the Extremities of the Nerves which are there terminated It also renders the same Skin even and smooth and so contributes very much to Beauty What is the Hair The Hairs are certain hollow Filaments planted in the Glandules of the Skin from whence their Nourishment is deriv'd They constitute the Ornament of some Parts cover those which Modesty requires to be conceal'd and defend others from the injury of the Weather What is a Nail The Nails are a Continuity of the Skin harden'd at the end of the Fingers to strengthen and render them fit for Work CHAP. IV. Of the general Division of a Humane Body HOW is the Humane Body divided before it is dissected in order to Anatomical Demonstration Some Anatomists distinguish it into Similar and Dissimilar Parts appropriating the former Denomination to all the simple Parts of the Body taken separately as a Bone a Vein a Nerve c. but they attribute the Name of Dissimilar to all those Members that are compos'd of many Similar or Simple Parts together such are the Arms Legs Eyes c. wherein are contain'd all at once Bones Veins Nerves and other parts Others divide it into containing and contained Parts the former enclosing the others as the Skull includes the Brain and the Breast the Lungs whereas the contained Parts are shut up within others as the Entrails within the Belly the Brain within the Skull c. Others again divide the whole Body into Spermatick and Sanguineous Parts the former being those which are made at the time of Formation and the latter all those that are grown afterward by the Nourishment of the Blood Are there not also other Methods of dividing the Humane Body Yes Many Persons consider it as a Contexture of Bones Flesh Vessels and Entrails which they explain in four several Treatises whereof the first is call'd Osteology for the Bones the second Myology for the Muscles the third Angiology for the Veins Arteries and Nerves which are the Vessels and the fourth Splanchnology for the Entrails But lastly the most clear and perspicuous of all the Divisions of the Body of Man is that which compares it to a Tree whereof the Trunk is the Body and the Branches are the Arms and Legs The Body is divided into three Venters or great Cavities viz. the Upper the Middle and the Lower which are the Head the Breast and the lower Belly The Arms are distributed into the Arms properly so called the Elbow and Hands and the Legs in like manner into Thighs Shanks and Feet The Hands being also subdivided into the Carpus or Wrist Metacarpium or Back of the Hand and the Fingers as the Feet into the Tarsus Metatarsus and Toes This Division is at present follow'd in the Anatomical Schools CHAP. V. Of the Skeleton WHY is Anatomy usually begun with the Demonstration of the Skeleton or Contexture of Bones Because the Bones serve for the Foundation Connexion and Support of all other Parts of the Body What is the Skeleton It is a gathering together or Conjunction of all the Bones of the Body almost in their Natural Situation From whence are the principal differences of the Bones derived They are taken from their Substance Figure Articulation and Use How is all this to be understood First then with respect to their Substance there are some Bones harder than others as those of the Legs compared with those of the Back-Bone Again in regard of their Figure some are long as those of the Arm and others short as those of the Metacarpium Some are also broad as those of the Skull and Omoplatae or Shoulder-Blades and others narrow as the Ribbs But with respect to their Articulation some are joined by thick Heads which are received into large Cavities as the Huckle-Bones with those of the Hips and others are united by the means of a simple Line as the Chin-Bones Lastly with relation to their Use some serve to support and carry the whole Body as the Leg-Bones and others are appointed to grind the Meat as the Teeth or else to form some Cavity as the Skull-Bone and those of the Ribs What are the Parts to be distinguished in the Bones They are the Body the Ends the Heads the Neck the Apophyses the Epiphyses the Condyli or Productions the Cavities the Supercilia or Lips and the Ridges The Body is the greatest Part and the middle of the Bone the Ends are the two Extremities the Heads are the great Protuberances at the Extremities the Neck is that Part which lies immediately under the Head the Apophyses or Processes are certain Bunches or Knobs at the Ends of the Bones which constitute a Part of them the Epiphyses are Bones added to the Extremities of other Bones the Condyli or Productions are the small Elevations or Extuberances of the Bones the Cavities are certain Holes or hollow places the Supercilia or Lips are the Extremities of the Sides of a Cavity which is at the End of a Bone the Ridges are the prominent and saliant Parts in the length of the Body of the Bone How are the Bones join'd together Two several ways viz. by Articulation and Symphysis How many sorts of Articulations are there in the Bones There are generally two kinds viz. Diarthrosis and Synarthrosis What is Diarthrosis Diarthrosis is a kind of Articulation which serves for sensible Motions How many kinds of Diarthroses or great Motions are there There are Three viz. Enarthrosis Arthrodia and Ginglymus Enarthrosis is a kind of Articulation which unites two Bones with a great Head on one side and a large Cavity on the other as the Head of the Thigh-Bone in the Cavity of the Ischion or Huckle-Bone Arthrodia is a sort of Articulation by the means whereof two Bones are join'd together with a flat Head receiv'd into a Cavity of a small depth Such is the Head of the Shoulder-Bone with the Cavity of the Omoplata or Shoulder-Blade and that of the Twelfth Vertebra of the Back with the first of the Loins Ginglymus is a kind of Articulation which unites two Bones each whereof hath at their Ends a Head and a Cavity whereby they both receive and are received at the same time such is the Articulation in the Bones of the Elbow and the Vertebrae What is Synarthrosis Synarthrosis being opposite to Diarthrosis is a close or compacted Articulation destitute of any sensible Motion How many sorts of Synarthroses or close Articulations are there There are Three viz. Sutura Harmonia and Gomphosis A Suture is that which joins together two Bones by a kind of Seam or Stitch or by a Connexion of their Extremities dispos'd in form of a Saw the Teeth whereof are reciprocally let one into another Such are the Sutures of the Skull-Bones Harmonia is the uniting of two Bones by a simple Line as the Bone of the Cheek with that of the Jaw Gomphosis is a kind of close Articulation which unites two Bones after the manner of Nails or Wooden Pins fixt in the Holes
