RV(>0^ 
 
 ^iiAU 
 
 ^^H^ 
 
 Columbia ©nitjeristttp 
 
 intlieCitpoflfWjgork 
 
 CoUege of ^tPJ^ina"^ ^nb ^urgeon^ 
 Hiljrarp 
 
J 
 
TREAT I S E 
 
 / y O F T H E ^\/^ 
 
 DISEASES 
 
 yfA /^f'i OF THE /Jf,//f^yy: 
 
 BONES; 
 
 Containing an Exk£t and Compleat 
 
 ACCOUNT 
 
 O F T H E 
 
 Nature, Signs, Causes and Cures 
 thereof, in all their various Kinds. 
 
 W I T M » ^ 
 
 Many new and curious OBSERVATIONS con-^^si'^ 
 cerning the Venereal and orher Distfmpf^Sv vV 
 with the neweft and beft Method pf t^iii^JjfeCia 
 . each relpe£live CASE. ^ . ^jg^S^ 
 
 A S A LS O " 4i^V> 
 
 The Figures reprefenting the !i^^f\l T^gJCngs 
 Machines and Inftruments^rt^^^efcriEedT 
 
 Tranflated trom xk^t French of John-Lewis PtiTit 
 of the Royal Academy of Sciences, fworn Sur- 
 geon of Var'is^ and late Matter of his Company. 
 
 L O a B O H: 
 
 Printed for T.Woodward, at the ilalj-Moon^ over-againft 
 St. I?«jf<i//i Church, xiiVlut'Stveit^ m,dcc,xx,vi. 
 
 
iv The PREFACE. 
 
 Surgery ; and the Authors 1 had^ 
 read, had not written any Thing- 
 better. •> 
 
 The Foreigners, and the Stu- 
 dents of our Nation, who were 
 pretent at my private Leilures, 
 were lb well fatisfie3 with them, 
 that they detired 1 would give 
 them my Dictates ; but as 1 had 
 not tranfcrib'd any 'rhing upon that 
 Head, 1 propoled their writing 
 down, themlclves, what they re- 
 lYiembered of riiy XlfTons, promi- 
 ^fing to make what Corrections and 
 Additions were neceflary therein. 
 They did fo ; I kept my Word ; 
 and from the Ledures I then 
 read, a rough Draught was form- 
 ed, whereon 1 have worked with 
 tolerable Succefs. 
 
 M y Manufcript was foon fpread 
 all over Tarts^ and the Fear of fee- 
 ing ii publilhed^ with all its Er- 
 rors, 
 
The P R E F A C E. 
 
 rors, cbligcd me to give it to' the 
 Sicur if Hour}', a Book feller, to 
 print. 
 
 Contrary to my Expcfla- 
 lion, jny Book was tranflated into 
 leveral Languuges. 'I'he tirlt Re- 
 ception proving lb tavourable, I 
 was tempted to let about a fe- 
 cond Edition , which had been 
 more immediately finifhed, had I 
 not been hindered by certain JParts 
 of my Profellion, vviiich prevented 
 my applying my lelt entirely to 
 the Practice of Chuurgical Ob- 
 fervations, and the Cure of Vene- 
 real Diilempers, to which the Pub- 
 lick were deilrous I iliould coniine 
 my felf 
 
 When I have anv leifijre 
 Hours, I will imploy ,them in wri- 
 ting thole Obfervatiqiis I have al- 
 ready made, and which 1 am ftili 
 daily making, in the Practice of our- 
 
 A 3 gery; 
 
The PREFACE. 
 
 gcry; and 1 will publifh them 
 from Time to Time, after this 
 Treatife. This Promiie fhall be 
 effectually performed , and that 
 with the greater Advantage to Stu- 
 dents, by Reafon molt Part ot thofe 
 who have treated of Surgery, are 
 Perfons whp have never praftifed 
 it, or Surgeons to whom the Pub-* 
 lickallovv'd fufficientTime to write ; 
 but not Bufinefs enough to ena- 
 ble them to relate Matters of Faft 
 verified by their own Experience. 
 'Tis the Misfortune of pari: Ages : 
 They who did not practice Sur- 
 gery, have treated of it ; and they 
 who have practiced it moft fuc- 
 cefsfully, have let their Obfervati- 
 ons die with them. 
 
 Wh e r e f o r e Vis nccefTary for 
 fucli as have practiftd, and conti- 
 nue therein, not to be fparing of 
 their Knovvlcdge ; but tliat they 
 either communicate it during their 
 
 Lives, 
 
The PREFACE, vii 
 
 Lives, or at leaft leave it to Per- 
 fons who may publifh it after their 
 Deceale. 
 
 Not to do fo, is to commit a 
 Crime againlt Humanity ; 'tis vio^ 
 lating the Laws of Society ; and 
 ^to ufe that Expreffion) dying 
 infolvent. I hope 1 (hall not de- 
 ferve that Reproach : Thefe Laws 
 are to me fo facred, and I carry 
 the Scruple fo far, that I referve 
 nothing particular for my own 
 Children, although I defign them 
 for Surgery : They (hall be equal 
 Sharers with all the Students ; 
 and (hall have no Advantage o> 
 ver them, but that of being un- 
 der my Eye, and trained up 
 by me. Above all, I will in- 
 fpire them with the Love I bear 
 my Country ; and if, at my 
 Death, I am any Thing indebt- 
 ed to her, I hope they will be 
 able to difcharge for me what 
 
 A 4. I 
 
viii The P R E F A C E. 
 
 1 have not had Time to repay 
 her. 
 
 1 N order to fatisfy the Obhga- 
 tion 1 contracted, 1 begin with the 
 Treat ife of the ^Dijcafes of the Bones : 
 This Work coft me more Pains 
 than 1 imagined. To lave Time, 
 1 was willing the firft Edition fhould 
 be my Guide in finifhing the le- 
 cond ; but 1 found, too late, that 
 I (liould have had lels Trouble if 
 1 had wrought upon a new Plan. 
 The Work will not be lefs valu- 
 able ; 1 dare even believe, that it 
 will be more ufeful to young Sur- 
 geon?, becaufe 1 have followed the 
 Order of the School ; it may indeed 
 tire the M afters of the Art ; but 
 the one will be obliged to me, and 
 the others will excufe it. 
 
 I HOPE it will be forgiven me 
 if the b::"tile is not equal thrcughout 
 the Work, It might have been fo 
 
 if 
 
The P R E F A C E. 
 
 if 1 had perceived fooner 'that 
 it is more difScult to comment up- 
 on a Book, than to wiite a new 
 one. In feme places they will find 
 the fame plain Stile which was pro- 
 per tor nie to life twenty Wars 
 ago, when I wrote the firft Edi- 
 tion : In others they will fee that I 
 have rilen above my felf^ by lome 
 Pieces that I had Leilure to finifh ; 
 but what will make an amends for 
 this Inequality, is the Exactnefs, 
 and Truth in the Relation of Mat- 
 ters of Fad:^ and the ingenious 
 Confeffion that is made of the E- 
 ventSj whether fuccefsful or other- 
 wife. 
 
 Amongst thofe that are ci- 
 ted, the Rupture of the Tendon of 
 Achilles is the only one that has, 
 as yet^ been difputed me ; but, I 
 hope, that in reading what is here 
 faid upon that Head, the Truth 
 will be known by the Proofs I have 
 
 given. 
 
X The PREFACE. 
 
 given, and yet better by the Ob- 
 jections that have been made to 
 it. 'Tvvere to have been vvifhed, 
 that before my printing the Chap^ 
 ter of the Rupture of the Tendons, 
 I had read what Tarceus lays con- 
 cerning that of the Tendon of A- 
 ehilles ; I fliould have quoted 
 him, and perhaps, my Adverfaries 
 would have been latished with that 
 Authority ; it is at lead, as much 
 to be regarded as that of TaUoco- 
 tins J an Author defcending in a 
 right Line from the old Reltorers 
 of the Nofe. 
 
 Let not what I have faid of 
 Tarceus be looked upon as an ufe- 
 lefs Epifode ; I was obliged to 
 juftify my ielf, or rather to pre- 
 vent thofe who might have re- 
 proached me with not having quo- 
 ted fo famous an Author. The 
 Truth is, that not having read 
 tlvat Part of his Book till mine 
 
 w^as 
 
The PREFACE. xi 
 
 was entirely printed off, I could 
 not do him Juftice but in this 
 Preface. 
 
 • The firft Part of this Work 
 treats of the Difeafes that atfe£t 
 the Joints : The Luxations in ge- 
 neral, and each in particular, are 
 amply explained therein ; on their 
 Account I fpeak of the Cliquctis 
 and Sprains ; the laft Chapter is 
 a compleat Treatife of the Amchy^ 
 Ufis ; each Article contains a great 
 Number of Remarks and Obfer- 
 vaiions, which will be of Advan- 
 tage to young Students^ for whole 
 Benefit I write. 
 
 They will alfo be inftrudted 
 in feveral Places, how to prevent 
 being impofed on by certain Bone- 
 fetters : 1 have taken Care to dis- 
 cover the Artifices they ufe a- 
 mon^ the People^ through whofe 
 
 Igno- 
 
xii The PREFACE. 
 
 Ignorance and Simplicity thuy have 
 acquired the fa lie Reputation they 
 enjoy. 
 
 Th e lecond Part contains 
 all the Dileafes that atfecl the Bo- 
 dy of the Bone. Both the Fra- 
 ctures in general, and the fimple 
 and complicated ones, of each Bone 
 in particular, are amply treated of 
 therein : And the Prognoftick, ma- 
 nual Operation, and Cure of all 
 are authorifed by feveral Obfer- 
 vations. In each Part there 
 will be found divers Didempers 
 that have not. been taken Notice 
 of by any Author, ancient or mo- 
 dern. Both in the one and the 
 other I have placed Figures, with 
 alphabetical Letters, to defcribe 
 the Dreffins^s and Machines that 
 are proper for the Cure of fra- 
 ftured or diflocated Bones . The 
 Practice of the ignorant Bonfe- fet- 
 ters 
 
The P R £ F A C E. xiii 
 
 -ters is there let down for the In- 
 lliu£tion of young Pupils, and to 
 difibufe the People. 
 
 The laft Chapter but one Is 
 a very ample Treatife of the Ep^of- 
 tofts and Caries : 1 may venture 
 to fay, that this Difeafe was ne- 
 ver fo exaftly examined into : 
 There are numberlefs Obfervations 
 inferted, to give a clear Iniight 
 into the Matter; and the Apho- 
 rifms, that conclude it, make me 
 flatter my felf, that it will be ac- 
 ceptable to all, who not being im- 
 plicit Admirers of Antiquity, are 
 willing to give their Votes in Fa- 
 vour of fuch new Difcoveries as 
 are founded upon Reafon and Ex- 
 perience. 
 
 The laft Chapter is a Trea- 
 tife of the Rickets, wherein not 
 only the Caufes of the Diftemper 
 and its Symptoms are fearched in^ 
 
 to, 
 
xiv The PREFACE. 
 
 to, but the Reafon of the Soft- 
 nels and Crookednels of the Bones 
 are explained ; the Sentiments of 
 the Authors moft in vogue quo- 
 ted, the Objections anfwered, and 
 the whole concludes with the Cure 
 of this Diftemper. 
 
 - . ' ' "^ 
 
 If I have taken Pains to make 
 
 my Work ufeful, the Bookfeller, 
 
 on his Side, has done his utmoft 
 
 to render the tdition perfedt : The 
 
 Approbation of the Fublick will 
 
 fatisfy the one, and a quick Sale 
 
 will be a Recompence for the 
 
 other. 
 
 ^^ EXTRACT 
 
xv 
 
 TTT 
 
 EXTRACT of the RE- 
 GISTERS of the Roy^ 
 
 al Acadeniy of Sciences, for 
 the Years 1 720, 1721, 
 1722- 
 
 MESSIEURS Utie and 
 Winjlowj who were appoin- 
 ted to examine Mr. Tetit the Sur- 
 geon's Treatifc of the ^ifeafes of the 
 Bones, having made their Report 
 to the Company ; and having laid, 
 that this Work was anfwerable 
 to thofe fignal Proots of Skill in 
 Anatomy, Induftry in Mechanicks, 
 Dexterity in Surgery, Fertility in 
 Invention, Solidity in Pradice, and 
 
 Clear- 
 
xvi EXTRACT, (s^c. 
 
 Clearnefs in Demonilration^ which 
 the Author has^ for thelc many 
 Years, continued to give the Fub- 
 lick, they have judged it worthy 
 of being printed. As a Teilimony 
 whereot 1 have iigned this prefent 
 Certificate. 
 
 Tans the ift oi March 1725. 
 
 FontencUc. 
 Perpet. Secret, to the Royal 
 Academy of Sciences. 
 
 'A' 
 
r o 
 
 TREATISE 
 
 O F T H E 
 
 Difeafes of the Bones. 
 
 H E Difeafes of the Bones are 
 of two Sorts ^ the one alfe£ts 
 the Bones themfelves, and 
 the other their Joints only. 
 The Body of the Bone is fub- 
 ieft to be hurt by a FraUurCy 
 Exofiofis, Caries, Softnefs, and 
 Crookednefs. The Joints are 
 afilided with the Gout, the jinchibfts, Rattling^ 
 Sprainsy and Luxations. I IhaJl begin with the 
 two laft of thele Diftempers* 
 
 B 
 
 BOOK 
 
A Treatise of the 
 
 «S» ®S) W (g© ig® 'S?^ IgO «© ®3) ®® «)® 
 
 BOOK I. 
 
 Of Luxations and Sprains. 
 
 Chap. I. 
 
 0/^LuXATIONS in QeiKYaL- 
 
 LVxation is a Diflocation of one, or more 
 Bones, from the Place where they are na- 
 turally jointed. 
 
 Several Tl^ii^gs are abfolutely necefTary for 
 the Cure of Lusintions. i . One muft have a per- 
 fect Idea of the Structure of the Parts aggrieved. 
 2. One muft know the different Sorts of Lux- 
 ations. 3. What are the Caules. 4. The Signs 
 by which it may be judged that the Bones are 
 diflocated. 5. The Accidents which arife from 
 thence. 6. What may be prefaged^.^ence. 
 And laftly, the different Means that are to be 
 uied in the Cure. 
 
 Struciiire of the Farts. 
 
 An Idea of the Strufture of the Parts may be 
 formed from the Species of the JrtiaiUtiotjy the 
 Lignments, the Mujclcs^ the C.irtilages^ the SinO' 
 via, the Fejfds^ the Bat, and even the Skin, 
 
 Of 
 
D/feafis of the Bones. 3 
 
 Of the Species of Articulation, 
 
 This reprefents to the Chirurgeon the natu- l^hcSp^ 
 ral Form and Figure of Articvlatlo-n, which ^^riciiia- 
 mf y be by a Gcnou^ or Ball and Socket, or by a tion. 
 Ginglymus \ by a Genouy with a large Head, Genu, or 
 and deep Cavity, as that otthe Thigh in the I[- ^^^^ ^^^ 
 ch'fum\ Or by '^Genou with large Head and fhallow Soccr. 
 Cavity, like the Bone of the Arm with the Omo- 
 pl.tta \ or by a Gcmu with a little Head and Imall 
 Cavity, like the Joints of the firft Phalanges of the 
 Fingers, with the OJfa Mctacarpiy Metatarfi, and 
 otJiers. 
 
 The Joints by Ginglymus have fometimes two Gingly* 
 Heads, and two Cavities, as the Leg with the "^"^' 
 Thigh J or three Heads, and three Cavities as 
 the Cubitus, the Humerus, tind others* 
 
 rf ^^"'^ ^^titre of Ligavtents, 
 
 The Ligaments of the Joints are of three . 
 Sorts; the firft ferve only as Tunicles to re- ^^^^^^5^ 
 tain the Sinovia, and to hinder its diffufing it Thrcei 
 felf any where but about the Joints. The fe- Sorts, 
 cond are as Bands to ftrengthen the Bones, or, 
 to limit their Motions, like the circular Liga-^ 
 •ments of the Joints by a Gcnou, the right, ob- 
 lique, or traniverie Ligaments of the Joints by 
 Ginglymus, whereof I ihall make Mention in 
 treating of each in particular. 
 
 The laft Sort ot Ligaments comprehends thofe 
 which di reft the Motions of the Body, as the 
 Semi-crrcuUg: Ligaments ot the upper and low- 
 er Part of the Radius, the hinder one of the. 
 rrocejfus Dcmiformis^ and feyerul others. 
 
 B 1 . Of 
 
4 A T KE ATI SE of the 
 
 Of the Lifpofition of the Mufcles, 
 
 Diruofui- For the Cure of Luxations, the Knowledge 
 Mufcles.'' °^ ^^^ Difpofitlon of the Mulcles which move 
 the Joints, together with their Number, Force, 
 and Situation, and whether they have Tendons, 
 or Jfoncurofeis, is very neceflary. Without this 
 Knowledge, 'tis impoJFible to have a juft Idea 
 of the Dillocatioji of Bones, or what Meafures 
 rauil be taken to reduce them. One muft alfo 
 know which Mufcles are peculiar to the Motion 
 of the Joint, and which only pafs by it, 
 in order to infert themfelves ellewhere •, all 
 which 'tis very requifite to obferve, as will be 
 iQQn by the Sequel. 
 
 Of Cartilages^ 
 
 Cartila- Some Cartilages cover and render fmooth and 
 ges : polifhed, the Heads and Cavities of th^ Bones, 
 5 Kinds, others raife the 'Sides ^ and there is a third 
 Sort, which, w ithout belonging to any of the 
 articular Bones, is placed between both : Thefe 
 are called Mediums^ this is obferved in the Ar- 
 ticulation of the under Jaw, in that of the Leg 
 with the Thigh, and of the Cubitus with the 
 Carpus. 
 
 Of the Sinovia, 
 
 Sinovia. ^ As to the Sinoviay 'tis known that it flows from 
 little Glands near the Ligaments. 'Tis a Li- 
 quor fomething vifcous, but very clear and 
 tranfparent, which falls upon the jointing of the 
 Bones, to facilitate their Motion. What is fu- 
 perfluous is taken back again by abforbent Pipes 
 or Glandsj as the fuperfluows Moifture is re- 
 taken 
 
 The Si 
 
 novial 
 
 Gliiads. 
 
s 
 
 Bifeafes of the Bones. 5 
 
 taken by t\ie Pun^a lachrymaUaj as the Lympha of Abfor- 
 the Ventricles of the Brain is conduced to t^^^e ^^^"^ 
 pituitary Gland by the Infundlbuhm \ or laftly, 
 as the Lympha of the Pericardium, with that of 
 the Cavity of the Breaft, of the Venter infimus, 
 and others, are refum'd by abforbent Pipes or other ab- 
 Glands, when there is a Quantity more than ne- 5[^*^^'^ 
 ceiTary to lubricate thofe Parts, and make them '^^ ^' 
 flip and move eafily one againft the other. 
 
 Of the ?aj]age of the Veffeh. 
 
 One muft obferve what Courfe the great Vef- Paflageof 
 fels take, to avoid preffing them', either in Ex- ^^^ Vef- 
 tenfions, or in putting on Bandages. Befides, ^^^^' 
 this Knowledge enables us to give a Reafon for 
 Phenomena, to make our Prognoftick of the 
 IlTue, and to determine us tfooner or later to 
 fet about the Reduftion. 
 
 Of the Fat. 
 
 The Fat is necefTary to be obfervM chiefly F«it. 
 for the right Application ot the Straps, in thofe 
 who are in good Cafe. It even directs us to 
 general Remedies, and makes us prelcribc a 
 Regimen more or lefs ftrict accordingly. 
 
 Of the Skhu 
 
 As to the Skin, one muftconfider its Wrin- sidn. 
 kles, Scars, Wounds, Ulcers, IlTues, and De- Obfcrva- 
 fefts of Conformation, as Warts, and other Ex« ^io»S' 
 crefcencies, to the End that one may avoid 
 them, as fhall be remarked in the Sequel. 
 
 Upon what has been faid, the following Re- 
 flexions may be made. 
 
 Firfi Refidiion, The Articulations by a C'lngli- Firrt Re- 
 B 3 rim% fli^ion. 
 
^Treatise of the 
 
 mus, are iiot eafily dlflocated and their Luxati- 
 ons are almoft always incompleat, both becaufe 
 they have leveral Heads, and (everal Cavities, 
 whence a great Part of their Surfaces touch 
 each other ^ ai.d becaufe their Ligaments are 
 very fhort, very many, aud have different Di- 
 reftions, which renders them very ftronL^ 
 
 Second Refuiiion, The Bor.es that are joiii'd 
 by Ghiglymus have their Motion reftrain'd to 
 Bending and Exrenfion. 
 
 Tiyird Rtfieclion. Thofe which are joinM by a 
 Cemu having but one Head, and one Cavity, 
 hardly touch each other but at a Point. 
 
 Fourth Rcflcclion. The Ligaments of the Joints 
 by a Cetiouy are more loofe, and not fo ftrong, 
 nor fo numerous as the others, and have gene- 
 rally bur one Direftictn, except at the Articu- 
 lation of the Thigh Bone with the Hip. 
 
 Fifth RcfiecHon. TheCenoux are not at all li- 
 mited in their Motions, fmce they perform 
 Adduftion, Abduction, and Rotatio::. 
 
 Sixth Refusion. The Genoux are always pri- 
 mary, that is to fay, the firft Articulation of 
 the Limbs, as may be feen by the Articulation 
 flfthe Arm, which is the firft of the upper Ex- 
 tremity •, by that of the Wrift, which is the 
 firft of the Parts of the Har.d • and by that of 
 the firft Th.tlnrix of the Fingers ^ the fecond and 
 third are joined by T^Chiglymus. 
 
 It is the fame -in the lower Extremity, ex- 
 cept the firft Articulation of the Foot, which 
 is a Ch.giymusy becaule the Foot ought to be ca- 
 pable ot a greater Refiftance than the Hand, 
 to fuftain the Weight of the Body. 
 
 The Gotoiix being thus Primary, are more lia- 
 ble to Luxations; becaufe in Blows and Fall 5, 
 the Strain is more felt there, than eliewhere. 
 
 Ssvtnth 
 
Difiafis of the Eon E s, 7 
 
 Seventh Reflection. For this Reafon, and all Scrcnrk 
 thole aforementioned, it is demoiiftrable, that ^^^^'^^^" 
 the Bones jointed by a Gemu^ are more eafily 
 diflocated than thole that are join'd by a Cin- 
 glymus. 
 
 Eighth ReflcBio-fU 'Tis alio obferved that they Eighth 
 generally lulfer a compleat Luxatiort^ which is Reflcai- 
 dilferent Irom the Ginglymus^ which can hardly on. 
 ever be compleatly disjointed by an external 
 Caufe without fome terrible Accidents happen- 
 ing, ofcen the Lofs of the Limb, and even Death 
 it lelf ", caufed by the Rupture of the Liga- 
 ments, or the Tendons, and fometimes of the 
 VeiTels, and Membranes. 
 
 If we confider the long Way that a Bone 
 joinM by a Cinglymus muft be forced, to be en- 
 tirely diflocated, we cannot wonder at the 
 Di (orders caus'd by its compleat Luxation. 
 
 It may alfo be obferved, that if an incom- Obfer?*- 
 pleat Luxation feldom happens to the Bones tion. 
 join'd by a Gemu^ 'tis becaule their Heads are 
 exaftly round, and the Sides of their Cavities 
 very narrow -^ for which Reafon the Head being 
 upon the Side, is fupported only by one Point, 
 whence it (lips, not being able to Hay there, and 
 Ibmetimes re-enters its Cavity, fometimes falls 
 farther off, amongft the Parts adjacent. 
 
 Neverthelefs, Authors fay, that the Bones Remark 
 of the Thigh and Arm may be disjointed more JjP^" ^^ 
 or lefs. This ought not always to be under- 
 ftood of an incompleat Luxation, but of a com- 
 pleat one -, when the Bone, being entirely forced 
 out oi its Cavity, may be removed to a greater 
 or lefTer Diftance from it, either by a Contra- 
 ftion of the Mufcles, the Fall of the fick Per- 
 fon, his Mojtion after the Fall, or the unprofi- 
 table Experiments of thole who are neither 
 B ^ verfecj 
 
Kinth 
 Rcflcai 
 
 CD. 
 
 Tenth 
 Reflecti 
 
 on. 
 
 8 J T TxZ AT iSE of the 
 
 verfed in the Theory, nor Praftice of the(* 
 Difeafes. 
 
 Ninth Refletlion. The Difpofidon and Force 
 of the Mufcles help us to give a Reafon for the 
 dilferent Figure of the I.imbs when diflocated, 
 and to find the Place where the Head of the 
 Bone lies. It aUo teaches us the eafieft Means 
 to fet it, and how to uifpofe, place, and propor- 
 tion the Strength employed for Extenfions, 
 Counter-Exceniions, and Conformations. 
 
 Tenfh Reflection. It is ufeful to have a juft Idea 
 of the Shape and Figure of Cartilages^ efpe- 
 ciallv of thofe which are Mediums, and thofe 
 which form the Sides of the Cavities ^ becaule 
 the one may give Way whil'ftthe Bone is re- 
 ducing, and one muft avoid over-letting the o-» 
 ther in the Cavicy, whilft the Head of the 
 diflocated Hone is entering into it. 
 Eleventh Elevef7th Reflexion. 'Tis not lefs necefTary to 
 Reflefii-J be ski! I'd in the Nature of the Sinovia, which 
 ^^' runs into the Articulation. 'Tis known that 
 
 this Liquor l^rves to facilitate the Motion of 
 the Joints, as Greafe does that of Wheels •, and 
 that when it abounds too much, and is corrupted 
 and thick, it hinders their Motion. Sometimes 
 it unites the Bones, and foders them Cif I may 
 fo Ipeak) which caufes j4nchilofes ^ or elfe it 
 drives and forces them out of their Cavities, 
 which occafions troublefome Luxations. Often 
 it corrodes and rots the Cartilages, and even 
 the Bones themfelves, whence happen Deflux- 
 ions attended with very fatal Accidents. 
 
 Of the Difference of Luxations, 
 
 Different The Kinds and Differences of Luxations are 
 
 Sorts of derived from feveral Things, njiz.. from the Ar- 
 
 Luxati- ticulatioa of the Bone ^ from the Place it ^et' 
 ons. jjgj 
 
D'jfeafes of the Bones, 9 
 
 ties in when diflocated, from the Caufes ca- 
 pable of disjointing it^ the Time it has been 
 ib ^ and laftly, from the Diftempers and Acci- 
 dents that accompany Luxations. 
 
 From the Species of the Articulationm 
 
 Some happen to Bones join'd by a Gemu, the Species of 
 others to thofe joined by a Ginglymus •, to which ^^^ ^^"' 
 may be added the opening of the Sutures, the dif- ^"^^"^'^^ 
 placing ot the Teeth, and the Separation of the 
 Bones joined by a Cartilage. 
 
 From the Place where the Bone fettles when 
 dijlocated. 
 
 Luxations are compleat, when the Bone is Place 
 forced out of its Cavity ^ and incom-v where 
 pleat, when it refts upon the Edge of it, or ^^^ ^°°® 
 elfe if there are divers Heads and Cavities ^ ^^"^^^* 
 'tis alfb called incompleatif one of the Heads 
 lodges ill the neighbouring Cavity ; as when 
 the external Condyle of the Femur flips into the 
 internal Cavity of the Tibia. 
 
 As to the Place, one may again fay, that the Remark. 
 Luxation is internal, when the Bone is driven 
 inwards ^ that it is external, when 'tis forc'd 
 outwards ^ that 'tis upwards, when the Bone 
 is thruft upwards, and downwards, when fal- 
 len downwards : And they compound thefe 
 Terms when the Situation is combined, as when 
 the diflocated Bone has taken a Diagonal, equal- 
 ly near to the inward and upper, or to the in- 
 ward and lower Part, and fo of the reft. 
 
 Of 
 
Internal 
 Caufcs. 
 
 There 
 arc Six. 
 
 lo J T f\. E AT 1 SE of the 
 
 Of the Canfes of Luxation, 
 
 Caufcs." There are two Sorts of Luxatio;is, the one 
 proceed from internal Caufes, the other from 
 external. 
 
 Of Litxations proceeding from internal 
 Canfes. 
 
 Some are produced by the Convulfion of 
 the Mulcles, others by the weaknei's ot the Li- 
 gaments, fome by the Pally, together with 
 the Weight of the Body, or of the Limb on- 
 ly, and others again by a ferous Matter, 
 whereby the Ligaments are foJden and relaxed. 
 There are fome that are caufed by the Sinovia, 
 which forces the Head of tlie Bone out of its 
 Cavity, and others that happen from the fwel- 
 Kng of the Bone it felf, as one fees in Rickety 
 Perfbns, or fuch as live in fenny Places, or work 
 in Lead, Quick-filver, and other Mines. 
 
 Of the Difference of Litxations, derive J from 
 the Difeafes and Accidents attending them. 
 
 Luxation. The one are called Simple, becaufe not ac- 
 Simple. companied with any grievous Diftempers or Ac- 
 cidents •, others are Compound, becaufe feve- 
 ral Bones happen to be diflocated ^ and fuch 
 as are attended with Impofthumes, Wounds, 
 Ulcers, Frailures, infupportable Pain, Fevers, 
 want of Sleep, Convulfion?, or the Palfy, ar^ 
 termed complicated. 
 
 Of the Caiifes, 
 
 'Tls neceffary to examine tlie Caules of Lux- 
 ations, which were mentioned in fpeaking of the 
 
 dif- 
 
 Com 
 pound 
 
 CompH 
 caica. 
 
Difeafes of r/j^ B o N E s, 1 1 
 
 dllferent Kinds of them: 1 will begin by the 
 
 firft of the internal Caufes, that is, permanent 
 
 GoiiVulfions. 
 
 ' i is eafy toconceive, thatif the Mufcles which Explica- 
 
 extend a Part, remain long contraded, thofe ^'^n of 
 
 which are deftined to a contrary Motion, be- ^'^^ ^*"" 
 
 ing no longer able to keep it in an zyiiqulitbrium, 
 
 the Head of the Bone muft be forced towards 
 
 tlie relaxed Mufcles, and the Limb will be Pcrma- 
 
 driven on the contrary Side by the Mufcles that "^'^'^ ,r 
 \r i • L r • r- Convulli- 
 
 are convulied, as is often ieen ni Cramps. ^^^^ 
 
 The Weaknef? of the Ligaments, tlie Palfy, The Pol- 
 and the Weight of a Part, are great Caufes of fy. 
 Luxations : For Example, if the Ligaments 
 that join the Humerus with the Shoulder are 
 relaxed, or the Mufcles, that move the Arm, 
 paralitick, the Weight of the Part will force 
 the Head of the Humerus out of the Cavity of 
 the Shoulder, becaufe the Ligaments can no 
 longer withhold it, nor have the Mufcles 
 Strength to fuftain the Arm. 
 
 'Lis not to be wondered at if the Bones are Relaxatl- 
 
 diflocated, when a ferous Matter overflowing, on of the 
 
 drenches and relaxes the Lieaments that ferve ^^t' 
 
 -. merits* 
 
 to ftrengthen the Joint, altho' the Mufcles are 
 
 not paralitick -^ becaufe that the Litter are not 
 always contrafted, and the Weight of the Limb 
 ads at all Times. 
 
 It's obfervable, that the Ligaments of the Rc- 
 Joints ferve, together with the Mufcles, to main- "^a^"^^^- 
 tain the articulated Bones in their rie;ht Pofi- 
 tion •, and that they fucceed each other in this 
 Office, as it were to relieve one another, not 
 being always contracted together ^ for which 
 . Reafon there happen Luxations by the Relax- 
 ation of the Ligaments, the' the Mufcles are 
 fovind j and in the Palfy the fame falls out, tho* 
 
 the 
 
42 A T K^ AT isz of the 
 
 the Ligaments retain entirely their elaftic 
 
 Force. 
 The Si- 1 he Redundance of the Sinovia will force the 
 tiovia the Bones from their Sockets by little and lit- 
 Caufc oftle^ becaufe in Proportion as this Liquor 
 Luxation, jncreafes, it removes the Head of the Bone from 
 
 its Cavity, which is the Caufe of Luxation, 
 
 and often of an jinchilofis. 
 Extern al That Strainings, Blows, or Falls, ihould caufe 
 Caufes. Luxations, is not at all extraordinary ^ 'tis {een 
 
 every Day \ but it hardly ever happens but 
 
 when the Limbs are at a Diftance from the 
 
 Body, as we fhall remark in the lequel of this 
 
 Difcourfe. 
 
 Of the DiagfioJIick Signs, 
 
 Diagno- Thefe Signs are common or proper, 
 ftick. The common are thofe which are met with 
 
 Common, in all Luxations •, and the proper are thofe by 
 Proper, which we diftinguiih every Species. 
 
 The common Signs are Pain, and the Weak- 
 nefs of the Limb. The proper ones are the 
 Hollow that is found at the Place from whence 
 the Bone is forced, and the Rifing that is ob- 
 ferved where it has fettled-, the Limb is longer 
 or ihorter, and turns to one Side or t'other, ac- 
 cording to the different Kinds of Diflocation, 
 which fliall be explained at full Length, when 
 1 enter upon an Enumeration of the Signs by 
 which we know a compleat Luxation from an 
 incompleat one, and thofe which proceed from 
 an internal Caufe from thofe which h^ippen 
 thro' an external one, whether upwards, down- 
 wards. Anterior or ?oJlcr'ior. 
 Common 'Tis obferved that the Pain and V.^caknef*; of a 
 and equi- Limb are not o:ily common, but equivocal Signs. 
 vocal There are Perfons fo fufceptible of Pain, that 
 Sign^ the 
 
t. 
 Luxation. 
 
 B'lfeafes of r^^ B o n E s. 19 
 
 the leaft is intolerable to them •, and then the 
 Weaknefs, or Inability of moving rhe Part may 
 aril'e from the Fear of fuflfering. On the o- 
 ther Hand, there are People who bear Pam 
 with Patience, and will let the diflocated Parts 
 be moved without complaining. 
 
 Of the Signs of aii inco??tpleat Litxation, 
 
 1. The Joint is raifed higher than it Signs of 
 fhouldbe. anincom- 
 
 2. The Limb hardly changes its Figure or P'^^^^ 
 Length. 
 
 3. The Partis almoft indifferent *, or, to fpeak 
 more properly, is not more difpoled to move on 
 one Side than t'other, which is not fo in a com- 
 pleat Luxation. 
 
 4. The Pains are more acute than in a corn- 
 pleat Luxation. Let us give the Reafons for 
 all thefe Things. 
 
 The Joint appears higher than it ought to Explic«- 
 be, becaufethe Head of the Bone is raifed up- tionofthe 
 on the Side of the Cavity, which makes it take Signs. 
 a Sally outwards. 
 
 The Limb hardly changes its Figure, or 
 Length, becaufe the Head of the Bone fcarce- 
 Jy removes from the Center of the Cavity ; 
 or, at leaft, a great deal lefs than in a compleac 
 Luxation. 
 
 The Part is not more difpofed to move on 
 one bide than t'other, becaufe the Mufcles are 
 almoft equally extended, feeing that the Re- 
 moval ot the Head of the Bone is almoft at an 
 equal Diftance from their Origin. 
 
 The Patients Pains are much more fharp than 
 in a compleat Luxation^ efpecially when the 
 Sides of the Cavity are high, becaule the Liga- 
 ments and Mufcles fiUfer a greater Extenfion 
 
 when 
 
H 
 
 Other 
 Signs. 
 
 A Treatise of the 
 
 when tlie Head of the Bone refts upon the 
 Side of its Socket, than when 'tis entirely out ; 
 it is not altogether the lame if the Sides of the 
 Cavity are lets railed. 
 
 Of the S'jgns of Luxation proceeding from 
 i?!ter?i/2l Caiifes, 
 
 1. The Part is unfteady as if it hung by 
 a Thread, becaufe it is always paralitlck, which 
 is fomecimes the Caule, and Ibmetimes the 
 
 , Effeel of the Luxation. 
 
 2. A void Space is felt about the Articu- 
 lation, between the Head of the Bone and 
 the Hollow that receives it, wh ch is the Confe- 
 quence ol^ the Pally, the Relaxation of the Li-' 
 gaments, and the Weight of the Part affefted, 
 which endeavours to feparate the articulated 
 Bones from each other. 3. The Bone is eafily 
 reduced, and as eafily dilplaced a^ain ^ becauie 
 the Ligaments and Mufcles having loft their 
 elaftick Faculties, can neither refift the Ope- 
 ration of reducing the Bone, nor retain it in 
 its right Pofition, when replaced. 
 
 The Part is longer than ufual, becaufe nei- 
 ther the Mufcles nor Ligaments perform their 
 Office \ wherefore the Limb is drawn out by its 
 own Weight. 
 
 Thele are the Signs given us by Authors, but 
 they are not fufficient, fince they are only to be 
 met with in the Luxationsof the upper Extremi- 
 ties proceeding from internal Caules, thro' the 
 Pally of the Mulcles, and the Relaxation 
 of the Ligaments. Wherefore it muft be fhown, 
 that they feldom are found in the lower Extre- 
 mities, and moreover, that there are fome Signs 
 that fhow when the Luxation is caufed by the 
 Pally, others when it prffceds from Convulfi- 
 
 ons. 
 
Difeafes of t/;<? B o N E s. I $ 
 
 ons, and others again when it is from the Re- 
 laxation of the Ligaments, or the Redundance 
 of the Sinovia. 
 
 I fay that all thefe Signs are only met with Rcn^a^"^* 
 in Luxations proceeding from internal Caules, 
 that affecl the upper Extremities, thro' the 
 Palfy of the Mufclt-s, together with the Re- 
 laxation of the Ligaments •, becaufe that then 
 nothing but the NA^eight of the Arm can re- 
 move the Head of the Bone, and make the Limb 
 longer. 'Tis not tha fame with the lower 
 Extremity, which lerves to fuftain the Body, 
 and is not pendant, wherefore it muft rather 
 be fhorten'd than lengthen'd, if the Weight of 
 the Body a8:s upon it. 
 
 The Signs of the Luxation's being cauled by Signs of 
 the Palfy are. i. The leannefs of the Part, the Palfy, 
 •which often feels but little Pain, and the Bone ,. ^^" r 
 is ealily reduced, i. The Difficulty of con- ^^^^"Lip-a- 
 taining the Bone when replaced. 3. Tfhe Limbs ments. 
 that are diflocated by the Relaxation of the 
 Ligaments, without the Mufcles being parali- 
 tick, are not lean -, /^hey are fenfible of Pain, the , 
 
 Joints fwell, the Limb is fhortened and liable ^^ ^ 
 to all the Diftortions which the Contraction ot 
 the Mufcles caufes in other Luxations. 
 
 Befides, lefs Strength is requifite to reduce 
 thefe, than thofe which proceed from exter- 
 nal Caufes •, neither need the Bandages that Remarks, 
 contain them be fo flrong, as fve fhall obferve 
 in treating of them feveraliy. 
 
 Luxations proceeding from an internal. Caufe 
 produced by Convulfions, are attended with ^°"^"^"^ 
 Pain, both when they commence, whilft they caufj'^of 
 are compleating, and when compleated. They Dinocati- 
 are very hard to reduce, as fhall be ihown in ons. 
 particular in the Courte of this Work. 
 
 'Twill 
 
perfluity 
 of the 
 
 i6 y^ Treatise ofthe 
 
 Signs of 'Twill be known that the Luxation is caufed 
 the Su- by fj^g Superfluity and Coagulation of the Sino- 
 vity when 'tis impofTible to make the Bone re- 
 enter its Cavity, although it is eafy to bring it 
 both to the Edges of it, and beyond them : Be- 
 fides, one fhall be fenfible of a Refiftance in 
 endeavouring to force its Entrance, and one fhall 
 hear a Noife like that which is made by knead- 
 ing Fuller'sEarth. 
 
 Children that have the Rickets are fubje£t 
 
 to Luxations, cauled by the fwelUng of the 
 
 Heads and Cavities of the Bones ; becaufe 
 
 of the Heads grow larger, and the Cavities are 
 
 The 
 
 Swelling 
 of the 
 Bones the 
 C^aufe 
 
 Luxati- 
 ons. 
 
 filled up by the Tumour at one and the fame 
 Time, whence there is no longer any Proportion 
 between the one and the other, and the Bones 
 leparate and diHocate. The fame Thing hap- 
 pens in Luxations that proceed from Strains in 
 hard Labour. 
 Obferva- A Child had its Thigh disjointed by the ill 
 tion. Management of a Midwife, in bringing it with 
 the Feet foiemoft •, which was not perceived till 
 five Years afterwards. They adviled with me 
 to know my Opinion, which was, that this 
 Incurable Luxation was abfolutely incurable, and that 
 Luxation, for two Reafons. 
 
 Firft The firfl is, its long flanding : The frefh ones 
 
 Keafon. Qp ^ Month or two fometimes recover, but one 
 
 ought not to hope to cure one of five Years. 
 
 Second The fecond Reafon why this Luxation was 
 
 Reafon. incurable after five Years, is, that at the*Birth, 
 
 all the bony Parts are fo tender that they 
 
 grow quicklv> and with Eafe : In growing they 
 
 acquire Hardnefs, and either don't retain, or 
 
 don't take their ufual Shape, but by adapting 
 
 themfelves to each other : Wherefore the Head 
 
 of the Femury after five Years, is no longer of a 
 
 round Figure, and the Cavity of the Jfchion mu/t 
 
 be 
 
Dife/ifcs of the BoNES* 1 7 
 
 be worn out, by Reafon of its not being ufed \ 
 fb tliat thefe two Pnrts which muft grow at 
 tlie lime Time, not being able to moul J them- 
 felves to each other, and prefervethe Relaxa- 
 
 -tion that ought to be between the Pieces thaC 
 compolb this Articulation, it is impolhble to 
 
 • replace them in their natural State. 'lis cer- 
 tain, that the Head ot" the Vemur had formed 
 
 -It lelt a new Refidence, at the Expence of the 
 Parrs near the ftrange Place where it has let- 
 tied. 
 
 'Tis even reafonable to think, that if at pre- RcflcQU 
 fent this Thigh Ihould happen, by ^ny violent on* 
 Fall, to be forced from the ft range Place where 
 it is, the Surgeon would be obliged to re- inflate 
 it in the fame : For altho' a Stranger, five Year3 
 
 ;Refidence therein has naturalized it there- 
 unto, and the Cavity ot the Ifchionj formerly 
 
 ,its natural abode, would then be a ftrange Place 
 to it. 
 
 Signs which fiem the Thee where the Bon^ 
 is fettled. 
 
 M 
 
 The Bones diflocate upwards, downwards, Tm 
 ^forwards, or backwards ; and each of thefe Lux- Sisns. 
 ations is diftinguifhed by the following Signs. 
 
 'Tis a general Rule that when a Bone is dis- Of gene- 
 jointed, the End of the fime Bone whiclvis/op- ralRuies* 
 pofite to the Luxation will be on the contrary 
 Side to where the Head is. U the find of the 
 Bone oppofite to that whicli is disjointe^tu^iis 
 Outwards, the. Dillocation is inwards r*il ic 
 turns inwards, the Luxation is outwaiok-, and 
 fo of the reft, except in fome Luxations pro- 
 ceeding from internal Caules, as ha? been 
 ^uft ©bfervsd. 
 
 <C5 J^h^C 
 
li A Tke ATI SE of the 
 
 What 1 have faid generally happens only hy 
 Reafon of the Head of the Bone's removing 
 from, or drawing near to the Mufcles that 
 move the Bone. 
 ExpUna- In order to comprehend this, it is to be ob- 
 tioa. ferved, that in their natural State, the Muf- 
 cles of the Articulations are almoft equally di- 
 flant from the fulcrum of the Bone : But if 
 the Bone diflocates, it draws near to the Ori- 
 gin of fbme Mufcles, and removes from that 
 of Ibme others: Thofe to which the Bone ap- 
 proaches muft be relaxed, and the others ve- 
 ry much ftretch'd. The firft will be (as one 
 may fay) without Adion, which will give the 
 others the Opportunity of drawing the Part on 
 their Side ^ confequently if the Head of the 
 Arm-Bone is forced inwards, the Elbow will 
 be turned outwards. 
 
 There are befides an infinite Number of Signs, 
 but as they are peculiar to each diflocated Part, 
 I fhall only mention them in the particular Ac* 
 count of each Luxation 
 
 -^^ 
 
 >i • 
 
 • Of the Accidents, 
 
 j^jj^j. The Accidents that attend Luxations are, 
 
 dents of Pain, Lofs of Motion, convulfiveTwitchings, th« 
 Luxati- Palfy, Reftlefsnefs, Inflammations, Gangrenes, 
 oil*- Rattling, Amhilofesj Numbnefs, and others, 
 
 which iliall be explained in the Sequel. 
 
 K^AfiJjorifms of Ufe in progyiojlicat ing. 
 
 I -A 
 
 ..f! 
 
 'he Luxation of a C'ujglymus is more dan* 
 geroiis than that of a Cem. 
 
 2. The compleat Luxation is more dange- 
 rous than that which is incompleat. 
 
 s- 4 
 
Brfiafes of the Bone 5. l^ 
 
 3. A Luxation from an internal C;uire is hard- 
 er to be cured, than that which is tVom aa 
 external one \ and very often 'tis incurable thro'* 
 the Difficulty of deftroying the Caufe. 
 
 4. Old Diflncations are harder to Heduce than • 
 thole newly contra£led. \ 
 
 5. Thole which are attended with Fradure^ 
 ^nchilofesy Impofthumes, Wounds, Ulcers, and. 
 other Dileafes, are very dangerous' •, becaufe each 
 ofthefe Diftempers requires a particular Cure, 
 the which is, in itfelf, rendered difficult by the 
 Luxation that accompanies it. 
 
 6. The Articulations that have many Muf- 
 cles are difficult to be diflocated, or reduced, be- 
 caufe the Stroke or the Fall, muft force the 
 Mufcles to be able to difplace the Bone, and one 
 mult get the better ot their Refinance, and 
 extend them in order to reinflate it in its 
 Socket. 
 
 7. The Limbsof young People, and Women, 
 diflocate more eafily than thofe of People in 
 Years, and ftrong Men ^ k^becaufe the Mufcles 
 have lefs Force in the one than in the others. 
 
 8. The more difficult a Limb is to luxate, the 
 more painful its Diilocation is •, becaufe the Li- 
 gaments, Tendons, and Mufcles, fuffer a more 
 violent Difteniion. 
 
 9. If the Patient feels great Pain in the Joint,' 
 after the Surgeon has ufed his Endeavours to re- 
 duce the Bone, 'tis a Sign the Redudion is not 
 perfeft, that fome Tendons or Ligaments havft 
 be'fn flretch'd, or elfe that the Head of tlie 
 Bone prelfes fome Part of a Ligament bft'ween 
 it and the Socket. ^ 
 
 10. Luxations caufed by the gathering ofthe 
 SinovUy are more difficult to cure, than thoJe 
 which proceed from the Relaxation of tne Li- 
 gaments, by Rcafon that 'tis hiirder for the 
 
 C 2 Medi- 
 
^' 
 
 20 ^ T R E A 1 1 s E »/ tj:fa 
 
 Medicir.cs to penetrate to the joint where the 
 Slnovi.i lies, t}i:iii to the Sides where (lie Liga- 
 ments are. 
 
 IT. The incompleat Diflocations in the Rick- 
 ets vaiiifh of themfelves when the bones of 
 the Children unknit, provided they are hin- 
 derevi from walking cxce/hvely. The compleat 
 
 uxations are incurable. 
 
 12. When rickety Children fall, they are 
 more fubjed to break their Limbs, than diflo- 
 cate them •, unlefs there be ah-eady fome Dif- 
 pohtlon in them towards a Luxation, proceed- 
 ing from an internal Caufe -^ and this, by Rea- 
 lon that their Bones are loft, ?nd bend, and 
 have not Forqe to refift againfi the Articulati- 
 on liiJficiently to diflodge the Bone from its 
 Cavity. 
 
 13. A Luxation caufed by the Palfy or 
 Convulfions, is a lefs troublefbme Diftemper 
 than its Caufe \ it is eafily reduced, and as ea- 
 fily difplaced \ fo that the Bone is with Diffi- 
 culty kept in its Cavity. 
 
 1 4. That which is the Confequence of the 
 Pally, is infinitely longer in curing, than that 
 which proceeds from Convulfions. 
 
 I Ihall enter upon the Particulars of Prog- 
 noftication when I treat of the feveral Sorts of 
 Luxations. 
 
 Of the Cure of Luxations* 
 
 Thft Luxations indicate three Things for their 
 
 Cure; Cur^.'l The Firft is to reduce the diflocated 
 recelrary ^^"f^ T^^^^ Second is to keep it in its right 
 Place when reduced. And the Third is to cor- 
 AcuiM- ^^^ prefent, and prevejit future Accidents, 
 live indi- The firft Indication is called Curative, becaule 
 cution. it precilely ihews us what muft be done for the 
 
 Cure 
 
D/fi^fis of tbs Bones. 21 
 
 Cure of die Patient. Now what muft be done 
 is to reduce the Bone, which cannot always be 
 brought about, becaule oF the following Com- 
 plications. 
 
 If there happen to be a Fra^ure, great Ten- A Coun- 
 fion, or violent Contufion, it is impoifjble to ^^^-}^^^'' 
 reduce the Luxation. For Ii]ftance, it the Arm 
 Bone were broken in the middle, and flipt at 
 the Shoulder, one muft abfolutely give over the 
 Luxation, becaufe 'twould be fmpoillble to 
 make the Extenfions neceliary to reduce it, un- 
 lefs it be in the Cale laid down in the Sequel. 
 
 When there is a Swelling caufed by a violent A Counr 
 Contufion, and not by the preffing of the Head ter-Indi- 
 oi the diflocated Bone upon the VefTels, or o- nation, 
 ther Parts-, one muft firft of all endeavour to 
 cure the Tenfion, Contufion, or Swelling ^ both 
 becnufe thefe Accidents are troublefome in them- 
 lelves, and hinder the making of the neceffary 
 Extenfions, and becaufe .they very often render* 
 the Knowledge of the Diftemper uncertain an4 jt 
 
 difficult. But if the Tumour happens thro' mJ^ I 
 the prefllng of the fanguinary Veffels by the 
 Head of the disjointed Bone, it muft be re- 
 duced asfoon as poflible, and by that Means 
 the Swelling willceale. 
 
 Sharp Pain does not hinder the reducing the 
 Part inftantly, but when the ftrange Situation 
 of the diflocated Bone is not the only Caufe 
 of it. 
 
 There are three Things to be done to reduce , Opera- 
 a diflocated Bone, 1//2.. Extenfion, Counter-Ex- tions in 
 tenfion, and the guiding the Bone into its rcaucin^ 
 Socket. theBon«> 
 
 We ihall call the Motion that we make in EJcpiana- 
 drawing the iiidifpofed Part to us, Extenfion, don. 
 and we ihall term Counter-Extenfion the Ea- 
 deavours we uftf to. draw the Part aH'ccled to- 
 C 3 wards 
 
22 A T KZ AT \%z of the 
 
 wards the Body, or to with-hold the Body, for 
 fear it Ihould yield with the Partaifected whilft 
 An In- one is drawine; it to extend it. 
 ftruaion To be fully' iiiftruded in thefe two Operati- 
 ^""'^Y'-f °"''' ^'^^ TCiuik kiiOw why they are done, with 
 t\\^ Ope- '^^^^^ ^h^y 3'*^ done, what muft be obferved in 
 rations, doing them, and laftly, the Signs or Tokens 
 ^hat they are fuccefsfully finillied. 
 
 The Extenfion and Counter-Extenfion are 
 
 made, in order to brhig the Head of the Bone 
 
 even with its right Cavity, to the End that it 
 
 may be eafily guided thereunto. 
 
 The Thele two Operations are performed either 
 
 Means by our fclves, or with the Help of Servants^ 
 
 '^^^LT^'2 ^"<i we make Ufe either of the Hands alone, of 
 made Uie ^ ■»«- i • 
 
 ^f btraps, or Machines. 
 
 Different f hey are done by our felves, in reducing the 
 
 Calcs. lower Jaw, the Fingers, the Wrift, the Foot, 
 
 and fometimes the Elbow, or even the Arm or 
 
 the Thigh, when they are reduced by the Heel. 
 
 A^ On all other Occafions one muft have Afliftants, 
 
 ■^ who make Ufe of their Hands alone when a 
 
 f n •flight Extenfion fuffices •, of Straps when a 
 
 ftronger is requifite \ or laftly of Machines, 
 
 when neither the Hands nor the Straps are fuf- 
 
 ficient. 
 
 Circum- The Circumftances to be obferved in making 
 
 fiances to the Extenfions, and Counter-Extenfions are, 
 
 ^ed°^^''''' ^-J^^^^ ^^^ ^^^y ^^ with-held, drawn, or thruft 
 
 ^' ' upwards, by a Force equal to that wherewith 
 
 the Limb is pulled downward, otherwife the 
 
 weakeft would give Way to the ftrongeft, and 
 
 the Extenfion would be imperfect. 
 
 2. The Force which draws to make the Ex- 
 tenfirn and Counter-Exterfion, muft be applied, 
 ?.s much a^ poftible, to the Parts rhemfelves that 
 are diftocated, otherwife "tis unprofitable, and 
 cftentimes hurtful. For Inftance, if the Lux- 
 ation 
 
Difeafes of the BoNE S, 2J 
 
 fttlon of the Arm were to be reduced, one muft 
 pull the Arm it lelf, and not the Cubitus ; thruft 
 back, or with-hokl the Shoulder, and not the 
 Body, becaul'e that Part oF the Force would 
 be loft in tlie Articulation of the Elbow, and 
 in the Adhefioiis of the Omoplata^ and one 
 might make fuch violent Extenfions, as would 
 hurt the Ligaments and Mufcles ot thofe Parts, 
 which might not have Strength enough to 
 refift, 
 
 3. The Force both in the one and t'other of^ 
 thefe Operations, ought to be proportioned to 
 the Diftance of the Head of the Bone from its 
 Cavity, and to the Strength of the Mufcles 
 which hold them back •, for lefs Force is requi- 
 fite to draw a Bone towards its Socket, when 
 'tis upon the Edges of it, than when 'tis three 
 or four Fingers Breadth from it. One muft 
 alfb pull with lefs Force when reducing the 
 Arm, than when reducing the Thigh, becaufe 
 the Mufcles of the Thigh are ftronger thau 
 thofe of the Arm. 
 
 4. The Part muft be Co placed that the Muf- j> i 
 cles may be equally ftretched, without which, *■"' 
 thofe that are moft contracted would make too 
 much Refiftance, and dimiuiili the Force of the 
 Extenfion •, befides that they might he torn. 
 
 5. The Extenfion muft be made by degrees, 
 for Fear of breaking the Mufcles by a too 
 ftrong, and too quick Morion. 
 
 6. Care muft be taken ot the Parts upon 
 which the Straps or Machines are faftene(J, 
 which pull or thruft, that one may avoid Contu- 
 fions. Excoriation, Scars, or Ilfues in thofe 
 who have them. 
 
 To avoid tearing the Parts, as may happen, ^ 
 one muft ftrcngthen them with Bolfters, and 
 C 4 Com- 
 
 > 
 
54 A Tkeajisz cf thd 
 
 Compreffes -, which muft be particularly obfcr- 
 vcd oa both Sities oi' th5 Palfage of the Yelfeh* 
 7. The Straps muft be placed ncarcft to the 
 Condyles^ or other Eminciices that arc capable 
 of retaining them, by giving them a good Hold, 
 becaufe they would flip, and be of no ElTecl, if 
 they were placed elfewhere. 
 
 They muft be bound ftrongefl: upon fuch as 
 
 are Fat, that they may appro;\ch the nearer to 
 
 the folid Part of the Limb, otherwlle the Fat 
 
 would hinder the Steadinefs of the Strap, which 
 
 would flip witli the Fat, over the common 
 
 Membrane oj- the Mufcles. 
 
 3Firft Sign The Signs which fhew us, that the Exten- 
 
 that the fion is fufficient, are, when the Sttjips that 
 
 lixtenfion draw contrary-ways, are diftant enough from 
 
 is made. ^^^^ Other. 
 
 When a diflocated Part is bound and faflen-d, 
 sfcn" ready to be extended, the Mufcles appear, be- 
 caufe they fwell, and feem as if preparing to 
 A 4^aw to oppofe the Efforts of the Chirurgeon, 
 
 or his Machines. 
 Third ^^ during the Time of the Extenfion, the 
 
 Sign. Mufcles fink, and lengthen, 'tis a Sign that the 
 
 Bone is in the right Way to its Socket, from 
 whence it is forced, and that the Extenfion is 
 fufficient. 
 The gui- When the Mufcles are found to be fufficient- 
 ding the ly lengthen'd, the Bone is guided intoits Socket, 
 Bone into q^. Cavity, by the Hands or Machines, by flack- 
 jts r ace. gj^jj^g gei^tiy thofe which draw, that the Bone 
 
 may replace itfelf. 
 ObferTft- It is not always neceffary to thruft it, as is 
 tjons. recommended by the Ancients •, for the Mufcles 
 and Ligaments themfelves which have not been 
 too much forced, will coritraft wlien they are 
 no longer ftretch*d, which makes the Koil^ that; 
 iB heard. 
 
 If 
 
Difeafes of ^/j^ B o N E S. 25 
 
 If the Bone weie to be left to the whole worlc- 
 iiig of theMuTcles, onelhould run the following 
 Rilques. 
 
 1. It there is a cartilaginous Border, it may 
 be^jacaten down when all the Straps are let go 
 together, which may caufe an Jiwhilofis, or at 
 ieaft render the Motion very difficult, this 
 would happen particularly in a Luxation of the 
 TJiigh. 
 
 1. If the Swiftnefs of the Return of the Bone 
 fliould rot break the cartilaginous Border, the 
 Head oftiie Bone would caule a great Contufioii 
 in the Cartilages on every Side. 
 
 It is therefore neceffary to guide the Bone The Way 
 gently, at lead till one is affured that it takes by whicii 
 the right Way to its Socket, into which one o"p "^".^ 
 has fometimes a great deal of Trouble to ^^^^ ^'"* 
 make it enter, and at other Times it will 
 re-enter of its felf, when one takes the right 
 Way. 
 
 This Way is not always the fliorteft that the Obferva. 
 Bone can take to re-enter its Cavity, but 'tis "^^^'^ "P°" 
 iliat by which 'tis found that 'twas forced out ^^^^ ^ 
 ot it, and one is obliged to follow this Track, 
 even if it Ihould not be the Ihorteft, both 
 becaufe it is already beaten by the Head of 
 the dillocated Bone, and becaufe it leads to 
 the opening of the Sacculus Ligament ofus, which 
 has been made by the Sally of the Head of 
 the Bone. If this beaten Track is not follow- 
 ed, another muft be made both to the great 
 Trouble of the Operator, and Pain of the Pa- 
 liont: Befides, the Head of the Bore coming 
 to its Cavity by a new Way, and finding no 
 Aperture in the ligamentary Tunicle, carries 
 it along with it into the Socket, which hinders 
 the Reduclions being exaft, and caufes Pains, 
 
 Tu- 
 
25 J T P^ £ A r J ^ E of tJj^ 
 
 Tumours, Infiamac'ons, Defiuxions, and other 
 melancholy Accidents. 
 
 The other Caufes which render the intro- 
 ducing the Bone difficult, are the Clears which 
 gather in the Socket, (which happens in old 
 Luxations^ the Border of the Cavities being 
 broken or over-turn'd, or laftly its being ftU'd 
 with Air. 
 
 If rlie Edge of the Ligament is not broken, 
 the Air will oppofe 'the introducing of the 
 Bone, becaule the Head will clofe in fo juft- 
 Jy with the ligamentary Circle, that the Air 
 will not be able to get out, but by a violent 
 Impulfion^of t]\e Head ot the Bone, and 'tis 
 this Air, fo prefs'd and forc'd out, which 
 makes the Noife that is often heard in re- 
 ducing Luxations , one may even be afTured 
 that without it the Percu/Iion or Clashing 
 of two Bones would not be perceptible to the 
 Ear. 
 rj^j^p The fecond Thing in which the Cure of 
 
 Means to Luxations confifts, is to retain the reduced 
 retain the Bone by the Application of Bandages, and the 
 Bone in Situation of the Patient: The Application of 
 Its Socket. Bandages is lefs neceilliry in Luxations pro- 
 ceeding from external Caufes, than in thofe 
 produced by internal Ones •, becaufe in the 
 former the Mufcles retain the Part bet- 
 ter than all the Bandages whatfoever •, but 
 Obfcrva- ^^^V are abfolutely in the latter, efpecially 
 tions. fuch as happen thro' the Relaxation of the Li- 
 gaments, or the Palfy •, and there is the fame 
 Kece/Iiiy for them in old Luxations from ex- 
 ternal Caules, wliere a Palfy has feiz'd upon 
 the Patient, or the Part is inclin'd to an v;/;;- 
 chilofts: The Bandage alfo muft be a little har- 
 dier bound than that which is made Ufe of in 
 
 Lux- 
 
Difeafis of the BoK ES. 27 
 
 Luxations, that are recent, and proceed from 
 external Caufes, becaufe that in moft part of 
 thele the Bandage only ferves to keep on the 
 Bolfters, and Medicines that are laid upon the 
 Part. 
 
 Thefe Bandages are made with Compref- TheDrcf- 
 fes, and Swathes roll'd, which are longer or ftngs. 
 fliorter, according as 'tis necellary to retain 
 the Bone in its Socket, or only to keep on the 
 Holfters and Defenfives that are laid upon the 
 Part affefted. 
 
 By the Situation, is meant, the Manner of The pro- 
 placing either the whole Body, or the Part per Situa- 
 alone, in a convenient Pofture. The proper "o" °^ 
 Situation of the Body, in all Luxations of the ^^^^ ^^J 
 Trunk, or lower Extremities, is to be laid pj^j-t. 
 down, but it is not requifite for the Patient to 
 keep his Bed in Diflocations of the Jaw, and 
 the upper Extremities. 
 
 To place the Part right, Care muft be ta- 
 ken that no Mufcle be confl rained, and that 
 the Fluids be not hindered from circulating ^ 
 to this end one muft have regard to five Things. 
 
 The firft is, that the Limb neither be too The Con- 
 bent, nor too much extended : The Mulcles dition of 
 are in Contraction cither to bend, or ftretch ^^*^ Simu- 
 out, wherefore one muft give the Part a mid- 
 dling Situation, in which it may be equally 
 contraOied and extended. 
 
 The fecond is, that the Limb be equal Iv fup- 
 ported •, if any Part is not fuftain'd, the Mufcles 
 ftrain to bear it up, and fupply the want of tlie 
 Stay, which caufes iharp Pains. 
 
 Tlie third Thing to be taken Care of, in 
 placir.g well the Part afTe^ed, is, that the Ben- 
 ding downwards does not hinder the Return of 
 the Fluids : If the Extremity of the Limb that 
 is hurt fliould hang too low, there would 
 
 hap- 
 
"7% A T r^ZATl^E of thf 
 
 happen a Tumour, Teiifion, Defluxion, or Im* 
 po/thume. 
 
 The fourth is, that what ferves to fupporc 
 the Part muft be foft, to the End that the 
 Patient may not be incommoded, which would 
 oblige hira to Motions that may be very 
 hurtful. 
 
 The fifth Thing is, to fecure tlie Part indif- 
 
 pofed, which depends upon the Solidity of the 
 
 Bed in Luxations of the Trunk, and inferiour 
 
 Farts, and upon the Regularity of the Scarf in 
 
 thofe of the upper Parts ^ ^nd one muft oblerve 
 
 to lay the Patient in fuch a Manner, that he 
 
 maybe conveniently drefsM, wherefore one muft 
 
 place the Part that's indifpos'd on the outer bide 
 
 ot the Bed. 
 
 The Cure , xhe third elTential Thing in the Cure of Lux- 
 
 *"^. ^^^" ations , is to deft roy the prefent, and prevent 
 
 fi^^ci- future Accident?. I ftiall treat of each of thefe ; 
 
 dents. I begin by Pain, and Lofs of Motion. 
 
 Inability I have faid, in fpeaking of the Signs in ge- 
 
 of moving peral, that Pain and Lois of Motion, muft uot be 
 
 * laways looked upon as certain Signs of Luxations, 
 
 the Ac- i^m- ^i^gy j^j-g always the Accidents that attend 
 
 that at- thsJ'^"'- P''^i^ is not a Sign •, there are lome who 
 
 tend Lux- diiquiet themfelves for a very Trifle, and o- 
 
 •tions. thers who are patient altho' they fuller very 
 
 much *, and 'tis not to be wondered at if fome 
 
 Perlbns are in great Torture, without there 
 
 being any Diflocation ; and that others have 
 
 Luxations without being fenlible of any great 
 
 Uneafmefs; 'Tis eafily conceived alfo, that a 
 
 Perlbn very fenfible of Pain will avoid all Sorts 
 
 of Motions that may excite it, and that one 
 
 muft not confound the Inability of moving, 
 
 which proceeds from the difplacing of the 
 
 Bones, with that which only comes from the 
 
 Me.ms of fear of Suffering. The Pain and Inability of 
 
 movii^'g 
 
Difeafes of tpe ijONZf>, «^ 
 
 moving the Limb, which always accompanies removing 
 Luxations, ufually ceafes when the Bone is re- ^^° ^^^™ 
 duceJ : I lay ufually, becaufe fometimes both ^"[j^ ^"*" 
 the one, and the other, remain, altho^ the Bone * 
 is reduced j by Reafon that the violent pulling 
 may caufe an Extenfion, or Ruptures of the 
 Fibres ia the Mufcles, and nervous Parts. 
 
 There are often Contufions fo ftrong, as to Contufi^ 
 caufe Tumours and painful Swellings : In that ons. 
 Cafe we make ufe of Bleeding, and Narcoticks, 
 and we apply Cataplafms, Liniments, Fomen- Their 
 tations, and other topical Remedies, to the Part, Cure. ' 
 which ought to be Emollients, Anodynes, and 
 Dilfolvents. 
 
 Convulfive Motiops are caufed by the ftretch- Convul- 
 ing of the Nerves, or nervous Parts ^ but they ^\^^ ^^o* 
 generally ceafe when the Bone is reduced. ^^°"** 
 
 A Fever often happens thro' acute Pains, of- Fever, 
 ten it does not appear til! the third or fifth Day. 
 This laft is excited by an Irritation caufed by itsCaufe* 
 fome Matter infiltrated, or diffufed ; or by an 
 Inflammation, which is always attended with a 
 Fever. The whole is cured by great Bleed- The 
 ings, Diet, and other general Remedies j one Cure# 
 muft even lay fuch Anodynes and Narcoticks 
 upon the Part, as won't clofe the Pores, and 
 they may likewife be given inwardly. ^ .' 
 
 The Gangrene does not happen to the diflo- Gan- 
 cated Part, but always below it, unlefs there grene. 
 be a Wound. It is caufed by the Compreifion xhe 
 of the Nerves, and Blood Veffels, as well as Caufe* 
 the Palfy, which is feen in the Luxations of 
 the f^ertebr/Cj and every where elfe where the 
 diflocated Bones prefs upon the Veifels, and 
 hinder the Diftribution ot the Blood, and ani- 
 mal Spirits. 
 
 The beft Way of avoiding it, is to make thcflis 
 Redu^iou j but if the Bones have been long Cur«« 
 
 diao- 
 
30 A TKt AT isz of thg 
 
 dillocated, or the VelTels bruifed in reducing 
 them ^ both thel'e Caufes interrupting the Cir- 
 culation of the Blood, may occafion a Gan- 
 grene that requires a particular Cure, which is 
 amply delcribed in the Chapter of the Luxati- 
 on of the Fertebra. 
 Rattling. The Rattling which follows Luxations, is ei- 
 ther caufed by the Want of the Sinovia, or 
 by too great Abundance of it. 'Tis a Noife 
 that is made in moving the Limb, either by 
 the rubbing of the Cartilages that are too dry, 
 or by the Simvia's owzing in too great Quanti- 
 ty •, or perhaps alfo by the Air which is joined 
 with it. 
 rj'he If there is not a fufficient Quantity of the 5/- 
 
 Cure. mviaj one muft anoint the Articulation with pe- 
 i:etrating Oil, and apply emollient Fomenta- 
 tions to fupply the Defe£b of it. 
 
 If the Rattling proceeds from the Excefs of 
 the Sinovia, one rauft move the Part, and ap- 
 ply to it fpirituous Dilfolvents. When in 
 Spite of all thefe Precautions there happens an 
 j4r7chiloJis, it muft be managed as fhall be men- 
 tioned in fpeaking of that Diftemper. 
 [f there If there chances to be a Wound, a Bandage 
 is a muft be made, as in a complicated Fracture, to 
 
 Wound, tj^e gj-^j ^-j^^t- (.|^g p^^^t may be kept in its right 
 
 Poiition without moving. This Bandage muft 
 not be tight, becaufe that in both thefe Difea- 
 fes it only lerves to keep on the Remedies that 
 are applied to the Part. 
 
 If there be an Impofthume, it muft be ma- 
 naged according to its Age and Terminati- 
 on*, and if it fuppurates, it muft be opened in 
 good Time without waiting for its Maturity, 
 becaufe the Matter by its Stay may hurt the 
 Parts about the joint, and even enter into it, 
 which would caufe a troublefome Diftemper. 
 
 When 
 
A Tv^E A riSE of the 31 
 
 When the Head of the Bone is forced out ^ great 
 
 Tvith fuch Violence that it breaks the Liga- p""P"- 
 
 ,_ 1 J r^i • • r- i/~ • r> 1. cation, 
 
 ments. Tendons, and Skin it lelr, it mult be 
 
 fet in again as foon as poiTible, and the Wound 
 be drelTed according to Art : But for rJie moft 
 Part there comes a Gangrene, and one is obli- 
 ged to have Recourfe to Amputation. 
 
 When a Fra£kire and Luxation meet in the Frji£hir« 
 fame Bone, one muft ftrive to reduce the Lux- ^^'.^ *-*^" 
 ation, and then reduce and drefs the Fracture. *"^"' 
 If 'tis impoinble to do the firfl-, which happens 
 when the Fra£ture it near the Articulation, 
 there not being then Hold fulficient to make 
 the Extenfion, one muft deal with them after 
 the following Manner. 
 
 The Frafture muft be reduced, and DeFenflves Th* 
 laid upon the Luxation *, and after that DifTol- ^^* 
 vents and Liquefyers, to the End that the Flu- 
 dity of the Sinovia may be preferved ; and 
 when the Callus of fraftured Bones is formed, 
 one muft make the Extenfion to reduce the 
 Diilocation. This Method does not always fuc-r 
 ceed, but there is no other ^ the only Rifque 
 is, that the Luxation may not be reducible after 
 fb long a Time, which does not always hap- 
 pen, becaufe that Diflocations are reduced and 
 cured after fix Months, a Year, and more, 
 and the CdHus is firm and hard before that 
 Time. 
 
 To avoid the Coagulation of the Sinovia a- Precaud* 
 bout the Articulation, during the Cure of the 
 Frafture, and hardening of the Callus, Cata- 
 plafms fhould be laid upon the |oint, made with 
 the Pulp of emollient and diifolving Herbs ^ 
 and when the Bone begins to be Iblid enough 
 at the Place of itsFrafture, one muft move the 
 AJticulation by little and little, increnfing the 
 ^otioii cv^'ry Day, in Order to preferve the 
 
 ons. 
 
^2 A T PvE A T I s E of the 
 
 Sir.ot'ui i 1 its natural Fluidity, nnd make the 
 Keciu'lbion fuccelsfully wlieii the Callus is ftroug 
 enough to bear the Extenfions. 
 The Luxatio;!S proceeding from an internal Caufe 
 
 Cure of are to l)e diliLMently manaj^ed. If tjie Convul- 
 ^"'^^"j"'* fioii ot" the Mufcles has tbrced the Bone from 
 11)1 from its Socket, the Luxation mufl: immediately be re- 
 imernal duccd and retained in its Place, whilftoie cures 
 Catifcs. the ConvuUions, which is done diiFereutly ac- 
 
 T, -^ cordini^ to their Caules, of ¥/hicli we fhan'c 
 
 By Con- . , v l • t ^•/- 
 
 rulf.uns. Ipe^^ 'i^ ^J^'^ T '■G'-^tile. , , , 
 
 If the 1 ,iu;.micnrs are relaxed, and the Mul- 
 .cles Paralitick, the Bone muft be reduced and 
 retained by a Bandage, and the Situation of 
 tlie Patient, and Part indilpofed, applying fe- 
 veral Times a Day fpirituous and aromatick Fo- 
 mentations, after having chafed it with hot 
 Xiniitn to open the Pore,^, both to facilitate the 
 Penetration of the topical Remedies, and to 
 give Room for Perfpiration. 
 
 In (hort, one muft obferve the Regimen, and 
 The Pal- ufe the general Remedies -, and, as for the 
 ^y* Palfy, it requires a particular Cure, but this is 
 
 . not the place to treat thereof. 
 The Si- j£ the Sifuvi.t has increafed to fuch a Degree, 
 that it has forced the Bone from its Place, the 
 . utmoft muiT: be done to fet it again, and keep 
 it ftrongly in. On this Occafton a Bandage is 
 lifed, wliich prefling the Head againft its Sock- 
 et, forces the Simii^t towards the Circumfe- 
 rence, and bringing it nearer the Surface of the 
 Body, coniequently expoles it the more to the 
 Operation o( the Topicks; whence 'tis more 
 eafy todilfolvc, and diiTipate it by Liquifyers, 
 and Dilfolvents, laid upon the Part* One muft 
 befides at every Dreiling, move the Head a 
 great wJiileinits Socket, fo that it bruifes and 
 dilTolvcs the Humours ^ke a PcftU in its Mor- 
 tar, 
 
Bife^fds of the FJ o n E s* 
 
 tar, and fenders it capable of pcrfpiring, pr ot 
 re-entring into its Receptacles. 
 
 The Luxations caufed by the Swelling of the 
 Heads and Cavities of the Bones, are cured 
 lometimes, when they are not compleat. 
 
 If the lick Perlbn is Ricketty, you will find 
 in the Trcaiife ot the Pvickets what Remedies 
 are fit for him. 
 
 If the Tumour is caufed by living in marfliy 
 Places, one muft add to the Chirurgical Ope- 
 rations a Kcgimcfiy which muft be hot and dry, 
 as well as the Air into which the Patient ihould 
 be removed. 
 
 Hydragogucx agree perfeOily well vvith it, and 
 ihe Uie of hot mineral Waters are alfo very 
 beneficial. 
 
 If the fwelling of the Bone proceeds from a 
 fcropliulous Humour, one muft ule fuch Re- 
 medies as are proper for the King's-Evil. 
 
 Mercurial Fridions are proper for rhofe in 
 whom the Swelling of the Jonits is caufed by the 
 Virulency of Qu^ck-Silver. I have i'een tliis Re- 
 medy ufed, and with Succeft, upona Gilder's Boy, 
 who had his Leg almoft entirely diflocated by 
 Mercury. This makes me believe that the 
 fame might be ufed for the Cure of Miners, 
 who are afflicted with Swellings in the Bones, 
 and whofe joints are warp'd. 
 
 CHAP. II. 
 
 0/ ^/:?^ Lu X A T I O N of the HcaiL 
 
 TH E flead has two Cofidyis on the Sides of 
 <-he occipital Hole, whicii are leceived 
 an(.t,oii^ted in the two oblique luperlour Pro- 
 D celfes 
 
34 A Tkt. AT I sz of the 
 
 celTes of the firft Vertehray whicli forms a GlN- 
 GLYMUSwithtwo/Z^^i^j, and two Cavities limiced 
 by Ligaments that are fliort, ftrong, and crofs. 
 The Mo- By this Articulation the Head can only bend 
 tion of and extend it felf •, it turns on each Side by the 
 the Head. Means of the jointing of the firlt Vertebra with 
 the fecond •, feven oi eight Pair of very ftrong 
 M f 1 Mufcles terve to execute all thcfe Motions. 
 
 This Articulation, with the fecond Fenebr.iy 
 belongs not at all to the Head, altho' by its 
 Means it can turn to the Right and to the left j 
 it is entirely formed by the firft and fecond 
 Vertebra, which is f\ftened to the occipital Bone 
 by a very flrong Ligament, that takes its Rife 
 from the P/oceJfus Dcmiformis, and inferts it felf 
 in the Fore-t*art of the occipital Hole, which 
 ftrengthens both the one and the other ofthefe 
 Articulations. 
 What The Occipital Hole, on the Sides whereof arfe 
 
 paflcs by the two Condyles which make the Articulation 
 the^Occi- Qf ^.j^g jjgj^^ ^yif j^ tl^e ^j.^ Vertebra of the Keck, 
 
 Hole '^^ ^^^^ large Opening from whence iifues the 
 Continuation of the Medulla Oblongata, which 
 palling thro' all the Holes of the Vertebr£y forms 
 the Marrow of the Spine. The accejjory Nerves, 
 and the 'vertebral Arteries, pals alfo by the occi- 
 pital Hole \ but the Carotidcs and the Ju^ulares 
 A palpa- do not. Forgive me this grofs Remark \ I had 
 ble Er- j-^gver thought of it, if I had not read the con- 
 ^^^' trary in a French Manufcript newly diftated. 
 
 Errors of this Nature fhew plainly that a Man 
 ought to be perfedly acquainted with Things 
 before he pretends to teach them. 
 
 'Tis almoft impo/Iible that the Head fhould 
 didocate from th^ firft Vertelra \ the fecond, 
 third, and others are more eafily dijjointed^ 
 not that they are lefs fixed, but becaufc they 
 are more diftant from the Head j and 'tis clear 
 
 that 
 
Dffiaps of the Bone s. -35 
 
 that the FertchrA are the eafier put out, as they 
 are more diftanc Irom tiie jointins^ of tlie Head, 
 or of the Hip Bones. 'Tis tor th's Renloii that 
 thoie of the Loins are diOocated with }^' eater 
 Facih"ty than the others, which ihali be proveti 
 more at ler.gth. Befides, the jointing of the 
 Head with the Neck is not made by the Means 
 of the firft VertehrnovXy^ but the fecond is alfo 
 ftrongly ftiftened to it. It may be aided like- 
 wife, that the firft will with Difficulty difio- 
 cate from the fecond, on Account of the ^po- 
 fhyfis Odo77toides, which ferves to limit it ^ and be- 
 caufe this Afofhyfis is reftrained and fixed by two 
 Ligaments, the one pofterior, which hinders 
 it from being overthrown backwards ^ and tiie 
 other binds it to the anterior Part of the occi-*- 
 pital Hole. 
 
 We will fpeak no more of the Caufes, becaufe 
 we have particularized them very m.nch at 
 length in the general Account \ neverthelefs I 
 can't forbear relating here a tragical Story which 
 may be of fome Ui^e. ' ' , 
 
 The only Son of an Artificer of fix orfeve'n 
 Years of Age, went into the Shop of a Neigh- 
 bour who was his Father's Acquaintance ^ in 
 playing with the Child, he put one of his Hands 
 under his Chin, and the other behind his Head, 
 and lifting him up into the Air, told him, ke 
 would JJjew him his Grandfather, a mean and vul- 
 gar Way of Speaking. The Child was no foon- 
 er lifted off the Ground than he grew refrado- 
 ry, dillocated his Head, and died that Inftant,- 
 His Father (who ivas immediately told of it) 
 being tranfported with Palfion, ran after his 
 Neighbour, and not being able to overtake him, 
 threw after him a Sadler's Hammer xvliich he 
 had in his Hand ^ the iharp End v/hei*eof pierced 
 What is called the Pit of the Neck, and cutting 
 
3<5 A Tkz AT IS E of tU 
 
 alUhe Mulcles, and penetrating the Space be- 
 tween the firft and Tecond P^ertehra of the Keck, 
 cut the Marrow of the Spine, whereof he ex- 
 pired the lame Hour. Thus thefe two Deaths 
 happened almoft after the fame Manner. 
 
 This Way of playing with Children is but 
 too common with the Vulgar, becaufe they don't 
 know the Danger to which they expofe them. 
 
 Perhaps alfo, the Child had not died it he ' 
 had not been io refraftory -^ for I do not at all 
 doubt but his ftruggling was one of the princi- 
 pal Caufes of the Dillocation ot his Head. 
 
 'Tis obferved, in almoft all hanged Perfons, 
 that the ftrft fotebra of the Keck is entirely 
 feparated from the fecond. It may be even the 
 greateft, and moft proper Caufe of their 
 Deaths. 
 
 This Obfervation makes me believe the Head 
 ' and firft Vertebra of the Neck are very difficult 
 
 to be parted, and that generally when the Head 
 is thought to be diflocated, 'tis nothing elfe 
 but a Luxation of the firft Vertebra from the 
 fecond. 
 
 Sigfis and Vrognojlicks^ 
 
 Siens. '^^^ Signs are evident, and very fatal, they 
 
 Prosno- don't continue long, becaufe the Patient dies 
 
 fticics. either by the Compreflion, or tearing off the 
 
 Trunk of the fpinal Marrow, it the Lyxation 
 
 be not timely reduced. 
 
 I fancy 'tis not impoHible to reduce a Luxati- 
 on of the Head, efpecially if 'tis not com- 
 pleat. 
 
 The Reduftion muft be made with a Strap 
 - that has a Hit in the Middle, as 'tis reprefented 
 ill this Figure. 
 
 Tht 
 
Dife^fes of the Bones. 
 
 57 
 
 The Head muft be put thro' the Opening (Aj 
 the Sides of the Slit muft be placed, one under 
 the Chin, the other behind the Nape of the 
 Neck, and the Ends (B) (E) above the Ears ; 
 after which they muft be joined in the Shape of 
 a Handle, upon the Crown of the Head, where 
 the Force muft be applied to pull. 
 
 There muft be another longer Strap, cleft in 
 the fame Manner, as at (F) in the Slit where- 
 of the Head muft be put, leaving the Sides 
 upon the Shoulders of the Patient •, and paf- 
 iingthe two Ends (G) ('H,) one along the Spine, 
 and the other the whole Length of the Breaft 
 and Belly, in the Shape of a Scapulary. This 
 done, the Ends muft be tied together between 
 the Thighs, a Foot below the Pudenda ; then 
 palling another Strap thro' the joining of this, 
 it muft be fattened to a fixed Point in luch a 
 Manner, that the Patient being laid upon his 
 Back, the Strap is pulled by the Hands, or Ma- 
 chines, whilft the lower Strap refifts at the 
 Point to which. 'tis fixed, which makes the 
 Extenfion, and Cojuter-Eiitenfton ; Then the 
 D 3 Ope- 
 
le 
 
 A TKf: AT isz of the 
 
 Operator iliould take Care at the fame Inftant 
 to ihnii\ the Liead on that Side which is moft 
 
 proper for the Keduftion. 
 
 The Dreiling confifts of a Comprefs covered 
 
 with ?i Delenlive^ made in this Figure. 
 
 X. 
 
 The Parts ( A; (B) fold round the Neck •, the Pare 
 (C) hangs down the Vertebr<t of the Neck to 
 the Back \ the Part (Ej alcends, and extends 
 1^ iiQii upon the Occipital. 
 
 The whole is kept on by a Sling (F) with four 
 Tails ^ two are wrapt round the Neck, and the 
 pther two meeting at the Forehead, are faden- 
 
 e4 
 
Bifeafes of the Bones. 59 
 
 ed round the Head, The middle of the Sh'ng 
 is pliiccd at the Nape of the Neck •, the Pati- 
 ent is laid upon his Back, with his Head very 
 high, leaning upon a Culhion, hollowed in the 
 Middle, and railed on the Sides, to ferve as a 
 Support to the Sides ot the Head, like Junks. 
 
 One muft bleed plentifully every three General 
 Hours, firft in the Arm, and atterwards in the ^^«'"^- 
 Foot •, this mufl be repeated more or left, ac- ' 
 cording to the Nature of the Hurt, ajid tlie' 
 Strength of the Patient. In the Beginning, the Parricu- 
 Juices of Buglofs, Borage, and Lettice are lurReme- 
 uled ^ three or four Ounces may be given eve- ^i^** 
 ry four Hours, and at Intervals, Brotiis, with 
 two Drachms ofSyrupus e quincj-^ Radic'buSy when 
 there is no Fever : An Intufion is alio given of 
 theSm//} Vulneraries, efpecially the Cephalicks, 
 the Belly is kept open by CI y Hers, and the 
 Patient, and Alliftants, muft obferve a perfect 
 Silence. 
 
 CHAP. III. -^ 
 
 Of the Luxation of the JJn^ 
 
 der JaisD, 
 
 TH E under Jaw is jointed by a double Luxation 
 Genu, with the two Bones of- the Tem- ^^ ^^^"n- 
 ples, in each of which is a Cavity wherein the f ^^ ■^'^^^'* 
 Condyle of the Jaw is received on each Side, ^-c,^'^' 
 There is a Median Cartilage between that which 
 covers the Condyle of the Jaw, and that which 
 is over the Cavity of the Temple-Bones. The 
 Ligaments are weak, but the Mufcles are very 
 ftrong, efpecially thofe which raife the Jaw, 
 and give it Motion for Maftication. 
 
 ^ The Jaw diQocates before, either on both The 
 §ides, or one only : Behuid, it can nfiither be ^-^-'- 
 jD 4 put 
 
40 A Tkzatisz of the 
 
 putout dircflily from Right to Left, nor from 
 Leic to Right. 
 yrn- The Roots of the Apophyffs Maftoidesy and 
 ^hc hollow o(- the long Canal of the Eur, hin- 
 ' :'■ tiie T uxaLioii behind. 
 
 rhe bony Eminence, whence the j4pofhyps 
 ^nlo:des ifl/jes, hinders the l,uxation of" the Jaw 
 j;, ij^j,^_ on both ifides, cither rVom Righn to Left, or 
 tmi. from Left to Right ; infomuch that this Diflo- 
 c^tioii can only happen before, whether one 
 Condyle alone, or the two are difplaced. The 
 Mouth mutt be open at the very Time of its 
 Luxation, for as long as it remains fhut, no fuch 
 Thing can befall it; becaufe the Condyles will 
 always be turned on the Side that is oppofite 
 to the only Road they can take to diflocate. 
 
 Of the Diagnojlick. 
 
 When the Luxatipn is on both Sides for- 
 wards, the Mouth is open, the Patient can't 
 Signs of chew, and the Cheeks are flatted ; when one 
 the Luxa- ()pg„s ^]^g Patient's Mouth he is in great Pain, 
 both ' ^^^ cdLW^ fpeak diftinftly, his Spittle flows in 
 Sides. great Quantity, and runs out of his Mouth 
 involuntarily, and what is moft troublefome is, 
 that he can't fwallow but with Difficulty, and 
 the Bottom ot' the Throat is dry. 
 
 If the Patient can't fliut his Mouth to chew, 
 
 ^ , Aqua pendente lays, it proceeds from the Corone 
 
 rim of °^ ^^^ Jaw's being come down from under the 
 
 .he %ns.'Zy^oma, and not being able to re-afcend. The 
 
 fame Author iay^, that this only happens in 
 
 great Luxations, when there is a confiderable 
 
 difplacing of the Jaw, which may very well 
 
 be : Neverthelefs, I believe that it generally 
 
 happens, becaule the Condyles flip forwards un 
 
 dcr the Fiilcrum of the Mufcles, and He in a 
 
 ' . •. - . richt 
 
 J 
 
Difiafes of the B o N E S. 41 
 
 right Line from their Origiri to their Inferti- 
 on ; inibmuch that not being at a llifficient 
 Diftauce from their Fulcrum when they con- 
 trad themfelves, they can only prefs the Con- 
 dyles againft the Bafis of the Cranium, without 
 being able to move them, which is eafy to be 
 conceived by thofe who have any Tindure of 
 Mechanicks. 
 
 The Cheeks are flatted, becaufe that tlie Scqud of 
 under ]aw being difplaced, gives an Oppor- ^'j^ ^.^~ 
 tunity to the Mufcles Bucclnatores to lie level P^*"*^*^^*^"* 
 within, whilfl the Maffctcr <\ndCrotaphitis,m:{ke 
 a Sally outwards, becaufe they are in Contra- 
 ction, as we are going to obferve. 
 
 The Patient is in great Pain when his Mouth 
 is opened, becaufe that the Mufcles which fliuc 
 it are flretch'd by the too great Diftance of 
 the jaw, for which Reafon, in endeavou- 
 ring to open it more, one exteads and pulls the 
 mufculous Fibres. 
 
 He can't fpeak, becaufe the Lips can't meet, 
 and the Tongue don't touch the Palate nor reach 
 the Lips, which is abfolutely necellary in t'he 
 Pronunciation of Words. 
 
 The Spittle flows in great Quantity*, and in- 
 voluntarily •, the firft by Reafon of the Com- 
 preilion of the falival Glands •, and the lecond, 
 becaufe the Tongue can no longer fend it back 
 to the Bottom of the Throat to be fvvallowM,and 
 the Lips can-t meet to retain it. 
 
 The Patient carft fwallow, becaufe the Tongue 
 no longer touches the Palate, nor has any Motion 
 backwards to fend down the Food, or tJie Saliva 
 ii.t'O the Oefofhagus. 
 
 The Bottom of the Throat is dry, both be- 
 caufe the Air palfes without modifying, and 
 becaufe the Spittle no longer moiflens, by Rea- 
 fon that the Patient throws it out. 
 
 When 
 
A Treatise of the 
 
 When the Jaw is only diflocated on one Side, 
 tho Mouth is not fo open, the Chin i*^ turn'd to 
 the Side oppofite to that which is difpl-nced, the 
 Teeth don't meet with thofe that are over- 
 againft them in the upper Jaw, and the Muf- 
 cles are fweird but on one bide ^ all the orher 
 Signs agree. 
 
 Of the Ctiufes, 
 
 The Caufes are either internal or external, 
 both the One and the other are Ipeciry'd in 
 the general Account of Luxations • to which 
 one may add, that the Jaw mull be open when 
 it diflocates, becaule if it is fliut, and forced 
 from betore backwards, the Condyles will meet 
 with the u^pophyfes Mafioides, and the bony Ca- 
 nal of the Ear. If it is thruft on the Sides, the 
 Condyles will be withheld by the Protuberancies, 
 whence the j4pofhyfes Stlloides have their Rife : It 
 the Blow forces it from below upwards, they will 
 meet with the upper Jaw, rs has been faid before, 
 whence I conclude, that it can only be difloca- 
 ted by a Blow that ftrains it from above down- 
 wards. One may add, that the Stroke works 
 its Effeft with more Eafe if the Jaw be gaping ; 
 I have never '^eex'\ any others, and great Pra- 
 ftitioners afBrm the fame : Iseverthelefs, it is 
 not impoflible, but it may happen from Blows ; 
 but, I believe, the Mouth muft at leaft be a lit- 
 tle open at the Inftant of the gtroke or tlie 
 Fall. 
 The Jaw The Jaw is diflocated with greater Difficulty 
 fomc- x}\2ir\ many other Parts, not only on Account 
 v!l.:\ ^r. of what I have juft faid, but becaufe there are 
 
 naiu to » • 1 • 11/ i-r\ 
 
 be diflo- two Articulations:, that thele two are diftant 
 
 ■»itcd. from each other, that they both make Kefl-. 
 
 ftarxe at the fame Time, and that the MuC 
 
 cles 
 
D'rfe^fes of the Bone?. '45 
 
 cLes are very ftrong, and tlie more fb, becaufe 
 they are very iliort, infomuch that they refift, 
 <ind retain it more ftroiigly in its Place. 
 
 Kotwithftanding, one lees lome in whom the Obfcrva- 
 Articulation of the Jaw is fo loole, that it often don. 
 diflocatesin gaping. 1 have fet it twice on the 
 fame Day, and for the fame Perfon. 
 
 Vrognojlick, 
 
 Myf cerates fays, that if the Jaw is not fpee- Progno- 
 
 diJy fet, a high Fever, Heavinefs, Inffamati- ^^ck. 
 
 ons, Convulfions, and Vomitings of bilious Mat- P"*'". 
 J ^ . -. riliTi or 
 
 ter will follow, and even Death it felf on the Hypo- 
 
 Toth Day. 'Tis what 1 have never met with, crates. 
 
 but yet 'tis not impofTible that it may happen The Pof- 
 
 fo ill violent Luxations, by Reafon of the great ^'^dity. 
 
 pulling and Extenfion of the Kerve, which fills 
 
 the Canal of the Jaw, and which is one of the TheRea- 
 
 great Branches of the fifth Pair, whofe Origin is fon. 
 
 very near. Thus this Luxation is not fatal if 
 
 ipeedily reduced. 
 
 Cure, 
 
 To make the Reduction, the Patient mufl be The 
 fet upon a Chair, as high as the Breaft of the Cure, 
 Chirurgeon's Servant, who fupports the hind- 
 part of his Head againft his Breafl upon a lit- 
 tle Pillow: He mufl hold his Head with both 
 his Hands, which mull be mutually join'd by 
 the locking of his Fingers, and ftrongly clafp'd 
 upon the Patient's Fore-head : Thus he draws, 
 clafps, and with-holds the Head, wliich per- 
 forms the Office of Counter-Extenfion : Then 
 the Chirurgeon having wrapp'd fome Linnen 
 about his Thumbs, that he may not hurt them The O- 
 figainft the Teeth, introduces them into the P^iation. 
 
 MoutJT, 
 
44 y^ T R E A T I S E <?/ ths 
 
 Mouth, the one on the Right, the other on 
 die Left ^ he refts them upon the laft Grin- 
 ders, as near as poiTible to the Articulation of 
 the Jaw, thrufting them downwards and back- 
 wards •, downwards to ftretch the Mufcles, and 
 afterwards to place the Condyles : This done, 
 he railes the fore-part of the Jaw, and at the 
 lame Time he throws his Thumbs into the 
 Cheeks as quick as poilible, to avoid being 
 bit, which would happen by the Contraftion 
 of the Mufcles, which then fhut the Jaw in an 
 Inflant. 
 yvn ill There are fome Chirurgeons who are for 
 
 Method, performing the Reduftion by ftrong Blows 
 with their Fift under the Chin, others make 
 ufe of a Stick, as of a Leaver to open the 
 |aw. They do this, by refting ic upon the 
 Fore-part of the upper Jaw, whilft they are 
 ufing their Endeavours upon the laft Grinders 
 of the under one. I reject both thefe Methods, 
 For wh.it ^vhich may break the hclfores^ caufe a great deal 
 Reafon. ^^- p^^-^^^ -^^^^ ^^^^^ j^^^.j. ^|^g Bottom of the 
 
 Throat, if the End of the Leaver fhould flip, 
 which is very poUible. 
 
 There are fome who put a Sort of Gag under 
 baTMe- ^^^ Teeth, and then ftrike the Chin under- 
 thod. " neath like the firft ^ but thefe Ways are entire- 
 ly wrong, and one cannot ufe them with Sue- 
 The di- ^^^'> uiilefs the Gag be placed under the laft 
 ficulty of Afolarcs, without touching the other Teeth : In- 
 fiicceed- this Cafe, by bearing upon the Chin, and ftri- 
 ^"S" king imder it, as if to bring tlie under Jaw near 
 
 the upper one, whilft the Gag remains at the 
 Point before-mentioned, perhaps it might be 
 reduced ^ becaufe the Blows of the Fift, or the 
 Force ot the Hands, and the Refiftance of the 
 Gag, extend the Mulcles, which may thruft 
 
 back 
 
Difeafes of the B o N E S, 45 
 
 back the Condyles into their Socl:et8. Diit as 
 it is impoffible to confine a Gag only to the la ft 
 Grinders, I think this Way very diflicult In pra- 
 ftice, tho' not lb dangerous as the precedent ones. 
 
 If thofe who make Ufe of a Gag reft it up- inddenc 
 on the other Teeth, they will never fucceed, 
 becaufe the Force that Operates, however con- 
 fiderablc it may be, is of no E.lFecl when it is 
 near the Fulcrum, they would fooner break the 
 Teeth and the Jaw it felf, than reduce it. I have 
 neverthelefs feen Ibme reduced by only one blow 
 of theFift without aGag^ but theLuxation wasin- 
 compleat,andtheG?«</>'/cj were notfofar removed, 
 butthat the A^fufcles were ftilldiftant enough from 
 their Fulcrum to allowof that Reduction-, where- 
 as 'tis impolfible to make the Reduction by the A poflible 
 means before mention'd, when the Mufcles pafs Cufe. 
 by their Fulcrum, that is when the Condyles are 
 in a right Line from the Origin of the Mufcles 
 to their infertion. 'Tis in this State that the of tif^^^^ 
 Maffeter and the Vterlgoldes Internus are *, the Crota- Mufcles- 
 phitis feems more favourably inferted, it is fo 
 itr etch'd that it can't aft. 
 
 When the Luxation is but on one fide, the Ex- ^ - 
 tention and other Operations are only made on ^\^^ Luk- 
 that fide. This Luxation is more difficult tore- ationon 
 duce than that which is compleat of both Con- one fide» 
 dyles, for two Reafons. The firft is, That the 
 Mufcles have retain'd more Force, and conie- 
 quently make more refiftance. The fecond is, , 
 
 That the jaw is lels open, which hinders the 
 introducing thy Thumb lb near the Articulati- ^i^q j„_ 
 on as is necelfiry to get the better of the Re- complcar 
 fiftance ot the Mufcles, whereas 'tis quite con- 'p'^''^' dif- 
 trary in a Luxation in both fides. ^^^^^ 
 
 All the Drefling confifts of a fimple Defenfive, Co,"/,!^^;. 
 ^ Compreis with four Ends crofswile faftncd to 
 
 the 
 
4^ A T KE AT I SE of th^ 
 
 the Cap. A Regimen and the general Remedies 
 are of no great Ufe, unlefs there be a Compli- 
 cation. 
 
 I can't help fiying en paffanty that this Difeale, 
 which feems to be diftinguifhable and known at 
 firft fight, was neverthelcls miftaken, one Day, 
 for an Accident proceeding from an Apoplexy 
 in the Govemante of the famous Mr. De Pile, Au- 
 thor of the Hiftory of Painters -^ but having exa- 
 mined her I couM find no other Symptom but a 
 difficulty of fpeaking, caufed not by an Apoplexy, 
 but by a Luxation otone of the fides of the |aw, 
 I made the Redudion, and the Patient inftantly 
 fpoke with as much eafe as before. 
 
 Chap. IV* 
 
 0/ //jc L u X A T I o N of the Ver- 
 tebrae. 
 
 TH E Articulation of the Vertebrx is not ve- 
 ry eafy to be defcrib'd ^ neverthelefs it is 
 impoffible to comprehend well the Manner of 
 their dillocating, if one has not At leaft a gene- 
 ral Idea of it. 
 Their The ycrtchrdi arejoin'd by their Bodies, and 
 
 Strufturc their oblique v^/jo/j/jv/o* Their Bodies are flat ac 
 Top and Bottom, except the fix laft of the Neck, 
 and the two or three ftrft of the Back. The uni- 
 on is made by Cartilages and Ligaments. 
 
 Tlie Cartilages have not the Confiftence of 
 thofe which join the other Parts ^ they are much 
 fofter, more flexible and capable of yielding to 
 the different Motions ot the Body: they become 
 •Imall on that fide that we Hoop, and thick, equal- 
 
Bifetifes of the B o N z S, 47 
 
 ly thick, oil the oppofite quarter. When the 
 Body is ftrait, and the Kcrtebu rell perpendicu- 
 larly upon each other, they are equally fmall 
 every where. If we ftand ftrait with a Burthen 
 upon our Heads, thefe Cartilages don't take up 
 the whole extent of the Surface whereby the Bo- 
 dies of the Vertebra are joined to them. Theyleave 
 about a line a;\d a half in the Circumference, 
 which not beu)gfi\l'dby the Cartilage, ferves for 
 a Place of Adbefion to the Ligaments. 
 
 'Tis to be remarked that the Place in the Bo- Remark*, 
 dy of theTcrtebra where the Cartilage is faften'd, 
 is more hollow and more porous than that where- 
 to the Ligaments are fix'd ^ and this Side which 
 is but one Line broad in the Vertebra of the Neck, 
 one, and one and a half in thofe of the Back, and 
 two in thofe of the Loins, is an Epiphyjis more 
 raifed, and lefs porous than that which ferves 
 for the Adhefionof the Cartilage. This Carti- 
 lage which is ieven. Lines thick at the Vertebra of 
 the Loins, is lefs at thofe of the Keck and Back. 
 
 The Ligaments of the Vertebra are very nume- Ltga- 
 ous, themoft confiderable are, firft thofe of which ments. 
 we have juft been fpeaking, and which I'm go- 
 ing to defcribe. 
 
 Thefe Ligaments (as has been faidj are faften'd Their 
 from the Body of one Vertebra to another, and Adhefion. 
 take up by their faftenings all the Side of the 
 Epiphyfis before mention'd. Their Fibres have 
 different Direftions, there are thofe which are 
 oblique in a different fenfe, which crofs each o- 
 ther on theoutfide in the form of the Letter X. 
 There are Circular Ones, which feem to be of 
 •no other Ufe but to bind and fupport the others ; 
 'tis even remarkable that in their oblique Plans 
 there are others which are perpendicular. Thefe 
 Ligaments don't appear to be terminated at tlie 
 5ideof the fiat Surface, they feem to pals over 
 
 the 
 
48 A Tk'e.at 1%-E. of ty 
 
 the round Part of the Body of the under rertehr£, 
 iiifbmuchthat thefeexteriour ligamentous Fibres 
 are look'd upon as one fingle Ligament, which 
 would taften alUhe ?'ertebr£ by the exteriour Part 
 of their Bodies, from the Head of the Os Sacrum 
 to the fecond Vertebra of the Neck. 
 The hin- Another very confiderable Ligament is that 
 dcr Li^a- which is found in the hind Part of theBody of the 
 racnt. yertebr£^ at the place where they form the an- 
 terior Part of the Canal of the Spinal Marrow j 
 and which reaches the whole length ofj't. 
 Another '^^^^ Second Articulation of the f^crtebr£ is, 
 Arricu- *^^^t which is made by the oblique ^^pophyfes. It 
 lation. is look'd upon by the Ancients as a Ginglymus^ 
 or Hinge, bccaule each Vertebra has four oblique 
 ^popk)fcs, the upper ones receive the oblique 
 j4pophyfcs ^ of the Upper Vertebra, and the un- 
 der ones are received in the two oblique j^po- 
 What phyfes of the under Vertebra. 
 Kamc Thefe Articulations ought rather to be regard- 
 
 oughr to ed as double Getiu, not that they have all the 
 be given Motions of a real 6'fw, but becaufe their Mo- 
 ^? J . tions are not confinM to only the Bending 
 and Extenfion of the Spines •, and the Back-bone 
 cannot move round, without thefe little Genus 
 Oblique beinsi moved alfb. 
 
 Apophy- Thefe Oblique Apophyfcs are r.gain cover'd on 
 
 Vc^- the Outfide of their Articulation by a Ligament, 
 
 or Ligamentous Tunicle that retains the Sinovia\ 
 
 and they are reftrain'd, as well as the Body, by 
 
 Their Several very ftrong Ligaments. 
 
 Licra- There are fome which faf^en the j4pophyfes 
 
 ment, Tranfvcrjalcs to each other, others reft rain them 
 
 by their Spiny ^pophyfes, and befides there are 
 
 others in the inner Part of the Canal of the 5;>/- 
 
 nal Marrow, viz. One improper that goes from 
 
 tiie Root of one fpiny Jpophyjes^to the Root of the 
 
 other ^ and one that is commom to all the Ver^ 
 
 tebr^ \vliich proceeds inwardly from the Head of 
 
 the 
 
Difeafes of the B o N E S. 49 
 
 the Os Sacrum to the Root of its firft Spiny J^fi- 
 fhyfsy and which pafling over all the proper Li- 
 gaments, adheres ftrongly to the inner Part ot 
 the Root of the Spiny yipofh)'fis, the whole length 
 of tJie Canal. 
 
 The Mufcles of the Spine are not lefs difficult The Spi- 
 to delcribe, then the Articulation of the Vertebra ; "*^ ^^"'* 
 but as the Defcription of them is not fo uleful ^^^ 
 for the Underftanding Luxations of the Vertebrsty 
 I Ihall content my felf with faying that almoft 
 all the Mufcles are fituated at the hind and late- 
 ral Parts, and that there is not one before, except 
 at the Neck, where is the long Flexor ^ and part 
 of the Scalenus. 'Tis alfo known that there are 
 Mufcles which are common to a great Number 
 of Kfrff^r^, and that there are many which are 
 proper to each. 
 
 All thefe Mufcles move the Spine very fenfibly The Mo- 
 at the laft VertebrA of the Back : All thofe of the tionsof 
 Loins have a confiderable Motion, and even thofe ^^^ ^P^"® 
 of the Neck •, but the VertcbrA of the Back move 
 much lefs, becaufe they are reftrain'd by the Ribs, 
 becaufethe Cartilages of their Bodies arefmall; 
 and their Spiny ^pophyfes are very long, and lie 
 upon each other. 
 
 'Tis known that the Spine forms a Canal which The 
 contains the Marrow •, that the Parts of this Ca- Spine 
 nal muft be made fo as to be moved without in- ^^^^^ 
 commoding this Marrow, or the Nerves which hurting 
 ilTue from behind, and from the Sides ot it acrofs the Mar* 
 the Holes which the Vertebra form by their Con- ro\v> 
 junftion. 
 
 From this Structure, one may infer feveral ^p Luxt- 
 Things •, lb that the Vertebra muft be difficult to ^^°'] '^^' 
 luxate, becaufe the Strokes, Falls, or Strains, ^ ^* 
 muft get the better of the prodigious Number 
 of Mufcles and Ligaments •, and that thev feem 
 to be fecured from it by this Junftion of the Bo- 
 
 E dy 
 
$0 A Hf^z ^^\<^>^ of the 
 
 dy of the f^ertebr^y fo well cemented by Liga- 
 ments and Cartilages, that it leems as if Nature, 
 ill forming this Union of fo many Bones, had 
 intended to reconcile Firmnefs with Motion. 
 
 2. There are feveral Difficulties to furmount 
 in the Reduction, but befides thole which we 
 might cite with regard to the Strudure of the 
 Part, there is one which feems to me not the leaft, 
 that is, that the means hitherto employed for the 
 Remedy ot theDifeale, are fo contrary to it, that 
 they can never fucceed, which Ihall be demon- 
 ftrated. 
 
 3. The Marrow of the Spine, the Kerves 
 which illue from thence, and confequently the 
 Organs where thefe Nerves diftribute themfelves, 
 ought to be the Seat of the Symptoms that at- 
 tend thisDiftemper •, becaufe the Canal of the 
 Spine is with refpeft to the Marrow which 
 it contains, what the Cranium is to the Brain. 
 What Accidents ought one not to expert if any 
 Vertebra (hould be out of its Place, and what will 
 not the Nerves fuffer which pafs by the Holes 
 tliat form their Cavities ? If the Marrow is com- 
 prefs'd, the inferiour Parts will fall into the Palfy, 
 and Gangrene, and ifthere are but certainNerves 
 comprefs'd, the Patient will fuifer intollerable 
 Pains at the place of Comprelfion, and will have 
 the Palfy in the Parts where the Nerves, fo com- 
 prefs'd, diftribute themfelves. 
 
 4. The Manner of reducing diflocated Verte- 
 ^/-<6 ought not to be the fime with that defcrib'd 
 by the Ancients, and ftill prafticed by the Mo-J 
 derns,to the great Injury of thole who are in 
 that melancholly Condition. 
 
 'Tis 18 Years fince I publifh'd a new Method, 
 funded upon the natural Structure of the Parts Jj 
 the DelTedion of Bodies, upon Succefs j a:;d I mayj 
 venture to fay, upon the bad iifue of the ai 
 
 cieal 
 
Btfeafes ^/f^tf Bones. 5* 
 
 cient Method •, no Body has followed it, To dif- 
 ficult ic is to fhake off the Yoke ot Pre- 
 poireilion. 
 
 Of their Sorts and Differences, 
 
 'Tis difficult^not toHiy impoiTir o, that a com- A com* 
 pleat Luxation ihou'd happen tot he rcrt£h/£, with pi^** _ 
 out the Patient's dying upon the Spor, or a h'ttle ^^"^'^"^jj" 
 afterwards •, and accordingly it is found, that their 
 Luxations are generally incompleat. 
 
 We call that a compleat Luxation, when the An in- 
 diflocated Bone no longer touches that to which compleat 
 it was joined at the Places which made the Jun- co^mmon" 
 ftion ^ r.nd in the ufual and incompleat Luxa- 
 tions of the rertcbra, greateft Part of their Bodies 
 always touch, infomuch that they are never di- 
 flocated entirely, but at their ohWque j^pophyfes : Luxation 
 One even fees every Day, that the two obi que of one 
 jipofhyfcs are not always equally diflocated, one Apopby- 
 may be forc'd from its Place, whilft the other 
 remains almoft in its natural Pofition. 
 
 There are Luxations of one, two, or three t 
 Vertehrdt, which mufl be underflood in this Manner: of \ n 
 for Inflance, if the RrB: Tertchra of the Lo\u^ is or5'vcr- 
 diflocated from the laft of the Back, and the lafl of tcbrac. i 
 the Loins from the firft of the Os Sacrum, one ^'^'^^^P^® 
 ought not to fiy, that the five f^ertchr£ of the 
 Loins are luxated *, this however is the common 
 way of fpeaking, but without Reafon, becaufe 
 the three Vertebra that are between the firft and 
 the fifth are not diilocated. 
 
 It muft alfo be remark'd that ^Tcrtehra may Remark, 
 be put out either at the Top, or at the Bottom, 
 or both together, which happen very feldom. 
 
 The Vertcbr£ can never be diflocated by a Strain q^ ^vhat 
 on the Side of the Extenfion of the Spine, unlefs side the 
 the Cartilage and Ligaments, which join the Bo- Ycrtebi» 
 j E 2 dy hixAie. 
 
52 ^ Tre ATI s E ^/r/j^ 
 
 dy of thcVertehrt^ be broken, and in that Cafe the 
 Patient would loon die by the ComprefTion, the 
 extraordinary dragging, ar.d even the Rupture 
 of the Sfinal Marrow. 
 On what ^^^ oblique Afothyfes cannot be luxated after 
 Side the this manner, becaule the Extenfion of the Spine 
 Apophy- rather draws them nearer than removes them ; 
 ^^^ thus all Luxations of the yertebrA at their ob- 
 
 * ' Uque Apophy fes, happen only by a Strain on the 
 outfide of the Flexion, whether the Strain is di- 
 reftly before, a little to the Right, or a little to 
 the Left, as ihall be explained immediately. 
 It one ftrains violently in bending the Spine 
 Firft Ex- d'reOily forwards, the inferiour oblique Apophy- 
 amp c. y-^,^ of one Vertebra^ will be forced from the Bounds 
 prefcrib'd to them by the fuperiour oblique 
 Apophyfes of the under F'ertcbra^^nd then there is a 
 Second Luxation of the two oblique Apophyfes of the 
 Example, upper Vertebra. 
 
 If the Strain happens, on the right Side in 
 Jjj^^.g bowing the Spine, the left oblique Apophyfes 
 ^ ' breaks out from the oblique Apophyfis which re- 
 ceives it. 
 
 If the Strain happens in the bending the Spine 
 on the left Side, there will be a Luxation on the 
 right Side. 
 
 Of the D'lagtiojlick Signs, 
 
 Signs They are common and proper. The common 
 
 common Signs are the deform'd Shape of the whole Bo- 
 andpro- ^^^ ^j^^ difficulty, and fometimes, impoITibiiity of 
 ^^^' walking,the Numbnefs oftlie Parts that are be- 
 
 Mclan- neath the Dillocation •, from whence there fol- 
 cholly lows inftantly, or fometime afterwards, a Pally 
 Acci- in the lower Extremities, the Belly becomes 
 •Icnts. bound, the Urir.e is ftopt the firfl Days, and ai 
 terwards runs involunrarily : Then comes a Moi ' 
 tification, and Deatli is not far diflant. 
 
 The 
 
Difeafds of the Bo N E s. 55 
 
 The Shape of the Body is deform'djbecaufe iftEx- 
 the Spine no longer retains its ufual uprightnels. P'""""* 
 
 It's difficulf, and ibmetimes impoilible,"fbr the °°* , 
 Patient to walk, both becaufe the Spine being Exola- 
 no longer ftrait, the Weight of the Body is not nation, 
 upon the Line ofGravity ^ and, becaufe if the Pa- 
 tient tries to replace it there (as hunch back'd 
 People do) in order to walk, all the Motions he 
 makes, are io many Shocks, which fhake and 
 prefs the Spinal Marrow, and caufe violent Pains, 
 which he will willingly avoid by ceaiing this 
 troublelbme Experiment, 
 
 What alfo caules a Difficulty of walking, is, Another 
 that the Compre/Iion of the Marrow interupts Reafon. 
 the Courfe of the animal Spirits in the Mulcles 
 of Progreflion, which are Ibmetimes not only 
 weakened, but entirely lofe their Elaflicity in 
 24 Hours, and even f()oner, according to the De- 
 gree of Compre/Iion which the Marrow and the 
 Kerves fuffer. 
 
