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. II. Of INSTRƲMENTS for REDƲCTION.

I. THERE are several In∣struments which are used in the Cure of Fractures and Dis∣location, which are scarcely used in any other part of Chirurgery: and seeing that what are generally useful in Dislocations, are also useful in Fractures, and that they must be treated of somewhere, we thought good to treat of them here; since it is necessary that they should be known and understood, before any Cures of this kind are attempted, or undertaken.

II. The chief Instruments for these purposes, are such as have a power to extend the Parts, or otherwise to make way, so as the Bones may be reduced, and put

into their natural right places again: and they are in number Six, viz. 1. The Trepan, Modio∣lus, or Vectis. 2. Hippocrates his Ambi. 3. The Glossocomon of Galen. 4. The Reductive Lad∣der. 5. The Pulley of Vitruvius. 6. Hippocrates his Table, or Scamnum.

I. Of the Trepan, or Modiolus.

III. This Instrument is called Abaptistum, Modiolus, Vectis, or Trepanum; and is used chiefly in profound Corruptions, Con∣tusions, Cuts, and Fractures of the Bone.

IV. But it is not to be applied, but 1. When the splinters, or points and prominences of the Bones prick. 2. When the up∣per Table is entire, but depres∣sed, and the lower broken. 3. When the Extravasated Blood is either so much in quantity, or so corrupted, as to endanger a Suffocation of the Animal Spirits.

V. The manner of Piercing or Boring therewith, is thus: the Hair is to be shaven off from the Head, then the Skin is to be cut to the Pericranium; avoiding as carefully as may be, the Sutures, and the Muscles of the Temples.

VI. And now the Wound is to be bound up, unless the Hemorrhage is so small, that the Pericranium, or Membrane of the Scull may at the same time be taken off also.

VII. Then in a few Hours after, you may stop the Ears of the Pa∣tient, and take that Instrument which is the Mastuline Modiolus, or Male Trepan; whose point is to be fixed in the Scull, but so far off the Fracture, that it touch it not with its teeth, much less the Suture: (tho' some never avoid the Sutures, and affirm, that they have perforated them as happily, as any other Part.)

VIII. Then holding the Instru∣ment fast with the left Hand turn it round with the right, 'till you have cut round a pretty deep Circle.

IX. After which, take the feminine Modiolus, or female Trepan (which has no point in the middle) and turn this round, as before: in the mean time, you must take away the dust or small particles, which proceed from the perfo∣ration or sawing; and moisten the Instrument with Oil and Water, to make it cool, and slippery.

X. In a little time, Blood will appear; which shews you, that you are gone as far as the second Table; to wit, beyond the Scull to the Meninx, or Dura Mater; and then you must press with your Instrument very gently, lest you should unadvisedly hurt the Membrane of the Brain.

XI. When the Bone begins to be a little loose, you must put something in between the sides of the Wound; to loosen it the more, and then take it out with a pair of Pincers, or Forceps. See Lib. 1. Cap. 3. Sect. 2. and Tab. I. Lett. AB, CD, EF, GH, I, M. The Male Trepan EF: the Female GH: the Point of the Male I, the Head of the Trepan AB.

II. Hippocrates his Ambi.

XII. This Instrument, called Am∣bi, Ambeen, or Glossocomon of Hippocrates, is designed to re∣store a Shoulder luxated into the Armpit, or place of the Jun∣cture.

XIII. It has first an upright Pillar of Wood A, fastned upon a Foot B, which Foot is fastned with Screw-pins CC: that it may not stir or move in the Ope∣ration. Secondly, there is fast∣ned a Spatha D, with an Iron Pin E, into the upright Pillar, which may be turned, lifted up, or pressed down at pleasure.

XIV. To this Spatha are added three strings FFF, for the binding of the Arm, that it might be kept steady: the Spatha must be four or five Fingers broad, and two Fingers or Inches thick, and about 30 Inches in length, or more.

XV. The end thereof G, must be round and narrow in that part, but very high, with Ears or Stops, to hold and keep in the top of the Shoulder; and the upper part of the roundness must a little stick out, not to touch the Side, but the top of the Arm. See Tab. XI. Fig. I.