third is all over beset with Glandules thro' which are filtrated the serous Particles of the Blood contain'd in the Vessels of the second Tunicle The fourth is a Series of Annular and Musculous or Fleshy Fibres Which are the-most numerous the Arteries or the Veins The Number of the Veins exceeds that of the Arteries and there are scarce any Arteries without Veins accompanying them Where is the Beginning and Original of all the Veins All the Veins have their Root in the Liver and two of the three great Trunks that proceed from thence are call'd Vena Portae and Vena Cava and the third is twofold viz. the ascending and the descending The Vena Portae is distributed to all the Parâ—â— contain'd in the lower Belly and terminated iâ— the Fundament where it makes the Internal Haemorrhoidal Veins The Vena Cava is immediately divided into two thick Branches one whereof ariseth upward to the Right Ventricle of the Heart and formâ— the ascending Vena Cava as the other goes downward to the Feet and constitutes the descending What is the Distribution of the ascending Venâ— Cava It perforates the Diaphragm goes to the Heart and ascends from thence to the Clavicles after having communicated to the Midriff in passing a small Branch call'd the Phrenicus as also one or two to the Heart nam'd the Coronary and some others to the upper Ribs besides the single Branch term'd Azygos only on the right side But the Trunk of the ascending Vena Cava being once come up to the Clavicles is divided into two Branches well known by the Name of the Subclavian one whereof Shoots forth toward the Right side and the other toward the Left and they both make various Ramifications like to those of the thick ascending Artery by producing the Cervicalis or Soporalis and the Internal and External Jugulars that go to the Head as also the Axillars which pass to the Arms and Shoulders forming the Cephalick the Median and the Basilick on the inside of the Elbow The descending Vena Cava in like manner accompanieth the Ramifications of the Aorta or thick descending Artery to the fourth Vertebra of the Loins where it sends forth two Branches nam'd the Iliack one whereof goes to the Right side and the other to the Left both inwardly and outwardly imparting divers Twigs or lesser Branches to all the Parts contain'd in the Abdomen or lower Belly even as far as the Fundament where it makes the External Haemorrhoidal Veins Afterward the outward Branch of the Iliack descends in the Thigh to form the Crural and others as far as the Saphaena together with those that are situated at the end of the Feet CHAP XII Of the Anatomy of the Abdomen oâ— lower Belly WHAT is the clearest Division of the Humâ—â— Body into various Parts and that which 〈◊〉 most follow'd in the Anatomical Schools It is that which constitutes three Venters thaâ— is to say the Upper the Middle and the Loâ—er which are the Head the Thorax or Breasâ— and the Abdomen or lower Belly together wiâ—â— the Extremities which are the Arms and Legs What is the lower Belly It is a Cavity of the Body that contains thâ— nourishing parts as the Reins the Bladder anâ— all those that are appropriated to Generation 〈◊〉 both Sexes What is to be consider'd outwardly in the lowâ—â— Belly It s different Regions and the several paâ—â— therein contain'd What are these Regions They are the Epigastrick the Vmbilical anâ— the Hypogastrick What is their Extent It is from the Xyphoides or Sword-like Cartilage to the Os Pubis the division whereof inâ—â— three equal Parts constitutes the three different Regions the Epigastrium being the first upward the Vmbilicus the second and the Hypâ—gastrium the third What are the Parts contain'd in the Epigastrium and what Place do they possess therein The Parts contain'd in the Epigastrium are the Liver the Spleen the Stomach and the Pancreas or Sweet-bread which lies underneath The Stomach takes up the middle before the Liver being plac'd on the Right side and the Spleen on the Left so that these two sides of the Epigastrick Region are call'd the Right and Left Hypochondria What Parts are there contain'd in the Vmbilicál Region and what is their situation They are the most part of the thin Intestines or small Guts viz. the Duodenum the Jejunum and the Ileon which have their Residence in the middle where they are encircled with a Portion of the two great Guts Coecum and Colon that take possession of the Sides otherwise call'd the Flanks The Reins or Kidneys are also in this Place above and somewhat backward What Parts are there contain'd in the Hypogastrium and of what Place are they possest The greater part of the thick-Guts Coecum and Colon are enclos'd therein with the entire Rectum there is also a Portion of the Ileon which hides it self in the sides of the Ilia or Hip-Bones In the middle under the Os Pubis the Bladder is situated on the Gut Rectum in Men and the Matrix in Women lies between the Rectum and Bladder After what manner is the opening of a Corps or dead Body perform'd at a publick Dissection It is begun with a Crucial Incision in the Skin from underneath the Throat downward traversing from one side to another in the Umbilical Region then this Skin is pull'd off at the four Corners and the Panicula Adiposa is immediately discover'd Under this Fat lies a Fleshy Membrane call'd Membrana Carnosa and after that the common Membrane of all the Muscleâ— of the lower Belly Thus we have taken View of what Anatomists commonly term the five Teguments that is to say the Epiderma oâ— Scarf-Skin the Derma or true Skin the Panicula Adiposa the Panicula Carnosa or Membrane Carnosa and the common Membrane of the Muscles The five Teguments being remov'd we meet with as many Muscles on each side viz. the descending Oblique the ascending Oblique the Transverse the streight and the Pyramidal by the means whereof the Belly is extended and contracted Afterwards appears a Membrane nam'd Peritonaeum which contains all the Bowels and covers the whole lower Belly being strongly fasten'd to the first and third Vertebra's of the Back The Fat skinny Net which lies immediately under the Peritonaeum is call'd Epiploon and Omentum or the Caul it floats over the Bowels keeping them in a continual Suppleness necessary for their Functions maintains the Heat of the Stomach and contributes to Digestion It remains to take an Account of the Bowels viz. the Stomach Mesentery Liver Spleen Kidneys Bladder and Guts together with the Parts appointed for Generation which in Men are the Spermatick Vessels the Testicles and the Penis and in Women the Spermatick Vessels the Testicles or Ovaries the Matrix and its Vagina or Neck What is the Stomach It is the Receptacle of the Aliments or Food convey'd thither thro' the Oesophagus or Gullet which is a Canal or kind of streight Gut that reacheth
