any Malignity as from the Bite of a Venemous Animal besides the signs of mortification which appear upon the part several others manifest themselves as Carbuncle Fever Vomiting Syncope and Phrensie Signs of a Sphacel The Signs of the Sphacel do not differ from those of the Gangrene but Secundum Majus and Minus A Sphacelated part is heavy black stinking and withered feeling is quite lost and the Skin is easily separated from the subjacent Flesh finally from being soft as it was before when it was Gangrenated it dryeth up when it is entirely mortified You must observe that if the motion sometime remain in a sphacelated part as in the Foot c. it proceeds from that the Bellies of the Muscles which are not interessed making their contraction the Tendons in the mortified part are obliged to follow their motions I pass to the Explication of the chiefest Accidents Cause of the Blisters The Blisters that come upon the Skin proceed from the Blood lying caking and curdling in its parts there separating from it a sharp and corrosive serosity which insinuates it self under the Skin separates the Cuticle and raiseth it almost like as in Scalds Cause of the Blackness The pulsation ceaseth in the part and its colour grows pale and livid I have shewed that the pulsation ceased by the compression of the Vessels It 's probable that the red colour disappears for want of new Blood and that which lyeth caking rots in the part giving a violent or black colour according to the degree of Corruption and Mortification Cause of the Pains The pains proceed from the irritation and great impression which the sharp and malign serosity makes upon the Membranes and on the Nervous Fibres which are dispersed in the parts The Pains cease because the Extravasated Matter lies heavy upon the Nerves as well as upon the Sanguiferous Vessels and stop entirely the passage of the Spirits we also observe that the pain gives soon over after the pulsation Some modern Authors pretend it to be enough that the motion of the Blood being hinder'd in a part to abolish the sensation and motion without the Nerves being compress'd to prove it they tie the descending Aorta and they observe the inferior parts deprived of sense and motion but they do not consider that these parts being no more irrigated nor stretched by the Arterial Blood they must needs sink and dry up and the Nerves whose substance is very soft must be pressed from whence I conclude that in all kinds of Gangrene where the feeling is entirely lost the Nerves do always suffer some compression Cause of the softness The softness of the part proceeds from the abundance of serosities that water the Fibres but also being no more vivified by the Blood and Spirits the relax and loose entirely their spring or Elaftic Vertue Cause of the Progress of a Gangrene The progress of the Gangrene comes sometimes from the Blood which ceaseth to vivifie the parts as in old People but for the most part it comes from the Action of the acid Juices which gnaw and successively destroy the neighbouring parts It 's doubtless this malignant Matter which causeth the Fever Syncope and the other Accidents which are ordinarily before Death Thus having spoken of the Causes Signs and Accidents of the Gangrene I come to its Prognostics and Cure A Gangrene which attacks old People and Hydropic's Prognostic's for want of Natural heat is always mortal In this kind of Gangrene where the Spirits have forsaken their subject we must not undertake the Operation because the Patient would infallibly succumb under the violence of the pain That which possesses the soft and tender parts especially the internal is veâ—â— dangerous and degenerates very often into a Sphacel It 's also sooner cured in young than old in strong Bodies than in Cachochymic Cure of a Gangrene from Gold The Gangrene which is caused by Cold and which ordinarily possesses the Extremities may be cured provided the part be not entirely mortified you bring the Patient near a moderate Fire chafe the part or steep it in luke-warm Water and when the great Cold diminishes and the Spirits begin to spread themselves upon the surface you apply Fomentations Similia That which follows great Inflammations Tumours Fractures Luxations Contusions Anevrisms Erisipelas Ulcers Scalds Scorbutick Spots Venomous Bites after application of too Emplastic Medicines Caustics and Actual Cauteries and generally upon all strong Compression may be cured in the beginning which makes us consider these kinds of Gangrene in two different states as that of their Birth and that of their Perfection In the first good Remedies capable of smothering and stopping this Disease as deep Scarifications which disengage not only the part but also give occasion for the Medicines to penetrate and produce a more sensible effect If in spight of all this care the Gangrene should increase and incroach on the neighbouring parts lay aside the use of Medicines and proceed to Amputation of the Member that the Mortification may not be communicated to the whole Body CHAP. XXXVI Of Amputation YOU must observe first of all that though a part be Mortified and Amputation the only help to save a Man's Life yet you must not always declare for the Operation for Example When the Operation is not to be attempted when the Mortification possesses the superior part of the Arm or Thigh it would be a profaning it to undertake it being too near parts so necessary for Life without causing the ruine of the whole Subject If it only possess the Extremities and an acute Fever Syncope and Vomiting which are Mortal Symptoms 〈◊〉 accompany it and the natural disposition of the Humours be entirely perverted and depraved the Operation would prove very dangerous and hazardous Every one knows that this Operation is practised in great shatterings of the Bones in old Ulcers and Fistula's of the Joynts but it 's first necessary to examine the Nature of the Wound For Example if the Bone be quite broke to pieces if the Splints be engaged and as it were forced down into the Flesh or among the Tendons if they prick some Nerves or Sanguiferous Vessels so that they cannot be restor'd to their natural position it would be necessary to try the Operation but if the accident be not too great and the pieces can be brought level again with the Bone be no way alter'd nor have caused any Inflammation or pain one might hope for its cure by Medicines unless some Joynt be concerned In a word I say that all compound Wounds are of difficult cure how inconsiderable soever the complication be especially there being any indisposition in the subject In this occasion the Pain and Inflammation the two Accidents most to be feared particularly when they continue and produce some more troublesome and when the Accidents are pressing it 's dangerous to delay and very often the Operation it self is not able to
Hydropics what I have said explains it sufficiently besides we well enough conceive that the serous Blood is deprived of spirits that it moves more slowly in the Extremities than any where else and consequently the heat must rather be lessen'd in these parts than in others as I have made you observe when I spoke of the Dropsie besides the ferosity filters in so great a quantity between the Fibres and the parts that it may by its weight press the Vessels and so cause a Gangrene Secondly great Cold causeth often Gangrene and Mortification in the Extremities especially the Feet Hands Ears and Nose particularly in Persons obliged to march in the Snow during excessive rigours of Winters as those which Travel in the Northern Regions How Cold causes a Gangrene To explain this Phenomena you must only remember what I have said in the comparison of Wine where we have seen that the spirits of Wine are concentred by the cold and that the exterior parts finding themselves deprived of spirits freeze This happens to a Bottle of Wine exposed to a very cold Air You may observe in breaking the Bottle that the spirits have retired to the center and preserved their fluidity while all the rest is congealed I say that the same thing happens in the Blood by the rigour of cold and while the spirits retire to the center of the Animal the exterior parts remain gangrenated being only irrigated with a dead and insipid Phlegme which congeals in the very substance of the parts It 's easie to comprehend that at the same time the parts feel the pinches of the cold they retire being compress'd by the action of the Air which first causes those quick and penetrating pains and hinders the Blood from continuing its motion in those parts therefore lying there still it insensibly stops every passage and causes an entire mortification Hinc Interdum saith ETTMULLER ex frigore extrinsecus Irruente partes Gangrenosae fiunt So much for what regards all kinds of Gangrenes that depend on the dissipation and concentration of the spirits Tumors Fractures Luxations c. may cause a Gangrene now I come to those that depend on the interruption of the course of the Blood and its motion First Tumours Fractures and Luxations may cause a Gangrene in a part by compressing too hard the Vessels that convey the Blood there I confess that this kind of Gangrene is rare because the Vessels communicate themselves in so many places and there coming so great quantity of different branches from them that it 's difficult that all the supply of Blood should be hindred in a member Nevertheless Fabritius Hildanus assures us Observation that he hath seen a Man who was attack'd with a Gangrene in both Legs and his Feet were always cold and benum'd so he died without a Fever without any other symptomes His Body being opened there was found a schirrous Tumour in the Region of his Reins over the division of his Iliac Branches This Tumor pressed first slightly the Vessels and caused the cold and benumming of the Legs but as it grew it press'd the Artery and Vein so hard that the Blood could no more descend into the inferior parts to vivifie them Concerning Fractures of Dislocations it may happen that the head of a Bone or some pieces may compress the Vessels so hard as to hinder the passage of the Blood for the same reason Bandages Too tite Bandages c. used in Fractures and Luxations strong and close Ligatures of the Vessels may cause a Gangrene especially if one makes it on the great Trunks unless the Branches which communicate together in several places furnish the Blood that 's necessary for the vivification of the parts Ettmuller saith Nimis firmae Ligaturae externae interdum hoc malum inducunt in quod fit interdum si in ossium Fracturis Locus Fractus orcte nimis Ligetur In all these cases it 's very easie to see that the mortification depends simply on the interruption of the course of the Blood without the concurrence of any other cause but you will see in what follows how the ill disposition of the Humours may augment and even produce this kind of Gangrene A Gangrene may happen by long lying on the Buttocks c. Secondly a Gangrene happens often upon the Buttocks of those who have had long Sicknesses and that are obliged to lie long on their Backs first the Cutis begins to rise afterwards there happens Inflammation in the Flesh which ends in Rotteness and Gangrene The first is caused by the sole compression of the Vessels in the part but if at the same time the Patient involuntary sheds his Water and Excrements the Gangrene comes sooner because they gall and heat the parts by their acrimony and so increase the Inflammation and consequently the Inflammation and Gangrene Great Inflammations Contusions c. may cause a Gangrene In the third place nothing's more common in the practice of Chyrurgery than to see Gangreens follow great Inflammations Contusions and even Anevrisms when ever the Tunicle of the Artery is broke and the Blood extravasated between the Muscles I say that in all these occasions if the Blood be extravasated in great abundance it must needs lie heavy on the part and press at the same time the Blood Vessels so that it entirely stops the passage to the new Blood which comes to irrigate and vivifie the part Behold this is the period of Inflammations proper to produce a Gangrene and as there must be great abundance of Blood to compress hard the Vessels so it happens only upon great Inflammations If I say that in great Inflammations the Extravasated Blood compress the Vessels it 's not a simple Imagination only but a constant Truth since the Pulse ceases to verberate at the same time the part begins to gangrenate and it 's red colour grows pale livid and black which clearly demonstrate that the sanguiferous Vessels are compress'd and the access of new Blood hindred Repercussive Astringent Medicines improperly applied may cause a Gangrene In the 4th place a Gangrene may happen upon the least Inflammation even on Érispielas when ever too strong Repercussive Astringent or Emplastic Medicines are inconsiderately applied To conceive this well you must observe that the Extravasated Liquors transpire very much and that this Transpiration does extreamly discharge the diseased part of the quantity of Humours which it contains so while the Pores are open in Phlegmons and Erisipelases and the most active and agitated particles of the Bile and Blood evaporate the part always discharges it self of some of its Burthen so not much fear of Gangrene This is the reason why in the Southern part of America there never was seen a Gangrene come upon Wounds or Inflammations because the great heat of the Countrey opens the Pores of the Body but when the Pores are closed by Astringent Repercussive or Emplastic Medicines and the transpiration
into the least corner that the Matter may not lurk there It 's so true that the Mass of Blood takes up the purulent Matter in the time of its flay there Matter often seen mixt with the Blood that whenever you Bleed the Patient you often find some Pus mixt with his Blood How to consume the Callosity of Wounds If the Lips of the Wound grow callous you must betake your self to general Remedies which sweetens the acrimony of the Blood or Topics which digest and ripen the Matter as Emplas Andreas e cruce which makes the edges of the Wound tender also Digestives of Turpentine Spirit Vini Ol. ovor Pul. Aristolochia If all this be not enough to waste the Callosity you slightly scarrifie the Lips of the Wound to give way to the Remedies to penetrate and excite suppuration If the part disengages it self by a copious suppuration you prefer Compresses soaked in warm Wine before Cataplasms because it fortifies the part Always after long Suppurations fungous Flesh grows It 's observed that after long suppurations there always grows proud Flesh which is sometimes taken away by compressing the Wound a little if this pressure be not enough we use Pul. Sabinae mixt with Hony or pass over it the Coustic Stone or use Pul. Alum Vet. after it 's consumed we stop its generation with the Aq. Phagodonica which dryeth and shuts up the Extremities of the Vessels which had been before relaxed by the Suppuratives which had given room to the nourishing Juice by its overabundance to beget this fungous Flesh The Method is often changed according to the disposition of the Wounded Subjects for Example elderly People or those that are lean and spare have ordinarily their parts soft and loose because a part of their heat is extinguished in this case the Phagedenic Water would be hurtful because in shutting the Pores too much and not permitting their little heat to open them the Wound would entirely dry up Detersive and Traumatic Medicines ordinarily supply its default because there contain alkaline particles which destroy the acid of the Blood by insensibly opening the little mouths of the Vessels and charge themselves with the Suppurative particles which being united with them stick at their Extremities to regenerate new Flesh such is the Spirit or Decoct of these Vulnerary Plants Some choice Traumatic Plants as Rad. Aristoloc O. Long. Fol. Vincae Pervinc Scord. Absinth Fol. Rad. Angelic Consolid Pyrolae Scrophulariae Sanicula Persicaria and may others These Symples are charg'd with alkaline particles which absorb the predominant acid hinders the rise of the Ever and makes the Wound of a Vermilion hue We observe according to the degree of Corruption that when the Suppurative particles cannot accommodate themselves to the Extremities of the Vessels without the help of some medium we mix with the Traumatic Decoctions some things that have a kind of unctiosity in them as Mel Rosat which is admirable especially when the Pus is thin and fluid whereas if it be thick we lessen its quantity If it be black and serous it 's a sign that it is in the last degree of corruption As in this alteration of the Blood where Traumatics cannot master the Acids we use successfully a Spirit drawn from brown Sugar An Extraordinary Spirit for Wounds Vitriol Mart. Hep. Antim which resists all sorts of