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 being laid upon her Back, the Surgeon makes a Longitudinal Incision beneath the Navel, on the side of the White-Line, till theMatrixappears, 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 theMatrix, and takes out the Child. Lastly he washeth the Wound with warm Wine, and dispatcheth theGastroraphyor Stitching up of the Belly, without sowing theMatrix. After the Operation, Injections are to be made into theMatrix, to cause a Flux of Blood; and a pierc'd Pessary must be introduc'd into its Neck.
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 Leg 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 theTourniquetorGripe-Stick; and the second below the Knee, to render the Flesh firm for the Knife. Before the Ligature is drawn close with theGripe-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 thePeriosteumis tobescrap'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 thePeroneorFibula, and ending with theTibia. 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 theGripe-Stick, to let the Blood run a little, and to discern the Vessels with greater facility; and then theGripe-Stickmay 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 ofHôtel-DieuatParis.
Others make a Ligature of the Vessels, taking up the ends of 'em with a pair ofForceps, having a Spring; or with theValet a Patin, which is a sort of Pincers that are clos'd with a smallRing 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 theGripe-Stickand the Band, the Stump is to be somewhat bended, and the Flesh let down to cover the Bones.
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 aMaltaCross; so that there are three or four Longitudinal Bolsters, and one Circular.
The Surgeon usually begins to apply theMaltaCross 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,
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 covered, and the whole Bandage wrapt up with Rollers or Bolsters.
TheCapelineor 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 Heads are carry'd up above the Knee; and one of the Ends are turn'd backward, to bring it down, and to pass it over the end of the Stump. At every back-fold which is form'd above and below the Knee, a Circumvolution is to be made with the other end of the Band, to strengthen the back-folds, continuing to bring the Band downward and upward, till the whole Stump be cover'd: Then Rollers are made roundabout theStump, and the Band is stay'd above the Knee. Afterward the Part may be brought to Suppuration, cleans'd and cicatriz'd.
This Operation is perform'd when the Surgeon hath prickt an Artery, or when a Tumour ariseth in an Artery.
To this purpose the Patient is set in a Chair, and a Servant employ'd in holding his Arm in a Posture proper for the Operation; then a Bolster is to be laid four double, following the Progress of the Artery, to the end that the Ligature may better press the Vessel; and the Arm may be also surrounded with another single Bolster, on which is made a Ligature screw'd up with aGripe-Stick, provided the Arm be not too much swell'd; for in this Case it wou'd be more expedient to deferr the Operation for fear of a Gangrene. The Artery being thus well stopt, the Surgeon lays hold on the Arm with one Hand, below the Tumour, and with the other makes an Incision with his Lancet, beginning at the bottom of the Tumour, and ending on the top along the Progress of the Artery. When the Tumour is open'd, the coagulated Blood may be discharg'd with a Finger; and if there are any Strings at the bottom, they may be cut with a crooked Pair of Sizzers, to the end that all the Clods of Blood, and other extraneous Bodies which are sometimes form'd inAneurismswhen they are very inveterate may be moreeasily remov'd. But theGripe-Stickmust be loosen'd, to discover the Opening of the Artery with greater facility, and the Artery separated from the Membranes with a Fleam; for it wou'd be dangerous to cut it with a streight Incision-Knife: The Artery must also be supported with a convenient Instrument to divide it from the Nerve and Membranes; and to be assur'd of the Place of its Opening, theGripe-Stickmay be somewhat loosen'd, and afterward screw'd up again. In the mean time the Surgeon gives the Instrument to a Servant to hold, whilst he passeth under the Artery a crooked Needle with a wax'd String, cuts the Thread, and takes away the Needle: Then he begins to make the Ligature beneath the Opening of the Artery, tying at first a single Knot, on which may be put (if you please) a small Bolster, that may be kept steady with two other Knots: It is also necessary that another Ligature be made in the lower part of the Artery, by reason that the little lateral Arteries might otherwise let out Blood.
The Artery ought not to be cut between the two Ligatures, lest the first Ligature shou'd be forc'd by the Impulsion of the Blood; but the Thread must be let fall, that it may rot with the Suppuration. Then the Wound may be dress'd with Pledgets, Bolsters strew'd with Astringent Powders and a Plaister; a Bolster being also laid in the Fold of the Elbow.
