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_
Is prepar'd with a Band six Ells long, and two Fingers broad; so that three
Circumvolutions may be made upon the Luxation; as also divers Rollers in
passing thro' the inside of the Hand between the Thumb and the Forefinger,
and in forming the Figure of KY upon the Thumb, after having made many
Rollers upon the Wrist. Two Pieces of Paste-board are also to be laid on
the sides of the Wrist, which are bound with the same Band in making
Rollers; and the Hand is to be trimm'd with a Linnen-Ball, to keep the
Fingers in their mean Situation. Then the Band is to be pass'd above, to
strengthen it, and carry'd up with Rollers along the whole length of the
Elbow, to be stay'd below the same Elbow.
* * * * *
CHAP. XII.
_Of the Luxation of the Fingers._
If the Fingers be luxated, it is necessary to make an Extension to reduce
'em, and afterward to use the following
_Bandage._
If the Luxation be in the first Articulation or Joint, the Bandage _Spica_
is to be apply'd, being made of a Band roll'd with one Head, an {310} Ell
long, and an Inch broad: It is begun with Circumvolutions round about the
Wrist, and brought over the Luxation in passing between the Fingers. These
Circumvolutions are also continu'd to form a _Spica_ upon the Luxation; and
the Band is stay'd at the Wrist.
If all the first _Phalanges_ were dislocated, it wou'd be requisite to make
as many upon every _Phalanx_, and with the same Band: This sort of Bandage
is call'd the _Demi-Gantlet_.
* * * * *
CHAP. XIII.
_Of the Luxation of the Thigh._
The Luxation which most commonly happens in this Part, is the Internal; so
that a Protuberance appears on the Hole of the _Os Pubis_; the indispos'd
Leg is longer than the other, and the Knee and Foot turn outward; neither
can the Thigh be any longer bended, nor drawn near the other.
If the Luxation be External, the Leg becomes shorter than the other, the
Knee and Foot turning inward, and the Heel to the outside.
When the Luxation is on the fore-part, a Tumour ariseth in the Groin, so
that the Patient cannot draw this Thigh toward the other, nor bend the Leg;
his Body resting only upon the Heel.
{311}
If the Luxation be Posterior, a Tumour is felt in the Buttocks with great
Pain, and the Legg is shorter than it ought to be: There also appears a
sinking in the Groin, the Leg is lifted off from the Ground, and the hurt
Person is apt to fall backward.
To reduce the Internal Luxation, the Patient is to be laid with his Back
upon a Table, to which is fixt a thick Wooden Pin, about a Foot long, which
is to be set between his Thighs, to detain his Body when his Legs are drawn
down; then a Strap is to be pass'd above the joynt of the Thigh, to draw
the _Ischion_ upward; and the Thigh is to be drawn down with another Strap
fasten'd above the Knee: In the mean while the Surgeon thrusts the Thigh
upward, to cause it to re-enter its Cavity, the Straps being somewhat
loosen'd in the time of the Reduction to facilitate the Operation.
To reduce the External Luxation, the Patient is to be laid upon his Belly;
and the drawing to be perform'd after the same manner as we have even now
shewn, whilst the Thigh is thrust from the outside inward, to cause the
bone to re-enter its Cavity.
In reducing the Anterior Luxation, the hurt Person is to be laid upon the
side opposite to the Luxation, and Extensions are to be made, by drawing
both upward and down-ward, as before: Then the Head of the Bone is to be
forc'd, by the means of a Ball thrust strongly with the Knee, in drawing
the luxated leg toward the other. {312}
The Posterior Luxation is thus reduc'd; The Patient being laid upon his
Belly, the double Extension is to be made, and his Knee drawn outward, to
set the Bone in its place. After the Operation hath been perform'd, a
Bolster is to be apply'd, steept in Spirituous Medicaments; and the Bandage
call'd _Spica_, of which we have given an Account in treating of the
Luxation of the Shoulder.
* * * * *
CHAP. XIV.