 The Confequences of this Compre(Iion, are, Third 
 Numbnefs, Coftivenefs of the Belly, the Palfy, Expla- 
 ftoppage of Urine. Involuntary EjeO:ions, and ""^fion' 
 the Gangrene, are the EfFeils of a Total Com- 
 prefTion of the Marrow and Nerves. 
 
 It mufl beobferved neverrhelefs that the Can- Obferva- 
 grene comes, firft, at the 5piny j^pophyfes, at the rion on 
 Spiner of the Ofsa Ifchij, the Flelli of the great 'j'^ ^^"^ 
 Trochanter, the Coccix, and the End of the But- ^^^'^^ 
 tocks ^ becaufe the Patient lying always upon 
 his Back, thefe Parts are comprefs'd, by the ^^^f^,^ 
 Weight of the Body, between the Bones and the of thefe 
 Bed, whence theBlood VefTelsare deprelfed there, things 
 and the Humours ftopt, fo much the more, be- 
 caufe the Parts that are Paralitick, and have loft 
 their Elaftick Force, fuifer therafelves to fnik 
 down, and can't withftand the CompreiTion. 
 
 : E 3 The 
 
54 A 1 KE Alls iL of the 
 
 I. Proper The proper Signs are four, the firft fhows 
 
 ^'8^ us whether one or more rtnebrs are luxated. 
 
 £. Proper The id whether the Luxation is of two ob- 
 
 S'gn* llque Jpophyfcsf 
 
 The 3(1/ If it is at the Right oblique Jpopbv- 
 5. Proper r. o -i t r J 
 
 4. Proper And the 4th, that the Diflocation is at the 
 Sign. Left oblique Procefs. 
 
 Sign of When the Luxation is of 2 or 3 rertebrdy 
 icveral the Crookednefs of the Spine is greater than 
 Vertcb:-* when there is but one difplaced. 
 being In a Luxation where the two oblique ProcefTes 
 
 g"gj^ jl^'^^ are disjointed, the Spine is bent forwards in a 
 theLuxa- J'ight Line, the Patient feels confiderable Pain 
 aon is of if 'tis bent any more, and on the contrary, 
 two Apo- he finds Eafe, if one ftraitens it a little ^ 
 phyfes. which is caufed by realbn that in the Flexion, 
 the Ligame)itsand theA^ufcuHExtenforesyWhichzre 
 alreadyviolentlyextended,areftretched too much, 
 and when the Spine is raifed a little, the Patient 
 finds himfelf eas'd, becaufe the Extenfion of 
 the Mufcles and Ligaments is dimlnifh'd. 
 An dTen- I muft make one elfential Remark. The MuC- 
 tial Re- cles have no fhare in caufing the Deformity 
 ^^^^'^' of the diflocated Part, as they have in other 
 Luxations^ this Diftortion proceeds wholly from 
 the dilplacingof the oblique Apophyfes^ and the 
 Spine always throws it felf on the Side that is i 
 bent, tho' the Mufcles don't draw it thither ^ 1 
 for notwithftanding the Body is bent, it is drawn ' 
 backwards by the. Contraftion of a prodigious 
 Kumber of the Mufcles, wherewith the whole 
 Back of the Spine is covered. 
 Refle^ti- if the Mufcles were in any ways the Caufe 
 of this Difiortion, the 5p;>;f wou'd be overturned, 
 and drawn backwards, and "'tis leen on the con- 
 trary, tliac it keeps bent, even after all the Mulcles 
 
 are 
 
 I 
 
 on. 
 
Bifeafes of the hoNES, 55 
 
 are cut, which I have try'd on feveral Bodies 
 of Perfbns who have dy'dof this Difeale. 
 
 The Signs that the obh'que Procefs of the Signs of 
 right Side is diflocated, are, partly thofe we '•* !-»'«*"* 
 have juft mention'd ^ to which muft be ^ddeJ, ^"jJi"^*® 
 that the Sfiyie bends to the left, that the Patient side 
 feels exceilive Pain if one bows the Body on the 
 Side to which it Jeans, and that he finds Eafe if 
 'tis thruft towards the Side from whence 'tis 
 luxated. 
 
 When the oblique Procefs of the left Side is Signs of 
 diflocated, the Body bends to the Right, the * ^"'^5|- 
 Patient is in Pain when one bows the Body on /^"f^s/J*e^ 
 the Side to which it bends • and finds Relief if 
 'tis thrufl the oppofite Way. 
 
 I fliall not give any Signs by which to find ^^* 
 out the Luxations which are faid to happen di- ^^j^g^ 
 really backwards, direftiy to the Right or on Luxations 
 the Left, I believe I have proved fufficiently that 
 they are impofiible. I leave the Care of defcri- 
 bing their Signs to fuch as think they have met 
 with tliem. 
 
 Trognojlick, 
 
 The Vertebra of the Loins are more eafily A Re- 
 diflocated than thofe of the Neck, and thele ^fe in 
 again more enfily than thofe of the Back. Progno- 
 
 The Vertebra of the Loins diflocate with lefs fticks. 
 Difficulty than the others, i. Becaufe they are Firft 
 fituated m the middle of ths Body, or at leaft at Ri^a^on- 
 the Part where the Flexion is the Itrongeft , and 
 where Strains have mofl fower, as is feen by 
 a Stick, which being prefTed at both Ends, is 
 confiderably more bent in the middle than at its 
 Extremities. 
 
 2. Their oblique j^pophyfes are more outward Second 
 than thofe of the Neck and Back, and confe- Reafou. 
 <juently are more expofed. 
 
 E4 3. The 
 
5^ 
 
 Fourth 
 Reafon. 
 
 Fifch 
 Rcafon. 
 
 Caufe of 
 Danger. 
 
 J, Caiifc. 
 
 Caufe. 
 
 Thcmoft 
 dangc- 
 rousLux- 
 atioDs 
 aad why 
 
 A Treatise of the 
 
 30. The P'ertebra of the Keck have a Cavity, 
 ill the upper Part of their Bodies, which re- 
 ceives the Eminenceof the ^<rrfr^r<« above them, 
 which gives them a ftronger jointing than thole 
 of the Loins, whofe Bodies are flat. 
 
 4. The Cartilage at the /^<rrff^r<<: of the Loins 
 being thicker, they move with the greater Fa- 
 cility, and 'tis known that Luxations happen 
 moft frequently, and moft eafily, at thofe Arti- 
 culations that have the moft Motion. 
 
 Laftly the rertebrd: of the Back are luxated 
 with moft Difficulty, becaufe the Flexion of the 
 Sphe is not great there, and they are moft ftrong- 
 ly jointed wi h the Ribs. 
 
 All Luxations of the VertehrA are dangerous, 
 which proceeds from two things. 
 
 Firft, From the Compreffion, Commotion, 
 and dragging of the Marrow of the 5/?/ «r, which 
 being only the Extenfion or lengthening out 
 of the Brain, muft fuffer infinitely •, and 'tis 
 well known of what Importance that is for the 
 moft ufeful Functions of Life. 
 
 The Second is from the great Difficulty of 
 reducing the Luxation, efpecially if one follows 
 the Praftice of the Antients. 
 
 Luxations of the Fertchr£ of the Keck and 
 Back, are more dangerous than thofe of 
 the Loins, becaufe there require a greater Strain 
 to disjoint them, and that when they are dillo- 
 cated, they comprefs a greater Extent of Mar-r 
 row -^ whereas 'tis contrary in the Luxation of 
 the Vertehtt, of the Coins, 
 
 Thus ill the Luxation of thofe of the Keck, 
 there are more Parts Paralitick, becaufe the 
 Kerves which ilf.ie from the Marrow, at th« 
 Keck and Back, have Communication in moi 
 Places with the eighth Pair, and the Intercofial, 
 
 befor< 
 
Bifeafes <?/ r/jf Bo N E s. 57 
 
 before it has fupply'd its Branches that are of 
 the moft Importance to the Katural Oeconomy. 
 
 The Luxation of two or three Fo-tcbrtt is Luxation 
 more troublefome than the Diflocation of one "^^<^'" J 
 only, becaufe the Marrow is comprefs'd in more rj°j5^''°^" 
 Places, or in a greater Extent. 
 
 The Luxation of two oblique ProcelTes, is lefs Luxation 
 difficult to reduce than the Diflocation of one of^obli- 
 only. que Pro- 
 
 If the Luxation of the VertehrA is not reduc'd, ^^^^s- 
 
 the Patient muft infallibly die. l^flL 
 
 ,^. „ . Ml !• 1 »• 1 J ?i 1 due d the 
 
 The Patient will die tho it be reduc d, when patient 
 
 it has been deferred too long, becaufe Defluxi- dies, 
 ons have followed the Diflocation*, or, becaufe If'tisde- 
 the Marrow and the Nerves, which are foft ^°° ^°"5" 
 and tender Parts, have been too long comprefs'd 
 to be able to refume their Tonus -, thus the Ob- 
 flrudion does not ceafe, and the Palfy conti- 
 nues with all the Symptoms. 
 
 Altho' the incompleat Luxation be the moft The In- 
 difficult to reduce, yet it is lefs dangerous than compleat 
 the compleat one, becaufe the Marrow is lefs }-"'i^"°" 
 comprefs'd in the one than the other. ge^rous!"" 
 
 I once knew a Soldier who did not die of 
 a Luxation of a Vertebra^ altho' it was not re- 
 duc'd, becaufe this Luxation was occafion'd by 
 a Strain, which gives me Reafon to believe that obferva. 
 the Diflocation of the VertehrA is yet more dan- tion, 
 gerous by the Commotion which a violent Fall 
 caufes in the Marrow, than by the difplacing 
 of the Bones. 
 
 The Parts may by little and little accuflom RcfleSi- 
 themfelves to the Compreflion that is occafion- ^^' 
 ed by the Bones being displac'd, but cannot 
 bear up againft the Compreilion, tho' but flight, 
 when they have been jarr'd by a violent Shock. 
 
 From the fame Reafon there are Fractures 
 and Depreflions of the Craniumy which are cured 
 
 \/ithouc 
 
58 ^ T R E A T I S E ^/ fiB* 
 
 without trepanning, but thefe uncommon Cales 
 don'c make a Rule. 
 
 Of the Cure. 
 
 Cure of ^^ reduce the diflocated Vertebra, the PatJ- 
 difloca- ^^^ "luft belaid upon his Belly, a crofs a Bed 
 ted Vertc" three Foot broad, with a large Sheet upon it, 
 brr. rolled up in the ihape of a Bolfter ^ this biheet 
 
 JJI^ri !f^ muft be plac'd according to the lens^ch of the 
 
 place ♦he n j i • i ,^ ,V ^ , ^ . • - 
 
 Patient. •^^*^> ^^^ ^P^" it the Belly of the Patient juft 
 
 oppofite to the diflocated Vertebra \ two AfDHants 
 
 muft lean, one upon the upper Part of the Sfitie^ 
 
 A new near the Root of the Neck, and the other up- 
 
 Mcthod. Q^ jj^p Q^ Sacrum, in order to bend the Sfine-, 
 
 then one muft piefs upon the luxated Vertebra, 
 
 that is to fay, upon that which is immediately 
 
 below the moft eminent Part of the Tumour 
 
 that is vifihle ^ at the fame Inftant they rauft 
 
 raile that Part of the Trunk that is towards 
 
 the Head, and the Vertebra is reduced. 
 
 One may make the following Remarks upon 
 
 Effential this new Method. 
 
 Remarks. We have already faid, that the Mufcles do 
 not change the Figure of the Part, in the Luxa- 
 tion of the Spifie, altho' they do their Endea- 
 vours to extend it •, it is the oblique Apofhyfes 
 which, by meeting with the Ends of each o- 
 ther, hinder the Sfme'^s ftreightening, which 
 makes the Attempt of the Mufcles fruitlefs, and 
 this is what has not been obferved by thole 
 who have written of this Diftemper, nor put in 
 Praftice by thofe who every Day attempt thefe 
 Sorts of Reductions. 
 "Errors of 'Xis not wonderful to fee Authors propofe 
 Authors. Extenfions, Counter Extenfions, laying under 
 of Rollers, Leavers, and PrefTes, in order to re- 
 duce luxated yertcbrs, \ it is not, I fay, wonder- 
 ful 
 
'Difeafes of the Bone $• 59 
 
 fill, "becaufe moft part of thofe who have writ- 
 ten were only Chirurgeons in Theory ^ Perfons 
 muft praftife ^ that is the Means to learn Surgery, 
 provided they refleft upon what they do, and 
 know how to profit both by their Succefs and 
 Misfortunes. There are fome who their whole 
 Lives do nothing but copy their own Faults. 
 
 I fay, that the Si>ine muft be bent, which is Thg^g 
 contrary to the ufual Manner of reducing other arc fome 
 Luxations, wherein one turns the Limbs on the who ne- 
 Side of the Mufcles that are ftretch'd, in order v^*" 
 to relax them. The fame muft not be done °^ * ^ 
 in reducing the Vertebra^ for, in bending the 
 Body, far from relaxing the Mufcles, one ex- 
 tends them ; 'tis by this Means that the ob- 
 lique Proceites of diflocated VertehrA are remo- 
 ved at a Diftance from each other, and that 
 they eafily refume their Places. In following the 
 Method which I have propofed, it always fuc- 
 ceeds when "tis well put in Execution. 
 
 They, who in order to reduce the Vertebrd:, A faulty- 
 make Extenfion, and Counter Extenfion, with Method, j 
 Straps, or other Means, can never fucceed, be- ^ 
 
 caufe all their Endeavours end in ftraitening "^ 
 
 the Spine, and that muft not be done ^till theob- 
 Vique u4fophyfes are difingaged, and no longer touch 
 each other, their touching being the only Caule 
 that hinders its becoming ftrait. 
 
 They who, hang up the Patient under the Anothet* 
 Arms, and they v/ho put Sticks and Rollers wrong 
 on the Side of the Spiny Procelfes, and prefs upon Method. 
 them with a Leaver, do at leaft as wrong as the 
 others •, their Endeavours tend only to prefs the 
 oblique Proceifes aganift one another^ but on 
 the contrary, one muft dilengage them to make 
 them return to their natural Pofition. 
 
 The other two forts of Luxations of the Spine, ^^''^qP^\'[ 
 require almoft the fame Operation-, neverthe- t\Yoothcr 
 
 Icfs 
 
6o J Tke ATI $E of the 
 
 kinds of lefs it muft be obferved, that if the Luxation 
 Luxation, -g ^^ ^^ oblique Apophyfa on the Left Side, one 
 muft bear upon the Bone of the Left Hip, and 
 upon the Right Shoulder •, that if 'tis the right 
 oblique j4fofhyfes which is diflocated, one muft 
 bear upon the Bone of the right Hip, and up- 
 on the left: Shoulder, in order to make an un- 
 equal Flexion that agrees with the Inequality of 
 the Disjointing. 
 
 ^^ When the Luxation is reducM, the ComprefTes 
 
 Drcffingv ^^^ ^^^ ^g^ ^^^ ^^ Ij^j^ ^H ^^^j. ^j^g 5p.^^^ 
 
 being kept on by the Bandage for the Body 
 (D), the whole fupported by the Scapulary (E) 
 and upon the Belly they put the Belly-Bard 
 (C). The Patient muft be laid upon his Back 
 in a fmooth Bed, be blooded feveral Times, and 
 obferve an exaft Regimen. 
 
 The 
 
J Tw.v.Arisz of the 6% 
 
 : 1 The Places that are benummed or paralitica, Topical 
 lliould have fpirituous Fomentations applyM to ^^^^- 
 them, and be chafed with hot Linnen. When *^^°^ 
 the Body is fuificiently emptied, and the Pain 
 is not confiderable, vulnerary Potions may be potion*. 
 given ^ on the contrary one muft only give Ano- 
 dyne and even Narcoticks if the Pain is acute. 
 If the Patient is coftive, he muft take Clyfters, Clyfter*. 
 and if he does not make Water, he muft be pro* Probing, 
 bed. 
 
 As for the Dreflings the taking them off, muft Dreflings. 
 be deferred as long, and be done as feldom as 
 po/Iible, efpecially if the Patient is quiet, and 
 the Pains are not fharp. One muft obferve what 
 pafTes, to the End that one may find Remedies for 
 any melanchoUy Accidents that may enfiie; if j^ ^ ^^ 
 the Pulfe beats high, one may bleed afrelh in verfol- 
 the Arm, and if that does not fucceed, in the lows. 
 Throat, fmce for any Diforder in the Head 'tis 
 ufual to bleed in the Foot, which alfo may be 9^^^^*'. 
 practiced in Luxations of the Fertebra, provi- ^*^ 
 ded one obferve two Things^ firft, That the 
 VefTels are well empty'd by the Bleeding in the 
 Arm, and idly, that the Patient may be let 
 Blood in the Foot without moving him. 
 
 If the Belly remains bound in Spite of the O^ferr*' 
 Clyfters, one may make them Cathartick ; and ^°"' 
 if that don't fucceed, one muft purge, provi- 
 ded there is Blood enough taken from the Pati- 
 ent, and the Dofe is not violent. 
 
 If the Belly becomes ft retched and painful, Tenfioa 
 Fomentations, emollient Embrocations and Ano- ^ il^* 
 dyne?, are very ufeful, together with the gene- ^ ^* 
 ral Remedies. 
 
 If there be a CangrenCy one muft deal with it 
 apart, according to the different Degrees of Al- 
 teration. When the Alteration is flight, one 
 make^ Ufe of fpirituous and faline Lotions, as 
 
 Spirit 
 
62 A Tkz ATI $z of the 
 
 Spirit of Wine camphorated, and a Solution of 
 Sal Armoniacky all laid on very hot, and often 
 reiterated. 
 Stirax If fbme Places are of a red-like Purple, Oint- 
 
 " ' ment o( Stir ax may be added, after having wafh'd 
 the Part with the abovementioned Lotion. 
 Scarify-] l{ the Spots are livid, one muft icarify to the 
 *^S' quick, foment with the before-mentioned Lotion, 
 
 and apply Pledgets covered with a Digeftive, 
 made of Bafdicon, and Ointment of Storax. One 
 muft cover the Part with a Cloath Ipread thick 
 with StoraXy and clap upon it thick Compreffes, 
 fteeped in the Lotion very hot. The whole muft 
 be kept on with a proper Bandage. 
 Separati- If the Efcars feparate, one may help their Se- 
 ^s of the paration, by cutting the dead Flefh, and avoid- 
 ^^^' ing the Quick, for fear of caufing Pain, and 
 then the Medicines penetrate better. 
 ^ d c"^- If in Spite of the Applications of thefe Me- 
 jj^„ " dicines, the Gangrene gains Ground, one muft 
 come to Incifions, and even to cutting after a 
 proper Manner, taking as much Care as is poC- 
 fible of the Parts neceffary. 
 
 When the Luxation is well reduced, the gan- 
 grenous Dilpofition ought to ceafe on the Ap- 
 plication of the firft topical Remedies that I 
 have prefcribed, provided the Marrow or the 
 Nerves have received no Contufton or Bruile, 
 confiderable enough to render the Topicks 
 fruitlefs. 
 Obferva- If the Gangrene were more advanced, as hap- 
 tioiis. pens when the Reduftion has been made too 
 late, a Cure may yet be hoped for •, but when 
 it comes after the Reduction is made, 'tis a fore- 
 runner of Death •, whence one may judge that 
 the difplacing of the f^ertchra has produced fuch 
 Diforders in the Marrow and Nerves, as are 
 incurable. 
 
 The 
 
Difeafes of the B o N E 5.' 6^ 
 
 The Gangrene is yet more fatal, when after 
 the Suppreiiion there follows an involuntary E- 
 jeftioa of the Urine, and Excrements. This 
 ftagnated Matter heats and corrodes the gan- 
 grened Parts, and hinders the Operation of the 
 Remedies. 
 
 It remains, to end this SubjeO:, that I exhort ?xl^ort»* 
 the Chirurgeons, who have fuch melancholy ^^^^ 
 Cafes under their Cure, to have Abundance of 
 Temper, to keep their Patients in as proper a 
 Pofitionas they can, to vifit them often, in Or- 
 der to prevent all their Wants, and hear their 
 Complaints : For I dare venture to fay, there 
 are none greater Objeds of Pity. 
 
 Befides, they muft always have their Bed pro- Whai: 
 vided with an Alaife, or Half-Sheet, and an ^^^^ ^ 
 Oyl Cloath ^ both the one and the ocher keep J,^^ 
 the Bed dry, and the Skirt in particular ferves to 
 turn the Patient, and place him upon the Belly, 
 for the more convenient dreiling of him. 
 
 If the Palfy don't ceafe, tho' the Patient be Obferva- 
 cured of his Luxation, the Waters of Bourbon ^^°^. 
 are very efficacious ; Pumping is prefer ibed up- 
 on the Parts that have fuffered, and they are to 
 be taken inwardly, obferving the flmie Precauti- 
 ons, as thofe who drink them after a Fit of an 
 Apoplexy. 
 
 W' 
 
 ^, 
 
 CHAP. V. 
 
 Of the Luxation of the Coccytc. 
 
 TH E Coccyx is the Extremity of the Spine, StruEhirc 
 placed where the Tail is in four footed A- 
 nimals, and has three or four ycrtchra. The 
 £i'ft is jointed at its Body by, a Cartilage, with 
 
 the 
 
^4 A TkZ A TTSE of th 
 
 the End of the Os Sacrum : It has alio two Sorts 
 of oblique Procelfes, which join it to the Os Sa^ 
 crum by a Ligament. One may likewile obferve 
 in it two u^pophyfes tranfverfales ^ the two other 
 F'ertebraof the Coccyx have no Manner ot Refem- 
 blance to the P^ertebra of other Parts ^ they are 
 joi'ated mutually between themlelves, and with 
 the firj^t by a Cartilage. Thefe Pieces together 
 make a kind of Raven's Bill, convex without, 
 and hollow and crooked within, in Order to 
 fuftain the Return. It gives Adhefion to the 
 SfhinEler Ani, and fbme Part of the Glutei. 
 The What is commonly called the Luxation of the 
 
 Word Coccyx^ is not fo, becaule it's Junction is not an 
 Luxation Articulation by Heads and Cavities, but an 
 ^ ^ ^ Union by Cartilage, which the Antients named 
 Synchondrofs. However it be, 'tis very feldom 
 that thefe Vertebra are entirely disjointed •, which 
 makes me believe that one ought to call their 
 Luxation outwards. Overturning \ and the Lux- 
 ation inwards, Depreflion. If the Coccyx were 
 Remark, entirely feparated from the Os Sacrum, it would 
 be faid the Coccyx is broken, and not diflocated. 
 But leaving the Names, let us come to the 
 Things, andfpeak like the Vulgar. 
 
 The Coccyx dillocates inwards and outwards. 
 pj,j^g The outward Luxation happens only after hard 
 Kinds. Labours, when the Infant has ftuck long in the 
 Birth ^ on this Occafion the Cartilages and Li- 
 gaments that join the Coccyx lofe their Elafticity, 
 becaule they are too long forced, and ftretched 
 by thelmpulfion of the Infant, which is it felf 
 continually thruft by the Spring of the Matrix, 
 the ftrong Contraftion of the Diaphragm, and the 
 CHufc. Mufcles of the jibdomttj, whence the Coccyx at 
 length not being able to refift any more, is forced 
 outwards j and can't return tQ, its natural Pofi- 
 
 tion 
 
D/fiafes oftheBoK-ES. 6$ 
 
 fitlon after the Delivery, becaule the Cartilages 
 iind Ligaments have loft their elaftick Virtue. 
 
 The Coccyx luxares inwards from contrary ^'"4 *"** 
 Oiifes, as Blows, Falls, &c. ^''''^^'^' 
 
 The Accidents which attend this Luxation acci- 
 are, a Heavinefs in the Fundament, and a con- clenrs oi 
 fiderable Pain, which is particularly felt when ^^^^^ . 
 the Patient goes to Urine, moves his Thigh?, q^^^^^' 
 goes to Stool, or cough?, fpits, blows his Kofe^ 
 or fneezes. 
 
 The Heavinefs proceeds from this, becaufe Explka- 
 the Coccyx, whofe Ufe is to fuftain the RcU:nm, ^io"* 
 finds its Weight greater than ordinary, by 
 Reafon its Ligaments are painful. 
 
 The Pain which the Patient feels when he ^^^P^^^** 
 moves his Thighs, or goes to Stool, is caufed ^"' 
 by the Gluteus Major being fattened to the late- 
 ral Parts of the Ocm-, and the Mufcles of the 
 RcH-um having Part of their Origin there like- 
 wife, whence it is always itiov'd when the 
 Mufcle? ad, either by the Motion of the Thighs^ 
 the Rctlum, or the Bladder. 
 
 The Pain remains a long Time, neverthelefs Pfogno- 
 this Luxation i? not dangerous, unlefs it hap- ^^ ' 
 pen to fome cacochymick Subject, and the 
 bad Qualities of the Humours caufe Diforders 
 which the Luxation alone cannot produce. 
 
 I once knew a Gentlewoman of lo Years old, obfer- 
 who fell upon the Ice, and got a very great vation. 
 Contufion in her CoffyA; : She negleded her Ail, 
 Shamefacednefs not I'uifering her to fhew it till 
 there was a Difpofition to gangrene. I bled her 
 immediately, and relieved her fo opportunely 
 with Topicks, a Regimen and general Remedies, 
 that ihe got (juit of it for a fuperftcial Impo- 
 fthume, which I opened, and of which ihe was 
 poll cured. 
 
 r. Ano- 
 
66 A T KE AT J 9, z of the 
 
 Obfcrra- Another happened not to be fo fortunate, ihe 
 **^"' had fallen upon a Corner Stone, which ftruck 
 the Coctyx near its Junction with the Os Sacrum. 
 The fame Bafhlulnefs which was prejudicial to 
 the former, was much more lb to this •, her 
 Pains indeed were not violent, but fne felt an 
 unealy Weight in the RcUumy wh'ch became 
 more confiderable from Day to Day. :5he would 
 not conlent to be touched until her Excre- 
 ments could no longer pafs thvo' the ReUum-^ 
 having placed her upon the Bed-Side in the 
 fame Pofture as one who is to take a Glifler, I 
 introduced my Fo^'e-Finger dipt in Oyl as high 
 as I could into the Anus. I touched with great 
 Difficulty a Tumour of the Bignefs of a mid- 
 dling Pippin •, and with my Fore-Finger of the 
 otheV Hand, which I placed without near the 
 End of the Os Sacrum, and the Beginning of 
 the Coccyx, I difcovered a Fluctuation, which 
 anl'vvered from one Finger to the other as I 
 moved them alternatively, which made me be- 
 lieve there was an Impofthume : The Bulinefs 
 was to open it (inftead of preparing it, as fbme 
 complaifant Folks propoled) having declared 
 the Danger of deferring it. The Relations of 
 the Patient were of my Mind, as ihe her felf 
 was alio, the complaifant Gentry were lb like- 
 wife, and all out of Complailance.. 
 
 I prepared Linncn Rags, a Comprels and Ban- 
 dage-, then I put again my Fore-Finger into the 
 ^nw with the fame Precaution, I even thruft it in 
 farther. I touched the Tumour a little better, 
 and forcing it outwards as much as wa? po/fi- 
 ble, to bring tJie Pus near the Place where I 
 had felt it, witli the Fore-Finger of the other 
 Hani, I plngei the Point of an Incifion 
 Knife dircftlv to the Seat of the purulent 
 Matter, which iifued out in great Abundance; 
 
D'/feafes of the Bones. ^j 
 
 and the interiour fwclling difappeared. \ put 
 Iny Fii](7er into the Wound, and 1 found the 
 Point of the Os Sacrum^ and the Head of the 
 Coccyx entirely bare and ftript of the Peri- 
 cflcuTTj, as well as rotted by the Pus^ which 
 arowned us with its Quantity, and poifoned 
 us with its Stench. The Head of the Coccyx 
 being entirely by it felf^ was feparated and 
 parted fo as to give way for, and facilitate the 
 Dreffings which continued a long Time, and 
 had not good Succefs, the Patient died at the 
 end of fix Months, by the melting the Greafe 
 of the Felv'is Renum, by extraordinary Suppura- 
 tions, which were attended with a flow Fever 
 and a Loolenefs till her Death. 
 
 A Lady by fitting down hard upon the Frame Obfeffd^' 
 of a Chair, inftead" of fitting on the Cufhion, ■^®"' 
 had a very great Contufion over the Coccyx. The 
 Pain was fo great that fhe fainted, and when 
 fhe recover'd from her Swoon, fhe bath'd her 
 Hurt in Brandy, and was bled, but wou'd not 
 fuffer her Surgeon to fearch her. She was 45 
 Years old, an Age when Baflifulnefs returns. 
 She had a very bad Night, her Surgeon was cal- 
 led, and only let her Blood again in fpite of all 
 the Intreaties he ufed to examine her. The Day 
 ►vas no better than the proceeding Night,- and 
 :he next was yet worfe. Day again appearing,' 
 he was Bled a third Time, her pain in her Coc- 
 )'^ abated, and another came at the La'hU of the 
 '^uha near the ^ms. Both the one ana the 
 )ther, fwelfd in fo fhort a Time,- that irx 
 ,4 Hours the Right Lip impofthumated ^ the 
 impofthume opened of it felf, and Fear deter- 
 nin'd the Patient to fulfer the proper Open- 
 ngs^ which done, ihe was cured without any In- 
 onvenience • 
 
 li' F 2 'tis 
 
63 j4 T KZ An sz of the 
 
 'Ti^3 eafily corxeivable that if this Lady had 
 fullered herfelf to be govern'd, more frequent 
 Bleedings, and a Regular Management, might 
 have prevented the Impofthumc. 
 
 All Luxations of the Coccyx are not Subjeft to 
 like Accidents ■, 1 have cured a great many where 
 not one has happened. 
 Rcdu£li- To reduce the Coccyx whendiflocatedoutwards, 
 on. one need only thruft it inwards with ones 
 
 Thumb, and keep it in its right pofition with 
 the graduated CompreiTes (H) and a Bandage 
 (T) which muft be placed in fuch a manner that 
 the Patient may go to Stool and Urine with- 
 out taking off the Drefiing. 
 
 Spirituoi 
 
Dife^fes of the B o N E S--' ^9 
 
 Spirituous Medicines arc very proper :Mc.li- 
 I Hkewife ufe 011 this Occafion a Defenlive, ^i'lcs. 
 the Method of preparing whereof I will lay 
 down as it was taught me by the Inventor of 
 it. 'Twas the late Mr. Martial who was Sur- 
 geon Miijor of Tournayy in the War concluded 
 at Reswick. 
 
 Brandy wherein a little Allum has been dif- Remedies 
 folved, with Spirit of Wine camphorated, and 
 a great many other Remedies, may be made 
 ufe of, not only in this Luxation, but all others, 
 lam no admirer of Oyl -^ I have obferved fo of- 
 ten that it 'caufes Itching, and an Eryjipelas^ 
 that I have left it off in all Dreilings of Fra- 
 ftures and Luxations. 
 
 To reduce the OcfyA- when luxated in\"ards,Redn£H- 
 one muft dip one's Forefinger in Oyl of Olives, o" 0* die 
 or of Sweet Almondf;, and introduce it into the?^'^'^^'^ 
 ^nus 2iS tar as is neceffary to get beyond the 
 end of the Coccyx, in order to raife it. The 
 fame Remedies are applyed •, but one makes 
 only a loofe Bandage purely Contentive to keep 
 them upon the Coccyx. 
 
 The Patient muft keep his Bed lying upon 
 a Roller or Pad, during the whole Cure •, 01 if 
 he rifes, he muft fit down upon a perforated 
 Chair that nothing may prefs upon the Part ^ 
 which would caufe new pains, and perhaps <i 
 Diilocation. 
 
 inwards. 
 
 P3, 
 
 cha? 
 
 I 
 
T I? ^4 Tkeatisz of tha 
 
 Chap. VI. 
 
 Of the Liixatlon of the Clavicula, 
 
 TH E Clavicula is. that Bone which, like a 
 fort of a Buttrefs, keeps the Omoplata, and 
 the Humerus at a diftance from the Breaft, both 
 to hinder the Weight of thefe Parts from 
 ftraitening the Breaft in its Dilatation, and to 
 give Liberty to the Arm to exercife all its 
 Motions. This Bone is articulated with the 
 Sternum and the Acromion. 
 6truQ:iire. To join it felt with the Acromion, it has a 
 Head a little railed, covered with a fmooth 
 Cartilage, which is received in a Cavity propor- 
 tionable to the largenefs of the Head, which 
 is hollowed in the internal Side of the End 
 of the Acromion. It is as it were the little Head 
 covered with a Cartilage fmooth and poliih'd : 
 The whole is overcaft, wrapt up, bound and fa- 
 ftened by ftrong and compaft Ligaments, info- 
 iTQuch that by this Articulation the Clavicle has 
 but little motion. The Deltoides and Trapezius 
 are faften'd to the Clavicula and the Acromion at 
 the place of their Junftion. 
 
 In its Articulation with the Sternum it forms aj 
 pretty large Head, covered with a fmooth Car-1 
 tilage. The Sternum has a Cavity whole Size 
 is not anfwerable to the largenels of the Head.] 
 neither the one nor the other have a regulai 
 Roundnef?, neverthelels they are joined to 
 Median Cartilage that is found in the Articulai 
 tion, like that which we have obferv'd in th( 
 jointingof the under Jaw. The whole is faftei 
 ed and covered over with Ligaments that are 
 pretty ftrong, but loole, and give the Cl.tvicle 
 
 grc 
 
Difeafes of t/je BoUES, 71 
 
 great Liberty in moving ; and it does move, 
 whenever the OmopUta either moves alone, or 
 with the Humerus. 
 
 The Afufculus Stermdi/wmafl aides takes its be- 
 ginning from the Sternum of the CI trjic I e at the 
 • place of tJu's Junftion. The Peroral is fa- 
 llened to the internal half, and the Deltoi- 
 des to the external half, of the Clavicle^ and 
 the Velfels that go to the Arm pafs behind it. 
 
 Both the Articulations of the Clavicle ma/ 
 diflocate. The moft eafy Luxation is that of 
 the Articulation of the Sternum^ becaufe it is 
 more moveable than the other, and that its 
 Head is larger than the Cavity that receives 
 it. Falls and Blows upon the Shoulder always 
 thruft the Cavide towards the Side of the Ster^ 
 mm, and 'tis this Articulation which fulfers 
 the moft. 
 
 It diflocates either backwards or forwards. 
 When 'tis thruft backwards, the Clavicle ap- The 
 proaches the Jf^era Jrteria. When it is luxated Kinds, 
 forwards, it breaks out of its Socket, and goes 
 beyond the Sternum. 
 
 The firft happens but feldom •, the fecond is 
 more eafy, becaufe the Clavicle inclines to that 
 Side by its natural Situation •, fmce that end of 
 it which is faftened to the Omop/ata is removed 
 farther backwards, than that which isjoiiied 
 to the Ster num. 
 
 Of the Cai4fe, 
 
 The Caufes both of the one and fother of 
 thefe Luxations, are Blows and Falls, which are 
 capable oFthruftingthe Clavicle againft theSr^rw^w, 
 and oblige it to leave its Socket, and throw iu 
 ielf backwards, if the Shoulder be forwards \ or 
 forwards it the Humous be in its natural Situati- 
 I on. 
 
 F 4 0/ 
 
75 
 
 Signs. 
 
 Progiio- 
 
 ftick. 
 
 A Treatise of the 
 
 Of the Signs, 
 
 It is eafy to know thefe Luxations •, the firft 
 becaufe of the finking in that is obferved at the 
 Place whence the Clavicle is come ^ and the 
 Second, by the prominence that i^ feen outwards. 
 
 T regno flick. 
 
 The Accidents in a compleat Luxation back- 
 wards are very melancholly, becaufe the Cla- 
 vicle Comprelfes the Jifpcra Ancrla, the Oefo- 
 ph.igus, the Jugular Vein, the Carotidcs, and the 
 Velfels adjpcent ^ which renders this Luxation 
 more difficult than the other. 
 
 ■Redu&i- 
 on. 
 
 Re- 
 marks. 
 
 Of the Cure, 
 
 'Tis eafier to reduce the Clavicle^ than to keep 
 it in. To reduce it, the Patient muft beplac'd up- 
 on a Stool, one fmgle Afliftant makes the Ex- 
 tenfion and Counter Extenfion, by leaning one 
 of his Knees on the two OmopUtue, and at the 
 fame time drawing to him the Scump of the 
 Humerus with both his Hands. Whilft the 
 Extenfion is making, the Surgeon examines the 
 Progrefs, and when he thinks it fuificient he 
 makes the Reduction ( his Ailiftant ft ill con- 
 tinuing to do his Part) by drawing tlie Clavicle 
 forwards with his Fingers, when the Luxati- 
 cn is backwards, and thrufiing it backwards 
 when the Diflocation is before. 
 
 This is the only Luxation, proceeding from 
 an external Caufe, that has much need of a 
 Bandage to keep it in its right pofition ^ be- 
 caufe the Head of the Clavicle is larger thaj 
 the Cavity of the Sternum^ which befideshas nc 
 
 Ledei 
 
 
Bifeafes of the Bones, 
 
 Ledge to retain it. Moreover the Ligaments are 
 either forced or broken, and there is no Mus- 
 cle that can reftrain it. 
 
 73 
 
 In 
 
75 A Tkzati SE of tbff 
 
 In the Luxation backwards, the Roller (A) 
 muft form a Figure of eight, which draws the 
 Shoulders backwards, and makes the internal 
 end of the Clavicle advance forwards. This Ban- 
 dage muft have but 3 or 4 Circumvolutions, 
 and muft be made in fuch a manner that the 
 difordered Part be left uncovered. It continues 
 (if I may fo fpeakj the Extenfions and Coun- 
 ter Extenfions that the Aftiftant made with his 
 Knees and Hands. Whil'ft the AiTiftant puts 
 on this Bandage, the Surgeon direfts it, and pre- 
 ferves the Bone he has reduc'd, in its Situation; 
 then he trims the fmking in that is behind the 
 Head of the Clavicle with the graduated Ccm- 
 prefs (B) or, which has fucceeded with me on 
 this Occafion, with Lint fteept in the White of -j 
 Applica- ^^^ ^S?> ^"^ Allum beat up together. This Lint 
 tionofthc is to be taken between one's Fingers, more or 
 Drpfling. Jefs, and fteept in the Remedy, and apply 'd to 
 the place that is moft deprefted ; and one muft 
 trim fucceftively all that hollow Space, whichis 
 called Salt-Sellers in Derifion, to ridicule Perfons 
 that are lean. When this Pit is fill'd up even 
 with the Sternuniy and the Clavicle, three Com- 
 prefles, muft be laid on two that crofs each 
 other as (C) (D) and one (E) which covers 
 them both. Over thefe Compreffes muft be 
 made the Bandage Sfica, with the Roller (K) 
 the Croflings and TrulTes ot which are palfed 
 over the a&ded Part, to keep it in its Place. 
 
Difeafes of the B o N E Si 
 
 74 
 
 In the other kind, one puts upon the Arti- 
 culation very thick Compreires (G) (\) They 
 niuft be kept in this Situation by the defcend- 
 ing Bandage Sfica. Both in the one and the 
 other kind, the Arm ought to be fupported 
 by the Scarf fL). The Roller (K) ought to 
 be four Fingers broad, and four or five Ells 
 long 
 
 The Luxation of the external End of 
 of the Clavicle, 
 
 I never faw the Luxation but twice •, the firft pirft Ob- 
 was iucompleat-, the End of the Clavicle had fervation. 
 fally'd but a little from the Acromion. It was 
 eafily reduc'd by making the Extenfion, as has 
 
 been 
 
j6 J T?^z A r IS z of the 
 
 been dire^ed, and leaning tlie Thumb upon 
 the End of the diflocated Bone, which 1 re- 
 plac'd, by preiTing it till I brought it even 
 with the Acromion. 
 
 The Second was compleat ; the End of the 
 Clavicle had fhot forwards, and pafTed over the 
 Acromion above eight Lines. This Ail was 
 taken by certain Perfons for a Fradure of 
 the Clavicle, which ihews how necefTary it is to 
 be acquainted with the Strufture of the Parf;, 
 that one may not be deceived in judging of Di- 
 llempers. Thefe two Luxations, the one com- 
 pleat, the other incompleat, are the only ones 
 that I have feen. of this Kind^ they were both of 
 them upwards ^ but I don't at all doubt but 
 the Luxation may happen downwards. 1 dare 
 even venture to fay, that it ought more eafily 
 to diflocate fo, than this way. 
 
 I reduc'd this Luxation as I had done the 
 former, by rendering the Extenfions ftron- 
 ger, and leaning my Thumb with more 
 force upon the End that was railed^ becaufe 
 the disjointing being more confiderable, it re- 
 quir'd more powerful Efforts. 
 
 If the Clavicle were luxated, beneath ihe^r 
 cromion, the fame Extenfions fhou'd be ufed, 
 the Head of the Acromion fhould be thruft 
 downwards, and the End of the Clavicle rais''d. 
 
 When the Clavicle diflocates at the End of 
 the AtromioTiy the DreiTmg muft be a gradua- 
 
 ted 
 
'A Treatise oftha 
 
 ted Comprefs (A) and upon the Clavicle^ ano- 
 ther Comprefs (B) which covers the ftump of 
 the Humerus, a Roller (C) the Sfica defcending, 
 and the Scarf (Dj. 
 
 77 
 
 M» 
 
7S A Tkzktis^ of the 
 
 As for that which luxates underneath the 
 'Acromion, the Reduction being made, a thick 
 Compre(s (E) muft be clapt under the End 
 of the Clavicle^ and one of the fame thicknefs 
 (F) upon the Acromioriy a third (}) muft fold 
 over the two firft, and the flump of the Humtrus-^ 
 then one muft make the Sfica afcending with 
 liie Swathe (G) as in the Luxation of the 
 Arm, and laftly the Arm muft be placed in 
 the b'carf (H). 
 
 chap; 
 
 .^ 
 
Difeafes of the Bo HE f;^ ^^ 
 
 Chap. VII. 
 Of the Luxation of the Arm. 
 
 TH E Bone of the Humerus is articulated ^'^^^^^^ 
 with the OmopUta by a Poples or Gemu* 
 This Bone has a large Head, and the Cavity 
 of the Omplara is fo ihallow that it don't con- 
 tain the fixth part of it. It only ferves as 
 (one may fay) for a Fulcram whereon on- 
 ly one point of the Head bears, which abates , 
 the friftion, and facilitates the Motion of the 
 Arm. The reft of the Head is lodged under 
 the Acromion^ which together with the End of 
 the Clavicle, forms a place of Refuge, where the 
 Head of the Humerus and its Articulation are 
 fecured from external Injurys. 
 
 The Proccjfus Coracoides is of fbme Uie in Apophy-' 
 the Conftruition of this place of Refuge, or fes. 
 fecond Socket-, It limits it on the internal fide 
 and there is a ftrong Ligament, which goes 
 from the Extu'emity of this Procefs to infert 
 itfelf with the Acromion, and the CLi'u:cle at the 
 place of their Junction. 
 
 A Ligamentous Tunicle, which folds round Tunicic 
 the Articulation, retains the Synovia which of the 
 bathes it. J°"^'^' 
 
 The Extent of this Tunicle, renders the its Ex- 
 Motions of the Head of the Humerus free and tent. 
 eafy, and the other Ligaments being alfb very 
 loole in Proportion, give the Arm a wonder- 
 ful facility in moving with quicknefs, and all 
 maimer of Ways. 
 
 This is the Articulation whofe Motions are Motions 
 moft combin'd. The Arm is raifed by the of the 
 Mufcles Deltoides, and Supra-Spinatus ; it is drawn Arm. 
 downwards by "the Rotundus Major andthe z;,<t- 
 
 tijfimus ; 
 
8o 
 
 Motions 
 of the 
 
 Arm. 
 
 Tonick 
 Motions. 
 
 Semicir- 
 eular' 
 
 Mufcles 
 that pafs 
 by the 
 Articula- 
 tioji. 
 
 A Tkz A risz of the 
 
 tiffimus'^ it is carried forwards by the Peroral 
 and tlie Coracolrrachidis ; and is drawn buck- 
 wards by the Iifra S^inatus and Suh-fcapulans. 
 
 Befides all thele Motions it has a Million 
 more, by the Conjuii^tion of the Mulcles j for. 
 it can move in all the Lines that can be drawn 
 from the Centre of tJie Cavity of the Omo- 
 flat a to the Circumference ^ and befides it 
 has a round and Semi-circular Motion. 
 
 The Motion round ways, is made by the 
 Succeilion of the Mufcles which affift in the 
 four former Motions whereof I have been fpeak- 
 ing, aiid which, when they all ad together, 
 keep the Arm ftilt and firm any way what- 
 foever, which is what is called the Tonick 
 Motion. 
 
 The Semi-circular Motion is, when the Arm 
 is extended and railed. Then the JDeltoides 
 and Supra Spwatus fuftaining it in this Situa- 
 ation, the Sub-fcapularis make it turn from 
 without inwards, and the Rotundus Major, with 
 the hfra-SpinatuSy turn it from within out- 
 wards. 
 
 Befides all thefe Mufcles jufl named, there 
 are two more which pafs by the Articulati- 
 on, viz.. the long Extenfor of the Fore- Arm, 
 which takes its rife from the Keck of the 
 OmopUta, and tlie two Heads of the Biceps, one 
 of which is lodged in a particular Sinuofity 
 in the fore Part of the Neck of the Hume- 
 It takes its Origin from the upper Part 
 
 rus 
 
 of the Cavity of the Owjop/rfM, the other comes 
 from the Vroccjfus Co racoides. 
 
 The Blood Veifels, the lymphatick Dufts, 
 nnd the Nerves pafs under the hollow of tiie 
 Arm. This Cavity is filVd with much Fat, 
 a lid fome conglobated Glands. It i& formed, 
 
 by 
 
Difegfis of the B O N E «« 8l 
 
 -ty the Diftance of the Pf^^^r^/ Muicles, the 
 jjLatilfiimuSj Rotutidus, ^uASerratus Major. 
 ^ Here is a general Idea, of the Articulation, 
 "'of the Humcrusy whkh \s i'ufTic'xQnt iov th^ un- 
 ^ierftaAcl^ig, .v^jiat f i)iali now lay of its Luxa- 
 tion. ' *" ,\'"'. ..T'^.,i7 ' J.J / 
 
 T]>e Hiirrteru's u fu ally difkfca ites u n d^ r the Arm- ^^^ 
 pit : it alfo luxates ibme::imes before, under Kindj^ 
 \h£ great PeBoralj direcljy downwards on the 
 nether Rib of the OmoplatA, and outwards un- 
 der its Spine, but it c^nnbt ever be dis- 
 jointed directly upwards, unlefs the jicromiort 
 and the CUvkle be fra£lur'd. 
 
 It cannot be luxated diredly upwards, be- j^. ^^^^^ 
 cauie the Mufcles Df/z^orW^/, the external Head luxato. 
 of the Biceps, the Procejfus Acromion and the 
 Clavicle oppofe this Luxation. 
 
 It is hard for the Head of the Humerus to Difficulty 
 diflocate dlreftly downwards, as well becaule of itsLujt-k 
 the Extenfor longus of the Fore- Arm withftands *"'^°* 
 \\.y as b^cauie it it is very difficult for the Head of 
 theBoiifl to remain on the nether Rib of the Omo- 
 pUta-j nevertneleis that Luxation has beenfeen. 
 TJiere are two Ways that are more enly * 
 tp ),vit^ OHtwards , and inwards. 
 
 /.fWhen ih^ 3one diilocates externally, it Theplac* 
 Wges under the Spii:}e of tp.e Omoflata at the where if 
 ^Loot of the Acromioyj. T^iis Luxation happens ^^^S®*^ 
 'fi^o\Q feldom than the other, becaufe the Muf- 
 cles Rotundus Alimr, and Injra Sfinatus, have lefs 
 i^orce to draw the Bone outwards, than the Suh- 
 fcapulartSy the Latijfimus and great PeClor.tl have, to 
 draw it inwards. This depends ftill more upon 
 the Situation of the Elbow, at the Time of th<? 
 Falls as has been laid elfewhere. 
 
 When the Head of the Done flips inward:> 
 it may lodge it felf in t;90 Places, viz.. und- 
 «r the Pf^orAl between the Apofhyfes Corttcddes^ 
 
 Q and 
 
52 Jl Tkz AT I %z of the 
 
 ' and thfc CUvicle, which cannot happen but with 
 Difficulty I, 6r eUe under the Arm-pit, where 
 there is a large Cavity, \or to £peak more 
 properly, a Space that is only fiU'd with Fat 
 Membranes, Glands and Veirels, that eafily 
 
 J. , give Place to the H^jad of the //i^wwrz//. 
 
 'Tis proper likwife to remark, that the //«- 
 
 merus never diflocates butwhen 'tis at a Diftance 
 
 'frohi the Breaft, which always happens whea 
 
 "one makes any Offer to f^ve one's fel fin a Fall. 
 
 Then, if the Fall be violent enough, and the 
 
 ttow the £ibow comes to the Ground, the Head of 
 
 xic^ ^^^ Arm, will be forced inwards, and the Luxa- 
 tion will be forwards under the Peroral, If 
 the Elbow is turned outwards, and a lit- 
 tle raifed, it will luxate downwards^ and out- 
 wards, if the Elbow is turned inwards. 
 
 The Arm muft be conliderably raifed when 
 
 ^^*^!^" i^ d'flocates direftly downwards, under the ne- 
 ther Rib of the OmopLtta ^ but the Head of 
 the Humerus can't reft long upon this Rib, 
 bccaufeit isround, and the Breadth of thisRibis 
 'very fmall j therefore it will fally either inwards 
 or outwards, but more eafily inwards, for the 
 Reafon above-mentioned. This will happen 
 every Time the Patient, or the Ailiftants who 
 raife him, move the Arm without Precaution, 
 for they will alter the Situation of the Head. 
 It may even happen by unadvifed Motions, 
 made with a Defign either to difcover thc^ 
 Luxation, or reduce it. 
 
 Of the Caufeu \ 
 
 Oiufes. ^5 ^Q ^}^g Caufes, Recourfe muft be had to 
 the general Account. I flull only fay thit 
 the Humerus diflcxrates with more E-afe than 
 any of the other Bojie^, becaule the Arm is the 
 
 ^art 
 
Bifeafes of the B o N E ^. 8^ 
 
 art which firft preients to liive the Body, 
 iii Falls ;, and as 'tis that we make Ul'e of to 
 Defend our ielves, it is tljc molt ciipolcd to 
 Strains and Falls. 
 
 The Cavity of the Ow(7f/*i/-^ is Shallow, having Hcraark. 
 no Fence but in the upper Part, where 'tis im- 
 poflible it fhould luxate ^ it is Jo fiat that it iS 
 not capable of retaining the Head of the BOn^. 
 
 The Articulation of the Bum^rui is by a Ge- Remark* 
 mu, and as its Headrefts (as One inay fay) on- 
 ly upon one Point, 'tis eafy to conceive that a 
 middling Blow will make it break from its 
 Axis, with lets Difficulty, than the Gcnou o^tkft 
 Thigh, which has a deep Socket, and even With 
 more Eafe than any Cinglymus^ which has al- 
 ways feveral Heads and divers Cav^ities, great 
 Part of which mutually tOucli each other ^ be- 
 fides that the Ligaments of the Arm are very 
 loofe, that 'tis not coilfined by* a round LJga^ 
 ment like the Thigh, and that all its Motions 
 are quick. TJiefe are the Reafons why the 
 Bone 6f the Arm dillocates with more Eafd 
 than the others. 
 
 Signs that the Htiirieriis is luxate d cloivn-' 
 ivanis, 
 
 Th6 Signs that the Humerus is luxated di- $JgnA 
 reftly downwards on the nether Rib of the 
 Omoplata are, ' that the Arm become^ lon- 
 ger, the Fore- Arm is fl retched, the whole Arm 
 •s a little railed j the Patient is in Pain when 
 :)ne bends his Arm down, and finds EaftJ \vhen 
 t is a little railed. It puts him to Torment 
 vhen one bends the Cubitus^ and he Is relieved 
 jpon flretchiiig it out. 
 
 The Humerus is longer, becaufj the Head of t'nft tK* 
 }i9 U0n9 Is under the Cavity of th« Omovlatd. ]^llc>^ti^^ 
 pi ' JU 
 
84 A Tkz AT IS f. of the 
 
 Second. TJie Cubitus is ftretched, becaul'e the Head of 
 the Arm thrufts the Extcnfor Lovgas backward-. 
 
 Third. The Humerus is a little railed, bec^ule the 
 
 Muicles Deltoidcs jind Supra-Spinatus are ftretch- 
 ed, being mofl at a Diftance from their Origin. 
 
 pourth. The Patient is in Pain when his Arm is bent, 
 
 becaufe oiiC ft retches the Ddtoides and Supra' 
 Spinatus, which are already too much exteiided 
 by th« Removal of the Head ot the Bone •, 
 and he finds P\elief when one raifes the Arm, 
 becaufe one abates the Extenfion of thofe two 
 Mufcles. 
 
 Fiftlk It caufes Angui/h, when one bends the Fore- 
 
 Arm, becaufe it ftretches the Extenfor Longusy 
 which is already too much ftraiteued : And 
 it eafes the Patient when one extends the Cuhi' 
 tus for a contrary Reafon. 
 
 Sixth, Th.Q Pain is felt from the Elbow to the Omo' 
 
 fUtay becaufe that is the Extent of the long 
 Mufcle. 
 
 Signs of an outward Luxation, 
 
 Siens and "^^^ Signs that the Luxation is outwtrds, are, 
 Expiica- that the Hurmrus. is brought near the Breali. 
 lion. becauie the Mufcle Coracoldeus and the Pcctora] 
 
 are extended. The Patient fulfers when om 
 removes the Arm from the Breaft, becauie cnc 
 forces the Pectoral and Coracoidius. Sometime 
 the Arm is longer, and feldom ihortcr. Th< 
 more it is removed from the Cavity Giemides o 
 the OmopUta, the longer 'tis •, and the lels "ti 
 removed, tlic Jhorter. 
 
 Stff 
 
Difeafes of the Bones. 2$ 
 
 Signs that the Jrfji is luxated under the 
 Arm-'Pit. 
 
 When the Humerus is diflocated inwards un- Signs, 
 der the Arm-pit, one finds a Cavity under the 
 Acromion, and this Part of the Omoplata leems 
 more prominent. 
 
 There is a Tumour under the u4xilln, the Sequel. 
 Humerus is a little railed, and at a Diitance 
 from the Body ^ the Elbow is a little bent, 
 and can't ftietch but with Pain : The Patient 
 fuffers very much whe^i one brings the Arm 
 near the Breaft. Sometimes the Humerus is lon- 
 ger then ufual, but often iliorter. 
 
 The Cavity that is obierved under the Aero- FirftEy- 
 mionj is th'it where the Bone of the Arm was plication, 
 before its Luxation, which makes that Promi- 
 nexe of the Omoplata appear more than it 
 ought. 
 
 The Tumour that is under the AxilU, is Second. 
 cauleJ by the Head of the Bone which is lodg- 
 ed there. 
 
 If the Humerus is a little railed, 'tis becaufe Third, 
 the Dehoides and the Supra-Splnatus areftretched ; 
 aud if 'is removed from the Breafl, that pro- 
 ceeds from the Contratlion of the Mufcles 
 which draw the Arm outwards. 
 
 The Elbow keeps bent, becaufe the two Fourth. 
 Heads of the BicepSy which come from the 0- 
 moplata^ are diftant from the Place of their 
 Inlertion. 
 
 The Cubitus is in Pain when ftretched, and Fifth, 
 the Patieiit finds Relief when 'tis bent, becaufe 
 'hat in the one the Biceps is extended, and iji 
 t'.Q Other Motion 'tis put in a more natural Po- 
 fition. 
 
 The Humerus is generally lonG:er than ufual, sixth. 
 rometimes 'tis of an eq lal Length, and at 
 G 3 other 
 
8$ A T ?^f. ATI sz of ths 
 
 other Tinies much fliorter than the found one. 
 If 'tis of equal Length, or longer, 'tis a Sign 
 that the Head of the Bone is not raifed higher 
 than the Cavity of the Omo\ilata^ and then all 
 nbf 'a- ^^^ Signs that we have juft given will nieet 
 tjon. there. But if the Arm be fhorter, from its 
 
 having been forced under the hollow of th^. 
 Arm-Pit, the Cubitus does not change its Fi- 
 gure, it is even indifferent either in Flexion 
 or Extenfion, becaufe the MufcuU Flcxores Cr 
 Jixtenfores are equally diftant from their Fulcrum, 
 
 Signs that the Humerus is luxated forwards. 
 
 tl^ns. When the Head of the Humcna has fallied 
 
 forward?, it is lodged under the great PeCloml 
 and Scrmtus Major y in the Space that is between 
 t]ie ^pophyfis Coracoides, and the Clavicle. 
 The Arm is not much fhorter. 
 -The Cubitus is a little bent. 
 The Elbow is at a greater Diftapce from the 
 Brenfl, than in the Luxation downwards. 
 The Arm is lefs railed. 
 
 There is a Tumour under the VcEtoral, he-, 
 tween the ^pcphyfis Coracoides and the Clavicle. , 
 This yfpophyfs is defaced, that is to fay, can't 
 be perceived by the Touch even in fuch as ar^ 
 lean. The Cavity under the j4cromion is lefs 
 perceptible than in the Luxation downwards, 
 and the u4cromion does not jut fo much out. 
 
 Ttie Patient is put in Pain when his Elbow 
 
 h brought near his Bread, and is relieved when 
 
 one removes it a little. 
 
 ^'-^ ^^' The Humerus is r^ot much fhorter than in it'; 
 
 phcanon. ^a^^ral State, becaule the 5p^ce between the 
 
 Prcecjfus Coraccidcsy .nnd the Clavicle ^ is but a 
 
 Finder's ^re^idth more raifed than the Cavity 
 
 iiUwdi^es. 
 
 ' ' Th€ 
 
Lifeafes of the ^ o N Z S. 9j 
 
 ^Ihe Cubitus is but a little bent, becaule the Second. 
 
 Arm not beiiig confulerably removed, the Head 
 
 of the Biceps is but a little fliortened in Pro- ' 
 
 portion. 
 
 The Elbow is more diftint fi-om the Breaft, Third, 
 becaufe the external Part of the Deltoidcs be- 
 ing firetched, draws the Arm outwards. 
 •^The Arm is lefs railed, becaufe the Head of Fourth, 
 the Bone which is over it, . keepS it from the 
 Touch. " 
 
 • The Cavity linder the Jcrorhion 'is hot lb Fifth, 
 perceivable as in the Luxations downwards, be- 
 caufe the Head At the Humerus makes a great 
 Sally, and fuftajns the Deltoidcs almoft in its 
 ulual Roundnefs, and from the fame Reafonthe, 
 Acromion does not jut fo much outwards. 
 
 The Patient is put in Pain when his Elbow Sixth. 
 15 brought near the Breaft, becaufe the exter-. 
 nal Part of the Deltoidcs bfiirg extended, can- 
 not be a/nftant in ftretching it felfout^ and 
 he is relieved when one removes it at a Di- 
 
 ftance, for the contrary Realbn. 
 a:. 
 
 ;»,. Prognojlick, 
 
 Firfl-, this Luxation, which is one of the ea- Progno- 
 left that happens, is alfo one of the leaft dan-ftick. 
 jerous. 
 
 An incompleat Diflocatipn of the Humerus 
 /ouid be yet lefs troublefome ; it is reduced' 
 >ith a great deal of Eafe. 'Tis th^s, without 
 oubt, th'it certain Boiie-Setters, and other 
 Gentry, who ling their own Praifes, pretend 
 ") have reduced without Help, only with the 
 "urn of a Hand. To hear them one would 
 hlnk the Bnnes obeyed their Touch, and that 
 ot one made the leaft DiiEculty of re-entring 
 
 its 
 
83 
 
 o 
 
 JL Tre^tiVe b 
 
 its Place, as foon as t^ey clap their mag'cal 
 Xiands upon it. 
 
 Tis difficult to fucceed when the Bone is be- 
 fore under the Femoral Mufcle. 
 
 That which is outwards is reduced with a 
 great deal of Eafe. 
 
 That which is .direfliiy downwards is th^ 
 hioft eafy to let, provided 'tis foon difcavered, 
 and one makes no Motion that may incline the 
 Head of the Bone to Tally outwards or inwards, 
 which would render the Luxation more trou- 
 blefome to reduce. . • 
 
 Remark. When the Head of the Humerus is luxated 
 under the Arm-Pit, the ReduO:i6ri is ea(}', if 
 the Arm be either longer,, or . as long as it i^ 
 \.., -naturally. ' /^-'T ...' I'^'/^V'^.' 
 
 If the Arm is Sorter, it is more diiEcuk \ 
 inlbmuch that when ' the Head of the Humervs 
 is funk into the' Hollow of the ' Axilla^ one 
 rrieets with' a great deal of Trouble in making 
 tfie Redu8:ion. 
 
 It is very dangerous when the' Head of the 
 Bone is funk fo far in, that, the Blood and 
 J.ymphatick Veifels and Nerves are compref- 
 fed, becaufe Kumbnefs, Swellings. and Deflux- 
 ions will follow. 
 B.emsrt. When PerfonS" are Fat, the Reduction with 
 Straps is difficult, becaufe the Thicknefs of the 
 Fat hinders the Straps from taking Hold of 
 tile Bone near enough, which makes them flip, 
 and renders them unferviceable. 
 -Eemark. VVhen Perfons are very fleiliy, the Redufti- 
 oii is hard to be iilade, by Reafon of the Force 
 and; Refinance of the Mufcles. 
 
 One may prOgnofticate from many other 
 Thine;s, but they who have Need of it may 
 find in the General Prognpfticic \^hatever iS 
 
 ^'^iitingiii the ParvicQlaT. 
 
 e/ 
 
Vifeafes of the ^oiiz%. 89 
 
 Of the Cure of the Luxation of the Arm* 
 
 To reduce the Bone of the Arm in what- ^^^^ of 
 e\'er Place its Head is lodged, the Patient t^eLuxa- 
 muft be fet upon a low Chair, to the. End that 
 the Part which is affe£led, may be ready to 
 make the Extenfion and Counter-Extenfion. 
 
 Tfiere are feveral Ways of performing thefe \Y^7 1 
 two Operations* but 1 will only examine and 
 defcribe fuch as have been moft in U(e, View- 
 ing the Advantages and Defeats of each in par-fc ; 
 ticulajr. 
 
 Firjl Method, 
 
 The Extenfion and Counter-Extenfion are Firft Me- 
 raade with the Hands, by drawing the Arm a- thod. 
 bove the two Condyles of the Humerus^ whilft 
 the Body is with-held or drawn, that it may 
 not follow thofe who pull the Arm ^ for other- 
 wife it would be impoinble to make a proper 
 Extenfion. The Surgeon, being placed on the Manual 
 Outfide of the Arm, muft have a Isapkin tied Operati- 
 about his Keck, wherein the Arm of the Pa- r^j. gjn* 
 tient muft be put above the middle, then h^ ° 
 muft lay hi? two Hands upon the Upper Part 
 of the Arm near the Shoulder, to the End 
 that obferviiig attentively the Degree of the 
 Extenfion, he may condu£l the Head of the 
 Bone into its Socket, with his Hands, and the 
 Kapkin, which he raifes up with his Keck, as 
 foo.i as the Extenfion is fufficient. 
 
 This Method is one of the beft that isj and 
 there is nothing in it contrary to Rule, but 
 the Force, which is not always fufficient, un- 
 lefs it be in young Perfons, or in any otlier 
 Subject that is \yeak and irlfirra. 
 
 Second 
 
^o ^Treatise ^/ the 
 
 Second Method^ 
 
 There are fome who keeping the Body fixed 
 to Ibme Place, pafs the Arm between their Legs, 
 and have it drawn by fome ftrong Perfon ; 
 then when it is fufficiently extended, they take 
 hold ot the Upper Part of the Arm near the 
 j^xilUy to raife it and put it in its right 
 Place, 
 )efea. TK\s Method has the DefeO: of the other, 
 joined to one that is much greater ; which is,^ 
 that the Arm being bowed down to pafs it be^ 
 tween the Legs, the Mufcles Levatores are too 
 much ftretched, and according to what we 
 have faid in General, they ought to be a little 
 relaxed, as fhall be more amply demonftrated 
 in the Sequel. 
 
 Third Method, 
 
 The Ladder and the Door have been made 
 Ufe of, and are ftill. In thefe two Methods 
 'tis not always Strength that is wanting, but 3, 
 proper Situation of the Part. 
 
 VVhen they would reduce the Arm with 
 the round of a Ladder, or the Tops of a 
 Door, they cover it with a Cloth folded in 
 twelve or fifteen Doubles, they let the Ends 
 of the Cloth hang down on both Sides, and 
 make the Patient get upon a Chnir or Stool of 
 a Height convenient, that his Arm may be e- 
 ven with the Door, or Step of the Ladder that 
 ■is trimmed with the Cloth. Then the Surgeon 
 mounts upon fomething that is firm and high- 
 elr than the Stool whereon the Patient ftand.% ' 
 that he may be in Readinefs to make good Ufe 
 ' f)f his Hands. He pai|es the diflocated Arm 
 
Difeafes of thg B ON z $, ^i 
 
 over the Door or Ladder, he has it held fteady 
 by two or three Perfons, who draw it, and bring 
 ix near the Door, then he puts his Hands upon 
 the Fart utiefted to obferve attentively what 
 palfes. He removes the Stool from the Patient's 
 Feet, and the Body being abandoned, to its owu 
 Weight makes the Counter Extenfion, whilft 
 they who draw the Arm on the other Side the 
 Door make the Extenfion. They who follow 
 this Method fay the Reduclion is made when 
 the Arm, the Door, and the Body are in three 
 parallel Line?, which ff.all be prov'd to be 
 tiilfe. •.,,■::;■ 
 
 This Method is very antient, one may fay pemici- 
 that 'tis deriv'd from the Creels. If they who ousWay^, 
 follow it are ignorant of its Defefts, I am going 
 to demoi,ftrate them, and I hope tobanilh froiri 
 their Chirurgical Arfenal thefe Inftruments, 
 which create as much Horrour as they are Perni- 
 cious. 
 
 To fhew in what the Door and Ladder are 
 perjiicious, it mbft be obferved that there may 
 be too much, or too little Strength j that one is 
 i)ot Mailer of it to give it a due Proportion, 4 
 
 and that if it happens to be fo, 'tis pure good 
 Fortune. In Effect, if a lean Man has a Luxati- 
 on where the Head of the Bone is lodged in 
 the inmoil Part of the Arm-pit, the weight of 
 the Body, which in this Method is the Princi- 
 pal Caule that ails -, would not be fufficient, 
 c'yid the Extenfion would be imperfedl. 
 
 If on the contrary, a fat Man has a Luxa- 
 tion where the Head of the Humerus is not 
 quite funk into the Cavity of the Arm-pit the 
 Weight of his Body will have a force infinitely 
 Superiour to the Refiftance of the Mufcles^ and 
 that which is more thanfufficent for reducing th« 
 l^uxatloa vyiU caufe fatal and perhnps incurable 
 
 DifordeifS 
 
92 J T P^E A T ISE of thff 
 
 Dir^rders, as a Rupture of the Mulclen, Tendons 
 and Ligaments. 
 obferva- Aljer Redu^iions made by the 1 adder or 
 tion. Door, there have been obferved profound Con- 
 tufions on the Rib?, under the Axilla, and in 
 the infide of the Aim along the V^eifels, which 
 liave been followed by very fatal Impollhumes. 
 Ihavefeen in the Hke cafa the Trunk of the 
 Brachial Artery opened, which inftai.tly caufed 
 a very great Aneurifmal Tumour, whereof the 
 Patient dyed. It took up the inward Part of the 
 Arm, the Cavity of the Axilla, and the Bottom 
 of the Peroral Mufcle. Another Time I faw the 
 Boi]e of the Arm broken near its Neck by 
 the Efforts of fome who try'd to make the Re- 
 duction with the Ladder. 
 Acci- This Method is always fatal when one does 
 
 dents that not lijcceed, ai:d ic often happens even when 
 happcji. the Boi.e is reduced, that alter thefe Strains, 
 the Joint becomes ii^flamed or paralitick •, or 
 that an AnchilcfiSy a Purulent Defiuclion, Oedema^ 
 Jbroffty in the Ai'ticuUtiov, and many other per- 
 nicious Symptoms enfue. I have often known 
 the Limbs deprived thereby of their Strength 
 and Motions, which the taking the hoc Mine- 
 ral Walters for fe\*eral SeaibixS had not cured 
 xvlthout great Difficulty. I have )^cen the Boiie 
 diljoint of it felfin a little Time after redu- 
 cing of Luxations by this Method •, and the Pa- 
 tient could not be cured witjiout a gi eat deal of 
 Trouble, ,by al) the Remedies and Means laid 
 down in the Cure of Luxations iji general. 
 
 Fourth McthoiL 
 
 There arc fome who make the Reduclion 
 with their Heel, layi ig the Paiient at his length 
 up:)n the GrounA, puUin3 cff their Shoes and 
 
 laying 
 
Lipafes of the Bones. ^g 
 
 laying themfeives by his Side with their Feet 
 to his Head. If tliey are to reduce rhe lefc 
 Arm, they place the Sole of their lefc Foot un- 
 der the Arm-pit, ajid taking hold of the Fore- 
 arm above the Wrill, they pufh with their 
 Feet while they draw the Arm with Force, by 
 which they make the Extenfion, and Counter- 
 extenfion, and the Bone is foraetimes redu- 
 ced. 
 
 This Method has two Faults •, the firft is 
 that the Situation, proper to the Mufcles, that 
 raife the Arm, is not obferved. The Second 
 is, that the Fore-arm, is puU'd, and I have 
 provr'd before in the general Account of Luxa- 
 tions, that the Extenlions fliould be made by 
 pulling that very Bone which is diflocated. 
 
 Fifth Method. 
 
 Being at the Army, a Surgeon Major, fee- 
 ing me reduce an Arm, told me, that he had 
 leveral Times had Succefs in feating the . 
 the . Patient upon a Chair, and himfelf 
 upon another of equal Height befides him, 
 with his Face towards his Patient. That it' 
 'twas the left Arm, he put the Palm of his left 
 Hand under the Arm-pit as far as he could, as 
 if he would feel the Articulation \ that he aP. 
 terwards leaned his Elbow upon the Patient's 
 Thigh, and with his Right Hand took hold of 
 the lower Part of his Arm j then bendirg it 
 down with a ludden Jerk, whilft his Right 
 Arm leaning upon the Patient's Thigh, ferv'd 
 as a Buttrefs againfl the Axilla^ he made it turn 
 upfide down and reduc'd it. 
 
 This Method has the Defe^ of Hipoctsius's 
 Ambiy and i^one of its Perfe^ions. 
 
 Sixth 
 
94 
 
 A T 
 
 R E A T I S E 
 
 of th 
 
 ^je 
 
 Sixth Method. 
 
 The Iiftrument cali'd Atnhi wa5 invented 
 by Hippocrates to reduce the Arm ^ it is c om- 
 pofed or" two Pieces of Wood joind together 
 by a Hinge. When 'tis made Ul'e of, the two 
 Pieces make a right Angle, the one which ferves 
 tor the Supporter, is parallel to the Body of the 
 Patient, and the other which ferVes for a Lea- 
 ver, is parallel with the Arm. The Humerus 
 is faftened to it by feveral Straps ^ the Angle of 
 the two Pieces is under the Arm-pit and when the 
 Reduction is to be made, the Leaver, or Branch 
 of the j4mbi to which the A rift is faftened, is 
 bowed down, and the Right Angle becomes 
 acute, which makes the Extenfion Counter-Ex- 
 tenfion and Reduftion of the Bone at the fame 
 Time. This Machine has a great many Ex- 
 cellencies. 
 
 Firft, the Arm is placed as ic ought for the 
 Relaxation of the Mufcles. 
 
 hJecondly, It has a fuiHcient Force, and one 
 might give more by lengthening the End of its 
 Leaver. 
 
 Thirdly, the Extenfion and Counter Exten- 
 fion are of an equal Strength, being produced 
 and aftuated by the fame Caufe, and at the fame 
 Time which is an elfential Thing, in all Machine^ 
 that are made Uie of for reducing Luxations. 
 
 Vcfaiptiy^ 
 
Difeafgs of the B o N E 5. 
 Defcription of the Arabi, and the Manner 
 ofujing it, 
 
 (A) (A). (A) The Arm faftened hy three 
 Straps to the Leaver or Branch of the jimbi 
 mark'd (B) (G) (D.) 
 
 (B) (D) is the other Branch, with its Foot 
 (D.) It lerves as a Stay for the Leaver, (B) 
 (G) which is joined by a Hinge to the Point 
 (B.) (D) (B) (G) is the right Angle form'd 
 by the two Branches of the Amhi when the 
 Arm that is faftened is placed in its right Por- 
 tion. 
 
 (G) is the end of the Leaver whereupon 
 the Surgeon leans with all his Might, to bring 
 the end (G) nearer the Point (D) by delcri- 
 bing the Curve Liae (G) (D.) 
 
 9% 
 
 * . "' 
 
 y" 
 
 It 
 
 fcfe=3^ 
 
 
 /C^ .MSk 
 
 
 
 n 
 
 i 
 
 v\ 
 
 Deftns 
 
o^ A Tf^ZAJi ^% of the 
 
 Defe&s of the Ambi. 
 
 Firft D«- The firft Defeft of this Machine is that \t 
 fca. ' thrufts the Head of the Bone into its Socket 
 ^before the Extenlion, and Counter Extenfion 
 is made. This is not proper, becaule every 
 Thing oppofes the Reduftion when the Bone is 
 not fufficiently diftant from the unnatural Place 
 which it tooli up •, whereas it reduces as it were 
 of it felf, when one has fufficiently ftretched 
 the Limb, and brought the Head of the Bone 
 to a Level with its Socket. 
 Remark. Experience fhejvs ys, that to make the Re- 
 duction with Eale, one ought not to thruft the 
 Head of the diflricated Bone into its Socket, till 
 fufflcient Extenf;ons are made^ without which 
 all Attempts are unprofitable. In ufing the 
 u4mhi one falls into this Error, becaule ic 
 thrufts the Bone towards its Socket at the fame 
 Time that ir extends the Arm. The Defeft 
 of the y^wi?/ is always found, whether the Lad- 
 der or the Door are ufed, as fume have expe- 
 rienced, to the Diladvantage of the Patient. 
 
 Seve?itb Method, 
 
 Manner There are alfo leveral other Methods laid 
 of Redu- down by the Antients to make the Reduction of 
 f Sdck^^ thef//w;fr«/: As toplace a Stick upon the Shoul- 
 ders of two Men of equal Strength and Big- 
 nefs, andto raile up the Patient with the Stick, 
 which is put under tjie Axilla, whilft his Arm 
 is with-held, and the Weight of the Body left 
 to ad, as when oneufes the Door or Ladder. 
 
 Eighth 
 
Difeafcs of the B o N E^. 07 
 
 Eighth Method, 
 
 Others have the Patient's Arm tal:cn by 
 a taller Man, who on a fudden places thd ^^^ 
 Axilla of the Arm aifected, upon the Edge of 
 his Shoulder, letting the Body hang upon his 
 Back, whilft he keeps the Arm beibre him with 
 both Hands. 
 
 All thefe Methods have the Defe^l: of the Defc£^. 
 Door, the Ladder, and the Ambi ^ and aH of 
 them only tei\d to raife the Head of the Arm- 
 Bone. It Teems as if they who propofed them, 
 had not kvown any other Sort of Luxations ^^^I^, 
 than fuch as hap»pen downwards^ neverthelefs ^hors. 
 we have proved that the. Humerus fometimes 
 diilocates outwards, and very often forwards. ^ 
 
 I have feen this laft Luxation thrice in one Obferv** 
 Month ;, therefore the Methods ought not to be "°"* 
 the iame for reducing all Kinds. I will now 
 offer that which I hav^; uled with moft Sug- 
 cefs. 
 
 If any Method is preferable, 'tis that where- AMe- 
 in one can re-unite the five following Proper- ^^°^ ^?*' 
 ties or Conditions. rablc^ ^^ 
 
 Firft, that there is fufficient Stre.igch. TwoPro- 
 
 Secondly, That the Strength is not too perties. 
 great. 
 
 Thirdly, That this Strength afts upon thofe 
 very Parts that are diflocated, and not upon 
 the Parts adjoining. 
 
 Fourthly, That it is ecjually adapted to Ex- 
 tenfion and Counter-Extenfion. 
 
 And Fifthly, that the Means employed in RemArl^- 
 drawing, don't hinder the guiding tli? disjoin- 
 :ed Bone into its natural Place, by the lama 
 ^Vay which it took to leave ir, at leaft 
 IS near as poiHblc? j and that this be not 
 
 H done 
 
^B A Tkz AT IS z of thi 
 
 done at the lame Time as the Extenfions, ar.J 
 Counter-Extenfions. 
 
 If one reflefts upon what I have laid of Lux- 
 ations in general, and the different Methods 
 I have juft defcribed, 'twill be tbund that thelis 
 Things are abfolutely neceffary, and that the 
 Want of one renders all the others vain. I 
 ihall not explain them farther, the rather be- 
 caufe they are to be met with dn the fuble* 
 quent Method. 
 
 Ninth Method, 
 
 The AH the World knows that the Moufle is a 
 
 Moufle. Machine compofed of divers Pullies, fet in one 
 and the fame Cafe. The Force of this En- 
 gine proceeds from this, that the Fully is a 
 perpetual Leaver, and that there muft be fevc* 
 ral Pullies to make a Moufle. 
 
 To fliew that the Fully is a perpetual Leaver, 
 look upon the Figure ou the other Side, 
 
 whicl^ 
 
toifeajii of the B O N E i. 
 
 ^9', 
 
 ./•■"■'' 
 
 "***■••. 
 
 /0\N 
 
 o y\ 
 
 / m\ 
 
 A) \ 
 
 / 1 
 
 \0 Tp/ 
 
 \a / 
 
 
 Pv \/ 
 
 IP 
 
 <vhich reprefents a fingle Leaver. The £xe(i 
 Point is at (A) the Weight at (B) and the 
 Power that moves it at (C) then join to it a 
 fecond Leaver fA) as in the 2d Figure, you. 
 will have the Beginning of a Wheel ; and if 
 you add yet two or three mo're, you will have 
 acompleat Wheel, as may be feen in the 3d 
 Figure, where four Leavers (O) (O) (O) (O) 
 which have all the fame Centre, make a Pully. 
 And if inftead of four Leavers, whereof this 
 is compoled, you can imaG;ine as many as will 
 fill the Places (M)^(N) (O) (D) (Q) (K) (S) (T) 
 you will have a full Pully. Then it is plain 
 th:\t the Pully is the ftrongeft of all Machines, 
 iince it is made of fo many Leavers, which 
 fucceed each other in Proportion as the Pully 
 turns :i now the Mechanicks tell us that the 
 Succeilion of Leavers multiply the Force. 
 
 If the Pully has lb much Force, the Movfit P^''^<J ^ f 
 ght to have more \ for if the o;ie is the Mul- ^^^ *^^*"* 
 
 ou 
 
 Hi 
 
 tipll 
 
 fle. 
 
100 A Tf^zATisz of th^y:^ 
 
 tlplication of Leaver?, the other is tlie Multi- 
 plication of Pullies ^ and if the Leavers of the 
 PuUy fuccecd each other, the Pullies of the 
 Afnujle alfo fucceed each other. 
 The Ufe The Afcufle, wherewith one miglit lift the 
 of Moil- Earth, if one had a fixed Point, is made Ufe 
 ^^V"a' ^^ ^^^^^ Succefs in the Redudion of diflocated 
 Re ut 1- Lini{35_ -pQ make a right Ufe of it in the Re- 
 duction of the Arm, they confine the Omoplara 
 and the Clavicle with Straps, which alio tie 
 round the Body, and have their fixed Point in 
 a Wall, or a Poft that is very firm •, they faften 
 a Strap to the lower Part of the Arm, above 
 the Condyles, which muft liave the Properties 
 requifite : Then they take anocher fixed Point 
 to faften the dormant Moufle at a proper Height 
 and Diftance. They make faft the moveable 
 Moafle to the Strap that is fixed to the Arm ^ 
 they give the Cord to Ibmebody who draws as 
 long as they defire, while they keep their two 
 Hands upon the Articulation to obferve wha<[ 
 paffes there, and watch attentively the Minute 
 when they muft work to replace the Bone. 
 This Minute is the Time when the Extenfions 
 are fufiicient, which is known by the Signs 
 beforementioned. 
 
 When the Surgeon fees that the Mufcles are 
 fufficiently ftretched by the Extenfions, he 
 goes to work, but differently according to the 
 various Kinds. 
 Different If the Bone is diflocated downwards, he muft 
 Ways of take hold of the Arm, as irear as poifible to 
 working, the Arm-pit ^ the four Fingers of each Hand 
 not making a Circle round the Arm, but being 
 placed a little obliquely, their Ends turned to- 
 wards the Axilla, in the inner Part of tlie 
 Arm, the Palm of both Hands leaning, the one 
 Tjpoii the Mulcles Flexorcsy and the other up- 
 on 
 
Di-feafes of the Bon E s, loi 
 
 ou the Ext en fores of the Cubitus , in fuch a 
 Manner as that hi^ two Thumbs, and the two 
 T7)eTjars, raaV be parrallel to each other, and 
 placed on ihe external Part of the Patient's One Way 
 Arm. The Wrifts and the Elbows mufl: alio p^ work- 
 be a little near one another : This Pofture of '''S* 
 the Surgeon's t^ivcs him the Liberty ofraifuig 
 eafily the upper Part of the Arm with his 
 Fingers, of bendint^ the lower Part with his 
 Elbows, which may be executed readily : For 
 in bending down his Elbows, he will bow the 
 lower Part of the Arm, and in raifing his 8. 
 Fingers, he raifes the Head of the Humerus^ 
 which will condud it into its Socket, by making 
 it (if I may fo lay) turn topiy turvy. 
 
 If the Head of the Humerus is turned out- Anothsr 
 wards under the Root of the Acromion, and ^^'*y* 
 the Spiny Apophyfis of the OmopUta, the Sur- 
 geon being on the outfide ot the Arm, fhall 
 (after the Extenlions being fufficiently made 
 with the Moufles') lean the Palm of one Hand 
 upon the lower and inner Part of the Arm, 
 and the other upon the upper Part near the 
 Shoulder. Then, thruftingftrongly with both 
 Hands, let him puih the lower Part of the Arm 
 outwards, and the upper inwards, which will 
 force the Head of the Humerus into its Socket. 
 
 When theHead of the Humerus is' dillocated Another 
 forwards under the great Peroral, between '^^y* 
 the Apophyfis Coracoides, and the Clavicle -, they 
 make in the like Manner Extenfions with the 
 Moufle, and when they are fufficient, the Sur- 
 geon thrufts the Head of the Bone into the Ca- 
 vity of the Omoplata, by puihing with one 
 Hand the lower Part of the Humerus from 
 without inwards;, and with the other, the 
 upper Part of the Humerus from within out- 
 wards, 
 
 H 3 This 
 
fc^ A Treatise of the 
 
 JVologuc. This Method of reducing the Humerus with 
 Moufles is fimplci it wo-ild be preferable to all 
 others, it the Moufles c'lrried with them their 
 fixed Point. 'Tis this that has rendered it ne- 
 celfary to reduce them- into the Compofitioa 
 of a Machine, which can carry with it the 
 fixed Point for Extenfion and Counter- Exten- 
 ^on. 'Tis not of yefterday that Machines of 
 this Kind have been invented for the Redu- 
 ftion of Bones. We have Hippocrates's Bench, 
 which has been in Ufe many Ages, and which 
 has been brought to Perfe<ilion by feveral Sur- 
 geons, the late Mr. Michau had lucceeded more 
 than any one •, but his M,'ichine did not aui'wer 
 all the Purpofes that might be defired. 
 Hiflory In 1702. I endeavour'd to correal Hippocrates'i 
 oY rhe Bench with fome Succefs j but, in Spite of this 
 Machine (^orreftion, I found fo many Defects in it, in a 
 p^JjJ^y"^ Tryal that I made ot "it on a Luxation of the 
 itions. Thigh, that I relblved upon inventing a Ma- 
 ' chine entirely ^^ew. I made it publick in !70«f , 
 
 in the firft Edition of this Treatile, in a pub- 
 lick Courfe that I went thro' at St. Cofmus. In 
 T706I expofed this Machine which I had im- 
 proved a fecond Time. It ferved me fuccels- 
 fully feveral Years, but the Reflexions that 
 T made upon continual Praftice engaged me to 
 form divers Obfervations on it, and I thought 
 in its utmoft Degree of Perfection, when in 
 17 TO a Luxation of the Arm, of Six Months 
 of ftanding, foiled me. I found out^he Ciufc 
 it and added a Piece, wherewith I fucceeded 
 Its Pro- the next Morning. In 1716 I prefented it to 
 grcfs. ^i^Q Academy •, it is in the Memoirs ot that; 
 Year. I ufed it with Satisfaction, until new 
 Difficulties arofe in Cafes which I could not 
 forefee. This has induced me to make new 
 Correftions in that which I ;iow rcccommend. 
 
 Ic 
 
Difeafis of the Bones. 103 
 
 It hn*; in it all the Properties of the firft, and 
 a great many others, which I flwll particularize 
 in the Defcription I now make of it. All 
 thele Improvements fucceilively, fliew that 
 one muft arrive at Perfeftion hj Degrees •, and 
 that Perfe£lnels in human Inventions is a Thing 
 merely relative. 
 
 This Machine has not the Defeats of i/Zp/'fl- Advranra- 
 crates\ Bench: it is portable, and that is a Load |^"^^['^** 
 for two Men. The Patient is not terrified by ^^*^^^^"^^- 
 the Noife of the gingling of Iron, of which 
 Hifpocrates's Bench is made : This is much more 
 lUccefsful, and one is Mafter of its Force by a 
 toothed \A^heeI, which feems to meafure its 
 Degrees. This Force a£ts and is divided 
 equally, as well for drawing the diflocated 
 Bone, as for with-holding or thrufting the 
 Socket, whence the Bone is ilTued, and one 
 may regulate it according either to the Strength 
 or V\'eaknels of the Subjects, and to that of 
 the Tendons or Mufcleii of the Parts that one 
 would let : It ferves for Fradures and Luxati- 
 ons, and as well for thofe where the Limbs are 
 lengthened, as fpr tl^ole where they are ftor- 
 tened. 
 
 H 4 -pfUnp' 
 
104 
 
 A 1' B. E A T I s E of the 
 
 Defcrlption of the Few Machine, 
 
 Tins Machine is of two Parts. One which 
 i.i called the Body (A) and- the other which I 
 iiilc the UiMiiches (B.) 
 
 ThQ 
 
Vtfeafds of the Bo N E 8, 105 
 
 The Body is compofed of two Cheeks (C) Dcfcrip- 
 (C) of Oak, (which are ftraic and parallel [j^'^'g^^^ 
 to each other) two Foot eleven Inches long, ^^ ° ^' 
 two Inches broad, and eighteen Lines in Thick- 
 nefs. 
 
 They are diftant from each other fixteen 
 Lines. There are two Traverfes or Crofs- 
 Pieces, which hold them together, and are 
 pinn'd to them by Tenons, Mortifes, and Pins. 
 One of thefe Crofs-Pieces is placed at the End 
 of the Cheeks ^ it is even with them on the 
 upper Side, and within four Lines of the low- 
 er one, to leave Room for a little Plank which 
 enters therein like a Groove, whereof we Ihall 
 fpeak hereafter. The other Traverfe or Crofs- 
 Piece, is two Foot five Inches diftant from the 
 firft, and is even with the Cheeks underneath, 
 but on the upper Side wants four Lines ofitj 
 it is alfo cut noliow. Arch-wife, for the PafTage 
 of a filk Cord, whereof Mention fhall be made 
 hereafter : It is joined like the other to the 
 thick Part of the Cheeks. 
 
 Between the Side of the two Cheeks that 
 face each other from the lower Traverfe to 
 the upper, there are two Grooves or Gut- 
 ters ^ one is in the middle of the thick Part to 
 lodge the Tongues of a wooden Moujiet^ which 
 {hall be defcribed hereafter. The other Groove 
 is even within two Lines of the under Part of 
 the Cheeks. It gives Palfage to the Tongue of 
 the little Plank abovementioned, which is ten 
 Lines broad, (without comprehending its two 
 Tongues) tour Lines thick, and two Foot five 
 Indies long ;, infomuch, that being in its Place, 
 it ftops up two Foot 'five Inches Space be- 
 tween the two €heeks. It paffes under the hrft 
 Traverfe, and goes on to join it felf even with 
 the lower Part of the fecond. The Remainder 
 
 of 
 
10^ ^ T Fv E A T I S E of the 
 
 of the Space that is between the Cheeks, is 
 filled up by a little Plank five Inches Jong, and 
 of the fameThicknefs and Breadth as the firft, 
 which is fixed at the Plnce where the firft en- 
 ters into the Groove, whence it can be drawn 
 out to give Liberty for fitting the Moufles^ and 
 their Cord alfo-, or for taking them out and 
 mending them according as is necelfary. Thefe 
 Moufles are two •, the one dormant •, which is 
 joined by a Tenon introduced into the Mortile 
 that is made in the Traverfe, at the End of 
 the two Cheeks. A Peg (D) palling thro' the 
 Traverfe, penetrates the Mortife and Tenon 
 Sequel of o'^ this A/l7z^y?f, and keeps it dormant. The o- 
 thc Pc- ther Movfie (E) is moveable \ it has twq 
 fcription. Tongues whxh enter into the Grooves of the 
 two Cheeks, and give it the Liberty of moving 
 backwards and forward"?. At its Head arq 
 Holes, thro' which the Strings of ^ double filk 
 Strap (Fj pafs, which is 6 Lines broad, an Ell 
 long, and of a Triple Weft. This Strap has 
 divers Knots about two Inches diftant from 
 each other \ the Knot which is at the Extre- 
 mity lerves as a Button, and the Spaces which 
 the others leave between them, are as the Holes 
 \v herein one faftens the firft Knot, which 
 forms a Loop wherein the Strap (B) (B) is fix- 
 ed, which draws the Limb that is to be fet. 
 There are feveral of thefe Button-holes (if I 
 may fo call themj the one near the Button, 
 the other at a Diftan.ce •, they are al) uled to 
 fit the Strap to the Leng:h o'l the diilocated 
 Part. 
 Dcfcrir- There are two Moufles, the O'.iC dormant, as 
 "*'"x« his been laid, the other moveable-, their Cafe 
 Acs.* ^"^ of fq-iare Wood: Each of them has fix Pul- 
 lies, th)Ie of the firft Row have one Inch Di- 
 dimeter, thole of the fccondten Lines, and all 
 
 of 
 
D //cafes of the Bones. 1,07 
 
 of them are three Lines thick. One runs 
 thro' a filk or flaxen String, of a Line and 
 half Diameter, and 27 or 28 Foot long, where- 
 of one End is made faft to the Cafe of the 
 dormant Moufle, beneath the Row of fmall Pul- 
 lies. The other End of the String is faftened 
 to the Eye of a Pin which goes thro' the Axle-* 
 Tree, whereof we are going to fpeak. 
 
 Two Foot from the End of each Cheek in The 
 their thick Part, two Beams, or upriejht Beams. 
 Pieces of Wood (H) (H) rife up like Walls 
 28 Lines high, and ^ in Thicknefs, even with 
 the outward Part of the Cheeks. They are 
 joined by Tenons rounded at Top, and pierc'd 
 by an Iron Linch-pin of four L-nes Diameter, 
 the two Ends whereof are Square, and go be- 
 yond the Beams an Inch ot the Radius. The 
 Linch-Pin carries between the Beams a wooden The At- 
 Axle-Tree, turned like 'a Bobbin, of an Inch Ic-Tree. 
 Diameter, thro' which runs a little Iron Pin 
 that is riveted at one End, and has an Eye at 
 the other, wherein one of the Ends of the 
 String is made faft. At the exteriour Side of 
 one of the Beams, there is an inchafing of 1 6 
 Lines Diameter, hollowed within four Lines of 
 its Thicknefs, wherein an Iron-Wheel CI) is fet, 
 of 1 5 Lines Diameter, and two in ThickneG, 
 thro' which the Linch-pin paifes. Its Teeth, The 
 which are made Rock-wife, are ingraifd with, toothed 
 and check'd by, the Beak of a Spring 30 Lines Wheel. 
 Jong, 4 broad, and half a Line TThick, fhaped 
 like a Rom.in fS) whereof the End that is moft 
 bent is fixed by two wooden Screws ow the 
 Ledge, of the Thicknefs of the Cheek. At The 
 the End of the Spring, which I call the Beak, Spring, 
 jind which is ingrailed with the Teeth of the 
 Wheel, there is, on its convey. Side, a little 
 Catch, which, when drawn, feives to difeigage 
 
 the 
 
ic li A Treatise of the 
 
 the Spring from the Teeth of the W}i€Cl 
 when 'tis requifite to relax the Movfies. 1 his 
 Spring is fupported by, and refts upon, a little 
 Iroa-pin, of one Line Diameter by 4 of Pro- 
 je^lure, which enters Screw-ways into thifl 
 I<otch, &c. of the Beam, which lodges that 
 Part ' of the Spring, which is check'd by the 
 Teeth of the Wheel. 
 Pc-fcrip- The Branches o'the Machine, are alfo com- 
 lion of poled of two wooden Cheeks (^) (a) but they 
 the ^re neither ftrait, nor parallel with each cch^» 
 
 Branches* -pj-jgy ^^q arched before like a Bow, whole Ar- 
 row is 18 Inches long \ their Length is 2 Foot 
 3 hiches, including a Tenon 4 Inches 9 Lines 
 long, by 8 Lines Diameter. Thefe Tenons 
 come out of the Part which is ftrongeft, and 
 is as the Bafis or Root ot* the Branches. Thi$ 
 Bafis (J)) (b) is Square, of the fame Breadth and 
 Thicknefs as the End of the Cheeks that be- 
 long to the Body of the Machine: It refts up- 
 right upon this wooden Surface, and the Te- 
 non of 4 Inches 9 Lines enters into the Cheeks 
 of the Body of the Machine, And touches, 
 with three of its Sides, 3 Sides of a Sort ot 
 Mortife made of the like Size, in the Fore- 
 part of the Cheeks that belong to the Body of 
 the Machine, infomuch that the End of the 
 Tenons refts upoH the Traverfe that is above 
 the Axle-Tree. And to give the End of thele 
 Cheeks ftrength enough to retain thefe Tenons, 
 and the Bafis of the Cheeks ot the Branchy 
 they are fupported by an Iron Ring (?) (*) 
 which covers them all but the Sides whereby 
 they face each other, where PafTage is left for 
 tlie filk Strap. This Ring is an Inch broad, 
 and a Liiie thick ^ it is retained by three 
 vyoodcn Screws ^ one upon the little dormant 
 Plank, and the other two on the Fore-part of 
 
 '• each 
 
Difeafes of the Bones. 109 
 
 each Check. The Tenons are parallel, but the 
 reft o^^ the Cheeks are not. At their Bahs tliey 
 are only 16 Lines diftant, they are lield toge- 
 riier by two Traverles, the firft begins within 
 ail Inch of their Bjifis^, and is 18 Lines broad, 
 and' ail Inch thick; as tor its Length be- 
 tween the Cheeks, it has id Lines toward the 
 Bafis, and t8 towards the Extremity of the 
 Cheeks, becaufe that as foon as the Cheeks be- 
 gin to grow diftant from each other, the le- 
 cond Traverfe, which is but 14 Lines from thp 
 lirft, is 20 Lines long between the Cheeks to- 
 wards thefirft Traverle, and 2 Inches to- 
 wards the End of the Cheeks ; which Clieek? 
 continuing to grow yet more diftant, are ac 
 their Ends 7 Inches and a half diftant from 
 each other. . , • 
 
 The Traverles are joined to the Cheeks by 
 Mortifes and Pins with covered Joints, they 
 are flat above, .and round underneath. The 
 Cheeks or Branches do not retain their Square 
 Figure, which they have at their Bafis, where 
 they are fitted to the Cheeks belonging to 
 the Body of the Machine ^ they are oftogo- 
 nal the reft of their Length, and decreafe gra- 
 dually , fo that they have one Inch Diameter 
 at thefirft Traverfe, and but 8 Lines at their 
 Ends, where they are blunt and rounded that 
 they may lodge themlelves eafily in two 
 Sheaths, which are at the Ends of a Sort of 
 Strap that I call Buttrefs, and ftiall defcribe 
 hereafter. ' J ' 
 
 To make Ufe 0^ this Machine, one muft The 
 have two other Pieces, the one ferving to Manner 
 with-hoUi the Body, and the other to draw ff ^J^r 
 the Limb. I call the firft the Buttrefs, and ^-"fj^J'^*^ 
 the fecond the Strap. The Buttrefs ^L) is j^iaduoc 
 made of a Piece of Ticking, a Foot loiia, and 
 
 3 Inch- 
 
A T TREATISE of tbff 110 
 
 3 Inches thick, with a Sort of Button-hole in 
 The the middle according to its Length: This Slit 
 Piece or Button-hole is 9 Inches long ; the Remain- 
 *^^5^ der of the Ticking, which is not flit, equally 
 theCoun-'^i^i^t^^ot^ ■•> underneath each of which Limits 
 ter-Ex- there is a Pocket or Sheath (/;) (/;) made^ 
 tenfion. which, as I have faid, ferves to lodge the Ends 
 ot the Branches of the Machine. This whole 
 Piece of Ticking is lined with Shammy, that 
 it may not hurt the Body nor the Limb, which 
 is to pafs thro' the Slit (M) 'Tis thus that the 
 Body is with-held by this Buttrefs. 
 »f I^c The Piece which ferves to draw the Limb is 
 
 Piece called the Strap, and is made of a Piece of 
 which Shammy, double and ftitched, being 14 Inches 
 fnakes long, and two and a half broad. In the mid- 
 utfionT ^^^^^^ ^^ length-ways, is a fllk Cord (5) (5) of 
 a double Weft, 3 Quarters of an Ell long, and 
 ten Lines broad, which palfes thro' the two 
 Loops of a Boot-ftrap covered with Shammy. 
 The filk Cord is fbwed to the Piece of Sham- 
 my, about the middle of the Cord, and near 
 each End of the Shammy, fo that the Stitch- 
 ing does not hinder either the removing the 
 Loops of the Boot-ftrap from, or bringing them 
 nearer to, each other ^ fo thit it may fuit with 
 the different Sizes of the Limbs to which 'tis 
 faftened. 
 
 This Strap (B) (B) which is 18 Inches long, 
 and one broad, makes a Loop of nine Inches, 
 thro' which the filk Cord, which is faftened to 
 the Head of the moveable Moufc^ pailes. The 
 Piece of Shammy (B) goes round the Limb^ 
 and is put in the Room of the circular Com- 
 prefs which 'tis cuftomary to ufe, to avoid the 
 Strap's hurting. I make ufe of Shammy 
 which is much fofter than Linnen. The filk 
 Cord (55) gOes twice round the Shammy, paf- 
 
 fing 
 
ill Difd^fifes of the B 5 N E $• 
 
 ling a fecond Time thro' the Loops (BB) a^- 
 ter which it is faftened and ty'd to a Knot and 
 a Rofe •, this done, the Machine entirely moun- 
 ted muft be placed under the Limb, and the 
 Ends of the Branches muft be made faft in the. 
 Pockets or Sheath (hh) of the Buttrels f L.) 
 
 The Strap (F) of the moveable A^oufle (E) Working 
 muft be put thro' the Loop of the Strap (BB) of ^^^ 
 which is fattened to the Limb •, and its Knot ^^*^*^^°** 
 muft be fixed, in pafling by, in one of thole 
 Button-holes ^ then one puts on the Handle 
 marked in the Machine (M) at the Linch-Pin 
 of the Axle-Tree, and turns as much as is re- 
 quifite for the Extenfion and Redudion of the 
 dillocated Limb. 
 
 I have render'd this Machine much more por- Proper- 
 table than heretofore •, it was both longer, Vf.* K"'^* 
 broader, heavier, and of one fingie Piece •, and ' 
 this takes in Pieces into two: It is al(b eafier 
 to' work, ftnce the Operator may govern the 
 Handle with one Hand, and the diflocated Part 
 with the other. 
 
 The Branches arched like a Bow, leave a 
 Space between them and the Limb, which ren- 
 ders them convenient tor palling the Hand un- 
 der both for judging of the Progrefs of the 
 Extenfions, and for thrufting the Bone where 
 'tis proper. Befides, the Branches of the ftrft 
 Machine being ftrait, the Limb was incommo- 
 ded •, moreover the Buttrels not being flit, did 
 not with-hold the Body lb exactly as this •, and 
 the new Strap, which ferves to draw the Limb, 
 is much fofter, ftronger and eafier to apply. 
 
 Example ferving as a 'R.ccap'itulation, 
 
 Thefe Sort of manual Operations can't be Rcpetiti-. 
 repeated too often, wherefore, to the End that or:. 
 
 young 
 
112 A TkZ AT ISE cf the 
 
 young Surgeons may the better underftand it 9 
 I will fuppofe the Arm diflocated, and wiU ftiew 
 them all that muft be done either before, du- 
 ring, or after, the Operation. 
 
 Before the Operation, one muft place the Pa- 
 tient well, and examine well the kind of Luxa- 
 tion, having the Machine and Dreilings all rea- 
 dy, and applying the Straps to it. 
 
 He muft be upon a Chair two Foot highy 
 the found Part leaning againft the Back of it, 
 which, if poifible, muft be but a Foot and half 
 |iigh •, and the diflocated Side muft be free and 
 difengaged from all Things thac are capable of 
 troubling the Operator. 
 
 The Part muft be examined, and 'twill eafily 
 be found where the diflocated Bone is lodged, 
 provided one comprehends well all the Signs 
 that we have given to diftinguifh the different 
 Kinds mentioned heretofore. 
 
 The preparing of the Machine confifts in 
 joining its two Parts together, in removing 
 the moveable Moujle from that which is dor- 
 mant as much as can be, and in taking Care 
 that the Cords are not intangled • in this Cafe 
 one applies it as is ihown hereafter. 
 
 For the DreffiJig ^ the Figure ivhereof is ri- 
 prefented hereafter, 
 
 Dreffings. There muft be a Comprefs folded 8 double, 
 g Fingers Breadth long, and 4 broad •, another 
 Comprefs cut like a half Crofs of Alaltay 8 
 double, 8 or pinches long and broad: Another 
 Comprefs between 7 and 8 Inches broad, 4 dou- 
 ble, and a Foot and half long ^ two Rollers, 
 one fix Ells long, and 2 Inches and 11 half 
 broad 5 and the other 2 Ells long, and 2 Inches 
 
 broad t 
 
Difeafes of the Bo N E S. 11^ 
 
 broad : A roU'd Comprefs, a Pellet, and a 
 bcarf for the Haiid. 
 
 In applying the Strap, regard muft be had Circum- 
 to divers Things : Firft to have the Skin of the be"obfer^ 
 Arm well drnwnup by the Hands of an AJfi- ^^^^ 
 ftant, who ]<eeps it raifed during the Applica- 
 tion of the Strap, to the End that from the 
 -Strap to the Arm-pit there may be as much 
 Skin as poiTible. When one does not take thispirftcir- 
 Precaution, it happens (efpecially in fac Per- cum* 
 fons) that all the Efforts of the Extenfion a£l ft^^ce^ 
 only upon the Skin : The Bones and the Muf- 
 cles are not drawn, and one can't remove the 
 Boi.es at a Diftance enough to reduce them. 
 
 Secondly, to lay on the Piece of Shammy (B) Second 
 inftead of a Linnen Comprefs, immediately a- Circum- 
 bove the Covdyles of the Humerus^ then to place '^^ ' 
 and tye over it the Strap mark'd (BBj to bind 
 it very hard leaft it fhould flip, to tye it even 
 twice, and with more Strength, on thofe who 
 are pretty fat, without which the Strap would 
 not come near enough the Bone of the Arm, 
 nor bind it clofe enough -^ and the Force wou'd 
 aft upon the Fat, and have no fiffeft upon the 
 hoiiQ which is the elfential Point. 
 
 Tliirdly, the two Parts ot the Strap which Third 
 make the Loop, muft be placed, one before Circum- 
 the external CojjdyU, and the other behind the *"^** 
 internal one. 'Tis proper to obferve this Poii- 
 tion, becaule if thefe Parts of the Strap were 
 upon the Condyles they would bruile them -^ and 
 if the Part, which I fay muft be placed be- 
 hind the internal Condyle, were belore, it 
 would bruile the Velfels. 
 
 The Strap being taftened, one muft place the Ofthc 
 Buttrefs (L) thrufting the Arm into the But- ^""^cfs, 
 ton-hole as near the Shoulder as polUble \ fo 
 that one of the Sides of the Slit bears againft 
 
 I the 
 
114 -^ TR.EAtI5E of the 
 
 the Clavicle and the yicromion *, and the other 
 againft the under Rib of thp OmopUta. The 
 two Ends {kk) nnuft be turned one towards the 
 Srrrnumy and the other towards the external 
 Face of the OmofUta. 
 
 I can't forbear correcting here a great Er- 
 ror in all the Methods before-mentioned, and 
 all thofe laid down by Authors •, 'tis this : that 
 they have taken no Care to with-hold the Omo' 
 plataj and the Clavxles. They have contented 
 themfelves with with-holding or thrufting back 
 the Body, whilft they drew the Arm, which 
 is not fufficient ^ fmce the Shoulder follows 
 the Arm when it is drawn, and the Extenfion 
 is truitlefs. It has been demonftrated that one 
 rauft remove the dillocatcd Bones at a Diftance 
 from each other, to put the Head even with its 
 Cavity from whence it has ilfued, and into 
 which one would have it return. 
 Remark. As it has been faid in general that the Ex- 
 tenfions and Counter-Extenfions muft be made 
 upon thofe very Bones that are disjointed, and 
 not upon thofe next to them, if any one has 
 had Succefs in fetting the Arm, without ha- 
 ving the Precaution to with-hold the Shoulder, 
 it has been at the Exper.ce of the TrAfci,ius, 
 tlie little Pectoral, and Rhnmboides, which have 
 had Strength enough to keep back the OmofU- 
 ta •, a Strength which they have not alway?, 
 and to which one ought not to truft, it being 
 dangerous to put it to the Teft. 
 How one VVhen the Buttrefs is put on, the Ends of the 
 rouft Branches of the Machine muft be placed in the 
 nlacc the (-^^0 Sheaths which are at the Point (W) of 
 Machine. ^^^ Buttrefs. The String (F) muft be run in- 
 to the Loop of the Strap (BBj andoneof itjj 
 Knots muft be fattened as it palfes by in one ol 
 its Button-holes ^ then one claps on the Han- 
 did 
 
Difeafes of tbe BoN Ei* 115 
 
 die (M) at the Linch-pin of the Axle-Tree, and Working 
 begins the Operation, during which, whnc fol- o^'f^'c 
 lows muft be obferved, tjiz.. That the lower ^^*^^^^"®' 
 End of the Machine refts upon the Ground j 
 that if 'tis the left Arm, the right Hand to the 
 Handle, and the left upon the shoulder of the 
 Patient. 
 
 This done, one turns the Handle, and the 
 Cord of the Movfics winds round the Axle- 
 Tree (K^ which brings the moveable A4ovft6 
 near the dormant one, and draws the Arm on 
 the fame Side, whilft the Shoulder is kept fix- 
 ed \ fo that in Proportion as the Handle turns, 
 
 one removes the Head of the Humerus from the ^t^- «»^ 
 ,_, , ., Ill ,. * ime to 
 
 unnatural Place wherein twas lodged, to bring reduce 
 
 it near the Cavity ot the Omop'ata which is its the Bone. 
 natural Seat, wherein it fometimes places its 
 felf without any other Operation •, and feme- ^i^nstliat 
 times one muft work wiih the Hands alfu ro tcnfn^,^''' 
 guide it thither, which muft not be done till is made 
 the Extenfion is found to be fuiEcient by the or ma- 
 Way that the A'foufle has took, and by the ^^^b' 
 ftretching of the Mufcle Deltoides. 
 
 'Tis known that the Bone has placed it felf. Signs that 
 as it were of its own Accord, by the Noife it t^'<i Re- 
 makes in re-entring, and by a roundnefs that ^"^""^^ '^ 
 is perceived at the Acromion, at the Place "^*-** 
 where there before appeared a Hbllownefs. 
 
 To facilitate the Reduction of the Boiie Means to 
 when luxated outwards, th^ lower End of the reduce 
 Machine muft be turned outwards, that the ^^^ ^'^"c 
 Head of the Bane may throw it felf in* luxated 
 
 To facilitate the Redudion, when the Hei^d Yor'^hc' 
 is forwards under the rcBor.d, the lower End Bonclux- 
 of the Machine muft be thi uft forwards, to atcd in- 
 carry the Head of the Bone on thecontrary Side, wards. 
 
 In fine, if the Arm-Bone is luxated down- ^ ,^ 
 wards, cue mtrft^afs both Hands between the Bone lux- 
 
 I J Branches, a:ei 
 
ii6 
 
 down- 
 w.irJi. 
 
 What 
 muft be 
 done af- 
 rer the 
 Kedufti- 
 on. 
 
 ^Treatise of the 
 
 Branches, join them together under the Arm- 
 pit, raile the Head of the Humous^ bow dow/i 
 the lower End of the Machine, and the Re- 
 du^ion is made. 
 
 After the Redudion, the String of the Ma- 
 chine that is put thro' the Loop of the Strap 
 muft be uritied, having the Strap held by fbme 
 ■Body who draws it by its Loop, and taking 
 olf the Machine and the Buttrefs. Then 
 leaning the left Hand upon the jicromion, and 
 the right under the Elbow which one brings 
 rear the Patient's Body, one puts on the 
 DrefTmgs, viz.. 
 
Difeafes of the B o K E s. 117 
 
 The Comprels (Aj its middle under the Arm- 
 pit, and its two crofs Ends over the Acromioriy 
 to wrap round the Shoulders ^ then the Com- 
 prefs CB) which covers the whole again, and 
 afterwards the Comprefs (C) which trims the 
 bottom of the Arm-pit •, the Roller (D) which 
 makes the Spic-i round the Shoulder : One muft ^^^f^^^^' 
 afterwards lay on the Comprefs (E) which co- the Drcf- 
 vers the Arm and the Elbow at the Place fmgs. 
 where the Strap was faftened. This Comprefs 
 muft be kept oil by the Roller (F) which muft 
 make circular Cafts round the Arm, and then a 
 Figure of 8 pafting from the Arm to the Foie- 
 Arm, and back from the Fore-Arm to the 
 Arm. One muft put into the Hand the Pellet 
 (G.) All thefe Dreflings muft be dipped in 
 Brandy wherein Alum has been fteeped. 
 
 One muft cover and fupport the Hand, Fore- 
 Arm and Arm, with the Scarf (K) made with 
 a fine Napkin, that muft be at leaft two Thirds 
 of an Ell long, and as much in Breadth. It The 
 muft be folded from one Corner to the other" iii ^*^*"' 
 a Diagonal Line, which will give the Napkin' 
 the Figure of a Triangle. It being thus folded, 
 muft be put between the Arm and the Breaft 
 of the Patient, ^0 that the right Angle may be 
 under the Elbow, and the great Side of the 
 Triangle under tlie Hand. Of the two acute Tlie 
 Angles, one muft be placed over the right Manner 
 Shoulder, and the other turning back again ^fput""g 
 and covering the Fore-Arm, muft go over the ^"^ ^"' 
 left Shoulder to meet that which went over 
 the Right. They muft be fowM togetJier to 
 keep them at a proper Height, after this, take 
 the two Angles of the Napkin, at that Part 
 which is at the Elbow, and feparate them, 
 drawing the internal Angle backwards, fo tJiat 
 the main Part of the Fore-Arm be almoft at 
 
 ' 1 3 the 
 
A T KZ ATI ^z of the 
 
 tlie Center of the Napkin -^ then one muft fold 
 again thefe two Angles, viz,, the Angle that 
 is before under the Hand, and that which is 
 behind under the Arm, bringing them near, 
 and faftening them to each other, and to the 
 Body of the Scarf with a ftrong Pin. 
 
 This Scarf is the moft proper, becaufe it 
 wraps round the whole Limb from the Shoul- 
 der to the Fingers Ends, whereby no Rilque is 
 run of the Patient's adling imprudently, or 
 difordering his Drefiings, as happens but too 
 frequeutly. 
 
 The Scarf ought to fupport well the EI* 
 bow, and keep the Fore-Arm bent almoft in a 
 right Angle, the Hand being of an equal 
 Height with the Elbow. 
 