Corruptions This Spirit is charged with Balsamic Styptic and Alkaline sulphureous salt particles The Balsamie particles supple the Vessels by their unctiosity the Styptic fortifie them by their Astringency and the Alkalist salts blunt and master the sharpest Acids by their porosity I think this method of dressing is to be preferr'd before that where they use greasy Unguents Plaisters and Balms without intermission Signs of good Pus That the Pus be right it must be of a moderate consistence white and without any ill smell It often happens that when we intend to destroy its acidity there riseth a soft fungous Flesh which depends on the great fermentation of the Acids and Alkalies and when that fermentation ceases that faint Flesh is dissipated only by compression Most Practitioners without any reflection presently use burnt Alom and if it work not fast enough they use red precipitate and if that performs no more than the other they make a mixture of them which may well be call'd the Diabolical Corrosive it increaseth the Pain and renews the Inflammation But to avoid the Impression of such a strong Corrosive you take the Traumatic Decoction in which you dissolve a Drachm or two of Calcin'd Vitriol so you consume insensibly the Flesh It 's observed that the Flesh often grows hard especially when the part is too much loaded or the Bandage too strait the motion of the Juices being intercepted which must be avoided in all sorts of Wounds If the Flesh be red and granulate well you must not press it you introduce only into the Wound a pledgit of Lint wet in warm Wine or Brandy You must never wash Wounds it 's enough to dry them with Lint If you are obliged to siringe them How to Siringe Wounds you must do it discreetly because the Injection melts and dissolves the Flesh so that instead of breeding good it produces Fungous in this case Lint only soaked in warm Wine sufficeth because it cleanses the Wound in drinking up the Impurities it finds there unless there be some Sinuses which cannot be opened by reason of the Vessels Tendons or thickness of the substance which we must be obliged to offend in making the Incision then we use Injections when we cannot introduce Lint in the bottom of the Sinuses We always observe in Wounds certain white and hard places which are nothing else but some broken Lymphatic Vessels and which most Practitioners take for the beginning of a Cicatrix in that case Lime-water is useful to dry up the Extremity of the Vessels and dissipate the Glutinous particles of the Lympha which produces some Fungus's to grow over the Vessels It 's very important to distinguish this white mark from the extremity of the cut Nerve for if one should put on a Nerve any corrosive Medicine it would excite an insupportable pain which it doth not here besides Experience Authorises it as often as we carry off a Gland and Lymphatic Vessel of a Veneral Bubo there appears next morning a round and hard point which cannot be consumed without Pul. Vitreol Rub. all other as Precep and Allom burnt c. work in vain But that which is most surprising is that this Corrosive Powder which in 1000 occasions is insupportable is not felt at all in this You must observe that if some Limphatic Vessel open in the bottom of a Wound and spils the Lympha there it fails not to turn Fistulous this for the most part happens unforeseen in which case to cure the Fistula you must open even to the Gland if possible to destroy it and
advantages we receive from it It 's this which recommends the Artist who dexterously reunites the Parts divided who divides those discreetly that are united who draws together with an extraordinary care those bodies which in respect one to another are strange and who with Art and Industry supplies whatever are wanting to our perfection whence the end which he ought to propose to himself is to perform well these four Operations to disentangle all the difficulties they contain and to observe all the circumstances which are precedent concomitant and which follow in order to maintain the parts in their union and natural Situation Here I have a large Field to dilate my-self into the praises of Surgery but besides that the shortness of time does not permit me I must acknowledge I dare not undertake it least I should sink under the weight of so painful an enterprize for all the Authors who have wrote of it and boasted of their Excellency in this Art were never able to give it those due Encomiums which are proportionable to the great advantages we find in it wherefore I shall stick close to my Subject and I dare say that if these new Anatomists who have made such great and wonderful discoveries had made a due and just application of them to the Art of Surgery and if those great Practitioners had enrich'd it with their Observations we should have found such advantages which will never be unless they change their Principles But the Subject being so thorny and difficult we find very few who are willing to cummunicate to us their Ideas and particular Discoveries Most do but treat of these matters superficially and without diving into the bottom which is the reason that oft-times we cast the difficulty of the Art upon the evil disposition of the subject I acknowledge that it 's very hard to hit always right because Nature is often various in her motions and works in such hidden corners and by ways so little known that she destroys by some unexpected stroke which we do not foresee the whole Oeconomy of her Operations It 's not enough to understand the practice of Chirurgical Operations by halves It 's not sufficient to undertake one Operation only we must have a perfect knowledge of the subject on which we are to exercise our Practice that is to say its Temper Disposition and the Part afflicted By the temper I mean a certain disposition of parts that consists in the order of these resorts or springs which compose them VVhat the Tempers and in the figure of their Pores proportionable to the nature of those liquors which pass thro' them and of their motion sometimes more sometimes less rapid Disposition of the Body The disposition of our bodies relates to the regimen of life Inclination Age Season Habit and Strength for if an indisposed person observe an irregular way of living if he be of a spare body void of strength if his age obstruct the performance of the Operation or in fine if he has a greater tendency to that which is contrary and hurtful to him than to what will be profitable and advantageous in this case the Surgeon ought to suspend his Judgment least he should run the risque of doing the indispos'd person more harm than good Part affected Touching the part which suffers the Operator must perfectly understand its natural Constitution Connection Action and Use in case he designs to draw any advantage from his Undertakings and prevent the emergent Symptoms usual in these occasions If the Operation may be delayed 't is convenient to expect a favourable Season as for example the Spring and Autumn Nature of the Spring In the Spring the Blood and Spirits which the cold had driven towards the Centre exalt themselves to the Surface and with a greater heat revive the parts which before were as if benum'd and without life they are in a Fermentation soft natural and by consequence capable of all the good effects which can be expected But on the contrary in Winter the cold obstructs the Pores hinders Transpiration changes the Oeconomy of the Circulation and the Blood is depriv'd of that vivacity which is capable to animate our bodies Nature of the Autumn In the Autumn the Action of the Salt and Sulphur which had seized the upper Parts and which were in a continual exaltation during the excessive heat of Summer is a little represt the Blood which had got a sharp and bilious disposition by an immoderate heat sweetens and allays the extraordinary Effervescence which was the occasion of a continual loss of Spirits These are as I conceive the chief Maxims which are to be observed before we enter upon the particular of every Operation I could enlarge my self more upon the Operations in general but as such long discourses don't clear the difficulties which they contain and according to the Order which I have proposed my self to publish nothing to the World which is not worthy the attention of the Reader I conceived I might be excused from producing the troublesome Definitions Divisions and Subdivisions which make up the Principal Ornament of the greatest part of Chyrurgical Authors CHAP. II. Of the Reunion of Wounds ACcording to the order of this Treatise we begin with the Sutures which are only practis'd to reunite the divided Parts but first we must say something concerning Reunion to be inform'd after what manner it s done we must observe two things Vnition of Parts divided the work of Nature The first is that the Reunion of the divided Parts is only the Work of Nature who on this occasion makes use of her natural Balm The second That all the Surgeons Art doth nothing for this Reunion but as he is the imitator of Nature he must to second her designs and to procure the Union of Wounds use three means Three Means to be us'd towards the Vnition of wounds First To cleanse the Wounds exactly and free them from all extraneous bodies Second To bring the Lips together and Third To keep them in the same situation for to satisfie these three Intentions a Surgeon must be inform'd of the Structure of the Parts and of the Nature of the nourishing Juyces which entertain them The Body only a heap of Fibres Vesicles and Vessels As for the first its necessary to know that all the parts of our body are only a heap of Fibres Vesicle and Vessels but because the different ranks they keep disposes in every one of them Spaces and Pores of different figures the nourishing Particles of Blood must needs accommodate themselves differently according to the various configurations of the Pores and Conduits through which they pass * Blood the common matter of nourishment yet not the red part but white In consideration of the nourishing Juyce one must imagine that the Blood which is the common matter of it contains and homogeneous liquor and though it appears to our eyes under the form of two
substances notwithstanding it 's certain that all the parts are nourished by its white and chilous part and not at all by the red if we conceive that this white part is sweet balsamick glewy and viscous which are all the requisite and necessary conditions for their entertaiment from whence we may conclude that its the Balsam and true Cement of all the Reunions which are made in Nature It would be hard to understand how this nourishing Juyce whose substance is Homogeneal can be employ'd to the maintaining so great a number of different parts if by what we have said of their Structure we did not conceive that this juyce tho' indifferent can easily become Flesh an Artery Membrane Bone Tendon c. according as it s modified passing thro' the insensible Chanels which must be regarded as so many little threads where it 's shap'd and fram'd differently according to the Configuration of their Porosities just as the parts of the sap which are confounded and as it were indeterminated in the earth take a form and determinate figure on them passing through the different Pores of the Fibres which compose the Plants as round pointed square c. this diversity of Figures is the cause that those Particles can produce quite contrary Effects as well in Plants as in Animals This being suppos'd and well understood I say that the Surgeons Science whether in the Reunion in losses of substance or finally in what occasion soever serves for nothing but to Rectifie this Sap by the way of general Medicines when 't is corrupted and Topics which have the vertue of conserving the natural Purity of the nourishing Juyce which the Arteries carry to the offended Part and to defend it in the same time from the impressions of the Air therefore the Traumaticks Sarcoticks Carminatives and Astringents which Surgeons use in the beginning Progress State and declination of wounds do produce such effects as I shall prove in explaining their vertues The Virtues of Traumatick Medicines Vulneraries are ordinarily charg'd with oily and salt Particles which cause two good effects First The oily Particles unite and adjust themselves easily to the viscous and nourishing Particles of the blood and make together a kind of covert which resists the powerful attacks of the Air which is a great enemy to Wounds Secondly The saline Particles divide cut and attenuate such parts which are most disposed to alteration and help them forwards in suppuration Sarcoticks and Carminatives The Sarcoticks and Carminatives which only differ secundum majus minus do always abound in fine saltish Sulphur and fixt disicative alcalies the saltish and most rarified Sulphur subtilizes and purifies the nourishing Particles and maintains them in their natural Motion and consequently in their state of goodness whilst the fixt Alcalies and other desicative Particles repel by a sort of caustick vertue the most sharp and malign Particles capable of producing a bad pus and begetting fungous flesh the most exalted sharp Particles being absorbed the flesh keeps united firm and red Of Astringents Concerning Astringent Remedies 't is proper to give a reason why Scars oftentimes are so deformed this depends almost commonly on the Surgeon either because he has not-skill enough to make the Fibres answer one another or else he compresses the Wound too rudely in searching for the strange Bodies or because he sinks the Fibres of the Parts of which some tend upwards other downwards in their intercussading one another Too Astringents make Scars deformed so that the two lips of the wound can never be exactly even or finally because he makes use of too Astringent Remedies all these contribute to make the Cicatrix defective but particularly Styptick Medicines because being filled with fixt Alcaline or Vitriolick Particles the fixt ones stop the Pores and the Vitriolick burn and cauterize them and take away even some of the substance This in general is the Idea one must have of the effect of these Medicines I pass now to the Reunion of the Tendons which the Ancients and most part of our Moderns had abandoned and which in imitation of them would have been neglected if late Mr. BIENAISE to who we are obliged for it had not renew'd it Sutures of the Tendons to be practised In effect there 's no more danger in practising the Suture of a Tendon than in that of a flesh wound if we consider that the Liquor which runs into its Channels is no way differing from that which passes into the Belly of the Muscle why should it not be allow'd that the cut Tendon unites as well together as a Muscle and since the same juyce runs into the Bones to serve them for their nourishment and is the true bond and cement which reunites them when broke why will not they allow that it should produce the same effects in respect of the Tendons which are continuous to them Don't we even observe in Plants when we put the Graff on a wild Stock A paraleâ—… Comparison that the Sap passes from the Porosities of the Longitudinal Fibres of the Stock to those of the Graff that its salfish and glewy Particles stop and fix themselves at every circuit about the union as well by the motion and action of the subtil and ethereous matter as by encountring the external Air and frame a Callous like that which is made in broken bones Likewise put in fix Graffs of different kinds in the same Stock An Experiment you will have the pleasure to see them bear Fruits of as different kinds which cannot be explain'd without saying that the Juyces which pass through the Roots and Trunk of the Stock have not yet any determinate Figure but that they receive one passing through the Pores of each Graff this is an experiment which I relate by the by because it fortifies the System which I have establisht concerning the Reunion Cause of the inequality of the Callous As for the inequality which remains at the Unition after the Formation of the Callous 't is not difficult to conceive that it proceeds from the too great abundance of salts which rise up to the Surface where they are stopt and fixt by the action of the external Air as we have remarked heretofore Having explain'd the principal difficulties that regard the reunion I conceive 't is made after this manner After the Surgeon has cleans'd the Wound from all the grumous Blood How the Reunion of VVounds is made and other strange Bodies after he has exactly brought together the Lips and endeavour'd to take all necessary care for maintaining them in the same Situation I say that the Molicule of the Blood how indifferent or indeterminate soever they be passing and repassing from one of the Lips of the Wound to the other by Pipes which I look upon as so many little Threads they Frame and Figure themselves differently according to the Configuration of their Pores it happens that by the different
