CHAP. I. Of Manual Operations in general .

ALthough the word Chirurgery signifies all Manual Operations in general ; yet , by reason of its pre-eminence above all the rest , it is now only given to that Art , which endeavours to remove the Diseases of the Body , by the assistance of the Hands .

'T is true , that External Accidents require not only the help of the Hands , but also Internal Means ; therefore it is no wonder for a Part of Physick to require the whole : Chirurgery being a Part , which depends upon the Body of Physick : But these internal Medicines we impart to you , not as Chirurgeons , but as Physicians .

The General Operations of this Art , to which all the particular ones may be reduced , are of four sorts :

1. Synthesis , which teacheth how to unite parts disjointed .

2. Diaeresis , To separate parts unnaturally joyned .

3. Exaeresis , To remove what is superfluous .

4. Anaplerosis , To supply those that are wanting .

CHAP. II. Of Synthesis or Vnition .

UNition is of two sorts ; one regards the Hard and Boney ; the other the Soft and Fleshy parts of the Body .

The Unition of Bones is again twofold ; the one , setting Bones broken ; the other , reducing Bones wrenched or disjointed . We will begin with Fractures .

CHAP. III. Of the Nature , Difference , Signs , Prognosticks and Cure of Fractures in general .

A Fracture is a Solution of Continuity in the hard parts of the Body , caused by an hard Instrument externally forced upon the part .

The Differences are taken , 1. From the Manner ; there being some transverse , which are properly called Fractures ; others that are made according to the length of the Bone , called Fissures : and others are Comminutions , when the Bone is broken into many small parts . 2. From the Part , it being some times in the Head , sometimes in the Shoulders , Ribs , Arms , Legs , &c. 3. From the Accidents ; there being sometimes a Wound accompanying it ; at other times , a Dislocation , Inflamation , Gangrene , &c.

Cause ] is , Whatever is able to break , bruise , or cut : Sometimes also a Bone corrupted by the Pox , Gout , or otherwise , hath been broken without any external force .

Signs . ] A Bone being transversly or obliquely broke , by handling it , you perceive an inequality ; the Patient is scarce able to move the Part affected , and sometimes that Part is shorter than the other ; the Thigh , Leg or Foot being broken , the Patient cannot stand at all ; but he may somewhat , though with pain , in a Dislocation : And this is the surest difference between a Fracture and a Dislocation . A Fissure is discerned by the thickness , pain and unevenness of the Part , and requireth the judgment of a skilful Chirurgion . A Comminution is easie to be perceived , the Bone being very unequal , and here and there yielding to the Fingers .

Prognosticks ] A Transverse Fracture is more easie to cure than an Oblique ; or when accompanied with apparent Inequalities ; that , where but one Bone is broken , than where two are , or where the Bones are much shattered ; that , which ●s made in the midst of the Bone , than what happens to be near the Head ; and a single one , than a compound . If the Patient remain undressed beyond the seventh day , the Member is in danger of mortifying , especially if that the Part be too ●ard bound .

The Cure . ] A broken Bone requires these four Operations ; Extention , Conjoining , Ligature , Well-placing ; and withal , the application of outward and inward Remedies .

Extention can hardly be performed without pain ; which yet will be much less , if the Member be so extended , that the Muscles do not labour ; that is to say , The Part must be so laid , that when in health , they could hold out longest without tiring . Sometimes the extension must be greater , sometimes lesser ; which will be performed aright , if regard be had to the time of the Fracture , to the Age of the Patient , and to the greatness of the Bone . A recent Fracture , a tender Patient , a small Bone , require a gentler Extention : on the contrary , an old Fracture , a strong Patient , and a big Bone , a greater . The manner of extending I describe not , because it is better learnt by the frequent view of Practice , than by Reading .

After Extention , you are to join the Bones together ; in the doing of which , the Muscles must not be wrested , but retain their natural position and figure .

Then the Part must be bound with a double Rowler ; the first is to be rowled thrice about the Fracture , and then upwards . The ( second ( which must be twice as long ) is to be once wound about the Fracture , proceeding downwards , and then upwards again , a little higher than the first Rowler ; to which you will give more firmness , if you bind some convenient Splints ( of Wood , or rather of Past-board ) round about the Member .

