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 ...

ARS CHIRƲRGIGA. Liber Sextus. OF FRACTURES.

The ARGUMENT.

I. Of Fractures in General. II. Of Catagmatick In∣struments. III. Of Accidents or Symptoms in Fra∣ctures. IV. Of a Fracture Simple. V. Of a Fra∣cture with a Wound. VI. A Fracture with a Wound, the Bone not bare. VII. A Fracture with a Wound, the Bone bare of the Periosteum. VIII. A Fracture with a Wound, the Bone sticking forth. IX. A Fra∣cture Distorted, and Ill-set. X. A Fracture with too little, or too great a Callus. XI. A Fracture with Atrophia, or Slenderness and Weakness of the Part. XII. A Fracture of the Skull. XIII. A Fissure and Contrafissure of the Skull. XIV. A Contusion of the Skull. XV. A Puncture and Incision of the Skull. XVI. A Fracture of the Nose-bone. XVII. A Fracture of the Jaw-bone. XVIII. A Fracture of the Clavicula, or Collar-bone. XIX. A Fracture of the Shoulder-blade. XX. A Fracture of the Humerus, Shoulder, or Arm-bone. XXI. A Fracture of the Cubitus, or Elbow-bone. XXII. A Fracture of the Carpus, or Wrist-bone. XXIII. A Fracture of the Metacarpium, or back of the Hand. XXIV. A Fracture of the Finger-bones. XXV. A Fracture of

the Sternon, or Brest-bone. XXVI. A Fracture of the Ribs. XXVII. A Fracture of the Vertebrae of the Spina-Dorsi, or Back bone. XXVIII. A Fracture of the Os Sacrum, or Great Bone. XXIX. A Fra∣cture of the Coccyx, or Rump-bone. XXX. A Fra∣cture of the Os Ilium, or Hip-bone. XXXI. A Fra∣cture of the Thigh-bone. XXXII. A Fracture of the Patella, or Knee-pan. XXXIII. A Fracture of the Leg-bones. XXXIV. A Fracture of the Bones of the Feet.

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.

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.

CHAP. III. Of ACCIDENTS or SYMPTOMS of FRACTƲRES.

I. THO' the Accidents or Symptoms attending Fra∣ctares are manifold, yet these five following are the primary or chief, viz. 1. Pain. 2. Inflammation. 3. Gangrene. 4. Itching. 5. Excoriation.

I. Of Vehement Pain in a Fracture.

II. Pain, whether great or small, •…•…ght to be cased and taken away; for by reason thereof, there may be a Flux of Hunters, whereby manifold Evils may be excited.

III. You are to consider the cause, and accordingly to remove it (causa ablata, ••ossitur effectus) and that, if it is possible, imme∣diately.

IV. If the Pain is from a Bon•• that pricks (which is known from •…•…ndling the Part) you must •…•…osen

the Bandage; and then either put the Bone back again into its place; or (if it may not be) take it forth; or else cut it off.

V. For so it is advised by Cel∣sus, lib. 8. cap. 10. It will be best (says he) to open it, for there is a necessity of cutting off these sharp pricking ands of the Bones.

VI. If the Pain is from over∣hard binding (which is known from the swelling which appears in the Extremity of the Part,) then the Ligature is forthwith to be loosned.

VII. If the Pain comes from an ill situation or posture of the affect∣ed Part, you are so to change the situation, or posture, and so often, till the Sick feels him∣self at ease.

VIII. If the Pain is from an Afflux of Humors, you must cure it altogether in the same way, as if it were an Inflammation.

II. Of an Inflammation in Fra∣ctures.

IX. An Inflammation proceeds from vehement pain, and an Afflux of Humors, and therefore ought to be opposed in the very be∣ginning, and in that manner as we have expressed under its proper Title.

X. The Pain (says Scultetus) is to be abated or eased by Fomen∣ting with Water and Oil; or with a Decoction or Broath of a We∣ther's or Sheeps Head, with Camomil-flowers.

XI. The Inflammation at hand is to be hindred with Anodyn and Repessing Medicaments apply'd out∣wardly to the Part: you may foment with Oil of Roses above, or else with Oil of Roses beaten up with the White of an Egg.

XII. Scultetus commends sharp Wine, Oil of Roses, and the Whites of Eggs mix'd in a fit proportion, and beaten together with a Spa∣tula.

XIII. If the pain is vehement, he leaves out the Whites of Eggs, and mingles the Oil with the Wine in greater quantities; in which Medicament, he also wets his Ligatures, and gently presses them out again.

XIV. For so Avicenna, lib. 4. F. 5. Tract. 1. cap. 5. does ad∣vise in the cure of a Dislocation; and withall, that we should be careful, that they be not laid on hot and dry: because, if hot, they heat, and attract Humors: if dry, they do not stick well together.

XV. You may apply this Cata∣plasm. ℞ Barley-flower ℥iii. Pulp of rotten Apples ℥ii. Pouder of Marsh-Mallow-roots, and of Cammomil-flowers, A. ℥i. Boil in sowre Wine, or in Vinegar, and fair Water, A. q.s. to the consistence of a Cataplasin.

XVI. Now, 'till the Inflamma∣tion ceases, the Part is not to be bound up, or at least it is not to be bound hard; nor Splinters to be imposed, or any other In∣strument, unless to uphold the part, and keep the Medicaments close to.

III. Of a Gangrene in Fractures.

XVII. A Gangrene often hap∣pens unto Fractures, especially if there be Contusion withal: and

it commonly arises either from taking too much Air, or from Inflammation, or from hard Binding, which how it is to be Cured, you may see in the pro∣per places, in lib. 3. cap. 11. and lib. 4. cap. 9. Sect. 22.

XVIII. However, the Part ought to be fomented with Lixivium, in which Te•• ••erfew, Sage, Southernwood, Saxifrage, Scor∣dium, Rue, Tansey and Wormwood have been boiled; mixed also with some Spirit of Wine.

XIX. Or with Spirit of Wine rectified, with which Spirit of Sal Armoniack ℥i. to lbi. of the S.V. is to be mixed; where note, that if the rectified Spirit is wanting, common Brandy or Spirits may do.

XX. Or you may foment with this: ℞ Spirit of Wine, impreg∣nated with the Tinctures of Worm∣wood, Scordium and Saffron, lbi. Camphir ℥iss. mix, and dissolve: It is a famous thing.

XXI. But above all things, nothing is more excellent, nothing more safe; nor any thing more speedy to retrieve the Mischief than Powers of Amber, or Powers of Lavender, of Limons, of Oranges, of Pennyroyal, of Rosemary, of Sage, of Turpentine, or of Wormwood, being fomented upon the Part.

XXII. Or you may use this: Take Powers of Amber ℥iii. Powers of Turpentine ℥ii. of Rose mary, and of Sassasras, A. ℥i. Camphir ʒiiiss. mix them for use.

VI. Of vehement Itching in Fractures.

XXIII. The most simple thing to allay itching, is to wash, bathe, or foment the Part often with warm Water; for it is of good use to wash away the ichorous Sanies, and to dissipate the Hu∣mor, or call it forth.

XXIV. And nothing inferior to Water, is Breast-milk, or the Milk of Asses, Mares, Goats, or Cows; or Whey of Goats or Cows Milk, being often fomen∣ted warm, for some small time.

XXV. Or, Take Rain-water lbii. Oil of Tartar per Deliquium ℥i. mix them, and foment there∣with, as aforesaid, warm; it opens the Pores, draws forth the Humor, and admirably al∣lays the itching.

XXVI. Or, Take fair Water, somewhat more than Blood-warm lbii. Spirit of Wine ℥iii. volatil Sal Armoniack ʒiii. mix them, to foment with.

XXVII. Or, ℞ Juice of Cow∣cumbers lbii. Juice of Lettice lbi. Spirit of Wine ℥iv. Oil of Tartar per deliquium, ℥i. volatil Sal Armoniack ʒii. mix, and foment therewith warm.

V. Of Excoriation in Fractures.

XXVIII. First wash, bathe, or foment the Excoriation very well with warm fair Water, or warm Milk, or Whey, then strew upon it fine pouder of white Starch, or white Starch mixed with very fine pouder of Rice.

XXIX. Or you may first wash it with Aqua Aluminosa, warm, and then strew it over with the afore∣named Pouder, or with fine Bole, or Terra Sigillata, or Catechu, in very subtil pouder.

XXX. Some commend Caput Mortuum of Vitriol, Ceruse, or white Lead; but they are more effectual, after the washing with Dr. Gardner's Aqua Styptica, or some other Styptick Water, of like Virtue and Operation.

XXXI. Some advise to wash first with clarified Juice of Night∣shade or Plantane, blood-warm; and then to anoint with Ʋng. Album Camphoratum, or desicca∣tivum Rubrum, or Rosatum, or Diapompholigos, &c.

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.

CHAP. V. Of a FRACTƲRE with a WOƲND.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Fractura cum Vulnere; we in English call, A Fracture with a Wound.

II. This comes to pass, when the sharp eminencies or points of the fractured Bones do perforate the Flesh which lies upon them; making thereby the Member shorter than it was before.

III. The Causes are from vari∣ous things; sometimes these Fra∣ctures happen by means of some cutting Weapon, which not only cuts the Flesh, but even the Bone it self.

IV. The Prognosticks. If such a Fracture as this is made, where the Flesh and Skin lying over are still whole and sound, it is more dangerous than where the Wound is open; because in the former a Pain and Inflammation are excited, and the Muscles thus affected, suffer a double Extension, the one from the In∣flammation, the other from the Extension in order to the Re∣duction.

V. And this danger is so much the greater, by how much the Parts fractured are greater, or more no∣ble and principal, as the Arteries, Veins, Nerves, Tendons and Muscles.

VI. A Fracture with a Wound made with a cutting Weapon, is dangerous, if the Bone that is cut is great, such as that of the Shoul∣der, or Thigh; for in these, if the Incision is direct and straight, the Bones will very difficultly be brought to grow together again; partly, because by the Cut the Pores are obstru∣cted, thro' which the Juice ge∣nerating the Callus did former∣ly pass; and partly, because the ends of the Bones being equal and smooth, cannot easily be kept fixt, till the Coalition is perfected.

VII. A Fracture in the Thigh and Shoulder, with a Wound and falling out of a Bone, is the most dangerous of all; and this in re∣spect to the magnitude of the Part, and greatness of the Ves∣sels.

VIII. Celsus, lib. 8. cap. 10. saith, That it is yet more grievous, when unto the Fracture of a Bone, there is added likewise a Wound of the Flesh; and especially if the Muscles of the Thigh, or of the Shoulder be sensible thereof; for these have always much the more dangerous Inflammations, and they have also Gangrenes more apt and ready to seize up∣on them.

IX. Hippocrates, de Fracturis lib. 3. text. 47. says, They sel∣dom or never escape, the Bones of whose Arms or Thighs, have fallen out outwardly; for as these Bones

are great, and full of Marrow, so there are many other Parts of great moment wounded; as the Muscles, Nerves, Arteries and Veins: whereupon if you reduce them, Convulsions are wont to be excited; if you do not reduce them, acute and cholerick Fevers are excited, with sighing, and blackness of the place affected; so that these do not yet less escape than the other.

X. But (says he) they are in less danger, or more likely, to escape, who have the lower Bone fallen out, than those who have the upper Bone fallen forth outwardly: and they do sometimes escape with Life, who have these Bones redu∣ced or replaced; but this is very rare.

XI. But if the Bone of the Shoul∣der or Thigh fall forth, to the inward parts of those Members, the danger is yet more augmented; because in the inner or under parts of those Limbs, there are Vessels of far greater magnitude and account.

XII. And in Text 41. he says, that if those Bones be reduced, or restored, Convulsions are rather produced, than if they be not redu∣ced, or in a possibility of being restored.

XIII. The Cure. The Indi∣cations of Cure are twofold: 1. That the Bones may be restored to their places, if possible; and exactly joined together again. 2. That the Wound may be healed. But as to this latter Indication, we shall refer you to what we have already written of Wounds.

XIV. The replacing of bones here is difficult, because of the Wound, and great pain, which may hazard a Convulsion, if the Parts be extended. Therefore the Ex∣tension is immediately to be made, (before an Inflammation has (••era'd the Part) but not with violence.

XV. If this cannot be done you must have in readiness some ••trong Iron Levers of different bignesses, out of which one that is convenient is to be chosen; which is to be applied to the lower part of the broken Bone, where pressing upon the lower Bone, it may lift up the upper part, and so slide it into its place.

XVI. But, says Hippocrates, de Fracturis, lib. 3. text, 12. if the Bone which is fallen forth over another, leaves not any place fit for the Lever to enter; or if it is so sharp, as that it starts away from it; we must with a File take away some of the broken Bone; or make it hollow, 'till room is made for the Iron Lever, so as to lay hold upon it.

XVII. But truly these things are are to be done instantly, before any Inflammation arises; for then no extension, or any such put∣ting forth of the Bone can be attempted without danger: but it is to be deferred 'till the Inflammation is abated and gone.

XVIII. If any small part of the Bone so stick out, that it cannot easily be put back again into its true place; but that one part of it may be a stop to another, and that it seems not fit strongly to extend the soft parts, lest pain and convulsion ensue, be∣cause some fragments, or sharp

ends of Bones, may by their eduction tear or hurt those parts which lye near them: in all these Cases, you must by the advice of Hippocrates, de Fract. Lib. 3. Text. 4. Cut them off, either with the Cutting-File, or with the Saw, as you shall see most convenient, as may be done with the best opportunity.

XIX. So likewise, if any part of the Bone break the Flesh, and excite pains; the reduction of them it not to be attempted, because it will induce the highest tortour imaginable: but that part of the Bone is to be cut off; but al∣ways with this Prognostick to the By-standers, that that Limb will be shorter than before, or shorter than its fellow; as our Hippocrates, de Fract. Lib. 3. Text. 46. has assured us.

XX. But in Fracturs with a Wound, the Skin and Flesh being yet fast to them; you must be cautious, that before reduction there is nothing at all sticking between the said broken Bones, for that will hinder their con∣glutination.

XXI. If any thing is sticking there, as a small part of a Bone, or Flesh, or any thing else, it is immediately to be taken forth, but without violence; lest vehement Pain, Inflammation, or Convul∣sions should be induced.

XXII. But if this is not done at first, even in the very beginning, or it cannot be done without vio∣lence and pain, you must defer it; for Nature her self will at length expel whatever is forein or extraneous; but withal you ought to assist her all you can, by applying proper Attractive Medicaments.

XXIII. The Fracture being set, or the Bones replaced, the lips of the Wound are to be closed up, and things must be applied to keep the substance of the fractured and wounded Part sound; and which may ease the Pain, and prevent Inflammation, repel a Flux of Humors, dry up what is there already, and press out what is gathered into the Part: and such are Astringents and Gluti∣natives, of which we have for∣merly spoken.

XXIV. If there is Pain in Winter-time, Ceratum Picatum is to be applied, which Hippocra∣tes says, eases Pain; but in Sum∣mer, a simple Cerat of Wax, Oil, and Vinegar: if there is no Pain, you must endeavour the strengthning of the Fracture, and prevent Inflammation, by applying fine Tow dipt in whites of Eggs; or a linnen Cloth, dipt in and wrung out of a mixture of rough Red-wine and Oil of Roses: Astringent Pouders may also be mixed with whites of Eggs.

XXV. The Bandage, or Way of binding up. The Fracture is to be bound up, as we shewed be∣fore; but the Rowlers ought to be softer, and broader, than in a Fracture without a Wound, that they may reach over the edges of the Wound on each side; and so may close, not press the edges of the Wound.

XXVI. Nor are the Rowlers to be drawn so hard, as in a Fracture without a Wound, lest by squeezing the Wound, Pain and Inflammation

should ensue: for which reason, the Ancients, as Hippocrates and Celsus, used many circumvolu∣tions; it being better to winde often about, than to bind too hard.

XXVII. Some bind this Fra∣cture up, as that without a Wound, so that the Wound may be covered, and they loose this Binding every third day: some rowl about the Swaths so, as that the Wound is not at all comprehended within them, but left naked: so that from day to day, all fit means may be used for curing thereof, without frequent binding up, and unbinding the Fracture.

XXVIII. Others use fewer Swaths, and bind up the Fracture after the usual and ordinary man∣ner; others again use broader, and more Rowlers; that so by their number, they may accom∣plish that which might have been done with fewer, when harder rowled: some use Splints, others slight them: and they that use them, apply them at a good distance from the Wound; some near, or upon the Wound; but it is then with some trouble.

XXIX. Now tho' by all these Ways, you may attain to the same desired End; yet Hippocrates, and all the more skilful Artists, will have it as undoubted Truth; That in the first Binding, the Wound ought not to be left naked; but is to be compre∣hended within the Swath or Rowler.

XXX. And therefore the Swath is first of all to be put upon the Wound it self, (for otherwise, the Humors will be pressed forth from the upper parts upon the Wound, and many dangerous Symptoms may thence arise:) and what is necessary of the Limb, is to be rowled up within the Swaths; nor from this Bandage need you fear any kind of danger; for that for the first three days, little Sanies or Pus will flow forth.

XXXI. Now tho' this Bandage ought not to be too hard, and ought to be somewhat less, than if there was no Wound: yet there ought to be a sufficient compression made, so as to retain and keep the Bones together.

XXXII. And the number of Rowlers may in some sort compen∣sate for the more loose and easy binding of them; since it is far more safe to rowl about the Swaths oftner, than in the least to hurt the Part by a too hard comprehension: for which rea∣son, Celsus his. Bandage with Six Rowlers, is the most excellent in this kind of Fracture.

XXXIII. Every third day the Fracture is to unbound, and then it is again to be dressed after the first manner; save that now a Hole may be made or cut thro' the Emplaster or Cataplasin, which is imposed on the Fracture, and on the Wound: and in the midst also of the very Swaths a Hole is to be left, that so fitting Medicines may be applied unto the Wound, that it may be throughly di∣gested and deterged, without any loosning of the Bandage; as Paraeus, lib. 14. Cap. 18. & 23. has directed.

XXXIV. As oft as the Wound is dressed, it may be covered with

a new Rowler, which may contain •…•…th, the Medicaments, and the Splenia, to defend the Wound from the external Air; which is to be loosned as oft as need shall require: but Ferulae or Splints are here not very profitable, be∣cause they are apt to beget Pain and Inflammation; and for that the number of the Rowlers may very well supply their places.

CHAP. VI. Of a FRACTƲRE with a WOƲND, the Bone not bare.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and in Latin, Fractura cum Vulnere, Osse non nudato; and in English, à Fracture with a Wound, the Bone not being made bare. viz. not made bare of the Periosteon.

II. Now it may be in a Fracture with a Wound, that no Bone, or part of a Bone, as splinters or bits of Bones may be made bare of the Periosteum; yet we may have great cause to fear, that some broken Bone may apostemate, and be expelled, or come forth; which is done, when in process of time they grow dry and withered, so that they cannot be agglutinated again to the whole or sound Bone: or in a Fracture, when they are so separated from the rest of the Bone, that they cannot be joined with it any more.

III. For Nature endeavours to expel whatever is troublesom to her, and what cannot be united again; nor will she be at rest, 'till whatever is offensive, is wholly cast forth; tho' some∣times it is a long time first.

IV. The Causes. They are either when pieces of Bones are so sepa∣rated, that they cannot be put together again, then an Apostem is generated; or from corrupt Sa∣nies, which fouls the Bones; or when they are altered by the ambient Air.

V. The Signs. Hippocrates, de Fract. lib. 3. text. 18. gives us the Signs of a Bone in danger of Apostemating, and so to be ex∣pelled: 1. There flows forth a much greater quantity of Sa∣nies, than could reasonably be expected, either from the ma∣gnitude, or the nature of the Wound.

VI. 2. The lips of the Wound do not meet together; or if they do so; yet they soon are separated; and the Wound putrifies, and is provoked and stirred up to Excre∣tion; the lips becoming loose and spongy, and in the wounded Part, there is a kind of soft motion.

VII. 3. If you perceive the Bone bare of Flesh, it is a sign of its separation, and dropping forth; for that it may be altered or corrupted by the Air, nor can any longer receive Nutriment from the Veins and Arteries, which used to convey the same.

VIII. 4. If you manifestly per∣ceive the Bone is broken into many shivers or bits, it is impossi∣ble for them to be reposited again; and if not, as they cannot be conglutinated, so they must apostemate, and be expelled; for Nature never heals a Wound, so long as any thing remains within that cannot be assimula∣ted, or agglutinated with the rest.

IX. The Prognosticks. It is a sign of a recession suddenly to follow, if good Flesh breed in the sides of the sound Bone; and also when there is a quick digestion or suppuration in the Wound.

X. But the time in which the Bones are wont to recede and fall forth, is various: for if it is in Youth, and in the Summer∣time, and the Bone not very great, it may be expelled or thrust forth in 20, or 30, or 40 days.

XI. But if it is in one of full and ripe Age, and in Winter-time, and the Bone is of the larger kind, it Apostemates not so soon; and it is many times 60 days, before it is separated and thrust forth.

XII. The Cure. If the displaced piece of Bone sticks in the very Wound, it is presently to be taken forth with the Volsella or Pliers, or Pincers, if it can be done with∣out pain and violence: but other∣wise, the whole Work is to be committed to Nature: for if Violence be used, Pain, Inflam∣mation, Fever, and Convulsions may possibly be excited, and a fistulous Ulcer may be induced.

XIII. You ought also to consider the piece of Bone which is to come away, if it is great, or little; which you may know by the intensness or remisness of the aforegoing Signs: for if Digestion or Suppuration comes slowly on, and much Sa∣nies appears, and much loose and spungy Flesh is bred, a great piece will be expelled; & è contra.

XIV. Now Nature is to be helpt by Art, and Medicaments are to be laid upon the Wound; which have in them a power of Attraction, to draw out of the Wound the broken pieces of Bones, and whatever is extraneous to the same.

XV. If the part of Bone to be extracted is small, you must be sure that the generated Pus, may not stay too long in the Wound, lest it corrupt the sound Bone; but that it may have liberty to be eva∣cuated, (not by pressure of strait Bandage, lest Pain and In∣flammation be excited, but rather) of its own accord.

XVI. Then the recession of the Bone is to be committed to Nature: and you must use loose Bandage, and frequent openings of it, that the Pus may not stop, but freely pass forth: Splints, or Ferulae, are to be avoided, lest they cause pain, by their compression; and such things are to be applied, as may soonest perfect the Digestion or Suppuration.

XVII. The Wound also, if it is large, is to he stitched, notwith∣standing the recess of the Bone; for Nature will never heal up the Wound, till the pieces of the Bone are come forth; then the Dige∣stive being applied, as you may see occasion, the Fracture is to be bound up loosly, but with many Rowlers, as we have al∣ready shewn.

XVIII. If the Fragment of the Bone to be extracted is very great, you must, as before, be very care∣ful not to retain the Pus, but that it may run freely forth, and the wounded Part is to be handled with all the gentleness imagina∣ble, as Hippoerates, de Fract. lib. 2. Text. 44. advises.

XIX. For the Fragments of the Bone, not being replaced as they ought to be, if they be much com∣pressed, they will prick the Parts lying near to them, which are very sensible of pain; for which reason, those strait bindings which are necessary in other Fractures, would here do mischief.

XX. Now Hippocrates, Text. 21. of the place afore-cited, makes no use of the Swathe or Rowler, lest the Parts should be prest to∣gether too much; or being for∣ced to lift it up, should excite pain.