turns and returns of the most Glewing Particles the most Nourishing and Balsamick which heat has thicken'd and hardned disengaging themselves from the other rank and apply themselves to the Mouths of the little Fibrils frame as it were a Million of little chains Horizontally drawn from one Lip of the Wound to the other for to tye and joyn them exactly together After this manner I shall always explain the Reunion Vegetation of the Particles and Progress of Wounds the losses of which are sometimes considerable I pass now to the Examination of the Sutures and the Circumstances which depend on them CHAP. III. Of the Sutures Three kinds of Sutures used by the Ancients THE Ancients have Established two sorts of Sutures the one of separate Points which they call'd Incarnative and the other of continuous Points call'd Restrictive they have also spoken of a kind of Conservative Suture which they used in great Wounds to avoid deformity Five kinds of Incarnative Sutures There be five kinds of Incarnative Sutures 1. The interfected or interrupted 2. The Quill'd or Spiral 3. The twisted 4. Hookt And 5. The dry Suture Five kinds of Restrictive Sutures The Tanners Shoomakers Taylor 's Stitch and from without inwards and that of Celsus which is made a cross are the five kinds of Sutures which Antiquity has described to us under the name of Restrictive but without insisting on the description of these last because absolutely useless I pass to those which are in use Three sorts of Sutures most in use viz. The Interrupted Quill'd and Twisted the last being used in the Hare Lip the quill'd in deep Wounds and the Interrupted in all others 'T is not enough to entertain you with the Sutures I am also obliged to make you remark all the circumstances which accompany them after I have given you the most perfect Idea that I possibly can of Wounds to which they are convenient and to which not Where Sutures are to be used The Wounds where ordinarily Sutures are Practised are Angular Transverse Oblique in a word every where the Bandage can't make the Reunion VVhere not first in altered wounds The Wounds in which Sutures are rejected are those alter'd by the Air. I will propose my conjectures about its Malign Action in such Wounds The malign Quality of Air in wounds I say that the Air is a fluid and transparent Matter full of Saline Nitre whose Particles are Branch'd and Irregular this being supposed 't is easie to draw some consequences concerning the manner how it Communicates its evil Qualities to wounds and how its capable to alter the Nature of the Blood which is not hard to conceive if we consider that it Rusts not only Iron and Copper c. but also corrupts even the most solid Bodies I consider the Humidity of the Air and the Nitre with which it 's loaded as two great Agents which have the power to consume and destroy the most Oyly Portion of the Nutritive Juyce of the Parts How the Air destroys the Tone of wounded Parts so that the Oyl of the Blood which is the true Balm that Nature makes use of to Re-unite Wounds and keep the Vessels supple being dissipated by the Humidity of the Air and action of the nitrous Salts which are disperst in it the Fibres dry up and the Pores contract which occasions very frequent and dangerous Obstructions the Salts thus having got the upper Hand and united themselves with those Salts which result from the consummation of the Oleaginous Particles that serve them as a Vehicle change into a Vitriolic and Arsenical Matter that gnaws cuts and corrodes the Vessels of this mixture arises a kind of Verdigrease almost like that we see on Copper after the Action of this powerful Enemy of Bodies so that if one does not defend the Wounds from its Ravage it happens that the Obstruction and Inflammation encrease more and more which occasions Fevers and gives way for a Gangreen to seize the Part. 2. Sutures not convenient in contused wounds The Sutures are not convenient in Contus'd Wounds because there is extravasated Blood between the Fibres and Vesicles which must needs turn to Pus we want no other indication to shew us that we must give it vent by way of Suppuration and so consequently the Suture would be very dangerous 3. VVhere there 's loss of Substance I say also that Sutures are not used in Wounds where there is great loss of Substance as in Gun shot or in those whose Lips the Surgeon cannot bring together 4. Nor in Bites of Venomous Animals Nor are Sutures made in Bites of of Venomous Animals For without doubt their Poyson presently Irritates the Spirits which ascend to the Brain and infects the whole Mass of Blood which must presently be Remedied by the help of Cardiacs and Corroboratives after having apply'd to the Wound strong Resolutives as Theriaca dissolved in Spirit Vini and other Medicines of the same Nature 5. Nor in great Inflammations They are also rejected in great Inflammations the understanding of which suffers no difficulty since the Obstruction precedes always the Inflammation 't is necessary that the Matter which is stopt and out of its Vessels be Evacuated 6. Nor where large Vessels are wounded They are of no use where considerable Vessels are open'd because the Blood which flows from them the Bandage which one is obliged to make and the Astringents which are strange Bodies oppose the reunion 7. Nor in wounds of the Thorax They must also be avoided in Wounds of the Thorax as well superficial as deep because of the frequent Motions contrary to unition for the Breast being forc'd to dilate and contract the Muscles and Cutis making an effort in assisting the Elevation and Dilatation of it would burst and be torn because of the resistance which the Sutures make which would excite Inflammation Pain 8. In discovered Bones according to the Ancients and difficulty of respiration Finally the Ancients have added that we must not use them in Places where the Bones are discovered because of Exfoliation but as there is nothing that alters more the texture of the Bones and Facilitates more quickly Exfoliation then the Appulle of the Air we must not question to shelter them by the help of the Sutures having a due regard to the Contusions and Fractures which often happen to the Bones However be it as it will we hazard nothing because if the Accidents should be urgent we have nothing to do but to cut the Threads so that one may without danger use Sutures in Wounds of the Head which penetrate even to the Bone unless they be in the furthermost part of the Coronal Bone or behind the Head or in a direct Line then we may use an uniting Bandage This being known and explain'd we must speak now of the circumstances which accompany the Sutures that we Practise They consist in chusing Needles
like that which one feels sometime after the cut of a Sword this does not proceed from the first division but by those which are made through the action of the sharp and extravasated Humours No Pain without Solution of continuity so that as often as the Animal feels pain there are some divisions made by which means the Soul which watches and interests it self in the conservation of the parts of our Bodies is afflicted The cause of Convulsions These sharp Humours coming to shake vigorously the little Filaments of the Nerves cause the Spirits to run irregularly into the Muscles which excites the Convulsion The Spirits being put to flight instead of running into the Fibres of the Heart And of Syncopes and ruling their motion are carried in disorder sometimes to one part sometimes to another the Heart being deprived of the influx of the Spirits which are the true Instruments of its ordinary motion and being no more capable of contraction the course of the Blood must be suspended for some moments from whence comes Syncopes And of Vomiting But as soon as they retake their course they double their Action and are Lanch'd with so great Precipitation into the Fleshy Fibres of the Stomach through the familiar commerce and mutual consent between the Cardiac Nerves and those of the Stomach that they oblige it to discharge it self of all that 's in it which is call'd Vomiting And Diarrhaea The Ventricle with its powerful and repeated Contraction passes so hard the Bladder of Gall and the Neighbouring Bilous and Pancreatic Ducts that it squeezes out their Juyces into the Cavity of the Guts which presently causes a Diarrhaea The cause of a Fever These two Liquors being thus prest out of their Vessels without having received all the preparations and alterations which are necessary for them fail not to make the Chyle Acid with mixing themselves in the Intestines they serve for Leven and Ferment to corrupt and produce a Fever Of heaviness of the Head and failure of the Senses The Blood being in Fermentation mounts with such an impetuosity to the Brain that the Sinews thereof which receive all the rest of the Blood of the Interior Head cannot discharge proportionably so much Blood into the Jugulars as the Arteries furnish by reason of the slowness of Circulation in these Sinews so that the Nerves which come from the base of the Skull to be distributed to the Organs of the Senses are a little comprest by the weight of the Blood which causes heaviness of the Head and that the Senses don't receive the impressions of their Objects with the same facility as before through the Obstacle that the Spirits find in their passage How to prevent those ill Accidents To prevent all these Accidents you have nothing to do but to cut the rest of the Tendon if the major part be divided but if the loss of the Fibres be not so considerable and the Symptoms not so pressing you must do nothing rashly If you perform the Operation you must Stitch the Tendon rather than cut it so that the Surgeons intention is to Reunite the two Extremities by Suture If it happen that the Extremity of one part be so far shrunk into the Flesh that it cannot be brought to the other by the Forceps it would be convenient to molifie the Fibres a little with some Oyls extracted without Fire as Ol. Amygd Dul. Ovor. Cerae c. which are proper to relax the Fibres and facilitate their Union for if the Oyl be Extracted without Fire the heat does not so soon dissipate their Viscosity which is the true Cement besides they are more capable of tempering the Acid of the Blood and of appeasing pain The Tendons being molified you must Stitch if you can and seeing they are Compos'd of little Fibres How to perform the Operation you must take half the breadth of a Finger upon the Body of the Tendon that the Stich may better resist the motions of the part and the flowing of the Matter If the Tendon be not discover'd enough you must try to make the Suture without unfleshing it because the Flesh secures it from all alterations After the Surgeon has put the part in a convenient Situation a Servant must uphold one Extremity with the Forceps whilst the Surgeon with his left Hand holds the other and with a strait Needle arm'd with double wax'd Thread knotted at the end pierces them from without inwards and from within outwards bringing them exactly together then lay away your Needle and take a little compress of Cloth with two holes in it to pass the two ends of the Thread through and make a single knot over which apply another little Compress which you fasten with the Surgeons knot and slip knot you must observe to wet the Compresses in some Spiritous Liquor and put some wax Candle on the knot instead of Lint The Suture being made you must humect the first Day with some Oyle and Spirit of Wine the following days we use a Balsam made of Tereh Tinct Aloes Vnctuous Medicices not proper or that of the Tinct Flor. Hyperici the use of Oyls or Fat 's are here to be rejected because they Putrifie the Tendons In the beginning Cataplasms made of the four Meals Wine the Yolk of an Egg and Hony are very proper It must be observed that as soon as Suppuration is made 't is evident that the Tendon begins to be united most good Practitioners Commend in long Suppurations to make use of Spirits on bared Tendons Emplas Andreae è cruce CHAP. V. Of the Hair-Lip VVhy so called IF Sutures have any use in performing Operations 't is doubtless in the Unition of the Hair Lip so call'd because this Animal has naturally the Upper-Lip slit This Malady comes sometimes from an imperfect Conformation and sometimes by Accident viz. it may be caused by some Blow Fall or other like mischance if the Reunion be then neglected it 's to be fear'd least the edges grow Callous and at length a true Hair Lip is form'd 'T is very often an Hereditary Deformity which we keep as long as we live unless we are willing to suffer the Operation however its cure cannot be accomplish'd but by Suture If there be great loss of substance you must not hazard the Operation because the Cutis wou'd be so much extended that it wou'd be very hard to Pronounce well certain Words and to make with care all the other motions which this part is capable of those which happens to the Under-Lip are of difficult cure because the Defluxions are more-frequent and the Lip always humected with many serosities Where cutting Hair-Lips wou'd be useless There are several other occasions where the Operation wou'd be useless as in Children by reason of their continual Crying in the old Scorbutick and Pox'd in irregular Women and in several other vitiated and indisposed Subjects in which the Blood
to attack are in a very little time Drown'd We observe that the Muscles of all Hypocondriacs are deprived of a part of the Spirits which are necessary to them for their natural motion for if we consider that the Sulphur which we have supposed to be destroyed VVhat the Animal Spirits are contributes only to the generation of the Animaâ— Spirits that the little cutting Particles which this Sulphur wraps up are the Matter of them and the residue the Vehicle and true Oyl with which the Brain is imbued we shall agree that the Glands of the Brain furnish very few Spirits in these Diseas'd Persons whose Bodies are depriv'd of Fat and that consequently their Muscles must lose of their force vigour and motion from whence comes the great heaviness which they feel You must also observe that they are no more provided with this Fat which before made their Fibres supple flexible and capable of activity This being so 't is evident that their motion must be weakned that they can no more communicate any to the Vessels the course of the Liquors must be slackned and the Animal Spirits which bring some formality to every part are no more in a condition to keep the Pores open or at least so wide as ordinarily so the Vessels being as it were sunk and the Arterial Blood not having any more the power or strength to make it's way the parts are almost defrauded of Life I alledge all these reasons because they fortifie our System of the formation of the Dropsie Old Men very subject to the Dropsie which is founded on the slowness of the Circulation of the Blood which is remarkable in old Men who are most subject to Dropsies The reason is because their Blood is only a fluid Indigested and corrupt Mass having lost all its consistence and unctuosity one may say it has lost its Oyl and consequently is made incapable of sustaining its Fermentation I add that those who Inhabit Boggy places being of a cold Temperament and used to moist Food will be more liable to it than others The Dropsie which often effects Fat and full People who nevertheless are in a certain moderate repose has for its cause only the slowness of Circulation through the frequent Obstructions which ordinarily happen in the Glands and Vessels which occasions the Lympha to disengage it self and overflow some part VVhen the Dropsie is incurable The waters sometimes gather together in a Cystis which makes the Dropsie incurable This Cystis is a strange Covert at first insensible but by degrees separates it self from some other covering either of the Peritonaeum or elsewhere by the saline and lixivious nutriture which it has contracted or by the too great humidity received after the same manner as the Particles of an Egg or Seed disengage or unfold themselves This Cystis is sprinkled with a multitude of Glands and Vessels which it receives from the part from whence it derives its Origin and from other Neighbouring Parts which are as so many sources that produce new Dropsies Signs of the Dropsie The signs of this Disease are swelling of the Belly transparency of the Waters and Fluctuation Difference between corpulant persons and hydropical Before I speak of the Accidents 't is necessary to give an Idea of the difference between the swelling of the Dropsie and a good habit of body In the Dropsie the Belly is extreamly extended and even the Navels rises and terminates in a point whereas in the latter its soft and less extended being more elevated on the sides than elsewhere where the fleshy Portion of the Muscles