XVI. The Ʋse of the Ambi. Let the Sick sit upon a Seat somewhat lower than the Frame; that so the Spatha which is thrust into the Armpit may be the more forcibly deprest on its longer part, so to force in the head of the Shoulder-bone.

XVII. The Arm must be bound to the Spatha at length, with its strings; 1. Just below the top of the Shoulder. 2. Next above the Elbow. 3. And lastly, upon the Wrist.

XVIII. This done, fix the Spa∣tha to the Pillar A, with the Iron Pin E; then the Artist on the outside shall pull the Arm downwards, whil'st a Servant on the other side taking hold of the Neck and Shoulders, shall likewise pull down the Patient. See Tab. XI. Fig. II.

III. The Glossocomon, or Com∣mander, of Galen.

XIX. This Instrument is for Fractures of the Thighs and Legs: it has on the lower part the Axis A, to which must be tied the ends of the Strings or Cords which extend divers ways: let the Strings be fastned upon the uppermost part of the Bone to be cured, and make them so, of two Bands, B and C, that both of them may have four ends; two on the right F, and as many on the left side G.

XX. From these ends, those things which are belonging to the lower String B, must be drawn to the Axel-tree, by the Holes made in the lower part of the Glossoco∣mon D.

XXI. And those things which belong to the uppermost String, must first proceed to the upper parts; then must they also be p••t through the perforated sides of the Instrument (fitted with Rundles or Pullies) whereby they are fastned to the Holes of the Screw F.

XXII. But on both sides, on the outsides of the Glossocomon

F and G, the ends of the upper Cord, C must be carried to the Axis: this done, one turning •…•…out of the Axis, both Strings ••or Cords will equally extend; that downwards, which is bound to the lower part of the broken part of the broken Bone; the other upwards.

XXIII. The Axis extends the String or Cord B, in the lower part, by a direct motion: but it extends the String or Cord C in the upper part, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, by a Regressive motion. See Tab. XI. Fig. III.

IV. The Reductive Ladder.

XXIV. This Instrument is a Ladder, whose uppermost Rundle has a round body upon it E; which is to lye under the Armpit, between the Side and the top of the Shoulder.

XXV. After this, the Artist draws downwards the Arm out of Joint, but not bound to the Spatha; another laying hold of his Neck, and top of his Shoulder, draws likewise on the side; a third laying hold of the whole Body, draws downwards also.

XXVI. It may have four Pul∣lies, (if the Artist so please) FFFF; intimating the Glosso∣comon or Commander of Galen.

XXVII. It may serve also for reducing the Thigh-bone out of Joint, or extending the Thigh, or Leg Bones, if fractured; or for reducing the Hip when disloca∣ted; whether it slip inward, forward, or out•…•…rd.

XXVIII. The Ladder is to be fixed either to some Stay, or Beam of the House, or in the Ground; whereupon the Patient is to sit, with his sound Leg extended, and bound about with the best conve∣nience: but to the Leg out of Joint, or fractured G, there is to be hanged a heavy Weight, or a Vessel full of Water. See Galen his Comment upon Hip∣pocrates de Articulis, lib. 4. text. 4.

V. The Pulley of Vitruvius.

XXIX. It is made like a Pul∣ley, viz. DD, within which there lye three wheels, thro' whose fur∣rows, or hollows, the Rope runs, which is to be drawn by the Cord H.

XXX. At the ends of the Pul∣ley are fastned Hooks, the one of which is to fasten the Pulley to a Post; the other is to draw the Part, being fastned to it by •• Ligature.

XXXI. AA, are the Covers: or Heads of the Cases BB, the Boxes or Cases in which the Pulley is put or inclosed; C, a Screw-pin, made so, that it may screw into a Post; having a hole somewhat less than the Screw, first bored by a Gimblet, whereby it may be let in.

XXXII. This Engin or Pulley, drawn with a small Cord, is taken out of Vitruvius, lib. 10. cap. 4. and is of singular good use in the Extension of Members or Joints, whether it be Fracture or Dislo∣cation.