XXI. But having replaced the Bones as well as may be, he applies unto the Wound Ceratum Piceum, Ceratum Rosaceum, or some other like Cerate, fit for green Wounds; for that these things help for∣wards the Digestion or Suppu∣ration, and prevent Inflamma∣tion.

XXII. If there is much Pain, and danger of Convulsions, he then applies Linnen-cloths dipt in Oil and Wine mixt together.

XXIII. This done, because of the weakness of the Part, and the imminent danger of a Fluxion of Humors, he uses many Splenia or Plagulae, made of double Lin∣nen-cloth about two Inches or more broad, and so long as to go once and almost half about the wounded Member.

XXIV. For if they should be shorter, they would not keep the Fracture stable; and if they should be longer, they would not be con∣venient; because when the Part is unbound to renew the Appli∣cations, it must be lifted up and moved; but they ought to be of such a length, that with∣out stirring the Limb, both the heads may be so loosned, that the Wound may fully appear.

XXV. These Plagulae (so ma∣ny as are necessary) are to be dipt into black or red austere Wine, to make them stick the better, pre∣vent Inflammation, and preserve the substance of the Part sound; (and Galen keeps them so wet, Night and Day, or else Sponge; dipt in such Wine.)

XXVI. They are to be so many that no space may be left empty; and they are so to be applied to the Member, that their heads may be drawn by the place affected, not round and circularly, but a little sloping, so as that from the con∣trary part where they begun, they may be brought together the one to the other, and cross one another, after the manner of the Letter X, by drawing the right head to the left part, and

the left head, to the right Part.

XXVII. These Splenia, for that they are not very long, and may be so opened that the Wound may appear, without lifting up or moving the Limb, are very con∣venient.

XXVIII. There may also be apply'd a binding up, which may be compleated with once rowling about, and which may be done with a Swath or Rowler folded together with a twice or thrice folded Linnen Cloth, after the manner of a Cross-cloth, but so artificially sew'd together in the sides, and so broad, that it may cover the whole Wound.

XXIX. These things perform'd, the Member is to be laid easily in some proper Capsula, or other like thing, to keep the Fractured Parts in their proper place.

XXX. When the danger of the Inflammation is over, you must ap∣ply things proper for to remove the Receeding Bone, in which work, Nature is to be assisted by Art; for this purpose, Oil Olive mix'd with Bees Wax, adding thereto of Euphorbium, j. part: of Comfrey ij. parts: and of round Birth∣wort iij. parts: Avicen com∣mends it, to be used in strong full grown Bodies, and in Win∣ter time: but he used Spurge, instead of Comfrey, which we have put in, instead thereof.

XXXI. Others commend for the Extraction of Bones, Ammo∣niacum and Bedellium, dis∣olved in Oil of Lillies: so also pouder of Earth-worms (some say their Ashes) mixt with Ho∣ney: which brings them forth by a specifick property.

CHAP. VII. Of a FRACTƲRE with a WOƲND, the BONE made bare.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. And in Latin, Frastura cum Ʋulnere Osseque nudato. And in English, A Fracture with a Wound, where the Bone is bare of the Periostenm.

II. The Signs. When such a Fracture as this occurrs, the Frag∣ment or Splinter feels loose; and if it is in sight, so as it can be seen, it may be pull'd forth with a pair of Pliers or Foreeps.

III. But sometimes the Bone is made bare of the Periosteon, where no Fragments or Splinters are; and in this case it is known by sight, or feeling.

IV. The Prognosticks. Such a Fracture as this is, is much more difficult to be cured than a Simple Fracture: but not so dif∣ficult where there are naked Fragments, as where they are held fast by the Periosteon.

V. Where there is a Fracture, and the Bone naked of the Perio∣steon, only without any Fragment,

it is yet less dangerous, and more easy of cure, than where it is broken into shivers.

VI. The greater the Bone or part, the more difficult and ha∣zardous the Cure: the lesser the Bone and Part, the sooner it may be effected.

VII. The Cure. Where the Fracture is with naked Fragments of Bones, they are to be taken forth with an Instrument, if they can be seen; but if they lie hid in the Flesh, you must apply attractive Medicaments, and wait till Na∣ture expells them; unless by pricking some more noble part, and causing much pain, you be forced to search for them, and take them forth.

VIII. Then a convenient exten∣sion being made, and a good confir∣mation, the Wound is to be closed up by stitching, or otherwise as you see most convenient; and if there are no great Lacerations or Bruises (the fractur'd Bones being well set) it may be healed up with Stypticks: as in other places we have taught; Dryers, and Catagmaticks being apply'd in the mean season, for conso∣lidation of the Bone it self.

IX. But if it is manifest that the parts are contused, you must apply Digestives, that the Wound being suppurated, it may be cleans∣ed with gentle abstersives, and then healed up according to Art: but in all these applicati∣ons, beware of things fat and greasy.

X. But if by reason of the Fra∣cture, the Bone is made naked of the Periosteon without any Frag∣ments or bits broken off, the Fra∣cture is first to be reduced (un∣less any Inflammation is pre∣sent) and then, it must be de∣fended from the injuries of the Air, lest it putrefie, and so you be forc'd to scale it.

XI You are to cover it, not with Oily Medicaments, nor Emol∣lients, or irritating Abstersives, which may foul or corrupt the Bone, putrefie the Wound, or cause pain; but with its natural covering, to wit, with the Flesh and Skin.

XII. And then the lips of the Wound are to be drawn together, till they touch, by stitching; after which you must proceed exactly as we have taught in the Cure of a Fracture with a Wound, in cap. 5. aforegoing.

XIII. In binding up, you must consider whether any part of the Bone will come off, or not: if none, or but a small Fragment is like∣ly to be separated, the Ligature is to be made with three Bands; and the Dressings must be as in a Fracture with a simple Wound, wherein there is the separation of some small Bone.

XIV. Now if the Bone that was made naked be presently covered with the Skin, there is none of it will come off; but contrariwise, if it be long naked and bare of Flesh, you may expect Excreti∣on: for so the Learned Hippo∣crates, de Fracturis lib. 3. Text. 44. has taught us. And Nature likewise, will cast out all such Bones as refuse, or cannot be replaced.

CHAP. VIII. Of a FRACTƲRE with a WOƲND, the Bone sticking out.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fra∣ctura cum Ʋulnere Osseque promi∣nente: and in English, A Fra∣cture with a Wound, with the Bone sticking out.

II. The Cause is from the greatness of the External violence, by which the Bone is so broken, and thrust forth of its place.

III. The Signs. It is known by sight, because the end of the na∣ked or bare Bone is visible, being thrust out beyond the Wound.

IV. The Prognosticks. It is of more difficult cure than those Fractures whose ends come not forth, because it is exposed to the Air, which corrupts the Bone; more especially if it has been any considerable time in the Air, before the Reduction.

V. The cure is harder to be per∣form'd also, by reason of its han∣ging out or over, for that in ma∣king the Reduction, the Exten∣sion must be greater; which as it will put the Patient to more pain, so it may endanger an Inflammation, A postem, Con∣vulsions, or other ill Symptoms.

VI. The Cure. If the extre∣mities of the fractured Bone, break thro' the Flesh, and stick out, thro' the Skin, you must endeavour their speedy Reduction, that they may not be altered and corrupted by the ambient Air, for then they must of necessity be cut off.

VII. In order therefore to their replacing, there must be a suffici∣ent Extension, and if occasion be, for their more easy Reduction, you must make use of a strong Iron Lea∣ven; then they must be covered with their natural Clothing, to wit the Flesh and the Skin: af∣ter which the Cure of both Fracture and Wound is to be consumated as we have before taught.

VIII. But if this Reposition cannot be easily done, or not with∣out pain and violence; then of two evils, the lesser is indeed to be chosen: and therefore that the Reduction may be made, the end of the longer Bone is to be cut off with a cutting File, or with a sharp fine Saw, or some other Instrument, that it may be made a little shorter.

IX. This done, by making a moderate Extension, you may then with your Fingers reduce the Bones to their places: if the Bones were not broken short off, and even; it will then be your best way to cut off the uneven parts of both ends, that they may the more evenly, and better join toge∣ther.

X. And truly this manner of Operation is much better to be done,

than to leave the Bones not put to∣gether; or otherwise by a too great and violent Extension to cause vehement pain, and there∣by induce an Inflammation, Gangrene, or Sphacelus, and hazard Death it self.

XI. The ends of the Bones be∣ing thus made even, you are then by a moderate Extension, and the help of your Finger, to re∣place them.

XII. But if notwithstanding this cutting, you shall yet find a dif∣ficulty in their Reduction, by rea∣son you may fear the Effects of a violent Extension; wherein, by reason of the Wound, many Fibres may be hurt, and great pain be caused, so as to endan∣ger an Inflammation, or Con∣vulsion, &c.

XIII. In this case, you must by the advice of Hippocrates, (a gentle Extension being made) put in a strong Iron Leaver, or a Chi∣zle, or some suchlike Instru∣ment, between the ends of the fractured Bone, and so raise the one, and depress the other, as with a Leaver; by which means, the Bones will be more extended than the Muscles, and so they may with little pain be reposited.

XIV. When the Bone is reduced, you must consider whether any part of the Bone will come off, or not: if it be reduced presently, nothing will come off; but if not, something may. If nothing is to come off, bind up the Part (having first laid a suppurative to the Wound) as a Fracture with a simple Wound: but if something is to come off, order the Bandage as for a Fracture with separation of a great fragment of a Bone.

XV. But because these Wound, are general, great, and contused, they are to be cured by the second Inten∣tion, and because they breed plenty of matter, they require often look∣ing to; and you ought also to cut a hole in the Bands and Plasters, just over the Wound, for the Is∣suing out of the Pus: and be∣cause this kind of Fracture for∣bids to lift up the part often, or to unbind the Ligature, you must take the middle way, which may answer the ends, both of the Wound and the Fracture.

CHAP. IX. Of a FRACTƲRE DISTORTED, or ILL SET.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura di∣storta: and in English, A Fra∣cture distorted, awry, or ill Set.

II. Many times a Fracture be∣ing ill Set, the broken Bones grow distorted or awry, by which the function or motion of the Member is much hurt or hindred, so that in

the Arms the laying hold of any thing is prejudiced, and in the Leg or Foot, a Lameness or Halting is caused.

III. The Causes. It arises either from a too long delay before the Fracture was Set, because a sufficient Extension could not be easily made, so as to set the Bones right: Or from the inordi∣nate and perverse motions of the Patient.

IV. Or from that which is ge∣nerally the chief Cause, viz. either the Ʋnskilfulness and Ignorance, or the Neglect of the Chirurgeon: This disaffection is known by sight.

V. The Prognosticks. There can be no hope of restoring the Mem∣ber to its true shape, without break∣ing of the Callus, so that the Fra∣cture may be set de novo again.

VI. The Cure. We are first to consider, whether the Callus is old or new; if it is already old, and of long continuance, and that it is grown very hard; and that the Patient also is either Cacochy∣mick, Weak, or Aged; then the best way will be not to meddle with it.

VII. For it is not then to be touched without the approach of dangerous Symptoms, which are usual to follow upon the breaking of the Callus; For which reason it is better of two Evils to chuse the less, and to be satisfied, tho' with living deformed, and for many Years so; than by a cruel and dangerous Cure, to hazard the inducing of deadly Symptoms.

VIII. Nor yet is it a thing possi∣ble, if the Callus is old, and ex∣tream hard, to break it; for if you attempt it, the Bone will sooner break in another place, than the place where the Cal∣lus is.

IX. Moreover, there would not only vehement Symptoms be indu∣ced, but the deformity or crooked∣ness of the Limb would not in the least be taken away; since that the crooked Callus could not be broken or amended, so that all this Work would be done in vain.

X. But where the Callus is re∣cent, or not above six or seven Months old, the Patient of full Age, and strong, and the fractured Bone not great, nor the function or action of the Member much hurt, the Callus may be broken, and the Bones better set together.

XI. In order then to the break∣ing of the Callus, and that it may be the more easily done, it is for some days to be fomented with a Decoction of emollient Herbs, and other softning things, as roots and leaves of Althaea, Mal∣lows, fat dried Figs, Raisons stoned, Lilly-roots, &c.

XII. And afterwards an emol∣lient Cataplasm may be laid on, such as this: In a strong Decoction of Fenugreek, and Linseed, boil roots and leaves of Althaea and Mallows, A. lbss. of Lilly-roots, fat Figs and Raisons stoned, A. ℥iv. flowers of Sulphur ℥ii. boil to a thickness, and beat all in a Mortar, to which add A tificial Cinnabar levigated ℥iii. Salt of Tartar or Pot-ashes ℥ss. mix, and apply it, renewing it Morn∣ing and Evening.

XIII. But at every dressing, and before application of the Cataplasm,

it will be good to foment the Callus for a quarter of an Hour together with this Bath: Take pure Sulphur ℥iii. melt it in an Iron Ladle, to which put Salt of Tartar in pouder ℥i. stir them to∣gether till they are incorporated; then being cold, beat all into fine pouder, and boil it in three Quarts of Water, or more, for half an Hour, and keep it for use, to foment withal.

XIV. And those who are at or near Bath, may daily go into the Hot Bath once or twice a day for some Weeks; this has been found by Experience, not only to sof∣ten the Callus, but even to waste and dissolve it, so that it may be broken with much ease.

XV. Or you may anoint with this Ointment: ℞ Ung. Dial∣thaeae ℥iss. Mucilages of Fenugreek and Linseed, A. ℥i. Oils of sweet Almonds, and of Camomil, Veal Marrow, Hens Fat, A. ʒvi. Bdel∣lium, Mastich, Turpentine, A. ℥ss. Wax, q.s. mix, and make a soft Ointment.

XVI. Also Empl. è Mucilagi∣nibus cum Gummi, è Cicuta cum Ammoniaco, è Cinnabari, Mercu∣riale, or de Ranis cum Mercurio, è Galbano crocatum, &c. are of Eminent Use in this Case, be∣cause they soften the Callus al∣most to a Miracle.

XVII. The Callus being now sufficiently mollified or softned; the Limb is by the help of two strong Assistants, to be drawn this way, and that way; and so by pulling with main strength to be ex∣tended, till the Bone seems to separate.

XVIII. Then the Artist with his Hands and Fingers is to put each Part into its true place, thrusting in that which sticks out by great force: If it will not easi∣ly yield to the Hand, he may wrap up in fine Tow, or in a Linnen-cloth, a small Bar of Iron, of an Inch or more broad, which laying upon the Distorsi∣on, he may be strong Bandage force the Bones back again to their due places, in which he is to endeavour to keep them, till the Fracture is perfectly well.

XIX. Or otherwise, the Ex∣tension is to be made till the Bone is perfectly broken: Or fixing the Member against his Knee, he may incline the Bone towards him with both his Hands, till he hears or feels it broken; after which it is rightly to be Set a∣gain, and Cured after the man∣ner of a Simple Fracture.

CHAP. X. Of FRACTƲRE with a VITIOƲS or EVIL CALLUS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in

Latin, Fractura cum Callo malo seu vitioso; and in English, a Fracture with an evil or vicious Callus; that is, in which the Callus is either lesser or greater than it should be.

II. The Causes. When the Callus is generated less than it should be, it is from scarcity or want of that thicker Nourishment, with which the Bones are to be nourished, and of which the said Callus is bred: And this scarcity or want, is either from too spare a Diet, or not eating those things which are most fit for the breeding of a Callus.

III. Or it may be from the too straight or hard binding up the fractured Part; or from Medi∣caments over-astringent, which hinder the affluence of the Nou∣rishment.

IV. When the Callus is genera∣ted larger than it should be, it is either from an over-abundance of the thick boney Nourishment; or from the too loose Bandage of the Fracture; or from giving the Osteocolla-Stone too plenti∣fully.

V. For such is the Nature and Property of this Stone, to generate a Callus, which it performs easily and speedily; and therefore if it is given too much, it causes the Callus to over-grow, or exceed its due proportion; and there∣fore is more fit for elderly or aged Persons, and such as are of ripe Years, than for such as are very young, or yet in their Youth: For if it is given unto these, it generates (as Fabri∣cius Hildanus observes) a Callus greater than it ought to be.

VI. The Signs. When the Callus is less than it ought to be, it is known by touching, wherein it is felt not at all, or but very small; the aforegoing Causes went also before, and the Member is also very feeble or weak, in its mo∣tion or action.

VII. When the Callus is also greater than it should be, it is known also by touching, wherein it is felt tuberous, or greater than it should be; the aforegoing Causes went also before, and there is a pain from the Compression of the Muscles and Nervous Parts, for which reason the Part is rendred less useful in its action or motion, especially if the Fracture be near a Joint.

VIII. The Prognosticks. Whe∣ther it be ex deficiente, vel ex abundanti, if it is recent, it may be reformed and cured; but if it is inveterate, or old, whereby it is grown hard, and the Pores thereof closed, it will be reme∣died with much more difficulty.

IX. The Cure, where the Cal∣lus is deficient. The Diet must be fuller, and of greater Nutriment, generating a thick and viscid Juice, of what kind are Neats-feet, Calves-feet, Sheeps-trotters, Sheeps-gathers; also Gellies made of them either in Milk or Water, and made savoury and pleasant.

X. Add to these things strong Broths of all sorts of Flesh both of Beasts and Birds: Pork, if young, is a singular good Food, also knuckles of Pork, and knuc∣kles of Veal; and their Bread may be a white sort of Bisket.

XI. The Bandage is to be loos∣ned,

and done up slacker, that there may be more room for the affluence of the Nourishment, which that it may be attracted to the Part, it is to be bathed with warm Water till the Part ap∣pears red.

XII. And then attractive or drawing things are to be applied, as Dropacisms, &c. which mo∣derately heat, and draw the Nourishment to the place af∣fected.

XIII. Inwardly you are also to give the Osteocolla-Stone leviga∣ted, ad ʒi. Morning and Evening in Comfrey-water, or rather in strong Meat Broth, or in Alicant; for that as Fabricius Hildanus Cent. 1. Obs. 90. says, it has a singular Virtue in generating a Callus.

XIV. The Cure where the Cal∣lus is abundant. The Diet is to very sparing, and such as gene∣rates not much Nourishment; and such as yields rather a thin, than a thick clammy Juice.

XV. It must be fomented, and often bathed with emollient and discussive Medicaments, as a Fo∣mentation of hot Water nitra∣ted, or of Emollient Herbs and Roots, as of Althaea, Mallows, Pellitory of the Wall, Beets, flowers of Cammomil and Meli∣lot, roots of Briony and Lillies boiled in half Water, half Wine, &c.

XVI. You may foment also with the Bath-water, and apply the Cata∣plasms which are described in Cap. 9. Sect. 12, and 13. aforegoing, and you may anoint with the Ointment in Section 15. there following, all which things have a great power to soften and dis∣cuss.

XVII. Sennertus commends this: ℞ Goose, Bears, and Mans Fat, A. ℥ii. juice of Earthworms ℥i. Ammoniacum ʒi. mix them. It will be so much the better if Vipers Fat ℥ii. be added to it.

XVIII. Also this Fomentati∣on: ℞ Roots of Althaea ℥i. roots of Briony, of white Lillies, Fenu∣greek and Linseed, A. ℥ss. flowers of Althaea and Mallows, A. M. j. flowers of Camomil and Melilot, A. Mss. boil in Water, Vinegar, and wine, for a Fomentation; and of the Mass make a Cataplasm.

XIX. These Fomentations are to be used, not till the Part grows red and swells only, but also till it falls again, and becomes lank and wrinkled.

XX. And if the Patient is near Bath, it will be good to bathe daily twice a day, till it is softned, wasted, and much diminished, as we hinted in Cap. 9. Sect. 14. aforegoing.

XXI. Also the Emplasters or Cerates mentioned in Sect. 16. of the same Chapter, may be here ap∣plied, which may be bound fast on, and renewed as you see oc∣casion, till the Callus is suffici∣ently diminished.

CHAP. XI. Of a FRACTƲRE with WASTING of the PART.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fracturacum Atrophia; and in English, A Fracture, with a slenderness, wasting or con∣sumption of the Part.

II. It oftentimes happens that in Curing of a Fracture, the Limb or Member becomes slender or wast∣ed, as if it consumed away, which we call an Atrophia of the Part: This happens both in old and young, but chiefly in such whose Flesh is soft and tender, and not come to the hardness or firmness of a full or well-grown Body.

III. The Causes. It is caused from the hindering of Nutriment coming to the Part, which is done by the too long and hard binding of the Part; by means of which the Arteries and Veins carrying the Aliment, are nearly closed up.

IV. Or it may be caused from the Folly or Poverty of the Sick, when he has not Food enough, or what is convenient for him to nourish him withal.

V. And sometimes it is caused by a long-continued rest of the Mèmber or Part, and its cessation from motion; or at least, this thing may add to the other Causes, to make them more Po∣tent in effecting this disaffection.

VI. The Prognosticks. It is known by sight; and therefore if it is recent, and in young, tender and growing Bodies, it is easily Cu∣red: But if it is of long stand∣ing, and in a Body done grow∣ing, it is Cured with much difficulty: If the Patient is very Aged, it is Incurable.

VII. The Cure. In order to this Cure, you must endeavour to remove the Cause; you must order a full and nourishing Diet, and such things chiefly which may agree with the Stomach of the Patient, and may corroborate or strengthen it: Of which kind are Gellies of all sorts, and strong Broths made savoury, and also a little acid with Juice of Limons, which gives to the Nutriment a pene∣trating quality.

VIII. You must also use and ap∣ply those Means which may attract or bring the Aliment into the Part; you must slacken the binding: And when you dress the Fra∣cture, the Part is to be fomen∣ted with such things as dissolve Congelations, and withal, may draw the Nutriment into the Member affected.

IX. You may bathe with the Powers of Amber, of Limons, La∣vender, Rosemary, Savin, or Sou∣thernwood; after which you may anoint with this Oil: ℞ Oils of Amber and Aniseed, A. ℥i. Oils of Juniper-berries, of Ben, and of

bitter Almonds, A. ℥ss. mix them.

X. Or, ℞ Oils of Costus and Camomil, A. ℥ss. Oils of Castor, and of Neats-feet, Mans Grease, Ung. Martiatum, A. ℥i. mix, and make a Liniment: This is good for broken Bones, which grow not as they should do.

XI. And over all you may apply Empl. Piceum, or some other powerful Dropacism, or Sina∣pism, which have a strength in them to attract the Aliment powerfully.

XII. Also inwardly you must give such things as resolve and open Obstructions, even the most inveterate; among which we com∣mend to you, Spiritus Aperiens, Spiritus Nitratus, volatil Salts of Harts-horn, of Vipers, and of Mans Skull, volatil Sal Armo∣niack, Ens Veneris, Salt of Tar∣tar, of Tamarisk and Worm∣wood, Salt or Vitriol of Mars, and Tincture of Mars made with Wine grown acid, or with Spi∣rit of Nitre.

XIII. To these things you may add Powers of Amber, of Ani∣seed, of Caraways, of Cloves, of Fennel, of Lavender, of Li∣mons, of Origanum, of Marjo∣ram, of Rosemary, of Sage, of Savin, of Sassafras, of Tyme, &c. given in a fit Dose in Canary twice or thrice a day.

CHAP. XII. Of a FRACTURE of the SKULL.

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

II. The Kinds. Fractures of the Skull are said to be sixfold, viz. 1. A Simple Fracture (of which we Treat in this Chapter only.) 2. A Fissure. 3. A Con∣trafissure, (both which we Treat of in Chap. 13. following.) 4. A Contusion of the Skull, (Treated of in Chap 14. next after.) 5. An Incision. 6. A Puncture; (both which are Trea∣ted of in Chap. 15.)