lie and the Navel is quite hidden Symptoms of the Dropsie The Symptoms which accompany this Disease are slow Fever weak Pulse heaviness of the whole Body difficulty of Respiration considerable Swelling excessive Thirst and difficulty of Urine 1. Slow Fever The slow Fever is nothing else but an effect of the impurity of the Chyle and other levens which intimately mix with it this mixture design'd to make the life of the part happy being impressed with this brine or rather charg'd with this impure and strange Matter passes to the Heart how corrupt soever it be where it ferments and disorders its motions the Heart communicating its unruly Pulsations to the Arteries excites this kind of Fever which is only felt very slightly 2. Weakness of the Pulse The Pulse's weakness depends on the slow influence of the Animal Spirits into the Fibres of the Heart which being incapable to augment their Action in respect of the Spirits as well as Blood by reason of their scarcity maintain the blood in that little degree of precipitate motion which distinguishes this slow Fever from the other and consequently causes this weakness of the Pulse 3. Heaviness of the Body The pale colour and heaviness of the body proceeds from the slow motion of the Blood and from the dissipation and concentration of the Spirits which are stifled and choak'd as it were in the Waters now as the heat and vigor depend on the presence and natural ferment of the Blood and Spirit which should animate these parts and be carried to the Surface you must not wonder if they be so pale and if the Muscles can't sustain the weight of the Body 4. Difficulty of Respiration The difficulty of Respiration is caused by the swelling and great tension of the belly which presses the Diaphragm against the Lungs and diminishes the Diameter of the Breast so that the Lungs having not the liberty to extend themselves the Respiration grows frequent and forced The excessive thirst is rais'd from the humors that are separated from the Glands of the Stomach 5 Thirst Oesophagus and other parts of the Gula to moisten their coasts and to maintain them in the Humidity which is requisite for them it 's not enough either through the frequent setlings which are made in other parts or that the invincible and intemperate fire which the Fever kindles in all parts dissipates consumes or ratifies it which cause these parts to heat and dry and that saltish Spirits whose actions are not corrected by any dissolvent rush into the little Fibres and produce a motion in the Nerves which excites thirst As to difficulty of Urine I suppose that part of the Water which used to take its course through the Kidneys 6. Difficulty of Vrine tends another way and that the Urinous Volatil and other fixt Salts of the Urine being deprived of a part of their dissolvent stop at the entry of the Pores of the Glands and hinder the Urine from running with that liberty into its Conduit the Salts thus having the upper hand and finding nothing in the Blood capable to blunt their points irritate all the parts through which they pass particularly the Areteries and oblige the Sphincter of the Bladder to a more than usual contraction which causes the Urine to flow very difficultly and by turns I pass to
since the ligaments of the Liver Pancreas and Kidneys being relax'd Also the other Viscera they may as well as the Spleen contribute to its formation According to the order I design in speaking of so nice an Operation I think it more proper successively to describe the Signs of all kinds of Hernias that I may not confound them Signs of Hydrocele I begin with those of the first kind of Hydrocele in which the waters are spilt between the Membranes of the Scrotum which are light tension considerable largeness heaviness we feel an undulation when we handle the tumor and perceive the transparency of the waters when we hold a light behind and the skin becomes tender soft without pain and looks extreamly shining In those of the second kind where the waters possess the Membrane of the Testicles are great tension pain greater heaviness than in the other the skin of the Scrotum is not so much extended and keeps its rugosities though it be very much swell'd through it be very much swell'd it possesses ordinarily but one side the Fluctuation's deep the transparency more obscure It 's to be observed that these two sorts may conjunctly meet together Signs of Sarcocele The signs of Sarcocele are great hardness insupportable weight and insensible augmentation of the tumor if there appears no elevation in the Groin it 's a sign that the preductions of the Peritonaeum are not accompany'd with any carcinomatous substance It 's distinguish'd from the Hernia Intestinalis that the one 's soft the other is hard this tumor may be divided into Scirrhous and Malign in the Scirrhous we feel neither heat nor pain but in the Malign an excessive heat and sharp burning pain Varicoâ—â—… Signs of Varicocele are great inequality heaviness pain and Inflammation particularly when it 's irritated with some Medicine it 's also known because it makes a Man somewhat impotent especially when it possesses both Testicles Circoce Signs of Circocele which is caus'd by the dilatation of the external Vessels different from the Varicocele which comes from the Internal are the same as the former except there is less pain weight and Inflammation add that the Membranes of the Scrotum are more extended and the tumor more apparent Of Pneumatocele Signs of Pneumatocele are when the tumor disappears from time to time it sounds like a Drum when it 's struck without pain weight and inflammation very transparent the colour of the Cutis changes not and the Wind is felt sometimes above sometimes below Sings of Hernias made from the parts Let 's now examine the signs of those Hernias which are caus'd by the parts and enquire exactly into them because 't is of the greatest importance In the beginning of these Hernias they are ordinarily soft without inflammation change of colour disappearing at the least pressure except they be caus'd by some Blow Fall or such-like inconvenience and are not accompanied with some Strangulation caused by Matter stopt and harden'd in the Intestines either by the course of the Blood and Spirits in these parts which presently excites inflammation and often mortification therefore you must do no violence to the tumor by rude handling lest it occasion a Gangreen but that we may have a clearer notion of all these signs let 's examine them in particular and see what are those which make us distinguish all these kinds of tumors 〈◊〉 that â—…ut is If the Gut be engaged without Inflammation Strangulation or adhereing to any part the tumor's soft plain and the colour of the skin not chang'd it disappears from time to time particularly when the Party lies on his back When the Intestine is reduc'd a kind of whistling noise is heard Signs of the Omentum But if it 's in Omentum the tumour's soft and doth not return so easily It 's unequal by reason of the Bands and Fat with which it 's charg'd when press'd with the Fingers there remains a mark and we feel the same resistance as in pressing a Steatomatous tumor This is more subject to mortification because the texture of the parts of which it 's formed is loose spongy and more subject to corruption so that at the least impression the Blood stops more easily there than any where else wherefore you must not delay the Operation in certain occasions as we shall hereafter mention Note That if Inflammation happen it 's always at the Intestines side if it 's the Omentum it grows livid at the least alteration Inflammation a veâ—â— severe â—â—mptome As for the Accidents I find none more dangerous than Inflammation which is always accompanied with pain Fever Strangulation and sometimes with the Illiac passion where the excrements are often forc'd against their own weight to mount and come out of the Mouth the cause of which cruel Symptom proceeds from the Guts being inflam'd by the excrements which are lodged there It communicates this Inflammation to the rings of the Muscles particularly to those of the external oblique which by reason of its tendinous Nature fails not to shut up the Gut and augment the Inflammation by a reciprocal action which causes interruption of the course of the Blood and Spirits in that part from thence comes the reflux of the excrements lividity and mortification It 's easie to conceive that having lost their motion there can follow nothing but divulsion pain and loss of Life There 's yet another kind of lividity which comes from having handled and press'd the tumor too much These unprofitable Touchings are as so many Bruises which are imprinted on the part the Gut and Omentum being press'd the Blood stops in the Vessels which causes immediate mortification and change of colour VVhen the Surgeon ought to avoid the Operation It 's also known by the pain which is greater as we have said The Surgeon seeing all these bad Symptoms ought to retire The rest of the Accidents I reserve till I describe the manner of performing the Operation An Idea of the Vmbilicus I begin with the Exomphalos but before I enter on the Operation I design to give an Idea of the disposition of the Navel It 's form'd by the Reunion of the Umbilical Vessels which slip obliquely into the thickness of the Peritonaeum which accompanies them and piercing conjuctly the Linea alba fasten themselves to the surface of the Cutis where they leave a little tumor which is call'd the Navel after the Birth In the Foetus the way through which these Vessels pass are as manifest as the rings of the Muscles of the lower Belly are in Adults but after the Birth they shrivel up and turn into Ligaments and as the parts where these Vessels meet grow bigger They oblige the Navel by their own weight insensibly From which I conclude that all the difference between the passages of the Umbilical and Spermatic Vessels is that the latter are easily distinguish'd and separated one
those which cover the bottom four or five days before you take them out to the end that by their stay the Matter which is stop'd become more sharp and that they may dissolve more easily the Tunicles which contain the Waters you suppurate it and dress it as an ordinary Wound Before you go further you must also observe that if the waters grow sharp and corrosive or rather lixivious they change often into Pus which makes the Testicle alter and corrupt so that you are forc'd to take it out Cure of Pneumatocele As for Pneumatocele you must use the bandage and all the carminative Remedies as well internal as external and as it 's a part of the Surgeon's prudence to order them according to his Knowledge I shou'd be ridiculous if I should boast here of Remedies which Authors are full of CHAP. XVI Of the Phymosis What Phymosis is THE Phymosis is nothing else but a shrivelling and contraction of the extremity of the Prepuce which compresses so hard the Glans that if you don't give it Air by way of Incision it becomes inflam'd and often mortifies This incommodity is either natural or accidental the natural comes from the parts being yet concentred and as it were retir'd into its Tunicle and that one has not yet betaken himself to any exercise or touching The Prepuce forms in this affect wrinkles which are like so many little Bolsters As Venery between which gathers and stagnates a tenacious Matter separated by the Glans with which the inner surface of the Prepuce is sprinkled which thickens by the heat and growing impure by its stay there is as it were a kind of Glew which fastens the Prepuce to the Glands and so straitly presses it that it will not let the Urin flow The Surgeon therefore first endeavours to free the parts pulling to him the extremity of the Prepuce then introduces at the side of the Virga an Incision knife between the Glands and Cutis piercing the Prepuce without danger and cuting all between the Instrument and Extremity of the Glans If one Incision be not enough to discover it you may boldly make another on the opposite side the sole motion of the parts being capable to extend the Fibres of the Prepuce and render them obedient and make them that they restrain and dilate themselves according to thenecessity of Nature You must not use this Operation till you have tried Fomentations Caution Emollent injections and all other Remedies in vain which method is to be observ'd in all Operations The second kind of Phymosis is caus'd by some Inflamation Shanker Ulcer Induration Callosity and often by irritative Remedies misapplied in all these cases whether the sharp Humour which comes from the Ulcers irritate the parts or corrosive Medicines it happens that the passage of the Blood and Spirits is hindred and the Inflamation becomes so considerable that the Fibres are no more in a condition to obey This is also the reason why this virulent Sanies which comes from the Shanker excoriates these parts excites sharp pains felt only at the extremity of the Yard and Inflamation which is soon followed by a Gangreen if you hinder not its progress Cause of Pulsation in the part The pulsisick pain which is felt in this part can't proceed but from the Glans which is covered with a thin and delicate Membrane humected by a great number of Vessels particularly of Nerves and that its Substance is of a very fine and sensible texture so the motion which these virulent Matters imprint on the Spirits not being able to communicate themselves to the rest of the Yard because of the force and thickness of the coverings of the cavernous Bodies the pain must needs augment and become much more sensible and acute in this part But before you resolve on the Operation use Bleeding Fomentations Suppurations mixt with some prepations of Mercury which you must introduce with the end of your Probe the cerot of GALEN Emollient injections a Ball of Lint put between the Glans and skin compresses wet in Oxycrate in a word all these Remedies must be apply'd but especially the Situation of the Virga which must be laid on the Belly and sustain'd with a little Bandage CHAP. XVII Of Paraphymosis VVhat Paraphymosis is PAraphymosis is a Disease quite contrary to a Phymosis in one the Glans being hidden in the other Strangled and so strip'd of its Prepuce that you can't cover it again The cause of this Strangulation comes sometimes from the overthrow of the Cutis Cause which forms a sort of Bolster and sometimes from Inflamation which a Shanker or some other tumor preceded if the Strangulation be considerable there must needs follow interruption of the course of Blood and Spirits in these parts and consequently a mortification In this affect the Yard-swells so hard that it forms three or four Bags as it were alternately dispos'd half a Finger's breadth one from another These pursings come partly from the obstructions and partly from the reflux of Blood and Spirits in the Body of the Virga they are commonly follow'd by a tumor which occupies the neck of the prepuce and which is full of a reddish water which by the great heat of the part so rarifies ordinarily that from an Aqueous it becomes Windy This tumor augments so considerably the Inflamation that if you don't scarifie deep the tumified places to give a discharge the Penis wou'd not fail to mortifie How to bring over the Prepuce You must endeavour to reduce the Prepuce without compressing the Glans or putting your Thumb on its extremities as most do that treat of this Disease The Reason is that when the extremity of the Glans is pressed it enlarges it self and swells more which instead of making the prepuce slip rather folds up and hinders its reduction You use almost the same Remedies as in Phymosis There be some that pour cold water on the Belly but I think it of no great use or at least see no great effects of it for want of these Remedies you may use in Inflamation some Styptick water in which dip your compresses and apply them about the part you must also keep the same Situation and Bandage as in Phymosis CHAP. XVIII Of the Stone and Lithotomy THe STONE with which Mankind of all other Animals is most troubled is called in Latin Calculus Name and those affected with it Calculosi Its origin wou'd have been always unknown to us if the Chymists Art had not discover'd to us the secret of its formation in shewing the principles which Compose it by the just Analysis that Science makes of it The Opinion of the Ancients concerning its formation All the Ancients and their Abettors have alway maintain'd with great heat that the Stone is form'd by the most Crass Course and viscous particles of Blood which being carried into the Bladder with the Urine came to be
