Nine books of physick and chirurgery written by that great and learned physitian, Dr Sennertus. The first five being his Institutions of the whole body of physick: the other four of fevers and agues: with their differences, signs, and cures.

CHAP III. Of Coaptation of broken bones.

Synthesis, which joynes together seperated parts, is either of bones, * 1.1 or of fleshy and soft parts, setting together bones is either a fitting those that are broken, or a restoring those which were out of joynt.

The putting together of broken bones, is performed by two operations, * 1.2 whereof the one is called Catastasis, Antitasis, or extension; the other is called Diorthosis conformation, or tis called reposition of the bones, into their owne places; extension is either equall, or unequall, equall is that wherein the member is equally extended from either side of the broken bone, but that is said to be une∣quall, when the member is more extended on one side; that side ought to be more extended, wherein the broken bone is contained but no man can rightly performe those operations, * 1.3 unlesse he knoweth the nature, and differences of bones and fractures, for when a muscle is drawn back to its head, and so carries with it that part of the member which is joyned to it, first there is need of extending, which the Greekes call Antitasis, which ought to be done, as neere as may be, with little or no paine, and that is performed by one worke, or more, and that either with the hands only, or raynes as it

were swathings, or instruments, according as the bone is more or lesse broken.

Diorthosis, or conformation, * 1.4 is a restitution of a broken bone into its place, and a right fitting of the extremities of the broken bone, which is performed if after the member be so much extended, that in putting it back the bones cannot touch one another, the Chyrurgeon is to take hold of the member on both sides, with both his hands, and that which is slid into the right part he should thrust into the left, and the contrary, and what ever hangs out of the bones, he should put back into their owne cavities, untill the extremities of the bone are rightly united, and thrust back, into their places, and the member hath recovered its naturall figure. * 1.5

But if the extremities of the broken bones, breake through the skin, that they hang out, some convenient instrument of Iron, like a barr, is to be used, to force the broken bones into their place, but if any particle of a bone so hang out, that it cannot easily be put into its place, it is to be cut off with a sharp paire of cissars, or to be filed off with a file, that it may be shorter, neither let it any more hinder the reposition: in such a fracture which is joyned with a wound, if any thing stick betwixt the broken bones, which may impede their glutina∣tion, whither particles of a bone, or any thing whatsoever, it is to be taken away without violence; when the bones are rightly placed, the extension is to be remitted by degrees, and with convenient binding and placing of the member, and so to be performed, that the bones united and rightly framed may remaine so.

Yet before swathing-bands are put about a broken mem∣ber some medicines used to be applyed, to hinder the Flux of humours and inflamation, and to farther the generation of brawny flesh, of which, read the Institutions.

The deligation is to be performed, * 1.6 neither too straight nor too loose, with two swathing-bands, whereof the first is to begin above the fracture, and to be bound about it, twice or thrice upwards; the other, being longer by halfe, is to be rolled about the contrary way, and is to be put on first upon the fracture, and beginning from thence to be rolled about something downeward and againe is to be carried above the fracture, and lastly towards

the superior sound part, but in fractures of great bones, that the deligation may be the more stable, and the bones firme∣ly put into their places, may remaine so, Bolsters or crosse folded cloathes, and splentors, and Plates, are also to be used, moreover the member is rightly to be placed, gently, equal∣ly, and inclining upwards, so that the part may obtaine its naturall position, to which purpose, both a hollow Pipe, and Cane, or Plate, or such like, are sometimes to be applyed, the deligation being well performed, is to be loosned the third day, the fracture to be cleansed, and bound up againe, and this is to be continued untill hard flesh be grown, and the fracture healed, but if a fracture be joyned with a wound, after the extension is abated, and there is convenient con∣formation of the broken bones, the lips of the wound are to be drawne together, and being drawn, to be kept together, yet so that the swath-bands be not too straight bound, which ought to be flacker, and to be extended on both sides, be∣yond the lips of the wound, least paine should be stirred up, but in the following deligations, a hole, or vent, may be cut above the wound, both through the Plaisters, and swa∣thing bands, that it may be perfectly cured.

Notes

• * 1.1

  Setting how many∣fold.
• * 1.2

  Of broken bones.
• * 1.3

  Extension.
• * 1.4

  Strength∣ning.
• * 1.5

  The cure of a fracture with a wound.
• * 1.6

  Manner of swathing or deliga¦tion.