or in a Chair, and supported by divers Assistants; one of 'em being
employ'd to hold the Leg at the bottom, and another to draw the Skin upward
above the Knee, to the end that the Flesh may cover the Bone again after
the Operation. In the mean while a very thick Bolster is laid under the
Ham, upon which are made two Ligatures, _viz._ the first above the Knee, to
stop the Blood, by screwing it up with the _Tourniquet_ or _Gripe-Stick_;
and the second below the Knee, to render the Flesh firm for the Knife.
Before the Ligature is drawn close with the _Gripe-Stick_, a little piece
of Paste-board is to be put underneath, for fear of pinching the Skin. Thus
the Leg being well fixt, the Surgeon placeth himself between both the Legs
of the Patient, to make the Incision with a crooked Knife, turning it
circularly to the Bone, and laying one Hand upon the Back of the Knife,
which must have no Edge. Afterward the _Periosteum_ is to be {250} scrap'd
with an Incision-Knife, and the Flesh with the Vessels that lie between the
two Bones are to be cut. When the Flesh is thus separated, a Cleft Band is
to be laid upon it, with which the Heads are cross'd, to draw the Flesh
upward, to the intent that the Bones may be cut farther, and that it may
cover 'em after the Amputation, as also to facilitate the Passage of the
Saw. Then the Surgeon holds the Leg with his Left-hand, and saweth with his
Right, which he lets fall upon the two Bones, to divide 'em asunder at the
same time, beginning with the _Perone_ or _Fibula_, and ending with the
_Tibia_. But it is necessary to incline the Saw, and to go gently in the
beginning, to make way for it, and afterward to work it faster. The Leg
being cut off, the Ligature must be unty'd below the Knee, loosening the
_Gripe-Stick_, to let the Blood run a little, and to discern the Vessels
with greater facility; and then the _Gripe-Stick_ may be twisted again, to
stop the Blood; which some Surgeons effect, by laying Pieces of Vitriol
upon the Opening of the Arteries, and Astringent Powders, on a large
Bolster of Cotton or Tow, to be apply'd to the end of the Stump; but if
such a method be us'd, it is requisite that some Person be employ'd to keep
on the whole Dressing with his Hand during twenty four Hours. However this
Custom hath prevail'd in the Hospital of _Hotel-Dieu_ at _Paris_.
Others make a Ligature of the Vessels, taking up the ends of 'em with a
pair of _Forceps_, having a Spring; or with the _Valet a Patin_, which is a
sort of Pincers that are clos'd with a small {251} Ring let down to the
bottom of the Branches. These Pincers being held by a Servant, the Surgeon
passeth a Needle with wax'd Thread, into the Flesh, below the Vessel,
bringing it back again, and with the two ends of the Thread makes a good
Ligature upon the same Vessel; then he looseth the _Gripe-Stick_ and the
Band, the Stump is to be somewhat bended, and the Flesh let down to cover
the Bones.
_The Dressing and Bandage._
After the Operation, it is requisite to lay small Bolsters upon the
Vessels, and dry Pledgets upon the two Bones, as also many other Folds of
Linnen strew'd with Astringent Powders; and over all another large Bolster
or Pledget of Cotton or Tow, cover'd in like manner with Astringent
Powders; then the whole Dressing is to be wrapt up with a Plaister and a
Bolster, in form of a _Malta_ Cross; so that there are three or four
Longitudinal Bolsters, and one Circular.
The Surgeon usually begins to apply the _Malta_ Cross and Bolster under the
Ham, crossing the Heads or Ends upon the Stump, and causeth 'em to be held
by a Servant that Supports the Part; then he likewise crosseth the other
Heads, and layeth on the two Longitudinal Bolsters that cross each other in
the middle of the Stump, together with a third Longitudinal, which is
brought round about the Stump, to stay the two former: These Bolsters ought
to be three Fingers broad, and very long, to pass over the Stump. Afterward
he proceeds to apply, {252}
_The Bandage commonly call'd _Capeline_ by _French_ Surgeons, or the
Head-Bandage._
Which is prepar'd with a Band four Ells long, and three Fingers broad,
roll'd up with one Ball, three Circumvolutions being made on the side of
the cut Part, the Band is to be carry'd upward with Rollers, passing
obliquely above the Knee; and is brought down again along its former Turns;
If it be thought fit to make this Bandage with the same Band, it must be
let down to the middle of the cut Part, and carry'd up again to the Knee,
many back-folds being made, which are stay'd with the Circumvolutions, till
the Stump be entirely covered, and the whole Bandage wrapt up with Rollers
or Bolsters.