III. The Definition. Now a Simple Fracture, is that which se∣parates (by breaking) a Part from the whole.

IV. The Signs. If the Wound is large, the Fracture may be found out by feeling with your Fin∣ger, but if small, by the Probe; in both which trials, an inequa∣lity, depression, or ruggedness of the Skull, will be felt: But ruggedness may sometimes de∣ceive you, if the Sutures vary either in form, or in place; as if the Sagittal Suture reaches to the Ossa Ethmoides: And that the Suture may sometimes de∣ceive us, Hippocrates, de Capitis vulneribus, Sect. 6. testifies: The Suture, (says he) may de∣ceive us, for that it is rougher than the rest of the Bone.

V. You are to consider the Per∣son inflicting the Wound; if a strong Person, and furiously done; if the Weapon was sharp, or great, or heavy; or if the Patient fell from some high place; if the Head (chiefly when bare) was struck against any hard Body, Post, or Stone; if the Blow was violent, or the Skull was weak or thin, as in Children, and such as are not yet come to their growth; all these things going before, shew the probability of a Fracture.

VI. There are also concomitant or conjunct Symptoms, as, 1. Bleed∣ing at Mouth, Nose, Ears, Eyes. 2. Deafness, or Noise in the Ears. 3. Vertigo, or Swimming of the Head. 4. Falling down suddenly after the Blow. 5. Slumbering after the Wound is received. 6. Vomiting, or Loathing. 7. Swooning away, and often Fainting. 8. Dumb∣ness sometimes, or loss of Speech. 9. Convulsions, Palsey, Fever, and Raving. See Paraeus, lib. 9. cap. 2. And Fallopius, in Hip∣poc. de Vulneribus Capitis, cap. 18.

VII. There are also Consequent Symptoms, as, 1. A constant Pain in the wounded Part. 2. A continuing Deafness. 3. A fre∣quent Vomiting of Choler. 4. Hurt or Dulness of the Judgment or Understanding. 5. A Fal∣tering in the Speech. 6. An Hurt of the Memory. 7. A Con∣tinual Fever. 8. Convulsions, or Convulsive Motions. 9. Fren∣zy or Raving. 10. A Palsey in one of the Arms, or Legs. 11. An Apoplexy, either per∣fect or imperfect.

VIII. Hippocrates has another Sign, taken from the crashing, which, he says, the Patient feels, if he chews Paper strongly on both sides of his Teeth: Or if he holds a Packthread strongly between his Teeth, and it be strongly struck, the wounded Patient will feel Pain in the Part. But Fallopius, in Hippocr. lib. de Vul∣neribus Capitis, cap. 23. makes some doubt of these Signs, not accounting them certain.

IX. But if the Hair is cut asunder, and sticks up in the Wound, the Skull must then ne∣cessarily be hurt; because it could not be cut asunder, without the resistance of the Skull.

X. The Prognosticks. You are to gather these from the Sym∣ptoms; yet let a Fracture of the Skull look as fair as may be, it is never without danger; but cer∣tainly more perilous, if both Tables are broken; yet more dangerous, if the Dura Mater be hurt; and most of all, if the Pia Mater be affected too.

XI. And Hippocrates, Prorrhet. lib. 2. advises us, That we carry our selves prudently in every point of Art, but in the Predictive part chiefly; calling to mind, that if the Event comes to pass according to our Presages, we shall be admi∣red, or have an Estimation with the Patient; but if we mistake, or presage false, we shall be ac∣counted Ignorant, and Despised; wherefore he advises us to use Discretion in our Prognosticks.

XII. Wounds with a Fracture of the Sinciput, or Forehead-bone, are more dangerous than those of the Occiput. 1. Because they

are thinner than those of the Occiput, and weaker. 2. Be∣cause there are several Cavities or Vaultings in them, by which the Brain is more easily wound∣ed, if the Fracture pierces both Tables. 3. Because there are many large Blood-vessels in the Forehead, which may endanger the greater Hemorrhage. 4. Be∣cause the most of the Brain is contained in the forepart. 5. Be∣cause the Skin is thinner in this part, whereby the Skull and Meninges may the more easily be hurt. 6. Because the Su∣tures Coronalis & Sagittalis, are in the forepart of the Head, so that the Skull being there broken, the Dura Mater (which sends filaments thro' the Sutures to produce the Pericraneum) may easily be hurt.

XIII. The Ossa Temporum be∣ing broken, are next in danger, be∣cause these Bones are very thin and weak; and they are repleat with remarkable Arteries, Veins and Nerves; also the Pericraneum does embrace the Temporal Mus∣cles, which Muscles have within, in their middle, a Tendon of exquisite sense, so that a Wound and Fracture in this Part may easily, even by consent, offend the Meninges, and the Brain, also the Nerves springing from it.

XIV. But a Fracture upon the Sutures, with a Wound within the Skull, or without it, is most dan∣gerous, 1. Because the Bones are not of a whole, but divided Sub∣stance, and so least able to re∣sist force. 2. Because Pus bred there, may easily fall upon the Dura Mater. 3. Because in the Sutures, the Dura Mater may be affected by consent.

XV. A Fracture being made, there is first Pain by reason of the solution of Ʋnity. 2. Watching, less of Appetite and Weakness. The Pain will cause a flux of Humors, the Fluxion will cause Inflam∣mation, and the Inflammation will cause a Fever, or a Con∣vulsion; sometimes a Gangrene, or a Mortification, if not pre∣vented.

XVI. In a Fracture of the Skull, you are not to think all the danger to be past, before an hundred days are gone over; for Experience has testified, that many have died at the end of that time, even when they thought all things to be perfect∣ly well. Fallopius, in Hippoc. de Vulneribus Capitis cap. 48. Pa∣raeus, lib. 9. cap. 13.

XVII. The Callosity which joins together the broken parts of the Skull, does require 20 or more days to be generated, and after that about 30 or 40 days more, for the hardning and confirming of it; but the Age, Strength, and good Temper of the Sick, have a great force in hastening the Confirmation of the same.

XVIII. It is very dangerous, if after a Fracture a Fever ensue; if the Head becomes very hot, if the Sick has been subject to a Catarrh; or if he has been of∣ten afflicted with an Erysipelas; so also if the Lips of the Wound swell not, or grow flat, there is yet more danger.

XIX. If the Skull at the very beginning of the Cure becomes or

appears blackish, and the Patient (having a Scorbutick, Cache∣ctick, or Cacochymical habit of Body) cannot sleep, but is trou∣bled with much watching, Death is not far away. Fallopius, in Hippoc. de Vulneribus Capitis, cap. 24.

XX. If the Flesh about the fractured Skull, is of a black Co∣lour, becomes dry, and affords not Pus enough in proportion to the magnitude of the Wound, it is dan∣gerous, for it is a sign of the Sphacelation of the Part.

XXI. If the Patient is wholly void of a Fever, if he digests his Food well, sleeps well, with a good excretion of Excrements of no ill Colour, nor offending in Sub∣stance or Consistency, Quantity, Time, or other Qualities, there is great hopes of Recovery.

XXII. So also if the Wound looks of a fresh and lively Colour, yields a good sort of Pus, or Mat∣ter; if its Lips swell a little, and are somewhat soft, and the motion of the Dura Mater is regu∣lar, there is great hopes of the Patients doing well. Paraeus, lib. 9. cap. 13.

XXIII. If much Pus appears upon the broken Skull, or there are Pustules upon the Tongue, from an acrid Sanies falling down upon it from the Brain, thro' the Fora∣mina of the Palate of the Mouth, the hopes of Recovery will be but small; more especially if these Acoidents continue, and cease not; for they shew the Brain it self to be ill affected. Paraeus, lib. 9. cap. 10.

XXIV. If the Occiput, Os Petrosum, or stone-like Bone be∣hind the Ears, be wounded or fra∣ctured, the danger is the less; 1. Because they are least subject to Injuries. 2. Because the Bone behind does contain only the Cerebellum, which is not so no∣ble as the Brain. 3. Because less quantity of Brain is contain∣ed in those places, than in other parts of the Cranium. 4. Be∣cause those Bones are thicker. 5. Because they are more firmly covered; for the Skin on them is thicker, the Flesh more plen∣tiful, the Ligaments are also strong, to strengthen the Bones.

XXV. Every Fracture of the Skull, with a Wound in the Head, is dangerous, tho' no dreadful Sym∣ptom does at first, or for many days appear; for the strength of the Patient, the soundness of the Body, cleanness of the Hu∣mors, wholesom and moderate Diet, and temperateness of the Air and Clime, do all contribute for the staving off of ill Sym∣ptoms, for a pretty long time.

XXVI. In a Fracture of the Cranium, the Parts above it must suffer a solution of Continuity, except only in a Contrafissure; for in that the solution of Unity is in the opposite place to the Fissure, viz. in the place where the Blow was made.

XXVII. Hippocrates, Sect. 7. Aph. 2. says, That if the Flesh about the fractured Skull appears of a livid or leaden Colour, it is an ill sign; for it is an Argument that the Natural Heat of the Part is extinguished by some malign Humor, which has caused the Putrefaction of it, or by some vehement Inflammation: But if

it becomes of a leaden Colour, by reason of the greatness of the Con∣fusion, it is not so dangerous, be∣cause the Evil may be prevented by application of Digestive or Suppurative Medicaments.

XXVIII. If the Memory is im∣paired, the Reason is hurt, the Tongue falters, the Eyes grow dim, the Ears grow thick of hearing, or deaf; if the Sick cannot move himself, or sinks from the head of the Bed downwards, and a conti∣nual Fever with raving is present; if either the Tongue grows black, of Clefts, or Pustules appear upon it; if the Wound grows dry, and yields no Pus or Mat∣ter, or becomes of a livid Co∣lour; if the Excrements be sup∣pressed, a Convulsion, Palsey, or Apoplexy do ensue, with a weak Pulse, and often Faint∣ings away; if all, or most of these Symptoms are present, or do appear, you may boldly pre∣sage that Death is at hand.

XXIX. These Symptoms if they appear presently after the Wound is received, bespeak, that the substance of the Brain is hurt; but if they are manifest about fourteen days after, more or less, they cause an Inflammation and Phlegmon of the Brain, by reason of the great Effusion of putrified Blood upon it. Pa∣raeus, lib. 9. cap. 12.

XXX. Some escape, who have great and dangerous Fractures of the Skull; others again die, where the Fracture is small, and but slight to all appearance; but this is caused, 1. From the strength or weakness of the Bo∣dy. 2. From the differences of the Parts hurt, some being more Sensible, or full of Vessels, or more Noble than the other. 3. From the diversity of Sym∣ptoms, some being more gentle, others more vehement; of which you may see Examples in Hip∣pocrates, Epidem. lib. 7.

I. Of Fractures of the Skull in Children.

XXXI. The Cure. They are either without a Wound, or with a Wound. If they are without a Wound, nor any fearful Symptom at∣tending; but the Skull is depressed, and an effusion of Blood out of the Veins, does wave up and down un∣der the Skin, when it is com∣pressed, (which falls out some∣times in hard Labour) the Hair is to be shaved off, and a soft Linnen-cloth 3 or 4 times dou∣ble, and well dipt into a Mix∣ture of Oil of Roses, whites of Eggs, and Vinegar, is to be ap∣plied to the Childs Head, and to lie 24 Hours before it is removed.

XXXII. If it is in the heat of Summer, it is to be applied cold; but in the Winter time, or cold Weather, it must be warm: This will repress or hinder the flux of Humors for the future, and dis∣cuss those which are already upon the Part.

XXXIII. After this, to the twelfth day, this Cataplasm is to be applied warm. ℞ Catechu, Myrtle-berries, red Boses, Samach, A. ℥iss. Barley and Bean flower, Rice-meal, A. ℥i. dried Sou∣thernwood, and Wormwood, A. ℥ss. Caraway and Fennel seeds, A. ʒiss. all being in fine pouder, boil them

in rough red Wine ℥xiv. to the consistency of a Cataplasm, adding afterwards Honey ℥ii. Oil of Ro∣ses ℥iss. mix them.

XXXIV. Apply it large enough to cover some of the adjacent parts; not too little of it, lest it grow dry, nor too much, lest it hurts by it's weight; and warm, that it of∣fends not by its coldness, and let it be renewed Morning and Evening.

XXXV. And from the 12 to the 24 day, you may apply Empl. Album, malaxed with Oil of Roses, adding ℥i. of the Oil to ℥iv. of the Emplaster. After the 24 day, you may apply Sticti∣cum Paracelsi, malaxed with Oil of Roses in the former propor∣tion, till the Cure is complea∣ted.

XXXVI. Arcaeus, lib. 1. cap. 5. advises to dress Childrens Heads thus: For the first dressing, ℞ Vinegar ℥ii. pouder of Myrtle-berries ℥ss. Barley and Bean flower, A. ʒiii. mix, and boil to the con∣sumption of a Cataplasm, adding one Egg, white and yolk beaten to∣gether, with Oils of Roses and Myrtles, A. ʒii.

XXXVII. Afterwards, a Ce∣rate made of Wax, Honey, Lapis Haematitis, Pumice-stone, Cumin-seeds, Wormwood, and Wheat∣meal, is to be applied; or in∣stead thereof Diachylon malaxed with Oil of Lillies, to be applied as the former.

XXXVIII. If there is a Wound with the Fracture, but without dangerous Symptoms, if the shivers or fragments of the Cranium stick together, Arcaeus will have them by no means to be taken forth, but the Fracture only to be anointed with his Liniment warmed, and applied with 3 or 4 Feathers, stripped till you come within an Inch of their ends, and tyed together with a Thread.

XXXIX. If dangerous Sym∣ptoms are present, as vomiting of Choler, Fever, Convulsion, Pal∣sey, &c. by which we know the Brain to be affected, the Cranium is then to be opened: Fallopius, in Hippoc. de Vulneribus Capitis, cap. 47. and Langius, his Epi∣stles, Tom. 1. Epist. 5.

XL. The Skull being opened, these Wounds and Fractures in Children, are no otherwise to be dressed than those in full-grown Persons, which in the following Discourse we shall at large de∣clare.

II. Of Fractures of the Scull, in grown Persons.

XLI. In every Fracture of the Skull, we are to consider how it may be Cured: It is either with∣out a Wound, and then we are to consider, whether or no the soft parts above the Skull are to be opened by Section: Or it is with a Wound, and then we are to consider, whether the Skull is to be opened or not; and if it is to be opened, by what Arti∣fice it is best to be done.

XLII. If the Fracture is small, and no evil Symptoms suddenly follow upon it, but that in a few days the depression of the Skull risea up again of its own accord, without any Inflammation, or other Tumor in the fleshy Parts, the opening may be forborn safely

till you see farther; for many times Nature her self, (being assisted with some proper To∣picks) makes a Consolidation of the Bones.

XLIII. But if the Fracture is great, or very manifest, with evil Symptoms present, or seeming im∣mediately to follow, there is a necessity then of making an In∣cision into the fleshy Parts, even to the Skull; and this by the Authority of Hippocrates, Galen, Celsus, and other the Ancient Physicians.

XLIV. If Blood or Pus falls upon the Meninges, or the Brain, Death will suddenly follow after, if a way is not presently made for their Evacuation, by an Incision of the fleshy Parts, and opening of the Skull; and this daily Expe∣rience shews us, thro' the omis∣sion of these Operations.

XLV. Now the Reasons for this Section or Incision, are, 1. That if dangerous Symptoms are pre∣sent, the Skull it self may be viewed, whether it be hurt or not. 2. For the removal of such things, as Blood or Pus, which may offend the Mem∣branes, or Brain; also pieces of the Weapon wounding, or Frag∣ments of the Skull it self prick∣ing those Parts.

XLVI. As to the places where this Incision is to be made. It may be made in all the parts of the Hairy-scalp, the Sutures, and the Temporal-Muscles only ex∣cepted.

XLVII. The Sutures are to be avoided, because the Filaments or Fibres by which the Meninges are joined to the Pericranium, are of an exquisite Sense, which being wounded, may be inflamed, and by consent of Parts, communi∣cate the Inflammation to the Membranes of the Brain, and Brain it self. Fallopius, in Hip∣de Vulner. Capitis, cap. 19.

XLVIII. The Temporal Muscles are to be avoided, 1. Because a Paralysis will be caused on that side the Head, on which the Wound is made, and a Convul∣sion on the other side, by which an uncomely Distortion of the Face will be made. 2. Because if the Incision is made trans∣verse, (which is the most dan∣gerous) it will scarcely ever be healed; for that it is almost always in motion, when we eat, drink, or speak. 3. Because the Sutura Squammosa lies under it, which is to be avoided for thereason in the former Section. 4. Because many Arteries, Veins, and Nerves are spread through∣out it; and if they should be transversly cut, many dangerous Symptoms would ensue, as ve∣hement Pain, Inflammation, Fe∣ver, Convulsion, and great He∣morrhage, also Fainting, or Swooning, because of the want and emptiness of the Vessels containing the Vital and Ani∣mal Spirits. Paraeus, lib. 9. cap. 19. Pallopius, in Hipp. &c. cap. 38.

XLIX. As to the form of the Incision; the Hair being shaved off, you must make it cross∣wise, and then with a Chizel, or sharp point of an Incision-knife, and beginning at the points of the Incision, take all up to the Cranium; then the

Pericranium is to be separated from the Cranium, either with your Nails, or with some other proper Instrument; and you are to begin the Separation from the points of the Incision.

L. If the Pericranium is not separated, it will induce great Pain, and an Inflammation, and possibly a Fever, more especially if it is torn with a Raspatory or Trepan. Paraeus, lib. 9. cap. 4.

LI. But this is to be considered, that no transverse Incision be made a little above the Eye-lids, lest the Frontal Muscle being cut asunder transversly, the Eye-lid should not be lift up, or a Palsey should hap∣pen to the same; for which rea∣son, in these places the Section must either be strait or oblique. Fallopius, in Hippoc. &c. cap. 23.

LII. As to what is to be done after the Incision. Care is to be taken to have all things necessa∣ry in a readiness, to stop the bleeding. The Lips of the Wound are to be kept asunder with Dossels and Pledgets of Lint armed with Stypticks or Astrin∣gents, if an Hemorrhage is fear∣ed; otherwise (according to Arcaeus, lib. 1. cap. 4.) only with the white of an Egg beaten; or if to ease Pain, with the white and yolk beaten together, according to Fallopius, in Hip∣poc. &c. cap. 29. and being thus drest up, it is not to be meddled withal for the space of 24 Hours.

LIII. In the mean season, you must be sure to give inwardly such things as strengthen the Heart, and fortifie the Animal Spirits; for which purpose we commend to you, Tinctures of Coral and 〈◊〉〈◊〉, Syrups of Corals, and Pears, and of the Juice of Citrons or Limons, Bezoar Stone, Bezoar Animal, volatil Salts of Vipers, of Harts-horn, and of Sal Ar∣moniack, Spirits of Angelica, Anise, Bawm, Caraways, Mar∣joram, Mint, Limons, Oranges, Sage, Time, Tinctures of Saf∣fron and Cochinele, Juice of Alkermes, &c. given with Sy∣rup of Juice of Pomgranates, or of Citrons, mixed with Mint-water.

LIV. These things being done, we now come to the Fracture it self, and to the opening of the Skull, which is to be performed in due time, in a proper part, and with fit Iustruments, as we are even now going to de∣clare.

LV. The Reasons why the Skull ought to be opened. 1. That the pieces of the Weapon, or shi∣vers of the Bone may be taken away. 2. That the part of the Skull wholly broken off may be removed; or if yet joined to the rest of the Bone, it pricks or hurts the Meninges. 3. That if the fractured Part be only de∣presied, it may either be redu∣ced or taken away. 4. That if either Blood or Pus be fallen upon the Membranes, thro' rup∣ture of some Vessel, it may be taken away. 5. That way may be made for the application of fit Medicaments.

LVI. The time in which the Skull ought to be opened. Fallopi∣us, loco citato, cap. 34. Arcaeus, lib. 1. cap. 4. and Paraeus, lib. 9. cap. 4. say, that it ought to be opened before the fourth day:

but it is sometimes opened with good success after the seventh day, both in Summer and Winter.

LVII. If then you are called to one of these Fractures on the fourth day, you may defer it 'till the seventh day, yea 'till the ninth is past, if ill Symptoms force you not to open it sooner: for on the fourth day the putrifaction of the Hu∣mors begin, as also the contest of Nature against the Disease; in which time, it is not good to obstruct Nature, or trouble her in her work: yet if you fear de∣lay may breed danger, you are presently to do it, even on the Critical Day.

LVIII. The Place, where it ought to be opened. In those Fractures where a part of the fractured Scull is to be taken away, for the discharging of the Blood or Sanies, &c. it is to be done on the depending part; except, 1. The Meninges be inflamed, whereby they may be apt to swell above the Cranium. 2. When the Membranes are also woun∣ded, so that the Brain appears: in this case, opening on the depending part is to be avoided; for the Brain being of a soft and fluid substance, it would be apt to fall down to the Hole or Opening, or fall out. Fallop. libro citato, cap. 35.

LIX. The Quantity of the Scull, which ought or may be taken away. Either the whole fractured piece is to be taken away, or only a part of it. If in a Fissure or Cut with an edged Weapon, the passage is not wide enough, the whole Bone which is seen, is to be removed.

LX. If the Fracture is in the Scull, as on the Vertex or Crown, where no depending Hole can be made to evacuate the Blood, Sanies, or Pus from the Meninges, the whole piece also is to be taken away: and all the shivered or splintred Bones which cleave not together, are also to be removed.

LXI. Otherwise, so much of the Scull only is to be removed; as co∣vering the Dura Mater becomes black: and so much as may make way for the application of pro∣per Medicaments.

LXII. The Chief Instruments with which the Skull is to be opened: These are, 1. The Rasp. 2. The Levator. 3. The Head-Saw. 4. The Terebellum, or Gimblet. 5. The Trepan.

LXIII. 1. The Use of the Rasp You may have several sorts of this Instrument, narrow and broad. First, placing the Patient in a good posture, wrap up the Head in folded Cloths, stop the Ears with Cotton, that the noise may not offend them; and cover the lips of the Wound with rags of Linnen Cloth, to defend them from the Air, and keep them from the Instruments touching them.

LXIV. Then, the Head being laid, and kept immoveable, make use first of the broadest Rasp, then of that which is narrower, and lastly of the narrowest: and that they may cut the better, let them be often moistned with Oil of Roses, that they may rasp the easier, and not heat the Scull: if Blood comes upon your Work, use a mixture of Vin∣egar and Water.

LXV. They are of use in Fis∣sures or Clefts of the Scull, and in Cuts with an edged Weapon; when the narrow point of the Weapon is left behind in the Bone: now after the Rasps are used, you must make use of the same Applications which are used after the Trepan.

LXVI. 2. The Use of the Levator. You may have them of several bignesses and strengths, and of divers forms; such as you may see in Paraeus, lib. 9. cap. 4, & 5. When you use them, you must be cautious, that you gently and equally lift up the Bone, and every part of it which is to be lifted up: for if any part of it be left depressed, it may hurt the Dura Mater.

LXVII. 3. The Use of the Head-Saw. It is to be used, when there is a Depression, or a Fracture on one side of the Bone: for one side being divided by it, in a streight Line, there will be way made both for the taking away of the Bone, and for the dis∣charge of Blood, Sanies, or Pus, with very little loss of the sub∣stance of the Scull: it also serves to cut asunder the distances of the Scull, which are left after the application of the Trepan in se∣veral places.

