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. I. Of FRACTURES in General.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Fractura; we in English call, A Fracture, which is the Solution of Unity in a Bone.

II. The Kinds. There are said to be Seven several Sorts of Fra∣ctures in a Bone, viz. 1. Fra∣ctura Transversalis. 2. In Mo∣dum Causis. 3. In Modum Ra∣phani. 4. In Modum Fissurae. 5. In Modum Assularum, vel Schidiorum. 6. Os Contritum. 7. Os Contusum.

III. 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Fractura Trans∣versalis, is when the Bone is broken in the midst obliquely overthwart, but not smoothly.

IV. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Fractura ossis per transversum facta in modum Caulis, when it is bro∣ken overthwart into long points like strings, as in the breaking of a Colwort-stalk.

V. 3. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Fractura Raphani modo facta, Aegineta, lib. 5. cap. 89. when the Bone is smoothly-broken short off, as in the breaking of a Radish-root.

VI. 4. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Fissura, Fractura in modum Fis∣surae, when the Bone is broken long-ways, but not separated.

VII. 5. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Scidia, As∣sulae, Fractura Ossis 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in modum Assutarum vel Schidio∣rum, when the Bone is broken into Splinters.

VIII. 6. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Contritum; when the Bone is broken in small bits, as if it were ground.

IX. 7. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and by Hippocrates 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Con∣tusus totius ossis, Fractura totius ossis in modum contusum, secundum ipsius crassitiem, juxta ipsum Ar∣ticulum. Galen, Meth. Med. lib. 6. when the Bone is bruised or

crushed, and that near to the Joint.

X. The Causes. They are ei∣ther External or Internal; the External Causes are either Con∣tusion or Flexure, wherein some external force, assaying to bow or bend them, they not being flexible, are broken.

XI. And indeed whatever thing may prick, cut, bruise, break, shatter, or bend a Bone, may con∣tribute to its breaking; among which things, falling from an high place may be accounted for one.

XII. The Internal Causes, are either from the Natural Constitu∣tion of the Bones; or from some Accidental Rottenness: From the Natural Constitution of the Bones, it is, when their Sub∣stance is so brittle, that it can∣not endure the least Violence.

XIII. From Accidental Rot∣tenness, it is when they are made weak, or dry, or porous, by reason of the Poyson and Virulency of the French Pox, an Exalted Scurvey, or an Inveterate Elephantiasis. We have several Memorable Hi∣stories of Rottenness of the Bones, and Fractures occasion∣ed thereby: Memorable is that of Marcellus Donatus in Historia Medic. Mirabilis, lib. 4. cap. 5. of Bones in the Right and Left Arm, which broke of their own accord, from a Rottenness caused by the French Pox.

XIV. And Schenkius in lib. 5. Obs. 8. has two parallel Histories from the Observations of Came∣rarius, of Bones which broke of their own accord, from their supposed Natural brittleness, Fabricius Hildanus, Cent. 2. Obs. 66. gives another Admirable Relation of a Man troubled with the Gout, who had the Bone of his Right Arm broken, only by endeavouring to pull on a Glove, which being reduced, in a little time after it broke again of its own accord in another place; all which, says he, was from a wonderful unwonted frailty and brittleness of the Bones, for that he altogether denied, that he had been at any time trou∣bled with any affect of the Bones; Contracted either from the foul Disease, or proceeding from any other Cause.

XV. The same Hildanus, in Cent. 2. Obs. 68. has another Famous Observation of this kind, of a Woman, the Bone of whose Arm broke of its own accord, and was Cured; after∣wards the Bone of her Right Leg broke, only by endeavour∣ing to put on her Hose, which was also Cured: This poor Wo∣man had several other Fractures of like kind, which made her lye by it in Misery for about two Years, and then she died: These, says he, were not caused either by the French Pox, or from any other Disease, she having not been at any time affected with the one or the other, nor ever in all her Life-time troubled with any such Sickness: but the true Cause was from some oc∣cult and secret Poyson, pro∣ceeding from some extraordina∣ry Corruption of the Humors, which up and down, every where, passing thro' the whole Substance of the Bones, corrup∣ted

or rotted them in this won∣derful and unexpressible man∣ner.