Is made with a Band six Ells long, and an Inch broad, roll'd with one end, being at first apply'd with divers Circumvolutions under the Elbow, and moderately bound. Many turns are to be made, and a thick and streight Bolster, is to be laid upon the Tumour, (as in the Bandage for Phlebotomy) along the Artery, till it pass under the Arm-Hole: The Arm and Bolster must be surrounded with the Band, which is brought up with small Rollers, to the Arm-Pit, and stay'd with Circumvolutions round about the Breast. Afterward the Patient is to be laid in his Bed, with the Arm lying somewhat bended on the Pillow, and the Hand a little higher than the Elbow.
To perform this Operation, the Surgeon holds the Lancet between his Thumb and Fore-finger, and three other Fingers lying upon the Patient's Arm, and thrusts the Point of the lancet into the Vessel, carrying the same Point somewhat upward, to make the Orifice the greater. If a Tendon, which is known by its hardness; or an Artery, which is discover'd by Pulsation, appear beyond the Vein, and very near it, the Lancet must be only set veryforward in the Vein, and drawn back again streight, without turning it up, otherwise the Artery or Tendon wou'd be certainly cut with the Point. If the Artery or Tendon lies immediately under the Vein, the later must be prickt somewhat underneath, holding the Lancet inclin'd side-ways, and thrusting it very little forward; so that the Point will finish the Opening, by turning it upward.
If the Artery stick too close to the Vein, the later is to be prickt higher or lower than it is ordinarily done; and if the Vein be superficial, and lie close upon a hard Muscle, the Lancet must not be thrust downright into the Vein, but it is requisite to carry it somewhat obliquely, and to take the Vessel above, lest the Muscle and its Membrane shou'd be prickt, which wou'd cause a great deal of Pain, and perhaps a vehement Inflammation. It is well known that the Veins of the Right Arm are usually open'd with the Right-hand, and those of the Left-Arm with the Left-hand.
Is made thus: The Surgeon having laid a Bolster upon the Orifice, keeps it close with two Fingers, and holds the Band or Fillet with the other Hand; then taking one end of the Fillet with the Middle-Finger, Fore-Finger, and Thumb, and applying it to the Bolster, he makes with the longest end of the Fillet divers Figures in form of the Letters KY in the Fold of the Arm; as also a back-fold with the shorter end of the Fillet, held between threeFingers. Afterward both ends of the Fillet are ty'd beneath the Elbow.
If an Inflammation happens after the Operation, the Bolsters are to be dipt inOxycratum: but if the Orifice were so small as to produce aRhombus, it wou'd be requisite to press the Wound often with two Fingers, and immediately to apply a Bolster dipt inOxycratum.
If the Tumours are small and hanging, and have a narrow bottom, a Ligature may be made with Horse-Hair or Silk, dipt inAqua-Fortis, which will cause 'em to fall off of themselves after some time; or else they may be cut above the Ligature.
If the Tumour or Wen be thick, and its bottom large, a Crucial Incision is to be made in the Skin, without impairing theCystisor Bagg; and when the Incision is finish'd, the Bag may be torn off with the Nails, or with the Handle of a Pen-Knife; but sometimes it is necessary to dissect it. If there be any considerable Vessels at the Root, they may be bound, or else cut; and the Blood may be stopt with Astringents. If any parts of theCystisremain, they are to be consum'd with Corrosives; and the Lips of the Wound are to be drawn together without a Stitch, making useonly of an agglutinative Plaister. But if the Tumour adheres very close to thePericranium, it is most expedient not to meddle with it at all.
Ganglionsare Tumours arising upon the Tendons and Nervous Parts, which may be cur'd by thrusting 'em violently, and making a very streight Bandage, provided they be very recent; a resolvent Plaister is to be also apply'd to the Part.
This Operation is perform'd when it is necessary to discharge watry Humours out of the Head: If these Waters lie under the Skin, a very large Opening is to be made with a Lancet, and a small Tube or Pipe left therein to let 'em run out. If the Water be situated between the Brain and theDura Mater, the Membrane is to be perforated with a Lancet, after the Trepan hath been apply'd, according to the usual Method, of which we have already given some account: Cauteries and Scarifications may be also us'd to very good purpose in this Disease.
When the Ligament of the Tongue in Infants is extended to its Extremity, they cannot suck without difficulty; and when grown up, they have an impediment in their Speech.