LXVIII. 4. The Use of the Terebellum, or Gimblet. This is an Instrument which Coopers use, to raise up the slaves or heads of Vessels: it has a screw-point, which by turning, and pressing upon it as it is turned, fastens into the Bone, and so helps to pull the piece out of it, after it is in part cut by the Trepan; for that it is not safe to cut the whole Cranium thro', as in the Bones of the Forehead.

LXiX. It has another use also, which is for reducing, or raising a depressed part of the Scull; by first making a small hole therein with the Pin of the Trepan, and then screwing it in.

LXX. 5. The Use of the Tre∣pan. The Ʋses for which it is applied, are threefold: viz. 1. To remove all such things which may hurt the Membranes and the Brain; as Blood, Sanies, Pus, Shivers of the Bone, bits of the Weapon, &c. 2. To raise up a Bone, depressing the Menin∣ges and Brain, &c. 3. To make way for the application of Me∣dicaments.

LXXI. The Places to which the Trepan may be applied. 1. It ought not to be applied upon the Fracture: for it will increase the mischief, especially if there are many fractured Fragments. 2. Nor is it to be put upon a Suture: for so the Neurotick Fibres, as also the Arteries and Veins, by which the Dura Meninx is joined to the Pericranium, and which give nourishment to it, would be lacerated or torn; from whence would come great Pain, Inflammation; and Hemor∣rhage; which being communi∣cated to the Membranes and Brain, might much hurt them. 3. Nor is it to be applied to the Temples; because of the Tempo∣ral Muscles and Sutura Squam∣mosa. 4. Nor to the places a little above the Eyebrows; because it would scarcely ever after heal, or be skinn'd. 5. Nor to the Sin∣ciput

in Children, not above seven years old; for that it is dan∣gerous to apply it there, in such as are of ripe age. 6. Nor yet to the lower parts of the Scull; especially if the Membranes are wounded; left the Brain should press out thro' the Foramen or Hole.

LXXII. The Way of applying the Trepan. 1. Take out the Pin, when you are come to the se∣cond Table. 2. Let it be moist∣ned with Oil, that it may cut the better. 3. The way the Trepan has made is to be now and then moistned with cold Water, lest by the sawing of the Trepan, the Scull should be healed. 4. You are to wipe away the Blood with a piece of Spunge, that you may see which part is deepest cut, and so lean hardest upon the other side. 5. When the Part cut by the Trepan begins to shake, your safest way will be to lift it up with the Levatòr. 6. If there be any ragged or pointed Fra∣gments, which may hurt the Membranes, they are to be taken away with the Scalptor lenticu∣latus, or the hollow Scraping. Levatory, (see it, Tab. 6. K.) 7. The Piece being taken out, the Wound and Fracture are to be drest with proper Topicks, as we shall presently teach you. See Lib. 1. Cap. 2. Sect. 3. ad 11. of this present Sixth Book.

LXXIII. Now because the Tre∣pan cannot well be applied, without a true knowledge of the Cranium, we shall here give you a short Description of it. First, the Hairy-Scalp presents it self; in which there is to be consi∣dered, its Sense, Thickness, Ves∣sels, and Muscles which lye under it. The Hairy-Scalp is thinnest on the top of the Head, nor is there any Muscle between it, and the Scull on that part; except you will call the Membra∣na Carnosa a Muscle, which some Anatomists of late do, and it may be not improperly, because by it, many Men move the whole Scalp.

LXXIV. If a Fracture is to be feared, there, viz. in the Vertex, you may boldly cut into the Hairy-scalp, because it is of a dull Sense, and easily healed up again: but be cautious of making an Inci∣sion into the Forehead; where a transverse Wound may cause the Eyebrows to fall over the Eyes: for which cause, if you are forced to make an Incision, let it be according to the length of the Fibres: nor make any Incision on the Temporal Mu∣scles, because Convulsions and other ill Symptoms may happen.

LXXV. Ʋnder the Hairy-scalp lyes the Pericranium, which you are to cut thro', in making way to the Cranium: you are to raise them both together, when you lay the Cranium bare for the use of the Terebra or Trepan: for in tearing this Membrane, great Pain, Inflammation and Fever may follow; as we have before told you.

LXXVI. Now follows the Cra∣nium it self, which is a concave or hollow Bone, composed of many parts joined together by Sutures; of which there are five which chiefly concern us, viz. three

true ones, the Coronalis, Lam∣bdoides, and Sagittalis; and two false ones, Suturae Nothae; which two, and chiefly to be regarded, are the Squammosae, that run under the Temporal Muscle on each side, round about the outermost Verge of each Ear.

LXXVII. Thro' the Sutures, the Dura Mater passes, and is con∣tinued with the Pericranium: the Sutures also divide the Bones so, that if one part of the Scull is broken, the other may be preserved whole or intire, which otherwise would be in much hazard: these Sutures are also weak in re∣sisting of Blows, or great exter∣nal Force; and between them Pus or Matter may be unhappi∣ly retained, and cause a Caries, and sooner work thro' the Dura Mater, than in the other parts of the Scull.

LXXVIII. Now the way to find these Sutures out, is by drawing a String cross the Head from Ear to Ear; and another from the Nose to the Crown of the Head: the for∣mer of these will shew the Sutu∣ra Coronalis, the latter the Su∣tura Sagittalis, which usually begins at that Point where these Lines intersect; being the Part where Fontanels or Issues are made, and reaches to the Crown of the Head, joining to the Lam∣bdoides; sometimes beginning just at the Nose.

LXXIX. The Lambdoides rises at the end of the Sagittalis, and goes forked down the two sides of the Occiput.

LXXX. Now this is to be ob∣served, that the Cranium is thin∣nest in the middle part of the Head, thickest in the hinder part, and of a middle thickness in the Forehead: for which reason it is, that Wounds are most dangerous on the Crown of the Head, where the Scull by reason of its thin∣ness, easily communicates its Injuries to the Brain; as also for that the uppermost part of the Brain there, lieth high, as it were imbossed; one of the largest cavities being imme∣diately under the Scull, and many Capillary Veins running so close with it, as to make them∣selves Trenches in the concave parts of the Cranium: for which reason, upon a Blow, Contusion, or Fracture in this place, the Veins may easily be broken, and the Blood extravasated between the Cranium and Dura Mater; whence ill Accidents easily follow.

LXXXI. The Dura Mater lies next under the Scull, and under that the Pia Mater, upon the sub∣stance of the Brain; of which see Lib. 4. Cap. 27. Sect. 4, & 5. under the Pia Mater lies the Brain, in whose Ventricles is lodged the Plexus Choroides, and under whose Basis lye a great number of branches of both Arteries and Veins, which by great blows of the Head are sometimes broken.

LXXXII. Now the Scull by violence may be broken; which if it is so broken, as that a piece is divided from the rest of the Scull, it is properly called a Fracture: this Fracture consists sometimes but of one piece, sometimes of many pieces; some whereof are deprest upon the Membranes, yea sometimes into the Brain it

self; whilst others lie entan∣gled in the Flesh: but this you must observe, that you take not out more Bones than needs must; for recent Fractures of the Cranium, do easily Unite, like those in other parts, if the Pus or Matter has a way made, to discharge its self from with∣in. See lib. 4. cap. 27. Sect. 20.

LXXXIII. The Cranium be∣ing thus perforated by the Mo∣diolus, Terebra, or Trepan, (call it by which Name you please) you are then to come to the Dres∣sing: first wipe off the Saw-dust of the Bone, with a bit of soft Sponge, or a little Lint upon your Probe; then come to the dressing, about which Authors somewhat differ.

LXXXIV. Avicen advises to Lenients: Celsus to driers, and sharp Vinegar: others to Honey of Roses, mix'd with Spirit of Wine.

LXXXV. If there is Putrefa∣ction of the Membrane, then Ho∣ney of Roses mixt with Spirit of Wine may be used; and stronger Detersives may be used, as the Putrefaction is more or less.

LXXXVI. If much Blood is ex∣travasated, or you fear a Haemor∣rhage, Celsus his drying pouders or drying Balsams, with sharp Vinegar may be used; but this is to be done when there is a Co∣agulation of the Blood, and danger of Putrefaction.

LXXXXVII. But if the Blood is recent, and exceeds not in quan∣tity being caused by some scratch of the Trepan, or some little Splinters of the inner Table, and the Mem∣brane is fresh, and of its natural colour, it is not prudent to grieve the Membrane, now exposed to the Air with Detersives, or with Vinegar, or Honey of Roses with Spirit of Wine; because these things are contrary to the Indi∣cations of Cure, which teaches us to digest recent Wounds, before we deterge or cleanse; nor in this case, is there any thing to be cleansed off.

LXXXVIII. Digestives are therefore to be used: some put down into the hole a long Lin∣nen or Silk Rag upon the Dura Mater, which is wet or moist∣ned with hot Oil of Roses, and ty'd at the end with a Thread, that it may be drawn out at pleasure; that so the matter run∣ning out, may be turned into quittor, and the Membranes de∣fended from being hurt by the Bone.

LXXXIX. After the Rag is put in, they stop the place up with dry Lint, laying dry Lint also up∣on the naked Bone, and anoint the lips of the Wound with some Di∣gestive, upon which they lay Linimentum Simplex, with a hole in the middle of the Cloth, that the Pus may not be stopped in; and over that a mixture of Wax and Oil; and then bind it up with the Band-Cancer; anoin∣ting the Parts adjacent with Repelling Oils or Ointments, to hinder Inflammation.

XC. Others apply a piece of Sat∣tin, or other Silk, moistned in a mixture of Honey of Roses, and Oil of Roses, which is continued 'till the seventh day: afterwards they use a mixture of Oil of

Roses, and Oil of Hypericon; and anoint the Cranium with Linimentum Arcaei melted, fil∣ling up the hole with Dosils and Pledgets, and laying over it such Topicals as we have before set down.

XCI. Wiseman advises to use Lenients, which by the advice of Fallopius and Aquapendens is a mixture of Oil of Roses with Rosin of the Fir-tree, or pure Turpentine, afterwards diminishing the Oil, and increasing the Rosin or Tur∣pentine: this mixture of Oil and Turpentine, by its Empla∣stick and Digestive qualities, perfects the Concoction sooner than other things; and by its Anodyn quality, secures the Part from Inflammation. See lib. 4. cap. 27. Sect. 15. 16. &c.

XCII. Or, ℞ Oil of Roses ℥iv. Honey of Roses, Spanish Wine, A. ℥iii. Venice Turpentine ℥i. Grains of Kermes ℥ss. Seeds of Hypericon ʒi. boil to the Consum∣ption of the Wine, then strain, and add Aloes in fine pouder ʒi. mix them.

XCIII. In the application of Topicks, consider the Part, and habit of the Body, and add to, or diminish the Ingredients according∣ly as you design to Digest, Deterge, or Incarnate: and tho' some Authors limit us as to time, to dress with these or other Medi∣caments; as to use Digestives to the fourth day; Detersives to the seventh day; and Sarcoticks to the fourteenth day: yet herein, you must make use of your own Judgment; always taking care to conserve the native heat.

XCIV. The Lips of the wounded Scalp you may dress with this. ℞ Oil of Roses ℥jss. Turpentine washed ℥i. Gum Elemi dissolved and strained ℥ss. Yolk of an Egg ʒi. Saffron in pouder ℈i. mix them: by the speedy Di∣gestion of the Wound the cure will be hastned.

XCV. After Digestion Sp. Vini will be found a thing of singular use, and by reason of its drying quality is most admirable, not only for Wounds of the Hairy-Scalp, and Cranium, but of the Meninges also; being used either alone upon Lint, or mix'd with Honey of Roses, or Syrup of dry'd Roses.

XCVI. Or thus mix'd. Take S.V. ℥vi. fine Aloes ℥i. Myrrh ℥ss. Frankincense, Sarcocol, A. ʒii. mix them. Or, ℞ S.V. ℥. xxiv. Malago Wine ℥xvi. Tur∣pentine ℥vi. Centory the less in pouder ℥jss. Flowers of Hypericon in pouder ℥ss. mix, infuse in B.M. and make a Balsam, which ap∣ply warm upon the Meninges.

XCVII. If the Dura Mater has changed its color, and will not be cleansed with the former things; then, ℞ Turpentine wash'd in White-wine ℥vi. Spirit of Wine ℥iii. Honey of Roses ℥ii. Myrrh, Aloes, white Sugar, A. ℥ss., mix them.

XCVIII. If the Wound tends to Putrefaction, Scarifie the Lips, and apply this. ℞ Mithridate ℥jss. Venice Treacle ℥ss. Vng. Aegyptiacum ʒii. Myrrh, Scordi∣um in pouder, A. ℈ii. Spirit of Wine, q.s. mix them, and ap∣ply it.

XCIX. When the Putrefaction is removed, you may dress it with this of Johannes Andraeas à

Cruce. ℞ Venice Turpentine, Honey of Roses of each equal Parts, mix them; this and the other Medicaments may be apply'd upon a piece of Silk or fine Linnen Cloth cut round, pro∣portional to the hole made in the Skull, which is to be placed under the edges of the Cranium by the Lenticular Instrument, to keep the edges of the perfora∣ted Bone from hurting the Dura Mater: A Thread or Silk must be fastned to it in the middle, to pull it out at pleasure: and over it you are to apply Dosils of Lint to fill up the void space in the Bone, thereby to keep the Dura Mater from rising above it.

C. And daily, when the Wound is bound up, let the Patient pro∣mote the comming forth of the Matter, which is run to the Membranes of the Brain, by Breathing out at the Nose, keeping the Mouth shut: and when you find the Wound Di∣gests, and good Pus to appear upon the Dura Mater, or on the Rag ty'd to the Thread; you may then absterge with some of the former things, or with Honey of Roses strained only.

CI. On the Bone lay dry Lint; and upon the Lips, Lint wet, spread with some detersive Dige∣stive; continuing those things as long as you see needful, with Hippocrates his Empl. of Wax and Oil, astringent Oils, and the application of the Band Cancer.

CII. When the Wound and Membrane are fully cleansed, omitting the Rag and Honey of Roses, or the other Medicaments, you may put into the hole a round gobbet of dry Lint, ap∣plying to the Bone this pouder. ℞ Orrice-roots, Birthwort-roots, Frankincense, all in pouder, A. ʒi. Sanguis Draconis, Catechu, Harts-horn burnt, A. ʒjss. Aloes, Ma∣stick, Myrrh, A. ʒss. make all into a fine pouder, which apply upon dry Lint.

CIII. The Skull will Scale, as Arcaeus lib. 1. cap. 4. says, in about 24. or 25. days, if the Li∣nimentum Arcaei be apply'd to the Bone; but Paraeus says it will be 40 or 50 days: from whence it appears that a certain set time of the Scaling is hard to be de∣termined.

CIV. When you dress the Wound, embrocate the adjacent parts of the Head with Oil of Roses warm'd, as also the Neck, more especial∣ly where the Jugular Veins are; as well to asswage the pain if it is vehement, as to contemperate the heat of the Blood and Hu∣mors.

CV. Dress the lips of the Wound with Linimentum Arcaei, or some other Sarcotick Ointment, over which lay Diapalma, or Empl. Album, with a Treble Linnen Cloth, wet in a Cepha∣lick Decoction of Red Wine, and then squeez'd out; with these things, and the Linim. Arcaei, let the Bone be covered with good Flesh, and produce the Cicatrice with Epuloticks ac∣cording to Art.

CHAP. XIII. Of a FISSƲRE or CLEFT of the SKƲLL.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin, Fissura vel Rima Cranii: and in English, A Fissure or Cleft of the Skull.

II. The Kinds. There are two kinds of Fissures. 1. Fissura simply so called, which is a Cleft of the Skull upon the very place where the blow was made. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Cranii Contrafissura, a Contrafissure of the Skull; where∣in the Cleft is made on the op∣pofite side or place, to that where the blow was given.

I. Of a Fissure or Cleft of the Skull, in the Part wounded.

III. Rima, or Fissura, is made by a hard and blunt Weapon, some∣times passing but thro' one of the Tables only, and sometimes thro' both; and this is accounted one of the simple kinds of Fractures.

IV. Rima, or Fissura, is also twofold, 1. Conspicua, which is easily to be discerned by the Eye. 2. Inconspicua, which is scarcely to be discerned by the naked Eye, without something of Art is added; and this is cal∣led Rima Capillaris, because the Cleft seems to be as small as a Hair.

V. The Signs. Rima, or Fis∣sura Conspicua, if it passes but thro' the first Table, to the spongy part between the two Tables, it is not only discernable by the Eye; but the Bone being wiped clean and dry, you will find after a little time, a little bloody Juice to issue out thereat.

VI. Fissura Inconspicua, or Rima Capillaris, is not easie to be found out: If therefore you cannot discern it by the naked Eye, or by help of a Microscope, or Magnifying-glass; you must cause the Pati∣ent to hold in his Breath, and to stretch out his Brest as much as may be, and possibly a thin Sanies or Bloody Humor may issue out, which is a good sign.

VII. If by this nothing appears, rasp or scrape that part of the Skull most suspected, and then drop a few drops of Ink upon it, and so dress it up; the next dressing dry the Skull, and cleanse it with a wet Rag, or Sponge; and if any Fissure be; you will see the tract thereof by the Ink, which will be sunk into, and re∣main in the Capillary Cleft thereof.

VIII. The Prognosticks. As no Fracture of the Head is with∣out danger, so that of a Fissure cannot be exempted; for that sometimes, for want of due Care, it carries Death along with it.

IX. If a Fissure is accompanied with evil Symptoms, there is much danger; and if the Skull

be not suddenly opened in such a Case, Faintings, Convulsions, and Death often ensue.

X. The Cure. If the Cleft or Crack gapes so, that Pus or Matter may come freely forth from it, there is no need to use the Tre∣pan, or to dilate the Wound with an Ineision-knife; and therefore Chalmetaeus says rightly, that those deserve to be Censured and Reprehended, who not on∣ly in a small Fissure of the Skull, (tho' it penetrates not) but also in a great Fissure, are bold to set on the Trepan, by which great Error, the Cure is very much prolonged, to the great damage of the Patient.

XI. Therefore, when (in this Case) the Trepan is not necessary, you must follow exactly the Cure of a narrow Fissure, as if it were after the use of the Trepan.

XII. If the Fissure passes not deeper than to the spongy part be∣tween the two Tables, it is then so far to be dilated: If it passes thro' both the Tables of the Skull, then it is to be dilated even to the Dura Mater, or thro' the first Table at least, ma∣king way thro' the second also; wherein you are to leave a suffi∣cient opening for the clotted Blood, Sanies, or Pus, and in the depending part of the Head, thro' the second Table.

XIII. In the Fissura Inconspi∣cua, after you have besmeared it with Ink, and come to the second dressing, you will see whether any signs of the Ink remains in the Skull, or not; if so, you must continue your rasping until the Ink with the Fissure is wholly gone, and the Bone grows some∣what bloody.

XIV. After which you may ap∣ply this Pouder: Take Catechu, Sanguis Draconis, Harts-horn burnt, A. ʒiss. fine Bole, Terra Sigillata, Orrice-roots, Frankin∣cense, Olibanum, A. ʒi. Mastich, Myrrh, A. ʒss. make all into a fine pouder.

XV. If you fear the second Ta∣ble is crackt also, or that any Blood is fallen down upon the Dura Ma∣ter, you must continue the Dilata∣tion, even till you can discover that Membrane; and now you are to make use of the Trepan, or Trafine; tho' in all sorts of Fis∣sures, these Instruments at first are to be avoided, and Raspato∣ries only are to be made use of, by which the Fissure is to be suf∣ficiently pared; but yet you are not to take away more of the Bone than need requires.

XVI. After which, the afore-described Pouder is to be laid on, or dry Lint, avoiding Digestives, or Ointments, or any fat or greasy thing; and the Lips of the Wound are to be drest in all re∣spects, as after the application of the Trepan,

XVII. A Digestive is to be ap∣plied to them upon Lint, and upon that Linimentum simplex, or that of Arcaeus, or this Mixture of Hippocrates: ℞ Oil of Roses ℥ii. Wax ℥i. mix them; and you are to bind it up with the Band-Cancer.

XVIII. When good Pus or Mat∣ter appears, mix Detersives with Digestives, till the Wound is per∣fectly clean, strewing the Bone with the Pouder afore-described,

and applying dry Lint thereon; but to the Lips Linim. Arcaei, or some Sarcotick Ointment with Diapalma, or Our Empl. Album, and over it a treble Linnen-cloth dipt in astringent Red-wine; lastly, incarnate and eicatrize according to Art.

II. Of a Contrafissure of the Skull.

XIX. A Contrafissure, or a Counter-Cleft, is that which is made (the place struck remaining whole) in the opposite part of the Cranium, or some distant place, from that on which the blow was given: This by some is called Resonitus.

XX. The Signs. This is hard to find out, yet there are some signs by which it may be discerned; there will be vomiting of Cho∣ler, a Fever, and other Sym∣ptoms belonging to a Fracture; and the Sick will be often put∣ting his Hand to the place.

XXI. Some Tumor or Softness will appear in the Cutaneous Part which is directly over the Fracture, which if you find, you may con∣clude there is a Contrafissure.

XXII. If the Fracture (not being in the Wound) is at some little distance from the Wound, and not in the opposite part, the Wound will not admit of Cure in that part which is near to the Fra∣cture, but grow ill-conditioned and rebellious.

XXIII. The Wound will also flow with an ichorous thin Matter, and more plentifully than the mag∣nitude of the Wound can seem to admit; the Flesh also growing pear to the Fracture, will be loose and spongy, not firm; and by the Probe thrust between, you will find the Cutis separated from the Cranium.

XXIV. If the Contrafissure is very remote, or much distant from the Part wounded, it is either in the self-same Bone, or in divers Bones. If it is in the self-same Bone, it may be either laterally, as when the left side of the Os Erontis is struck, and the right side is cleft, and contrariwise; or, perpendicularly, from the upper to the lower part; as when not the upper Table which received the blow is crackt, but the lower Table.

XXV. If the Contrafissure is in divers' Bones, then it is either when the right side: Suppose the right Parietal is struck, the cleft or crack will be in the left: Or, if the Os Frontis receive the blow, the Os Occipitis may be crackt.

XXVI. Now this kind of Fra∣cture happens chiefly to such, who have either no Sutures at all, or, where they are either very obscure, or very close; for in such the Air being violently comprest, re∣bounds to the contrary or oppo∣site side, with the greater force; and so not being able to get out, makes a cleft.

XXVII. This has been often seen in the cracking of great Bells, designed for melting down: Do but bind the Bell round firmly with a Cord, or a Hoop; and then striking very hard upon it with a great Iron Hammer, the sound having not its wonted li∣berty to get forth, or make its way thro, presently splits the

Bell in the place opposite to that where the blow was given.

XXVIII. To discover this kind of Fissure, the signs at Sect. 21. above, are for the most part pre∣sent; besides, if there is a Tu∣mor or Softness appearing, where-ever it is, you may be assured, that there is a Fracture in the Skull subjacent thereto.

XXIX. The Prognosticks. It is difficult to make the proper Prognosticks in this case; and if the Patient should die, the Ar∣tist is not much to be blamed, because of the difficulty of know∣ing truly how the Case is.

XXX. For if the Cranium should by a violent Contusion be de∣pressed, and presently return to its own place, leaving no signs of a Fracture behind; it would be dif∣ficult to foreknow the success: So also if the cleft or crack be only capillar, and hard to be seen.