The Ligature ought not to be too strait , lest it cause pain , and rob the Part of its nourishment ; nor too loose , lest the Bones slip out of their place . And unless great pain , or other symptoms require , it must not be opened before the third day ; and at the second dressing , it must be bound somewhat closer ; and afterwards changed but once every four , five or six dayes .

Lastly , The Part ought to be well placed , that is , softly , evenly , and a little raised . If you lay it too low , the Bone will bend outwards ; if too high , it will bend inwards : Wherefore you must observe a mean .

Now , whether these four Operations have been duly performed , may be known by the ensuing Signs .

The Extention is well done , if the part be strait , and as long as its fellow ; if it appear to outward view every where even , and a little hollow about the Fracture .

The joining together is duly made , if the Bone be any thing firm , and all about the Fracture be found equal .

The Ligature is as it ought to be , if the Patient , as soon as he is dressed , find the pain abated ; if the pain do somewhat encrease the first and second night , and there be perceived the third day , without the place of binding , a little swelling yielding to your hands .

The Bone is well placed , if in the second dressing you find all even .

Before you rowl the Ligature about the Member , bathe the part with Spirit of Wine or Red Wine ; or , with Oyl , Wine and Vinegar mix'd together ; Or , take the White of an Egg , with some Bolus , Frankincense , Dragons-Blood , &c. Or anoint it with Oyl of Roses , Mirtles , Violets , &c. or lay Plaisters on it . In Winter , the Oxycroceum will do well : At all times that which follows ;

Take Mastick , Frankincense , of each two drams , Aloes , Gum Tragacanth , Dragons-Blood , Bole-Armonick , of each a one dram ; Lapis Haematitis , Burnt Talch , of each one dram ; Whites of Eggs , and Oyl of Roses , as much as is sufficient . Make it into a Plaister .

If a Wound accompany the Fracture , then ought you to extend the Part first ( yet somewhat gentler than in a simple Fracture ) then you are to join the Bones together ; next , to observe the Wound , to bring the Lips thereof together with Plaisters , rather than with a Needle , and to guard it with a Defensive : And lastly , rowl the Part , and lay it conveniently .

If there be a Cominution , or great shattering of the Bones joined with the Wound , then endeavour with Forceps to remove the small loose Bones , leaving those to Nature that are yet any way fixed ; for she will , though somewhat later , of her self throw them out ; and sometimes she will unite them again to the whole . Yet , to forward her , you may assist Nature with the following Medicaments .

Take Ashes of Earth-worms , three drams ; Virgins-Honey , an ounce and half , mix them , and make an Oyntment .

Or ,

Take Aloes , Myrrhe , of each half a dram ; Roots of Comfrey the great , Round-Birthwort , of each three drams , Euphorbium , two drams ; Turpentine and Wax , as much as is sufficient , with a little Oyl of Lillies , to make it into an Oyntment .

If the Bone be bare , cover it with its own skin and Nuscles , and defend it from the Air as much as is possible .

If it be bare and also started out , endeavour to reduce it again into its place ; but if it be got out too far , take away the pieces thus started out , with Saw or Nippers .

Now these Manual Operations being well performed , the Patient must observe a good Diet ; open a Vein upon occasion , and afterwards purge the Blood . In the Fractures of the lower parts , purging is not convenient ; but if the Patients Belly be bound , he must take a Suppository .

In the Fractures of the upper parts , Purging or administring Clysters , is oftner necessary , and may be done by the ensuing compounded or simple Medicines , which may also serve you in all other Accidents that we may describe in this whole Treatise .

Medicines purging Choler .

Rhubarb , Cassia fistula , yellow Myrobalans ,

Tamarinds , Manna , Scammony , Syrup of Sicchory , with Rhubarb , Elect. Catholicum , Hiera picra , Lenitivum , Diaprunum solutivum , & Succus Rosarum , Pil. de Aloe Rosata , Aureae , Aloephanginae , Ruffi .

