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. XXI. Of a FRACTƲRE of the ELBOW.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Ossis Cubiti; and in English, A Fracture of the Elbow, or, of the Elbow-Bone.

II. This Part consists of two Bones; of which, the greater, which lyes lowermost, is called Cubitus, or Ulna: and the lesser, which lyes uppermost, is called Radius. Now sometimes but one of these Bones are broken, and sometimes both.

III. The Prognosticks. A Fra∣cture of these Bones, is more easily cured than a Fracture of the Os Humeri: and if one Bone only is broken, the Cure is easier and sooner to be performed, than if both be broken together.

IV. And if the Radius is only broken, it is easier to be cured, than if the Cubitus is broken; because this latter is the larger Bone, and requires a greater extension: and if this latter is kept whole, whil'st the other is broken, it serves as a Prop, or Stay to the other broken Bone, that it may be kept the better in its place.

V. If both the Bones are broken together, the Cure is performed with some difficulty; 1. Because they have no Prop, or any thing to sustain them. 2. Because they need a greater extension, for that the Nerves and Muscles are very much contracted; and when extended, there is no∣thing to keep them so. 3. Be∣cause the Parts adjacent are also the more hurt.

VI. A Fracture of these Bones is generally consolidated in about 30 days, or little more: but in this case, you must have respect to the constitution or habit of Body, the nature, disposition, and age of the Patient: all which things make the punctual time more difficult to be limited.

VII. The Cure. If the Radius only is broken, there is need of less strength or force to reduce it, than when the Cubitus is broken: if both the Bones are broken, a stronger extension is to be made, but yet equal, than if one only were broken: but if one only of the two Bones is broken, the greatest extension is to be on that part or side, where the Bone is broken.

VIII. For which purpose, a Ser∣vant is to be ordered to grasp the Arm above the Elbow, with both his Hands, and another to lay hold of it above the Wrist; whil'st the Artist reduces the Bones with the palms of both his Hands; and fixes them so well, as no inequality is felt in any part.

IX. The broken Bone being thus reduced, the Dressing and Bandage is to be the same with that in the former Chapter, but the Swaths

which are carried upwards, are to terminate above the Elbow: and if the Sick keeps his Bed, his Arm is to be laid upon a Pillow, and the Elbow is to be laid a little higher than the Hand.

X. But Hippocrates, de Fract. Lib. 1. Text. 22. would not have the Hand lower than the Elbow; lest by that means the Blood should flow towards the Fra∣cture, or a flux of Humors should ensue: and yet it is to be so placed, that the Part may be as much as may be, at ease.

XI. And it is to be placed in that figure, which may not in the least pervert any of the Muscles, hurt the motion of the Member, or breed pain: for which reason, the Arm is neither to be right∣out extended, nor to be wholly bent up, nor to be placed in a supine or prone manner.

XII. The Arm being thus bound up and placed, it will be necessary that the Patient should keep his Bed for ten days.

XIII. And when he leaves his Bed, the fractured Arm is to be hung in a broad or soft Scarf or Napkin; which may equally sus∣tain a good part of the Arm within it, with a part of the Palm of the Hand; so that none of the reduced Bones may be in danger to be removed out of their places.

XIV. And afterwards, every third or fourth day, the Arm is gently to be stretched out; that the Humors which flow thither, and make a kind of stay there, may not cause a concretion in the Bones, or a contraction in the Tendons; nor yet a stiffness in the Arm, not easily afterwards to be remedied.