The Compleat Surgeon Part 26

If the Bone be put out of its place by a coagulated sort of Matter like Mortar or Plaister, Resolutives and Attenuants are to be us'd, such as the volatile Spirit of Tartar prepar'd with the Lees of Wine, volatile Spirit of Tartar destill'd with Nitre in a Retort with a long Neck, or Spirit of Tartar prepar'd by Fermentation with Tartar, and its proper _Alkali_: This last is the best of all, and the use thereof ought to be continu'd. The volatile Salt of Human Bones is also very efficacious; but it is necessary to begin first with the taking of Laxative and Sudorifick Medicines, appropriated according to the respective Circ.u.mstances. The Spirit of Earth-Worms may be also apply'd outwardly, which is made by Fermentation, and may be often laid on the Part either alone, or with the Spirit of _Sal Ammoniack_.

If a dislocated Bone be not set in good time, a _Coagulum_ or kind of curdled Substance is form'd in the Cavity, which hinders the reducing of it to its place; but this _Coagulum_ may be dissolv'd with the following Medicament, before you attempt to set the Bone. Take one {187} part of the destill'd Oil of Human Bones, two parts of foetid Oil of Tartar; mingle the whole, and add quick Lime to be destill'd in a Retort: Let the Parts be fomented with this Oil.

If the Dislocation happen'd by the Relaxation of the Ligaments, recourse may be had to universal Sudorificks taken inwardly; as also to such Medicines as are full of an unctuous and volatile Salt, particularly Aromatick Oils, and Spirit of _Sal Ammoniack_. In the mean while Aromaticks, Resolutives, and moderate Astringents may be apply'd outwardly.

CHAP. II.

_Of the Fractures of Bones._

_What is the Fracture of a Bone?_

It is the Division of the Continuity of its Parts.

_After how many different manners may a Bone be broken?_

Three several ways, _viz._ cross-wise, side-wise, in its length, and perhaps in Shatters or Splinters.

_By what means may a Bone be fractured?_

It may happen to be done by three sorts of Instruments, _viz._ such as are fit for bruising, cutting, or wresting; that is to say, a Bone may be divided in the Continuity of its proper Parts, by Contusion, Incision, or Contorsion.

_How is the Fracture of a Bone discover'd?_ {188}

Divers ways, _viz._ by the ill Disposition of the Part, which becomes shorter; by its want of Motion; by its flexibility or pliantness elsewhere than in its Articulations; by the unevenness that may be perceiv'd in its Continuity; by the cracking which is heard; sometimes also by the shooting forth of one of its ends thro' the Flesh which it hath open'd; and lastly by a Comparison made thereof with the sound Part on the other side, as that of the Right Arm with the Left.

_What kind of Fracture is most difficult to be discern'd?_

It is that which happens in the length of the Bone, commonly call'd a Cleft or Fissure, which gives occasion to very great Symptoms when it is unknown: But it may be found out by the Pain and Swelling felt at the bottom of the Cleft in touching it; besides the Conjectures which may be made from the Relation of the Person who hath had a Fall, and might have heard the cracking of the Bone.

_What sort of Fracture is most difficult to be cur'd?_

The shattering or splitting of a Bone in Pieces, by reason of the great Number of Splints which daily cause new Pains and Suppurations.

_What is a simple and what is a complicated Fracture?_

The simple Fracture is that whereby the Bone is broken, without any other Accident; and the complicated Fracture is that which is follow'd by some Accident; as that in which there is a splitting of the Bone in pieces, or {189} where the Bone is broken in two several places, or else when the Fracture is accompany'd with a Luxation, a Wound, an Inflammation, or other Circ.u.mstances of the like Nature.

_Are old Men or Children most subject to these Fractures of the Bones?_

Old Men, because their Bones are drier; whereas those of Infants are almost Cartilaginous, and yield or give way to the violence offer'd to 'em; from whence proceed the sinkings and hollowness that happen in their Skulls, especially in the Mould of their Heads, or elsewhere; for which a Remedy is found out by the means of Plaisters, Splints, and Bandages, fitted to the shape of the Parts. It is also on the same Account that Bones are more easily broken in the Winter than in the Summer.

