal. in Com.
• * 1.39

  A description of the lower Jaw. The manner of restoring a bro∣ken Jaw.
• * 1.40

  The description of a fit ligature for the under Jaw.
• * 1.41

  In what time it may be healed.
• * 1.42

  Hipp. sent. 63. sect. 1, de art.
• * 1.43

  How to restore the fractured Clavicle. The first way.
• * 1.44

  The second way.
• * 1.45

  The third way.
• * 1.46

  How to bind up the fractured clavicle.
• * 1.47

  It is a difficult matter perfectly to restore a fra∣ctured clavicle.
• * 1.48

  An anatomical description of the shoulder-blade.
• * 1.49

  How many wayes the shoulder blade may be bro∣ken.
• * 1.50

  The cure.
• * 1.51

  Lib. de vul. capitis. A history.
• * 1.52

  Nature of its own accord makes it self way to cast forth strange bodies and matters.
• * 1.53

  Why a fracture in the joint of the shoulder is deadly.
• * 1.54

  Signs that the sternum is bro∣ken. Signs that it is deprest. The cure.
• * 1.55

  A history.
• * 1.56

  In what place the short ribs may be bro∣ken.
• * 1.57

  Sent. 56. sect. 3. de art.
• * 1.58

  Why an inter∣nal fracture of the ribs is deadly.
• * 1.59

  The signs.
• * 1.60

  The cause of spitting blood when the ribs are broken.
• * 1.61

  Sent. 15. sect. 3. de art. Paulus lib. 6. cap. 96. Avicen. 4. The cure.
• * 1.62

  A simple fra∣cture may be cured only by Surgery.
• * 1.63

  The cause.
• * 1.64

  The signs.
• * 1.65

  The cure.
• * 1.66

  The affect of the Vertebrae.
• * 1.67

  Sect. 2. Proth. The cure of fractured Ver∣tebrae.
• * 1.68

  The cure of the Processes.
• * 1.69

  Signs that only the processes are fractured.
• * 1.70

  What fracture of the holy-bone curable, and what not.
• * 1.71

  The descripti∣on of the rump.
• * 1.72

  The cure.
• * 1.73

  The description of the hip.
• * 1.74

  The signs.
• * 1.75

  The cure.
• * 1.76

  The description of the arm, or shoulder-bone.
• * 1.77

  The cure.
• * 1.78

  How the arm must be placed when the bone is set. Sect. 3. offic. sect. 1. de fract.
• * 1.79

  In what time it will knit.
• * 1.80

  The differences.
• * 1.81

  The cure.
• * 1.82

  Sent. 3. sect. 1. de fract.
• * 1.83

  Com. in lib. de art.
• * 1.84

  Sect. 2. de fract. sent. 9.
• * 1.85

  The cure.
• * 1.86

  To what pur∣pose the car∣rying of a ball in a fractured hand serves.
• * 1.87

  Why the bone of the thigh is more difficultly set.
• * 1.88

  Sent. 67. & 68. sect. 2. de fract.
• * 1.89

  The natural and internal crookedness must be pre∣served in set∣ting the bone.
• * 1.90

  The part to be bound up, must be made plain either by nature or art.
• * 1.91

  The manner of binding used by Surgeons at this day.
• * 1.92

  Why the wind∣ings of the up∣per ligatures must be thicker and straiter than the lower.
• * 1.93

  Why the third ligature must be rowled con∣trary to the two first.
• * 1.94

  The Surgeon must be mind∣full of three things in pla∣cing the mem∣ber.
• * 1.95

  Sect. 2. de fract.
• * 1.96

  Sent. 33. & 56. sect. 2. de fract.
• * 1.97

  When the first ligation must be loosed.
• * 1.98

  Sent. 15. sect. 3. de offic.
• * 1.99

  Rest necessary for the knit∣ting of set bones.
• * 1.100

  A History.
• * 1.101

  Another fra∣cture of the thigh, resem∣bling a luxati∣on.
• * 1.102

  Why the fra∣cture of a bone near a joint is more dange∣rous.
• * 1.103

  Lib. 3. sent. 6. tract. 1. c. 14.
• * 1.104

  In what space the thigh-bone may be knit.
• * 1.105

  The Differen∣ces.
• * 1.106

  Signs.
• * 1.107

  Cure.
• * 1.108

  Why those halt who have had this bone fractured.
• * 1.109

  Sent. 65. sect. 2. de fract.
• * 1.110

  Signs that both the bones are broken.
• * 1.111

  A History.
• * 1.112

  A soon made medicine.
• * 1.113

  What to doe when the leg 〈◊〉〈◊〉 broken.
• * 1.114

  That the liga∣tion must be most strait upon the wound.
• * 1.115

  What symp∣toms ensue the want of bind∣ing upon the wounded part.
• * 1.116

  Signs of the corruption of the bones.
• * 1.117

  When the wounded part must be omit∣ted in liga∣tion.
• * 1.118

  Lattice-like binding to be shunned.
• * 1.119

  Unguentum Ro∣satum, where∣fore good in fractures.
• * 1.120

  You must have a care, that the compresses and rowlers grow not hard by driness.
• * 1.121

  The description of a sugred water.
• * 1.122

  The causes of a feaver and ab∣scess, ensuing upon a fracture.
• * 1.123

  Signs of scales severed from their bones.
• * 1.124

  Why the ex∣tream parts are cold when we sleep.
• * 1.125

  The natural faculties lan∣guish in the parts by idle∣ness, but are strengthened by action.
• * 1.126

  How and what Ulcers happen upon the fra∣cture of the leg, to the rump and heel.
• * 1.127

  Remedies for the prevention of the foresaid Ulcers.
• * 1.128

  The use of a Lattin Casse.
• * 1.129

  A suppurative medicine.
• * 1.130

  A detersive.
• * 1.131

  Catagmatick powders have power to cast forth the scales of bones.
• * 1.132

  The causes both efficient and material of a Callus.
• * 1.133

  Medicines con∣ducing to the generation of a Callus.
• * 1.134

  The black pla∣ster.
• * 1.135

  The Descripti∣on of a Spara∣drapum, or Cere-cloth.
• * 1.136

  Medicins good of themselves, not good by event.
• * 1.137

  When the Cal∣lus is breeding the ulcer must be seldom drest
• * 1.138

  Hipp. sent. 43. sect 1. de fract.
• * 1.139

  Meats fit for generating a Callus.
• * 1.140

  Lib. 6. meth. c. 5.
• * 1.141

  Why the mar∣row may seem to have sense of feeling.
• * 1.142

  In what space the leg is usual∣ly knit.
• * 1.143

  Discussing and unctuous medi∣cines hinder the generation of a Callus. What helps forward the ge∣neration there∣of.
• * 1.144

  What Callus must not be broken, though distort, or o∣therwise ill conformed.
• * 1.145

  The causes of too slender a Callus.
• * 1.146

  Remedies therefore.
• * 1.147

  When we must desist from fo∣menting and frictions.
• * 1.148

  Warm water. The effects thereof.
• * 1.149

  Notes of short, just, and too long foment∣ing. Fomentations hurt plethorick bodies.
• * 1.150

  Why the fra∣ctured bones of the foot must be kept in a strait posture.