Compleat Surgeon/Fractures

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 sides of the Nose; and they are to be anointed with Oil of Turpentine mixt with Spirit of Wine: These Pipes are also to have little Handles, with which they may be fasten'd to the Cap. If there be no Wound in the Nose, there will be no need of a Bandage; but if the Fracture be accompany'd with a Wound, after having apply'd the proper Medicines, it wou'd be requisite to lay upon each side of the Nose a Triangular Bolster, cover'd with a little piece of Paste-board of the same Figure. This small Dressing is to be supported with a kind of Sling that hath four Heads; being a piece of Linnen-Cloath, two Fingers broad, and half an Ell long; it is slit at both ends, and all along, only leaving in the middle a Plain of three Fingers, that is to say, a part which is not cut. The Plain of this Sling is to be laid upon the Fracture, causing the upper Heads to pass behind the Nape of the Neck, which are to be brought back again forward; the lower Heads are likewise to be carry'd behind, crossing above the upper, and afterward to be return'd forward. If the Bones of the Nose be not timely reduc'd, a great Deformity soon happens therein, and a Stink caus'd by the Excrescences and Polypus's.

Of the Fracture of the lower Jaw.
The Operator at first puts his Fingers into the Patient's Mouth, to press the Prominences of the Bones; and afterward doth the same thing on the outside. If the Bones pass one over another, a small Extension is to be made. If the Teeth be forc'd out of their Place, they are to be reduc'd, and fasten'd to the sound Teeth with a wax'd Thread.

The Dressing and Bandage.
If the Fracture be only on one side, a Bolster sow'd to a piece of Paste-board is to be laid upon the flat side of the Jaw, both being of the Figure and Size of the Jaw it self. The Bandage of this Fracture is call'd Chevestre, i.e. a Cord or Bridle, by the French Surgeons, and is made by taking a Band roll'd with one Head or End, three Ells long, and two Fingers broad; the Application of it is begun with making a Circumvolution round about the Head in passing over the Fore-head; then the Band is let down under the Chin, and carry'd up again upon the Cheek, near the lesser Corner of the Eye in passing over the Fracture; afterward it is rais'd up to the Head, and brought down again under the Chin, 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.

Of the Fracture of the Clavicle.
The Patient is to be set in a Chair, and his Arm is to be drawn backward, whilst an Assistant thrusts his Shoulder forward: In the mean time the Operator sets the Bones again in their place, by thrusting the Protuberances, and drawing out the sunk Bone.

Or else a Tennis-Ball may be taken, and put under the Patient's Arm-Pit, whose Elbow is then to be press'd against his Ribs, whilst the Surgeon reduceth the Fracture.

Otherwise, the Patient may be laid upon his Back, putting a Convex Body under both his Shoulders, as a Bowl, or large wooden Porrenger; and then the Shoulders may be prest, to raise up the two ends of the Bones, which the Surgeon must take care to reduce,

The Dressing and Bandage.
The Cavities which are above and below the Clavicle, are to be fill'd with Bolsters trimm'd with Paste-boards; another is to be also laid upon the Bone, which is almost of the same Figure with the Clavicle, and a large Bolster, to cover the three others: This Dressing is to be secur'd with the Bandage call'd the Capeline or Head-Bandage, provided the Fracture be in the middle of the Clavicle. A Band being taken about six Ells long, and four fingers thick, roll'd with two Balls; it is apply'd in the middle to the Fracture; one of its Heads or Ends is let down upon the Breast, whilst the other is pass'd behind the Back, below the Arm-hole, opposite to the indispos'd Arm-hole and above the Breast, to be carry'd over the other end of the Band, which is rais'd up, to make a Roller or Bolster upon the Fracture: The other end is pass'd under the indispos'd Arm-pit, and upon the Band that made the Roller, which is elevated by making a third Roller upon the Clavicle: These Circumvolutions around about the Body are continu'd, as also these Rollers upon the Clavicle, till it be entirely cover'd. Some Circumvolutions are also made upon the upper part of the Arm, near its Head: The Space that lies between the Rollers and the Circumvolutions of the Arm, and which bears the Name of Geranium or Stork's-Bill, is likewise cover'd with some Circumvolutions, and the Band is stay'd by making Circumvolutions quite round about the Body.