_In what Parts are the Fractures of Bones most dangerous?_

They are those that happen in the Skull and Joints; in the former by reason of the Brain; and in the latter in regard of the Nervous Parts.

_What Course is to be taken by a Surgeon who is sent for to cure a Fracture?_

He ought to do three things, that is to say, at first he must incessantly endeavour to reduce it, to the end that Nature may re-unite the Parts with greater Facility, and that its Extremities may be brought together again with less trouble, before a Swelling, Inflammation, or Gangrene happen in the Part. Afterward he is to use means to retain the Parts in their proper Figure, and {190} natural Situation, and to prevent all sorts of Accidents.

_How is the setting of a broken Bone to be perform'd?_

When the Fracture is Cross-wise, it must be reduc'd by Extension and contra-Extension; and when it is in length, the Coaptation or bringing together again of the Sides, is only necessary.

_What is to be done in a Fracture complicated with a Wound?_

The Operator must first reduce it, and then administer the other Helps, as in a simple Fracture.

_How may it be known that the reducing of the Fracture is well perform'd?_

When the Pain ceaseth; when the Part hath resum'd its natural Shape; when no Unevenness is any longer perceiv'd therein; and when it is conformable to the sound Part on the other side.

_What are the Signs which shew that the Splints remain in the Fracture after it hath been reduc'd?_

They are the secret and continual Workings of the Fibres, or twitchings, that are felt by Intervals in the Part, with great Pains, which are the Indications of an Abcess arising therein; and when a Wound is join'd to the Fracture, the Lips of it are puff'd up, and become more soft and pale, the purulent Matter abounding also more than ordinary.

_When the Splints appear, must they be drawn out by force?_ {191}

By no means; for great care ought to be taken to avoid all manner of violent Operations; it being requisite to wait for their going out with the purulent Matter; or at most to facilitate their Pa.s.sage by the use of Injections of the Tincture of Myrrh and Aloes; by the application of _Emplastrum Andreae Crucii_, and by the help of the _Forceps_.

_How is a simple Fracture to be dress'd, after it hath been reduc'd?_

The Parts are to be strengthen'd and consolidated with Liniments of _Oleum Lumbricorum_, or of Oil of St. _John_'s-Wort mingled with Wine, Brandy, or _Aqua-Vitae;_ with Fomentations of Red Roses, Rosemary, and St.

_John_'s-Wort boil'd in Wine; and with _Emplastrum contra Rupturam_, or _de Betonica_, carefully wrapping up the broken Member, but after such a manner that the two Extremities may not cross one another; and that a small s.p.a.ce may remain open between both. Afterward the Splints and Bands are to be apply'd, taking care to avoid binding 'em too hard, and to take 'em off every three Days, in order to refit 'em, to abate troublesome Itchings, and to give Air to the Part; by these means preventing the Gangrene, which might happen by the Suffocation of the natural Heat. If the Thighs or Legs are broken, Scarves are to be us'd to support and stay 'em in the Bed.

_What s.p.a.ce of time may there be allow'd for curing the Fracture of a Bone?_

The Cure will take up more or less time, according to the variety of the Parts, or the different thickness of the Bones: Thus to form {192} the _Callus_ of the broken Jaw-Bone, twenty Days may well be allotted; for that of the Clavicle, or that of the Shoulder-Bone, twenty four; for that of the Bones of the Elbow, thirty; for that of the Arm-Bone, forty; for that of the Wrist-Bone, and those of the Fingers, twenty; for that of the Ribs, twenty; for that of the Thigh-Bone, fifty; for that of the Leg-Bone, forty; for that of the Bones of the _Tarsus_ and Toes, twenty.

_What ought to be done in particular to promote the formation of the _Callus_?_

The fractur'd Part must be rubb'd with _Oleum Lumbricorum_ and Spirit of Wine heated and mingled together: The Decoctions of Agrimony, Sayine, and Saxifrage are also to be us'd, and the _Lapis Osteocolla_ is a Specifick: It is usually given in great Comphrey-Water, or in a Decoction of Perewinkle made with Wine, and is often re-iterated.

CHAP. III.

_Of the particular Fractures of the Skull._

_What is a Fracture of the_ Cranium _or Skull?_

It is a Wound of the Head complicated with a Fracture of the Skull-Bone.

_After how many manners may the Skull be fractur'd?_ {193}