Chapter VIII: Part 8

In this Operation, the Patient being laid upon her Back, with her Buttocks rais'd up, Fomentations are to be apply'd to the Part; a Linnen Cloth is to be laid upon the Neck of the fallen _Matrix_; and it is to be thrust very gently with the Fingers, without using much force. If the _Matrix_ shou'd fall out again, it wou'd be requisite to convey a Pessary into it, after it hath been reduc'd; and to enjoyn the Patient to lie on her Back with her legs a-cross.

* * * * *

CHAP. XXXIII.

_Of the Application of the _Cautery_._

The Cautery is an Ulcer which is made in the Skin, by applying Causticks to it, after this manner:

The Surgeon having moisten'd the Skin for a while with Spittle, or else having caus'd a light Friction to be made with a warm Cloth, applies a perforated Plaister to the Part, and breaks the Cautery-Stone, to be laid in {266} the little Hole, leaving it for a longer or shorter time, accordingly as he knows its Efficacy, or as the Skin is more or less Fine. Afterward he scarifieth the Burn with his Lancet, and puts a Suppurative, or piece of fresh Butter into the Part, till the Escar be fallen off.

_The Dressing and Bandage._

After the Application of the _Lapis Infernalis_, or any other Cautery-Stone, it is necessary to lay over it a Plaister, a Bolster, and a Circular Bandage, which ought to be kept sufficiently close, to press the Stone, after a Pea or little Piece of Orrice-Root, hath been put into the Ulcer to keep it open. Then the Patient is to make use of this Bandage, with which he may dress it himself. Take a piece of very strong Cloth, large enough to roll up the Part without crossing above it: And let three or four Holes be made in one of its sides, as many small Ribbans or Pieces of Tape being sow'd to the other, which may be let into the Holes, as occasion serves, to close the Band.

* * * * *

{267}

CHAP. XXXIV.

_Of the Application of Leeches._

It is requisite that the Leeches be taken in clear running Waters, and that they be long and slender, having a little Head, the Back green, with yellow Streaks, and the Belly somewhat reddish. Before they are apply'd, it is also expedient to let 'em purge during some Days in fair Water, fast half a Day in a Box without Water. Afterward the Part being rubb'd or chaf'd with warm Water, Milk, or the Blood of some Fowl, the Opening of the Box is to be set to the Part, or the Leeches themselves laid upon a Cloth; for they will not fasten when taken up with the Fingers. The end of their Tail may be cut with a Pair of Sizzers, to see the Blood run, and to determine its quantity, as also to facilitate their sucking. When you wou'd take 'em away, put Ashes, Salt, or any other sharp thing upon their Head, and they will suddenly desist from their Work; but they are not to be pull'd off by force, lest they shou'd leave their Head or Sting in the Wound, which wou'd be of very dangerous consequence. When they are remov'd, let a little Blood run out, and wash the Part with salt Water. {268}

_The Dressing_

Is made with a Bolster soakt in some Styptick Water, if the Blood will not otherwise stop; or in Brandy or _Aqua-Vitae_ if there be an Inflammation; and it is to be supported with a Bandage proper for the Part.

* * * * *

CHAP. XXXV.

_Of the Application of the _Seton_._

To perform this Operation, a Cotton or Silk Thread is to be taken, after it hath been dipt in Oil of Roses, and let into a kind of Pack-Needle; then the Patient sitting in a Chair, is to hold up his Head backward, whilst the Surgeon gripes the Skin transversely in the Nape of the Neck with his Fingers, or else takes it up with a Pair of _Forceps_, and passeth the Needle thro' the Holes of the _Forceps_, leaving the String in the Skin. As often as the Bolster that covers the Seton is taken off, that part of the String which lies in the Wound is to be drawn out, and cut off.

* * * * *

{269}

CHAP. XXXVI.

_Of _Scarifications_._

Scarifications are to be made more or less deep, accordingly as necessity requires, beginning at the bottom, and carrying them on upward, to avoid being hinder'd by the Haemorrhage. They must also be let one into another, that Strings may not be left in the Skin.

* * * * *

CHAP. XXXVII.

_Of the Application of _Vesicatories_._

Vesicatories are compounded with the Powder of Cantharides or Spanish flies, mixt with very sower Leaven, or else with Turpentine. Before they are apply'd, a light friction is to be made on the Part with a warm cloth, and a greater or lesser quantity is to be laid on, accordingly as the Skin is more or less fine, leaving 'em on the Part about seven or eight Hours; then they are to be taken away, and the Blisters are to be open'd, applying thereto some sort of Spirituous Liquor.

* * * * *

{270}

CHAP. XXXVIII.

_Of the Application of _Cupping-Glasses_._

A Good Friction being first made with warm Clothes, lighted Toe is to be put into the Cupping-Glass, or else a Wax-Candle fasten'd to a Counter, and then it is to be apply'd to the Part till the Fire be extinguish'd, and the Skin swell'd, re-iterating the Operation as often as it is necessary; and afterward laying on a Bolster steept in Spirit of Wine. These are call'd dry Cupping-Glasses: But if you wou'd draw Blood, every thing is to be observ'd that we have now mention'd, besides that Scarifications are to be made, according to the usual manner; and the Cupping-Glass is to be set upon the Scarifications: But when the Cupping-Glass is half full of Blood, it must be taken off to be emptied, and the Application thereof is to be re-iterated, as often as it is required to take away any Blood. Lastly, the Incisions are to be wash'd with some Spirituous Liquor; and a Bandage is to be made convenient for the Part.

* * * * *

{271}

CHAP. XXXIX.