 The Patient muft bleed once, twice, or thrice, 
 according as is necelfary : He rauft alio obferve 
 a proper Dyet. As for the reft, you will perfeft 
 the Cure, by obferving what has been faid in 
 General upon the Subject of Accidents and 
 Symptoms that precede, attend, or follow the 
 Reduction, 
 
 They who are Mafters of what I have faid 
 of Luxations in General, and what has juft 
 been mentioned about that of the Arm, may 
 be in a Cor.diiinn to cure the others ^ at leaft 
 there wili be but little war.ting. Thefe 
 two Chaprers include the whole Theory and 
 Practice of Dillocation*?, for which Realbn I 
 have enlarged very much both upon the one 
 and the other. 
 
 CHAP 
 
Difertfes of th^'^ONE s. 1 1^ 
 
 CHAR VIIL 
 
 Of the Luxation of the Fore- 
 Arm from the Humerus, 
 
 THERE are two Bones in the Fore-Arm Struaur« 
 which are jointed with the Humerus ^ 
 tliis JunclioQ is one of the moft compact Gin- 
 glymuis that can be, ^nd the moft difficult to 
 Juxate. 
 
 The Cubitus makes the greateft Part of the 
 Cinglymus, it cannot move without the Radius, 
 but the Radius move« without it in making the 
 Pronation and Supination. 
 
 The Fore-Arm luxates before, behind and The 
 on the Sides. I have never feen one diflocated Kinds 
 forwards, and I believe fuch a Luxation very ^^^ ^^^" 
 difficult. If it does happen, the Arm muft be ""' 
 ftretched out, bscaufe the Bicep and the Brachi- 
 aus interms are relaxed, and the Extenfors are 
 ftretched by the Diftance of the Olecramtn 
 where they infert their Apneurofes. 
 
 When it is diflocated forwards, the anterior Remirlc 
 ^pofhy/is of the Cubitus is lodged in the hinder and 
 Cavity of the Humerus \ and the Fore- Arm is ^'o"S' 
 a little bent, becaufe of the Diftance of the 
 Infertion of the Mufcles, which being greater 
 in tlie Extenfors when the Luxation is forwards, 
 ought on the contrary to be greater in the 
 Flexors when the Luxation is backwards. 
 
 When the Luxation behind is incompleat, signs, 
 the anterior Eminence of the Cubitus is at the 
 Centre of the Kind of Pully made by the Arm- 
 Bone. At that Time the A'fufcuU Flcxores are 
 a little lefs extended, and the Ext^nfores lets re- 
 
 1 4 laxed. 
 
lio A T K'L AT isz of the 
 
 Jaxed, than in the compleat Luxation behinJ ^ 
 and the Fore«Arm is a little lefs bent in the 
 Compleat than the incompleat. The Pain 
 is violent when cu"ie extends the Elbow, and 
 the Patient finds Relief when one bends it. 
 'gi^s. When 'tis compleat inwards, the V'eflels fuffer 
 
 confiderably •, and Ibmetimes they are fo torn, 
 that itoccafions ajieurlfmal Tumours, or Trom- 
 bofes, which one is often obliged to open and 
 caufe fuppurate. 
 jigns. When 'tis incompleat, the internal Semi-lu- 
 
 nar Cavity of the Cuhitusy receives the inter- 
 pal Eminence of the Humerus \ and as this Emi- 
 nence is a little lefs raifed than that wh'ch re- 
 ceives the external Cavity of the Cubitus, the 
 Fore-Arm is turned a little outwards, the Ra- 
 dius is near the middle Eminence of the Hume- 
 rus, the internal Part of the Arm is lefs raifed 
 than in the compleat Luxation, and the VefTels 
 alfo are in Pain. 
 Signs. When the DiHocation is compleat outwards, 
 
 the VeiTels are only a little ftretched, but don't 
 fuffer fo much as in the internal Luxation. 
 There is a great Prominence outwards towards 
 the Fore-Arm, and a coi.fiderable one inwards 
 towards the Arm. The firft is formed by the 
 Prefence of the two luxated Bones, and the fe- 
 cond by the lower End of the Humerus. 
 Skuation '^^^ incompleat Luxation may happen two 
 of the Ways-, the firft is outwards, in which Cafe the 
 luxated Kadiushs, entirely diflocated, and no longer re- 
 Bones, ceives the Eminence of the external Cor.dylc \ 
 the exterior Cavity of the Cubitus receives the 
 external Condyle, and the inward Cavity of the 
 Cubitus receives the Emirerce that its outward 
 Cavity did before receive. 
 Situation '^^^^ fecond is i;:ward?, the R.tdius no longer 
 •fthe touches the external Condyle of the Humerus, rt 
 luxated receives 
 
Difiafes of the l^o k E s. I2i 
 
 receives the middle Eminence *, and the inner Bones. 
 Cavity of the Cubitus no longer touches the in- 
 ternal Eminence of the Humerus. 
 
 The Caufes are amply particulariz'd in treat- Caufes. 
 ing of Luxations in general, to which may be 
 added that the Luxation forwards never hap- 
 pens, but thro' a violent overftraining on the 
 Side of the Extenfion by a great Fall, or Ibme 
 other extraordinary Caufe. 
 
 The Luxation behind is moft commonly oc- Caufes. 
 cafioned by a Strain on the Side of the Flexi- 
 (n. I Hiy moft commonly, becaufe I have 
 Inowi one behind caufed by a Strain on the 
 S'de of the Extenfion, in a Lady that was very 
 f; t, unweildy, and heavy, who fell in her 
 Chamber upon her right Hand. The Fore- 
 Arm was extended, and the Weight of her 
 Body being greater than the Refiftance of the 
 Fore-Arm, forced it to bend on the Side of the 
 Extenfion. The lower Part of the Humerus 
 broke the Biceps and the Brachiaus Internus, 
 whole Ends came out thro' the Skin ^ the Hu- 
 merus ifTued out of the Wound, and refted up- 
 on the Floor : The Olecranum mounted up a- 
 bove four Fingers Breadth behind the Hume^ 
 rus under the Skin, The Extenfions and the obferva- * 
 Reduftion vvere made wich Eale •, the Part oftion. 
 the Biceps which ifTued thro' the Wound the 
 Length of a Thumb, cou'd not be replaced •, 
 it was forced to be cut off. The Fore- Arm 
 was bent, and the Lips of the Wound were in 
 the Bending. This Pofition which was favou- 
 rable to the Re-union, was not lefs fo to the 
 Luxation^ both the one and the other were 
 cured in fix Week?. 
 
 The Luxations on the Sides don't happen Obfcrya- 
 enfily, becaufe the Motion of the Articulati- tion, 
 on neither favours the fallying of the Bone 
 
 inwards . 
 
122 ^Treatise of the 
 
 inwards nor outwards. The Fall muft be 
 complicated, and befides the Fore-Arm muft 
 bj in Extenfion at the Time of the Fall. Falls 
 may be complicated Itjveral Ways •, For In- 
 flance, I once Taw a Luxation outwards in a 
 Footman, who falling from a Coach that was 
 overturned, had his Arm lock'd in the Spokes 
 of the Wheel. 
 )bferva- Another had hi?; Elbow diflocated inwards 
 ion. by being thrown with his Horle, who fell up- 
 on his Arm in an uneven Place, whereupon 
 the lower Part of the Humerus re^ed •, and the 
 Fore-Arm not beinc; I'upported gave Way to 
 the Weight ot the Horle which thruft it in- 
 wards. 
 lemaik. Therefore I believe that the Fall mud be 
 complicated to produce either inward or out- 
 ward Luxations, 
 lemark. The Diflocations on the Sides are generally 
 incompleat, becaufe the Surface of the Bones 
 is lo confideiable at the Place of their Joint- 
 ings, that an entire Dillocatioa cou'd not hap- 
 pen without a total Rupture of the Ligaments, 
 and fbraetimes of the Mufcles. 
 Phe The Manner of reducing thefe Luxations is 
 
 Cure. diiferent, according to their Kinds-, neverthe- 
 lefs botli in the one and the other, one muft 
 make the Extenfion and Counter- Extenfion, 
 and thruft the Bones into their Places. 
 
 If the Olccramim is in the Civity of the Cu- 
 bitus, the Surgeon to reduce this Luxation, puts 
 his Elbow ill the bending of the Arm-, he 
 joins the Palm of the Patient's Hand to the 
 Back of his, and holds them both ftrongly with 
 his other Hand ;, then he bends his Arm with 
 all his Might, which makes the Extenfion and 
 Couiiter-hxteiifion at the fame Time. 
 
 Thii 
 
B'jfeafes of the Bones, 123 
 
 This Method is not the beft. Authors have Another 
 propol'ed a Bed-poft, or fomething like it to^P"*'^ 
 make the Reduction thus. If 'tis a Bed-poft,*''^ 
 they fet the Patient upon the Bed, with the 
 diflocated Side near the Poft, which the Surge- 
 on places having firft covered it with Lin- 
 nen, in the Bend of the diflocated Arm : A 
 Servant with his two Hands puihes the Elbow 
 againft the Bed-poft, the Surgeon places him- 
 felf on the found Side, taking the Fore- Arm 
 that is alfeded near the Wrift with his left 
 Hand, and the Shoulder with his right Hand, 
 if 'tis the right Arm that is to be reduced : On 
 the contrary, he takes the Fore- Arm with his 
 right Hand, and holds the top of the difloca- 
 ted Arm with his left, if 'tis the left Arm that 
 is to be reduced. Being thus placed, he brings 
 forcibly his two Hands near each other, as if 
 to bend the affefted Arm, whilft his Servant 
 thrufts againft the Bed-poft, and the Redudi- 
 on is made. 
 
 This Method does not always fucceed, and Defeft of 
 may be pernicious, becaufe the Mufcles are ^'"^ M^- 
 drawn before they are fufficiently relaxed. In 
 EfTeft, the Extenfors, which are confiderably 
 fl retched by the Diftance of the Olecranum, are 
 yet more fo when th« Extenfion and Counter- 
 Extenfion is made with the Bed-poft. 'Tis bet- 
 ter to follow the Rules that 1 have laid down 
 in General, which ought to be yet more regu- 
 larly obferved when the ^pophyfis Coronoides of 
 the Cubitus is found precifely upon the middle 
 of the Pully of the Arm-Bone. This Luxati- 
 on can never be reduced by bending the Fore- 
 Arm, if the ulual Extenfions are not firfl made. 
 When they are, one mufl bear with one 
 Hand upon the bending of the Arm, and with 
 the other take hold of the Fore-Arm near the 
 
 Wrift, 
 
124 
 
 Another 
 
 Manner. 
 
 Another 
 Way. 
 
 Anorher. 
 
 Another. 
 
 Another. 
 
 DreflTing, 
 
 y^ T R E A T I s E of the 
 
 Wrifl, to make the Flexion at the Minute that 
 the Extenfions are judged fufficient : Or el(e, 
 if you will, you may thruft the Olecrdnum for- 
 ward from behind, which does almoft the lame 
 Thing, but with lefs Force. 
 
 When the Apofhyps Coronoides is in the hin- 
 der Cavity of the Humerus, they make ftronger 
 Exteniions, and they continue them till the 
 Olecranum re-enters into its Place, then they 
 bend the Fore-Arm, and the Reduftion is 
 made. 
 
 When the Luxation is forwards, they alfo 
 make ftrong Exteniions, and they bend the 
 Fore-Arm, when the Limb is fufficiently 
 ftretched. 
 
 If the Luxation is outwards (whilft the Af-. 
 iiftants are employed in making the Extenfions 
 and Counter-Extenfions) you muft lay your 
 Hands, the one within, upon that Part of the 
 Articulation that is formed by the Hume- 
 rus, and the other without upon that Part that 
 is formed by the Radius and the Cuhitvs, and 
 bringing both Hands together, with a Jerk,* 
 theReduftion is made. 
 
 When the Luxation is inwards, whilft the 
 Extenfions are making, one Hand muft be laid- 
 on the inward Part of the Articulation formed 
 by the Boaes of the Fore-Arm, and the other 
 without, on that Portion ot the Articulation 
 that is formed by the Humerus^ and by bring- 
 ing them forcibly near each other the Redufti- 
 on is made. 
 
 After the Reduftion, one puts on all the 
 Sorts of Luxations the Comprefifes marJced 
 (AB) in the Figure of the Page following \ and 
 they muft be dipped in camphorated Brandy, 
 it there is an Ecchymofis or Trcmhops. This 
 done, the Bandage Sfica muft be maae with the 
 
 Roller 
 
Difeafes cf the Bone s. 13 j 
 
 Roller CC) and afterwards the Arm muft be 
 placed in the Scarf CD) with the Pellet (E) 
 in the Hand. 
 
 chap; 
 
i2l{ A Treatise of the 
 
 CHAP. IX. 
 
 0/* i/:?^ LuxATio N <?/^Z?d? Radius 
 caUei Diallafis^ or Escurjion of the 
 Bone, 
 
 Whether T T is difficult for the Radius to feparate from 
 the Dia- J^ the Cubitus in the outward Luxation of the 
 ftafisis*n Fore-Ariti, or in the Luxation or fpraining of 
 ftempcn' f^® ^^'^^ ' ^^^v-erthelefsall the World talks of 
 it as of a common Diftemper, and as frequent 
 as the Excurfion of the Perona in the Luxati- 
 on of the Font, but fuppofmg it does happen, 
 it is much lefs confiderable. 
 Why the The Foot is fubjeft to more violent and more 
 piaftafis frequent Sprains than the Hand, becaufe it is 
 IS more ^j^^ Support of the whole Body, ferves to 
 jrT^he" tranfport it from one Place to another, and, 
 Pcron«. ^'n Spite of the unevennefs of the Ground 
 whereon we walk, adapts it felf to its un- 
 evennefs as favourably as poffible, fo as that 
 the Line of Direftioii palTes always thro' the 
 middle of the Foot j whence the Sprains that it 
 gets are confiderable. 
 Another The jointing ot the Foot is made by a Cin- 
 Reafon. glymus, which is reftrained by two Malleoii, 
 againft which the Foot ftrains whenever we 
 make a falfe Stepg||nd they, not being of one 
 fingle Piece, may leparate : Which Separation 
 is caird Dia(iafi5. 
 Diffe- 'Tis not the fiime in the Wrift, which is 
 
 rcncc iirjiomted by a Getiu, and which can turn either 
 ^'le ill or out without draining coiitrary to th« 
 
 VYrift. Bounds of its Articuhtion, which Bound"^ are 
 much lets raifed than thole of tha Foot, and 
 
 htve 
 
Lifeafes of the Bo N E 5. 19? 
 
 h ave lefs bold ot the Head ot the Bone, and 
 the Cubitus belongs not (as one may kiy) to the 
 Articubtion, which rei ders the Liafi^fs yet 
 more difficult • for to caufe a Diafiafa, ihe E- 
 m inence of one of the Bones of" the Fore-Arm 
 muft be the Point that fupports the Head of 
 the Bones of the Wrifl, at the Time that ic 
 makes an Effort againft the Eminence of the 
 other, without which it will not aft ib as to 
 make the Separation. 
 
 One may add that the Adujcnlns Quadrator Fo- Continu- 
 f ww^wj oppofes this Separation- and befides the *^**'°' 
 inter-oifal Ligament helps very much to retain 
 th r Bones, both in the one and the other Part. 
 All thefe Reflections made upon the Stru- 
 -^tureof the P*rt, not only prove that the D/- 
 aji^nfis feldom happens to the Wrift, but they 
 pe;iuade me that 'tis imaginary, and that or- 
 dinary Strains cannot caufe it. 
 
 There are Surgeons who pretend to have They fay 
 feen it. I won't" difpute againft Matters of jj*^^ ^"^^^ 
 Fad, but I may be permitted to doubt of thole feen, 
 I have not feen ^ not thatl will accufe thole of 
 Impofition who fay they have cured the Diafta- 
 fis oi the Radius^ but they may bemiflaken. 
 
 I don't fay that the Diafia/is is ablblutely im- How it is 
 poffible, if the Caufe be complicated-, for it P^^iblc* 
 may happen that a Fall or Blow may have a 
 Combination of Co many Circum.ftances, that 
 the Strain may have a Tendency to retain the 
 Cubitus in its Place, and at the f tme Time, and 
 with the fiime Violence, may force the Radius 
 from its right Pofition ^ but it will never hap- 
 pen in an ordinary Strain, Blow or Fall. 
 
 I have been carried to lee Pat'e its, who they Obfcrva- 
 fiid had the Diafia/is •, there was indeed a great ^'o"^. 
 Relaxation in the Joint of the Wrift, which 
 allowed the Radius a Motion, that is not com- 
 mon 
 
 ^ 
 
128 A Treatise of the 
 
 mon to it: I was lei:fib!e of a Koile of a glea- 
 rous Matter, but found no Separation. Thele 
 Patients had had Sprains or Luxations of the 
 Wrilt, which had been fucceedel by a Tu- 
 mour of the Joint, either by the Swelling of 
 the Parts next the Articulation, or by the In* 
 creafe of the Sinovia which had relaxed the Li- 
 gaments, and permitted the Separation of the 
 Bones. 
 
 This Difeafe has no other Dr effing than that 
 of the Luxation of the Wrift, which will bi' 
 found in the fubfequent Chapter. 
 
 CHAP. X. 
 
 0/ ^& Lu X A T I O N of the IVriJl, 
 
 StruSurc f-r^ H E Wrift is joined by a Genu with the 
 JL two Bones of the Fore-Arm. This Arti- 
 culation is one of the moft curious that is to 
 be leen in a human Body. The 2d, 3d and 
 4th Bone of the Carpus or Wrift, form a round 
 and oblong Head, covered with a polifhed Car- 
 tilage, which is jointed ill a pretty fuperficial 
 Cavity formed by the Radius. The Cul.'tus has 
 liO Share in this Articulation, aitho' it feems 
 to have, becaufe the Cartilage that is over the 
 Cavity of the Radius is prolonged, and makes 
 an Appendage which covers the End of the 
 Cubitus, and places it felf between the Bones of 
 the Carpus, and the lower Extremity of the 
 Cubitus. This Appendage is hollow on the Side 
 of the Wrift Bones, and is fas one may fay) 
 a Prolongation of the Cavity of the Fadius j 
 
 with- 
 
Btfeafes of the Bo N ts. 1 29 
 
 -without it, this Cavity would not be fuiEc-enC 
 to lodge the Head of the Wrift-Bones. 
 
 The Side of the cartilaginous Apendagethat 
 is next the Cubitus^ is alfo hollow, to lodge the 
 the lower End of the Cubitus. 
 
 Several Ligaments faften this cartilaginous 'T'^e Li- 
 Appendage to the Cubitus, and the Wrift-Bones : S-^^^ritj. 
 One of them, which faften it to the Cubitus, 
 makes a Sort of Ring, which gives Liberty for . 
 the Motion of Pronation and Supination. 
 
 The Flexion and Extenfion of .the Hand are Move- 
 more apparent Motions, than thofe which are "^^'"s. 
 itiade Sideways, b^caule the lecond Row of • 
 Bones of the Carj>us has a particular Articula- 
 tion with the ftrft-, the latter form a Cavity^ 
 ,the former a Head which is jointed therein, and 
 moves very fenfibly ; Co that the Flexion is 
 made in two Places, viz. at the Junction of the 
 firft Row of the Wrift with the Radius , and ac 
 the Junftion of the fecond Row with the firft. 
 This Junction is, as well as the other, fattened Liga- 
 by feveral very ftrong Ligaments, which have incnts. 
 different Direi^lions, without diminifhing the 
 Facility of the Mufcles in moving. 
 
 The Mufcles that belong to the various Mufcbs. 
 Movements of this Articulation terminate in 
 tendinous Strings, and pafs over the Articula- 
 tion to the Wrift-Bones, where they infert 
 themfelves without being fixed to any Thing 
 whatever, any more than a Cord that palfes 
 thro' a Pully \ thev are covered with Sheath?, 
 wherein they flip without futfering any Frifti- 
 on, becaufe a Liquor like the Sinovia of the 
 Articulations, moiftens and lubricates thele 
 Sheaths, and the Tendons. 
 
 In almoft all other Articulations the fiefhy Remark' 
 Part of the Mufcles paffes over the Joint-, but 
 in the Wrift and the Foot, there"' are only 
 
 K tendi- 
 
ijo A T K z A r I s z of the 
 
 tendinous Strings. What is very erfential to 
 remark, is, that not only the Mul'cles which 
 belong tp the Movement of the Wrift, pais 
 over this Articulation, but alfo the proper, a$ 
 well as the common, Flexors and Extenfors of the 
 Fingers. 
 
 Kinds. The Wrift may luxate forwards and back- 
 
 wards, that is to lay, on the Side to wliich it 
 bends, and on the Side of its Extenfion. It 
 alio diflocates on the Infide, and on the Out- 
 fide 9 that is to fay, towards the Thumb, and 
 towards the little Firger. 
 
 Remirk- '^^^ Luxations before and behind are the 
 moft common, for I believe the others very rare, 
 at ieaft they are more difficult, becaufe the E- 
 minences o\ the Cubitus 2.nd Radius^ which lerve ^ 
 as Limits, or (it I may venture to lay lb) as 
 Malleoli, or Ankles, as in the Articulation of 
 the Foot) are fo narrow and fo pointed, that 
 when the Wrift is forced outwards, it cannot 
 reft upon them, and is obliged to flip forwards 
 or backwards •, in like Manner if it is carried 
 inwards, it will be obliged to flip before or be- 
 hind, the pointed Emii.ence ot the Cubitus in- 
 clines it to fall 'Lo. 
 
 Renuik. In all Falls the Palm of the Hand feems to 
 go before us, as it were to defend us from its 
 ill Effects : In this Cafe if the Hand lux- 
 ates, it turns to the Side of the Extenfion, and 
 the Head of the Wrift-Bones falls on the Side 
 of the Flexion. 
 
 Remark. When one falls on the back of the Hand, 
 and the Wrift diflocates, the Hand remains 
 turned on the Side of the Flexion, becaulc the 
 Head of the \V rift-Bones falls on the bide of 
 the Extenfion ^ fo that 'tis uncommon in Luxa- 
 tions of the \Vrift for the Hand to be turned 
 towards tlie Thumb, or the little Finger. 
 
 When 
 
Djfeafes of tht BoNES. 131 
 
 Whenthe Wrift is diflocated inwards, I mean Signs, 
 towards the Thumb, one finds an Eminence to- 
 wards the Pudiusy tlieJHand is turned outwards 
 •.towards the CuhituA, the Fingers can neither 
 bend nor extend themiblves without great Pain, 
 Which is caufed by the Flexors and the Extcn^ 
 fors being equuUy ftretched, being alike diftant 
 from their Origin. The Hand is turned out- 
 wards, becaufe the Cuhitsus intemus and extemus 
 are extended. 
 
 The Patient is in Pain when his Wrift is Signs, 
 turned outwards, and he is relieved if his Hand 
 is brought near the Cubitus -^ becauie it eafes 
 the Mufcles whereof we have been fpeaking, 
 by putting them in a more tolerable Degree 
 of Tenfion. 
 
 The Pronation and Supination are made with sipn*, 
 P.nin, becaufe it is impoifible to make thole 
 Movements without the Hands following, 
 xvhich gives it Shocks that irritate the Mul- 
 cles and Ligaments which are in a great Ten- 
 fion. 
 
 The Pain which the Patient fiiffers is altvays ^\o^.^ • 
 felt the whoie Length of the Cubitus to the in- ^ ^' 
 ternal Condyle of the Humerus •, becaufe the Cu- 
 bitAus tnternus & externusj which are ftretched 
 in this Luxation, are faflcned all along the Cu- 
 bit us ^ from the Condylus intirrnis to the VVriil. 
 
 When the Luxation is outwards, I mean to- Signr. 
 wards the little Finger, the End of the Hand 
 is turned to'wards the Thumb, and the Head 
 of the Wrift-Bones faces the little Finger ^ 
 which is caufed by the Radi^us intcrmtSy the tori' 
 pis & brevis which are in Contradion. 
 
 The Fingers can neither bend nor extend 
 themfelves without Pain, by Keafon of the Tcn- 
 fiOn both of the Mufculi Flexores & Exicnfotes. 
 
 ¥.0 Tie 
 
132 ^Treatise of the 
 
 Signs. The Patient is in Pain when his Hand is 
 
 turned towards his Thumb, becaufe it extends 
 the Mulcles already ftretched ^ and he finds 
 Relief when one turns it towards the little Fin- 
 ger, becaule it relaxes thofe very Mulcles. 
 
 In Pronation and Supination (as in all the o- 
 ther Motions which put the Patient to Pain) 
 the Angui/li is always felt from the Wrift to 
 the external Condyle ^ for 'tis in this Compafs 
 that the RadUi extemi^ the longus & hrevis 
 (which are called together RadUus extemusj or 
 Bicornis) are lodged and have their Rife. Thi? 
 Pain is alfo felt in the Fore-part of the Condy" 
 lus interfiusy becaule the RadUus internus which 
 takes its Origin there, is extended like the 
 others. ^ 
 
 Signs. If the Wrift is luxated on the Side of the 
 
 Extenfion, there will be an Eminence on the 
 Side of the Flexion, and a Cavity on the o« 
 ther. The Eminence proceeds from the Head's 
 being forced thither, whence a Hollownefs is 
 found at the Place from whence it has ilTued. 
 
 Explica- The Wrift is forced on the Side of the Flex- 
 
 tion. ion, and the End of the Hand on that of the 
 Extenfion, becaufe the Extenfors, which are 
 ftretched, draw on that Side. 
 
 Explica- The Fingers are bent, and can't be extended, 
 
 tion- becaule the Head of the Wrift-Bones thrufts 
 the Tendons of the Suhlimis and the Profundus 
 inwards ; which confiderably removes their O- 
 rigin from their Inlertion. 
 
 It caules great Anguifli when one bends the 
 Wrift, becaule it ftretches the Extenjors which 
 are in a confiderableTenfion. 
 
 Se^cL The Pronation and Supination are yet more 
 difficult and painful than in the foregoing Lux- 
 ation, becaule the Head of the Wrift-Bones 
 
 are 
 
Llfeafes oftheEoNES^ 135 
 
 ^re precifely in the Place where the Movement 
 of the Radius with the Cubitus is made. 
 
 The Pain is felt all over the Fore- Arm* to Sequel. 
 the two Condyles, becaufe the Mulcles that are 
 itretched on both Sides, have their Faftenings 
 at the two Condyles ot the Humerus. 
 
 The Signs that the Luxation of the \Vrift is Signs, 
 on the Side of the Flexion, are, that there is 
 an Eminence on the Side of the Extenfion, and 
 a Hollownefs on that of the Flexion ^ tho' the 
 one and the other are lefs apparent than in the 
 Luxation aforegoing. 
 
 The Wrift is forced on the Side of the Ex- Explicfi' 
 tenfion, and the. Hand is turned on the Side of tion. 
 the Flexion, becaufe the Flexors of the Wrift 
 are more ftretched than the Extcnfors. 
 
 The Fingers are extended, and one can't Sequel, 
 bend them without Pain, becaufe the Head of 
 the diflocated Bones thrufts and prelfes the 
 Tendons of the common and four proper Ex- 
 tcnfors. 
 
 It puts the Patient in great Pain to extend the Sequel. 
 Wrift, becaufe the Radi<cus G~ Cubit ^us intcrnus 
 which are in a great Tenfion, are yet more vi- 
 olently ftretched when one would extend the 
 Wrift. There is the lame Difficulty of Prona- 
 tion and Supination, as in the preceding Luxa- 
 tions. 
 
 The Pain extends all over the Fore-Arm to sequel, 
 the external and internal Condyle, becaufe the 
 Mufcles that are ftretched are on both Sides the 
 Fore-Arm, and are faftened to the two Condyles, 
 
 Of the Vrognojlick and Accidents that at" 
 tendy or maj follow thefe Luxations, 
 
 The Luxation of the Wrift is one of the moft Proono- 
 Melancholy, both by Reafon of its extraordi- flick. 
 
 K 3 nary 
 
134 A Tkz AT isE of tbs 
 
 nary Pain, the Difficulty of reducing it, the 
 Inilaniation thnt follows it, the Swelling of 
 the "Part by tlie Inflammation, the Defiuxiofi 
 and Impofthumesof glearous Matter, and hift- 
 ly, becaufe it is long in carii^.g, and there often 
 remains a periodical Pain, a Difficulty of mo- 
 ving it, «na fometimes an Anchih/is^ on Account 
 of the Clears that diffufe themfelves and coa- 
 gulate in the Articulation, in the Sheaths of 
 the Tendons, and other neighbouring Parts. 
 Explica- It is eafy to explain all thefc melancholy Ac- 
 tion, cidents, when one reflects on what we have faid 
 of the Strufture at the Beginningof the Chap- 
 ter, and in the Account of Luxations in ge- 
 neral. 
 "Explana- Every Time there happens to be a Sprain or 
 tion. Luxation in the Wrift, there does not only hap- 
 pen a difplacing of the Boi.es, but alfo every 
 Tendon is, as it were, difplaced-, their Sheaths 
 being removed, and extraordinarily ftretched, 
 and the Spring of the Sinovia comprefTed -^ this 
 Liquor flows into the Sheath, and removes it 
 vet more, it comprelTes the Tendons, and 
 they can't flip into their Sheaths to make 
 their Movements, or if they do, 'tis with 
 Difficulty, and acute Pains ^ caufed not on- 
 Jy by the Tenfion which this Matter occa- 
 iions in the Sheath, but alfo by the Com- 
 prejfion that the Matter and Refiftajice of the 
 Sheath caufes in the Tendons. 
 
 In the End this Matter coagulates or is cor.» 
 rupled, either by its own ill Quality, by the 
 Fault of the Patient, or that of the Surgeon. 
 ObfervA- Ifthe5/»w/*« coagulates, it renders the Joiiit 
 tioQ, ftiff, and fometimes produces an ^i;f/;/7o/7/^ and 
 if' tis corrupted, it caufes AblcelTes that are 
 ^ry hard to cure, and very often terminate in 
 
Difiafes of the Bo:^E.s. 155 
 
 FIJIuliis with a Ctrics and Putretadious, which 
 generally end in Amputation. 
 
 Thele Accidents may alfo come thro' the- 
 Fault of the Patient, who oblerves no Regi- 
 men • and they happen thro' that of the bur- 
 geon, if he applies oily Medicines thatcaufe 
 an Inflammation, or too fpirituous ones which 
 coagulate the Simvia-^ or, in Ihort, by having 
 negleded Bleeding. 
 
 I can't forbear taking Notice here of a Fault Reflefti- 
 into which they fall, who have not praililed <>"s* 
 much- they believe that they muft not bleed 
 if the Fever, the Pain, or Intiammation don't 
 induce them to it; but they don't retted that 
 when the Reduftion is made, the Pain may 
 ceafe without the firft Caufes- of the liiHam- 
 mation, the Fever^ or the Return of the Pain's 
 being removed j forafmuchas, in the Luxation 
 we are treating of, the Sheaths and Tendoiis 
 themlelves have fiaffered more in Proportion 
 than the reft of the Articulation, the Sinovia 
 has ditfufed it felf over the Sheaths of the 
 Tendons in great Quantity ; and the Glands, 
 which lerve to ablbrb the IJquor, have no lon- 
 ger Power to fuck it back, on Account of their 
 Ixvelling •, and therefore, tho' there be no 
 more Pain, one muft bleed, to empty the Reafonsl 
 Blood Velfels that feed the Parts of thefe Joints, forblced- 
 and thereby caufe the Arteries (by their not ^g» 
 being {o full) to furnifh Sincrjia^ and enable 
 the Veins, by being evacuated, to receive with 
 more eafe the Sinovia of the lymphatick Vef- 
 fels, to the clearing of which their fullnel's is 
 an Impediment. 
 
 After what has been fald, we ought to refle£t RefleSi. 
 upon two Things. Firft, that only Tendons ^^^ 
 pafs over the Joint •, and Secondly, that not 
 only thofe which belong to the Movement of 
 
 . K 4 the 
 
136 A T Kt AJ I $z of the 
 
 the Hand, pafs thereby, but alfo thofe which 
 move the Fiiit^ers ^ lb that thefe Dillocations 
 inuft be more daijgerous. 
 
 There is not here as in the Arm, a Deltoid's 
 and a Pefhral, nor as in the Thigh, GlutAuis 
 and Triceps'fi, whofe fielhy Bodies, which are 
 immediately at the Place of their junftion, re- 
 fift more and with much lefs Pain, than all the 
 Tendons of the Hand, fmce the Flelh of the 
 Mufcles is infinitely lels fenfible than the Tex- 
 ture of the Tendons. I will add fome Apho- 
 rifms to finifh the Prognoftick. 
 
 Firfl: Aphorilm. The VVrift is eafily reduced 
 
 when the Luxation is incompleat, and the Dil- 
 
 jointing'is between the firft Row and the ^4- 
 
 dius. 
 
 Obferva- Second Aphorifm. There are Luxations of 
 
 tion. the Wrift, which can never be fet, when the 
 
 Articulation of the fiift Row has diflocated 
 
 from the lecond. It is hard to make the Re- 
 
 duftion, becaufe to fucceed, the Effort rauft 
 
 be made upon the Bones that are luxated, 
 
 and not upon thofe next to them. Kow the 
 
 firft Row has not Compafs enough to be taken 
 
 hold of, and grafped by the Hands that make 
 
 the Counter-Extenfion •, one is obliged to pull 
 
 the lower Endot the Bones of the Fore-Arm, 
 
 whence one Part ot the Strength is loft on the 
 
 Articulation of the firft Row with the Ka/liuj ; 
 
 the Remainder has not Power enough to fepa- 
 
 rate the fecond Row from the firft, to difen- 
 
 gage the Bones and replace them. 
 
 Third Aphorifm. Altho' the Reduftion be 
 well made, there remains a long Time a Diffi- 
 culty in moving the Wrift and the Fingers ^ 
 the Redundance of the Slnovia has (as one may 
 fay) drowned all the Places where it did good 
 QffictiS b^ its unOiuouG Quality, and its du§ 
 
Difaafes of the Bo KES. 137 
 
 Quantity *, and it requires a confiderable Time 
 before this Liquor re-enters within its Bounds, 
 or the Places overflowed are dried up ; at the 
 End of which, the Movements are yet diffi- 
 cult, and the Tendons don't flip in their Sheath 
 but with a great deal of Trouble. 
 
 Fourth Aphorilm. The Pronation and Su- 
 pination are difficult, and made with Pain. The 
 Eadlus, which makes by it felf the Junftion with 
 the Wrifl, ought, one would think, to move 
 over the Cubitus^ and carry the Hand without 
 Pain from Pronation to Supination, and from 
 Supination to Pronation : But (as has been faid) 
 the Cartilage, that covers the Cavity of the 
 Cubitus, makes an Appendage, which extending 
 it felf between the Cubitus and the Bones 
 of the Wrift, finifhes the Cavity that con- 
 tains the Head of the Bones of the firfl 
 Row, and forms alfo the Socket that lodges 
 the Eminence of the Cubitus, over which the 
 Radius rolls in Pronation and Supination. Now 
 this Cartilage, and the Ligaments which ferve 
 it as faflenings, are fwelled and in Pain, whence 
 the Movements of the Radius oVer the Cubitus 
 for Pronation and Supination, can't be made 
 without Anguifli. 
 
 Fifrh Aphorifim. Altho* the Wrifi- may be 
 well fet, there will appear a long Time after 
 its Cure a Deformity at the Cubitus, and an 
 Elevation of its Eminence near the Wrift, 
 which makes the Patient, and ignorant Per- 
 fons believe, that the Reduftion has not been 
 well made. The Bone-Setters take Advantage Knuvery 
 of this falft Idea of the Patients, to make °^ ^^"^" 
 themfelves efleemed, feme f\ying that there is a ®"^'^ 
 Fradure, others cry a Diafiafis, and fome pre- 
 tend that the Bones are disjointed, and fet 
 themfelves about curing them by fraudulent 
 
 Ope- 
 
 I 
 
13^ A Treatise of the 
 
 Operation?, to which the credulous People tall 
 a ViCUni, and are the Bubbles^ but let them 
 know that this detbnned andapparejit BlemiJh 
 is the natural Conlequenre of their Difeale. 
 Rei^ark. y^g deformed Swelling or Tumour that ap- 
 pears, is only the ocdematous fwelling of the 
 fat that covers the Mufcuhs Ouadrarus as far 
 as its Origin at the Cuhlrut under the Palfage of 
 the Cubitaus internus •, and the Emineixe of the 
 Cubitus, near the Wrift, is nothing but the na- 
 tural Eminence of that Bone which appears 
 snore raifed, both becaufe it is thruft a little 
 outwards by the Si7iovia o^ its Articulation with 
 the Radius, and by the Swelling of ligamentous 
 Covers that wrap round it. 
 
 Of the Cwe, 
 
 To make The Extenflons and Counter-Extenfions feem 
 the Re« ea'fy, becaufe there is hold enough on the 
 duoiw. Hand Side to make the one, and towards the 
 Fore-Arm for the other. One muft place 
 Ibme ftrong Perfon towards the Fore-Arm, who 
 muft gralp it with both Hands 3 or 4 Fingers 
 Breadth from the Joint : Another yet ftronger 
 muft take hold ot the Metacarpus as near the 
 Carpus as poilible. The Surgeon muft make 
 them puli at firft Ibftly, the;i increafe by De- 
 grees till the Extenfion is llifficient, then the 
 Wrift will fbmetimes reduce of it felf, without 
 one's being obliged to do any Thing elfe : Ac 
 other Times it is requifite to direct the Perfon 
 ^vho pulls the Hand, how to m^ve, and to 
 work ones felf to guid6 the Head into its Sock- 
 et, fo that if the Bone is luxated on the Side 
 of the Flexion, the Perfon who pulls the Hand 
 muft be ordered tothruft it on the Side of tlie 
 Flexion, whilft the Surgeon favours this Moti- 
 on 
 
Dife/tfis of the ^o\z ^. 7qo 
 
 on with bjth Hands, by inclining tJie VVriftto 
 throw it Ibir on the Side ot the Extenfion. 
 
 If the Wrift be luxated on the Siue of the 
 Extenfion, one muftcaufe him to make a con- 
 tiary Motion •, and by a contrary Operation 
 one jnuft pulh the Wrift on the Side of the 
 Flexion. 
 
 If the Luxation is on the Side of the Thumb, 
 (the Extenfions being madej the Perfon who 
 draws the Hand muft turn it towards the 
 Thumb, and the Surgeon muft incline the • 
 Wrift towards the little Finger. 
 
 In fine, if the Diflocation be towards the lit- 
 tle Finger, the Perfon who holds the Hand, 
 muft turn it on that Side, whilft the Surgeori 
 incli:ies,the Wrift the contrary Way. 
 
 DreJJings, 
 
 The Comprefs (A) muft be laid upon the 
 
 Articulation, taking up the lower Part of the 
 Fore-Arm, and a great Share of the upper 
 Part of the Hand. In beginning to put it on, the 
 Thumb muft be thruft into its Hole (B) then 
 one muft draw the Comprets round the Wrift, 
 lay over it the Bolfter fC) and apply thereup- 
 on the Roller (D) two Ells and a half long, 
 and two Fingers broad •, it muft make a Figure 
 of 8, whereof the CroiTnig in Spca muft al- 
 ways be where the Bone was whifft dilplaced*, 
 viz.. on the Side of the Excenlion, of the Flex- 
 ion, of the Abduftion or Addufl:ion, which are 
 the four d;flferent Sides whereon the Wrift can 
 luxate: The reft of this Roller muft be rolled 
 in Circles, Ibme above the Articulation, and 
 others beneath. 
 
 One 
 
-^Treatise of the 
 
 One muft fill the Palm of the Hand with the 
 Pellet qEJ made of Linnen pretty large and 
 foft, it muft be kept on by a Comprefs, as the 
 whole muft be by the Roller (F) of an Ell and 
 a half long, and two large Fingers broad. All 
 the CompreiTes, Rollers and Pellets muft be 
 dipt in good aromatick orcamphorated Brandy. 
 
 The Arm muft be put in the Scarf (G) as it 
 has been defer ibed in the Luxation of the 
 Arm. 
 
 The Regimen, Bleedings, and general Re- 
 medies muft be obfervedj as has been mentioned 
 in other Luxations. 
 
 CHAP. 
 
Difeafds of the Bones. 141 
 
 C H A P. XL 
 
 Of the hux AT ION of the Thumb 
 and other Fingers, 
 
 TH E Fingers have their firft ThaUnx ar- Strudur* 
 ticulated with the Bones of the Meta- 
 carpus by a Cenouy the other Phalanges are jointed 
 by a Ginglymus. The firft PW^wa- of the Thumb 
 is jointed by a Genou with the fifth Bone of the 
 CArpuSy it is jointed by a like Articulation with 
 the fecond PhalanXy which is jointed by a C/w- 
 glymus with the laft. 'Tis known that all thefe 
 Jointings are moved by the Tendons ot the 
 Sublimis and the Profundus, by the proper Flex- 
 or of the Thumb, by the Lumbricales, and by 
 the Extenfors both proper and common \ to 
 which muft be added the Interojfei, the Thenar ^ 
 the Antithenar, the Hippothenar, the Antihypo- 
 thenar, and the Adduthr Indicts. 'Tis remarka- scruShire 
 ble that only Tendons pafs over thofe Phalanges 
 that are jointed by Ginglymusy and that over 
 thofe that are jointed by Genuox, there pafs muf- 
 culous Bodies: The latter are the firft of each 
 of the four Fingers, as well as the firft and fe- 
 cond of the Thumb \ they are much more fuf- 
 ceptible of Luxation than the others, for Rea- 
 fons that 1 have laid dov/n in general. 
 
 The Thumb, as well as the other Fingers, Kinds* 
 may luxate on the Side of the Flexion, and of 
 the Extenfion, inwards and outwards. The 
 Dillocation is eafier made on the Side of the 
 Flexion than of the Extenfion: The two late- 
 ral Luxations are yet more difficult: When 
 the firft Phalanx of the Thumb is diftocated on 
 
r^t A T Pv E A T I s E of the 
 
 Sivic of the Flexion, the Thumb is ftretdied 
 out, and the Tendons that exteiid it Tally out- 
 wards. 
 
 Signs. When the Luxation is on the Side or" the Ex- 
 
 tenfion, it is bent, aidthereappeaisan Eminence 
 outwards, and its Extrcmi'.y turi.s towards the 
 Boiy when it isoutwa iis, and on the co. .trary 
 it inclines towards the other T ingers, when this 
 Phalanx is diflocated inwards, that is towards 
 the Bo ay. 
 
 Signs. The 2d Phalanx when luxated, gives almoft 
 
 the Tame Signs ^ but as its Articulation is leTs 
 covered wichlVIuTcles, it iseyfily known by the 
 Touch, and no Body can be miilaken therein. 
 
 Signs. ^'^le Dillocation of the ftril Phalanges of the 
 
 other Fingers is almoft like that oT the id ot 
 the TJiumb. 
 
 The Luxations of the Phalanges jointed by 
 Gin^lymuSy are lo eaTily known at Siglit, and 
 by the Touch, that I need not give any Sign to 
 judge of them. 
 
 Caufcs. The Caufes are Falls, Blows^ and Strains, or 
 the Fingers being taken or lock'd in any Thing, 
 
 Frogncjlick, 
 
 Prcno- "^^^ ^^^ Phatj-figcs are more eafily dlflOcated 
 flick. and let than the others ^ the firft Phalanx oT 
 the Thumb has nevertheleTs Tome Difficulty, as 
 being liid hy the Thenar y j4ntithenar, and the 
 AdduBor Jndicis, and what is more, one cannot 
 eafily make the ExtenTions. The laft Phalanges 
 being luxated are hard to replace, becauTe one 
 has no hold of them, they are To ihort that one* 
 cannot without Difficulty keep one^ Grafp. I 
 would not advife the putting in Pracliie what 
 was laid in publick by a Man who always pro- 
 poTes Methods liiitable to his Ruftlcity. " To 
 
 " nuke' 
 
Difiafes of the BoKES. 
 " make the Extenfioji in thefe Cafes, I make 
 " no Difficulty (lays he) of taking hold of the 
 *' luxated Phalanx with a pair of fincers, and I 
 " pull it ftrongly till 'tis replaced.'* Such an 
 Author Ibmetimes deferves richly to have his 
 Fingers Ends pinched. 
 
 When tho Luxation is reduced, there muft 
 be laid on two little crofs Compreffes (AAA) 
 fteept in Brandy, then a Bandage muft be made 
 with the Roller (B) viz,, a Spica for the Luxati- 
 on of the Phalanges of the Thumb, or for the 
 firft Phalanges of the other Fingers ^ and for the 
 others i circular one. One muft put into the 
 Hand the Pellet (C) whereupon the Fingers 
 muft be placed in a middling Flexion : The 
 Hand muft be again covered and wrapt in the 
 Comprefs (D) and the Roller (E) then the 
 Scarf (F) muft be made as ufual. The Cure is 
 continued as in other Luxations. 
 
 145 
 
 CHAP. 
 
144 -^ Treatise of the 
 
 CHAP. XII. 
 
 Of the Lux AT ION of the Thigh, 
 
 $tnjaurc|_j^£ Articulation ot the Thlgh-Bone 
 
 I with thofe of the Hips, is by a Genou. 
 The Head of the Femur is very large and 
 fmooth, and poiilhed, on Account of the Carti- 
 lage that covers it j the Cavity of the Ifchium 
 is deep, and alfo covered with a Cartilage 
 which polifhes it like the Head that it receives; 
 at leaft both the one and the other have this 
 Smoothnefs at the Places of their Friftlon, 
 which is all over, except the Faftenings of the 
 round Ligament, which takes its Origin from 
 this Head, a little lower than the Center, and 
 inferts it lelf in the exceiitral and inferiour 
 Part of this Cavity. 
 
 Around this Socket there are cartilaginous 
 Borders, that are terminated by a Ligament in- 
 ferted in the Neck of the Head ^ this Liga- 
 ment being there narrower than the Head of 
 the Femur ^ with-holds it, and withftands the 
 Efforts that might difplace it. 
 
 The lower Part of this Socket is floped ; a 
 Ligament clofes this Hoping \ under this Li- 
 gament the VelTels pais that feed the round 
 Ligament, the Sutovial Glands, and other Parts 
 of the Joint. 
 
 Below this floping is the great Foramen Ovale^ 
 which is clofed by a Ligament, and the two 
 Obturators. 
 StruSnre The Mufcles that move this Joint are the 
 ftrongeft that are, efpecially the Glutei that car- 
 ry the Thigh behind and before. 
 
 The 
 
Lifeafgs of the B o N E 5. 14^ 
 
 The Triceps that draws \t inwards is pretty 
 coiifiderable \ and if the Pfoas, the Iliacus, and 
 Ptctineus have not lb much Force in Appearance j 
 their Situation, and their Paffage over the Os 
 Pubis is a Help to their Action, and makes chem 
 bend the Thigh with a great deal of Vigour. 
 
 The Arch of the Mufcles of the Jbdomen 
 gives Paffage to them with the Blood, the ner- 
 vous, and lymphatick VefTels, vvhich go to mak^ 
 what is called the String of the crural Veifels. 
 
 The A^ufculus Quadratus, the Pyriformis, the 
 Ohturatores, and the two Ganini, have alfo great 
 Force by their advantagious Situation, and be* 
 caufe they are fhort -^ thefe laft five form an 
 j^poneurojisy which is inferted in the! Cavity of 
 the ^ve^itTrochaNter. 
 
 Of all the Jointings by Gehou, that df the 'the 
 Thigh is the moft difficult to luxate. Thigh 
 
 1. Becaufe the Head of the Femur is very ^'^'"^ *^ 
 large, and the Cavity of the Ifchlum is very ^^^^^^^ 
 deep \ wherefore the Strain that forces it froni 
 
 its Place muft be very violent. 
 
 2. There is no Part where the Mufcles are 
 flronger, and more numerous than here; and 
 becaufe the Mufcles ferve to keep the Boies in 
 their Places, as has been often faid, there re- 
 quires a greater Force to diflocate this Bone, 
 than thofe where the Mufcles are weaker. 
 
 3. There is a cartilaginous Border that adds 
 to the Hollow of the Cavity, and this Border 
 Is form'd in fuch a Manner, that the Side whicli 
 is molt ftrait is againft that Part of the Head 
 that is ftraiteft, which is that which faces the 
 Neck ; the broadeft is on the Side of the Cavi- 
 ty, and thus it enclofes it below the Axis of 
 the H^ad. It is eafy to conceive that by this 
 Mechanifm, the Thigh that is firm in its Joint 
 is extraordinary hard to luxatff* 
 
 L A- There 
 
146 A Treatise of the 
 
 4. There is a round Ligament which oppo- 
 fes the Luxation: This takes its Rife from the 
 Head of the Temur^ and inferts it felt in the 
 Cavity of the Ijch'ion \ it is not, indeed, faften'd 
 direftly in the Center of the Cavity, nor in 
 the middle of the Head, whence it cannot re- 
 fift againft all Sorts ot Luxations, as fhall be 
 Ihown in treating of their different Kinds. 
 
 5. Altho' there are very flrong and many 
 Mufcles, it has not fo free a Motion as the 
 Arm •, and we have faid that the Joints, whole 
 Motions were greateft and moll apparent, diflo- 
 cated with more Eafe than the others, becaule 
 their Articulations are iefs compleat. Thefe 
 are the Realbns why the Thigh is more difficult 
 to luxate than the other Joints. 
 
 Of the Kinds and Difference, 
 
 Eafieft The Thigh diflocates upwards and inwards, 
 
 LuxAtion. upwards and outwards, downwards and in- 
 wards, downwards and outwards. 
 
 The Luxation downwards and inwards is 
 moft eafy. 
 
 1. Becaufe the Cavity of the Ifchion is not fo 
 deep on that Side, as oa all the others. 
 
 2. There is a lloping that is only clofed by 
 one Ligament, which leaves fas one may fay) 
 a Breach that facilitates the ilTuing out of the 
 Thigh-Bone on the Side of the Foramen Ovale, 
 
 3. The round Ligament that retains the Head 
 of the Bone, is neareft the internal Side of the 
 Cavity, whence the Head may remove farther 
 on that Side than any other, without the Oppo- 
 iition of this Ligament. 
 
 4. The ftiongeft Mufcles are fituated out- 
 ward?, and upwards, fo that the 'veakeft are 
 |pn the lower and inner Side, whence the Thigl 
 
 bunc 
 
Lifeafes of the B o N E 5. 147 
 
 Bone has fewer Impediments to conquer on that 
 Side, than any where elfe. 
 
 The LuXJitions upwards are more difficult : A more 
 Firft, becaufe the Head of the Bone (on Ac- difficult 
 count of the Obliquity of the Cavicy that re- ^"'"*"^''* 
 ceives it, and of the Neck that fupports it) 
 can more esfily refift the Strains that thruft 
 the Bone on that Side. 
 
 2. It luxates more difficultly upwards and 
 outwards, on Account of the Height of the 
 Border of the Cavity, which is an almoft in- 
 vincible Obftacle. 
 
 4. The Gluteus major, medius & minimuSy are 
 the ftrong Mufcles that oppofe this Luxation, 
 and do with Refpeft to this Luxation what the 
 Deltoides does in Regard to that ot the Arm. 
 
 The Luxation downwards and backwards is Themoft 
 the moft difficult of all, becaufe the Mulcles al- difficult 
 ways have a Tendency to draw the Thigh up- Luxation, 
 wards and outwards •, and befides the Border 
 of the Cavity has no Breach on that Side, as it 
 has inwards : I even believe that all the Luxati- 
 ons downwards happen downwards and in- 
 wards j the Bone placing it felf on the Foramen 
 Ovale, it is impoflible, I think, that the Head 
 of thQ Femur fhould reft upon the Os Ifchion. 
 
 There are a great Many who believe that all 
 the Luxations happen thro' the floping, and 
 that the Fall, being complicated or followed by 
 Ibme exrriiordinary Motion, inclines the Head 
 of the Bone to take one of the other Pofitions. 
 
 Sig 
 
 ns. 
 
 The Signs of the Luxation upwards and in* 
 wards, are. 
 
 I. That the Thigh is fhorter. 
 
 * L 2. 2. That 
 
14$ 
 
 Fourth. 
 Fifth. 
 
 Sixth. 
 
 Seventh, 
 
 Eighth. 
 
 .<^ T R E A T I 5 E of the 
 
 2. That the great Trochanter is raifed higher, 
 and the Buttock finks in. 
 
 3. The Knee, the Leg, and the Foot turn a 
 little oufvvards. 
 
 4. The Thigh is a little ftretched. 
 
 V The Thigh can't bend without great 
 Pain. 
 
 6. There is a great Tumour on the Os Pubis* 
 
 7. The Scrotum (wells. 
 
 5. The whole Thigh is choaked up, and be- 
 numm'd, and fome Authors fay that there fol- 
 lows a Stoppage of Urine. 
 
 Explication, 
 
 The Thigh is fhorter, becaufe it is mounted 
 upwards, and the great Trochanter is raifed on 
 the fame Account. 
 
 The Knee and Foot are turned a little out, 
 becaufe the Obturators are ftretched. 
 
 The Thigh is a little extended, becaufe the 
 Mufcles are in Contraftion, and the Pfoas, Ilia- 
 cus and Peciineus are relaxed. 
 
 The Thigh can't bend without great Pain," 
 becaule the Glutxi are too much ftretch'd ; and 
 alfo becaufe of the Head of the Vemur\ com- 
 preffing the crural VelTels. 
 
 The Tumour over the Os Puhis is made by 
 the Head of the Bone which is over it. 
 
 The Scrotum fwells, by Reafon of the Com- 
 preilion of the Spermatick VeiTels. 
 
 The Th^gh Swells and is benumm'd by the 
 Compreflion of the crural Veins, Arteries 
 and Nerves. 
 
 Tic 
 
Difeafes of the Bo N E S. 149 
 
 The Signs that the Luxation is i4pwards^ 
 and outwards^ arc: 
 
 1 . That the Thigh is iliorter. Sign*. 
 
 2. There is a Swellir.g outwards. 
 
 3. The Thigh, Knee and Foot are turned in- 
 wards. 
 
 4. The Thigh may be mo'/ed inwards, but 
 rot outwards without great Pain. 
 
 5. The End of the Foot refts upon the 
 Ground. 
 
 5. The bending of the Buttock is higher. 
 
 7. The internal Mufcles are flretched, as if 
 there were a Cord from the Vuhis to the middle 
 of the Thigh. 
 
 Explication, 
 
 1. The Thigh is fhorter, becaufe the Bone Ejfplana^ 
 is got upwards. tion. 
 
 2. The Tumour or Bunch outwards is caufed 
 by the disjointed Bone. 
 
 ). The Thigh, Knee and Foot turn inwards, 
 becaufe the Glutai are relaxed, and the Tricep\ 
 are contrafted. 
 
 4. The Thigh may be moved inwards, but 
 not outwards without Pain, becaule the Tncefs's 
 are too ftretch'd, 
 
 5. The End of the Foot refts upon the 
 Ground, becaufe the Thigh being ihortened, 
 the Patient to fupply the Defeft, endeavours 
 to render it longer by extending the Foot. 
 
 6. The bending of the Buttock is higher, be- 
 caufe the Thigh is mounted up. 
 
 7. The Cord that is felt from the Tuhls to 
 the middle Part of the Tiiigh, proceeds from 
 the Triceps^s being in a great Tenfion. 
 
 L3 7T9C 
 
1 5<5 A TkZ AT l$Z f)f tht 
 
 The Signs that the Luxation is downwards 
 and internal^ are. 
 
 Signs. T. Thnt the Head of the Bmur is on the Fo- 
 
 ramen Ovale. 
 
 2. That the Thigh affeded is longer than the 
 found one. 
 
 3* The Ends of the Foot and Knee are turn'd 
 outwards. 
 
 4. The Thigh can't move inwards without 
 AnguiJh. 
 
 5. There feems to be a Cavity in the Buttock, 
 at Jeaftic finks in. 
 
 6. There is an Eminence under the Groin. 
 
 7. The bending of the Buttock is lower on the 
 Side that is indifpofed, than on that which is 
 found. 
 
 8. When one fets the Patient upon his Feet, 
 his Heels, and the Ends of both his Feet being 
 upon the fame Lines, 'twill be obferved that 
 when the found Leg is flrait, the other will be 
 bent ?t the Knee. 
 
 9. The Patient walks as if he were mowing, 
 that is to fay, that the Thigh, the Leg, and 
 the Foot defcribe a Semi-Circle. 
 
 10. The Patient fets the whole Sole of his 
 ) Foot to the Ground at the fame time, from his 
 
 Toes to his Heels. 
 
 Explication, 
 
 Explana- j. The Head of the f^wz^r is on the Foramen 
 """• Ovale^ becaufe the Thigh being luxated inwards, 
 the Head of the Bone can't find a Place better 
 difpofed to receive it : This Hole forming (as 
 one may fayj a Socket. Experience has fhown 
 it in thofe in whom t|ie Reduftion has never 
 
 been 
 
D'lfeafes of the Bones. 151 
 
 been made, becaufe they walk and reft upon 
 their Thigh, almoft as firmly as if the Bone 
 were in its proper Cavity. 
 
 2. The Thigh affefted is longer than the 
 found one, becaufe the oval Hole, where the 
 Head of the Bone is, is lower than the Cavity 
 of the Jfchion. 
 
 3. The Foot and the Knee turn outwards, 
 becaufe the Thigh being diflocated inwards, .is 
 drawn on the contrary Side by the GhttAi • and 
 the Leg and Foot which are joined to it, muft 
 follow and turn on the fame Side, 
 
 4. The Thigh can't move inwards without 
 Pain, becaufe then one draws the Glutal violent- 
 ly, which are in Contraftion •, befides the Head 
 of the FeTTJur bears roughly upon the Obturator 
 externus, which bruifes it, and increafes the 
 Angui/h. 
 
 5. There feems to be a HoUownefs in the 
 Buttock, or at leaft it fmks in, becaule the great 
 Trochanter which has followed the Head of the 
 Femur, is forced inwards, and no longer makes 
 a Protuberance outwards as in its natural State. 
 
 6. The Tumour that is beneath the Groin, 
 is form'd by the Head of the Femur, which is 
 then upon the Foramen Ovale. 
 
 7. The bending of the Buttock is lower on 
 the Side that is indifpofed, than on the found 
 one, becaufe the Thigh is lower, which makes 
 the whole Buttock come down, and confequent- 
 ly the bending, 
 
 8. When one fets the Patient upon his Feet, 
 ^ the Leg can't make it felf even with the found 
 
 one, without bending it felf, becaufe it is lon- 
 ger than the found one-, whence it" the Patient 
 would ftretch it out, he carries it forwards, or 
 throws it a fide. 
 
 L4 9. The 
 
153 A T KZ AT I sz of the 
 
 p. The Patient walks as if he was mowing , 
 and the Thigh makes a Semi-Circle, becauie 
 t)eing longer, the Patient can't carry it for- 
 wards in a ftrait Line, when he walks, but in 
 a Curve ^ forafmuch as the found Thigh can't 
 raife the Body fufficiently to. let the indifpofed 
 Thigh move forwards without touching the 
 Ground ^ which neverthelefs is abfolutely iie- 
 cefTary, that one may walk eafily. 
 
 lo. The Patient fets his Sole to the Ground 
 all at a Time, from the Toes to the Heel, be- 
 caufe the Thigh is too long, and would be much 
 more (6 it the End of the Foot or the Heel 
 refted upon the Ground: 'T is for this Reafon 
 t^atthey who have the Palfy, walk with yet 
 Boore Difficulty, becaufe their Leg hangs and 
 trails upon the Ground. 
 
 Of the ProguoJiicL 
 
 All the Luxations of the Thigh are fatal ; 
 but Ibme are more fo than others : The leaft 
 daiiigerous is that which is upon the feriimen 
 Ovaley wherein the Head of the Bone lodges. 
 It is neverthelele raoft difficult to reduce, but 
 whether it be reduced or no, it is always lef? 
 dangerous than the others •, for altho' one can't 
 >bi'£:v4. reduce the Bone, the Patient for all that, can 
 lou. fometimes make ufe of his Thigh to walk 
 on, and he is almoft always unabl.e to ufe it 
 when one don't reduce the oth^r Luxations, 
 This proceeds from the Head of the Bone's a- 
 grceing (b well with the Forawen Ovale, that iii 
 Procefs of Time it moves tliere with almoft as ' 
 much Eafe, as it did before in the Cavity of 
 the Ifchion : There have even been Ibme leen 
 where it had made it fell" Borders as ftrong as 
 t^fe of the Cavity of the Ifchm. 
 
 This 
 
Difeafes of the Bone s# 155 
 
 This may ferve to prove what I have faid in Obfcrva- 
 treating of the luxated and fractured Arm, ^'o"«« 
 when I propofed to reduce the Humerus after 
 two or three Months Luxation ^ for it is eafier 
 for the Head of the Arm to replace it felf in 
 a Place where it has already been, and which 
 is made for it, than it is for that of the Thigh 
 to lodge it felf in the oval Hole, where it has 
 never been, and where it ought to be looked 
 upon as a ftrange Tenant. 
 
 When 1 faid that the Patient can walk, I did Remftrk. 
 not mean that it was with the lame Eafe, 
 becauie he muft neceffarily limp, and have all 
 the Accidents of a luxated Thigh, except the 
 Pain, which he has not always •, but he makes 
 a Shift to walk •, and in the other Sort of Diflo- 
 cations, where the Head of the Bone is not up- 
 on the oval Hole, it is moit commonly impof- 
 fiblefor him to fupport himfelf: Befides, thofe 
 are dangerous after the Reduftion, and this 
 hardly is at all fo •, this proceeds from the Remark, 
 j'ound Ligament's being ftretch'd, torn and bro- 
 ken in all other Luxations, but that which is 
 upon the Foramen Ovale \ becauie in this latter, 
 the Bone removing at a lefs Diftance from its 
 Cavity, the round Ligament, far from break- 
 ing, is lefs extended, which is becaufe it is 
 faften'd below the Center of the Cavity of the 
 Jfchium, towards the Bottom, and near the Side 
 that faces the Foramen Ovale j this Origin gives 
 the Head of the Bone more Liberty to ifTue out 
 on that Side without breaking this Ligament. 
 
 The moft dangerous of all Luxations of the onthe 
 Thigh, is that which is upon the Os Pubis, be- Os Pubis 
 caule it comprelfes the VefTels, whence great very dan- 
 Accidents happen, as may be judged by the S"ous. 
 Signs that 1 have defcribed -, and this as well 
 as the other that happen upwards or outwards 
 
 is 
 
i54 A Tkeatise of tbf 
 
 is dangerous, becaufc of the Rupture of the 
 round Ligament •, for which Reafon in thele 
 Sorts of Luxations, the Patient muft be kept 
 more quiet than in the others, and tighter 
 Dreflings be applied, till fuch time as the round 
 Ligament is re-united, which is not always. 
 Remark. When the Luxation of the Thigh is not re- 
 duced in 24 Hours, one runs a Rifque of the 
 Bones ilTuing again out of its Cavity, a little 
 after 'tis replaced. 
 
 It is always good to try to reduce it, tho' the 
 Bone has been long luxated, provided the Caufe 
 be external ; for wheu it is internal, 'twill not 
 fucceed. 
 
 There is ftill another Cafe wherein 'tis almoft 
 impoffible to fucceed, altho' the Caufe I'eems 
 external ^ 'tis when the Diflocation happens a 
 long time after a Fall upon the great Trochanter-^ 
 and, as it feems of Importance to treat fiilly 
 of this particular Kind of Luxation, where- 
 of no Author has made mention, I will give 
 an Idea of it in the following Obfervation, 
 after which we will fpeak of the Cure of all 
 Luxations of the Thigh. 
 
 Obfervatwis. 
 
 A very 'Tis fome Years fince I was called to fe* a 
 particu- Lady, who for two Months after a Fall, had 
 UrLuxa- complained of a rheumatick Pain, that had fei- 
 zed upon her Hip, and her whole Thigh. At 
 the Recital that was made me of her Fall, and 
 the Circumftances that attended if, I waspre- 
 polfefTed, even without touching her, with an 
 Opinion that the Thigh was diflocated upwards 
 and outwards-, neverrhelefs before 1 told her 
 Ail, I examin'd her, and found all the Signs 
 that denote this Luxation. 
 
 Ith«n 
 
 tion 
 
Difeafes of the B o n ^ 9» 155 
 
 I then declared to her that her Thigh was 
 disjointed. The Afliftants blam'd the Surgeon 
 who had her under Cure, becaule he had not 
 difcover'd this Diflocation. I inform'd them 
 that they blam'd him wrongfully, becaufe he 
 had not feen the Patient but the 3 or 4 lirft 
 Days, and thatbefides thisDifeafe is not known, 
 tho' very frequent, and does not manifeft it 
 lelf till a long Time after the Fall. 
 
 'Tis a Luxation of a very particular kind, 
 which the Strokes don't produce at firft, but of 
 which they are the occafional Caufes. 'Twas 
 by having been deceived my felf^ and having 
 reflefted upon ray Error, that I found it out, 
 and give the Observation of it at prefent, to 
 the End that for the future the Number ot 
 Cripples may not be Co great. There are ma- 
 ny whofe limping is only caufed by this Di- 
 ftemper's not being known in its beginning. 
 
 Many of the Profeilion, who were call'd in Falfe 
 as well as my feif, pretended to excule the Brethren 
 Surgeon, but by fuch weak and extravagant Ar- 
 guments as, tar from deftroying, conlirm'd the 
 Error of thofe who blam'd him. There are 
 many fuch falfe Brethren, who only attack our 
 Reputation by Silence •, a dumb Language but 
 ib much the more eloquent as 'tis affe£ted. As 
 I am an Enemy to fuch treacherous Perfons, 
 far from being filent on this Occafion, taking 
 part with the Truth, I aifured them that the 
 Thigh was not luxated at the Time of the Fall, 
 but long after. This Sentence feeming a Para- 
 dox. I explain'd my felf thus. . 
 
 When the great Trochanter is ftruck in a Fall, pirft 
 the Head of the Femur is thruft with Violence Caufe of 
 againft the Sides of the Cavity of the Jfchion ^ this Lux- 
 and as it fills this Cavity exaftly, the Cartila- *"°"* 
 ges that covei- it, the Sinov'ml Glands, and the 
 
 round 
 
15^ A Treatise of the 
 
 round Ligament, which faftens thefe two Parts 
 together, muft fuller a violent ConCufion, 
 which will be followed by an Obftrudion, In- 
 flamation, and Defluxion. 
 ad Cftufc. The Sinovia will tiow down thither in a great- 
 er Q,uanticy, will fill the CapfuU, or Tunica Li' 
 gamentofa, and the whole Cavity of the Articu- 
 Jation, which by Degrees will be followed by a 
 Luxation. Becaufe this Sinovia which always 
 diflufesit felf, and even then more than in its 
 natural State, being no longer diiTipated by the 
 Motion of the Part, will force away the Bono 
 with fo much the more Eafe, in that having 
 relaxed the Ligaments, it puts them out of a 
 Condition of refifting not only the Efforts which 
 they make to drive the Bone horn its Socket, but 
 even thole of the Mufcles to draw it upwards. 
 EffeSs. Thus the Extenfion of the round Ligament 
 is made by Degrees, and the Pain will increafe 
 and not diminilh till this Ligament, being en- 
 tirely relax'd and broken, has abandon'd the 
 Head of the Bone to the whole Force of the 
 Mufcles that draw it upwards. 
 
 What has been now laid, ihews that, in this 
 Diieafe, the Bone is not difplaced at the Inftant 
 of the Fall, but along time after, and by De- 
 Rcmark. grees. The firft Day the Bone keeps its natu- 
 ral Pofition, and the Thigh does not begin to 
 be fhortened, till the Head begins to be driven 
 away by the Simvia. One would think that 
 the Thigh ought not to be Shortened till the 
 Head of tne Bone is entirely out •, neverthelels 
 itbeccm^s Shorter by little ?nd little, in Pro- 
 portion as the Head makes its Progrefs out- 
 wards. 
 E-.'plana- The fpherical Figure of this Head is theCaufe 
 tio.i. of this ^ it lefTens from its Neck to its Top, 
 whence when the Sinnid has removed it one 
 
 Line 
 
Difeafes of the B o N E s. 157 
 
 Line from the Bottom of its Socket, the Muf- 
 Cles draw the Thigh a Line upwards •, and if 
 at that Time the Thigh were to be meafured 
 from the Place where the Head ot the Fermir 
 touches the upper Side of its Cavity, 'twould 
 be found a Line ihorter •, fo that if this Head is 
 forced 4 or 5 Lines, the Thigh will be found 
 ihorter by 4 or 5 Lines, provided it be meafur'd 
 from the Place where it touches the upper Side 
 of its Socket. Thus as much Progrefs as the 
 Head of the Femur makes outwards, fo much 
 the Thigh will lofe of its Length ; and when 
 the Head is entirely out, its Center, which in 
 its natural State anfwered to the Center of the 
 Cavity, will be found on the upper Side of this 
 Cavity ^ and the Thigh will be fliorter by half 
 the Diameter of the Head: It would even be 
 carried farther by the Aftion of the Mufcles 
 were it not for the round Ligament, which re- 
 tains it yet in that Place. 
 
 Things being thus, 'tis eafy to conceive that 
 the Pain muft increafe \ in Effeft whilft the 
 Head can be with-held by the Border of the 
 Cavity, the round Ligament Ihares the Effort 
 of the Mufcless with it, and is extended by lit- 
 tle and little •, but when the Head is once en- 
 tirely forced out, the Ligament bears fingly 
 the draining of the Mufcles, and the Anguiih 
 becomes infupportable; and continues fo till the 
 Rupture of the Li'^ament, or its entire Relaxa- 
 tion, permits the Mufcles to carry the Bone as 
 far as their Contraction will fuffer them. 'Twas 
 wrongfully therefore, that they cenfured the 
 Surgeon, for not having difcovered a Luxation, 
 which did not happen till a long Time after 
 the Fall. 
 
 It mufl be remark'd, that the Head of the 
 Thigh-Bone being thus carried upwards, and 
 
 out- 
 
j58 J T kz ATI se of the 
 
 outwards, may turn either betbre or behind. 
 When it turns forwards, the Knee and the 
 End ot the Foot are outwards, and when it 
 turns backwards (which is moft often) 'tisdif- 
 cover'd by the Signs of the Luxation upwards 
 and outwards before-mehtioned. 
 
 This Difeafe is incurable, when, by Reafbn 
 of its not being known, one does not fpeedily 
 apply the Remedies that are proper to pre- 
 vent it. 
 Cure 1 have feveral Times had Succefs by ufing 
 
 Defenfives, made with the White of Eggs, 
 powder'd AUum, and aromatick Brandy, where- 
 with I moiftened CompreiTes 8 or lo double ^ 
 I applied them all over the Articulation of the 
 Thigh i I kept them on by a Bandage, that was 
 only conteative, and I moiftened them twice or 
 thrice a Day with the fame Liquor, without 
 taking off the Dreihngs. ' 
 
 I placed the Patient conveniently in his Bed, 
 and made him avoid all Motions capable of ex- 
 citing Pain. 
 
 I bled him twice or thrice the firft Day, and 
 the following I repeated it more or lets, accor- 
 ding as the Pain required, and the Strength of 
 the Patient permitted. One muft not fpare 
 Blood on this Occafion, if one would avoid Ob- 
 ftruftions in the Velfels, and Inflamations and 
 Defluxions in the Articulation. 
 
 A moift and refrigerating Regimerij the refined 
 Juice of Plants a little bitter, together with 
 Anodynes and Narcoticks, adminifter'd with 
 Difcretion, are very helptul. 
 The Fate The Fate of thefe Luxations is different •, 
 of fuch as fome there are, which caule a Palfy in the low- 
 have this er Extremity •, others occafion Defluxions which 
 Diltem- terminate in Suppuration, and others in fine, 
 ^ ^* have no other ill Coi.fequence but limping -, oi 
 
 thefe 
 
Difeafes of the B o N E %. 15^ 
 
 thefe fome leave (6 deformM a Figure, that the ExpHca- 
 Patients can't walk, others leave them the Li- ^^^^' 
 berty of walking at firft with a Crutch, then 
 with a Canei and fome there are who can go 
 without any Support. 
 
 The Pally is caufed by the CompreHion ofExplicA- 
 the fciatick Nerve, whereon the Head of the ^^°"' 
 Femur bears'^ a leannefs and waftingof the whole 
 Limb, with an almoft continual Chilinefs, are 
 the Confequences. 
 
 The Defluxions proceed from feveral Caufes, 
 fome from the Pain, others from the Compref- 
 fionof the Blood-Velfels, and others again irom 
 the Pally. 
 
 The Paincaufes Defluxions by the Obftruftion 
 of the Lymphatick and Blood-VefTels, whe:xe 
 proceed Swellings, Dilatations, Ruptures, 
 and a Diffufion and Converfion of the Matter 
 diffufed into Pus. Thefe AbfcefTes are form'd Where 
 in different Parts ^ fome in the Socket of the *^« Ab- 
 Joint, when the Slnovia ferments, turns eager, y*^ 
 and is changed into Vns'. others in the Place *^^^ ^ 
 where the diflocated Head relides; and there 
 are fome form'd in the Interftices of the Glutaiy 
 or the Tricipites •, and, in fine,^thers are in the 
 Parts that are diftant from tne Joint, as the 
 Knee, the L,eg and the Foot. 
 
 I have opened Numbers of Impoflhumes of Obferr*- 
 this Nature, they are all hard to be cured ; but tion* 
 thofe which are moft difficult are in the Cavity 
 CotyloUcy or in the Place where the Head lodges : 
 Thefe remain almofl always liflulous, if the 
 Patient does not die of a lingering Fever, a Vo- 
 miting and Loofenefs :;, or a geieral Solution of 
 the whole Mafs of Blood, whence follows a 
 fwelling in the Legs, and Thighs, a Bloating 
 of the Face and Hands, and a Dropfy in the 
 Breaft and Ahdotneu. 
 
 At 
 
|6<S A Tkz Ari%z of the 
 
 At other Times, thefe Patients don*t live Co 
 long after the opening of the Impofthume, be- 
 caule the Putrefaction gets into the Wound, 
 and the Mafs of Blood being corrupted by the 
 length of the Difeale, the Pain, the Fever, and 
 the Want of Sleep, render the Application of 
 the moft proper Medicines, and the beft con- 
 certed Operations, fruitlefs. 
 Obferva- Oftentimes one finds the Bones rotted with- 
 tion. out being able to help it, either by Reafon of 
 the Difficulty of making the necelfary Operati- 
 ons, or becaufe the Strength of the Patient 
 won't permit one to venture it. 
 A very I have found in opening fuch an Impofihume 
 remarka- that the Bones were carnify'd ^ 1 mean that the 
 ble Ob- j^gad of the Femur and the Cavity of the Ifchl- 
 ervration. ^^ being feparated from each other by the Lux- 
 ation, and both of them laid bare by the open- 
 ing of the Impofthume, had the fame Confi- 
 ftence and Colour as FlelK •, their Size was in- 
 crealed, and they were fb like Flefh, that they 
 bled at the leaft Touch. This Obfervation is 
 very particular, but I fhall relate in the Sequel 
 ieveral that are not lefs furprizing, ai:kd which 
 prove, that if the Flefh becomes Bone, the 
 Bones will alfo change into Flefli. 
 
 The AbfcefTes that are form'd in the other 
 Parts, have nothing particular in them, but on- 
 ly that they return often. 
 
 When the Luxations that are not reduc'd 
 have no fatal Confequences, they leave the Pa- 
 tient the Liberty of Walking, as had been fiiid^ 
 but he is tormented with Pains that arecaufed 
 by bad Weather, and are renewed by it : They 
 become (as one may fay) living Barometers that 
 foretel Rain, or fair Weather. 
 
 I have alfo obferved, that the Bones folder 
 themfelvcs together by a Sore of Callusy as fra- 
 
 ftured 
 
h'jfeajes of the E o N E s^ i6i 
 
 ^ur'd Bones do, \vlii<!:h forms an Anchilofis of a 
 particular Kind, fince in this th.Q uinchilofts does 
 not caufe the Defed of the Joint, but on the 
 contrary, the Defeft of the Joint caufes the 
 jinchi lofts. 
 
 The Deformity that remains after this Di-^"°<*^ 
 ftemper, proceeds generally from the pernici- p*^/. r 
 ous Pofture which the Patient is fuifer'd to h'e DefonTrf- 
 in, it being hard to make him reft in any o- ty. 
 ther but that wherein he fuffers leaft \ happy 
 He ! if this Pofture is not contrary to the natu- 
 ral Figure of the Limb. 
 
 They who can walk, do it with Pain at the 
 beginning, the Crutches fupply the A£t:ion of 
 the Part •, but by little and little, the Parts* 
 near which the Head lodges, become ufed to 
 this new Tenant. 
 
 Cf the Curd. 
 
 To make the Redu£lion of the Thigh, let Cure. 
 the Bone be placed where it will, one muft al- 
 ways make the Extenfion and Counter-Excen- 
 iion, and guide the Bone into its Socket. 
 
 The Counter-Extenfion and Extenfion muft^ Neceffa- 
 be ftronger than in the other Parts, becaufe ryCondi^ 
 the Mufcles of the Thigh are confiderably ^^°^^' 
 ftronger, and 'tis always neceftary to get the 
 better of their Refiftance, to bring the lux- 
 ated Bone near to, and even with the Cavity, 
 into which it miuft enter. 
 
 All the Methods that we have made ule of in Methods 
 the Reduftion of the Arm, to perform thefe of Rcdu- 
 two Operations, will not agree with the Thii^h ^^°°' 
 there are only the Hands, the Straps, the 
 Monfles, Hippocrates^^ Bench, and the Machine 
 that 1 have defcribed, which can be ufed 
 therein. 
 
 M The 
 
i62 A Tkeatisy. of the 
 
 The The Hands are lefs proper here than elfe- 
 
 Hands. where, not oiJy becaufe the Mufcles are ftron- 
 ger, but alio becaufe the Parts are too large, 
 and cannot be grafp'd by the Hands of the 
 Afljftants. 
 The The Straps are applied in the fame Manner 
 
 Straps, as to the Arm, that is, to that Part of the 
 Thigh which is near the Condyles o^ the Femur ^ 
 to make the Extenfion • and the Body is with 
 held by a loole Strap which palTes within the < 
 Groin, one End being turned under the But- 
 tock, and the other over the Belly : They muft 
 be joined together four Fingers above the Crifra . 
 oT the Os Jlium, and 'tis there that it muft be 
 held by Ibme ftrong Perlbn, or that a String 
 muft be put thro' it, that is capable of refi- 
 fting, and muft be faften'd to a fix'd Point, 
 when one wou'd make Ule of Movfles. 
 
 I fiiy nothir.g of the Manner o' ufmg the 
 Bench of Hippocrates, becaufe it is no where to 
 be found. 
 Of the If any one wou'd take my Machine, the But- 
 
 Machine, trefs muft not be flit, nor muft the Thigh be 
 put thro' it, as is done by the Arm •, 'tis fuf- 
 ficient that there is a ftrong Band, like one of 
 the two that make the Button-hole, the middle 
 whereof muft reft upon the Protuberance of 
 •the Ifchion\ and one of the two Ends where 
 the Pockets or Sheaths are (which muft enter 
 the Ends of the Branches of the Machine) muft 
 be put before, and the other behind : The Ma- 
 ch ne muft be placed between the two Thieh?, 
 and the Strap of the Thigh muft be tafteif d to 
 the String of the Moufics. As to the reft, it is 
 to be ordered as has been explain'd at full 
 Length in the Reduftion ot the Arm. 
 5 Things In all thefe Operations, there are three 
 
 to be ob- Things to be obferv'd : Firft, that the Patient 
 fcnrc'li jjg 
 
Lifaafes of the Bo liES, 1 63 
 
 be placed on the oppofite Side, and that the 
 ailino; Hip be turn'd upwards. Second- 
 ly, that the Leg be bent^ and thirdly, thac 
 the Surgeon be always attentive to what palfea 
 ill the Exteijfions, to the End that he may 
 make opportunely the ncceirary Motions with 
 his Hands, which are dilferent in all the Kinds 
 of Luxations. 
 
 If the Thigh is diflocated upward?, and in- Firft ma- 
 ternally, that is to lay, upon the Of Pubis-, the""'^jOp^- 
 inward End of the Machine muft be mov'd a ^*^^°"* 
 Jittle backwards when the Extenfion begins, 
 and it niuft be brought forward when one thinks 
 it fufficient^ and the Surgeon muft work with 
 his Hands fo as to favour thefe Motions, thac 
 he may incline the Head of the Bone to take 
 the VVay of the Cavity. 
 
 If the Thigh is luxated upwards and exter- 2d manu- 
 nally, the End of the Machine muft be thruft ^^ .*^P^- 
 forwards, when one begins the Extenfion, then ^*^^°'^' 
 move it backwards, when it is thought fuffici- 
 ent ; during which the Surgeon muft work 
 with his Hands, fo as to difpofe the Head of 
 the Bone to re-enter its Cavity. 
 
 If the Luxation is downwards and external, 3d manu- 
 the Extenfions muft not be fo ftrong ; tliey alO^jera- 
 muft only keep the Mufcles in their right State, "°"* 
 whilft tlie Surgeon turns the Head of the F-?- 
 tnur on the Side of its Socket, by taking che 
 inner Part of the Knee in the Palm of one 
 Hand, whilft with the other he leans upon the 
 Leg near the Foot, that he may make it turn 
 (as it were) upfide down, which throws back 
 the Head of the Bone, and guides it into its 
 Cavity. 
 
 I don't believe tliis Luxation poftible, but Remark. 
 when it proceeds from an internal Caufe, at 
 leaft 1 have never feen it. 
 
 M 2 Whea 
 
164 
 
 4th ma- 
 
 jiualOpc- 
 rarion. 
 
 Addition 
 to the 
 Machinei 
 
 i^ T R E A T I 5 E of the 
 
 When the Luxation is internal upon the Fo* 
 rdmen Ovale, the Extenfions maft be but very 
 flight, only to difengage the Head ot the Bone 
 a little, whilft the Thigh being put up to the 
 Groin in a Napkin (ty'd like that which was 
 M^ed about the Arm) the Surgeon has the Nap- 
 Icin drawn, whilft he bears upon the external 
 Gondyle of the Femur, near the Place where 
 the Strap is faften'd, which will draw the 
 Head of the Fem^ir back from the Foramen Ovale^ 
 and replace it in its Cavity. 
 
 I have even added to the two Branches of 
 the Machine, two Sorts of Crefcents, whereof 
 
 
 A 
 
 
 __^^^ 
 
 
 
 
 jg^^S^ 
 
 
 
 
 
 
 
 the one (A) half bears upon the 0/ Ilium, and the 
 other (B) upon the middle of the Thigh j 
 then I put a Napkin within the Groin, I make 
 a Loop which 1 faften to the String of the 
 Afoufle, and turning the Handle, I make three 
 different Efforts, viz,. The upper Crelcent bears 
 againft the Os Jfchium -, the lower thrufls the 
 Bottom of the Thigh inwards, and the Nap- 
 kin draws the Top of the Thigh outwards. 
 Thefe three Movements are abfolutely necef- 
 fary to reduce the Thigh- Bone, when the' 
 Head is lodged in the Foramen O-.ale, 
 
 It 
 
Lifeafes of the Bone s. j6$ 
 
 tt muft be objerved in this Reduftion ^ firO, 
 that the Extenfion Is difficult. Secondly, that 
 it ought not to be ftrong. Thirdly, that it 
 muft continue till the Bone is replaced. 
 
 As to the firft Remark, the Extenfion is dif- 
 ficult, becaufe the fl:rongeft Mufcles are ftretch- 
 ed, as they are almoft all, becaufe the Bone is 
 lower than in its natural Pofition. 
 
 Second Remark. The Extenfion muft not 
 be ftrong, that is to fay, one muft not ftretch 
 the Limb much, becaule it is not iTiorten'd ; 
 on the contrary 'tis too long, for the oval Hole, 
 which is the Place where the Head of the Fe- 
 mur lodges, is lower than the Cavity of the 
 Jfchiorty which renders the Thigh longer. 
 
 Third Remark. The Extenfion muft be 
 continued till the Surgeon has drawn the 
 Head of the Bone outwards, and placed it in 
 the Cavity of the Ifchion-^ becaule if the Ex- 
 tenfion were difcontinued before the Bone were 
 come to its Socket, it couM never get thither, 
 and one would be obliged to begin again. It 
 may be added, that when the Luxation is in- 
 compleat, and the Head is on the inward Bor- 
 der, the ^vesit Trochanter muft be grafp'd with 
 one Hand, and the Femur thruft inwards with 
 the other, to replace the Head : And on the 
 contrary, if it is on the outer Border, the 
 Thigh muft be mov'd inwards to make the 
 Head re-enter its Socket. 
 
 When the Reduction is made, a very long 
 and broad Comprels fA) muft be laid on 8 
 double ^ the Spica muft be made with the Roll- 
 er (B) which muft be four Fingers broad, and 
 five Ells long ^ the Place where the Straps 
 were muft be coverM again with the Balfter 
 (Cj and kept on by the Swathe (D.) The Pa- 
 tient muft keep his Bed and lie quiet ^ he muft 
 
 M 3 be 
 
i66 
 
 A Treatise of the 
 
 be blooded, as his been fa id above, and obferve 
 the Diet and Fegimen that has been prefcribM fo 
 often elfe where. 
 
 CHAP. XIII. 
 
 Of the Luxation of the Ro- 
 tula a'iid Tibia, 
 
 TH E ^otula may fuffer an incompleat Lux- 
 ation without the Tib'as being at all dis- 
 located ^ but the Leg can never be disjointed 
 xvithout the RotnWs tol lowing. 
 
 It luxates iiidependantly of the Tibiae inter- 
 nally and externally \ internally when the out- 
 ward Cavity of the Fotula is upon the internal 
 Condyle oiths Femur) externally, when the 
 
 inner 
 
Difeafes <?/ rZ?^ B o N E s. i6y 
 
 inner Cavity receives the external Condyle of 
 the Femur. 
 
 The Leg cannot diflocate without the Rotw 
 la's following, becaufe the Rotula is joiu'd to it 
 by a very ftrong Ligament, whence it is obli- 
 ged to follow the Tihia when the Leg luxates, 
 be it inwards, outwards, before or behind. 
 
 The Rotula fuffers a compleat Diflocation 
 when the Hhia is entirely luxated, and the 
 disjointing of the Rotula is incomplL\it when 
 that of the Leg is fo like wife. 
 
 The RotuU never fuffers a compleat Luxati- 7^^ 
 on by it felf, neverthelefs I have heard that j^it^Lux- 
 this Luxation has been feen ^ but People are ation is 
 deceived •, let us refer it to the Structure ot the made. 
 Part, it can never induce one to believe it. 
 
 For how can the Rotula diflocate dowiiwards, 
 if it is kept upwards by the Extenfors of the 
 Leg ? How can it luxate upwards, if the ten- 
 dinous Ligament keeps it always join'd to the 
 Protuberance of the Tibial They who have 
 believM thefe two Luxations poiTible, or who 
 lay they have feen them, have taken a Fracture 
 for a Luxation, or the Rupture of the Liga- 
 ments of the ji^onenrops of the Extevfors for 
 the Luxation downwards, or that of the Liga- 
 ment that faftens it to the Tibiay for the Lux- 
 ation upwards ; and they who think that the 
 Rotula c^n throw its felf entirely on the infide 
 or on the outfide of the Articulation of the 
 Leg, are deceiv'd in the fame Manner, the 
 Mufcles cannot allow thefe two Kinds. It re- R^^"^^* 
 mains that what has been fiiid above of the 
 Luxation of the Rotula only, or with the Tibia, 
 is true, an4 that this Bone cannot luxate other- 
 wife. 
 
 I was caird to fee a Rotula luxated upwards, Obfcrva- 
 becaufe they would convince me th it this Dillo- "on- 
 
 M 4 cation 
 
i6B A Treatise of the 
 
 cation was poiTible : In Effect, 1 found the 
 EctuU mounted up above* a Fingers Breadth*, 
 but upon examining;, I difcover'd that 'twas the 
 Rupture of the Ligament that joins the RotuU 
 to the Ttbiaj and I convincM the A/fiftants of 
 it : It is hard to break, and the Tendons of 
 j^chilles are not lefs lo ^ and tho' the Reality 
 of both the one and the other has been difpu- 
 ted, feveral Perfons that were Judges, and 
 worthy of Credit, Jiave fince feen both the one 
 and the other : One under the ^ands of M. 
 ^ravniers my Brother Member •, and the other 
 under the Cure of M. Cdin. Thofe who 
 doubt, may be more amply inform'd of thefe 
 Fa£ts in the fecond Volume, when I fhall treat 
 exprefly of them. 
 
 I am not at all incredulous in Things that I 
 think poHjble, but 1 can't acquiefce with thofe 
 that I believe, not even out of Complaifance : 
 There are fo many who would let themfelves 
 up for wonderful Perfons, that they would be 
 aihamed to relate a Fa£l that has been feen by 
 others :, but let us not make a wrong Ufe of 
 the Word. There muft fometimes be a Diffe- 
 rence made between Seeing^ and Seeing •, all thofe 
 who fee fick PerlbiiS, don't for that Reafoa 
 know their Difeafes ; feveral fee more fick Per- 
 fons than Difeafes, but few fee more Dif^em- 
 pers than Patients. This is often for want of 
 examining, for all the World has Eyes and Fin- 
 gers, and all the World knows, or at leafl all 
 the World ought to know the Strufl:ure of the 
 Parts, and the Diforder that happens when 
 Advice they are hurt. They who with this Know- 
 before ledge don't judge well, owe it to their notma- 
 9^^ king a right Uie of it. Perfons may be de- 
 
 y^^l^' ceivedaltho' they fee and touch, if they don't 
 coiiiiderj becaule they pafs Judgment too rafh- 
 
 ly: 
 
T)ifeafis of the B o N E $• 169 
 
 ly : One muft firft examine well, then confider, 
 and then pafs Judgment. 
 
 What I lay may perhaps not be ac;reeable to 
 all the World, but I liatter my felf that I fhall 
 have on my Side all thole who are capable of 
 judging. 
 
 The Leg is not eafily diflocated, for feveral Why the 
 Reafons. Leg is 
 
 1 . Becaufe it is joined by a Ginglymus. "°^ ^^V|y 
 
 2. Becaufe it is joined to the Femur in feveral 
 Places, by ftrong, compa£t, and crofs Liga- 
 ments. 
 
 3. Becaufe the Ends of the F-fwar and of the 
 Tibia are large, and great Part of them touch 
 mutually. 
 
 4. It is jointed by a Gingymus, and all fuch 
 Joints are the harder to luxate, becaufe otthe 
 Multiplicity of their Heads and Cavities. 
 
 5. Its Motion is reftrain'd to Flexion and 
 Extenfion. 
 
 6. There is middle Cartilage which renders 
 this Luxation more difficult, in that it deadens 
 part of the Violence of the Motions and 
 Blows, andraifes the Borders of the Cavities, 
 and renders them deeper. 
 
 The compleat Luxation is as uncommon as 
 difficult , but the incompleat may happen more 
 eafily. 
 
 Whenever it does, whether it be before or 
 behind, internally or externally, the Leg al- 
 ways turns to that Side which is oppofite to the 
 Luxation, which is not the fame as in the com- 
 pleat one ^ but this does not hinder the latter's 
 being eafy to be difcoverM, becaufe the difloca- 
 ted Bones caufe fb great a Deformity, that there 
 needy no other Sign of their disjointing : As for 
 the rert, the Bone turns on the f\me Side as the 
 Luxation, as has been jufl laid. 
 
 If 
 
I/O ^Treatise of the 
 
 Prosnc- If the RediiO:io:i is not made fpeedily, an 
 ■ick. ji'ichi lofs \v\\\ foWoWy becaule the Ligaments are 
 almoft all broken, whence their nutritive Jui- 
 ces are diffufed and congeal themfelves with 
 the Simvia 0^ the Articulation. This will alfo 
 happen even when the compleat Luxation has 
 been reduced, if the necelfary Precautions are 
 not taken to avoid it, bccaufe 'tis fufficient for 
 the forming an AnchiloftSj that the Ligaments 
 are broken, and that the Liquor of the Articu- 
 lation is no longer confined, nor reftrain'd from 
 diffufmg it felf. 
 RcduGi- To reduce the RotuLt when luxated, one need 
 on. only extend the Leg fo as that the MufcuU Ex- 
 
 tcnfores may be beyond their Tonus, and prefs 
 the RotuU with ones Hand to put it in its 
 Place. 
 
 The Leg is reduced by an Exte:.fion and 
 Counter-Extenfion in a ftrait Line, on what- 
 ever Side it is luxated \ and it will lucceed, pro- 
 vided Care is taken to replace the Bone in its 
 Socket, by grafping with one Hand the Con- 
 dyles of the Femur, and with the other the 
 Eminence of the Tibia, thrufting the one againft 
 the other the contrary Way, as when reducing 
 Fraftures. 
 Dreffirgs. The DrefJing is the fame in both thefe Di- 
 feafes, being only contentive of the Remedy 
 wherein 'tis fteep'd ^ thus after the Reduftion 
 of the one or the other, one muft lay on the 
 Comprefs (A) which muft be 8 double, then 
 Circumvolutions muft be made about the Pare 
 with the Roller (B) rolling it alternatively in 
 Circles and Figures ot 8, till the whole Swathe 
 is ufed. It muft be 3 Fingers broad, and 2 
 Ells long. The Regimen and general Reme- 
 dies muft be oblerv'd as in other Luxations. 
 
 CHAP. 
 
Difeafes of the Bone?. 
 
 '71 
 
 CHAP. XIV. 
 Of the Luxation^/ the Foot. 
 
 TH E Foot luxates internally and exter- Kinds, 
 nally, forwards and backwards. When 
 the Head of the Jjlrdgalus is dillocated inwards, 
 the Sole of the Foot is turn'd outwards : When 
 it is luxated outwards, the Sole of the Foot 
 turns inwards: When it is disjonited before, the 
 Heel is very ihort, and the Fore-part of the 
 Foot feems long •, when 'tis difplaced behind, 
 the Heel is very long, and the Foot feems 
 very fhort. 
 
 There is a Luxation that has been fometimes A parti- 
 taken for a Dillocation of the whole Foot, cular 
 when it is but the Luxation of the Jlflragdus Luxation. 
 and CalcaNcuntj from the Scafoidcs and Cuhoides. 
 
 I never faw it but twice, and both Times it 
 was occafioned by the locking of the Foot in 
 feme Clog, as under the Iron Bar that makes a 
 Bridge for the Kennels under great Gates, or 
 
 feme 
 
1 ; 3 A T ?< E A 7 I s E of the 
 
 fome other Thinf; like it. 'Tis eafily concei- 
 ved that if the Foot is thus held, and the Bo- 
 dy is carried on one Side or 'tother, there will 
 be a Luxation, not of the Aflragalus from the 
 Ltg, but of the joiliting of the Afifa^alus and 
 the Calcaneum with the Cuhoides ar.d Scafoides. 
 ThisDiftemper is known by the Deibrmity of 
 the Part alone, it (hews the Side where the 
 Bones are lodged. 
 Remark. The Reduftioa is the harder, becaufe the 
 Hands have no hold. Both in the one and the 
 other of thefe Luxations there may be a Dia- 
 [taps of the Perofia, or a Fracture of one of the 
 Aialleoll. 
 Obfcrva- I have feeii feveral Times the Luxation of 
 tion. the ^y?r<?^.Jwf from the Leg attended with the 
 
 FraOiure of the Ferotja. 
 Remark. There alfo happens fometimes a Frafture of 
 the Tihiay but what is moft frequent is the 
 Frafture of the Malleolus Intemus, which fome- 
 times happens alone, and often is accompanied 
 with the Diaflajis of the rcro?;a. 
 Obfcrva- The compleat Luxation of the jifiragalut^ 
 tionj. which fome, but wrongfully, have called the 
 Luxation of the Malleolus, is a very trouble- 
 Remark, fome Diftemper. There are Praclitioners who 
 fay it can't be cur'd, but that there will remain 
 a Limpine:; or Deformity : Neverthelefs 1 have 
 had the Advantage of curing feveral without 
 leaving them any Ailment whatfoever. 
 Advice "^^^ ^^V ^° fucceed perfeClly, is to make 
 for the lufficient Extenfions •, it can't fail but when 
 Rcdu^- there is not Strength enough for the Extenfi- 
 ^'^- ons. For this Reafon I was never contented 
 
 with making Ufe of the Haud% I always took 
 Straps, and would have had Recourle to Ma- 
 chines, if more Force had been wanting : There 
 is no Hazard run in employing too much, it 
 
 may 
 
Bifeafes of the Bones. 175 
 
 may be moderated -^ but, in not having enough, 
 one runs the Rilque of making but an imper- 
 fect Reduftion, wh'ch will leave the Patient 
 cither deform'd, or a Cripple. 
 
 I (aften a Strap with two Loops above the Opcrad- 
 M^Heoli, and another with one Loop, which **"* 
 goes round, and grafps the Foot above the 
 Heel and the Inftep •, both thefe Straps muft be 
 ■drawn by Ibme b^dy that is very ftrong, and 
 one muft take hold of the Joint to make a pro- 
 per Conformation. 
 
 When the Luxation is fingle and without 
 Fracture, one has not always need of ftrong 
 Extenfions made with the Strap, but neverthe- 
 Jefs 'tis the fafeft Way to ufe them. 
 
 When the Extenfions are judged fufHcient, 
 one muft obferve the four following Ways of 
 working. 
 
 If the Foot is luxated externally, the Small ofFirftVVay 
 the Leg muft be taken hold of near the Ankle ?^ work- 
 wirh the left Hand, (the Thumb being over the "'^* 
 Malleolus externus) whilft with the right one 
 grafps the Sole of the Foot over againft the 
 Leg, and the Sole muft be turn'd on the ex- 
 ternal Side, whilft at the fame Time the Small 
 of the Leg is thruft inwards. 
 
 If the Luxation is internal, one muft take Second 
 hold of the Small of the Leg, and the Sole of "^^'-'y **^ 
 the Foot, as has juft been faid •, but the Sole ^^'°''''"S- 
 muft be turn'd inwards, and the Small of the 
 Lfg thruft outwards. 
 
 When the Foot is luxated before, with one 
 Hand take hold of the Small of the Leg under- 
 neath, within two Fingers of the Heel ^ then 
 with the other grafp the Foot near the Joint, ' 
 
 and pufli at the fame Time the Foot backwards, 
 and the Small of the Leg forwards. 
 
 In 
 
174 -^ Treatise of the 
 
 III fine, when the Foot is diflocated behind, 
 tJie Extenfions being made (as has been laid) 
 one muft hold the Small of the Leg before near 
 the Joint, and with the other Hand gralp the 
 Heel, and at the Hime Inftant pufh the Small 
 of the Leg towards the Heel, and the Heel to- 
 wards the Leg. 
 
 The Dreifing for thefe four Sorts of Luxati- 
 ons, confifts of a Comprefs (A) four double, 
 which is laid on like a Stirrup, a-crofs the Sole 
 of the Foot, its two Ends going, one on the in* 
 fide, and the other on the outfide ot the Leg, 
 as high as its middle ^ then another Comprefs 
 (B) eight double muft make a Figure of 8, paC 
 fing under the Sole of the Foot, croifing it feif 
 on the Fore-part of the Articulation, and then 
 wrapping round the two Malleoli going into a 
 Circle from one to the other. To keep on the 
 whole, take the Band (C) wherewith defcribe 
 a Figure of 8 paffing over the Foot under the 
 
 Sole, then from the Sole upwards ; cover the 
 Malleolus, and pafs it behind the Foot above 
 the Heels, then cover the other Malleolus, co- 
 ming 
 
Difeafes of the Bones, 175 
 
 ming back over the Foot and crofilng the Band, 
 from thence to the Sole, then make a Circum- 
 volution over the Tarjfus and Metatarfus, and 
 begin rolling the Band till the wliole be taken 
 up. The Foot muft be placed in the Hollow 
 of a foft Pillow, rhe Bed-Cloatlis muft be fup- 
 ported with a Cradle, a Regimen muft be ob- 
 ferved, and the general Remedies prelcribed. 
 
 The compleat Luxation where there is a 
 Rupture of the Tendons, andLigaments, or even 
 of the Skin it felf, is a very fatal Dileafe, I ne- 
 ver faw it cured ^ and the only Way to pre- 
 ferve the Patient's Life is to cut off the Leg. 
 One may neverthelefs try to prevent it •, but if 
 in 24 Hours there is no Difpofition found to- 
 wards a Cure, one muft not defer the Amputa- 
 tion ^ to wait longer wiii be too late. 
 
 CHAP. XV. 
 
 Of Strains of the Foot, 
 
 THIS Ailment has great Relation to the 
 Diajlafis of the Wrift, both by Reafon ic 
 occafions the fame Pain, and becaufe the Pain 
 and the Difeafe continue a long while ^ and that 
 both are produced by the fame Caufes, and 
 have a Number of C'ircumftances that rel^m- 
 ble each other. 
 
 There are feveral Things in the Chapter of 
 the Diaflafs of the Wrift that may be ufeful 
 here, wherefore 1 refer the Reader thither ^ I 
 ftiall only fay that the Luxations and Sprains ot 
 the Foot and Wrift are long in curing, becaufe 
 of the Tendons that pals by this Arciculatfon, 
 
 which 
 
iy6 A Treatise of the 
 
 which are very numerous, and don't only be- 
 long to the Fool, but to all the Toes, which 
 has been remark'd el few here. Moreover each 
 Tendon has a particular Sheath wherein it 
 ought to flip, which facilitates the various Mo- 
 tions of the Limbs ^ and to render them yeC 
 more eafy, there runs continually into their 
 Sheaths a Liquor call'd Sinovia, which filtrates 
 thro' little adjacent Glands, like thofe whereof 
 we have fpoken in the Anatomy of the Articu<* 
 lations, in treating of Luxations in General. 
 
 Upon thele Remarks two Reflexions may be 
 made : Firft that the Numbers of Tendons 
 which pafs by each of the Articulations here 
 mentioned, and whereof we have enlarged very 
 much in treating of the Sprains of the Wrift,- 
 are extended^ or to Ipeak like the Vulgar, 
 Ijprain'd, which cannot happen without being 
 followed with great Pain, and an Inflammation, 
 which will befo much the harder to cure, in 
 that the Parts afflifted are extremely fenfible. 
 
 The Simvla, which is in the Sheaths of each 
 of thefe Tendons, diffufes it felf in their Inter- 
 vals, which will caule, firft an Increafe of 
 Pain. 
 
 2. A Hardnefs and Swelling of the Articu- 
 lations. 
 
 3. Incurable Impoflhumes, as ihall be faid, 
 hereafter. 
 
 The Pain increafes •, firft, becaufe the Matter 
 comprefTes the Tendons, forafmuch as it takes 
 up rtirt of the Place they ought to fill, idly, 
 becaufe this Lympha ftretches the Sheath that 
 contains it, which caufes very acute Pains, be- 
 caufe this Sheath is very fenfible, forafmuch *5 
 it is of the Nature of the Teadon, and the 
 
 The 
 
hifeafes of the Bone s. ifj 
 
 The Hardnefs and Swelling of the Articulati- 
 ons, proceed from two Caufes. The firft is 
 that the Sheaths, Ligaments and Tendons which 
 have been inflamed, are fwell'd, and muft for 
 that Reafbn take up more Room, and confe- 
 quently inlarge the Joint. 
 
 The fecond is, that this Slnovla takes up a 
 great Space, and even forms Tumours wherein 
 one may dilcover a FlufEuation, and 'tis this 
 that is ufually called a gathering of the Clears. 
 
 The incurable Abfceifes are caused by this 
 Sinovia, which coming to turn Ibwr, and fer- 
 menting, by its Stay forms a Pus, which cor- 
 rodes the Sheaths, Tendons, Ligaments and 
 Bones •, Difeafes which are the moft dangerous^ 
 and tlfb longeft in curing of any, if they arg 
 not wholly incurable. 
 
 Cure of this Dijlempeiri 
 
 The Part affeded muft, if polfible, be put • 
 into a Bucket of Well- Water, at the Inftant of 
 the Fall ^ becaufe cold Water is a Reper- 
 cuflive, which hinders the SwoviA's diffufing it ^ 
 felf-^ prevents Inllamation, and abates and takes 
 away Pain. Care muft be taken if 'tis a Wo- 
 man, to be informed if fl\e has her Terms, or 
 expefts^them. One muft alfo obferve not ta 
 ufe this*Remedy to fuch as are troubled with 
 Catarhs, or are fubjeft to a Rheum and 
 Cough • but if the Difeafe is too confiderable 
 to yield to this Remedy, or it was not done at 
 that Inftantr, the Patient muft bleed plentiful- 
 ly, and keep his Body open by emollient Cly- 
 fters. Spirituous Liquors may be applied up- 
 on the Part, as Brancfy, or Spirit of Wine 
 camphorated, and others which fhall be pre- 
 icrib'd in fpeaking of jinchylofes^ in Cafe th^ 
 
 M Pain 
 
178 -^ Treatise of^tht 
 
 pain be moderate, or there be no Inflainatioii ; 
 for if thele Accidents Jhou Id happen, emolli- 
 ent and anodyne Fomentations fhould be m^de, 
 and afterwards one Ihould prepare Baths, and 
 Fomentations with Henbane and Friftions, 
 with diftiird Oils. 
 
 Catharticks, that are hydragogues, Opiates, 
 wherein there are abfbrbent Powders, with 
 Mercurius Dulcis and others, are very good, e- 
 fpecially if there is any' Sufpicion of an inter- 
 nal Cau{e. Laftly, they put the Hand or the 
 Foot into the Belly or Throat of fome Animal^ 
 as an Ox •, or elfe they have Recourfe to hot 
 mineral Waters, as thofe of Bourhony Bonrhon- 
 fiCy Barege^ Aix la ChapelUy &c. One muft ap- 
 ply the Topicks with thick Compreffes, roird 
 in the Shape of the Bands (AA), then make a 
 Bandage like that in the Luxation defcrib'd a- 
 bove, taking the Band,(B) 3 Ells long and 3 
 
 Fingers broad. I fay nothing of Luxations of 
 the Toes, they don't at all differ from thofe of 
 the Fingers. 
 
 I hope 
 
bifeafes of vhe Bone s. ijc^ 
 
 I hope there is nothing more wanting uplon 
 the Subjett of Luxations -, there will be found 
 either in the General or particular Accounts, 
 Means to cure all Cafes, even fiich as we have 
 Bot been able to forefee. 
 
 C MAP. XVL 
 
 Of the Anchjlops. 
 
 THIS; \Vord fignifies a Limb that is significa- 
 crooked or bent at the Place of its Arti- tion of 
 cuiation ; but they give it a much more exten- ^^ , 
 five Meaning. One may call \t an Anchylojis ''^ord* 
 where the two Bones are re-united, io that they, 
 can no longer move themlelves, and make but 
 one, as if they had been fblder'd togethe'r l3y 
 ^ Matter ot the fame Nature as the Bdne. NoW " 
 as the Bones, thus folder'd at their Jointing j 
 may either leave the Limb crooked {<o as it can- 
 not be ftretch'd outj or ft rait, fo as it can't' 
 bend, that hiakes immediately two Sorts ot An- 
 chylofes -^ thb', according to its juft Significati- 
 on, it can only be prof et- to that where the 
 Limbs remain crooked. ''.''. 
 
 'J . They extend yet much farther tlie Meaning Exteifitt ■ 
 of the Word, they take the Liberty of calling ^^^ ■. 
 all Tumours in the joints, which hinder their- ?S£*'' 
 Motion, Anchylofes ^ as the fwelling of the ^x^q 
 Bones, that of the Ligaments, theDitfulidn of Word, 
 the Simvia, theDropfy of the Joints, thefcro- 
 phulous Tumours that atfeft the Epiphyfa, and 
 feveral other DifeafeS of the Joints, which 
 inuft neverthelefs be only look'd upon as Caufes 
 6fj or at leaft Difpofitions to, an Amhylofts. 
 
i8o 
 
 Divifion 
 of An- 
 chylolcs. 
 
 FalfeAn 
 chylofcs. 
 
 Oiures. 
 
 FraSurc 
 in the 
 
 Remark. 
 
 A Tr-eatise ofth^ 
 
 It is proper therefore to divide the AnchyUfa 
 into true and falle : The true are fuch wherein 
 the Bones are folder'd at the Place ot their 
 Jointing, fo as that they make but one Piece, 
 and that the Motion is entirely loft, not being 
 able to ftretch themfelves out it they are fol- 
 der'd in a crooked Pofition, nor to bend if 
 they are joined in a ftrait one. 
 
 Thie falfe Anchylofes are thofe where the 
 Bones are not fo folder'd, and wherein the Mo- 
 tion is not entirely loft, but only diminifhed 
 by one of the Indifpofitions above-mentioned, 
 or fome other, whereof I fhall fpeak hereafter. 
 
 The Caufes of this Diftemper are, Fraftures, 
 Luxations, Sprains, Swelling of the Bones, Li- 
 gaments, or Joints, purulent Defluxions, and 
 the ill Qualities of the Slmvia. 
 
 Fraftures may be the Caufes of an Anchylofit 
 if they are in the Joint, if they are near it, 
 and fometimes even if they are at a Diftance. 
 . 'Tis not liard to comprehend that the Bones, 
 which are broken in the Articulations, ihed 
 their nutritive Juices, which are the Matter 
 whence the Callm is made \ and that thefe Jui- 
 ces diflufing themfelves in a common Place, 
 form a Callus, which folders together all the 
 fraftur'd Pieces, and makes but one ot them ^ 
 thus there is no more Motion in the Part, it 
 remains in the Situation that has been given it 
 during the whole Cure, which forms an An- 
 chylofis. 
 
 Tnere are Fractures of the Joint which may 
 not always be attended with an Anchylofis^ be- 
 caufe there will only be a Frafture of one of 
 the Bones jointed together. For Inftance, when( 
 in the Articulation of the Knee the RotuU only 
 is fractured, and when in the Articulation of 
 
 the 
 
L'lfeafes of the Bone s. i8i 
 
 the Elbow there is only a Frafturein theOU' 
 cratium. 
 
 When I fay that they are not always atten* Remark, 
 ded with an jinchylofis^ I fuppofe that the ne- 
 cefTary Precautions are taken to avoid it. In 
 thefe Fraftiires the Matter of the Callus fallsinto 
 the Joint, and as it is impoifible to hinder it, I 
 will lay down in the Sequel the Manner to pre- 
 vent, at leaft the Diifufions creating an An- 
 chylofis. 
 
 The Fraftures near the Joint are followed by FraQ:ure 
 an Arichylofis, where the Matter, whence the near the 
 Callus is form'd, Ipreads itsfelfinthe Neigh- Jo'"^* 
 bourhood, confounds the Ligaments together, ^ 
 and incruftates them, to ule that Expreilion ^ 
 or when it fills the external Cavities that ferve Obfcrra- 
 for the playing of the Joint, as when a Fra- "o"s. 
 fture of the lower Part of the Humerus gives 
 the Matter of the Callus an Opportunity of 
 filling the anterior and ppfterior Cavities that 
 facilitate the Motion of the Bones in Flexion 
 and Extenfion. 
 
 Altho' the Fradures are diftant from the Ar- Fraaures 
 ticulations, there may happen an Anchylops^ ^^ * Di- 
 when Care is not taken to ftir the neighbouring J*"^^ 
 Joints from Time to Time, becaule it gives the jo'inr/ * 
 Sinovia leave to coagulate for want of Motion. 
 'Tis a Precaution that muft be taken, whereof j^gj^^^j.^ 
 we already made Mention in the general Ac- 
 count of Luxations, and whereof we fhall treat 
 exaftly in the Cure of Anchylofes. 
 
 Luxations may produce aii Anchylofs, becaufe Luxation 
 they are not reduced, or becaufe there has been the Caufe 
 a Contufion, Inflamation, or a Negleftof mo-*'^^"^"* 
 ving the Bones from Time to Time during the ^^^^^^^ 
 Cure. 
 
 'Tis eafily conceived that the Boies which are Bones 
 not reduced, cannot move for the raoft Part, not re- 
 
 N 3 and ^"^"'^ 
 
i82 A Tkz ATi^z of tha 
 
 and that the continual touching of the fame 
 Surfaces is the necelfary Coniequence of the 
 Want ot Motion, and confequentlv of the y^»- 
 ch)lofis\ forafmuch as this Touching, produces 
 - j^^ two Things :, one is the Co-agulation of the 
 Sinoviay for Reafons that have he^n fo often 
 mentioned •, the other is that the Ligamenti, 
 the Mufcies, and all that can contribute '"o Mo- 
 tion, are (as one may fay) ufed to reft ^ and 
 when in the Sequel this Caufe of reft ceafes, 
 the Articulation will not be able to move. 
 Ccmpleat The Luxations that are compleat, and not 
 Luxjcion. reduced, are not fo fubjefl: to aii Jnchylofis as 
 ^ the incompleat ones. The Luxations of the 
 Thigh, tho' not reduced, don't always hinder 
 ■ the Patients from walking, vheiher the Head 
 Obfcrva- Qf ^j^g Femur is lodged in the Foramen Ov-tU^ or 
 has made it feJf a Receptacle under xhtGlutsiy 
 and the Parts m Procefs of Time are hardened 
 and grown callous, fo as not to be fenfible of 
 the Motion of the Thigh. 
 