the Matter of the Stone Of Hypocrates Hypocrates imagined that the Stone was form'd by the Urines retention in the Bladder and that the most gross and terrestrious Particles stop'd there and stuck to the bottom almost in the same manner as the Gravel gathers in the bottom of a pot where the Urin has been long retain'd and that certain slimy Particles gather there which serve for a tie to the little Gravels there assembled and that after this manner by the overgrowing of a new Matter the Stone becomes insensibly bigger This Opinion is more probable than solid for it 's evident if the Stones were form'd after Hipocrates's way supposing the principles which he admits 't would doubtless not have consistence strong enough to resist the Hammer as this doth it 's much more reasonable to believe that what we see in the Urinal of those thus Diseas'd is nothing else but the Volatil Spirit of Urin which taking its flight sticks rather to the sides of the Urinal than bottom as experience demonstrates The Opinion of Fernelius Fernelius pretends that all the Stones which are found in the Bladden fall from the Reins by Nephritical pains and says That if the Gravel which passes from the Reins into the Bladder be of any considerable bigness and that it lies there for some time the Stone is form'd there which grows bigger and bigger by the access of new Matter which comes to it without intermission And that which fully perswaded him to believe that Nephritick pains excited the Gravel to fall from the Kidneys into the Bladder was That he never found any one troubled with the Stone but some Nephritick pain went before He says also That when you break the Stones which are wholly form'd you find in the middle a little Kernel which has a covering different in Colour and Substance from the rest of the Stone and whose Figure perfectly imitates the Pelvis of the Kidneys from whence he concludes the Stone is formed in it before it falls into the Bladder Fernelius wanted nothing more than the knowledge of the principles of the Stone to have had a perfect Idea of it And what made him fall into this Error after Hipocrates was That he founded himself on that old Maxim of the Ancients that Stones are formed by the terrestrial and gross particles of the Blood which disengaging themselves from the others and uniting together form Calcules The only reason which they give for it is that these Gravels are very firm and massy and that such Bodies can't be fram'd but by the assembling of that which is most irregular and heavy in the Blood They pretend also that we must conceive this generation to be like the gross and massy Bodies which are made on the Earth to which the formation of the Stone in Man's Body has a great deal of Analogy All Minerals having no other principles than the most inflexible and weighty Particles of the Earth But this is a prejudice grounded only on the impression and confus'd Ideas of the Senses Reason and Experience are their opposites for this latter shews that the Volatile Spirits and most subtle Bodies frame by their mixture a heavy and solid Body which the sixt Salts and other grosser Bodies more incapable of motion cannot do as Chymistry Demonstrates Nay Reason convinces us of it for it 's easily conceiv'd that the grosser and more irregular Particles cannot adjust or restrain so well or press themselves with so much strength as the more fine and regular in order to the framing a solid and compleat Body Two essential principles towards the generation of the Stone Chymistry discovers to us two essential principles in the Urin by the Analysis which it has made of it The one is a Urinous and Volatil Salt which much resembles the Spirit of Nitre And the other a very Aethereal Sulphur which is like Spirit of Wine Experience Demonstrates Experiment that if we mix Spirit of Wine with Spirit of Nitre a coagulum is presently form'd but these two principles being engaged in the Urine and it's course not permitting them to Unite together to form the Stone Van Helmont's Opinion The Urine as Van Helmont says must fall into some disorder before the Stone be form'd and although the essential principles of the Gravel in which consists the Seed of the Stone be in the Urine it needs an intermedium or ferment to excite and cause the Seed to germinate like as in other generations therefore 't is a corruptive ferment says Van Holmont which is sometimes ingendered in the Urine and which awakes and vivifies the principles of putrefaction which uniting themselves intimately form the Stone in the midst of the Kidneys This is the manner this Author proves it and we may say to his Credit that of all who have written on this Subject none has done better than he He says there 's no Transmutative Principle in Nature without Ferment The Urine does not corrupt in us because of its motion but there must needs be found in it a corruptive Ferment by occasion of which 't is apt for Putrefaction so that the Putrefaction is not made by the Urin's being vitiated but the Reins Suscitate the vitious Ferment to the generation of this strange Body And he supposes that 't is the smell alone of the principle of Putrefaction which stirs up and separates in Heterogeneal parts that which before seem'd to be Homogeneal like as the smell of a Vessel wherein there has been some acidity coagulates and sowers Milk The Ferment of the Stone consists in a smell only or as the smell of Leven Ferments and infects the Dough and the smell of a musty Fat corrupts and Ferments the Wine even so in the Urine does the Ferment which disposes to the Gravel consist in a pure smell only It 's also observ'd that the Urin putrifies sooner in a stinking Vessel in which Urin has been kept a long time than in one which is clean and new He supposes that the coagulation of the Stone is made in an instant though its growth is made by degrees and sometimes all at once In the Distillation which he has made of the Urin he has always found therein a Spirit of Nitre which he calls a coagulating Spirit associated with the Spirit of Wine and though they be both very volatil they coagulate as Spirit of Vitriol mix'd with Sal Armoniac which evaporates also very easily Besides this coagulating Spirit and the Spirit of Wine which meet together in the Urin he says there is also found in it a terrestrial Styptick Spirit which by the means of putrefaction becomes volatil so that this Spirit of Urine drinking up the terrestrial Spirit excited by a putrid Ferment suscitates the Spirit of Wine which is in repose and concentred in the Urine which mingling intimately together and acting one with another by a reciprocal action condenses in the middle of the Urine and forms a
specific Remedies to hinder the progress of this Disease are Bleeding which keeps the first rank and I say that if it be of any use at all in Surgery it 's without doubt in this occasion Bleeding no where of so great use as here because in emptying the vessels it hinders the Blood from being carried so abundantly to that part and must consequently lessen the bigness of the Tumor in diminishing the quantity of the Blood Approved Remedies in a Plurisy The other Remedies are those which rarify subtilize and attenuate the Blood as Horse or Mule's dung infused in White-wine old He-goat's Blood in Powder all Volatil Salts and several other Remedies of that nature The decoction of Nettles in strong Wine which you sweeten with Sugar is also excellent you may at the same time you take the Decoction lay on the sides the bruised Nettles in form of a Cataplasm Of a Peripneumonia Having thus in general explain'd the Cause of a Plurisy I am obliged to say something of a Peripneumonia that sometimes proceeds from an Impostume of the Brain or from the Inflamation of some Membrane which changes into an Abscess as experience demonstrates in those that die of great Wounds of the Head but for the most part it 's caused by the corruption of the Blood that is to say by the exaltation of its sharpest Particles All the difficulty is to know why the Pus or Blood stops rather in the Lungs than in any part else for to make an Impostumation I say that three Causes contribute to its formation the alteration of the Blood Causes of Peripneumonia long and slow Respiration and the structure of the part First Cause Alteration of the Blood Concerning the first you must only make reflection on the nature and mixture of the Chile and thickest Blood which the right Ventricle of the Heart sends in every Sistole to the Lungs through the Pulmonic Artery We know that these two Liquors pass through the Heart and Lungs for to receive some necessary preparations for the function of the parts therefore we may say that they are the two receptacles of all that is most thick and indigested in the mass of Blood but if the Heart hath the strength and power by its constriction to subtilize and cast off all that is most heavy and material in the mass the Lungs have not the same advantage as we will prove so that the grosser substances being accompanied with some impurity and having only felt the first effects of the Heart for its perfection it must needs stop there and putrefy Second Cause Long and slow I espiration The second Cause which I establish is a long and slow Respiration It 's certain the more free the Air enters into the Breast and the more the Vessels are extended they are in a more fit condition by their elastic vertue or spring to express the Air through the Pipes of the Trachea Arteria and the more the Blood is agitated by the inspiration of the Air it 's driven with greater quickness into the Veins But on the contrary if the Blood is moved slowly by a long Respiration it follows that the Vessicles being not so extended as they should be and not expelling the Blood out of them with such a violence it stops and corrupts there gradually by the arrival and mixture of some ill Leaven or by the exaltation of its salt Particles from whence it comes that those who have a long Neck are more subject to it than others because the Air is obliged to make a long traverse before it comes to the Lungs which makes them dry up and alter insensibly Third Cause on the Structure of the Part. What the Lungs really are The third Cause is grounded upon the Structure of the Part the Lungs are a complication of little Vessicles in which the Arteries pour the Blood and where it 's mingled with the Air to receive some alteration there Now it 's shew'd in the Hydravlic's that a Liquor which passeth from a little Pipe into a greater loseth much of its motion and being the Arteries are very little in proportion to the Cells it 's no wonder if the Blood grow slow there and changeth its nature by the exaltation of some sharp and tartarous Salt and by the Fermentation which they cause there wherefore the alteration of the Blood the irregularity of Respiration and the largeness of the Vessicles of the Lungs in proportion to those of the Arteries are the three Causes that concur to the formation of the Peripneumonia Since the Signs of all these kinds of Diseases are of the greatest importance to succeed well in the Operation and to make a favourable or dangerous Prognostic I will endeavour to describe them with all the Order that is possible Signs of Pus or Blood in the Pleura The Signs which shew us that there is some Pus or Blood stopt in the Pleura are Inflamation penetrating Pain Heaviness a languishing and continual Fever a hard thick and deep Pulse accompanied with shivering difficulty of breathing a dry Cough and Thirst one cannot lie on the sound side by reason the matter lieth heavy on the Pleura and one grows lean and thin in a few days Signs of the Matter on the Diaphragma But if the Impostume break and the matter falls on the Diaphragma all these Symptoms cease and the Patient finds some ease for a time but immediately there comes others not less dangerous and insupportable besides the difficulty of breathing which is common to every Empiema one feels a heaviness upon the Diaphragma fluctuation a great uneasiness the Fever increases and becomes burning the Pulse rises the Pain indeed is not so sharp it being felt towards the false Ribs one cannot lie but on the side where the matter is for if you lie on the opposite side one feeleth a twitching upon the Mediastinum more cruel Pain and a much greater heaviness their spittle is sometimes stinking and there follows very often Impostumes of the Liver after these kind of indispositions even as it is observed after great wounds of the Head If the Pus be diffused on both sides one cannot lie on either by reason of the sharp Pains one suffers to be eased you must lie upon the back or belly Signs of Pus in the substance of the Lungs The Signs when there is Pus in the substance of the Lungs may be divided into equivocal and convincing the equivocal belong to other Diseases of the Lungs it 's very dangerous to be mistaking therefore let 's endeavour to examine them well that we may draw some advantages and that we may not undertake an Operation whose effect would prove not only useless but fatal If there be any Pus in the substance of the Lungs the diseased cannot breathe without pain he finds an insupportable and troublesom heaviness upon the Diaphragma because the weight of the matter deprives it of
the liberty of moving He suffers a fixed and dull pain which is a common sign of a PLURISY with this difference that the Pluretic Pain is pungent comes all of a sudden whereas the Pneumonic Pain that is to say that which proceeds from an Impostume of the Lungs comes only by little and little and successively The continued Fever doth not leave accompanied sometimes with an immoderate thirst his spittle is purulent his mouth and throat dry he hath red cherry cheeks sunk and hollow eyes having lost their lively and glittering colour his nails bend backward and the whole body grows at lest dry and emaciated and if the Fever increase the Patient falls into Delirium and his Spittle be black livid or ash-colour'd Death is not far off because they are mortal Symptoms which oftentimes accompany it So much for the Impostumation of the Lungs which comes from an internal Cause Let 's now examine those that follow the Impostume of the Lungs caused by Wounds the difficulty of Breathing is not so considerable the Fever is continual accompanied with shivering and cold Sweats which appear from time to time these two last accidents are depending from the Pleura The Patient spits pretty often Blood in the beginning and towards the end it 's frothy and purulent When the Spittle is of a yellow colour it 's mortal he cannot lie but on his back because being on his sound side the wounded Loab lieth heavy upon the Mediastinum and causeth a twitching and cruel pain and when he turns himself on the wounded side the Lungs coming to lie heavy upon the Pleura which is hurt doth not fail to excite the same pain wherefore he dares not stir Signs of the Lungs being wounded In the beginning his eyes are brisk but at last they grow dull and the face puffs up but the most certain Signs that the Wounds reach to the capacity of the breast and of the Lungs being hurt are the Probe the noise which the Air makes in coming forth and the Emphysema When you probe you must observe to make the Patient put himself in the same posture he was in when wounded that the extravasated blood may run easier out If the Wound penetrate to the substance of the Lungs the Blood which flows is forthy and the Air makes less noise and comes not out with such impetuosity as when the Wound penetrates only the Breast without touching the Lungs If one asks Objection Whence cometh the Air that is in the capacity of the Breast the Lungs not being alter'd and the reason why it makes such a noise You may answer Answer That it 's the outward Air which is got in through the mouth of the Wound and endeavouring to escape because of the expansion of the Lungs which press it every where It hapneth that those Particles which appear at the passage not being able to get out but with a great deal of pain through the resistance of the external Air and the smalness of the Aperture push and press one another so hard that they must needs make a noise and produce a kind of whistling passing out of the breast which can put out a Candle held to the mouth of the Wound Cause of the Emphisema The Emphisema is likewise only caused by the particles of the Air which penetrate the Porosities of the neighbouring parts which swells and blows them up so that often one cannot find the mouth of the Wound nor introduce a Probe It 's easy to see from what we have said that the Emphisema and the Air 's coming out of the breast are not always convincing signs of the Lungs being hurt because they happen when the Wound penetrates into the breast without having touched the lungs wherefore there are only the signs which we have spoken of that can give us afterwards certain marks of it but the Probe and the exit of the Air are two true signs that the Wound penetrateth into the breast You must observe Caution that if the breast be pierced through and through you must never let both the orifices be open at once for fear