_Of the opening of _Abcesses_ or _Impostumes_._

An Abcess or Impostume ought to be open'd in its most mature part, and in the Bias of the Humours, endeavouring to preserve the Fibres of the Muscles from being cut, unless there be an absolute necessity, avoiding also the great Vessels, Tendons, and Nerves. The Opening must be rather large than small, and not too much press'd in letting out the purulent Matter. If the Skin be thick, as it happens in the Heel, it may be par'd with a Razor; and if the Matter be lodg'd under the Nails, it wou'd be required to scrape 'em with Glass before they are pierc'd.

* * * * *

{272}

A

TREATISE

OF THE

OPERATIONS

OF

FRACTURES.

* * * * *

CHAP. I.

_Of the Fracture of the Nose._

When the Fracture is considerable, the Nostrils are stopt up, and the Sense of Smelling is lost. In order to reduce it, the Surgeon takes a little Stick wrapt up in Cotton, and introduceth it into the Nostrils as gently as is possible, to raise up the Bones again, laying the Thumb of his Left-hand upon the Nose, to retain 'em in their place. The Bones being thus set, he proceeds to prepare {273}

_The Dressing and Bandage_

By conveying into the Nostrils certain Leaden Pipes of a convenient Bigness and Figure, which serve to support the Bones, and to facilitate Respiration. But care is to be had to avoid thrusting 'em up too far, for fear of hurting the sides of the Nose; and they are to be anointed with Oil of Turpentine mixt with Spirit of Wine: These Pipes are also to have little Handles, with which they may be fasten'd to the Cap. If there be no Wound in the Nose, there will be no need of a Bandage; but if the Fracture be accompany'd with a Wound, after having apply'd the proper Medicines, it wou'd be requisite to lay upon each side of the Nose a Triangular Bolster, cover'd with a little piece of Paste-board of the same Figure. This small Dressing is to be supported with a kind of Sling that hath four Heads; being a piece of Linnen-Cloath, two Fingers broad, and half an Ell long; it is slit at both ends, and all along, only leaving in the middle a Plain of three Fingers, that is to say, a part which is not cut. The Plain of this Sling is to be laid upon the Fracture, causing the upper Heads to pass behind the Nape of the Neck, which are to be brought back again forward; the lower Heads are likewise to be carry'd behind, crossing above the upper, and afterward to be return'd forward. If the Bones of the Nose be not timely reduc'd, a great Deformity soon happens therein, and a Stink caus'd by the Excrescences and _Polypus's_.

* * * * *

{274}

CHAP. II.

_Of the Fracture of the lower Jaw._

The Operator at first puts his Fingers into the Patient's Mouth, to press the Prominences of the Bones; and afterward doth the same thing on the outside. If the Bones pass one over another, a small Extension is to be made. If the Teeth be forc'd out of their Place, they are to be reduc'd, and fasten'd to the sound Teeth with a wax'd Thread.

_The Dressing and Bandage._

If the Fracture be only on one side, a Bolster sow'd to a piece of Paste-board is to be laid upon the flat side of the Jaw, both being of the Figure and Size of the Jaw it self. The Bandage of this Fracture is call'd _Chevestre_, i.e. _a Cord or Bridle_, by the _French_ Surgeons, and is made by taking a Band roll'd with one Head or End, three Ells long, and two Fingers broad; the Application of it is begun with making a Circumvolution round about the Head in passing over the Fore-head; then the Band is let down under the Chin, and carry'd up again upon the Cheek, near the lesser Corner of the Eye in passing over the Fracture; afterward it is rais'd up to the Head, and brought down again under the Chin, {275} to form a Roller or Bolster upon the Fracture: Thus three or four Circumvolutions and Rollers being made upon the Fracture, the Band is let down under the Chin, to stay and strengthen its several Turns, and is terminated round the Head, in passing over the Fore-head.

If the Jaw be fractur'd on both sides, it wou'd be requisite to apply thereto a Bolster and Paste-board, perforated at the Chin, and of the Figure of the entire Jaw; the Bandage which we have even now describ'd, may be also prepar'd in making Rollers on both sides of the Jaw: Or else the double _Chevestre_ may be made with a Band of five Ells long, and two Fingers broad, roll'd up with two Balls, that is to say, with the two Ends. The Application of this Band is begun under the Chin, from whence it is carry'd up over the Cheek, cross'd upon the top of the Head, and brought down behind the Head, where it is cross'd again; then it is let down under the Chin, cross'd there, and carry'd up over the Fracture; afterward the Band being pass'd three or four times over the same turns, in making Rollers upon the Jaws, is turn'd upon the Chin, and stay'd upon the Forehead round about the Head.

* * * * *

{276}

CHAP. III.

_Of the Fracture of the _Clavicle_._

The Patient is to be set in a Chair, and his Arm is to be drawn backward, whilst an Assistant thrusts his Shoulder forward: In the mean time the Operator sets the Bones again in their place, by thrusting the Protuberances, and drawing out the sunk Bone.

Or else a Tennis-Ball may be taken, and put under the Patient's Arm-Pit, whose Elbow is then to be press'd against his Ribs, whilst the Surgeon reduceth the Fracture.

Otherwise, the Patient may be laid upon his Back, putting a Convex Body under both his Shoulders, as a Bowl, or large wooden Porrenger; and then the Shoulders may be prest, to raise up the two ends of the Bones, which the Surgeon must take care to reduce.