The _Capeline_ or Head-Bandage, having two Heads, is made with a Band of
the same breadth, but somewhat longer. This Band being at first apply'd to
the middle of the cut Part or Wound, the Heads are carry'd up above the
Knee; and one of the Ends are turn'd backward, to bring it down, and to
pass it over the end of the Stump. At every back-fold which is form'd above
and below the Knee, a Circumvolution is to be made with the other end of
the Band, to strengthen the back-folds, continuing to bring the Band
downward and upward, till the whole Stump be cover'd: Then Rollers are made
round about the Stump, and the Band is stay'd above the Knee. Afterward the
Part may be brought to Suppuration, cleans'd and cicatriz'd.
* * * * *
{253}
CHAP. XXII.
_Of the Operation of the _Aneurism_._
This Operation is perform'd when the Surgeon hath prickt an Artery, or when
a Tumour ariseth in an Artery.
To this purpose the Patient is set in a Chair, and a Servant employ'd in
holding his Arm in a Posture proper for the Operation; then a Bolster is to
be laid four double, following the Progress of the Artery, to the end that
the Ligature may better press the Vessel; and the Arm may be also
surrounded with another single Bolster, on which is made a Ligature screw'd
up with a _Gripe-Stick_, provided the Arm be not too much swell'd; for in
this Case it wou'd be more expedient to deferr the Operation for fear of a
Gangrene. The Artery being thus well stopt, the Surgeon lays hold on the
Arm with one Hand, below the Tumour, and with the other makes an Incision
with his Lancet, beginning at the bottom of the Tumour, and ending on the
top along the Progress of the Artery. When the Tumour is open'd, the
coagulated Blood may be discharg'd with a Finger; and if there are any
Strings at the bottom, they may be cut with a crooked Pair of Sizzers, to
the end that all the Clods of Blood, and other extraneous Bodies which are
sometimes form'd in _Aneurisms_ when they are very inveterate may be more
{254} easily remov'd. But the _Gripe-Stick_ must be loosen'd, to discover
the Opening of the Artery with greater facility, and the Artery separated
from the Membranes with a Fleam; for it wou'd be dangerous to cut it with a
streight Incision-Knife: The Artery must also be supported with a
convenient Instrument to divide it from the Nerve and Membranes; and to be
assur'd of the Place of its Opening, the _Gripe-Stick_ may be somewhat
loosen'd, and afterward screw'd up again. In the mean time the Surgeon
gives the Instrument to a Servant to hold, whilst he passeth under the
Artery a crooked Needle with a wax'd String, cuts the Thread, and takes
away the Needle: Then he begins to make the Ligature beneath the Opening of
the Artery, tying at first a single Knot, on which may be put (if you
please) a small Bolster, that may be kept steady with two other Knots: It
is also necessary that another Ligature be made in the lower part of the
Artery, by reason that the little lateral Arteries might otherwise let out
Blood.
The Artery ought not to be cut between the two Ligatures, lest the first
Ligature shou'd be forc'd by the Impulsion of the Blood; but the Thread
must be let fall, that it may rot with the Suppuration. Then the Wound may
be dress'd with Pledgets, Bolsters strew'd with Astringent Powders and a
Plaister; a Bolster being also laid in the Fold of the Elbow. {255}
_The Bandage_
Is made with a Band six Ells long, and an Inch broad, roll'd with one end,
being at first apply'd with divers Circumvolutions under the Elbow, and
moderately bound. Many turns are to be made, and a thick and streight
Bolster, is to be laid upon the Tumour, (as in the Bandage for Phlebotomy)
along the Artery, till it pass under the Arm-Hole: The Arm and Bolster must
be surrounded with the Band, which is brought up with small Rollers, to the
Arm-Pit, and stay'd with Circumvolutions round about the Breast. Afterward
the Patient is to be laid in his Bed, with the Arm lying somewhat bended on
the Pillow, and the Hand a little higher than the Elbow.
* * * * *
CHAP. XXIII.
_Of the Operation of _Phlebotomy_._
To perform this Operation, the Surgeon holds the Lancet between his Thumb
and Fore-finger, and three other Fingers lying upon the Patient's Arm, and
thrusts the Point of the lancet into the Vessel, carrying the same Point
somewhat upward, to make the Orifice the greater. If a Tendon, which is
known by its hardness; or an Artery, which is discover'd by Pulsation,
appear beyond the Vein, and very near it, the Lancet must be only set very
{256} forward in the Vein, and drawn back again streight, without turning
it up, otherwise the Artery or Tendon wou'd be certainly cut with the
Point. If the Artery or Tendon lies immediately under the Vein, the later
must be prickt somewhat underneath, holding the Lancet inclin'd side-ways,
and thrusting it very little forward; so that the Point will finish the
Opening, by turning it upward.
If the Artery stick too close to the Vein, the later is to be prickt higher
or lower than it is ordinarily done; and if the Vein be superficial, and
lie close upon a hard Muscle, the Lancet must not be thrust downright into
the Vein, but it is requisite to carry it somewhat obliquely, and to take
the Vessel above, lest the Muscle and its Membrane shou'd be prickt, which
wou'd cause a great deal of Pain, and perhaps a vehement Inflammation. It
is well known that the Veins of the Right Arm are usually open'd with the
Right-hand, and those of the Left-Arm with the Left-hand.