This Ligament may be cut with a little pair of Sizzers; to which purpose the Thumb of the Left-hand being laid upon the Gum of the lower Jaw, to keep the Mouth open, the Tongue may be rais'd upward with the Fore-Finger of the same Hand, and the Sizzers may be pass'd between the two Fingers, to divide the String as near as is possible to the Root of the Tongue, avoiding the Vessels: If an Hæmorrhage happens, recourse may be had to Styptick-Waters. Afterward the Nurse must take care to let a Finger be often put into the Child's Mouth, to prevent the re-uniting of the String.
If there be only one Membrane that stops the Entrance of theVagina, an Incision may be made, and a Leaden Pipe put into it, having Rings to fasten it to the Waste, to hinder the re-uniting of the Wound.
If the Lips of thePudendumare conglutinated or clos'd up, the Patient must be laid upon her Back, and her Knees rais'd up, in order to make an Incision with a crooked Incision-Knife, beginning at the Top; and then a Leaden Pipe is to be put into the Opening.
If theVaginabe fill'd with a Fleshy Substance, an Incision is to be made therein, till it be entirely perforated, putting at the same time a Leaden Tube into the Orifice.
If the UrinaryDuctusas well in young Boys as in Virgins, be stopt up, an Incision is to be made therein with a very narrow Lancet; and if a small Leaden Pipe can be conveniently introduc'd, it may be done; but it is not very necessary, in regard that Children are almost always making Water, which wou'd of it self hinder the closing of the Orifice.
If theDuctusof the Ear be stopt with a Membrane, it must be perforated, taking care not to go too far, for fear of piercing the Membrane of theTympanumor Drum, anda small Leaden Pipe is to be put into the Opening.
If there be a carnous Excrescence on the outside of the Ear, a Ligature ought to be made therein, or else it may be cut with a pair of Sizzers, to cause it to fall off; and the rest of the Fleshy Substance that remains in the Ear must be consum'd with Causticks, convey'd to the Part by the means of a small Tube, care being had, nevertheless, to avoid cauterizing theTympanum.
When thePræputiumis so streight that theGlanscan be no longer uncover'd, this Indisposition is call'dPhimosis; but if thePræputiumbe turn'd back above theGlans, after such a manner that it can no longer cover the sameGlans, it is aParaphimosis. If in thePhimosisthePræputiumcleaves very close round about theGlans, it is most expedient to let it alone; but if in handling theGlansit be perceiv'd that it is moveable, or else that some parts of it only stick together, the Operation may be perform'd after this manner: The Patient being set in a Chair, a Servant is employ'd in pulling back the Skin to the Root of thePenis, to the end that the Incision may bemade directly at the bottom of theGlans: Then the Surgeon having drawn out the bottom of thePræputium, introduceth a small Instrument with a very sharp Point on its flat side, at the end of which is fixt a Button of Wax, pierceth thePræputiumat the bottom of theGlanson the side of the Thread, and finisheth the Incision by drawing the Instrument toward himself.
TheParaphimosisis cur'd by making Fomentations on the Part, to allay the Inflammation if there be any; and it is to be pull'd down with the Fingers. But if Medicinal Preparations prove ineffectual, Scarifications are to be made round about thePræputium; and afterward convenient Remedies may be apply'd to remove the Inflammation, and prevent the Mortification of the Part; so that at length thePræputiummay be drawn over theGlans.
In order to cure this Tumour, the Surgeon having first cut the Skin to discover the dilated Vein, separates it from the Membranes, and passeth underneath a crooked Needle with a double wax'd Thread; then he makes a Ligature both above and below the dilatation of the Vein, opens the dilated Part with a Lancet, to let out the Blood, and applies a convenient Bandage: But without performing thisOperation, the Vein might be open'd with a Lancet, to draw out a sufficient quantity of Blood; and then theVarixis to be press'd with a somewhat close Bandage.
ThePanaritiumis an Abcess which ariseth at the end of the Fingers; some of these Tumours are only superficial, and others penetrate even under thePeriosteum; nevertheless after whatsoever manner thePanaritiummay happen, it ought to be open'd on the side of the Finger, that the Tendons may not be hurt. If the Abcess be extended under thePeriosteum, the opening must be made on the side, and the Lancet thrust forward to the Bone: Afterward thePusor corrupt Matter is to be discharg'd, which wou'd cause the Tendons to putrifie, if it shou'd remain too long upon 'em.