_The Dressing and Bandage._

The Cavities which are above and below the Clavicle, are to be fill'd with Bolsters trimm'd with Paste-boards; another is to be also laid upon the Bone, which is almost of the same Figure with the Clavicle, and a large Bolster, to cover the three others: This Dressing is to be secur'd with the Bandage call'd the _Capeline_ or Head-Bandage, provided the Fracture be in the middle of the Clavicle. A Band {277} being taken about six Ells long, and four fingers thick, roll'd with two Balls; it is apply'd in the middle to the Fracture; one of its Heads or Ends is let down upon the Breast, whilst the other is pass'd behind the Back, below the Arm-hole, opposite to the indispos'd Arm-hole and above the Breast, to be carry'd over the other end of the Band, which is rais'd up, to make a Roller or Bolster upon the Fracture: The other end is pass'd under the indispos'd Arm-pit, and upon the Band that made the Roller, which is elevated by making a third Roller upon the Clavicle: These Circumvolutions around about the Body are continu'd, as also these Rollers upon the Clavicle, till it be entirely cover'd. Some Circumvolutions are also made upon the upper part of the Arm, near its Head: The Space that lies between the Rollers and the Circumvolutions of the Arm, and which bears the Name of _Geranium_ or Stork's-Bill, is likewise cover'd with some Circumvolutions, and the Band is stay'd by making Circumvolutions quite round about the Body.

If the Fracture were near the Head of the _Humerus_ or Arm-Bone, a sort of Bandage might be prepar'd, which is call'd _Spica_, with a Band roll'd with one Ball five Ells long, and four fingers broad; one end of this Band is pass'd under the Arm-pit opposite to the indispos'd one behind the Back: The other end is convey'd under the indispos'd Arm-pit; the Figure of the Letters KY or X is made on the Shoulder; the Band is return'd below the other Shoulder behind; it is brought back again before, to form a second KY upon the {278} Fracture; three or four more KY's are wrought upon the Fracture; two Circumvolutions are made in the upper part of the _Humerus_, which constitute a Triangle call'd _Geranium_; this Triangle is cover'd with Rollers, and the Band is terminated round about the Breast.

* * * * *

CHAP. IV.

_Of the Fracture of the _Omoplata_ or Shoulder-Blade._

The _Acromion_ is usually fractur'd, but it may be known that the middle of the _Omoplata_ is broken by a Numness which is felt in the whole Arm: Whereupon the Surgeon, after having examin'd the place of the Fracture, thrusts back the Prominences of the Bones into their place; and if any Splints happen to prick the Part, he makes an Incision to take 'em out, or to cut off their Points.

_The Dressing and Bandage._

A Bolster is laid upon the _Omoplata_, as also a large piece of Paste-board of the bigness and Figure of this Bone, and a sort of Bandage is prepar'd, known by the name of _the Star_, with a Band roll'd with one Head four Ells long, and as many Fingers broad. This Band is convey'd behind the Back, one of its ends lying under the Arm-hole, opposite to the indispos'd one; but the other is pass'd under the {279} Shoulder, and afterward above it, to make a KY in the middle of the Back; then passing under the other Arm-hole, it is brought up to the Shoulder, to be let down, and to form a second KY upon the middle of the Back: These Turns are continu'd in making Rollers, till the _Omoplatae_ are all cover'd: Circumvolutions are also made round the upper part of the _Humerus_, as in the _Spica_; and the Bandage is finish'd by Circumvolutions round about the Breast.

* * * * *

CHAP. V.

_Of the Fracture of the Ribs._

When a Rib is broken, one of the ends pusheth into the Breast, sometimes on the outside; and sometimes the Ends lie against each other. In order to reduce it, the Patient being laid upon the sound Rib, a Plaister of Mastick is apply'd to the Fracture; and it is drawn out violently; so that sometimes this Attraction brings back the Bone, which is advanc'd into the Breast; but the surest way is to make an Incision therein, to raise it up with the Finger.

If the Rib appear without, the Patient is to be set in a a Chair, and oblig'd to bend his Body on the side opposite to the Fracture, holding his Breath, with which he must puff strongly, without letting it forth, in order to dilate the Breast, whilst the Surgeon thrusts the Rib into its place.

{280}

_The Dressing and Bandage._

A Bolster is to be apply'd to the Fracture, with two little Pieces of Paste-board pass'd in form of a St. _Andrew's_ Cross; and another Bolster upon the whole Dressing, on which is also laid a large square Paste-board cover'd with a Bolster. The Bandage is made with a Napkin folded into three Folds, which is put round the Breast, being sow'd and supported by the Scapulary; which is a Band six Fingers broad, perforated in the middle, to let in the Head. The two ends of the Scapulary are fasten'd before and behind to the Napkin.

* * * * *

CHAP. VI.

_Of the Fracture of the _Sternum_ or Breast-Bone._

To reduce this Fracture, the Patient is to be laid upon his Back, with a Convex Body underneath; both his Shoulders are to be press'd with some weight, to push 'em backward, and to raise up the _Sternum_, which is sunk down; or else an Incision may be made upon the Bone, to discover it; and then a _Vectis_ is to be apply'd thereto very gently, in order to heave it up into its place.

{281}

_The Dressing and Bandage._

A Bolster and Paste-board are to be laid upon the _Sternum_, almost of the same Figure with the Part; and the Bandage is to be prepar'd with a Napkin supported with a Scapulary. Or else the Bandage call'd _Quadriga_ may be made with a Band roll'd with two Heads, five Ells long, and four Fingers broad: The Application of this Band is begun under the Arm-pit; the Figure of KY is form'd under the Shoulder; the Band is carry'd downward with the two Balls, once before, and the other behind; it is pass'd under the other Arm-hole; the Heads are cross'd upon the Shoulder, and it is brought down backward and forward, forming a KY before and behind. Afterward the Bank is roll'd about the Breast in making Rollers or Bolsters; these Rollers are continu'd till the Band be terminated; and it is stay'd by a Cirumvolution round the Breast.

* * * * *

CHAP. VII.