of the Arm. 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 Canpus 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 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 Fore-finger 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 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 If the Luxation be Posterior a Tumour is selt 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 â—isted off from the Ground and the hurt Person â—s apt to fall backward To reduce the Internal Luxation the Patient â—s 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 â—o 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 downward 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 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 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 â—s 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
perform'd b◠others upon the Bodies of their Patients What are the Diseases in general that belong 〈◊〉 Surgery They are Tumours Impostumes Wound◠Ulcers Fractures Dislocations and generall◠all sorts of Distempers whereto Manual Operations may be applyed What are the Instruments in general which a◠commonly used in Surgery for the curing of Diseases They are Five viz. the Hand Bandages Medicines the Incision-Knife and Fire What is the general Practice which ought to be observ'd in the Application of these different helps Hippocrates teacheth us in saying that whe◠Medicines are not sufficient recourse may b◠had to the Incision-Knife and afterward t◠Fire intimating that we must proceed by degrees Are there any Distempers that may be cured 〈◊〉 the Surgeon's Hand alone Yes as when a simple and small Dislocation 〈◊〉 only to be reduced CHAP. II. Of Chirurgical Instruments portable and not portable WHAT do you call portable and not portable Instruments Portable Instruments are those which the Surgeon carries in his Lancet-Case with his Plaister-Box and not portable are those that he doth not carry about him but is oblig'd to keep at home the former being appointed for the ready help which he daily administers to his Patients and the others for greater Operations What are the Instruments which a Surgeon ought to have in his Plaister-Box These Instruments are a good pair of Sizzers a Razor an Incision-Knife streight and crooked a Spatula a greater Lancet to open Impostumes and lesser for letting Blood They likewise carry separately in very near Lancet-Cases a hollow Probe made of Silver or fine Steel as also many other Probes streight crooked folding and of different thickness a Pipe of Silver or fine Steel to convey the cauterizing Button to a remote Part without running the hazard of burning those that are near it another Pipe or Tube serving instead of a Case for Needles which have Eyes at one end for sowing a Carlet or thick triangular Needle a small File a Steel Instrument to cleanse the Teeth a Fleam a pair of crooked Forceps to draw a Tooth a Pelican a Crow's Bill several sorts of Raspatories a Hook to hold up the Skin in cutting c. What are the Instruments which a Surgeon ought to keep in his Repository to perform the greater Operations Some of them are peculiar to certain Operations and others are common to all The Instruments appropriated to particular Operations are the Trepan for opening the Bones in the Head or elsewhere The Catheters or Probes for Men and Women afflicted with the Stone or difficulty of making Water Extractors to lay hold on the Stone in Lithotomy and to gather together the Gravel large crooked Incision-Knives and a Saw to make Amputations of the Arms or Legs great Needles with three Edges to be used in making Setons small Needles to couch Cataracts other Needles thin Plates and Buckles to close a Hair-Lip c. May not the Salvatory be reckon'd among the portable Instruments Yes because the Balsams Ointments and Plaisters contain'd therein are means whereof the Surgeon makes use to restore Health CHAP. III. Of Anatomy in general and in particular of all the Parts whereof the Humane Body is compos'd WHAT is Anatomy It is the Analysis or exact Division of all the Parts of a Body to discover their Nature and Original What is requisite to be observ'd by a Surgeon before he goes about to dissect a Body Two things viz. The external Structure of the Body and the Proportion or Correspondence between the outward Parts and those that are within Why so Because without this exterior and general Knowledge the Surgeon wou'd be often mistaken in the Judgment he is to pass concerning a Dislocation or Wound inasmuch as it is by the Deformity which he perceives in the Member that he knows the Dislocation as it is also by the means of the Correspondence which the outward Parts have with the inward that he is enabled to draw any certain Consequences relating to a Wound which penetrates into the Body What is a Part It is that whereof the whole Body is compos'd and which partakes of a common Life or Sensation with it How many sorts of Parts are there in a Humane Body We may well reckon up Fifteen distinct Parts which are the Bone the Cartilage the Ligament the Tendon the Membrane the Fibre the Nerve the Vein the Artery the Flesh the Fat the Skin the Scarf-Skin the Hair and the Nails What is a Bone It is the hardest and driest Part of the whole Body and that which constitutes its principal Support What is a Cartilage or Gristle It is a yielding and supple Part which partakes of the Nature of a Bone and is always fasten'd to its Extremities to mollifie and facilitate its Motion What is a Ligament It is a Membranous Contexture usually sticking to the Bones to contain them as also sometimes to other Parts to suspend and retain them in their proper place What is a Tendon It is the Tail or Extremity of the Muscles made by the re-union of all the Fibres of their Body which serves to corroborate it in its Action and to give Motion to the Part. What is a Membrane