you choke the Patient the reason of it is evident because the Air cannot enter by two opposite sides without compressing the Lungs and hinder the motion of the Breast I have said that the true scituation when the Lungs are alter'd is to lay one down on the back for to ease the Patient because the Bronchia are compressed by the weight of the extravasated blood which presently takes away the liberty of breathing I intend to speak here of the superficial Wounds of the Lungs for if they be deep and that any great Vessel be divided one feels almost as much pain lying on the back as on the sides A certain Sign of extravasated Blood in the body of the Lungs But one of the most certain Signs that there is some Blood extravasated into the body of the Lungs and of which we have not yet spoken is that if we put our Finger far enough into the Wound provided the bigness or Diameter of the breast permit it we find that the Lungs are fastned to the Pleura round about the Wound and reunite themselves there even as the Intestine is united to the Peritoneum A Sign that the Wound has not passed the Pleura The Signs which demonstrate that the Wound doth not pass the Pleura are the Probe and the Air which never passeth through the Wound There are some others as the Pain Inflamation Fever Heaviness and Difficulty of Breathing besides the thickness of the exterior parts which may in some manner guide us for to be sure of it All these Signs nevertheless do not always shew that the Wounds are deep since a simple Inflamation of the Intercostical Muscles hinder free Respiration If we consider that the use of these Muscles is to raise the Ribs to enlarge and widen the Cavity of the Breast and that Inflamation and Tention are utterly contrary to their Action we shall agree that the Lungs cannot dilate themselves but with difficulty and seeing the Contraction of an inflamed Muscle encreaseth the Tention and great Tention many Divulsions and many Divulsions vehement Pain you must not wonder if the Diseased for to ease himself a little from the Pain retard the course of the spirits and have very great difficulty of Breathing Cause of the Heaviness The Heaviness proceeds from the Impotency of the Muscles for as soon as a part is out of action it seems heavy to us for it 's a burthen which the neighbouring parts must support and being they have neither strength nor motion to raise what offends they must succumb under the weight of a new and superfluous matter from whence depends the Heaviness We have explain'd in several places of this Treatise the cause of Pain Inflamation and Fever we have said that the Pain is excited by some actual Divulsions by whose occasion the Soul perceiving the destruction
of a part is afflicted the Inflamation hapneth when the course of blood is hindred in any part and that it 's sufficient to produce the Fever which is a Consequence of the Pain and Inflamation if a drop of extravasated and corrupted blood be carried to the heart Cause of Red Cheeks One hath Red Cheeks in an Impostume of the Lungs this comes from the irregular motion which the purulent Particles communicate to the Principles of the Blood and from the great number of Blood Vessels which irrigate the Cheeks Cause of the Dulness of the Eyes The Eyes lose their vivacity and sink into the head because the blood loseth its consistence and colour in losing its oil and unctuosity which makes the Eyes sink and become insensibly wan and dull proportionable as the sharp and tartarous Salts dissipate the oily and sulphureous Particles In all Diseases of the Lungs the Caule and Mesenterium always corrupted This I say is so true that in all Diseases of the Lungs we always find the Epiploon and Mesenterium which are the two Reservatoriums of the Fat corrupted it 's for the same reason that all parts of the body dry up and grow lean What gives the Red Colour to the Blood You must also observe that the Red Colour of the Blood doth not only depend on the mixture of the Sulphurs but also on the action of the Air which whirl about its Particles and being the Air that gets into the impostumated Lungs changes its nature it 's no more capable of setting them in motion neither to excite so lively a Sensation as before Cause of the Nails bending back The Nails bend backward because their Extremity being irrigated with a serous Liquor deprived of Spirits the Cutis must of necessity fall away and dry up now as the Nails are only a production of it it pulls them along and constrains them to bend like as a slice of Bread held to the Fire You must look upon all these signs as certain tokens that the Wound penetrates into the breast you may stay some days to examine its progress for if they proceed from a not penetrating Wound in a few days they cease by bleeding and suppuration and they continue and increase when the Lungs are alter'd or when the Diaphragma is oppressed by the weight of some extravasated matter An Emphisema may happen to any parts of the Body The Emphisema is not always a sign that the Wound penetrates because it may happen not only to Wounds of the breast but also to all other parts We see it even to come on Wounds of the Head where we cannot suppose the Lungs to send any Air so that unless the oppression be very great you must not try the Operation These signs do not only lead us to the knowledge of the nature of the Empiema but they tell us also whether it's necessary to practise the Operation For example Where the Operation would be useless it would be useless in the Empiema of the Lungs by reason the opening of the breast contributes nothing at all to the evacuation of the matter unless the Impostume be on the superficies of the Lungs then it would be of more use because we know that the Lungs are fastned to the Pleura and the Impostume is precisely where one feels a fixed pain but if so be the Impostume should be deep and manifest it self in that place by a fixed pain it would be fruitless If the effusion of the blood should happen from a Wound and that by good luck the Wound were in a place where the extravasated blood could easily get out provided the Lungs were not adherent by enlarging the mouth of the Wound to make way for it or by laying the Patient in a posture convenient for the running out of the matter the Operation would be useless Finally let the Wound be of what manner soever if we can facilitate the evacuation of the Pus by making the Aperture bigger we ought to avoid the Operation but if the Matter cannot have its free course you must make use of it for to deliver the Patient from suffocation and the chiefest circumstance of the Operation is to chuse a proper place to facilitate the exit of the matter The most proper places to perform the Operation Of Necessity There are two places in the breast proper to make the Operation one of Necessity the other of Election of Necessity where the matter appears as in the Impostumation of the Pleura or in that of the superficies of the Lungs adhering to the Pleura because we are forc'd to make the Operation where the Impostume is that of Election Of Election when there is nothing that obliges us to make it rather in one place than another in this case you must chuse the most convenient place which is between the second and third of the true Ribs reckoning from below upwards four fingers from the inferior Angle of the scapula and as much from the spine You must observe that in those who have been troubled with any long Disease of the Breast as with a long Pleurisy c. the Diaphragme is insensibly fastned to the Ribs and reaches sometimes even to the third fourth or fifth Rib A Caution to be observed particularly when the breathing is frequent and forc'd therefore you must inform your self which is the place where the diseased feels the pain if it be about the second of the true Ribs where ordinarily the Diaphragma is fastned or if it be higher which must be well examined before you make the Operation CHAP. XXIII Of the Operation of the Empiema HAving preparel all that must precede such a necessary OPERATION you place the diseased on a Chair or Bed he must keep his Body very strait and be held up by Servants that the Chirurgion may the easier take notice of the place where he 's to make the Incision In fat People you make it somewhat large that you may not be mistaken How to perform the Operation You pinch up the Teguments for to cut them at length with a Bistory and the fibres of the great Musculus Dorsalis cross for if they were cut otherwise they would stop the Aperture of the Pleura and so hinder the running out of the Matter you continue to incise dextrously the Intercostal Muscles some incise them at the uppermost part of the Rib to avoid the Vessels that lie all along its internal lower Sinus but seeing the Wounds which are near the Bones degeneration often into Fistula's Caution it's more proper to make it in the middle of the Intercostal Muscles When you are come to the Pleura you put your finger there all along which you slip a Bistory for to Incise the Pleura minding to guide well the point of the Instrument with the finger and penetrate not too deep lest you offend the Lungs or Diaphragma which are often fastned to the Pleura
the Aperture being made you put your finger into the Cavity of the Breast as well to make the Incision bigger as to push back the Lungs and Diaphragma and to loose them if they are fastned to the Pleura particularly where the Operation is made in a place of election different to that which is practised in a place of necessity without breaking the Adherences as we have observed in the foregoing Chapter If the Lungs strive to come out at the orifice of the Wound you must push them back with a blunt hollow Probe for to help the running out of the Matter or with a Pipe of a thickness and length proportionable to the deepness of the Wound These long Pipes are very useful in the Emphisema because the Aperture of the Wound being little and deep it 's very difficult without their help to give Issue to the Matter You must not make use of a Probe Caution to try whether the Pleura be pierced for in passing it often separates from the Ribs and there is a Vacuum made where some Blood is apt to gather which produces a new Impostume More Blood to be drawn at a time than Matter If it be Blood that comes out of the Aperture you may draw a sufficient quantity of it but if it be Pus less by reason it contains more spirits and the Patient is apt to fall into a Syncope After this you stop the Wound with a blunt Tent of Lint having a large head and being a little crooked at the end lest it offend the Lungs Most commonly we tie a Thread to it fill the rest of the Wound with little Dossels of dry Lint to keep the Tent in and absorb the Blood and lay a Plaister on it with Compress and Napkin about the Body with the Scapular which is cut in two at one end and put cross to fasten the Napkin the easier When the Patient is dressed you make him keep his Bed with his Head high as if it were half sitting and you let him rest till he finds himself oppressed with the weight of a new Matter then take the Dressings off and having made the Matter run out you push the Lungs back with a long Pipe by whose means you facilitate the flowing of the Matter that remains in the Breast you continue to dress it so every day We observe often that the first three or four days Blood comes out the next days Water and afterwards Pus that groweth thick by little and little We have observed already that in case the Empiema should afford much Matter or Water mixed with Pus you must not evacuate it all at once lest the Patient should fall in some weakness The Air to be corrected when you dress the Patients You must always correct the Intemperies of the Air with fire when you dress the Patient and hinder it from entring too abundantly into the Breast because it thickens and coagulates the matter which is extravasated there hinders it from flowing and causes it to come forth in Clods If it be Blood the Serocity separates from it as after letting Blood nevertheless whether the Pus or Blood be thick or mixt with some Water you always use with Prudence Injections of Barley Water and Mel Rosar with which you cleanse the Lungs and Breast you must always cause the injected Liquor to come out by the help of the finger or hollow Probe and if the Lungs should stick you must loose them If in time the Blood should grow too watry and the Patient be oppressed by the quantity of the Pus you would do well to dress him three or four times a day The Matter runs sometimes for the space of three or four months and as soon as there comes nothing out but what comes from the Wound you procure the generation of flesh and cicatrize You must observe that when the Air works upon the Blood that is in the Breast it coagulates it sometimes without changing it into Pus and so it comes out in Lumps Bitter things not to be used in Injections You must not use Injections in the beginning neither make them with Aloes or other bitter things because when the Lungs are open the Patient casts them out through the mouth but after the Vessels are consolidated you may use the tincture of Aloes or Wine mixt with a traumatic Decoction and Mel Rosarum this is used when the Pus comes out in a small quantity Often after a wound of a Sword there comes out of it an abundance of blood and after three or four days no more appears in this occasion you must quickly close the Wound and you have all the reason to believe that there were only some little Vessels broke which gave some blood and which afterwards were stopt by the most glutinous particles of the blood of the rest however the thing happens there remains no danger CHAP. XXIV Of the CANCER I Look upon a CANCER as the most inflamed and rebellious of all the schirrous Tumours the red part of the Blood as well as the white contributing to its formation Principal Causes When CANCERS happen in glandulous parts there is great appearance that the Lympha is the principal cause there if they attack any other part it 's to be presumed that the Tartarous Particles of the Blood have the greatest share therein However it be I say that the concourse of these two Humours is always necessary for the production of a Cancer all the difficulty is well to distinguish which of those two predominate What a Cancer is I say a Cancer is a round hard unequal livid and painful Tumour caused by the meeting of abundance of Acids and of the Tartarous Particles of the Blood from which proceeds the pain and tention of the Vessels which very well represent the Claws of a Crab. Cancers of the Glandulous Parts most painful Those CANCERS which possess the Glandulous Parts are much more painful than the others through the abundance of Nerves which enter into their Composition and if the alteration of the Lympha contribute any thing to their generation it 's because the Glands are its principal Reservatories Cause of the Roundness The Roundness of the Tumour cometh from the Round Figure of the Glands because the Humours which cause the Obstruction and extend the Vessels can easily tumify these Glandulous Bodies without changing their Conformation Cause of the Tentions c. As for the Tention and fulness of the Vessels it 's known that the Matter which they contain is nothing else than the Matter which forms the Tumour This Humour is Tartarous fixt and gross and consequently not very capable of Fermentation the slow progress the Tumour makes in the beginning is a convincing Proof of it The Lympha being acid it may well excite some little Fermentation with a porous and terrestrial Salt which the red part of the Blood furnishes but it serves rather to fix and concenter