Take Electuary Lenitive , two drams ; Elect. of the Juice of Roses , one dram ; Cassia fresh extracted , two drams ; Cream of Tartar , two scruples ; Succory-water , as much as is sufficient ; Spirit of Vitriol , a little . Make it into a Potion .

Or ,

Take Rhubarb , Senna , of each two drams ; Cream of Tartar , one dram ; Aniseeds , half a dram : Infuse them two hours in a sufficient quantity of Sorrel-Water , let it boil a little , and to three ounces of the strained Liquor ,

Add of the

Elect. of Diaprun . Sol. one dram , or a dram and half , and drink it .

Or ,

Take of Pilulae Aureae , Extract . Catholicum , Rhubarb , of each half a scruple . Make them into seven Pills .

Or.

Take Cream of Tartar , Sal Prunella , of each xij grains ; vitriolated Tartar , Diagredium , of each vj. grains . Make it into a Powder .

Medicines that purge Phlegm .

The Roots of Asarum , Mechoacan white and black , Hellebore , Colocinth , Myrabolani , Belliric , Emblici , Chebuli , Agarick , Turbith , Syrup of Diacarthanum , Electuaries of Hierae with Agarick , Diaphoenicon , Diacarthamum , Confection of Hamech , Powder of Diaturbith , Pills of Cechiae , Foetidae the greater , Aggregativae , Lucis the greater , Assajeret of Avicen , Troches of Agaric , Alhandal .

Take Roots of Grass , two drams ; Flower-de-luce , Trochiscatum , Agarick , Turbith , of each one dram ; Aniseeds , Fenel seeds , of each one scruple : Let them infuse for three hours in a sufficient quantity of Parssy water ; boil it , and strain it ; and to three ounces of it ,

Add of

Electuary of Diaphenicon , one dram and half . Make it into a Potion .

Or ,

Take Electuary of Diacarthamum , Confection of Hamech , of each two drams ; powder of Jalop ; eight grains ; Cream of Tartar , two scruples , Fennel water , as much as sufficeth . Make a Potion .

Or ,

Take of Pill Aureae , six grains ; of Pill Cochiae , Pill Faetidae the greater , of each twenty grains . Make them into seven Pills , and gild them .

Or ,

Take Extract of Catholicum , xiij grains ; of the Troches of Alhandal , one grain . Make three Pills , and gild them .

Medicines purging Melancholy .

Roots of black Helebore , Polipody , Senna , Lapis Lazuli , Syrup of Roses solutive with Senna , Electuaries of Diacatholicon lenitive , Confection of Hamech . The Powder of Dia Senna , Pills of Lucis minoris , Troches of Alhandal , Myrobalans of India .

Take Bark of Tamarisk , three drams ; Roots of Polypody , two drams ; Staechas Flowers , half a pugil ; Senna , one dram and half ; Aniseeds , half a dram ; Mirobolans of India , one dram : Infuse them two hours in a sufficient quantity of Borage-water ; boyl it , and strain it ; and to four ounces of the strained Liquor ,

Add ,

An ounce of Syrup of Roses with Senna , Spirit of Salt , as much as will give it a little acidity ; and make it into a Potion .

Or ,

Take Electuary of Diacatholicon , one dram ; the Electuary of Diaphoenicon , Confection of Hamech , of each a dram and half ; Cream of Tartar , two scruples ; Powder of Jalop , six grains ; Whey , a sufficient quantity . Make a Potion .

Or ,

Take of Pill Indiae , of Aggregativae the greater , of each fifteen grains : Diagridium , three grains ; Troches of Alhandal , one grain . Make seven Pills , and gild them .

Note , All these Receipts are set down for full-grown Bodies , their quantities being to be lessen'd according to the younger age , and strength of the Patient .

CHAP IV. Of particular Fractures of Bones .

THe Fractures of the Skull are divided into six several kinds ; A Fissure , Contusion , Fracture , Incision , Puncture and Contra fissure .

A Fissure is made by a hard and blunt Instrument , and passeth sometimes through both Tables , sometimes through one only .

A Fracture is made , when a part of the Skull is separated from the whole .