It is a Nervous Part the use whereof is to adorn and secure the Cavities of the Body on the inside and to wrap up or cover the Parts What is a Fibre They are fleshy Lines of which the Body of a Muscle is compos'd What is a Nerve It is a long white and thin Body consisting of many Fibres enclos'd within a double Tunick and design'd to carry the Animal Spirits into all the Parts to give them Sense and Motion What is an Artery It is a Canal compos'd of Four Coats that carryeth with a kind of Beating or Pulse even to the very Extremity of the Parts the Blood full of Spirits which proceeds from the Heart to distribute to them at the same time both Life and Nourishment What is a Vein It is a Canal made likewise of Four Tunicles which receives the Arterial Blood to carry it back to the Heart What is Flesh It is a Part which is form'd of Blood thicken'd by the natural Heat and that constitutes the Body of a Muscle What is Fat It is a soft Body made of the Unctuous and Sulphurous part of the Blood What is the Derma or Skin It is a Net compos'd of Fibres Veins Arteries Lymphatick Vessels and Nerves which covers the whole Body to defend it from the Injuries of the Air and to serve as an universal Emunctory It is very thin in the Face sticking close to the Flesh and is pierc'd with an infinite number of imperceptible Pores affording a Passage to insensible Transpiration What is the Epiderma or Scarf-Skin It is a small fine Skin transparent and insensible having also innumerable Pores for the discharging of Sweat and other Humours by imperceptible Transpiration It is extended over the whole inner Skin to dull its too exquisite Sense by covering
made to receive them Such is that of the Teeth in their Sockets What is Symphysis Symphysis is the uniting of two Bones by the interposition of a Medium which ties them very streight together being also threefold Such is the Connexion of the Knee-Pan or Whirl-Bone of the Knee and the Omoplata or Shoulder-Blade Are not these three kinds of Articulations or Symphyses distinguish'd one from another Yes for tho' they are all made by the means of a third Body intervening which joins them together nevertheless every one of these various Bodies gives a different Denomination to its respectivé Articulation Thus the Articulation which is caus'd by a Glutinous and Cartilaginous Substance is properly call'd Synchondrosis as that of the Nose Chin Os Pubis c. But an Articulation which is made by a Ligament is termed Synneurosis as that of the Knee-Pan Lastly that which is wrought by the means of Flesh bears the Name of Syssarcosis as the Jaw-Bones the Os Hyoides and the Omoplata or Shoulder-Blade Have the Bones any sense of Feeling or Motion They have neither for their sense of Pain proceeds from nothing else but their Periostium or the Membrane with which they are cover'd and their Motion is perform'd only by the Muscles that draw them Doth the Marrow afford any Nutriment to the Bones No all the Bones are nourish'd by the Blood as the other Parts but the Marrow is to the Bones what the Fat is to the Flesh that is to say it is a kind of Oil or Unctuous Substance which moistens and renders them less brittle Are all the Bones of the same Colour No they follow the Temperament and Constitution of the Persons How many in number are the Bones of the Humane Skeleton There are two hundred and fifty usually reckon'd viz. 61 in the Head 67 in the Trunk or Chest 62 in the Arms and Hands and 60 in the Legs and Feet but the true Number cannot be exactly determin'd by reason that some Persons have more and others fewer for some have more Ossa Sesamoidea Teeth and Breast-Bones than others Again some have many indentings in the Lambdoidal Suture and others have none at all Can you rehearse the Number of the Bones of the Head There are Fifteen in the Skull and Forty six in the Face The Fifteen of the Skull are the Coronal for the fore-part of the Head the Occipital for the hinder-part the two Parietals for the upper-part and each side the two Temporals for the Temples the Os Sphenoides or Cuneiforme which closeth the Basis or bottom of the Skull the Os Ethmoides or Cribriforme situated at the Root of the Nose and the four little Bones of the Ear on each side viz. the Incus or Anvil the Stapes or Stirrup the Malleolus or Hammer and the Orbiculare or Orbicular Bone Of the Forty six of the Face Twenty seven are counted in the Upper-Jaw viz. the two Zygomatick or the two Bones of the Cheek-Knots the two Lachrymal in the great Corners of the Eyes toward the Nose the two Maxillar that receive the Upper-Teeth and which form part of the Palate of the Mouth and the Orbits of the Eyes the two Bones of the Nose the two Palate-Bones which are at its end and behind the Nostrils the last being single is the Vomer which makes the Division of the lower part of the Nostrils and there are generally Sixteen Upper-Teeth The Lower-Jaw contains Nineteen Bones viz. sixteen Teeth two Bones that receive them and the Os Hyoides which is single and fix'd at the Root of the Tongue How are the Teeth usually divided with respect to their Qualities Into Incisive or Cutters Canine or Dog-Teeth and Molar or Grinders There are eight Incisive and four Canine which have only one single Root as also twenty Molar every one whereof hath one two or three Roots Can you recite the Number of the Bones of the Trunk or Chest There are generally thirty and three in the Spine or Chine-Bone of the Back viz. seven Vertebra's in the Neck twelve in the Back five in the Legs five six and sometimes seven in the Os Sacrum three or four in the Coccyx and two Cartilages at its end There are twenty nine in the Breast viz. twenty four Ribs two Clavicles or Channel-Bones and commonly three Bones in the Sternum The Hip-Bones are likewise divided into three viz. Ilion Ischion and Os Pubis Do you know the Number of the Bones of the Arms There are thirty and one Bones in each Arm that is to say the Omoplata or Shoulder-Blade the Humerus or Shoulder-Bone the two Bones of the Elbow call'd Vlna and Radius eight little Bones in the Carpus or Wrist five in the Metacarpium or Back of the Hand and fourteen in the Fingers three to every one except the Thumb which hath only two Can you give us a List of the Bones of the Leg in their Order There are thirty Bones in each Leg viz. the Femur or great Thigh-Bone the Knee-Pan or Whirl-Bone on the top of the Knee the Tibia greater Focile or Shin-Bone and the Perone or Fibula or lesser