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._