of the CANCER Three ways of extirpating a Cancer THE Cure of a Cancer may be attempted by Incision by Ligature or by Actual Cautery If you undertake it by Incision 1 By Incision you must cut its most deepest Roots that is to say you must anticipate upon the nighbouring parts and having taken it off you must squeeze the adjacent Vessels to make the Blood and Humours come out which may have contracted malignancy In respect of the Ligature 2 By Ligature it 's not much in use but if you would put it in practice it must be when the Bases of the Tumour is but small when the Roots extend themselves not far in compass and when it terminates in a kind of strangulation but being it is rare not to say impossible to meet with such a disposition the Ligature has no other use than that of suspending the Tumour that you may make the Incision more commodious You must observe that if you apply slightly the Actual Cautery after the Operation it 's to stop the blood 3 Actual Cautery and absorb and destroy some portion of the unclean matter which could serve as a Ferment for the Generation of a new Cancer and might even infect the whole mass of blood How to perform the Operation The method used in performing the Operation is this you introduce into the top of the Tumour a Needle arm'd with double Thread to make a sort of Loop with which you uphold the Tumour and the Surgeon cuts it round about the Base 'till to the Ribs with a very sharp Knife having taken off the Tumour you squeeze the blood out and pass slightly over it an Actual Cautery you dress the Wound with Pledgets arm'd with astringent Powders and lay a Plaister on it with Compress Napkin and Scapuler The best way of oxtirpating a Cancer But the best method is to make an Incision cross over the Tumour even to the Ribs and separate dextrously the flesh from the skin by this means you avoid the great deformity and pain and secure better the Wound from the Air. If the Diseased be not in a disposition proper to endure to Operation either through fear of pain or being weak and the Surgeon not make a favourable Prognostic it would be a rashness to undertake it besides that the great loss of substance and dangerous accidents which happen are worthy of reflection which break often the measures that the most daring Practitioners can take for as soon as the Tumour is taken off the Ulcer grows often malign painful and of a round figure which is a mark of slow cicatrisation the sides become calous livid high black and inverted according to the disposition of the Juices with which they are water'd An extraordinary way to cure a Cancer There are some that without performing the Operation do assure us that they have cured ulcerated Cancers with great Red Snails freed from their shells which are laid upon the Ulcer they say that they creep sometimes about the Ulcer fasten to it and leave their foam there that we find the bottom of their belly gnaw'd as it were and they grow so monstrous that in a short time they burst The reason is that these Animals contain an abundance of Volatil Alkalys which charge themselves with the Acids that entertain the Cancer and which grow and ulcerate the belly of these Animals so that being convey'd through the little branches of their veins into their mass of blood according to the order of Circulation they excite such an extraordinary Fermentation that these Animals must needs perish CHAP. XXVI Of Bronchotomia Bronchotomia a nice Operation THere is no Operation in Chyrurgery of a more nice undertaking than the Bronchotomia neither is there any more pressing or useful when ever one has the happiness to succeed in it The Causes of this troublesom Affect Causes proceeds ordinarily from some Wound great Crying long Discourses violent Passions or the alteration of the Humours If a simple Inflamation be capable of hindring Respiration what will not happen if any of these Causes concur to increase it Now whether the Inflamation attack the Muscles of the Larynx or some other parts it communicates it self not only to the Aspera Arteria but also to the Muscles of the Pharinx and neighbouring Glands which obliges the blood and spirits to stop in all these parts and to cause great obstructions then doth the blood which without intermission pressing on not finding its passage free stay there and augment both Inflamation and Tention the Vessels being after this manner distended and swoll'n up take up more space than before and must needs press the Aspera Arteria and hinder the passage of the Air in that part whence follows Suffocation Bleeding Clysters Resolutive Cataplasms Gargariems made with strong Wine in which you boil in B. Mariae Sanicle Golden Rod Perivincle and Angelico with many other Remedies are to precede the Operation unless danger of Suffocation oblige us to make it If the Obstruction and Inflamation attack only the Amigdals or Glandulae Tyroides you must endeavour to open them by the mouth with the point of a Lancet arm'd with a band of Lint If all parts of the Throat be inflamed and all Remedies proved without success you must betake your self to the Operation How to perform the Operation To do it methodically the Patient must sit upon a Bed or Chair with his head back leaning on a Servant's breast who upholds it with his hands Being in this posture the Surgeon chuses the most convenient and less dangerous place where he may make the Operation which is a Thumb's breadth from the Larynx between the third and fourth Ring of the Aspera Arteria he pinches the Cutis c. cross makes an Incision at length and separates very gently and artificially the Brochales and Musculii Sternobyoidei Having discover'd the Aspera Arteria Caution you incise cross-ways with a Lancet arm'd the Carnous Membranes which ties the cartilaginous Rings together avoiding the recurrent Nerves which carry the spirits necessary for the function of the organ of the voice which if they should chance to be cut would be lost The Incision being made before you withdraw the Lancet introduce a Probe which facilitates the entry of a short Pipe which must be crooked and proportionable to the Wound there must be a hole on each side to pass a little Ribon through which is to be ried behind the Neck to keep it fast we put a little Cotton or piece of Sponge at its entry for to modify the Air a little then apply a Plaister on it with holes in it Compress and a pierced Bandage CHAP. XXVII Of Fistula Lachrimalis THe Fistula Lachrimalis is always caused by a sharp and salt Humor If the Matter of the Tears which run through the lachrimal passages have received any alteration it may cause some obstructions in those passages which terminate at
the Head may be cured by the Suture or by the uniting Bandage unless the loss of substance be considerable But if the Wound be compound that is if besides the exterior parts the Skull Dura Mater or the substance of the Brain it self be offended the Physitian and Chyrurgeon ought to suspend their Judgments and recollect at the same time their Ideas and Knowledge to prevent the ill Consequences of any Accident whose causes and symptoms are so dangerous and very often Mortal The Skull may be fractured the Dura Mater prick'd cut broken torn depressed and the Brain cut taken away shaked or filed with some extravasated matter The Skull may be hurt 2 ways 5 Kinds of Hippocrates The Skull may be hurt two ways by Incision or Contusion Hippocrates has established five kinds of Fractures which he hath called Fissure Contusion Incision Depression and Counter-Fissure Whether the Fissure be Oblique or Perpendicular 1. Fissure it contains one only difference which is to distinguish well whether there be but one or both Tables fractured The Contusion is of two sorts 2. Contusion the one doth not destroy the Continuity Hippocrates called it Thlasis vel Phlasis it 's nothing else but the forcing down of the Bone without being broke Most incident to Children According to Hippocrates it happens on the Skulls of Children that have as yet the Bone very soft and tender This Depression is after the same manner as a bruise in a Pewter Pot. The other kind of Contusion destroys the Continuity In this the Bones are equal and contiguous It 's a single Fissure which always reaches beyond the place where the blow was given If it be apparent it 's called Khegma If it be insensible it 's called Trikismos or Capillary Fissure The Incision is of three sorts 3. Incision Eccope Diacope and Apokeparnismos Eccope is a perpendicular Incision of the bone without carrying off the piece leaving nothing but a mark HIPPOCRATES calls it Hedra the Latins Vestigium or Sedes Diacope is when the blow lights obliquely and goeth deep into the substance of the bone without carrying it off And Apokeparnismos is when the piece is intirely carried off The Depression destroyeth both the equality and contiguity of the bone 4. Depression HIPPOCRATES calls it Esphlasis or Enthlasis depression or fracture with a splint he hath established three kinds of it Ecpiesma Angisoma and Camarosis Ecpiesma in Greek is a depression of the Skull where the Splints press the Dura Mater Angisoma is a depression where the Splint separates it self and passeth under the sound bone Camarosis or the Vault is the third kind this is divided in five sorts In the first a part of the Bone bends down in breaking and the other turns up In the second the Bone boweth downward without any slit this hapneth only to Children as I have explain'd heretofore The third is a Depression where the sides are forced down the middle remains bent upwards as a kind of Vault leaving some hollowness under it The fourth riseth of it self this is also when the Bones are only membranous because they have a kind of spring or elastic virtue till they begin to ossify Lastly the fifth kind of Camarosis is when the second Table is depress'd and the outward return'd to its first state this last only happens to Infants for Reasons which we have alledged The Contra Fissura which HIPPOCRATES hath established without ground 5. Counter-Fissure hapneth in the same Bone in divers Bones and in different Tables in the same Bone when the uppermost part is struck and the lower broke in divers Bones as when the blow is given on the occipital and the coronal is broke in different Tables when the first is struck and the second broke These are three Chymeric Examples quite contrary to the structure of the part if we see wounds of the head of this nature happen after Concussions of the brain it proceeds not from a Counterfissure as HIPPOCRATES pretends but by true Relapses No such thing as a Counter-Fissure It may easily be seen that when a man has lost his senses and hath recover'd them partly again he is yet all giddy and may after this manner relapse twice or thrice and get new Wounds for it 's impossible that a Machin composed of several pieces as the Skull is can break in a place opposite to that where it received the impression it being certain that the blow dieth in all the circumference of the assemblage and that the diploe hinders the shake from being communicated to the interior Table But without confounding and mistaking our selves we may say that the Skull may be slit depressed fractured cut or carried off If it be slit the Fissure is visible or almost insensible but whether it be apparent or not nothing is capable of giving us convincing marks that it penetrates and that there is blood spilt on the dura mater than these which succeed The use of Ink the Rugine and the Handkerchief in the mouth keeping one's breath is absolutely useless because the Diploe confounds and hinders one from seeing whether it reaches to the dura mater or not besides the practice of the Rugine will never be approved on by good Practitioners not only because they do not give us any knowledge but also because there remains a loss of substance and deformity of the part If it be Depression it presses with it the dura mater and causeth several Accidents which we will examine If it be fractured either the Splinters are separated from the Cranium or not so by either way the dura mater may be compress'd prick'd or torn and the Brain hurt or at least some Blood may be spill'd upon these parts In all these occasions I say if the Fracture do not permit an unition of the shatter'd Bones and vent given to the strange bodies which might alter the dura mater you must without more ado perform the Operation provided some ill Symptoms preceded otherwise the Patient would die If it be cut or carried off either with or without shattering the Bone as for example If the Incision penetrate not and there be only a part of the Bone separated the consequences are not dangerous but if it go deep and there be some Splints separated that offend the dura mater if we do not soon remedy it the Patient is in danger of life Signs of inflamed dura mater If the dura mater be inflamed either by diffused blood or by some pricking compression tention cut or rupture one presently feels pain and heaviness in that part the Eyes grow puft up and inflamed the Face red and swell'd the diseased is drowsy with Fever the Pulse hard with shiverings and blood comes often from the nose ears and mouth just as in great concussions of the brain We know that the dura mater is prick'd or torn when there are some sharp pointed Splints or rugged pieces
of the bone which press it We are persuaded that it 's compressed c. when the bones are depress'd and appli'd as it were against its surface or that the broken pieces of bones are separated or finally that there is some extravasated blood which offends it We are convinc'd that it 's cut when it 's caus'd by a sharp and cutting Instrument and that the Fracture be of a great length but if the bone be only crackt and some blood be extravasated upon the dura mater only those signs which I have describ'd and which I am going to explain can give us certain evidences of it I need not here repeat the explication of the pain Cause of the Heaviness The Heaviness proceeds from the diffused blood upon the dura mater for since she is to rise and follow the motions of the Brain if the weight give her not liberty to obey and the Brain find any resistance her motion must be somewhat interrupted Now seeing the motions of the Brain depends on that of the Arteries the Impulsion of the Blood not being sufficient to elevate the substance of the Brian and the weight upon it its course must be slower in this part and a heaviness must follow thereon Cause of puft-up and inflamed Eyes The Eyes become puffed up an inflamed to explain this Phoenomena you must only remember that the Sinus's of the Basis of the Skull are only productions of the dura mater and that they receive all the residuous blood that comes from the veins which are distributed about the globe of the Eye This being so it 's evident that if the dura mater be inflamed she communicates it to the Sinusses and so opposes the return of the blood which the veins are to pour into these little reservatories and since the arterial blood still presses forwards the globe of the Eye which is pressed by these two liquors by the reflux of one and arrival of the other must needs tumify and inflame Not to confound the Inflamation of the Eye with that of the Eye-lids you must consider that that which happens to the globe of the Eye proceeds from the Inflamation of the dura mater and that of the Eye-lids from the Inflamation of the pericranium for the interior membrane of the Eye-lids is a production of it We observe that Inflamation of the Eyes doth sometimes not appear till the third fourth or fifth day this can come from nothing else but from the long passage which there is between the Inflamation of the Sinuffes and the more or less progress it makes during that time Reasons of redness of the Face c. The Face groweth red and puffed up by reason the Inflamation of the dura mater obligeth one part of the blood that mounteth to the head through the internal Carotides to spread on the place where they pierce the dura mater even to the neighbouring parts and external Carotides which is so much the more true since we know that all parts of the Face swell and grow red in a very little time after any Inflamation being water'd with a great many sanguiferous vessels for the same reason the blood runs out of the nose mouth and ears and besides the blow that troubleth the whole oeconomy of the brain it 's to be presumed that the blood which flows in abundance some little cappillary vessels may be broken by the great distentions they endure Reason of Drowsiness The Patient is drowsy To explain this kind of Lethargy we must still have recourse to the Inflamation of the dura mater and to the blood which is stopt in its Sinusses or at least to the slowness of its motion be it that the arterial blood is no more mingled with the grosser blood which they contain or that the Inflamation increaseth It happens that the weight of the blood which is pent up in these Sinusses press the corpus callosum and the nerves which are distributed about the organs of the senses so by this means makes the head dull and heavy You must observe that this kind of Lethargy is not so deep as that which comes when the matter is diffused upon the brain as we shall speak of in its place Cause of the Fever The Fever is caused by the inflamation and pain for it 's sufficient it but one drop of corrupted blood be convey'd into the whole mass to produce it Cause of hard Pulse The Pulse is hard To explain this Phoenomena you must consider that the dura mater accompanieth the thick cords of the nerves is their passage and the inflamation and great tention which she suffers are capable to straiten all the little membranous sheaths which invelop them and consequently to hinder the spirits from flowing with that liberty into the fibres of the heart so that its spring being weakned for want of this distribution you must not wonder if it doth not force the blood into the Arteries with the same force and vigour as before and if the Pulse be deep in this occasion Cause of the Shiverings The Shiverings which accompany the Fever can proceed from nothing else than the purulent matter which causes the Impostumation and from the disposition it has to be stopt and prick the membranes at the time when the veins are charged with it to carry it to the heart and from thence to all the parts and seeing the most part of membranes are carnous and each muscle hath its particular membranes which is separated into a million of membranous fillets which spread themselves into the body of the muscle and inchain all the little carnous fibres to one another we have reason to believe that the spirits running tumultuously into the fibres occasioned by the motion which was imprinted in them exciteth shiverings which are so many little convulsive motions The Brain may be offended divers ways The Brain may be hurt by a great commotion of the Head by some blood diffused into its substance or by some particular wound Signs of a Concussion of the Brain If the Commotion be great yet without any vessel broken one falls to the ground with loss of the senses feeling and motion blood comes out of the nose mouth and ears the Excrements and Urine come out involuntary with often swooning and vomiting sometimes soon sometimes late Cause of falling down If one falls down it 's an evident sign that not only the spirits are in disorder but also that the commotion hath violated the nervous fillets of the corpus callosum and that it has so rudely shaked the brain it self that the course of the animal spirits hath been suppressed Now since the spring and tonic motion of the muscles that hold perpendicularly our bones together and sustain the whole machin depend only from the influence of the spirits which pass through the nerves into our muscles if by any misfortune these cords come to slacken and to lose some