_Of the Fracture of the _Vertebra_'s._

The _Apophyses_ of the _Vertebra's_ are commonly broken, and their Bodies but seldom: It may be known that the Body of the _Vertebra_ of the Neck and Back is fractur'd by the Palsie of the Arm, accompany'd with the loss of Feeling; by the suppression of Urine; {282} and by the Palsie of the _Sphincter_ of the _Anus_; so that the Excrements cannot be any longer retain'd. If these Symptoms appear, it may well be conceiv'd that the Marrow is compress'd, and prickt with Points; for the removing of which, it is necessary to make an Incision upon the Body of the _Vertebra_ in the fractur'd Place.

If the _Apophyses Spinosae_ are only fractur'd, these Accidents will not happen, only some Pain will be felt: To reduce 'em, the Patient is to be laid upon his Belly, and the Surgeon must use his utmost endeavours to raise up the Bone again, and to set it in its Natural Situation.

_The Dressing and Bandage._

If the _Apophysis Spinosa_ were fractur'd, it wou'd be requisite to apply to each side of it a small long Bolster, which is to be cover'd with a Paste-board of the same Figure with the Bolster; another Bolster lying upon each Paste-board. The Bandage is to be made with a Napkin sustain'd by its Scapulary; or else the _Quadriga_ may be prepar'd, according to the manner we have already describ'd in the Fracture of the _Sternum_.

* * * * *

{283}

CHAP. VIII.

_Of the Fracture of the _Os Sacrum_._

It is reduc'd as the other _Vertebra's_; but its Dressing and Bandage are made with the T perforated at the _Anus_, or else with the H or double T. It is made with a Band two Fingers broad, and long enough to encompass the Body above the Hips; so that to the middle of this Band is fasten'd another Band of the same breadth, and of a sufficient length to pass over the Dressing of the _Os Sacrum_, as also between the Thighs, to be join'd in the fore-part to the first Cincture. The double T is made by fastening two Bands at a Finger's breadth distance one from another, to the Band which ought to be roll'd about the Body; and this sort of Bandage is to be supported with a Scapulary.

* * * * *

CHAP. IX.

_Of the Fracture of the _Coccyx_ or Rump-Bone._

This Bone is usually broken by falls, and sinks into the inside; so that to reduce it, the Fore-finger of one Hand is to be put into the _Anus_ or Fundament as far as the {284} Fracture, to thrust it back again into its place, whilst the other Hand setleth it on the outside.

_The Dressing and Bandage._

Are the same with those in the Fracture of the _Os Sacrum_; but the Patient must be oblig'd to lie on one side, and to sit in a perforated Chair, when he hath a mind to rise.

If the _Os Innominatum_ be broken, the _Spica_ is to be us'd after it hath been dress'd, of which Bandage we have given an Account in the Fracture of the Clavicle.

* * * * *

CHAP. X.

_Of the Fracture of the _Humerus_ or Arm-Bone._

To set this Bone, a strong Extension is to be made, if the two ends cross one another, to which purpose the Patient is to be plac'd on a little Stool or Seat, and supported by a Servant, two other Assistants being employ'd to draw, one at the upper-part, and the other at the lower, above the Elbow, and not beneath it. In the mean time the Operator reduceth the two Bones, by closing 'em on all sides with the Palms of his Hands, and afterward prepareth {285}

_The Dressing and Bandage._

It is necessary at first to lay round the Fracture a Bolster steept in some proper Liquor, as Claret or _Oxycratum_; then three several Bands are to be taken, three or four Fingers broad, and an Ell and a half long: The first of these is to be laid upon the Fracture, round which are to be made three very streight Circumvolutions; then it is to be carry'd up with small Rollers to the top of the Arm, and stay'd round the Body. The second Band being apply'd to the Fracture, on the side opposite to the first, two Circumvolutions are to be made upon the Fracture; so that the same Band may be brought down along the whole length of the Arm, making divers Rollers, and at last stay'd below the Elbow, which, nevertheless, it must not cover. Afterward our Longitudinal Bolsters must be laid upon the Fracture round about the Arm, which are to be kept close with a third Band; it being of no great Importance whether the Application of this third Band be begun at the Top or at the Bottom; but it may be stay'd round the Body, or else beneath the Elbow. The Arm ought also to be encompass'd with two thick pieces of Paste-board made round at the ends, and of the length of the Arm; but they must not cross one another. These Paste-boards are to be fasten'd with three Ribbands, and the Arm is to be put into a Scarf made with a large Napkin, which is to be first apply'd in the middle under the Arm-pit, the Arm resting upon it, so that {286} the four ends may be rais'd up, and fasten'd to the opposite Shoulder; but the Hand must lie higher than the Elbow.

* * * * *

CHAP. XI.

_Of the Fracture of the Bone of the Elbow._

If both the Bones of the Elbow be broken, a stronger Extension is to be made than if only one of 'em were so hurt; to which purpose a Servant is to be appointed to grasp the Arm above the Elbow with both his Hands, and another to hold it above the Wrist, whilst the Surgeon sets the Bones with the Palms of both his Hands, till no unevenness be any longer felt in the Part.

_The Dressing and Bandage_

Are the same with those in the Fracture of the Arm; but the Bands which are carry'd upward are to be stay'd above the Elbow. If the Patient be desirous to keep his Bed, it is requisite that his Arm be laid upon a Pillow, the Elbow lying somewhat higher than the Hand.

* * * * *

{287}

CHAP. XII.

_Of the Fracture of the _Carpus_ or Wrist-Bone._

If the Bones of the _Carpus_, or those of the _Metacarpium_ be fractur'd, a Servant must hold the Arm above the Wrist, and another the Fingers; whilst the Operator sets the Bones in their place, so as no unevenness may appear in the Part.