An Incision is made by a cutting Instrument ; where sometimes one part of the Bone is rais'd up and separated , as it were , but is yet fast to the rest of the Bone ; sometimes a part is quite taken away ; sometimes there remains a mark in the Bone according to the Figure of the Instrument .

A Puncture is made by a pungent or thrusting Instrument , and seldom passeth through both Tables .

A Contra-fissure is made , when the part struck remaining whole , the opposite part is cleft .

The Signs are , Swimming of the Head , dimness of the Eyes , Vomiting , Bleeding at the Mouth , Nose and Ears . The Patient grows dumb , and suddenly falls to the ground : whereupon follows Raving , a Feaver , Convulsions , Palsie . Any hard thing , as a piece of Wood , a Spoon , &c. being put into his Mouth , he is not at all , or hardly able to bite upon it . Here it must also be carefully enquired , in what manner , and with what Instrument he hath been hurt ? Whether he be young or old , tender or strong , healthy or unhealthy ? Presently after the Fall or Stroke , before the Part swells , you may sometimes feel the hurt with your Fingers ; and if there be a Wound with it , you may either see it , or find it out with a Probe .

Prognosticks . ] The Fractures of the Skull , how fair soever they may look , is never without danger , but more dangerous , when both the Tables are hurt or broken ; and more dangerous yet , if the Dura Mater , and most dangerous , if the Pia Mater be also hurt . The more Symptoms there are , the less hope of a good event . If the Bone grow black in the beginning , that is a mortal Sign .

Cure . ] If the Skin be yet whole , or the wound not large enough , make a cross incision , and divide the Pericranium . If under it you find a fissure , put some Ink into it , and bind up the wound . The second day , or as soon as the bleeding is ceased , scrape the Skull at once , or at several times , until the Ink with the Fissure is altogether gone , and the Bone grow somewhat bloody , then throw the ensuing Powder upon it .

Take Dragons Blood , burnt Harts-horn , of each one dram and half ; Myrrhe half a dram ; Frankincense , and Orrise roots , of each a dram ; Make it into a very fine Powder .

If the Fissure pass through both Tables , then are you to make use of Trepanning ; as likewise in the Contra-fissure , Fracture and Contusion of the Skull , or else you will quickly lose your Patient .

The Incision is healed like the Fissure .

In the Puncture you must put the Trepan just in the middle , and not on the sides of the place hurt .

If you find a Fracture with a Cominution , then take out all the small loose Bones , committing to Nature those that are yet fast to the Pericranium , or cannot be taken away without force . And then if the Fracture be so large , that you can free the Brains from the coagulated or corrupted Blood , or from the pricking Bones , Trepanning will be needless ; but if it should happen otherwise , you must , with great care , apply the Trepan , unless the Patient be strong , and the matter very little . The manner of Trepanning will be taught in another place .

2. In a Fracture of the Nose , what is raised , is to be pressed down ; and what is pressed inward , to be raised with a Spatule , or other Instrument : afterwards a Pipe or Quill is to be put up , and continually kept there , till the Cure be done , and a Fracture-Plaister is to be laid on without . If the Bone be not corrupted , it will be healed in ten or twelve days .

3. A broken Jaw-bone is restored by ones fingers used both within and without the Mouth ; and if those be too weak , then one is to draw the Head backward , and the Chirurgeon forward , and so to put it in . It is cured in twenty days .

4. The Clavicle being broken , there must be one to draw the Arm backward , and another to draw the Neck or Shoulder forward ; the Chirurgeon himself , in the mean time , drawing upwards what was fallen down , and downwards what was raised too high . If a Ball be put into the Arm-pit , and the Elbow be pressed against the Ribs , the Operation will prove more easie . It is cured in twenty four days .

5. If the Shoulder-Blade be broken about the place where it is united to the Arm , then is the hurt for the most part incurable . If it break in the Acromion ( which may be easily felt ) then let the Arm or Shoulder be pulled down , either with Hands or Ligatures , and in the mean time set it in . If it be broken into several pieces , make an Incision , and take them out , unless they be yet fast to the Peri-estium ; in which case , you must leave Nature to her self , which will either make them unite again , or throw them out . It is healed in forty days .

