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. IV. Of a Simple FRACTƲRE.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Fractura Sim∣plex; we in English call, a Sim∣ple Fracture, which is a Fracture of a Bone only.

II. The Causes. They are ei∣ther from External Violence, or from an Internal Sharpness and Malignity of Humors, which ma∣king the Bone brittle, or rotting of it, causes it to break.

III. The Signs. If it is with∣out a Wound, it is known, 1. By feeling the pieces of Bones, in hand∣ling the Part. 2. In handling, it makes a noise and crackling in the broken Part. 3. There is a vio∣lent pain, by reason of the divulsion or straining of the Nerves, or from some sharp parts of the Bone pricking the Nerves. 4. An Im∣potency in using the fractured Limb, or leaning upon it. 5. Some∣times there is a crookedness or shortness in the Part. 6. Last∣ly, The Causes of Fractures have gone before the foregoing Signs. 7. If split lengthways, it is un∣even, and thicker than naturally.

IV. The Prognosticks. No Fracture in the Bone is wholly void of danger, 1. Because it lies deep, and not easie to be come at; but in a great Bone, they are more difficult than in a small. 2. And so also harder of Cure in an Aged Person, where the Bones have done growing, than in a Young; and more hard, when manifold, than when fingle. 4. And hardest of all, when in or near the Joints.

V. The Cure. This has one on∣ly Indication, viz. that what is thus broken and disjoined, must be again united and conglutinated, which is done by the means of a Medium, which Physicians call a Callus.

VI. Now when the broken Bones are fallen out of their places, they are reduced by, 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, to wit, Extension. 2. By 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, emendatio vel directio recta, a Conformation, or right replacing of the broken Bones in their own proper places.

VII. The Member being by some of the former means extended, and rightly conformed, that it may re∣main

so, it is necessary that it may be, 1. Well bound up, with proper Medicaments appli∣ed, and good Bandage. 2. That it be well placed, in a convenient and easie posture.

I. Of Extension of the Part.

VIII. Extension is to be made, either by the Hands of the Artist, in a small part, or where the Bones are not great: Or by Cords on Bands, where the Bones are lar∣ger: Or by Instruments, where the Parts or Bones are very great.

IX. Now because some parts of the fractured Bone may stick out, and others be hollow; or because one part of the Bone may lye upon the other, making the Limb shor∣ter, and so give opportunity to the Muscles to contract themselves, (for they always draw towards their Original) it is necessary that Extension should be made; other∣wise the Bones cannot easily be put in their right places again, so as to set (in transverse Fra∣ctures chiefly) their ends one against another.

X. And tho' sometimes the bro∣ken Bones do not shoot one over another, (as when there are two Bones, and but one broken) yet the Coaptation cannot be made as it ought, without Extension; for otherwise the shivers or points of the fractured Bone would be in danger of breaking off, or of turning round, or of rubbing their ends one against another; and then if the shivers break off, they either fall between the ends. of the Bone, and so hinder Con∣glutination; or they fall be∣sides the Bones into the Flesh, and prick the Nervous Parts, causing vehement Pain, Inflam∣mation, Apostemation, &c.

XI. You must endeavour that this Extension be done with no pain at all; or else with as little as may be: And this will be done, if the Part to be extended is placed in such a Figure, as that the Muscles may do nothing at all, but be as it were idle and loosned, that so all their Fibres may be extended directly, and straight forwards; by which means there will be need of the less Extension, and the whole Work will be done with little or no pain.

XII. If a Finger is broken, or other small and render Member, the Extension may be performed by the help and pains of one alone, who laying his Right Hand on one part, and his Left Hand on the other part, may so draw them one from another.

XIII. Or it may be done by two together; the one holding part of the fractured Member, the other the other part, and so extending them: Or if the part is greater, it may be necessary that one Person should lay hold on one part, with both his Hands, and another on the other part with both his Hands; so that by draw∣ing both ways, one part from another, the said broken parts may at length close together. In greater parts, it is done either by Bands or Instruments, as at Sect. 8. above.