XXXI. When the second Table of the Skull is broken, the first re∣maining whole, it is very doubt∣ful to be known, and therefore no presages can be exactly made.

XXXII. When the Fracture happens in the opposite part to that which is wounded, by reason it is not to be seen, the most Skilful Artist may easily be deceived, and therefore he is cautiously to deliver his Judgment.

XXXIII. For these Reasons then, if you suspect the Skull to be fractured, the Cutis Musculosa not being broken or divided, you are to enquire, whether the Pa∣tient has vomited Choler, whe∣ther he lost his sight, or could not speak; whether Blood did come forth of his Nostrils and Ears, or he seemed to be in a Trance; or whether he percei∣ved a Vertigo, or giddiness af∣ter the Blow, or a vehement Sickness at Stomach; for if these Symptoms have been, or are present, they indicate a Fracture: And then, tho' no other Symptoms do manifest themselves, you are farther to enquire, whether the Patient had not formerly the Headach, (for then there is less danger) and whether he was struck with a heavy Weapon, or by a strong Hand of one enraged; and whe∣ther he felt or heard a noise in the Brain, when the Blow was given; if these signs appear, you are to suspend your judg∣ment as to any good Event, and regulate your presages ac∣cording to some other succeed∣ing Accidents or Symptoms.

XXXIV. The Cure. If no Tumor or Softness appear in the op∣posite part, you are to shave the Head, and apply upon the Part Empl. Cephalicum for 24 Hours; or this, ℞ Ship-pitch, and Wax, A. ℥iii. Turpentine, Gum Elemi, A. ʒvi. Mastich, Orrice in pou∣der, A. ʒiii. mix, and make an Emplaster, and apply it to the opposice part.

XXXV. If after the Emplaster is taken away, the Cutis Muscu∣losa appears in any place more moist, soft, or swell'd, than the rest of it is, it is very probable that there is a Fracture.

XXXVI. When the Fracture is found, it is Cured as a Contusion of the Skull, with a Fracture un∣der a whole Skin; viz. by ma∣king Incision in the Skin with

an Incision-knife, and separating it with the Pericranium from the Bone, and then, (if the crack which penetrates is narrow) perforating the Skull with the Trepan, &c.

XXXVII. If the second Table is broken, the first remaining whole, then you are to apply the Trepan, as well for this cause, to take away the Splinters which may prick the Dura Mater; as for another cause, to make way for the discharge of Blood, Sanies, Pus, &c.

XXXVIII. Having found out a Contrafissure, you are first to make Incision thro' the soft parts above the Cranium, and then with your Rasps to make way for the discharge of the Blood, Sanies, Matter, &c.

XXXIX. If the Cranium is cleft, (the Cutis Musculosa, or the soft Parts above the Skull not being broken or wounded) and no fearful Symptoms appear, then you are to shave off the Hair on that part of the Head where the blow was received, and apply Anodyns or Medicaments easing Pain, which may be withal drying and astringent. As,

XL. Take Barley-flower ℥xii. pouder of red Roses, of Myrtle-berries, A. ℥ii. Catechu, Mastich, A. ℥i. Oil of Roses ℥iii. Vinegar, Water, A. q.s. mix, and boil to the Consistence of a Caetaplasm; this for Summer; but if it is Winter-time, instead of the Water, take as much Wine.

XLI. And now and then gently purge with an Infusion of Sena in half Wine half Water, or with Pulvis Cornachini mixt with Sy∣rup of Roses solutive, or with Syrupus Catharticus.

XLII. Some open the Cephalick Vein on the same side, or apply Cupping-glasses with Scarification; and withal drop Oil of Sweet Almonds into the Ears, for dis∣charge of the Sanies or Pus, if any is gathered there; also the pas∣sages of the Nose are to be made smooth and slippery with Oil or sweet Butter.

XLIII. On the fourth day you may use a Gargarism, made of a Decoction of hull'd Barley, and Elm-bark, which is to be sweet∣ned with Syrup of Mulberries, Mel Rosatum, or Oxymel sim∣plex.

XLIV. After the seventh day, apply Discussives, as Diachylon simple & cum Gummi, Empl. de Betonica, and such other like; which soften with Oil of Roses, or Camomil.

XLV. But if after the use of all these means, dreadful Symptoms shall appear, (which may hap∣pen, tho' the Parts above the Skull are not broken or wound∣ed) you must not then defer the Incision of the Cutis Muscu∣losa, and opening the Skull; for indubitably there is Blood, or Matter, or both, fallen upon the Dura Meninx; and this may be known by Blood coming forth from the Ears or Nostrils, after the blow was given; also by the sleepiness of the Patient, stupi∣dity, or heaviness of the Head.

CHAP. XIV. Of a CONTƲSION or DEPRESSION of the SKƲLL.

I. IT is first culled in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Cranii depressio, a depressi∣on of the Skull: And 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Cra∣nium depressum, a Skull depressed.

II. It is also called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Cranii Contusio, a Contusion of the Skull: and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Cranium Con∣tusum, a Contused Skull.

III. A Depression or Contusion of the Skull, is made by a hard and blunt Instrument or Weapon, where∣in the Skull is so hurt, that tho' it appears whole on the outside, yet it is depressed down, or bruised, and is for the most part severed from the whole within.

IV. Others define a depression of the Skull to be a Solution of Conti∣nuity in the Cranium, made by the violence of some external In∣strument or Weapon, whereby se∣veral parts of it are brought nearer together, than naturally they should be.

V. It is indeed when the Skull is beaten down, or inwards: And it is either of the outward Ta∣ble only, or of both Tables to∣gether; in which latter kind, shivers of the Skull are many times separated from the whole Skull; and sometimes they cleave to the whole in one part, and are separate from it in ano∣ther.

VI. The Signs. It is known partly by sight, partly by feeling, and partly by relation of the action, or force which was used, and kind of the Weapon giving the blow.

VII. In its beginning, it is known by the alteration of the Colour of the Skull; for while the Bone is living and sound, it is of a whi∣tish Colour, mixed with a lively ruddiness; but if it is mortified, or dead, it will be white or whi∣tish, without any kind of red∣ness: And if it is carious or rot∣ten, it will be of a livid or blackish Colour.

VIII. If therefore you meet with such a kind of Fracture, the plea∣sant or desirable ruddiness of the Bone will be gone, and white spots or patches will appear in it, such as are sometimes seen upon the Nails of ones Fingers: If it is left untouched, so that the Disease makes a progress, it will be cari∣ous, and of a livid or blackish Colour: In this kind of Fracture you are to take away so much of the Cranium, as is mortified by the Contusion with Raspatories, and then to heal up the Wound with Sarcoticks.

IX. The Prognosticks. If recent, and without evil Sym∣ptoms, there is hope: But if evil Symptoms follow, not gradually,

but on a heap, and as it were up∣on the spot, the danger of Death is not small.

X. If evil Symptoms come on with violence, and go off again, and then come on again, it shews that Nature has had a great contest with the Disease: and tho' she seems Victrix for a while, yet she is so spent, that at length she is overcome; and that last return of the Symptoms proves fatal, for they never go off any more, but with the Life of the Patient.

XI. The Cure. A Depression or Contusion is made in Children some∣times without a Fracture, (by reason of the toughness of their Bones:) but there is for the most part the suspicion of a Fracture.

XII. It is cured, as Scultetus says, with admirable success, with the Skins of Beasts newly killea; especially of a Dog, Cat, Wea∣zle, Rat, Mouse, Lamb, or Sheep; if applied while they are yet hot, and left on for 24 Hours.

XIII. If the Contusion is not wholly discussed with one Skin, you must apply another; and the Skin of a Lamb, or Sheep, is as powerful as any other.

XIV. By this one excellent Re∣medy, Scultetus affirms that he has cured many; as also, that it never failed him: I have also used it three or four times with the like happy success: and with Sculte∣tus, I advise all young Chirur∣geons, that they never open Contusions, or other Tumors, unless they sind them to resist the help of Topicks.

XV. If with the said Contusion there is a Fracture, as in a simple Depression of the Scull, the Skin being whole above; if the fractu∣red part cleave to the whole on one side, you are to elevate the other with a Levatory: but if with that it cannot be done, you are then to apply the Tre∣pan, as near to the fractured part as you can, that as little of the Cranium, may be taken away, as may be.

XVI. Afterwards, you are either to reduce the depressed part to its own place, or wholly remove it, as you shall think most fitting: but in doing these things, you must take great care that the Meninges be not hurt by the sharp splinters of the fractured Bones.

XVII. But in Children this Con∣tusion many times happens without a Fracture, (tho' scarcely ever in those of ripe age:) and therefore in those little ones the Depres∣sion may be raised, as Paraeus, lib. 9. cap. 3. has taught; and that excellently, with a Cupping-Glass, and reduced to its proper place.

XVIII. Hildanus, Cent. 2. Obs. 5. invented two Helps, viz. a Horn-Cup, and an Emplaster; which if they prevail not, he then advises to the raising of the Bone by a Pierce, upon a Triploides: but this is in many things both needless and unprofitable, yea sometimes very dangerous.

XIX. For that such Depres∣sions in Children, which press upon the Brain, hindering the generating and distributing of the Animal Spirits, are mortal: and in others, not only make work for the Chirurgeon, but oftentimes

prove very dangerous; because the Levitor being fastned upon the center of the Depression, the Pit in the Scull is easily made greater.

XX. 'Tis true, that Manual Operation being neglected, the Cure, with danger to the Fatient, is often prolonged: yet the prudent. Ar∣tist ought rather to omit it, than to lay an Infamy upon the Art.

XXI. The only thing to be ap∣plied, is the aforesaid hot Lamb∣skin, for a day or two; with convenient Ligature of the Band-Cancer.

XXII. When the Tumor is dis∣cussed, and no great Symptoms ap∣pear, apply under the Lambskin Ceratum Diapalma, or Emplastr. Album, brought to the softness of a Cerat with Oil of Ben; which spread upon a broad Lin∣nen Cloth, to corroborate the Part.

XXIII. If there is a Contusion of the Cutis Musculosa, a Depres∣sion of the Scull, with a Fracture of the inner Table, without any Wound in the Flesh or Skin, or any Crack in the outward Table; you must presently cut the Skin with the Incision-Knife, either crosswise, like the Letter X; or triangu∣larly, like the Greek Letter A, or the Greek Letter T.

XXIV. Then the Skin, Flesh, and Pericranium together, must be parted, or raised from the Scull, and the gaping Wound must be kept open with Pellets; to see whether there is a Chink, Cleft, or Crack with the Depression in the outward Table.

XXV. But if no such thing is found in that Table, but it appears whole; yet by the ill Symptoms accompanying the Depression, it is feared that the inward Table is broken: the Cranium must then be opened with the Trepan, by the side of the Depression, that the Matter which is fallen down by the secret Fissure of the inward Table, upon the Membranes of the Brain, may have a place to come forth; and the Scull which is depressed or fallen inwards, may be raised up, by the help of the Levitor.

XXVI. But if the Contusion is without a Depression, or Pitting-down, no Manual Operation must be attempted, but only the Lamb∣skins aforementioned, are to be laid upon the place as afore∣said; unless Symptoms shewing the Scull to be broken, follow.

XXVII. But if there is with the Depression, a broad Rife in the middle of the inward Table, or in one side of the Depression, it re∣quires the taking off the Peri∣cranium.

XXVIII. The Crack in the mid∣dle of the Depression, is either broad or narrow: if it is broad, and the Depression not great, the Scull must be raised with the Levitor, in Tab. VI. Lett. N, M. But if the Depression is greater than ordinary, you must raise it with a stronger Levitor, as that in Tab. V. Lett. L, L.

XXIX. If with a broad Crack the Scull is gone far in, the said Levitors are then of little use; but you must come presently to the use of the Terebra and Tri∣ploides.

XXX. If the Depression has a narrow Crack in the middle, then

at the bounds of the Depression, the Scull must be cut away with the Trepan: and the distance be∣tween the Holes is to be taken a∣way with a Turning-Saw; (which, if rightly made, with a double Socket, and a firm Screw) is done without the least danger.

XXXI. This done, you may raise the Depression with the Levitors, and take away any small fragments of Bones, (which are sometimes parted from the inward Table of the Scull, and prick the Mem∣branes like Thorns) with all the ease imaginable.

XXXII. If with the Depression there is a Crack, whether broad or narrow, at the side of the De∣pression, you must (if broad) pre a Levitor under the Scull, to raise it. Or, (if narrow) the Scull must be evenly terebrated on that side which is sound and bare, with the Modiolus or Tre∣pan; and then it must be raised by the help of Levitors.

XXXIII. If the Levitor let down at one hole, cannot raise the Scull; you must make another hole, and then cut forth the di∣stance between these holes, with the round Saw; that in what part soever of the Fissure it is need∣ful, the Levitor may be put down, and the Scull raised by it.

CHAP. XV. Of an INCISION and PƲNCTƲRE of the SCƲLL.

I. THAT which the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Cranii Incisio; we in English call, An Incision or Cutting of the Scull: but when any piece of the Scull is wholly cut off, then the Greeks call it, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Cranii Excisio.

II. That which the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Cranii Punctura; we in English call, A Puncture of the Scull: but when the Weapon sticks so fast, that by pulling it forth, the Scull thereby seems to be pulled up, and to vault forth; the Greeks call it, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Cranii concameratio.

I. Of an Incision of the Scull.

III. An Incision is made by a cutting Instrument; wherein either a part of the Scull is raised up, but is yet fast to the other part: or, a mark of the Cut only remains in the Scull, according to the figure of the Instrument, which they call Sedes, or, the Seat; being the Seat of the Weapon: or, a part of the Scull is cut slopingly thro', and quite taken away.

IV. As to the Sedes, where the Print of the Weapon is only left behind in the Scull; the

Wound is to be dilated or opened, and the Skin and Flesh with the Pericranium is to be raised, and the Sedes or Seat of the Weapon is to be imme∣diately pared away with a Knife or Chizel; or it must be scraped with a Scraping-Instrument, and that 'till the whole Sedes or Incision is gone.

V. After the Sedes or Print of the Weapon is pared or scraped away, you must dress it with con∣venient Medicaments, such as we use in the Cure of a Fissure, or after the rasping of the Scull.

VI. If it passes thro' both Ta∣bles, and splints of Bone prick the Meninges; and way enough is made by the Weapon, for the evacuating of the Pus or Matter; no farther apertion is to be made, but the Wound is to be dressed, as after the application of the Trepan.

VII. But if either splinters of Bones do offend the Dura Mater, or the way out is too narrow for the coming forth of the Sanies or Pus; a farther opening of the Scull is to be made, with such Instru∣ments as you shall think most fit for the Operation.

VIII. But if the Sedes passes no farther than the first Table, then the Cranium is only to be smoothed with Raspatories; that the Pus or Matter may not settle in the Sedes, and so cause a deeper ca∣riosity; and the Wound is to be drest with Linimentum Arcaei, melted in a Spoon: in these Cases many times, if the Patient is of a good habit of Body, the Cranium casts off no Scales.

IX. If a part of the Scull is raised up by the Cutting, out yet is fast on the other parts; having dilated the Wound, see whether the Weapon has passed the first Table only, or the first and second, if the first only, the Bone may be rasped away; but if both, there will be a necessity of applying the Trepan, to make way for the Matter.

X. The lips of the Wound may be kept asunder with Pledgets, or Dossels of fine Tow dipt in whites of Eggs, which will also stop the flux of Blood: the Parts which are ad∣jacent are to be anointed with astringent Oils made hot, to prevent Inflammation, and con∣venient Ligature is to be ap∣plied, which is the Band-Cancer, with a thrice doubled linnen Cloth; that the wounded Parts may not be more hurt by the ambient Air, (which is an Enemy to the Wounds of the Head;) and that the Medicaments laid on, may be kept close, and not fall off.

XI. The following Figure repre∣sents the Band-Cancer, which for Wounds of the Head, is the best of all to contain them, and also the most useful and commodious: it is broad in the middle A, and both ways it has four ends; of which two begin from the Temples, and end on the hin∣der part of the Head; where they must be sewed, as E, E: two arise from the hinder part of the Head, and are bound together on the forepart of the Head, as B, B: two are turned behind the Ears, and fastned under the Chin, as C, C: and

two of them come before the Ears, and are fastned as the other also, under the Chin; as D, D.

[illustration] depiction of the band cancer, a bandage for the head

The Band Cancer

XII. The second day, let the Wound be drest; being cleansed of its Sanies, let some Astringent Pouder or dry Lint be laid upon the Bone, and let the lips of the Wound be drest with some Dige∣stive, which apply upon Lint; and and over that Emplastr. Album, or Diapalma, with a Hole cut in in it for the Pus to issue forth; over which Hole lay Linimentum Arcaei, with a Pledget of Cloth three times doubled: anoint the Parts adjacent with some Astrin∣gent Oil before-named, then bind it up with the Band-Cancer, and a good Rowler; and con∣tinue this course of Dressing, 'till a good and white sort of Pus, and not stinking, is pro∣duced.

XIII. If the Artist is careful, he will find, where the Bone is only rasped or scraped, that if the Ce∣phalick drying Pouders be strewed upon it, and dressed with dry Lent, it will be covered with Flesh the next day: they that will not endure Scraping or Rasping the Bone, (when it is altered) leave it to Nature for the Scaling of it: but such Men prolong the Cure.

XIV. The Wound being digested, you must daily apply Detersives, mixed with Digestves, until it is throughly cleansed; continuing the use of the Pledget of Cloth thrice doubled, with the Un∣ctions and Bandage.

XV. The Wound being cleansed, you must with Sarcotick Ointments, as Linimentum Arcaei, &c. laid upon Lint, to the lips; fill it up with Flesh, (and not use Oil of Roses, as some Ignorants do;) and over that Diapalma, or Em∣plastr. Album, malaxed with a little Oil; and then a Cloth thrice doubled, wet in Red-wine, or some Astringent Decoction, and prest out again.

XVI. The Wound being filled with Flesh, it must at last be covered with a Cicatrice; which is done either with dry Lint only, or else by applying Cera∣tum Diviaum, or such other like; renewing the Dressing 'till the Skin is produced.

XVII. When a part of the Scull is separated, so that the first Table is divided from the second, and sticks close to the Skin, you must first take away the Bone, and then cure the Wound.

XVIII. If a part of the whole Scull is divided, so that the Dura Mater is seen, you must reduce

the Incision, being first cleansed with Canary or S.V. or with them mixed equally together; and so keep it, either by stitch∣ing the Lips of the Wound, or rather by fit Bandage.

XIX. But a smooth Chopping away, or Cutting off a piece of the Skull, requires no Manual Operation; but it ought to be co∣vered with Flesh, by strewing on it some Cephalick astringent Pouder, &c. as a Skull newly scraped, or rasped with Rasps.

II. Of a PƲNCTƲRE of the SKƲLL.

XX. If the Puncture pierces not both Tables, (as it seldom does) it must be taken off with Pier∣cers, or the Trafine, which must be put just upon the middle.

XXI. But if it penetrates thro' both Tables, the Skull must be opened with the Trepan, setting the Pin of the Male-Trepan upon the Point or Puncture, and so turning it round till it make a print, upon which the Female may stand fast.

XXII. Now that these Opera∣tions may be performed quickly, safely, and pleasantly, the Cutis Musculosa and Pericranium must be separated from the Bone: And when the Trepan has done its work, the rest of the Cure must be compleated, as we have al∣ready taught in Chap. 12. Sect. 83. ad 104.

XXIII. In all Fractures, if they be so large, or well-condition∣ed, that you can thereby free the Brain, or Place, from Coagulated or Corrupted Blood, or from the prickings of the Splinters; these Operations will be needless.

XXIV. But if otherwise, there is a necessity, you must use great Care in applying the Instru∣ments; which ought to be done before the Patient is grown too weak, or the Cure of the Dis∣ease is become past hope.

XXV. It is also to be noted, that if the bare Bone lies open to the ambient Air but for two Hours, the Bone will be altered; but if it lies open longer, it will grow black: In these Cases, if the Weapon (whether sharp-edged, or poin∣ted) pierces not both Tables, or pierces only one, or the Su∣perficies of the first Table, you must then scrape or rasp off all round about, till the Colour is changed, or the Sedes or Pun∣cture is taken totally away; or till Blood comes forth of it, &c.

XXVI. If there is a Concame∣ratio, or vaulting out of the Skull, made by the plucking out of a poin∣ted Weapon forcibly, whereby an empty space or vacuity is left be∣neath, and the upper Table is se∣parated from the lower; you have no more to do, but (dilating the Wound by Incision) to rasp or smooth the Skull, and then to heal up the Wound ac∣cording to the Method before laid down.

XXVII. But if it passes thro' the second Table, you must open the Skull in the most depending Part with the Trepan, to make way for the issuing forth of the Sanies or Pus, which of necessity must be lodged in the void space, if the hole the Weapon has made is

large enough to give a passage for the same.

XXVIII. And if any ruggedness or pointed Splinters prick the Dura Mater, the whole Fracture is to be removed, compassing it with a large head of a Trepan; after which the Wound is to be Cured, as we have formerly taught.

III. Of an Incision or Puncture of the Skull, under the Temporal Muscle.

XXIX. This is always with a Wound; and the Incision is either transverse, or according to the length of the Muscle: If it is a Puncture, or a transverse Inci∣sion, it will be of dangerous Consequence, as we have alrea∣dy proved, and for the most part, Mortal.

XXX. If the Wound is made longways, it is to be dilated by Dosils or Sponges; and if the Fra∣cture is a Cleft, it is to be remo∣ved by Rasps, or some scraping Tool: But if it is a great Fra∣cture, in which the points of the shivers do prick the Membranes, or the depression of the Crani∣um does press them down; then a triangular Incision is to be made, a little above the Fra∣cture, avoiding the Temporal Muscle.

XXXI. Which done, the Mo∣diolus or Trepan is to be applied: The Skull being opened, the Splinters which are perfectly se∣parated from the sound part of the Skull, are to be taken away; and the remainder which are not wholly separated, are to be reduced (if possible) to their true places.

XXXII. And as often as the Patient is drest, you are to cause him to stoop down his Head, and (stopping his Mouth and Nose) to cause him to force his Breath strongly, by which means the Sanies will be the better forced out of the Wound.

XXXIII. This being done, you must make some mundifying. In∣jection of red Wine, clarified juice of Smallage, and Honey of Roses strained, or with other things as you shall see most fit, to wash out all the Sanies, Pus, or other foulnesses, which other∣wise would necessarity lodge there.

XXXIV. And tho' Pareaens, lib. 9. cap. 19.) advised to keep a leaden Pipe in the Wound, yet this by reason of its hardness and solidity, would not dilate the Se∣ction, but cause pain; I should rather advise you to compressed or prepared pieces of Sponge, which is by much the better.

XXXV. For this as it is soft, it cannot hurt; and as it is po∣rous, so it will dilate it self, and suck up the Impurities; and with∣al, it will dilate the Wound, and keep, it sufficiently open, till all the Splinters of the Cra∣nium are fully come forth, after which the Wound is to be healed up, as other Wounds of the Head and Skull.

CHAP. XVI. Of a FRACTƲRE of the NOSE-BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractu∣ra Ossis Nasi; and in English, A Fracture of the Bone of the Nose.

II. Hippocrates, de Articulis, Text. 30, &c. shews, that the Bone of the Nose may be broken many ways; for a part of it may either be broken off, or the ridge of it may be broken down, &c. wherein a Wound general∣ly happens unto the Fracture.