6. The Sternum , or Breast-bone happens either to be broken , and then you 'll find an unevenness , which being toucht , will yield to the Fingers , and cause some cracking ; or to be pressed in , and then you 'll feel a bending inwards , which will cause pain , a short breath , coughing and spitting blood . To restore the same , lay the Patient on his Back upon a great stone , pressing both his Shoulders downwards ; then press the Ribs backward and forward , until the Bone be reduced again in its right place . This is cured in twenty days .

7. A simple Fracture of the Ribs , which is without any great Contusion , or Inflamation of the neighbouring parts , may be healed in twenty days , applying the Fracture-Plaister . If the Ribs stand out , they must with ones Hand be pressed in . If they bend inward , let the Patient keep in his Breath , and so press the Rib outward ; in the mean time , assisting him with your hand . If that succeed not , then lay a sticking Plaister upon it , and pull the same off so often , until the Rib return into its place . Cupping-Glasses here are of no use .

8. A simple Fracture of the Joynts of the Back-bone is easily set again with ones finger , and is made whole in twenty days . But if the Marrow of the Back-bone be so hurt or pressed in , that the Arms or Legs of the Patient become lame or senseless , that he cannot retain his Urine , or his Excrement , then he seldom escapeth death . Yet you are to do your utmost ; and if one or more small Bones be altogether loose from the Periostium , then make Incision , and take them out .

9. The same is to be understood of the Fracture of the Os sacrum , which alone hath this peculiar , that you may put your fingers into the Anus , and restore it to its right place .

10. The Hip-bone being broken , is to be set as soon as possible may be , and then it will heal in twenty four days ; otherwise you may expect various accidents . But if it be fractured into many pieces , then you are forthwith , in the first dressing , to make an Incision ; take out the small Splinters , and re-place those that have yet any hold-fast . Yet , by reason of the multitude of the Tendons , Muscles , Veins , Arteries and Nerves , that are spread over the whole part , such an Incision cannot be made without great danger .

11. If the upper-Bone of the Arm be broken , first bend the Elbow toward the Breast , then take the lower part of that Bone close to the Elbow , pulling it straight down towards the ground , and so restore it ; well observing here , that the Arm , during the whole time of Cure , must remain in that posture in which it was extended ; otherwise the Fracture will , upon the least change of its posture , slip out again . Where yet 't is to be understood , that the Chirurgeon after the second or third dressing , as often as after that he dresseth the Patient , must stretch out his Arm strait , to the end that the Tendons which run from the Arm , and are inserted below the Elbow , shrinking by the long lying still , may not cause a troublesome stiffness . However , this shrinking of Tendons ( which are by pretenders to Chirurgery , ridiculously call'd Nerves ) may yet conveniently be cured in two or three months , if you make the Patient to carry every day some weight , and endeavor to relax and mollifie the Tendons with Fomentations and Embrocations , abstaining from the use of any Brandy , or any other corroborating and astringent Medicines . I have always found successful the following Unguent .

Take Man's and Duck's Grease , of each one ounce ; Oyntment of Marsh-mallows , half an ounce ; Oyl of Earth-worms , white Lilly , and Camomile , of each two drams . Make an Oyntment .

This broken Bone is cured in forty days . The restoring of the broken Thigh-bone , hath nothing different from this .

12. The Elbow hath two Bones ; of which , the greater is called Radius , the lesser Ulna ; both Fociles : The small Focile being broken , 't is easie to restore it . The Cure is harder , when the great one is broken ; and yet harder , when both are broken : In which case , the extention is to be made the stronger . When they be well set , and bound up , then must the hand be placed a little higher upon the Chest than the Elbow ; and afterwards , every second or third day ( without pain or violence ) the Arm is gently to be stretch'd out , to the end that the Humors flowing thither , and there staying too long , may not cause a concretion in the Bones , and a stiffness in the Arm , as not extensible any more . It is cured in thirty days .

13. The Leg hath also two Bones , the greater called Tibia , and the lesser Fibula . Their Cure had nothing different from the next foregoing .

