The Compleat Surgeon Part 38

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 {292} 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 Circ.u.mvolution 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 b.a.l.l.s is to be pa.s.s'd thro' the Hole; it must also be well clos'd, and divers Circ.u.mvolutions are to be made upon the Knee-Pan, so as it may be altogether cover'd.

CHAP. XVII.

_Of the Fracture of the Leg._

If the _Tibia_ be only broken, it pushes into the Inside; but if both Bones be fractur'd they are sometimes separated on both sides, or else they pa.s.s 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. {293} Thus whilst the a.s.sistants 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 Circ.u.mvolutions 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 Circ.u.mvolutions; it is to be brought down with Rollers, to pa.s.s 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 encompa.s.s'd with large Paste-boards made round at the Ends, which are not to cross one another, {294} 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 pa.s.sing 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 {295} 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.

CHAP. XVIII.

_Of the Fracture of the Bone of the Foot._

The Reduction of the Bone of the Foot is perform'd after the same manner as that of the Hand. {296}

_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 Circ.u.mvolution above the Ankles; it is pa.s.s'd on the Foot, and in like manner makes a Circ.u.mvolution 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_.

{297}

A

TREATISE

OF THE

OPERATIONS

Which are perform'd in

LUXATIONS.

CHAP. I.

_Of the Luxation of the Nose._

The Bones of the Nose may be separated from that of the Fore-head by a Fall, or some violent Blow; and the Surgeon in order to set 'em, at first lays his Thumb upon the Root of the Nose, and then he introduceth a little Stick trimm'd with Cotton, into the Nostrils, and by the means thereof thrusts back the Bones into their place. {298}

_The Dressing and Bandage_

Are the same with those that have been already describ'd in the Fracture of the Bones of the Nose.

CHAP. II.

_Of the Luxation of the lower-Jaw._

The Jaw may be luxated either on both sides, or only on one. When the Dislocation happens on both sides, it hangs over the _Sternum_ or Breast-Bone, and the Spittle runs abundantly out of the Mouth: To reduce it, the Patient must sit down, and his Head is to be supported by a Servant; then the Operator or Surgeon having wrapt up his two Thumbs, puts 'em into the Mouth upon the Molar Teeth, his other Fingers lying under the Jaw, which is to be drawn down by raising it up, having before set two small Wooden Wedges upon the two Molar Teeth on both sides of the Jaw, lest the Surgeon's Fingers shou'd be hurt, as the Bone is returning to its place.

If the Luxation be forward, a Band or Strap is to be put under the Chin, an a.s.sistant having his Knees upon the Patient's Shoulders, where he is to draw the Strap upward, to facilitate the Extension; which the Surgeon makes with his Hands, at the same time thrusting the Bone back again into its place. {299}

When the Jaw is luxated only on one side, the Chin stands a-cross, and the dislocated side is squash'd down, a small Cavity being perceiv'd in it, and a Rising on the other side; so that the Mouth cannot be shut close, but remains somewhat open, the lower Teeth appear farther out than the upper; and the Canine or Dog-Teeth lie under the Incisive. This Luxation is reduc'd by giving a blow with the Hand upon the luxated Bone, which is sufficient to cause it to re-enter its Natural Place.

_The Dressing and Bandage_

Are altogether the same with those us'd in the Fracture of the Bones of the lower Jaw.

CHAP. III.

_Of the Luxation of the _Clavicle_._