_Of the Luxation of the Knee._
When the _Tibia_ is luxated behind, its Prominences are in the Cavity of
the Ham, and the Leg flies off, or is bended. If the same _Tibia_ be
dislocated on the side, a kind of Tumour appears in the luxated side, and a
Sinking in the opposite. But if the _Condylus_ of the _Tibia_ remains in
the inside, the Leg turns outward; and if it be in the outside, it turns
inward.
The Posterior Luxation is reduc'd by obliging the Patient to lie upon his
Belly, whilst the Surgeon during the Extensions bends the Leg, in drawing
the Heel toward the top of the Thigh.
If the _Tibia_ be luxated on the side, the usual Extensions are to be made,
and the Bone is to be push'd with the Knee. {313}
If the Luxation were in the fore-part, it wou'd be requisite to lay the
Patient upon his Back, to make the Extensions, by drawing the Thigh and
Leg; and to press the protuberant Parts.
_The Bandage_
Is prepar'd with a Band three Ells long, and two Fingers broad, roll'd with
two Balls: A Circumvolution being at first made above the Knee, the Figure
KY is form'd underneath, and a Circumvolution above it; then the Band is
carry'd up again over the Knee, in making Rollers and KY's underneath, till
the Knee be entirely cover'd.
* * * * *
CHAP. XV.
_Of the Luxation of the _Patella_ or Knee-Pan._
The Knee-Pan is luxated by starting upward; and to reduce it, the Patient's
Leg is to be held streight, whilst it is thrust back into its place with
the Hands. Then he must be oblig'd to keep his Bed; and the same Bandage is
to be apply'd with that which hath been describ'd for the Luxation of the
Knee.
If the _Perone_ or _Fibula_ be remov'd from the _Tibia_, the sides of the
Foot are to be press'd, to draw it back again; and it may be kept close
{314} with the Bandage which is appropriated to the Fractures of the
_Tarsus_.
The _Astragalus_ may be also luxated in the fore-part; so that the Operator
ought to thrust it back into its place, and to make use of the Bandage
which we have prepar'd for the Fracture of the Foot.
The _Calcaneum_ sometimes flies off from the _Astragalus_ both in the
inside and without; and the Bones of the _Tarsus_, _Metatarsus_, and Toes
are likewise apt to be luxated. But a little Circumspection is only
requisite to reduce all these Dislocations.
* * * * *
{315}
A
TREATISE
OF
_Medicinal Compositions_
Necessary for a
SURGEON.
* * * * *
CHAP. I.
_Of Balsams._
* * * * *
_The Balsam of _Arcaeus_._
Take two Pounds of the Suet of a He-Goat, _Venice_ Turpentine and Gum
_Elemi_, a Pound and a half of each; and of Hogs-Lard one Pound. After the
Gum _Elemi_, being cut into small Pieces, hath been melted over a very
gentle Fire, add to it the Turpentine, Goats-Suet, and {316} Swines-Grease;
and when all these Ingredients are well dissolv'd, strain the Liquor thro'
a new Linnen-Cloth, to separate the Scum and Dregs from it; then let the
whole Mass cool, and the Balsam is made.
This Balsam serves to incarnate and consolidate all sorts of Wounds and
Ulcers: It is likewise us'd in Fractures and Dislocations of the Bones; as
also to cure the Contusions and Wounds of the Nerves.
_The Balsam of _Spain_._
Take pure Wheat, the Roots of Valerian and _Carduus Benedictus_, of each
one Ounce, and beat 'em well in a Mortar with a Pint of White-Wine; strain
the whole Composition into an Earthen Vessel Leaded, having a narrow Mouth;
stop up the Vessel, and set it upon hot Embers during twenty four Hours:
Then add six Ounces, of St. _John_'s Wort; set the whole Mass in _Balneo
Mariae_, till the Wine be consum'd and let it be strain'd and squeez'd.
Afterward add two Ounces of Frankincense well pulveriz'd, with eight Ounces
of _Venice_ Turpentine, mixing 'em together over a gentle Fire, and the
Balsam will be made.