If the Fracture were near the Head of the Humerus or Arm-Bone, a sort of Bandage might be prepar'd, which is call'd Spica, with a Band roll'd with one Ball five Ells long, and four fingers broad; one end of this Band is pass'd under the Arm-pit opposite to the indispos'd one behind the Back: The other end is convey'd under the indispos'd Arm-pit; the Figure of the Letters KY or X is made on the Shoulder; the Band is return'd below the other Shoulder behind; it is brought back again before, to form a second KY upon the 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.

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 Shoulder, and afterward above it, to make a KY in the middle of the Back; then passing under the other Arm-hole, it is brought up to the Shoulder, to be let down, and to form a second KY upon the middle of the Back: These Turns are continu'd in making Rollers, till the Omoplatæ are all cover'd: Circumvolutions are also made round the upper part of the Humerus, as in the Spica; and the Bandage is finish'd by Circumvolutions round about the Breast.

Of the Fracture of the Ribs.
When a Rib is broken, one of the ends pusheth into the Breast, sometimes on the outside; and sometimes the Ends lie against each other. In order to reduce it, the Patient being laid upon the sound Rib, a Plaister of Mastick is apply'd to the Fracture; and it is drawn out violently; so that sometimes this Attraction brings back the Bone, which is advanc'd into the Breast; but the surest way is to make an Incision therein, to raise it up with the Finger.

If the Rib appear without, the Patient is to be set in a a Chair, and oblig'd to bend his Body on the side opposite to the Fracture, holding his Breath, with which he must puff strongly, without letting it forth, in order to dilate the Breast, whilst the Surgeon thrusts the Rib into its place.

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.

Of the Fracture of the Sternum or Breast-Bone.
To reduce this Fracture, the Patient is to be laid upon his Back, with a Convex Body underneath; both his Shoulders are to be press'd with some weight, to push 'em backward, and to raise up the Sternum, which is sunk down; or else an Incision may be made upon the Bone, to discover it; and then a Vectis is to be apply'd thereto very gently, in order to heave it up into its place.

The Dressing and Bandage.
A Bolster and Paste-board are to be laid upon the Sternum, almost of the same Figure with the Part; and the Bandage is to be prepar'd with a Napkin supported with a Scapulary. Or else the Bandage call'd Quadriga may be made with a Band roll'd with two Heads, five Ells long, and four Fingers broad: The Application of this Band is begun under the Arm-pit; the Figure of KY is form'd under the Shoulder; the Band is carry'd downward with the two Balls, once before, and the other behind; it is pass'd under the other Arm-hole; the Heads are cross'd upon the Shoulder, and it is brought down backward and forward, forming a KY before and behind. Afterward the Bank is roll'd about the Breast in making Rollers or Bolsters; these Rollers are continu'd till the Band be terminated; and it is stay'd by a Cirumvolution round the Breast.

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 Spinosæ 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.

Of the Fracture of the Os Sacrum.
It is reduc'd as the other Vertebra's; but its Dressing and Bandage are made with the T perforated at the Anus, or else with the H or double T. It is made with a Band two Fingers broad, and long enough to encompass the Body above the Hips; so that to the middle of this Band is fasten'd another Band of the same breadth, and of a sufficient length to pass over the Dressing of the Os Sacrum, as also between the Thighs, to be join'd in the fore-part to the first Cincture. The double T is made by fastening two Bands at a Finger's breadth distance one from another, to the Band which ought to be roll'd about the Body; and this sort of Bandage is to be supported with a Scapulary.

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.