14. If the Patella , or Knee-pan , break cross-ways , the Patient commonly remains lame . If it break long-ways , then by the Muscles that draw upwards , without any great help of the hands , it is almost of it self restored , and cured in twenty days .

CHAP. V. Of the Nature , Difference , Signs , Causes , Prognosticks , and Cure of Dislocations in general .

A Dislocation is a forcing of the Bone out of its cavity and natural place into another , hindering voluntary motion .

The Differences are taken , 1. From the manner ; for sometimes the Bone is altogether forced out of its place , and that is properly called Luxation or Dislocation : Sometimes it is got out but a little or half , which is called Sub-laxation , or Elongation . 2. From the Cause ; for sometimes it is from an external accident , as by wrestlings , Falls , or Blows , &c. Sometimes from internal Causes , by the afflux of Humors .

The Causes are of two sorts ; 1. External , Such as are Falling , Beating , Running , Wrestling , and vehement extention , as it often happens to Women in Labour , through the unskilfulness of Midwives ; yea , by a violent stroke or fall , even the Bones of the Infant in the Womb , may be dislocated . 2. Internal , By the afflux of Humors , which falling into the Joints , relax and resolve the Ligaments , and so causeth the Bones to slip out of their places .

The Signs , especially in a lean Body , are manifest enough . The Bone causeth in the place to which it is forced , a tumor or rising ; and in that whence it is forced , a cavity . If there be a perfect Dislocation , the Member will be drawn up , and shorter ( unless the luxation happen by the laxity of the Ligaments , than it becomes longer ) the part is painful , chiefly upon motion . In a Subluxation , these Accidents are lesser , and seldom all together .

Prognosticks . ] In Children and other tender Bodies , the Bones may be reduced more easily ; but are kept in with more difficulty ; the contrary happens in strong and full grown persons : The Dislocation of the Head is mortal , that of the Vertebra's dangerous ; and that which is inveterate is hard to be cured . That which proceeds from an inward Cause , is of a slower Cure , and does easily return .

Cure . ] The Bone forced out , must be reduced to its place , either by the Hands , Ligatures , or Instruments ; but by which of these three it shall be performed , the Nature of the affected part will declare . 'T is certain , that these four Manual Operations ( Extention , Setting , Binding and Well-placing ) must here be used as well as in Fractures of Bones .

Extention must be made so great , that there may be a cavity between the Bone that remains well , and that which hath been forced away , to the end that in the setting , the one may not rub against the other ; whence afterwards are wont to rise very grievious , and sometimes incurable Accidents .

In the Setting , care must be had not to wrest the Bones nor the Muscles , but to keep their natural figure . Before you proceed to binding up the Member , endeavour to preserve the part from inflammation and flux of Humors , and strengthen it with the following Medicines .

A strengthening Plaster .

Take Frankincense , Mastick , Bole-armonick , Dragons-Blood , of each half an ounce ; fine-Flower , an ounce ; Roots of great Comfrey , two drams ; Weather-Sewet , three ounces ; white-Wax , as much as sufficeth to make a Plaister .

Another .

Take Litharge , Wax , Rosin , of each three ounces ; being melted over the fire , add to them , of great Comfrey , Bean-Meal , Bole-armonick steeped in Vinegar , and dried , of each three ounces ; Tragacanth , two ounces . Make it into a Plaister .

If the pain , or other symptoms do not necessarily require it , you ought not to loosen the Bandage before the fifth , sixth , or seventh day , and then do it with as little motion as is possible . Lastly , lay the Part even , and in such a posture , in which , when found , it can longest remain without trouble .

If you find the Dislocation accompanied by an Inflammation , beware of extending the part , or doing ought to it before that be removed ; which you are to do , first with emollient , and afterwards with discutient , Medicines .

An Emollient Unguent .

Take the compound Ointment of Marsh-mallows , two drams ; Hogs-grease , half an ounce ; Oyl of white-Lillies , Roses and Mirtles , as much as is sufficient to make it into a Linament .

A Discutient Plaister .