III. The Prognosticks. A Fracture of this Part is the easiest set of all; if it is not presently set right and straight, it cannot be set straight at all, but it will always stand awry.

IV. In this Bone a Callus also is soon bred, and confirmed; and it is healed in ten or twelve days time, unless the Bone is corrupted: Yet some say it is not done in less than 18 or 20 days; but this is according to the various habits of Body.

V. The Cure. If the Bone is equally crusht down unto the lower part, and made as it were flat; then something is to be put in∣to the Nostrils that may raise it up again, which may be done with some searching Instrument, or a Spatha; or else it may be lifted up with the Finger, by putting it up into the Nostrils, outwardly also nipping it up on both sides, that so it may be restored to its natural situation and place.

VI. Or wrapping up a little Stick in Cotton, you may put it into the Nostrils as gently as may be; and therewith raise up the Bone, laying the Thumb and Finger of your left Hand on both sides the Nose, to direct, reinstate, and retain the Bones in their proper piaces.

VII. If the Nose is broken only on one side, it is gently to be set right and strait from that way to which it declines; either by thrusting in the Finger, or by the help of some fit Instrument as aforesaid, directing it also straight out∣wardly.

VIII. And that the Bones thus set may be kept in their proper places, Plugs made of Linnen-rags are to be put up the Nostrils; or else Pipes of Lead, anointed with Oil of Turpentine mixed with Spirit of Wine, which may both support the Bones, and facilitate Respiration.

IX. Some put up Sponges, but they are pernicious, for thro' the moisture of the Nostrils they will swell much, whereby becoming very thick, and much dilated, they are apt to distend the Part, and to move the Bones out of their places, after they have been well set.

X. The leaden Pipes which are

put up, ought to have leaden Ears or Handles, by which they may be fastned to the Cap, or Head; and if you please, to make them the more healing, they may be co∣vered with some Empastick Medicament, as Manna Thuris, (which is a pure white sort of Frankincense, exsudating of its own accord thro' the Bark of the Tree, and which in the West-Indies I have often gather∣ed with my own Hands) made up with Mastich, Gum Traga∣canth, and Oil of Roses, into a Body.

XI. If there is no Wound in the Nose, there will be little need of Bandage; but if a Wound is present, you are to apply pro∣per Topicks, and to lay upon each side the Nose a kind of tri∣angular Bolster, covered with a small piece of Pasteboard of the same figure.

XII. This Dressing may be kept on with a kind of Bandage, which has four ends or straps, being a piece of Linnen-cloth about two Inches broad, and two Feet long; it is slit at both ends, and all along, leaving it only in the middle whole, for about three Inches in length.

XIII. This whole part is to be laid upon the Eracture, causing the upper straps to go round the Nape of the Neck, which are to be brought back again forwards: The lower straps are also to be carried backwards to the Neck, crossing above the Neck upwards, and afterwards to be brought a∣gain forwards.

XIV. If the Nose, near to the Gristle, is turned away, a glutina∣tive Emplaster with a little Loop is to be applied to the reclining side of the Nose; which being dried firmly on, is afterwards to be straitned as much as is conveni∣ent, that so the Note may be set straight again.

XV. Paraeus uses this: Take fine Bole, Frankincense, Mastich, Dragons-blood, A. ℥i. Pine Rosin, Roch Allum, A. ℥ss. all being in fine pouder, mix them with whites of Eggs well beaten q.s. and make a sticking Emplaster.

XVI. Or this Emplaster may be put upon a very broad Tape, or a Linnen Rowler, which may be so long, that being drawn below the Ear, and so wound about the Head, it may be agglutinated upon the Forehead: After 14 days it may be removed, and a Cerate laid on, to consummate the Cure, and to confirm and strengthen the Bones.

XVII. If the Bone is shatter∣ed into small pieces, they are, as much as may be, to be put all in their places again with fit Instru∣ments; nor must you easily ad∣mit the taking of any forth, if it is possible that they may be agglutinated, lest it cause de∣formity.

XVIII. Now as some Authors approve of this Bandage, or Bind∣ing up of these Fractures, so others wholly disapprove of them, saying, it is more safe wholly to omit them; for that they either per∣form nothing at all if they be loose, or else draw the Nose a∣wry, or make it flat, if drawn but indifferently close or hard; and that the broken Bones of the Nose may very easily be

kept fast in their planes by pro∣per Plasters, without any bind∣ing at all.

XIX. And truly in this Case only is this Bandage convenient, where in the ridge of the Nose, the Flesh is bruised with, and the bro∣ken Bones stick forth; so that the Bandage pressing them together, may make them to acquire their own natural form.

XX. And yet in this very case, Bandage is not altogether necessary or profitable, for that a proper Ce∣rate or Emplastey may sufficiently do the Work without it; But we thought good in the aforegoing Sections, so deliver the Method or Way of doing it, that this our Work might not be thought defective in that particular.

CHAP. XVII. Of a FRACTURE of the JAW-BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Mandibulae vel Maxillae; and in English, A Fracture of the Jaw-bone.

II. The Signs. When the lower Jaw-bone is broken, it is easily known, both by sight and feeling.

III. The Prognosticks. If in the Practure there is not an Inflam∣mation from the very beginning, the Cure may be compleated in twenty days, the Teeth remain∣ing safe.

IV. But if the Cure is ill ma∣naged, or long delayed, the Teeth may be vitiated, and rendred unuseful.

V. The Cure. It is restored with ones Fingers, used both within and without the Mouth; to press the prominences of the Bones into their proper places.

VI. If they be too weak, then one is to draw the Head backward, and the Artist the Jaw forwards, and so reduce the fractured Bone to its place; and if the Bones pass one over another, a small Ex∣tension is to be made.

VII. If the whole Jaw-bone is broken in a transverse manner, (which yet seldom happens) let there be an Extension of the Parts, then by compression with the Hand, reduce or set the Bories together.

VIII. If the Bone is restored rightly, to its place, it will be known by its equality and evenness, and by the Teeth being restored and disposed again to their for∣mer natural situation.

IX. If the Teeth have been moved on •…•…sned, they are with a small Gold or Silver Wire, or with a waxed Silk or Thread, to be fustned to the sound Teeth which stand next them.

X. These things being thus done, some proper Medicament is out∣wardly to be applied to the Jaw-bone, that so the broken Bones be∣ing

set together again, may be firmly fastned in their places; and externally a little Bolster of Leather, or other like thing, may be applied, with conveni∣ent Ligature.

XI. The Bandage may be with a Swath two Inches or more broad, slit at both ends, into straps, or cut longways, that it may on both sides take in and contain the Chin; and therefore there being four Heads of the Swath, thus slit at both ends, the two lower of them are to be brought and drawn along to the top of the Head, and there to be tied toge∣ther, or sewed to the Night-cap; but the two uppermost are to be drawn to the lowest part of the Head behind, and tied together, or sewed, as afore∣said, to the Night-cap.

XII. Others lay a piece of Pasteboard, cut to the stupe and size of the Jaw, to the flat side thereof; and then with a Bandage nearly twelve Feet long, and two Inches broad, rowled up with one head, they begin the Application, by making a Circumvolution round about the Head, and passing over the Forehead; then the Band is let down under the Chin, and carried up again upon the Cheek, near the out∣ward corner of the Eye, pas∣sing also over the Fracture: Af∣terwards it is raised up to the Head, and brought down again under the Chin, to hold the Bolster upon the Fracture; thus three or four Circumvolutions being made upon the Fracture, the Band is let down under the Chin, to stay and strengthen its several Circumvolutions, and ends round the Head, in pas∣sing over the Forehead.

XIII. If the Jaw is fractured on both sides, it would be necessary to apply to it a Bolster and Paste∣board (perforated at the Chin) of the shape or figure of the whole Jaw; and the Bandage may be 18 or 19 Feet long, and two Inches broad, rowled up with two heads.

XIV. The Ligature is to begin at the middle between the two heads, and to be applied under the Chin, from whence it is to be carried up, over the Cheeks to the top of the Head, where they are to cross, and then to be let down again behind the Head, where they cross again, and so being brought under the Chin, they cross there also, and are carried over the Fracture on both sides; afterwards the Bands are passed about three or four times over the same, and rowling upon the Jaws, are turned upon the Chin, and be∣ing carried round the Head, end upon the Forehead.

XV. Let the Patient lye upon the contrary Jaw-bone (when but one is broken) viz. upon that which is not fractured, but let him not rest thereupon, but upon his Head, lest the Fracture should renew, or the Bone go awry.

XVI. And keep the Jaw, is much as may be, immoveable, or at rest; let him not speak much, or chew any hard thing, but be nourished with soft and moist Food, till the Callus is hardned; on the third day dress it, and regulate what Symptoms you find appear.

CHAP. XVIII. Of a FRACTƲRE of the COLLAR-BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Cla∣viculae; and in English, A Fra∣cture of the Channel-bone, or Collar-bone.

II. Hippocrates, de Articulis, Text. 62. reckons up Six Dif∣ferences of Fractures in this Bone. However, it is broken either transversly, or longways; and these are either in the middle, or near the Brest-bone, or near the Joint of the Shoulder.

III. The Signs. It may be known both by sight and touching, as also by the Pain the Patient en∣dures.

IV. The Prognosticks. If it is broken transversly, it is the more easily Cured; if longways, the more hard: And because it can∣not be bound about as other Fractures may, it breeds a Cal∣lus, causing a very great desor∣mity.

V. This Bone does easily grow together again, as do all other thin Bones; but in a thin Bone, the Callus always grows greater than in other thicker Bones; and the Cure is performed in twenty, or twenty-four days at the far∣thest.

VI. The Cure. You must make an Extension by the help of two strong Persons; there must be one to draw the Arm backwards or sideways, and another to draw the Neck and Shoulders for∣wards; the Artist himself in the mean time, thrusting or draw∣ing upwards what was fallen down; and thrusting or putting downwards what was raised too high.

VII. And if a Ball, or some tu∣berous Body be put under the Arm∣pit, and the Elbow is pressed a∣gainst the Ribs, the Operation will be the more easie.

VIII. But if the ends of the broken Bone are so depressed, that they cannot in this manner be brought back again upwards; then the Patient is to be laid flat up∣on his Back upon a hard Pillow, or Cushion put under his Back-bone, between the Shoulder∣blades.

IX. Then the Shoulders are by main strength of the Hands lying upon them to be so pressed down, that the ends of the fractured Bones which are depressed may be lifted up so high, as to be reduced to their true places.

X. If the Bone is shattered into many small pieces, pricking the Flesh, or causing a difficulty of breathing; you must make an Incision into the same Part, and remove them, or cut off the sharp pricks or points of the broken Bones, and then join the Bones together.

XI. Then drawing the Lips of the Wound close, apply things pro∣per

for a Fracture, and such as may withal hinder Inflamma∣tion.

XII. But if there should be many fragments of Bones (the Skin remaining whole) which are not sharp-pointed nor do at all prick, then a Sprinter of Lea∣ther, Pasteboard, or some other convenient Matter; is to be smeared or anointed with some proper Ointment or Balsam, and to be applied to them.

XIII. Afterwards three cover∣ings must be provided, of a fit length and thickness; two to fill up the hollownesses on each side the Bone, and a third to be impo∣sed upon the Fracture sticking forth; all which will keep the broken Bones in their due place.

XIV. The Bandage. It is to be well bound up with a Swath four Inches broad, and of a suffi∣cient length, viz. about eight Yards long, rowled up to the middle at both ends, and so making two heads.

XV. It is bound crosswise in form of the Letter X, which is rather to be often drawn or wound about the place of the Fracture, than that it should be too close, or hard bound; and it is to be so rowled about, that it may draw the Arm unto the hinder parts: which that the Sick may the better endure, Bolsters are to be put under the Arm-pit, near the Part affected.

XVI. The Ligature is not to be loosned before the seventh day, un∣less as Itching, or other Cause re∣quire it: but if it is at any time unbound, it is in binding up again, to be drawn a little clo∣ser and harder.

XVII. Or, the Swath being rowled up with two heads to the middle, apply it in the middle to the Fracture: one of its heads is to be let down upon the Brest, whilst the other is carried be∣hind the Back, below the Arm∣hole, opposite to the indisposed Arm-hole; and above the Brest, to be carried over the other end of the Band, which is raised up to fix a Bolster upon the Fra∣cture: the other end is to be passed under the affected Arm-hole, and upon that end of the Band which fixed the Bolster; which is again to be elevated by applying another Bolster upon the Part: these Circumvoluti∣ons are continued round the Body, and pass over the Clavi∣cle, till it is perfectly covered therewith; and passing over the upper part of the Shoulder near its Head, it is to be carried over the space which lyes be∣tween the Bolsters, and the Circumvolutions of the Arm, and then is to end, by passing round about the Body.

CHAP. XIX. Of a FRACTƲRE of the SHOƲL∣DER-BLADE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Scapulae; and in English, A Fracture of the Shoul∣der-blade.

II. A Fracture may happen ei∣ther in its point, or top of the Shoulder, called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 (ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 extremus, sum∣mus, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, humerus) sum∣mitas humeri; or in the body of the Blade-bone it self, pro∣perly and more especially cal∣led Scapula, or Omoplata.

III. The Signs. If the Acro∣mion is broken, it is known both by sight and feeling, there being a certain unevenness in the Part, especially, if being compared with that which is sound.

IV. If the Scapula is broken in the middle part, it is known also by the touch, there being a certain Cavity felt: there is also a pricking Pain in the Part, and a numbedness is felt in the whole Arm, more especially if it is stretch'd directly out.

V. The Prognosticks. A Fra∣cture in the Acromion, or top of the Shoulder, is more difficultly Cured, than in any other Part of the Shoulder-blade.

VI. If the Blade-bone it self is broken, the Cure is generally per∣formed in about twenty-four days time.

VII. If the Neck of the Shoul∣der-blade is broken, or the Fra∣cture is in the Dearticulation of the Shoulder, it is scarcely ever Cured.

VIII. For since near about this Joint, there are the Arteries and Veins of the Arm-pits; and the Nerves arifing from the Vertebrae of the Neck behind; an Inflam∣mation, and other vehement Symptoms do generally hap∣pen.

IX. The Cure. First examine the Place and Circumstances of the Fracture, and see if the broken Bone does still adhere to the Shoul∣der-blade; if so, you are with your Hands to thrust back the Prominences of the Bones into their proper places.

X. But if this cannot be done easily, and that there is need of great strength, then a Ball of Linnen is to be put under the Arm-hole, and the Assistant is to draw the Shoulder down∣wards, by drawing about the Elbow unto the Ribs; and the Artist himself is with his Hand to press down the fractured piece of Bone, into its right place.

XI. If the broken Bone is wholly separated from the Scapula, but hangs by the Periosteum, and the Ligaments; and that no vehe∣ment Symptoms are induced by reason of the Pain; you are

then to restore it to its place again.

XII. But if the broken Bone is wholly separated both from the Sca∣pula, the Periosteum, and the Ligaments; or there happens to be any Splinters, which may prick the Nervous Parts, &c. you must then make an Incision in the Skin and Flesh, and those fragments are to be taken out, or their points are to be cut off.

XIII. But if they prick not, they are then to be left remaining; for Nature will at length expel of her own accord, those things which will not join with the rest; tho' sometimes it may be a conside∣rable time before it is done.

XIV. The Bones being re∣duc'd as well as may be, pro∣per Medicines are to be apply'd upon the Fraction; with conve∣nient Ligature or Bandage.

XV. A Bolster is to be laid up∣on the Scapula; and a large piece of Paste-board, of the bigness and Figure of the Bone, over which may be apply'd a small Bandage, resembling the Band-Cancer, or a Star, with a Swath five Yards long and four Inches broad, rowled up with one Head.

XVI. This Swath is to be car∣ried behind the Back, one of its ends lying under the Arm-hole op∣posite to the side affected; but the other is to go under the Shoulder, and afterwards above it, crossing the middle of the Back, and so running under the other Arm-hole; it is brought up to the Shoulder, to run down, and form a second Cross upon the middle of the Back: these Cir∣cumvolations are to be continu∣ed till the Scapulae are all cover∣ed; and Circumvolutions are also to be made round the upper Part of the Humerus or Shoul∣der, and then the Ligature is to be compleated by a Circumvo∣lution round about the Brest or Stomach.

XVII. If the Acromion is bro∣ken, a Linnen Ball is then to be bound under the Wing thereof, and the Ligature is not to be loosned before the seventh day, unless some Symptoms urge it.

XVIII. Lastly, Let the Pati∣ent lie on the opposite side, and let the Part affected be kept in as much quietness as may be.

CHAP. XX. Of a FRACTƲRE of the ARM.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. In Latin, Fractura Hu∣meri, vel ••ssis Humeri and in English, A Fracture of the Arm, or of the Bone of the Arm.

II. The Signs. It is known partly by sight, partly by feeling, and partly by the weakness of the Part, and complaint of the Sick.

III. The Prognosticks. A

Fracture of the Os Humeri is more eaily cured than a Fracture in the Bones of the Elbow.

IV. The Shoulder-Bone being broken, is consolidated in about 40 days; for it being a great Bone, it requires a long time for the generating of the Callus

V. The Cure. To restore the Bones to their proper place, the fractur'd Part is to be ex∣tended; one plucking strongly the upper part, another draw∣ing the lower Bone above the Elbow straight out, and then to reduce it to its place with your Hands, by closing it on all sides.

VI. If this cannot be done by the Hand above, in such as are of full and ripe Age, by reason of the thickness and strength of the Muscles, then it will be necessary to make the Extension by proper Instru∣ments, and Cords, as Hippo∣crates has taught us, and of which we have sufficiently spo∣ken before.

VII. In the Extension, let the Sick be kept immoveable, whe∣ther sitting or lying along, and let the Shoulder be kept in about the upper part of it, and let the broken Bone be drawn this way and that way, till you have truly fixt it in its right place.

VIII. The broken Bones be∣ing thus set right and straight, you are to apply fit Medica∣ments thereto, such as we have formerly described, and then it is to be bound up with fit Swaths, beginning at the Fracture it self.

IX. Lay round the Fracture a Bolster dipt in Red Wine, or Oxycrate; then three several Bands are to be taken, 3 or 4 Inches broad, and 5 or 6 Foot long: the first of these is to be laid upon the Fracture, with which you are to make three ve∣ry straight Circumvolutions; then it is to be carried up with small Rowsings to the top of the Arm, and stay'd round the Body.

X. The second Swath is to be apply'd to the Fracture, on the opposite side to the first, with which you are to make upon the Fracture two Circumvolu∣tions; so that the same Swath may be carried down along the whole length of the Arm, with many turnings about, and at last terminate below the Elbow, which yet it is not to cover.

XI. This done, four long Bol∣sters are to be laid round about the Arm, upon the Fracture, which are to be kept close with the third Swath; in the binding of which about, it signifies not much, whether you begin it at bottom, or at top; and so accordingly it may end either round the Body, or below the Elbow.

XII. The Arm ought also to be encompassed with two thick pieces of Pasteboard, made round at the ends, and of the length of the Arm, which must be apply'd so as not to cross one another, and then ty'd on with Tape, or Ferret-Ribband.

XIII. After which the Arm is to be put in a Scarf made up with a large Napkin, which is first to be apply'd in the middle under the Arm-hole, the Arm resting upon it, so that the four ends being rai∣sed

up, may be fastned to the Cloths of the opposite Shoulder; and the Hand ought to be kept higher than the Elbow.

XIV. And you must always be careful to bind up the Member in that figure or posture, in which it ought to remain; so as that the Shoulder-Bone with the Elbow-Bones, may make a Right-angle.

XV. Hippocrates binds on Splin∣ters the seventh or ninth day, be∣cause of the magnitude of the Mu∣scles of the Shoulder: for that in a longer time those Bones would become slender and loose; but you are to be careful, that these Splints touch not the extremity of the Joints.

XVI. Celsus, lib. 8. cap. 10. says, That they ought to be very long on the outside of the Arm; some∣what shorter on the brawn of the Arm; and shortest of all under the Arm-hole.

XVII. If the Splinter be imme∣diately fastned on, at the very first of all (as indeed most of the Mo∣derns now do,) they ought then to be tied on but loosly; and after the seventh or ninth day to be bound harder.

XVIII. And that the Member may be so placed, that the Shoul∣der may not be perverted, or turned awry; the broad Bandage which encompasses the Shoulder, should be drawn in a manner round about the Brest.

XIX. Let the Sick (when in Bed) lye upon his Back, putting his Hand upon his Stomach, and soft Pillows under the Shoulder; and lift up the Elbow by a Scarf put about the Neck, to preserve the orthogonal figure, and that the Angle may not be altered whil'st the Patient sleeps.

XX. After the second or third Dressing, as often as the Patient is dressed, he must stretch out his Arm streight; to the end the Tendons which run from the Arm, and are inserted below the Elbow, (contracting themselves by the long bending of the El∣bow) might cause a very trou∣blesom stiffness.

XXI. The shrinking of Tendons (which Barbers, and ignorant Chirurgeons call the Shrinking of the Nerves or Sinews,) may yet easily be cured in ten or twelve Weeks time, if you cause the Patient to carry every day, some fit or proportional Weight.

XXII. And then withal endea∣vour to relax and soften the Tendons with emollient Fomentations and Embrocations; (abstaining from all Astringent Medicines) and applying over the Contracture a Cloth dipt in Empl. de Minio, being but a little more than half boiled.

XXIII. You may also bathe the Contracture twice a day with Spi∣ritus Mirabilis, which softens hard Parts, and restores Contractures, to a Miracle: then anoint with this. ℞ Mans, Ducks, Goose, and Vipers Grease, A.℥i. Oleum Catel∣lorum, Ung. de Althaea, A. ℥ss. Oils of Earth-worms, of Neats-feet, of Camomil, and of white Lillies, A. ʒii. mix them: and after an∣ointing, apply a Sparadrap of Emplast. de Minio, a little more than half boiled.

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.

CHAP. XXII. Of a FRACTƲRE of the WRIST-BONES.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Carpi Fractura; and in English, A Fracture of the Wrist-bones.

II. The Prognosticks. There is no great danger or difficulty in this Cure; for the Consolidation of the Bone or Bones is generally compleated in about 20 days.

III. The Cure. Two Assistants are to be provided, to make the Extension; one must hold the Arm above the Wrist, and another the Fingers and Hand: and the Ex∣tension being made, the Artist is to reduce the broken Bone in∣to its place; so that no inequa∣lity or unevenness may appear in the Part.

IV. When the Bones are reduced, or set right, then some proper Me∣dicaments, such as are usually ap∣plied in other Fractures, are to be applied here: and then the Part is to be bound up with a Swath, in the following manner.

V. You are to provide a Swath two Inches broad, and six or seven Yards long, or longer; which is to be rowled up with one Head: with this you are to make three circumvolutions about the Wrist.

VI. The Band is then to be pas∣sed over the Hand, between the Thumb and Forefinger; and so by that passage to be directed again to the Wrist, on which a Bolster is to be applied, with a little piece of Pastboard, of the same figure with the Wrist.

VII. After this, having made several circumvolutions over the Bolster and Pastboard, the Swath is to be carried by several cir∣cumvolutions to the top of the Elbow, and the Band or Swath is to end above it; which done, the Arm is to be carried in a Scarf.

CHAP. XXIII. Of a FRACTƲRE of the BONES of the HAND.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Ossium Metacarpii; and in English, A Fracture of the Hand; or, of the Bones of the Hand.

II. The Prognosticks. The Cure is performed without much diffi∣culty, and in no great length of time: the Consolidation of the Fracture being accomplished in the space of about sixteen or eighteen days.