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 cover. Afterward our Longitudinal Bolsters must be laid upon the Fracture round about the Arm, which are to be kept close with a third Band; it being of no great Importance whether the Application of this third Band be begun at the Top or at the Bottom; but it may be stay'd round the Body, or else beneath the Elbow. The Arm ought also to be encompass'd with two thick pieces of Paste-board made round at the ends, and of the length of the Arm; but they must not cross one another. These Paste-boards are to be fasten'd with three Ribbands, and the Arm is to be put into a Scarf made with a large Napkin, which is to be first apply'd in the middle under the Arm-pit, the Arm resting upon it, so that the four ends may be rais'd up, and fasten'd to the opposite Shoulder; but the Hand must lie higher than the Elbow.

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.

Of the Fracture of the Carpus or Wrist-Bone.
If the Bones of the Carpus, or those of the Metacarpium be fractur'd, a Servant must hold the Arm above the Wrist, and another the Fingers; whilst the Operator sets the Bones in their place, so as no unevenness may appear in the Part.

The Dressing and Bandage.
Of the Fracture of the Wrist are to be prepar'd with a Band roll'd with one Head, being six Ells Long, and two Fingers broad; so that three Circumvolutions are to be made upon the Wrist; the Band is to be pass'd over the Hand, between the Thumb and the Fore-finger, making the Figure of KY upon the Thumb. Then after having made divers Rollers upon the Carpus, a Bolster is to be apply'd, with a little Piece of Paste-board of the same Shape with the Wrist; several Rollers are to be form'd on the top of the Elbow, to stay the Band above it; and the Arm is to be put into a Scarf.

Of the Fracture of the Bone of the Metacarpium.
Two Servants are to hold the Hand, after the same manner as in the setting of the Carpus or Wrist-Bone, whilst the Surgeon reduceth the broken Bone by fixing it in its Natural Situation.

The Dressing and Bandage
Are made with a Band roll'd up with one Head, five Ells long, and two Fingers broad: This Band being fasten'd to the Wrist, with a Circumvolution, is to be laid on the Metacarpium, between the Thumb and the Fore-finger, and the Figure of KY is to be made upon the Hand: Then the forming of Rollers and KY's is to be continu'd till the Metacarpium be cover'd; a Bolster and Paste-board are to be laid upon the same Metacarpium; as also one in the Hand, of the Shape of the Part: The inside of the Hand is to be trimm'd; and the whole Contexture is to be cover'd as before, with Rollers; which are continu'd till above the Elbow, where the Band is stay'd.

Of the Fracture of the Fingers.
A Light Extension is to be made in the Fingers to reduce 'em, and a small Dressing is to be prepar'd for every Finger, almost like that of the Arm. The Fingers are to be somewhat bent, and the inside of the Hand is to be trimm'd with a Bolster, to retain 'em in this Situation. The Bolster is also to be stay'd with a Band, and the Arm to be put into a Scarf.

Of the Fracture of the Thigh.
If the Thigh-Bone be broken near its Head, the Fracture is very difficult to be discover'd; but if the Bone pass one over another, it may be soon known, because the hurt leg will be shorter than the other. Therefore a very great Extension is to be made; and if the Hands are not sufficient for that purpose, recourse may be had to Straps and Engines. In the mean time the Operator is to lay his Thumbs upon the fractur'd Bone, to thrust it back into its place, and afterward to apply

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 on upon the Thigh. The Scarves are to be bound with three Ribbands for the Legs, and as many for the Thighs; the Knots being ty'd without, and on the side.

Of the Fracture of the Knee-Pan.
The Knee-Pan is cleft or broken in divers pieces in its length, and cross-wise: If it be broken cross-wise or obliquely, the two Pieces fly out one from another; and on this occasion a strong Extension is to be made; whilst the Surgeon at the same time thrusts back again the upper-part of the Knee-Pan into its place.

If the Knee-Pan be fractur'd in its length, no Extension can be made, because the pieces of the Bones remain in their place.