_The Dressing and Bandage._

Of the Fracture of the Wrist are to be prepar'd with a Band roll'd with one Head, being six Ells Long, and two Fingers broad; so that three Circumvolutions are to be made upon the Wrist; the Band is to be pass'd over the Hand, between the Thumb and the Fore-finger, making the Figure of KY upon the Thumb. Then after having made divers Rollers upon the _Carpus_, a Bolster is to be apply'd, with a little Piece of Paste-board of the same Shape with the Wrist; several Rollers are to be form'd on the top of the Elbow, to stay the Band above it; and the Arm is to be put into a Scarf.

* * * * *

{288}

CHAP. XIII.

_Of the Fracture of the Bone of the _Metacarpium_._

Two Servants are to hold the Hand, after the same manner as in the setting of the _Carpus_ or Wrist-Bone, whilst the Surgeon reduceth the broken Bone by fixing it in its Natural Situation.

_The Dressing and Bandage_

Are made with a Band roll'd up with one Head, five Ells long, and two Fingers broad: This Band being fasten'd to the Wrist, with a Circumvolution, is to be laid on the _Metacarpium_, between the Thumb and the Fore-finger, and the Figure of KY is to be made upon the Hand: Then the forming of Rollers and KY's is to be continu'd till the _Metacarpium_ be cover'd; a Bolster and Paste-board are to be laid upon the same _Metacarpium_; as also one in the Hand, of the Shape of the Part: The inside of the Hand is to be trimm'd; and the whole Contexture is to be cover'd as before, with Rollers; which are continu'd till above the Elbow, where the Band is stay'd.

* * * * *

{289}

CHAP. XIV.

_Of the Fracture of the Fingers._

A Light Extension is to be made in the Fingers to reduce 'em, and a small Dressing is to be prepar'd for every Finger, almost like that of the Arm. The Fingers are to be somewhat bent, and the inside of the Hand is to be trimm'd with a Bolster, to retain 'em in this Situation. The Bolster is also to be stay'd with a Band, and the Arm to be put into a Scarf.

* * * * *

CHAP. XV.

_Of the Fracture of the Thigh._

If the Thigh-Bone be broken near its Head, the Fracture is very difficult to be discover'd; but if the Bone pass one over another, it may be soon known, because the hurt leg will be shorter than the other. Therefore a very great Extension is to be made; and if the Hands are not sufficient for that purpose, recourse may be had to Straps and Engines. In the mean time the Operator is to lay his Thumbs upon the fractur'd Bone, to thrust it back into its place, and afterward to apply {290}

_The Dressing and Bandage._

The Cavity of the Thigh is to be fill'd with a thick Bolster, of the length of its bending; and three Bands four Fingers broad are to be provided, the first being three Ells long, and the second four, as well as the third: Then three Circumvolutions are to be made upon the Fracture with the first Band, carrying it up with small Rollers, and it is to be stay'd round the Body. The second Band is to make two Circumvolutions upon the Fracture, and is to be brought down with small Rollers, which are terminated above the Knee; or else they may be continu'd all along the Leg; it is also to be pass'd under the Foot, and to be drawn up again upon the Leg: Then a Bolster is to be apply'd to the lower part of the Thigh, being thicker at bottom than at top, to render the Thigh everywhere even; and four Longitudinal Bolsters are to be added, on which are laid Splints of the same length and breadth, which are to be wrapt up with a single Bolster. The third Band is to be roll'd upon these Splints, beginning at the bottom, and ascending with Rollers. Then two large Paste-boards are to be us'd, which may embrace the whole Dressing, without crossing one another, being fasten'd with three Ribbands. Afterward a Pair of Pumps is to be put under the Foot, and the Heel to be supported with a small Roll, the Thigh and Leg being let into the Scarves, the inner of which is to extend to the Groin, and the {291} outermost is to be somewhat longer: Two little Cushions are also to be laid on each side below the Knee, and two others below the Ankles, to fill up the Cavities. These Cushions or large Bolsters are to lie between the Scarves; and a thick Bolster is to be laid upon the Leg all along its length, as also on upon the Thigh. The Scarves are to be bound with three Ribbands for the Legs, and as many for the Thighs; the Knots being ty'd without, and on the side.

* * * * *

CHAP. XVI.

_Of the Fracture of the Knee-Pan._

The Knee-Pan is cleft or broken in divers pieces in its length, and cross-wise: If it be broken cross-wise or obliquely, the two Pieces fly out one from another; and on this occasion a strong Extension is to be made; whilst the Surgeon at the same time thrusts back again the upper-part of the Knee-Pan into its place.

If the Knee-Pan be fractur'd in its length, no Extension can be made, because the pieces of the Bones remain in their place.

_The Dressing and Bandage._

If the Knee-Pan be broken cross-wise, a Band is to be provided three Ells long, and two Fingers Broad, which may be roll'd with {292} one or two Heads. The Application is to be begun above the Knee-Pan; the Figure of KY is to be made in the Ham, and a Circumvolution under the Knee; then the Band is to be continually carry'd up and down, till the Knee-Pan be entirely cover'd.

If the Knee-Pan be fractur'd in its length, that is to say, from the top to the bottom, the Uniting-Band must be us'd, being two or three Ells long, and two Fingers broad, perforated in the middle. It is to be at first apply'd under the Knee, and one of the Balls is to be pass'd thro' the Hole; it must also be well clos'd, and divers Circumvolutions are to be made upon the Knee-Pan, so as it may be altogether cover'd.

* * * * *

CHAP. XVII.

_Of the Fracture of the Leg._

If the _Tibia_ be only broken, it pushes into the Inside; but if both Bones be fractur'd they are sometimes separated on both sides, or else they pass one upon another; and in this case the Leg is shorter than it ought to be. If the _Perone_ be broken, it pushes to the outside.