Focile which are the two associated Bones of the Leg seven little Bones in the Tarsus five in the Metatarsus and fourteen in the Toes that is to say three to every one except the great Toe which hath only two Thus the Number of Bones of the Humane Skeleton amounts to two hundred and Fifty without reckoning the Sesamoides the Indentings of the Skull and some others which are not always to be found CHAP. VI. Of Myology or the Anatomy of the Muscles of a Humane Body WHAT is a Muscle It is the principal Organ or Instrument of Motion or it is a Portion of Flesh wherein there are Veins Arteries Nerves and Fibres and which is cover'd with a Membrane How many parts are there in a Muscle Three viz. the Head the Belly and the Tail The Head is that part thro' which the Nerve enters the Belly is the Body or Middle of the Muscle and the Tail is the Extremity where all the Fibres of the Muscle are terminated to make the Tendon or String which is fasten'd to the Part whereto it gives Motion Have all the Muscles their Fibres streight from the Head to the Tail No some have them streight others transverse and others oblique or circular according to the several Motions to which they are appropriated How many sorts of Muscles are there with respect to their Action There are two different kinds viz. the Antagonists and the Congenerate the former are those that produce opposite Motions as a Flexor and an Extensor a Depressor and a Levator The Congenerate are those that contribute to one and the same Action as when there are two Flexors or two Extensors and then one supplies the defect of the other whereas when one of the Antagonist Muscles is cut the other becomes useless and void of Action How is the Action of a Musole perform'd It is done
lowermost and narrowest part the two Auricles 〈◊〉 small Ears being as it were little Cisterns 〈◊〉 Reservers that pour the Blood by degrees it to the Heart are situated on each side aboâ—â— the Ventricles The Ventricles which are likewise two in Number are certain Cavities 〈◊〉 its Right and Left Sides The large Vessels 〈◊〉 the Aorta or great Artery and the Vena Caâ—â—â— together with the Pulmonary Artery and Veâ—â—â— The Pericardium is a kind of Bag fill'd wiâ—â— Water wherein the Heart is kept which 〈◊〉 fasten'd to the Mediastinum by its Basis and to the large Vessels that enter and go out of its Ventricles What are the Terms appropriated to the continual beating of the Heart They are Diastole and Systole from whence proceed two several Motions the first whereof is that of Dilatation and the other of Contraction communicated to all the Arteries which have the same Pulse To what use serves the Water contain'd in the Pericardium It prevents the drying of the Heart by its perpetual Motion What are the Lungs They are an Organ serving for Respiration of a soft Substance and porous as a Spunge being all over beset with Arteries Veins Nerves and Lymphatick Vessels and perforated with small Cartilaginous Tubes that are imparted to it from the Wind-Pipe and are call'd Bronchia Their Natural Colour is a pale Red and marbl'd dark Brown and their whole Body is wrapt up in a fine smooth Membrane which they receive from the Pleuron They are suspended by the Wind-Pipe by their proper Artery and Vein and by the Ligatures that fasten them to the Sternum Mediastinum and frequently to the Pleuron it self They are also divided into the Right and Left Parts by the Mediastinum having four or five Lobes whereof those on the Left side cover the Heart Their continual Motion consists in Inspiration to take in the Air and Expiration to drive it out The Larynx makes the Entrance of the Wind-Pipe into the Lungs and the Pharynx that of the Oâ—sophagus or Gullet at the bottom of the Mouth to pass into the Stomach CHAP. XV. Of the Anatomy of the Head or upper Venter WHAT is the Head It is a bony Part that contains and encloseth the Brain within its Cavity What is most remarkable in the outward parts of the Head The Temporal Arteries the Crotaphitae of Temporal Muscles and the Sutures of the Skull Why are these things considerable The Temporal Arteries are of good Note because they are expos'd on the outside lying even with the Skin The Crotophite Muscles are so likewise in regard that they cannot be hurt without danger of Convulsions by reason of the Pericranium with which they are cover'd And the Sutures because the Meninges of the Brain proceed from thence to form the Pericranium What is the Pericranium It is a Membrane that lies under the thick hairy Skin of the Head and immediately covers the Skull What are the Meninges They are two Membranes that enclose the Substance or Marrow of the Brain What is a Suture It is a kind of thick Seam or Stitch that serves to unite the Bones of the Skull How many sorts of Sutures are there There are two sorts viz. the true and the false or Bastard What are the true Sutures They are three in number namely the Sagittal the Coronal and the Lambdoidal What is the disposition or situation of the true Sutures The Sagittal is streight beginning in the middle of the Fore-head and sometimes at the root of the Nose and being terminated behind at the joining of the two Branches of the Lambdoidal Suture The Coronal appears in form of a Crown passing to the middle of the Head and descending thro' the Temples to finish its Circumference in the Root of the Nose The Lambdoidal Suture is made like an open Pair of Compasses the Legs whereof are extended toward the Shoulders and the Button is in the top of the Head backward What are the Bastard Sutures They are those that are call'd Squamous or scaly What is the disposition or natural situation of these false Sutures They are plac'd at the two sides of the Head and make a Semi-Circle of the bigness of the Ears round the same Ears What difference is there between the true and spurious Sutures The true Sutures are made in form of the Teeth of a Saw which enter one into the other and the false or Bastard ones are those that resemble the Scales of Fishes which are join'd together by passing one over the other What is the Vse of the Sutures The Ancients were of Opinion that they were made to hinder the Fracture of one Skull-Bone from passing thro' the whole Head but there is more reason to believe that they have the three following Uses that is to say 1. To promote the transpiration of the Brain 2. To give Passage to the Vessels that go to the Diploe 3. To retain the Meninges and to support the Mass of the