 'Tis alfo obferved that the Luxation of the 
 Arm, tho' not reduced, is not always foUow'd 
 by an AnchylofiSy efpecially when it is not atten- 
 ded with Pain, Swelling, and above all, when 
 they have not made tormenting Tryals to re- 
 duce the Bones ^ becaufe that if the Patient 
 has any Liberty of Motion left, he preferves 
 it, and even increafes it, by* making Ufe of his 
 Arm for the Neceiliry of Life, which prevents 
 the Adl efion which the Head of the Bone 
 might c(.ritra£t with the OmopUt.%. Keverthe- 
 Jefs an j4nchylcfis happens oftner in this Luxa- 
 tion, when not reduced, than in any other Ar- 
 ticulation by a Genu,, becnufe the Bone of the 
 Arm is, as it were, lock'd between the OmofU-^ 
 u and the Ribs. 
 
 .ion. 
 
 Obfcrva- 
 uon. 
 
 <i -.— .. 
 
 It 
 
Lifeajes of the 'Ron Zi, 185" 
 
 It is not the lame in incompleat Luxations Incom- 
 rot reduced : We fee that the incompleat Lux- P^*^»*^ . 
 ations of the Elbow and Leg are always atten- "'^*"°"* 
 ded w i th a n yinchylofs . 
 
 When a Luxation has been accompanied with 
 a violent Contufion, an Ar.chylofn will follow, if a 
 particular Care is not taken, altho' the Bone 
 has been fpeedily an(> eafily reduced. The 
 Contufion fometimes aflfefts the Cartilages and 
 the Bones, and draws a Swelling there (which 
 is a Sort of Inflamation :) This Swelling is capa- 
 ble oi' caufing an Anchylofis^ as fhall be faid elfe- 
 where. 
 
 At other Times the contus'd Ligaments re- Contufi- 
 mainfliff, even after the Inflamation has ceas'd, «nof the 
 they keep the Joints inflexible and tight, and |^^§*" 
 hijider the Motion, and the Bones fjlder toge- 
 ther if this Difficulty of moving continues long. 
 This kind of Arichylojis is not quickly iorm'd, Remark. 
 it comes by Degrees in Proportion, as the StilT- 
 nefs of the Limb increafes ^ thus the Unplia- 
 blenefs of the Ligaments, and the Difficulty of 
 Motion, are the mutual Confequencds of each 
 other. 
 
 If the Contufion affects the Bones, Cartilages Contufi- 
 and Ligaments, it fometimes attacks the Muf- on. 
 cle?, and they lofe their Power of acting, which 
 caufes an Afichylofisy for Realbns that have been 
 fufficiently particulariz'd. 
 
 I have not forgot tliat the Contufion of the sinovial 
 Slnovuil Glands may be the Caufe of this Di- Glands, 
 f^emper : But I fhall (ay fomething of it in the 
 following Article, and hereafter I fhall treat of _ 
 it at length, in fpeaking of the ill Qualities of 
 the Sirovlct. 
 
 Sprains may occafion an Anchylofn by the Sp^ains 
 pulling and tearing of the Mufcles and Ten- c.iulean 
 don5, and often by the Ditfufion of the Simvia. Anchylo- 
 
 N 4 The ^'^ 
 
i84 ^Treatise <^f th 
 
 The tearing, or at leaft the forced ftretchirg 
 of the Ligaments, Mufcles, and Tendons, 
 caufes a Pain and Inilamationin the Joint, which 
 is very often followed by an yi/ichyhfts y either 
 becaufethe Iitiamation increafesandfuppurates, 
 or becaufe the torn Parts don't recov«r them- 
 felves •, or laftly, becaufe the wandering 5»W- 
 via fpreads and gathers ^t fclf in the Cavity of 
 the Articulation, or in the Sheaths of the Ten- 
 dons. See what 1 have written upon this 
 Head with Regard to Sprains, the DiaftaftSy and 
 Luxations of the Wrift and Foot. 
 fiexiiKiki' This Liquor does not only moiflen the Joints, 
 but die Tendons in their Sheaths, to facilitate 
 their Motions. 'Tis for this Reafon that one 
 fees the Tumour that happens in Sprains is not 
 reftrained to the Circumference of the Articu- 
 lation ', it fpreads above and below the whole 
 Extent of the Sheaths that give PalTage to the 
 Tendons: 'Tis there that the 5/«mrf diffufmg 
 it felf, ftretches the Sheaths, and comprefTes 
 the Tendons, which augments the Swelling, 
 and renders the Pain more acute. This hin- 
 ders the Motion, and the whole together in- 
 clines the Part to an j4nchylo/is, which infallibly 
 happens, if one don't take all the necefTary Pre- 
 cautions to prevent it. 
 
 The Infiamation of the Joints, by Reafon of 
 Luxations, may without Doubt be looked up- 
 on as the Caufe of an ^mhyloftSy when it comes 
 hefore the Redudion, and hinders the Surgeon's 
 
 Inflamfi- 
 tion be- 
 fore the 
 Rcdufti- 
 pn. 
 
 fetting the Bone, or when it follows the redu- 
 
 Afi^r the cing of the Bone. Befides that fuch an Acci- 
 
 Redu£li- dent prefuppofes a vitiating of the Blood and 
 
 ^°' the Lympha, there often happen Suppurations on 
 
 its Account, or elfe there remains an Obftrufti- 
 
 pn in the whole Part, wh'ch renders it unable 
 
 to 
 
Bifeafes of the Bo N E 8. 185 
 
 to move, and in Procefs of Time forms an uin- 
 chylofis. 
 
 'Tis alfo known that Luxations may be atten- Want of 
 ded with an Anchylofis, when Care is not taken ^/>"o? 
 
 ^L A • 1 • c -r-^ *. T- what it 
 
 to move the Articulation from \ ime to Time, caufes. 
 beginning from the Day that the Pain and 
 Swelling ceafes. The Motion hinders the Sino" 
 vias co-agulating, it makes it fluid, and obli- 
 ges it to return into its Receptacles^ as fhall be 
 faid. On the contrary, when the Part is not Remark, 
 fiirr'd, the Sinovia^ either by its Quantity, or 
 by^ its Coagulation, becomes the Caufe of an 
 j4nchyloJis. 
 
 One of the moft ufual Caufes of an Anchylofu Swelling 
 is the fwelling of the Eplphyfes : We have Num- <*f thcE- 
 bers of Inflances in Perfons afflifted with the P'P'^y^e*' 
 Evil, the Pox and the Richts ^ fometimes alfo in Obfcrv*. 
 thofe who are troubled with the Scurvy, when '^^"* 
 the Blood is not turned to an acid, when the 
 Juices, and elpecially the Lympha, are coagu- 
 lated. 
 
 When the Epiphyfes are fwell'd by any of thele Tumour 
 Caufes, the Heads and the Cavities that form the 
 the Articulation, no longer keep the Proporti^ ^*"^° ^^ 
 on they ufed to bear to the Ligaments •, and ^hyl "fls. 
 thele being too Ihort, with Relation to the tu- 
 mefied Bones, bind them fb exactly, that they 
 deprive them of the Liberty of moving. The 
 Sinovia being driven from the Places where the 
 Bones are joined, flows back upon the Sides, 
 coagulates there, and there being no longer any 
 Motion, the Bones folder together, either by 
 the Sinovia whith glews them, or by the Adhe- 
 fion wh'ch they contrad between themlelves, 
 in thofe Places where they are ftrongly and con- 
 tinually kept together. 
 
 The 
 
it^ A Treatise of the 
 
 Dcfluxi- The Defluxionsof the Joints are fometimes 
 **"• tlie Caule of a:i Anchylofis^ whether they ter- 
 
 minate in Suppuration, or in Induration. 
 ti"on^""^" Suppuration may caufe th'S Diftemper, when 
 it deftroys the Texture of the Bone, which it 
 impairs and rots, or when it ruins thofe Carti* 
 lages which render the Bones fmooth and po- 
 Ories. jifl^ed. If the Texture of the Bone is fpoiled 
 and rotted in the Articulation, the moft fortu- 
 nate IlTue that a Patient can expeft, is Exfoh'a- 
 tion \ the Flefh unites together, and making 
 but one Bone of the Two, there follows an An- 
 chylofis. 
 The Car- The Cartilage alo:ie being deftroyed, or on!/ 
 tilagede- jrnpaired or render'd unequal will produce the 
 or ru^- ^^^^ Dileafe, becaufe the Bones will unite if the 
 getj. ^ Cartilage exfoliates-, or they will only lofe 
 their Readinefs in moving, if the Cartilages 
 have only loft their Smoothnefs : Then the 
 moving Faculty growing more and more trou- 
 blefomeand uneafy, will be diminifhM, and in 
 the End the Bones will folder together, a:.d 
 produce an Anchylofis from this Caufe alone. 
 Indurati- If thefe Defluxions terminate in Induration, 
 ^^^° £ and neither fuppurate, nor can bedifcufs'd, they 
 an An- ^^^^ make the Motions of the Joints uneafyj 
 chylofis. and deftroy the pliantnefs of the Tunicles and 
 Ligaments, which not being any longer able to 
 bend or yield to the Motions, will be the Caufe ' 
 of an Anchylofis. 
 Sinovial If thefe Defluxions attack the ^mcwW Glands, 
 Glands, an Anchylofis will follow, whether the Suppura- 
 tion fpoils them, or the fcirrhdus Induration 
 hinders the filtrating of the Sincvia. In either 
 of thefe Cafes the Joints muft be motion lefs, 
 and the Bones will unite themlelves, fo that 
 whatever Force is ufed, 'twill be impoilible to 
 give their Articulations any Play. 
 
 If 
 
Bifeafes of the Bo ke s. 187 
 
 If the Tumour of the Boi:es cnufes them to Swelling 
 approach lb near eacli other, as that rhcy fol- "^ *'^® 
 der themielves, and foim an ^mhylofis •, the *?*' 
 lwellin<i of the ligaments does the fame, be- *^ " '* 
 caule they become ihorter. 
 
 The mcft ufual Caules of this fwelling are j? 
 
 Inflamations, or an Oedema : The Shtovia has 
 fome Share in it, efpecially in the Gout, as 
 ihall be obferv'd in the Article following. 
 
 It may have been remark'd, by all that has Sinovia 
 been laid, that the Sinovia has a great Hand in the 
 the forming of Anchylofes ^ and there is hardly ^*"f® *>f 
 any Sort wherein it has not fome Part : Its Re- chvloJis. 
 dundance or Deficience ., its acid, fower, or fe- 
 rous Qualities, are the Sources of a great Num- 
 ber of Difeafes of the Joints, and often of ^«- 
 cfoylofes. 
 
 The Redundance of the Sinovia may firft be Redun- 
 caufed by a certain Dilpofition of the Blood, dance of 
 whereby it produces a greater Quantity of fu- the Sino- 
 perfluous Juices than ufual. Secondly, by the ^^** 
 Obflruftion of the abforbent Glands. Thirdly, 
 by the exceiTive refting of the Part. 
 
 'Tiseafy to conceive that the Blood may be Caufe of 
 difpofed to furniih a great Deal of Sincvia, by its Re- 
 Caufes which we don't dive into, for fear of ^""^*"^^ 
 equally difpleafuig the Partifans of Triturati- 
 on, and thole who maintain the Part of Fer- 
 mentation : However it be, the Blood, which 
 fupplies thofe with Moifture who are troubled 
 with the watering ol'the Eyes, and which pro- 
 vides abundance of Saliva in the Ptyalifmus, and 
 which fas onem:y fay) relblves it felf into 
 Water in the Diabetes , may very well fupply 
 the Sinovial Glands, with fijch a Quantity of 
 that Liquor, that the Joints may be over-run 
 therewith. If the abforbent GInnds are ob- 
 ftruQed, x\\Q Sinovia will not le carrie.l back \ 
 
 and 
 
l85 >^ T R E A T I s E of the 
 
 and even if the SvwvUl Glands Ihould only fil- 
 trate the requifite Quantity, that not having 
 any longer free Pal&ge, would gather in the 
 Joint, overflow it, and produce all thofe Dif- 
 oiders which Excefs is liable to create. 
 Phyfical Some, perhaps, will not admit of what I 
 ZxpUna- have juft faid ot the gathering of the Swovia \ 
 tions. neverthelels, 'tis the necelfary Confequence of 
 the dilcompofing the natural Stru£lure, and 
 this Diforder which caufes the gathering of the 
 Siaoviaj does not at all differ from that which 
 occafions the watering of the Eyes. I am to 
 give a Proof of what I here advance, in Favour 
 of thole who are ignorant of the Structure of 
 the Parts, or who are not in a Condition to 
 make a juft Application. All the World knows 
 that thofe Parts of our Body which touch each 
 other without Adhefion, as the Lunas the PUw 
 i-ay the Hearty the Pericardium, the Brain, the 
 Dura Mater, the ^pple of the Eye, and the Eye- 
 lids ;, all the World knows (I fay) that thefe 
 Parts are moifteiied in the Places where 
 they touch, by a Lympha, which lubricating the 
 Surfaces that touch each other, gives them a 
 Readinefs of moving and (lipping one agaii ft 
 Phyfical ^^^ other. 'Tis not unknown that what is fu- 
 Explica- perfluous of this Liquor is taken back by abfor- 
 'oJ'i- bent Pores or Gland?, which convey it in- 
 to the Mafs- I will cite three Proofs of this 
 i rrU Mechanifm: The firft is in the Ventricles of the 
 F:ooi- Brain, where the hfundibulum receives all the 
 Humidity of the Ventricles, and carries it to 
 the pituitary Gland, wh'ch difcharges it into 
 the Sinus lateralct of the Bafts of the Cranium. 
 Sec 01. d The fecond is in the Eye, where 'tis feen 
 
 Proof. that after the lac ry ma I Gland has conveyed the 
 Matter whence the Tears are produced, between 
 the Apjie of the Eye and the Li is, to lubri- 
 cate 
 
Difeafes of the BotJ t$. i8^ 
 
 cate thofe Parts, the luperfluous Remains of 
 this Liquor is abl'orb'd by the lacrymal Points, 
 which carry it into the lacrymai Dufts, and 
 tlie Nofe. 
 
 The Third is the following Experiment : ThiM 
 Let a. Troifcju art b2 run into the Belly of a living Proof. 
 Dog, then draw it out, leaving the CanuU there- 
 in, thro' which let a Gallon of warm Water 
 be injefted •, then draw out the Camla, and two 
 Hours after open the Belly of the Dog, ther^ 
 won't be one Drop of the injected Water. 
 But in fine, they who believe that the Bladder 
 abforbs from without inwards, don't attribute 
 this Effeft to it \ let them make Tryal of the 
 Breaft, it will have the lame Succefs; all the 
 Cavities have abforbent Pores or Du^ls; the 
 Throat it felt is one for the Saliva, which flows 
 into the Mouth, and one can't refufe this Name 
 to the lafteal Veins in the Cavity of the In- 
 teftines. 
 
 Tis prov'd then that there are Glands or Refult, 
 Pores which abforb the Superfluity of the Flu- 
 ids, that diffufe themfelves in Sheets over the 
 Surface of the Parts whereof we have been 
 Ipeaking ^ and if we had not Proofs of their 
 Exigence, we fhould be obliged to fuppofe 
 them, to give a Reafon for feveral Phanomenasy 
 as well natural, as the contrary •, for Inftance, 
 the watering of the Eyes is caus'd by the Ob- 
 ftruftion of the lachrymal Points •, thefe Points 
 are the abforbent Pores of the Lympha Lachry- 
 malisy when this Liquor is no longer abfoi b'd, 
 nor convey'd into the Nofe, it falls in Tears 
 down the Cheeks, which is call'd the watering 
 of the Eye. 
 
 The fame happens in the Articulations of the Applica- 
 Bones ^ there a^re Slnovial Glands which fupply tion of 
 the Sinovia, and abforbent Pores that carry it die Ex- 
 back. *^^^P^''' 
 
190 . A TK'Lk'ri^z of the 
 
 back. The ObflruLlion of thefe Pores is one 
 Caufe of the gathering of the Sinovia, and, 
 perhaps, in Conlequence of that, one of the 
 Caufes of the yinchylofiSy if this accumulated 
 Liquor acquires a viicous Quality, whereof we 
 Ihall make mention in the Sequel. 
 
 The keeping of any Part exceiTively ftill, 
 occafions the gathering of the Sinovia ^ 'tis 
 known that the moving of the Bones contri- 
 butes not a little to the Motion of this Liquor, 
 becaufe it augments its Fluidity, and haftens 
 its Introduction into the ablbrbei:t Pores. Reft 
 therefore is the Caufe of the Redundance oi 
 the Sinovia, which may afterwards produce an 
 Anchylofis. 
 
 The Want of S/wo-z/Z^ is caufed, ift. By the 
 Difpofition of the Blood to produce little of* 
 this Liquor. 2. By the ObitruOiion of the 
 Sinovid Glands •, and 3. By the exceilive moving 
 of the Articulations. 
 
 If the Blood can be difpofed to produce too 
 much Sinovia, by a contrary Difpofition, it may 
 not produce enough. The Nofe, the Mouth, 
 and the Eyes are dry, when the Blood does 
 not fupply the M-ucus, the Spittle, nor the 
 Tears ^ and the Body is bound in thole whofe 
 J Blood does not furniili the Lympha of the In- 
 
 aralleL ^^f^jj-j^g^ Sweating is in vain hoped for in Di- 
 ilempers where the Blood is not inclined to 
 furnilli the Matter that caufes it •, and the U- 
 I'me which palfes in great Abundance when one 
 has taken Diureticks, will not pnfs at all when 
 the Blood is in a Difpofition contrary to that 
 which thele Remediei arc fometimes capable of 
 giving it. By a like Caufe the Blood may not 
 be inclined to furnifli the Simvia, and the Joints 
 will be dry and without Unitioii. 
 
 The 
 
Bjfeafe^ of the BoNDS. 191 
 
 The ObftruUioii of the SimviAl Glands will 
 have tlie lame Elted, fuice 'tis tiie lame Thing 
 to thc,3<)ints, whetlier the Blood will not fup- 
 ply theC^ands with Slnorjia^ or the Glands re- 
 iul'e to receive it. 
 
 Exceflive Motion difperfes the Sinov'/'a^ conti- 
 liual FriiHon heats the Cartilages, Ligaments, 
 and Mufcles of the Joints, and creates a Thlogo- 
 fis in the Simvial Glands, which puts it out of 
 their Power to furniih Unftuofity. Thus by EfFcfts <yf 
 one of thefe three Caul'es, or all together, the thefe 3 
 Joints will be without Unftion, they will rub Cnufes. 
 harihly againft each other if they move, or 
 perhaps they will be fo dry that 'twill be im- 
 poffible to ftir them, and theforc'd Reft, which 
 is continued by the Caufe's remaining, will be 
 quickly follow'dby 2in Anchylofs. 
 
 The Acidity of tlie Sinoyia may be derived The' 
 from the Blood whereof 'tis Part, or by its Re- Caufes of 
 lidence in the Joint, when detained thereby the Sino- 
 any of the Caules abovemention'd. The Aci-^^** 
 dity which it derives from the Mafs of the 
 Blood, may have different Degrees, and vari- 
 ous Caufes. 
 
 A certain Degree of Acidity will only render 
 the Simvia too Huid, it will lofe the Un^luofity • 
 which makes the Motion of the Joints eafy, 
 and caufes the Bones to flip one againft the o- 
 ther without Noife, and to rub even theMuf- 
 cles that move them, and the Ligaments that 
 with-hold them, without Pain. The Acidity 
 which deftroys the Unduofity of the Simvia^ 
 will do the contrary, the Bones will not be able 
 to flip with Eafe, but they will rub harflily a- 
 gaii.ft each other, and the Motions will be gra- 
 ting and painful. ^ 
 
 If the Acidity increafes, all will irxieafe, jpfte^ of 
 the Cartilages will not only be deprived of the the Aci- 
 
 ui.iH- dicy. 
 
ips A TKZAriSE of the 
 
 unOiIous Liquor that lubricates them, but their 
 Irnooth and polifhed Surface being corroded by 
 the acid, will become uneven and rugged j and 
 the Ligaments that were infenfible of the mo- 
 ving of the Bones, and the Touch of the natu- 
 ral 5/;7ot/M, will, even in their State of I naftiojiji 
 be fufceptible of Pain. The working of the 
 Acrimony will irritate them, andcaufea Phlo- 
 gofis, by io much the more painful, as they are 
 faftened to hard and inflexible Bodies which 
 cannot, by giving Way, ihare with them in 
 their inflam'd Tenflon. 
 Increafe By this Time the Articulation is inflamM," 
 of Acci- the Acrimony ferments with the nutritive Jui- 
 dents. ces, and in a little while the rotten Bones, and 
 the fuppurated Ligaments will form one of the 
 moft dreadful u4nchylofes. 
 The The Caufes of the Acidity of the Sinovia are 
 
 V^^* "^^^^'ous, a bad Diet may corrupt the Mafs of 
 cleof^the ^^^ Blood, and turn it acid ; and as Acids are 
 Sails. Salts, and Liquids are the Vehicles of Salts, 'tis 
 not wonderful that the Lymfha, which is the 
 Vehicle of the whole Mafs of Blood, ihould al- 
 io be th?.c 6f the acid Salts \ and as the Sinovia* 
 ^ is as an Emanation of the Lymfha, 'twill not be 
 furprizing that it acquires this Acrimony, 
 which is capable of caufing all the Diforders 
 abovementioned. 
 Caufe of A bad Diet is not the only Caufe that will 
 the ill turn the fweeteft Liquors acid. The Contaft of 
 Qualities ^.gj.^g-j^ Bodies that perfpire, itiay alfo very 
 Sinovia. ^^^^ occafion it, for there are in the Blood Dit 
 pofitions contrary to Nature that are contagi- 
 ous. We ihall fpeak of them hereafter. 
 
 'Tis alfo obferv'd th.7\.txhe Sinovia may become 
 acid by its Stay in one Place. Reft gives the acid 
 Salts Time to unfold themfelves : It has even 
 beenfeen feveral Times that the Sinovia being co- 
 
 agula- 
 
Difeafes of the Bone s. ij3 
 
 lated by Sowers, has become Sower it felf, and 
 has afterwards turiiM acid by another Degree o^ 
 Fermentation; in the fame Manner as Milk 
 turn'd lower, becomes acid after another De- 
 gree of Fermentation more or lefs. Thus the 
 Stay of the Sinovia may be the Caufe of the 
 Acrimony it acquires. 'Twill be feen hereaf- 
 ter that the fame Reft may well inclii^e it to 
 Sowrnefs, and that the whole depends upon a 
 Degree of Fermentation more or lefs, which 
 can't be determined. However it be, thefe 
 Sorts of vicious Qualities are often the Caufes 
 of the Anchjlofis. 
 
 We ought to judge of the Sowrnefs of the 
 Simvia as we have of its Acidity, it may derive 
 this Quality from the Mafs of the Blood, or 
 may acquire it by its Stay; the Caufes being 
 the fame, we fhail fay no more of it-, we Ihalt 
 only obferve that the Sowrnefs of the Sinovia is 
 fometimes the Effedof the Pox, or the King^s 
 Evil, and that the acid is generally occflilon'd "* 
 
 by thehigheft Degree of the Scurvy. 
 
 The ferous Quality of the 5;>fw//<i (whereof I 
 have given a particular Cha rafter) is not al- 
 ways, there are fon»etimes Eifufions of Water 
 in the Cavity of the Articulations, that one 
 may call arthritick Dropfies, which are often 
 caufed by the Acrimony of the Sirjovia, where- 
 of we have fpoken, and which I have known 
 to be the Confequence of the Coagulation of 
 the Sinovid, which has fermented to fuch a 
 Pitch, as to diifolve and reduce it felf into 
 Water. 
 
 When the congeal'd Simvia does not refolve Arthri- 
 into a lerous Matter, it hardens and produces rick 
 the arthritick gouty Knot, whereof we fhall Knorj. 
 fpeak iji the Sequel of this Chapter. 
 
 O We 
 
194 ^ Treatise of the 
 
 Lympha We fliall alfo obferve that the SinovU being, 
 
 in fcor- coagulated by a Sowr, may very well be a 
 
 butick bymptom of the Scurvy, becaufe this Difeafe 
 
 Pcrlaos. bggjns by Coagulation, and generally ends in 
 
 Dilfolution. 'Tis even feen that Coagulations 
 
 caus'd by the fcrophulous or venereal ^«>a/, end 
 
 in Solutions that tend to Acidity. The Nature 
 
 of the Salts, and Turn of the Fermentation 
 
 decides it •, at leaft 'tis the bed Conjefture we 
 
 can make upon this Matter, which is very 
 
 problematical. 
 
 If People wou'd determine the Specie s of Art' 
 chylofes by their Caules, it might eafily be done; 
 I have particulariz'd them in fuch a Manner, 
 that I believe I have forgot none. They who 
 deliretodo it, need only run over each Kind, 
 and give it a Name fuitablc to the Charader of 
 the Caufes that produce it. Neverthelefs, one 
 may at firft divide them into true and falfe, as 
 has been faid in the Beginning of this Chapter. 
 • Befides, it may be difcover'd that fome are 
 
 produced by external, and fome by internal 
 Caufes : External, as thole which are occafi- 
 on'd by Blows, Falls, and violent Motions, and 
 which are only the melancholy Confequences 
 of Fra£lures, Luxations, Sprains, or Contu- 
 iions. 
 
 Internal, as are all which proceed from the 
 vitiating of the Blood, whether its vicious 
 Quality has no particular Chara£ler, or itbears 
 the Marks of the Evil, the Pox, the Scurvy, 
 or the Gout. 
 
 Signs, 
 
 'Tis not neceTary to give many Signs tvherc- 
 by to know a true Anchylojis : The Impoffibility 
 of moving the Bones at their Joints, Uie invin- 
 cible 
 
Lifeafes of the BoNE5. 1^5 
 
 Cible Refiftance they make againft Flexion and 
 Extenfion, becaufe they are not any longer butt 
 one Piece, are lufficient Marks to charaderiza 
 a true Anchylops. 
 
 " Neither have the other Indifpolitions which 
 we have laid are falfe Anchylofts^ need of any 
 other Judges than the Sight and the Touch ^ 
 but to diftinguifli the Caufes which have pro- 
 duced them, it is neceffiiry to add together all 
 that the Sentes and Reafon can fuggeft to us. 
 
 'Tis known that that which is produced by 
 theFraftureof allthe Bones of a Joint, is not 
 only found out by the Signs which at firft diH 
 cover'd the Frafture •, but alfo by the Swelling 
 of the Joint, which at firft is painful, by the 
 Difficulty of moving it, which increafes by 
 Degrees, fo that at length 'tis impollible for 
 the Chirurg;eon to bend the Joint, tho' he 
 ihould even join his whole Strength to that of 
 the Patient. 
 
 When one oblerves what paffes at the Fra- 
 fture of the RotuU, or Olecranum, if an Anchy* 
 lofis follows, there is no Doubt whence it pro- 
 ceeds. What is certain is, that thefe come 
 more flowly than thofe which happen in a Fra- 
 p:ureof all the Bones of the Joint, and that it 
 is more ealily avoided, as Ihall be fa id. 
 
 The uinchylofis that is diftant from the Fra- 
 fture is eafy to be known, when this Difeale 
 comes, one is not deceived by the Signs that 
 foretell it, fmce 'tis generally caufed by Ne-- 
 gligence, and is yet longer in forming than the 
 two others. 
 
 The Signs whereby we know that the Anchy» 
 /o/?i is occafion'd by Luxations not reduced, are 
 the fame with thofe we have given of Luxati* 
 ops 3 to which may be added the Swelling that 
 
 O 2 follows, 
 
196 A TkT. ATI $E of tU 
 
 follows, and the Adhefion of the Bones trhich 
 takes away all Power of moving the Joint. 
 
 The Signs, that the jinchybfis is the Effect 
 of an incompleat Luxation, are alfo contained 
 in the Signj that I have given of this Sort of 
 Luxation ; and as for the Anchylops that follow* 
 a reduced Luxation, it will be difcovered by 
 examining the Accidents that preceded it, as a 
 Contufion, Inflamation, Swelling, or the Ef- 
 forts that were made to reduce if, orelle one 
 muft look into what follow'd the Redudion, as 
 a Continuance of Pain, or the keeping the Part 
 too long without Motion. 
 
 As for the Signs which difcover that the Att" 
 chylojis is caufed by a Sprain, 'twill be known 
 that the Patient has made fome Effort, or falfe 
 Step, that a Tumour followed, that he has not 
 obferved a proper Diet, and that the general 
 Remedies have been neglefted •, and it may be 
 diftinguifh'd whether the Sinovia of the Articu- 
 lation only has a Hand in the Anchyhfis, or if 
 that which moiftens the Tendons and their 
 Sheaths is alfo included \ becaufe that if tha 
 Sinov'iAoftht Articulation alone occafions the 
 Swelling of the AnchyloftSy it is reftrain'd to the 
 Circumference of the Joints but, when that 
 of the Tendons and Sheaths has a Share in it, 
 the Tumour extends it feU a great deal above 
 and below it : Befides the Swelling is unequal, 
 becaufe the Sheaths don't take up the whole 
 Circumference of the Part •, and that moreo- 
 ver there are circular Ligaments which with- 
 ftand the Swelling at the Place where the Ten- 
 dons pafs over the Joint, which often caufts a 
 Sort of Obftru^Hcn in the Part. When this 
 gathering of the Smoz'ia is conliderable, the 
 Bones are fometimes feparated from each other, 
 and don'c touch j this is fcnfibly perc^ved in 
 
 the 
 
Difeafes of the B ON E *. 197 
 
 the Articulation of the Leg with the Thigh.; 
 Lean your Hand upon the RotuUy it feems to' 
 iluftuate;, prefs upon it, you will not find any 
 Refiftance, till by your preffing you have dia- 
 per fed all the SimvU that is between it and the 
 Condyles of the Femur \ and if you take off your 
 Hand, the Sinovia will lodge it felf again be- 
 tween the Condyles and the Rotvla. 
 
 Thcfe laft Signs are marks of the Redun- 
 dance, and gathering of the Sinovia j but \t \i 
 difficult to diftinguifh all the Caufes, which, as 
 we have faid, are apt to make it gather. 'Twill 
 not be eafily found out what is the Caufe that 
 renders the Blood fit to fupply this Liquor in 
 great Quantity : Neither have we any Signs 
 whereby to difcover the Obftruftion of the ab* 
 forbeut Glands •, but one may know by the Re- 
 lation of what has palfed, whether exceffive 
 Reft has occafioned the accumulating of the 
 Si7Jovi4' 
 
 The Acidity of the Simvia will be known by 
 the Pain, the harlh Friftion, and the grating 
 of the Articulation \ there happens a Sort of 
 Clicptetis, but to be aflured of that, the Habit 
 of the Body muft be examin'd, whereon there 
 will be Tetters and Boils. One muft alfo re- 
 mark whether it has remain'd long in the joint, 
 becaufe its Stay occafionsa Fermentation, which 
 ufually turns to acid or fowr. 
 
 There are no Signs whereby to difcover a 
 fowr or an acid, but thofe which attend the 
 DifeafeS of this Kind, whereof the j4nchylops 
 is the Confequence, for Inftance, the Signs of 
 the Scurvy, the Pox, the Evil, or the Gout. 
 
 O 3 frai' 
 
198 A Treatise of the 
 
 Trognojlick. 
 
 The Jftchylofis that comes at the FraOrure of 
 the Joint is incurable, becaufe it proceeds from 
 the Effufion of the Matter of the Callusy which 
 h^s folderM the united Bones. 
 
 But if the foldering is not yet perfect, and 
 that but one qf the united Bones is broken, 
 as the Rotula at the Knee, or the Olecramm at 
 the Elbow, the Anchyiofes not being quite 
 form'd, one may fometiraes prevent it, as fhall 
 be faid. 'Tis the fame in Cafe of the Anchylofis 
 that comes after a FrafVure near the Joint. 
 
 The Anchylofis that happens after a Fra8:ure 
 difiant from the Joint, is not always incura- 
 ble, becaufe it does not proceed from the Mat- 
 ter of the Callus, but only from the Sinovia thsit 
 has been fuffer'd to gather and coagulate in the 
 Joint, by not ftirring the Part from Time to 
 Time during the Formation of the Callus. The 
 jinchylofs, occafioned by an incompleat Luxati- 
 on not reduced, is abiblutely incurable when 
 once form'd ^ it may fometimes be cured in the 
 Beginniiig, when the Bone can be reduced, and 
 one obfervcs all that is requifite in the Cure of 
 ^nchylofes and Lvxations. 
 
 The compleat Luxation, tho' not reduced, 
 is npt always attended with an Anchylofis, and 
 the Patients can even aflift themfelves with 
 their Limbs, tho' diflocatcd, provided they 
 make ufeofthem when they are no longer in 
 Pain. » 
 
 The Anchylofis that happens after the Redu- 
 ftion of the compleat Luxation, is troubleiome, 
 if it iscaufed by the Contufion of the Parts ^ 
 the Blow or the Fall which produced the Diflor 
 cation may have occafioned the Contufion ; the 
 
 Bones 
 
L'jfiafes ef the Bones. 1^9 
 
 Bones themfelves being thruft violently againft 
 each other, may be mutually bruiled j and 'tis 
 obferved that this Sort of Contufions are very 
 fatal, becaufe they occalion the inflaming and 
 fwelling of the Part, whence comes an Obltru- 
 ftion and Stiffnels in the Ligaments, and confe- 
 quently a Difficulty of Motion, or elfea Sup- 
 puration, the Effeit whereof is the Deftruftion 
 of the Cartilages, and Caries of the Bones; and 
 the Patient is verV happy if he comes oif for 
 an yifjchylofis : Very often this Contufion caules 
 the Gathering and Stay of the Sinovia, which 
 produces a Sort of Anchylofis that indeed is lefs 
 troublefome than the others ^ but altho' it may 
 fometimes be heal'd, the Cure is too painful 
 for the Patieiit and the Surgeon. 
 
 The Anchylofis that comes after the Redufti- 
 on, and which is only caufed by the coagula- 
 ting of the Sinovia^ is not fo troublefome : One 
 may often cure them, provided the Bones are 
 not fblder'd, and that there is ftili fbme Flui- 
 dity in theSimvia. 
 
 The Anchylofis that proceeds from the Acri- 
 mony of the Sinovia, is more fatal than that 
 which is caufed by its Sowrnefs, becaufe 'tis 
 leldom that the Acidity does not deftroy the 
 Ligaments, the Cartilages, and the Bones 
 themfelves, which complicates this Diftemper, 
 and makes it incurable, the rather in that the 
 Scurvy is the Caufe •, and 'tis known how hard 
 it is to cure the that Difeafe, when it bas be- 
 gun to attack the Iblid Parts. 
 
 When the Anchylofis proceeds from the Pre- 
 dominancy of Sowrnefs in the Sinovia^ it is not 
 fo fatal, becaufe Sowrnefs coagulates this Li- 
 quor. The Coagulation keeps all its Salts in- 
 adive that they don't operate, and the Solids 
 are Iheltered from their working, at Icaft for a 
 
 O 4 Time 
 
ac# A Treatise cf the 
 
 Time, till the firft Principles of this Liquor 
 ferments a new \ for it has been observed, in 
 the Caufe? of the congealii^ ot the Sinaviit by 
 Sowrs, that they may by again fermenting 
 "become acid : However it be, 'tis always good 
 to fay that the Coagulation is lefs fatal thin 
 the Solution. But of two Caufes of its Coagu- 
 lation, <wz.. the venereal Sowr, and the fcro- 
 phulous Sowr *, the latter is infinitely the moft 
 troublefome, becaufe we have a Specifick for 
 the Pox, and we have but Palliatives for the 
 Evil j at leaft it is common to cure the Pox, 
 and very extraordinary to cure the Evil •, info- 
 much, that it may be faid the pocky jifchylo- 
 fes are curable, and the fcropulous ones feldom 
 healed. One may add, that the fcrophulous 
 Ferment may be eradicated without curing the 
 fcrophulous Anchylofsy and -'tis feldom that the 
 pocky Anchylofis is not healed, when the Bones 
 are not quite lolder'd. 
 
 The Anchylofts that proceeds from the Drop- 
 fy of the Joint, is lefs fatal than that which is 
 produced by the pargetty or plaiftery Concre- 
 tion of the Sinoviiiy unlefs the fcorbutick or fcro- 
 fulous Ferment is the Caufe of the SinovitCs So- 
 lution into Water. The Cure of the Anchylo- 
 (is is palliative or Radical •, the Palliative is on- 
 ly proper to mitigate the Pain of fuch as have 
 incurable Anchylofes, which we have termed 
 true ones, fuch as thofe where the Bones are 
 entirely Ibldered ; the Radical Cure is for thofe 
 xwe have termed falfe, and which not deferving 
 the Name ot Anchylofcsy have been looked on 
 as Difpofitions tending to this Diftemper, or as 
 the Caufes that produce it. 
 
 The true Anchylojcs ought to occaflon no o- 
 ther Accidents but the l.ofs of Motion j 'tis 
 an indiiperi'able Confequence of the Ibldering 
 
 ot 
 
Difeafes of the Bones. 201 
 
 of the Bones that form a Joint ^ therefore the 
 Iblderingot the Bones is not capable of produ- 
 cing it by it felf : When the Bones are foldered 
 together after it<? Fracture in the Joint, the 
 Accidents that attend and follow this Diftem- 
 per from the Beginning, are. Swelling, Pain, 
 and Defluxions. 
 
 All thefe Accidents which at firft were 
 caufed by the Blow, or Fall, are countenanced 
 by the Obftruftion that remains after the Con- 
 format ion of the Callus ', the Ligaments being 
 choak'd up can't eafily recover themfelves, be- 
 caufe the VefTels that belong to them, and even 
 thofe that are near them, are obftrufted by the 
 Compreflion caufed by the Bignefs of the Callus ^ 
 and this Difordcr which deftroys the Joint, 
 muft caufe a confiderable Confufion in the 5/»o- 
 vial Glands, and in the flowing of their Li- 
 quor. 
 
 AH thefe Things, which muft be looked up- 
 on as the Caufesof the Swelling, the Pain and 
 the Defluxions, prefcribe the Ule of a 'Regimen^ 
 general Remedies, and Topicks. 
 
 The Patient muft not obferve a levere Diet, 
 he muft only be moderate in the Quantity of 
 his Food, regular in his Hours of eating it, 
 and very circumfpe£b as to tke Quality of it. 
 Frelh and moift Victuals are proper ^ Ragouts, 
 Ibwr Fruit and Milk, are abfolutely contrary* 
 He muft keep both his Mind and Body at 
 Reft •, the affected Part muft not be moved but 
 very moderately, and the whole anfwerable to 
 it. I mean one muft not attempt to move the 
 Place of the Articulation, not only becaufe 
 'tis impoilible to recover its Motion, but alio 
 becaule it wou'd occafion frefti Irritations, and 
 confequently Pain, Tumour and Defluxions. 
 Befides Motion, which is ufeful for the Cure 
 
 •f 
 
20> A Tkz ATI sz of the 
 
 of Tome Sorts of Anchylofes where the SinoviA 
 abounds, or is clotted, is entirely imprafticable 
 in this Cafe, becaufe the Bones being folder'd 
 by the Callus^ will not allow of any Motion. 
 
 What mult be done then, if the Shiovia. feems 
 to be gathered in Ibme Place near the Joint ? 
 One muft make Friftions with hot Cloths, to 
 fupply the Defeft of Motion in the Joint, and 
 to keep the Sinovia as fluid as poffible ^ by the 
 often reiterating of thefe Helps, which arc 
 what Surgery makes Ufe of to fupply Defeft 
 of Motion^ this Liquor will be attenuated, 
 and the Topicks proper to difpofe it may work 
 more effectually. 
 
 For this Purpofe one muft ufe Pumpings of 
 hot. Water, which muft fall from a great 
 Height, to the End that they may penetrate 
 the better. If the Simvia is very outwards, it 
 will not be long before the Succefs of this Re- 
 medy is perceived j if it is deep, it requires 
 more Time. 
 
 When the Sinoviit feems coagulated, one 
 muft dilfolve Ibme Sal MarinBy or Sal ArmoniaCy 
 in the Water. This pumping is very effeftual, 
 it muft be repeated feveral Times a Day, and 
 muft be given for a longer or ftiorter Time, ac- 
 cording as the fick Perfon can fupport it pa- 
 tiently. 
 
 If this Remedy don't difperfe the SinovU^ 
 'twill ac leaft render it more fluid, and in a 
 Condition to be difperfed by other Means. 
 Frictions made before the Fire with Spirit of 
 Wine and Lavender, and Fomentations of aro- 
 matick Wi le often repeated, are very fuccels- 
 ful •, but thefe muft not be ufed till the Pain 
 is coifiderably abated: We will mention elfe- 
 wliere what muft be done to allay ir, when we 
 
 treat 
 
Difeafes of the Bone ?. 
 
 trtat of the Means to prevent or cure De- 
 fluxions. 
 
 'Tis alio known that hot Waters are perfeft- 
 lygood to dilTolve and dilperfe Obftruftions in 
 the Joints ^ thole of yiix la Chafelle, Bourbon^ 
 Bouriorine, Burege^ and others are in great Re- 
 putation^ a great Number of lick Perfons go 
 thither every Year, and return cured or eas'd. 
 Thefe Waters are ufed for Baths, Pumpings, 
 and even to drink \ fome of them produce 
 Slime or Mud, which being applied hot like a 
 Cataplafin, liquefys and dilTolves the Matter 
 that caufes the llvelling of the Joints. I have 
 known feveral Diflempers of this Sort perfectly 
 heal'd thro' the Means of thete Waters. 
 
 When there is a Difpofition to an Anchylofis 
 in Confequence of the Fra£lure of a Joint 
 where there is but one Bone, it ought to be 
 moved gently, and repeated every Day that 
 the Dreifings are taken ofl^ afterwards every 
 pther Day, and then every Day : By this Means 
 'twill prevent the Matter of the Callus from dif- 
 fufing it felf between the Condyles and the Cavi- 
 ties, where it would coagulate and form irre- 
 gular Prominences which would flop the Moti- 
 on, and folder the Bones. 
 
 I have known an Anchylofis of the Knee, 
 where the Bones were not yet united ; it was 
 caufed by the Frafture of the Rotula ^ the Mat- 
 ter of the Callus had penetrated between the 
 Eminences and Sockets of the Joint: The Stiff- 
 jiefs of the Knee made it apprehended that 
 there was a per f eft Amhylofts^ but the flirting 
 it, which had been negleded till then, was 
 put in Praftice with fo much Succefs, that in 
 lefs than a Month the Patient bent and exten- 
 ded the Leg luiliciently, to walk with Eafe 
 enough. 
 
 The 
 
504 -hTTrcatise of the 
 
 TiiC Anchjtofis that h!>ppens after Fraftures 
 near the Articulation, is only caufed by the 
 ipreadhig of the Matter of the CaIIvs about the 
 LigJ^wients, or elfeby the Reft, which certaia 
 Perfon5, little ret fed in the Surgery of the 
 Bones, very unreafonably make the Patient ob- 
 §e:Tve^ more exaftly on this Occafion, than on 
 any other. 
 
 To avoid ^n j^rrchito/t/s being caufed by ei- 
 ther ot thefe Things, the fraftur'd Part muft 
 firil be placed fo that the Matter of the Ca/tus 
 may have a Biafs to carry it from the Articula- 
 tion. Secondly, Compreffe*; muft be applied, 
 Supported by feveral Circumvolutions of Ban- 
 dages between the Articulation and the Fra- 
 fture, which by a fbft Compre/Gon will fe<»ve 
 as a Rampart againft the Matter of theCailut, 
 
 In fine, the Joint muft be moved, and (boner 
 in this Cafe than any other. One muft not fol- 
 low the Error of thofe who pretending to be 
 expert in this Part of Surgery, are not afham'd 
 of faying they are infallible: The Truth is, 
 ^ey only feducethe Vulgar, or at moft only 
 I thole of a better Rank, who believe they know 
 
 all, without having learnt any Thing. Not to 
 fall into the fame Error, on the firft taking off 
 the Dre/Iings, in a Frafture of this Kind, one 
 muft begin to move the Articulation, the Bones 
 run no Hazard of difplacing. This Fear, which 
 i& common to all Bone-Setters, tho' without 
 Foundation, is regularly obfervM by fuch as 
 don't reflect that when the Fraftures near the 
 lointare reduce.^, they are not eafily difplaced, 
 bccaufe that a much greater Part of the broken 
 Bones join together, than in thofe which are 
 fir^c^ ired in the middle, the Middle of Bones 
 being much fmallcr than their Ends. 
 
 As 
 
Difiafet of the Bone s« 99^ 
 
 As for the Anchylofes that are the Conlequen- 
 ces of Fradures at a Diftance trom the joint. 
 Motion alone will prevent them, and wilieren 
 cure thera, where a Redundance or too t^xevt 
 Thickiiers of the StnovU has already inclined 
 the whole Joint to an Anchylofis, One may aU 
 io ufe the Topiclcs prefcribed heretofore. The 
 Difpofitionsto an Anchylofis^ that proceed from 
 a reduced Luxation, are direded by the follow- 
 ing Means. 
 
 If there has been a Contufionby the Blo\r, 
 or the Fall, or by the ill Management of Ibme 
 ignorant Perfon ^ one muft bleed the Patient 
 coniiderably, then put anodyne Cataplalrns up- 
 on the Part, then partly DifTol vents with the 
 Anodynes, and afterwards Diliblvents alone ; 
 and when the Pain find the Swelling is over, 
 one muft begin to move the Part gently, with- 
 out forcing any Thing, that one may not draw 
 a frelh Deiluxion which may be more fatal than 
 the former. 
 
 If the Tendency to an Anchylofis proceeds 
 from having overthrown the Sides ot the Ca- 
 vity in the Time of reducing the Bone, or from 
 not having conduced the Head of the Bone by 
 the fame Way which it took in ilfuing from its 
 Place ^ one muft make Ufe of the fame Reme- 
 dies as in the Cafe aforegoing •, but I doubt 
 whether theCaufecan be taken away, I mean 
 that the Sides can't eafily be raifed that are 
 overthrown, and that it feems yet harder to 
 me to remedy the laft Error, becaufe that the 
 ligamentous Tunicles of the Articulation being 
 pinched, between the Head of the Bone and 
 its Cavity ; one muft difplace the Bone to fet 
 it better, after having difengaged the Tunicle. 
 
 If after the Reduction they have neglected 
 moving tlie Part, it muft be help'd, as has been 
 
 alrea- 
 
3o6 A Tke ATI SE of the 
 
 already laid, in fpcaking of the fame Error 
 with Regard to Fraftures. 
 
 When the Bone is not reduced, one muft ob- 
 ferve whether there be a Tumour, Hardnefs, 
 Inflamation and Pain, or whether the Part has 
 retained almoft its natural Situation. If there 
 be a Swelling, Tenfion, or Inflamation, Re- 
 courfe muft be had to general Remedies and 
 Topicks ^ and when thefe Symptoms are over^ 
 one muft try to reduce the Bone .- If it fucceeds^ 
 the Regimen and Topicks muft be continued ; 
 and if it fails, the Patient will be lame, and 
 an Anchylofis will follow, as has been faid in the 
 Caufes. 
 
 If there is no Inflamation nor Pain, the Pa- 
 tient ihouid bleed twice, and then the Redufti- 
 on i}iould be attempted, unlefs the Luxation 
 be of too long ftandiug. I have fet Arms that 
 had been fix Months and a Year diflocated \ 
 and in others that have been luxated but two 
 Months, I have not been able to fucceed, nor 
 others after me ; which may proceed from the 
 Sinovia that fills the Cavity of the Joint, or the 
 Tenfion of the Mufcles. After having in vain 
 attempted % I advifed a Perfon to the Waters 
 of Bourbon, which difperfed the Sinorjia^ and 
 made the Mufcles pliant ^ he came back Poft 
 to Paris, and I made the Reduction with Eafe. 
 Another Perfon of the Duke D' Jibe's Retinue 
 had diflocated his Arm fix Months, I could 
 not reduce it, he went to the Waters of Baregty 
 aiKi a Surgeon of Bayonne let it two Days af- 
 terwards with a great deal of Eafe. 
 
 We have faid that an incompleat Diflocation 
 not reduced is fooner attended with an jlnchy- 
 hfisy than that which is compleat •, neither 
 have I ever leen a Tendency to an Anchylofts, 
 proceeding from this Caufe, cured, when a 
 
 Month 
 
Difeafes of the Bone s. 207 
 
 Month had efcaped without making the Redu- 
 ftion : Neverchelels, I advile making the Ac- 
 tempt to replace the Bone, the worft that can 
 happen is not fucceeding •, and the Surgeon has 
 nothing to reproach himielf, provided he does 
 all that Art prefcribes : Befide?, it fucceeds 
 Ibmetimes, and 'tis I'ufficient that it may once 
 do, to determine us to make the Attempt. 
 
 It is eaiier to heal thofe Dripolitions to an 
 j^Hchylofts which proceed from the want of 5j- 
 ftovia, than thofe that are caufed by its Redun- 
 dance, unlefs the Want is occafioned by the 
 Want of the Simvial Glands, as has been ob- 
 ferved in the Caufe of it. 
 
 If the Joints of any one are without Sinovlay 
 becaufe the Blood is not dilpofed to fupply the 
 Glands with it ; one muft bleed the Patient, 
 make him obferve a Reg^imen, prefcribe the 
 general Remedies, and let him ule dilating 
 Broths, Drinks that are mildly bitter, Baths of 
 emollient Plants, gentle Purges, light Frictions 
 upon the Part affefted, and emollient Cata- 
 plafms, wherein fortie black Soap muft be put • 
 all thefe Remedies are proper. Pumping 
 ought not to be omitted, it works Miracles e- 
 very Day in the C/iquetis, which is a Difpofiti- 
 on tending very much to an Anchylojls. 
 
 On the contrary, if the SlnovU abounds too 
 much, the Patient muft bleed more plentifully, 
 efpecially if the Excels of that Liquor caules 
 Tenfion and Pain ; he muft be confined to a ve- 
 ry exaft Diet, he muft take Broth and Drinks 
 that are gentle Operatives, the Part muft be 
 chafed with hot Cloaths, and diftblvent Cata- 
 plafms be laid upon it ^ one muft ufe Pumpings 
 with a Decodion of the fame Plants, and oit#ii 
 move the Joint to oblige the SinovU to re-enter 
 its Receptacles: and if this don't fuihce, lay 
 
 on 
 
2o8 /^Treatise of the 
 
 on a Cat^plafm of difTolving Herb% adding to 
 it aromatick Plants, Snails, or Frog's Spawn ^ 
 I ufe Pumpijigs of Lime-Water, together with 
 a Solution ot Sal Armoniac. This Liquor is ex- 
 cellent on Account of the volatile Salt that fe- 
 parates from it, which is very proper to ren- 
 der the Sinovia. iiuid ; 'tis a Remedy of my own 
 Invention, which I have made Uii of very 
 fuccefsfully, not only on this Occafion, but 
 many others. 
 
 The Time and Manner of moving the Joints 
 that are inclined to an Andyiofis^ is not an in- 
 different Thing. As to the Time, it ought al- 
 ways to be when the Violence of th^ Fain is 
 over ^ it is dangerous to make thefe Sorts of 
 Motions, as long as it continues, for that would 
 increafe it, and Convulfions, Paintings, and 
 Death it felf would follow. 
 
 The Manner of ftirring them depends upon 
 the different Motions which the affefted joint 
 is capable of. The Joints articulated by Genou, 
 mufl be moved gently, and in a Round, taking 
 Care never to force in any Degree the narrow 
 Bounds prefcribed by the Ligaments. 'Tis for 
 this Realbn that the Arm muft never be turned 
 round, without being at a little Diftance, and 
 the Thigh in Proportion ; the Fore-Arm and 
 the Leg mufl not be extended beyond their 
 flrait Figure, nor be bent but a little beyond 
 the right Angle, fo that in bending them one 
 muft never make the fore Part of the Cubitus 
 touch the Arm, nor the Calf of the Leg the 
 hinder Part of the Thigh ; it would caufe Ex- 
 tenfions and tearing of the Tendons, which 
 would foon be attended with more melancholy 
 Symptoms. 
 
 The Siriovid often coagulates, in Spite of the 
 yfe of ;dl thefe Remediies, and folders the 
 
 Bones, 
 
hifecifis <?/ r^<^ B o N t s. 309 
 
 Bones, and forms an Anchy lofts. At othet 
 Times this Liquor difToIves, and is changed 
 into Water, and either thro' the Fitult: of the 
 Receptacles deftiii'd to carry it back, or per* 
 Jiaps becaule being watery, it has not Cor, fi- 
 guration proper to pafs thro' them ^ it remains 
 in the Joint, and forms a Dropfy : Then no- 
 thing being able to difperfe it, a Punfture rauft 
 be made with the Troifquarts, or with the Lan- 
 cet, but Care iiluft be taken not to be deceived 
 in miftaking an Oedema for a Dropfy. 
 
 The Oedema feizes on the Cells of the Fat,' 
 and the Dropfy on the inner Part of the Arti- 
 culation. The Tumour of the Oedema ble ds 
 it felf with the reft of the L^mb, that of the 
 Dropfy is confin'd within the Tompafs of thd 
 Tunicle of the Joint. The Oedema h:is no Fha- 
 cluation, the Dropfy difcovers it felf chiefiv by 
 this Sign. In the Oedema the Bones of the Joint 
 are brought near one another, in the Dropfy 
 they are feparated. For Inftance, if there is 
 ?. Dropfy in the Knee, the Kotula juts our, be- 
 caufe the Water that is diffufed, removes it 
 from the Condyles •, on preiling the Eot2iU, it 
 gives Way to theJ Finger, untill it toucl-ies the 
 Condyles of the Femur, which is, when by thru- 
 fting it, all the Water is forced away that was 
 between it and the Condyles. 
 
 Again, one muft not take a Fluctuation of 
 glearous Matter for a watery Fluftuation •, Wa- 
 ter anfwers clearer than Clears, thefe have but 
 an obfcure Fluftuation. 
 
 When a Perfon is convinced that there al- 
 feady is an Effufion, he muft make the Pun- 
 fture with the Troifijuarti, or the Lancet. I 
 have never made this Operaition but with the 
 Lancet •, I don't doubt but the Ule of the Troif- 
 Quarts is as good ats the Lancet. When this O- 
 
 ? pera-' 
 
2IO A Tkz Ar I f^z ef the 
 
 peration is made, whether it be with the one" 
 or the other, Care muft be taken to place the 
 Part fo as tlie Punfture may be made in the 
 fhelving Place, that the Waters may not flay 
 in any Cori:er of the Articulation. 
 
 The thickeft Parts of the Joint muft not be 
 pierced ^ on the contrary, the fmalleft muft be 
 chofen, to the End that fewer Parts may be 
 pierced : Thofe muft be chofen preferably to 
 others where there are no Afoneurofes^ becaufe 
 that Accidents may happen thro' the Divifiort 
 ot thofe Parts ; one muft prefs all the Neigh- 
 bourhood of the Joint very exaftly, thus the 
 Water may be expelled more exaftly. 
 
 If, inftead of Water, there is an Evacuation 
 of Clears, the Surgeon may be glad that he 
 has preferred the Punfture of the Lancet to that 
 of the Trois-quarts^ becaufe the Clears iffue out 
 better thro' the Punfture of the Lancet. 
 
 Havir.g; cleanled the Joint well, lay upon 
 the Puncture a Pledget cover'd with Balfam of 
 A/-c£usy and keep it on with a little Plaifter of 
 Nkremhurg^ or burnt Cerufe. The reft of the 
 Part muft be wrapt round with the Cataplafm 
 prescribed above, it will be found very effectual 
 in bringing the Patient to a perfeft Cure. If a 
 Tumour comes, the Patient muft bleed, it is 
 not r.eceftary to ftay ftill Accidents happen, 
 'tis better to prevent them. H the Smovia be- 
 comes purulent, 'tis not fuificient to make a 
 Puncture ^ one is obliged to make large Incifi- 
 oijs on both Side? the Joints, for all this Max- 
 im of fome Prrftitioners, who fay that the 
 Joints muft not be laid bare ^ thefe Parts are 
 no more to be refpc^ted than the others, when 
 there is a Neccj]i:y, I have known fome Per- 
 fbns to obferve this Maxim, let the Fus ftagnate 
 in the Joint, and draw out no more than what 
 
 came 
 
Difeafes <?/ ^tf B o N E s. ail 
 
 came from a fiftulous opening : 'Tis a pernici- 
 ous Practice ^ it is eafily conceived that the 
 Pufy which takes up its kefidence in Places fo 
 fenfible, can't but produce melancholy Symp- 
 toms j that Pains, Fevers, Vomiting and Loole- 
 nefs, irregular Shiverings, and a Retiux of pu- 
 rulent Matter into the Blood, muft be the Con- 
 lequences ^ and that Impofthumes in the Li- 
 ver, the Lungs, and other Intrails, are the Di- 
 {eafes which muft end thofe who have been ib 
 ill-managed. 
 
 Again, 'tis obferved that the expulf».ve Dref- 
 flngs which are fo beneficial in Praftice, can 
 not be made Ufe of to expel the Pus thatf 
 remains in the Cavity of the Joint, befides 
 the Parts give Way, and yield to the Com- 
 preflion, which is what forces out the Pus : 
 Here, on the contrary, the Bones refift, and 
 the Pus is {helter'd from the CompreHion in an 
 infinite Number of Corners of the Joint. For 
 this Reafon, they muft not only be opened, 
 but there muft be large Openings made, fo that 
 they may have Communication with each o- 
 ther, to the End that there may not be any 
 Part nor Crevice of the Joint, but what may 
 be cleanied by the Injeftions, and be difcharged 
 outwards with Eafe by the Openings. I know 
 that fometimes the Bones are corrupted, and 
 one is obliged to make them exfoliate, but the 
 Fault muft not be laid upon the Incifions, the 
 Continuance of the Pus there may be the Caule: 
 'Tis for this Reafon tbat I advife the opening 
 it in Time, and the giving the Matter a Biafs 
 by a proper Situation, as a!fo the waihing the 
 VVound with the Injedions, as has been fiid. 
 
 Exfoliation may be procured by taking ey.i\dt 
 Care that the Bones be not again covered with 
 Unfound Flefh, by often laying L^p/j infernalls 
 
 P 2 to 
 
212 A TkZ AT ISZ of thd 
 
 to that which does appear, and applying an 
 adual Cautery, or a Solution of Mercury 
 and j^^ua Fortis j this Remedy is very efficaci- 
 ous, as ihall be oblerved in treating of Exoftofes^ 
 and a Caries. 
 
 'Twould be now requifite to fpeak of the 
 Anchylofes (or rather the Difpofitions to this 
 Diftemper) which may be caufed by the Pox, 
 the Scurvy, or the King's-Evil ^ but as thefe 
 tliree Cautes are common to Exofiofes and Caries, 
 I will treat of this Matter in the fecond 
 Part, when 1 fliall explain the Formation of 
 theCe two Dileafes, and give an Account of the 
 Means to cure them, which are the fame, ex- 
 cepting the* manual (Operation of the Surgeon, 
 whereof I have Ipoke amply in this Chapter. 
 
Bifeafes of the Bone s. 
 
 ?^.'>i') T.i'm-i-xffl 
 
 TREAT ISE 
 
 O P T H E 
 
 Difeafes of the Bones.- 
 
 PART II. 
 
 for a 
 from 
 for a 
 by an 
 
 CHAP. I. 
 
 Of FraSlures in General. 
 
 H E Word FraUure is tal{en General- Three 
 ly, Properly, and moft Properly : Accepta- 
 Generally, for any Solution of: the ^j^"^ ^^ 
 Continuity in the Bone ^ Properly ly^j.^ 
 
 cjoiution of the Continuity that proceeds Fraftiirc. 
 
 an external Caufe^ and moft Properly, 
 
 Solution of the Continuity th:\t is caulei 
 
 Inftrument that bruifes. 
 
 P 3 Tiiefe 
 
5X^ 'ATKi.Artst.ofth^ 
 
 Thefe Dlftinftions are made i. To put a 
 pifference between a Caries and a Solution from 
 an external Cauie. 2. To diftinguifh the So- 
 lutions proceeding from external Caufes from 
 each other, becaufe thefe Words, a?: Injlrw 
 rnent that bruifes, make a Difference between a. 
 f cal Fradure, and a Wound in the Bone, made 
 by a cutting or pricking Inftrument. 
 
 To treat of Fractures in Order, we will fbl* 
 low as much as poffible the Method we laid 
 down in treating of Luxations ; thus we have 
 eight Things to know, which are 
 
 I . The Strufture of the Part in general. 
 1. Ttie Sorts of Fraftures. 
 
 3. The unnatural Shape of the Limb. 
 
 4. The Caufe of the Fradure. 
 
 5. The Signs. 
 
 6. The Accidents. 
 
 7. The Prognoftick. 
 
 8. The Cure. 
 
 Struaure ^^^ Strufture and natural State of the Limb 
 is abfolutely necefTary to be known. 
 I. With Relation to the Bones. 
 2., With Regard to the Mufcles. 
 j.'WithRefpea to the Veifels. 
 With Relation to the Bones, becaufe there 
 ?doii to ^^^ ^°"^^ ^^^^^ where there are two Bones, and 
 ^J^e others where there is but one : Befides one muft 
 
 Bones, know the Solidity of the Bone, its Smooth- 
 nefs, or rather the Inequalities that are on its 
 outlide ; all which Things, if not known, make 
 one judge amifs of Fractures, and make the 
 Surgeon fall into confiucrable Errors. 
 To the With Relation to the Mufcles ^ there are 
 Mufcles. ^ome fraftured Farts, round which are a graat 
 many Mufcles, and others where there are but 
 few, which 'tis requihre to know that one may 
 judge of the various Difpiacings that happen 
 
 to 
 
Difeafes of r/;^ Bones. 215 
 
 to the Bones, and the Strength that muft be 
 u(ed to make the Extenfion and Counter^Ex- 
 teniion. 
 
 With Regard to the VefTels, there are (bme TheVef- 
 near the broken Bones, of which one muft not (els. 
 be ignorant, efpecially when one is to work 
 upon complicated Fractures \ and if one would 
 prognofticate aright in thofe Cafes where Ac- 
 cidents happen thro' the Compreflion, or hurt- 
 ing of the Blood VelTels or Nerves. 
 
 The feveral Sorts of Fraftures are derived, The dif- 
 
 1. From the fraftur'd Bone. f<^'*ent 
 
 2. From the Shape of the fradur'd Bone. ^°"*- 
 
 3. From the Caule. 
 
 4. From the Diftance of the broken Pieces. 
 
 5. From the Difeafes or Accidents that at- 
 tend it. 
 
 Fraftures may happen to hard or to fpon- Of die 
 gious Bones ^ to long or ihort Bones, to thick ^^"^^ 
 or fmall ones : And both the one and tlie other ^^ 
 may befall thofe of the Head, the Trunk and 
 the Extremities. 
 
 :»' The Figure of the Fradure is different in al- Shape of 
 moft all ^ fbme are oblique, others Crofs- fr«<^^i'd 
 ways, and there are fome where the Bones are, ^^^ 
 as it were, crufhed in Pieces. 
 
 The Fradures crofs-ways are either unequal, 
 or broken clean off, like a Rad Ih without any 
 Inequality. There are other Fraftures where- 
 in one of the Ends of the broken Bone is ihi- 
 ver'd, forming, as it were, the Mouth of a 
 Flute, or a Nail. 
 
 . The oblique are of two Sorts, the one have 
 their Obliquity the whole Length, others are 
 broken tranfverfally for fome Lines, and the 
 reft is oblique •, 'tis alio feen that the fame 
 Bone is fractured in leveral Places. It would 
 be very hard to defcribe all the Figures of fra- 
 
 P 4 aured 
 
i6 A T KZ An sz of the 
 
 ifraelur'd Bones, I don't believe that ever there 
 has been feen two alike. 
 
 As to the Fracture length-ways, 1 believe it 
 imapiiiary, and fancy that they who have treat- 
 ed of it, have only fpoken according to Authors 
 whom they have milunderftood f, for fabriciusalt 
 u^cjuaferidente has fpoken of this Frafture inthefe 
 Terms : " If the Frafture is the longway of 
 " the Bone, Galen i^iVs thiit there are two part- 
 ticular Indications, the one to replace the 
 abo/ementioned broken Bones, viz^. to adapt 
 • the broken Parts to each other, and re-fettle 
 '' ihem in their Places-, and the other to keep 
 *' them in the-'r right Proportion when re-ui- 
 *^ ted and adapted. He fays that Extei.fion is 
 " necefTa-y to compafs the firfl End, as alfo 
 " the middling Figure of the ]oint, and pro- 
 -^ per Configuration of the Mufcles, &c. And 
 " for the feccnd End, wh'ch is to keep the 
 ** Part entirely adapted, it is done by the 
 " Ligature, which as OVfw teaches, &c. 
 Refle&i- 'Tis evident by what Fahriclus fays u^on Ga- 
 9^' /f«'6 Authority, that boih he and C^/Vw meant 
 
 by the Frafture longways, what wc mean by 
 the oblique Fradure *, for altho' Fahrici-us fays, 
 in enumerating the different Sorts, that the 
 Bones break crofs-ways, obliquely and long- 
 ways : he does not treat of the oblique Fra- 
 fture, which makes it to be thought, that what 
 he calls a Frafture Irng-ways, is only that which 
 is moft oblique, and that he intended to treat* 
 of the one in treating of the other, there being 
 no elfentiai Diference, but only in more or 
 lefs Obliquity. In Eifeft, he would not pro- 
 pofe making the Extenfion, becaufe it is plain 
 it is no*: proper -^ and he would not enjoin the 
 ad-ipring the Bones, becnufe there is r.o difpia- 
 cing in a Fra^rjre long-ways, fuppofmg it couM 
 
 ha|)- 
 
Difiafes <?/ r/j<f B o N E S. 217] 
 
 happen. I fay, fuppofing; it cou'd happen, be- 
 caufe there is no Blow which cou'd frarfure the 
 Bone length-ways, but what wouM break ic 
 crols-ways with much more Eafe *, befides this, 
 I have never leen it, and great Praftitioners, 
 who are Men of Credit, have alTured me that 
 they never met with an Inftance of it but in 
 Books. 1 know very well that Mufquet Balls Remark. 
 bruife the Bone?, and fplit them long-ways, 
 even within their Articulations •, but 'tis not of 
 th^fe Sorts of Fradures that we have been 
 ipeaking. 
 
 Tne Caufes generally are all external •, ne- Catife*. 
 verthelefs, befides Blows and Falls, one may 
 add, that there are occafional and internal 
 Caufes, which render the Bones more brittle, 
 as is vifibly feen in the Pox, the Scurvy, the 
 Kin^'s-Evil, and the Rachitis. 
 
 As to the Diftance of the Pieces of the 
 Bones, the one are very dift*nt, the others lefs, 
 and others not all. 
 
 There are two Sorts of Difplacings in fra- Of the 
 £i:ured Bones, for the one may be diiplaced clifpla- 
 lengthways, when the Ends are one above the ^'"|°^ 
 other • and the other oiily in their Thicknefs, gongs, 
 when they are feparated, but not fo but that 
 fome Part of the broken Surfaces touch each 
 other. 
 
 There are Ibme Fraftures that are attended Diffe- 
 wirh l>uxations, Wound?, Impofthume"', Fe- rcnce ia 
 vers. Pain, Convulfions, or a Hemorhage ^ and R^fpcft 
 others have no Symptrom, wherefore we fiy ^^^^^ ^^ 
 there are Simple, Compound, and complicated Difeafes. 
 Fra£lures. 
 
 We call that a funple FraO;ure where there is Simple 
 but one Bone broken, without any other Acc.i Fiaiiur*- 
 dent than wh^t is ufual in Fra8:ures,and whicl 
 ojily indicates one Thing for its Cure. 
 
 Some 
 
2l8 
 
 Compli- 
 cated 
 FrafturCt 
 
 A Treatise of the 
 
 Some are Compound, becaufe at the famft 
 Time there are two or three Bones broken in 
 th« fame Part, and they are not called compli- 
 cated, becaufe they only indicate one Thiiig for 
 their Cure, which is the re-uniting them. 
 
 That is term'd a complicated Fradure which 
 is attended with the Diieafes or Accidents be- 
 fbrementioned, which give different hidicati- 
 on?, and require various Remedies and Operati- 
 ons to compleat their Cure. 
 
 Befides, a Fratlure is called compleat when 
 the Bone is entirely broken, and incompleat 
 "when there is dill fome Part of it whole; this 
 is only met with in the Bones of the Cranium^ 
 thofe of the Hips, and the Omoflata ; and if it 
 fometimes happens to other Bones, it is only 
 in very young Children, or fuch as have the 
 Rickets. 
 
 The third Thing necefTary to be known in 
 curing of Fradures, is the unnatural Figure 
 of the broken Limb, which is different accor- 
 ding to the fraftur'd Part ; it depends only up- 
 on the Situation and Force of the Mufcies, as 
 Ihall be obferved in treating of particular 
 Fraftures. 
 
 The fourth Thing to be known is the Caufes ; 
 they are fas has been already faid) all cKternai, 
 unlefs one adds to them a Caries Exojiofis, Soft- 
 nefs, and other Difpofitions to render the 
 Bones more brittle, whether in the Scurvy, the 
 King's-Evil, the Pox, or the Rickets, which 
 has been already faid in fpeaking of the Diffe- 
 rence of Fra^ures, .with Helped to their 
 Caufes. 
 
 The fifth Thing to be known is the Signs, 
 which are Rational or perceptible by the 
 Seiifes. 
 
 The 
 
Difeafes of the E ones, ^ r*^ 
 
 The Rational ferve particularly to di (cover Sigm. 
 the Fraftures of the Cranium, whereof we fhall 
 not fpeak in this Treatife. 
 
 The Signs perceptible by the Senfes are equi- 
 vocal and univocal \ the Equivocal are Pain, 
 and the Impotence of the Limb. 
 
 Pain is an equivocal Sign, 'tis known that the Equivo- 
 fame Caufe of Pain produces different Effefts, cal Signs, 
 according to the Subjefts •, whence what is an 
 infupportable Pain to fome, is but very flight 
 to others lefs fufceptible \ befides, we fee 
 Fradures without Pain, and we fee great Pain 
 without Fraftures. 
 
 The Difficulty of moving the Part is alfo an Equivo- 
 cquivocal Sign in Fradures, becaufe it is met cal Sign, 
 with in all Contufions • and befides the Difficul- 
 ty of moving proceeds from this ^ mofl: part of 
 Perfons fufceptible of Pain dare not flir for 
 Fear of the Anguifh. n 
 
 The univocal Signs are difcover'd, fome by - 5^^^^ ^^ 
 the Sight, others by the Hearing, and others signs, 
 again by the Touch. 
 
 By the Sight, in comparing the found Part tIi© 
 with that which is affected, whereby we may Sight, 
 better perceive its Deformity. 
 
 In which, however, it muft be obferved, that obferva- 
 the Parts on the right Side are not always con- tiou. 
 formable to thofe of the left, that the Eyes 
 themfelves are not always alike : Some Perlbns 
 have been miftaken for want of asking the Pa- 
 tients, Aififlants, Relations, Fathers or Mo- 
 thers, if the Deformity that appeared was not 
 of long /landing, or even from the Birth. 
 
 By the Touch, when one feels the Inequali- The 
 ties caufed by the difplaced Bones : In this Touch, 
 three Things muft be obferved. Firft, that the Remark. 
 Patient be fituatedin the Place where he muft 
 itay during the Cure, and confequently where 
 
 the 
 
t2o A T?^zATiSE of the 
 
 the Rcduilion of the Frafture muft be made 
 It is uniieceflary, and even dangerous to make 
 Tryals to judge of the FraOiure, before he be 
 in this Pofition. 
 
 Kemark. Secondly, that heb^ held by fome ftrong Per- 
 fon, to the End that, it he is put to any Pain in 
 theEx'iimination one is obliged to make to judge 
 of the Frarture, he may hi well reftrained • for 
 the Anguilh fometimes forces a Man to make 
 fuch Motions, as without Doubr, would be ve- 
 ry prejudicial on this Occafion. 
 
 Remark, Thirdly, To feel to Purpofe, and not caufe 
 unprofitable Pains, one muft choofe the Places 
 where the broken Bone is leaft cover'd with 
 ; / Mufcle^, following the Surfaces or the Ex- 
 
 (C^ ^<^- crefcencies of the Bones-, and if there arc 
 any fharp Ends or Splinters,^ they muft be 
 touch'd very gently, that one may not pufk 
 the lenfible Parts againft the Points or Edges 
 of the Bone?. 
 
 T>ie Fraftures are difcover'd by the Ear, when 
 
 Hearing, the Noife is heard that the Bones make, which 
 is called Crepitation. To caufe this Crepitation, 
 one of the Ends of the broken Bone muft grate 
 againft the other, which happens by moving the 
 Limb-, but, to make this necelf'.ry Experiment 
 with lefs Pain, the upper Part of the frafl:ur'd 
 Limb muft be held, fo as it may not ftir, to 
 the End that in moving the lower Part gently, 
 it may be touch'd by it, and occafion the Noife 
 that is called Crepitation. 
 
 Remark. Obferve that this grating which caufes the 
 Crepitation, may be only perceived by the 
 Surgeon, ar.d him that holds the upper Part, 
 becHufe it is not requifice that the outward 
 Air fliould be moved to fuch a Degree as to 
 ftrike the Ears j it is iufHcient that their Hands 
 
 are 
 
Difeafes of the B o N E s. 221 
 
 are mov'd by the Shock or grating of the 
 traclur'd Bones. 
 
 It muil alfo be obferved that the Limbs are 
 Ibmetimes fo broken in Pieces, that they are 
 known at Sight, lb great is their Deformity j 
 in which Cafe the firft Touch ought to be to 
 make the Reduftion, it may even be made be- 
 fore the Dreflings are got ready, if the Cai'e is 
 pre/fing. It is unneceifary, and even prejudici- 
 al to make Motions to oblerve the Crepitation, 
 fince we are certain by other Means that there 
 is a Frafture. 
 
 I fhall obferve en paJfAnt, that the Crepitation obferra- 
 is equivocal, and Ibmetimes deceitful. I was tion, 
 one Day fent for to alfift a Perfon that had 
 fallen •, I came later than a Bone-Setter, whom 
 I found preparing the DreiTings for a Fradure 
 o^ the Rotula: Whilft he was fo employ'd, I 
 touch'd the Patient's Knee, and not difcove- 
 ring any Fra£Vure, I call'd the Bone-Setter, 
 andask'dhim by what he judg'd that the Ro- 
 tuU was fra£lured. He anfwer'd with an affu- 
 ming Air, Sir, don^t you perceive the Crepitation ? 
 No, Said I : He took the Knee, and moving it 
 violently made the Articulations grate, telling 
 me that I might hear it •, I hear a Cli<^uetls, re- 
 plied I, but not a Crepitation. He would 
 maintain his Ignorance or his Knavery ^ but 
 for all his fliarp and grofs Speeches, which 
 would have affronted me from the Mouth of 
 any other, I chofe Moderation, and favour'd 
 him fo much as only to accufe him of Ignorance, 
 which perhaps was not his greateft Fault. \n 
 Effeft, can the Crepitation be taken !br a Sign 
 of the Rotula's, being broken ? 'Tis, perhaps, j^g^^j.^ 
 the only Fra£Vure where it can't happen, be- 
 caufe the Pieces of Bone muft touch to make a 
 Koife 'j and in the Frafture of the Rotufa, the 
 
 upper 
 
222: 
 
 The Ac- 
 cidents of 
 FraOwres 
 
 A Treatise oftU 
 
 upper Part is always diftant from the lower^ 
 by the Attradion of the Mufcles which draw 
 it upwards* 
 
 But, perhaps, feme will ask me, whence came 
 ^Q. Isoife of the Articulation, upon the vio- 
 lent Motion made by the Bone-Setter ? I an-, 
 fwer, that it is ufual when the Joints have fuC- 
 fer'd, and that 'tis more or lefs perceivable, 
 becaufe the Ligaments are fwell'd and fliorten- 
 ed, and draw the Bones nearer each other, the 
 Sinovia is dilpers'd; and 'tis known that the 
 Reafon of the Bones rubbing againft each other 
 "without Noife is, becaufe this Liquor, which 
 lubricates the Cartilages, flows between them. 
 
 It muft be again remark'd, that when the 
 Bones, tho' fra£tur'd, have retain'd their Even- 
 nefs, the Deformity, if there is any, cannot 
 proceed from the difplacing of the Bones; 
 therefore this Sign is not infallible. I have 
 known a Bone-Setter fent for to the taking off 
 the firft Dreflfing of a Frafture of the Leg, 
 which had been {o perfeftly reduced by one of 
 my Brethren, that the Bone-Setter thought 
 there was no Fradure ^ he had the Impudence 
 to tell the Parents of the Patient ib^ and per- 
 fwaded them to it. He took off the Dreifing, 
 and gave the wounded Perfon Leave to get out 
 of Bed, which he did, but had hardly fet Foot 
 to Ground before the Bones were difplaced, 
 whereupon the Bone-Setter was turn'd off, and 
 the ufual Surgeon was again fent for, who was 
 very much furprized at what had pafled^I 
 don't know whether, as Devout as he was, it 
 did not fenfibly pleale him to fee the Impoftor 
 and the Incredulous fb punifh'd. 
 
 The fixth Thing to be known in curing of 
 Fraftures, is the Accidents : There are a great 
 Number ; the chief are, Pain, an Incapacity 
 
 of 
 
Difgafis of the Bones. "^ 223 
 
 of moving the Part, a Pruritusy an Inflamation , 
 a Fever, a Gangrene, a Hemorrhage, ConvuUi^ 
 ons, the Palfy, an Atrofhy, Crookednefs, an 
 jinchyLofisy and the Deformity of the Callus, 
 
 1 . The Pain is caufed by the Solution of the 
 Continuity, and the twitching caufed by the 
 broken Bones in the neighbouring Parts; and 
 this Pain is greater when the Tendons, Nerves, 
 Membranes, or Ligaments fuffer. 
 
 2. 'Tis not to be wonder'd at if the Limb be P*i»« 
 impotent, becaufe its Strength depends upon 
 the Mufcles being fupported by the Bones, 
 which being broke, can no longer help them : 
 Belides, Motion creates Pain, and the Patient 
 Iceeps ftill for Fear of increafing that he has al- 
 ready, whence he remains quiet, more from a 
 Fear of fuffering, than want of Power to ftir. 
 
 3. Sometimes a Pruritus or Itching feizes up- Of the 
 on the fraCtur'd Parts, thro' the Surgeon's Pruritus, 
 Fault, in uling unctuous Medicines that flop 
 
 the Pores, hinder infenfible Perfpiration, and 
 keep in the Matter of the Clandes A^iliares of 
 the Skin, and of the Sebaceae ; this Matter turns 
 fowr, and irritates the nervous Fibres of the 
 reticular Texture of the Skin, which caufes 
 little Pimples, or Herfes Miliares that are Ibme- 
 times followed by an Eryjipelas by the Continu- 
 ance of the Irritation, and often an Impo- 
 fthume happens, if the Tumour feizes on the 
 whole Thicknefs of the Tegument, becaufe 
 that in a little Time the Corpus Mipofum will 
 fuffer, and become the Seat of Impofthumes. 
 , 4. The Fever proceeds from the Pain cauled 
 by the Points of the Bones, or from their hurt- 
 ful Situation, with Regard to the Parts ad- 
 joining, which are very fenfible •, or elfe from 
 theDifquiet of the Patient, on Account of o- 
 |,ther Paifions wherewith his Mind may be agi- 
 tated, 
 
124 ^ Treatise of the 
 
 tated, all thel'e Caufes being capable of putting 
 the animal Spirits, and the Blood, in an immo- 
 derate Motion. 
 
 <. The Gangrene is the Confcquence of the 
 Innamation and fwelling, which not being to 
 be afTwaged, wholly obftruft the Motion of the 
 Liquors, whence follows Corrupt'on, and the 
 Death of the Patient -^ which alio happens by 
 the Rupture or the CompreiTion of the VefTels. 
 
 6. The Hemorrhage is caufed by the Solution 
 of the Continuity of the VelTels, occafioned by 
 the Points or Splinters of the Bones. 
 
 7. Convulfions happen thro' the Compre/JT- 
 on of the Nerves or Tendons, or elfe thro' their 
 being prick'd by the Points of the Bones, or 
 fome Splinters that a!e feparated from them. 
 
 8. The Palfy which comes at flrft, is the 
 Effeftof the violent Compreifion of the Nerves, 
 and that which happens afterwards, proceeds 
 from Defluxions that fall along the Progrefs of 
 the Nerves. 
 
 p. The Atrophy, or falling away of the Parr, 
 is not an Accident that happens at the Begin- 
 ning, but in Procefs of Time, thro' the weak- 
 ening of the Nerves and Arteries, which con- 
 tinue comprefs'd ^ or elfe by ileafon of the 
 Bandage's being too long bound, together with 
 the Difpofition of the Subjeft. 
 
 10. The Crookednefs is caufed by the Redu-» 
 ftion's having been ill made, or by the Patient's 
 not having kept himfelf in the Pofition that was 
 enjoined him. 
 
 1 1 . The Anchylofis comes when the Fradure 
 H near the Joint, and the nutritive Juice or 
 callous Matter has fpread in the Neighbour- 
 liood of the Ligaments, where it coagulates, 
 and folders (to ufe that ExprefTion) the Bones 
 ill their Jointings : Or elfe it fometimes hap- 
 pen- 
 
Lifenfts of the Bone S^ a^ 5 
 
 pens thro' the Peilon's coiitiiming^a long Time 
 in the IJme Pdlurc without moving, v^heiice 
 the 5/;/o^7/« thickens, and produces the lame Ef- 
 fect as the nutritive juice beforementioncd. 
 
 1 2. Tlie Callus is milhapen trom its i:ot ha- 
 ving been lufficiently reftraia'd by the Ban- 
 dage, or becaule the Bones have not been well 
 reduced. 
 
 Often times 'tis not po/Tible to retrain the 
 growing of the C<«//«/, elpecially when the Pain, 
 Inilamation, and other Accidents prohibit th^ 
 ufing a tight Bandage^ but it otlen happens 
 that the Surgeon himl'elf is in Fault, when 
 without any Realon he does not bind the Ban- 
 dage fufiiciently : In this Cale the nutritive 
 Juice, that muft folder the Bones is not con- 
 fined •, then the Bandage muft be put on ia 
 fuch a Manner as it may fufiiciently and e- 
 qually comprefs the Bones, to the End that the 
 juice may not have an Opportunity to diffufei 
 it feU in the Neighbourhood •, and 'tis for this 
 Reafbnthat it appears more mif-ihapen in the 
 Fraftures, where the Bones have not been well 
 placed, both becaufe the Bones wh^ch lie one 
 upon the other, occii/ion an external Deformi- 
 ty:;, and becaufe the Bandage caii't comprefs 
 equally, nor produce the Erfeft of which we 
 have been fpeaking. 
 
 The feventh Thngneceflary to be known in Progno^ 
 managing Fradures, is the Prognoftick that is ftick, 
 drawn from the different Kinds, and according 
 to that we will fay that the ob.ique Fraftures, 
 and thofe which are like a Nail, or the Mouth 
 of a Flute, as alfo thole that are broken into 
 feveral Pieces, are more fatal than the Fra- 
 ftures Cro(s-ways. 
 
 They which proceed only from external 
 Cafes without any internal Defcd, are lefs 
 
 Q, d.in- 
 
2i6 i^ T Fv E A T I s E ^/ the 
 
 dangerous than thoi'e where the Bones have 
 been renderM more brrtle by the Scurvy, the 
 Pox, the Kir.g's-Evil, or the Rickets, 'in all 
 thde Cafes the bony Juice is not well conditi- 
 oned, and CfartVom yielding a Subdance capable 
 of harde.iing, and tbrming a, C^/Zttj) it deftroys 
 the Subllance of the Bone it felf, and corrupts 
 it, inftcid ot ioldeiing and uniting it. 
 
 Wl'.en the two Bonesof one and the f^ime Part 
 are fraftured, the Fra^l^ure is more dangerous 
 than when there is but one : If the difplacing is 
 confiderable, the Fia^lure is harder to cure, 
 than if it i«: moderate, or there is none at all. 
 If any Accidents happen, the fimple Frafture, 
 being turn'd Complicate, becomes more dan- 
 gerous. 
 TheCurc The 8th Thing to be known is the Method 
 of Fra- (,f Cure, wherein Regard muft be had to three 
 times. Intentions, which are, to reduce the broken 
 Bones, to fupport them when reduced, and to 
 correct the prelent, or prevent future Acci- 
 dents. There are (ome who add a 4fh, that is 
 to labour at the Formation of the Callus. 
 Firft In- The iirft Intention comprehends three 
 tendon. Thinus, 'z.-.x. Extenfion, Counter-ExteHfion 
 and Conformation. To make thefe • firft, the 
 Patient muft, as near as poflible, be fituated in 
 the f ime Place anil Pofition wherein he muft re- 
 main during the whole Cure. 
 
 2. The Ends of the fra£lured Bone muft be 
 drawn with the lame Degree of Strength. 
 
 3. The Force that draws muft, as near as 
 poffible, be applied to the two Ends of the 
 broken Bone, and never to Parts that are 
 near it. 
 
 4. In putting on the Straps or placing the 
 Hand<t that? draw, one muft remove a little 
 from the fraltur'd Fartj and choofe thole Pla- 
 ces 
 
L'jfeafes of the B g N E s. 227 
 
 ces where the Hands and Straps have beft hold, 
 lis near the Condyles^ and the Parts where the 
 Limbs b2ini|; Imallefl are eafieft to pals, becaule 
 rliefe Eminences may with-hold the Hand'? or 
 Straps, and hinder them from flipping, which 
 gives tliem beLt6r hold. 
 
 5. The Extenfions mufl be proportionable to 
 the Diltance or dilplac/ng of the Pieres of the 
 broken Bone, and to the Force of the Mulcles 
 th.it caufe the difplacing, and relift the Ex- 
 ten fion. 
 
 6. The Mufcles muft (as much as poiTible) 
 be in a State of Inaction, becaufethat other- 
 wife, to get the better o\ them, one runs the 
 Hazard of tearing or breaking them, as has 
 been often feen, for want of Precaution. 
 
 7. It muft be made by Degrees, for fear of 
 ruining the Muscles, which would happen if 
 one was to pull forcibly of a fudden, foraf- 
 much as 'tis requiflte to give the mufculous Fi- 
 bres time to yield to the Strength that extends 
 them. 
 
 '^ The Way of making thefe two Operations is. With 
 with the Hands, S&raps, and fbmetimes with wjiat the 
 Inftruments or Machines. Extenfi- 
 
 The Hand's on/y are to bs ufed when the ^^f"^® , 
 Limbs may be eafilv grafped, and when thexhe'.V 
 Mufcles have no confiderable Force. Hands^,^ 
 
 On the contrary Straps are ufed, \vh?n the alone. 
 Hands can't 'grafp the Part, nor have Strength ^^^^1-^**^ 
 -tfnoughto mafter the Power of the Mufcles. 
 
 l>ail:ly. Machines are ufed when neither the Ma- 
 Hands or Straps are fufficient, whether in Re fpetl chines. 
 to their Force, or their Application. 
 
 To make the Conformation, t. The Exten- Remarks 
 fion and Counter- Extenfio;i muft he fufficient. f""" .'^^*^*^ 
 Tiie Ufe of thefe is to remedy the difplacirii^ ";'f'"-^ 
 or the DJnes wJxjch h:ippens long-ways, whe 1 formaci- 
 
 Q 2 - *^ ■-'^^ they on. 
 
228 A Treatise of tht 
 
 they lie one upon the other. Now i^: is Impof- 
 fible to make them conformable whilft their 
 Sides touch each other, theretbre they muft be 
 drawn upw:^rJs and downwards before their 
 Conformation. 
 
 2. The Conformation may be made with the 
 Palm of the Hand, the flefhv Part of the 
 Thumb, or the Fingers •, fometimes even with 
 Inftruments, as the Trepan, the Elevatory, 
 
 ^ and others, and that according to the refpe- 
 ftive Cafts. 
 
 3. The Force that tends to replace the Bones 
 muft, as near as poflible, be fo placed as not t» 
 work upon their Ends, or their Spiii.ters, to 
 the End that one may avoid a Solution of the 
 Continuity, and Divulfions, that would caule 
 fatal Accidents. 
 
 4- The Strength that is employed in adapt- 
 ing and replacing the Bones, muft be propor- 
 tionable to the Solidity of the Bone, the Thick- 
 ncfs ot the Flefh, and how far it is difplaced, 
 as to its Thicknefs. 
 
 To the Solidity of the Bone, becaufe Bones 
 that are thin ref fting lefs than thick ones, there 
 is lefs Strength rcquifite to replace them. 
 
 To the Thick re Is of the Flefli, becaufe if it 
 The is thick, the Force is more diftant from the 
 
 ^'*k^'' ^^"^» ^'^'^ ^^'"^ ^^^^ ^W^^. 
 fngS" "^^^ fecond Intent'o.i in the Cure o^ Fra- 
 Bone in ^ures, is to fupport the reduced Bone, which 
 its right is d.or.e. by the Dreillngs and Pofition of the 
 Pofition. Part, wherein all thit follows muft be obferved. 
 muftL ^ * ^^^ Dreftingscoiifift ot Comprefles, Bands, 
 done in Splints, Paftboards, Cafes, Straps, Junks, 
 dreffing Scarves, Pellets, Medicines, and others, accor- 
 of Fra- ding as is requifire, in the Application of wliich, 
 ^**"**^«- one muft obferve, i. That tlie Hair be fhaved. 
 2. Thrit the Part and the Mulcles be in their 
 Reditude or Situation. 
 
 ^. That 
 
Lifeafes of the BoN ES. 129 
 
 3. That they who hold the Part whilft the 
 Dreflinii!,is putting on, be ftrong, and that th^V 
 be as little conftrained as poUible, that they 
 may hold it equally till the End ot the Ope- 
 ration. 
 
 4. That the fiift Comprefs be fingle, to the 
 End that the Band may be more eafily applied, 
 and may bo nearer the Part it is to bind and 
 keep in. 
 
 5. That the Hands be moderately fine, cut 
 to a Thread, and of Linnen that has beesi a lit- 
 tle worn •, that they be fuffic^ently lon^ and 
 broad ^ that the firft be clapt on immediately 
 upon the fradur'd Place, as near as polfible, 
 that it makes three Rounds, and goes upwards, 
 ending in Circumvolutions that muft be neither 
 too tight, iior too Hack •, not too tight, for 
 fear of hindering the Circulation :, nor too 
 flack, becaufe it woi^t keep in the fractured 
 Bones. 
 
 6. The fecond Roller ought to have the fame 
 Qualities as the firtt ^ it begins at the fame 
 Place, it is continued downwards, and re- 
 mounts upwards, according to the Cafes, the 
 Sorts of Fraftures, aad the different Bones th:\t 
 are broken. 
 
 7. The Splints muft only be thick Compref- 
 fes, after the Manner of longitudinal Bolfters, 
 they muft be laid on along the Parr, in thofe 
 Places where there is no Eminence nor Excref- 
 cency of tjje Bone ^ formerly they were made 
 of Paftboard, cover'd with a thick Cloath that 
 tljey might not hurt. 
 
 8. There muft fometimes be Compreftes to 
 equalize the Parts, that the third Band, and 
 the Paftboards may make an equal Compre/Ti- 
 on. There are fome Parts more funk in than 
 Others, and thefe Compreifes ferve to fill them 
 
 Q. 3 up, 
 
2 30- A. T RE ATI s E of the 
 
 up, which niak^s the whole. Part upon a Level, 
 and renders the Application of the Rollers 
 more exa£t. 
 
 . 9. The F^iftboards ought. to be cut in Pro- 
 portion to the Size luid Sliapc ofthc Part ^ they, 
 are faftened with two or three Straps. One 
 begins to ty,e them at the lowermod, if there 
 are but two Straps, or at the middle \\ there 
 are three. The Number is determined by the 
 Length and Compals of the Fart. 
 
 After the Application of the Drelhngs, one 
 muft place the Body a;.d the Part afleiled : The 
 Pofition of the whole Body is dilfcrent, accor-i 
 ding to the various Parts that are fractured. 
 In all Fradures of the lower Extremities, and 
 thofe of the Hip-Bones, the Patient muft ab- 
 folutely be in Bed till the Formation of the. 
 Callus \ he muft do the fiime in all other Fra- 
 Ttures, till the Pain, the Fever, and other 
 Accidents are over, after wh"ch lie may beta- 
 ken up, at firft only to make his Bed, and af- 
 terwards he may be left more or lelsin anea- 
 fy Chair to refrefli himfelf. 
 
 If 'tis the Arm or the Fore-Arm, it muft be 
 hung in a Scarf ^ if the Leg, it muft be placed 
 quite extended in junks, or in a Gale i^ and in 
 ■^' both the one and the other the three Conditi- 
 ons muft be oblerved, whereof we have treated 
 amply in the Accouiit of Luxations in gene- 
 ral, and which are reducible to three Thinjis, 
 vix., that the Part be placed high, foft, and 
 fteady. 
 
 It muft be high, that the Juices being ailj- 
 ,fted by a Bias, may circulate the more ea- 
 fily. 
 
 Soft, that the Part may r.ot be hurt, nor the 
 Patient have asy Keaion to ftir. 
 
 Steady, 
 
Bifeafes of the BoNES, ;^l 
 
 Steady, becaufe the Re-union can'r be made, 
 when the Partis upon a Place that lhal;es and 
 is unfteady. 
 
 The third Intention in the Cure of Fractures, 
 is to correal, or prevent Accidents ; to rom- 
 p:irs this, and not be furprized, the Surue.in 
 jnuft viiit the Patient very often, and examine 
 the Parts next the fradured Limb, as the Foot, 
 if 'tis the Leg, the Hand, if tlie Arm, tint he 
 may be alfured of wliat paifes in Refped to the 
 Bandage, for thofe are the Places where its 
 Perfeftion or Imperfeftion is difcovercd. It is Pcrfcfti- 
 as it fhould be, if one finds a foft, red Tumour, o"s of 
 of a temperate Heat, and without Pain. ir'^^eBan- 
 the Bandage be too loole this Tumour won't '*^^* 
 appear, and 'tis a Sign that, far from being 
 tight enough to fupport the Bor.es, it is not 
 Sufficient to comprels the Blood V^elfels mode- 
 rately, for this Comprelhon is the Caufe of the 
 Tumour that appears when the Bandage is 
 tight enough. 
 
 In fine, when there appears a hard black and What 
 cold Swelling, 'tis a Sign that the Bandage is "^"^ ^e 
 too hard bound , in thele two laft Cafes the "^' 
 Drefllng muft be taken off, to be put on better. 
 
 A very exad Regimen muft be prefcribed if Rcgiq:.cn 
 the Fraftnre be conliderable, and attended with 
 any melancholy Accidents. 
 
 The firfl Drefllng is taken off fooner or later, 
 according as there is need, which is known by 
 the Accidents ^ for when there h.ppens to be 
 Pains, SwelVng^:, Inflamations, and others, oi.e 
 is obliged to take off the Drelfing to clap on 
 another immediately;, otherwiJe 'tis lett on 
 longer, 'till the eighth Day, if no Acc-detit 
 appears, and even if there was no Swelling at 
 the Time of making the Redu'.tion, and put. 
 tij]g on the Dre/Iings. For the Drefling is 
 a; J Q_^ forced 
 
Q53 A Treatise cf the 
 
 forced to be taken off looner than one would 
 otheiwife, (altho' no accident appear) when 
 the Tumour is cohfiderable at the Time ot ap- 
 p'yingthe firft Bandage, and it abates fo that 
 the Bandage often becomes too loole the next 
 Morning. 
 Precauti- jn taking- oiT the fecond Drefling, the fame 
 ^^^l^ ? Precautions miift be obferved as before, and it 
 \w takfncT ^^'^ ^^ P^'^ *'*" f^^^ lame Way, binding it a 
 otf the '^ little harder if the Swelling is gone off. 
 cd. Drcf- The Accidents are to be correded after the 
 f"-S- following Manner : If the Patient feels any 
 ^^'^Ta'" Pain, 'tis not ufually at the Place of the Fra- 
 cidents ^' ^"'^ *^> efpecially when the Bones are reduced. 
 Pain. Therelore he is relieved by loofening the 
 
 Straps, the junks, or the Scarf ^ by raifing or 
 lowering lome Cufhions, by applying hot 
 C!o:hs, ar.d making fome Fomentation, for 
 this Pain often proceeds from fome very Tri- 
 fle •, other Times it continues, and obliges us 
 to take off all the Dre/fing : One is even forced 
 to ufe Bleeding and Narcoticks, to cure and mi- 
 tigate it when 'tis violent. 
 Jrd»ing. The Pruritus is prevented by not ufing un- 
 ftuous Remedies, that are capable of clofng 
 the Pores. It is taken away by Lotions of Spi- 
 rit of Wine, and warm Water, and other v^- 
 tery and fpiricuous Fomentations, and by u- 
 fing clean Linnen walli'd in Lye, for Keatnefs 
 is eTential in dreiSng of Fraftures. 
 Infl<ima- The Inflamation is cured by ("peedy, plentir 
 lion. ful and re-iterated Bleeding, bv a mild moift 
 tiegimen^ a ftridfc Diet, and birrer Broths:; or 
 the refined juices of Buglofs, Burrage and 
 Succory, whereunto muft be added, according 
 to the Cafes, i <; Grains of Nitre iiito every 
 Dofe of 3 or x Ounce>, which the Patient mufl; 
 take during the Intervalof his Broths. 
 
 His 
 
T>ifeafes of the B o N E s. 295 
 
 His Drink muft be a light Ptilan of Dog's 
 G.afs, and Succory Koot, and in each Pint 
 which the Patient drinks in a Day, during the 
 Interval of his Broths, he muft dilfolve a Dram 
 of well purified Nitre. 
 
 The Fever is only the Effe£b of the Infiama- fever, 
 tion, or Pain, wherefore 'tis cured by the Re- 
 medies that will put a Stop to the one, or mi- 
 tig tte the other. 
 
 If a Difpofition to a Gangrene appears, one A Gan- 
 muft abandon the Bandage juft defcribed, and ^^^fj,T 
 make ufe of that with 18 Tails. One muft ^**^' "' 
 apply the Fomentations fit to refift Putrefafti- 
 on, as Spirit of Wine camphorated, Sal Marine 
 and ArmoniaCy Afhes of Vine Branches^ the 
 Tinftures of Myrrhe, Aloes, and long and 
 round Ariftolochia^ are alfo very good. 
 
 \^ the Gangrene increafes, Scarifications, Inci- A Gan«. 
 fions, and Cuttings muft be made, as need re- gfcne 
 quires \ and if the Dileafe give not Way to all ^o^md. 
 thefe MeaiiS, the Limb muft be cut off. See 
 what has been faid of the Gangrene in the 
 Chapter of the Luxation of the f^ertcbr^. 
 
 The Hemorrhage is generally found only in Hemor- 
 Fra£tures where there are Wounds^ ne/erthe- rhagc. 
 lefs I have leen the Artery that palfes between 
 the two Bones of the Leg, opened by the Edge 
 of a Frafture of the Tibia that was broken in 
 the Sh-ipe of the Mouth of a Flute, an Echy- 
 mofis Ipread all over the Leg, and the Part be- 
 came cold and blackifli *, 'twas thought to be 
 gangrened, I open'd the Leg from 4 Finger^ 
 Breadth above 10 as many below the Fradlure, 
 and made an Incif on as far as, and beyond, the 
 InterolTal Ligaments, and ftopped the Flux 
 without difplacing the Bones ; 1 managed this 
 Difeafe like a complicated Fradure, as it was, 
 and cured my Patient. 
 
 It 
 
^:?4 ^ Tke AT IS z of the 
 
 Ways ro /It mift ablblurely be hid bare, to ftop.'an 
 
 flop the opeifd VeJfei, that ojie may comprefs, biud^ oC 
 
 rhapcr ^PP^y ^J^yP^^cks to it, which are the three 
 
 Metns.toilop extraordiiriry Blced'r/j:s. f 
 
 "Ways ro Th^* Co.iVullio:is don't coiitiiiue loijfj, becaule 
 
 cure the -they •ai'e"t;cnefalIV caufed bv the Points of the 
 
 *^°"^'"^^'' Splinters 'that prick the.Kerves or nervous 
 
 Parts, and thei'e Farts are jio longer prick'd 
 
 when the Reduction is made. 
 
 Neveithelel3 there will remain Startings that 
 may be prejudicial when violent^ they are al- 
 lay'd by Bleeding, and the Juices of bitter 
 Plants, with feme Grains of diiiblved Nitre. 
 When they are yet more violent, add, to 
 thefe ApozL-ms; feme Grains of Pulvit de Gutte^ 
 and at Kight they render them hypnotick 
 by Syrup of Diaeodhm, or the Icdative Salt of 
 Mr. Homber^. 
 The Pal- T^he Palfy of the Limb, and its Atrophy or 
 fy. Leannefs, are cured by FricHons with hot 
 
 Cloath?, and by fpiritaus Fomentations that 
 are proper to give Motion to the Blood and 
 Spirits:^ and as this is not diltovcred till after 
 the Cure of the fradlured Bone, it being fblid, 
 one mav pat the whole Part in the Dregs ot' 
 Wine or Beer.- The Waters of 7?6j<rW, Bour- 
 bonne, and th^irMud are alfo very good. 
 
 The Anchylofts is incurable wlie.i the nutri- 
 
 Anchylo- tive Jui:e has taken Po.feffion ot the Joint, and 
 
 ^'"* is coagulated there ^ but thit which proceeds 
 
 from not moving the Parr, and not difperfing 
 
 the Sinov'ut, is to be managed as h^' bee.i laid in 
 
 the Luxations, and the I'reatife of the Avchy- 
 
 The Cil- As to the Deformity of the Callus, there is 
 
 iu3. no Remedy when orxe 'tis formed •, this Imper- 
 
 fecl'On i? only, to be prevented by makiijg a 
 
 proper Bandage in the Beg icnirg, provided tJie 
 
 . - Bones 
 
'Difeafis of the ^ouz9i, 235 
 
 Bones are well reduced, and nothing Iilnders 
 the ufi ic, the ordinary Band.ii^e. 
 
 The Formation ot" the Callus \s as eafy to be Formatl- 
 conceived, as that of a Scar, being, both the ^""^ ^^® 
 one and the other, the Means whereof Nature "^' 
 oiid Art make ufe to rejoin thole Farts which 
 have I'uifer'd a Solution of their Continuity. 
 
 In order to comprehend well the Formation 
 01 t\\Q Callus y one need only call to Mind the 
 Idea of the Structure of the Bone, and the 
 Mechanilin which Nature ufes to 1 ouriih it : 
 'Twill be known that by the Means of the Te- Pcriofle- 
 riofteum the Blood is carried into the Body of "'t^* 
 the Bone by an innumerable Number of httle 
 Arteries, which enter by as many little Holes, 
 and penetrate the Bony Subftance, to fuppiy it 
 with a faline and fulphurous Juice that intro- 
 duces it lelf into the Channel of bony Fibres, 
 to repair their Wafting : The fupertluous Part 
 of this Piece i* -taken back by the Lymphatick 
 VeJlels, and that of the Blood by the Veijis •, 
 both the o:ie and the other are carried to the 
 Heart by the Circulation: This being fo, 'tis 
 eafily conceived that this Lympha, which is fup- 
 plied by the Arteries, and runs into the Pipes 
 of the long Fibres, ditfufes it felf thro' thole 
 that afe broken, at the Place of the Frafture •, 
 iind becaule it don't flow in great Quantity, ic 
 congeals at their Ends, when it is naturally, 
 that is, impregnated with faline and fulphurous 
 PrincipleSj which are the Principles of the 
 Juice that are propereft to congeal, as weih:tll 
 obferve in the Treatife of the Rachitis. And to 
 explain how the Circulation is made in this 
 new Part, 1 fi\y that the firft Drop o'{ the Lym~ 
 fha, that flows from each bony Conduit, is 
 thruft forwards by the fecond, whi.h divides 
 it to open it felf a Paltige, and is afterwards it 
 
 fclf 
 
A TfvY. AT ISY. dfthe^ 
 
 lelf divided by a third, and the 3d by a 4th, 
 wiitch by a little and little fills up the VMuum^ 
 and forftis a Pipe thro' which the 5th, and fb 
 cm <2>^ hfinifnm^ preferve themfelves a Paliage- 
 to introduce themfelves into the empty Spaces^ 
 »ud fili them up. This being thus continuedj^ 
 tiB thefe congealed Particles have Strength e- 
 nough towithftand a new Separation ; and the 
 Circumference is fuiEciently fortified that the 
 Li^u€>r can no longer diffule it felf upon the 
 SidiQ^y and being obliged to follow its Motion 
 in a right Line, enters into Part of the Pipe 
 that is in the other Part of the broken Bone, 
 where it finds the Veffels difpofed after the 
 lame Manner-, and fo the Circulation begins 
 again in this new Part. 
 
 CHAP. II. 
 
 Of the FraSIure of the Nofe. 
 
 StiuQure » I ^ H E upper Part of the Nofe is formed by 
 I two little Bones, which joining them- 
 felves together form a Sort of Arch very proper 
 to withftand external Blows, and which refift 
 fo much the better, becaufe they are fuppor- 
 ted by the bor.y Lamina of the 'Ethmoides •, ne- 
 verthelefs there are Blows capable of beating 
 them in, and breaking them different Ways. 
 
 Caufcs. For Inftance, if a St»ck, a Stone, or any o- 
 
 ther Body flrike the two Bones of the Nofe up- 
 on the. Line defcribed by the bony Lamina that 
 fuiiaii.s them •, or if one fall upon fomehard 
 Body that hits the two Bones upon the fame 
 Line, a Fradure may happen both to the bo- 
 ny Lamina and the Nofe-Bones. Never thelefs 
 
 'tis 
 
Lifeafes of r^^ Bo N ES* 2^ 
 
 'tis more ufual for one of the two Bones to 
 break, and the other only to fink in, efpeclaliy 
 in thofe the T<5p of wliofe Nofe is flat. 
 
 But there niuft be a Frafture of the bony £<«- 
 mina^ provided, as has been faid, the Blow he 
 given upon the Union of the two Bones., and 
 on the Line defci ibed by this Lamina^ altho* 
 there ihould be but one of the Bones IraduriCd, 
 and the other ilnik in. 
 
 This Fra£ture is with or without Wound ',^i»<3s. 
 with a Wound inwards and outwards at the 
 fame Time, or on one Side only. 
 
 It Is ealy to know the Fradure if there he Si^ias. 
 no fwelling, but there often is, which hinders 
 our dilcovering it. 
 
 It is not generally fatal •, tlie violent Strokes Pko^"**- 
 and Falls upon the Nofe that are without Fra-^^'^ 
 iture, are Ibmetimes much more dangerous, 
 becauleif the bony Lamina, refifts wiihiout fra- 
 ^uring, it caufes a Commotion in the Brain: 
 Several Patients have died of AbfceiTes in the OVfeiwur 
 foremoft Lobes, and an Effufion under the Du- ^^'^' 
 .ra Mater "^hich. covers the (^i ^atcpft^h smd Qf' 
 brcfnm. ^ H-»fHv/ h-if: ' "^'^i 
 
 Sometimes Impofthumes are formed within 
 the Kofe, between the pituitary Membrai:ie and 
 the Bones, thefe require a particular Cure- 
 
 Mr. Sauret called me in one Day to a C<mfuil- OMcrwsr 
 tation upon the Diftemper of one of his Neigh- nstm. 
 hours, who had a little Wound in the Nol<i?, 
 at the Place where the Bones and the Cartila- 
 ges are join'd togetJier •, the Bone was hare, 
 and there came from the Wound a Spoonful of 
 Pus 2it every Dreiling: We prefTed theoutfide 
 of the Nofe, and the Parts next to it, without 
 getting out the leaft Drop of Pus. I put my 
 Finger up the Noftril, and felt a foft Tumour 
 that difperfedin Proportion as i made the Pwr 
 
a^S A TfkE AT I sz of the 
 
 iflTae thro' the exteiour Openmo; by compref- 
 liiig it. 
 
 I thruft in a hollow* Probd; fit to make the 
 Operation of the F:ftula in ytno \ \ carried it 
 into the purulent Bag till I felt it with the 
 Fin8;er that 1 had' in the Nofci \ pierced the 
 pituitary Membrane, and by the Help of the 
 channelling of the Probe, I • made an Incifion 
 therein with a Blftouri fix Lrne? wide j there 
 came out again a great deal of Pus \ I ran a Se- 
 to;i from the outfide of the Nofe into the infidc, 
 which I took away th- ee Days afterwards, ai:d 
 the Pa':ient was cured in a little while. 
 Obferva- ^' ^^ff^^ ^7 Brother Member fhew'd me a 
 tion. 1'^'^ Calb a few Days afterwards, the fame 
 Courfe was taken, and 'twas noC'long before the 
 Patient was cured. ' -' ' r.f ^'.. 
 
 Obferva- 1 had praftifed this Operation in two Cafes a 
 tion. little different from thele two. One was the 
 Confequence of a FiftT/la Lachrymalisy accompa- 
 n'ed with an Impoflhume, which extending'it 
 ielf along the Nofe, form'd a little foft Tu- 
 mour in the infide of the Noflril, which I 
 prefTed, and which difcharged it felf into the 
 Hole of the Fiftuhi Lachrymalis \ it was propoled 
 to make an Incifion from the Fiftvla to the Bot- 
 tom of the Inipofth'jme, but, to avoid dis- 
 figuring the Face, I advifed opening it oi the 
 irifide of the Noflril* I did it, and the Abfcel<5 
 was dried up in 24 Hours, and the Patient 
 cured in a few Days after/ '>t^*^';' ' '''■ ' '-^* 
 Obferva- The Other 'wa*? an Impofthume, which was 
 tion. the Confequence of a Blow upon the Kofe, and 
 had formed if felf 4) )th on th'? (nut and infide^ 
 fo x\\\t when it wa? prei^'d without, the Tu- 
 mour oi7tha& 6ide diminiflied, and tliat with- 
 in incfeafed • and when it was pfefs'd ontheiV.- 
 -4ide, the i:iternul Swelling abat.^d, and that 
 i with- 
 
Dffdiifis of the l^oi^'E^. 259 
 
 wittlout grew hrger : 'Twas deliberated on 
 which Side to open ic, but 'twas ai^rcod that it 
 ou'^ht to be done internally, to avoid the Dis- 
 figurement, and that if Neceifity required the 
 Opening it outwards', it would be Time ei.ough 
 to do it. V\'heretote I opened the Abcelf; in- 
 wardly, I introduced a 1 ent, wh'ch was ^up^ 
 ported by a Stopple of Vnt, and by a iUn- 
 ci;ige outwards-, I applied Lint fteeped in the • 
 White of an Egg beat up with Alhim, and ii 
 BoHier and Binda^e to comprefs it. There 
 came again out a good deal of Pus at the taking 
 off the firft dreffing, at the iecond there ap- 
 peared iefs, and yet iefs at the tliird-, and by 
 little and little the Patient was cured in S Days, Speedy 
 -without any Thing's being feen on the outfide ^"^ 
 of the ^oie, at the Place where the FUiftuati- 
 on was fo apparent,' that it might have deter- 
 mined us to open it on that Side, Iboner tiLin 
 on the other. I don't give the' Reafon ot'thefe 
 • Fafts, they fpeak enough of themfelves ^ what 
 has been faid proves that the Fracture of the 
 Nole is not always without Danger. ■ 
 
 Of the Cure. 
 
 Whether the Fra^ure of the Kofe be fimple Rcdufiti- 
 or complicated, one muft begin bv reducing ^♦'^ 
 the Bones ;, and to clTect that the Patient muft 
 be feated upon a Stool, or a Chair, whofe Back 
 is very low, that the Head may reft againft 
 Ibme one who will hold it ftcady, as in the 
 Luxation of the Jaw. 
 
 After tills take a SpatuUj or Steel Elevator}, 'SUuial 
 wrapt round with Lini:en, introduce it into the ^l^'*"' 
 >3c{lril to tlie i'lace where the Deprc/lion is mofl°"' 
 vifible, and ute it as a Leaver to ralfe the Bones 
 that are driven in or broken, wichout Fear of 
 
 hurtinn, 
 
240 A Treatise of the 
 
 hurting the pituitary Membrane, or thrufVing 
 the Boues too much outwards, becaule the Hand 
 that don't hold the Elevator^ but touclies the 
 outfide of the Nole, is the Direftor of this 
 Motion, and is attentive (if I may ufe that Ex- 
 preflion) to wliat paifes. 
 