If one Bone be only fractur'd, so strong an Extension is not requisite as when they are both shatter'd, and it is to be drawn only on one side; whereas the drawing ought to be equal on both sides when both Bones are concern'd. {293} Thus whilst the Assistants are employ'd in drawing, the Surgeon performs the Operation, by laying the ends of the Bones exactly against one another; and they are known to be reduc'd when the great Toe remains in its Natural Situation.

_The Dressing and Bandage._

A simple Bolster dipt in a convenient Liquor is at first apply'd, and three Bands three Fingers broad are prepar'd, the first being two Ells long, the second three, and the third three and a half. Three very streight Circumvolutions are to be made upon the Fracture; the Band is also to be carry'd up with Rollers, and stay'd above the Knee. The Application of the second Band is to be begun upon the Fracture with two Circumvolutions; it is to be brought down with Rollers, to pass under the Foot, afterward carry'd up again, and stay'd where it is terminated. The Leg is to be fill'd with a Bolster thicker at the bottom than at the top; and then are to be laid on the four longitudinal Bolsters, two Fingers broad, and as long as the Leg; to which are to be apply'd the Splints of a plyable and thin Wood: These are wrapt up with a simple Bolster, and strengthen'd with the third Band, which is apply'd indifferently either at the top or bottom, opposite to the former; so that it is carry'd up or else down in making Rollers, and stay'd at its end. The whole Contexture is to be encompass'd with large Paste-boards made round at the Ends, which are not to cross one another, {294} but must be streighter at the bottom than at the top, and are to be ty'd with three Ribbands or pieces of Tape, beginning at the middle; so that the Knots be ty'd on the outside. Afterward the Leg is to be put into the Scarves, and the Heel is to be supported with a Linnen-Roll, to which are fasten'd two Ribbands that are ty'd upon the Scarves: These Rolls are made with a small piece of Cloth, which is doubl'd, and roll'd up with the ends, in which is contain'd some Straw, and a little Stick in the middle, to consolidate 'em. The Foot is supported with a Paste-board or Wooden Sole, trimm'd with a Bolster, or small Quilt sow'd over it. Divers Strings are also fasten'd to the middle of the sides of the Sole or Pump, which are cross'd to be joyn'd to the Scarves; and another is fixt at the end of the Sole, which is ty'd to a Ribband that binds the middle of the Scarf. These Scarves are likewise fasten'd with three Ribbands, beginning with that in the middle, the Knots being without, and trimm'd with four Bolsters, that is to say, two on each side, to fill up the Cavities that are below the Knee, and above the Ankle. Lastly, the Leg is to be plac'd somewhat high, and a Cradle to be laid upon it, to keep off the Bed-Cloaths, the Scarves passing over the Knee and Foot.

_The Dressing of Complicated Fractures_

Of the Arms, Legs, and Thighs is prepar'd with a Bandage having Eighteen Heads or Ends, in order to make which, a Linnen-Cloth is to {295} be taken of the length of the Part, and broad enough to cause it to be cross'd thereby: It is to be folded into three doubles, and cut in three places on each side, leaving the middle plain; so that eighteen Heads or small Bands are form'd, every one of which will be four fingers broad, the upper Heads being a little shorter than the lower. This Band of eighteen Heads is to be laid upon the Scarves, and a Bolster is to be apply'd to it four Fingers broad, as long as the Scarves. The Leg is laid upon this Bolster, and it hinders the corrupt Matter from falling on the Bandage.

When the Wound hath been dress'd, the fracture is to be incontinently surrounded with one of the Heads, which ought to cross one another: Then after the Leg hath been bound with the first Heads, two Longitudinal Bolsters are to be apply'd to the side of it; and the other Heads are to be rais'd up, with all the rest of the Dressing, which hath been describ'd in the simple Fracture.

* * * * *

CHAP. XVIII.

_Of the Fracture of the Bone of the Foot._

The Reduction of the Bone of the Foot is perform'd after the same manner as that of the Hand. {296}

_The Dressing and Bandage_

Are made with a Band roll'd with two Heads, being three Ells long, and two Fingers broad: The Application of it is begun with a Circumvolution above the Ankles; it is pass'd on the Foot, and in like manner makes a Circumvolution round it: Afterward the same Band is cross'd over the _Metatarsus_, upon which are made some Folds in form of a _Rhombus_ or Diamond; as also on the Toes, and it is stay'd above the Ankle-Bone; or else it is carry'd up along the Leg, to be stay'd above the Knee. This Bandage serves for all Fractures of the Bones of the Foot, and is call'd the _Sandal_.

* * * * *

{297}

A

TREATISE

OF THE

OPERATIONS

Which are perform'd in

LUXATIONS.

* * * * *

CHAP. I.

_Of the Luxation of the Nose._

The Bones of the Nose may be separated from that of the Fore-head by a Fall, or some violent Blow; and the Surgeon in order to set 'em, at first lays his Thumb upon the Root of the Nose, and then he introduceth a little Stick trimm'd with Cotton, into the Nostrils, and by the means thereof thrusts back the Bones into their place. {298}

_The Dressing and Bandage_

Are the same with those that have been already describ'd in the Fracture of the Bones of the Nose.

* * * * *

CHAP. II.

_Of the Luxation of the lower-Jaw._

The Jaw may be luxated either on both sides, or only on one. When the Dislocation happens on both sides, it hangs over the _Sternum_ or Breast-Bone, and the Spittle runs abundantly out of the Mouth: To reduce it, the Patient must sit down, and his Head is to be supported by a Servant; then the Operator or Surgeon having wrapt up his two Thumbs, puts 'em into the Mouth upon the Molar Teeth, his other Fingers lying under the Jaw, which is to be drawn down by raising it up, having before set two small Wooden Wedges upon the two Molar Teeth on both sides of the Jaw, lest the Surgeon's Fingers shou'd be hurt, as the Bone is returning to its place.