Brain which is cover'd by them What are the Names of the Bones that compose the Skull The Bone of the fore-part of the Head is call'd Sinciput or the Fore-head-Bone as also the Frontal or Coronal Bone The Bone of the hinder-part enclos'd within the Lambdoidal Suture is term'd the Occipital The two Bones that form the upper-part and are distinguish'd by the Sagittal Suture bear the Name of Parietals one being on the Right side and the other on the Left And those behind the Ears are call'd Temporal Squamosa or Petrosa These also are distinguish'd into the Right and Left Temporals and are join'd to the bottom of the Parâ—etal by a bastard squamous Suture What is most remarkable in the thickness of the Skull-Bones The Diploe which is nothing else but a Plexâ—â— or Contexture of small Vessels that nourish the Bones and in the middle of their thickness make the distinction of the first and second Tablature of the Bones whence it sometimes happens that an exfoliative Trepan or Semi-Trepan is sufficient when the first of these two Tables is only broken the other remaining entire Is the Brain which is preserv'd in the Skull all of one Piece or one equal Mass No it is distinguish'd by the means of the Meninges into the Brain it self and the Cerebellum or little Brain the Brain properly so called takes up almost the whole Cavity of the Skull and the Cerebellum is lodg'd altogether in the hinder-part where it constitutes only one entire Body whereas the former is divided into the Right and Left Parts by the Meninges which cut it even to the bottom whence these Foldings are call'd Falx i. e. a Scythe or Sickle What is chiefly remarkable in the Substance of the Brain The Ventricles or Cavities which are found therein together with the great Numbe of Veins Arteries Lymphatick Vessels and Nerves that carry Sense to all the Parts of the Body and Spirits for their Motion An exact Historical Account of all the Holes of the Skull and the Vessels that pass thro'
off whatsoever is corrupted scarifying the Ring on the inside to to make a good Cicatrice or Scar. The Dressing and Bandage The Dressing may be prepar'd with a Linnen-Tent soft and blunt of a sufficient thickness and length to hinder the Intestines from re-entring into the Rings by their Impulsion a Thread being ty'd thereto to draw it out as occasion serves Then Pledgets are to be put into the Wound after they have been dipt in a good Digestive such as Turpentine with the Yolk of an Egg applying at the same time a Plaister a Bolster of a Triangular Figure and the Bandage call'd Spica which is made much after the same manner as that which is us'd in the Fracture of the Clavicle Of the compleat Hernia or Rupture It happens when the Intestinal Parts fall into the Scrotum in Men or into the bottom of the Lips of the Matrix in Women To perform this Operation the Patient must be laid upon his Back as in the Bubonocele and the Incision carry'd on after the same manner which is to be made in the Scrotum tearing off the Membranes to the Intestine Then a Search will be requisite to observe whether any parts stick to the Testicle if the Caul doth so it must be taken off leaving a little Piece on the Testicle but if it be the Intestine so that those Parts cannot be separated without hurting one of 'em it is more expedient to impair the Testicle than the Intestine If the Caul be corrupted it must be cut to the sound Part and the Wound is to be dress'd with Pledgets Bolsters and the Bandage Spica as in the Bubonocele CHAP. XIV Of the Operation of Castration THE Mortification or the Sarcocele of the Testicles gives occasion to this Operation to perform which the Patient must be laid upon his Back with his Buttocks higher than his Head his Legs being kept open and the Skin of the Scrotum taken up one end of which is to be held by a Servant and the other by the Surgeon who having made a longitudinal Incision therein or from the top to the bottom slips off the Flesh of the Dartos which covers the Testicle binds up the Vessels that lie between the Rings and the Tumour and cuts 'em off a Fingers ' breadth beneath the Ligature But care must be taken to avoid tying the Spermatick Vessels too hard for fear of a Convulsion and to let one end of the Thread pass without the Wound If an Excrescence of Flesh stick to the Testicle and it be moveable or loose it is requisite to take it off nearly leaving a small Piece of it on the Testicle and if any considerable Vessels appear in the Tumour they must be bound before they are cut The Dressing and Bandage The Dressing is made with Pledgets and Bolsters laid upon the Scrotum and the proper Bandage is the Suspensor of the Scrotum which hath four Heads or Ends of which the upper serve as a Cincture or Girdle and the lower passing between the Thighs are fasten'd behind to the Cincture There is also another Bandage of the Scrotum having in like manner four Heads of which the upper constitute the Cincture but it is slit at the bottom and hath no Seams the lower Heads crossing one another to pass between the Thighs and to be join'd to the Cincture Both these sorts of Bandages have a Hole to give Passage to the Yard CHAP. XV. Of the Operation of the Stone in the Ureter IF the Stone be stopt at the Sphincter of the Bladder it ought to be thrust back with a Probe If it stick at the end of the Glans it may be press'd to let it out and if it cannot come forth a small Incision may be made in the opening of the Glans on its side But if the Stone be remote from the Glans it is requisite to make an Incision in the Vreter to which purpose the Surgeon having caus'd the Skin to be drawn upward holds the Yard between two Fingers making a Longitudinal Incision on its side upon the Stone which must be prest between the Fingers to cause it to fly out or else it may be taken out with an Extractor Then if the Incision were very small the Skin needs only to be let go and it will heal of it self but if it were large a small Leaden Pipe is to be put into the Vreter lest it shou'd be altogether clos'd up by the Scar It is also expedient to anoint the Pipe with some Desiccative Medicine and to dress the Wound with Balsam Afterward a little Linnen-Bag or Case is to be made in which the Yard is to be put to keep on the Dressing but it must be pierc'd at the end for the convenience of making Water having two Bands at the other end which are ty'd round about the Waste CHAP. XVI Of the Operation of Lithotomy THIS Operation is