XVI. The Signs. A trans∣verse Fracture, or that which is made in an oblique manner, is ea∣sily known, because by the very touch, the Extremities of the sra∣ctured Bone are soon discovered; for in the place of the Fracture there is a Cavity or Hollowness found, which is not natural; and withal, the Body, but espe∣cially the fractured Member, cannot be moved after the due or wonted manner.

XVII. And there is likewise before the Bones are set, or reduced into their right places again, a most extream and intolerable pain; for that the Extremities of the broken Bones prick, or press upon the Parts which they touch, being very full of Sense and Feelling.

XVIII. Now that these things may be the better discerned, the Member that is fractured ought to be compared with that which is found; as Arm with Arm, Leg with Leg, &c.

XIX. It also oftentimes hap∣pens, that when a Member is fra∣ctured, it is made shorter than it should be, for that the Muscles draw up the inferior part of the Bone that is broken.

XX. And for the most part a Fracture may be known from the preceding External Violence done to the Part, those Violent Causes having a sufficient power to break the Bone.

XXI. The Fractures made long∣ways in the Bone, are known with more difficulty; but they may be discerned, from the pain of the Part, its inequality, and the preternatural thickness of the Member.

XXII. Those Fractures which break the Bones into Splinters, are known many times by an Apo∣stemation; for that when all their smaller parts and little pieces could not be reduced, or set in their proper places, the Flesh Corrupts and Aposte∣mates, whereupon the Splinters become naked of Flesh, and so in process of time drop forth.

XXIII. And this will be known by sight, by the blackness of the Bone, if it lies open to view, or else by the stirring and moving up and down of the Splinters, where they adhere not, or stick not fast to the main Bone.

XXIV. The Differences. They are taken, 1. A Figura, from their Figure, which is either right, according to the longi∣tude of the Bone; or, trans∣verse, which is cross the thick∣ness of the Bone, and that ei∣ther directly or obliquely.

XXV. 2. Ab ossibus ipsis, from the Bones themselves, whether it be in the Head, Neck, Shoul∣der, Arm, Hand, Thigh, Leg, Foot, &c. which are also ei∣ther greater or lesser.

XXVI. 3. Ab Accidentibus, from their Accidents or Symptoms, being either without, or with a Wound, Pain, Inflammation, Apostemation, Ulcer, proud Flesh, Gangrene, Mortificati∣on, &c.

XXVII. The Prognosticks. A Fracture of the Bones made ac∣cording to the length of them, is

more easily Cured than that which is made transverse, whether right or oblique; because there is no such need of any laborious Re∣position, it being enough that they be brought close together again.

XXVIII. And among the trans∣verse Fractures, the right are of easier Cure than the oblique; and among the oblique, that is ea∣sier to be Cured, and has least danger in it, which is single, or simple, and equal, and in which the broken Bones are not mo∣ved at all out of their places.

XXIX. There is but little dan∣ger in those Fractures, where the heads of the Bones are retuse and blunt; but if they are sharp∣pointed they are the worst, and most dangerous of any; because you cannot easily set them close, there being not any blunt part to rest upon: Besides, as Celsus lib. 5. cap. 7. says, they also hurt and wound the Flesh, Muscles, or Nerves.

XXX. A Fracture wherein the Bone is shattered into many frag∣ments, is of very difficult Cure; and the more the fragments or small pieces are, so much the more diffi∣cult the Cure: So also when there are sharp points of Bones stick∣ing out, which prick and wound the Parts near them.

XXXI. When two Bones are joined together, as the Ulna and Radius in the Arm, the Tibia and Fibula, viz. the Focile Majus and Focile Minus in the Leg, and they are both broken, the Cure will be more difficult, than if one of those only were broken: For if one of those Bones remain whole, as the Muscles cannot so easily contract themselves, being kept out by the unbroken Bone; so the broken Bone being once set again, the whole Bone is as a prop or stay to that which is fractured, and a greater help to it than either Swaths or Splin∣ters, or both together; whereas if both be broken, they will be much more troublesom and dif∣ficult to set; and being set, more troublesom to be kept in their places.