Take Colophony , Frankincense , Mastick , Pitch of each an Ounce ; Cummin-seeds , Fennel-seeds , of each six drams ; Wax and Oyl of Dill , as much as sufficeth . Mix them , and make it into a Plaister .

CHAP. VI. Of particular Dislocations .

1. THe Jaw-bone , except it be in young Children , can hardly be dislocated otherwise than forwards . Sometimes it is only dislocated in one side , and is easily restored ; sometimes in both , in which case it is difficult to set , and very dangerous , and often mortal .

It is very seldom luxated from a debility of the Muscles ; sometimes from the laxity of the Ligaments ; for the most part , from a too wide opening of the Mouth . If it be dislocated but on one side , it stands a-skew , and is turned towards the side hurt ; some thing is prominent , the Teeth stand not directly under one another , nor can they be brought together , so that the Mouth remains open . You must draw it towards the opposite side , and reduce it to its place , which is not hard to do ; yea , by a stiff box on the Ear it hath often been restored .

If it be dislocated on both sides , then does it fall forwards , the Mouth stands open , both the Apophyses are prominent , the lower Teeth stand further than the upper , and the temporal Muscles are distended . In this case , let yout Servant hold the Patient's Head firm , or hold it against a Wall ; draw the Jaw-bone first downward , putting both your Thumbs in the Mouth , then backward , and lastly upward .

2. The Collar-bone rarely happens to be luxated , and is seldom set , but it stands somewhat out ; whereby it often comes to pass , that the Patient cannot lift up his hand to his mouth , much less to his head . For restoring it , you are to lay the Patient on his back , and a stone under his shoulder ; then you must draw his Arm forward and backward , as the Dislocation requires ; then press the Clavicle , so raised , down into its place .

3. The Great Bone of the Arm ( Adjutorium ) is never dislocated backward ; seldom upwards and forwards , but for the most part downward : a certain sign of it is , if you find it roundish hardness under the Arm-pits , and on the top of the Shoulder a hollowness , and the Arm be longer , and the Patient cannot bring his hand to his Mouth . It may be reduced several ways ; but these are the most convenient , and the most sure . 1. Let a strong man hold the Patient fast about the hurt Shoulder , and let another draw the Arm downwards ; then lift the upper part of the Arm into its Cavity , and the Bone will be soon restored into its place . 2. Take a strong Ladder , at the foot thereof put a ●tool for the Patient to stand upon ; on the uppermost step , bind something round that may just fit the Arm-pits ; put the Patients Arm upon it , and draw it downward , moving the Shoulder-bone to and fro ; let your Servant , mean while , draw the sound Arm downward , and withal , thrust away the Stool from under the Patient , that whilst he is thus pendulous , the Shoulder-bone may be restored . 3. Lay the Arm-pits of the Patient upon the Shoulder of a strong and taller man than himself ; draw the dislocated Arm downward , so that he lifting up his own Shoulder , the Patient may remain in a pendulous posture : In the mean time , press his Shoulder downward , working the Arm to and fro , until it be restored to its due place . 4. The Glossoc●mium described by Hyppocrates , and approved by Paraeus , is the most convenient of all ; to be seen in the Authors themselves .

4. If the Vertebrae of the Neck be out of joint , the Patient is to be set upon a little low Stool , and his Shoulders pressed downward . After this , his Head is to be lifted up with both hands , turning it to and fro ( yet with as little force as may be ) and thus they are to be reduced . Whereupon the Patient will presently find himself at ease , and turn his head whithe● he pleaseth .

5. If the Vertebrae of the Back be forced outwards , the Patient is to be laid upon his Belly and by two Men and two Ligatures , one tied under the Arm-pits , the other about the Hip he must be strongly stretched out , and the Ve●tebroe's be thrust in again . If they be forced i●wards , it is mortal .

6. If the Os sacrum be out of joint , put you● fingers into the Anus , and press it from within as well as from without , into its place .