If the Luxation be forward, a Band or Strap is to be put under the Chin, an Assistant having his Knees upon the Patient's Shoulders, where he is to draw the Strap upward, to facilitate the Extension; which the Surgeon makes with his Hands, at the same time thrusting the Bone back again into its place. {299}

When the Jaw is luxated only on one side, the Chin stands a-cross, and the dislocated side is squash'd down, a small Cavity being perceiv'd in it, and a Rising on the other side; so that the Mouth cannot be shut close, but remains somewhat open, the lower Teeth appear farther out than the upper; and the Canine or Dog-Teeth lie under the Incisive. This Luxation is reduc'd by giving a blow with the Hand upon the luxated Bone, which is sufficient to cause it to re-enter its Natural Place.

_The Dressing and Bandage_

Are altogether the same with those us'd in the Fracture of the Bones of the lower Jaw.

* * * * *

CHAP. III.

_Of the Luxation of the _Clavicle_._

The _Clavicle_ is oftner loosen'd from the _Acromion_ than from the _Sternum_; when it hath left the former the Arm cannot be lifted up; the _Acromion_ makes a Prominence, and the Clavicle descends downward, a Cavity appearing in its place. To reduce this Luxation, the Patient is to be laid upon some Convex Body put between his Shoulders; both which are to be press'd backward, to raise up the Clavicle: Afterward he is to be set in a Chair, that his Arm may be drawn backward, whilst the {300} Surgeon is employ'd in pressing the Clavicle and _Acromion_, to join 'em together.

_The Dressing and Bandage_

Are the same with those that we have already shewn, in treating of the Fracture of the Clavicle.

* * * * *

CHAP. IV.

_Of the Luxation of the _Vertebra's.

In the Luxation of the _Vertebra_'s of the Neck, the Head stands to one side, and the Face is swell'd and livid, with a difficulty of Respiration.

To reduce this Dislocation, the Patient is to be set upon a low Seat, an Assistant leaning on his Shoulders, to keep his Body steady, whilst the Surgeon or Operator draws his Head upward, and turns it from one side to another: Then if the Accidents or Symptoms cease, the Cure is perform'd; so that Fomentations may be apply'd to the Part; and the Patient being laid in his Bed, must take care to avoid moving his Head.

When the _Vertebra_'s of the Back or Loins are luxated on the inside, a sinking of the Bone is soon perceiv'd; whereupon the Patient being laid on his Belly, the Extension is to be made with Napkins pass'd under the Arm-Pits, and upon the _Os Ileum_, whilst the Surgeon with {301} a strong Extension makes some Efforts on the Spine, endeavouring to draw back the _Vertebra_. If that be not sufficient, an Incision is to be made upon the _Apophysis Spinosa_ of the _Vertebra_; so that after having laid open this Process of the Bone, it may be taken out with a Pair of _Forceps_. Then the Wound is to be dress'd with Pledgets, a Plaister, and a Napkin, which must not be bound too close, for fear of pushing back the Spine.

When the _Vertebra_ is luxated on the outside, a Prominence appears; so that to reduce this Dislocation, the Extension is to be made as before, the Patient lying in like manner upon his Belly; but in order to push back the _Vertebra_, two little Sticks trimm'd with Linnen-Cloth are to be prepar'd, and laid along the two sides of the Spine of the _Vertebra_; yet these Sticks ought to be thick enough to remain more elevated than the _Apophysis Spinosa_; and a large wooden Roller is to be often roll'd upon 'em, which by its turning backward and forward, may thrust the _Vertebra_'s inward; so that when all the _Vertebra_'s are of an equal height, the Reduction is finish'd. If the _Vertebra_'s are luxated on the side, the same Extensions are to be made, and the Prominence is to be push'd, to re-establish the _Vertebra_ in its place.

_The Dressing and Bandage._

The Dressing is prepar'd by laying two thin Plates of Lead on each side of the Spinous Process of the _Vertebra_, to maintain it in its Place, and a long Bolster over 'em. The {302} proper Bandage is the _Quadriga_, which hath been before describ'd, in treating of the Fractures of the Breast-Bone.

* * * * *

CHAP. V.

_Of the Luxation of the _Coccyx_ or Rump-Bone._

If the _Coccyx_ be sunk on the inside, it is to be rais'd with the Fore-finger of the Right-hand put into the _Anus_; and if the Luxation be on the outside, it may be gently thrust back again. An Account of its proper Dressing and Bandage hath been already given in the Fracture of the _Coccyx_.

* * * * *

CHAP. VI.

_Of the _Bunch_._

The _Bunch_ is nothing else but an exterior Luxation of the _Vertebra_'s, and for the Cure thereof, it wou'd be requisite to keep Emollients for a long time upon the _Vertebra_'s, to loosen the Ligaments, and to wear Iron-Bodice; which in compressing the _Vertebra_'s by little and little, might perhaps drive 'em back into their Natural Place.

* * * * *

{303}

CHAP. VII.

_Of the Luxation of the Ribs._

The Ribs are luxated either on the outside, or on the inside: If they be dislocated on the inside, a Cavity is perceiv'd near the _Vertebra_'s, the Patient drawing his Breath with Pain, and not being able to bend his Body.

When the Luxation is on the outside, and happens in the upper Ribs, the Patient's Hands are to be hoisted upon the top of a Door, to raise up the Ribs, whilst the Surgeon presseth the Prominence of the Rib to restore it to its place.

When the lower Ribs are luxated, the Patient must be oblig'd to stoop, laying his Hands upon his Knees, and the Prominence of the Bone is to be thrust back.

If a Rib be luxated on the inside, an Incision is to be made to draw it out with the Fingers.

_The Dressing and Bandage_

Are the same with those that are us'd in the Fracture of the Ribs.

* * * * *

{304}

CHAP. VIII.

