The Compleat Surgeon Part 36

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 b.a.l.l.s, 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 pa.s.s'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.

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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 a.s.sistant 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 {277} being taken about six Ells long, and four fingers thick, roll'd with two b.a.l.l.s; 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 pa.s.s'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 pa.s.s'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 Circ.u.mvolutions around about the Body are continu'd, as also these Rollers upon the Clavicle, till it be entirely cover'd. Some Circ.u.mvolutions are also made upon the upper part of the Arm, near its Head: The s.p.a.ce that lies between the Rollers and the Circ.u.mvolutions of the Arm, and which bears the Name of _Geranium_ or Stork's-Bill, is likewise cover'd with some Circ.u.mvolutions, and the Band is stay'd by making Circ.u.mvolutions 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 pa.s.s'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 {278} Fracture; three or four more KY's are wrought upon the Fracture; two Circ.u.mvolutions are made in the upper part of the _Humerus_, which const.i.tute 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 p.r.i.c.k 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 pa.s.s'd under the {279} Shoulder, and afterward above it, to make a KY in the middle of the Back; then pa.s.sing 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 _Omoplatae_ are all cover'd: Circ.u.mvolutions are also made round the upper part of the _Humerus_, as in the _Spica_; and the Bandage is finish'd by Circ.u.mvolutions round about the 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 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.

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_The Dressing and Bandage._

A Bolster is to be apply'd to the Fracture, with two little Pieces of Paste-board pa.s.s'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 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.

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_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 b.a.l.l.s, once before, and the other behind; it is pa.s.s'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.

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; {282} and by the Palsie of the _Sphincter_ of the _a.n.u.s_; 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 p.r.i.c.kt 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_.

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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 _a.n.u.s_, or else with the H or double T.

It is made with a Band two Fingers broad, and long enough to encompa.s.s 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 pa.s.s 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.

CHAP. IX.