undertaken when it is certainly known that there is a Stone in the Bladder to be assur'd of which it may not be improper to introduce a Finger into the Anus near the Os Pubis by which means the Stone is sometimes felt if there be any The Finger is likewise usually put into the Anus of young Virgins and into the Vagina Vteri of Women for the same purpose But it is more expedient to make use of the Probe anointed with Grease after this manner The Patient being laid on his Back the Operator holds the Yard streight upward the Glans lying open between his Thumb and Fore-finger then holding the Probe with his Right-hand on the side of the Rings he guides it into the Yard and when it is enter'd turns the Handle toward the Pubes drawing out the Yard a little to the end that the Canal of the Vreter may lie streight If it be perceiv'd that the Probe hath not as yet pass'd into the Bladder a Finger is to be put into the Anus to conduct it thither Afterward in order to know whether a Stone be lodg'd in the Bladder the Probe ought to be staken a little therein first on the Right-side and then on the Left and if a small Noise be heard it may be concluded for certain that there is a Stone But if it be judg'd that the Stone swims in the Bladder so that it cannot be felt the Patient must be oblig'd to make Water with a hollow Probe Another manner of searching may be practis'd thus Let the Yard be rais'd upward inclining a little to the side of the Belly let the Rings of the Probe be turn'd upon the Belly and the end on the side of the Anus and then let this Instrument be introduc'd shaking it a little on both sides to discover the Stone In order to perform the Operation of Lithotomy the Patient must be laid along upon a Table of a convenient height so as that the Surgeon may go about his Work standing the Patient's Back must also lean upon the Back of a Chair laid down
Knot at the end of the Thread to be stopt upon the Bolster Afterward he pierceth the Tendon from the outside to the inside at a good distance lest the Thread shou'd tear it and proceeds to pass the Needle in like manner under the other end of the Tendon upon which is laid a small Bolster for the Thread to be ty'd in a Knot over it Then he causeth the Extremities of the Tendons to lie a little one upon another by bending the Part and dresseth the Wound with some Balsam It may not be improper here to observe that Ointments are never to be apply'd to the Tendons which wou'd cause 'em to putrisie but altogether Spirituous Medicaments and that the Part must be bound up lest the Extension of it shou'd separate the Tendons CHAP. XX. Of the Caesarian Operation WHEN a Woman cannot be deliver'd by the ordinary means this bold and dangerous Operation hath been sometimes perform'd with good Success The Woman boing laid upon her Back the Surgeon makes a Longitudinal Incision beneath the Navel on the side of the White-Line till the Matrix appears which he openeth taking great care to avoid wounding the Child Then he divides the Membranes with which it is wrapt up separates the After-Burden from the Matrix and takes out the Child Lastly he washeth the Wound with warm Wine and dispatcheth the Gastroraphy or Stitching up of the Belly without sowing the Matrix After the Operation Injections are to be made into the Matrix to cause a Flux of Blood and a pierc'd Pessary must be introduc'd into its Neck CHAP. XXI Of the Operation of Amputation with its proper Dressings and Bandages THE Leg is usually cut off at the Ham the Thigh as near as can be to the Knee and the Arm as near as is possible to the Wrist But an Amputation is never made in a Joynt except in the Fingers and Toes In order to cut off a Leg the Patient is to be set on the side of his Bed or in a Chair and supported by divers Assistants one of 'em being employ'd to hold the Jâ—eg 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 â—o 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 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 Hôtel-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 Princers that are clos'd with a small 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 Milta 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 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 cover'd 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
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 Hâ—el it may be par'd with a Razor and if the Matter be lodg'd under the Nails it wou'd be requisite to scrape 'em with Glass before they are pierc'd 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 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 fides 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 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 found 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 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 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 Capeâ—ine or Head-Bandage provided the Fracture â—e in the middle of the Clavicle A Band being taken about six Ells long and four Finâ—ers thick roll'd with two Balls it is apply'd is 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-â—ole and above the Breast to be carry'd oâ—erthe 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 â—â—nd about the Body are continu'd as also these Rollers upon the Clavicle till it be enâ—irely cover'd Some Circumvolutions are also â—â—de upon the upper part of the Arm near is Head The Space that lies between the Rolâ—â—s and the Circumvolutions of the Arm and â—hich bears the Name of
