Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. VI. Of FRACTURES.

I. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Compositio, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, quod est, componere. Synthesis or Uniti∣on is that which teaches how to unite parts disjoined, and it is twofold, 1. What regards the hard and bony parts. 2. What regards the soft and fleshy parts.

II. The Unition of Bones, is either the Setting of Broken Bones; or the Reduction of Bones out of Joint: the first is called a Fracture, the other a Dislocation.

III. A Fracture, is the Solution of Ʋnity in the hard or bony Parts of the Body, caused by some exter∣nal Violence upon the Part. Yet sometimes a Fracture may come without any such external force, as when a Bone is corrupted by the Scurvy, Pox, Gout, or Le∣prosie.

IV. The general Causes, are ei∣ther Falls or Blows, and by whatsoever is able to break, bruise, or cut.

V. The Differences. 1. From the manner, some being transverse, which are properly called Fra∣ctures: others according to the length of the Bone, called Fissures: others Comminutions, when the Bone is broken into small parts.

VI. 2. From the Part, it be∣ing sometimes in the Head, Shoulder, Clavicula, Arm, Cu∣bit, Ribs, Thighs, Legs, &c.

VII. 3. From Accidents, as being sometimes accompanied with a Wound, Dislocation, In∣flammation, Gangrene, &c.

VIII. The Signs. If a Bone be transversly or obliquely broken, it may be known by handling it, wherein you will find an inequa∣lity, the Patient being scarce a∣ble to move the part affected, and sometimes that part is short∣er than the other.

IX. If the Thigh, Leg, or Foot be broken, the Patient cannot stand at all (but he may a lit∣tle, tho' with pain, in a Dis∣location,) and this is the surest difference, between a Fracture and a Luxation.

X. A Fissure is discerned by the thickness, pain, and unevenness of the part, which a skilful Chi∣rurgian is only fit to judge of.

XI. A Comminution or Brui∣sing,

wherein the Bones are shattered, is perceived by the Bones being very unequal, and yielding here and there to the Fingers.

XII. The Prognosticks. A trans∣verse Fracture is more easie to Cure than an Oblique, or when accompanied with apparent in∣equalities.

XIII. A Fracture where but one Bone is broken, is easier to Cure than where there are two, or where the Bones are much shat∣tered.

XIV. A Fracture in the midst of a Bone, is also easier to be Cured, than that which happens to the Head, or lower end of the Bone; so also a single Fracture more easie than a Compound.

XV. If it remains undressed be∣yond the seventh Day, there will be danger of Mortification; so also many times, if the Part is too hard bound.

XVI. In Setting of a broken Bone, there is Extention, Con∣joining, Ligature, and well Placing.

XVII. 1. Extention is an O∣peration performed with pain; which being done aright, must be greater or lesser, according to the time of the Fracture, age of the Patient, and magnitude of the Bone. A new Fracture, tender or young Patient, and a small Bone, require a gentler Extenti∣on; an old Fracture, strong Pati∣ent, and a big Bone, a greater.

XVIII. This Extention is to be so done, that the Muscles do not labour; for then it will be with much less pain: The Part must be so laid, as when in Health, they could longest endure it without tiring: But the exact manner of doing this, is better learnt by Practise than by many Words.

XIX. 2. Conjoining the Bones is the next Operation; in doing of which, be cautious lest the Muscles be wrested from their natural Po∣sition and Figure: It is well done, if the Bone be any thing firm, and all the places about the Fracture be found equal.

XX. 3. Ligature is done with a double Rowler: The first is to be thrice rowled about the Fracture, and then upwards: The second (which must be twice as long) is to be once wound about the Fracture, proceeding down∣wards, and then upwards again, a little higher than the first Rowler; to which you may add convenient splints (of Wood or Past-board) round about the Member.

XXI. Let not the bandage be too streight, lest it cause pain, or en∣danger a Gangrene, by robbing the part of its Nourishment: nor too loose, lest the Bones slip out of their Places: This you will find to be well done, if the Patient soon after he is dressed finds his Pain abated, and on or after the third day, the ligatures seem loose, and the place a little below the binding be a little swelled.

XXII. At the second Dressing, it must be bound somewhat closer, and afterwards changed yet but once every four, five, or six days.