III. The Cure. Two Assistants are to hold the Hand in the same manner as is directed in the former Chapter, in Setting of the Wrist-Bone: which being extended to the fractured Bone or Bones, are to be reduced to their own places by the Hand of the Artist.

IV. Then proper Catagmaticks are to be applied, such as we have directed to in the Cure of a Simple Fracture: after which, the Hand is to be bound up with proper Swaths.

V. The Swaths are to be about two Inches broad, and five or six Yards long; (because many circumvolutions strengthen the Part, tho' they are not made very strait;) and to be rowled up with one head.

VI. This Band is to be fastned to the Carpus or Wrist, with a circumvolution; from whence it is to be carried to the Metacar∣pium, over which it is to pass between the Thumb and the Forefinger.

VII. From whence it is to cross the Hand, and to form the Let∣ter X, which is to be continued with several circumvolutions, 'till all the Metacarpium is co∣vered.

VIII. Then a Bolster and Past∣board are to be laid upon the

Metacarpium; and another Bol∣ster in the Hand, in the shape of the Part: which done, the whole is to be covered as before, with many circumvolutions of the Swath, which are to be conti∣nued above the Elbow, where it is to end.

CHAP. XXIV. Of a FRACTƲRE of the FINGERS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Ossis, vel Ossium Digiti; and in English, A Fracture of a Bone, or Bones of a Finger.

II. The Prognosticks, This Fra∣cture easily consolidates; and if carefully lookt after, the Cure is performed in 14 or 16 days time.

III. The Cure. A gentle Ex∣tension is to be made on the Fin∣gers, whereby the Bones are to be be reduced to their proper places: after which a small Dressing is to be prepared for the Finger, much like to that of the Arm, but every way lesser.

IV. The Fingers are to be a little bent, and the inside of the Hand is to be fitted with a Bolster, to retain the Parts in that situa∣tion; and the Bolster is also to be stayed with a Bandage.

V. And indeed, if the Fingers should be fractured, they are to be bound fast to those Fingers which are sound, and next to them: that so by them, as it were by Splin∣ters bound on, they may be kept immoveable in their places.

VI. After which, the hollow of the Hand is to be filled up with a Ball or Bolster of Linnen Rags, as is afore mentioned; not only to retain the Bones in their places, but that the Fingers may also preserve a figure of a middle form.

VII. Care must also be taken, that no Callus be generated in the Junctures, or places serving for the extension or contraction of the Fin∣gers; for so the Function or Office of the Hand in laying hold of any thing, would be much hurt.

VIII. Lastly, the Hand is also with the Arm to be hung in a Scarf, or broad Swath, or a Nap∣kin, from the Neck; that so the whole Hand with the Fingers may kept up, and resting upon the same, may be kept easy.

CHAP. XXV. Of a FRACTƲRE of the BREST-BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Sterni; and in English, A Fracture of the Brest-Bone.

II. This Bone is seated in the middle of the Brest, being joined to the Ribs by Cartilaginous Pro∣ductions: in Children it is almost wholly Cartilaginous, and con∣sists of seven or eight parts: but after some Years they grow firmly together, and in ripeness of Age, it seems to be composed but of three parts; and this in old Age seems to be but one Bone, but 〈◊〉〈◊〉 distinguished by two transverse Lines, which shew the former division.

III. The whole Bone seems to be of a red fungous substance, the up∣permost of which is thickest and broadest: having in each side a long cavity, assisted with a Car∣tilage, to receive the heads of the Clavicles; and a small sinus or cavity on the inside, to permit a passage for the Wind-pipe.

IV. The second Bone is neither so thick, nor so broad, but much longer; joined to the former by a Cartilage, with five or six Sinus's, for the inarticulation of so many Ribs: the third Bone is the shortest of all, but broader than the second, and joined to it at its lower end by a Cartilage also, which receives into its sides the rest of the Ribs: to the lower end of this is joined the Cartilago Mucronata, or Ensifor∣mis, which is about an Inch long, and of a triangular form.

V. This Bone thus composed, may be sometimes broken; either by a Blow, or some external vio∣lence.

VI. The Signs. It is known by the Pain, but chiefly from the ine∣quality or unevenness, which is known by touching; for that being touched with the Fingers, it will yield to them, or retire in∣wardly, and cause a kind of crashing.

VII. Being pressed in where it is broken, it will yield inwardly, and a cavity outwardly may be taken notice of; with pain, coughing, shortness of Breath, and spitting of Blood.

VIII. The Prognosticks. It is very dangerous, by reason of the Pleura-Membrane (which is easily hurt with it) and the noble Parts which lye under it: for which reason, it is apt to cause many sad and terrible Symptoms.

IX. And by reason it is soft, spungy, and thin, it may be conso∣lidated in twenty days, or twenty-four days time.

X. The Cure. To restore this, the Patient is to be laid upon his Back, on a great convex Stone covered with Cloth, or a convex Bolster: his Shoulders are both of them to be pressed down, or backwards, that the Sternum

which is sunk down, may be re∣duced to its right place.

XI. Or an Incision may be made upon the Bone to discover it, and the Modiolus or Trepan may be applied thereto very gently, to raise it up into its true place; or it may be done with a pro∣per Levator.

XII. Sennertus advises to put a Pillow under the Spina or Back-bone, right under the Fracture; and then observing the former Directions, the Artist is to press together with his Hands on both sides, till the Bones are brought again to their right places.

XIII. After this, those Medica∣ments which are wont to be im∣posed on other Fractures, serving to prevent Inflammation, and for Conglutination, are to be applied here.

XIV. And the binding up, is to be done with sit Swaths, above the Shoulders, in the form of the Letter X; which binding ought not to be made too straight or hard, lest it hinder the breathing.

XV. Or, a Bolster and Paste∣board are to be laid upon the Ster∣non, almost of the same figure with the Part; and the Bandage is to be fitted with a Napkin, and a Brest-plate.

XVI. The Swath is to be four Inches broad, and six Yards or better long, and wound up to the middle with two heads: you are to begin with it under the Arm-hole, and it is to be carried downwards with its two heads, the one before, and the other behind; and passing under the other Arm-hole, the heads are raised, and they cross one ano∣ther upon the Shoulder, whence they are brought down back∣wards and forwards, forming an X, both before and behind.

XVII. Then the Swath is rowl∣ed or carried about the Brest, in making Circumvolutions, which are continued till the Swath comes to its ends, which are to terminate by a Circumvolution round the Brest.

CHAP. XXVI. Of a FRACTƲRE of the RIBS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Costae pl. Co∣starum Fractura; and in Eng∣lish, A Fracture of a Rib, or Ribs.

II. The Ribs are sometimes so broken as to decline inwardly, and sometimes to stick forth outward∣ly; sometimes they are only broken in part, and sometimes wholly broken; and yet then sometimes they are not moved out of their places, and some∣times the Flesh about them is broken or contused withal.

III. The Signs. If the whole

Rib is not broken, there follows neither spitting of Blood, nor Fe∣ver thereupon, nor any Apostem, or Suppuration, nor any great Pain; yet there will be some Pain felt upon touching of it.

IV. If the Rib is wholly bro∣ken, and yet the broken ends not removed out of their places, nei∣ther inwardly nor outwardly; these seldom spit Blood, or have a Fever, or any Apostem in the Thorax or Pleura, but the Part is sore and painful outwardly.

V. But if the broken ends are removed out of their places, then there is an inequality or uneven∣ness, and a hollowness, that may be found both by sight and feel∣ing.

VI. If the Rib is broken in∣wards, there is a very great and grievous Pain, much resembling the Pleurisy, difficulty of Breathing, and a troublesom Cough, with sometimes spitting of Blood; to which a Fever is also adjoined.

VII. The Flesh lying upon the Ribs is puffed up, which is known both by feeling and sight; and if the place is pressed with the Hand, there is heard a certain noise and sound of Air going out thereof.

VIII. This, if not timely reme∣died, proves to be an Inflamma∣tion, to which an Apostem suc∣ceeds; and sometimes a Corrup∣tion of the Bone, or Rib it self.

IX. The Prognosticks. If the Fracture is single, without any Contusion, or bruising of the Parts adjacent, there is little or no danger, and the Ribs will grow together again in about twenty days.

X. If the fractured Part is driven inwards, and there pricks or wounds the Pleura-Membrane, then all those Symptoms accom∣panying a Pleurisy, are here at∣tending, and the Case then is very dangerous; and if the Cure is accomplished, it is sel∣dom done in less than 40 days.

XI. If there is a Contusion withal, it is yet more dangerous, because of the afore-enumerated Symptoms, and sometimes it is Mortal, of which Hippocrates, de Articulis has wrote.

XII. The Cure. If it is a simple Fracture, it is Cured by only laying on the Emplastrum Catagmaticum upon the Part. Some apply Cupping-glasses to the place, to reduce the Bone, but they are hurtful.

XIII. If the Rib stands out, it is to be reduced, or pressed in with ones hand, and then the Catag∣matick Emplaster, or some such like, is to be laid thereon.

XIV. If the Rib is gone in∣wards, let the Sick draw in his Breath, as strongly and as long as he can, thereby to force the Rib outwards; the Artist in the mean time assisting with his Hand.

XV. But if this succeeds not, let the Patient be laid upon the sound Side, and upon the fractured Rib, let a sticking Emplaster be applied, as a Plaster of Mastich, or this of Paraeus, in lib. 15. cap. 11. ℞ Turpentine, Rosin, black Pitch, Mastick, Aloes, Wheat-flower, A. q.s. mix, and make a Plaster, which spread upon strong new Linnen-cloth, and apply it.

XVI. When it has stuck some time, pull it suddenly with great violence, and often if need re∣quires, from below upwards; this sometimes reduces the Bone, which is fallen into the Brest, to its place; but it ought to be pulled so often, till such time as the Sick finds ease, and breathes more freely.

XVII. Sennertus has this: ℞ Fine Wheat-flower, Whites of Eggs, A. ℥ii. Ichthyocolla ℥iss. Bird-lime ʒvi. Frankincense in pouder, Tragacanth, A. ʒv. Rose-water (but Poppy-water is bet∣ter) enough to mix them.

XVIII. But if these things will not do, the only way left, is to make an Incision therein, and then with your Finger, or a Levatory, to raise it up, and so to put it into its true place.

XIX. If the Membrane Pleura is pricked by any Fragment of a Bone, the Part must then also be opened with an Incision-knife, that you may take away, or cut off the said Fragment; and then Cure it as a Wound of the Ribs, according to Art.

XX. If the Rib is not wholly broken; or if broken, and not re∣moved out of its place, apply things to consolidate the Fra∣cture, as a Plaster of fine Bole, Frankincense, Wheat-flower, and the White of an Egg, or some such like.

XXI. If there is a Contusion or Bruise, give inwardly Spirit of Sal Armoniack in a proper Vehi∣cle, and bathe the Part with this: ℞ Damask Rose-water, or Poppy-water, or Rosemary-water ℥iii. Spirit of Wine ℥ii. volatil Sal Armoniack ʒiii. mix, and foment therewith warm.

XXII. Then apply Discussives, and such things as repress an In∣flammation: as, ℞ Aloes, Bar∣ley-flower, Catechu, Pouder of red Roses, Sumach, Myrtle-ber∣ries, Cypress-nuts, Galls, Tormen∣til, and Bistort Roots, Saccha∣rum Saturni, A. ℥ss. Whites of Eggs, N^o ii. Oils of Roses and Camomil, A. q.s. mix, and make a Cataplasm.

XXIII. If it Apostemates, you must speedily open it, lest the Mat∣ter foul the Bones; after which you must Cure it, as we have in other places of this Book taught you.

XXIV. In this case it is neces∣sary that the Sick keeps himself as quiet as may be, and composes him∣self to rest, without Coughing or Sneezing, or much Talking, or Laughing; and withal, that he takes a particular Traumatick Diet-drink; and once in five days purge with some Liquid Cathartick, as Tinctura Purgans, Syrupus Catharticus, &c. See Galen, in Hippocrat. de Articulis, lib. 3. Text. 54. and Paraeus, lib. 14. cap. 12. if these things takes no effect, the Sick falls in∣to a Consumption, and so dies.

XXV. When the Ribs are re∣duced, tho' Nature will indeed ge∣nerate a Callus, yet Sennertus thinks that this following Em∣plaster, as one of the best and chiefest, may be imposed to give assistance therein.

XXVI. ℞ Pouder of Myrtles, red Roses, A. ℥i. Barley-flower, Meals of Beans, Lentils, Orobus, Mastich, Acorn-cups, rinds of Cy∣prus-nuts,

Frankincense, Sanguis Draconis, Aloes, Myrrh, Terra Lemnia, A. ʒii. Oils of Myrtles, of Roses, and Oil-omphacine, A. ℥ix. Wax, Turpentine, A. lbss. mix, and make an Emphaster. If Catechu, dried Blood, A. ℥i. be added, the Emplaster will be yet much more powerful.

XXVII. Lastly, as to the bind∣ing up, a Bolster is to be applied to the Fracture, with two little pieces of Pasteboard layed in form of an X, and another Bolster upon the whole Dressing; on which also may be laid a petty large square Pasteboard, covered with a Bol∣ster: and the Bandage is made with a Napkin, made into three folds, which is to be put round the Brest, being sowed to, and supported by a Back and Brest∣plate, or Scapulary hanging from the Shoulders, whose two ends are fastned both before and be∣hind to the Napkin.

CHAP. XXVII. Of a FRACTƲRE of the BACK-BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and in Latin, Fractura Ossium vel Spinarum Dorsi; and in Eng∣lish, A Fracture of the Back-bone.

II. The Signs. Celsus, lib. 8. cap. 9. says, That if any Process of those Bones is broken, it may be discerned by the touch, because that it may be moved this way, and that way: and indeed it may be known by a Cavity in the place, with a Pain and Prick∣ing.

III. If the Sick lyes upon his Fuce, the Pain is so much the greater, because the Skin is ex∣tended, and the Flesh bruised and prickt with the fragments of the Bones, as if they were Thorns or Nails.

IV. But if the Patient stands upright, the fragments of the Bones prick not so much, by reason the Skin is then slackned or loos••ed.

V. The Prognosticks. If an involuntary egestion of Excre∣ments, or a stoppage or suppression of Ʋrine happen in a Fracture of the Vertebrae, the Patient is de∣sperate, and in great danger of his Life.

VI. A Fracture in the Process of the Vertebrae, is easily consoli∣dated and cured; for that those Bones are spongy and thin, un∣less some ill Symptom should intervene.

VII. But if the Spinal Marrow is hurt or prest in, whereby the Arms or Legs of the Sick become sensless, or that he cannot retain his Ʋrine or Excrements, Death com∣monly follows: and this more especially, if the Fracture hap∣pens in the Vertebrae of the Neck; for that with the Spinal Mar∣row, the Nerves and Mem∣branes are also hurt.

VIII. If in a Fracture of the Vertebrae of the Neck, the Sick escapes with Life; yet an inoura∣ble Falsie of the Arms and Hands follows thereupon.

IX. If the Fracture happens in the Vertebrae of the Inferior Parts, and Motion and Sense are not al∣together abolished, there may be some small hope of Recovery; but then by reason the Nerves are hurt, there follows a Palsey of the Thighs, Legs and Feet: if Motion and Sense are whol∣ly lost, Death infallibly suc∣ceeds.

X. The Cure. The in some of these Cases, there may be but lit∣tle hopes of a Cure, yet the poor Patient is not altogether to be de∣serted, but the most proper Means are to be attempted in order to a Cure.

XI. If the Spinous Apophyses are only broken, the Patient is to be laid upon his Belly, and with your Hands you must en∣deavour to raise up the Bone again, and reduce it to its own proper place.

XII. Then you may apply to it on each side a small long Bolster, which may be covered with a Pasteboard of the same shape or form, laying also another Bolster upon each Pasteboard: the Ban∣dage may be made with a Nap∣kin, which you may keep fast by a Scapulary falling from the Shoulders.

XIII. As to Topicals, they are such as are generally applied in Fractures, viz. such as ease Pain, prevent Inflammation, and in∣duce Conglutination.

XIV. If the Process is wholly broken off from the Periosteon, and is loose, you must make an In∣cision, and take it out: so also if fragments of the Vertebrae press upon, or prick the Spinal Mar∣row, or the Nerves; for other∣wise dismal Accidents may hap∣pen, and Life it self may be lost: afterwards the Wound is to be healed according to Art.

CHAP. XXVIII. Of a FRACƲRE of the GREAT BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin, Ossis Sacri Fractura; and in English, A Fracture of the Os Sacrum, or Great Bone.

II. This Bone is the largest or greatest of all the Bones of the Buck, and does sustain all the other Vertebrae: it is smooth on its inside, and concave; on its outside, convex, and uneven, being almost of a triangular form.

III. Its upper part on each side is very firmly knit to the Ossa Ilia, by an intervening Cartilage; and consists of five or six Bones in Infants, but in grown Persons scarcely distinguishable.

IV. These Bones resemble the

Vertebrae, and are so called; for each of them had a Body, and Pro∣cesses, and a large hole for the Spinalis Medulla; the lower part of these Bodies are always less than the upper, whereas in other Vertebrae they are always bigger.

V. Their oblique Processes can scarcely be discerned, except the first: the transverse Pro∣cesses are pretty long, but so united, that they all seem but one: and the hinder Processes or Spines, are like those of the Loins, but lesser, and still lesser the lower; the lowest having no Process but a Protuberance.

VI. The Prognosticks. These, if they shall be so bruised and bro∣ken, that thereupon the Spinal Marrow shall be hurt, the Affect is very dangerous, if not mor∣tal; for the Reasons which we shewed you in the former Chap∣ter.

VII. The Cure. A Fracture in this Bone, is reduced as a Fra∣cture in the other Vertebrae; but the Dressing and Bandage are made like a T, with a hole per∣forated through it, at the Anus or Fundament; or else like the Greek Letter Π, or a double T.

VIII. It is done with a Swath two Inches broad, and long enough to go round the Body above the Hips; so that to the middle of this Swath, another Swath of the same breadth is fastned, and of a length long enough to pass over the Dressing, as also be∣tween the Thighs, to be joined in the forepart, to the first Cir∣cumvolution.

IX. The π, or double T, is made by fastening two Bands at an Inch distance one from another, to the Swath which is rowled round the Body; which Bandage is also supported with a scapu∣lary, hanging down from the Shoulders.

X. The Topicks must be such as are anodyn, prevent Inflammation, and resist a flux of Humors; be∣ing also of an Astringent force, and Catagmatick.

CHAP. XXIX. Of a FRACTƲRE of the RƲMP-BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Ossis Coccygis Fractura; and in English, A Fra∣cture of the Rump or Crupper Bone.

II. This Bone is joined by a Cartilage to the Os Sacrum, but somewhat loosly, that it may bend a little backwards; especially in Women in Travail, for the more easy passage of the Foetus.

III. It is composed of four Bones, the first of which has a small ca∣vity or hollowness, which re∣ceives the last Vertebra of the Os Sacrum.

IV. The other three Bones grow

each less than other, and are join∣ed together by Symphysis or Coa∣lition; and at the end of these, is a small Cartilaginous Sub∣stance or Gristle.

V. It is called Os Coccygis, because in its form, it resembles the Cuckow's-bill; and it bends inwards (like it) at its lower end, that it may be a stay to the Intestinum Rectum, and the Sphincter Muscle, which are joined to it.

VI. Its Bones are spongy and soft, but without Marrow, or any Process, or Hollowness; for the Medulla Spinalis descends no lower than to the bottom of the Os Sacrum.

VII. The Bone is commonly fra∣ctured by Falls, and then it sinks inwards, scarcely ever out∣wards.

VIII. The Prognosticks. Whilst recent, there is not much danger in it; but if it is neglected, it may be of very evil Consequence; and if that Part is hurt and corrup∣ted, to which the Intestinum Rectum and Sphincter Musele are joined, very evil and dangerous Symptoms may follow.

IX. The Cure. The Cure is to be ordered as that of the Os Sa∣crum in the former Chapter; but this has something peculiar to it self: for by putting your Fore∣singer into the Anus as far as the Fracture, and thrusting it hard against the fractured Bones, you may reduce them to their true situation, the other Hand fixing them in the mean while on the other side.

X. The Dressing and Bandage are the same with the former, but the Sick must be obliged to lye on one side, and keep his Bed: but if he has a mind to rise, he ought to sit on a Chair, with almost no bottom in it; yet it is best keeping in Bed during the whole time of the Cure, &c.

CHAP. XXX. Of a FRACTURE of the HIP-BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Ossis Anonymi vel Inno∣minati Fractura; and in English, A Fracture of the Hip-bone.

II. This Bone consists of three Parts or Bones, 1. Os Ilium, The Haunch-bone, because it lyes under the small Gut, called Ilium: this is the uppermost and broadest, semicircular in its form, convex without, and concave within; and is joined to the Os Sacrum, by a common membranous strong Ligament, and a Cartilage intervening.

III. 2. Os Ischium, or Os Coxendicis, the Huckle-bone, (which some call the Hip-bone) this is the outer and lower part of the Os Innominatum, contain∣ing the Acetabulunt Coxendicis,

or large Cavity which receives the round head of the Thigh-bone, the edges of which are covered with a Cartilage, called Supercilium.

IV. 3. O. Pubis, or Os Pecti∣nis, the Share-bone; which is the lower, and inner, or fore∣part of the Os Innominatum; and is joined to its Fellow, on the other side by a Cartilage, which is much thicker, softer and looser in Women than in Men, that it may a little give way to the Foetus in Travail.

V. These three Bones in Men of full growth, are so fast knit and joined together, that they can by no means be separated; but in Chil∣dren, they may be divided with∣out much ado.

VI. These Bones may be broken (like those of the Shoulder-blade) either in their Extremities, or transverse, or longways.

VII. The Signs. A Fracture of this Bone is known by its pain∣fulness, which is more especially exasperated by the touch and com∣pression; as also by a pricking, a depression or cavity, uneven∣ness, or inequality, and numb∣edness of the Leg on the same side.

VIII. The Prognosticks. The Fractures of these Bones are usual∣ly consolidated in the space of 24 days, especially if they be sud∣denly set; otherwise you may expect various Accidents.

IX. The Cure. The Fracture is with all possible speed and dili∣gence to be set, and the Bones are to be reduced into their own places; after which, fit and proper Ca∣tagmatick Medicaments are to be applied.

X. But if there are any frag∣ments of the Bone broken off, which by their continual pricking may ex∣cite Pain, and there is withal fears of an Inflammation; some advise to make Incision, and take them out, replacing pre∣sently these pieces which have fast hold.

XI. But whereas these frag∣ments or splinters very rarely lye under the Skin alone, but also un∣der the very Muscles themselves, as also under Arteries, Veins, Nerves and Tendons, or heads of Muscles; for this cause, such a Section or Incision cannot be made without much danger.

XII. If any one therefore will attempt such an Operation, he ought to be very cautious, that he hurts or wounds none of those Vessels or Parts, especially that very large Nerve, which de∣scends down to the Muscles of the Thigh.

XIII. The fragments or splin∣ters being taken away, and the Parts not separated from the Pe∣riosteon, being reduced with your Fingers, you are to pursue the rest of the Cure, as necessity, and a recent Wound of those Parts may require.

CHAP. XXXI. Of a FRACTƲRE of the THIGH-BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Ossis Femoris: and in English, A Fracture of the Thigh-bone.