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 be 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 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 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 â—over Afterward four Longitudinal Bolsters must be laid upon the Fracture round about â—he Arm which are to be kept close with a â—hird 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 â—ay be stay'd round the Body or else beneath â—â—e 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 â—â—e Arm but they must not cross one another These Paste-boards are to be fasten'd with â—â—ee Ribbands and the Arm is to be put inâ—â— a Scarf made with a large Napkin which 〈◊〉 to be first apply'd in the middle under â—e Arm-pit the Arm resting upon it so that 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 CHAP. XII Of the Fracture of the Carpus or Wrist-Bone â—F the Bones of the Carpus or those of the Metacarpium be fractur'd a Servant must old the Arm above the Wrist and anoâ—her the Fingers whilst the Operator sets the â—â—ones in their place so as no unevenness may â—â—pear in the Part. The Dressing and Bandage Of the Fracture of the Wrist are to be preâ—â—â—'d with a Band roll'd with one Head beâ—â—g six Ells long and two Fingers broad so â—â—at three Circumvolutions are to be made upâ—â— the Wrist the Band is to be pass'd over â—â—e Hand between the Thumb and the Fore-finâ—er making the Figure of KY upon the â—humb Then after having made divers Rolâ—â—s upon the Carpus a Bolster is to be apâ—â—'d with a little Piece of Paste-board of the â—ne Shape with the Wrist several Rollers 〈◊〉 to be form'd on the top of the Elbow 〈◊〉 stay the Band above it and the Arm is to 〈◊〉 put into a Scarf 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 Skape 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 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 day'd with a Band and the Arm to be put â—â—â—o 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 Bones pass one over another it may be soon known because the hurt â—eg 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 â—ay his Thumbs upon the fractur'd Bone to thrust
it back into its place and afterward to apply 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 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 one 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 to 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 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 oâ— else they pass one upon another and in thiâ— 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 aâ— Extension is not requisite as when they arâ— both shatter'd and it is to be drawn only oâ— one side whereas the drawing ought to be equaâ— on both sides when both Bones are concern'd 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 â—lls long the second three and the third three and an half Three very streight Circumvolutions are to be made upon the Fracture the Band is also to be carry'd up with Rollers and â—tay'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 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 sixt 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 beloâ—â— 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 be taken of the length of the Part and broad â—nough 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 â—â—e form'd every one of which will be four fingers broad the upper Heads being a little â—orter than the lower This Band of eighteen Heads is to be laid upon the Scarves and a Boller is to be apply'd to it four Fingers broad â—s long as the Scarves The Leg is laid upon â—his Bolster and it hinders the corrupt Matter â—â—om falling on the Bandage When the Wound hath been dress'd the fracture is to be incontinently surrounded with â—ee of the Heads which ought to cross one aâ—other Then after the Leg hath been bound with the first Heads two Longitudinal Bollers 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 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 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 â—â—â—s his Thumb upon the Root of the Noâ—â—â—â—â—en he introduceth a little Stick trimm'd 〈◊〉 â—otton into the Nostrils and by the 〈…〉 â—hereof thrusts back the Bones in 〈…〉 â—lace 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 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 reremains 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 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 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 â—ear 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 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 lo 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 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 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 Bart 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 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 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 â—he Hand toward the Shoulder or else a Tenâ—is-Ball may be laid in the Fold of the Elbow â—â—ed the Arm drawn toward the Shoulder For the External Luxation the Extension is 〈◊〉 be made whilst the Surgeon thrusts back â—â—e Elbow into its place Or else a round Stick â—ay be taken and trimm'd with Linnen-Cloth â—ith which the Bone is to be push'd back into 〈◊〉 place during the Extension This Stick may â—e also us'd in the reducing of the Internal Luxaâ—ion For the Lateral Luxations the Extension may be made in like manner the Surgeon at the â—â—me 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 Roliers 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
Geranium or Stork's-Bill is likewise cover'd with some Circumvoâ—â—tions and the Band is stay'd by making Cirâ—mvolutions quite round about the Body If the Fracture were near the Head of the â—â—merus or Arm-Bone a sort of Bandage might be prepar'd which is call'd Spica with a Band â—â—ll'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 â—â—e behind the Back The other end is conâ—ey'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 â—â—her Shoulder behind it is brought back again before to form a second KY upon the 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 â—houlder and afterward above it to make a KY in the middle of the Back then passing â—â—der the other Arm-hole it is brought up to 〈◊〉 Shoulder to be let down and to form a â—â—ond KY upon the middle of the Back These Turns are continu'd in making Rollers â—â—ll the Omoplatae are all cover'd Circumvolutions are also made round the upper part of â—e Humerus as in the Spica and the Baâ—â—â—ge is finish'd by Circumvolutions round about â—e 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 adâ—anc'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 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 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 theâ— 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 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 one 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 Band 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 〈◊〉 Circumvolution 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 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 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 〈◊〉 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