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 ...

III. Of Binding up the fractu∣red Part.

XXV. But before we can come to the very action of Binding up the Part, we must be provided with, and have ready to apply, good and proper Medicaments, to ••prevent the afflux of Humors, and In∣flammation, and to help for∣ward the generating of the Cal∣lus.

XXVI. Hippocrates used the Ceratum Rosatum: Celsus dipt Cloths in Oil and Wine, or Juice of Pomgranates: Others use both these: Some use fine Tow, wrung out of Al••cant, or other rough red Wine: Others use fine Tow, throughly moistned in Glair of Eggs, and then a little squeezed.

XXVII. Others make a Cata∣plasm of equal quantities of fine Bole, Catechu, Consound or Comfrey Roots, Dragons Blood, Frankincense, Myrtle-berries, Pomgranate-peels, red Roses, Sumach, and Terra Sigillata, mixed with Oil and Wine, to which some add also Glair of Eggs: Others mix all these things in fine pouder, only with Glair of Eggs, and make a Me∣dicament as thick as Honey, which they apply upon combed Flax, or fine Tow, applying the same round the fractured Limb.

XXVIII. These said Medica∣ments are in all the bindings or dressings so long to be continued, till there is no farther fear or Fluxion, or Inflammation.

XXIX. And afterwards you may apply (if in Summer time) Empl. Album, or Diapalma; but if in Winter time Empl. Barba∣rum, or some other like Empla∣ster or Cerate fit for this purpose and occasion.

XXX. When therefore you are for strengthning the Fracture, (no ill Symptoms being present) those Astringent Pouder•• with the

white of an Egg, or Astringent Cataplasms, are to be applied.

XXXI. But if the Patient is in great pain, Ceratum & Oleum Rosatum, and Wine are to be ap∣plied: Or this, ℞ Catechu, Dra∣gons, Blood, Linseed in pouder, Comfrey-roots in pouder, Osteocolla Stone prepared, Oil of Roses, A. ℥iv. fine Bole, Coruse, A. ℥i. whites of Eggs N^o xv. fine flower q.s. mix, and make a Cataplasm, which put upon the fractured Part.

XXXII. Or, ℞ White Starch ℥vi. Catechu ℥ii. Mastich, Oli-banum, Mummy, fine Bole, A. ℥i. whites of Eggs q.s. mix, and make a Cataplasm.

XXXIII. Or, ℞ Empl. Al∣bun. ℥iv. Catechu, fine Bole, Com∣frey-roots, red Roses, Osteocolla, Terra Sigillata, A. ℥i. ad in fine pouder; mix them over a gentle Fire, and with Oil of Roses q.s. make an Emplaster.

XXXIV. Some of these things being applied, after two days they may be removed; and they may be repeated five times one over after another; binding up, and placing the Part as we shall afterwards direct, laying over the Applica∣tion a piece of Cloth, wrung out of Wine; and the first and second Rowlers may be dipt in∣to and wrung out of rough red Wine.

XXXV. By the Application of these things, Accidents and Symp∣toms will be prevented, and the substance of the Part will be kept bound; all which are to be ap∣plied before Bandage is made.

XXXVI. And these things are to be done so long, till the Callus is bred, and the Fracture healed; which in the Thigh may be in about 40 days; in the Shoulder and Ankle in 30; in the Radlus and Elbow about 20; and in the Bones of the Fingers in a∣bout 5 or 6 days time: How∣ever, the time of Healing much varies, according to the Age, Constitution, and Nature of the Fracture it sent, being Cured much sooner in a young Person, than in one old; and more speedily in the Spring or Au∣tumn, than in Summer or Win∣ter.

XXXVII. Now we come to the way and manner of binding up, which we shall deliver to you, 1. According to Hippocrates his Method. 2. According to Cel∣sus; tho' it is certain that some Modern Chirurgeons, presently take a Rowler, and rowl the Fracture to both ends, not va∣luing much what either Celsus or Hippocrates says.