7. A Rib dislocated , must not remain long out of its place , lest more grievous Accidents follow . If it be removed out of its Vertebra upwards , then hang the Patient by his Arms over a Door , and so press it in . If it be out of joint downward , the Patient must bend himself , laying his hands upon his Knees , and the Chirurgeon in the mean time , must move to and again the displaced Rib till it be restored to its right place . If it be dislocated inward , lay a sticking Plaister on it , and often pull it away with violence ; and thus sometimes it may be restored ; if not , it often proveth mortal , not being capable to be reduced by the Hands .

8. The Cubitus may be dislocated forward or backward , inward or outward . And sometimes the Radius is likewise dislocated with it , sometimes it remains in its place ; which by handling the part , is easily perceived . If the Cubitus be out forwards , the Arm thereby becomes shorter , & cannot be bent ; the Bone stands out forwards , and behind there is a preternatural hallowness . The forced-out Bone must , as well in this , as in all other kinds of dislocation of the Elbow , be speedily restored ; otherwise there will follow grievous Pain , Inflammation , Feaver , Vomiting of Choler , and sometimes Death it self . Let the Arm be extended obliquely , and so far , that one Bone may not hurt the other in the setting . If the Hands be not strong enough , then bend the dislocated Arm about a Pillar or a Bed-post , and by the help of a Bandage extend it , pressing the Bone backward , until it be replaced . If it be dislocated back-ward , the Arm will then also be shorter , and cannot be bent , the Bone will stand out behind ; and before there is a preternatural cavity . If it be inward or outward , there are the like signs ; only the Tumor will be in the place , to which the Bone hath been forced ; whereas the hollowness is there , whence it hath been forced . All these three dislocations may be easily cured by a convenient Extention , if they be not inveterate . The same is to be understood of the Radius , when forced out of its place .

9. The Hip may be put out of joint four manner of ways chiefly ; inward , outward and forward , but seldom backward . If inward , the Leg is longer , and moveth with difficulty ; the Knee is turned outward , and the head of the Thigh-bone by the hands may be perceiv'd in the Groin . As it is difficult to put in , so easily doth it slip out again , whereby the Part affected is wasted , and the Patient lamed . To reduce it to its place , lay the Patient upon the midst of a Bench or Table ; between his Legs put a strong stick , wound about with Linnen , and upon it let him stifly stretch out his Leg , and the Chirurgeon in the mean time with his hands set it . If outwardly dislocated , the Leg grows shorter , and the Foot is turned inwards . The Patient can then indeed bend his Leg , but hardly bring it to the ground . Though it be not set aright , yet the pain vanisheth of it self , and the Patient in time is able to go without Crutches . Lay him on a Bench or Table as above ; let the Leg be strongly extended , either with hands or Bandage , and mean while reduce it into its place . If the Hip be forced out forward , the Groin is swoln , and the Buttocks fallen , the Leg is neither longer nor shorter , nor cannot be bent but with trouble ; and the Urine is suppressed . Though it be not set aright , yet the Patient in time will be able to go well enough upon it ; though sometimes it falls out , that he must somewhat trail his Leg after him . To restore it , let the Patient lie on his sound side , and strongly stretch out his Leg , press it into its former place ; and in case the hand be too weak , thrust it in with your Knee . If it be dislocated backward , the Patient can neither stretch out , nor bend his Leg , nor is he able to bring his Heel to the ground , and if he should force himself to do so , he would fall backward ; the Leg is shorter , there is a hollowless in the Groins , and if the Buttocks be pressed upwards , you shall find an unusual swelling . Though it be not put in , yet the pain will in time vanish , and then the Leg may be bent again , but it remains shorter and straight , nor is the Foot turned inward nor outward . Lay the Patient on his Belly , and strongly extend his Leg ; mean time apprehend the Thigh bone above the Knee ; stretch it outward from off the sound Leg ; press the Head into its Cavity , in which yet it will not stay , if thenceforth the Patient do not keep himself very quiet .

10. The Dislocations of the Tibia and Fibula , are cured after the same manner as those of the Cubitus and Radius .

11. If the Knee pan be out of its place , let the Patient stand upright , and press it in again ; lay on the side whence it hath been forced away , a hollow Splint , answerable to the shape of the said Pan , and below in the cavity of the Leg , put one or more compressing Splints , binding the whole Leg so stiff , that the Knee may not bend .