_Of the Sinking of the _Xiphoides_, or Sword-like Cartilage_.

To raise up the _Xiphoid_ Cartilage, it must be fomented before for some time with Oil of Turpentine, or other Fomentations, made with Aromaticks; then the Patient is to be laid upon his Back, with a Convex Body underneath, and the Shoulders, and Sides of the Breast are to be press'd, to lift up the Cartilage. When this Operation is not sufficient, dry Cupping-Glasses are usually apply'd, till the Part be elevated, and a strengthening Plaister is afterward laid upon it.

* * * * *

CHAP. IX.

_Of the Luxation of the _Humerus_, or Arm-Bone_.

The Head of the _Humerus_ generally falls under the Arm-Pit, so that the luxated Arm becomes longer than the other, the _Acromion_ appears pointed on the outside; the Elbow starts from the Ribs, and cannot be mov'd without great Pain. To reduce this Bone, the {305} Patient is to be set upon a low Seat, or else on the Ground, whilst some Person supports his Body with a Napkin: In the mean time the Surgeon is to lay hold on the upper-part of the _Humerus_, a Servant kneeling behind him, who is to hold the Patient's Arm above the Elbow, which is to pass between the Surgeon's Legs, and is to be drawn down by the Assistant as much as is possible, whilst the Surgeon in like manner draws the Arm, to remove the Head of the Bone out of the place where it was stopt; insomuch that the Bone sometimes makes a Noise in re-entring its Cavity.

Or else the Patient's Arm may be laid upon the Shoulder of a taller Man than himself, who is strongly to draw the luxated Arm upon the Fore-part of his Breast; during which time, the Operator is to push the Head of the _Humerus_, to cause it to re-enter its Cavity.

Otherwise the Patient may lie on the Ground, a Tennis-Ball being put under his Arm-Pit, which a Servant is to draw strongly with a Handkerchief pass'd under the Shoulder, whilst another Assistant stands behind the Patient, to thrust down the Shoulder with his Foot; at the same time the Surgeon sitting between the Patient's Legs, is to push strongly with his Heel the Ball that lies under the Arm-hole.

Or else, a thick Battoon or Leaver may be laid on the Shoulders of two Men, after a Tennis-Ball hath been nail'd on the middle of it; otherwise a Bunch may be made therein, and cover'd with Linnen-Cloth; two Wooden Pins being also fixt on each side of the Ball: {306} Then the Patient's Arm-Pit is to be set between those two Pins, and upon the Ball, where he is to remain hanging, whilst his Arm is pull'd down by main force. The same thing may be done by laying the Patient's Arm-Pit upon a Door, or else upon the Round of a Ladder.

_The Dressing and Bandage_

A little Ball of Linnen is to be laid under the Arm-Pit, and underneath a Bolster with four Heads, which are cross'd upon the Shoulder; as also a Bolster under the sound Arm-Hole, that it may not be gall'd by the Bandage _Spica_, the Nature of which we have shewn in treating of the Fracture of the Clavicle.

* * * * *

CHAP. X.

_Of the Luxation of the Elbow._

When the Elbow is luxated on the inside, the Arm flies out, and the Hand is turn'd outward; but in the Luxation on the outside, the Arm is shortned: If the Luxation be Lateral, a Prominence appears in the Dislocated, and a Cavity in the opposite Part.

To reduce the Internal Luxation, the _Humerus_ and _Cubitus_ are drawn, and at the same time the Surgeon bends the Elbow, by carrying {307} the Hand toward the Shoulder; or else a Tennis-Ball may be laid in the Fold of the Elbow, and the Arm drawn toward the Shoulder.

For the External Luxation, the Extension is to be made, whilst the Surgeon thrusts back the Elbow into its place: Or else a round Stick may be taken, and trimm'd with Linnen-Cloth, with which the Bone is to be push'd back into its place during the Extension. This Stick may be also us'd in the reducing of the Internal Luxation.

For the Lateral Luxations, the Extension may be made in like manner; the Surgeon at the same time thrusting back the Bone into its Natural Situation.

_The Bandage_

Is made with a Band five Ells long, and two Fingers broad, roll'd with one Ball: The Application of it is begun with a Circumvolution at the lower part of the _Humerus_, it is pass'd over the Fold of the Arm; a Circumvolution is also form'd in the upper-part of the Elbow, and the Figure of KY in its Fold. Afterward the Rollers are continu'd upon the Elbow, and the KY's in the inside of the Arm, till the Elbow be entirely cover'd: The Band is likewise carry'd up to the top of the Arm with Rollers, and stay'd round about the Body. The Patient must be oblig'd to keep his Bed, or else his Arm may be put in a Scarf, after the same manner as in the Fracture of the Arm.

* * * * *

{308}

CHAP. XI.

_Of the Luxation of the Wrist._

If the Luxation be Internal, the Hand is turn'd back to the outside, so that for the Reduction thereof, it wou'd be requisite to cause the back of the Hand to be laid upon a Table, and the Extension to be made by drawing the Elbow and Hand, whilst the Surgeon takes care to press the Prominence.

If the Luxation be External, the Hand is bended on the inside; so that to reduce it, the inside of the Hand is to be laid upon a Table, and the Surgeon is to press it after the Extension.

If the Luxation be on the sides, the Hand is turn'd to one side; so that the Extension must be made, and the Hand turn'd on the side opposite to the Luxation. But the Fingers are usually drawn one after another, to the end that the Tendons may be set again in their Place.

The eight Bones of the _Carpus_ may be in like manner dislocated both on the inside and without; and to set 'em right, the Hand is to be laid upon a Table, and the Extension to be made, so as to press the Protuberances on the inside, if the Luxation be internal, and on the outside if it be external. {309}

_The Bandage_