Are made with a Plaister cut in form of aMaltaCross, which is apply'd at the middle to the end of the Finger, the Heads being cross'd round about. The Bolsters must be also cut in the shape of theMaltaCross, or of a plain Cross only; the Band being a Finger's breadthwide, and long enough to be roll'd about the whole Dressing: It must be pierc'd at one of its ends, and cut the length of three Fingers at the other; so that the two Heads may pass thro' the Hole, to surround the Finger with small Rollers.
To reduce theAnusto its proper place when it is fallen, the Patient being laid upon his Belly, with his Buttocks higher than his Head, the Operator gently thrusts back the Roll that forms theAnuswith his Fingers dipt in the Oil of Roses: Then he applies the Bolsters steept in some Astringent Liquor, and causeth 'em to be supported with a sort of Bandage, the Nature of which we shall shew in treating of the Fracture of theCoccyx, that is to say, the T. the double T. or else the Sling with four Heads.
In this Operation, the Patient being laid upon her Back, with her Buttocks rais'd up, Fomentations are to be apply'd to the Part; a Linnen Cloth is to be laid upon the Neck of the fallenMatrix; and it is to be thrust very gently with the Fingers, without using much force. If theMatrixshou'd fall out again, it wou'd be requisite to convey a Pessary into it, after it hath been reduc'd; and to enjoyn the Patient to lie on her Back with her legs a-cross.
The Cautery is an Ulcer which is made in the Skin, by applying Causticks to it, after this manner:
The Surgeon having moisten'd the Skin for a while with Spittle, or else having caus'd a light Friction to be made with a warm Cloth, applies a perforated Plaister to the Part, and breaks the Cautery-Stone, to be laid inthe little Hole, leaving it for a longer or shorter time, accordingly as he knows its Efficacy, or as the Skin is more or less Fine. Afterward he scarifieth the Burn with his Lancet, and puts a Suppurative, or piece of fresh Butter into the Part, till the Escar be fallen off.
After the Application of theLapis Infernalis, or any other Cautery-Stone, it is necessary to lay over it a Plaister, a Bolster, and a Circular Bandage, which ought to be kept sufficiently close, to press the Stone, after a Pea or little Piece of Orrice-Root, hath been put into the Ulcer to keep it open. Then the Patient is to make use of this Bandage, with which he may dress it himself. Take a piece of very strong Cloth, large enough to roll up the Part without crossing above it: And let three or four Holes be made in one of its sides, as many small Ribbans or Pieces of Tape being sow'd to the other, which may be let into the Holes, as occasion serves, to close the Band.
It is requisite that the Leeches be taken in clear running Waters, and that they be long and slender, having a little Head, the Back green, with yellow Streaks, and the Belly somewhat reddish. Before they are apply'd, it is also expedient to let 'em purge during some Days in fair Water, fast half a Day in a Box without Water. Afterward the Part being rubb'd or chaf'd with warm Water, Milk, or the Blood of some Fowl, the Opening of the Box is to be set to the Part, or the Leeches themselves laid upon a Cloth; for they will not fasten when taken up with the Fingers. The end of their Tail may be cut with a Pair of Sizzers, to see the Blood run, and to determine its quantity, as also to facilitate their sucking. When you wou'd take 'em away, put Ashes, Salt, or any other sharp thing upon their Head, and they will suddenly desist from their Work; but they are not to be pull'd off by force, lest they shou'd leave their Head or Sting in the Wound, which wou'd be of very dangerous consequence. When they are remov'd, let a little Blood run out, and wash the Part with salt Water.
Is made with a Bolster soakt in some Styptick Water, if the Blood will not otherwise stop; or in Brandy orAqua-Vitæif there be an Inflammation; and it is to be supported with a Bandage proper for the Part.
To perform this Operation, a Cotton or Silk Thread is to be taken, after it hath been dipt in Oil of Roses, and let into a kind of Pack-Needle; then the Patient sitting in a Chair, is to hold up his Head backward, whilst the Surgeon gripes the Skin transversely in the Nape of the Neck with his Fingers, or else takes it up with a Pair ofForceps, and passeth the Needle thro' the Holes of theForceps, leaving the String in the Skin. As often as the Bolster that covers the Seton is taken off, that part of the String which lies in the Wound is to be drawn out, and cut off.
Scarifications are to be made more or less deep, accordingly as necessity requires, beginning at the bottom, and carrying them on upward, to avoid being hinder'd by the Hæmorrhage. They must also be let one into another, that Strings may not be left in the Skin.