 If this Eifort of the Elevator don't raife both 
 Sides at oiiCe, which ought neverthelcfs to 
 happen •, one muft pafs it into the other Mo- 
 iiril, and. do as has been juft faid • then thruft- 
 ing ^Stopples into the Nofe fteept in vuh^erary 
 Water, or in good Brandy •, cover the outfidLe 
 with a Comprefs (A) dipt in the fame Liquor ^ 
 put on another (BB) which covers the Nofe, 
 the Eyes, and the Forehead: The whole is 
 )(ept on by a Handkerchief (C) negligently fa- 
 ftened that it may not comprefs the Nofe, r.or 
 particularly the Eyes. The Stopples of Lint 
 that are put up the Kofe rauft not be covered 
 nor made faft, becaufe they may be renewed by 
 others fteept and applied in the fame Manner. 
 
 They 
 
bifeafes of thff B 6 N E $4 24! 
 
 Thefe Stopples ferve only to keep on the Me- 
 dicines. 
 
 They who devifed the puttinf^ Linnen Stop- ReiTfJ^rJ^- 
 pies to luftain the Bones, leaft they fliould dis- 
 place them le Ives, have never reduced any Fra- 
 cture of the Kofe, or they would have learnt 
 that it requires more Force to drive in thefe 
 Bones that are juft replaced, than was necel- 
 fary to ufe in railing them with the Elevatory ^ 
 Things being thus, the Quills to help the Pati- 
 ent's breathing, are equally unprofitable, and 
 I even believe the Stopples muft be hurtful. I 
 never uled them dipt in vulnerary Water, but 
 as Topicks proper to comfort the Parts that 
 have been griev'd by the Blow, or the SpafuU 
 that made the Reduction : For this Realbn they 
 ought to be very foft, and be left off as foon as 
 the Pain ceafes. 
 
 If there be a Wound with the Fra£lufe,- it com'pfj-^ 
 muft be drefs'd when the Reduftion is made ^ cated 
 one muft bring the Lips near each other, and "ErxStmSi 
 keep them fo with little CompreiTes fupported 
 by the reft: of the Dreffing, as has been faid. 
 
 Bleeding, a Diet, Reft, in a Word, a due 
 Regimen and the general Remedies are not to be 
 leglefted, efpecially if there be a Pain in the 
 Head, bleeding in the Nofe, Heavineft, and 
 3ther Symptoms, which may be the ErtfeO:s Cf 
 >. Commotion; 
 
 ft CHAP. 
 
243 ,/4 Treatise of the 
 
 C H A B. III. 
 
 Of the Fradlure of the Lower Jaw, 
 
 T 
 
 H E Lower Jaw is more difficult to 
 
 break than a great many other Bones, be- 
 
 caufe its Articulations deaden a Part of the 
 Shock that Blows or Falls may give it ; be- 
 fides the Teerh which are let in it partake of 
 the Shock, and when, by Strokes or Falls they 
 are thruft againft the upper Jaw, the Teeth of 
 the one meeting with thofe of the other, com- 
 municate the Motions to each other, which 
 takes off lo much of the Force that afts upon 
 the Jaw, to break it. 
 Remark. ^\iq broken Piece's feparate but a little, fome- 
 times not at all ^ and if there is any difplacing 
 from above downwards, becaule there are no 
 Mufcles that draw the Ends of the fraftur'd 
 Bones over each other, 'tis always the Fore- 
 Part thatfn-iks by Reafon of its Weight, and 
 the hind Part that is raifed by the Influence of 
 the Aiaffeter^ the Perygoid^us internus, and the 
 Crotaptitis : Thus the difplacing is riot confi- 
 derable, unlefs ;it be made by the Violence of 
 the Blow, which continuing after the Fradure, 
 leparates the Pieces from each other. 
 The Xhe Fradlure of the Jaw is known by put- 
 
 S'S'"' ting ones Hand into the Mouth, the Teeth of 
 one Part will be found not to be in the fame 
 Line with thofe of] the other-, befides, one 
 may perceive an UildVennels without, by run- 
 ning a Finger along the Bafis of the Jaw •, but 
 this only happens when there is a Difpla- 
 cing. 
 
 When 
 
B'jfeafes of the B o N E 5. 243J 
 
 When the Pieces of the Jaw that is brolceil 
 iare not difplaced, 'tis hard to difcover the Fra- 
 fture. To be convinced of it, one muft lean 
 upon the Fore-Teeth, and thruft them down- 
 wards ^ and at the fame Time pulh the Patt of 
 the Jaw that is near the Argle, and the Crefi' 
 tatio7j\v\\\ be heard i but ic is not material to 
 ]cnovv it, fmce there is then no Redu£lion to be 
 made, and 'tis fulficient to keep the jaw in that 
 Polition. 
 
 There are fome Strokes and Falls fo violent 
 that the difpiacing caufes a Deformity vifible to 
 the Eye, io that there is no need of feeling. 
 
 Vrognojlich 
 
 The fimple Frafture is not of. ill Confe- Fraaure^ 
 quence, efpecially, when there is no difpla- Y'i^^?®^'^ 
 
 If the difpiacing were confiderable, there 
 would be more Danger, becaufe the String ofFraaura 
 the VefTels that pafTes along its Canal^ would v/ithdif- 
 be torn, broken, or ftretched, which caufes ve- ^ •^^^"S' 
 ry fharp Pains, and may bring Convullions, by 
 Keafon that this Nerve is one of the great 
 Strings of the hinder Branch of the 5th Pair^, 
 Ivhich pafTes along the Canal of the Jaw, to 
 ■jTupply the Teeth with Branches: There even 
 liappens a rufliing in the Ear, becaufe from the 
 Trunk of this Nerve proceeds the little Branch 
 that crofiTes the Skin of the Drum •, and the 
 Cheek fcems benummed, both hj Reafon of the 
 StroI:e, and becaufe the little Nerve of the 
 Maxillary that paffes by the Drum, falls intc? 
 the Trunk of the Vonio Dura, which diftributes 
 it felf thro' all the Cheek. 
 
 Befides 'tis known that the lower Maxillary 
 'jbas Communication with the Vortiv Dura co- 
 ll 2 ming 
 
HA 
 
 Acci- 
 dents. 
 
 A Treatise of the 
 
 ming from the Canal of the Jav near tlie 
 Chin. 
 
 Sometimes Convulfions, or convulfive Moti- 
 ons affeft the Lips, and even other Parts, by 
 Realbn of the Communication of that Nerve 
 of the 5th Pair with all the other Pairs of 
 Nerves j the Eyes are inflamed by the fame 
 Caufe. The Saliva flows in Abundance by the 
 Compreffion of the Glands •, and thefe Acci- 
 dents are the more confiderable, when the Jaw 
 is broken nearer the Angle than the Chin. 
 
 Cf the Cure, 
 
 Rcduai- 
 on of the 
 Fradure. 
 
 In reducing the Jaw when broken, one muft 
 obferve of what Kind the difphcing is : If 'tis 
 in Thicknefs, 'tis eafy to help it, by making 
 the Conformation with the Thumb, which 
 prelTes upon the Teeth, whilft the Hand runs 
 along the Bafis of the Jaw, to level the Inequa- 
 lities ; but if the Pieces of the Bone are got 
 over one another, the Extenfion and Counter- 
 Extenfion mufl be made, which does not fecm 
 eafy. 
 Remurk. To compafs this, one muft trim the Index of 
 one Hand, and the Index and mcdiiu of the o- 
 ther with L.inncn ; the Fore-Finger of the one 
 being thruft into the Mouth beyond the far- 
 theft Tooth, muft lerve as a Buttrefs againft 
 the Root of the Apofhyfis Coronoides, and muft 
 thruft this Part backwards, whilft the two Fin- 
 gers of the other Hand being placed under the 
 Tongue, a nd the Thumb of the fam^ Hand 
 under the CJiin, muft draw the Fore-part of 
 the Jaw forwards. Thefe two contrary Moti- 
 ons will make the Extenfion and Counter-Ex- 
 teniion, which will remedy the Difplacing 
 
 length- 
 
 Remark. 
 
Difiafis of the B o N E S. 245 
 
 length-ways, and then the Conformation will 
 be made eafiiy. 
 
 When it is done, the Lower Jaw muft be RemArlc 
 brought near the Upper one, which will lerve 
 it as a Splint, provided it is Sufficiently tur- 
 nifhed with Teeth, and the Teeth anfwer ex- 
 adly to each other ^ if not, it is necelTciry to 
 fill up the empty Spaces with Compreiles, to 
 equalize them, to the End that the Support 
 may be equal and fufficient. 
 
 The Redudion being made, the Comprefs Drcflings. 
 (A) muft be laid upon the Part, fteeped in 
 Aromatick Brandy ^ after that a very thick 
 Comprefs f B) fupported by a Band (C) where- 
 of the Bandage called Chevcftre mnft be made, 
 or elfe it muft be fuftained with the Sling, or 
 Chin-Cloth (D.) 
 
 The Patient muft neither fpeak nor read, nor 
 muft he be allowed the Ufe of any Thing but 
 Broth, Jellies, and other liquid Food, which 
 
 Ri3' 
 
 won't 
 
JFraSbire 
 with a 
 ^ound. 
 
 Obferva- 
 tion. 
 
 Obferva- 
 tion. 
 
 y^ T B^ E A T I S E of the . , 
 
 won't oblige him to move the Jaw. One muft 
 alto prefcribe Bleeding, Potions, and other ger 
 peral Remedies. 
 
 Of the comj^licated Fra^fure of the Lower 
 Jaw, 
 
 The complicated Frafture of the Lower Jaw 
 is not hard to drefs, becauie one may take off 
 the DreFings every Day without Fear of dif- 
 placing the Bones : When they have once beei; , 
 replaced, they kecpfo, bccaufe there are no 
 Mufcles that aft to fcparate them. Thus the 
 Wound that accompanies this FraQure, does 
 not require the Bandage with i8 Tails, nor 
 one with a Hole, as fome Authors have pro- ^ 
 pofed : I have even drelfed a great Number of 
 Wounds by Mufquet Shot, where the Jaw was 
 not only broken, but had Joft two Fingers 
 Breadth of its Length, without ever being in 
 pain for its Difplacing ^ it never happens pro- 
 vided that, after the Dreffing, the proper 
 Bandage above mentioned b^ made. 
 
 Thef^^ b'orts of JBurts are very eafily cured, 
 if Care is taken at firft to bleed vigoroufly, to 
 avoid Accidents ^ and if one is careful, when 
 the Wound penetrates into the Mouth, to hin- 
 der the Sali'vas fpreading into the external 
 Wound, duiinn; the whole Time of the Stench 
 and Putrefaftion, which are infeparable from 
 this Diftemper ^ for when the Wound is per- 
 fectly iuppurated and cleanfed, and the Spittle 
 has; left its ill Smell, it is no longer hurtful. 
 
 When the firaclured Bones are bare, one 
 muft draw the Flefh together, and attempc 
 the Re-union. 1 have ieveral Times fee n the 
 
 Bones acquire new Flefh, the Ca!i-us 
 
 fornfd 
 a;.d 
 
Btfeafes of the Bone s. 247 
 
 and the Wound cicatrize, without any Exfoli- 
 ation's happening, more or lels. 
 
 There was a Man who had received a Kick Obrcrra- 
 from a Horle that had been juft iliod, and the ^^°"' 
 ]i.dge of the Slioe cut the Flefli that covers the 
 jaw, near the Hole of the Chin \ and glancing 
 from this Hole towards the Angle of the Jaw, 
 it laid open the Bone that whole Length, and 
 broke it between the laft Grinder and the Apo- 
 fhyfis Coronoides •, which according to all Appear- 
 ance had not happened, if the Foot of the 
 Horie, which till then had only glanced along 
 the Bone, had not been ftopp'd by the Apofhyfs 
 Coro72oidcs of the Jaw. 
 
 I made the Reduftion, coverM the Bone with 
 t\\Q Shred of FJeih, and brought the Lips of 
 the Wound fo exactly together, by Compref- 
 Xes, Bandages, &c. that the eleventh Day the 
 Re-union of the Wound was made, and altho' 
 the C(tllus was not begun, the Patient let out 
 for the Army, whence he wrote me Word a 
 little after, that he had left off a great deal of 
 the Regime?! I had enjoined him, and that he 
 found himfelf vei"y well after it* 
 
 ^^ CHAR IV. 
 
 Of the Fra^urc of the Ribs. 
 
 IN this Chapter I {hall confid»r what is ca- 
 pable of breaking the Ribs, and the dilfc- 
 rent Ways they may bi fradured, that I may 
 deduce thence the various Means ot reducing 
 tliem. 
 
 K 4. Tlie 
 
^48 ^Treatise of the 
 
 Frafture The Caufes capable of breaking the Ribs, 
 <>^ J^'^*^. , are all bruifing, but fome are more fo than 
 'y^^j^ J others. Thofe which are extremely violent, 
 ' as a Mufquet Ball, or a Shiver of a Bomb, Gre- 
 nade, (^c. may eafily break the Ribs, all-ways, 
 and all-Manners-, but, becaufe thele Sorts oi 
 ]f raO:ures are then look'd upon as Wounds in 
 the Breaft ^ I won't fpeak of them here, that 
 1 may keep wholly to the Examination of thole 
 which being without Wound, ought to be 
 deemed only Diieafes of the Bones. 
 Kinds. The Ribs may be fraftured two Ways •, they 
 may break fo as that the fraftured Ends may 
 bend towards the Pleura, which I call an 
 inward Fracture •, or elfe the broken Ends may 
 lean towards the external Mufcles, which i 
 term an outward Frafture. 
 Internal. That which I ftile an internal Fra£ture, is 
 caufed by a violent external Blow, which 
 thrufts the broken Ends, and forces them to- 
 wards the Pleura. 
 External That which happens externally, proceeds on 
 ^^rafture. ^j^^ contrary from the anterior and pofterior 
 End of the Rib's being comprefs'd one againfl 
 the other by Powers diametrically oppolite, lo 
 that the broken Ends turn outwards. Thus 
 one may break a Bow by bending it. 
 Cafes This Fratlure happens jn two different 
 
 wherein Cafes. 
 
 ^is Fra- -jhe firft is, when of two Bodies that prcfs 
 
 Imnoens ^P^" ^^^ ^^^° Ends of the Rib, one only is in 
 
 firft ' Motion, whilfl the other is at Reft \ as when 
 
 Cafe. a Man lying receives a violent Stroke upon the 
 
 ' ^ foremoft End of the Rib, or when a Wheel 
 
 runs over the Fore-part of a Man's Breaft, 
 
 whilft his Back is aga'nft the Ground-, or in 
 
 fin?,' when any one is preifed a^ainft the Wall 
 
 by 
 
Difiafes of the B o N E s. 34^ 
 
 by the Pole of a Coach, or any other fuch like 
 Thing. 
 
 The fecond Cafe, where the Ribs may be 
 broken outwards, is, when the Powers that 
 prefs the two Ends of the Ribs are both in Mo- 
 tion, as when a Man is fqueez'd between the "'^ 
 Wheels of two Coaches that are driving two j 
 different Ways ^ that is to fay, when one is go- ^ 
 ing upwards, and the other downwards. 
 
 'Twill be eafily conceived by what I have juft ^^^ 
 faid, that whether the two Bodies that com- j^*""*^ 
 prefs are in Motion, or only one of them, if 
 the Compreflion is made on the Line which 
 pafTes from the End of the Ribs to the Vertebra^ 
 the Ribs will approach each other, the Ends 
 will bend^ and if they break, the Fracture will 
 be fo that the middle of their Arch will become 
 more acute, and will throw it felf outwards. 
 
 All thefe Ways the Ribs muft be fradured 
 outwards. 
 ' The difplacing of the broken Pieces is not of the 
 #f onfiderable, becaufe the Fore-part is kept DifpU- 
 clofe to the Sternum, and the Hind-Part to the «'"S- 
 VertehrA of the Back. There can be neither 
 any confiderable difplacing internally nor ex- 
 ternally, and yet lefs upwards or downwards, 
 becaufe the Inter-Coftal Mufdesy which wou*d 
 be capable of caufing the Difplacings, draw 
 each of them equally on their own Sides. 
 
 Sometimes there is but one Rib broken, at 
 other Time, two, three, or tour, and even 
 more. 
 
 The Signs of thefe Fraftures are diagnof^ick, sign?, 
 and Prognoftick \ the diagnoftick Signs are 
 Unevennefs, Crepitation, Difficulty of Breath- 
 ing, and Pain. 
 
 As to thefe two laft Symptoms, they are lefs Symp- 
 in the external, becaufe the Ends of the Bones toms. 
 
 dou'c 
 
350 A T P^E ATI SE of the 
 
 don't prick the Fleura. Befides a leiTer Effort 
 will break a Rib outwards than what will fra- 
 ttureit inwards, becaufe the Blow that ftrikes 
 externally, falls upon a fpherical Body, w]iich 
 refifts lb much the more in that the Fulcrum of 
 the Sternum, and the Fertebra takes oli Part of 
 its Force. 
 
 Tile Unevennefs is never great, becaufe, as 
 we have laid, the difplacinj^ of the broken 
 "i the Pieces is but Ihiall. As for the Crepitation, 
 repita- ^^^^ mvi?c not confound it with a fallacious Noife, 
 cccitful ^^^^ accompanies almoft all Contufions of the 
 loilc Ribs th:\t are attended with an Emphyfema-^ and 
 'tis known that in this Diftemper there al- 
 ways is a hollow Noife proceeduig from the 
 Collifion of the Air, that may be perceived by. 
 the Touch, but which is very different from 
 that caufed by the rubbing of tvyo hard Bo- 
 dies, as arethe.two Extremities of a broken 
 Rib. I have already faid feveral Times in this. 
 Treatife, that the Crepitation and Cllcjuetis 
 inight be difcoyer'd by the Touch, which per- 
 haps feems abfurd, bacaufe the Ear is the Or- 
 gan deftined for the Perception of Sounds. 
 However it be, if I hold twO Nuts in my 
 Hand clench'd, I fhall be lenfible of a Crepi- 
 tation or Rubbing, which will not be percepti- 
 ble to any one near me, and which I Ihou'd not 
 obferve my felf if thele two Nuts were rubb'd 
 in the Hand of any other. This is not a Place 
 to give a phyfical Reafon for it. , 
 
 The prognoftick Signs are derived from the- 
 various Kinds of Fractures, and Accidents. 
 
 As for the Frafture, that which is internal 
 is more troublelbme than that which is exter- 
 nal •, thofe which caule great Pains, with a Dif- 
 ficulty of Brenthiiig, thole which prick the in- 
 tercoftal Nerves, or tliole wh'ch open the 
 
 Blood 
 
Blfeafes of r/j^ B o N E 5, 25 1 
 
 Blood Veffels belonging to them, are the moft 
 dangerous. 
 
 If the Tleura be torn, and one of the inter- Pleura 
 collal Arteries be prick'd by Ibme Splinters, °P^"^* 
 and the Blood fpreads it felt' over the Breaft ^ 
 the Operation of the Empyema muft be made ^ 
 but if the Haemorrhage be confiderable, one Hxmor- 
 need not trouble ones felf about this Operati- rhagc. 
 on, for perhaps the Patient will die betbre the 
 H<^morrh(iic be perceived, or before it be deter- 
 mined what Way to flop it. However one 
 ought not to be in Sufpence about making an 
 Incifion at the Place of the Frafture, to get at 
 theVelfels, and ufe the proper Operations to 
 ftanch the Blood, whether by Stypticts, Li- 
 gatures, or even CompreiTion, tho' th"s laft is 
 hard to practice in this Place. 
 
 if this Fra8-ure were at thefalfe Ribs, there if it is at 
 would be nothing elfe to do but to make an thefalfe 
 Opening in the Bread, confiderable enough to ^^^^* 
 dilcharge the Blood, but if it were one of the 
 upper Ribs, the Wound muft be left clofe, af- 
 ter having ftoppM the Blood, and make the O- 
 peration ot the Empyema at the ufual Place, in 
 Cafe there be any Eifufion. 
 
 The Reduftion is different according to the ReduQi- 
 Kature of the Frafture. If the Ends are on of tho 
 turned inwards, one mufl do the contrary to Fr*"^'^'^* 
 the Caufe that fraclured them: Therefore for 
 this Reafon one muft prefs with both Hands 
 the Fore-Part againfl the Hind-part, to bring 
 the broken Ends outwards, and let them even 
 with the other Ribs. If the Ends are turn'd 
 outwards, which is uncommon, they muft be 
 tliruft inwards, till they are on a Level with 
 the other Ribs. One muft not bear upon the 
 Frailure it klf^ but on bjth Sides, leift the 
 
 iJuirp 
 
552 A T?<E ATI SE of thff 
 
 Iharp Ends of the Bones ihould prick theFlefh, 
 which would occafion confiderable Pains. 
 >rcffings. As for the Application ol the ComprefTes 
 and Bandages, wlmtever the Frafture be, one 
 muft lay upon it the Comprefs (A) half a Foot 
 fquare, fteeped in Aromatick Brandy ; the 
 Comprefs (B) muft be an Inch thick, three 
 broad, and eight long ^ and they muft be laid 
 near the broken Ends, in the external Fra- 
 fture, that they may thruft them, and oblige 
 them to re-enter into their Places. On the 
 
 contrary, when the Frafture happens fo that 
 the Ends are turned inward*-, the Compre/Tes 
 muft be laid upon the Ends of the Ribs, 'viz,. 
 near the Stemumy and rear the Spine, that the 
 broken Parts may be thruft outwards ^ and, to 
 retain thefe Compreffes in this Situation, one 
 muft [\\{)ien tliemon with Circumvolutions made 
 with the Roller (C) four Fingers broad, and 
 four or five Ells long, which muft be fuftained 
 by the Scapulary (D) faftenM with ftrong Pins, 
 ot with b:ft ::^, 1 don't know whether the 
 
 Pre- 
 
Diffaps of the Bone ?• 253 
 
 Precaution ufed by certain Bone-betters in (ew- 
 ing their Bandages every where and very exact- 
 ly, would not be proper to be taken, not tor 
 the keeping on the DrefHngs, that is ncedlels, 
 but to prolong the Time of taking it oil. 1 re- A Sfory* 
 member that I had laid a DrefTing upon a Gon- 
 tufion in the Breaft, and had fiiftened it on with 
 Pins: A Bone-Setter was fent for, they came 
 to give me Kotice of it, 1 was not at home, 
 but at my Return I went to the Patient. The 
 Bone-Setter had taken off my Drefling, and 
 clapp'd on another, affirming that there were 
 two Ribs broken, and one deprelTed ^ I was 
 looked upon as an ignorant Fellow. I had my "^"^ 
 
 Revenge-, 1 perfuaded the Patient, but with 
 Difficulty (fo great is the Prepoffeilion of Peo- 
 ple, and fb hard to conquerj that the Bone- 
 iletter impofed upon him: A Confultation was 
 granted j I was juftified, and the Patient agaia 
 put his Confidence in me, to which the Bone- 
 setter's not coming tho' fent tor, contributed 
 not a little. The Patient was cured of his 
 Contuiion in a little Time, and was convinced 
 of the Bone-Setter's Knavery, who had not le- 
 duced him, if I had lewM my Bandage, inftead 
 of fattening it with Pinsj the Time, it would 
 have taken in undoing it, would have given me 
 the Opportunity of getting foon enough to 
 the Patient's to have met the Bone-Setter, who 
 doubtlefs had not been eloquent enough to per- 
 fuade had I beenprefent. I have told this fhorc p^j. 
 Story, to fhew that the Dreffings may be faften- whom 
 ed with Pins, and that fowing is only proper the Story 
 when oiic has to do with Children who may " "j^ 
 undo their Dreil^ngs, or when one is apprehtn- '2* 
 five of the Knavery, Uiipoliteuefs, ai.jGiec- 
 dinefs of Bone-Setters. 
 
 Sir.cs 
 
Q54 -^ Treatise of the 
 
 Of the Since we are upon this Topick, it will not 
 
 Crack cr \^q improper to fpeak of the cleaving of the 
 
 ■^"* Ribs, 'tis a Term they ufe to exprels an incom- 
 
 pleat Frafture : I believe that in this Frafture, 
 
 Cleaving or Cracking may happen, the Pofhbi- 
 
 lity of it is demonftrable : But how impudent 
 
 jnuft he be who dares to averr it ? Can he fhew 
 
 any Signs of it ? By what Senfe can he difcover 
 
 it ? Is it by the Sight, the Touch, or the Hearing ? 
 
 The Rib is covered j there is no Unevennefs ; 
 
 by what Signs then fhall he have Knowledge 
 
 of it ? On this Occafion an honeft Man is very 
 
 - • much perplexed if he happens to be with a 
 
 • Bone-Setter whb ftiaintains that the Rib is 
 
 crack'd, becaufe if there are no Signs whereby 
 
 to know that the Rib is cleft, there are none 
 
 to difcover that it is nOt. 
 
 Of the The Depreifion of the Ribs is another Difeafd 
 
 Depreiu- ^jj-j^ which the Bone-Setters delude the weak 
 
 Multitude. I don't deny but that the Ribs 
 
 may be deprefs'd by a Blow, a Fall, or fome 
 
 other like Caufe ^ but I deny that there is an^ 
 
 Operation to be performed for the raifnig 
 
 them : They remain no longer lb than during 
 
 the Blow or the Fall ^ their Elafticity with 
 
 that of the Cartilage and the Mufcles raife 
 
 them immediately, and one ought to treit this 
 
 Diftemper only as a Contufion. I fliall fpeak 
 
 hereafter of the DepreiTion, I only merition it 
 
 here en fajfant. 
 
 The Patient mull be blooded feveral Times 
 efter the Reduftion of the Fraclure of the 
 Rib?, efpecially if the Pain be great ^ and he 
 finds a DifHculty in breathing , one mufl pre- 
 Icribe an exaft Diet, give Clyfters, Anodyne 
 Potions, and even Narcoticks *, in a Word, on6 
 muft make Ufe of every Thing that is capable 
 of diminiihing th© Quantity, and abating tji^ 
 
 Motion 
 
Difiaps of the 'Bo NILS. 255 
 
 Motion of the Blood. All this being founded 
 upon one fole Principle, which is that theBreaft 
 is the Work-Houfe or Manuthfture of the 
 Blood, 'tis there that it is attenuated and fub- 
 tiliz'd by the Refpiration •, therefore the lefs 
 Blood there is, the lefs Force is necelTary, 
 and the lels frequent is the Refpiration, for 
 which Reafon the Blood muft be diminihed by 
 Bleeding and Diet. The more its Motion is 
 quieted, the more eafy and foft will be the 
 Breathing ^ the Mufcles of the Breaft will be 
 the lefs in Aftion, and the broken Ribs will be 
 the more in that State of Tranquility that is 
 proper for their Re-union. Clyfters are ufeful, R^me- 
 both becaufe they evacuate the Abdomen^ and ' 
 free it from the tainted Matter that might get 
 into the Blood, ajid becaufe the Diaphragm can 
 more eafily lie even towards the Abdomeriy 
 when it is empty, which renders the Breath- 
 ing freer and lefs conftrain'd. The Patient Pofuion. 
 muft be placed half upright in his Bed, that . 
 
 he may breathe the eafier, and he muft not 
 fpeak, nor do any thing that is capable of in- 
 creafmg the Refpiration. The Bandage muft When 
 not be taken oft" till it bjcomes too loofe, or thcDrcf- 
 incommodes the Patient. {j"S js f® 
 
 The moft grievous Accidents in tliis Difeafe o^-/'^^^^ 
 generally end in 12 or 15 Days, and at the General 
 •Expiration of 30 the Callus is form'd entirely. Events. 
 
 CHAP. 
 
556 A Treatise of the 
 
 CHAR V. 
 
 Of the 7)e£reJfiof?s of the Ribs. 
 
 Whether 'Hr' ^ ^ "°^ ^° ^^ doubted that the Ribs arcf 
 the Rib$ X deprefs'di I have already laid it, but 
 Cnit onemuft be either very ignoraiit or kiiavifli to 
 affirm that they will keep fo without being 
 Whai the fraftur'd : The Ribs are deprefs'd (that is to 
 Deprefli- f^y>^ ^j^^^ ^j^g ^^ ^.^^o Ribj may be thru ft in- 
 
 ®°*^ wards, and in that Senfe not be upon the Le- 
 vel with the Ribs next to them. When this 
 happens by fome Blow or Fall, they recover of 
 themfelves, and refume their Level, as foon as 
 the Bodies that ftrike, or whereon they fall, 
 no longer a£t upon the Place that is deprelTed ; 
 therefore 'tis either out of Ignorance, or to 
 BoneSet- impofe upon the Publick, that thefe Gentlemen 
 ters. jibufe the Credulity of the People, by making 
 them believe that they have raifed the Ribs of 
 Perfons who at moft had but Contufions ^ they 
 even make no Scruple of pretending there are 
 Fraftures where there are not, calling, as a 
 Witnefs to confirm it, the fallacious Noife that 
 accompanies the Emphyfrma. 
 What They hardly ever foretell the Danger of a 
 
 guides Difeafe from the greatnefs of the Diftemper ; 
 thciT*" the mean and fimple Afpeft ot the Patient di- 
 Progno- refts them more frequently ^ every Stroke, eve- 
 fticks. . ry Fall fupplies them with a Subje^ for a Mi- 
 racle, which they render to their own Advan- 
 tage more or lels Great according to the Sim- 
 plicity of the Patient : One fhall have hi« 
 Bones ground to "Powder, or broken into a 
 Thoufand Pieces, who if he were of another 
 Phyfiognomy would have but a fimple Fra- 
 
 fture. 
 
D'lfeafes of the Bo kz S, 257 
 
 fturc, or a DepreJlIon, a Man of Senfe, of 
 tvho is thought a Judge, fliall come oft lor a 
 ftarting oF the News. The foUowing Story 
 will confirm it. 
 
 A Bone-Setter was fent for 1 2 or 15 Years obferrii- 
 ago to iQpk after a Peribn who had falFn from tion. 
 a Horfe, and laid he h:id broken iiis Ribs, 
 the Bone-Setter comina; iound it no hard mat- 
 ter to make it believM that the R'bs were 
 broken, tho' they weie all whole, becaufe the 
 Cries of the Patieiit, and the Pain he f;iid he 
 felt, had already eftablifli"d it as a Truth in 
 the Minds of all the Ainftants, who judged of 
 the greatnefs of his Hurt, by his Cries. 
 
 He diefs'd the Patient as for a Fracture and IH man- 
 
 Depreflion, but the Pains neither ceas'd nor agemenc 
 
 abated, a Fever feizM upon him, at:end^d ^ f ^°"^ 
 
 • iu- A. -JL* 1- Setter, 
 
 wich reachings to vomit, and the Jaundice 
 
 with all its Symptoms ^ and the Patie.it be- 
 
 ijig reduced to the laft extremity, lofing th& 
 
 implicit Confidence he had repos'd in the 
 
 Bone- Setter, had recourfe even to thole whofe 
 
 Counfel he had neglefted taking. 
 
 I found upon him a very great Difficulty 
 of Breathing, a violent Cough, a fpitting of 
 Blood, with his Urine of a brick Colour,, 
 and his Looks wild •, it was the 17th Day of 
 his Fall. 
 
 1 he Bone-Setter having leftthe Patient on my 
 coming, 1 cou'donly know what had been d'''ne 
 from the Affiftants, who told me nlraoft exaftly 
 what 1 have related, excepting thit they were 
 perhvaded that the Patienc's Ribs were broken, 
 and that all hi? illnefs proceeded from their 
 not having been well Set: A fort of Juftice 
 tliey did the Bone-Setter, and real Surgeons. • . 
 
 1 took off the Bone-Setter's uielefs dreilinp^s, ^qJJj-|..qj^, 
 aad exaraiifd the place iilYeiled attentively, i found 
 
 S and the Pafc; 
 
258 A Tp^E AT ISE of th^ 
 
 and found an Oedcnuty but not the lea ft fign of 
 a FraLlure, not even the firft formation of a 
 Callus^ which made me look elfcwhere for the 
 Caufe of the Symptoms wherewith the Patient 
 was alHided. He had tall'n upon the five falfe 
 Ribs of the Right Side, the Skin was a little 
 fweird, accompany 'd with a confiderable Fe- 
 ver, Rednefs, Hardnefs, and fuch a ftiarp 
 throbbing Pain, that I did not at all fcruple to 
 fay, that a purulent Matter was forming, and 
 that there already was fome, but it lay too 
 deep to be percel/'d by the Touch, the rather 
 becaufe I fulpeded the Defluxions being under 
 the Ribs, perhaps even in the Liver, or at leaft 
 in that part of it that join'd to^ the Dia- 
 phragm. 
 
 Havir.g told my Sentiments, two things were 
 requir'd of me : Firft to give a Reafon for the 
 Symptoms of the Diftemper, and fecondly to 
 prefcribe what was neceifary to cure it. 
 MySenti- ^^ comply with the firft, 1 laid, that the 
 ments up- Ribs not being broken, the Diforder proceeded 
 on the from a violent Contufion of the Liver, occa- 
 JDifeafe. fjon'd by the fail upon the falfe Ribs, which 
 Contufion had not been fo great, had th'3 
 Ribs been b'.oken, nor had it been attended 
 with fuch ill Coniequences, but for the il 
 management of the Bjne-Setter, which wa 
 faulty in three things. 
 
 Firft, in that he had clapt on a Sear-cloth. 
 Three ^ Medicine that prevents Perfpiration ; 
 ^h"p* Secondly, this Sear-cloth was kept on by 
 
 Setter!"^' Bandages that were too tight, which oppreJline 
 the Breaft hinder'd the Breathing. 
 
 Tliirdly, he had not blooded the Patient, 
 as he ought to have done, not only to mitigate 
 the Pain, but alfo to avoid the Dc-fluxion 
 which I alie.'.dy believ'd at fuch a heichr, thai 
 
 th« 
 
D/feafes of the IjONE 9,, 25^ ' 
 
 the letting blood thencou'd at moftbut r.bate the 
 Obfl:ruO:ion of the neighbouring P;irt.'<, to pre- 
 vent a Gangrene, which never fnils attending 
 the Suppuration of- this Ibrt of Deliuxions, a 
 Gangrene Co fatal and fb fwift, that it carries 
 off the Patient before the Maturity of tlid 
 Impoflume. 
 
 The fecond Thing that was defired, was the 
 Jnoft requifite, 'twas to propofe means to heal 
 this flital Difeafe, wherein the Gai]gre.:e was 
 yet more to b3 feared than the Irapofthume, 
 becaufe it gave no Time to deliberate. My 
 advice was to bleed the Patient, and repeat f 
 the fam^ as often as his ftrength would per- 
 mit^ to apply all over the Hurt a Cataplafm 
 made with the Pulp of Emollient Kerbs, and 
 Anodynes, obferving a proper Drink, Diet, Method 
 and other things convenient. I went back to of Cur^; 
 Parisy the Day following I found the Patient 
 much better, I bled him again, and orderM 
 it to be repeated at IS ight, and that the Ca- 
 taplafm ihould be continued, which had fofc- 
 iied the Part already fo much that I cou'd feel ,, 
 
 the Interval between the Ribs ^ I found themi ' 
 
 at a greater diftance than in their natural 
 Condition, and carrying my Fingers uiider 
 the Cartilaginous fide of the Ribs from the 
 Cartilage Xiphoides to the End of the laft Rib, 
 I felt a confiderable hardnefs, and the Patient 
 felt very iharp Pains. The next Day I found ^, ^, 
 all the outfide much eafier :; and perceiving pcration 
 that there was a hollow Fluftuation near propofedi 
 the laft of the fiilfe Ribs, I propofei opening 
 the Abfcefs : 'Twas oppos'd, the IJanger 
 leem'd to lefTen, and the Contideiice of the 
 Patient diminifh'd alio, whereas in Perfons of 
 good Senfe it ought to have pr<>duce I a con- 
 trary Etfed. I went then no more to fee' 
 
 S a l>im". 
 
26o A Treatise of the 
 
 h'm, and I was inrcrm'd that a MountebanJc, 
 a great purifier of the Bloody had worm'd himfelt' 
 into h"s good OpiLioji, by promifiiig to make 
 him vo'd the Impofthume by Urine. Having 
 made ufe of thcfe Remedies for Fifteen Days 
 without any Relief, He had again recourle 
 to me. I foifd not refufe vifiting nor taking 
 Care of h'm, and I found fuch long and vio- 
 lent luff nations upon him, that 1 was afraid 
 of feeing him expire in my prefence \ I touch'd 
 the Part affe^ed, which I found much alter'd, 
 the Tumour that lay hid under the fa lie Ribs 
 was turiiM cxtetr.al, and the Fluctuation was 
 as manifeft as in the Dropfie j4fcites. There 
 wa<; alio a Pulfation like that of an Anrurifm^ 
 which did not prevent my propofing to open 
 it, beraufe I had already openM Tumours of 
 this Nature, wh^ch had taught me that who- 
 ever in a I'ke Cafe are apprehenfive of open- 
 ing an Aneurifviy their Fear is ill grounded. 
 Havir.g firfl made a Progroftick to the Pa- 
 
 . " re ts, wherein 1 Ihew'd them the li't'e Hope 
 Deration , ' r ^ i i t ■ '^ 
 
 •nude. t'iCre was or a Cure, and that the only means 
 
 to fave the Patieit was to open the Ablccfs, 
 I lancM ir, aid the firft Day 1 drew out two 
 P'nts of Fus^ the next Day there came out a 
 Pint, the fublequei t Davs to the number of 
 Seven, the Matter diminifli'd continua-l1y, and 
 fbme ot the Symptoms, but the Vomiting and 
 ; Loo'lere's, Fe'-er, ftoppage of Urine, Tu- 
 ticmdics ^^"J^^? ^^''^ Dropfy, carry'd off the Patient 
 the 27rh Day after the Operat'on. 
 
 I ope.i\l the Corpfe, and obfervM that the 
 Abfcefs was be::ween the Fiver and the Dia- 
 fhragrnj fiom its rervcus Ce ter to the Place 
 where ♦^his Mulcle is fiften'd to the lafl of 
 the fa'fe Ri'is^ the Sufpenfory Fiizamei.t wi>s 
 deilroy'd, thj :rupcrficies pf the Liver ulcer- 
 ated 
 
Lifeafes of the Bone s. 261 
 
 ated nlmoft the wliolc extent of the Abfcef*;, 
 the DLiphraim ftuck to the Kib% and to the 
 iiUbriour Lobe of the Right Lungs:, tliere 
 was a Pine of purulent Water diffui'ed over 
 the BrealV, and all the Ribs were entire, 
 without any appearance oi." a Fradure, or 
 Callus. 
 
 It may be remarkM, in this Obfervation, 
 that there being 110 Fracture in the Ribs, 
 tJie Contufion of the Liver was the eTential 
 Part of this Dife^le, and that it only became 
 mortal thro' the Ignorance of the Bone-Setter, 
 who neglected bleeding, and clogg'd the brea- 
 thing by Bandages which had been too tight, 
 e/en if the PJbs had been fractured \ thus by 
 this ill management the Impofthume was 
 cau fed. 
 
 Neverthelefs the Patient might have beeu 
 cured in fpite of all thefe m.iftakes, \t\ i iftead 
 of giving Credit to the fecond Mountebank, 
 they hid let me lance it when I firft propofed 
 ic \ 'twas the time that the Pus began to dif- 
 cover it felf, it had not as yet caufed all the 
 Diforder, and one might with Ibme pro- 
 bability have hoped for a Cure. 
 
 This is not the only Oblervation I cou'd T>efleas; 
 relate, but 'tis one of thofe that proves be- ©n. 
 yond Quertion, the Danger of Iiearkening to 
 thefo vain, prefumptuous Perfons, who cloak 
 their Ignorance under a talkativenels, or elfe 
 under an artful filence, which is always at- 
 tended with the vain and leducing promile 
 of Curing.^ 
 
 S3 CHAP. 
 
262 A T Fv E A T I s E of the 
 
 C H A P. VI. 
 
 Of the FraSltcre of the Sternum. 
 
 TIT E Sternum may be forced in and broken 
 by lome v oler.t Blow •, it is liable to Ac- 
 cidents almoft like thofe of the Ribs *, 'tis 
 even feen fometimes that an inward Httmorrhage 
 happens by Reafon of the Arteries, and Veins 
 of the Bieafts that lye under it, but this is 
 only in great Fraftures, where the Bones, be- 
 ing confiderably thruft inwards, tear or cut 
 the VelTels. 
 
 Diagnojlkk and Trognojlick, 
 
 The Fracture of the Sternum is fometimes 
 hard to be known •, becaufe in a h'ttle Time 
 ithere comes fuch a fwelling as difguifes the 
 Difeaie, and prevents its behig dilcover'd by 
 the Touch •, however it is dangerous not to 
 find ic out at firft, for 'tis often in vain to 
 wait for the end of the Tumour, and other 
 Accidents-, they are fometimes {o fatal, that 
 the Patie.^it expires before they difappear, ia 
 fpicc of all tfie AlTiftance that can be given 
 him. I once open'd the Body of a Man that 
 dy'd of this Diflemper, who had a Gangre- 
 nous Swelling that took up the whole ex- 
 ternal part of the Bread and Neck up to his 
 Ckin •, 1 fou;:d that the fecond Bone of the 
 Sterr.um was thruft in, and comprefs'd tlie 
 Heart, that there was abundance of bloody 
 Water in the Pericardium and the fides of the 
 Breafl. 
 
 I have 
 
Difeaps of the Bones. 263 
 
 I have oblerv'd that a Man is fubjc^t to a Obrcrva- 
 dry Cough, with a Palpitation of tlie Heart, »ions. 
 and difficulty of Breathing, after having the 
 lower part of the fiift, and upper part of the 
 fecond Bone of the Sternum forced inwards •, 
 becaufe the DeprelTions not having been raifed, 
 caufe an internal fwelling and clog the Refpi- 
 ration. 
 
 Spitting of Blood, violent and frequent Symp- 
 Coughing, Suffocations, and a Fever are bymp-toms. 
 toms almoft infeparable from the Fradure of 
 the Sternum. 
 
 Where the Pain and other Symptoms con- Error in 
 tinue after the Reduction of the Bones, an Praftife. 
 Abfcefs will be form'd under the Sternum, the 
 Perfons fptt purulent Matter, and have all 
 the Signs of the Peripneumonia. It is therefore 
 of great importance to difcover and reduce 
 this Fraelure, and if 'tis impolTible to fucceed Rcmark- 
 with the Hands, one muft not hefitate at able o- 
 making an Incifion upon the Place affected to pcration. 
 find out the Fracture and raife the Bones 
 with the Elevator, Trepan, or other Inftru- 
 ments. 
 
 The Example of FraOrures in the Cranium Parallel 
 authorifes us-, they make crucial Incifions to of th<r 
 difcover them, 'tis not a fault even if one don't ^^jaftures 
 find a Fradure, on the contrary it relieves the ^ ■ 
 Patient, by giving the Pericranium and other 
 Teguments an opportunity to difcharge them- 
 felves. Why therefore ihould a Part be re- 
 fpefted, where the Incifions are in themfelves 
 much lefs dangerous than thofe of the Cra- 
 nium ? Befides it is not lefs important to dif^ 
 cover the Fractures of the one than of the 
 other. 
 
 Tfje 
 
264 
 
 A Treatise ff the 
 The Cure» 
 
 Operation To ralfe the Sf^>';;:/w,tIieBrea{l mufl be prefs'd 
 from Rii^ht to Left, and ffom Left to Right, 
 which obliges the Ribs to advance forwards, 
 and raife the Sternum by thruiting out their 
 Cartilati,c5 : If this way is infufficient, and 
 phe Accidents are fatal, there is no danger in 
 pnaking an Inciiion, and raifing the pieces of , 
 BonGy as has been laid •, and even if an Abfcefs 
 were form'd under the Sternum, for want of 
 remedying ic at the Begiiniing, the Trepan 
 may be apply'd •, as is done to the Cranium, to 
 dilcharge the Fus, or even the Blood, and raile 
 the pieces of Bone that are forced in. 
 
 Drefllr?. The Drefiir;g is very plain •, for the fimple 
 F/acture there is only need of two Com- 
 preiTes (AA) fteep'd in Aromatick Brandy, 
 and a Body-bandage (B) fupported by a Sca- 
 pulous (C.) And if one has made an Incifion 
 or Trepan, the Wound mull be drels'd, as 
 it Should be otherwife, always ufing 
 Compreifes, a Body-bar.dage, and the Sca- 
 pulary. 
 
 i 
 
Vifeafes of the B o N E s. 265 
 
 CHAP. VII. 
 
 Of the PraSlure of the Offa Ilia and 
 Tubis. 
 
 TH E Offa IIU, and Os Pubis feldom break ; 
 1 have often feen both the one and the ^7 Mines 
 other happen to Soldiers, who, being blown 
 up by Mines, fall down again upon the Guns, 
 or other hard Bodies : The moft part of thefe 
 Fractures were without Wounds. Thofe with 
 Wounds are very common in the Army, by By Fire- 
 Musket-fhot and other Fire-Arms, we ihan't Arms, 
 mention them in this Treatiie. 
 
 The OJfa Ilia may .be fraftured different Several 
 ways -J if they are broken Crofs-ways, the Ways of 
 Creft of the OJfa Ilia is removed from the^^i"g 
 reft of the Bone, becaufe the Gluuus Major ^^^^^ 
 and Medlus, which are ftronger than the JUack 
 Mufcle, carry the broken part on their fide, 
 and the oblique Mufcles of the Abdomen have 
 not force enough entirely to oppofe it. 
 
 The Fraclure is hard to difcover when sicns. 
 there is a fwelling, and 'tis feldom that there 
 is not one, becaufe a Blow that will break 
 fuch a Bone, muft make terrible Contufions on 
 the Mufcles, Membranes, and A^omurofes ot 
 thofe Parts. 
 
 When there is no Tumour, the Fra£lure iscjgnj^ 
 eafily found out by the Touch, and the Cre- 
 pitation, which one muft not confound with 
 the noile ot the Emphyfcma. 
 
 The Accidents that attend this Fracture are 5 _ 
 Pains, at the Part affected, occafion'd bv the toinsF' 
 Contufion, and by the tearing, the Prickings 
 
 and 
 
J Treatise of thff 
 
 and other Divulfio.is that are made by the In- 
 equalities of the broken Bones. 
 
 The Belly becomes ftretchM, inflam'd, hard, 
 and bound, and the Gripes, the Hickup, Vo- 
 miting, Stoppage of Urine are generally the 
 Conlequences. 
 
 Trognojlick, 
 
 'Tis more difficult to retain the Bone, than 
 to reduce it \ the Danger is great when the " 
 j^ccidents above mentioned meet, efpecially if 
 the Patient's Pulfe be low, and his extre- 
 mities cold. 
 
 Death is unavoidable if in his Vomitings 
 he brings up a Matter like Chocolate : This 
 Matter, which is nothing but the Blood con- 
 geal'd by the Menftrum of the Stomach, 
 fiiews that fome Veifels are broken in that 
 Inteftine : I have never known any recover 
 that had this Symptom •, aad it moftly comes 
 after a ftroke upon the Region of the Sto- 
 mach, the Reafon is eafily conceiv'd. 
 
 Of the Cure, 
 
 To make the Reduftion, the Patient muft 
 be plac'd on the Bed-fide, lying o;i the fide 
 oppofite to the Fradare, having two Pillows, 
 upon one of which the upper Part of the 
 Body muft reft, and upon th^ other his 
 Thigh, Leg and Foot, fo that the Part op- 
 ■ pofite to the FraO:ure is not fnpported by 
 any Thing, and the fra£lur'd fide is bent, 
 that the Mufcles of the Abdomen and the 
 Clut.-ii are f-fliciently relax'd, and the Re- 
 duftion of the fradured Piece may be made 
 with th^ Hands. Aft^r the Redutlion, the 
 
 broken 
 
Difeafes of the Bones. 
 
 broken Bone muft be fix'd with two or three 
 Strong ComprefTes (AAA) dip'd in Aromatick 
 Brandy ^ they muft reft upon the dilplaced 
 Bone to retain it in its right pofition, and 
 muft extend along the Belly and the Thigh. 
 They muft be kept on by the Band (B) lour 
 or five Ells long, and four Fingers broad. 
 
 2^7 
 
 If general Remedies, and efpecially bleed-* 
 ing are neceifiry in any Diftemper, 'tis in 
 this. One muft make ule of every thing to 
 prevent the Inllamation of the Ahdomeny which 
 is a terrible Accident. 
 
 CHAP. VIII. 
 
 Of the FraSlure of the Clavicle. 
 
 THERE is no Fradure more fubjefl: to Rd-n^rt 
 difplacing than that of the Clavicle, be- 
 caule it cannot be broken but by an external 
 Blow, which thrufts and forces the Pieces to- 
 wards the Breaft, and that moreover the 
 
 weight 
 
268 A Treatise of the 
 
 weight of the Arm c.irries one of the Pieces 
 downwards, whilft the otlier ^s rais'd up- 
 wards by the Mulcles. 
 
 It is difplaced length-ways and breadth- 
 ways^ the Caiifes of its beijig difplaced 
 breadth- ways are ftrokes, and the weight of 
 the Arm which draws the Shoulder down- 
 wards, and conll'qaently that part of the 
 Clavicle that is join'd to it: Herein that 
 which is next the Sternum keeps in its place, 
 being retain'd there by the Mufculous part 
 of the Sternocllncma^oideuS' 
 ifpla- jhe Mufcle Veltoidcs draws the other End 
 °S* downwards, becaule the Clavicle, which was 
 the Stay, is no longer fo after its being 
 fraftured, whence inftead of drawing the Arm 
 towards the Clavicle, by its contraction, it 
 draws the Clavicle towards the Arm, that 
 part of the Clavicle being become the move- 
 able point, and the Arm the fix'd one. 
 
 It is diiplaced length ways, becaule the 
 Arm, being no longer fuppo.rted by the Cla- 
 vicle, falls upon the Breaft : 'Tis known that 
 in its natural ftate the Clavicle ierves as a 
 Stay, and keeps the Arm at a diftance from 
 the Bre.ift, thn it rriAy move vvith Eafe; 
 therefore when 'tis friiClur'd it can no longer 
 ferve for this purpofe, a id the Arm being no 
 more kept outwards mufl fall upon the Breaft, 
 the rather by reafon that the Omoplata and 
 the Arm are drawn on this fide, the one by 
 the little, and the other by the great Peroral, 
 which drags the End of the Clavicle that is 
 joinM to the Acromium, and makes it pafs uo- 
 der rhe End that is join'd to the Sternum. 
 
 The Signs whereby to know this Fracture, 
 arc the fame with thofe we have given in 
 
 general 
 
Difeafis of the Bones. 269 
 
 general for all ^ but theie is one more certain, 
 that is, the tall of the Arm upon the Breaft. 
 
 The Caul€S are Strokes, Falls, and violent Gaurcs.J 
 Motions. 
 
 The Prognoftick is the liime as is drawn 
 from other Fractures in general : One may 
 Hiy moreover thit the Clavicle is more eafily 
 broken than the other Bones, both becaule 
 external Blows have more Power, (as it is 
 fituated parallel with the Horizon, and mcft 
 part of the Strokes which one receives fall 
 perpendicularly upon it) and becaufe it is nei- 
 ther cover'd with Mufcles nor Fleih that c';\n 
 deaden the Blows. A Iblid Body cou'd hardly 
 be better placed than the Clavicle to be broken ; Rcmarlc 
 it refling only upon its two Ends, whilll the 
 remainder of it has no fupport at aH. 
 
 The Frafture of the Clavicle is eaify to be Rcmarfc 
 reduced, becaufe the Extenfions are not hard 
 to be made, and becaufe it being lefs cover'd 
 with Mufcles, is lefs difficult to touch and 
 grafp with the Fingers, efpecially in fuch 
 as are lean. 
 
 It is harder to keep in its pla:e than other 
 Bones, for three Rea Ions. 
 
 Firft, Becaufe it is fmall, and the Ends that 
 are reduced touch but by a very little Sur- 
 face. 
 
 Secondly, The Bandage can't furround the 
 Bone, as in the Arm, or Leg, and it is difficult 
 to place Compreifes -^ and even they, it one is 
 not very careful, thruft in the Pieces of the 
 Bone, and produce an-ElIe^l almoit like that 
 which caus'd the Fracture. 
 
 Thirdly, The Arni\i.«nd the Mufcles feem 
 continually to draw the Clavicle towards rha 
 Sternum, unlcfs one takes the PrecTutiont which 
 \v^ ihall lay down in the Cure hereafter. 
 
 To 
 
570 ^Treatise of the 
 
 The Cure To reduce the Clavicle when broken, the 
 Patient mull be feated on a low Chair. 
 
 A Servant muft fee his Knee upon the 
 Spine, between the Omo^Ut^, and take the 
 two Shoulders, that is to fay, the Ends of 
 the Omoplatay and the Arms with both Hands, 
 and, having placed himfelf conveniently at a 
 proper height, he muft draw the Shoulders 
 equally backwards, whilft he thrufts the 
 whole Body forwards with his Knee, which 
 makes the Extenfion and Counter-Exten- 
 fion. 
 
 The Surgeon ought to ftand before the 
 Patient, and when he perceives that the Ser- 
 vant has made the Extenfion and Counter- 
 Extenfion, he brings near and adapts* the 
 Ends of the Clavicle with his Fingers •, and 
 in putting on the Dreilings, he appoints a 
 fecond Servant to keep the Bones thus join'd 
 together, whilft he performs the reft of the 
 Operation. 
 
 But when the Bones have no Stay, and 
 can't be kept right, 1 lay on a longitudinal 
 Bolfter (G) two thirds of an Ell long, and two 
 Fingers broad •, then over it I make a Figure 
 of 8 with the Band (H) 3 Ells long, and 
 two Fingers broad. The Crofting of the Fi- 
 gure of 8 muft be between the Shoulders, 
 and the two Circles muft turn round the 
 Ends of the Acromion on each fide, fo that 
 this Bandage keeps the Shoulders backwards, 
 and does the fame thing as is before men- 
 tion'd in making the Extenfions. 
 
 After the Application of this Roller, the 
 Stopples (AAA) muiWDe clap'd on to fill the 
 Hollows, wherefore one muft prepare feveral 
 (AAA) beirg made of Lint or Tow dip'd 
 in the White of an Egg : Over thefe I lav 
 
 tlve 
 
Difeafes of the B o N E s. ^ji 
 
 the Crucial (BB) cover'd with the Gomprefs 
 (C) and the whole muft be hept on by the 
 deicerding Bandage Spic^^ made with the 
 Roller "(D) 5 Ells long and 4 Fingers bread. 
 After this the two Ends of the longitudinal Bol- 
 der (G) mull be turn'd back over the Breafc • the 
 one from the Right fide to the Left, and the 
 other from the Left to the Righ*-, con- 
 trary-ways to each other, and one muft 
 faftcn them with llrong Fins. Thefe two 
 Ends thus reversed contrary-ways hinder the 
 Figure of 8 from flipping backwarvis, and 
 fecure the whole Baniage. Then the Arm 
 Diuft be placed in a Scarf (E) and th- Pellet 
 
 (F) ill 
 
272 ^Treatise of the 
 
 (F) in the Hand. The Elbow mud be brought 
 forwards, and not carry'd backwards as 1 
 have f(?en Ibmetimes, for this pofture is coi> 
 1^ rained •, befides, it thrufts the Clavicle for- 
 wards, inftead of drawing it backwards : 
 Therefore the Elbow and tl:e Hand muft 
 be brought forward as much as poiTible with- 
 out making the Patient too unealy^ 
 
 Ol'fervatio?is, 
 
 Altho' the Fracture of the Clavicle be eafy 
 to be known, the following Obfervation ihews 
 that Perfons may be miftaken in it, and that 
 a great many have Eyes without making ufe 
 of them. 'Tib' true a Man muft be ignorant 
 of the firft Principles of his ProfeJTion to be 
 deceiv'd therein, and indeed thofe of whom 
 I'm going to fpeak, were no great Conjurers : 
 Ke^erthelefs one was the Favourite Surgeon 
 of one of the greateft Families of the Blood 
 Royal, and the other was a Bone-Setter. A 
 young Man of 22 fell from his Horfe, and 
 bruiVd the End of the jicromion which pro- 
 duced an Ecchymofis ^ he was blooded feveral 
 Times, and had ComprefTes fteep'd in Brandy 
 laid jjpon the Part, which Cured him. 
 
 A little after he difcover'd a fwelling on the 
 middle of the Clavicle on the fame fide, which 
 pain'd him very confiderably •, one of my 
 Brethren, whom he confulted, ibund out his 
 X)iftemper -^ but the Patient wou'd not give 
 credit to him ^ he went to the Surgeon that 
 had been recommended, who was of Opinion 
 that he had broken his Clavicle in his fall, 
 and that, his Surgeon not having difcover'd it, 
 it had clos'd again of it felf, which had oc- 
 cafion'd a Deformity in the Qillus. After this 
 
 the 
 
Difenfc's of the Bon ES. 275 
 
 the Young Man had rccourfe to a Bone-Setter, 
 who told him tluit his Clavicle muft be broken 
 ngaiii to replace it better ^ he came thereupon 
 to confult me, and f, having examinM Jiim, 
 and ask'd him feme Queftions about Times 
 paft, found that this Tumour was a 
 Venereal Exofiojis, which I er.c luntring 
 with Mercurial Fridions, procured him a 
 good conditiou'd Flux, and cured him per- 
 feaiy. 
 
 There are two Things to be remark'd in the 
 «Error of thefe Gentlemen -, the firft is their ha- 
 ving taken this Swelling for a deform'd Caf/uSf 
 and the fecond the advifmg the Patient to break 
 this fuppofed Callus, to fet the Bones again 
 better. 
 
 As to the firft, I fay that this Difeafe coni'd 
 not reafonably be taken for a Deformity of the 
 Callus, becauie the Clavicle had not been bro- 
 ken, which is proved by three Reafons ^ firft-, 
 becaufe the Patient did not complain at the 
 Time of his Fall, of Pains in his Clavicle, and 
 ^tis known he would have felt very iharp ones 
 if that Bone had been broken. 
 
 Secondly, altho' the Callus had been form'd, 
 the Arm would have been found in an unnatu- 
 ral Pofitio.i, as it always is when the Clavicle. 
 is broken^ that is to fay, it would have been 
 unfteady, and without Force, refting upon the 
 Fore-part of the Breaft, becaufe this Frafture 
 never happens without the Bone's being di/pla- 
 ced, as has been faid. 
 
 The 3d Reafon wherefore they were in the 
 wrong to take this Tumour for a deform'd 
 Callus, even if there had been a Frafture, is, 
 that the Redu^iion not having been made, the 
 Callus, inftead of being found at the middle ofe 
 rJie Clavicle, as was this Patient's Tumour, 
 
 T muft 
 
274 ^Treatise of the 
 
 muft have been near the Acromion^ as 1 have 
 fmce feen it in an Officer of her ferene High* 
 rids the Dutchefs of Brunfwick. This Officer 
 had his Clavicle broken in Provence^ and not ha- 
 ving found any one there that could reduce it, 
 the Pieces had re-united of themfelves one up- 
 on the other, fo that the End that is joined to 
 the Sternum went over the End that joins to the 
 Acromion : And as, at that Time, the Arm, and 
 coafequently the Otnoplata draws always near 
 the Bieaft, the End of the Clavicle that is join- 
 ed to the Acromion was come nigh the Sternum^ 
 a^id that which is joined to the Sternum, near 
 the OmopJata -^ fo that the nutritive Juice wh^ch 
 had flow'd from the latter, had form'd a Cal- 
 ius an Inch from the Acromion, a Place whera 
 the Calms had not been form'd if the Clavicle 
 had been reduced. 
 
 How then can any one advife the breaking the 
 Clavicle again when there is a Deformity in the 
 Callus, iincethe Callus of the C/^u'c/f is general- 
 ly deformed, however well it may have been 
 reduced ? The Realbn is becaufe the DrefTing 
 can't comprefs the nutritive Juice near enough ^ 
 befides, one may give this Advice, when the 
 Deformity proceeds from the Bones being got 
 one upon the other. This may be difcovered 
 by two Things^ firft, when the Callus is near 
 the Acromion, as has been faid •, and fecondly, 
 when by meafuring the Clavicles, that which is 
 hurt proves fliorter than the found one ^ but 
 when both are of the fame length, one muft 
 be very ignorant to be deceived therein. I 
 concluded that the Swelling of the Patient be- 
 forementioned was an Exoftops from three in- 
 difputable Points •, firfl, bsc.^ufe the Length of 
 the Clavicle was the fame as before. Secondly, 
 it had not been reduced j and thirdly, he had 
 
 h:^ 
 
Difeafes of the B o N E S. -27^ 
 
 rhad venereal Diftempers, whereof he had ne- 
 ver been well cured. 
 
 CHAP. IX. 
 
 Of the FraSlure of the Omoplatao" 
 
 TH E Omoptata may be broken either in its 
 Body, or its Appendages : Its Body may 
 be broken but in two Pieces at the moft, its 
 Epiphyfes, as the Apophyfes Acromion^ the Coracoi- 
 desy the Sphie, and its Neck may be fraftured 
 aifo. I have never feen the Apophyfs Coracoldes 
 broken, but by Gun-Shot. 
 
 The Body of the OmopUta may be broken Kind#»- 
 long-ways crofs-ways, or obliquely ^ when ft 
 is broken long-ways, the Sptny Apophyfis is bro- 
 ken a-crofs," and then there can hardly be any- 
 great difplacing, becaufe the" Surface of the, 
 fraftured Spine is confiderable, which makes itl 
 difficult for the Bones to get one upon t'other t 
 On the contrary, when it is broken acrofs or 
 obliquely, the fractured Pieces are fo thin, and 
 confequently the Surfaces whereby they are 
 join'd, that the lead Contraftion of the Muf- 
 cles force one Piece over the other, let the 
 Blow have feparated them never fo little, or 
 the Mufcles of one Side have got the better of 
 thofe 0:1 the other. For this Reafon I have 
 almoft always ^een the hind Part under the 
 Fore-part, on Account of the Scrraius Majoir 
 and Sub-ScapuUris, which being fixed to the 
 iBaJis make it turn topfy-turvy -^ then the In- 
 fra SpinatuSy Kotundus Adajor and AUmr draw 
 it under the Fore-Part, more or lefs. 
 
 T2 The 
 
21^ ^Treatise of the 
 
 The Signs, whereby tkis Frafture is known, 
 are the fame with thofe we have given oK all 
 Fradures in general, and befiies there is ge- 
 nerally an Emphyfema. 
 
 I have already obferved the Emphyfema to be 
 a Symptom that attends Fractures, and even 
 great Contufions on the Reg-on of the Breaft. 
 I hive not explained it, which methinks I ought 
 to have done: And there are a great many 
 who perhaps will not be able to imagine how 
 the Emphyfema, which is a windy Diftemper, 
 can come where there is no VVound, thro"" 
 which the Air might get in : The Emphyfema 
 has been feen -n Wounds in the Breaft, and in 
 thofe of the Afpern Arteria^ and it has been ea- 
 fily comprehended that the Air that ijfuesout, 
 or enters ia at thefe Openings, may lodge in 
 the Sacculi Adlpofi that are adjacent ; hat 'twill 
 b3 askei wlience comes the Air that forma the 
 Emphyfema, which, (as I have faid) accompa- 
 nies the Frai^lures and Contjfions of the Ribs, 
 and thofe I have obferved in Fra^ures of 
 the Omoplata, where there is no Woui>d : The 
 fubfequent Obfervations will aiifwer this Que- 
 flion. 
 
 ift. Obfervatlon, the Wounds that pene 
 trate the Breaft, or that pierce the Trachea, are 
 not the only ones that are attended with an 
 Emphyfema \ this Symptom happens alfo in thofe 
 that do not penetrate; we hive feen feveral 
 of this Kind, and likewife many that did pe- 
 netrate where there has been no Emphyfema, 
 
 id Obfervation, the Emphyfema often accom- 
 panies Wounds in the Ahdomen, whether they 
 penetrate or not, I have o^'ten known it ii: 
 Wounds in the Arm and Thighs, and they 
 who have (cen a great many Wounds by Gun. 
 (hot, know th^c^there are few but whathavg» 
 
 this 
 
 J 
 
Bifenfes of the Bone s. 277 
 
 this Symptom, if they havrebeon never f()IIrtle 
 expaled to the Air before their firit Drei- 
 lings are put on. 
 
 • 3d Obrervarioii, a Cobler returning from 
 VauxgirArd to Paris^ was lb cudgel T J, that he 
 was bruifed to the very Bone in feveral Parts 
 of his Body \ all the Places that had b^^en (truck 
 made a Noife, and almoft his whole Body be- 
 came one Errtphyfema : He died, I opened him and 
 was very much lurprized at finding Air every 
 whore, the Knife cut no one fat Part but it 
 made a Noile^ and what I remarked, which 
 was very particular, was, that almoft all the 
 Mufcles had loft their natural Confiftence, 
 and made no Manner of Kefiftanre to any 
 Thing, whether one drew them long-ways or 
 in-crofs, they were equally eafy to be fepa- 
 I rated. 
 
 ! 4th Obfervation-, there are Impofthumes o- 
 ipen'd every Day, out of- which, jointly with 
 the Pus, there iifues Air that makesaKoile, 
 as if it came from a Bladder blown up •, one 
 may even fee Part of the Pus frothy or in a 
 Foam. 
 
 5th Obfervation, are not Gangrenes, that 
 come after EryfipeUtnus or Phleamomus De- 
 jluxions, attended witJi an Emphyfenu ? 
 
 From all tliefe Obfervations a Mi^n may 
 conclude, that there are two Sort-^; of Emphy- 
 femas ^ one whereof is caufed by the external 
 Air that ilTues out of the Wounds of the 
 Lungs, Breaft, oxTyachcay which is that men- 
 tioned in the firft Obfervation. 
 
 The other Sort muft proceed from ilie Rare- 
 fii^lion of the Air that is found in the Juices 
 and the Subftance of the Parts, which is tliat 
 jOf the three laft Obfervations ^ and indeed^ 
 fwhea there is no Wound, one can't believe 
 
 T 3 ^^'^t 
 
27$ ^Treatise of the 
 
 Conclufi- that the external Air has enter'd to form thefe 
 on of the £m^.{jyfemr'.s •, nor that the Air of the Breaft and 
 Cbicrva- j^mjj;5 j^j^g aot thither, at leaft not by fenfiblc 
 Openii-gs, fmce there is no hurt in the Lungs 
 nor Breait : It proceeds then from the Fermen- 
 tation of the dilfus'd Juices, which difuniting 
 the elfential Parts of the Liquid?, breaks the 
 Prifoiis of the Particles of Air, which, being 
 no longer confined, dilate themfeWes, rarety, 
 and uniting together, form an Emphyjcma. 
 
 PrognoflicL 
 
 If the Frafture of the Omoplata is fimple, 
 and without any confiderable Contufion, it is 
 not fatal ^ on the contrary, if it is attended 
 with a violent Contufion, a Tumour, Emphyfe' 
 nta. Fever, Pain, and Difficulty of Breathing 
 wiii follow, and there is great Danger, efpeci- 
 aliy it the Patient be fat, Cacochymick, or Pie" 
 thoriel. 
 
 Cure, 
 
 The Reduction is pretty difficult to be made, 
 
 when the Bones are ditplaced, and the Pieces 
 
 are got one upon the other :, becauiethe OmofUta 
 
 is covered with ftrong Mufcles, and one cannot 
 
 get the better of them by the Extenfions, for 
 
 want of having Hold of the Pieces, that muft 
 
 M ual ^^ brought even with each other. However, 
 
 Operati- 'tis for this End that they raife the Arm for- 
 
 op, wards, pattiiig the Hand upon the Head, io 
 
 that the Nofe is over againft the Angle of the 
 
 bending of the Elbow. Whiift an AiTiftant 
 
 ]^■eeps the Arm in this Pofition, the Surgeon 
 
 does his utmoft to replace the Bones with his 
 
 ti^igers, to the doiiig whercot the Mufck? 
 
 Rhom - 
 
Difeafes of the Bone s. 27^ 
 
 Rhomhoidcs contributes very much, bccaufe It 
 retains the hinder Piece near the Spine, whilft 
 the Surgeon brings the Bones together. When 
 they are reduced, one muil keep them right 
 with both Hands, cauling tJie Arm to be let 
 down Ibftly, and Ibllowing the Omoplata till ic 
 be above the hinder Part of the Ribs, which 
 lerve as a taftening to it on that Side. To fa- 
 flen it on the outfide, they fix the thick Com- 
 preJfes (AA) from the Spine ot" tJie Omoplata 
 to underneath the lower Angle, which mult 
 reach down towards the Back-Bone, and they 
 cover them, and the whole Shoulder with the 
 large Comprels (B.) Then the Bandage Qua- Drcfling, 
 <iri^a muil: be made with the Roller (C) four 
 Fingers broad, and live or fix Ells long, more 
 or lefs, and the Arm muft be placed in the 
 5carf(F) with the Pellet (E) in the Hand. 
 
 I. 
 
 T4 
 
 jHi 
 
58o 
 
 General 
 
 3leme- 
 
 dics. 
 
 Firft 
 VVuy ro 
 raiic the 
 Bone. 
 
 Second 
 Way. 
 
 Preflirs 
 
 y^ T R E A T I s E of the 
 
 The Patient muft bleed plentifully, his Re- 
 gimen ihould be ft rift, and he muft keep filent 
 and quiet, as in the Fraftures of the Ribs and 
 Sternum. 
 
 If the Acromion be fraftur''d, they endeavour 
 to raifc it one of thefe two Ways. The firft 
 is by raifing the Arm to relax the Deltoides and 
 putting the Ends of the Fingers as far as one 
 can under the Acromion and the Clavicle^ to 
 draw them upwards. 
 
 The fecond Way is to tal<e hold of the El- 
 bow to thruft the Humerus upwards vertically, 
 and to make Ufe of the Head of the Bone to 
 thruft the Acromion upwards and raile it. 
 
 They put on the Coniprefs (A) fteepr, and 
 ir.ake only a contentive Bandage with the Band 
 (B) then they ufe the Scarf (C) with the 
 Pellet (F.) 
 
 Obieiva- 
 tion. 
 
 The Keck of the OmofUta cannot be broken 
 but with great Difficulty, becaufe it is defen- 
 ded by a great many Mufcles, by th« Acromi'\ 
 »Hy the Clavicle^ and tlie Fjjead of the Humnus \ 
 
 nevei- 
 
Difi/ifes of the Bone s. 281 
 
 neverthelefs I have feen it broken near the 
 Edge of the Socket. It was eafily reduced, 
 but very hard to contain, and the Patient con- 
 tinued lame. 
 
 ObftWatmu 
 
 I was one Day at a Conftiltation for a Lady 
 who had fallen about fix Weeks before, and a 
 great many fruitlefs Attempts had been made 
 to reduce her Arm, which we lound difloca- 
 ted. The Confultation was famous, all Sorts 
 of Minifters of Health were there, and even 
 the Bone-Setter who had the Patient un- 
 der Cure, who affirmed that the Bone was well 
 fet, and that if fhe did not ufe her Arm, 'twas 
 becaufe the Socket of the Omoplata had been 
 broken, and that therefore there was both a 
 Luxation and Fracture. Thofe who were ex- 
 perienced in the Art were not fatisfied with 
 thefe Words, they would have Proof?, and 
 they defired no other of him but to tell the 
 Signs wherebv he had difcover'd that there 
 was a Fradtire of the Neck of the Omoplata: 
 He could not give us any, which would have 
 been very eafy for him to do, fnice the Que- 
 ftion was about a Thing of fix Weeks land- 
 ing, whereof he had been the only W^itnefs, 
 "Upon this only, his having no Proofs, we 
 might conclude that his Allegation was falfe ^ 
 befides, he had faid nothing in fix Weeks, and 
 'tis known that thofe Gentlemen don't ufually 
 make Diftempers lefs dangerous than they 
 are. He thought to creep out at this Loop- 
 Hole, but he did not know the Way ^ the 
 Reduction was made in his Prefence, and he 
 faid not a Word, which was wonder'd at. 
 
 'Twas 
 
282 A TkE ATISZ of thff 
 
 'Tvvas then demanded whether the Fra^ure 
 oi the Humerus^ and tlie Fraftiire of the Sides 
 of the Cavity oi" the OmopUta, cou'd happen 
 togetlier. All the Perlbns of good Senle, and 
 expert Praftitioners agreed, that it was mo- 
 rally impoJTible lor Reafons founded upon the 
 Strudure of the Parts, and the Laws of Mo- 
 tion. 
 
 The Structure of the Articulation fhews 
 that the Tiling is impoilible : Firft, becaule 
 the Sides of the Cavity is much harder than 
 the Head of the Humerus j and tlierefore in 
 flriking againft each other, the latter would be 
 broken fooner than the former. 
 
 Secx)adly, The Head has a great deal more 
 Surface than the Cavity, therefore when a Bo- 
 dy which has much Surface, ftrikes againft a 
 Body harder than it felf, the hardeft Body 
 muft refill:, and the fofteft mufl be broken in 
 Pieces. It may be objeded to me, that a Can- 
 dle being fliot from a Gun will pierce a Deal 
 Board, whofe Body is much harder than it felf: 
 'Tis true, but if this Candle did not come End- 
 ways, where it has leaft Surface, this would 
 never happen, whatever Force were given it. 
 
 The 3d Reafoa why the Heid of the Hume* 
 rus cannot break the Side of the Cavity is, 
 that it is not fliot from a Diftar.ce like a Can- 
 dle •, on the contrary, it immediately touches 
 the Cavity. 
 
 The 4th is. That the Omoplata is a Bone 
 whereupon the Head of tlie Bone does not 
 bear in a Line of Gravity ^ and befides, it has 
 no Bone that ferves it as a Stay, to make it 
 able to refill: ^ on the contrary it gives Way, 
 and all the Motion that the Head of the Bone 
 imparts to it is deaden'd and loft in the Fleih, 
 
 and 
 
Bifenfes of the BoNZS, 285 
 
 and other foft Bodies wherewith it is incom- 
 palFed. 
 
 5. Let us fuppofe that 30 Degrees of Mo- 
 tion are fufiicieuc to hixate the Arm, what 
 muft happen when in a Fall thefe 50 Degrees 
 are communicated to the Head of the Hume' 
 rus ? I aulwer that the Determination of the 
 Motion muft decide it ^ if the Head be deter- 
 mined by a Line that does not tend to the Ca- 
 vity, it will be forced out, and the Remainder 
 of its Motion will he imparted to the Parts 
 adjacent ^ if it is thruft by a Line that falls 
 upon an excentrick Point, the Head may be- 
 beaten back a little, and if its firft Determina- 
 tion be liOt deftroyed it may again diflocate ; 
 and if the Head moves upon a Line that ter- 
 minates in the Center of the Cavity, it will 
 not come out in that Cafe, and if the Motion 
 be ftrone; enoueh to caule a Fracture, it will 
 be the Head, and not the Socket, which will 
 be broken. 
 
 From this laft Reafon it may be concluded, 
 that if the Bone luxates, neither the Head nor 
 the Cavity are in Danger, and that if it does 
 not luxate, the Head fuffers all, and the Sock- 
 et refift?. 
 
 I have known this Cafe happen, a Man fell 
 upon his Shoulder, having been juft run three 
 nr four Times through with a Sword ^ I was 
 caird, he complain'd more of his left Shoul- 
 der whereon he fell, than of his other Wounds, 
 whereof he died 24 Hours after. I opened 
 him, to give an Account of it;, I examined 
 the Articulation of the Shoulder, wherein I 
 found tliat the Head of the Humerus broke h:to 
 feveral Pieces, and the Cavity 07f*o/Vfj was en- 
 tire. There was no luxation, the Arm was 
 only diiplaced by Reafon of the Fracture. 
 
 CHAP. 
 
234 >^ T R E A T I S E of the 
 
 CHAP. X. 
 
 0/ the 'FradiiYc of the A)m. 
 
 IT muft be obferved in the Fracture of this 
 Bone, thatitluffers lefs difplacing length- 
 ways thanotherwii'e, on Accountof the Weight 
 of the Limb, which oppofes the ContraLtioii 
 of the Mufcles, that ufually caufe the Difpla- 
 cing. But for all this Weight, there would 
 Tieverthelefs be a difplacing length-ways, if the 
 Bone were fraclured in its upper Part above 
 the Infertion of the Mufcle Deltoides -^ becaufe 
 the Force of this powerful Mufcle, aifjfted by 
 the BiccpSy and the long Extenfor of the Fore- 
 Arm might get the better of this Weight. 
 The difplacing being little, theie reeds but a 
 _ . ._ flight Extenfion to reduce it. 
 jj^^ In performing this Operation, an A/fiftant 
 
 holding the Arm with both his Hands, the one 
 upon the Fore-Arm near the Wrift, and the 
 other near the jointing of the Elbow, mufl 
 rai(e it up gently and by Degrees, whilft the 
 Suriieon, fuftaining the two fraftur'd Ends, 
 railes them with the fame Softnefs as h"s Af- 
 fiftant, till the Arm almoft makes a right An- 
 gle with the Body. 
 
 Thiiigs being order'd thus, the Extenfions 
 muil be made by two other Aififtants -^ one 
 whereof muft take hold of the Head of the 
 Humerus^ and the End ot the Omcplata with 
 borh Hands, and the ether mult grafp the 
 Humerus near the Articulation of the Elbow. 
 The latter drawing makes the Extenfion, and 
 the other refifting, or even drawing, makes 
 
 ^ the 
 
Difeafes of the B o N E 9« 285 
 
 the Counter-Extcufioii. Tlie Surgeon being at- 
 tentive to what palTes, muft endeavour to adapt 
 the Ends of ehe broken Bones ^ but he mull 
 not begin this Operation till he judges the £x- 
 tenfions fufficieiit, and he muft oblerve all that 
 we have faid, in our general Account, on this 
 Subjeft. 
 
 One muft ufe a Scarf, which fhould be as 
 fhort as poffible when this Bone is fraftur'd 
 crofs-ways -, but when 'tis broken obliquely, 
 it muft be ty'd loofe, that the Arm may hang 
 down, and the Weight of it may withftand 
 the eafy mounting of the Bones one upon the 
 other : The Arm muft be hinder'd from mo- Remark 
 ving towards the Ribs, becaufe that Motion upon the 
 wou'd caufe a fecond Difplacing. When the Drcffing, 
 Frafture is in the upper Part, a rollM Band 
 muft not be ufed, becaufe the Roll of it can't 
 eafily pafs under the Arm-Pit, which would 
 oblige one to make fbme Motion outwards that 
 would be very hurtful •, for this Reafon in 
 thefe Cafes they ufe a Bandage with eighteen 
 Tails. 
 
 The Signs, the Prognofticks and putting on 
 of the Drefting are as in the Fractures of other 
 Limbs. See that of the Thigh, or of the Leg. 
 The Drefhngs muft be cut out after one of the 
 Manners here engrav'd. 
 
 Fir/l Plate. 
 
 Apply the fimple Comprefs (A) for a Fra- 
 fture of the Neck, or near the Neck of the 
 Humerus ^ ap.d make ufe of the Bandage with 
 leveral Tails (B) of the Comprefs made like 
 a Cylinder (C) under the Arm-pit, ofthetwo 
 Comprelfes (OR) to wrap round the reft of 
 the Arm and the Fore-AiAi, <3t the Pellet (F) 
 
 to 
 
A Treatise of the 
 
 to put in the Hand, of the Roller (G) to fur- 
 round the Whole, and laftly of the Scarf (H.) 
 
 Second PrinU 
 
 IftheFrafture is in the under Part, they 
 ufe the fimple Comprefs (A) the Band (B) 
 then another B^nd (C,) after this the 3 longi- 
 tudinal Bolfters 1.2. 3. they are made faft 
 with the Roller (D,) the Fore-Arm being co- 
 ver'd with .he Comprefs (E,) and the Pellet 
 and Scarf put on as beforemention'd. 
 
 CHAP. 
 
Bifeafes of the Bones. 
 
 287 
 
 CHAP. XL 
 
 Of the FraiBure of the Fore^Arm. 
 
 TH E Fore- Arm has two Bones, tlie Cu- SmiQun 
 bit us and the Radius, which are jointed 
 above with the Humerus and below with the 
 Wrift, leaving between them a Space that pro- 
 ceeds from the bending of thefe two Bones \ 
 the one a little inwards, the other outwards. 
 They are both join'd at their two Extremities •, 
 and the Space that is left in the Middle Vz. 
 wholly fill'd up the whole Length of it by a 
 ftrong, but fmall Ligament, that adheres both 
 to the Ohe and the other. 
 
 They may be broken either both together, Kinds. 
 gr feparately '- The Fracture of both may bi 
 
 eafily 
 
288 J Treatise of the 
 
 eafilv known by the Signs we have fpoken of 
 ill General. 
 &gns. The Frafture of the Cubitus is fooner difco- 
 
 verM than that of the Radiusy becaule it is lefs 
 cover'd with Mufcles, and it is the principal 
 b'upport of the Fore-Arm : But in judging of 
 the Fra«^ure of the Radius^ 'tis elfential to 
 hold the upper Part ot the Fore-Arm with 
 one Hand, whilft with the other one makes 
 the Handof the Patient alternatively perform 
 How the the Motion ot Supination and Pronation^ and 
 Crcpira- if at that Time the Radius is found to refifc 
 /fw^k.* the Hand that holds the upper Part, and 
 ^ .J makes an Effort againft it to move in Pronati- 
 on or Supination, one may be alfured that 
 there is no Fra£l:ure. On the contrary, it the 
 Bone is broken, it will not refift, and a Crepi- 
 tation will be heard, becaufe the under Pare 
 of the Radius in moving, will rub againft the 
 upper Part, which is kept, as it were, im- 
 moveable by the Hand that holds the upper 
 Remark. Part of the Fore-Arm. This would not hap- 
 pen frequently, if one were only to move the 
 Patient's Hand in Pronation or Supination, 
 without holding the upper Part ;, for it might 
 very well follow the under one, altho"* the Bone 
 were broken, which muft not be ; for there 
 muft abfolutely be but one Piece in Motion, 
 to the End that the Crepitation may be felt, 
 or elle both of them muft move contrary 
 Ways. 
 
 The Ends of the broken Bones may be 
 difplaced two Ways, either in length, by 
 getting one upon the other, or elfe in thick- 
 nefs only, which both together are of greater 
 thicknefs than the one was wheii whole. 
 
 As to the difplacing length-ways, I know 
 It may be disputed me in Fratlures of one 
 
 Bone 
 
Difeafes of th^ Bo N E s. 28^ 
 
 Bone only : But I flnll prove it hereafter To 
 as to leave no Room to doubt it. 
 
 I pals on to the Difplacing in Th^cknefs 
 which may happen two ways. The firft, is 
 when the Bones are not entirely feparated in 
 Thicknefs, that is to fay, th:it their broken 
 Ends ftlll touch a little : The fecond, is when 
 they are brought near the Cubtus, which hap. 
 pens becaufe the Rotundas and the Quadratu;, 
 two Mulcles that help the Pronation, work 
 together, and drjivv tU«ie Pieces of the Bona 
 towards the Cubitus. ' " ' '/^^^''^^ '^' ' 
 
 It muft be obfervM, that'tHefe Mufcles, in The 
 drawing the fraftur'd Bones towards the C»- Peiccs of 
 bitvs^ draw them a little inwards, that is to ^ \^g " 
 fay, on the Pronation fide \ which the round brought 
 Mufcle does with moft force, becaufe it is in- near the 
 lerted farther from the Point of Adhefion of Cubitus, 
 this Piece with leTpeft to it alone, than it 
 was before the Fracture with refpeit to the 
 whole Bone: For 'tis known that this Mulcle 
 inferts it felf at the middle part of the Radlnsy 
 and if the Radius is broken at that Place, the 
 Mufcle at that Time is entirely remov'd from 
 the Point of Adhefion, becaufe it is quite at 
 the End of this Piece of the Bone, which gives 
 it more ftrenpth to draw it. 
 
 The Mufcle Quadratus carries al(b the lower 
 Part inwards, \vhich however it can't do with 
 fo much Eale, nor fo much Force as the 
 Rotundus. 
 
 Having explain'd why the Ends of the 
 Bones draw near the Cubitus, the Difplacing 
 length-ways muft be prov'd, for the Adhefion 
 of this Bone with the Cubitus withftands this 
 Difplacing. Neverthelefs, to prove it, one 
 Jieed only remark that the two Ends of the 
 Bone cannot incliiie towards the Cubitus, 
 
 U without 
 
290 
 
 Difpl*- 
 
 length 
 
 A Treatise of the 
 
 without approaching one another, and that 
 if their Ends don't meet, they can't draw 
 near the Cubitus: But if they are difplaced 
 in Thicknefs, and the Ends don't meet, then 
 they will be brought near the Cubitus, which 
 they can't do without mountinga littleuponone 
 another, becaufe the Radius is a little crook'd. 
 You need only look upon this Figure, where 
 I fuppole the Radius frallur'd at the Point (D) 
 I fay, firft that the End CM) of the upper 
 Part of the Radius will be carry'd by the In- 
 fluence of the round Mufcle (AD) towards 
 the Cubitus, not by the right Line (DG) but 
 by the crooked Line (DF). 
 
 I fay, 
 
B'lfeafes of f;&«? B o N fe s. ^9 i 
 
 I fay, fecondly, that the lower Part of the 
 Fadius mark'd (1.) will be brought near the 
 Cubitus by the Ac.lion of the fquare Mufcle 
 (BSj not by the right Line (DGj but by the 
 crooked Line (DE) lb th;it the End (L) of 
 the Radius being got to (E) will be mounted 
 upon the End (M) of the Radius that is got 
 to (Fj by the whole Quantity of (EF). 
 
 Obferve that not one of thefe difplacings 
 wou'd happen, if at the End of the fradlur'd 
 Bones there ihouM be any little i:ieqdalicies, Remark; 
 fharp Ends or Splinters j becaufe they wou'd 
 lock themfelves one in the other, and op- 
 pofe the difplacing •, thus there are Fraftures 
 found where there is but little difplacing, and 
 confequently little Extenfion faffices to reduce} 
 them. 
 
 But where there is a difplacing, Extenfioii 
 and Counter-Extenfion muft always be made : 
 If the Ends of the Radius are near the Cabitusi 
 the Surgeon muft bow down the Hand on the 
 fide of the Cubitus, that he may raile the lower 
 End of the Radius, ih that by tliis means he Manual 
 will make the Extenfion and Counter-Exten- Opexatioa 
 fion, necelfary to mend the difplacing length- 
 ways J and he muft prefs with one Hand the 
 Fore-Part of the Fore- Arm againft the Hind- 
 Part, and wich the other the Hind-Part againft 
 the Fore-Part ) to the End that the Mufclei 
 that are before, being thus thruft againft thofe 
 that are behnid, may be oblig'd to lodge 
 themfelves between the Radius and the Cubitus 
 Which they can't do without raifing the 
 Pieces of the broken Bone. 
 
 The fecond thing done by this Civcie Pref- 
 fion of the Surgeon's two Hands is,- that it' 
 helfjs the difplaci.ig in thickneft, by making 
 ^vhat we have eallM the Conforniation. There 
 
 U 2 iie«is 
 
^92 A TKZ ATI SZ of the 
 
 needs no precaution to prevent the Bo les fe- 
 paracing trom each other, btcaule they arc 
 retain'd by the inter-oiTal Li^iuueiit. 
 
 When they are reduced, lome lay Splii.ts 
 upon the Ends of the broken Bone^, tvhich 
 ought carefully to bo avoided, for, far fionh 
 beariiig upon the. frnftur'd Ei:dF, the Bands^ 
 Corriprtlles, and Splints muft be fo piaced aa^ 
 to produce almoft the fame EJfclk as ohe 
 "Hands of the Surgeon in reducing tlie Bones > 
 -That is to fay, that afrer iiaving put on a 
 Dicfling. £niple Comprefs, aiid the ftrft Band flightly 
 iaften'd, two thick Compreffes muft be laid on, 
 one upon the internal and tke other upon the 
 external Part, which being both held on, and 
 prefs'd by the fame Band, thruft and make 
 an effort agairft eich other, by oppofing 
 themfeives agaii:ft thedifplacing of the Bones 
 e'ther in length or thickrefs, and by this 
 means they will eafily contain the broken 
 Pieces, becaufe they thruft the Mulcles into 
 the fpace that is between the Boiies, which 
 keeps the Pieces always rais'd ^ b^fides the 
 Effort even of the Mufcles in coi.tr ading 
 themfelves will zt\ m Favour of the Bo;:e5, 
 by the Refiftance of the Compreffes that op- 
 pofe their external fwellings, for which 
 Re^fon the Comprelles mull ad upoii the 
 middle. 
 
 Over this fecond Band they put a third, 
 or they ufe the reft of the lecor^d, it 'tis 
 long enough to make fome Circumvolutions 
 round the Hand, borh to keep it without 
 Motion, and to i'Aien a Pellet that keeps 
 the Fingers half bent. Then they put on 
 two Paftboards cut luitable to the Part, antl 
 afterwards they place the Hand and Fore- 
 Aim ill a Scarif^ the Fore-Arm aud the Hand 
 
 bciiii; 
 
Lifiafes of the B O N E S. 293 
 
 being in a commodious and natural Situation, 
 lb that the Mulclcs be not conftraiu'd. 
 
 As to the Cubitus, 'tis obferv'd that the' 
 upper Piece is alw.iys in its place, whilft the 
 ui)der one is broui^ht near the Radius by theQ^^j^^ 
 means of the Square Mufcle, provided there Cubitus, 
 is no Urirp End or Splinter of a Bone tliat 
 with-holds it. 
 
 Some there are who believe that the Cubitvs, 
 when fradur'd, throws it lelf outwards, but 
 Experience iliews the contrary^ in compli-_,j. 
 cated Fradures it has always been remark'd ^-^j^^ 
 that the upper Pare of the Cubitus is in its 
 Place, aiid that the lower End is brought near 
 the Radius. Befides 'tis demonftrated that nei- 
 ther of thefe Bones, nor of their broken 
 Pieces can be dilp laced by removing from each 
 other, becaufe the inter-olFeous Ligament al- 
 ways retains them. 
 
 The upper Part can't come near, becaufe 
 there are no Mufcles that can draw i: inwards, 
 and 'tis impolhble it ihou'd throw it lelf out-) 
 wards by leparating from the Radius, becaule* 
 the inter-olleous Ligament withftands this le-' 
 pa ration. 
 
 <4t is not the flime with the lower Extre- 
 mity of the Cubitus, which may be brought 
 near the Radius by the influence of the Square 
 Mufcle •, for altho' this Mufcle be defign'd for 
 the movi.ig ot the Radius, it produces a quite 
 contrary ElTeft on this Occafion ; for whe.i 
 this Piece of the Cubitus to which the Quadra- 
 tus is faften'd, breaks, and is lepa rated from 
 the upper one-, it necelfarily follows that it 
 can no longer be the fix'd point of the Qua- 
 dvatus, and that therefore this Mufcle dra^^s 
 tins Piece towards th^ Radius, rather th;m the 
 Radius towards the Piece, becaufe the Radius 
 
 U 3 has 
 
^P4 ^ Treatise of thi 
 
 has two points that fupport it, one at the 
 Arm, aiid the other at the Wrift •, and the 
 lower Piece of the Cubitus has no longer any 
 but that below. 
 
 As to the ReJuclion it is the fame with 
 that of the RmI:us with this Diilerence that 
 the Hand muft be turn'd towards the Thumbs 
 to make the Extenfion, whilft one prefTes the 
 fraftur'd Part with both Hands. 
 
 The Bandage muft be made as for the Ra- 
 dius, with this Exception, that there is not fo 
 much care to be taken to make faft the upper 
 Part of the Cubitus, becaufe it can only move 
 in Fleftion and Extenfion, which muft be hin- 
 dred by the Scarf. 
 
 When bDth Bones are fraftur'd, one muft 
 obferve almoft the fame Circumftances, which 
 muft be deduced from the ftruO:ure of the 
 Part, which ought always to be kept in view, 
 not only in this Operation, but in all others. 
 
 The breffing confifts of a fimple Comprefs 
 (A) fplit, of two thick Compreifes (BB), of 
 three Bands (i) (2) (3) of one large Paft- 
 board (C) or two little ones (DD), faften'd 
 with two Straps (HH) of a Comprefs that 
 furrounds the ^Hand (E) of a Pellet (F) to 
 fill it, and of a Scarf (G) to fupport and in- 
 clofe the Hand, the Fore-Arm and the El- 
 bow. 
 
 CHAP. 
 
Lifeafes &/ the BoNES. 29S 
 
 U4 
 
 CHAP. 
 
296 A Treatise of the 
 
 CHAP. XI. 
 
 Of the Fratlurc of the Thigh, 
 
 T 
 
 H E Bone of the Thigh may be broken 
 in its upper Part, its Middle, or near 
 the Knee : Both the one and the other of 
 thefe Frafture- either happen a-crofs, or ob- 
 liquely ^ it feldom is broken in feveral Pieces, 
 becaufe this Bone is cover'd by a number of 
 Mufcles th^t deaden the Blow. 
 
 The Caufes, Diagnoftick and Prognoftick 
 Signs, are like thofe in other fimple Fradures, 
 therefore we ihall only of treat of the Cure. 
 The Bone broken crofs-wife is eafier to Cure 
 than if 'twere obliquely, there being nothing 
 to do after the Reduftion, but to make a 
 common Bandage : The Reft of the Cure 
 bjing as we have prefcrib'd in the general 
 Account, except the fituation of the Patient, 
 and the Ways to alleviate, and eafe him in 
 his Keceflities. Hereof we fhall fpeak very 
 much at length in the treating of the Oblique 
 Fracture which muft be look'd upon as one 
 of the Rocks upon which the Art of Surgery 
 often fplits. 
 
 In general one muft make the Extenfions, 
 Counter-Extenfion, aud Conformation to re- 
 duce the Fradures of the Thigh-Eone, as has 
 been faid in generjil, and as we fhall fay 
 hereafter in the Fracture o[ the Leg. 
 
 The Reduction of the FraO:ure of the Thigh 
 being made, the Drelhng muft be put on, viz.. 
 The limple CompreJs (A) which covers the 
 fraGur'd Part. It muft be fteep'd in Aro- 
 
 matick 
 
Difeafes of the B o N E S. 
 mat'ck Brandy, then three Turns muft be 
 made over the Fratture with the Band (B) 
 which is employ 'd in making TrulTes al'cend- 
 ing upwards towards the Groin, then muft be 
 put on the Band (C) which alio makes three 
 turns over the Part, and Ends jiear the Knee 
 in Truil.s. 
 
 297 
 
 When 
 
2^9 ATrkatise of the 
 
 When the two Rollers are taken up, the 
 Part muft be equalized by the graduated Com- 
 prels (M) being tliicker on one fide than on 
 the other -^ then they place the longitudinal 
 Bolfters, t, 2, 3. which ferve as Splints, and 
 they are made faft with the Band (D) which 
 begins near the Knee, and ends at the Groin. 
 Thi<; done they clap on the two Paft-boards, 
 (CC) one within and the other without and 
 they are ty'd with the Straps (GG). 
 
 The Bandage and the Paft-boards ought be 
 Something more T^ght when the Frafture is 
 oblique, than when it is crofs-ways, becaufe 
 that in the latter the broken Bones are fup- 
 ported, as it were of themfelves, lb much 
 the more in that the Mufcles a£ting, thruft 
 the Pieces of the broken Bones againft each o- 
 ther, and ftrengthenthem, whereas in the other, 
 each End of the broken Bones being of an 
 oblique Figure, cannot heir one upon another, 
 and the working of the Mufcles make them 
 flip, and get one upon the other, wherefore 
 the Bandage muft be tighter, bDth to prefs 
 the Pieces of the Bone, to pre ferve them in 
 their right Pofition, and to keep the Mulcles 
 extended, that not being able to contraft 
 themfelves with the fame Force, the Bones 
 mav be retained in their right fituation. 
 
 Having put on the Binds, ComprelTes, and 
 Paft-boards, one muft faften two Straps 
 (NN) one above the Condyles of the Knee, 
 and the other abo"^e the AlaHeolij and befides 
 one muft pafs a great Cloth, or a half Sheet 
 bet veen the Thighs, one end within the Groin, 
 i^nd the other beh'nd under the oppofite But- 
 ton k to bd faften'd to the Head of rh2 Bed, 
 one end on the R'ght Pi:d the other on the Left. 
 This do.ie the Junks (B) muft: be put on, 
 
 which 
 
Difeafes of the Bones, 
 
 which muft reacli the one from the Sole of 
 the Foot to the Groin, and the other from 
 the Sole of the Foot to the Cri/^a of the OJfa 
 JlUy to the end tliat they may keep the Foot, 
 the Leg, and the Articulation of the Thigh 
 with the Jschion at reft, fo that all that can 
 be ft ill, may be fo. 
 
 299 
 
 The 
 
gco ^Treatise of the 
 
 The Junks muft be trimmM with httle 
 Cufhions, or the Compreires, i, 2, 3, 4, 5, 
 <^> 7> ^) 9- ^vhic'h are to be put from th^- 
 Hip to the Foot, to fill up the inequalities;' 
 and to the End that the Junks may be fo well 
 adapted aa to make an equal Comprefhon, 
 they put on a long Comprela (F) which rea- 
 ches from the Foot to the Groin, over which 
 theStraps tio that tye the Junks. They put on 
 a Sole (Hj faften'd by its double Strap, 
 which fjrves to keep it firm on each fide •, 
 and to the end that the upper extremity ot' 
 the long Junk may be kept very fteady, they 
 pafs the Napkin (K) round the Body above 
 the Junks, to which they fix them with ftrong 
 Pins •, then they make taft the Knee-Strap to 
 the Foot of the Bed, to retain the Thigh 
 downwards, and keep it at its full length, 
 whilft the Sheet which is faften'd to the Head 
 of the Bed with-holds the Body, and prevents 
 it its being carried down. But^ becaufe the 
 Cloth or Half-Sheet might at length incom- 
 mode the Patient, they change the Ends from 
 Time to Time, putting the Right to the Left, 
 and the Leh: to tiie Right. In the feme 
 manner, to eafethe Patient, the Strap whi^h is 
 ty'dto the Imall of the Leg (and which we have 
 not before men tion'd) .lerii£S when he finds 
 himfelf incommoded by that at his Knee, 
 for then they faften it to -the-Foot of the 
 Bed, and loofen that at the Knee, doing thus 
 alternatively as he is hurt by the one or 
 the other. The Quilt of the Bed muft be 
 perforated, for fear the Rump fhou'd ^all, 
 which might be fatal, and one has the Con- 
 venience of putting a Bed-Pan between the 
 Quilt and the Mattrefs when then Patient 
 wou'd go to Stool, arid that he may do it 
 
 with 
 
Difeafis of the Bon Eu 501 
 
 with Eafe, the under Sheet is of two Pieces, 
 which meeting at the Buttocks there is no- 
 thinu; to be done, but to fepanue'therti. 
 
 At the Foot of the Bed there rnuit be a 
 Board hxed^^ ^hereunto they nail a Billet, 
 covert wkh a little Quilt, againft which the 
 Patient may thruft his found Foot to eafe 
 himfelf, by bearing againft it to raife him- 
 felf from Time, to Time, when having ilip'd 
 dovvnwards, he finds himfelf incommoded by 
 the Half-Sheec that goes between his Thighs ^ 
 for by thrufting the Sole of his found Foot 
 ^^aii.ft the Billet, he raifes himfelf hetter than 
 two Perfons couM do it for him. The Board 
 is alio convenient when the Frafture is a-crofs, 
 becaufe then they neither make u(e of Straps 
 nor a Half-Sheet to withold the Sick Perfbn, 
 and it is proper the Feet, even that which 
 is hurt, ihou'd reft againft fomewhat. 
 
 That the Patient may move himfelf with 
 the more Eafe, a Cord fKou'd be faften'd to 
 the Ceiling, and come down thro' the middle 
 of the Bed's Tefter, within reach of his Hand, 
 which is very ufeful. 
 
 One muft examine the Rump very often, 
 for in fpite of all one's Care it fometime galls, 
 and a Gangrene follows. 
 
 In this Cafe the Vulnerary Water is ufed 
 with good fuccefs, wherewith they bathe the 
 Parr, then they clap on fome Storax fpread 
 upon a foft Paper or fine Linnen, which is all 
 that is particular in this Frafture, the reft of 
 the Management is to be found in the general 
 Account, wherein we have treated of it very 
 mufh at length. 
 
 SECT. 
 
309 -.4 T R E A T I 5 E of the 
 
 SECTION 11. 
 
 Of the FracHure of the Neck of the 
 Femur, 
 
 TH E Keck of the Femur breaks either in 
 its middle near its Head, or near the 
 great Trochanter. 
 
 When it breaks near the Head, fome take 
 this Fracture for the coming off of the £p*- 
 phyjisy and others for a Luxation, neverthelefs 
 there are figns whereby one may diftinguiih 
 all thefe Difeafes. Thefe three Fraftures have 
 often been taken for Diflocation, There is 
 even an Example in the famous Amhrofms 
 Faraus, who was miftaken therein, and relates 
 his Error with all poilible lincericy •, a fm- 
 cerity very uncommon in the Age we live 
 iiij and of which we have hardly any Example 
 fince Hippocrates. Ko Man need be alliamed 
 of his Faults but when he has neglected be- 
 ing inftru^ted ;, a fincere Confeilion accom- 
 pany'd with the Circumftances, 'is often more 
 ufeful then fuch Difcourfes as are di£lated by 
 felf Love ^ which ferve only to render a Book 
 as tedious for its length, as the little worth 
 of the Work. We Ihou'd perhaps have fewer 
 Volumes to read, but more obligations to the 
 Authors, if inftead of only relating their fuc- 
 cefjfal Prafl:ice they had only treated of their 
 Faults. 
 
 I can't therefore forbear blaming the Au- 
 thor of thefe Books fo ftufTd with frivolous 
 Tri!ies, that they nevjr make amends for thtf 
 
 Fains 
 
Difeafes of the Bo li E^, 303 
 
 Pains one has been at in reading them ; I 
 blame yet more thole, wlio, tar from running 
 this Rifcjue, negled the Advantage of read- 
 ing fuch as wou'd inftru^l them. 
 
 Paraus had never been read by him who, 
 having taken a Frafture of the Neck of the 
 Femur for a Luxation, and thinking he had re- 
 duced the Bone, contented himfelf with re- 
 taining it by a fimple Bandage. The acute 
 Pains which the Patient felt after this pre- 
 tended Reduction, made him doubt his Con- 
 dition, and fend for me to be afTured of it i 
 He who had drefs'd him affirmM that the Bone 
 of the Thigh had been diflocatcd, but 1 found 
 that the Redu£lion had never been made be- 
 caufe the Thigh that was hurt was ihorter 
 than the found one. The Bandage being un- 
 done> I perceiv'd the great Trochanter four 
 Fingers breadth higher than it ought to be; 
 the end of the Foot and the Knee were turn'd 
 inwards, which, join'd to what had been told 
 me, made me believe that the Bone was dif- 
 locatcd^ but taking hold of the Foot and 
 turning the End outwards without Refiftance, 
 I difcover'd that there was Fradure at the 
 Keck. I reduced it, and drefs'd it, following 
 all the Rules I have laid down in the fimple 
 Frafture of the Thigh, and the Patient was 
 cured without Limping. 
 
 Several Refle^lions that may be ufeFul in 
 Praftice, may be made upon this Obi'ervation ^ 
 the firft relates to the Signs, whereby one dif- 
 covers the Fra£lure. jit leems, by what 1 have 
 jfcjft faid, as if the eafy turning the End of 
 the Foot inwards and outwards, were the only 
 Sign by which I found it out •, neverthelefs ic 
 is not the only one ^ but in the Cale in Quefti- 
 'ini il; proved that there was a Fradiire, and 
 
 that 
 
504 A Treatise of the 
 
 that it cou'd only be at the Neck of the Femur* 
 That this may be comprehended, I fay that when 
 a Perlbn that is hurt lies upon h-'s Back, ex- 
 a£lly in a ripht line from Head to Foot, 
 his Legs and Thighs ftretch'd out by the fide 
 of each other, if the Malleolus hnernus of one 
 fide is higher than that of the other the 
 breadth of three Fingers, and the FotuU in 
 proportion, all this lower Extrem ty will be 
 ihorter than the other three Fingers breadth, 
 which cannot happen after a Fall, but whefe 
 there is either a Fracture or Luxation. Then 
 if upon moving the Ciid of the Foot it can be 
 turned inwards or outwards with eqaal Eale, 
 I fay there is no Luxation, becaiife it has been 
 demonftrated, in the Chtpter of the Difloca- 
 tion of the T/iigh, that, when the Bone is luxa- 
 ted on one (ide, the Mulcles draw the Limb 
 on the other, and that it can't without Pain 
 be carry M on the fide contrary to that whi- 
 ther it is drawn by the Mufcles, thus there 
 is no Luxation, and there muft be a Fra- 
 fture. 
 
 Obferve than that when the Neck of the 
 Femur is broken, the Head of the Bone re- 
 mains in its Socket, with part of the Neck •, 
 the Femur no longer having any Eminence to 
 withold it, noth'ng can hinder its turning at 
 the will of the Hands that mo^^e it. 
 
 What deceives thofe who don't examine 
 narrowly, is that in touching the Femur, they 
 find it entire its whole length from the Tro- 
 .chanter to the Condyles ^ but they will be fully 
 convinced of what Lve faid, when they make 
 the Extenfions to reduce the Femur, which 
 they believe diflocated :, for wh^n by that 
 meaiiS they have brought the fraftur'd Pare 
 • pf it near that piec<j oi the Neck that keeps 
 
 with 
 
Lifeafes of the Bone ». 305 
 
 with the Head, which is in the Cavity, they 
 will hear the Crepitation, and tliea the in- 
 credulous will be obliged to own that they 
 have mift iken if they are Honeft \ tJiis is what 
 1 had to lay of the bigns of this Diftemper. 
 
 As to the Caufe of it, what I have fcen is 
 this. The Sieur Co/In, a Mafter Taylor, and an 
 Koneft Man, hav-ng a mind to drop down 
 from a Wimiow Ibmewhat high, llip'd along 
 tlie Wall, holding the Ledge of the Window 
 >yith his Hands ^ and when he thought he 
 vyas come as near as he cou'd to the Pave» 
 menr, that lie might fall from a lefs height, 
 he let go his hold, and fell to the Ground 
 upon both his Feet, but unequally, for the 
 right Foot came firft •, thus all the wc'ght of 
 his Body, which receiv'd a confiderable ad- 
 dition from the fwifcnefs of the Fall^ fell 
 upon the Right Thigh, Leg, and Foot ^ tho 
 Foot, Leg, and Thigh bore the ihock, b^caufe 
 the Line of Direction of the weigiit of the 
 Body fell perpendicularly upon them, and 
 the Neck of the Femur broke, for a contrary 
 reafon, becaufe of its oMiquity. 
 
 As to the Cure, it conlifis in making fuffi- 
 Icient Extenfions, and Counter-Extenfions : And 
 'to keep the Bone right, one m.ufb manage as 
 in the oblique Fradure of the Thigh, to 
 which I refer you. 
 
 To finifh this matter, 1 muft fav a Word 
 about the Decolement, or coming olf of the 
 Ep/phyJ?s \ viz.. i**. If this Difeale b^ pojhble, i'^. 
 IJie :5igns whereby to know it, and in the 
 3d place way to Cure it. 
 
 Tirft 
 
3c6 A Treatise of the 
 
 FIrft one muft deftiie this Word * Decolement^ 
 which is equivocal ^ it may be taken tor the 
 leparation of the Head from the Neck, in the 
 Senfe that one fays a Criminal has been be- 
 headed •, or elfe one may underftand by this 
 Word, the feparation of the Epiphyfis from 
 the Neck, looking upon the Cartilage that is 
 found between them as a Cement that joins 
 both Parts. 
 
 In the firft Signification, all the Fra£tues 
 that are beneath the Head are comprehended, 
 and coiicquently in the Keck of the FemuKy 
 which is th'4t above mentioned. 
 
 Decolement taken in its fecond Signification, 
 viz,, uncementing or coming off, can only hap- 
 pen in fubje£ls where the Cartilage that joins 
 the Epiphyfis is not yet oilifyM ; for in thofe 
 where the Ofiification is perfect, the Neck 
 and the £p/p^^y;/ make but one, and if it hap- 
 pens that the Head feparates 'tis by a Fracture, 
 and not a fimple uncementing. 
 
 There have been two Perfons, within this 
 little while, in this City, who have had a 
 Dccolcmenty one whereof confulted me ; but my 
 Opinion was, that this w^?: not Separation of 
 the Epiphyfis from the Neck, becaufe the Pa- 
 tient was 3<^ Years old, an Age wherein the 
 OiTification is perfeft, and the Separation of 
 of the Epiphyfis is impofTible. 
 
 That one may not be mifiakcn in deciding 
 whether the Decolement is fimple, or caufed 
 
 by 
 
 * Inmkcufe of thcFrcnch Word Decolencnr, becaufe 
 tho' it is equivocal in the French, 'tis not fo in the Eng- 
 lifli, iinghiinn and beheading being vaftly ditferenr. 
 Nor is it ftrivtly fo in the French ; for the one ought to 
 be fpelt with a double II, DecolUment, and the other 
 with A finglc QU*. 
 
Difeafes of the B o N E i. 307 
 
 ty the Fracture of the Neck, o\q muft imme- 
 diately have regard to the Age of the Pa- 
 tient •, and befivies oblerve that when the Ex- 
 tenfions are made, as has been faid in the 
 Frafture of the Neck of the Femur, the Cre- 
 pitation is hollow, becaule the Bones only 
 touch a-crofs a Cartilage •, whereas 'tis clear 
 and plain when there is a Fradure, becaufe 
 they touch without any Interpofiiion. 'Tis 
 true, this Sign is only eertcdn when the Hurt 
 is recent, for when 'tis of long Handing, the* 
 Ibund is hollow even in the Fradure it felf, 
 becaufe the Ends of the Bones are cover'd 
 over with the Callous Matter, which bias co- 
 agulated there, and produced the fame elFeft 
 as the Cartilage, in a fimple uncementing of 
 the Epiphyjfs. 
 
 It muft alfo be remark'd that the Neck of 
 the Femur is much longer in the Simple un- 
 cementing of the Epi'phy/ts, than in the Fra-^ 
 fture, whence they can't turn the End of th*' 
 Jpoot inwards j<nd outwards, with f) much 
 Eafe as in the Fradure, and that this EafeS 
 is greater when the Fraftiire is at that part 
 of the Neck that is>-neirefl the Trochanter. 
 
 After all, of what importance is it to the 
 Cure, to diftingiiifh the fiinple Decoiement, or 
 ungluing from the Decolcment by a Fraftiire^ 
 lince the Operation is the fame, and there ii 
 no difference in the means or fupporting the 
 Bones when reduced? We have defcribed 
 them amply in treating of the Simple anc? 
 Oblique Fracture of the Thigh, wherefore f 
 ihaiil fay no more. 
 
 X 2 SECT, 
 
gc8 A TKJE.AriSE. efcle 
 
 SECTION III. 
 
 Of the ccm^scated PrdSvcrc of the 
 
 ALTHC Fra9:«res may be complicated 
 in tbisic Caufes, as vhen a AIuskec-Bail 
 is iodgM in a Limb, alter having broiceu or 
 fpiintaerd the Bones, or tlio" they roay be 
 complicated in their Acdd«:tsor .Symptcms, 
 as Pa'uT, GouviiUions, C^c. Ke'rcrdieiefs, when 
 one ^ys, that a Fra£lure is complicated, 
 Cu£lcm has brought it to li.gnity a Fra£bure 
 with a Wou3x3 ^ 'tis in this iJeule that I treat 
 of the complicated -Fracture of the Thigh, 
 having fufficieutly diicouried of the Caulcf 
 of Complication in the general Cure of 
 Fra&ures. 
 
 Tiie Wounds tvhich accompany the Fra-^ 
 Orures of the Thigh-Bone are in geiiera 
 two Sorts ^ the o\ie are produced by the Caul 
 it ielf that broke the Boiie, as by a Coach 
 Wheel, a Musket-Ball, a Splinter of 
 Bomb or any other -^ the otiiers are caufed by 
 the Bones themlelves that are broken, 
 when they pierce the Mufcles, the Fat, aiK 
 Skin : Both the oi-;e arjd the otiier are atteixiei 
 with more or lefs Contufion, have or havi 
 not a Hemorrhage, are with or without ex 
 traneous Bodies, che Bones are fometimes noi 
 uncover'd, fometimes they are, and even iil" 
 out t)iro' the Wound. 
 
 The Diagnoftick Signs don't at all diffe 
 from thofe whereby other Fradures are dil^ 
 cover'd. 
 
Difiajes if the Bones, 309 
 
 Of the fro^JHsk. 
 
 Of a3 complicated Fraftures thatof theThigfe 
 h the moJ[t tiTKiWerorae;, k is fo*rd to keep 
 lite Bones in choir p?aGe3, efpeciaHy when they 
 
 are l>roke!i ©iiliqtiely. iift. TJieBoiie J5£iigie, 
 has but iittle lurface in its iniddfe, and be- 
 iide5 a great }iutnber of very Sn-Oiii» Mufcfes 
 that fur round it cm ali fides, cmfe the \xcik&a. 
 \ iejes to mount caGly oxe upon t'cther. Thefe 
 lame Mufcies oppole that Reduftfon, ^nd 
 okeii dilplace them, even after tbey have been 
 well reduced. 
 