_The Bandage_
Is made thus: The Surgeon having laid a Bolster upon the Orifice, keeps it
close with two Fingers, and holds the Band or Fillet with the other Hand;
then taking one end of the Fillet with the Middle-Finger, Fore-Finger, and
Thumb, and applying it to the Bolster, he makes with the longest end of the
Fillet divers Figures in form of the Letters KY in the Fold of the Arm; as
also a back-fold with the shorter end of the Fillet, held between three
{257} Fingers. Afterward both ends of the Fillet are ty'd beneath the
Elbow.
If an Inflammation happens after the Operation, the Bolsters are to be dipt
in _Oxycratum_: but if the Orifice were so small as to produce a _Rhombus_,
it wou'd be requisite to press the Wound often with two Fingers, and
immediately to apply a Bolster dipt in _Oxycratum_.
* * * * *
CHAP. XXIV.
_Of the Operation of _Encysted Tumours_._
If the Tumours are small and hanging, and have a narrow bottom, a Ligature
may be made with Horse-Hair or Silk, dipt in _Aqua-Fortis_, which will
cause 'em to fall off of themselves after some time; or else they may be
cut above the Ligature.
If the Tumour or Wen be thick, and its bottom large, a Crucial Incision is
to be made in the Skin, without impairing the _Cystis_ or Bagg; and when
the Incision is finish'd, the Bag may be torn off with the Nails, or with
the Handle of a Pen-Knife; but sometimes it is necessary to dissect it. If
there be any considerable Vessels at the Root, they may be bound, or else
cut; and the Blood may be stopt with Astringents. If any parts of the
_Cystis_ remain, they are to be consum'd with Corrosives; and the Lips of
the Wound are to be drawn together without a Stitch, making use {258} only
of an agglutinative Plaister. But if the Tumour adheres very close to the
_Pericranium_, it is most expedient not to meddle with it at all.
_Of _Ganglions_._
_Ganglions_ are Tumours arising upon the Tendons and Nervous Parts, which
may be cur'd by thrusting 'em violently, and making a very streight
Bandage, provided they be very recent; a resolvent Plaister is to be also
apply'd to the Part.
* * * * *
CHAP. XXV.
_Of the Operation of the _Hydrocephalus_._
This Operation is perform'd when it is necessary to discharge watry Humours
out of the Head: If these Waters lie under the Skin, a very large Opening
is to be made with a Lancet, and a small Tube or Pipe left therein to let
'em run out. If the Water be situated between the Brain and the _Dura
Mater_, the Membrane is to be perforated with a Lancet, after the Trepan
hath been apply'd, according to the usual Method, of which we have already
given some account: Cauteries and Scarifications may be also us'd to very
good purpose in this Disease.
* * * * *
{259}
CHAP. XXVI.
_Of the operation of cutting the Tongue-String._
When the Ligament of the Tongue in Infants is extended to its Extremity,
they cannot suck without difficulty; and when grown up, they have an
impediment in their Speech.
This Ligament may be cut with a little pair of Sizzers; to which purpose
the Thumb of the Left-hand being laid upon the Gum of the lower Jaw, to
keep the Mouth open, the Tongue may be rais'd upward with the Fore-Finger
of the same Hand, and the Sizzers may be pass'd between the two Fingers, to
divide the String as near as is possible to the Root of the Tongue,
avoiding the Vessels: If an Haemorrhage happens, recourse may be had to
Styptick-Waters. Afterward the Nurse must take care to let a Finger be
often put into the Child's Mouth, to prevent the re-uniting of the String.
* * * * *
{260}
CHAP. XXVII.
_Of the Operation of opening stopt _Ductus_'s._
If there be only one Membrane that stops the Entrance of the _Vagina_, an
Incision may be made, and a Leaden Pipe put into it, having Rings to fasten
it to the Waste, to hinder the re-uniting of the Wound.
If the Lips of the _Pudendum_ are conglutinated or clos'd up, the Patient
must be laid upon her Back, and her Knees rais'd up, in order to make an
Incision with a crooked Incision-Knife, beginning at the Top; and then a
Leaden Pipe is to be put into the Opening.
If the _Vagina_ be fill'd with a Fleshy Substance, an Incision is to be
made therein, till it be entirely perforated, putting at the same time a
Leaden Tube into the Orifice.
If the Urinary _Ductus_ as well in young Boys as in Virgins, be stopt up,
an Incision is to be made therein with a very narrow Lancet; and if a small
Leaden Pipe can be conveniently introduc'd, it may be done; but it is not
very necessary, in regard that Children are almost always making Water,
which wou'd of it self hinder the closing of the Orifice.