XXIII. 4. Well placing is the last of the prescribed Operations, which ought to be softly, evenly, and a little raised; if you lay it too low, the Bone will bend

outwards; if too high, it will bend inwards: This you will find to be well done, if in the second dressing you find all even.

XXIV. Before you rowl the Li∣gature about the Member, bath the Part with S.V. or with Oil S.V. and Vinegar mixt together: Or lay Oxycroceum, Opodeldoch, Ca∣tagmaticum upon it; or lay a Cataplasm of fine Bole, Wheat, Meal, Whites of Eggs, Bole, Frank∣incense, Dragons-blood, and a little Camphir, which let go round the Part, and about three Inches be∣low the Fracture.

XXV. But at any time you may apply this following, ℞ Mastich, Catechu, a. ʒiij. Oliba∣num, Frankincense, a. ʒij. Aloes, sanguis Draconis, fine Bole, Gum Tragacanth, Lapis Haematitis, Talck calcined, a. ʒj. Whites of Eggs and Oil of Roses, a. q.s. make a Plaster.

XXVI. If there is an Inflam∣mation in the Fracture before Ex∣tention, foment it with an Emol∣lient Oil; or lay the part in warm Cow-dung, which will digest and ease pain.

XXVII. If the Fracture is ac∣companied with a Wound, then ex∣tend the Part first, (but gentler than in a simple Fracture) next join the Bones together; then have respect to the Wound, to unite the Lips thereof with Plasters, rather than with the Needle, and to guard it with a defensa∣tive; lastly, bind up the Part with Rowlers, and lay it conve∣niently, or easily.

XXVIII. If it be a Commi∣nution, or shattering of the Bones, joined with the Wound; those which are small and loose remove with the Forceps: Those which are any ways fixed, leave to Nature, for she will throw them out of her own accord, though somewhat later; and if they be not too much displaced, she will sometimes unite them again (by a Callus) to the whole.

XXIX. But to make the mat∣ter the more easie, you may assist Nature with the following things, ℞ Ashes of Earthworms, Bone-ashes, a. ʒiv. Olibanum ʒij. Myrrh ʒi. Honey ℥ij. mix, and make an Ointment. Or this, ℞ Pouder of Comfrey roots, round Birthwort, a. ℥ss. Olibanum, Ma∣stich, a. ʒiij. Euphorbium ʒijss. Aloes, Myrrh, Catechu, a. ʒjss. Wax, Turpentine, a. q.s. which with a little Oil of Ben, make into an Ointment.

XXX. If the Bone it self be naked, cover it with its own Skin and Muscles, and defend it from the Air as much as is possible.

XXXI. If it be naked and start∣ed out, endeavour to reduce it a∣gain into its place; but if be na∣ked, and too far, take away the piece or pieces thus started out with a proper Saw, or a pair of Nippers.

XXXII. These four Manual Operations being this well perform∣ed, you must now come to act the Part of a Physician, prescribing to the Patient a good Diet, and some proper Purge, according to the Quality of the Humour a∣bounding.

XXXIII. In Fractures of the lower Parts, Purging is not so convenient; but if the Patient is Costive, a Suppository may be exhibited.

XXXIV. But in Fractures of the upper Parts, Purgings and Cly∣sters may be often necessary, ac∣cording to the following Dire∣ctions, and which you are to observe in all other Accidents and Cases, wherein the skilful Artist sees need of Purging.

XXXV. These among Simples are said to Purge Choler, Rhu∣barb, Cassia, yellow Myrobalans, Tamarinds, Manna, Scammony. Among Compounds, Syrup of Suc∣cory with Rhubarb, washed A∣loes, Angelick Pills of Grulingius, Diacatholicon, Hiera Picra, Le∣nitivum, Pilulae de Aloe Rosata, Rudii, Ruffi, &c.

XXXVI. Among singular Compounds we have these; ℞ Lenitive Elect. Cassia extracted a. ʒij. Cremor Tartari ʒj. Spirit of Sulphur gut. x. ad xx. black Cherry-water q.s. mix, and make a Potion.

XXXVII. Or this, ℞ Rhubarb, Sena a. ʒij. Cremor Tartari ʒi. Aniseeds ʒss. Water q.s. mix and Infuse scalding hot for two hours, and at last give it a walm or two; strain out and give it.