XXXIII. The Member or Joint being by this or some of the former means extended, the Bone is with the Hands and Fingers to be rightly conformed, or reduced into

its true place: and that it may remain so, after the application of proper Topicks, (as we shall hereafter teach) it is then to be well bound up, and well placed. See Tab. X. Fig. I. and II.

VI. Scamnum, or the Table of Hippocrates.

XXXIV. The Table A may be seven feet long, and three feet wide; and the thickness Ae which turns up, will be nine inches: it has also four other Boards, which are round on the upper parts, viz. B, B, which are two at each end, and are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 by Hippo∣crates.

XXXV. These 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Hold∣fasts, are perforated with a round Hole in their breadth; thro' which the Axie-trees CC, CC pass, which at the ends DD, DD have Handles, to turn them about.

XXXVI. The whole Table from end to end, has hollow places EEE, &c. which are four inches distant one from another; whose breadth and depth are equally three inches; in which a round piece of Wood F is set: and these Holes which go not quite through, Hippocrates calls 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i.e. Fossar, Holes or Prenches.

XXXVII. This Table or Plank, besines the four 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, bar two other Posts or Boards GG in the middle, through which Holes are made, and through which is put the cross-piece of Timber H, which may serve to reduce the Spina-Dorsi.

XXXVIII. The Table is move∣able, and may be lifted up, and removed from place to place: it slands upon six feet, which in my opinion would be more useful; if they were so made as to run upon six small Box Run∣dles, or little Wheels, put upon or fastned into the feet, with Iron Axle-trees: to which Wheels Remora's may be fitted, to keep them fixed or unmoveable.

XXXIX. The Ʋse of the Table, exemplified in the reduction of the Ancle-bone dislocated. The Anele-bone, whether dislocated inwardly or outwardly, is thus to be reduced. Lay the Patient upon the Table on his Back, the Leg offended being stretched out.

XL. Ʋpon the Leg (just under the Knee) bind about the Cord or Swath A, AA, after the manner it is bound on the Top-must of a Ship; and extend it equally, and bring the ends of it to the Axle-tree at the end of the Table, which is above the Head.

XLI. But on the Ancle he must tye the Cord or Swath B, B, and bind the ends of it to the nether Axle-tree: and then either draw the Part divers ways; or hold it so, ex∣tending from the lower part.

XLII. And the Strings being drawn as much as needs, redute the Bone into its place conveniently, when it started forth to the inward or outward part; but when it is gone to the hinder part, you must make a forcible extension, to make the reduction; without which, it will not be easily done.

LXIII. And in a fracture of the Shin-bone, or Minor Fossile, or both Bones at once, where the Leg cannot be extended enough by

the Hands, the Patient is then to placed upon this Table; and the Ligature A being put about the Leg below the Knee; and the Sandal or Swath B, being bound above the Ancle, let the Leg be extended by the Bands drawn divers Ways; then with your Hands reduce the fractured Bones.

XLIV. The Ʋse of the Table in the extension of the Spina Dorsi, dislocated towards the external part. This may be done, if the middle Posts G G be removed with the Priapiscas F, and into the Hole of the right Post A, some hollowed fit piece of Wood B, is put in; bored through with a hole at D, to keep it in with a Pin.

XLV. Then the Patient being laid on the Table, with his Face downwards; two Cords are to be put about his middle, the one about E, the other below F, the bunch on the back being between; and the ends of those Cords must be fastned each of them to their proper Axletrees, which being turned about, may duly extend the Back-Bone.

XLVI. And the hollowed Post A, must have at least three holes, that it may so fitly receive the Cross-bar or Spatha, C, as to be conform'd to the greatness, or height of the banch on the Back.

XLVII. This done, the Spatha, or Cross-bar must be laid over, just upon the bunch, which (at the ve∣ry moment of time when the Exten∣sion is made) is then to be pressed down with a convenient violence, that the dillocated Bone may be forced into its own place. See Tab. X. Fig. III. IV. V.