If the _Ductus_ of the Ear be stopt with a Membrane, it must be perforated,
taking care not to go too far, for fear of piercing the Membrane of the
_Tympanum_ or Drum, and {261} a small Leaden Pipe is to be put into the
Opening.
If there be a carnous Excrescence on the outside of the Ear, a Ligature
ought to be made therein, or else it may be cut with a pair of Sizzers, to
cause it to fall off; and the rest of the Fleshy Substance that remains in
the Ear must be consum'd with Causticks, convey'd to the Part by the means
of a small Tube, care being had, nevertheless, to avoid cauterizing the
_Tympanum_.
* * * * *
CHAP. XXVIII.
_Of the Operation of the _Phimosis_ and _Paraphimosis_._
When the _Praeputium_ is so streight that the _Glans_ can be no longer
uncover'd, this Indisposition is call'd _Phimosis_; but if the _Praeputium_
be turn'd back above the _Glans_, after such a manner that it can no longer
cover the same _Glans_, it is a _Paraphimosis_. If in the _Phimosis_ the
_Praeputium_ cleaves very close round about the _Glans_, it is most
expedient to let it alone; but if in handling the _Glans_ it be perceiv'd
that it is moveable, or else that some parts of it only stick together, the
Operation may be perform'd after this manner: The Patient being set in a
Chair, a Servant is employ'd in pulling back the Skin to the Root of the
_Penis_, to the end that the Incision may be {262} made directly at the
bottom of the _Glans_: Then the Surgeon having drawn out the bottom of the
_Praeputium_, introduceth a small Instrument with a very sharp Point on its
flat side, at the end of which is fixt a Button of Wax, pierceth the
_Praeputium_ at the bottom of the _Glans_ on the side of the Thread, and
finisheth the Incision by drawing the Instrument toward himself.
The _Paraphimosis_ is cur'd by making Fomentations on the Part, to allay
the Inflammation if there be any; and it is to be pull'd down with the
Fingers. But if Medicinal Preparations prove ineffectual, Scarifications
are to be made round about the _Praeputium_; and afterward convenient
Remedies may be apply'd to remove the Inflammation, and prevent the
Mortification of the Part; so that at length the _Praeputium_ may be drawn
over the _Glans_.
* * * * *
CHAP. XXIX.
_Of the Operation of the _Varix_._
In order to cure this Tumour, the Surgeon having first cut the Skin to
discover the dilated Vein, separates it from the Membranes, and passeth
underneath a crooked Needle with a double wax'd Thread; then he makes a
Ligature both above and below the dilatation of the Vein, opens the dilated
Part with a Lancet, to let out the Blood, and applies a convenient Bandage:
But without performing this {263} Operation, the Vein might be open'd with
a Lancet, to draw out a sufficient quantity of Blood; and then the _Varix_
is to be press'd with a somewhat close Bandage.
* * * * *
CHAP. XXX.
_Of the Operation of the _Panaritium_._
The _Panaritium_ is an Abcess which ariseth at the end of the Fingers; some
of these Tumours are only superficial, and others penetrate even under the
_Periosteum_; nevertheless after whatsoever manner the _Panaritium_ may
happen, it ought to be open'd on the side of the Finger, that the Tendons
may not be hurt. If the Abcess be extended under the _Periosteum_, the
opening must be made on the side, and the Lancet thrust forward to the
Bone: Afterward the _Pus_ or corrupt Matter is to be discharg'd, which
wou'd cause the Tendons to putrifie, if it shou'd remain too long upon 'em.
_The Dressing and Bandage_
Are made with a Plaister cut in form of a _Malta_ Cross, which is apply'd
at the middle to the end of the Finger, the Heads being cross'd round
about. The Bolsters must be also cut in the shape of the _Malta_ Cross, or
of a plain Cross only; the Band being a Finger's breadth {264} wide, and
long enough to be roll'd about the whole Dressing: It must be pierc'd at
one of its ends, and cut the length of three Fingers at the other; so that
the two Heads may pass thro' the Hole, to surround the Finger with small
Rollers.
* * * * *
CHAP. XXXI.
_Of the Reduction of the falling of the _Anus_._
To reduce the _Anus_ to its proper place when it is fallen, the Patient
being laid upon his Belly, with his Buttocks higher than his Head, the
Operator gently thrusts back the Roll that forms the _Anus_ with his
Fingers dipt in the Oil of Roses: Then he applies the Bolsters steept in
some Astringent Liquor, and causeth 'em to be supported with a sort of
Bandage, the Nature of which we shall shew in treating of the Fracture of
the _Coccyx_, that is to say, the T. the double T. or else the Sling with
four Heads.
* * * * *
{265}
CHAP. XXXII.
_Of the Reduction of the falling of the _Matrix_._
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._