 2dty,The neceffity of moving tlie Patfent for jteasnjt 
 his OccafionSjis a great Obftacle to the Reumoa 
 of the Bwies, which requires a perfeO: Tran- 
 quil) ky. 
 
 jdly^TheTliirgh is covered vnth (6 much Ffefb^ IResmrfc* 
 "''it 'tis almaft impoffible to prefer ve the In- 
 
 jns in that extent which is proper for leaving 
 the broken Bones bare as Iwig as is neceffiiry, 
 for obtaining Exfoliation. 
 
 The Mufcie Fafciatjttay which in all De- I^ec^arfc 
 fiuftions caufes fo many Diibrders, is here the 
 iburce of an jiitinite number of Itnpolihumes. . 
 
 When the Wound is in the tower Partr^ tliis 
 Di/eafe is yet more fata 1, in Ipite of will tiie 
 ways taken to prevent dilplacing the Bones 
 in dreiJing the Wound ; and one has often the 
 vexation of feeing Patients die ijnder one's 
 Hands, for whom (if I may ufethe Espreilion) 
 one has tired out the Patience, aiid exhiiuilei 
 all the Remedies in the p;)wcr of Art. 
 
 When this Fra-llure is lb near the Joinings; FrmSharc 
 thit the Articulation is inflam'd, and De- »^ ^^ 
 Auctions happen there, 'tis very rv^re th;it J^'^^'^' 
 one fucceeds, and t'le Paticnis perilh hy a 
 X 3 Vomitiiig 
 
510 -^Treatise of the 
 
 Vomiting and Loofenel's, a flow Fever, tn4 
 the Reliux of purulent Matter, tvhich caufei 
 AbfceiTes in the Liver, the Lungs or Ibme 
 other of the Inteftines. 
 
 When the Frafture is near the upper Ar- 
 ticulation, it 13 ftill more Dangerous. 
 
 Of the Cure. 
 
 That Pupils in Surgery may be inftru£lcd 
 with the more Eafe in th s matter, I will take 
 the principal Examples, to which 1 will add 
 particular Obfervatioiis that will help to clear 
 up their Doubts-, and I will give them a Rea- 
 fon for all that 1 ihall teach them in this 
 Cure, which is apt to perplex the moft ex- 
 perienced Surgeons. 
 
 Tor Injlance, 
 
 A Man had his Thigh broken by a Kick 
 Ofafcrva- of a Horfe, which had cut part of the Ex- 
 tioos. icr.fois of his Leg, without having broke the 
 Skin ', I made the Redutlion as 1 have direfted 
 in the Article of the fimple Frafture, eccept- 
 ing that I did not ufe a roird Band, but a 
 Bai.dage with i8 Tails, as 1 mention'd in the 
 fame place and elfewhere. Comprelfes fleep'd 
 in Spirit of Wine camphorated, and Aroma- 
 tick Brandy were of great fervice, as were 
 plentiful and repeated Bleeding?, till the Di- 
 minut:on of the Pain and Tumour made me 
 look upon what remain'd in the Mafs of Blood 
 as abfolutely ueceiTary for the Life of the 
 Patient •, belides this, makii.g him obferve a 
 proper F g'imenj I had the latisradion of fee- 
 ing the Ecchjmofis foften and difperfe, and the 
 '.•••• divided 
 
Bifenfes of the Bone?, 51a 
 
 divided Fleih and broken Dones grow firm, 
 wliich was follow'd by a fucceiitui Cure in 
 two Mo.iths time. 
 
 Things are not always attended with lucii Obfcrva- 
 good luck^ I hat-e often been oblig'd to make *'o"- 
 an Incifion to open Contufions of this Ibrt, 
 which happen when the Effufion is coniider- 
 able, when the Subject is Cacochynick, or 
 when the Effufion is at the very place that 
 i» frafturM, and the Ends of the Bone are 
 Ibak'd in the diffus'd and coagulated Blood. 
 
 It muft alfo be remark'd, that if the Effu- Rcmnrk. 
 iion be of the Blood alone, it does not fo 
 often Heat, Ferment, or turn into a Sanies^ 
 as when the Lympha is intermingled with it : 
 One generally fees that it dilperfes in the in- 
 terval of the Mufcles, and in the SaccuU j4dipafij^ 
 which forms the Ecchymarpps outwardly of a 
 black Colour, which difperfes by degrees, by 
 changing from black to a dark Colour, from 
 that to Blue, and from Blue it turns by 
 fhadows to an Orange, and fb to a clear Yellow, 
 till at laft it becomes of the natural Colour of 
 the Skin ^ then they leave off the Bandage 
 with 1 8 Tails, and put on a Roller as in fimple 
 Fractures. If fuch Effufions happen over a- Obrerva- 
 gainfl the Fradure, they muft be open'd if tion. 
 they are confiderable j Bandages wou'd be ufe- 
 lels, and cou'd not retain the broken Bo.es, 
 becaufe they cou'd not bind them near e- 
 iiough. 
 
 When one has been oblig'd to open the obferva- 
 Tumour, if 'tis not at the place that is tiou* 
 fradur'd, the Wound muft be drefs'd, as 
 is convenient, making ufe of the Bandage 
 with 18 Tails till the Wound is clofed, and 
 afterwards of a Roller. 
 
 X4. It 
 
312 A T KZ AT is^ of the 
 
 If the Defluftion is at the very place that 
 \i^ frattured, and the Hones are bare, they ex- 
 amine ^v^ether tht^y are in their right place, 
 and whether there is a Dilpohcio.i to a Re- 
 union, in which Cafe they don c make ufe 
 of Stopples: l-*lede;its doubled in two, or any 
 Obferva- Other foit Lint is fufficient. If it fuppuraces 
 tion. well, and no*: in too great Quantiry, and no 
 
 Accidents h:ippen, the Reunion will be made, 
 the Bones th.it have /or fuiier"d turniih wich- 
 , out trouble their Co:.tina,eat for the Forma- 
 tion of the CMlvs, and wiien the V^''ound is 
 Hcmark ^lofed they put on Rollers, if *tis ft''il liccef. 
 fary, to fupport the Bones. If oii the con- 
 trary 'tis found th.1t there is any dilplacing, 
 and that the too great, or too irregular Cralh, 
 takes away all hopes of Reunion, then ojie 
 mud manage as in the lollowing Example. 
 
 Second Exaviple, 
 
 
 A Labourer fell from a Scaffold with a 
 piece of unhewn Stone, which he was holding 
 He came to the Ground a Jittle fooner tha 
 the iytone, becaufe hpving quitted hold of ii 
 it was detained a Moment upon the fide of i 
 PJank, from whence it fell upon his TJiigh 
 from above 30 Foot high, and made a very 
 large Wound, thro' which I touched the Bones 
 I advis'd Amputation, becaule the Crafh wa 
 as corfiderable as the Contufion, and tearing 
 of the Flefli •, and that moreover the Patieni 
 had rot wherewith to provide all that wa 
 necelTary tor fucli various Dielhngs, and Coa 
 yeniencies as are requifite in fuch a Cure 
 'Nevc^rthel'?f<5 I did alt that I eou'd to prcferv 
 his Thigh, hoping Jie would be aihlied an* 
 reliev'd in his Wants. I caus'd him to b 
 
 pu 
 
Lifetifes of r/7<f B o N e"s. 3 1 3 
 
 put into his Bed, (which was firft equah'zM) 
 wirh the Part thiif^ was hurt, near enouj^h the 
 Bed-fide, to render the Operations and Dref- 
 fm^s eafy. I put a Handkerchief, or Iquare 
 Cloth, within the Groin, which was ty"d by- 
 two diagonal Ends, to make a Loop that was 
 taken by an Affiftant, who held it without 
 moving •, then I made a fecond grafp the Manual 
 Thigh with both Hands above the Condyles, ^"^^^^^^ 
 and a third took the Leg : This done, I made 
 them draw a little, not fo much to reduce it, 
 as to give the Thigh its due ftreightnefs, a 
 Circumftance that ought always to be obfervM 
 before the Operation is begun, both becaufe 
 the Mitions excited by I*<iin are lefs hurtful, 
 and becaufe to make an Incifion the Parts muft 
 be as much as polTible in their natural Situation. 
 
 My Finger being introduced into the Wound, 
 was the Conductor of the Bi/louri, wherewith 
 I cut all the di lacerated Parts above and be- 
 low, which facilitated the evacuation of a 
 great deal of Blood already coagulated, and 
 the taking out ot divers pieces of Bones le- 
 parated from their Oiiginal. I difcover'd 
 with the fame Fore-Finger, the Stays which the 
 Parts leave by their feparation, and I cut them 
 all, especially thofe that are always form'd 
 by the yiponeurofis of the Fafcia lat^, which 
 ought to be cut afunder, without any other a- 
 parent Reafbn than the tear of Defludlions ; 
 that never fail accompanying the Obftruftions 
 causM by the Inflamation of this Jponcjirofisy 
 and the SweHing of the Mufcies which it 
 covers • which Swellings alfo happens at the 
 lame Time. 
 
 This done, I made them compleat the Ex- 
 tenfions, whilft I guided the Bones with my 
 
 Fi.]-er.% 
 
 c 7 
 
314 A T KTL ATISE of the 
 
 Fiiigers, and replaced them in proportion as 
 they drew the Limb. 
 
 'Tis not lecure in this Cafe to fufler the 
 Bones to be au,ain cover'd with Fleftj, for 
 *-aaicc. "^^^^'<^h Realon I drelVd the Wound with dry 
 Lint, and Liniien Rags, fb as to keep them 
 bare lill tlie Exfoliation \ the reft was apply'd, 
 I placed the Part alfefted, and bled the Pa- 
 tient twice iji 12 Hours, and i ext Day a third 
 time before the taking off the firft Dreirmg: 
 At the third Dreifing I left the Linnen Rags 
 that I had put on, near the Bene \ lb that 
 the Ends of the Bones were (if 1 may fo fayj 
 wrap'd up in them, and not in a condition to 
 hurt the Fleih b/ their iharp Points, they 
 were even faftn'd on that they might not be 
 dilplaced by flight: Motions. 
 
 At the third DreiTmg I took off all, and 
 clap'd on great Doffels, which had the fame 
 Effeft on the Bones as the Linnen Rags j 
 they were fieep'd in Brandy, and thofe which 
 fill'd up the reft of the Wound, were arm'd 
 with a fimple Digefiive, quickned with a 
 little Brandy. The whole was cover'd with 
 ComprefTes, and a proper Bandage, as fhall be 
 very exadly defcrib'd in the complicaced Fra- 
 fture of the Leg. 
 
 Third Example^ 
 
 T cou'd give great numbers of Examples of 
 this fort, but I liave chofed only thofe where- 
 in I have found the greaceft number of Cir- 
 cumftances met together, and I hope it will be 
 fufficient to c'ear up this matter entirely. 
 The prefent Cafe is of a Fradure of the 
 Thigh, made by Gun-lhot ; Two Balls were 
 (Rntred in at the middle of the Fore-Part of 
 
 tlie 
 
Bifeafes of the B o N E s, 5 1 j 
 
 the Thigh, whereof one went out at the mid- 
 dle of the Hind-Part, an Inch lower than 
 where it entred, and the other remain'd in 
 the Thigh. The Ffw»r being broken into le- 
 veral Pieces, and a confiderable Hemorrhages 
 might have determin'd us to an Amputation, 
 if the Patient had not fhown all the Relblu- 
 tion, and all the Courage that is necefTary to 
 bear up patiently under the Pain of the Dref- 
 fmg, and the fatal Accidents that happen 
 during the Courfe of fb long a Sicknefs ^ 
 wherein one is lefs certain of a Cure in en- 
 deavouring to preferve the Limb, than in re- 
 Iblving to cut it oif.. 
 
 I cut open the PatientV Breeches, and ftrait- 
 en'd his Thigh, which was bent, by his Fall 
 after receiving the Shot, like a broken Stick ; 
 I tented the Wound with Lint, which I faflen'd 
 on with a Band •, after which they made a 
 Litter, andhe was carry'd into his Tent, and 
 laid upon his Field Bed, fo as to facilitate the 
 necefTary Operations. The DrefTings being all 
 ready, I made them hold the Foot, draw the 
 upper and lower Part of the Thigh as has been 
 faid above ^ then carrying my Finger towards 
 the broken Bones, I compleated the Dilata- 
 tion at the Bottom, and made that at the 
 Top, being conduced thro' the whole by my 
 Finger. I drew out thro' this Wound a great 
 deal of clotted Blood, which difcover'd the 
 opening of the VelTel, whereon an AlTiftant 
 put his Finger, whilft I dilated the Wound 
 behind, by caufing the Thigh to be a little 
 rais'd, and turning the Patient on his found 
 Side, I drew out but little clotted Blood by 
 this new opening, which 1 made larger, but 
 got fi great many fragments of Bone, ar.d bits 
 of the Cloth of the^Breechcs, that the Balls 
 
 hud 
 
ajacB. 
 
 5B^ J T s^j, M ri ^-E. 0f the- 
 
 J^'.aaE hsd dri%'eri 21:1, I ti.ei fearch'd for tbe leooad 
 j,igr.ai- gaii^ and fouaadit ia xh^Vafats ExtsrmSy near 
 rlie Skin, and tiie feiali Ke^aftlie- BicefSj, 
 2lx)Bt an inch on ooe Srde &t' the Pl-»ce wkere 
 tke otlier Ball went cmt-: To ectjra^k it I 
 3?ii!de no- diiEcutty of cuttFng the Skm sad 
 Mufcles s-crois tVc-m the ln£d« to the Out- 
 £dQy frora the place where the Ball that ijsade 
 the Woiind went out, to ttet thro' v^hic}i 
 ■diis wouM hav^- iiSiedj, hsni it ceetiniied hs 
 Way. One may witiiout tear ©f diminiihfGg 
 
 :i£:i-isrT?; ^"tsafkion, and without dEnger^Cut a-cr€>fs fudi 
 little Parts af ib isrge a Male le as the Fafius 
 
 Having xucide what Diistati^is were proper,, 
 snd drayjii out ail the erS:raneous Bodies, I re- 
 placed the Thigh in jt5 right portion ; then I 
 made the Finger he taken oix the VeiTel, and 
 pafs'd a crooked Needle with a double Thread 
 of that iort, call'd Fie d''€pway from Top to 
 Bottom, and i^gfiin from Bottom to Top^ and 
 tg?'d the Veffel m g double Knot, 1 cut off 
 the Thread within two Fing&rs of the MeS^^ 
 and laid upon the Knot a Compfefs of 231 
 Inch Square, and tour Lines thick^ 1 triram'd 
 the Wound witli Dozels, ^nd efpecially the 
 Ends of the BpneSj as lias beea faid in the 
 forgoing Example ^ then I put over them a 
 , Comprels four double., and apply'd the Dref- 
 
 fng proper for complicated Fratiures. 
 
 Remark vfifid for yotmg Fnpihi, 
 
 When the Ve'fel is not Htuated in a plac^ 
 convenient for the Pallage of a Needle, they' 
 make ufe of ;a Dofii fteep'd in Styptick Water, 
 well fqueez'd out, that this Water may not 
 Ipread over the Wound, becaufe it is both 
 
 ufelefs 
 
Difi/ifes ef the Bo N £s, ^ly 
 
 tteVfs 5uxi hurtful there, in appltrijig tKis^ 
 they wipe tlje P?at weJl ^vhencc the Bi/X)i 
 slii2es., ^ud they chp cm tlie Dofil rt^ep'd, at 
 the very init^nt that they withdraw the 
 Liiuien di.1t feas wip'd the VelTbl *, the oii« 
 Jiiiift foe placed immedhtely iipon. die removal 
 of the other, becaufe if the leaft Time he 
 ioft, tlie Blood dmt \i&es out wcakeus the 
 force of the Stypt"ck, wherewith, the Dofil if 
 impregnated, which hi ders its Operatioji. 
 Upon this they put a Cotnprsis iike that 
 which wa5 upon the Ligature, mid lup- 
 port it ill the fame manner b^r 3. number -of 
 Doiils-, "which tiiey raife a Fingers breadth a- 
 fco^e the Le'yel of the Wtjund, to the End that 
 the Comprefs which is laid over i", and the 
 Bandage that contains all, may compiefs thifi 
 part more than the reft^ without which th« 
 Dofil wou'd be forced oif by the Etfuhon of 
 the Blood, and the Hemorrhage wou'd hz^m 
 afrefli. 
 
 If the VelTel ihouM 'be i>ear the Bones, -it 
 rauii be ftop'd by comprefhng it, fo as that 
 among the Dofiiis, there may be one that 
 may prefs upon it above, whifft the Bone re-^ 
 iifls underneath. The Dofills muft noc be 
 ileepM in Styptick Water, but they tnuft be 
 raisM in the fame manner a Fingers breadth 
 above the Wound, and the reS: muft be ap- 
 ly'd as above. 
 
 If one does not ufe Styptick Water on thif 
 Occaiion, 'tis becaufe one ought to be appre- 
 henfive of iaying the Bone more bare than was 
 done by theFrafture. It ought alio to beavoided 
 if the Veffel ihou'd be near the Tendons, 
 Nerves, or other ferfib^e Parts: CompreiJiora 
 muft, as much as pofiible be prefer'd to the 
 Ligature and to the Styptick ; when the 
 
 VdB 
 
5i8 A Treatise of the 
 
 VefTel is not confiderable it always fucceeds • 
 but when it is the Lignture ought to be pre- 
 ferr'd : And if 'tis impoffible to put that in 
 Practice, the Stypticks muft be usM not only 
 liquids, as the Styptick Water of Rhabel or 
 any other, but even Solids, as Buttons of 
 Vitiiol. 
 
 You wouM perhaps be at a Konplus if a 
 VefTel were open'd at a diftance from the 
 Bone, and in a place where the Ligature were 
 impracticable, and the Stypticks dangerous. 
 To determine you, remember that all other 
 confiderations muft be paft by when the Bufi- 
 iiefs is to flop the Blood, therefore don't be 
 apprehenfive of touching the Bones, the Ten- 
 dons, nor the Nerves, but of your Patient's 
 perifhing thro' lofs of Blood, and even if you 
 had neither Needle nor Styptick, your Ge- 
 nius and Sagacity will furnifh you with a 
 ready Way to Stanch the Blood by the Com- 
 preffion alone : The Genius of a Surgeon 
 mufl find him Refources every where, even 
 in places where Nature feems to have deny'd 
 them. 
 
 Having thus provided Remedies for the 
 Hdtmorrhage, drawn out the extraneous Bodies, 
 replaced the Bones, trimm'd their Ends that 
 they might not hurt, drefs'd the Wound, 
 apply'd the Bandage, that fhall be defcrib'd 
 in the complicated Frafture of the Leg, ha- 
 ving prefcrib'd all that had regard to the Re- 
 gimen, it was necefTary to provide for the 
 Tranfportation of the Patient from the Camp 
 where he was, to the neighbouiing Town. 
 To compafs this without danger, I had two 
 long Sticks made, of an Afh which 1 order'd 
 to be feird, and fitted to the Field Bed whereoit 
 the Patient lay, the two Ends palling behind 
 
 and 
 
Djfeaps 0/ t^^ B o N E s. 519 
 
 ami before i'l the ihape of a Litter, which 
 was laid upon two Mules, and carry \l Ibflly 
 to the next Town. The Mules were unloaden^ 
 and tlie Bed was carry'd into a low Parlour 
 prepar'd for tliij pinpofe, and there I thought 
 of all that was necelfary to drefs the Patient 
 conveniently, and procure h'm a way to la- 
 tisfy his Occafions with Eafe. 
 
 To fucceed in this important Point, regard 
 muft be had to the fituation of the Part, and 
 of the whole Body •, the Part ought to be iil 
 iafety, and the Bandages fuch as can be un- 
 done and clapt on again without ftirring the 
 Limbs •, for this realbn in a Fracture of the 
 Thigh, where there is a Wound underneath, 
 I advife not to Sow the Bandage with t8 
 Tails, but let all the Pieces be feparate ^ fa 
 that there may rather be a Band with Nine 
 Ends, than a Bandage cut into Eighteen, that 
 thefe Ends of the Band may be chang'd altoge- 
 ther if requifite, or each by it felf, as there 
 is occafion. 
 
 Secondly, The Longitudinal Bolfters that 
 are placed at the lateral Part?, muft be thicker 
 than thofe ufed in other Fractures •, they mull 
 be large enough to take up, both within and 
 without, as much as poilible of the under 
 Part of the Thigh, and they muft come near 
 each other at the upper Part, not leaving above 
 one Fingers breadth from one another. 
 
 Paft- boards are not the beft Things to re- 
 tain the Bones, 1 prefer Splints of Tin var- Drcffing 
 I nifh'd, or the Bark of a Tree, becaufe mo'fture that is 
 Ibftens Paft-board, and then it no longer fup- prcfer- 
 portsthe brokea Bones. Tin varnifh'd or the *^^^* 
 Baik of a Tree are firm by their fubftance, 
 and the Tin refifts Moifture by its varnifh. 
 They make them of a fkape agreeable to 
 
 that 
 
520 A Treatise of the 
 
 that of the Part, and trim them with Com- 
 prelies that they may not hurt, which done 
 tiiey tye thL*m on wjth two or three Thread 
 Straps of a Finger's brendth. 
 
 As to junks or a Cafe, i know that each 
 
 of them has its admirers, for whicli realoa 'tig 
 
 fit to rela e the Qualities both ot the o;:e and 
 
 the other, and leave you to your Choice. 
 
 The Cafe feems moft fee u re, becaufe being 
 
 The good of Wood 'tis inflexible, but Junks well made 
 
 and of ^'^"^6 ^"^y ^ pHantnefs that is ufeful, and does 
 
 Juijks. ^i^t e;o lb far as to alovv the dilplacing of the 
 
 Bones: I lay more, atho' the Cafe be firm it 
 
 does not lb well fupport the broken Bones, 
 
 becaufe it is not tyd with the reft of the 
 
 Bandages^ whereas the Junks are made faft 
 
 with Straps. Neverthelefs one may give a 
 
 Cafe, this advantage by adding b'traps to it. 
 
 They who prefer the Caie lay, that it 
 forms an even Surface, and that on the con- 
 trary the Junks give way and conform them- 
 leives to the unevennefs of the Bed, but they 
 doi:i't refleft that the equality of the Surface 
 of this Cale is a Defeft, becaufe it can't fuit 
 with the inequalities of the Heel, the Calf of 
 the Leg, the Condyles, and the top of the 
 Thigh. That if they endeavour to help this 
 by Quilts, this Remedy is not fufficient be- 
 caufe the Heel, the Calf of the Leg, and 
 other places that flick out, will always bear 
 much more upon them, then the places that 
 fink in ; thefe inconveniences are not found in 
 the Ju» ks provided one obferves. 
 
 i*^. That they hive a great deal Surface, 
 except in the £nd that approaches the Pu- 
 denda. 
 
 2^. That the Cloth which covers them 
 make a treat many Circumvolutions round the 
 
 Straw 
 
 I 
 
Difeafes of the BoNE S. 321 
 
 Straw whereof they are made, to that degree 
 that the Inequality may be taken away. 
 
 S^. That there be two Cloths to trim them, 
 ^iz,. One that covers them trom that Part of 
 the Junks, which is above the Condyles of the 
 Femur to the bottom, and the other to wrap 
 round them four Fingers above the Frafture 
 to the Top^ fo that when they are put on, 
 there will hardly be any of the Cloth of the 
 Junks in almoft all the hind Part of the Thigh, 
 which will render the Dre/fings ealier, as will 
 be feen by the fequel. That thefe two Cloths 
 be cut after fuch a manner, that what gees 
 round' the Junks be proportionable to the 
 length of ther little Junk plac d on the infide, 
 and of the long Junk placed on the outfide j 
 for the latter muft go beyond the Trochanter^ 
 and both the one and the other below muft 
 reach only a Fiugers breadth beyond the Sole 
 of the F(iot. 
 
 4^. The Junks muft be faflen'd on, and 
 trimm'd with ComprefTes, to fill up the empty 
 fpaces, to the end that they bear equally upon 
 all the Parts, except thofe that are painful, 
 and efpecially thofe where the Wound is. 
 
 5^. The ComprelTes muft be placed fothat 
 the Ankles, the Condyles ot the Femvr^ the Tro* 
 chanter y and the Groin be not comprefs'd. 
 
 6^. There muft be a Comprefs half a Fin- 
 ger's breadth thick, and four broad, to go the 
 whole length of the Th'gh, the Leg, and 
 part of the Foot, that the Straps may not 
 hurt whea they faften on the Junks. 
 
 7^. The Junks muft be bound fo that they 
 may be moftly under the Part, that is to ixy^ 
 that the Limb refts upon them, and is not en- 
 clofed in them* 
 
 V %° Thcr« 
 
32i A T P^ E A T I S E of the 
 
 S^. There muft be fix Straps, three to the 
 l.ee, and three to the Thigh •, thole of the 
 Thiuh imift be firft ty'd, and thofe of the 
 Leg afterwards, beeinniiig both in the one 
 and the other by that in the middle. 
 
 9^. They place a Wooden Sole trimm'd 
 with Linnen and two Suap5, or.e great, one 
 little: The great ore muft pals thro' Holes 
 made in that Part oi the Sole which is over 
 ag?inft the Ankle, and the little one thro' 
 other Holes, which muft be at that Part of 
 the Sole whereon the firft Articulation of the 
 Toes bears. The firft Strap muft be equally 
 divided into two Ends, which after making a 
 St. u4rtdr€w''s Crofs upon the Ir.ftep, mfift be 
 faften'd to the Junks within two Fingers 
 breadth of the Ankle •, after which they muft 
 again crofs each other feveral Times, and be 
 faften'd to the Junks, with Pins, forming as 
 they crofs each other Lozenges, as far as the 
 upper Fart. 
 
 The little Strap alfo crofTes it felf once at 
 the Top of the Foot ^ and its two Ends muft 
 be faften'd to the Junks, near the place where 
 the great Strap was made fnft at firft. 
 
 lo^. There muft be other Junks a great 
 deal fbfter, and with more Linren upon them 
 than the others, not covered with one Clot/i, 
 but fepa rated, they are properly two Cylmders-^ 
 they muft be put underneath : The Straps of 
 the inner Junks muft go under, and come 
 outwards, and thofe of the outward Junk 
 muft go urtdcr, and come inwards, fo as to be 
 fafteiiM one to the other upon the Limb, to 
 hinder their ftparation, which is elTential, be- 
 caufethey ferve as a fupport to the true Junks ; 
 we will call tliefe falfe Junks. Th'ngs being 
 thus, the whole under Part of the Foot, Leg^^ 
 
 and 
 
B'lfeafes of the Bone 8. 325 
 
 and Thigh will touch the Quilt but little n 
 not at all, and will only relt upon the Cloth 
 of the firft Junks, as upon a Hammock, '.vhere- 
 in the whole under Part of the Hcl*!, Leg, 
 and Thigh are mounted, except the Place of 
 the Frafture, as has been faid above ^ 'twill 
 be itien by the fequel how advantagious this 
 management is to facilita^e the Dre/fings. 
 
 For the reft, there muft be a Cord at thtf 
 Cieling, a Board and a Billet at the Fe^T of 
 the Bed for the ufes before mention'd. I pafs 
 on to the means of procuring the Patient the? 
 Convenience of going to Stool, making Water, 
 and taking his Drink and other Food. 
 
 There muft be two Quilts, the! one entire, 
 and the other of feveral Pieces which may be 
 adapted to each other, and taken away as need 
 requires. One large Piece muft reach from 
 the middle of the Buttorks to the Head of 
 the Bed, the reft muft ba divided into four 
 Pieces, two on each fide j the one on the fide 
 that is hurt muft begin where the upper 
 part juft mention'd ends, and muft reach 
 tour Fingers breadth below the Fracture, 
 and the other muft begin from this, and reach 
 below the the Foot ^ the two o:her Pieces 
 muft do the fame on the found fide, excepting 
 that they muft be larger according to the 
 bignefs of the Bed, lb that it muft confift one 
 third of the Pieces that iupr>ort the Part af- 
 teded, and the two other thirds of thofe thic 
 fupport the foui.d fide. 
 
 When the Patient wou'd g-'* to Srool, one 
 muft remjve the middle Piece on the found 
 fide, then one Part of the th^gh and the 
 Buttock of the Part stfecled will b.* without 
 fupport, a:d the l^lace that was taken up by 
 ;his,Partof thv; Quilt make room for the tJei- 
 rV Y 2 Pa:a 
 
324 ^ T K E A T 1 5 1 ef the 
 
 pan which may be given the Patient, and re- 
 moved when he has done with it. 
 
 That the Piece of the Quilt may be eafily 
 replaced, there muft be two narrow Girths, 
 or Boot-Straps iow'd to it, which pafs under 
 that part of the Quilt that is on the woui.ded 
 fide •, thefe Girths muft be ^o drawn by one 
 as not to move nor change the place of that 
 part of the Quilt that fupports the Frafture, 
 ar;d whilft they are fo drawn, others take 
 care to facilitate the replaciog of this part of 
 the Quilt that has been removed. 
 
 If ore wou'd give the Patient a Clyfler, 
 this part of the Quilt muft be again taken a- 
 way, and that which is under the reft of the 
 Thigh and Leg of the fame fide •, the Patient 
 muft be made bend his Knee, the Sole of his 
 Foot refting upon the fecond Quilt, he re- 
 moves his Knee as much as he can, which, 
 leaves all the fpace that is proper between 
 the Thighs for the introducing of the Pipe, 
 and the management of the Syringe. 
 
 When the Patient has taken the Clyfter, 
 only the lower part of the Quilt muft be re- 
 placed, whereon they put the Patient's Leg, 
 and they flide the Bed-Pan under, that he, 
 may give back his Clyfter, which when he 
 has done, they replace the other part of the 
 Quilt as has been faid. 
 
 Each of thefe four Pieces of Quilt muft be 
 wrap'd in Cloth, which ferves as a Sheet, and 
 is more convenient, becaule a Sheet makes, 
 folds that might be trouble Ibme. The upper' 
 Part of the Quilt is cover 'd with a Cloth or 
 half Sheet, which having no communication 
 with the four other lower Pieces, does not 
 at all hinder one in removing or replacing 
 them, thefe Cloths muft be changed when^ 
 
 they 
 
 n /X-CO 
 
 i;^ 
 
Difdafes of the Bones, 525 
 
 they are dirty, and be wafhM, to keep the 
 Patient clean. 
 
 To drefs the Wound they draw away the 
 Piece of the Quilt which is under the Fratlure, 
 and has like the other two Girths or Boot- 
 Straps that go a-crols the Bed under the oppo- 
 f\lQ Piece •, thefe are long enough, not only to 
 give Liberty to remove the Piece of the Quilt, 
 but alfo to leave Ends fufficient to take hold of 
 again, and draw them back, when one would 
 replace the Quilt after the Dreffings. 
 
 When this Piece of the Quilt is drawn away, 
 the broken Piece of the Thigh is entirely open, 
 and there is Liberty to put ones Hands on all 
 Sides to take otf the Dreifing, and lay it on a- 
 gain without running the Rilque of difturbing 
 the Fradure ; then the Straps of the falfe 
 Junks muft be loofen'd, and whilft one railes 
 gently all the Limb fupported by the true 
 Junk^, the falfe ones muft be taken away, and 
 the Limb be laid down bound in thefe Junks. 
 
 Two Afliftants muft hold, one the Foot, and 
 the other the Top of the Thigh, only to prc- 
 ferve its Streightnefs, and oppofe the Start- 
 ings and other involuntary Motions of the Pa- 
 tient •, they unty the Straps of the true Junks, 
 keeping in its Place that which is on the inlide, 
 and unrolling that which is on the outfide, to 
 unwrap the two Cloths that furround it •, they 
 draw the upper Cloth a little upwards, and the 
 lower downwards, to give more Eafe j they 
 untye the Paft- Boards, or Tin Plates, and they 
 take off conveniently all the Dreffings, obfer- 
 \ ving not to touch the Comprefs that is laid 
 I upon the Ligature of the Veffel, or upon the 
 ( Button or Doifil that has been mide ufe of to 
 ftanch the Blood •, for, in the Example that I 
 have giveo, there was a Hanjorrha?e. 
 
 Y 3 ^ The 
 
j2 6 J T ht. ATI $Z cf tbf 
 
 The whole DreiTing being taken off, the Si- 
 tuation and Fit^ure of the Boi e^ muft be ex- 
 amined, that they may be remedied by repla- 
 cing, if th«y are leparated, and by cutting 
 their fharp Ends with the incifive Pincers, if 
 they are like to prick the neighbouring Parts; 
 then one muft drefs the undermoft Wound firft, 
 becaufe the Medicines that run down from the 
 upper Wound when 'tis dreUing are retain'd, 
 and don't fpre^d as they xvou'd do, if it were 
 diefs'd before the under one. 
 
 It muft always be obferv'd, in dreiJjng both 
 the one and the other, to cover and wrap roijnd 
 well the Ends of the Bones with fine Linnen, 
 or pledgets fteep'd in Brandy • ai:d efpecially 
 not to diforder the CompreiTes or Doilils that 
 comprefs the open VelTels. The reft of the 
 DoiTils or Pledgets muft be arm'd with a ftmple 
 Digeftive, only quicken'd with a little Spirit of 
 Wine, or good Brandy. Both the one and the 
 other muft be incompaffed with a Comprefs 
 fteep'd in Brandy ^ then one muft lay on the 9 
 Ends of the Bands, inftead of the Bandage of 
 1 8 Tails; after th"s the longitudinal Bolfters, 
 the Paft Boards or Tin Plates varnifh'd muft be' ' 
 clapt on, and faften'd with their Straps •, the 
 upper and lower Cloth that was a little re- 
 moved, the one upwards, and the other down- 
 ward?, muft be brought back and carried near 
 each other to faflen it as it was, the Sole muft 
 be replaced, and the Limb railed to put on 
 the falfe Junks, which muft alio be bound on^ I 
 as they were: This done, the Piece of Quilt 
 that was taken away to facilitate the Dreilings, 
 muft be reftor'd to its Place. If the Space that 
 ^his Piece of Quilt leaves in the Bed fhould 1 
 rot be fufficient to f;.xilitate the Dreilings, al 
 MkQ Gap may be m^de iji the uiider Mattrels, | 
 
 an4 i 
 
Lifeafes 6f the Bones. 3^7 
 
 and C'/en in the Straw-BeA, that one may have 
 all the Liberty that can be defired. 
 
 I ci^n't know any more convenient Way of 
 drefiing the complicated Fraitures ot the 
 Thigh, it leems to me to aniwer all the Ends 
 that" can be propoied in this melancholy Di- 
 ftemper, which, as I have faid, is lefs dange- 
 rous wlien the Limb is cut off, than when one 
 endeavours to prelerve it: If any Doubt re- 
 main*?, you may have Recourlcto theFraclure 
 of the Leij both fimple and complicated. 
 
 G H A R XIII. 
 
 0/ the FtaSIure of the Rotula. 
 
 TH E Rotula is faften'd at Bottom to the 
 Protuberance of the Tibia by a ftrong Li- 
 gament, which has been taken, but without 
 Reafbn, for a Continuance of the ji^oneurofis 
 of the Extenfors of the Leg : At its upper Part, 
 the fame RotuLt gives Infertion to the ftrong 
 j4poncurofjs tliat is form'd by the crural Mulclcs, 
 the Relius Anterior, and a Part of the two ^nfti ^ 
 lb that when the Leg is either /^retch'd outer 
 bent, the Rotula follows the Determination iuid 
 Motion of the Mufcles. 
 
 If our Knee is bent, it is obfervable that the 
 Rotula is drawn downwards by the Weight of 
 the Body, which influences the Ligament that 
 keeps the RotvU f;<ften'd to the Tibia^ and that 
 it is at the fame Time drawn upwards by 
 working of the Extenfors. If the RotuLi c^in 
 refift thefe oppofite Determinations it will 
 jiot break, on the contrary it will, if it cannot 
 Y 4 withfland 
 
528 -^ Treatise of the 
 
 withftand them. 1 hat what I have Taid may 
 be the better underUood •, I fuppofe that a Cord 
 is taken d to a lix'd F(uiit, as a Cramp-iron 
 fix'd in a great Wall, and the o her End of it 
 to a Horfe's Shoulders : buppofe auain that the 
 Horfe draws this Cord with a Hundred De- 
 grees of Strength, I fay, that they will 
 endure the Etforu of almolt 200 Degrees, bc- 
 caufe the Refifrance or the Cramp-iron is equal 
 to the Force of rhe Horic \ and if there be ai^y 
 weak Part in this Cord tJiat can't wirhftand 200 
 Degrees of Force, that Place of the Rope will 
 break. In the like Manner, fuppole the Weight 
 of the Body that afts upon the Leg when 
 bent, makes an ElFort to draw rhe Rotula down, 
 whilft the Extenfors ftrive to draw it upwards ^ 
 I fay, that if any Part of the Rotula be roo 
 wealf to oppofe both thefe Powei s, it will break 
 in that weak Part, fo that the RotuU will make 
 two Pieces, the one kept fixM to the Tibia by 
 the firong L'gament beforementioned, and the 
 other carried upwards by the Influence of the 
 £xtef2j'rs. 'Tis plainly feen that if in any vi- 
 oler.t Fall, the Line of Gravity falls upon the 
 Leg, ajid the Leg be bent, the Exterfors will 
 ftrive to fuftain the Weight of the Body, and 
 the Rotula at that Time will be kept below, by 
 Reafon of its being faften'd to the Leg, altho* 
 the Mufcles ftrain to draw it upwards. The 
 Forces being equal, and contrary to each o» 
 ther, it will remain at Refl, provided the Ten- 
 don and the Mufcles have Strength enough to 
 bear up againft the Weight of the Body •, if 
 not, either the Ligament that ftfteas the Ro- 
 tu'a^ or the Mufcles that draw it upwards, or 
 the Rotula it felf muft break- It will remain at 
 Reft, becaufe the Powers are equal ^ but as 
 the Ligaments and the Mufcles are leis brittle, 
 
 thty 
 
 ♦s. ^ r- —' 
 
Difeafes of th Bones. 529 
 
 they continue entire, the Kotula breaks, and 
 tJie piece on the upper Side is carried away by 
 the Mulcles. I have (eeii feveral Rotulas broken 
 by f;iUe Steps and Strains, without their ha- 
 ving been itruck at all •, and if at any Time tlic 
 RotuU appears to have been ftruck, one ought 
 not ♦"o accufe the Blow of having made the 
 Fracture ^ it would never break, if it were not 
 drawn ftrongly upward;?, and retained below 
 as we have fiid. What I fhall fay hereafter in 
 fpeaking of the Rupture of the Tendons, will 
 better prove what I advance. 
 
 The Fracture of the RotuU is eafy to be dif- 
 cover'd, the Finger need be only laid upon the 
 Knee, and the Separation of the upper Piece 
 may be felt ^ and if it is carried up confidera- 
 bly by the Aftionof the Mufcles, it is eaiily 
 perceived by the Touch. The lower Piece nei- 
 ther mounts up nor falls down, becaufe it is 
 not fafrenM to any Mufcle, wherefore 'tis ea- 
 fier to be found than the upper Part. 
 
 According to what has been faid, the RotuU 
 almoft always breaks a-crofs, and it is impof- 
 fible it Ihould break long-ways, unlels the 
 Fradure be complicated, as when 'tis broken 
 by a Gun-fliot, a Splinter of a Bomb, an Axe, 
 a Club, &c. 
 
 When the Piece that I's mounted upwards is 
 but fmall, it is harder to diftinguifh the Fra- 
 cture, but 'tis lefs dangerous, tho' more diffi- 
 cult to reduce*, becaufe thit it not uncovering 
 fo much of the Joint, gives lefs Room for the 
 nutritive Juice that forms the Cnllus to diflufe 
 it felf in the Articulation, which would c.iule 
 an jinchylofis of the firft Kind ^ for 'tis almoft: 
 an inevitable Confequence, in all Fractures of 
 the Rotula, for the Juice that flows from tlie 
 two broken Ends, to ipread in the jointing of 
 
 ths 
 
55© J Treatise ofthff 
 
 the 1 eg, and folder the articulated Pieces, or 
 at leall render the Motion very harfh, forming 
 a Ibrtof rough Cruft upon the Surface of the 
 Cartilages, w hich ought iiituraliy to be tmooth, 
 to the End that the Bones may flip one againft 
 another with Eai'e. 
 
 Thofe who have not the RotitlM (et, find a 
 great Difficulty in walking-, becaufe thnt, be- 
 fides the Effufion of the nutritive Juice in the 
 Joint, An?tomy teaches us that this Bone 
 ferves for the Adhefi on of the ^ponnrofes, and 
 tfiat in its natural State it is as a Pully, and 
 removes them from the Fulcrum of the Leaver 
 of the Leg^ of which Advantages the PatieJit 
 is then deprived, and which are of great Ule 
 for walking ftrong and faft. 
 
 To reduce the Rotuluy the Sole of the Foot 
 mufl: lean againft fomething that is fteady, the 
 Leg being well ftrerched out, then making ui'e 
 fucceffively of ones two Thumbs, one brings 
 ic down by little and little into its right Place. 
 Great Care muft be taken not to bend the 
 Leg fbr any Caufe whatever ^ becaufe that 
 wou'd remove the Piece of Bone farther than 
 it is ^ this is fo true, that it hardly mounts 
 up at all, in fuch as immediately ftretch out 
 their Leg after the Frafture, ai'id it gets up 
 almofl to the m'dJle of the Thigh in thole 
 who fall wholly with their Leg bent, or in 
 thofe whofe Legs have been bent to find out 
 the Fradure. 
 
 This Remark is Co eflential, that the Suc- 
 cefs of the Cure depends almofl always upon 
 it \ in effeft, altho' the Rotula be b. oken there 
 ftill remain lome Parts of the yiponeurofts that 
 retain it, which arc deftroy'd by bending the 
 Leg. 
 
 When 
 
Difeafes of the Bones, 
 
 When the Kotula is in its place, it muft be 
 kept there by a Bai^dage, that may be made 
 ditferently •, fome firft make a little Bandage 
 with the Roller (A) which forms a Figure of 
 8 with two Tails, and goes but two rounds; 
 after this they put on the Rolls of Linnen, or 
 
 
 
 Plaifter (BB) upon and under the brolcen 
 Bones, in the Figure of a Crefcent ; they are 
 cover'd with the Plaifter, with four Ends 
 (C) which fome put under the Crefcent/, 
 immediately upon the Rotula^ but it is better 
 
 331 
 
 t« 
 
332 A Tre A TISE ofthr 
 
 to lay it over them ^ dien they make a Dan- 
 dace with a larger Band, which forms a Fi- 
 gure of 8 like the firft, and is made with' 
 the roll'd Band, with one Head fDD) or 
 that with two Heads (E), and after 'tis put 
 on they turn up the tour Ends of the Plaifter 
 (C) over the Bandage, and faften them with 
 Pin?, fo as that they may exaftly bring tha 
 two Pieces of the RotuU together, and prevent 
 the Bandage from flipping. 
 
 After this the Part muft be put into Junks, 
 or into the Paft-board (G) trimm'd with a 
 Napkin, to hinder the bending of the Leg. 
 
 There are f(ime who make ufe of the falfe 
 Junks (F) with a Napkin folded 8 double, 
 which they lay under the Kam, and unroll fo 
 as the two Roils meet exaftly at the linall of 
 the two Condyles. Then they take a Band like 
 (E) fix Ells long, and roll'd up in two equal 
 Beads, between which they fow aComprefs half 
 Finger's breadth in thicknefs, which they 
 put in the place of the Thumb, that has 
 kept the upper Part of the Rotula, whilft you 
 were taking your Band ^ then they apply the 
 Band and CoirprefTes holding the Heads one 
 in each Hand, and having the Thumbs on 
 that part of the Band where the Comprefs is 
 fow'd, they carry each Hand from Right to 
 Left, pafling over the falfe Junks ^ but fome 
 bodies Thumb mufl be always upon the Com- 
 prefs, to fupport the upper Part of the Rotula. 
 When the two Head''^ of the Band are brought 
 to the Ham, one muft crofs them by changing 
 Hands, to carry them like a Crelcent under 
 the lower Part of the Rotula, which is alfo 
 cover'd with the Comprefs or Crefcent (B) : 
 The two Heads mull be fliifted from 
 on« Hand to the other, and guided ob- 
 liquely 
 
Difeafes of the Bones, 222 
 
 liquely under the Ham, as they come upwards, 
 where they muft crols each other to make 
 them pals over the round, and the fame muft 
 be continued to the end of the Band, bring- 
 ing the Trufi.es near, by little and little, thac 
 the Pieces may be bound the clofer. When 
 this Band is ended, the Comprefs (H) four 
 Fingers broad, and as long as the falfe junka 
 muft be placed upon the fraflured Part, and 
 the Paft-board (I) half a Foot broad under 
 the Ham ; the whole muft be kept on by the 
 Band (K) which at firft makes two or three 
 Cafts round the lower Part, and afterwards two 
 oblique turns that muft crofs each other upon 
 the RotuUy then two cafts round the upper 
 Part, and may end where it will. The Part 
 muft be placed ia Junks, and laid upon a 
 Pillow, rais'd towards the Foot, to keep the 
 I^eg extended, and facilitate the motion of 
 the Fluids : The fame Precautions muft be 
 taken in dreifing the Frafture. The Callus is 
 50 Days in forming, or at lieaft before 'tis 
 firm enough to allow of the Patient's walking. 
 1 have fince contrived a fort of Frame which 
 ferves me inftead of the falfe Junks : It is 
 made of Turkey Leather, lined with Shammy, 
 and has four Notches or Holes, that ferve to 
 retain the turns of the Band, as may be feea 
 ip the Figure. (LL) make the two fides, 
 and (MMj the Semicircles, whereof one goes 
 round the upper, and the other round the 
 lower Part of the Ham, (NN) are the Bran- 
 ches which retain the Cafts of the Band by 
 their unevennefs. 
 
 OhfervAtion 
 
334 
 
 ^Treatise of the 
 
 Chfervation of Cvtifequence. 
 
 On all Occafions wherein any Motions muft 
 be made, to replace the b''oken Bones, one 
 muft avoid thoie that are ufelefs^ Pain is not 
 of fo little moment as to be caufed for no- 
 thing : An Obfervation that was communi- 
 cated to me in publick will lerve to prove 
 what I fay, and that I may alter nothi.ig, I 
 ihall quote here the Letter juft as it was given 
 me by the Clerk of St. Cofmus^ in the prefenct 
 of the Audience, as I was reading my publick 
 Leftures. 
 
 AN Accident happened fome Days ago 
 " to a Man who fell npon his Knee, 
 and a Surgeon was fent for who cou'd not 
 difcover any Difplacing: After this, by 
 reafon of the great Pain the Patient felt, k 
 Mafter Surgeon, who was very skilful was 
 caird in, who cou'd no more find any Fra- 
 cture nor Luxation than the firft, therefore 
 he order'd what was proper. 
 " The Patient or the Affiftants, not being 
 fatisfy'd with this, fent for a Mafter Bone- 
 Setter, who immediately examined the Part, 
 and perliiaded the Patient and the AiTiftants 
 that there was a Diflocation, which was not 
 hard for him to do, by reafon of the Pain the 
 Patient was in. Hereupon he let himfelf about, 
 reducing this pretended Luxation, and be- 
 gan to bend the Leg to the Buttocks with 
 all his Strength, and to ftretch it out, which 
 caufed fuch acute Pain that the Pat-enC 
 fwooned away. Upon this he left cff his 
 
 « Ope- 
 
Difeafes of the BosEfi, 5^5 
 
 *' Operation to recover the Patient, which 
 being done, the Workman began his Work 
 again, and the Patient Iwooned a fecond 
 
 " time and Died upon the Spot. Wherefore, 
 
 " Sir, do us the favour if you pleale to tell 
 
 ** iiow this cou'd happen. 
 
 Anfiver to the Letter. 
 
 FIRST, One may obferve, that the Pa- 
 tient had been vifited by two Perlbns, 
 who leparately were of Opinion that there 
 was nothing difplacedj but let us fuppofe for 
 oiKe that there was a Dillocation, I fay, that 
 this Bone-Setter ought not to have made thefe 
 murdering Extenfions, for it is certain that 
 one ought not for any Cafe whatever to bend 
 the Leg either at the Time or after the manner 
 that this the Bone-Setter did. 
 
 The Time that the Patient felt fuch acute 
 Pains was not proper to make the Extenfions. 
 If the Bone-Setter had read the Pages of the 
 firft Volume of this Treatiie, where the Time 
 and Manner of moving the Joints is fpoken of, 
 perhaps he wouM not have committed this 
 fault. In that Part of the firft Volume, one 
 may fee how and which way the Limbs muft 
 be moved, and above all, 'tis obferv'd. there, 
 that the Fore-Arm ought never to be bent fo 
 as to make it touch the fore part of the Arm, 
 nor the Leg 9i as to bring it to the hind 
 part of the Thigh, on any Account whatfoe- 
 ver. The Frifture of the fihiay and that of 
 the Femur ^ near the Articulation of the Knee, 
 only require Extenfions and Counter-Extenfi- 
 ons in a right Line. 
 
 The Luxition of the Leg has no need of 
 any other Motions j and whoever in Fra£lures 
 
 of 
 
336 ^ T R E A T I S E ^/ r^^ 
 
 of the Joints fhou'd make a Motion of Flexion, 
 wou'd rather dilplace the Bones than join them. 
 'Tis true, that ni a Luxation one may make 
 a little Flexion an! Extenfion to replace the 
 Bone, but this oua,ht to be done gently^ and 
 as it were to try whether the Joint can make 
 all thele Motions. 
 
 U" the Bone-Setter Aiou'd tell me that the 
 Mttula was diflocated, he wou'd not juftify his 
 Management a jot better, becaufe it is certain 
 that only continues luxated becaufe it is 
 ftrongly forced againft the Condyles of the 
 Femur, by the excelV.ve ft retching of the Ex- 
 tenfors •, wherefore to replace it, this Exten- 
 fion muft be leffen'd by ftretching out tlw 
 Leg as much as poilible, then one brings the 
 Infertion of the Extenfors near their Origin, 
 which relaxes them a little, and renders the 
 reduftion of the Bone eafy. 
 
 If the Bone-Setter fays there was a Fra- 
 fl:ure, 'tis ftill worfe, becaufe it has been de-* 
 monftrated in the Chapter of the Frafture of 
 the Rotula that the Flexion of the Leg is hurt- 
 ful : The Stru£ture of the Part is fufficient 
 to prove it. Neverthelefs he muft have an 
 excufe, and won't fail to lay that the ftarC- 
 ing of a Kerve was the Ail that raus'd him 
 to make thefe extraordinary Motions. I will 
 ask what he means by a Kerve ftarted : If 
 he means that fort of convulfive Motion that 
 is known thro' the World under the name 
 of Parting, all the World will fee that he 
 was in the wrong to make thefe Motions, 
 they are not proper, and wou'd be more ape 
 to make it ftart then to cure it. Does he un- 
 derftand by the ftarting of a Nerve the dif- 
 placing of the Tendons ? Let us forgive him 
 this Expreffion in favour of his Ignorance ; 
 
 buc 
 
L'jfeafes of the Bo N E S. 33^ 
 
 but let us nCTt confirm People in this Error, "^ 
 
 for the Tendons cannot be difplaccd without 
 breaking (as will be feen in the Chapter that 
 treats of this Subject) or unlefs there be a 
 Luxation or Frafture, befiJes this does not 
 happen after the manner that he may un-i 
 derltand it, but as it has been explain'd in 
 the general and particular Treatifes of 
 thefe Difeafes. 
 
 Wou'd he fiiy that the Tendons may come 
 out of their Sheaths? The Strui^ure aloie 
 proves that it cannot be \ and ihou'd one 
 grant a po/fibllity ot it^ nothing wou'd be 
 more contrary to replace them than the vio- 
 lent Motions we have fo much blam'd : And 
 if one wou'd grant what is not fa^l, that one 
 fhou'd bend and ftretch out the Joints wirH 
 Violence, to replace the Tendons when out of" 
 their Sheathe, this wou'd only be for thole 
 Joints where the Tendons have Sheaths, it 
 cou'd not be for tha Knee, where 'tis known 
 that the Tendons which move it have nd 
 Sheath. 
 
 I conclude that the Pain proceeding from the! 
 ufelefs Extenfions, may have been the Cauf«* 
 of the Patient's Death. 
 
 C H A E XllL 
 
 Of the Simple FraSnre of the Leg. 
 
 Y F there is any thing Wanting in thiS Chap 
 
 I ter, you may have recouf fe to the general 
 
 Cure of Frailui'es, whereon I hav< enlary^ed 
 
 Z very 
 
358 A Treatise of the 
 
 ^ vevy much •, nevevtlielcfs I hope that you v»i\\ 
 find in this enough to latisfy you. 
 StoiGurc '^^^ ^^^ ^^ composM of two Bones, the itioft 
 confiderable is the Tibta^ which Torms the whole 
 Articulation with tl;e Thigh, and moft part 
 of that of the*. Foot. The lealt confiderable 
 is the PcYcrray wi'hich contributes not at all to 
 the forming of the Articulation ot the Knee, 
 and or.ly makes the external limit ot that of 
 the Foot, which is calFd the Ankle, or the 
 AfaUeolus Externus. 
 
 Thefe two Bones may be broken both to- 
 
 Thc gether or leparately •, fometimes the one is 
 
 Kinds. broken above and the other bt?low, feldom 
 
 both in the fame place, except when the fame 
 
 Caule afts at the fame Time upon both, upon 
 
 both, as the Wheel of a Waggon, Coach, g^c. 
 
 When the Leg is broken by a blow that on- 
 ly ftiikes the Tibia^ this Bone only is broken 
 at the Place that is flruck, and the Terotm 
 fometimes is fractured by the fall of the Pa- 
 tient, becaufe this Bone is not able alone to 
 fupport the weight of the Body ^ in fuch 
 Cafe the fra£lure of the Verona is generally di-- 
 ftant from the Place where the Tihia, is broken : 
 We lee that in falls the Tih'ia and the Verona 
 generally break, one in one Part and the o- 
 ther in another. 
 
 Sometimes there are Shivers or Splinters 
 feparated from the body ot the Bone, but flill 
 adherent to the Fle/h. 
 
 'Tis even feen that the fame Bone breaks 
 in two or three Places, and its Fraftures fome- 
 times happen near the Jo-nt, or. even ir^ it, 
 as the Malleoli have been known to be broken. 
 
 The fraftured Ends have different Figures^ 
 and fuffer various difplacings. 
 Si^ni. The Signs are dilcoverable by ' the Sight' 
 
 the Hearing, aiid the Touch : It may be fee 21 
 
 it 
 
B'lfedfis of the Bone s. 3^9 
 
 iT the Leg has loft its ftraitncfs, and its ihaj^e \ 
 the Crepitation may be heard when one mo'/es 
 the Part, and the Bones grate againft each 
 other ^ and the une^ennels may be tl-lc with 
 ones Fingers by running them alo:ig the inner 
 Surtace of the Tibia, or along its Creft. 
 
 The Fradure of rhe Ttbia only is eafily dif- signs of 
 covered, becaule the internal Surface of this the fra- 
 Bone is not cover'd with Mufcles ^ but the ^t"'"^ ^[ 
 Frafture of the Pei-ona. is hard to be found out t^*^'^^^'*" 
 when the Tibia is not broken. 
 
 To be airured whether the Perona be broten^ 
 one muft grafp with one Hand that Part of 
 th^ Leg which is below the Cemclliy and with 
 the other the Sole of the Foot near the Heel,' 
 and then turn the Foot alternately out and 
 in, to thruft the Aftragalus agaii ft the AMe- 
 olus Externus, and move the Verona. It' 'lis 
 whole the Hand that holds the Leg will be 
 fenfible of it by its Refiftance \ and if the 
 Bone is broken, it will be pferceiv'd by the 
 Crepitation. 
 
 When one is certain of the Fraflure, and 
 has a juft Idea of the Place where the Bone 
 is broken, and as near ss pollible of the F'gure 
 of the broken Pieces, the Part muft be fhav'd 
 if 'tis Hairy, and the Rediiftion made. 
 
 Suppofe both the Boies of the l,eg were jExturmta; 
 frailur'd four Fingers breidth above the Ankles^ 
 the Patie'it being laid in his Bed, with the 
 broken Leg as near aS pofTible tothe Side, to 
 facilitate the Operation, an Aftiftant muft put 
 the four Fingers of both Hands very gentlV, 
 the one within, and the other without, belou* 
 the Articulation of the Knee, where the Cnlt 
 of the Leg is not quite at the largeft : Eis 
 Fingers muft be lock'd in one another to 
 ftrengtheii hiij holJ, a. id the two Thumbs muft 
 
 Z 2 bt 
 
«&. 
 
 340 A Treatise of the '^ 
 
 be extended before, to taJ<e hold of the Leg 
 M*no*l below the Promir.ence of the 7/^i<t. Another 
 Opcniti- AfTiOant, ftron^er than the fiift, being placed 
 at the Fndofthe Bed, muft put the Fingers of 
 both Hands under the L^ above the Heel, 
 lock'ng them or.e in another like h-m who 
 holds the upper Part, and even more, becaule 
 the Part \»hich he holds is not fo large: He 
 muft bring his Thumbs forwards, fo as to 
 make them touch in a Parallel Line, to grafp 
 the two Bones of the Leg circularly •, then 
 t?ie Surgeon being on the outfide of the Leg, 
 with his Back to the Foot of the Bed, muft 
 take hold gently of the frattured Place with 
 both Hand?, the Fingers under, and his 
 Thumbs above-, he muft order the two Al- 
 fiftants to draw each on their Part raifing the 
 Le^ gently, whilft he at the fame irjfl:ant lifts 
 up the fraftur'd Part foftly with his Hands, 
 without making as yet any ufe of his Thumb*;. 
 V^hen the Leg is raised enough to facili- 
 tate tile Operation, he muft order the A/fiftants 
 to draw ftrongly in a right Line, then he muft 
 work, with the flefhy Part of his Thumbs, 
 placed one lower than the other, upon the 
 fraftured Part to replace the Bones. 
 
 This Operation which the Ancients call Co- 
 aptation or Conformation, is not always per- 
 form'd the fame Way. 
 
 \^'hat his been juft mentionM fuffices fome- 
 time.-H, but the Surgeon is often obliged, that 
 he may Comprefs the Part with more ftrength, 
 and more exaftly, to p'ace the tiefhy Parts of 
 his Thumbs over againft e.ich other, to make 
 an effort on th? very Place that is fraftured -, 
 foraetimes the Thumbs do the bufinefs, and 
 when all thefo means don't avail, one is o- 
 biiged to make an Inciiion to lay the Bone o- 
 
 pe». 
 
Bifeafes' of the B o N E s. 54» 
 
 pen, and ufe the Elevatorfes, or the Trepan. 
 I h:«ve hitherto avoided this Operation, (which 
 is I'ometimes more tiital in its confequencet, 
 than cruel in its felf ) by ufiiig of Straps, in- 
 ftead of Hands, to make the Exteafions ftrong 
 enough ^ for the Difficulty o{ making the Re- 
 duftion proceeds only trom fbrae Part of the 
 Bone's, continuing to touch by its fides, and 
 this Obftacle to the replacing them fubfifts 
 HO lorger when the Extensions are liifficient : 
 It may alfo depend upon the turn of a Hand Rei^»rk. 
 to be made by him who holds the lower Part, 
 ibmetimes to the Right, fometimes to the Left, 
 at other times upwards or downwards, and 
 always at the time that he is bid \ he muft 
 not aft without orders, and even ought to 
 be well inftru£led, that he may execute them 
 right ^ for this Realon one muft not only 
 place the AlTiflant that is ftrongeft at the 
 Foot, but alio him that has mcft Experience. 
 As thefe Operations are ibmetimes long, 
 one muft at the beginning place the Aftiftants 
 commodioufly, that they may be able to keep 
 in the fame fituatioi all the Time of the 
 Reduftion, and putting on ot the Dreftings. 
 
 This is the Time when the AiTiftant that i^emark. 
 held the lower Part ot the Leg, above the 
 Malleoli^ muft Ih'ft his B«nds gently : \i 'tis 
 the right Leg, he muft fl"p the Palm of the 
 Left Hand mider the Patient's Heel, his 
 Thumb being at the bottom ot the Malleolus 
 Exter?jus, and the four Fingers at the bottom 
 of the Malleolus Jnternus :, he muft fliift his 
 right Hand with the fame eifmefs by llid'n?; 
 it away, and without letting go his Hold, Eflc»»J*l 
 he muft replace it lb, as that the Palm of his Opci^i- 
 Hand may be at the inner part of the®"* 
 Foot, his Thumb at the Sole, and his four 
 
 Z 3 Fingers 
 
J42 
 
 Drefling. 
 
 A T p^E ATI s f. of the 
 
 Fingers rriHy {jralp tlie Tarfus^ as near as pof- 
 fible to its jointing wirh the Leg. This 
 changing of Hands muft be done tpeedily, 
 ei^fidly, and gently ^ preierving the Leg in 
 the fame Pofture, and drawing always with 
 one Hand, whilft the other is removed, 
 ai.d then with both, when the fecond is 
 placed. During this the Surgeon always fup- 
 poits the fraitur'd Part that it may not be 
 dilb'der'd. 
 
 Things being thus, the Surgeon mufl have 
 his Dreflings brought near him, which he muft 
 fet in order himielf, that without being at 
 any trouble, he may find all the Pieces in the 
 place he has laid them, which is as they are 
 to be put on. 
 
 He muft take Simple Comprefs (A) fteep'd 
 in Aromatirk Brandy, holding it by the two 
 Corners that are not cut with the Ends of 
 his Thumbs a.id his Fore-Fingers, the latter 
 being placed underneath and the former at the 
 Top : He muft carry the Comprefs on the 
 ^PP^'^^j^^ infide of the Leg, and letting fall his Hands 
 3imple ^^i^h the Ends of the Comprefs on the out- 
 Coaipiefs. lide of the Leg, he muft take hold or" the 
 Ends that are cut with the Middle-Finger, 
 and other Fingers of each Hand, and muft 
 draw them outwards from the infide over that 
 end of the Comprefs that is not cut, which 
 end muft be made faft underneath, by little 
 and little, lettirg go the Thumbs by degrees, 
 till the two ends of the Comprefs that are 
 cut have entirely cover'd the other, and go 
 over it to finiih their Circumvolution. One 
 muft avoid Folds and Ruiiings which would 
 caufe Pain. 
 
 This Comprefs bjing put on exaftiy, one 
 muft take the fiift Band (B) three Ells and a 
 
 lialf 
 
Lipufis of the Bones. 343 
 
 lialf long, more or lets according to the i\:r.e 
 ot the Leg •, it mufl be at moll: but three Ihiall 
 Fingers broad, and muft be unrollM eight or 
 ten Fingers breadth, the Imall end muft be 
 dipt in Aromatick Brandy, that it may ftick 
 and not flip. 
 
 To hold the Band well, and put it on with AppHca- 
 more ea(e, one muft keep the Roll in thetionofthe 
 Palm of the right Hand, if 'tis the right Leg, J^^^J^*"' 
 the Thumb being placed on that fide of the *^ * 
 Band that unrolls, and the four Fingers on the 
 oppofite Side \ the End that is unroll'd is held 
 between that Part of the End of the middle 
 Finger that is oppofite to the Nail, and the 
 Kails of the Fore and Ring-Finger, or elfe 
 'tis held by the Thumb and the Fore-Finger, 
 the firft way is ihe moft convenient. 
 
 The Band being held thus, the Surgeon 
 muft turn the back of that Hand that has 
 the Roll towards the Leg, and bringing the 
 Band and his two Hands within an Inch of 
 the Leg, he muft put the End ot* it held by 
 his left Hand under the Leg, beyond the in- 
 fide of the Tendo;i o^ Achilles , near the In- 
 ternal Surface ot the Tibia^ over againft die 
 Fracture, where the End of the Band will be 
 eafily faften'd, becaufe 'tis wet, and refts upon 
 the Comprefs. The unroll'd Part of the Band 
 muft be carry'd thither with the right Hand, 
 and when it has been unroll'd and carry'd 
 down perpendicularly the length of fix Fin- 
 gers, the left Hand muft take the roll at this 
 Place, and the four Fingers of the right Hand 
 replace themfelves ilightly within the inner 
 Fart of the Leg upon the Fradure, to follow 
 the Band underneath, where they muft re- 
 main to fupport the fraftured Pieces, whilft 
 the left Ha;id finilhes the firft circular call 
 
 2 4 of 
 
J44 ^ TREATISE of the 
 
 of the Band, and unrolls it by carrying the 
 Roll perpendiculiirly upwards, where the Band 
 muft be unroird five or fix Fingers bieadth, 
 and where the right Hand muft take it again, 
 without moving it till the left Hand has taken 
 its Pbce under the Leg to fupport the Fra- 
 fture, till the right Hand has finifh'd the fe- 
 cond Caft of the Band, which it does by car- 
 rying what is unroll'd of this Band over th^ 
 firft Caft •, then continuing this Method, they 
 make a third Caft, and begin the firft Trufs 
 going upwards. This firft Trufs ought not 
 to be above two Lines diftant from the third 
 Caft \ the fecond Trufs two Lnies and a half, 
 the third three Lines, and the others but 
 four Line", or four and a half at the moft. 
 Tliey continue always the fame Method alter- 
 natively :; one of the Hands fupports the Part, 
 whilft the other makes ufe ot and carries 
 round the Band. 
 
 It muft be cbfervM that the Leg being 
 fmaller at the Place where we have fuppos'd 
 the Frafture, the turns of the Band can't 
 Kemark. be made going upwards towards the Calt of 
 the Leg, but there will be a Pucl<er, that is 
 to fay, an empty fpace at the Place which 
 the Band don't bear upon. 
 
 To avoid this Ir.conveii'erce feveral Me- 
 tJiods are propofed, fome wou'd fill up, and e- 
 qxialize rhe I es with Comprelfes from the 
 He?i to the Calf, before the putting on of 
 the fti ft Band •, others don't trouble them- 
 felves about Folds or empty fpaces ^ and o- 
 thers again make Reverfe*^. I will propofe a 
 fourth way to take up the Baijd, wherein I 
 have had very good Succef>. 
 
 As for Comprelfes, I wou'd not advife the 
 putting them on before the firft Band, beraufe 
 
 the 
 
 I 
 
Lifeafes of the Bone s. 5^5 
 
 the Circumvolutions muft be as near the Fra- 
 ilure as poflible, to retain the Bones the bet- 
 ter in their Places. 
 
 They who let the Roller be rumpled tall 
 into two Incovcniences, firft they only com- 
 prefs the Part by the upper Edge, as a Cord 
 pr narrow Ribband wou'd do, which is not 
 proper, and fecondly the lower Edge of the 
 Band which has no fupport, is loofe, makes a 
 Pucker, and folds at the will of the Cafts of 
 the Band that pafs over it : Thele two in- 
 conveniencies render the Band ufelels ^ becauie • 
 it don't contain the Part, and hurtful • by 
 reafon it plaits and rumples fo as to hurt 
 the Patient. 
 
 The Reverfes therefore are much more con- 
 venient. In making them feveral things muit 
 be obferv'd, 1 ^, to begin them where the Pare 
 growing larger won't allow the Roller to lye 
 even ; that is to fay, whea one perceives rhat 
 if one continues to roll the Band it will make 
 Puckers, or Rampants inftead of Trulfes. 
 
 The fecond thing to be obferv'^i is not to 
 unfold lb much of the Roller, 
 
 The third is to hinder the Trufs, that is juft 
 raide, from loofeaing, which is done by lean- 
 ing the four Fingers of the lefc Hand upon the 
 \^A part of the Band that is underneath, and 
 bringing the Thumb forwards to direft it. 
 
 The fourth is to reverfe the Head of tha 
 Band, the upper fide under, the Part that is 
 roUM hindmoft, and the Part unroU'd foremoft, 
 to fold the Band above, fo as that the upper 
 edge of the Roller may be undermoft, arwi 
 that which was on the infide may be on the 
 outfide. 
 
 The fifth is not to draw the Head of the 
 Band till the fold or or Reverie be ended. 
 
 The 
 
34^ >rf Tre ATis E <?/^fjfr(r 
 
 The fixth is to obferve, in drawing the 
 Band Ibftly downwards, to unroll as inudi as 
 necelTary to finijh the turn, and to hold the 
 right Hand in this Phct till the left has 
 taken the Roll of the Band, as has been faid 
 above. i 
 
 7°. The right Hand, on parting with the 
 Roll, n^uft pals lightly, from the inVide to the 
 Part undexntath over the Reverfe juft made to 
 foiooth it ai d make it equal, tbibwing the 
 Roll which is carry'd by the left Hand from 
 below upwards, and drawing the Band Wghdy' 
 at the very inftant that it is unroll'd to make 
 the fecond Reverfe. ■ "^ 
 
 This firft Reverfe being finifh'd they make 
 a fecond, then a third, a fourth, or more if 
 requifite, and all going upwards toward the 
 Knee, obferving two things, ftrft to raife the 
 Band at every Reverfe and Trufs, at the time- 
 that the left Hand carries it under, that is' 
 to fay, that one caft of the Band muft not be 
 made upon another, becaule the Bandage 
 muft terminate going upwards, and every 
 turn muft be Jiigher than that which went be- 
 fore it ^ and for this they take the time that 
 the Band goes under the Lee, and trims the' 
 External Part^ which they^ regulate by the 
 diftance they put between each Reverfe. If. 
 this Circumftance be not obferved the Band' 
 that comes to thti outftde of the Leg would 
 be lower than the Reverfe juft made. The 
 lecond thing to be obferv'd is to place the 
 ■plaits of the Reverfe io as that they may meet 
 in the lame Line going upvvards, which gives' 
 them exaftly the ihape of an Ear of Corn. 
 When there is nn lona.er need of the Rev^erfes, 
 they make circular Cafts going always upwards 
 to finifh the Bandaf^e near the Knee. 
 
 This 
 
 i 
 
Difeafes of the B o N E S. 247 
 
 This is a Method wherein I have had 
 good Succefs^ and which is founded as 
 7nnch upon Reafon as FraBice, 
 
 Having put on the Simple Gomprefs (A), 
 I take the Band (B) three Fingers broad, 
 and two Ells and a half long, 1 ufe it in 
 making Circumvolutions one over the other 
 at the Place of the Frafture, and then Truffes 
 going upwards till I find my felf obliged to 
 make Reverfes, and inftead of lo doing, I go 
 "down again in TrulTes pafs over the Fra£lure, 
 and finifh my Band by going down to the 
 Malleoli: This done, 1 lay on three Com- 
 preOTes, two (DD) are graduated at their 
 ends and fellows, being each four or five 
 Fingers long, an Inch broad, and fix Lines 
 thick, except at their Ends which I leave a 
 little fmaller. Thefe two ComprefTes are placed, 
 the one internally in the hollow that is be- 
 tween the Tendon of Achilles and the Tihia, 
 and the other on the outfide in a like hollow 
 that is between the Tendon of Achilles and the 
 Perona, fo that the Tendon is not comprefs'd, 
 and the Bones are kept as clofe as poilible. 
 
 The 
 
^ T R E A T I s E of the 
 
 The 
 
Dlfeafes of the D o n e s* 5^^ 
 
 The third Comprels (E) is a little more 
 than five Fingers Tquare ^ it is fix Lines tJilcJc, 
 except half a Fingers breadth on every fide 
 xvhere it ii> graduitei, and uoc lb thici: hj 
 half. I lay this third Comprels from die rma.ll 
 of the Heel to the Small of the Calf^ ih that 
 Its mid.lle encompaffes the former ii^vo littl? 
 CompreiTes, which I callM twins. This done, 
 I take the fecond Band (C) to ta'Ae fail tlie 
 whole, be2;inning near the Heel, t\\e\\ going 
 up to the FraO:ure, over which I make thre^ 
 rounds, before I go higher to ilniih ray Band- 
 After thi-8 I lav on the longitudinal Bolfters 
 (FFF), then the third Band which taliei.s 
 them on, and after that the Paft-boards^ junks, 
 and the reft that are going to be defcrib'd 
 
 In the follow! ig Method of Reveries, one 
 «ught after the firft Band (B; to put on the 
 fecond (Cj, which muft make three turn^ 
 upon the fraftur'd Part, then go down m 
 Truffes to the MiiKeohs ExtemuSj which it 
 »iuft cover, paihng obliquely over the Iniiep, 
 to crofs the Sole of the Foot^ and coming 
 back obliquely upwards, to make a St. ^^sb^ 
 ArcTcPs Crofs with the firft oblique turn, then 
 covering the Malleolus wterNuSy returning bicfc 
 to the Leg, going upwards in Trulfes pa fling; 
 over the Frarture, and thence to the Calf of 
 the Leg, where it forms Reverfes if need be 
 to end in Truffes^ near the Knee like the fii it- 
 Band. 
 
 V\'hen this fecond Roller is put on, they 
 place the grriduat-ed CoiuprefTes (H j wh-ch are 
 thicker from the Heel to the Calf than they- 
 are beyond it. I content mv felf with ha- 
 ving propofed the Method that feems to me 
 the beftj without pretending to fliow the De- 
 feat of graduated Compreffes^ pra£l:Tng will 
 
 determine 
 
55o yf Treatise of the 
 
 determine you of your felf -to chooie the beft. 
 I Ihall conclude by adding that they faflen on 
 this graduated Compiefs with Pins, and after- 
 wards put Oil three longitudinal Boifters 12 
 or [3 Inches long, an Inch and* half broad for 
 great fubjeds, and lefs in proportion for fmall 
 ones ^ and as to their tliicknels 'tis different. 
 That which is laid from the Small of the 
 Heel to within two or three Fingers breadth 
 of the Ham, is very thick below, and (lender 
 at the Top ^ another which is laid alon|; the 
 infide of the I'ibiay is two Lines thick ail a- 
 long •, the third, which is laid on the outfide^ 
 is a little thicker than at the Top. Thefe 
 three Comprelles being thus put on, are held 
 above and below by the two Alhftants, and 
 then made fa ft with the third Roller (C), 
 which is longer than the others. They be- 
 gin to apply it below, at the edge of the 
 three longitudinal Bolfters, over which they 
 make three Cafts to fix the end of the Band, 
 then they go upwards in TrufTes, which form 
 Circles to the upper End of the longitudinal 
 Bolfters. 
 
 Then they clap on the Paft-boards (1 K) 
 which are an Inch fhorter then the Bolfters, 
 and fufficlently large to encompafs the whole 
 Leg within a Finger's breadth bath before and 
 behind-, they are cut a little floping at the 
 bottom and top, and are put one on the infide, 
 and the other outwards^ they are faften'd 
 with three Ribbands, t, 2, 3-, which go twice 
 round, and are ty'd on the outfide of the Leg, 
 in a Knot and a Rofe : They begin by tying 
 the middle Strap, and then the other two. 
 
 The Leg bsing thus made ready, they plnce 
 it \\\ the Junks (L), which are m^de with a 
 handful of lon^ Straw, and bound in 
 
 the 
 
Difeafes of the B o M E ?. 
 
 the fliape of a Fa^or, or twifted about with 
 Fillets or Packthread: They cut them ot a 
 proper length, to take up from the bottom 
 of the Foot to abnve the Knee, and they 
 wrap them in a Napkin which they roll over 
 the two Ends. 
 
 5'5 
 
 Thefe Junlcs muft be long enough to en- 
 compafs the Joints above and below the fra- 
 ftured Bone : The fiies of the Leg muft be 
 trimm'd in the hollow places, and thofe 
 whereon the Junks muft reft, with little 
 Compreffes or fmall Cufhions. The Junks 
 itiuft be bound on with Straps, wherein what 
 we mention'd in tying on the Paft-boards muft 
 b? oblerv'd. The fore-part of the Leg, over 
 which the Straps of" the Junks go^ muft ba 
 trimm'd wich a thick Comprefs to lecure tlis 
 Tegument that covers the Cref^ ot the Tihia. 
 
 The 
 
352 ^ T R E A T I S E ^/ ri^^ 
 
 The Leg being in the Junks, the Pillow 
 whereon 'tis placed muft be even, and loft, 
 and laid upon a Quilt, which muft it felt be 
 very even ; and to pieierve both the one and 
 the other m this evennefs and fteadinels, the 
 Bed muft only be of Quilts withotit a Fea- 
 ther-Bed, and there muft be a Plank laid be- 
 tween the ftrft Quilt and the fecond, which 
 muft reach from the Foot to beyond the 
 Hips. 
 
 They make ufe of the Sole (M), trimmed 
 with the Comprefs (N) on that fide whereon 
 the Foot refts, both the one and the other be- 
 ing taften'd to the Junks by a fort of Strap 
 (O O) ; which ferves to keep the Foot in a 
 proper (ituation. 
 
 They put a Comprefs (P) fteepM in fome 
 Spirituous Liquor, as Aromatick Brandy upon 
 the Inftep, to prevent Swellings and De- 
 fiuftions. 
 
 One muft ufe the Cradle (Q) being a lort 
 of Semicircle, half Drum, or half Bucket, 
 which makes a Lodging for the Leg and Foot, 
 to defend it from the weight of the Sheet and 
 Bedcloaths, and under which there is room 
 enough to fupply the Leg and Foot with 
 Napkins, and other hot Cloths, which they 
 warm from time to time when the Foot is 
 cold. 
 
 As to its pofition, the Leg muft be raifed 
 towards the Foot, becaufe this Pofture fa- 
 vours the return of the Blood and the Lymfha, 
 It muft lye foft to prevent Pain, and fteady, 
 becaufe Motion would difplace the Bones, and 
 prevent the formation of the Callus. 
 
 The Patient muft lye in a right Line upon 
 his Back, with his Head moderately rais'd 
 tor his Convenience, but net too much, for 
 
 feac 
 
 i 
 
Lifeafes of rbe Eon E $. 5 5 j 
 
 fear the Weiglit of ilic Body ihoulddniw h'm 
 down to the Foot ot the Bed. 
 
 They have a board cut as brond hs the Foot 
 ot the Bed, which they f.Oen to the ReJ-pods, 
 with Pegs or Kails the lame way as the He<id- 
 board. 
 
 Againft this Board they i'aften a BIllco four 
 fir five Inches thick, and trim it with NapkinSj 
 which makes it yet larger for the convenience 
 of the Patient, who makes ufe of it fiom Time 
 to Time, to raife his whole Body towards rhs 
 Bed's Head, or only to refift the Tenuency 
 which the Body has to flide towards the Feet 
 of the Bed. He mi.ft not make ufe of this 
 Billet till fuch time as all Accidents are over. 
 
 There muft alfo be a Cord hanging at the 
 Teller of the Bed, or at the Cielir.g if the 
 Teller is not firm enough, which he'ps the 
 Patient to move himfelf for his neceffary Oc- 
 cafions. 
 
 Being tlius placed, they Bleed him fome 
 time after, or even upon the fpot, in cafe of 
 Keceffity, they repeat the bleeding, make him 
 obferve a Regimen, keep him very warm in 
 Winter, and alleviate the exceilive heats of 
 the Summer j fee the general Cure of Fra- 
 dtures. 
 
 \\\^' 
 
 OF TME 
 
 A a CHAP* 
 
354 ^Treatise of the 
 
 CHAP. XIV. 
 
 Of the Complicated FraUure of the 
 Leg. 
 
 AFTER what I have fuid of Compli- 
 CvUed Fraftures in my Accouiit of Fra- 
 ^ures, in general, or in that of the Thigh in 
 particular, I might be excufed from fpeaking of 
 the L«g •, but one can't treat too amply ot a 
 fubjeft fo uitfful, all the Cafes whereof can 
 never be forefeen. However, I hope that ei- 
 ther in this Chapter or the others there will 
 be enough to prevent any one's being a 
 Kovice in the Cure of the Complicated Fra- 
 ctures that may befal the other Parts of the 
 Body. 
 
 'Tis known that three Things render a 
 Frafture Complicated, viz.. the Dileafes, the 
 Caules, and the Symptoms. 
 
 The Difeafes are Diflocations, Impofthumes, 
 Ulcers, and Wounds. We have treated ibf- 
 ficiently of Luxations with Frafture, in tlie 
 general Account of Luxations, and of Fra- 
 dures with Wounds, in that of the Thigh, 
 therefore 1 go on to Fraftures with Ulcers j 
 and to the end that what I fay may make 
 greater impre/fion on the Reader, I will cice 
 two Cafes upon this Head that are very dif- 
 ferent. 
 
 In the one, the Bones were laid open with 
 a Caries and Frailure, and in the ether there 
 was a Frafture without any other alteration 
 in the Bone, but there was an Ulcer at the 
 
 fam« 
 
D'lfeafgs of the B o \ E s. 355 
 
 fame place where tlie Fra£lure wis, without 
 the Bones being bare. 
 
 The firfl: was a Youth between t8 a;'/A 20 
 Years Old, who had an Ulcer with a CArics in 
 the middle of the Tibi.t, which had been neg- 
 Jested tor feveral Years. It hippen'd by 
 chance that a Cart-Wheel ran over his Leg, 
 
 fid fractured that Part where the Citries was. 
 he VVheel had no great difficulty to uncover 
 the Borje, which was only cover'd with proud 
 and Spongious Flefh : The Perona was whole, 
 and perJiaps the Tibia had not been broken 
 but for the Caries^ which had affefted almofl: 
 half its thicknefs. In this condition he was 
 brought into the Hofpital at Cowtray, where I 
 was then firft Affiftant. Having difcovered 
 the Dileafe to be as I have defcrib'd it, I 
 pfaced the fractured Part upon a little Qj.iilt 
 of the length of the Leg, during the Timt? 
 tlr^t I prepared my Drefling?. I placed upon 
 the Junks (KKj all the -Pieces neceiTary ac- 
 cordmg to the order in which they were to b^ 
 apply'd \ after which I drefs'd the Wound. 
 
 I cut all the unfound flefh into loofe Pieces, 
 ar.d even thofe which ftill adhered to the pu- 
 trify'd Bones. There v/as no need of anv 
 Extenfion, becaufe the Ver$n,i was entire, which 
 had prevented the Bone^ getti.:g one upiii 
 t'other^ the lower Part only went beyoi.dthe 
 other two Lines, I re-united it by thruftir.g 
 it with the Thumb of one Hand, and railing 
 the Foot wirh the other •, 1 drelVd all the 
 Wound with dry Lint, and hiving wiped 
 away the Blood that was about it, I put 
 under the Leg the Junks, whereon all my 
 DreiTii^g was, which confilled of the ^mple 
 Comp-e's (A) cut at both Ends, with whijji 
 I- covered the V\'ou:id, turning back the (owe 
 A a 2 £11 ^s 
 
356 j^ TREATISE of tht 
 
 Eiids ot the Coitiprels ouc after another ; after 
 this I cover'd it with a thicker Comprels (B) 
 which lerves ulbally to prevent the reft of the 
 Bandages being fpo\i d, becaufe it ibaks up the 
 Matter that flows from the Wounds or Ulcers. 
 Alter this I put on the Bandage with iS Tails 
 (C) beginning at the Middle, then at the 
 Bottom and Top, faftening always the Ends o^ 
 the Band with thole that follow'd. When V 
 had placed fix Tails on each Side, I put two 
 ComprefTes (DE) all along the Leg, one within 
 and tlie other on the outfide, to ferve as 
 Splints, which were made faft by the fix laft 
 Tails of the Bandage- Over all this I bound 
 with the Straps, i, 2, 3 •, the two Paftboards 
 ('DE) which encompafs'd the Leg: I placed 
 the thick Comprefs (H) four Fingers broad, 
 and as long as the junks, upon the fore-pare 
 ^f the Thigh, the Leg, and the Foot-, this 
 Comprefs ierves to prevent the Straps of the 
 Junks from hurting -, and afterwards I ty'd the 
 Junks with four Straps t, 2, 3, 4- at equal 
 diftances from the MaUeoU to four Fingers 
 above the Knee, taking Care, above all, not to 
 let the Straps pafs over the Place where the 
 Wound or Ulcer was, becaufe it vvou'd be 
 very detrimental. The Foot muft be fup- 
 ported by the Sole (L) trimm'd with the Com- 
 prels (M) fieep'd as ufual. One muft make 
 ule of felfe junks as has been propofed in the 
 Complicated Frafliire of the Thigh ^ or if, in- 
 ftead of all thele Junks both true and talfe, 
 one choofes a Cafe, I have contrived a new 
 one, the Ufe and Defcription whereof you 
 will find at the end of this Chapter. 
 
 I drefs'd 
 
Difeafes of the B o N £ s. 
 
 357 
 
 e^^ 
 
 -^iIiL:.Ri.iliWllllblltlllliilMlita,lliil!l 
 
 ^^mmTOifminirvriJTi?''' 
 
 A3 
 
 I drefsM 
 
^ 58 A T K L A 7 I i I. of the 
 
 I drefsM this Fra£lure thus for feveral Days, 
 without takii.g a^y Care of the Radical Cure 
 of the Caries, becaufe the Patiei.t had the Fe- 
 ver :, but as foo;: as this Accident ceas'd, I 
 apply 'd the a^ual Cautery to the Ends of the 
 broken and putrify'd Bones, after having 
 taken away part or the Caries^ with the Ex- 
 foliative '1 repar. The i.ext Day I apply'd 
 the Fire a2;a'n, and 1 drefs'd it afterwardi 
 with Pledgits fteep'd in Tincbure of Ala£s, 
 which! laid upon the Bone, ufmg at the begin- 
 ning only a fimple digeftive for the Flcih, 
 a-.d after that the brown Ointmei.t to pre- 
 vent the growth of the Flefh which is very] 
 hurtful. I follow'd this Method till the Bone 
 was exfoliated, which was 50 Days atter the 
 Application of the Fire , then I let the Flefli 
 crow, and procured the Scar after the ufual 
 mini er. 
 
 As to the Fraclure with an Ulcer, but 
 without Caries, or the Bones being bare, it 
 might be drefs'd like a Simple Frafture but 
 for the Ulcer, whidi being to be drefs'd every 
 Fay ablblurely requires the making ule of 
 the Bandage with 18 Tails, till it be cured ^ 
 then one m.ay ufe the Bandage of the Simple 
 Frafture, if the Ca^us be not yet form'd. 
 
 As to the Fracture with a Wound where the 
 Bones are brol^en in pieces and laid open, one 
 n^uft take all the Precautions that have been 
 given tor the Bandage, and even for the 
 Dreiling of the Fradure, with a Carles, ex- 
 cepting the Application of Fire, which at the 
 moft can only be proper at the End, I mean 
 when the Exfoliation is flow and difficult, 
 and even thcji it mufl be done with Cir- 
 irumlpedlion. 
 
 If 
 
Difiafes cf the Bo\E ^, 550 
 
 If any Pieces of the Boiie are found to be 
 entirely feparated, they muft be drawn our 
 and in their room muft be pUiced fach as ftill 
 adhere to the Flelh, becanfe they may dole 
 again, if not, they fall off with the Suppura- 
 tion ; neverthelefs if thele Splinters, or even 
 the Ends of the Bones iliou'd be fo fliarp, as 
 that they may huit the Velfeis, the Mulrles 
 or the Tendons, they muft be cut off with a 
 Chifel, Incifive Pinchers, or other Inftruments 
 which the Surgeon ihal] think proper. 
 
 If there Ihould be a Hsmorrhi^c^ the Blood 
 muft be ftunch'd by the Ligature, the Button, 
 other Stypricks, or Compreiiion. 
 
 By the Ligature, if the Surgeon fees the 
 VelTel, and can run the crooked Needle thread- 
 ed thro' eafily, without hurting any Kerve 
 or Tendon. 
 
 By the Button, when the VeiTel is very large, 
 and a way can't be found to make ufe of the 
 Ligature. 
 
 By the other Stypricks if the Veflel is fraall. 
 By Coir.pre/Ilon when it is ro: pDfiible to 
 make a Ligature, and the Application of the 
 Button or other Stypricks ihall b3 judged per- 
 nicious to the neighbDuring Part?, whereon 
 the Vitriol might make fome ill impreiiions. 
 
 If there be any Extraneous Body, as Stones, 
 Balls, Pieces of Boot, of Stockings, &c. they 
 muft be drawn out oblet'/ing all the rules of 
 the Operation of the Ex^refis \ then one ;nuft 
 brir.g the Shreds of the Wound rear each 
 other, if there are any, and afterwards bind 
 the Part, and give it a right fituation as has 
 been already faid. 
 
 A Frafture with a Wound made by a cut- 
 ting Ir.ftrument is to be differeritly managed \ 
 one muft immediately bring the L^'ps of the 
 A a 4 Wound 
 
;6o yi Tr^zATisz of the 
 
 Wound together by an ui itir.g Bandage, if jC 
 be long •, ai'id if it be very oblique or tranl- 
 verie, one muA m^Ve the Suture ; they ufe 
 the Bandajie with iS Tails, till the entire Re- 
 u!vori of the VVound. 
 
 Tiiis Method fucceeds, provided the fubjeft 
 be good, and obferves an exaft Regimen, at 
 le i{i I have feen it have fuccefs in an Arm al- 
 moin cut oil" by the ft^oke of a Sabre, a: d even 
 ill the Jaw, where there was a Wound with 
 the Fleih dilacerated. 
 
 I have Teen in Fraftures with Wounds in 
 ■ the Arm, the Fore- Arm, the Jaw, and the 
 Leg, a foit of Cuirafs us'd with good fuccefs, 
 hcn.^i, moulded to the Part, and ti imm'd witli 
 a Comprefs, and having a little W^icket join'd 
 by a Hii.ge or two, made in it, which fhuts 
 with a Hook, and opens at the place where 
 Wound i?, that it may be drelsd: Tho' I 
 have feen it usM for the Leg, and the Fore- 
 Arm, it har. nor had tlie lame fuccels ;, it fuirs 
 much better with the Arm, and Jaw, becaule 
 one may place the Fore-Arm and the Leg con- 
 veniencly upon PillowF, and lix them lb that 
 one may drels them conveniently without ail- 
 plac"ng the Bor.cF, whereas it is not the fame 
 with the Jaw, and the Arm, where it is pretty 
 Difficult to keep the Bones in the Condition 
 wherein they are placed. Scd-etus furnifhes us 
 with fomething like ic m jiis Magazine of 
 Surgery, to which 1 re'er you. 
 
 .•/ 
 
Bifiafes of the BoNES. 361 
 
 A Defcriptiofi of a dife of a t^eiv Inven- 
 tion^ for tJje Dr effing of Complicated 
 FraSures of the Leg, 
 
 THERE are three Thii^gs abfolutely ne- • 
 cefTary for the perieit re-uuiting of 
 broken Bones. 
 
 1 ^. The Bones «muft be fo join'd and brought 
 togetlier, that they may touch exactly through- 
 out the'r whole iiurface. 
 
 ^^. Both ends ought reciprocally to fweat 
 out or diftill a nutritive Juice which has all 
 the Qualities requifite to agglutinate, join, and 
 folder the Bones together. 
 
 3°. During the 30 or 40 Days, more or 
 lefs, that the Re-union of the Bones is per- 
 fecting, they muft be kept Aill, to the end that 
 the Cement which is made by the Islutritive 
 Juice, may not be interrupted in its Aggluti- 
 nation, by Motions that would deftroy in one 
 Minute the Work of feveral Days. To com- 
 pa(s this laft End, the Fraftures muft be 
 dreiVd as feidom as poiiible, the Bandage muft 
 be neither too tight, nor too loofe ; the Pa- 
 tient's Body muft be placed commodioufly, the 
 wounded Part a little raised, to facilitate the 
 return of the Fluids: It muft aUb lie foft, 
 that all may induce the Part and the Patienc 
 to obferve that Reft which is lb necellary 
 for his Cure. 
 
 This Machine which I have prefented to 
 the Academy, is of great u(e in procuring all 
 thefe Advantaize^, but before I defcribe it, I 
 believe it will be better to give an Account of 
 thofe that have been us'd till now, that the 
 
 advantages 
 
^67 A Tf^E ATI SE of the 
 
 adv^antages of this may be the better per- 
 ceived. 
 
 1 fliall take no notice of the Cafes or Junks 
 that are proper for Simple Fraftures, bccaufe 
 it is eafier to contain tliem •, 'tis not the fame 
 with CompIicareJ ones, for which they have 
 made ufe of the Bark of Trees, Junks, falle 
 Junks, and a Cafe^ fuccefs has made them 
 prefer this lafl Method to the others, there- 
 lore I fliallonly I'peak of the Cafe, the rather 
 becaufe the Machine that I otter is it felt" a 
 Cafe in perfeftion 
 
 The 
 
Difeafes of the B ONES. 563 
 
 The 
 
 »5 
 
5'% A Tr,z AT i$E of thff 
 
 The Common Cafe is compofed of four 
 Pieces, ^'iz.. a Sole, a Floor, and two Walls. 
 
 The Sale is joined to the extremity of the 
 Floor by two Hinges that turn upon two 
 Hooks, and the Walls are jornM in the dime 
 aninner to the lateral Parts of the Floor, for 
 ^ the Ules that Ihall be mentioned hereafter : 
 The Floor is cover'd with a little Quilt which 
 lupportsthe Leg-, the Walls alfo being triram'd 
 vrichaQirilt contain the Leg by drawing near 
 each other, and prevent the Motions it might 
 awake on the Sides. The quilted Sole fupports 
 the Sole of the Foot, which by its means is 
 kept more or lefs bent by the help of two 
 Hooks, which fafteii on each fide the Sole in 
 two Irons like Pot-Hangers, that are at the 
 End, and on the outfide of the Walls, which 
 Hangers have feveral Holes to give more or 
 lei's elevation to the Sole whofe Hooks they 
 receive. 
 
 The Kew Calc differs from the Old in 
 Strufture, and in ufe. 
 
 It dilTers in Structure, i^. Becaufe inftead 
 of a Floor it has a fort of a Girth-Bed, formed 
 by a Tickinc; iiail'd upon a Frame, which is 
 compofed of two Cheeks archM at the part 
 that comes to the bend of the Knee, and of 
 two crofs-pieces, the one which is ftrait and 
 ihortefl joins the Cheeks at the End that is 
 towards the Foot *, the other which is longeft 
 and archM does the fame at ^the Knee. The 
 lecond thiuj,, wherein this Cafe differs from 
 tlie firft, is a frame compofed alio of two 
 Cheeks and two Cr(^fs- pieces, the whole pa- 
 rallel to the upper Frame, excepting tint the 
 Checks of this latter are quite ftrait, and 
 thofe of the i;pper one are arch'd. The 
 Cheeks both of the o.ie and the other Frame 
 
 are 
 
Difetafes ef the Bones, 3^$ 
 
 are join'd togetlier, at the end that is towards 
 the Thigh by two Hinges, which gi/es liberty 
 to feparate or bring them near more or lels; 
 and to Jvcep them at a proper Dtftaiioe. Ther« 
 is a fort -of Pallet joijited by two Woodeia 
 Hinges, that hang upon two Hooks f<illen'«d 
 to the ends of the Cheeks of the upper Fr:irae:i 
 which Pallet falls againft the Cheeks, and raavy 
 be raised by degrees that ari? anark''d by 
 Kotches cut for that purpofe, in the upper 
 part of the Cheeks of the under Frame, to- 
 wards the Foot, fo that one may raife or let 
 down, the upper Frame whereon the Leg lies, 
 more or iefs, for tlie Ufes w>fi are goui^ ta 
 mention. 
 
 This Cafe differs from the otber, in thai' 
 with the fame advantages, it has an infinite 
 number of others more effential, without any 
 of its defefts. 
 
 1°. By reafon -of the double Frame, the 
 Leg may be raifed more or Iefs for the ^'a- 
 tisfa£lion of the Patient, who finds relief wlieja 
 his Leg is raised, or let down, not being abls 
 without Pain Co •continue long either in the 
 one Pofture or the other \ and one may change 
 it without fear of the Bones dilp lacing, be- 
 caufe the alteration depends only upon tke 
 Fl-exion or Extenlion of the Knee, which 
 Motions may be made by the means of the? 
 upper Frame, without running the Rifque o^ 
 di (placing the Bor>es- 
 
 2°. The Pallet having degrees of reining, 
 upon the Cheeks of the under Frame, may 
 ra'.fe the Leo; fafely to any degree th;<t is 
 convenient for the Patient in his Drelaings, 
 or in the Intervals- 
 
 3<^. As Complicated Fractures ought to be 
 drelVd every Uay once or twice, "and as i\t 
 
 each 
 
A Treatise of the 
 
 each Dreffing one muft raife and let down 
 the Leg, that thefe Motions may not be pre- 
 judiciar to the Formation of the C.tllus. It is 
 obfervable that one may raife the upper Frame, 
 and confequently the Leg, till the Pallet beat 
 its higheft degree of Elevation, then have the 
 Leg held by two of the Surgeon's Men, and 
 bow down the upper Frame to draw it from 
 beneath the Leg, and give to an Alhftant 
 who muft clean it, and trim it with a new 
 Bandage, after which it muft be replaced 
 tinder the Leg at a height proper to receive it - 
 by this means avoiding the Hazard one may 
 run by having two Perfons not equally Strong 
 nor Skilful, either to raile or let down the 
 Leg. 
 
 4°. The Ticking that is in the upper Frame 
 makes a fort of Girth-Bed, whereupon the 
 Leg is much more commodioufly fituated 
 than on the Floor of the old Cafe •, the Calf 
 of the Leg and the Heel form themfelves a 
 lodging therein, and the whole Leg feems to 
 adapt it felf to it. 
 
 5'^. The Arch of the Cheeks of the upper 
 Frame, which is at the bending of the Knee, 
 is very ufeful, by reafon it gives liberty to tlie 
 Leg to bend, which contributes not a little to 
 the preventing of that intollerable Pain which 
 almoft all feel, whofe Legs are put in the or- 
 dinary Cafe ^ the rather becaufe the principal 
 Caufe of this Pain proceeds from the Tenfion 
 of the Tendon of AchllUf, which one relaxes 
 by bending the Leg, becaufe tlie two Mufcles 
 Gemelli wliich compole ic with the Soleus, 
 take their Origine from the Con.dyles of the 
 Femur, and pals by the Articulation of tha 
 Knee. 
 
 <^°. The 
 
Bifetifes of the Bones. 367 
 
 6^. The lower Frame receives in its fquare 
 the fwngging of the Quilt prefs'd by the weight 
 of the Leg, which retains the Cafe ari'l hinders 
 it from fliding down towards the Feet of the 
 Bed, an advantage which the common Cafe 
 has not. 
 
 CHAP. XV. 
 
 Of the Rupure of the Tendons thcit 
 are inferted at the Heel^ and are 
 called the Tendons of Achilles. 
 
 TH E being convinced of a Fafl:, or the 
 doubting of it, is not always what in- 
 duces Perlons to grant or denying it. 'Tis 
 the weaknefs of certain Men, that lelf Love 
 determines them more than the Truth •, an 
 Abfurdity is granted upon a lingle Relation, 
 and the Truth (even whea demonflrated) is 
 call'd in Queftion. 
 
 Who can believe, fays one of thefe Weak • 
 
 Who can believe that the Tendons can break 
 with a Strain ? Their Striidure alone coPi- 
 
 vinces me that 'tis impoflible. Befides D 
 
 who has feen the pretended Rupture vvhicb 
 they quote for an Example, iays that the 
 Allegation is falfe. 
 
 When this Man (peaks thus do you believe he 
 
 gives credit to whatD' fays ? No, he knows 
 
 him too well. Neverthelefs this Witnefs t!io* 
 falfe, tho' weak, isfufficientto determine him to 
 take that part that flatters his k\f Love, becaufe 
 
 he 
 
^Treatise of the 
 
 he thinks to injure my Reputation •, but he is 
 miftaken, having no other objefl: but the Truth, 
 1 derpile his Flings, and 1 dare (Tor any 
 thing that regards him) believe my lelf 
 invulneriible even in the Tendon of Achilles. 
 
 Experience which I take for a Guide, and 
 which is lb to all who fearch after truth, has 
 let me fee fevered Times that the Tendons 
 were apt to break. I have given fome Me- 
 morandums upon this fubjecl to the Academy 
 of Sciences ^ what I fViall fay here is but an 
 Extraft, but 'twill be fufficient for young Sur- 
 geons, for whofe Benefit I write this Treatife. 
 
 It feems difficult for a drain only to break 
 the Tendons of Achilles •, 'tis neverthelefs what 
 1 have feen, and ihown to leveral of my 
 Brethren. 
 
 The Sieur Cochoix, one of the moft aftive 
 Leapers in his Troop, broke the two Tendons 
 of Achillesy in a Leap he took with his Feet 
 clofe, upon a Table three Foot and a half high, 
 without making any External Wound. This 
 Rupture happen'd fo, that the Mulcles of the 
 Calf of the Leg carried away on their fide 
 the greateft part of the Tendons, and the 
 Heels retain'd the reft. The Part which re- 
 main'd at the right Heel was above two In- 
 ches long, and that which kept at the Left 
 but 12 or 13 Lines. The broken Ends were 
 fo far diftant from each other, that one 
 might find under the Skin room er.ough to 
 put three Fingers in the fpace that was left 
 between them. I drefs'd this Wound till I 
 brouieht it to a perfect Cure, and the Cafe 
 feem'd to me fo fingular, that I thought I 
 ought to communicate it the Publick. 
 
 What 1 have to fay upon this Head is re- 
 ducible to three Things, viz.. how this Rup- 
 ture 
 
Bife^fes of the Bo N E s. 5^0 
 
 tiire was made ^ how Art and Nature con- 
 fpired to cure if, a d laftly the Expllc;itioiiof 
 tiirc^e fingular Phduomcrjas that were obferv'd 
 therein. 
 
 That one may compreherd how this Rup- 
 ture couM be made, it muft be obferved, firfl 
 that in cur natural State, when we ftand ex- 
 adly upright, thfe line of Gravity palTes hro' 
 the middle of the Banes of the Thigh, J.eg, 
 and Foot : Thefe Boijes at that time mutu- 
 ally fupport tfach other, as do the Scones in 
 a Column, and bur Mufcles hardly aft at all. 
 On the contrary they aft: very much to 
 lliftain our Bodies when our Joints are bentj 
 and their Contraftions ate fo much the ftronger 
 as the Flexion of the Joints is greater ^ and 
 they may be even bent to fuch a pitch that 
 the weight of the Body, and the Mufcles that 
 Iveep it in an Efi'librium, will makeanElFort 
 upon the Bone the utmoft of their Power •, 
 then the j4pofhyfes where the Mufcles are in- 
 ferted may be'b'oken if the Mufcle^ refift *, 
 but if the j4pophyfes of the Bores are ftrongefl-i 
 the Rupture will be in Mufcles or the Ten- 
 dons. 
 
 All the World knows that the Bone of 
 the Knee will break by a ftrain : By a like 
 Caufe I have feen the Tendoiis of the Ex- 
 tenfores FeBi of the Ki.ee broken. Mr. Pcncelei 
 mv Brother Member, a famous Surgeon, cured 
 a Man who in a filfe ftrp broke the Bone of 
 h's Heel by the fole Rerraftion of the Tendon 
 jichilles. 
 
 If the Mufcles, the Tendons, and even the 
 Bones may be broken by Caules fo flight to 
 a^l appe trance, without doubt they wou'd 
 icarcclv be able to refift, when the Mufcles are 
 obli^'d to aft not oidv to bear up againft the 
 B b we'jht 
 
57 o ATk^ ATisz of the 
 
 weight of the Body, but even to raile it with 
 Strength, carry it off the Ground and flioot 
 it into the Air, as Leapers do wlien they jump 
 with their Feet together upon the ^dge of a 
 Table. 
 
 In leaping thus they bend their Head and 
 their Body upon their Thighs, their Thiglis 
 upon their Legs, and tlieir Legs upon their 
 Feet, then in an inftant relaxing all the 
 Mufcles, as if to take their Spring, tliey put 
 them into that fudden ContcaO;ion which 
 makes a Rebound againft the Earth, whence, 
 they Ihootthemfelves into the Air, and firaiten- 
 on comir.g upon the Table. 
 
 Altho' this ftrain feems fuificient to break; 
 the Tendon of Achilles, and feveral Leapers 
 have hurt themfelves in taking fuch Springs, 
 that of the Steur Cochoix was much greater, the 
 Table whereon he leap'd was too high, his 
 Spring did not raife him enough, and only the 
 Ends of his Feet touch'd the Edge of the 
 Table, whe.e they refted but long enough 
 to ftraiten themfelves, and break their Deter- 
 mination forwards ^ the Line of gravity not 
 falling upon the Table, the Leaper came to 
 the Ground direftly upon his Tiptoe?, ex- 
 tended in fuch a manner that the Tendons of 
 ylchilles were, if I may fo fay, furprizM in 
 their ftrongeft degree of Tenfion, ar.d the fall 
 of above three Foot added to the weight, 
 a force more than fuificient to break them, 
 ftnce it was what the weight of the Body had 
 acquired, mukiply'd by the fwiftncfs of the 
 Fall. 
 
 Art and Nature laboured in Conjunction to 
 effect tlie Re-union of thefc broken Teiidons. 
 
 Art 
 
Difeafes f)f the Ijonz^. 571 
 
 Art was ablblutely necelfary thereunto, 
 whether ic were to bring together tJicir le- 
 parated Ends, or to keep tnem, whe.i brought 
 together, whihi Nutu: e was at work for their 
 Re- union. 
 
 To perform the firft Operation, 1 laid rhe 
 Patient upon his Back, bent his Ham, thruft 
 the Calf ot his Leg towards the Heel, and 
 brought his Heel towards the Calf, by ex* 
 tending the Foot till the two Ends of the 
 broken Tendon touch'd each other. Whilft 
 the Parts were held in this Pofture, I fteep'd 
 a doiable Comprefs in Brandy, with which I 
 encompafs'd the wounded Part^ and I put 
 ai.other calfd longitudinal, which was thicker 
 than the firft, two Inches broad, and two 
 Foot and half long behind, from the Ham to 
 beyond the Toes, covering the Calf of the 
 Leg, the Heel, and the Sole of the Foot. To 
 taften this Comprefs, 1 took, whilft they held 
 It thus, a Fillet four Ells long and two Firfgers 
 broad, with which I made four rounds about 
 the place where the Rupture was, in which 
 rounds I made faft the middle of the Longi- 
 tudinal Comprefs ; then carrying the Fillet 
 obliquely from without inwards over the 
 Foot, I brought it a-crofs under the Sole •, I 
 faften'd the Longitudinal Comprefs again in 
 this Place, and coming back from within out- 
 wards obliquely over the li ftep, making a 
 St. Jnctrew's Crofs with the firft oblique turn, 
 1 carry'd the Fillet over the Ankles where I 
 made a circular Caft, and whence! came buck 
 obliquely from without inwards over the 
 Foot, under the Sole, and then again up- 
 wards to make a fecond Time a St. 
 jindrexvs Crofs, and a Circular Caft over 
 the Ankles. Having repeated thefe fame C-r- 
 B b 2 cum- 
 
37* A^ T K E A T I s E of the 
 
 cumvolutioii four Times, and the Fillet be- 
 ing come to the Ankles, inftead of going a- 
 gain downwards towards the F<x)t, I went up- 
 wards in Circles to theCalt of the Leg, where 
 I had tvliat remaiuM of the Bandage held, 
 that I might with both Hai-ds leverfe the two 
 Ends of the Comprels that were not yet made 
 iaft. The End at the Ham was rcvers'd to- 
 wards the Heel, and that at the Sole of the 
 Foot was turn'd back towards the Leg, 1 
 faften'd them with Pin?, and with the reft of 
 the Fillet which I pafs'd feveral times over 
 them at difterent Parts of the l^eg and Foot. 
 Thefe two Ends of the Longitudiiial Comprefs 
 being thus faften'd aixi reversed the contrary 
 way one to the other, kept the Foot in its laft 
 degree of Extenfion, (b that the Ends of the 
 Tendons were r.ot only brought near, but 
 touch-d and mutualy thruft againft each 
 other. 
 
 Having apply 'd this Bandage to one of the 
 Feet, 1 did the fi<rae to the other \ then 1 
 placed a Pillow under the Hams to keep them 
 bent, relax the GcmelUy which by their Con- 
 tradion might have drawn the upper Part 
 oi the broken Tendon upwards. I fteep'd the 
 dreffings of both the one and the other in 
 Brandy, aiKi 1 order'd them to be mo ften'd a- 
 freih every four Hours, I bled the Patient that 
 very Evening, and twice next Day, and pre- 
 JcribM h'm a Regimen. 
 
 £ ight Days atterwards I took off the Drefr 
 /ij.g, and found the Parts favourably dif- 
 pos'd towards a Cure, at the Fifteenth I took 
 it off again, and the difpofitions leeraii.g yec 
 more favourable, I did not at all doubt of hi$ 
 Recovery : The Twenty iecond, lome flight 
 irotions that \ made in DfcJliiig him coiihrniM 
 
Difeaps of the BoN e S. 375 
 
 me l^'M rhe Re-ilnion was made ; and the 
 Thirty ierond Day, I found him by the Fire, 
 
 whether he hnd made h-mfelf bec^rry'd, and 
 he toid me thtt he believ'd he couM perform 
 his ordin?>ry Exercifes. 
 
 'Tis not to be doubted that Art had « 
 great ihare in this Cure, but without the 
 help o:' nature all my precautions hrrd been 
 vain : Not contented with finiOiing (he Nu- 
 tritive Jjice which iblderM the Tendons, Ihe 
 ma le the Sheaths that cover them ferve as 
 Moulds ^ without them the Juices would have 
 fpread in the neighbourhood, the Scarwoufd 
 have been too weak, and the Tendons wouM 
 have contrafted an adherence with the Parts 
 adjacent, which would have depriv'd them of 
 that facility of Slipping, which renders them 
 io proper for motion. 
 
 1 flviU finifli this Observation with explafr?- 
 ing three Th^nomcnois that are very lingular^ 
 the firft is that the Patient extended and bent 
 his Leg the inftant after the Rupture of his 
 Tendons, the (econd is that he cou'd not fland, 
 the third that he felt no manner of Pain on 
 the becking his Tendons, nor indeed after- 
 wards during the whofe Cure. 
 
 He cou'd bend his Foot becaufe the Mufcle? 
 Flexores were not hurt, and he cou'd ftretch it 
 out, akho' the Tendon o'i j^chlHes was broken, 
 becaufe the TihUm ^ Perortisvs rojhicus which 
 were not rent, are fuffic'ent to make the Ex- 
 tenfion, as I have experienced in a Caetavtr 
 after having cut off this Tendon of yleh'Hcs. 
 
 The Patient cou'd not (land, becauie, ah ho' 
 the TihUus & Perondus Tofiicus were fiiificient 
 to extend the Foot, the Point, by which thefe 
 Mufcles pafs from the Leg to the Foo*-, is wo 
 near the Fulcrum, 
 
 B b 3 This 
 
374 A T F^E ATI s¥. of the 
 
 This Obfervation fliews that the Diftance 
 of the Tendon of y/rWocaufes a '1 the Arength 
 of the Foot, and 'tis ieen, that the more this 
 Tendon is diftant from the Articulation, the 
 more force it has. The Animals that run and 
 and leap with the moil agility are thofe in 
 whom th'S Tendon is at the greattft Dftance^ 
 Men whole Keel is very loiig are the leaft 
 wearied with walking, and the longer the Foot 
 is, the more neceliary is the length of the 
 Heel. 
 
 If the Tendons of Achilles were rent with- 
 out Pciin, 1 don't believe that the Senfation 
 was deftroy'd by the premeditated Aftion of 
 the Leaper \ it feems to me that it proceeded 
 from the velocity of the Motion which broke 
 them totally, and at the fame Ir.ftant. 
 
 In fpite of all the Care 1 have taken to give 
 exactly the Truth of this Obfervation, riiere 
 have been incredulous Performs, whom I cou'd 
 willingly forgive, if I we:e fure of the In- 
 tegrity of their Inte.itions. I know that Peo- 
 ple may invent Lies, and that all Novelties 
 may be fufpe^-led as fuch, but it is not lels 
 impudent to deny, than to fubfcribe to them 
 without examination, and when one has e- 
 fpoufed any fide one is obliged to tell the Rea- 
 fjns that have induced one to it. 
 
 If thofe who have declared againft my Ob- 
 fervation upon the Rupture of the Tendons 
 cf Achillesy had communicated their Reaions 
 to me, 1 wou'd have done my utmoft to have 
 anfvver'd them \ but they have fpared me that 
 Trouble, by contentinu: themfelves with faying 
 obftinately that the Tendons cannot break. 
 Altho' this man .er of attacking me be very 
 Mvantagious to me, the Truth or Falfity of 
 this Oblervation is of fuch great Importance 
 
 to 
 
Bife/ifes ef the Bone s. 375 
 
 to the Publick, that I fhouid believe my ielf 
 as wanting to its Interefts, and 'o my own Re- 
 putation, if I negle>-ted clearing up this 
 Point. 
 
 It may hTve been obfer\r''d in one of the Dlf- 
 lertations rh!tt I prefented upon this Head to 
 the Academy of Sciences, that the Rupture 
 of the Tendons only by a fham was no new 
 thing : I have alfb remark'd therein th?.t the 
 Bones them (elves, to which the Tendons ad- 
 here, are not exempted from fracturing, when 
 the Tendons -ixjfi ft more than rhey, againft a 
 Strain that is capable of breaking the one or 
 the other. 
 