XIV. This Extension is either equal, or unequal; that is equal, in

which the whole Member is equally extended from both sides of the fra∣ctured Bone; that is unequal, when the Member is more extended on one side than on the other; which is, when only one of the two Bones of the Elbow, or Leg, are broken; for that side is most to be extended, in which the broken Bone is placed.

XV. But there ought to be a measure in this Extension; for if it is more violent than is necessary, then great pain will be caused, whence Fevers, Convulsions, and Palsies do often arise: And some∣times, as Galen in Com. de Fra∣cturis, lib. 1. text. 1. says, the Muscles have been pulled asunder.

XVI. Again, if the Extension be too little, the shivers or points of the Bones will rub one against another, and so break; or else the broken ends will not be lodged in their proper places.

XVII. Great Bones, and large Muscles, such as are in the Shoul∣der and Arm, the Thigh and Leg Bones, (especially if both the Bones are broken) require violent Ex∣tension, because their Muscles draw to their Original very strongly; but the Radius, or upper Bone in the Arm, re∣quires but small Extension, be∣cause it has no Muscles to draw upwards.

XVIII. As to the time of the Extension, if the Artist comes the first day, he may make the more forcible Extersion; but if he comes after the first, he must (according to Celsus, lib. 8. cap. 10.) either not extend at all, or else more gently, for fear of Inflammation. Also Chil∣dren, and such as are of a soft habit of Body, do better bear a more violent or strong Extension, than such as are full grown, or aged.

XIX. But if the Bone be bro∣ken only longways, (which you may know if there be no Cavity or Hollowness perceived, nor any sense of pricking, nor that the Member is shorter than it was before) then in this kind of Fracture, you will not have any need at all for Extension of the Member, or to trouble your self in the least with the reducing, and fit join∣ing of the broken Bones or Parts.

II. Of Coaptation or Conformation of the broken Bones.

XX. The Diorthosis is perform∣ed after Extension, the Artist lay∣ing hold on both parts with both Hands, and thrusting back to the right part the Part or Bone which is fallen forth to the left; and to the left, that which is fallen forth to the right, or forward; conti∣nuing to thrust back the emi∣nencies, or stickings forth, into the cavity or hollowness, till the ends of the Bones are put in their proper places, and the Limb recovers its Natural Fi∣gure.

XXI. But these Bones are not to be thrust in with any violence, lest thereby they should be the more broken, or some bits might break off from them; but they ought to go in (as it were) of their own accord, which done, and their ends placed right one a∣gainst another, the Extension is

gently to be loosned, and they are gently to be joined together.

XXII. All these things are to be done as soon as may be, before Inflammation happen: But if an Inflammation should be induced, the extending of the Member afterwards, and reduction of the Bones, may easily excite a Convulsion.

XXIII. If an Inflammation is already begun, so as that you can∣not attempt the Extension and Reduction; the Inflammation is then to be removed, as we have taught in the former Chapter, and other places; and with great care the afflux of Humors is to be re∣sisted by Repellents, and posi∣tion of the Part, so as it may be depending as little as may be, and cause the least pain.

XXIV. Now Hippocrates de Officin. Med. lib. 3. text. 24. teaches us to know if the Bones are well or rightly placed, which you may know, 1. By the pain cea∣sing. 2. By the eminencies of the Bones no longer pricking the Part. 3. If no cavity, or stick∣ing out, be perceived. 4. By comparing it with its Fellow which is sound: These things being done, the remaining part of the Cure is to be performed by the two remaining Operati∣ons, of Bandage and Posture.

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.

IV. Of Collocation, and the Po∣sture the Member is to be laid in.

LXI. The position, or placing of the Member, is the next Conside∣ration; this according to Hippo∣crates is to be, 1. Soft, lest by pressing or lying hard, it causes

Pain and Inflammation. 2. E∣qual, lest it distort the Member. 3. High, lest by its depending position, the Humors should de∣scend, because even by their own weight they are apt to fall downwards, and flow to the place affected.

LXII. Therefore the Patient is to be laid in Bed, and the fractu∣red Part is to be put upon a Pillow, or soft Bed-cloths, stuft with Flocks or Feathers: Or a Pasteboard may be formed into a Case, the inside of which may be lined with Tow for the Arm, and such Parts as do not oblige the Patient to keep his Bed.