II. This Bone, of all the Bones in the whole Human Body, is ab∣solutly the biggest, thickest, and longest, and may be broken ei∣ther in the middle, or towards the extremities, in any of the kinds of Fractures.

III. The Signs. If the Thigh-bone is broken near its Head, it will be very difficult to be discove∣red: but if it is broken more towards the middle or lower part, it may soon be known, because the Bones will tye one over another; also, one Leg will be shorter than another.

IV. The Prognosticks. Cel∣sus, lib. 8. cap. 10. says, If the Thigh-bone is broken, it must of necessity be made shorter, because it never more returnes into its old place.

V. Peccettus, lib. 4. cap. 24. expounds this Opinion of Cel∣sus to be, when the Part is less Extended than need requires, and when the Bones are not well and exactly set together: for we daily see, many having had a Fracture of the Thigh, to walk straight and upright, without any Lame∣ness at all. And this Avicenna, lib. 4. Fen. 5. Tract. 3. cap. 14. Guido Cauliac. Tract. 5. Doct. 1. cap. 7. And Andreas, Chirurg, lib. 2. cap. 14. with divers others affirm.

VI. But Fabricius Hildanus, Cent. 5. Obs. 86. says, that he never saw nor knew any, that had this kind of Fracture who escaped without a Lameness, except one young Maid only, whom he cured after a new and peculiar manner. But this is chiefly to be under∣stood, when the Bone is broken near to the Hip; and of this kind of Fracture, the afore-quoted Authors are to be under∣stood to Speak.

VII. But if the Bone is broken towards the Knee, or in the mid∣dle, if care and diligence is used in the Cure, it may certainly be healed without Lameness, or any great difficulty: but if the said Bone is broken near to the Hip, Lameness for the most part fol∣lows.

VIII. A Fracture of the Thigh-bone will be consolidated, or brought to grow together again, in about 50 days, and not sooner; in regard that it is the greatest of all Bones; for which reason, it requires a longer time for the generating of a Callus.

IX. The Cure. If the Thigh-bone is broken, and the parts re∣moved out of their places, the Extension must be very strong and forcible; because the Muscles which encompass the Thigh, are

greater than all the rest, and therefore being contracted, are the harder to be extended.

X. This, if it is in one of ripe years will 〈◊〉〈◊〉 be done by the Hands, without some Instrument, 〈◊〉〈◊〉 Engine, for which purpose we commend either the Pulley of Vitruvius in Tab. XI. Fig. III. both which two have before de∣scribed, cap. ••. sect. 19. ad 23. and sect. 29. ad 33.

XI. Hippocrates approves of Extending this Bone, when it is broken so much, that the greatness of the Extension may be such that the ends of the fragments be some∣what distant asunder, and an Empty space may be left between (for otherwise the Bones will not easily reduce) after which a ligature is to be made.

XII. But it is not here, as in the Extension of 〈◊〉〈◊〉 Bones; for the Ligature is not in his place of such force alone, 〈…〉〈…〉 and keep the Bones and Muscles in that State, wherein the Artist shall place them; by reason the Mus∣cles are large and strong, and apt to prevail against the Liga∣ture.

XIII. Paraeus, lib. 15. cap. 20. advises, therefore, that because the Thigh-bone is hollowed or croo∣ked on the inside, and gibbous on the outer side, that 〈◊〉〈◊〉 may be kept in its native Figure by putting into the hollowness a Compress, or thick Bolster, with a Plaster or Cerate under it spread with Ʋng. Rosatum, or some gluti∣nous thing, that it may not fall off; otherwise the Patient would halt, and be Lame all his Life after.

XIV. Due Extension being made the Artist is to say his Hands upon the Fleshy parts of the Thigh, and direct his Thumbs to the fractured Bone, and so force it back into its place.

XV. This done, fit Medicaments are to be apply'd thereto, with the thick Bolster, as long as its bend∣ing is; and then the Fracture is to be bound up with good Li∣gature.

XVI. You must provide three Swaths, each of them 4 Inches broad: let the first be four Yards long; the second five Yards long; and the third nearly six.

XVII. With the first Band, you are to make three Circumvolutions upon the Fracture: carrying it up∣wards with small Ambages, and making it to end round the Body.

XVIII. With the second Band you are to make two Circumvolu∣tions upon the Fracture; and this is to be carried down wards with small Ambages, and this is to end above the Knee; or if you think it fit, it may be continu∣ed down the Leg, and passing under the Foot, and be carri∣ed up again upon the Leg.

XIX. With the third Swath, you are to bind on Bolsters and Splints: A bolster is to be ap∣ply'd to the lower part of the Thigh, thicker at bottom, than at top, that the Thigh may be every where even; and four Splenia, or long Bolsters are to be added, on which Splints are to be laid of the same length and breadth, which are to be wrapp'd up in Linnen Rags.

XX. These Splenia and Splints

being 〈◊〉〈◊〉 about the Feacture, the third S•…•…th it to be 〈◊〉〈◊〉 about them, beginning at 〈◊〉〈◊〉 ••om, and gradnally ascending upwards with many Circumvo∣lutions.

XXI. Then two large •…•…fe∣boards are to be apply'd, which many embrace the whole Member without crossing one another, which may be ty'd with three pieces of Tape; a pair of Pumps are to be put under the Foot and Heel, and to be fastned with a small Swath.

XXII. Semertus Med. Pract. lib. 5. part. 5. cap. 11. says it will not be amiss to cut Li•…•…en Cloth into pieces, of a sufficient length, and to mind them r•…•…d the Hip, and near the Ilia, as likewise the Groins and Perine∣um; for by this means, says he, the naked parts will not only be defended against the Splinters, but thereby a Flux of Humors may in a great measure be pre∣vented.

XXIII. The Placing of the Part is next to be considered, which is to be put into a Junck or Cose•• so large or long, as it may take in the whole Thigh, from the very Hip to the Foot; in the end of which, near the foot, there ought to be a hollow for the Heel.

XXIV. And such in Instrument as this is to be used, because that other sort of Bandage, 〈◊〉〈◊〉 about a Fracture of the 〈◊〉〈◊〉 to hold the Part firm and easy, can by no means be used here.

XXV. This Case or Truck is to be made of Wood; in making of which, great care is to take for the bottom of the Heel, that it may lye easy, lest by the uneasiness of that part, you disorder the whole Member, and bring upon it a pain, or numbedness.

XXVI. And herein you must observe; 1. That the Part lyes soft; and than nothing which is hard, be immediately applied to it; but that between the wounded Place and this Case or Trunk, some soft Splenia be interposed; or little Cushions or Bolsters may be laid on each side; two below the Knee, and two others below the Ancles, to fill up the cavi∣ties: and a thick Bolster is to be laid upon the Leg, all along in length, as also one upon the Thigh.

XXVII. 2. That the whole Limb may lye smooth and even, and that it may lye rather somewhat higher than the rest of the Body.

XXVIII. This Case or Junck is to be 〈◊〉〈◊〉 with many Bands; three for the Thigh, and three for the Leg; and on both side Woollen Gloths or Flannels are to be put, that so the Member may not decline either way: all which is to be done, that the Sick may lye free from Pain, or as much as may be, at ease, and that he may not move the Part.

XXIX. This you must also ob∣serve, that if a Swelling arises in the Ham, or parts beneath it, greater th••n 〈◊〉〈◊〉 wight be ex∣pected; that then the Ligature is too hard, and the Splints too strongly bound on, whereby the Part is pressed too much; and therefore you ought to loosen the binding.

XXX. And the Tumor is to be fomented or anointed with such things as are anodyn, digestive, and repercussive; applying to it Cotton or Lint dipt in Oils of Myrtles, Roses, and Whelps.

XXXI. The Ancients advised, that the Ligature should be loosned every third day, to the tenth day; and from thence every seventh day: but for this there is no certain Rule.

XXXII. For according as Ac∣cidents or Symptoms may arise, so the Sick ought to be dressed sooner or later; more often, or sel∣domer, renewing the Ligatures with the Dressing.

XXXIII. If no Symptoms urge, let not the first Dressing be quickly moved, but defer it as long as conveniently may be: because bro∣ken Bones have very much need of Rest, for the breeding of the Callus, which begins about the thirteenth or fifteenth day, and may be farthered by ap∣plying Catagmatick Emplasters.

XXXIV. If there is a Wound, with the Fractures or Splinters of Bones, you are to apply (the Fracture being first rightly Set) a proper Suppurative; such as Galen's Teirapharmacum, or Ʋng-Basilicon; and you must daily wet the Swaths with Wine and Oil, 'till the fear of an Inflam∣mation is over.

XXXV. Then, to help Nature in casting forth the Bones, you must inject Decoctum Divinum, or some such like; and lay on Empl. Sacrum Galeni upon the lips of the Wound only, and lay round about the Part af∣fected Empl. Album, or Diapal∣ma: and if it may be without Pain, it is to be bound up with single Splints.

XXXVI. The Bones being cast forth, the Wound is to be healed with Ceratum Divinum, or some other Consolidative; and being brought to the Cicatrice, the whole Member is to be kept easy, and in rest and quietness; and Ferula's to be placed round about it, to corroborate the Part, and confirm and strengthen the broken Bone.

CHAP. XXXII. Of a FRACTƲRE of the KNEE-PAN.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i.e. Pelvis, vel Patine parvae; in Latin, Fracture Fatellae; and in English, A Fracture of the Knee-pan.

II. This Bone is sometimes bro∣ken lengthways in respect to the Thigh, sometimes transverse, and sometimes obliquety: sometimes it is broken into two parts, sometimes, all manner of ways; and sometimes it is with a Wound, and sometimes with∣out.

III. The Signs. It is easily known

by feeling; there is a distance be∣tween the broken Bones, and the Patient has a weakness and dis∣ability in going: it is also known by the cavity, which is in the place where the Fracture is; by its motion; and by the crashing sound, in the handling the roof.

IV. Prognosticks, If tis rightly set, and so preserved, it easily grows to∣gether again; especially if the Fra∣cture was made in the length thereof.

V. If the Fracture is made transverse or crossways, the Patient proves lame, and for the most part halts all his Life after.

VI. So also if it is broken ob∣liquely; because in both these ways, the concretion of the Callus being produced, the con∣solidation does hinder the free motion of the Knee.

VII. If it is broken longways, it is easily reduced, and consolida∣ted, without any fear of a Callus bunching forth, or a Lameness fol∣lowing thereupon: because the extremities of the seventh, eighth, and ninth Muscles, which move the Ancle and Leg, end in that most strong Ten∣don which is implanted in the Patella; and that the Muscles are wont of their own accord to be moved, and to draw towards the place of their original.

VIII. But Par•…•…us, lib. 14. cap. 22. says, he never saw any one who had this Bone broken, that was not same, and halted all their Lives after: for that the concretion of the Callus being produced, the consolidation does hinder the free bending of the Knee.

IX. This indeed, as to the Trans∣verse Fracture, may be granted; yet, says Fabricius Hildanus Cent. 5. Obs. 88. this is not always necessary in the Fracture made longways; because such a Callus so sticking forth, is not of ne∣cessity to be bred: and we may see in the coalition of other Bones, that Nature many times breeds a Callus with that near∣ness, that there scarcely remains the least sign of any Fracture upon the Part.

X. And this more especially happens when the Periosteum is whole, or unbroken; for then it keeps in the matter of the Cal∣lus, that it cannot grow out overmuch, or bunch, cut too far.

XI. Again, being broken trans∣versly or obliquely, tho' all the industry is used that can be, it is not to be cured without Lameness or Halting ever after; because the seventh, eighth, and ninth Mu∣scles, moving the Ancle, draw the one part of the Bone up to∣wards the Hip: but the Tendon that under the Knee is inserted into the Shin-Bone, draws the other part of the Bone down∣wards; so that they can hardly by any Art be conglutinated again: whereupon a Callus bunches forth; which hurting the Muscles moving the Leg and Ancle, causes Lameness.

XII. The Cure. If the Knee-Pan is broken lengthways, no ex∣tension is to be made; because the pieces of the Bones remain those ways in their places.

XIII. If it is broken transversly or obliquely, as the two pieces fly one from another, so here an exten∣sion is to be made; and the Artist is at the same time to thrust

back the upper part of the Ratella into its true place; and in this posture it is to be kept, during the time of the Cure.

XIV. Then a Cataplasm or Em∣plaster proper to the Fracture is to be laid on; and the hollowness of the Ham is to be filled up with a Bolster, lest the Knee should bend unawares, whereby the fragments of the Patella would fly asunder.

XV. After which, the Part is to be bound up with a fitting Liga∣ture, if it is broken crosswise, &c. the Swath ought to be four Yards long, and two Inches broad, which may be rowled up, with one or two Heads: it is to be applied above the Knee-pan, making a circumvolution, and crossing un∣der the Knee; then the Swath is to be constantly carried up and down, 'till the Patella is wholly covered.

XVI. If the Fracture is long∣ways, a Swath like to the former must be used, which must be divi∣ded, or cut thro' in the middle: and is first to be applied under the Knee; and one of the Heads of the Swath is to be passed thro' the Cut, by which the Bones are to be well closed, with several circumvolutions made upon the Patelia, 'till it is all covered.

XVII. Aegineta, de Re Me∣dica, lib. 6. cap. 103. will have the Leg extended, and the Patella joined with the Fingers, and so kept, 'till the edges of the broken Bone touch one another, and are grown together: this may indeed be advised; but I am afraid, that it is a very hard thing to be performed.

XVIII. Then with a Junck of Straw, or made of some other fit substance, (as in a Fracture of the Thigh or Leg) the Member is to be kept fixt and immoveable, taking care that the Knee is not bended in the least measure.

XIX. If sharp fragments of Bones are separated from the rest of the Bone, and prick the Skin; some there are, who advise to make incision, to take them out; but this, if done, ought to be performed with great care and caution; and if any vehement Symptom should succeed, you are timely to oppose it with proper Remedies.

CHAP. XXXIII. Of a FRACTƲRE of the LEG.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Cruris Fractura, vel, Fractura Ossis, pl. Ossium Cruris; and in English. A Fracture of the Leg; or, of the Bone, or Bones of the Leg.

II. The Leg, is that part which goes from the Knee to the Foot; and consists of two Bones, viz. 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Tibia, the Shin-bone;

which is the greater, thicker, and upper Bone. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Fibula; which is the les∣ser, thinner, under, or outward Bone.

III. These Bones are broken, sometimes both of them together, and sometimes but one of them only: and the Fracture is either in the upper, or middle, or nether part.

IV. The Signs. When both Bones are broken; the Leg may be bended or bowed, many ways.

V. The Fracture of the Shin-Bone may be known both by sight and touching; there is a sufficient cavity and unevenness, and the Patient is also in much pain, and unable to go.

VI. But if the Fibula only is broken, it is not so easily known be∣cause it is covered with much flesh, but for the most part the broken Bones incline inwards.

VII. The Prognosticks. If one Bone only is broken, the Cure is much easier to be performed, than if both be broken; for then one Bone is a support or stay to the other.

VIII. The Fibula being broken, is more easily cured than the Ti∣bia, for that the Leg in reduction of that Bone, needs less extension; and withal the Shin-bone, not only supports it, but also sus∣tains the weight of the whole Body.

IX. But the Tibia or Shin-bone being broken, the Cure is done with more difficulty; because as there is need of greater Extension, lbthe Sick is much longer, before he is able to walk.

X. As to the Time of the Conso∣lidation of these these Bones, it seldom happens in less than fourty days; but the Patient ought to put but little stress upon the Leg, 'till fourscore days are past; and this more especially, if both the Bones are broken.

XI. The Cure. Whether one, or more Bones are broken, the Legis to be extended, that the Bones may be reduced, and joined together. But so great and strong an Extension is not requisite, when one Bone only is broken, as when both are fractured.

XII. This is commonly done by two strong Persons: but if by the Hand it cannot be accomplished, the Reduction must be per∣formed by help of Engins or Instruments, as we have for∣merly taught.

XIII. If one Bone only is broken, it ought to be most extended on one side; if both are broken, then it it to be equally extended every way: and whil'st the Part is extended by the Assistants, the Artist is with his Hands to reduce the Bones; thrufting the ends of the Bones exactly one against another.

XIV. And they will be known to be rightly reduced; because the great Toe will be in its right or natural situation, which other∣wise would not be.

XV. The Bones being thus set right, you must impose proper and convenient Medicaments; and then it is to be rowled about with Swaths, as we have formerly directed; which ought to be both broader and longer than for the Arm.

XVI. You must prepare three

Swaths; one of these three Yards long; the second of four Yards; and the third of five Yards long, and about three Inches broad.

XVII. The first Swath is to be applied, a Bolster being first im∣posed, dipt in some Styptick or Catagmatick Liquor; and three strait Circumvolutions are to be made upon the Fracture, and the Swath is to be carried up∣wards, with several circumvolu∣tions, and to terminate above the Knee.

XVIII. The second Swath is to begin upon the Fracture, with two circumvolutions; and wind∣ing, it is to be brought down, to pass under the Foot, and then afterwards is to be carried up again, and to be terminated above.

XIX. The third Swath is now to be applied, but first the Leg is to be filled up with a Bolster, thicker at the bottom than at the top; and then you must lay round four Splenia, or long Bolsters, as long as the Leg, and 2 Inches broad, upon which are to be apply'd Splints made of thin plyable Wood: Upon these Splenia and Splints (wrapt up in Linnen Rags) the third Band is to be apply'd, which may indif∣ferently begin either at top or at bottom, opposite to the for∣mer; so that it must be carried in its turnings and windings either downwards or upwards, and so accordingly terminate.

XX. The whole Contexture of this Bandage, is to be encompassed with large Paste-boards, made round at the ends, which are not to cross one another; but they must be straighter at bottom than at top, and ty'd with three pieces of Tape, beginning at the middle; and the knots are to be ty'd on the outside.

XXI. And the Leg is so to be disposed of, that it may not be turned away unto any part, lest the Bones be disordred, which may be don by a Junk of Straw, or a Wooden Case; where care is to be taken for the easy laying of the Heel, as in the Fracture of the Thigh-bone we have already ad∣vised.

XXII. The Splinters are not to be apply'd upon the Extremities of the Bones sticking out; nor upon that Tendon which passes along from the Leg to the Foot, and is knit unto the Heel, by reason of its exquisite sense, which will not endure compression.

XXIII. But Hippocrates, de Fracturis lib. 3. text. 23. &c. advises not to lay on the Ferula's or Splints, till the fear of Inflam∣mation is over, which is generally after the seventh day; and then they are to be apply'd with the Pledgets and the upper Ligature, and to be bound fast with three Girts. His words are these.

XXIV. 1. Then at length things necessary being provided, the Fra∣cture being join'd (the part being yet extended in a mean Figure) we must bind it with a Linne•• Rowler, laying the beginning of the first Band upon the Fracture, so that it may hold it firm, but not yet press it violently.

XXV. 2. When you have Wound the first Band about the same place, the second and third time, you must carry it upwards, that you may

thereby stop the Flux of Blood com∣ing to it: and there it is to end; but this Band is not to be so long 〈◊〉〈◊〉 the second.

XXVI. 3. The other Band, at the beginning of it, is to be wound about the Fracture once, and then is to be carried downwards, and not pressing so much, it must take a greater distance in rowling of it about, that so it may come to that place, where the first did end.

XXVII. 4. After these, Pled∣gets smeared with some proper Ce∣rate, are to be laid on, for so by these means, they will stick the faster, and smoother, and these must be bound on with Rowlers.

XXVIII. 5. But a Band with two Heads, will perform the of∣fice of three Bands; changing the order so among them, that they may be carried sometimes to the Right Hand, sometimes to the Left Hand, and very much indeed from the lower parts upwards; and sometimes from the upper parts, they must be carried downwards.

XXIX. 6. But when the fear of Inflammation is past, you must lay on the Ferula's, and they are to be contained with Bands very loose, that they may only be staid on; and that the putting on of the Ferula's, may not add any pres∣sure to the Part. Thus Hippo∣crates.

XXX. Lastly, if need be, or you find that Symptoms are induc'd, you must sometimes use convenient Purging, with a Vulnerary Diet: let the Sick Eat very sparingly at first, and as much as may be, be at rest and quiet.

CHAP. XXXIV. Of a FRACTƲRE of the FOOT.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Ossis vel Ossium Pedis: and in English, a Fracture of a Bone, or Bones of the Foot.

II. Hippocrates, de Articulis, saith, That the Bones of the Feet, (as also of the Hands) cannot be broken, without a Wound of the Fleshy parts, by something very sharp or heavy: because these Bones are harder th••n ordinary, and therefore cannot suffer with∣out hurt of the adjacent Flesh.

III. Paulus Aegineta, lib. 6. cap. 106. saith, That the Ancle-bone can by no means be broken, not only by reason of its hardness, but because also, it is guarded and de∣fended round about.

IV. The Signs. A Fracture of the Bones of the Foot, is found both by sight and touching; be∣cause those parts, have but little Flesh about them; for common∣ly they stick out, upon their breaking.

V. The Prognosticks. A Fra∣cture in these parts is not very

dangerous, or of difficult cure; yet because the Member is full of Nerves, which are generally bruised and wounded; there are most vehement Pains, Inflam∣mations, and other evil Sym∣ptoms excited.

VI. If a violent Flux of Hu∣mors falls down upon the Part, the Cure will be exceeding difficult, by reason it is a depending Part.

VII. Otherwise, if no ill Sym∣ptoms occur, these Fractures will, be for the most part consolidated in about twenty days: except the Fra∣cture is near the Ancle; for then a longer time will be required.

VIII. The Cure. It is nearly the same with that in the Hand: there ought to be a due exten∣sion, and then with the Fin∣gers, the broken Bones are to be put in their proper places.

IX. This will be best done, if the Sick stands with the fractured Foot upon a Table, covered with a Woollen Cloth: then proper Me∣dicaments are to be apply'd, and the Foot is to be wrapp'd about with Swaths.

X. Splinters cannot well be im∣posed here, therefore Splenia ought to be used to cover the Part, and then the Fracture is to be bound up with Swaths; so the Bones being once put in their right places, they may be kept there.

XI. You are to have a Swath about two Inches broad, and four Yards long, which is to be rowled up to the middle, with two Heads.

XII. It is to begin with an Ap∣plication, and a Circumvolution about the Ancle, and then it must pass on to the Foot, and n•• like manner make a Circum. volution round it.

XIII. This done, with the same Swath, you must cross over the Metatarsus, making some Figures, in form of a Rhombus, or Diamond fashion, as also over the Toes: and then it is to be carried up again, to end above the Ankle.

XIV. But some are for carrying the Heads up the Leg, and then to end them above the Knee: this kind of Bandage is called the Sandal, and indifferently serves for any Fracture of the Bones of the Feet.

XV. The Situation and placing ought to be otherwise than in the Hands, for our Hands being gi∣ven us to lay hold with upon things, are to be placed in a crooked Figure: but our Feet being given us to stand upon, and to go withal, are to be situ∣ated in a straight Figure, lest their Action should be hindred, or depraved.

XVI. You must also take all imaginable care to hinder as much as may be Inflammation, and pre∣vent defluxion of Humors; for that, if they once have a recourse to those Parts, they seldom or ne∣ver after, suffer a Revulsion, without great difficulty.

XVII. Thus much upon Fra∣ctures: if you would see more upon this Subject, you must Read the most Learned Books of Hippocrates de Fracturis, and de Articulis, with the admirable Comment of Galen upon them, where possibly you may meet with much satisfacti∣on: and yet we think, that here∣in, we have omitted nothing, which is absolutly necessary for the Young Artist to know.

Explicit Liber Sextus