XXXVIII. Our Family Pills are inferiour to no other for this purpose; but if the Sick is in great pain, and wants rest, you may give this: ℞ Angelick Pills of Grulingius à gr. xv. ad ℈i. of our Volatil Laudanum gr. ij. iij. or iv. mix for a Dose. Give it over Night, it will give pleasant Rest, and a Stool, two, or three the next day.

XXXIX. A Purging Pouder may be thus made: ℞ Resinous, Scammony a gr. vi. ad x. or xij. Sal Prunellae, Cream of Tartar An∣timony diaphoretick a. gr.xij. Tar∣tar vitriolated gr. vi. mix for a Dose.

XL. These following Purge Flegm and Watery Humours: Roots of Asarum, Mechoacan white and black, Colocynthis, Myrobalans Belliric, Emblic and Chebuls, Agarick, Turbeth. Among Com∣pounds these, Syrup of Diacar∣thamum, Electuary of Hiera with Agarick, Diaphoenicon, Diacar∣thamum, Confectio Hamech, Pilulae Cochiae minoris, ex duo∣bus; our Family Pills, our Pan∣chymagogue Pills, Troches of Agarick, of Alhandal.

XLI. Among singular Com∣pounds we have these: ℞ blew Flower-de-luce Roots, Troches of Agarick, Sena a. ʒi. Aniseeds ℈ij. Mechoacan ʒss. Water, or Parsly-water q.s. Infuse three hours, boil a little, strain, and sweeten with Syrup of Roses solutive, or with Manna ℥i, and then give it for a Dose.

XLII. Or this: ℞ Syrup of Roses solutive ℥i. Pouder of Jallap ℈i. Cream of Tartar ℈ij. Scam∣mony gr. vi. Decoction of Aniseeds q.s. mix, and make a Potion.

XLIII. Or you may give Our Family Pills from ℈i. ad ij. Or this, ℞ Scammony in fine Pouder à gr. x. ad xvi. plus minus; of our Volatil Laudanum à gr. ij. ad iv. or vi. mix, and make Pills: Give it over Night, it will make the Patient easie, and not work, or but rarely, till the next Day.

XLIV. Or thus; ℞ Pilulae ex duobus ʒss. of our Laudanum Vo∣latile gr. ij. ad vi. mix for a Dose. Or, ℞ Scammony gr. viij. Tro∣ches Alhandal gr. ij. ad iv. of

our Laudanum Volatile gr. ij. ad vi. mix, and with the Pap of a reast∣ed Apple make a Dose to be given over-night.

XLV. These among simple Me∣dicaments are said to Purge Me∣lancholy; Sena, Roots of black Hellebor, Indian Myrobalans, Lapis Lazuli. Among Compounds, Syrup of Roses solutive with Sena, Diacatholicon, Confectio Hamech, Pulvis Diasena, Tro∣ches Alhandal.

XLVI. Among singular Com∣pounds we have these. ℞ Sena ʒij. Indian Myrobalans ʒi. Ani∣seeds ℈ij. Liquorice bruised ʒss. Water q.s. Infuse two hours, then boil a little, strain out, and add Syrup of Roses with Sena ʒvi. Tartar vitriolate gr. x. mix for a Potion.

XLVII. Or this, ℞ Syrup of Sena ℥i. Scammony, Jallap, a. gr. x. Cremor Tartari ℈ij. Deco∣ction of Aniseeds ℥iv. mix and make a Potion.

XLVIII. Or you may Purge with our Family Pills à ℈i. ad ij. Or you may give this, ℞ Sena in Pouder ʒi. ad ʒiss. Ginger gr. xij. Sal Gem gr. vi. Laudanum vola∣tile gr. ij. ad vi. mix, and with Honey, or pap of an Apple, make Pills, to be given over Night, which will work kindly the next Day.

XLIX. Or thus; ℞ Sena in Pouder ʒss. Scammony gr. vi. Co∣locynthis gr. iij. Aniseeds, Ginger a. gr. viij. Sal Gem gr. iv. Vola∣til Laudanum gr. ij. ad vi. mix and with Honey make a Dose of Pills, to be given over night, if the Patient be in much Pain.

L. Lastly, this is to be noted, that in all these Prescriptions, the Dose is to be proportioned according to the Age and Strength of the Patient; the Quantities here in these Recipes prescribed, being for Men, and such as are grown to their full Strength.