LXIII. But if the Patient is confined to his Bed, nothing can be better than to make a Cap∣sula, or Case of thin Oak, or Deal Boards, and to line or fill it sufficiently with soft Tow or Wooll, that the Part may lye easie in it.

LXIV. As to the posture the Member is to lye in, it ought to be that of a middle figure, in respect both to the Joints, and to the Muscles: And therefore Hippo∣trates de officin. Med. Text. 3. & 30. advises us to heed these three things, 1. Rest 2. Mean∣position. 3. Custom.

LXV. By Rest, is intended such a posture, as a Man is apt to put the Part into, when being free from Business, he reposes him∣self for Rest, Ease and Pleasure.

LXVI. By Mean-position, is meant such a posture, as we natu∣rally lay our Limbs in when we have nothing to do, which is a mean between extream Disten∣tion and close or acute Contra∣ction: The Arm is in such a middle position, when it makes not an acute Angle, nor yet a right in the Elbow, but rather an obtuse Angle, as if it were half way stretched out; for that is the posture when Men are Idle, they hold their Arms in, as being most easie, natural, and free from pain.

LXVII. By Custom, we mean such a posture as Nature and Cu∣stom has given to any Part; for that no habit is so easily born, as that to which Nature and Cu∣stom have given preference: And so by this Rule, a streight posture in the Wrist is only to be chosen.

LXVIII. Hippocrates de Fra∣cturis, lib. 1. adds a fourth, viz. the Course of the Muscle, which is taken from the Ductus of its Fi∣bres: He so figures and places the Muscles, that their Fibres may be direct, and stretched forth in a straight manner.

LXiX. These things being thus all done, and the Patient easie, the rest of the Work, which is the pro∣ducing the Callus, is to be commit∣ted to Nature: Now it is bred of the Nourishment of the Bone, which issuing out of the edges of the Fracture, coagulates and hardens about the fractured Part.

LXX. This tho' it is no Bone, yet it is so hard and strong, that if the Bone should chance to be broken again, it will break ra∣ther in another part, than in that where the Callus is.

LXXI. But tho' the breeding of the Callus is the Work of Nature, yet the Physician ought to assist and

help her in her Operation; and this he may do, if he prevents Inflammations, or other ill Sym∣ptoms; and also by drying Me∣dicaments so disposes the Ali∣ment, that it may the sooner be converted into a Callus.

LXXII. The Food for genera∣ting a Callus, ought to be such as is viscid and glutinous, viz. Bar∣ley hull'd, Rice, and Wheat boil'd in Water, and afterwards mixt with Milk, Gelly of Harts-horn, Sheeps Trotters, Knuc∣kles of Pork and Veal, Calves Feet, Feet and Stomachs of Oxen, boil'd soft, and eaten with good Sawce, or made into Gellies, and so taken; also strong Broths made of the Flesh of Fowls; Beef, Mutton, Veal, &c.

LXXIII. The Internal Medi∣caments which are given in this Case, are chiefly the Pouder and Juice of Agrimony-roots; Pou∣der of Comfrey-roots, and Sy∣rup, but chiefly Blood of Com∣frey; the levigated Pouder of the Osteocolla Stone, which may be given ad ʒi. Morning and Evening, in Syrup of Comfrey, or Blood of Satyrion; or Par∣snip-roots.

LXXIV. In the beginning, a sparing Diet is to be used, till the danger of the Symptome are over; but when they are over, and the Callus begins to grown, which will be about the twelfth day, then •…•…ore plentiful Diet is to be allowed, because it contri∣butes to the more absolute gene∣rating of the Callus.

LXXV. Decoctions or Vulne∣rary Drinks may be prepared from Wound-herbs, as Bugle, Com∣frey Roots, Consound, Dra∣gonwort, Avens, Agrimony, Angelica, Primroses, Sanicle, Savin, Speedwell, Yarrow, &c.

LXXVI. ℞ Roots of Consound and Dragons, A. ℥i. Roots of Angelica, of Comfrey, A. ℥ss. Storksbill, Savin, A. M. i. Speed∣well, Yarrow, Primrose leaves, A. Mss. Galangal, Zedoary, Mace, A. ℥ss. Nutmegs. ʒii. Wine q.s. boil in B.M. and strain; sweeten with white Sugar, and let the Patient drink of it twice a day.