XXXVIII. The M••thod, accor∣ding to Hippocrates. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, in Greek, Obligatio, vel deliga∣tio, in Latin; Bandage in Eng∣lish, is performed after Hippo∣crates his way, with Bands or Swaths, which Hippocrates calls 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ligamen vel fascia pl. Ligamina, fasciae.

XXXIX. These Fasciae, or Swaths, are three in number, made of Linnen, that they might not stretch; not too coarse, lest it hurt the Part; nor to fine, lest it want strength, and so tear.

XL. The first Rowler, which may be dipt and prest out of Oxy∣crate,

is to be put over the Fra∣cture, and then rowled round a∣bout it upwards, three or four turns, so that much of the sound Part be taken in in Swathing, that so the Bones being reduced, may be kept or held in their places, and the Conflux of Blood and Humors to the Part affected, may be prevented.

XLI. The second Rowler, which is to be longer than the other by the one half, or rather twice as long, is to be put upon the very Fracture, and rowled about the contrary way once, (viz. if the former was rowled to the Right Hand, this ought to be rowled to the Left) and then some certain times more, which is here to be done downwards; that if the Muscles were drawn too much to one side by the first Rowler, they might be restored by drawing them somewhat the contrary way by this second Rowler: then after 3 or 4 rowlings down∣wards, it is to return again up∣wards over the Fracture to the sound Part, making a Circum∣volution over the Fracture it self, and so continuing it up∣wards till it comes to the end of the first, where it must ter∣minate.

XLII. Where note, that this Rowler is first rowled about the Fracture, that it may press the Humors from it; for all Bandages whatsoever, have in them a power of pressing forth the Hu∣mors out of those Parts, upon which they are first of all cast, into those Parts where they are ended: then it is carried down∣wards, to stop the Humors which might flow from the lower Parts: And because there may be a fear of a falling down of Humors from the upper Parts, Hippocrates therefore does not end the Rowler downwards, but rowls it upwards, that it may end where the first ended.

XLIII. But that in the greater Bones the Bandage may be the more stable and firm, Hippocrates puts over the former Bandages, Com∣presses made of Linnen cloth 3 or 4 times double, and narrow, that 5, or 6, or more of them, may be applied lengthways about the Fra∣cture, an Inch or better, one from another, which are to be spread with some sticking Cerate, for their better holding fast: These Modern Authors call Plagulae, and Splenia.

XLIV. Ʋpon these the third Rowler is to be put to fasten them, making the first turn upon the very Fracture; then one head of the Rowler is to be carried upwards, and the other downwards: And it is to be observed, that the Rowlers are to be drawn straiter upon the fractured Part, than any where else, that it may the better be kept from Fluxions.

XLV. But yet you ought to be cautious, that the Bandage be not too hard, lest it cause pain; nor yet too loose, lest the Bones slip out of their places again; but it ought to be in a Mean, for the Advan∣tage of the Cure.

XLVI. But because these Sple∣nia are very flexible and yielding, and that they cannot possibly keep the Fracture firm and direct; and that the Bones, when they a••e re∣duced, may be the bette ••ept in

their true places. Hippocrates or∣ders Ferulae or Splinters to be put above them, if the nature of the place will allow it; for that being light, they will not press upon the Part to hurt it; and being stiff, they will the more firmly keep the Bones in their right places.

XLVII. But these Hippocrates used mostly after the seventh day; because before the seventh day, the Intention to prevent In∣flammation is more considera∣ble, than that to confirm the Part; but after the seventh day, the contrary.

XLVIII. On the third day af∣ter deligation, Hippocrates un∣binds the Rowlers, because, 1. They begin to grow slack. 2. An In∣tolerable Itching affects the Pati∣ent under the Bandage, for the Vapours and Humors being de∣tained grow sharp, &c. this Itching you must allay, as we have taught in Cap. 3. Sect. 23. ad 26. aforegoing; after which it is to be bound up as before again.