Vesicatories are compounded with the Powder of Cantharides or Spanish flies, mixt with very sower Leaven, or else with Turpentine. Before they are apply'd, a light friction is to be made on the Part with awarmcloth, and a greater or lesser quantity is to be laid on, accordingly as the Skin is more or less fine, leaving 'em on the Part about seven or eight Hours; then they are to be taken away, and the Blisters are to be open'd, applying thereto some sort of Spirituous Liquor.
A Good Friction being first made with warm Clothes, lighted Toe is to be put into the Cupping-Glass, or else a Wax-Candle fasten'd to a Counter, and then it is to be apply'd to the Part till the Fire be extinguish'd, and the Skin swell'd, re-iterating the Operation as often as it is necessary; and afterward laying on a Bolster steept in Spirit of Wine. These are call'd dry Cupping-Glasses: But if you wou'd draw Blood, every thing is to be observ'd that we have now mention'd, besides that Scarifications are to be made, according to the usual manner; and the Cupping-Glass is to be set upon the Scarifications: But when the Cupping-Glass is half full of Blood, it must be taken off to be emptied, and the Application thereof is to be re-iterated, as often as it is required to take away any Blood. Lastly, the Incisions are to be wash'd with some Spirituous Liquor; and a Bandage is to be made convenient for the Part.
An Abcess or Impostume ought to be open'd in its most mature part, and in the Bias of the Humours, endeavouring to 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 Heel, it may be par'd with a Razor; and if the Matter be lodg'd under the Nails, it wou'd be required to scrape 'em with Glass before they are pierc'd.
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
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 andPolypus's.
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.
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'dChevestre, i.e.a Cord or Bridle, by theFrenchSurgeons, 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 doubleChevestremay 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.
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 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 theCapelineor Head-Bandage, provided the Fracture be in the middle of the Clavicle. A Bandbeing 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 ofGeraniumor 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 theHumerusor Arm-Bone, a sort of Bandage might be prepar'd, which is call'dSpica, 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 theFracture; three or four more KY's are wrought upon the Fracture; two Circumvolutions are made in the upper part of theHumerus, which constitute a Triangle call'dGeranium; this Triangle is cover'd with Rollers, and the Band is terminated round about the Breast.
TheAcromionis usually fractur'd, but it may be known that the middle of theOmoplatais 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.
A Bolster is laid upon theOmoplata, 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 ofthe 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 theShoulder, 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 theOmoplatæare all cover'd: Circumvolutions are also made round the upper part of theHumerus, as in theSpica; and the Bandage is finish'd by Circumvolutions round about the Breast.
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.
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'sCross; 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.
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 theSternum, which is sunk down; or else an Incision may be made upon the Bone, to discover it; and then aVectisis to be apply'd thereto very gently, in order to heave it up into its place.
A Bolster and Paste-board are to be laid upon theSternum, 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'dQuadrigamay 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.
TheApophysesof theVertebra'sare commonly broken, and their Bodies but seldom: It may be known that the Body of theVertebraof 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 theSphincterof theAnus; 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 theVertebrain the fractur'd Place.
If theApophyses Spinosæare 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.
If theApophysis Spinosawere 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 theQuadrigamay be prepar'd, according to the manner we have already describ'd in the Fracture of theSternum.
It is reduc'd as the otherVertebra's; but its Dressing and Bandage are made with the T perforated at theAnus, 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 theOs 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.
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 theAnusor Fundament as far as theFracture, to thrust it back again into its place, whilst the other Hand setleth it on the outside.
Are the same with those in the Fracture of theOs 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 theOs Innominatumbe broken, theSpicais to be us'd after it hath been dress'd, of which Bandage we have given an Account in the Fracture of the Clavicle.
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
It is necessary at first to lay round the Fracture a Bolster steept in some proper Liquor, as Claret orOxycratum; 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 thatthe four ends may be rais'd up, and fasten'd to the opposite Shoulder; but the Hand must lie higher than 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.
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.
If the Bones of theCarpus, or those of theMetacarpiumbe 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.
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 theCarpus, 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.
Two Servants are to hold the Hand, after the same manner as in the setting of theCarpusor Wrist-Bone, whilst the Surgeon reduceth the broken Bone by fixing it in its Natural Situation.
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 theMetacarpium, 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 theMetacarpiumbe cover'd; a Bolster and Paste-board are to be laid upon the sameMetacarpium; as also one in the Hand, of theShapeof 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.
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.
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 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 theoutermost 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.
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.
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 withone 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.
If theTibiabe 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 thePeronebe 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.