The Dressing and Bandage.
If the Knee-Pan be broken cross-wise, a Band is to be provided three Ells long, and two Fingers Broad, which may be roll'd with 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.

Of the Fracture of the Leg.
If the Tibia be only broken, it pushes into the Inside; but if both Bones be fractur'd they are sometimes separated on both sides, or else they pass one upon another; and in this case the Leg is shorter than it ought to be. If the Perone be broken, it pushes to the outside.

If one Bone be only fractur'd, so strong an Extension is not requisite as when they are both shatter'd, and it is to be drawn only on one side; whereas the drawing ought to be equal on both sides when both Bones are concern'd. 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 Ells long, the second three, and the third three and a half. Three very streight Circumvolutions are to be made upon the Fracture; the Band is also to be carry'd up with Rollers, and stay'd above the Knee. The Application of the second Band is to be begun upon the Fracture with two Circumvolutions; it is to be brought down with Rollers, to pass under the Foot, afterward carry'd up again, and stay'd where it is terminated. The Leg is to be fill'd with a Bolster thicker at the bottom than at the top; and then are to be laid on the four longitudinal Bolsters, two Fingers broad, and as long as the Leg; to which are to be apply'd the Splints of a plyable and thin Wood: These are wrapt up with a simple Bolster, and strengthen'd with the third Band, which is apply'd indifferently either at the top or bottom, opposite to the former; so that it is carry'd up or else down in making Rollers, and stay'd at its end. The whole Contexture is to be encompass'd with large Paste-boards made round at the Ends, which are not to cross one another, but must be streighter at the bottom than at the top, and are to be ty'd with three Ribbands or pieces of Tape, beginning at the middle; so that the Knots be ty'd on the outside. Afterward the Leg is to be put into the Scarves, and the Heel is to be supported with a Linnen-Roll, to which are fasten'd two Ribbands that are ty'd upon the Scarves: These Rolls are made with a small piece of Cloth, which is doubl'd, and roll'd up with the ends, in which is contain'd some Straw, and a little Stick in the middle, to consolidate 'em. The Foot is supported with a Paste-board or Wooden Sole, trimm'd with a Bolster, or small Quilt sow'd over it. Divers Strings are also fasten'd to the middle of the sides of the Sole or Pump, which are cross'd to be joyn'd to the Scarves; and another is fixt at the end of the Sole, which is ty'd to a Ribband that binds the middle of the Scarf. These Scarves are likewise fasten'd with three Ribbands, beginning with that in the middle, the Knots being without, and trimm'd with four Bolsters, that is to say, two on each side, to fill up the Cavities that are below the Knee, and above the Ankle. Lastly, the Leg is to be plac'd somewhat high, and a Cradle to be laid upon it, to keep off the Bed-Cloaths, the Scarves passing over the Knee and Foot.

The Dressing of Complicated Fractures
Of the Arms, Legs, and Thighs is prepar'd with a Bandage having Eighteen Heads or Ends, in order to make which, a Linnen-Cloth is to be taken of the length of the Part, and broad enough to cause it to be cross'd thereby: It is to be folded into three doubles, and cut in three places on each side, leaving the middle plain; so that eighteen Heads or small Bands are form'd, every one of which will be four fingers broad, the upper Heads being a little shorter than the lower. This Band of eighteen Heads is to be laid upon the Scarves, and a Bolster is to be apply'd to it four Fingers broad, as long as the Scarves. The Leg is laid upon this Bolster, and it hinders the corrupt Matter from falling on the Bandage.

When the Wound hath been dress'd, the fracture is to be incontinently surrounded with one of the Heads, which ought to cross one another: Then after the Leg hath been bound with the first Heads, two Longitudinal Bolsters are to be apply'd to the side of it; and the other Heads are to be rais'd up, with all the rest of the Dressing, which hath been describ'd in the simple Fracture.

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.