XLIX. And the Patient is now to be kept in this condition from the third to the seventh day, and on the seventh it is to be opened again, bathed with warm Water (as be∣fore) and hound up again, at what time you are to apply the Ferulae or Splints: We in our time use thin pieces of Wood, cut off of that which they call Scabbard, which are wrapt up in Tow; and some use Splints, or pieces of Hoops of half an Inch thick, or more, whose uses are not on∣ly to keep the Bones fixt, but to preserve the Limb straight.

L. The Method of Binding up according to Celsus, lib. 8. cap 10. Fere vero Fasciis sex opus est, &c. he says, that it is ne∣cessary to have six Rowlers: But he first applies about the Fra∣cture, a Linnen-cloth dipt in Oil and Wine; then he takes his first Rowler, which is the short∣est: Prima brevissima adhibenda, quae circa fracturam ter voluta sursum versum feratur, & quasi in Cochlea serpat, satisque est eam ter hoc quoque modo circuire. The first, which is the shortest, is to be applied, which is to be thrice rowled about the Fra∣cture, and to be carried upwards winding round like a Screw; and to be carried thrice round in this manner, will be enough.

LI. The other Rowler is to be twice as long, and is laid also upon the Fracture, and rowled down∣wards, and then turning upwards, it must end at the upper part, a∣bove the first Rowler. These two Rowlers, are the two first of Hippocrates; over these a broad Linnen-cloth spread over with some proper Cerate, is applied to fasten them, and keep them tight.

LII. And where the Bone sticks out, the Linnen-cloth is to be ap∣plied three or four times double, dipt in a Mixture of Oil and Wine, (or in the white of an Egg, if the Fracture is without pain) and over or upon this, the third and fourth Rowlers are to be put; but so always, as that the follow∣ing may be wound the contrary way to that which went before; and the third only to end down∣wards, three in the upper part.

LIII. This Bandage is to be con∣tinued for three days, which will be good and well done, if nothing •…•…rts the Patient the first day, and it also grows somewhat looser; and yet looser on the second day, and very loose on the third day, as if it were almost undo∣ing.

LIV. It is then to be bound up again, and then to the other four Rowlers, you must add a fifth Rowler; and when that fifth be∣gins to be loose, you are to bind it about with a sixth, the third and the fifth ending downwards, and all the rest, viz. the first, second, fourth and sixth end∣ing upwards.

LV. Quotiescunque autem sol∣vitur Membrum, calida Aqua fo∣vendum est: sed si juxta Articulum, diu instillandum Vinum est, exigua parte Olei adjecta, eademque om∣nia facienda donec ab eo Inflamma∣tio solvatur. And as often as it is opened, (says he) the Part is to be fomented with warm Water; but if it is near a Joint, it is to be bathed for a pretty while with Wine, to which a small quantity of Oil is added: And all these things are to be done so long, till it is freed from the danger of an Inflam∣mation.

LVI. Now if there is but little pain, Galen, Meth. Med. lib. 6. cap. 5. approves most of Hippo∣crates his Bandage: But if any vehement pain afflict the Part, Celsus his Bandage is better.

LVII. When the Fracture is bound up so hard, as the Patient can well endure it, it is well: But if he complains that he is in ve∣ry great pain, the Bandage is speedily to be loosned, lest the too hard binding should cause dangerous Symptoms to arise.

LVIII. But if the Bandage is too loose, and that the Patient says he feels not the binding at all, it is then to be unbound also, and bound harder; for the Bandage, if it is over-loose, will make the Member to be depraved or dis∣torted in the place where the Fracture is.

LIX. If also in the same Day and Night, on which the Fracture was first bound up, the Patient feels the Bandage to press, but yet lightly, and the day following a small and soft Tumor does arise in the Extremity of the Member, (as in the Hand, if the Arm was broke; or in the Foot, if the Leg,) the Bandage is well made; for the smallness and softness of the Swelling shews that there is something prest forth by the binding, from the Part affected, unto the extremity and utmost part of the Member.

LX. But if no Swelling at all appears, it shews that the Ban∣dage was not hard enough; but if there is a Swelling, and it is great and hard, so as it will not rea∣dily yield to the Touch, it is a sure sign that the Part affected is too hard bound up.