XXXII. Galen, de Fract. lib. 3. Text. 37. says, That in a Fracture of some of the more emi∣nent Bones, if the Cure is delayed beyond the seventh day, there will be danger of a deadness of the Bones, or of Apostemation.

XXXIII. Hippocrates, de Fract. lib. 3. Text. 44. says, When the Bones are so broken, that they can∣not possibly be restored again, they will Apostemate in a short time, and fall forth; so also if they are naked, or bare of Flesh.

XXXIV. The thinner the Bones are, the sooner they Apostemate, and are separated, it may be, in less than fourteen days time; but the greater and more solid Bones are longer before they Apostemate and separate; because it is a lon∣ger time before they can be wi∣thered, and driven forth by the Flesh growing underneath, sel∣dom before the fortieth day at soonest; sometimes the Aposte∣mation and coming forth, is not before the sixtieth day; and sometimes it is the space of se∣veral Months before that Work is accomplished.

XXXV. A Fracture with In∣flammation

and Contusion of the Flesh, is dangerous, for that it cannot be perfectly Cured, till the Symptoms are wholly re∣moved.

XXXVI. So much the greater the Fracture is, and by how much the greater the fractured Bones are, so much the more difficult and slow will the Cure be.

XXXVII. If the Fracture is recent, it will be easie to be conso∣lidated: But if it has been any con∣siderable time delayed, the Cure will be made the more difficult and tedious; 1. Because there will then be an Inflammation, and then the Part cannot be extend∣ed without danger. 2. The Extremities of the Bones be∣come harder, so that they can hardly ever be brought to join again, more especially in Aged Persons; but in such as are yet growing, the Case is different.

XXXVIII. If the Bones are so broken and shattered, that they cannot be reduced as they ought, a perfect restoration cannot be pro∣mised: For though the Bones may possibly grow together a∣gain, yet the Member may be much shorter than before, and so unfit for performance of its former Function or Duty.

XXXIX. The Age, Temper, Habit of Body, Course of Living, the Country, Season of the Year, and State of the Heavens, and Air, and whatever else has a power of altering or dispasing of the Natural Strength, so as to increase or diminish it, do all help to make the Cure more or less ea∣sie to be performed.

XL. A Fracture in the middle of a Bone, is lighter and less dan∣gerous, than that which is nearer to the head of the Bone, whether it he in the higher or lower Part: For near to the upper head there are very many Nerves; and near unto the lower head there are many Tendons, which being hurt, excite the greater Pains, whereby the Cure is made the more difficult and long.

XLI. If the Fracture is very near to the Joint, it is then the most dangerous of any; for that there are in that place both Nerves and Tendons, as also Ligaments: Besides, there the fractured Bone cannot be so well bound up; and withal, the heat of the place is small, and very weak, because it is in a manner bloodless. And tho' it may be consolidated, yet it leaves be∣hind it a defect in the motion of that Member or Joint, be∣cause of the Callus, which con∣stricts as it were the Muscles and Tendons.

XLII. If a Wound and Contu∣sion are conjoined with the Fracture, it is then very dangerous; and so much the more perilous, by how much the Wound and Contusion are the greater; more especially if any of the greater Muscles of the Thigh and Shoulder should be wounded; for then vehement Pain and Inflammation may easi∣ly happen, and afterwards a Gangrene and Sphacelus: Be∣sides, Splinters, and other Ne∣cessaries for keeping the Bones in their places after reduction, cannot so conveniently be appli∣ed, for that a hole is to be left open for the better Curing of the Wound.

XLIII. As for the time of a Fractures consolidation, it is not easily to be presaged, by reason of the differing Ages, habits of Body, Seasons of the Year, and other Circumstances: Youth of a good habit, and observing a good Diet and Order of Living, and in a good Air, are much sooner and easier Cured, than those who are aged, weak, infirm, cacochymick, and keep a disor∣derly Course of Living.