 I have give;i an Account how the Lady of 
 the Prelident dc Boiffife, walking ibftly in the 
 Court of the Hjtcl de Soub'fc, broke the Bone 
 of her Heel by the fole retra'-Hon of the Ten- 
 don of Achilles : I have mentioned a like Ac- 
 cident with which Mr. Voncelct acquaiited 
 me, I have given an Example o^RotuWs b'oken 
 by the fame Caufe •, I had a Machine made for 
 Mr. Peron, (a Mafter Surgeon very expert in 
 Bandages) to fupply the defect of the Tendon 
 of the ReHus Ext en for of the Leg, which a 
 Dutch Officer had broken in leaping a Ditch. 
 To thefe Examples I added that of the Sier 
 Cochoix, and to that I now fubjoin two others 
 which have lately happen'd at the Time that 
 I was reading Lectures at St. Cofmus upon this 
 Subjea. 
 
 One of thefe Examples is the Rupture of 
 the Tendon of uichilksy which befel a Woman 
 3^5 Years old and very lufty. She was going 
 over a Plank that lay a-crofs a Boat, and her 
 Feet flipping, fhe fell, to the bottom of the 
 Boat, full upon the end of her right Foot, 
 which refted alone upon the Edge of a Crofs- 
 
 B b 4 piec« 
 
57^ A Treatise of the 
 
 piece of Timber, f a ii^rt of Rafrer) which 
 they Call a Table. Tiie Sole of the Foot, 
 the Heel, ai.d all the left Foot were without 
 fupporr, fo that (ro make u(e of th- fame 
 Terms as in my firft Oblervation) the Tei don 
 of Jchilles oC the right Foot bore alone all the 
 ihock, and was (if I may (b exprefs my lelf) 
 crulhM by the Weight of the whole Body, to 
 wh'ch weight the fall, from above fix Foot 
 high, added a force more than fufficient to 
 hreak it, becaufe this force was what the 
 weight of the Body had arquireJ, multiplyd 
 by tiie F<ap'dity of the Fall. 
 
 Mr. Grdnler^ the Patient's ordinary Surgeon, 
 had ipe calVd 'n with feveral others ot our 
 Brethea*, he apply'd the Comprefs and the 
 Bandage delcr'Vd above, and the Patie.it was 
 cured ill as little Time, and as perfectly as 
 the S-eur Cochoix. 
 
 I have made ieveral Obfervatious upon this 
 Difeafe. 
 
 Firft the force thar broke the Tendon of 
 this U^oman was much greater than that 
 whirh re.t thofe of the Sifur Cochoix, becaufc 
 th's Woman is ve:y heavy, fell fix Foot, and 
 refted oiily upon one Foot. Cochoix on the 
 ccn-rary is liijht, fell fiom a lefs he'ght by- 
 half, and both his Feec jliared in the ihock of 
 his Fall. 
 
 ' Stcoidly tlic Patient felt fome Pain r^ar 
 the Rupture, and Cochoix had none : Neither 
 the ore nor the other were fenfible of any 
 Fnin at tl,e Iiif^ant of the Rupture of their 
 Te idons, and if the Lady felt any near the 
 Kupt^uro, 'twas bcaufe on her falling fhe 
 foui.d norjijng to ft.jy her felf, and Cochoix 
 fav'd himfelf agaiiift the Table upon which he 
 leaped, fo that without this help he hod fall'n 
 
 a fecond 
 
Lifeafes of the Bones. 377 
 
 a fccond time which wou'd have caus'dteariiig.s : 
 This is what the Patient couM not avoid, 
 wh'ch occafionM an Ecchymofis by the fpread- 
 ing of feme drops of Blood which the bj ojcen 
 VelTels had let elcape under the i^kin, and in 
 the Saccull Adlpf.fi. 
 
 The third Obfervation that I have made is 
 that Women fthe Caufes being equal) muft 
 bre.ik the Tendon of Achilles e^fier then Men; 
 becaufe the Heel ot their Shooes "being very 
 high keeps that Tendon more Ihortned, and 
 their Feet for this Reafon are always in Ex- 
 tenfion," which gives the Weight of the Body, 
 multiply'd by the velocity of the Fall, a 
 great deal more power over them than it 
 would have were the Heels of the Shoes 
 lower. 
 
 I will fubjoin to this Obfervation that which 
 I have made upon the Rupture of the tendi- 
 nous Ligament that fafteiiS the Rotula to the 
 Prominence of the Tibia. 
 
 The Sieur Galin, a Licenced Surgeon, fent 
 for me to fee the Son of a Perriwig-maker, 
 in the Street St. Homre^ over againft the great 
 Council. This Child, which was Nine Years 
 Old, fell with his Leg bent ^ the Ible weight 
 of the Body forced the Leg, and carry 'd ic 
 beyond its utmoft Degree of Flexion. The 
 Mufdes Extenfors were fo ft retched that they 
 were in a fituation to be broken, as well as 
 the RotuU or its Ligament. This latter being 
 apparently weaker than the Mufcles or the 
 RotuUy broke only becaule it had not ftrength 
 to bear up againft the Weight of the Body. 
 
 The Signs that dilcover this Rupture are, 
 
 i'^. The void fpace that one feels under 
 the Skin between the end of the Rotula and the 
 Tibia. 
 
 1^. The 
 
qj8 JTKEAristo/tbe 
 
 1^. The jutting out of the lower Part of 
 .the Rem fa. 
 
 3*^. The weakiiefs of the Extenfion of the 
 I^g, whxh is only made by the lateral Parts 
 of xhe /Iponeurofts o' the Extcvfors, wh'ch pafles 
 by the fides of the RotuU to inlerc it lelt at 
 the Tbia. 
 
 This Rupture was without Pain like that 
 of the Tendons of Achilles : There was an 
 Eechymofisy tecaufe the Child had an entire Fall, 
 not having any Body near, by which it micht 
 ftay it felf 
 
 The Drefliiig was put on with the fame 
 view as that in the Rupture of the Tendons 
 of Aih:lies\ a G^mprefs i8 Inches long, and 
 three Fingers broad, reach'd from the middle 
 of the Tiiigh, paifing over the Knee towards 
 the middle of the Leg. TJie croiling of the 
 Ear.dage was placed under the Ham, the two 
 circular Cafts faften'd on the Comprefs, the 
 c-i\i above, and the other below the Rotu'a. 
 
 After feveral rounds of the Bandage had 
 thus faften'd on this Comprefs, the Ends were 
 turn'd back contrary-ways to each other •, 
 that which went up the Thigh was revers'd 
 towards the Leg, and that which was upon 
 the Leg, was turn'd back towards the Thigh j 
 then the unfolding of the reft of the fame 
 Band was made ufe of in circular Cafts, to 
 bind On thele two revers'd Ends of the Com- 
 prefs, fo that the Leg not being able to bend, 
 . the two Ends of the broken Ligament might 
 cnjny tlieir mutual Proximity, and Reft, two 
 things equally neceffiry to procure their Re- 
 union. 
 
 CHAP. 
 
Difeafas of the B o K £, S, 57^ 
 
 CHAP. XVI. 
 
 Of the Esoffojis^ and the Caries, 
 
 THESE two Difeafes are the mofl: fatal 
 that can alfeft the fubftanceof the Bones : 
 They have a refemblance, the one to the Tu- 
 mours, and the other to the Ulcers that (elze 
 upon the foft Parts •, and as the Ulcer follows 
 the Impofthumes that fuppurate, the Caries is 
 the necelTary confeque^ice of rlie Exoflofes that 
 fuppurate : 'Tis for this Reafon that I com- 
 prehend thefe two Difeafes in the fame 
 Chapter. 
 
 The Exojlofis is a Tumour that rifes above Definition 
 the natural furfiice of the Bone ^ it caufes oiten of the 
 very acute Pains, at other Times they are ^^'/"i'^- 
 moderate ^ it is often without any Fever ; 
 fometimes 'tis attended with one that is pretty 
 violent, and proportionable to the Pain : There 
 are fome that are only accompany'd with a 
 flow Fever, and thofe are not the leaft fital. 
 
 There are fome Exoftofes that are caus'd by 
 Blows, Falls, and other external Caufes ^ o- 
 thers are occafioned by the vicious quality of 
 the Blood. 
 
 Some terminate by DifToIution, others fup- Thcdif- 
 purate, others remain hard, and rais'd, with- fcrcnt 
 out terminating either after one manner or K.inds. 
 another, juft as Impofthumes, whereof fome 
 are Critical, and others Syraptomatical. 
 
 The ditferent Bones, and the various Parts 
 of the Bones which this Difeale affecls, might 
 make particular Kinds; for if the Exojlo/is is 
 a Tumour of fome Part of a Bone, 'tis alio 
 ofteu the fwelling of a whole Boi:e. One fees 
 
 the 
 
a8o 
 
 The 
 Boi esthut 
 are riOC 
 
 entirely 
 
 with an 
 Ixoftofts, 
 Thoie 
 TfHich are 
 a]^'e£ted 
 
 A Treatise of the 
 
 rhc middle or the Extremities of a Bone 
 Iweird leparately, one alio finds the Tumour 
 extended all over it. 
 
 The Femnr^ the Humerus^ the Tih'ia^ the 
 Terovay die FacLuSy the Cubitusy the Ribs, and 
 the Bones o? the Hips, and Cranium are not 
 g nerally affiifted with an Exoftofa all over 
 them. 
 
 When the Boiies of tl>e Carfusy Afctacarpuf^ 
 TarfuSy Aietatarfus^ VertebriCy &c. aie feiz'd witU 
 Exoftojisy it ufuaily alfeits them throughout 
 their wholo Dimenfions. 
 
 Altho' the Exofiufs aifeds but one part of a 
 Cylindrical Bone> it may iweil it quite round, 
 and in this Cafe the Bone will be raisd 
 throughout its Circumterence. At other Times 
 the Excfiofis ailefl-s but Oiie fide only, and the 
 Boi.e is only rais'd in oj;e of its Surfaces, 
 whether it be that which is before, or that 
 which is behind. 
 
 The Exoflofis that attacks the Bones which 
 lerve as Boundaries to ferae Cavities, may 
 either jut outwards or fwell inwardly. There 
 are every Day to be feen fome that break out 
 externally upon the Bones of the Cranium on 
 the Stcrnumy the Ribs, and the Ojfa Ilia ^ laiid 
 there have been feen feveral that were not 
 vjfible outwardly, which neverthelefs by their 
 growing caufed dreadful Accidents, as ihall 
 be remarked in the fequel of this Chapter. 
 
 There are fonie Exoflofes that render the 
 Bones harder, and others that make them 
 more fpungy : 'Tis very rare for ci Bone 
 attack'd with this Diftemper to retain its na- 
 turid Confiftence. 
 
 1 have law'd Icme Exoflufes with eafe, be- 
 caufe the Bone at the Top was fpjngy, with 
 Qihers 1 have been puc to a great deal of 
 
 "^rouble. 
 
Difiafes of the Bone s,- 381 
 
 Trouble, bccaule their Hardnefs was increas'd-, 
 Ibme make more refiftance than Ivory. 
 
 In the Extiraination that I have made of the 
 Exoftcfis when Tawing the Bone?, I have often 
 obi'erv'd that the Confiftence was not the ^'^^^ryac^-^ 
 throughout the whole •, fome were Tofter wiih- ^,^^.^5 ^ 
 out, and htirder within- others on the 'con- Ext^fiojit, 
 trary were Ibfter within, and harder without, 
 ib that 1 either the Confiftence of the one nor 
 the other was like that of the natural Bone. 
 Isi Ibme J have found Fleih, in others a fort 
 cf Mucilage, in others ?m, and in others again 
 a Sanies: Sometimes 1 have found the £.vo^<jy?j 
 as it were wrapt in a bony Lamina^ as hard as 
 the Enamel of the Teeth, and the infide more 
 fpongioufj then the E-piphyfes, When 1 iay 
 wrapt in it, 1 mean that the Part of the Exofto- 
 fs which (luck to the Body of the Bone was 
 of the fame hardnefs, and that that place be- 
 ing favv'd according to the Diameter of the 
 Exofiofs, one might fee the Continuation of the 
 hard cover, which was even whiter, and much 
 more clofe than the Ibund part of the Bone, 
 
 There is hardly any one who has not ieea 
 Exofiofej that have rifen to a great heigth upon 
 the Body of the Bone, and which fcarce ad- 
 hered to it at all ; others which were only 
 join'd to it by a very narrow Bajisy having a 
 very large Body and Summit *, others again 
 very flat, and of great extent which were (if 
 I may io Ipeak) but like an incruftation of 
 the Bone, from which they were fcparated 
 ivith Eafe. 
 
 One may reckon among the forts of Exoflofes 
 ivh'^t certain Authors have improperly erxjugh 
 caird Spl}ia Fentofa. 'Tis an extraorpinay Di(- 
 eafe, didere.ttly treated of, nevertheiels I be- 
 lieve we ou^hc to give more Credit to the 
 
 Er^llfh 
 
9^2 -r^ T R E A T I S E of the 
 
 A ^arucu- £nglifl} than to any others, becaufe it often 
 l^'^n^M ' ^^''PP^'^ in their Country, and yet more in 
 fome Iflands in the North that are under their 
 Jurisdi£lion. It is thus delcrib'd by the Phy- 
 ficians ot" that Nation. 
 
 It begins to difcover it lelf by Pains botli in 
 the Bones aiid foft Parts, which alter every 
 Minute. Sometimes fharp Exnfiofes break out, 
 whence the Pain is To Acute, the Bones become 
 lbfr,andasit were diirolved,whichoccafions their 
 breaking every where •, they no longer being 
 hard enough to ke^p an Equilibrium with the 
 Mufcles : At other times they are Rotten, 
 and as it were Worm-eaten •, it is often attended 
 with a ^abes in fome particular Part, and fome- 
 times all over the Body, the Mortification of 
 the Limbs follows, and there are fome Skilflil 
 Englijij Phyfitians who believ^e that the Plague 
 of Athens, defcribM by Thucydides, was ac- 
 company'd with the Spina Fentofa it feif, be- 
 caufe they write that the Limbs, of thofe, 
 who were feiz'd with it, rotted off piece- 
 meal. 
 
 It is aifo very probable that the Difeale de- 
 fcrib'd by Mr. Saviard, in his Chirurgical Ob- 
 fervations, is a real Sfiva Verttofa^ as well as that 
 which we find in the famous Mr. Courtiafs Re- 
 marks upon the Difeafes incident to the 
 Bones. 
 Caufcs. The Gaufes of thefe Diftempers are Internal, 
 
 or External \ they may alfo be divided inta 
 thofe which proceed from the vicious Quality 
 of the Juices, and thofe produced by the dif- 
 ordering of the Velfels ^ What is certain is, 
 that either the one or the other, conjoiritly 
 or leparate, may produce this Diftemper • 
 whether the Diforder of the Juices has caufed 
 that of the VelTels, or the latter has occa- 
 
 fion'd 
 
Difeafes <?/ r/?^ B o N E s. 38^ 
 
 fionM the vicious quality of the former, Of 
 whether External Caufcs have produced boiJi 
 the one and the other. 
 
 One thing ellential to be known, is that tlic 
 Difeales of the Pcrlojlcum may occafion the 
 Exojlofis and the Caries. Before I proceed any- 
 farther upon the Caules of thel'e two Diieales 
 of the Bones, 1 will give my Ihoughls upon 
 this Head, which will not a little contribute 
 to the having true Ideds of the Formation of 
 the Exoflofis and Caries. 
 
 That one may rightly conceive in what thegfj^g-^j^ 
 Indilpofition of the Periofieum contributes to of the 
 the Dileafes of the Bones, it muft be ob-Bonc, 
 ferved, i^. That the Periojleum is elaftick, ad-'^y'"'^'* 
 herine to the Bone throughout the whole ex- ?^I.^^,* 
 tent of Its ijurface. ^ oftheFor- 
 
 2°. This Membrane is pierced to give paf- nurion of 
 f^ge to an iiifiinte number of very imdW "Exop^s, 
 VefTels. 
 
 3^. Thefe VefTels go fome way between the 
 Surface of the Bone and the Perio(i:eum. 
 
 4°. There are little Clefts in the Surface 
 of the Bones which are only made by the 
 Pulfation of the Arteries, and to lodge theii 
 little VelTels. i,,,] t 
 
 5*5. The Bones are hard Bodies capable of 
 refifting the Penetration of the Juices •, this 
 being fo, I reafon thus. The linall VefTels 
 which are between the Perioftemn and the Bone, 
 cannot be fill'd by the Motion of the Heart 
 without being dilated, nor be dilated without 
 raifmg up the Periofieum. But becaule this 
 Impulfion of the Heart ceafes and begins a- 
 gain every Inflant, this Dilation muft ceafe^ 
 and be foUow'd by the Action of the Peri' 
 fifteum \ this [ look upon as a Spring bent upon 
 .the Surfiice of the Bones, which coming to hs 
 
 uiibent. 
 
384 ^Treatise of the 
 
 unbent, compre/Tes the VcfTels fgai. ft the Sur- 
 face ot" the Bone which refills, and brces the 
 Blood and the J.ymfha with more IWittnefs 
 even into the moft remoie Pores of the bony 
 Fibres: 1 hefe Ai^ions and Re-a£b"ons end, 
 aiid begin again every Inftant, wherefore the 
 PerioJIeum muft alio be rrn's'd each moment by 
 the Velfels that h'e underneath it, and muft 
 be level rd by its Spring. This is the Office 
 of the Periofteum in its natural State, but it by 
 any Caufe whatver its Spring is relax'd, it caa 
 no longer quicken the Motion of the Nutri- 
 tive Juices which the Velfels bring and carry 
 back, whence Obftruft-ons will iiappen that 
 will be folio w'd by a Caries or ExoJIofis. 
 
 Thelnrer xhe internal Caufes are the Rickets, the 
 
 ^^^^*^\7 Scurvy, the Pox, the King's-Evil, or Can^ 
 
 keJ. 'cers. 
 
 We have every Day examples of rickety 
 Children that have Exoflofes in the Body of 
 their Bones, or even in their Joints. Thofe 
 which are in the Body ot the Bone, render it 
 apt to be fradur'd : I have dften known 
 Fractures in the Bones of the Arm, the Fore- 
 Arm, and the Thigh which had no other 
 external Caiile but a Strain. I can't wirh-^ 
 out Pain fee them drag Children by their 
 Arm, the moft of thofe whom I have 
 known thus hurt, had been roughly haled, 
 -either to make them get up a Stair, ftep 
 over a Kennel, or go fafter then they 
 
 ^.- wou'd, or perhaps cou'd. Thofe whofe 
 
 Thighs were broken had falVn •, neverthelefs 
 there are I'ome who have been in this Cafe, 
 purely by the Negligence or Brutality of 
 thofe who carry 'd them in their Arm% 
 bv their having let them fall back, and 
 be carry'd away by the wjiciht of the 
 
 Body, 
 
 fion. 
 
L'ifeafes <?/ r^&tf B o N E S. 5^5 
 
 Body, wliilft their Thighs beiiig held in their 
 Arms weie obliged either ro bL;,d or break, 
 not being able to bear up agaiiifl it. 
 
 The £Arc//r/f/ that caulethcle Ibrts of Fractures, Obrerrn* 
 happen only becaule they render the Boiics ^^o"* 
 moie brittle : I here are feveral to be found 
 at the Ribs and their Cartilages^ the Eplphyfes 
 of Children that are rirketty are almcft al- 
 ways affected with them, 1 fhall explain the 
 Caufe that produces them in the Treatife of 
 the Rachitis-^ only it muft be obferv'd that if 
 the Exoflofis in the middle of the Bones is an 
 occafional Caufe of Fractures, that of the 
 Epiphyfes ot the Joints produces occafionally 
 Luxations or Anchylofes. 
 
 The Scorbutick Exofiofes are uncommon 5 Tb^Scor- 
 the Scurvy will rather produce ^. Carles than ^""J 
 an Exoflofis •, neverthelels tis lometimes leen , Three Ob 
 but 'tis obferved, 1°. That they are not fo fcrvations 
 high as the other, 1^. That they don't hap- 
 pen in all forts of Scurvy, and that 'tis ufu- 
 ally in that which is complicated with the 
 Rickets, the King's-Evil, or the Pox, 3^. That 
 Exojiops never come in the Scurvy but at 
 the Beginning, when the Blood and the Lympha 
 are coagulated ;, for when the Scurvy has 
 continued long eiiough to caufe Solution of 
 the Blood, it will caufe a Caries fooner than 
 an Exojlo/is. 
 
 ToA'ards the end of the Year, K^pi, and Obrcrvji-> 
 the beginning ot 1693, 1 faw a number of ^^<^"* 
 Scorbutick Perfons at the Hofpital ot^ B/ruvi^ny 
 near D^aan upon the Alaefe -, an Hofpital where 
 there was always between 4 and 500 Perfons 
 Sick of this Diieafe, and yet I faw but three 
 TV ho had the Exojltfts a id above too the Caries. 
 
 The Exojlofis weie all at the Bone of tha 
 lower Jaw, in that Part where the greater 
 C c Grinders 
 
^6 
 
 Obferva- 
 
 Obferva- 
 tioa. 
 
 ^ T R. E A T I s t eftbe 
 
 Gnndersarefituatedjthe Jaw was only one tliird 
 iargerthan its natural State. Neverthelefs I have 
 leen a Soldier in th« Hofpital of Dinan^ who 
 died of the Scurvy, and whole Foot was con- 
 iiderably fweird, hard, and without FluQ:ua- 
 tion ; I openM it, and obferv'd that all the 
 Bones of the Tar f us and Metatarfus were Ex- 
 e^os^dy and the Periofleum fweU'd by a coagu- 
 lated Lymfha. 
 
 The Per Ions in the Hofpital of Emvigny who 
 had the Scurvey eompiicated with a Caries 
 were the moft unfortunate ; almoft all of them 
 dy'd, excepting thofe who had a flight Caries 
 in the Mveoli : I obferv'd in thole that I o- 
 pen'd that the Periofleum was loofen'd from the 
 Bone in feveral places, and that in many it was 
 loofen'd from all the Bones of their Body, fo 
 that making an Incifion along the Ribs, I found 
 them naked, rugged, uneven, feparated from 
 their Cartilages, and adhering but little to the 
 Ligaments and Tendons that are faften'd to 
 their hinder Part. From under the Periofieum 
 there came out a dark blackifli Lympha, in- 
 clining to a dark red, which had iniupportable 
 Imell : And I found the fame thing in making 
 an Incifion to the Bone, along the Arms and 
 Legs •, in fome of them 1 drew out the Bones 
 entire, excepting their Epiphyfes, which were 
 retain'd by the Tendons and Ligaments, and 
 this only happened to new recruited Soldiers, 
 of which we h:^d a great number. They fell 
 into this Diftemper thro' the Fatigue, the 
 Mifery, and the bad Nourifhment of thofe 
 Times ; and perhaps too by the Melancholly 
 that had feiz'd upon their Spirits on feeing 
 themfelves in an Hofpital, and remembring 
 their Father's Houfes, the Lofs oi the Iwcets 
 whereof they regretted. 
 
 Tins 
 
 i 
 
Difeafes of the B o N E s« 5^7 
 
 This Recical is not made without Reafon^ 
 the Scurvy is hardly ever caused but by Fa- 
 tigues, Mifery, bad Diet, and above all Anguilh 
 •of Mind, and MelanchoUy. 
 
 Sailors after a long Voyage, wherein they ^.^^^^ ^£ 
 undergo all forts of (alamiries, are very often j^e Scur- 
 affiided with this Diftemper. I don't pretend vy^ 
 to exempt thofe from this Difeafe who lead a 
 voluptuous idle Life, eating only luxurioufly, 
 as the firft fall into this illnefs thro' a bad 
 Digeftion, the Stomach being overcharg'd ia 
 Perfons that are fenfuai and gluttonou?, di- 
 gefts not a jot better. 
 
 We fee Men of Prudence who are in no want 
 of any Thing, and whofe Virtue preferves 
 them from all Excefs, fall alfo into this 
 Diftemper, becaufe they give themfelves 
 over to laborious Employments, are taken up 
 with important Affairs, or Study aWlrafted 
 Science : 'Tis known that nothing is more 
 apt to difbrder the Stomach in its Fun£tion ; 
 whence the fame Effeft happens thro' a dif- 
 ferent Caufe. To all thefe Caufes of the 
 Scurvy one may add the Diftemperature of 
 the Seafons, the Air, the Difference of Cli- 
 mates, Age, and the fair Sex. 
 
 I don't pretend to determine what Nature \Vharon© 
 the Blood partakes of when it is renew'd ; ou<^ht to 
 but by a Crude and indigefted Chyle, things think of 
 which are problematical are not proper in a ^^^ ^*' 
 Treatife fill'd with fo gteat a numb.-r of Fads g^'^^^f J_^® 
 that are inconteftable, which daily Experience tick r/r/^/, 
 embellifhes, and never contradifts. ' Pis this 
 Experience which makes me look upon all 
 thefe Things as a remote Caufes of the Scur- 
 vey. The Hy^othefes, upon the Nature of tha 
 Salts which form the Scorbutick Firus, are 
 Arbitrary, and 'tis there that a Man of fin- 
 
 C c 1 cerity 
 
388 A Treatise of the 
 
 cerity ought to own that his Knowledge is 
 but very iraperteft •, neverthelefs we will not 
 make a particular ai'd new L-anguage tor our 
 lelves, but ufmg the Terms that are receiv'd 
 we will try to draw Confequences not from 
 Words, but from the Things that have been 
 often corlirm'd to us by Experience. 
 _, I have laid before that the Scorbutick Ex" 
 
 cnS is' fftof^i did not rile ^o high above the natural 
 more cer- Surface of the Bones as the others, 'tis Ex- 
 tain then perience that teaches us this \ it wou'd be 
 Syftems. difficult for me to give a Realbn for it, un- 
 lels I fliou'd fay that the Scorbutick Virus 
 being an Acid, rather corrodes than Coagu- 
 lates, and that it will not lo foon caufe an 
 Exojlofis where the Juices are coagulating, as 
 a Canesj the Juices whereof are known to be 
 Corrpfive. For this Reafon 1 have remark'd 
 that if the Exoflofis happens in the Scurvy, 
 'tis but at the beginning of that Diftemper, 
 when the Blood and Lympha are ufually in a 
 ftate of Coagulation, and may caufe an Exojlofay 
 but this State not continuing long, they turn 
 acid and produce a Caries. It muft be ob- 
 ferved that the Scurvy may be but a Pox 
 degenerated, or elfe may have been occafioa'd 
 by the Pox, and in this Cafe there are Ex' 
 oftofes accompariyM with the Signs of the 
 Scurvy, whereof nevertlielefs the Scurvey 
 can't be faid to have been the lirft Caufe ^ 
 and theie may be Signs of the Pox and Scur- 
 vy both together. In the Sequel there will be 
 be certain marks given of both diefe Difeafes, 
 that right Meafures may be taken for their 
 Cure. 
 Venereal The Pox is. the mod ufual Caufe of the 
 Caufes. Exoflofis^ neverthelefs *this Symptom don't ap- 
 pear at the Beginning, ai:d -it ought only to 
 
 , ' * bf 
 
Bifeafis of the Bone s. 9S9 
 
 be lookM on as one that is confecutfve of the 
 Pox. 'Tis not at all llrange that a t^irusy which 
 is capable of coai!;ulatlni5 the Lympha, iliouid . 
 ■produce an Exoftojis. 
 
 This Lyinfha is (as is known) the Vehicle ^^Rcmark. 
 the Nutrive Juice of the Bones j perhaps 'tis 
 the very thine; that i:ourifhes them. That 
 the Lympha coagulates in the Pox is proved 
 by all the Circumftances which attend that 
 Diftemper. We will examine this Fad in the 
 Sequel, andTfhall content my felfwith ob- 
 lerving that all the Parts where the Lympha 
 abounds are the Seatsof the Pox. The GUnduU 
 conglobata, the Skin, the Mouth, the Inteftines, 
 the Joints, and even the Bones themlelves are 
 the places where it appears, either under its 
 ufual Ihapes in which Cafe all the World knows 
 it) or under fuch Masks and Difguifes as con- 
 ceal it fo as not to be difcover'd, but by thofe 
 who know it to be a very Proteus.- 
 
 If the Pox very feldom caufes an Exoftofts The 
 immediately, 'tis that the ftopp'ng of the Pocky £x- 
 Lympha in the Channel of the Bone's pro- cjfoj'idocs 
 ducing an Obftruftion there is not fu/ficient, ^J^come 
 it muft alfo dilate it, difplace the Fibres, and *^ -• 
 gathering together there, increafe by little 
 and little the frze of the Tumour ^ therefore 
 the Symptoms of the Pox appear fooner in the 
 fbft Parts, on account of their flexibility, and 
 later in the Bones for a contrary Reafon. 
 
 How often have Pocky Exoftofes been known y^n 1 
 to come upon People who thought themfelves be}ic\-e 
 free from the Pox, becaufe they otherwife were them^ 
 in perfed Health ? They had had Shankers, ^^l^csfrce 
 Bubos, or Claps, whereof they believ'd them- ^ "^ ^^® 
 felves perfectly cured, becaufe they hid been ^or i^ 
 under the Hands of Skilful Perfons, who had 
 managed them regularly : Thefe Skilful Men 
 C c 3 however 
 
5^0 ^ Treatise of the 
 
 however fall mod of them into the Error of 
 thi!:iking that thefe Diilempers when encouti» 
 tred with budoritick Ptyfans, and by the Pd' 
 nace^, are radically cured without fear ot Re- 
 lapfe, or at leaft of the Pox. Keverthelefs 
 they are miftaken, I dare here aver, that let 
 the moft experienced Surgeon take in hand 
 the mofc regular Patier.t, who has a Sharker, 
 a Bubo, or a Clap, and give him Ptyfans and 
 Mercurial Preparations, I dare aver, 1 fay, 
 that after having fo done, this Surgeon nei- 
 ther ought nor can alfure him that he won't 
 have the Fv x. 
 Obferva- ^^^^ manner of thinking will not be agree- 
 tion. ^t)le to all the World, but experience co .firms 
 ic. 1 here are PerfoKS to be ften every Day 
 that have the Pox, after f.aving had Shankers, 
 and Bubos well cured by the Remedies above- 
 mention'd. In fome it breaks out ib that none 
 doubt ot its Exiftence, in others the bymptoms 
 are different, which often depends upon the 
 Time that the Patient had the Shankers, and 
 Bubos. We will give the Reafou of all thefe 
 things in fpeaking of the Signs •, there I ihall 
 make known that thole who have only had 
 Ciitps are not always the moft fortunate. 
 How the The Pox may caufe the Ex«ftofis, becaufe 
 Poxcaufes that by coagulating the Juices it deprives them 
 the Ex- of the Power of gliding with Eafe into the 
 (Jioftf. bony Channels, or of being forced thither by 
 the Spring of the Periofteum, whether thele 
 Juices only penetrate into the external Part of 
 the Bone, which forms external, or fuperficial 
 Exofto/isy which are only incrftated, or whe- 
 ther they penetrate into the inner Part, but 
 the return of the Overplus is prevented by 
 the li^me Caufe ^ for it his been obierv'd that 
 the Uleof the Periflfteum is not only to caufe the 
 
 Juices 
 
T>7fe(7fes of the Bones. 591 
 
 juices to penetrate the ^one, by afting upon 
 the Veifeb thiit carry them into their Sub- 
 iiance, bu6 that it is to render the return of 
 the Overplus eafy, by compreilinj? tho/e that 
 carry them back into the Mafs of tlie Blood. 
 ' If Exoftofes may happen only by the stiter- Rcmarfc. 
 «tion of the Spring of the Ttrioftevmy it may 
 be imagined that the fame alteration may hap- 
 pen in the Membrane of the Marrow that co- 
 vers the inner Hart of x.\iq Cavities, or th^ 
 CellulU Difloictes MtdnllAres^ b^cauie this Meiu- 
 brane does the f ime within as the Ftriofiaam 
 without. 
 
 The Dura. Mater in the inner Part of the Rcjnajt 
 Cranivvty the Pituitary Membrane of the No% 
 that of the Sinm Frantaiis, MaxiHarisy and Cu- 
 tieiformis do the fame; the Internal and Ex- 
 ternal Cavities of the Organs of Hearing are 
 alfo cover'd with Membrane?, which perfbmj 
 the Office of the Feriofrtnm on the Surface of 
 the Bones that He under them, and muft be 
 fubjeil to the fame Difeafes, wherefore one 
 muft naturally think that the internal Part 
 of the Bones, and their interior Subftancej 
 mufl as well as the exteriour be liable toOb- 
 ftruftion, and confequently to Exoftofes and 
 Caries. 
 
 It may alfb be conceived that Exoftofes wilj 
 happen by the vicious Q_uality of the Finofezost 
 only, without any Virulency's being id the 
 Mafs of Blood. Thele may be calFd tiadlyj 
 becaufe tney occafion no Fains, are not detri- 
 mental to the Fun£lions, but with re/pec^ to 
 the Places they affed, and moreover when o- 
 pen'd, one finds no Alteratiai, thefubftancft 
 of the Bone being indeed much harder^ bwt 
 otherwife very natural. 
 
 C c 4 I have 
 
393 ^Treatise of t^ 
 
 A file T hrivc feen five ox fix fxcfinfcs of thlslcind 
 
 Obferva- a Soldier of the Koyal Roujfillcn Hegimeiit came 
 ^^°"- into the HofpiLil oi" Z.»y?f, in tUficUn, being 
 troubled with Stone : The Operation was per- 
 form'd upon him, he dy d, and 1 dilfefted 
 him, to inform my felfof the Nature of a 
 Tumor, he had had fifteen Years. It wasup- 
 pon the Bone of the Temples, where it had 
 grown and flvell'd by degrees, till it became 
 of the fize of a fmall Mellon. It refembled 
 this Fruit fo much the more, in thit it was 
 oblong, and a great many Veins that were 
 fweird, and branched out upon its Surface, 
 reprefented pretty well thole that are upon 
 the Coat of a Melon. 
 
 Having laid open this Tumour and looien'd 
 all the Tniofteimy I look'd upon it at firft as a 
 fort of Hernia, into which part ci the Brain 
 was lengthen'd \ I the more readily believ'd 
 this, becaufe I knew thit the Bone of the 
 Temples was naturally very thin in this Part. 
 With this Thought I open'd the Cranium^ not 
 on the fide where the Tumour was, but by de- 
 flroying the Tarittalia, the Coronale, the Occip- 
 tale^ and the Bone of the Temples on the op- 
 Opening pofite fide, which I did fometimes with the 
 St if* ^^^'^^ ^'-^ fometimes with the Chifel, the 
 Mailer, and Incifive Pincers, fo that I difco- 
 ver'd as much of the Dura Mater as was ne- 
 ceifary to fee plainly that I wasmiftaken in what 
 I had imagin'd. The Dura Mater and the Brain 
 had nothing particular on that lide, and the 
 BoPiC of the Tenjples was only monftrous on 
 the outfide, the infide retain'd its natural Con- 
 formation even to the leaft Cleft which the 
 VefTels ufually make by their Pulfation. I 
 fancy'd the Tumour was an Exofrofts, and I 
 ^und it to be a benign one, after having taken 
 
 it 
 
Difiafes of the Bou ES. 395 
 
 it off, and Taw'd it into two equal Parts. It 
 was as hard and as white as Ivory, there not 
 appearing to be auy Pores in any Part of its 
 fubftance. 
 
 Exoftofes of this kind, but vejy fmall, are Obfcrv*- 
 often leen on the Spine of the Tihiay and on ^io"* 
 the Cranium in Perfons who have no manner of 
 Diftcmper, and almoft all thofe of whom I 
 have askM the Caufe of thefe Tumours, have 
 told me, that they had had Falls, or Blows 
 which having bruis'd the Body of the Bone, 
 or the Periofrevm, were foUow'd by th's hard 
 Tumour, which was nothing but the Nutritive 
 Juice of the Bone ditfuled, gather'd together, 
 and harden'd by length of Time. 
 
 'Tis no new Thing to fee a Rifing up of the ^"""^^^^ 
 Bone near the Callus that is form'd in Fra- 
 ctures, which don't proceed from the fpread- 
 ing abroad of the Juices of the broken Bones, 
 but is ufually caus'd by the ftrong and con- 
 tinual Compiellion of Compreffes, or Splints 
 that are too hard, or too tight bound. 
 
 I have oblerv'd in fawing the Callus of Remark. 
 Perfons who dy'd a long Time after the Cure 
 of their Fraftures, that the infide of the Callus 
 was of an hardnefs like that of thefe Exoftojisy 
 and that no Pores appear'd therein, which 
 might induce one to believe that the juices 
 wJiich form the Callus congeal and harden, 
 without preferving a PafTage for the Velfels. 
 If it be lb, one may think that the outfide of 
 the Callus, which is covered by the Periofteunty 
 or the Membranes of the neighbouring Parts, 
 may have fbme Communication with the 
 Vellels, but that the Infide has not, and fub- 
 fills like the external part oi the Teeth. 
 
 ^ S"^'''i can't 
 
394 ^ T.RE A risz of tb^ 
 
 I caift ^aIs ever in Slleuce an Ob(ervatJOn 
 1 made upon a Dileale, almoft like the Tu* 
 mour jult nieiuioird, of the Soldier's of the 
 Royal RoujfiUon. 'Twas a your.t; Man who 
 had had it ic Seven Years from the Time it: 
 firft appear'rf to that wherein he relblv'd to 
 undergo the Operation. This Tumour was 
 upon the upper and middle part oi' the Parte- 
 talia being above tour Inches high and of a 
 j\ rtry Conick Figure, four Inches in Circumference 
 very fi"<^ in its BafiSy three in its middle, and two to- 
 
 "'^Ki^ob- ^^'^^^^ ^^^ ^^^^P» ^^^^ ^"^ ^f vvhich was flightiy 
 r ^ ,I^;„n putrif'y'd. This Patient was recommended to 
 me by one or my Fnenus, m whole prelence 
 I examined him, and promis'd to perfom his 
 ■ Operation, for which reafon 1 prpa'd him by 
 Bleeding, Purging, and Dieting. His Emi- 
 nence die Cardinal de Rohan recommended him 
 to me, and order'd him all the Ailiftance 
 whereof he might ftand in need. This un- 
 common Difeafe made fome PerfoiiS curious to 
 fee it, and envioufly defirous of performing 
 the Operation, fince they got my Patient away 
 from me by fecret and underhanded Praftiles, 
 fuch as I have ne^cr made ufe ot, apprehended 
 nor avoided. The Patient, who repofed fome 
 Confidence in me, obtain'd as a Favour of thefe 
 "Ufurpers that I might be prefent at the Opera- 
 tion-; they propofed it to me, 1 refufed it, and 
 did them a Pleafure without defign. They 
 made an Incifion, uncover'd the Swelling, and 
 look'd upon it as a HcmU of the Braiii, where- 
 ot the Bag was made by the lengrhening ot 
 the Brain. They trepamvd this Tumour, at 
 the Place where the Caries was, with a great 
 deal of Diificulty, on account of its hardi,e(s; 
 and they introduced the Corona till the top of 
 the fwelling touch'd tlie bottom of the Corons^ 
 
 and 
 
Bifenfes of the ]jON ES. 595 
 
 and being fatigued with an Operation as la- 
 borious as unprofitable, they drefs'd the Pa- 
 tient, and put oil the reft till the next Day. 
 They had not the fame Trouble, the Fever 
 that feii'd upon the Patient prevented their 
 continuing it, their rafh and plentiful bleed- 
 ings did not at all diminifh the Accidents, 
 and a Delirium that follow'd carried off the 
 Patient. 
 
 -je'Tbey open'd the Cranium^ and were un- 
 deceived as to the Idea they had of its being 
 a Hernia, a Notion I my lelf had ot the Sol- 
 dier's fwelling, but not of this, becaufe the 
 other had inform'd me better. The Tumour 
 which they took off being faw'd, they found 
 it full, hard, and as white as Ivory. I may 
 certainly have the Liberty to make Reflexions 
 upon this Difeafe, efpecially upon the Caufe 
 of fuch a fudden Death, but if I fay nothing 
 of it in this place, I referve to my felf the 
 right of fpeaking thereof hereafter in the 
 Cure of Exoftofes, a fubje£t whereupon this has 
 ibme Dependance. 
 
 If there are Exoftofes whofe infides are Remark, 
 harder than the Bone, as has been oblerv'd in 
 the different kinds, there are on the contrary 
 fome that are only bony at the outfide, and 
 which far from being hard at the infide, are 
 entirely foft and iiefhy. This Difference cer- 
 tainly does not proceed fiom the Caufe, that 
 ?s the fame, I mean that Strokes, Falls, and 
 the Difpofition of the Pericfteum may produce 
 both the one and the other Species, what oc- 
 cafions the Difference is the turn which the 
 Kutritive Juice that is diffufed takes, a thing 
 that can't be clearly explain'd, and which I 
 leave to go on to what is clear, certain, and, 
 I may venture to fay Vieful. 
 
 This 
 
996 -<rf Treatise of the 
 
 A very This fort of Exoftofs whereof I have juft 
 curious heeu Ipeakiug is more common than is thought 
 Obierva- f^j-^ ji^^j j^g it generally comes near tlte Eft" 
 ^^*^ fhyfesy there is reafon to believe that the 
 middle of the Bones has not a fuffkient num- 
 ber of lilood-Veifels to contribute to its For- 
 mation. 
 
 I perrorm''d a very fmgular Operation, 
 which i am goiig to relate, on account of fuch 
 an ExofrofiSy ar.d tho' this is not the place for 
 it, i am perlwaded it will be agrreeable to 
 the Reader. 
 
 A Man of about 40 Years old fell off his 
 Horfe, and gon a llight Wound upon the Skin 
 that was rais'd up by an Exoftofis^ whicli for 
 20 Years had ben forming by little and little 
 upon the upper u^pofhyfis of the Tibia. This 
 ExoftofiSj tho' twice as large as his Fift, was 
 was not troublefome, but in bad Weather. 
 
 After his Fail he had recourfe to the Sur- 
 geon of his Part of the Town, who omitted 
 nothiiig in the Cure of his Wound that 
 might procure its Re-union. It feem'd to 
 heal, when a continued Fever with Paroxyfnis 
 induced him to lend for M. Tcnelier^ Doftor 
 Regent, and a very skilful Phyfician, who took 
 him in haiid methoaically, but iio purpofe, 
 which made him think there might be Ibme 
 hidden Caufe, aftd fufpefting the Wound for 
 all its good Condition in appearance, he had 
 me calfd in. 1 ii;troduced a Snllet into a 
 little place in the Wound, and \ difcover'd a 
 Bag of purulent Matter, which I open'd to 
 the Bottom, where I perceived a little Hole, 
 thro' which my StHUt penetrated to the Bone, 
 the Teguments whereof 1 found loofen'd a- 
 bout the bignefs of the Palm of the Hand. 
 An Incifion in the form of a (T,) and the ex- 
 tirpating 
 
Difeafrs of the Bone s. 597 
 
 tirpating of the two Angles, having laid it 
 open to view^ I percciv\i a Piece oi Bone of 
 a triaiiguiar Figure, which being feparated 
 from the whole, was funk in a little, and no 
 longer kept even with the Reft. 1 thought 
 that I muft raiie it and draw it out, which 
 ^, cou'd not do till I had hrft cut away floping 
 a Part of the iblid Piece, whith ftrong b'cil- 
 fars. By the help of this Hoping I ran a 
 Myrtle-leaf under the Piece tliat was funk in, 
 and I took it away, making ufe of this in- 
 ftrumeiit as an Elevator, which done, there 
 iifued out a ftinking Vus.- This Piece being 
 taken away, I had liberty to thruft my Fore- 
 Finger into the opening, and I found that 
 this Tumour was nothing but a Lump of 
 '^h^ enclofed in a bony Cafe, which was 
 thick on that fide of the Bone to which it 
 adhered, and fo thin every where elfe, that 
 fome Parts were eafily cut with the SciiTars, 
 tho' they were as hard as the middle Parts of 
 the great BOnes. I cut off enough to give 
 me leave to loofen eafily the Lump of Flelh, 
 and to take it out in fev.eral large Pieces, 
 which being put together, were a third big- 
 ger than the Fift. This being extracted, I 
 put my Fingers into this fort of Cranium^ 
 where I found by -places, wherein were Pieces 
 of the lame Flefh that I feparated exaftly, 
 which laid the Bone almoft bare. I fill'd up 
 this great vaccmm with Lint, the Reft was 
 coverM with Pledgets, and wrapt iround with 
 Comprelfes and Bands : He was blooded as 
 was proper, and had a fuitable Diet and Re- 
 medies. .iforiT 
 
 The next Day I carry'd the IrftrumentJt scqucl. 
 that were necelfary to break and cut away 
 the Parts of the Bony Cavity that h.ad vtJ^ 
 
 lifted 
 
598 ^ T Fv E A T I s E of the 
 
 fifted the irciif'irs, and yet formed a confider- 
 able Cavity, whole railed fide made a Cavern, 
 wlicrein 'twould have been diHicult to have 
 upply'd the Remedies proper for procuring 
 Exfoliation. Befides if the Scar cou'd have 
 been made, the Deformity would have been 
 troublelome to the Patient •, wherefore 'twas 
 fit to take away theie fides, and to level the 
 Swelling to bring it as near as poifible to the 
 Natural Figure. The Mallet, the Chiiel, and 
 the Incifive Pincers, ferved me alternatively, 
 and tvhen 1 had demolifh'd this bony Arch 
 down to the Body of the Bone which lerved 
 for its Bafis, I drefs'd it with Lint fteep'd in 
 the Tinftures of Myrrh and ^/of/, until the 
 Patient was on the mending hand, then all 
 Things were made ufe of that procure an 
 eafy Exfoliation, after which the Wound ci- 
 catriz'd and heal'd. 
 
 The Bony Cafe, and the Lump of Flefh en- 
 Parallel clofed therein, like the Brain in the Skull, 
 Difeafe. ^^''^ ^^ "^^ allow us to compare this Difeafe,and 
 the Operation I perform'd, the one to the 
 Wounds in the Cramum, and the other to the 
 Trepan ? 
 
 Strokes, and Falls, may hurt the Teguments 
 only that cover the Galium ; and making but 
 a Simple Fradure, one ought to attempt the 
 Re-union, which was the Intention of the Sur- 
 geon that firft drefs'd our Patient. The Peri- 
 cranium may be contufed, and loofen'd from 
 the Cranium, there happens an overflowing 
 between it and the Ik)iie, the Matter ferments, 
 which is follow'd by Pains and a Fever, an 
 Incifion is made, the Pus comes out, the Ten- 
 fion of the Pericranium ceafes, and the Acci- 
 dents abate, wh'ch is juft what befel our 
 Patient. 
 
 The 
 
 ( 
 
 / 
 
Difiafes of the Bones. 599 
 
 The Fall had bruis'd, and feparated the 
 Bones fi'om the Membranes that covorM it •, 
 tlie Juices being dilfare<l between the one and 
 the other, by their termentiijg cauled the 
 Pains, the Fever and the Impofthume, which 
 Accidents were abated by our Opening, 
 
 In making an Iixiiion on the Craniunty on 
 the Teguments that are looren''d, one not only 
 difcharges the 'Pax, but one lays open the 
 Bone, and if 'tis trailured, efpecially iMtis 
 dcprefs'd, one Trepans to take away the Piece 
 that is feparated from tlie whole. Had not 
 we a fractured Bone, a Depreilion, did not I 
 perform the T'rej>atiy when I cut away floping 
 the Piece next to the Depreffiou, to put the 
 Inftrument under that lerv'd as an Eltvatory, 
 to raife up and take away the Bony Piece, 
 which the Fall had forced in upon the l,umps 
 of Flefh, on the infide of this Exoftafis ? In- 
 fine if they Trepan to raife the Pieces of 
 Bone, they alio Trepan to dilcharge the Blood 
 tliat is diifufed, whether it be fluid, coagu- 
 lated, or changed into Pus. Did not I, by this 
 Operation, make room for the Difcharge of 
 the Pus fbrm'd under the Piece that was funk 
 in, a "Suppuration which occafion'd the Fever 
 and other Accidents, which avouM infallibly 
 have carry'd off the Patient, if by the means 
 of this Operation the Qiule had liOt been 
 deftroy'd ? 
 
 This Parallel may be carry \l farther t The 
 Commotion that happens in Blows on the 
 the Head, perhaps happened to the Exofrnfit 
 of our Patient-, the Pus th't was under the 
 Piece of the Bone that was funk in, was per- 
 chance caufed as much by the Commotion as 
 the DeprelFion. The AblceiTes that arc Ibrm'd 
 \n the Cavity of the Marrow, after a Simple 
 
 Contufioii 
 
400 A Treatise of the 
 
 CoTitufion of the Bone, prove rufficiently that 
 Commotion is not the Cauie ot a Diftemper 
 that is peculiar to the Brain. 
 
 The Caufe of Scrophulous Bxfftofs is not 
 more ealy to determine, thaji that of the 
 Swelling of moll Part of the conglobated 
 Glands. They lay that the Lympha being 
 congeal'd produces both the one and the o- 
 ther, and altho' the Eifefts of the Scrophu- 
 ious f^irus be almoft like thofe of the Venereal 
 one, there is neverchelels fome Ditference not 
 only between thefe two F/Vaj's, but alfo be- 
 tween the two fame Elftffts ot thefe two va- 
 rious Caufes ^ and they diftinguiih between the 
 £xoJlofejy jihfcejfes, VlcerSy Caries^ and PuftuUs 
 that are Scrophulous, and thofe that proceed 
 from the Pox : We fhall endeavour to make 
 known the Difference, by giving hereafter 
 the marks both of the one and the other. 
 
 Kot but one may fometimes be miftaken, 
 if one is not very careful, when the King's 
 Evil is complicated with the Pox, or when it 
 i? only the Effe£t of a degenerated Firus. 
 There are Perfons attack'd with the Scrophula 
 who can neither be fufpc£ted of having them- 
 felves got the Pox, or of having inherited it : 
 Others may be fufpeeted of the one or the 
 other, fometimes both. 
 
 May not one believe that that is free from 
 the Pox, which feizes upon a fmall number of 
 Inhabitants in a Place where not fo much as 
 the name of the Pox is known ? On the con- 
 trary ought not one to judge that it is Pocky 
 when it affeOis a great number in a Country 
 where the Pox is very common, becaule io 
 few Perfons get cured of it, that it is heredi- 
 tary for lb many Degrees that it degenerates, 
 and would (to ule that Expreilion) denote the 
 number of their Anceftors, if fome one did 
 
 not 
 
V)ifeafes of the Bo N E S, 401 
 
 not increafe the inheritance by new Acqui- 
 fitions. 
 
 We fee every Day Perfbns afflided with fhe Remark. 
 King's Evil who have been cured, and to 
 whom it has returii'd upon an impure Co- 
 pulatioii. 
 
 Are there not Poxes obfervM in Praftice, Another 
 which have for their Sympcoms an almofl Remark. 
 univerlal Iwelling ot the conglobated Glands ? 
 
 I have known Women who had been cured obferva- 
 of leveral Scrophulous Kernels in their Youth, tion. 
 who on their fiift being with Child, or a little 
 after, fell again into this Diftemper, whether 
 thev had contraded Ibttie Virus from their 
 Husbands, or wheiher the Milk lowering in 
 the Mafs of Blooo had coagulated the Lympha^ 
 or laltly wh.ther their new Condition had let 
 at liberty the old Scrophulous Flrus, which 
 the Remedies thev had taken had only weak- 
 en'd and palliated. 
 
 A young Womnn of Twenty Years of Age, 
 had been in perfect Health for Ten Years^ 
 after ihe had been cured of two Scrophulous 
 Tumors, one in the Foot, where the Bone of 
 the MetAtarfuSy that fupports the great Toe, 
 was almoft entirely falPn off by Exfoliation, 
 the other at the Angle of the Jaw, where 
 fome Glands had been deftroy'd by Caufiicks, 
 and the Ulcer perfectly confolidared. After 
 having been Teu Years per fed ly cured to all 
 appearance, flie was marry'd. Her Husband, 
 who had had Venereal Difeafes ill cured, 
 had a runr.ii.g remaining, he gave her a Go- 
 Mrrhe.1, which unfortunately was only treated 
 as a Gonorrhea^ and that by a Ferfon of the 
 number of thofe who think that to flop the 
 ruiining of a Clap is to cure it. A little after 
 this Palliative Cure of the Clap, the Glands 
 
 Dd of 
 
4C2 A T Fv E A T I 5 E of the 
 
 of die Keck, the Arm-Pit, and the GroU 
 Iweird, the old Sores broke out afrcfh, the 
 obierva- T^ifus^ and the Arigle ol the Jaw were £*■- 
 "***• oftofcd. For a lo 5 Time fhe had only anti- 
 icrophulous Medicines prelcrib'd her, becaufe 
 they did net fufpcfl: the Pox, but only the 
 Return of the Kiug's-Evil. This long and 
 unprofitable method of Cure occafion'd a 
 Confultation, wherein they gave a more fin- 
 cere Account of what had paft, than had been 
 done to the ordinary Surgeon, and 'twas con- 
 cluded that the Return of the ScrofhuJa was 
 owing to the Pox, and that the Patient muft 
 go thro' a Courlb of Phyfick, which had all 
 the fucccfs that couM be expelled. 
 Obferva- 'Tis leen therefore that fhe Pox and the 
 tion. King's-Evii may caufe Exoftofes^ whether one 
 of thefc Difeafes precede the other or no; 
 but wliat is remarkable in the Scrophulous 
 and Pocky Exoftofs is, that they more ge- 
 licrally fuppurate than thole that are only Ve- 
 nereal, and the lort of Caries tliat fucceeds 
 is always very fatal. 
 Obferva- In the Small-Pox there a rife Tumours, 
 tion npon which terminate lb fpeedily in Impoflhumes, 
 the Small- j-i^at 'twou'd be hard to remark the tour 
 ^^'^' Stages which the Ancients pretended to di- 
 ftinguifli in Impofthumations. The firft thing 
 that is perceivM is a FluO:uation, and altho' 
 the Matter has made no (lay there, one finds 
 the Bones bare and fwell'd, and often Rotten, 
 which may proceed from two Caufes, ei- 
 ther from the iharpnefs of the Matter, or 
 from its breeding under the Periofteum, or in 
 the neighbourhood of the Bones. 
 
 I have known the Small-Pox attended 
 with fuch virulent Ablcelles, that they have 
 laid the Bones opea almoft their u-hole 
 
 lejigth. 
 
Difeafcs of the BoNZS, 40^ 
 
 length, and have fent forth fuch a vaft Quan- 
 tity of Pus, tiiat the Patients died in a A£t- 
 rafmusy or in a Lcucophlc^matia cauled by the 
 Sohition of the Blood. 
 
 The Exoftofes may be Cancerous ; I have feen Remark, 
 feveral. A Woman of 50 Years of Age be- 
 ing alftided with a CAnccr in her Breaft, lent 
 for me to give her Ibme Relief. What I 
 thought the propereft was to cut olY the 
 Brealt, the moveable Tumour, the Arm-Pits 
 being free, and exempt from any l\vellii;g, 
 the firength of the Patient, her confidence 
 in the Operation, all invited me to perform 
 it, and feem'd to alTure me of Succels \ the 
 iealbn it lelf was not improper, I hoped for 
 a good Hfue, and ihe was cured. Two Months 
 after ihe was feiz'd with an intolerable Paiia 
 in the Heel without any fwelling, the Part 
 was neither clnng'd in Colour nor Conliftence, 
 all the Remedies were ufed that are proper 
 to alfwage Pain, but to no purpefe, there ap- 
 pear'd an Oedema, at the Ankle Bones. 
 
 The Bone of the Heel fwell'd by degrees, 
 and the Skin became red and Oedematom, „, ^ 
 an Incifion was made, and the Ca'cancum "^vas j.-^^^^^*"' 
 found to be fwelfd, bare, and rotten. They 
 fufpefted the Pox, the Patient went thro' a 
 Courfe of Phyfick, but the Difeafe increas'd 
 fo tliat the AdalleoU fwell'd, and the whole 
 Foot falling into a Gangrene, made us refolve 
 to cut olf the Leg. There broke out of the 
 Marrow a Cancerous Fungus which made a 
 confiderable progrefs in a little Time ^ it be- 
 came hard, painful, black and noifome, and 
 there ilFued out fuch a great quantity of 
 ftinking ferous Matter that the Patient fuik 
 under it and dy'd. 
 
 D d 2 Ano- 
 
4^4 A Treatise of th^ 
 
 Another Woinaa, a great deal older, had 
 for a long time a Cmtctr in her Breaft, g/hich 
 gave her riO difturbance hut i30or and then 9 
 ihe tvas ItrlzM with a Tiimour in the middle 
 of her lefc Thigh, for which Ihe had recourle 
 to Surgery. On examining her I found that 
 the Body of the Bone was fwell'd quite roujjd: 
 Three Days after it appeared to me to be more 
 fo, I judged that there was an Ex^ftofit - the 
 ibaip arid continual Pai/is with ihootings con- 
 firmed me in tliis thought •, and their per- 
 tbreraiice, in fpitse of the Remedies prescribed 
 made roe believe that the Exoftcfls would Im- 
 pofthumate, arid that the Cojilequerxe would 
 be a Caries. It fell out juft fo, atter two 
 Months conftant fulTering widiout Inter- 
 rai/Soii, till dfhe broJce her Thigh in turning 
 ill iier Bed, A Tumour ot the lame Nature 
 broke out in her A rm, and another at the 
 Clavicle \ tliey were not fo long painful, be- 
 caufe the Bones brolce iooner than the Thigh 
 had done<^ 
 
 'Tis eafy to imagine how diificult 'twas to 
 more this Woman for the leaft of her ne- 
 ceflary OccaCons- The Excrements, and the 
 Urine caus'd a Gangrene in the Buttocks 
 and the Oi Sacrum \ ajid flic died in fuch a 
 deplorable Condition that Death was a Be;ie/it 
 to her. 
 
 Another died of a Cancer flie had had 
 Eight Years, which had been Six Months 
 ulcerated, but they would not let her un- 
 dergo the Operation, becaufe it had ad- 
 hered to the Ribs from its very beginning. 
 I diirefl:ed the Part underneath to fee in what 
 tht Adhefion confifted ^ and I found that all 
 the Part which fhou'd have been either 
 Gland, Mufcle, or Fat, was nothing but an 
 
 uniform 
 
Dijeapt of the B o N E 5- 40$ 
 
 uniform Lump of Flefh, a?moft »s hard as 
 tfje Cartilages. The Ribs that fenped as a 
 Support to this uicer:»ted l^urxjour^ fbrm'd 
 'Ev»ftofes in that place that were eve» a licde 
 
 lotteti. 
 
 The Carirr is a Dileafe very common to Cm- 
 trrs :: The C/vncer of the Nofe becomes a D»- 
 fliemper of the Bones almoft Ttf&y&a as of the 
 FFefli, and the Carlct that follows rt has oftea 
 Something particular in it, which t caii^t 
 jwfs over in fifencc^ bwf t»hich 'twill be hard for, 
 iiae to defcribe, and makeunderftood by thole 
 ^ho have not feen it. 'Tis- not a Caries 
 \vi^ Worm-hoSes^ it fetdom happens to be 
 ivveU'd, as in the ExoftofiXy but the Bones, wear 
 stvrAfy Rnd laltotr ii> fuch fmall Piec«?^ that 
 they difappear without ot7e\'; perceiving any 
 Splinters, excepting it be the laft Piece that 
 falfe off whicii h pretty large, becauie the Mat- 
 ter feizes upoii the Suture that joins it to 
 the Jaw-bone. When this lafl Part of the 
 Kole-bcrne comes off, the Piece of the Jaw- 
 bone,, to which 'tis join^'d, does not feem rotten^ 
 nearer thelefs the Cancer increafes^ <tnd the 
 [Bone waftes without its being perceived to 
 |be ktre, or Tiny Splinters l^eing, feen to come 
 from it; on the contrary 'tis ahvays hidden 
 ;by a fpungy Flefl), which might, I thijik, 
 jbe compared to the Afhes that hide the 
 'Fire which confames a Match or rottei 
 jWood. 
 
 I have fbmetimes feen the Bones fall off 
 Kvhole, as that of the Nofe, the Vnp'uj^ the 
 inferior fpongiou.s Lamina:, and even the Bone 
 of the Vomum ; but this only happens in thole 
 Cmiccys of the Face, thit lei/e upon a errent 
 Part at one Time : The Votne-,', the QxTti*' 
 \moidcSy the S^henoiHfSy tlie Ccronnlc^ ai^.d the 
 D d -5 r}.t 
 
4c6 A T f^ E A T I s E of the 
 
 Os MaxlHare, fall off always by imperceptible 
 Pieces, becaufe they are of too great extent 
 to be univerfally attack'd at oiice. 
 
 Befides thefe Examples of Exoftofes, and 
 Cancerous Caries, Mr. Afalavnl a S-vorn Sur- 
 geon, and very famous, dkew''d me a Can- 
 cerous Exofrofis that leiza upon the upper 
 Parts of the Ttbia and Perona, near the Knee ^ 
 but: as he intends to publijh this Oblerva- 
 tion, 1 fhall give no account of it. 
 
 The formation of this FlCih upon the Bones 
 in proportion as they decay .-nd difappear, 
 is a Phenomenon hard to be explained, but 
 there is yet more Difficulty to account for 
 the Metamorphofis of the Bones into Flefli, a 
 Difeafe which I fhall call the Camification of 
 the Bones, becaufe that from beir.g hard, as 
 they are naturally, tliey change iito a fub- 
 ftance altogether like Flefli, as will be feen 
 by the following Obfervations. 
 
 A Man of 50 Years Old had been for i8 
 Years affiled with Pains in h"s Head, fet- 
 tling a little more on one fide his Forehead 
 than on the other ^ he bled very violently at 
 the Kofe : He went to For^c, ai^d the Wa- 
 ters relieved him a little, but on his return- 
 ing home the bleeding and Pains came again, 
 which was follow'd by two Polypus's in the 
 Kofe, a rednefs in the left Eye-lid, the j4d- 
 nataTunicaj and the great Angle rear the Kofe, 
 There apear'd under the Skin of the great Ai - 
 ale a little foft Tumour, being almoft without 
 Pain, and diminiiliing when prefs'd with the 
 Fingers, becaufe it difcharged it felf partly 
 into the Kofe, and partly into the Cavity 
 of the Palpebrx by the PunCia Lachym.dia. 
 The Matter was a purulent Lympha. This 
 is almoft the Account I had of it in a Me- 
 morandum 
 
Bifeafes of the Bo N E 5. 407 
 
 morandum that was fent me, to whfcli I ari- 
 anfwer'd, that if the Patient cou'd i^ive us any 
 Infight into the matter, he might perhaps o- 
 pen us a fhorter and more certain Method of 
 Curing him. He took a Refolution to come 
 to Pcn-isy where his Prefence inftru^ed me 
 much better, both by the Exnminatiou I made 
 outwardly of his Ail, and by a Converfa- 
 tion we had together, wherein ! learnt le- 
 verjil Circumftances which let me into the 
 Nature of the Difeafe. 
 
 On examining his Ail, I made all the fol- 
 Jowiiig Obfervations, 
 
 1 ^. That the left Eye was fltrther from the 
 Root of the Nofe dian the right, by a Imoft 
 a Finger's breadth. 
 
 2^\ That the Ball of this Eye ftuck out 
 more than that of the Right, by a Finger's 
 breadth. 
 
 3*^. That there was under the fi^ft Tu- 
 mour at the great Angle, another fwelling 
 which was harder and retllled the Touch, 
 and that far from difappearing on CompreP- 
 fion, as the firft did, it was much plainer to 
 be feen, when the Tus was di'charg'd out of 
 the other. 
 
 4^. I obferv'd in this Tumour a very con- 
 fiderable Aneurifmal Puliation^ this Pulfa- 
 tion was felt even at the great Angle of the 
 other Eye, at the little Angle of that which 
 was indifpofed, and one might perceive it very 
 fi'rong on touching the two Polypus'' s with the 
 Finger ; it was even fo confiderable that one 
 might lee the Finger rais'd up, when laid 
 upon the fwelling, by this Puliation which 
 anfwer'd perfectly to that of the Arteries, 
 lb that on touching the PuUe and the Tu- 
 mour both at a Time, there was fuch an ex- 
 ^^^ he): 
 
4c8 A Treatise of the 
 
 a^ Conforinity, rhar one n^i^ht obferve an 
 InteriTii/Tioii or the Puliation, ever) Ten Vi- 
 brations, both in the Pulle and the lumour. 
 
 What couM 01 e think of fuch a iwelh'ng, 
 and it<? PuHhtioi., bur that it was an Aneurifm? 
 Keverthelefs I did hot judge it fo, and I gave 
 the following Reafons. 
 
 1^- The Aneurifm is a fofc Tumour, and 
 this is hard. 
 
 2^. The AnruYifm goes in again, and this | 
 Tumour does liOC. 
 
 3°. The Aneurifm is accompany 'd with a 
 whittling and hiifing Noife that is perceivable 
 bv the Ear, and even bv the Touch, and 
 this fwelling has neither the one nor the o- 
 ther. 
 
 4°. I cou'd rot imagine that Arteries fo 
 fmall as thofe at the Fart which was affeil- 
 ed couM form lb cox.fiaerc;ble an Aneurifm. 
 'Twas objected that the leift Arteries can 
 dilate th m^elves extreamly, and prcduce 
 great Aneurlfms j I anfwer'd that it was true, 
 but that they had no Pulla'-ion, or at leaft 
 fo little that it cou'd not be perceivd by 
 the Touch, which was not the Cafe of'the 
 fveiling in Q;aeftion, wherein the Pulfation 
 was as ftrong as that of the Carotid Ar- 
 teries. 
 
 Thefe Phanomena are I confefs very hard 
 to explai; , iieverthelefs 1 will endeavour to 
 fatis^y fuch Perfbns as will be contented with 
 the probability of Explanations drawn from 
 the StrLduve of the Part, and from different 
 Obfervations that can't be calFd in Queftion. 
 
 I thought thi'- the Difeife was a Carcinoma^ 
 I mean a lie/hy Body, which being formed 
 
 in 
 
Difeafes of the Bones. 409 
 
 in the fpongious Lamina of the EthmotdeSy 
 had grown and fpread on difEerent fides. 
 
 The Patient was troubled with a Stoppage 
 in the Nole, at the beginning, becaule the 
 Diameter of the Koftrils was diminifji'd b/ 
 the Bulk of the Excrefcence, and befides 
 there was a fwelling in the Pituitary Mem- 
 brane, by reafon of the ComprelTion which 
 this Tumour caufed in the Blood Veffeis, 
 which occafion'd the Pain in the Head, and 
 the Bleedings at the Nofe. 
 
 'Tis known that the Communication of the 
 Inten.al and External Veins with each other, 
 was only fettled that thefe Veffels might be 
 a reciprocal Relief: to each other, in ferving 
 mutually to difcharge one another : If the In- 
 ternal VelTels of the Brain, that are next to the 
 Part affeOred, can't empty themfelves into the 
 Velfels, that are kept ftopt by the Part in- 
 difpofed, this alone mufl: caufe a Diforder in 
 the Brain ^ but this Obftruclioii can not laft, 
 becaufe this Communication was only efta- 
 blifh'd for urgent Cafes, as when there is a 
 Diforder in the one, then the Difcharge is 
 made into the Ve.Tels of the other. Befides 
 'tis" known that when a Part is obftru^ted, 
 the Blood of the Arteries can't penetrate it 
 but with Difficulty, and that what don't pafs 
 thro' this obftrufted Part, is fharcd again 
 amongft the neighbouring Arteries. 'Tis for 
 this Reafon that in a Commotion of the 
 Brain there enters lefs Blood into the Cra- 
 nium, and more into the Face : On the con- 
 trary when there is an Obftrudion externally, 
 there palTes lels Blood into the External Ca- 
 rotid Artery, and more into the Internal one; 
 This is the Cafe whereof we have been 
 f'peaking, and 'tis this fupernumerary q^jan- 
 
 tity 
 
4to J Tkeatise of the 
 
 tity of Blood (\{ I may ufe that ExpreA 
 fioii; tfint Iwells the Internal Veilels, com- 
 prelfes the Brain, and caufes the Pain in the 
 Head.. 
 
 If the Pains, in the Head are infeparable 
 from the Difeale l^ queftion, ought one to 
 wonder at the bleeding at the Nofe which, 
 return'd often and abundantly, becaufe the' 
 Velfels of the pituitary Membrane beii^g com- 
 prefs'd, dilate them lei ves, become fubje£t to 
 Varices, burft a. d Hied more or lefs Blood, as 
 they are more or lefs in Diameter ? 
 
 The Pnt'cnt was relievM by the Waters of 
 Torge, becaufe they render'd the Blood more 
 fluid, the Obflruftions were abated, and had 
 not lb much power over the VefTels, . where- 
 in the Blood circulated better in Ipite even 
 of the Comprefllon which ftill continued. 
 
 The growiFig of this Flelli may alio have 
 caufed the Head-ach of it felf, by making 
 an Effort to lodge it felf at the Expence of 
 the neighbouring Parts, which are, as is well 
 Icnown, very fufceptible of Pain. The Red- 
 neis of the Eye-lids was causM by the Com- 
 prefllon of the Velfels that ferve to carry 
 back the Blood which paffes thro' them. 
 The Watering of the Eyes had at firft but 
 two Caufes, "jlz.. the Interruption of the 
 Blood's Return into the Lachrymal Glands, 
 and the iwelling of the Palpcbr^ and the 
 Tuv[}a Lachrymalla. By the firfl more Tears 
 were produced, and the lecond preventing 
 their running into the Nofe, the Tears over- 
 flowed the Eye-lids, and fell upon the Cheek. 
 
 In procefs of Time the Excrelcence of Flefh 
 growing larger, was a third Caufe of the 
 Rednefsofthe Eye-lids, and of the Water- 
 ing of the Eye, not only by reafon the 
 
 Com- 
 
Dffcafes of the B o K z %. 411 
 
 CompreiTion of the Veirds was ftroiiger, but 
 alio by the Compreflion of the Bag of the 
 Nofe and the Puvcla Lachryma/ia. Bcli Jes tJicie 
 was an Inflamatioa in the Cavity of the Hag, 
 attended with what they call a flat Fiftulay 
 which increafiiig form'd a pretty high Tumour, 
 that when comprels'd not only difcharg'd 
 it felf in the Nofe, but in the fequel eva- 
 cuated it felt alfo in the PunBa Lachrymalia. 
 'Twas this foft iwelling whereof we have 
 made mention, and which being entirely 
 cleared of the Fus, difcoverd the fwelling 
 which was not otherwife perceptible to the 
 Eye, but only to the Touch. 'Twas alfo this 
 fwelling which, being Part of a greater, had 
 been takei for an Aneurifmd Tumour on ac- 
 count of its Puliation. Keverthelefs it was 
 not one, as I have already alledg'd, and as I 
 am going to make good by giving the Rea- 
 Ibn why there was a Pulfution, and why not 
 the other Signs of an Aneurifm. 
 
 In order to give a Reafbn for this it muft be 
 laid down for a lafting Rule that the Bones 
 may be chang'd into Flelh •, I don't only 
 mean that they may become foft as is feeri 
 in the Rickets, (and as is cited in the daily 
 Memoirs, and particular Treatiles of the 
 Difeafes of the Bones,) hut 1 mean that they 
 have the fame foftnefs as the Flefli, being 
 penetrated by the Blood, not as all the Bones 
 are in their natural State, but in the fame 
 manner as the Inteftines, the Glands and o- 
 ther Parts are. For the reft, one may cut 
 them with the f.ime Eafe, they make no Re- 
 fiftance againft the weak Efforts of a cutting 
 Inftrumenr, one can't difcover any long Fibre 
 therein, and in a word they are of fuch a na- 
 ture. 
 
tare, that being tep.iraced troin the Dodjf, so 
 me can refufe them the name of Flcili. 
 
 To return to the Tumour of our Valient^ 
 1 lay, that it had ks Root at ihe Qj JErfc- 
 moidrs -y this Uone was btacoine- Fleli as w«Jl 
 as the bony Laminx of the Nole> the Cx 
 flannin, »nd the O^ "J'ngT^is. The Brain beat- 
 isg uptM:i the Oi Ethmn'des which Twas cxnsfy'd, 
 corarrunicated its Pallktron to it, b<r r<a4(« 
 €)t' its Ibttiieis ^ and as this Bone was the 
 Root aad Ba&s of the Tumour, the Pulfo- 
 tiai a»iweir'd at all the Piacei where the 
 Branches of this v>/ellxiig hnd fpread : 
 One might feel it on couching both Eyes, 
 at each great Angle, and on putt/ng ones 
 Fmgers in the Kollriis. This Difeale isy I 
 contefs, very particular, and I fiiall have bat 
 very few, on my iide in \vhat I advance on 
 ^is Head. AU I am do to procure meibroe 
 is to relate the ObfervatioriS that corw 
 filled jne o\~ the Faft in Queftion. 
 
 Firft Obfervation. ^Tis above Twenty Years 
 fince 1 had a Soldier under Cure, who had a 
 Swelling as big as an Eeg upon his Inftep, 
 uesr the prntirig of tlie Foot with the Leg. 
 It ftuck out under the fole of the Foot:, the 
 ^4fcnrurofiSj that covers the Miilcles, had re- 
 fifted, and forced it to fpread and ihew it felf 
 on the Sides. This Tumour broke, and was 
 drefs'd a long time to no purpofe •, and 'twas 
 refblv'd to cut olf the Leg, becp.ufe the Ar- 
 ticulation was drench'd, and neither the libim 
 nor Perc-/ia cculd fecure themfelves from the 
 rapid progrefs of this Swelling. The Ampu- 
 tation bein^ made, I diifefted the Limb for 
 jny hiftruflion, and in the whole Compals 
 of the Tumour, I found no folid Part but 
 the Cartilages that cover'd the Surfices 
 
 whereby 
 
^Dip^es of the Bones. ax 5 
 
 ivliereby the Bo pes toucliM each oth«r. AR 
 the bony Parts had the CorJillejir!^ of GSjiikIs, 
 without ary bony Fibres, unlefs it \vx% ii\ 
 ibme Bones the :T)fifl: diftaiit fVcjm tlie CenttT 
 oftlifc Tumour, wherein f found ibme Place? 
 that •were nor yet carnify'd, but wJiich h\^ 
 been fb, had the Operation beezi deferrd -ae- 
 ver fo iitt'e- 
 
 2^. Mr. Mttrand^ one of my Bretliren cet 
 off a Thk^h, at which I affifted -^ afcer the O- 
 peratioii v/e diue^led the Articuhtion -of the 
 Kidee, which, had iaiduced us to take off the 
 Limb, 2lvv\. -we found that the ConJyU's of the 
 ftmwr^ the Epiohyfs of tiae Tibia and the Riti/Uy 
 were of the Conliiieiice of fofc Flefh, Tr.id ^li 
 the Cartilages, both of the RotuLtj the Cundik^ 
 of the Femur ^ and the Cavities of the Tihiti^ 
 were of their jiatural hardnefs , they were 
 only become thin, and even cleft in feme 
 Pkces, becauie the Bones which they cover"'d 
 were grown larger on their becoming Fleik. 
 
 3°. Obfervation, A Tumour broke out m 
 the Carpusy near the root of the Thumb, m 
 the iPiape of a Wen, LiqueRers and Relbl- 
 vents were apply'd a confiderable Time with- 
 out Eifect ^ on the contrary the Tumour in- 
 creafed- Mr. Marechaly firft Surgeon to the 
 King, was prefent, and honoured me with his 
 Advice ^ whicJi was, that I ihouii encounter 
 the Sv/elling with CauAicks, by this means 
 'twas difcovered that the whole C.i/pas was 
 withered, and that the Bones had no fup- 
 port ; the reft of the Bones of the Hand 
 changed in the fame manifer, and we were 
 obliged to cut off the Patient's Wrift, to fave 
 his Life. I diffeded the Hand, and found 
 that all the Bones of the C^/p.7x were carnify'd, 
 excepting the two that form the Jun^iiou 
 
 vvi(h 
 
414 y^ T Pv E A T I S E of the 
 
 witli the Fore-Arm-, nil the reft were become 
 pretty loft Flefli, except the Cartilages : I 
 have eve!) kept this piece. 
 
 4*^. Oblervatlon, Mr. BcuMn, Surgeon Royal 
 of Lrival, a Proviixe of Maine, came to Pdris 
 to be cured of a Tumour that had feized on 
 the Palm of his Hand, extended to the 
 outfide, between the Thumb and the Bone 
 of tile Metacarpus that fupports the Fore- 
 finger, and belides reach'd to that Part of 
 it which fuftains the Middle Finger. He was 
 advis'd to have his Hand cut oif, but the 
 need a Surgeon has of that Part, prevented 
 his confenting •, he chol'e rather, with the 
 Hazard of his Life, to fuffer me to diffed 
 his Hand to feparate the Tumour from the 
 Tendons, wherewith it was blended. After 
 the Operation, 'twas found that the Bone of 
 the Metacarpus, which fupports the Middle* 
 Finger, being changed into Flefli, formed the 
 Center of the Tumour, and made no manner 
 of Refiftance againft the cutting Inftrument, 
 nor even againft the Fleam, whereof I made 
 ule on this Occafion -, which was again veri- 
 fy'd by the opening of his Body, which 
 was perform'd by Mr. de Garengeot in the 
 prefence of feveral Mafter Surgeons. 
 
 5°. Obfervation, 'Tis two Years fince Mr. 
 Leaute, one of my Brethren, fent for me to 
 an Operation which he perform'd upon a Tu- 
 mour under the Eye, at the place where the 
 Bone of the upper |aw is join'd to that of 
 the Vomum. This fwelling, which in appear- 
 ance was no larger than a Nut, extended to 
 the Mouth, the Sinus Maxillaris^ and tlie Orbit 
 of the Eye, whence it had remov'd it ^o as 
 to make it f'.ick out a large Finger's breadth. 
 They took away as much of this Swelling 
 
 as 
 
Difeafes of the ^o^^^-, 41^ 
 
 as they couM, without meeting with ai^y Re- 
 l^flance from the Bones, either in entring the 
 Sinus Maxil/arijy in fiiiding out its Communi- 
 cation with the Mouth, or in fbllowlr.g it in- 
 to the Orbit, wJiich iliew'd plainly tliat the 
 Cones were carnity'd, as was provM after the 
 Death of the Patient. The Os PLmum, that 
 of the Vnguisj great part of the Pomum, an4 
 the Os A^axillare were found to have the Coii- 
 liftence of Fiefh, not refifting the cutting In- 
 ftrument, nor even the Fingers which pierc'd 
 them with eafe. One might penetrate even 
 into the Crartiumy by thrufling one's Finger 
 thro' the Os Cribrcfum and the Sphenoides, whicii 
 having loft their hardnefs, made no more 
 Refiftance than if they had been of Flefh, 
 rather ea(y then d'fHcult to penetrate. 
 
 6^. Obfe^vation, 'Tis 17 or 18 Years finctf 
 Mr. Marech.il, firil Surgeon to the King, then 
 head Surgeon of the Hofpital of the Charit* 
 des Hommcsy and always the firft in the Ex- 
 ercife of his Profeffion, fhew'd me a youn§ 
 Man of 20 Years of ,Age whofe lefc Ey^ 
 iluck outwards above a Finger's breadth, hj 
 reafon of a Swelling that appeared at the 
 great Angle of the Eye, and was attended 
 with a Pain of the Head, -Stupefaction, a 
 Watering of the Eye, and a Drinefs of 
 the Koftril on the fame fide. This celebrated 
 Surgeon encountred this Tumour with a 
 Stone Cautery proportionalple to its bignefs. 
 The Efcar was cut to the bottom, and there 
 came out two or three Spoonfuls of Zympha 1 
 little reddilh, upon which the Eye returned 
 almoft to its natural place. Louis le Cntnd^ 
 of Pious and Triumphant Memory, loling 
 Mr.FeliXy hlsijrd Surgeon, chofe M^s: . MArechd 
 to flipply his 'Place, whom the Publick hid 
 
 lior 
 
4i6 A T?^z AT I %z of the 
 
 not parted with without Regret, if they had 
 not valued the Health oi" their Monarch more 
 than their own. As his Bufiiieis lear the 
 King made him overlook fo particular a Dif- 
 eafe, he will thank me for recalling it into 
 his Memory, and giving an Account of it to 
 the Publick. 
 
 The Flefh burnt by the Cautery being 
 fall'n off, 'twas thought that the Wound 
 cicatrizM, but in eight or ten Days after 
 the fall of the Efcars, there appeared in the 
 middle of the opening a Rifmg which leem'd 
 to be a Bladder by its Sottnefs, jSmoothnefs, 
 and the Eafmefs of its being thruft in again. 
 It was open'd by a Lancet, the Water that 
 came out was like that of the former, but in 
 a fomewhat greater Quantity : Two Days 
 after there appear'd a third which was lanc'd 
 after the fame manner, but there came little 
 out \ the Eye removed from the Nofe, and 
 ftuck out as at the Beginning ; the Head be- 
 came heavy, a Fever broke out, and the Patient 
 dy'd in a little Time in a lethargick Stu- 
 pefaction. 
 
 Upon opening his Cran'mm I found no- 
 thing particular in his Brain \ I only obferv'd 
 that the Burn Mater which covers the middle 
 and lower Lobe of the Brain was confiderably 
 laifed up, which induced me to take away all 
 the Brain, that I might the more eafily 
 examine into the Caufe of the T>ura. Maters 
 Elevation. 1 rais'd up the Membrane by 
 little and lit^le, fepararing the Middle of the 
 Scaly Part of the Bone of the Temple, to 
 which it adhered, fo that it was confounded 
 with the Rone, which !'eem'd to me i;i this 
 Place Cartilaginovs or Flefliy. This done, I cut 
 the upper Part of the Edge of the Orbit, 
 
 and 
 
D/feafes of the B o N E S. 417 
 
 and when I came near that Piece of the 
 Coronale that forms the Arch of tlxe Orbit, 
 1 found tliat alio Cartilaginous. Then ha- 
 ving railed the Dura Muter with tiie Scd- 
 pery 1 found three Bladders lull of a reddiih 
 Water, one in the Orbit, the other, halt in 
 the Orbit, and half in the Canium^ and the 
 third in that Part of the Cavity of the Skull 
 that is fbrm'd by the Os Tempris^ the Pafis of 
 the Sphenoides, and lialf the ^pophyfis Pctrofa. 
 Thefe Pieces of Boiie. and thole that rbrm the 
 Optick Hole were ot the fame Confiftence as 
 FJeih, being firmer in fome places, ai.d ibi'ter in 
 others, ib tiiis Dilpofition reach'd trom the A- 
 pophyfis Petrofot to the great Aiigle of- the Eye : 
 The Os VtJguis and Os Planum were carniiy'd. 
 
 Whoever would account tor this Aicta- 
 morphofis wou'd do me a Favour • neverthelefs 
 *tis no harder to explain than the Oififica- 
 tion of Bones -^ and whoever can tell hovv the 
 Flefh is chang'd into Bone, may i's well 
 account tor the Bones changing into Flelli. 
 
 Diagno flick ^igns of the Exoflofs, 
 
 The benign Exoftofs is not hard to di- 
 ilinguifh, efpecially if one reflefts upon the 
 Caufes that have produced it, the ab (ence of 
 violent Caufes, and of any fiital Symptoms. 
 
 As a Blow may be the Caufe ot this kind 
 of ExoftofiSy there will no Signs of the Scurvy, 
 Pox, or other Internal Caufes, nor of the 
 Symptoms that attend thefe D'flempers. Islot 
 but there may happen troublelbme Acci- 
 dents by reafon of an Exo/'tofis, when ih Tu- 
 mour chances to be near any Part which is 
 incommoded by its Figure or its fize. For 
 inltance, I have I'een one which grew perpen- 
 E e dicuiariy 
 
4i8 i< Treatise of the 
 
 dicu 'akly upon the upper aixl hinder Part o\ the 
 Externjii ComiyU ot the Ffmur. It caufed w 
 Fain when the Patient was either {landing 
 or fitting, iK>r even when he walkM Ibftly v 
 but when he walked fi\ft he felt fliarp Pains, 
 and pcrceiv'd the Noife ot the Giijuetis, that 
 was cccafion'd by the roHgh PaiT^ge of the 
 Tendon of the Biceps over the Tumour, this 
 Tendon being in the Fore-part of the Exef- 
 tops when the Patient's Leg was extended, 
 and in the Hind-part when 'twas bent ^ lb 
 that it paH^'d alternatively backwards and 
 lorwards when the the leg was bent and 
 extended. When he walkM foftly, this Paf- 
 fage was made with Eaie, and the Patient was 
 put to no Torture \ on the contrary when he 
 ran or walk'd briskly, the rubbing of the 
 Tendon againft the Exoftofs was grating, 
 harfh, and painful. 
 
 A kindly Exoftofs neither caufes any Pain 
 of it leir, nor is the iikin that covers it red 
 nor fweird. I have feen one on the upper 
 fide of the Orbit towards the little Angle of 
 the Eye, which had raisM up the Palfehra, 
 and jutted out lb far over the Eye-ball, ai:d 
 the Adnata Tumca^ that the Eye-lafhes came 
 over the End of the Tumour that appear'd, 
 and divided it in two, fo that the upper half 
 was cover'd by the Skin, and the lower reft- 
 ing upon the Eye-ball, cx)mprefs'd it in its 
 upper External Part. The Patient now look- 
 ing a fquint, faw objefts double, which is not 
 ufual, for 1 know thole who liardly fee them 
 fingle -^ but the Realbn why this Man did io 
 was, becaufe the Tumour that comprefs'd rhe 
 Eye, had the fame Effecl as the Finger when 
 put between the Eye-ball and the little Can* 
 
 thus 't 
 
bifeafes of the BoN E«. 41? 
 
 thui •, it chaiiges the Line of Dire^Hon of the 
 Eye, which cauies one to fee double. 
 
 The Exofrofti of the Soldier belore-nnen- 
 tion'd upon the Os Tcmporufn ga\^e him no 
 Pain, but he was a little incommoded vheii 
 he open'd his Moutli, becaufe the MufcJe Cro- 
 taphitij ivas rery much extended, and he was 
 forced to turn his Head to lee the Objefts 
 that were on that fide, becaufe the Swelling 
 made a fort of Mountain that obftru^.led 
 his Sight. 
 
 That of the Young Man who beldng'd td 
 the Cardinal de Rohan caus'd no Pain •, the 
 Deformity alone made him refolve to have 
 this Tumour rooted out, which fhews that 
 the Deformity of a Thing is not a fufficienc 
 Motive to induce us to perform an Operation 
 that may have fuch fatal Confequences, fince 
 he died two or three Days after the Opera- 
 tion. 
 
 There are Exofiofes near the joint that may" 
 by their growth, either utterly deftroy the 
 Motion, or very much diminiih it, bv coa- 
 fining the Heads of the Bones within tod 
 Harrow bounds. An Exoftcfis at the inner 
 Malleolus was known to be benign by the 
 Caufe that had produced it^ which tfls sir 
 blow with Bowl, and yet better by its Con- 
 fequences which were not bad, fince the Pa- 
 tient had had it Fifteen Years, and felt n6 
 inconvenience, but a ftifuefs in moving his 
 Foot to bend it. 
 
 Several others might be cited which ontf 
 can't call to Mind, but I believe, I have faid 
 enough to teach how to diftinguiih the Exof- 
 f$fes that are benign from fach as are not, 
 
 I believe thefe Extoftofes are of the lame 
 Nature as a Cahs, and that in the like matter 
 
 E e 2 the 
 
42G A Treatise cft\:>e 
 
 the mif-ili-ipcn CaJluf might piifs fov a benign 
 £xofrofs, bccaule it is is not attended by any 
 incoaveiiieiice, ruxi does no Jiijuiy but by its 
 fize, 'ts ihapc, and its Situation. 
 
 TJie £x:ft<>jif caus'd by the vicious quality 
 of the Penoft€um hzs peiicrully Ibme prelimi- 
 nary Signs •, it is ordinarily preceded by a 
 Blu\v, a Fall, aii old Ulcer, efpecially one 
 xhat is 'varkofe^ a paintui Swelling, or au Or- 
 devuiteus Tumour. , _ ^, 
 
 One ilei Swellings, fmall or great, break 
 out upon the Leg-bone ;i there are few Per- 
 iojis but carry Ibme proof or it. I have leen 
 one which roe up four Lines in heighth like 
 an j4popLyiif StyloiJes -upon the m'ddle of the 
 Tjifua-j ic'caus'd very acute Pains at its firft 
 appearance, which were but flight when I 
 firlt law it, and have dimini/h'd by little and 
 little, till they are come to nothing, io that at 
 prefent it caufes no Pain at all. 
 , 'lis veiy feldom that old Soies don't cor- 
 rupt or relax the Periofreum: \t 'tis cor- 
 rupted a Caries enfues, and if "tis only re- 
 laxed the Bote fwells, and produces an Ex- 
 oft.jfis, for the Reafons we have mention'd in 
 theii- place. Hippoaaus makes this remark, 
 when he lays, that the Ulcers near the Bones, 
 which remain a Year or more, impair the 
 Bone and rot it. • ur >: 
 
 Old Ulcers are always accompany'd with 
 a Swelling of the Body of the Bone, and I 
 hnve often diifefted the Legs of Perlbns who 
 have had them, wherein I have found this 
 Tumour. I have a 77/;m, whofe middle is h;^lf 
 as bii? again as it ought to be ^ I am not in- 
 deed Cure that the Perfon was free fromthe Pox, 
 nfiverthelels 1 believe th.t this Swelling was 
 liot Pocky, th« rather becaufe there was a 
 
 callous 
 
Tiffeafes of the Bones. 421 
 
 callous "Ulcer in the Leg for Ten or Twefvc 
 Years. 
 
 The/'V/fo/^ Ulcers are yet oHner attended 
 ^irh a Corruption of the Ferioftcumy and the 
 Bone, when tliey are nenr them, bccaule the 
 varix is not Only a Dilatation of" the Vdfels tliat 
 are apparent, but alio of the little Capillar y 
 Ye/Tels which muft empty tliemlelves into 
 the large ones ^ 'tis even partJy tlie Realbii 
 why the Varices are almoft always attended 
 with 3n Oedema. Wherefore if this Varicofe 
 and Oedemnious Difpofition happens to the 
 Vellels of the Teriofteumy 'tis eaftly conceiv"'d 
 that the Elafticity of the hitter will relax, 
 and the Bone corrupt. I judge the tlime ot 
 the Oedema that continues a long time upon 
 the Bone, becaufe it produces the l?tme Effect. 
 'Twin be known that the Veriofteum is af^ 
 fe£led with the Ocdenuxy w]ieh the Difeale is 
 fix^d ?nd circumicrib"'d to one Point, with- 
 out there being any elfewhere. ! have o' ten 
 ^QQTk this Oedem.t upon the Bone of the l£^, 
 without its appearing on the Sides: It is 
 not (b apparent as the common Qedemxy it 
 begins deep, and afterwards Ipreads outwardly. 
 When it firft begins the Skin is loole over 
 it \ if you prels your Finger lightly upon it 
 the mark won't remain ; if you prefs harder 
 it will remaiii, but don't continue long, and 
 as foon as it difappears, if you remove th^ 
 Skin by pre/Ting lightly upon it, vou may 
 feel the pitting of the Oedema of the Pevafttrmjy 
 which continues fix'd and immoveable, while 
 y^ou draw the Skin backwards ^nd tbrwards 
 over it with Eafe. 
 
 All thefe Signs are generally fuificlent for 
 one to judge that an Exoftofis is benign, but 
 one may alfo do_ it by realon of the ctlAereat 
 
 E e 3 marks 
 
423 >^ Treatise of thw 
 
 marks of thofe of contrary kinds. 1 mean 
 that if the Sigr.s of the Pox, the Scurvy, 
 &c, are evident, and induce one to judge 
 that an Exoftofts, or a Caries is Pocky, th* 
 want of thefe Signs caule it to be believed 
 not fb, or at leaft make one fufpend one's 
 Judgmeiit till it has been exarain'd more am- 
 ply, and may judicioufly be determined, ei-? 
 ther upon certainty or probability. 
 
 Signs that the Exoflofis is Rkketty, 
 
 This Exoftofis is known, by being attended 
 with the Symptoms of the Rhachitisy as we 
 fhiU explain in a particular Difcourfe that 
 follows this. I fliall add here that the Ric- 
 ketty Exoftcfis feizes upon young People: and 
 that it does not always go away, altho' the 
 Rivkets fliou'd be cured. Perfons are ^eea 
 whole Joints are knotted all their Lives, who 
 otherwijfe are in good Health, and of thefe 
 fume are only mif-fhapen by the Crooked- 
 nefs of the Bones which continues, and o- 
 thers by the Swelling of the Epiphyfcs, which 
 cou'd not be difperfed nor diifolved by all 
 the Efforts of Art and Nature. 
 
 The ricketty Exoftofes are not in fmall 
 numbers like the others^ they feize upon al- 
 moft all the fpungy Bones of the Spine aj.d 
 the joints. 
 
 Other kinds of Exoftofes caufe a great deal 
 of Pain in t^ie beginning, and yet more whilft 
 they are growing : 1 he Pain ceafes fome- 
 times when they are entirely form'd, and al- 
 ways when they difpe/le. On the contrary 
 the ricketty Exoftofes caufe no Pain from the 
 Time of their hrft Rile, to their intire For- 
 mation, |3ut they caule iharp and cruel ones 
 
 when 
 
Dife/ifes of the Bone s. 425 
 
 wKen they difperle, and rhefe Pains are fom^' 
 tianes by fit?, and at other times continual, 
 
 (This Thmiwinion leems hard to explain, ne- 
 verthelels \ believe it may proceed from two 
 Cauies. Firft from theOr<rf^Ws ceafing at the 
 Ferioftnnty before the Body of the fwcH'd 
 Bone is recoverM, fo that the Terioftaim luP- 
 fers, becaufe that this Membrane refuming 
 its TofrstSy the Bone being ftill Iwell'd oppoles 
 the contra8:ion of its Fibres, which produces 
 the f^me Eifeft as its Tenfion, or elfe from 
 the Membranes of the Marrow 2ik1 the S&ecvs 
 Mf^itlfarij, being perhaps comprels'd by the 
 Contraftion of the Bony Fibres of the £.v- 
 •//o/Tj which happens when it dilperfes- How- 
 ever it be, this is certain, that Children are 
 in violent Pain when their Nodus^s begin to 
 diiperfe. 
 
 S^gns that TTtTifi accompany or precede the 
 Scorhitkk Exofiofis* 
 
 This Difeafe is to be known by all the 
 Signs that ihew a Melancholy Hypochon- 
 driack Difpofition, whereof the Scurvy is 
 generally the Confequence. The proper Signs 
 of this biftemper are a Wearinefs and Pains 
 in the Arms and LeG;s, a frequent and noi- 
 fome fuppuration, the Breath fmells very 
 itrong, the Salha is thick, vifcous and fticJc- 
 ing, the Teeth are foft, that is to lay, that, 
 being but ioofely fet in the Gums and the 
 Mvtolly they don't chew the Food with 
 Strength- the Gums Iwell, and become Red, 
 dnrkiih, and then Black \ they fweat a jbrc 
 of ferous Suppuration of an intollerable linell, 
 they bleed, and grow to that degree that 
 
 E e 4 they 
 
424 y^ T Pv E A T I s E o/ the 
 
 they hide the Teeth, comii.c; over them a 
 zooS way : The Gums lepuare from the 
 Teeth and leave th»^m, and tlie Alveoli doing 
 the lame, the Teeth ihake and tall out eafily. 
 The yilvfoli di'rnvrr rh-m (elves, rot and fall 
 out by Putrefailion if the the Dileale con- 
 tinues, or by ExfoJiacion ir" it heals. 
 
 Hypochonciriack Ferlbns are tei der, their 
 Heads heavy, and all the Faculties o the 
 Soul feem out of Tune, efpccinlly the Ima- 
 uination which torments the Patient, and 
 thole that attend him ^ he feels Pains in his 
 Arms and Legs, and a Wearinefs in all his 
 IJmbs. He has often the Cramp in his 
 Th'ghs and legs, he falls away or becomes 
 bloated, his Fitce is of a Lead colour, and 
 his Eyes iliew by their wildiih Looks the 
 Difquiet and Terrors of hi?. Mi. d. 'Tis very 
 common to bleed at the Kofe \ and a //<- 
 tnnrrhagc is a very ufual Symptom in the 
 Wounds and Ulcers of Scorbutick Perfbns. 
 "Ulcers in the Mouth are almoft infeparabie 
 from ii", efpecially thofe that break out 
 round the Gums, they alfo come in the 
 Tongue, the Throat, the Cheeks and the 
 Pallate: There have been fome feen that 
 have eateii quite thro' the Cheeks. 
 
 The Legs are not exempted, and it may 
 be faid that after the Nofe and Mouth they 
 ate the Farts the moft commonly attack'd by 
 the Scorbuiick Vims. 
 
 Jt has been fecn in the brg'ni ine of this 
 Chapter, that almoft all the Bones of the 
 Body or at lenft Teriofxciirn was affeiled with 
 jr, lince amon2.ft the Scorbutick Patients be- 
 fore ment'orcd in tlie Hofpitil o'i Bou- 
 ^igmtiy th^re were fome who had almoft all 
 
Difiafes of the Bones. 425 
 
 ^he Bones of their Body feparated from th» 
 
 Feriofteum. 
 
 I ihould never have done if I fhould rf- 
 late the different Symptoms that attend the 
 Scurvy *, and if one would give ear to the 
 Dilcourfes which Fear puts into the Mouths 
 of Perfons afflifted with this Diftemper, there 
 are nor^e but what they feel : No Body can 
 complain of any Difeafe but they think they 
 have it. And one may add^ that no body 
 has more Faith than them in Phyfick, but 
 unfortunately for them, they think to find 
 Re) iefevery where and without Diftinftion. Moft 
 part of them go from Mountebank to Moun^ 
 tebank till Death or a Cure decide their Fates. 
 
 'Tis therefore by thefe Three Signs, or 
 fome of them that the Scorbutick Exofto/is 
 or Caries muft be known •, I fhail not meddle 
 with them all, this is not a place for it, 
 but as the Spots have been defcribM by 
 Authors I fliall fay a Word or two of them for 
 the Benefit of young Surgeons who are the 
 moft expos'd to the Danger of confounding 
 them with others. 
 
 Sometimes there are Spots all over the 
 Body, at other Times only in the Leg. The 
 Scorbutick Spots are of four Kinds ^ fome 
 are of a livid or Violet Colour, and fpread 
 very much •, thefe only come upon the Arms 
 and the Legs, or the Pudenda up to the yinus: 
 I have Ibmetimcs feen them on the PalvehrtCy 
 which rcder'd them like thofe who have, 
 as is proverbially laid, their Eye poched in 
 black Butter, that is to liiy black and blew. 
 I have fecn fome of thefe Spots larger than 
 my Hand, nay fome have fpread over a whole 
 Limb. This blacknefs is a true Ecchymofis, 
 thQ Blood bsingobftrufted in the VelTels can't 
 
 circulate 
 
cfrculate freely, which males it tear m^ 
 bar ft iome of them, and lb drffufe it <elf and 
 fpread more or iel's, whence proceeds the 
 black or Violet colour'd Spot, which de- 
 pends upoti the Blood's being more or lefs 
 deep. 
 
 This BlackneCi is apt to a {arm thoie who 
 iasre not experience enough to know how to 
 difperle it, and has been more than once 
 taken for a gangrenous Symptom, but 'tis 
 ealy to diftinguifh the one from the other. 
 The Scorbutick Biackneft is not i'o dark as 
 that which is gangrenous, it inclines to the 
 Violet, and fometimes little red jvlaces may 
 be diftinguilli'd therein, and even fonie that 
 rfctain the natural Colour of the Skin. The 
 gaD^enous Blackiicfs don't difperle, and this 
 does5 it may be perceived to abate by little and 
 Httle, and the other on the contrary increafes 
 by degrees, and Ibmetimes with fpeed. When 
 one touches the iikin that is Wacken'd by the 
 Scurvy the Patient feels it, and he that has 
 his Flefh blacken'd by a Gangrene does not. 
 
 The Gangrenous Blacknefs has more regular 
 Bour.ds than that which is Scorbutick. 
 
 Now I am fpeaking of the Colour of 
 the- Skin in the Gangrene, I will men- 
 tion an Obfervation which I made upoii 
 a Nigro belonging to a Reverend Father of 
 the Order of Sc< Dominicl, that was come 
 from ?cru. This Ne^ro had a Defluxion on 
 the Scrotum'^ 1 was fent for by the Farher, 
 who had known me e/er fince I had cured 
 the Ccnftable of NavArrey Son of the Duke D* 
 j4lha, whole Phyfician was cali'd into Con- 
 fuitation. His Advice was not to bleed the 
 Patient, and to give him fome Powders which 
 he did noc name, nor I did not know, and 
 
 I 
 
Difeafes of the Bones, 427 
 
 I was for bleeding him plentifully and fpeedi- 
 ly to prevent a Gangrecn^ which feiz'd him. 
 in 24 Hours, becaule he was not. The;i I 
 would have made Scarifications to Kinder or 
 fet bounds to the progrefs of this Diftemper, 
 but I met with Oppofition from Perlbns 
 who told me that the Blacknefs of the Skin 
 was an exceptionable S'gn of a Gangrene in 
 a Moor •, neither was it upon the Blacknefs 
 that I had affirm'd there was a Gangrene, 
 on the contrary 'twas on the Whitenefs : For 
 I have obferv'd that if the Skin of White 
 Men blacken in the Gangrene, that of the 
 Moors Whitens. 
 
 The black or dark Spots are not the only 
 Ibrt that attend the Scurvy as we have ob- 
 ferv'd •, there are ib;ve of a Purple Colour, 
 which are of a different Form and Bianefs; 
 lome are no larger than the Point of a Pin, 
 others are as big as a Grain of Millet, others 
 again a little larger : They come out ia 
 Clufters as of the fize of a Farthing, or a 
 Crown Piece. There are fome ^een as larga 
 as the Hand, which feem of a Violet and 
 dark Colour \ the firfb caufe an Itching. I 
 have known Patients who were feniible when 
 fuch little Purple Spots twere coming out up- 
 on them, they had notice of it by a light 
 Pricking, and an Itching that foUow'dit. 
 
 The third fort of Spot is red like the Bite 
 of a Gnat, being at the Top of a Hardnels 
 that lies under it, and is more or lefs con- 
 fiderable, bat generally they are as large as 
 the End one's Fir.ger, and referable a Pufh, 
 excepting that the Swelling of the Pufh is 
 feen and outwardly, and that the Tumour ot 
 thele Spots lies hidden in the Body of the 
 ^kin, and feldom riles outwards. 
 
 The 
 
4^3 A i' R E A T I s E of the 
 
 The middfe of thefe Spots is redder than the 
 ^\dt?y whereas the Purple Spots areas red at 
 their Sides as in the Center : The Tumour 
 which attends thele Spots dilappear lome- 
 tfjnes imperceptibly, and they return tK> the 
 lame place, or any other ¥mh the lame 
 Bafe, Sometimes they leave na mark after 
 their going away ; at other times they ieftve 
 a flight Spot like a Bruife, 
 
 The 4th fort of Scorbutick Spot is Yellow; 
 thele fpread ^e\y much, and have not the 
 lame degree of Yellow throughout, fome places 
 are clear, others are deeper"^ the Skin as one 
 fees it in the Degrees of the difperfing of 
 Eccbymo/es and Contufions. All thefe Spots 
 are Scurfy -^ the Epidermis peels off and falls 
 in Scales like Bran, or MeaL 
 
 Signs of the Focky Exojlofts. 
 
 Befides what I have faid in the beginning 
 of this Chapter concerning the Marks of 
 the Venereal Exoflofis^ I thought it necell-^ry 
 to add one Word of the Signs of the Pox. 
 It may be remembred that I have obfervd 
 that the Exoftofis is not a primitive Symptom 
 ot this Difeafe, on the contrary 'tis known 
 that it only appears in the third Stage. 
 
 There are ieveral Signs of a Pox-^aC/^^r, 
 a Sharker, a Buh, a Phymofis, and a Paraphymcjts 
 are generally the firft Stages ^ the Puftules 
 are of the fecond- not but that 'tis fome- 
 times otherwife. Oie fees Perfons who get 
 the Pox at once, and who have Buhos or 
 Sharkers two or three Months afterwards, 
 without having defervM them by any new 
 Converfation with impure Women, 'tis ob- 
 ferv'd every Day. I have known two Pa- 
 ^" ^ ticnts 
 
Dtp fifes of the Bones, 42^ 
 
 tients in whom the iirft Sign of the Pox 
 was Puftules •, tlie one had been abov« two 
 Years without having CO do with any Wo- 
 man when the Puftules came out, and die o- 
 ther two Months, and neitiier the one nor 
 the other had ever had any other Symptoms 
 of the Venereal Difeafe, but thefe Puftules. 
 
 The Clap, which I look upon to be a Pox, 
 is ix>t attended with the Symptoms of tiiis 
 Difeafe when it runs plentifully, when the 
 Running carries away with it the Pain, the 
 fmarting and the other Accidents \ when the 
 Matter changes Colour, and becomes White 
 by degrees -^ whei the quantity diminifhes by 
 little and little, only by ithe Ufe of the la- 
 liial Remedies, without the Affiftance of A- 
 flrtn gents, either taken inwardly, or apply 'd 
 externally by Injeftion *, when there is no 
 CorAee '^ when it does not fall into the Scr(h- 
 tum^ when there is no Defluxion in the Joints 
 or the Eyes \ and laftly, when uo Fever 
 comes and itops the Running. When the con- 
 trary to any of thefe happens one may be 
 affured that the Pox won't fail of dilcover- 
 ing it felf. 
 
 The Shanhry however well it may be cured, 
 generally caufes the Pox, efpecially if it grows 
 hard, if there remains any Hardnefs after the 
 Cicatrizing of the Ulcer, if the Prepuce 
 continues fwelPd, or in fine, it any Gland of 
 the Groin remain hard or Isirger than in 
 ought to be. 
 
 Amongft the great numbers of Patl-ents af- 
 flicted with the Veneral Difeafe, that have 
 been under my hands, I have found few 
 that have had the Pox but have it one of 
 thefe way. 
 
 If 
 
431 A Treatise of the 
 
 If the Clap and the Shanker may be at- 
 tended with a Pox, it ought not to be doubted 
 but the Bubo will alio. The Diftinftion that 
 is made of Bi^hos into primitive and confecu- 
 tive is juft, but the Interei-ce that is drawn 
 from thence is not lo. 
 
 'Tis true the Primitive Bubs pre-fuppofes a 
 Tranfportation of the rirus from the Penis to 
 the Glands of the Groin, immediately by the 
 Lymphatick VefTel of this Part •, but it ought 
 not therefore to be concluded that all the 
 yirus is carry'd into thofe Glands. 
 
 1^. Becaufe the Lymphatick VefTels which 
 go to the Glands of the Groin, are not the 
 only ones that carry back the Lymvha from 
 the Vi7ga. There are fome of thefe VefTels 
 that go along under the Vrethra, which dif- 
 charge their Lympha in the Lymphatick Vef* 
 fels of the Hyfogaftriumy which is an open road 
 whereby the Hms may infmuate it felf im- 
 mediately into the Mafs of the Blood. 
 
 2°. There are alfo other Lymphatick Duft?, 
 which follow the yena-inhontfla interrja, which 
 pafs with it under the Arch of the Os Pubis, 
 and alfo empty themfelves into the Lympha- 
 tick VefTels of the Hypogaflrium, both the one 
 and the other of thele VefTels may carry the 
 f^irvs immediately into the Mafs of the 
 Blood. 
 
 3^. If all the Virus ^ou'd only take the 
 Rout of the Lymphatick VefTels that go to the 
 Glands of the Groin, Can one be certain that 
 all this infefted Lymfha flops at thofe Glands ? 
 To make this poflible there muft be an Ob- 
 ftruftion immediately after Coition, whkrh 
 mu{t be total at the Beginning, otherwife 
 Ibme of the Lympha, wou'd pals into the 
 
 Bloody 
 
Difeafes 0/ t J:?^ B O N E "Sw ^ys 
 
 Blood, and confetiuently the f^iriu along 
 with it. 
 
 4<». The Lymphatick Du£ls are not the 
 ojily Veliels capable of carrying the Virus 
 into the BlcK)d, the Veins may alio do it, 
 and 'tis known that tliis PafTage being iii# 
 terrupted by any Glands, the Virus muft m\- 
 mediately mix widi the Blood. 
 
 The Bubo whereof I fpealc, is that whicTn 
 rnoft Surgeons think exempt from the Pox 
 when it fuppurates ^ neverthelels it may be 
 feen by what I have juft faid, that it ought 
 not to be trufted. 
 
 The Confecutive Buhtf pre-fuppoles that 
 the Virus has palsM immediately into tl"« 
 Mafsof the Blood, and that afterwards it in- 
 finuated it felf by Circulation into the Glands 
 of the Groin, by the Lymphatick Velfels:: 
 'Tis agreed upon that this is Pocky, no Body 
 difputes it ^ I muft make Iiere one Reflexion, 
 if the Virus has got into the A4nfs, it proves 
 that the Glands are no fure Barriers, iince 
 the Virus tlio' (as it were) a Counterband caia 
 pais them. Wherefore if the Virus can in- 
 sinuate it feif in fpite of the Glands, this 
 proves that in the Primitive Bttho there may 
 remain little or much, and therefore more 
 or lefs of the Virus v/ill intufe it felf into 
 the Blood •, but becaufe however little it may- 
 be it is fufficient to corrupt the whole Maifs, 
 it may be concluded that all Bubos 2.xc 
 Pocky. 
 
 Thus the differenQe between a Primitive 
 and a Conlecutive Bubo is, that the Primitive 
 comes a little after the Coition, and the Con- 
 lecutive a good while after : The Primitive 
 one is form'd at the {\v(k. by the Virus that 
 \^ carried immediately from tliq VirgA to the 
 
 Gl.md^ 
 
43^ -^ T R E A T I S E ^/ f/j^ 
 
 Gljtnds, and the Confecutive by the f^irus^ 
 wli ch after having circulated in the Mais, 
 has fettled in the Glands either a little or 
 a long time after ^ whence it fometimes ap- 
 pears a Week or Fortnight, a Month, a 
 Year, or more after the Coition, as Experi- 
 ejice fhews daily. By what has been before 
 iaid, the o.;e docs not differ elTentially from 
 the other : I can neither believe that in the 
 Confecutive Bubo all the Virus palTes into the 
 Mafs of Blood, without any Part's remaining 
 ill the Glands, nor that in the Primitive o:;e, 
 all the Infection flops at the Gland without 
 any getting into the Blood ^ therefore the 
 Difference between the one and the other, is 
 only that more or Ipfs of the Virus has in- 
 fmuated it felf into the Mafs, or is retained 
 in the Glands, and that they require more 
 or lefs Time to appear or be form'd in. 
 Both the one and the other may make a 
 flow or a fwift progrefs, may fuppurate, 
 harden or difperfe, may etfect feveral Glands 
 or one only, may feize upon the Groin, the 
 Armpits or the Keck. 
 
 It muft be obferv'd that the Primitive one 
 which has been got by Coition, always ap- 
 pears at the upper Glands of the Groin ^ 
 that that which has been catch'd at the 
 Breaft either by having given fuck to an in- 
 feO;ed Child, or otherwiie breaks out at the 
 Glands neareft the Arm-pits, and that that 
 which is the confequenc« ot lafcivious kilfes 
 leizes upon the Glands the moii contiguous 
 to the Throat and Neck. 
 
 'Tis not the fame with the Confecutive 
 Bubo, it may affed all the fame Glands in- 
 differently, and therein one may confound ic 
 
 with 
 
Bife^fes of the Bo N E s^ 433 
 
 with the other ^ iieverthelefs there are Cales 
 wherein one can'; be mifta ken. 
 
 If after an impure Coition a Bubo breaJis 
 out under the Armpit, it can't bedeny'd but 
 that tliis Bubo or Boil is Confecutive ^ like- 
 wife if a Nurfe has one appears at the Neck 
 or Groin after having given Suck, this Bubo 
 is Confecutive alio. 
 
 If, after having kifs'd an infected Woman, 
 lafcivioufly, a Bubo breaks out at the Armpit, 
 or Groin, this Bubo likewife is Confecutive. 
 
 Wherefore any Bubo that feizes upon the 
 Glands, that are diftant from the Part which 
 contra£i-ed the Infedion, is a Coi fecutive Bubo ^ 
 but every Bubo that affefts the Glands con- 
 tiguous to the Parts that have offended is not 
 a Primitive one. It has been already proved 
 that the Confecutive Bubo'^s may feize upon 
 the moft adjacent Glands, but there are Bubo'^s 
 that break out in the fame Nei^^hbiurhood 
 that can only be look'd upon as Conlecutive 
 Buboh^ altho' they appear immediately after 
 the Coitus. For inftance, if thev come on the 
 lower Glands of the Groin, 'tis krown that 
 the Lymphatxk Veflels difcharge themfelves 
 into the upper Glands, wherefore this Bubo 
 muft be Confecutive, becaufe it can only have 
 been form*d by the infected Lympha iht is 
 come b.Tck from the lower Extremides, and 
 th'S Lymfha cou'd not come back but that 'tis 
 carry'd thither by the Laws of Circulation. 
 