LXXVII. As to Topicks, you may make a Cataplasm of white Starch, and whites of Eggs, which may be applied to Wo∣men and Children.

LXXVIII. To Elder Persons you may apply this of Fabricius Hildanus in Cent. 3. Obs. ••0. ℞ Oil of Earthworms ℥ii. Juice of Earthworms ℥i. Grains of Ju∣niper ℥ss. mix them, and make a Liniment, with which anoint the Fracture.

LXXIX. ℞ Vigo's Plaster for broken Bones, or Catagmaticum, ℥ii. Osteocolla Stone prepared ℥iss. Pouder of Earthworms ℥i. Oxy∣croceum ℥ss. Oil of Earthworms q.s. mix, and make an Empla∣ster, which lay upon the Part affected.

LXXX. The same Fab. Hil∣dames, to hasten the Callus, gives also internally this Preparation of the Osteocolla. ℞ Osteocolla levigated ℥i. Cinnamon in sine pou∣der ʒiv. white Sugar ℥iv. mix them. Dose, ʒii. every Morn∣ing in strong Broth, made of Meat.

LXXXI. Where the Callus is bred to confirm it, you may ap∣ply

this: ℞ Catechu, Terra Si∣gillata, Aloes, Mastich, Myrrh, Olibanum, Laudanum, Nat-galls, Frankincense, Comfrey-roots, A. ℥i. all being in fine pouder, mix it with whites of Eggs, and a little Wheat-flower, and apply it.

LXXXII. Or, ℞ Wax ℥iiiss. Oil of Roses ℥ii. Frankincense, Mastich, Olibanum, A. ℥ss. Ca∣techu ʒiii. fine Bole, Cyprus-nuts, Saffron, A. ʒi. mix, and make a Cerate, which spread upon Lin∣nen and apply: This, when the Callus is bred, and come to its just magnitude, will very much corroborate and confirm it.

LXXXIII. If the Callus is ge∣nerated less than it should be, you may know it by its being less than it should be, or when touched, very little or no Callus can be felt, and the Part being weak in its moti∣on: It is caused from the Pati∣ents using too thin and sparing a Diet, or eating Meats not vis∣cid or thickning enough, or from the Bandage being too straight.

LXXXIV. In this case the Diet must be more plentiful, and stronger, made of strong Broths, Gellies, &c. The Medicaments must be less astringent, the Bandage must be loofer, and the Nourishment must be attracted, by bathing with Water, only Blood-warm, (not hotter, lest opening the Pores, the Humors should per∣spire) till the Part looks red, and swells a little.

LXXXV. If the Callus is too great, (which causes deformity and unaptness for motion) you may know it by handling of it; you will find its magnitude too large; and by pressing the Mus∣cles and nervous Parts it causes pain, and hurts its Function in moving.

LXXXVI. In this case, the Diet must be more thin and sparing, the Bandage must be straighter; and the Callus must be softned and discussed; you may first foment, or bathe, with Decoction of Be∣tony, Bawm, Pellitory, Scabious, Scordium and Speedwell, so long till the Part first grows red and swells, and then abates again, and corrugates; after which you may anoint with Mans, Vipers or Bears Grease, and then ap∣ply Emplast, de Althaea, è muci∣laginibus cum Gummi, de Ranis cum Mercuris, with other things of a resolving and discussive Na∣ture.

LXXXVII. If an Atrophia happens to the Limb, it is caused from too straight Bandage, and poor or hard keeping, or too thin and spating Diet: Here Food of good and strong Nutriment ought to be given, the Patient must feed plentifully, and of Meats succulent and easie of Di∣gestion; his Meat, he must eat with the bloody or red Gravey in it: The Part must be often fomented with strengthning things; and Dropaces or Pitch spread upon Cloth, must be ap∣plied to attract the Juices and Nourishment to the Part; and all these things must be conti∣nued so long till you see a mani∣fest recuperation of the Flesh, and restoration of the strength of the Part.