XLIV. Lastly, As to the time more particularly, Fractures of the Nose, of the Jaw-bones, of the Clavicle, of the Brest, of the Shoulder-blades, the Ribs, Spines of the Back-bone, the Hand, An∣kle, Heel, and Sole of the Foot, are conglutinated in 20 or 25 days; those of the Arms and Legs in 35 or 40 days.

XLV. The Cure. You ought to have in a readiness every Ne∣cessary, as a Plaster of Empl. Album, or Diapalma, something broader than will cover the Fra∣cture, and long enough to encom∣pass the Member; two Cloths thrice double of the same length, three, four, five, or six Ferulae, or Splints, cloathed with Tow, a large Cloth to put over them, four or five pieces of broad Tape to bind with, a Junk of Straw to lay the Member in, Bolsters of Cloth and Tow to put in the hollow places that the Part may lye smooth and level; lastly, proper Instruments of Extensi∣on, &c. of which we shall speak more particularly in the next Chapter.

XLVI. Then put the Patient into a fit posture to extend the Member, causing one to take the end thereof in both his Hands, ex∣tending it, hot hastily, but by de∣grees, whilst others hold the Sick that he moves not; then let the Artist grasp the Fracture with both his Hands, that as the other extends the Member, he with his Fingers may reduce all the broken Bones to their just places, as in particular Fractures, we shall in the following Chapters Discourse more at large.

XLVII. This done, lay on the Emplaster, (two Men holding the Part steady) then put on the two folded Cloths, the one a little above, the other a little below the Fracture, so that their edges may meet.

XLVIII. Then lay on the Splints or Ferulae, the breadth of a Splint distant one from another, which with the Tapes tye on, not too hard, for fear of a Gangrene; nor yet too slack, lest the Eones fall asunder again.

XLIX. Then Cover all with a large Cloth to keep the Part warm, (because a temperate heat con̄tri∣butes to consolidation) and lastly, put the Member into the Junk made of Straw, or Boards, bind∣ing it fast on; and putting the Bolsters in the hollow places, lay the Member on a Pillow, as straight and as level as may be.

L. Thus let the Sick rest in his Bed for seven or eight days, unless Pain, or other Accidents or Causes force you to open it; then open it to refresh it, and bind it up a∣gain for seven days more, at the end of which you may renew your Emplaster, or apply Catag∣maticum, or Sticticum Paracelsi.

LI. I know many Chirurgeons, even at the very first, do oftentimes apply Empl. Oxycroceum to the Fracture; or if not at first, yet they scarcely ever fail to make use of it within a very few days after the Fracture is made.

LII. But the application of this, or of any other hot, or drawing Emplaster, cannot be done without much danger; as Fabricius Hil∣dan•…•…s shews us by an Example: for that this Emplaster heats the Part affected, and so attracts the Blood and Humors; producing either a gentle Itching, or a Pain, with Inflammation, and Gangrene, especially in Chole∣rick and Cacochymick Habits of Body.

LIII. With a Lenitive Electuary; or Our Syrupus Catharticus, keep the Body soluble; and now and then help him to raise up his Back, to refresh it, lest it excoriate: and to remove his Hips, lest they, or the Leg and Thigh, should grow numbed or dead.

LIV. If the Fracture is with a Wound, so order the Cloaths and Splints, that you may dress the Wound, and not undress the Part: and be fure you apply no un∣ctuous, fat, or greasy thing near the Bone; lest you thereby foul and corrupt it: but dress it with dry Pouders, and other proper things, as we in their respective Places teach.

LV. And for the first Weeks time, give the Patient three or four times a day, Osteocolla-stone in pouder, in Syrup of Comfrey; and sometimes (tho' but now and then, to refresh him) in a little Alicant-Wine; or give Tinctura mirabilis, in Syrup of Angelica or All-heal; or Pouder of Catechu, or Balsam of Sal-Gem, or two spoonfuls of the juice of Knot∣grass, or Bistort, or of Solomons-seal, or of Comfrey, in Rhemsh-Wine mixed with Syrup of Comfrey; or in Canary, or Tent, or old Malaga, or Alicant, every Morning.