 It a Nurfe has a Bubo under the Arm, this 
 Bubo is Confecutive for the fame Reafon, be- 
 caufe the Lymphatick Velfels that come 
 from the Breaft difcharge themfelves into tlie 
 upper Glands of the Armpit. 
 
 f f If, 
 
A Treatise of the 
 
 Ir, immediately utter lafcivious kilTe?, a 
 Bubo breaks out Dear the Throat, it is not fo 
 c'uiy to difiinguilli it, for the Mouth is of 
 iuch extent that its Lymphatic k Ducts pals 
 by an infinite number ot ditTerent Ways : 
 Wherefore we fee Bubos break out under the 
 Chin, above and under the Angle o{ the |aw, 
 and along the Keck as far as the Clavicles : 
 They have been known to leize upon the 
 Glands 'Thyroidcs^ and even the TIjymus. All 
 thele Bubos may be either Primitive or Con- 
 fecutivc ^ one can't diftinguifli them by their 
 Situation, becaufe that (as has been obferv'd) 
 the Mouth being ot great Extent, the Lympha 
 retun.s by d fferent Way?, and may imme- 
 diately difcharge it felf into all the Neigh- 
 bouring Glar.d^. 'Tis true that all thefe va- 
 rious Pailages unite themfelves into two or 
 three on each fide, the chief whereof is th€ fa- 
 mous Dwc^w.^rorz/fr:/^ of Bijfius, which empties it 
 felf iiito the Suoclavian Velfels : Wherefore 
 there are only the Bubos that come behind 
 the Ears, or the Neck, and thofe of the 
 Glar.ds T^}yroidesy or of the Thymus, which can 
 be a/Hrm'd to be Bubos Conlecutive of wan- 
 ton and impure KiiTes •, becaufe the Lymfha 
 of the Mouth does not pafs by thefe Ways -, 
 but this is not luffic'ent ground for one to 
 aJfert that the others are Primitive Bubos, for 
 Reafpns already mention'd. 
 
 'Tis very feldom necelfary, 'tis even al- 
 moft always needlefs, to diftinguilh thefe 
 Bubos, the one from the other. I have al- 
 ready fiid that both the one and the otAer 
 were Pocky, and tho' the Method of curing 
 them mny leem different to many, I am of 
 Opinion that it ought in general to be the 
 lame ; and if thofe who think the contrary 
 
 fltou'd 
 
Difeafes of the B O N E s. 43 J 
 
 fliou'd reflect that moft part of thofo who 
 have been under Cure for a good condition'd 
 Pox, have been managed agreeably to that 
 indulgent Syftem •, which only gives the Pox 
 to thofe over whom that Diteafe cxerciles 
 all its Fury ^ they wouM lay that many who 
 have been lo managed are in good Health. 
 To this I anfwer two Things, firfl: that we 
 know leveral Perfons who have never been 
 under Cure, or at leaft who have been ia 
 very ill Hands, who in appearance enjoy a 
 perfeft Health, becaufe the Pox gives Ref* 
 pite of 15, 20 and 30 Years, nay more. Se- 
 condly, who can allure us that thole whom 
 we have treated lb indulgently, have not 
 fought a Cure amongft others of our Fra- 
 ternity, who, not being fb eafy, have ad- 
 miniftred effeftual Remedies to them : We 
 lee them in good Healtli, and we believe our 
 Palliatives to be the Caufe of it, by realbii 
 they conceal what they have done without 
 our Knowledge-, wherefore I fliall judge an 
 £xo[lofis to be Venereal when the Patient has 
 had a Clap, whether well or ill cured * be- 
 caule we have obferv'd that a Man may get 
 the Pox at the firft, and that the Clap may 
 be Conlecutive, that is to fay, a Symptom of 
 the Pox : For in the fame manner as the 
 Virus of a Clap, whofe running is fupprefs'd^ 
 may infeft the Blood, this latrer being in* 
 fefted may corrupt the Proftatx and caufe a 
 Clap. 
 
 If an Exojlofts follows after the Suppref- 
 fion of a Gonorrhea by Inje£lion, 1 lliall judge 
 this Exoftofs to be Pocky. 
 
 If during the running of a Clap a Fever 
 comes and flops the running, the Exoflofii 
 which enfues will be Pocky. 
 
 Vi 1 If 
 
A Treatise of the 
 
 If an r.xojlofts comes after a Clap that has 
 been of long ftand^ng and diftkulc to Cure, 
 it wiU be Veneral. 
 
 If the Clap falls into the Scrotum, tlic Ex- 
 oppfis is Pocky, tlie fame may be laid of tlie 
 other Caules of the Suppreifion of a Go- 
 nor r be a. 
 
 The Shanker ought not to be lefs fufpefted, 
 but rather more, lince the Hopes of not ha- 
 vii,g the Pox, on account of a Clap, is only 
 founded upon the Copioufnefs of the Run* 
 ning that attends it :, one ought the rather 
 to apprehend the Pox after a Shanker, be- 
 caufe th'S "Ulcer fuppurates lefs in a Month 
 than a Clap in a Day •, wherefore when an 
 Exoftofs feizes upon any one who lias had 
 Shankers, 1 fhall make no fcruple of judging 
 it Pocky, becaufe it has been obferv'd that 
 the Primitive, as well as the Conlecutive, 
 Shanker is the Pox. 
 
 I Ihall add no more concerning Bvics, 1 have 
 laid enough ^ I have even given an Infight in- 
 to this Matter which I may venture to fav, 
 was but little known, and perhaps will be 
 but ill reliih'd ^ It is not my Fault, 1 fpeak 
 what I th'nk, and which is more, what I have 
 always been coufirm'd in by above 30 Years 
 Praft'ce. 
 
 Tho' I don't here treat fully of the Pox, 
 I cant forbear faying fomething en p^Jpnt of 
 the Nature of the Puftles and Warts •, lea- 
 ving the other more common Symptoms till 
 another Occafion • hoping one Day to publilh 
 the Ob'ervations whereon I ground the fevere 
 |udgment I pafs upon all thole that are af- 
 feited with any Venereal Diftemper whatlo- 
 ever. 
 
 The 
 
Difcafes of the B o N E s. 437 
 
 The Puftules .-nid Warts are efteem'd hy 
 the whole WorM as certain Symptoms of 
 the P(>x, wherefore I fhan't ainule my felf in 
 proving that they are the Pox it felf. I 
 ihall only defcribe the Marks whereby to 
 Jciiow them. 
 
 There are ieyeral kinds of Pocky Puftules, 
 the one are dry, the other moilt, and both 
 the one and the other are flat or rais'd, ir- 
 regular or round, p;tintul or not. 
 
 The dry Puftules are alio of federal Sorts, 
 fome are like Tetters, fome fiery, others 
 Scurfy, Scaly and Scabby •, fome are Yellow, 
 others of a Red, inclining to a Purple. 
 
 The moift Puftules are apt to fuppurate 
 and to bleed, or run with reddilh Serum % 
 l()me of thefe lie even with the Skin, others 
 are corrofwe and attended with deep Ulcer- 
 ations, others again break out in Tumours, 
 which render the Skin uneven and roua;h. 
 
 The round Puft:ules may be either humid 
 or dry, but they are generally Imal), the 
 iargeft being about the fize of the Little 
 Finger Nail : There are fome lefs that rife 
 up Iharp, from the ends whereof there comes 
 out a Drop of red Lymfhe imperceptibly. Some 
 lie under, or in the Body of the Skin ; 
 thele appear generally immediately after the 
 going HI of a Shanker or a Bubo, and are 
 taken by the Patients for what is commonly 
 caird an Ebullition of the Blood. They don't 
 Ulcerate the Skin, but they make it fpeckled, 
 and when they difperfe, the Epidermis falls 
 in Scales. 
 
 The irregular Puftules are only fo, becnufe 
 feveral of thera grow together in Clufters- 
 they may be of the fame Quality witJi all 
 thoie before-mention'd. 
 
 F f 3 Tiie 
 
^38 A Treatise of the 
 
 The Puftules that caufe no Pain, are al- 
 imoft all thole that come after the dilap- 
 pearing of the Bubos. 
 
 All thole which fuppurate or incline to 
 Suppuration are paintul ^ which proceeds 
 from the Acid Quality of the Pus that is 
 bred in, or runs from, them. Several ot thefe 
 Puflules rife up like little I'^ils and don't 
 fuppurate, but remain a loi.g Time red and 
 hard : Others fuppurate like a Boil, and 
 grow black as a Coal, and the Ulcer that at- 
 tends them is deep and hard to Cure : One 
 jnay fee by all thefe forts ot Puftules, both 
 painful and fuppurating, that thofe who think 
 that the Pufiules which fuppurate are not 
 Pocky, are deceiv'd ^ neither js it upon their 
 not being painful that one rauft rely, as fome 
 think. 
 
 It muft alfo be obferv'd that the Puftules 
 gather to a head, or are painful, according as 
 they are fituated •, thofe which are bred in 
 the bending of the Thigh, between the But- 
 tocks, on the Scrotum, under the Virga^ at that 
 Part which refts upon the Scrotum, under the 
 Arm-pits, and behind the Ears, are both 
 more painful on account of the friftion of thofe 
 Parts, and more fuppurating by reaibn thev 
 touch mutually, and the one difcharges its 
 Tus or ferous Matter upon the other, wJ:ich 
 together with the Fridion irritates, heats, 
 and iniiaraes them. 
 
 This is fufficient to give an Idea of the 
 Puftules by their diftinguifhirg Marks ^ I 
 might fay more, but 1 fhou'd di2;rels too 
 much frrm my bubjeft^ wherefore 1 fliall 
 finidi in fpeaking oi.e word about the \A arts. 
 
 The Wart is lo certain a bign of the Fox, 
 that we cannot be miftaken in it, It comes out 
 
 upon 
 
Lifedfes of the BoNES. 459 
 
 upon the Thighs near the Groin, the yimsy 
 the Scrotum y and the f'ir^^'-, thofe which are 
 on the Thighs, the Scrotum., and the Outfide 
 of the ^irj^a, are ufually only Jhaped like a 
 Wart, but th )re in the I3end of the Thiih, 
 or at the j4ms, and thole which come upon 
 the GUnSy or the Infide of the Prepuce, have 
 dilferent Forms. 
 
 In the Bend of the Thigh, and at the 
 jims they are fbmetimes long, high, and 
 jagged like a Cock's Comb. Upon the Gla?7s 
 and Oil the Infide of the Prepuce, they are 
 like fi;itted Raipberries. All thefe various 
 Forms proceed from the prefTure they fulFer, 
 which obliges them to frame themfelves to 
 the Parts, and hinders them from growing 
 every way, as they do el fe where where they 
 are not conftrain'd and nothing prevents 
 their growth. 
 
 Pains in all the IJmbs, Want of Sleep, 
 Reftlefiefs in the Legs, the Falling of- the 
 Hair of the Head and other Parts, Wea- 
 rinefs, Leannef-^', Indigeftion, a Vomiting, 
 and Loofeneis, the Jaundice, Inflamations in 
 the Eyes, the data Serena, the Catarn^:, 
 the FifluU Luhi^mal^Sy in the Vennxum and 
 the Anus, thofe which come after certain 
 Impofthumes-, the Difficulty of hardenir.g the 
 Callus after a Fradure's being well reduced, 
 and kept in its right pofition •, all the Ulcers 
 of the Kofe, the Eye-lids, the Throat, the 
 j4ms, and the Lungs-, in a Word all manner 
 of Difeafes may be caufed by the Pox ^ and 
 if few Perfons are of the fime Mind, 'tis by 
 reafon few of them oblerve: 'Tis Oblerva- 
 tion, 1 repeat it again, that makes us Sur- 
 geons '^ without th.1t' we may viiit Patients, and 
 have them under Cure, without knowing their 
 F f 4 Di- 
 
^^o A Treatise of the 
 
 Diftempers ^ which has made me often fay 
 that to fee Patients, and fee their Difeafes, 
 were very diifereut things : They that are 
 Ignorant fee more of their Patients than of 
 their Difeafes, and thofe that are Skilful fee 
 more of the Difeafes than of the Patients. 
 
 I conclude that all I have faid concerning 
 the Pox ought to be confidered, when cne is 
 to decide whether an Exoflofis. be Venereal or 
 no*, and that 'tis an Ignorant Raihnefs to 
 affirm that an Exoflofis is not Pocky, when the 
 Patient has been aliened with a iy Venereal 
 D:ftemper, however flight it might feera, 
 and even if it were 30 or 4.0 Years ago, and 
 the Patient had during all that time enjoyed 
 the mcft perfe£l Health in the World. This 
 Diflemper has no Prefcription, it appears 
 and diliippears, it caufes a Symptom, which 
 vaniflies, Jind another fucceeds j 'tis, as I be- 
 fore oblerv'd, a very Proteus. 
 
 Methinks I hear certain Perfons critic ife 
 upon what I fay *, but till 1 can anfver their 
 Criticifm!', let them examine whether they 
 have (een a fufficient number of Venereal 
 Difbempers to judge of it :, whether thole 
 whom they believe to be living Proofs againft 
 my Praftice, are fo much as they imagine, 
 and whether what they think a radical Cure 
 be not a Palliative. When I have finifh'd this 
 Treatife of the Difeafes of the Bones, I will 
 fet about a Tre.uife of Venereal Diicafes, 
 wherein I will quote all the ftrongeft Argu- 
 ments that are againft what I advance of this 
 Diflemper -^ and 1 will refute them by fuch 
 ror.vincing Reaions and Ob(ervatio:is, that I 
 {}m\ only hive Prepoffeifioa and prejudiced 
 
 Perfons 
 
Difeafes of the Bone s. 441 
 
 Perfons againft me, Knowledge, Experience 
 and Houefly fliiill be my Judges. 
 
 Signs of Caiiceroits Exoftofcs. 
 
 'Tis here that a Man muft be very at- 
 tentive to what is paft, that he may not be 
 miftaken ^ there are hardly any Fathogmmonick 
 Signs known whereby to diftinguifli tlie Can- 
 cerous Exoflofis \ 'tis true, one may realbn 
 thus, the Patient who has the Exoflofis has 
 no Signs of the Scurvy nor of the King's- 
 Evil^ he has never run the Risk of gectiiig 
 the t'ox, therefore his Exoflofis is Cancerous. 
 Befides his Swelling is of a dark Colour, ic 
 came by degree", it was little and exaftly cir^ 
 cumfcribM ac its iirft appearance;, in a word 
 there are no other Signs that difcover an Ex- 
 ofiofls to be Cancerous, the Pain it felf which 
 is fo certain a Sign of an Occult Cancer, is 
 not more violent here. It may alfobe judged 
 that an Exoflojis is Carcerous when ic does 
 not yield to Merairial Remedies: That of 
 the Woman's, whereof I have made mention, 
 whofe Bones broke, was eafier to judge ot, 
 becaufe this Patient had the Cancer in her 
 Breaft -^ one cou'd not be mirtaken, no more 
 than in hers, whofe Breafl I took olf and dif- 
 fefted after her Death. 
 
 Signs of a Scrophitloits Exoflofis, 
 
 When the Patient that has the Exoflofis has 
 had the Strumz in his Youth, when he has 
 Kernels gather'd in his Neck, under his Arm- 
 pits, at the Groin, when his Body is bound, 
 his Digcftion bad, his Complexion pale and 
 
 a little 
 
44^ ji Treatise aftbg 
 
 a little Vvridy when he has fwellingsin his No(e, 
 or his upper Up, wjien his Eyes are weak and 
 water, when he has a pituitous running at the 
 Nofe ^ all this may make us fufpeit that his 
 Exoflofs is Scrophulous, el'pecially if he has 
 been ill nurF.'d, in his Youth, if he]i^'es in a 
 Fenny Country, if he is a Spaniard or Piemon- 
 tefcy and if his Father, Mother or other Re- 
 lations have been afflided with this Di- 
 flemper. 
 
 One is not miftaken in Exojiofes that come 
 after the Small Pox, the Difeafe is not long 
 e're it appears, and the purulent Defluxions 
 that leize upon the Parts near the Bone, tore- 
 te'l the approach of an Exoftofis or Caries. 
 Thefe Defluxions come in a Days time, and the 
 Flucluation of the fuppurated Matter is alraoft 
 as fudden as the Tumour. I have open'd a 
 great Number of thefe AbfcelTes, and I have 
 almoft always found the Bories bare. Ex- 
 «ftos''d, or putrify'd. M. Barbeffon one of my 
 Brethren fent for me to a Confultation for the 
 Child of the Mafter of a Bagnio, for whom 
 he had already lanc'd two Impofthumes, one 
 at the Elbow and the other at the Knee : 
 That at the Elbow cured pretty eafiiy, and 
 without any fenfible Exfoliation, altho' the 
 Bones were bare. The other at the Knee 
 had laid open the RotuUj Co that the bony 
 Part of it was entirely feparated from the 
 Cartilages, Ligaments, and jifoneurofesy with- 
 out the Cavity of the Articulation's having 
 fuffer'd by it : The Tus took its Courfe out- 
 ivards, and the Cartilages that cover and fur- 
 round the Rotul a remaining whole and found, 
 the Joint was prefer v'd. This Obfervation is 
 vtry curious. 
 
 frogmjlicl. 
 
Difeafes of the Bones. 449 
 
 Progrwjiick, 
 
 The benign Exofiofes are only curable by 
 Manual Operation, which is not advileable un- 
 lets the Situation of the Exoflofis is detri- 
 mental to ibme motion, as has been obfervM 
 before. 
 
 The Scorbutick Exoflofis is troublefome, the 
 Pocky is lefs fo, and the Ricketty often heals 
 of it felf •, the Cancerous one is mortal unlefs 
 the Limb can be cut off, and even then fatal 
 accidents Ibmetimes happen by reafon of the 
 Defluxion of the lame Tumour on fome Part : 
 The Prognoftick of the Caries is the fame. I 
 Ihall hereafter lay down fome Aphorifms 
 concerning this Difeafe, by the help whereof 
 it will be better underftood. 
 
 Of the Cure of the Exojlofis^ and Caries^ 
 
 The benign Exnflofis is only to be cured by 
 Extirpation, but then it mufl incommode one 
 very much in fome o the Motions of the Body, 
 before one ought to refolve on it. That of his 
 Eminence the Cardinal de Rohan\ Domeftickwas 
 only a little incommodious, it never hurt him 
 in the leaft, but in putting on his Hat, nor 
 wou'd not, if he wou'd have fufFer'd that flight 
 inconvenience •, 'tis true the Way of rooting it 
 out contributed a little to it. • If I were 0- 
 bliged to perform fuch an Operation, I wouM 
 do ?s I had defign'd then. I had been chofen 
 to undertake this Tumour, and my Intention 
 was to make a Circular Incifion in the Te- 
 guments at the Bafis of the Exoftofis, to law 
 the Swelling to cut the Teguments Srar- 
 ways in Three or Four Places, and particu- 
 , larly 
 
444 ^ T Pv E A T I s E of the 
 
 larly the Verkraniumy in order to loolen all th^ 
 Stays, being convinced that when one don't 
 take this precaution, it is upon the ftrctch, 
 and will be inflam'd, which is foliow'd by all 
 the Symptoms, whereof this poor young Man 
 died. Having thus rut the Teguments, I 
 ihou'd have applyM the Fire, or ufed all the 
 means to procure Exfoliation that fhall be 
 mentioned hereafter. 
 
 The Bony Wen of the Soldier's at Ll^e was 
 too large for any one to attempt to extirpate it. 
 That which grew upon the Condyle of the Fr- 
 mur in the fnnpe of a Stiletto might hive been 
 both hard and. diingerous to have taxen away \ 
 fuch Operations muft not be attempted, but 
 when one is forced to it by melancholy Symp- 
 toms. 
 
 The ricketty Exofiofes and Caries^ are cured 
 by making ufe of the Remedies that are pro- 
 per for the Rickets, whereof we ihall take 
 notice in the following Chapter. 
 
 The Pocky, Scorbutick, Scrophulous, and 
 Cancerous Exofiofes and Caries dire£l us to 
 two Things, the one is to combat and deftroy 
 the internal Caufe, and the other to encoun- 
 ter and fubdue the local Imperfection. 
 
 The Internal Caufe of Scorbutick Exoj^ofes 
 and Caries is to be remov'd by Diet, and by 
 ger.eral and antifcorbutick Remedies. 
 
 The Internal Caufe of the Pocky Exoflops 
 is taken away by Mercurial FriO:ions, which 
 procure a good coi;d"tion'd Salvation j this is 
 call'd the great Remedy, becaufe it cures in 
 a iljort time, eafily and certainly. The pre- 
 parations ot Mercury that are taken at the 
 Mouth are infufficient Remedies, always Per- 
 nicious, and the Sudor iftck Ptifans are not 
 more efficacious ^ what is moft furprizing is 
 
 that 
 
Bifeafes of the Bo NES, 44^ 
 
 that tho' certain Ferfons vend them under 
 tlieii Names, they find Bubbles to take tJiem. 
 The whole City is full of thefe Mountebanks, 
 and the Numbers of Bills that one fees let 
 up in all Parts, giving Notice where infal- 
 lible Remedies may be had for all Ibrts of 
 Diftempers, would make the Siamefe believe 
 that People cou'd i.ot die in Paris: Nay they 
 wou'd have reafon to ask of what ufe the 
 Phyficians, Surgeons and Apothecaries are, 
 
 I fliou'd be very defirous of knowing in 
 whole hands they would truft themfelves if 
 they were Sick ^ if 1 may prefume, thele 
 Siamefe would judge more realbnably than 
 mofl of our French, 
 
 To Cure therefore the Pocky Exoflofis 
 and Caries^ one muft cure the Pox ^ which is 
 not what I pretend to in this Treatile, that 
 is not my Subjeft : I ihall only fhew the 
 manner of deftroying the local Imperfection 
 by the different Methods of Operating in 
 one and the other Diftemper •, and to the end 
 that young Surgeons may be fully inftruded 
 in all the Operations, I will, as much as pol^ 
 fible, take different Examples. 
 
 As for the Exoflofs that is only Scro- 
 phulous, it is hard to deftroy the Internal 
 Caufe. The Difficulty is not fo great when 
 the Pox is the firft Caufe, nor even when the 
 Virus follo^vs the King's Evil. I ihall not 
 fpeak here of the Remedies that take away 
 the Internal Caufes, the Local-vice, which is 
 the Exoftofis or the Caries , muft take up all 
 my attention. As to the Cancerous Vijus 1 
 would not do the fame •, if I knew any Re- 
 medy that would either mitigate or deftroy 
 it, as it cou'd not be known too foon, I would 
 not wait till I publi/h'd a new Treatile before 
 
44^ -<^ T R E A T I s E of the 
 
 I dilcoverM it. 1 confefs, together with all 
 Skillful Perfons, that this ^irus is incurable, 
 and I believe, as well as they, that none but 
 Quacks and Impoftors will propole it. Let us 
 leave thele wretched and abominable Parafites, 
 and let us teach young; Students how to ex- 
 ercile our Profeilion with Skill, Judgment, and 
 Dexterity. 
 
 Of the Cure of the Local Vice of the Ex- 
 oflofis and Caries, 
 
 One ought not to undertake Exoftofes but 
 when they Suppurate, or when, alter having 
 cured the lnten;ial Caule, they continue as 
 large as ever. 
 
 When the Exoftofis has fuppu rated, one 
 muft open quite to the place where the Pus 
 refides •, it will either be found that it has 
 feizM upon the foft Parts only, and that the 
 Bone is cover'd with good Flefh •, or elfe it 
 will have exfoliated, and the Bone will be 
 cover'd with good Fle(h \ but for the moft 
 part the Bone is found to be bare, rotter., 
 and Wormeaten, and fometimes penetrated 
 to the very Marrow. 
 
 If 'tis found that the Pus has only feiz'd 
 on the fofc Parts, and that the Bone be co- 
 ver'd with good Flefh, 'tis fuificient to give 
 it a free Vent by a large Opening, and to 
 manage this Diftemper like lancing of a fim- 
 ple Impofthume. 
 
 Obferve neverthelefs that altho' the Flefh 
 may feem good, it is not always fo ^ but a 
 Kttle Time will inftrud one how to know it. 
 It muft be of a good Grain and firm, muft 
 grow no more than is r.ecellkry, and its 
 
 growth 
 
Bifeafes of the Bones. 447 
 
 growth mull not be too fuddL'u. It muft be 
 feiifible, but yet lb as to bear touching, mull 
 not bleed, and muft be of a roi'y red. On 
 the contrary if the Fleili that is oter th^ 
 Bone be fmooth, or full of fungous excre- 
 Icencies, or \{ it be foft and grows too fnit;, 
 if it be painful or infenfible, if it bleed, bi.* 
 white, of a lead colour, an angry red, or a 
 deep or black, red, that fliews that the Flefh 
 is bad, and the Bone difeasM. In this Gale 
 one muft treat the Ulcer, not like the lancing 
 of a Simple Abfcefs, but like an Ulcer with 
 a Caries, whereof mention ihall be made in 
 the Sequel. 
 
 Tho' the Fleih may not be in this laft 
 Condition, and even tho' it may feem found, 
 it happens in the Courle of dreiling that it 
 becomes fungous \ then Care muft be taken 
 to correct it with Powder of Allum calcin'4 
 with red Precipitate, Lime-Water, or Pha- 
 gedcenick-Wnter : The folution of Mercury 
 with uicjUAfortis, Or Spirit of Nitre is very- 
 good •, one may render it more or lefs weak, 
 by mixing with it a little Simple, or Vulne- 
 rary Water. The brown Ointment which is 
 nothing but Bafilicum and Precipitate mix'd 
 together is excellent, and may be made mor« 
 or lefs ftrong. Green Bilfams in the Com- 
 pofition, whereof Brafs is an ingredient, as 
 the Ballam de Feuillet, V-erdigreafe, and ^gyp- 
 tiacum are very ufeful. Kor muft one forget 
 the Balfam of Steel, made with Filings dif^ 
 folv'd by Spirit of Nitre, and mix'4 with Spi- 
 rit of Turpentine. 'Tis very efficacious toe 
 correding the Flefh, and even afterwards be- 
 caufe it may be lower'd bv mixing thereunto 
 Vn^uef/tum Hypericum^ or Tsrebaithinum, TJais 
 
 mvA 
 
448 A Treatise of the 
 
 muft be done till the Fleih be grown even 
 with the Skin, and when it gets above it, 
 one muft Cau:er'//,e it with Lafis infernaliiy 
 till the Ulcer be confolidated. 
 
 The Exojfofis being open'd, when the Ex- 
 foliation is perfect, it muft be extracted from 
 the Ulcer, and examine th? Fleih in or- 
 der to heal it as in the two toregoing Gales. 
 But if the Exfoliation is not total, oi;e muft 
 procure it by all the means that will be pro- 
 pofed hereafter. 
 
 If, after lancing a fuppurated Excftcps, the 
 Bone is only bare or elfe rotten. Worm-eaten, 
 or pierc'd to the Marrow, one muft oblerve 
 what follows. 
 
 If 'tis only bare, or has what they call a 
 dry Caries, or Simple Alteration, one need 
 only lay over it a Pledgit of Lint fteepd in 
 Brandy or Spirit of Wine : The Wound 
 may be fill'dup with dry Lint, and the whole 
 be covered with Pledgits, after which the reft 
 of the DreiTmgs may be put on. 
 
 At the firft DreiTing the Bone muft be ex- 
 amin'd, it may be drels'd in a Pledgit dipt in 
 Spirit of Wine, and the brown Ointment may 
 be apply 'd to the FleJli. But if the Bone be 
 loni^ in Exfoliating; one muft make ufe of the 
 Medicines proper to haften the Exfoliation. 
 
 In the Caries of the Bones, whi'ft one is 
 combating the internal Caufe vvith the ge- 
 neral Remedies; aid Speciftcks, one muft go 
 to work upon the rotten Place, fo as to pro- 
 cure the Exfoliaticf?, that is to fay, the fepa- 
 rating of the unfound Pait from the found. 
 This feparation is without difpute one of the 
 Afts wherein l<<irure rot only exerts her 
 Power, but whertin ftie conceals her ways of 
 working, as much *is in other Inftances. How- 
 ever 
 
hifeafis of thi B o N E s. 449 
 
 ver it' I hiay be perrnitted to relate* what I 
 have obferv'd, iji tbllowing her witli great 
 attentioi), I ihall liiy that 1 liave always re- 
 marked that when the Bone don't Iweat out 
 any Moifture, but is dry, the Exfoliation is 
 made Iboner then when a ferous Matter di- 
 itills from it:, which has made me imagine 
 that the Exfoliation is never quick in com- 
 munication with the Velfels of the Ibund 
 one. Ihit) intercourfe being cut olf induces 
 me to believe that the Juices which run \n 
 the Velfels of the found Part make an Eiibrc 
 Qgainft the Part that is impaired, and that 
 thefe Elforts being redoubled by the Re^ 
 fiftance, and reiterated every Moment of Life, 
 are the Caufe of the infeufible feparation of 
 the corrupt part of the Bone. 
 
 I perceive in a little while, about the Cir- 
 cumference of the rotten Piece, Ibme nevv 
 Fleih that grows more and more j and I have 
 reafon to believe that in proportion as the 
 firft Elforts of the Juices caufe the feparation, 
 thefe nutritive Juices congeal and turn to 
 Flelh, and that 'tis the infenfible growth of 
 this Flefh which infallibly finiihes the fepa- 
 ration of the Difeas'd Bone, and forces ic 
 away. 1 am the more fure that Nature arts 
 thus, in that 1 find this Flefh of a good grain 
 at the place, where the feparated Piece of 
 Bone was, and becaufe this Flefh afTures me 
 by its good Quality that the Bone which 
 remains underneath is found. 
 
 I don't pais the fame judgment on the 
 Caries^ whe.i lome matter fweat^ thro' the 
 porous Parts of the Bone. On the contrary, 
 1 fay, that fince the juices find means to cf- 
 cape, and the corrupted Bone is no Obu^^cie 
 to their Pailage, thev make no Ef^jrt againft 
 ' G S "it. 
 
450 ^Treatise of the 
 
 it, and will not fcparatc ib foon. • This Ob* 
 Icrvation wil\ help us to give a Realbn for 
 the manlier of tlie Working of certain Re- 
 medies that cauie the Bones to exfoliate 
 Ipcedily. 
 
 Before 1 proceed any farther I will not let 
 flip two Oblervations that 1 have made upon 
 the fweating of the Matter thro' the porous 
 Farts of Bones that are bare. The firft is 
 that when this fweating is lerous, the Caries 
 often degenerates into a \^''orm- eating • and 
 the fccond is, that when 'cis bloody, there 
 grows Flelh in the intervals of the Rotten 
 bone, which produces a Caries of a particular 
 kind^ the Flelh, tho'foft, feenis firm, becaufe 
 'tis neftled between the Fibres of the Bone 
 which fupports it •, by laying a Finger upon 
 the Fleili, one may feel little bony Ine- 
 qualities that go a-crofs and fuftain it. 
 
 If then the Caries is dry, and there is no 
 fweating, it muft be drelTed fimply, as we 
 have iliewn above, efpecially if 'tis fuperficial ; 
 but if 'tis deep, or if, tho' fuperficial, it will 
 not exfoliate, or if it fweats a bloody or a 
 ferous Matter, the folution of Mercury in 
 Aquafortis, or in Spirit of Kitre, may be 
 apply'd fuccefsfuUy ^ and this Application 
 muft be repeated more or lefs accordij^gly as 
 the Caries appears to be more or lefs deep. 
 One muft drels it with dry Lint on the Day 
 of applying; the Remedy, and with Lint fteep'd 
 in Spirit of Wine the Day that it is not ap- 
 ply \1. 
 
 When the flveating is attended with Worm- 
 holes, or when one would prevent it, ff the 
 Solution of Mercury is not fufficient, recourle 
 muft be hnd to the actual Cautery, after the 
 manner that fhall be mention'd hereafter. 
 
 If 
 
Bifeafes of the B o N E S. 451 
 
 If the Sweating is attended with an Excre- 
 fcence of the Flcfh, as has been before faid, 
 one n:iuft not ouly ule the Adual Cautery, but 
 a Rafpatorum or Sc^lpum, to raile up the Fleih 
 and iirrape the Bone, to the End that the 
 Fire may penetrate and eat away both the 
 one and the other with the more Fale. 
 
 The Caries that is accompany'd with Worm- 
 eating of the Bone is not always ea(y to 
 cope^with-, I don't mean that the internal 
 Caufe is hard to take away, all the World 
 iy convinced of that, but I mean the Local- 
 Vice. And indeed 'tis often that in a Caries 
 of this fort, which has been neglected, almoft 
 the whole body of the Bone is Worm-eaten 5 
 neither is this of fuch fatal Confequence when 
 it happens to Bones that don't ferve as Props 
 and Supports to the Body -^ but if this Dif- 
 eafe attacks the Bones of the Thigh or Leg, 
 Arm or Fore- Arm, one may judge it very- 
 fatal, for the Bone may be broken entirely^ 
 and then the Limb will have no fupport. 
 For this Reafon the Part muft be fuliain'd 
 with Tin Plates, Paft-boards, Cafes, or other 
 Machines, whilft the necelfary Operations 
 are performing •, which are to fcale the BoLe> 
 and afterwards to burn it with the Adual 
 Cautery, being careful always to have a Scal^ 
 fum that cuts well, lb as that Ouq need not 
 lean hard upon the Bone, for that might 
 break it. For the fame Reafon the A8:ual 
 Cautery, which is an iron, muft be a? red hoc 
 as poflible, that it may burn tho' laid on but 
 lightly. 
 
 For the right Application of thele one muft 
 
 have feveral Cauteries of the iaitie Size and 
 
 Figure, which muft all be put a heatir.g in 
 
 fiery Coaks, whilft the Surgeon opens the 
 
 O g i vVotfnd 
 
452 ATKT.Atl^Zoftkg 
 
 W^ound, wipes ic, and turns it with wet Liii- 
 iieii to prelerve ic from the Fire. One muft 
 begin to bum at the middle of the Caries^ 
 and continue by (he fides, to prevent the 
 Heat's annoying them. The Cauteries that 
 are apply'd to the middle may be clapt on 
 one alter another, but fome diftance muft be 
 Jeft bi-'tween the applying of thole to the 
 fides of the Caries^ tiiat the wet Linnen may 
 have time to cool ^ one may even wet the Cloth 
 again to cool them the more fpeedily, but 
 muft take care to fqueele the Water well out 
 that it mayn't run out, for that would cool 
 the Cauteries. 
 
 This Application being made, the Curies 
 muft be drefs'd with dry Liiit •, it may be 
 fteep'd in Spirit of Wine, if the Patient was 
 very fenfible of the Heat, as it happens fome- 
 times on applying the Cauteries to Bones 
 that have Marrow, the reft of the \J\ceT 
 fpreads as ufual. 
 
 The adual Cauteries muft not be apply'd at 
 ' once, 'tis better to lay them at feveral Times 
 
 upon the Part affe£led, becaufe other wife the 
 Heat might penetrate deeper then it ihou'd. 
 One may judge of the neceftity of burning 
 more or lefs by the apparent thicknefs of the 
 Caries^ or by its Species. 
 
 That which is attended with Worm-eating 
 or a Hyfcrfnrcofis requires a ftronger appli- 
 cation than the others, for in the one 'tis ne- 
 celfiiry to deftroy the bad Fleih, to affecl 
 wiiich one mnft burn quite to the found Parts, 
 whence the VelTels come that feed the Flefh j 
 ?i.d in the other one muft dry up thofe wheiiCe 
 the lerous Matter ilfues. The Fire muft alio 
 be apply'd with more Force to the Spongi- 
 
 ous 
 
D'tfenfes of the BoNES. 453 
 
 ous Bones when tiiey are attack'd with thcfe 
 two Ibrts of Carles. 
 
 When the Carles has Commu iication with 
 the Channel of the Marrow, one is obli-^eJ 
 to trepan the Bone. They ibmecimcs trepan 
 the Stertium to cUfcharge t\v2 Pus that is un- 
 der it, and runs out at a little Hole of' the Ca- 
 ries. The Caries of the Marrow is lometimes 
 the Confequence of Abfcelfes that are bred 
 there ; and thefe Abfcelles proceed tVom Bbws 
 that have caus'd a Commotion in the M;u-iow, 
 »s they are known to do in the Brain. At o- 
 ther Times the Impofthumes are produced by 
 the Corruption of a Part of the Bone, which 
 exfoliates quite thro' to the Channel of tiie 
 Marrow • and when the exfoliated Piece is 
 not taken out, it hurts the Marrow, and an- 
 noys the good Fleih that has feparated it; 
 and as this Flefli grows over it, it hardei:s 
 and inchafes this Piece of Bone (to ufe that 
 Expreifion) ^o that 'tis impo/hble to extraL.1: 
 it without a great lofs of the fabftance of 
 the Bone by applying two or three Crowns 
 of the Trepan. 
 
 It often happens that the Exoflofes caufe 
 thefe Ablceiles, when they ftick out towards 
 the Ch-mrel of the Marrow, comprels its 
 Velfels, and interrupt the Courfe of the Juice>. 
 The Exoflofes of" this Kind are preceeded by 
 great Pains which the Patients feel m the 
 Heart of the Bone, and when they fuppurate 
 they break fometimes towards the Marrow 
 inftead of breaking o'utwardly. 
 
 I had a Man under Cure for the Pox, wjio 
 had fuch an Ablcefs in th? middle of rhe 
 Tibia -, he had a kindly Salivation, and his 
 Swelling in his Leg, which was but fma>l, 
 difappearM, tho' the Pains did not entirely 
 G i; ^ ceafe. 
 
454 ^ Treatise of the 
 
 ceafe. TJiey increased a Fortnight after hi$ 
 leaving my Hoafe :, lie came to Tee me, and I 
 found him a little Feverifh, and his Leg was 
 become red and Painful outwardly. Mr. Cajles 
 and Mr. Robordca:/^ who had been Witnelfes 
 to part of his Treatment were call'd to a 
 Confultation, and 1 gave them an Account of 
 what they Ijad rot feen •, they agreed that 
 he had been regularly managed, and that for 
 the prefent fonie Blood ihould be taken from 
 him, and the Part fhould be fomented and 
 pump'd with hot Water and Brandy ^ that for 
 the reft the Tumour being gone, the place 
 where it had been fhould be laid open, that 
 being the Part where he felt mcft Pain, be- 
 lieving that all thefe Accidents might be 
 caufed by feme matter which might be got 
 within the Verio fteum. 
 
 1 open'd it, but the Patient found no Relief, 
 and two Days afterwards it was refolv'd to 
 apply the Trepan, which was painful enough, 
 but diicover'd to u? the Caufe of thefe Pains, 
 by the confiderable Difcharge of a very ftink- 
 ing Tus. 
 
 The Marrow was quite difTolv'd and the 
 Channel feeming almoft empty, caufed me to 
 apply three Crowns more, and to cut the 
 Spaces that remain'd between the one and the 
 other. The Aftual Cautery was apply'd, the 
 Exfoliation made, and the Patient cured. The 
 late Meffieurs Ledran, Arnaud, and my felf 
 were fent for to a Young Girl of Provencty 
 on whom we perform'd' the fame Operation, 
 with equal Succefs. 
 
 it nnay be obferv'd, en jt.iffant^ that if a great 
 deal more Tus comes from moft part of the 
 Ulcers, wherein tlie whole extent of the Caries 
 is not difcover'd, than the bignefs of the Ulcer 
 
 ought 
 
Dffeafes of thg Bone s, 455 
 
 ought feemingly to breed, 'tis bccaufe there 
 is a Hole in the Caries that has Communi- 
 cation with the Channel of the Marrow ^ ajid 
 if one does not lay open the Bone to Trepan 
 it, the Pus y which always ftagnates, caules the 
 Patient's De;it]i : I have often pertbrmM thii 
 Operation, and almoft always with Succels. 
 
 I ilia 11 finifli the Cure of F.xoftofes, by fay- 
 ing one Word of the rnanrer of encountring 
 the Exoftofesy which will not difperfe up )n the 
 curing of the Pox, or any other internal 
 Caufe. 
 
 The Tumour of the Bone muft be laid open, 
 by making a large crucial Incifion ; one muft 
 cut away part of the Angles, and drefs it 
 dry in order to take off the Drellings the next 
 Day, and make u(e of the boring Trepan, 
 wherewith feveral pretty deep holes muft be 
 made pretty near one another, being care- 
 ful that they fill up the whole fpace of the 
 Swelling that is to be cut away. After this 
 one muft make ule of a Chifel, or Googe, 
 that is very fliarp, and a leaden Mallet, where- 
 with one ftrikes moderately to cut off all that 
 has been bored by the Trepan. Thefe Holes 
 weakening the Bone, it is the more eifily cut, 
 without running any Rifque of Iplitting it with 
 the Chillel. 'Tis a way the Joyners ufe, 
 to prevent their Wood from fplitting when 
 they work upon it. If the Swelling be con- 
 fiderable, one muft repeat the Strokes of the 
 ChilTel and Mallet, the. reft of the Operation 
 fhould be defer'd till the next Day, becaufe 
 the reiterated Strokes may jar the Marrow, 
 and in the end caule an Abfcefs. When all is 
 take:i away, the Bene muft be drefs'd, as has 
 been faid, and to procure a quick Exfoliation 
 one may apply the Solution of Mercury by 
 
 G g 4 ^iJU4 
 
4 56 j4 T K¥. AT I %z of the 
 
 j4nia fovtis, or by Spiiit of Nitre. 'Tis one 
 Oi the beft Remedies that can be ufed, and 
 1 don't piet'er even the Fire to it, but when 
 the Canes is deep, or attended with Worm- 
 holes, or a fleiliy Excrefence. 
 
 To end tliis Dilcourle oi the Exrftofs and 
 Cartes, I have compos''d lome Aphorilm^ which 
 are only *he product of my Oblervatiojis, and 
 daily Praftice. 
 
 APHORISM I. 
 
 If the Exoftofis dont appear, after the Vfe of 
 the Remedies that ought to take away the internal 
 Caufe, one mvft attack the Local Vice. 
 
 We have taken notice of this Obfervation 
 in the Cure, and it muft be obferv'd punftu- 
 aliy, unlefs one difcovers feme Fault in the 
 manner of adminiftring thefe internal Re- 
 medies. 
 
 APHORISM IL 
 
 We have [aid that the Exoftoils terminates In 
 Solution, Induration, and Suppuration ; one might add 
 Kottenhcfs, when the Bone is IVorm-eatcn, and De- 
 litefcencc. Since vpe have fcen fcvcral Exoftofei 
 vani^j without the Application of any Remedies. 
 
 APHORISM III. 
 
 11:6 Exoftofis that terminates by Solutioffy is 
 the vjoft perfc^, provided proper Remedies are ufed^ 
 the Reafon is eafily conceivd. 
 
 APHORISM. IV. 
 
 j4 Fit of an Ague fometimes caufes the Exoflo/Is 
 to dJfappear : Perhaps it may be the d'fappearing 
 
 of 
 
Difeafes of the B o N E s. 457 
 
 of the Exoftofis that produces the Ague^ by the 
 Virus again entring into the Blood. 
 
 APHORISM V. 
 
 When the Exoftofis vanifhes without having 
 made ufe of any Remedies, it is generally follow a^ 
 by other Symptoms. It may be feen dtfappear in 
 one place^ and break out in another. This yecjuires 
 no Explanation, the Caufe is cafily comprehended. 
 
 APHORISM VI. 
 
 One may be morally affured that the Pocky Ex- 
 oftofis is cured J when it goes away after the ufing^ 
 of friCliOftSy and a kindly Salivation. 
 
 APHORISM VII. 
 
 Mtho a Pocly Exoftofis pjou^d not entirety 
 difappear after a regular Cure, one mufl not believe 
 that the Patient fitll has the Pox. Becaufe the 
 Exojlofis always leaves fome mark, efpecially 
 if 'tis of long ftanding, the bony Fibres 
 not returning again to their Priftine State fo 
 eafily as the Fielhy ones. 
 
 APHORISM VIII. 
 
 When the Exoftofis is painful "'tis a fign it grows. 
 When the Skin that covers it is red and fai?iful^ 
 "'tis a fign of Suppuration. 
 
 APHORISM IX. 
 
 When the Tumour foftens, and the Pain and red- 
 nefs abates, tis a fign the Exoftofis ts SuppU" 
 rated : And upon mature examination ont fi^all 
 perceive a FluUuaticn. A P H O- 
 
453 A Tkzatise of the 
 
 APHORISM X. 
 
 In the Exoftofis nhere the Flejh opefjs of 
 it felff the Ofenittg wtU be Fifiulous \ the Bone 
 he'wg uncover d fweats a reddijli and very noifom 
 
 Sanies. 
 
 APHORISM XI. 
 
 If' a bloody and thick Pus ijfues out, if any Part 
 §f the Bone feparatcSy and comes out at the Open' 
 ifj^, the Vlcer will heal without a Fiftula. 
 
 This often happens in the Pocky Exoflofis 
 which fuppurates, breaks, and exfoliates na- 
 turally, without any Operation, if it has been 
 encounter'd with Mercurial Friftions. 
 
 APHORISM XII. 
 
 'Tloe Exoftofes that fufpurate generally caufe 
 (harp and continual Painsy which mufi not be cort' 
 founded with thofe that are caufed by the Elevo' 
 ticn and Divulfions of the Periofteum during tlix 
 vrowth of the Exoftolis. 
 
 APHORISM XIIL 
 
 In VlcerSy when the Bone is cover d with Flejh 
 that is fpongiousy foft,- pale, or of a Mulberry red, 
 ^tis a fign the Bone is corrupted, 
 
 APHORISM XIV. 
 
 If the Probe pierces eafdy thro'' the FleJJj to the 
 Bones, if it bleeds with eafe and without Pain^ 
 the Bone is tutrify'd, 
 
 APHO- 
 
Vifeafes of the ?»otizs, j 5^ 
 
 APHORISM XV. 
 
 If on examining "with the Probe the Bone is found 
 rough and uneven, ^tis impaired *, unlefs it be a 
 natural unevennefs, which Anatomy teaches 
 us to diftinguilh. 
 
 APHORISM XVI. 
 
 If after having pierced the Flepj with the Trohe^ 
 one feels at the end of it as if it touched rottejt 
 Wood, or wet Pa/t-board, the Bone is rotten^ and 
 the rottene/s will turn to a Worm-eating. 
 
 APHORISM XVII. 
 
 When the Plaifters are blackened by the Matter^ 
 the Bone is corrupted. 
 
 If there be any Lead in the Compofition of 
 the P/laifter, this fign is equivocal, but it al- 
 ways fhews that the Sanies is of the Nature 
 of uiqua fortis, fince it dilfolves the Lead. 
 
 APHORISM XVIU. 
 
 If the Skin about the Vlcer is of a Violet or 
 Lead Colour, the Bone is corrupted. 
 
 APHORISM XIX. 
 
 If the Sanies be ferous, jinking, and in greater 
 Quantity than ought to be for the bignefs of the 
 Vlcer, \is a fign of the Bones being corrupted or 
 rotten. 
 
 APHO- 
 
460 >^Treatise of the 
 
 APHORISM XX. 
 
 Tlje Scar that is vfon the impaired Bone is foft^ 
 high J and without j4dhcfion. 
 
 APHORISM XXI. 
 
 !)}€ Scar that comes over the Sound Bone after 
 Exfoliation mufi be deep and firm, cleave clofe to 
 the Bone, and be white. 
 
 It is deep bicaufe Part of the Bone being 
 exfoliated, there is a lofs of Subftance, and 
 the Veliels which fupply the Juices are ih runic, 
 tecaufe they have been long expofed to the 
 Air, to the Influence of drying Medicines, 
 and to the Compreflion of the Tents where- 
 with the Ulcer has been long kept open. 
 
 The Scar is firm, becaufe it refts upon the 
 Bone, and becaufe part of the bony Juices con- 
 tribute^ to the making it. 
 ,^ It cleaves clofe, becaufe the Bone and the 
 ""ijle/h have form'd out one and the fame Scar. ' 
 ' It is white becaufe the Pores are very clofe, 
 
 and yellecl a greater Quantity of Light. 
 
 APHORISM XXIT. 
 
 When the V leers near the Bones m'e of a Tear or 
 more fiandin^^ the Bones rot. 
 
 The Cartes feizes on the Bones that are near 
 old Ulcers, becaufe 'tis impoffible duiiiig that 
 Time the Matter of the u leer, and the Oe- 
 dema it caiifes in the Parts adjoining, fliou'd 
 rot change the i^atural D-lpofition of the Pc- 
 rio/Ieum, which occalions the Obftrudlion of the 
 Velftls that pafs thro' tlie Bone, whence fol- 
 lows the 'Stoppage, Acidity, and Eliufion of 
 
 the 
 
L}fi{ifes of the Bones. 461 
 
 the Juices, and the Deftrudion of the bony- 
 Fibres. 
 
 APHORISM XXIII. 
 
 When the Patient complains of havifig fuffer^d 
 j^cute and grait Pains in the Beginning of the Jm^ 
 fofthume that brought the Vlcer, one ought to fuf- 
 feet a Caries, or it DIfpofition thereunto. 
 
 This Fain Ihevvs that the Periofieum has fuf- 
 fe#'(l, and tluit the Bone may have been ;i 
 therein iharer for the Reafon above mentioned. 
 
 APHORISM XXIV. 
 
 the Bones may he impair d without the Flejh^s 
 being fpoiTd -^ becaule they are nouriili'd by 
 the Lympha, and this Liquor is generally th* 
 Vehicle of the F'lrus, of whatever nature it be, 
 the rather becaufe the Firus is Salt, as has 
 been obferv'd elfewhere. 
 
 APHORISM XXV. 
 
 7'tje Vlcers of the Articulations^ the Corner of 
 the Eye^ the Mouthy and Nofe^ are more frequently 
 Attended with a Caries than the Vlcers of other 
 Tarts of the Body. This proceeds fom thefe Or-r 
 gans being more full of LymphatickVeiTelSjand 
 the Lympha that Waters them is the Vehicle 
 of the Focky, Scorbutick, and Scrophulous 
 Salts. 
 
 APHORISM XXVI. 
 
 All the Bones that are feparated from their Pe- 
 rioiU'um don'f exfoliate. 
 
 This 
 
A Treatise of tht- 
 
 This is only to be underftood of thofe 
 Bones that have loft their Teriofieum by Blows, 
 Falls, or benign linpofthumes. The VefTels 
 in the infide of the Bone always carry the 
 Juices outwards, becaufe they have Commu- 
 nication with thofe that are broken \ and the 
 Kutritive Juice ftops there, and forms the 
 jittle flefhy Buds which one fees rile infen- 
 Jlbly upon the furface of the Bone, then unite 
 together, and in the End cover the whole 
 furface of the naked Bone. ♦ 
 
 APHORISM XXVII. 
 
 Bones that are laid open by external Blows, eX' 
 foliate more readily than thofe that are corrupted by 
 Jmpophumes or other Defluxions. Becaufe the Caries 
 that attends the latter is fed by an internal 
 ■Canfe. Now to the end that the good Flefh, 
 which produces the Exfoliation, may grow, 
 and force away the infefted Bone, there muft 
 be no vicious Quality in the Juices that breed 
 it. Therefore, &c. 
 
 APHORISM XXVIII. 
 
 The deep Caries exfoliates with areater Difficulty 
 than the Superficial one. 
 
 The Realon is that their Caufe is generally 
 malignant : Befides the Piece of Bone is 
 thicker, and much harder, for the good Flefh 
 that grows under it, to feparate. 
 
 APHORISM. XXIX. 
 
 \\%cn the Bone is ready to exfoliate, the Pa^ 
 tient is in Pain if one touches it with the Probey 
 and fome times pIjc Vlcer bleeds* 
 
 Th« 
 
Dipafes ofte Bones. 46^ 
 
 This Pain procee- ■< from the Surface 
 of the Bone, it beiiig always rough and un- 
 even on the fide that fepa rates • and 
 if one thrufts it with the Probe, one alfb 
 thrufts its fharp ends and uneven Parts againft 
 the good Fleih that is under it, which caufes. 
 the Pain •, and as thele fame fharp ends and 
 uneven Parts don't fail to tear Ibme Blood- 
 VelTels, one may then perceive the Ulcer all 
 Jbloody. 
 
 APHORISM XXX, 
 
 Cne mufi not move or endeavour to feparate tigs 
 Tiece of Bone too foon. 
 
 Becaufe that if the Separation be not yet 
 advanced enough, one may break the little 
 Pieces that ftill adhere to the found Bone, 
 which may renew the Ulcer, or prolong the 
 Cure. 
 
 APHORISM XXXL 
 
 Isfeverthelefs om mufl move the Bont that h 
 ready to fall off. This muft be done gently for 
 fear of breaking the little Parts of the Bone 
 that are not loofen'd •, for ifone don't move 
 it, nor endeavour to draw it out in due time, 
 the Flelh that is bred by the found Bone 
 grows over, inchnfes and keeps it in, whence 
 there often proceeds liftulous Ulcers, thd 
 confequences whereof are fbmetiraes mor- 
 tal. 
 
 CHAP- 
 
464 A Treatise of the 
 
 CHAP. XVII. 
 
 Of the Rhachitisy^ or Rickets, 
 
 TH E Rhachitis is a Diieafe almoft pecu- 
 liar to Children •, and 'tis generally 
 oblerv'd that thofe who are affefted with it, 
 have a livelier and more pei^.etrating #^it 
 than others. The Organs of thei/ Senles are 
 well difpofed, their Face is full and well 
 thriven, their Head large, and their Com- 
 plexion ruddy. They eat much and with a 
 good Appetite ^ their Liver and Spleen are of 
 , a confiderable fize. Their Colour and Con- 
 
 fiftence is natural, and their Heart feems found, 
 whilft in other Parts thefe poor Children have 
 a thoufand Diforders which render them Ob- 
 jeds of Surprize and Pity. 
 
 They are lean, dry'd up, and as it were 
 Skeletons in all the other Parts of their 
 Bodies. The Back-bone grows crooked, their 
 Joints are relax'd, their Bones become foffj 
 and their Epiphyfes, and almoft all the Spon- 
 gious Bones, grow knotty. Their Sutures are 
 open, the FontanelU is Membranous, the Ribs 
 are deprefsM, the Off^ Illia, and the OmopUta 
 are thick, ihrunk, and, as it were, bent back. 
 The great Bones grow crooked, which renders 
 all the Limbs deformed. And, in fine, when 
 one opens thofe that die of the Rickets, 
 one finds thac the Lungs, which cleave to the 
 Fleuuty are. Livid, Schirrous, and full of Ab- 
 fcelfes, and that almoft all the conglobated 
 Clar.ds are fwelFd with a thick Lympha. 
 
 Of 
 
Lifiafes of the Bone $0 4^5 
 
 Of the Caufes of the Rickets, 
 
 All Diftempers have but two forts of 
 Caules, the one is in our lelves, and the o- 
 ther is external. Thofe which are in us 
 ought only to be confidered as lecor.d Caufes, 
 or, to fpeak more properly, as the Effefts of 
 the external ones. And indeed, the vicious 
 qualities of the Spirits, the Bkx)d, and other 
 FJuWs, which we look upon as internal Caules^ 
 are but the EfTeds of the vicious quality of 
 the Air, the Intemperature of the Seafons, 
 the Excefs or ill quality of our Diet, hard 
 working, extreme Idlenefs, long Sleeps or over 
 VVatchings, and very ofcen of the not go- 
 verning our Paflions. 
 
 This being the Cafe, we ought to impute 
 the Caufes ot all our Diftempers to the Abufe 
 of fome of thole things which the Ancients 
 call'd the Non-naturals. 
 
 In order to compafs the Defign which I 
 have propofed to my felf, I fay, 
 
 1°. That this Abufe corrupts the Hu* 
 mours. 
 
 2^. That the Humours being corrupted after 
 9l certain manner occafion the Softnefs of the 
 Bones. 
 
 3^. That this foftnefs hinders the regular 
 diftribution of the Spirits in certain Parts, b/ 
 the Diforder it produces in the Spne. 
 
 4*^. That the Animal Spirits b2ing inter- 
 rupted in their diftribution, caufe the Lean- 
 nefs of the Soft Part, where the Nerves that 
 are their Veliicles terminate. 
 
 5^. That the Softnefs of the Bones, ancj 
 the GojmpreiTion of the Nerves are the Oc<- 
 
 H h cafionai 
 
66 J Tv^h AT iSL of the 
 
 cnfional Caules of their Crookednels, and all 
 the other rhoefwrnnin. 
 
 1 begin by enquiring into tlie Primitive 
 Caules of the vicious (jualities ot the Hu- 
 mours-, and in Children, 1 lind pnrticularly 
 five, viz.. The diiferent Regions and Climates, 
 the Teeth, wlien they are about cuttiiig, or do 
 tia^lually cut, the Worms to which they are 
 'fubjed, the 111 quality of their Milk and other 
 Alimeuts, and the Change of their Diet when 
 weari'd. 
 
 »-' The Climates have a great fhare in th^vice 
 of the Humours that caufes the Rickets, fmce 
 we fee that that Difeafe only happens parti- 
 cularly in France^ Flanders, Holland, and Er/n- 
 '■lavd : Undoubtedly becauie the Air there is 
 Jefs impregnated with Saline, Volatii, and Sul- 
 phurous Particles, than in the other Regions 
 ^f Europe, and becaufe thele Principles are 
 ellential to the Hardnefs of the Bones as fhall 
 be obferv'd. 
 
 When the Teeth begin to cut, Children 
 are in danger of becoming Ricketty, on ac- 
 count of the Pain they feel, which may be 
 occafionM by two principal Caufes. The one 
 is in the Tooth, which has feveral little (harp 
 Ends that are like fo many Needles, which, 
 piercing and tearing the Nervous Fibres of 
 the Gums^ caufe very acute Pains. The other 
 is in the Gums, when they are hard, becaufe 
 'they refift the more againft the Efforts of the 
 Teeth in cutting, whence the Nervous Fibres 
 that compofe them are the more rudely 
 fliakcn, which renders the Pain more Acute. 
 
 Th's Pain may caufe the Rickets two 
 ways ^ 
 
 lO. By reafon it occafions Crying, a Fever, 
 want of blvep, «"»nd Convulfione ^ .which are 
 
 Acci- 
 
Dipafus of the B N E s. 4^7 
 
 Accidents fb flital to Children, that iiothlng 
 is more apt to difturb the Chylilication, 
 weaken the Body, corrupt the Humours, aiid 
 preveiit their regular Dlftribution. 
 
 2^. TheGums being intlam'd, by the Teethg 
 irritating them, make the Cliildren often move 
 their Jaws, to prefs their Gums againft each 
 other, without doubt to mitigate their Pain j 
 iince one iees that thole pretty Innocents are 
 ealed when one rubs the Gums of thole Teeth 
 gently with ones Fingers, and 'tis obfervM that 
 they flay a confiderable Time at the Breaft, 
 not (b much to Suck, as to nibble at the 
 Kipple, and rub it againft their tender 
 Gums. 
 
 In fliort they carry every thing indiffer- 
 ently to their Mouths to eafe themfelves ^ 
 and the repeated motion of their Jaws com- 
 prelTlng the Salival Glands, caufes the Saliva 
 to run in a great quantity into their Mouths, 
 and thence into their Stomach and Inteftines, 
 where it produces a Loofenefs, which, being 
 joined to the Accidents that proceed from the 
 Pain only, reduce the Children to a miferable 
 Condition. 
 
 The Worms occafion fuch great Diforders, 
 that the Children who have them have but: 
 broken {lumbers-, they prefs their Jaws hard 
 againft each other in their Sleep, they feel 
 convulfive Motions in their Extremities, with 
 violent gripings that ceafe fbme time after 
 liaving eaten \, they often rub their Nofes, be^ 
 caufe they itch; their Bellies are fwell'd, 
 their CompleO:ion is fometimes red, fome- 
 times p:de , they become pale, have a devour- 
 ing Appetite, a dry Coue^h, and their Mouth 
 is always full of Spittle. 
 
 H h 2 Th?r 
 
4^8 A Treatise of the 
 
 Caufcs They have but broken flumbers, becaufe, 
 
 ° j^^ the Worms are every Minute irritating the 
 {lumbers. Membranes of the Inteftines, and caule a re- 
 flux of Spirits that agitate them, as fliall be 
 explained hereafter. 
 Whence The corrofive Gripes proceed from three 
 theGripes c^ufes ; 
 
 i^. From the motions of the Worms a- 
 gainft the Coats of the Inteftines, which 
 does with refpeft to them (but much more 
 eff-ilually) what a Feather or Straw does 
 with rcfpcft to the Lips when drawn to and 
 fro over them. 
 
 2^. From the prickings they occafion by 
 their biting or pitching, with their Teeth ^ 
 fince one fees that Worms eat into Planks 
 and Stones : Even the Fruits themfelves with 
 their Stones and Kernels, Nuts, Filbreds, and 
 Walnuts are pierced by them. 
 
 3^. The Impreflion of the Verminous Mat- 
 ter upon the Coats of the fame Inteltines, is 
 capable of caufmg thefe Gripes by the Oxygly 
 con that is contain'd in it. 
 
 'Tis from the Influence of thefe Vermin 
 upon the Membranes of the Inteftines, and 
 that of the Verminous Matter upon the fame 
 Membranes, as alio from the Introduflrion of 
 this Oxyglycon into the Mafs of Blood, that I 
 fliall derive the Explication of the other Tha- 
 nomena.. 
 
 The Startings happen thro' the Cor.cufllon 
 and painful fenfation of the Nerves, that 
 caufe a Reflux of the Animal Spirit, which 
 being violently forced back into other Nerves, 
 produce thefe Starting5, and even the Con- 
 vulflor.s in the Mufcles where thele Nerves 
 terminate. Where'bre if this Reflux happens 
 m the Nerves of the Arms, th&re will becon- 
 
 vulflve 
 
Bifeafes of the B O N E 5. 469 
 
 vulfive Motions and ftartings in the Arm : Media- 
 if in the Optick Nerves, the Eyes will be in '"^^" ^^^^ 
 Conv/ulfions •, it it tails upon thofe of the IJps ['I'lc Con- 
 it will caufe a fort ot Sardonick laughter ^ vulfivo 
 and infine if the Nerves which havecommuni- Motions, 
 cation with the Mufcles that move the Jaws 
 are affected with it, this Reflux will be at- 
 tended with a grating of the Teeth. 
 
 It muft b^ oblerv'd that not only thefe 
 Convulfions, Startings and Convulfive Mo- 
 tions, are cauled by the Oxyglycon before- 
 mention'd, which, being got into the Mafs 
 of Blood, afts upon the Nervous Membranes, 
 and there caul'es Irritations which are attended 
 with all thele Accidents, but alio that having 
 infinuated it felf into the Blood, it may- 
 filtrate thro' certain Velfels, where it caules 
 diiferent Vhoemmcna \ tor if 'tis carry'd to the 
 Glands of the Lungs, it caufes a dry Cough, 
 by its irritating the VefTels of the Lungs. 
 
 It the Cemplexion of thefe Children is Different 
 fometimes Red, ibmetimes Pale, it may be ^°^°"" 
 obferv'd that it is Red when they Cough, comptex- 
 becaufe the Contra£lion of the Breaft and ion. 
 the Mufcles of the Abdomen comprefs the 
 Lungs, whence the Blood is ftopt for a Mo- 
 ment in the Veffels of the Face and the Suh- 
 cl avians. On the contrary the Complexion 
 becomes Pale when the Cough is over, becaule 
 the Blood that was ftopt in the Face refumes 
 its Courfe thro' the "Jugulars and SubcU- 
 vians. 
 
 Their Mouths are moiften'd with Spittle, ^. , 
 becaule the Oxyglycon irritites the Salival chHdren 
 Glands, and obliges them to difcharge them- haverhcir 
 lelves more copioufly into the Mouth. Be- Mouths 
 fides the Mufcles of the Jaws, the Lips, and alwayi 
 other Parts adjacent, that are in a Convulfive "^^'^^* 
 H h 3 Motion, 
 
47^ A Treatise of the 
 
 Motion, comprefs thele Glni.ds more fre- 
 queiitly, which occafioiis the Dilcharge of 
 that Liquor which is feen to liow out ot their 
 Mouths. 
 ^1^^ They rub their Nofe?, becaufe they feel an 
 
 often rub Itching therein, which proceeds from the 
 their Oxyglycon that lias infinuated it felf therein 
 Mofcs. with the Mucus, and irritates the pituitary 
 Membrane •, and the Breath that palles thro' 
 the Noftrils be'nu, impregnated with this Oxy- 
 glycon which it has deriv'd from the Veffels of 
 tjie Lungs, muft alfo irritate the Membrane 
 ot the Nofe. 
 
 Shou'd it b3 ohjecled that the Caufe which 
 CI take for granted, and affirm) a£ts upon this 
 internal Membrane, can never excite the 
 itching on the outfide at the Tip of the 
 Kole, I fliou'd anlvver that 'tis a SenHition 
 which the Soul carries to that place (altho"* 
 it perhaps may not be there) as it does on 
 divers other occafions which fnall not b3 ex- 
 amin'd into here. In a word, it is certain 
 that this Oxyglycon infinuates it felf into the 
 Blood, fince it difcovers it felf in the Spittle 
 and Breath of Verminous Infants, as may be 
 obferv d by the Orong fmtll that exhales from 
 their Mouth and Nofe. 
 r- The Convulfions in the Eyes are often 
 look dim. attended with a certain Difpofition which 'tis 
 hard to defcribe, but which never thelefs is 
 remarkable, the Eyes being as it were wild, 
 dim, and in a word verminou?. This pro- 
 ceeds from part ot ^\\e Oxyglycon s having pene- 
 trated into the Lytnpha Lachrymalis, irritated the 
 palvdra, and caused an Itching therein : And as 
 the Lachrymal Gland thro' which this Acid 
 filtrates is near 'the Mvfculus Ltvator of the 
 
 Eye- 
 
Difeafis fif rbe Bo KZS. 471 
 
 Eye-11 Is, this Mufcle being irritated contratL.^ 
 it leK and draws tlie Eye-lid upwards. 
 
 The dimneCs of the Eye may be accounted 
 for the fume way, for this Acid being mix'd 
 with the Aqueous Humour, caul'es a flight 
 Coagulation therein, that renders it lefs trau- 
 fpareiit. 
 
 The Fever which attends this Diftemper, 
 and the irregular Paroxyfms that are obferv'd 
 therein, are produced by the f.ime Caule ; 
 by realbn fometimes more, fometimes lefs of 
 this Acid gets into the Mafs of Blood, which 
 makes it ferment more or lefs. Thus one , 
 may account for the irregular Fevers ando- 
 ther Accidents that afflid Children fubjeft 
 to Worms. In fliort it may be fuppofed that 
 lo many Accidents muft hirider the Digeftioii 
 iind the Chylification, whence enfues Blood 
 of an ill Quality, and a vicioufnefs in the 
 Lympha and otlier Humours, which prove the 
 Caule of the R'ckets, and an Infinite number 
 of other Diftempers. 
 
 If a Child has fuck'd a ferous Milk, with- 
 out Subftance or Confidence, as often happens • 
 in Kurfes that work hard and fatigue them -{7 
 felves, or in fuch as fare hardly, have any 
 T3ifeafe, or continue to Suckle after being 
 with Child, if, I fay, a Child has fuck'd this 
 Milk without Confidence, its Blood will be 
 clogg'd with an infipid Lympha^ deftitute of 
 Volati! and Sulphurous Salts, which far from 
 hardening the Bones will render them the 
 fofter, fiii:e their natural Solidity d spends 
 upon the imbibing of Saline and Sulphurous.'^ 
 principles which are not to hi found in this 
 l.ympha. 
 Tf Children are deprived of the ufe of good. \ 
 Milk, b:tore they have mofl part of their 
 il h 4. Teeth, 
 
A Treatise of the 
 
 Teeth, not being able to chew, they often 
 fall into a Conlumption or KhAcWitis \ becaufe 
 the Menfiruum of their Stomach is not ftrong 
 enough to fcparate and difToWe all the Prin- 
 ciples of folid Food, and to make a good 
 Chyle, whence two Things enfue. One is, 
 that the Blood which is bred from thence, 
 being deflitute of thefe Aftive Principles, will 
 caufe the Rickets ^ and the other is that the 
 Child, not being ftror.g enough to endure 
 the Pain, will be expofed to all the Accidents 
 already mentioned. 
 
 Thus it may be affirmM that the difference 
 of Climate^, bad Milk, the Pain that attends 
 the Breeding of the Teeth, Worms, change 
 of Diet, and other Caufes before cited may 
 fpoil the Chyliiication, lb that the Blood, 
 being deftitute of Volatil and Sulphurous Salts, 
 will produce a Softnefs in the Bones, if what 
 the analyzing them teaches us be true, viz.. 
 that they are nourifli'd by a Juice impregnated 
 with thefe two Principles, and that their 
 Hardnefs proceeds from the compleat mix- 
 ture, the Application, and the Coagulation of 
 this Juice m the interiour Membranes, and 
 the extremities of the Bony Channels. 
 
 Of all the Bones, thofe that are moft Porous 
 are mofl eafily foften'd • wherefore the Fer- 
 teh'A grow fott the firft, and having loft their 
 Firianefs they muft prefs one upon another, 
 whence they leave lefs fpace between the 
 Holes that are made by their Hollows for 
 the comiiig out of the Kerves, and thcle 
 l^erves which iiTue from the Marrow of the 
 Spine are comprefs'd, which hinders the flow- 
 ing of the Animal Spirits into the Parts where 
 tiie Nerves d'ftribute themfelves ;, and as the 
 A«imal Spirits conduce to the nourifhment 
 
 of 
 
Bjfe^fes of the Bones. 473 
 
 of the Parts, as ihall be proved in the fequel, 
 thofe which doiTt receive a I'ufficient quantity 
 of them muft fink, grow dry, and Lean. 
 
 Upon thefe Principles it will be eaiy to ex- 
 plain feveral Phcenomena thit attend thefe 
 Diftafes, wliich I fliall do after having ac- 
 counted for the Crookednefs of the Bones. 
 
 Of the Crookednefs of the Bo?ies in the 
 Rickets, 
 
 Glijfoti, a famous Englijli Phyfician, pretends 
 tliat this Crookednefs proceeds from the fame 
 Reafon as an Ear of Corn bends towards the 
 Sun, or a Plank, Paper, a Book, &c. warp to- 
 wards the Fire •, becaufe the Sun or the Fire 
 attraft fome of the humid Particles that are 
 in the Pores of the fide expofed to them, 
 and drive the others to the other fide, which 
 produces the fame etfed with regard to thefe 
 things, as feveral Wedges would do if driven 
 between the feparations of the Stones that 
 compofe a Column, for it all thefe Wedges 
 were on the fame fide, the Column would bend 
 to the oppofite one. 
 
 Applying this Example to the Crookednefs 
 of Bones, he fays that they bend when the 
 ISIourifhment inclines more to one fide than 
 the other,^ecaufe that fide fwelling and growing 
 confiderably, obliges the oppofite furface to 
 bend. For this Reafon the fame Author pre- 
 fcribes the rubbing the crooked fide with 
 penetrating Oyl, and hot Cloths, to recall the 
 nourifliment into this Part, and caufe the nu- 
 tritive Particles to enter its Pores to extend 
 its Fibres, being aififted by Bandages and 
 Splints, which he orders to be apply'd to the 
 Side oppofite to that which is crooked. 
 
 This 
 
A T KEAji^z of the 
 
 This Syftem of Gli{fo7i\ labours under le- 
 veral Difficulties, which liave been confuted 
 fo often, that I ihall think it fuffic'ent to lay 
 it niieht pafs for probable, it on^ ki.ew any 
 Caule tJiat couM produce an unequal diftri- 
 bution of the Nourifhment in any Bolc, and 
 if the Bones did not bend on that fide where 
 they receive moft nourifhment. And in effefl: 
 the Legs bend outwards, whereas accordii g 
 to what Gliffon fays, they fhould bow in- 
 wards. 
 
 Moiyovo lays down a quite difTerei t Syftem', . 
 where he fays, that the tendinous St. ings and " 
 Mufcles are wither'd and flirunk for want 
 of Nourifhmentj whilft on the other hand the 
 Bones far from lefTening grow larger, whence 
 they bend, in the fame manner as a Cord, 
 being faftea'd to the two Ends of the Trunk 
 ot a yourg Tree, will oblige it to bow, be- 
 caufe this Cord can't give way when the 
 Tree grows and ft niggles to (hoot upwards. 
 Fere follow the Objections that are made 
 againft this Syftem. 
 
 f/Vy?, There are Bones which being coverM 
 on all fide"^, muft be equally drawn, and ought 
 not to bend. Neverthelefs this happens in 
 thofe of the Arms and Thighs which are 
 equally cover'd by Mufcles. 
 
 Secondly^ There are no tendinon"^ Strings 
 that are faflen'd ro the two e^itremitics of 
 one and the fime Bone, as the Cord before- 
 mentionM is to the two Ends of the Tree. 
 On the contrary 'tis feen that the Mufcles 
 which have their Origin at one Bone go beyond 
 the Articulation to infert themfelvcs |in the 
 Bone below it, whence they draw this Conie- 
 quence, th;!t the crookednels of the L^mbs 
 wou'd only be in the Joints, juft as fuppofing 
 
 there 
 
Difenfes ofthe^oNZS,_ 475 
 
 there was a Hin'j!,e in the middle of the Tree, 
 the Rope couM only bi'nd it at that place. 
 
 Tlmdly^ It is not true that the Hones grow 
 more than the Mufcles, fince Children liave 
 been known to be Paralitick for two or three 
 Years, without their Bones growing crooked. 
 Thefe Objedions don't in the leaft deftroy 
 Aiaycivs Syftem. In anlwer to the firft, I fay, 
 that altho' fome Bones are cover'd all o/er 
 with Mufcles, one muft not therefore con- 
 clude that they are of equal Strength, on the 
 contrary it may be fuppofed that the ftrongeft 
 muft get the better ot the weakeft, and force 
 the Bones to bend. 
 
 To the fecond may be andverM, that altiho* 
 there is no tendinous Stri ig which is faften'd 
 to the two Ends of the fame Bone, it ought 
 not to be concluded that thofe which pafs 
 by the Articulations are lefs d'fpofed to bend 
 the Limbs in the middle of the Bones, than 
 ill the Joints, and that for three Reafons. 
 
 1^. The Mufcles that bsnd the Foot can't 
 keep it continually in that Situation, becaute 
 the Extcnfors aft alternatively : And if it fhou'd 
 be ob]e£led, that 'tis the fame Thing with 
 refpeft to the Bones, what I iliall lay pre- 
 fently will prove the contrary. 
 
 2°. The Mufcles that pafs by the Articu- 
 lation are Antagonifts, whence if they aft all 
 together, they may perhaps make a Tonkk 
 Motion, 'wherein they can^t incline the Part 
 more to one fide than the other ^ but with 
 leipeft to the Body of the Bone, tJiey are as, 
 one may fay, congenerate, becaule they have 
 all a Tendency to bend it the fame way, as 
 may be '^een m the Leg, where the Perova 
 and Tibia bend outwards, becaule the Flexors 
 and Extrnfurs pf the Foot and 'Foes are all 
 
 firuated 
 
A T K Z A T I ^ E of the 
 
 fituated on the outfide, before and behind, 
 and tliere is not one in the infide of the Leg, 
 as is known by all. 
 
 3*^. The MufcuU flcxores, or Extenfores muft 
 be always in Contraction to make a Limb 
 crooked in the Joint, as happens in Convul- 
 fions that produce certain kinds of Amhylofes. 
 But it is not the fame with the Bones, which 
 may bend altho' the Mufcles be not always 
 in Contra^lion •, becaufe the Bones being loft, 
 if they are bent by the Aftion of any Mulcles, 
 they can't recover themfelves during their 
 Inaction, the Bones having no Elaiticity which 
 they muft have to relume their Priftii.e ftiape ^ 
 wherefore continuing in this form, they grow 
 more crooked at the fecond Contraction of the 
 Mufcles, and fo on, more and more in pro- 
 portion, as the Contractions are repeated. 
 
 In Aniwer to the third Objection,! fay,That 
 if Children have been feen who have been two 
 or three Years Paralitick without rheir Bones 
 being crooked, it is not to be wonder'd at • 
 becaufe undoubtedly the Bories of thefe Chil- 
 dren were not foft :; and lecondly, becaule 
 the Mufcles ought to aCt in order to bend 
 them, and thofe of a Paralitick are without 
 Action. Wherefore all the Objections that 
 are brought againft Mayoxv's bJyftem, tho' 
 they are made by a very Ingenious Man, 
 Ihall not hinder my following it, at leaft in 
 part, the rather becaufe 1 have refuted all 
 the Objections that have been ftarted. 
 
 I lay then with M.iyow, that the Crooked- 
 nefs of the Bones proceeds from the Con- 
 traction of the Mulcles, but I add, that 
 were it not for their loftnefs they cou'd not 
 bend •, that the weight of the Head and the 
 Body contributes thereunto, and particularly 
 
 the 
 
Bifeafes of the Bones. ajj 
 
 the natural Crookednefs that is in all the 
 Bones : Wherefore 1 admit of four Caufes 
 of the Crookednefs of the Bones in ricketty 
 Perfons, their foftnefs, the Contraftion oftlie 
 Mufcles, the weight ot the Body, and their 
 natural bending. 
 
 And in order to explain the Crookednels 
 of every Bone in particular, I fay, firft that 
 the Spine bends becaufe of the foftnefs of the 
 Fertebr£. Secondly by Reafon of the Adion 
 of the VfoaSy LotJgus, Scalenus^ FeSluSy and Obli' 
 ^uus of the jibdomerj, which drawing the 
 Breaft forwards, oblige the Spine to grow out- 
 wards. Thirdly, the Head being very large 
 in Ricketty Children prelfes confiderably upon 
 the Spine, which having no folidity is obliged 
 to give way as a leaden Pillar would when 
 prefs'd upon by too great a Weight. Fourthly, 
 The Neck bends behind, and grows arch'd 
 forwards, and fo of the other Parts of the 
 Spine, becaufe thele Parts are naturally a little 
 crooked on that fide. 
 
 The Ribs are flatted in their middle, and 
 forced inwards by the Preflion of the Mufcles 
 FeElorales and Serratus Major^ ib that thele half 
 Bows become lefs bent, whence the Breathing 
 is obftrucled, becaufe the Sternum is thruft 
 forwards, which makes the Breaft feem 
 pointed. 
 
 The Cartilages, and the end of the Ribs 
 grow larger towards the Cavity of the Breaft, 
 becaufe there is nothing that comprelfes them 
 inwardly. 
 
 The Off^i Illia are narrow and bend inwards,' 
 by reafon of the Contrafl:ion of the G/utxi 
 aad///^c«/,which, drawirg on their fide, ftraiceii 
 and bend thefe Bones. 
 
 The 
 
A T K E A T 1 s E of the 
 
 TheOmoplatac^Vti not To large asul'ual, and 
 thicker, becauie the Mufcles, Supra and hfra- 
 Spin>-itusy Sub-Scapvlaris, and Rotundus Aiajor and 
 Minor which cover them, draw e:ich on their 
 Retpeftive fides, and bring (as or.e may fay) 
 all the Circumfcreixe near the Center. 
 
 The Arm-bor.e hardly chinges its Figure, 
 becauie it is furrounded wirh Mufcles of al- 
 moft an equal ftrength, befidcs that this Bone 
 don't lerve as a fupport to any other as does 
 the Bone of the Thigh. 
 
 Keverthelefs it mufl be obferv'd that when 
 the foftnefs of the Bones is great, it not only 
 grows out behind and in betbre, at the place 
 of the Insertion of the Deltoides, a. id the 
 Origin of the Brachiaus internus^ but very often 
 'tis found to be half broken, as I h:ive feen 
 feveral Times, which happens thro' the op- 
 pofite Aftion of thefe two Mufcles. This 
 Accident not only hnppens to the Arm- 
 Bone, but frequently to the Rib?, and middle 
 Parts of the Bones of the Thigh and Leg. 
 
 The Bones of the Fore-Arm are crooked in 
 their Fore-Parr, becaufe the ftronger Mufcles 
 are placed there. Befides thefe two Bones 
 are drawn near to each other, by the Mufcles 
 Botimdus, Suphator hrevis, and Quadratus, 
 
 Altho' the Thigh-Bone be furrounded with 
 Mufcles of almoft equal ftrength, it is not the 
 leaft crooked for feveral Reafons. 
 
 Firft becaufe 'tis expofed to a number of 
 Motions which can't be perform'd but by the 
 A^^ion of the Alufcle.'^, and we have proved 
 thit this Adion is one Caufe of the Crooked- 
 nefs of the Bones. 
 
 2^. Becaule 'tis the longeft of all the Bones 
 of the Body, and 'tis more eafy to bend a 
 long than a ihort one. 
 
 3°. Be- 
 
Lifeafes of the Loisi ^s, 479 
 
 3^. Becuufe 'tis naturally more crooked 
 then the others. 
 
 4*^. The reafon this Bone bends, is thnt it 
 props and fupports the weight of almoft the 
 whole Body, becaule this weight has the 
 liime Effed with rclpc^t to it, as when a Man 
 prelfes a Bow againft the Ground to bend it. 
 
 There remaii.s now nothing to give a com- Explica- 
 pleat Idea of the Richts, but to account for tion of 
 the i.-irgeiiefs of the Head, the plumpnefs ot ^t^vcral 
 the Face, and the vivacity of the Wit of ^^^"^^"J ^_ 
 ricketty Children •, as likewife of the Delicacy ccrnin^ 
 of the Organs of their Senfes, the leanefs of the Rict- 
 the Parts below the Neck, the largenefs of cts. 
 their inward Parts, the narrownefs of the 
 Breaft, and Difficulty of Breathing : In fine, 
 to explain the Adhefioii of the Lungs to the -^^M 
 Tleura, their Hardnel's, Lividnefs, and the Im- ^B 
 
 poflhumes that breed therein, together with 
 the fwelling and hardneiV of the Thymus, the 
 G lands y the Mediaji-imim, the Tamrcas and the 
 Mefemery^ which I fliall do in few Words, 
 and afterwards anfwer Ibme Objections that 
 have been made againft this Syftem. 
 
 As for the Bignels of the Head, it proceeds 
 from the fofcnefs of the Bones of the Cra- 
 nium, in that their Sutures are Membranous, 
 and the Brain which receives the Blood in 
 greater quantity than the other Parts, becaule 
 of their Compreilion, mufl grow, and confe- 
 quently open the Sutures, and feparate the 
 Bones of the Cranium that indoles it. 
 
 The Plumpnefs ot the Face, and -Delicncv TheUrgi 
 of the Organs of the Senfes, proceed from ""^^^ °* 
 the An'mal Spirits Howlng thither without iu- ^"*^ ^*^^* 
 terrupcion, whence thefe Organs mufl: be 
 ihaken by the leaA imprefTion- t;hat is maie 
 upon them by external Ohjecb. 
 
 Ricketty 
 
4.8o A Tke AT IS E of thf 
 
 Rirketty Ricketty Perfons have a lively and pene- 
 PcrCons trating Wit, becaufe more filtradons are made 
 TcryWity -J-, fj^g Brain of llich Perfons than elfe where, 
 whence they have a greater quantity of Spi- 
 rits for the Fu;idioiiS of the So.il. The Or- 
 gans of the Senfes being eafily moved fas has 
 been faid) muft carry back all the Senlations 
 to the Soul more regularly, and it muft judge 
 more foundly. 
 All the ^^^ Parts below the Neck are more lean 
 Parts ex- ^^^ fiUVn away, becaufe the Animal Spirits 
 cept the that are diftributed there, come from the 
 Head are Marrow of the Spine, and the Diforder of 
 lean. ^he Vertebra, caufes them to comprefs the 
 Roots of the Nerves that come from thence, 
 as has already been,and Ihall be farther obferv'd 
 in my Anfwers to the Obje^ions that have 
 been made. 
 The Li- The Liver and Spleen are larger than the 
 vcrand other Inteftines, becaufe their Nerves are the 
 Spleen g^.}^ p^-j. ^^^ ^^^ Intercoflal which come 
 Are larger - ^i, o • 
 ^ from the Brain. 
 
 They find great Difficulty in breathing. 
 
 1°. JBecaufe the Liver and Spleen, which 
 are large, take up more place in the Breaft, 
 and render the Diaphragm Convex, which 
 makes the Breaft ftrait. 
 
 2^. The Ribs are flat and i\nk in the mid- 
 dle, which resders the extent of it yet lels. 
 
 3^. The Mufcles that ferve to aftuate the 
 Ribs have but little Force, and the Ribs thro* 
 their Softnefs and Weight are more difficult 
 to mo'v-'e 
 
 4*'. The Di/^ortion of the Spine (whether 
 it bends outwards, inward, or towards the 
 Ribs^ alters the Difpofition of the Ribs,and the 
 Direftion of the Mufcles that influence them- 
 
 Thefe 
 
Difeafes of rhi J^o^i^ E%, 481 
 
 Thefe four Points being well cxplaiuM, \t 
 will not be hard to account for the Adhe- 
 fion, the Impofthumcs, and the Schirrhus 
 of the 1 ,ungs ^ nevertheiefs befides tlie Dilfi- 
 f^i-ilry of Breathing:, we may difcover two 
 Cauies, viz.. the ill quality of the Blood, and 
 the ftrength of the Heart. 
 
 As for the "Difficulty of Breathing, it may 
 caufe the Diforders of the Lungs two ways; 
 the one by attecling the I nfpi ration, and the 
 other by obftrufting the Expiration. 
 
 By the Infpiration's being hurt, the Lungs 
 not having a fuificient quantity of Air to 
 fubtilize, attenuate and prepare the Blood, 
 that comes thither from the right Ven- 
 tricle of the Lleart, will flow thither more 
 flowly, and by its heavinefs and grofTnefs 
 will be apt to caufe Ibme Obftruflion in 
 the Capillary Veffels of the Subftance of the 
 Lungs. 
 
 When the Faculty of Expiration is affected, 
 the Confcquence will be that the Air not ha- 
 ving a free Palfage thro' the Bronchus^ and 
 there being but a little of it, the Evacuation 
 of Fuliginous Matter will be imperfeO:, and 
 the Dilcharge of the Spittle will be difficult 
 and i.i fmall quantity •, fo that thele Humours, 
 being retain'd in the Capillary VelTels of the 
 Windpipe, will caufe the Delluxions and Ob- 
 ftrudions whereof we have made mention. 
 
 Another Caufe is the iU quality of the 
 Blood as it is grofs and circulates flowly^ not 
 only thro' the difficulty of Breathing, but 
 alio becaufe it is the produ£l of a crude and 
 indigefled Chyle, as 1 have prov'd in fpcn Ic- 
 ing of the Primitive Caufe^;. This bid Blood 
 will ftagnate in the Capillary Veliels of the 
 I i Pul- 
 
4^2 vf T R E A T 1 S E of the 
 
 Pulmonick \'eins and Arteries, upon fiiiclii^g the 
 lead Dil'pofition thcieun*-o in thele Organs. 
 
 But oi.e of the Principal Caull'S is the force 
 ot the I^eart, which is lb far from being 
 leAcn'd in this Diftcmper that it fccms to in- 
 crcafe, when tlic Blood is fent from the 
 lieait to the Lungs with more Eafe than 'tis 
 returned from the Lungs to the Heart, which 
 is no fmall Caufe of the Diforders that hap- 
 pen therein. 
 
 In fine, it will be eafy for me to account 
 for the Thymvsy the Glands of the Medi- 
 ajlinum^ the Pancreas^ and the Ai( font cry s be- 
 ' ii:g Schirrhousy becaule I am convinced by A- 
 
 a'iatomy, tliac the one ferve for a PafTace to 
 the F.ympha and the Chyle, the others for the 
 filtrating of the DiJfol vents, and in fliort thofe 
 of the Mefentry for the Preparation and Paffage 
 of the Lyr/ipha and Chyh, and we have difcover'd 
 a groffnels both in the one and the other 
 of thefe Liquids, fufficient to ftop them in 
 the Glands where they co-agulate, harden, 
 and fwell. 
 
 Having found out b^th the Primitive and 
 Secondary Caufe"', aijd explain'd all their 
 Effefts in the Difeafe in queftion, I ihall now 
 mention fome Objeftior.s that have been made 
 againft the Syflem 1 have advanced. 
 
 ift. OhjeBiDPy Children have been known to 
 fall into the Rickets, without its beir,g dif- 
 coverYi that either the Teeth, the Worms, 
 bad Milk, or any fuch like Caufes have bcca 
 the Occalion of it. 
 
 2d. Ohjicl. There have been fbme who have 
 raeveV falfn away, wliofe Arms and Legs 
 
 were 
 
nrticnlar mpans of in- 
 bably well known at 
 linions now, as to their 
 oe, our judgments are 
 y the event of insol- 
 
 If so soon after the 
 
 Mr. Dakin, nor Mr. 
 
 Bank, were g-cnerally 
 
 the time of the loans 
 
 minute investigation 
 cnlar quarters miglit 
 
 umstances materially 
 
 the pecuniary credit 
 y persons, usually ac- 
 
i 
 
 ly owing to his laborio 
 ertions, that the systeiT 
 was introduced into the 
 into all the other dcpai 
 we think we niay be p 
 tion to say, now charac 
 
 It should also be obs 
 ing no concealment noi 
 sponsibility of any p« 
 adopted the following 
 
 «' Resolved, That the 
 ity of Mr. Harison, or 
 now or heretofore conn 
 for any loss to it by rea 
 
Difeafes of the VjoN ZS. 4^9 
 
 wdre iicvertlielef? crooked, wlucli icems con- 
 trary to wliac I have luid dowji. 
 
 3d. Ohjc[h. Others liave only been Crooked 
 and Lean on one fide, which ought not to be 
 if what I faid in the Caiifes of the Crooked- 
 nefs and Leiinnefs were true. 
 
 4th. Ohjeci:. If the Compre/fion of the 
 Kerves of the Spine caufeg the L.eannefs in 
 the foft Parts, it ought, one would think, to 
 prevent the fwelling of the Bones which 
 are inider the foft Parts that are fallen a- 
 Way. 
 
 5th. ObjeSi. According to what has been fi'd 
 ot the good plight of the Organs of tlie Senle?, 
 the Liver, and the Spleen, and the Leannefs 
 of the other Parts, it can't be coijceivM that 
 this fhould happen thro' the Ibftnels of the 
 Spine, which preffes upon the Roots of the 
 Kerves, lince this Diforder does not alfed the 
 Kerves of the Brain, although the Bones o\. the 
 Cranium grow foft, as has been faid in fpeaking 
 of the largenefs of the Head in ricketty Per- 
 IbnSj and the opening of the Sutures that 
 unite the Bones oi thQ Cranium. 
 
 In anfwer to the firft Obje^lion, I fay, that 
 if any Child has been feiz'd with the Rick- 
 ets, without any Diforders being perceiv'd 
 in the five Things that I have laid down for 
 Caufes, one ought i;ot to doubt but fome of 
 them have had a ihare in it ^ finceone may 
 be miftaken in examining a Nurfe's Milk, 
 and in the Judgment one makes ot the other 
 Caufes :i feeing we are often attack'd with 
 
 1 i 2 com- 
 
484 y4 T R E A T I 5 E of the 
 
 common Diftempers, wheicot we our felves 
 ^ can bui imperfectly guefs at the (econd Caules, 
 and which we cani.ot certainly afcribe to any 
 Primitive one. 
 
 Anl'wer to the. fecond Objeftion. If any 
 Ricketty Child has been known wlio lias noe 
 fall'n away, I may anfwer that 'tis poflible 
 the Soltnels of his Bones was not confider- 
 able, befides that it may only ieizc upon 
 certain Bones of the Extremities, wiihouc 
 the Spine's b^ing touch'd, and that thro' 
 fome particular difpofition, as I have juft 
 faid, or thro' fome ill pofture the Nurle 
 may have ufed it to, or laftly thro' the 
 Cuftom of the Child when it walks : For we 
 lee fome lean to the Right fide, fome to the 
 Left, and that walk tottering, and bend their 
 Bodies alternatively, firft on one fide and 
 then on the other, whence the Spine inclines 
 different ways ^ fometimes the Crookednefs 
 is on the Pvight fide, fbmetimes on the Lett, 
 and often it bends towards the Ribs, i'o as 
 to aifnme the fliape of a Wave. 
 
 It will by this Time be eafy to conceive 
 why the leannefs is but on one Side. For 
 inftance, if the Spine bends to the Right, 
 tlie Hollow Parts of the F'trtcbr^ will be 
 brought near each other, ajid the reitchr<t 
 will, as it were, crufh one another on that 
 fide that crooked ^ whilft on the contrary 
 the Fertcbr£ will be feparated, and their Hol- 
 lows larger on the oppofite fide -^ whence the 
 Kerves of the Spine are only comprefs'd on 
 the crooked lide, and the Animal Spirits not 
 having their free Courfe, the Parts where 
 they ought to be diftributed will be lean 
 and withcrMj whereas the oppofirc Farts 
 
 will 
 
Difitifis of the Bones. 48$ 
 
 will be in good Cafe, becaufo their Nerves 
 iilue from the Spine on. thole Sides where 
 tlie rcrtebrx are not deprefsVi by each o- 
 thcr. 
 
 Anfvver to the fourth Objedion. If the 
 Bones don't wither like the foft Parts, that 
 proceeds from the Animal Spirics contri- 
 butii:g but little to their nourifhment, fee- 
 ing that th'S Spirit only helps to nouriih the 
 foft Parts by enduing them with an Elafticity 
 that makes an Equilibmtm wi(h the external 
 Air, to the end that the Blood may pene- 
 trate them with eafe, without being repell'd 
 by the Spring and Weight of the exteriour 
 Air \ and the Bones however foft they be have 
 yet folidity e lOugh to oppofe this Weight. 
 
 Anfwer to the fifth Objeftion. 'Tis fuffi- 
 cient to give an Account why all the Nerves 
 that come from the Cavities of the Spine are 
 comprefs'd, whiirt there is no interruption 
 of the Courfe of the Animal Spirits in the 
 Nerves that ilTue from the Bafis of the Cra- 
 nium.' We can al ledge Three Reafons, 
 
 The firfl is that the Spine is (as it were) 
 crufh'd by the weight of the Head, bjt the 
 Head having nothing to fupport, is not fo 
 crufli'd, wherefore the Nerves may pais 
 without fuiferiag any Compreflion. 
 
 The fecond is, That the Nerves of the 
 Spine run a greater length than thofe of 
 the Brain, excepting the 8th Pair and the hi- 
 tcrcoflal. 
 
 The third is, ThaC the Nerves of- the 
 Spine come out Hornizontally, and thofe of 
 the Brain Perpendicularly, whence they are 
 not comprelsM like thofe of the Spine. 
 
 1 i 3 All 
 
486 ^Treatise of the 
 
 All that we have faid feems luificient to 
 give an Idea of the foftriefs of the Bones, 
 of their Crookednefs, and the other Acci- 
 dents that proceed from it •, we ihail go on 
 to the Prognoliick and the Cure. 
 
 The Rickets are feldom cured when there 
 is an Hydrocephalus, becaule this Difeale is 
 Mortal oi- it lelf, elpecially when it is come 
 to that E eight as to leparate the Sutures. 
 
 The}'' are but feldom cured whole conglo- 
 bated Glands are hard and Schirrous, and par- 
 ticularly when tho(e of the A^efmtery have 
 this Defect, becaule the Chyle rauift pals 
 thro' thefe Glands, which it can't eafily do. 
 And as Life is prelervd by the Chyle, which 
 jaifes thro' thefe Glands to mix it felf with 
 the Blood and jrenew it, if this Paffage be 
 oaice intercepted the Animal in the endmuft 
 periih. 
 
 They who have not bred their Teeth but 
 feldom recover, both becaufe they fink un- 
 der the Pain "of cutting them, and becaule 
 *'tis neceifary theiy ihou'd have them to'chew,, 
 efpccially if they are wean'd. 
 
 They whole Spine is not crookd are more 
 eafily cured : In fliort, fuch as eat with a 
 good Appetite, and are brisk and lively, rer 
 cover Tconer than others. 
 
 The Queftion ut prefent is, Eow to cure 
 this Dii^emper, and it rauft be obferv'd, that 
 it is like others ealier to be mafler'd in its 
 Infancy, then when it has been of Ibme ftand* 
 ing ", that 'tis much ealier to prevent it, 
 tl^en to hinder its Confequence?, and that 
 when it is once at the height, Art has lei's 
 • (iiare iji the Cure of it th^n Kature ; And 
 
 what 
 
 
Difeafes of the Bones. 487 
 
 what IS moft certain, is that one can't de- 
 itroy any of its Effects, hut by removing 
 the Caufe. Tlierefore to follow [a the Cure, 
 the fame Order that I have obferv'd hitherto, 
 one muft firft have regard to the Primitive 
 Caufes, after which the fecondary Caufes and 
 their Elfefts may be deftroy'd. 
 
 As to the Primitive Caufes, one wards a- 
 gainft them as much as poffible, by letting 
 Children breath in a fine Air, by giving them 
 nothing that will breed Worms, but efpe- 
 cially by providing them good Nurfes, and 
 not making them leave a good Milk till they 
 have moft part of their Teeth, without 
 xvhich they fall into this D'ftemper as has 
 been faid. And if for want of taking thele 
 precautions, the Child happens to be attack'd 
 with this Diftemper, here is in two words 
 what muft be done, either to cure it entirely, 
 or palliate it. 
 
 Firft one muft prefcribe a Diet, which is 
 different according as the Caufes are dilferent : 
 If the Air be in fault, the Patient muft 
 change his abode •, or if that be not poifible 
 the Air wherein he refides rauft be correfted 
 by the perfume of Plants impregnated with 
 Sulphurous Particles, ly the Calcination of 
 Partridge's Wings, of Kids, of Harcfliorn, 
 and other things that are full of Volatil 
 Salts. 
 
 If the Teeth are hard to cut they muft 
 be help'd by rubbing the Gums often with 
 the Blood of a Cock's-Comb, the Brains of 
 a Hare, the Oyls of Sweet Almonds, LiJlies, 
 Palm, and other little Remedies, wh'ch Sue- 
 cefs has made cuftomary amongft thofe who 
 hiive the Care of, and Nurfe Children : If 
 I i 4 the 
 
ii 88 J T KZ AT I sz of thg 
 
 the Gums are too hard, they may be lanced 
 
 to tacilitate the cutting of the Teeth. 
 
 Whe 1 there arc Worms one muft bleed to 
 prevent an Infiamation, and give Clyfters of 
 Milk, wirh a Decodion of Figs,- Raifins, aqd 
 a little" Sugar. On the contrary one mull 
 give them all the Bitters at the Mouthy as the 
 Preparatioi.s of Wormwood, Succory, Rhu- 
 barb, Cuinciuina, Opium, and other Medicir.es 
 that are proper to kill them. 
 
 The fweet Clyfters attract the Worms, 
 which being but meer Machines, muft me- 
 chanically remove from the bitter Medicines 
 that are taken at the Mouth, to draw near 
 the fweet one, which we have recommended 
 to be given in Clyfters, which they can't do 
 without appro? chi:ig the PalTage whereby one 
 would expel them. But to difpofe them the 
 n-;ore to pafs, one may give Catharticks with 
 Succory Water, the Syrup of the fame Plant 
 and Rhubarb, or in its ftead the Syrufus Ma- 
 f^ifiyalis, which produces two good Effects, 
 for the Bitters kill or drive away the Worms, 
 and befides the working of the Purgatives, 
 qu'ckens the Periftaltick MotioR of the Guts, 
 which inclines thefe Vermin to crawl down- 
 wards. 
 
 One muft not forget Emeticks, and the 
 Preparations of Mercury, which are good to 
 kill the Worms and to dilcharge them, as 
 well as the Verminous Matter. Infine, the 
 Patient muft be made obferve a Regimen, 
 by prohibiting the Ufe of all Food that is 
 fweet, milky, or apt to turn fowr.^ 
 
 If the Nurle who has begun to Suckle the 
 
 ■ Child, has not a good Milk, is Sick, has 
 
 '^.ny Chagrin, is obliged to work much, or 
 
 fares 
 
Bifciijds- of the Bones. 4^9 
 
 fares hardly, one rauft provide another from 
 whom the Child may derive a good lufte- 
 nance, to the end the Chyle, the blood, and 
 t]\e Lyrnpha may be corrected, lb as all the 
 yjivts may refume their Plumpnels, the Bones 
 may grow and harden, the Teeth may cut, 
 and the Child may have Strength iufricie.it 
 to bear up under the Fain they caule j fo 
 that if the Child falls into the Rickets im- 
 mediately after being wean'd, and has been 
 wean'd too foon, or before the cutting or its 
 Teeth, it muft .be provided with a good 
 Nurfe, whilft one eiideavours to deftroy the 
 Ibcvondary Caufes-.and their iiileOis, after the 
 following manner. 
 
 One muft Purge, but it muft be feldom, 
 and with the moil gentle Remedies, unlefs 
 there be any Worms, becaufe 'tis not fo ne- 
 ceifary to evacuate as to correct the Blood 
 and the Lympha, by the Decoclions of Aro- 
 matick Plants, and by Broaths, wherein one 
 may put the Polypodesj the Powder of Vipers, 
 inftead ot common Salt, the Volatil Salts of 
 Hartfhorn, and Cranium Humanum : In a word 
 all Volatil Salts are proper. 
 
 If the Child can't take thefe Remedies, or 
 even if it takes them eafdy, one can't do bet- 
 ter than to make the Nurfe ufe them alfo. 
 
 As for the Deformity of the Spine, the 
 Breaft, and other Limbs, they may be cor- 
 re«:led, and even remov'd, if befides the Re- 
 medies prelcrib'd. Care be taken to keep in 
 the Spine by Bodice, and the Arms, Legs, 
 and Thighs, by bandages of Leather, Linnen, 
 and Steel, and by a Boot. 
 
 This 
 
490 -^ Tke AT I SI. of the 
 
 This is the liim of what 1 thought proper 
 to fay, in order to give an Idea of the Rickets- 
 if I have been more prolix upon the Caules, 
 and the Explication of the Symptoms, than 
 upon the Methods of Cure, 'tis becaufe I am 
 convinced that Diieafes which are once well 
 known, indicate of themfelves the Remedies 
 that are proper for them. 
 
 FINIS. 
 
 THE 
 
THE 
 
 CONTENTS. 
 
 Book I. Chap. i. Page 
 
 ATrcatife of the Difeafes of the Bones, Page i 
 Of Luxations and Sprains^ of Luxations in 
 general 2 
 
 StniEliire of the Tarts ib. 
 
 Of the Species of Articulation 3 
 
 Of the Nature of Ligaments 1 6 
 
 Of the Difpofition of the Mufcles 4 
 
 Of Cartilages three kinds 4 
 
 Of the Sinovia 4 
 
 Of the Taffage of the Feffels 5 
 
 Of the Fat 5 
 
 Of the Skin 5 
 
 Of the Diff?rence of Luxations 8 
 
 From the Species of the Articulation - 9 
 
 From the Place where the Bone fettles when diflocated 9 
 Of the Caufcs of Luxation i o 
 
 Of Luxations proceeding from internal Caufes i o 
 Of the difference of Luxations derived from the Dif- 
 eafes and Accidents attending them i o 
 Of the Caufes I o 
 Of the DiagnoflicJ: Signs 1 1 
 Of the Signs of an iucornpleat T uxation 1 3 
 Of the Signs of Luxation proceeding from Internal 
 Caufes 1 4 
 Signs which [hew the Place where the Bone is [ettle4 17 
 Of the Accidents 1 8 
 Aphorifms of ufe in prcgnofiicatin7 18 
 
 Of 
 
The CONTENTS. 
 
 Of the Cure of Luxations 20 
 
 Chap. 2. Of the Luxation of the Head 33 
 
 Signs and Proancfticks 35 
 
 Chap. 3. Of the Luxation of the Vnder Jaw 39 
 
 of the Diagnofiick 40 
 
 Of the Caufes 42 
 
 Trognoftick 43 
 
 The Cure 43 
 
 Chap. 4. of the Luxation of the Vertebnt 46" 
 
 Of their Sorts and Differences 5 1 
 
 Of the Diagnojlick Signs 5 2 
 
 Trognoflick 5 5 
 
 0/ /^tf Cure 58 
 
 Chap. 5. 0/ the Luxation of the Coccyx 63 
 
 Chap. 6. Of the Luxation of the Clavicula 70 
 
 Of the Caufe 7 r 
 
 Of the Signs 7 1 
 
 Trogno(iick 7 2 
 
 0/ f/^f Cz/r^ 72 
 'The Luxaticn of the external End of the Clavicle 74 
 
 Chap. 7. Of the Ltix at ion of the Arm 79 
 
 Of the Caufes 82 
 
 5z^^^ that the Humerus is luxated downwards S 3 
 
 5'^«^ of an Outward Luxation 84 
 5/^??J that the Arm is luxated under the Arm-Tit 85 
 
 Signs that the Humerus is luxated forwards 85 
 
 Trognof^ick 87 
 
 Of the Cure of the Luxation of the Arm 89 
 
 The fir ft: Method 89 
 
 The fccond Method 90 
 
 The third Method po 
 
 The fourth Method p2 
 
 The fifth Method 93 
 
 The fixth Method 94 
 A JDefcription of the Amhl and the mafwcr of ufi»g 
 
 it 95 
 
 Defc'ds of the Amhi 96 
 
 Tnc 
 
The CONTENTS. 
 
 Page 
 
 The feventh Method 96 
 
 The eigth Method 97 
 
 The ninth A<fcthod 98 
 
 ^ DefcriptioT? of the Netv Machine 1 04 
 
 for the Dre(fing 1 1 2 
 
 Chap. 8. Of the Luxation of the Fore-Arm from 
 
 the Humerus . * 1 1 9 
 
 Chap. 9. Of the Luxation 'of the Radius called Di~ 
 
 aflafs, or Excurfon of the Bone 125 
 
 Chap. TO. Of the Luxation of the Wriflr 128 
 
 Of the Prognofiick and Accidents that attend^ or may 
 
 follow thefe Luxations 133 
 
 Of the Cure 1 38 
 
 Chap. II. The Dreffmgs 139 
 
 Of the Luxation of the Thumb and other Pingers 141 
 Prognoflick 1 42 
 
 Chap. 12. Of the Luxation of the Thigh 144 
 
 Of the Kinds and difference 1 45 
 
 The Signs I47 
 
 The Explication 148 
 
 The Sign that the Luxation is ufwards and outwards 
 
 Ihe Explication 149 
 
 The Signs that the Luxation is downwards and internal 
 
 The Explication I co 
 
 Of the Prognoflick 1^2 
 
 Ohfervations '54 
 
 Of the Cure i5i 
 
 Chap. IS- Of the Luxation of the Rotula and Tibia 
 
 16S 
 Chap. I^. Of the Luxation of the Foot I7I 
 
 Chap. 15. Of Sprains of the Foot I75 
 
 The Cure j'jj 
 
 Chap. 16. Of the Anchylofs 1 79 
 
 The Signs Ip^. 
 
 Trogncjlck 1 93 
 
 Part 
 
The CONTENTS. 
 
 page 
 Part id. Chap. i. Of the traEluresinGeKeralix^ 
 
 Chap. 2. Of the Frdlure of the Nofe 2^6 
 
 Of the Cure 2 3p 
 
 Chap. 3. Of the Frdlure of the lower Jaw 242 
 
 Frogno(ilck 243 
 
 Of the Cure 244 
 
 Of the complicated FraUure of the lower Jaw i ^6 
 
 Chap. 4. Of the Frdlure of the Ribs 247 
 
 Chap. 5. Of the Deprejfions of the Ribs 256 
 
 Chap. 6. Of the Fraclure of the Sternum 161 
 
 Di<egno(lick and Prognoflick 262 
 
 Tl;c Cure 26a. 
 
 Chap. 7. Of the Fran:ure of the Of a Ilia and Pubis 
 
 265 
 
 Trognoflick 266 
 
 Of the Cvre 266 
 
 Chap. 8. Of the FraElure of the Clavicle 26j 
 
 Obfervatiorjs thereon 272 
 
 Chap. 9. Of the FroBure of the Omoplata 275 
 
 Prognoflick 278 
 
 The Cure 278 
 
 Obfervations thereon 280 
 
 Chap. 10. Of the FraBure of the Arm 284 
 
 Chap. II. Of the Fracture of the Fore- Ann 287 
 
 Chap. 12. Of the Fr ad: we of the Thigh 296 
 
 Of the FraSlure of the Neck of the Femur 302 
 
 Of the cor^if Heated Fra5lure of the Thigh 308 
 
 . Of the PrcgricfTick . 509 
 
 Of the Cure ^lO 
 
 Remarks ufeful for young Pupils 316 
 
 Chap. 13. Of the Fral'turc of the Rotula 327 
 
 Obfervation of Cotifequence 334 
 
 Chap. 1^, Of the Simple FraSlure of the Leg 337 
 Chap. 15. Of the complicated FraBure of the Leg 
 
 354 
 A Befcripticn cf a Cafe of a rew Invention for the 
 
 Dreffwg cf complicated FraBurcs of the Leg 36 1 
 
 Chap. 
 
The CO is TENTS, 
 
 Page 
 Cliap. I<5. Of the Rufture of the Tendons that arc 
 
 inferted at the Heely and art called the Tendons 
 
 of Achilles 3<^7 
 
 Chap. 17. Of the Exofiofis, and the Caries 379 
 DIagno flick SI pis of the Exoftofs 4I7 
 
 Signs that the Exofiofis is Richtty 422 
 
 Signs tlxat nuift accompany or precede the Scorhutick 
 
 Exofiofis 423 
 
 Signs of the Pocky Exofiofis 428 
 
 Sians of Cancerous Exofiofis 44I 
 
 Signs of a Scrophulous Exofiofis 44 1 
 
 Progno flick 443 
 
 Of the Cure of the Exoflofisy and Caries 443 
 
 Of the Cure of the Local Vite of the Exofiofis and 
 
 Caries 445 
 
 u4phorifms compofed by the Author being the ProduSt 
 
 of his Obfervations 4^5 
 
 Chap. 18. Of the Rhachitis, or Rickets 46^4 
 
 Of the Caufes of the Rickets 46" 5 
 
 Of the Crookednefs of the Bones in the Rickets 473 
 
 -^\\V Of T>A t , 
 
 FINIS. 
 
BOOKS pr hit ed for Tho. Woodward, at the Half- 
 MoDM, ove}-aga'r,!Ji St. Dui;ltanVChurch tn 
 Flect-ftreet. 
 
 I. A Trcarifc of Ciiiiurgical Operations, according 
 /\ to the Media!. ifm of the Purts of the Human 
 Botly ; and the Tlicory and Pta£iicc of the moll Learned 
 and lixperienc'd Surgeons in Paris. With the Bandages 
 for each Apparatus, and a Defciiprion of the InlVrumcnts 
 proper for ChiriirLncal Operations. Trarifl.ucd from 
 the Frnich of Monfieur RnitrtuSy panics Croijfant Carercfot, 
 reviled ai.d corrciStcd by Mr. St. ^k^/>? Anaton^.ilt to his 
 Alajefty. 
 
 II. General Obfervations, and approved Prcfcriptions, 
 in the Modern Prafticc of Phyfick ; containing the befl: 
 Method of curing moft Diftempers; amongft wliich, the 
 Plague, the Gout, the Cholick, Confumption, Scurvy, 
 Jaundice, Venereal Difcafc, Small-Po.v, and Mcafles, A- 
 poplexies, Palfics, Stoppage of Urine, Afthma, Dropfy, 
 Pleurify, &c. 
 
 III. A Syllabus of what is to be performed in a Courfe 
 of Anatomy, Chirurgical Operations, and Bandages, by 
 John Douglas, Surgeon; to which is added, His Ac- 
 count of a New Method of making the high Operation in 
 order to extraft the Stone out of the Piladder. 
 
 IV. A New Treatife of the Art of Thinking, or a 
 Complcat Syftem of Reflections, concerning the Conduft 
 and Improvement of the Mind, illuftratcd with variety 
 of Chara&crs and Examples drawn from the Ordinary 
 Occurrences of Life. Written in French by Mr. Cro/az^ 
 Profcffor of Philofophy and Mathcmaticks in the Aca- 
 demy of J.niifanc^ l)or.c into Englifli. In two Vloumes. 
 
 V. Tlie Praftical Fruit-Gardener, being the bcft and 
 Kewcft Mctiiod of Raifing, Planting, and Pruning all 
 Sorts of Fruit-Trees, agreeably to the Experience and 
 Praftice of the n:oft Eminent Gardeners, and Nurlci-y- 
 Men. By Stephen Siv'nzer. Reviled and Recomineded 
 by the Reverend Mr. Laurence^ and Mr. Br.iMc\\ .A- 
 dorn'd with proper Plans. 
 
 F J S I S. . 
 
COLUMBIA UNIVERSITY 
 
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