spirits by any mishap the machin must needs fall Cause of loss of the Senses The Senses are lost by reason the course of the spirits is interrupted in the brain and cannot repair to the organs of the Senses now since the functions of the Senses depend on the course of the spirits in the nerves it 's no wonder if the exterior objects make no more impression upon our Senses and we be no more in a condition to distinguish them The Phaenomena is a consequent of the precedent Cause of bleeding of the Nose Mouth and Ears The Blood flows out of the Nose Mouth and Ears To explain which Symptom you must consider that these parts are rudely shaked in the time of the assault that the blood and spirits are stopt in the brain and that the great cords of the nerves which at their passage out of the skull pass between the branches o the carotidal and vertebral Arteries imprint there such a violent motion at the time of the concussion that they oblige the arterial blood to turn short and flow into the external Carotides so that these receiving almost all the blood which mount to the head as well from the Inflamation as from the shakings of the nerves must needs break some capillary vessels The cause of involuntary shedding of Urine and Excrements The Excrements and Urine come forth against one's will because the spirits repair no more in such cases to the sphincters of the Anus and Bladder than to other parts which causes them to lose their spring and permits the issue of those Excrements the motions of the heart are weak and languishing only for want of these same spirits Cause of Vomiting One vomits at the very instant or some time after If one vomits presently it 's a sign that the Commotion has not been one of the greatest and the course of the spirits not long interrupted since the impulse of the blood hath broke the sluce of them and forced them to retake their course and launch with so much quickness into the ventricle that they excite this first vomiting in which one renders nothing but Aliments But if the spirits be long retarded it 's a sign that the shake hath been very rude and that the figure of the Brain is vitiated since we see that when they are at full liberty they run with precipitation into the tunicles of the ventricles and intestines which by their irregular and vermicular motions oblige the Bile which runs into their cavity to force the Pylorus and pass into the stomach from whence it 's driven by the powerful contraction of its carnous fibres You must observe that in this last Vomiting where one renders Bile it 's much more violent than the first and that the diseased lose their strength vigor and ordinary motion these are the Accidents which immediately follow Concussion of the Brian Now it 's very important to examine well those that happen when the Brain is hurt and when any Blood or Pus is extravasated in its substance sometimes it is an effect of the Concussion that hath broken some vessel and sometimes an effect of the blow which hath prickt or cut the dura mater or which has penetrated or carried off some portion of the Brain or finally it 's some Pus between the dura and pia mater which is shed upon the Brian In all these Causes the Fever comes with double Fits and Shiverings accompanied with Vomiting Convulsion Delirium Lethargy and Apoplexy And besides this croud of Symptoms the Liver and Lungs often impostumate which is known by a fixt pain on the Breast or in the region of the Liver and by reiterated Shiverings Cause of the redoubling of the Fever As for the Fever with its Intermittings which come upon it it 's not hard to give Reasons for this extraordinary Fermentation as soon as we be a little attentive upon the changes of corruption which happen to the matter that 's diffused upon the substance of the Brain It 's not to be doubted but that it grows impure and more or less sour according to the time it lieth there that the veins are from time to time charged with it and that a part passeth into the Heart Lungs and all the other Organs which by their continual motions form and grind them as it were into a thousand little parts which lively hasten the impetuous course of the blood and which cause the trouble and perturbation of the spirits which march in disorder which precipitate the motions of the heart and increase the Fever and when ever that strange matter which is offensive to the Brian hath got some degree of corruption and made it self fit to circulate with the venal blood this matter I say receiving the same alterations and triturations which we have supposed sets the blood more sensibly in motion and puts it in a much greater effervescency on which depends the strength of the returns of the Fever After this manner as often as the Blood is charg'd with it the returns which are a sit were periodical are renew'd From all the Reasons which I have alledged it 's easy to understand that there are few parts or corners of the body where this purulent matter is not thrown it pricks the Nerves irritates the Membranes transmits its action on the ventricle nests its self sometimes in one muscle sometimes in another and causes shiverings vomitings and the vicissitude of irregular and convulsive motions which shew that the mass of blood is mightily suppress'd the course of the spirits much agitated so that Delirium and Lethargy must follow Cause of Delirium The Delirium is an effect of the great inequality of the course of the blood in the redoublings of the Fever and of the diffused matter which begins to penetrate and corrupt the substance of the Brain the inequality of the course of the blood in the time of the redoublings rules the irregularity of the course of the spirits in the parts and the extravasated matter gnaws by its acrimony the vessels and nervous fibres of the white part so puts to the rout the spirits into the muscles organs of the senses and in the passages of the brain where the Idea's are weakned with irregularity and confusion Cause of the Lethargy The Lethargy follows when ever there 's much blood spilt upon the brain being in its last degree of motion and exaltation the weight of the extravasated blood presses the brain and the quick motion of the blood causes the courser particles to separate from the fine ones that they stick to the pores of the glands and stop the passage of the spirits so that the brain finding it self oppress'd with the weight of the matter the Patient falls into a profound drowsiness but in the time that this extravasated matter dissipates its self the courser particles which are so many sluces be put out of order by the impulsion of new blood the
spirits fly out into the parts with so much vivacity and confusion that they renew the Phrensy which succeeds the Lethargy just as the Lethargy succeeds the Delirium you must observe that in this kind of Lethargy the Eyes are sometimes open and troubled Lastly It happens that the blood hastens with so great impetuosity to the brain and that the extravasated matter gathereth there so abundantly that it interrupts by its weight the course of the spirits and constrain the Sinusses of the dura mater every where to overflow Cause of Apoplexy so that the Arteries being unable to empty themselves either into the Veins or Sinusses the brain finds it self so press'd on all sides that the wounded falls into an Apoplexy which makes us know that Death is not far off and that there is no more help How the Liver or Lungs impostumate in Wounds of the Head The Liver of Lungs impostumate in great Wounds of the Head by the arrival of Pus which comes from the Brain of which the mass of blood hath got some impressions we have in the Chapter of the Empiema given an account of the Formation of an Impostume of the Lungs For to have an Idea of that of the Liver one cannot ground upon more solid Reasons than to examine its structure in relation to that of other Viscera which are contain'd in the ABDOMEN What the Liver is The LIVER is the biggest and most considerable of all the Viscera it 's a conglomerate Gland deprived of all carnous fibres water'd by a prodigious number of sanguiferous Vessels among which the vena porta doth the office of an Artery and the Circulation consequently must be very slow there besides we are sure that the little Glands which compose it separate a liquor which is extremely glewy and viscous of its own nature which are all the requisite and necessary conditions to retain a matter which already hath a great tendency to stop and cause some disorder so that after the heart and the other organs have prepared and put it in a condition to produce its effect it diffuseth it self into the whole mass of blood and being the Liver receiveth a great number of vessels it followeth that the Hepatic Artery and Vena Porta which are distributed through its whole capacity having cram'd every glandulous grain with it according to its disposition and different alterations which it receives it this Parenchima it putrefies it or makes it schirrous You must observe that the Hydrocephalus is almost always followed with the same accident and that in these kinds of Impostumations the shiverings cease most commonly some days before death We suspect that the Brain is alter'd when the Fracture is big and some of the Animal Functions are depraved for since our Actions depend on the Functions of the Brain when ever those are hindred they shew that the Brian is offended You must observe that in all I have proposed concerning Wounds of the Brain I have not comprehended the hind-part of the Brian I am throughly persuaded that an Animal dieth presently Wounds of the hinder part of the Brain inevitably mortal as soon as the cineritious substance of the hind part of the Brian be prickt carried off or compress'd because the nerves that furnish us with spirits for the functions of the vital and natural parts take immediately their origin from thence This is doubtless the reason that hath obliged Nature to take so much care and precaution to preserve this part so precious to life she has plac'd it under two posterior advances of the Brain for fear it might be interessed in the great havocks which happen in divers places of the Head she hath separated it from the Brain by a membranous Inclosure very strong and thick to hinder it lest in any concussion it might be compress'd by its two posterior Lobes Lastly Nature hath cover'd it behind with a piece of very hard thick and irregular Bone for a defence against outward injuries and to secure it from all that may be hurtful Prognostics of Wounds of the Brain You must observe that the more Wounds approach to the medulla oblongata the more mortal they be because all the nervous fillaments of the white substance join there together and a considerable quantity of them is divided All this has regard to the Prognostics of Wounds of the Head but to speak of them more largely we have only to consider the nature of the Wound and to examine their Accidents If the Fracture be made with a cutting Instrument it 's not so dangerous as one made by a pricking or that which is caused by a Fall or contusing Instrument which cannot break the Skull without great violence upon which follows always a great Commotion but if it be made with Gun-shot it 's always mortal unless the Bullet carry off only some portion of the Cranium without offending the brain We know that contused Wounds of the Head are simple or compound the latter are more dangerous because accompanied with Fracture If a simple Wound with Contusion be only superficial it 's cured with Resolutive Medicines as an Ecchimosis If it penetrate it requireth Superation If the Pericranium be rumpled and that it suffers some divulsions the eye-lids inflame and there comes some Accidents upon it as upon Wounds of the Tendons to remedy this Inconvenience we have nothing more to do but to cut the Pericranium to the bone and to dress the Wound after the ordinary manner Sometimes it hapneth that the Skull is fractured the Teguments being undivided the reason is that being made of a hard and brittle matter it cannot resist the fury of the blow as bodies which are pliable do and it can break even as a Sword which in its Scabbard may be broken without endangering the Scabbard in this case we make an Incision over the Fracture more or less as is convenient with this circumstance that we lean not too hard with the Knife upon the fractur'd part especially if it be a considerable one lest you offend the brain The Prognostics also of wounds of the Head depend on the good or ill disposition of the Patient the violence of the blow and the strength of him that gave it with more or less force A Fracture that keeps its equality is not so dangerous as one of several pieces which press or prick the parts that are under them particularly when they are engaged or lie one upon another because the compression is much stronger and the Dura mater suffers more Besides when the Skull is so broken it 's always a sign that the Blow hath been violent enough to shake the Brain Wounds of the Dura mater very dangerous If the Dura mater be broken by the Splints the wounds are very pernicious because of the Blood spilt upon the Brain and of the Tention and Inflammation it suffers The Inflammation of this Membrane tends often to Mortification because of its hardness and
sensibility Great Concussions hardly cured Concussions of the Brain are seldom cured if great because it 's impossible to make the Extravasated Matter to come out Vomiting upon Dilirium and Lethargy mortal Observe That if Vomiting come upon it in time of the Dilirium and Lethargy it 's a mortal sign and if Irregular horrors or shiverings come it 's a sign that the Extravasated Blood putrifies and corrupts the white substance of the Brain Wounds of the Cortical part of the Brain are not always mortal especially when the bigness of the Aperture facilitates the entry of Medicines unless the Brain has been too rudely shaked whereas if they penetrate to the white subtance they are always mortal not only because the principle of the Nerves are hurt but also because we cannot penetrate unto that substance without cutting thick Branches of Arteries which are concealed in the Anfractuosities of the Brain from thence cometh the Extravasation of Blood which admits of no cure If the wounds of the Skull considered in themselves had any Indication like other Fractures it would be Re-union but seeing the Skull cannot be broke without the inferior parts receiving some troublesom impression we must trepan there to introduce Medicines and as soon as we know that the Skull is broke we ought not to defer the operation Therefore whether it be split or broken it 's always true to say that the Dura mater is concerned The Fissure causeth a tention because the Dura mater is ordinarily adherent to the Skull by all the Vessels of Communication and those which carry the nourishment to the Inferior Table besides the little Fibres which pass through the Sutures which is particularly observed in young People This Tention is soon followed by an Inflammation for as much as the Vessels cannot long remain stretcht without breaking and spilling of Blood which by its abode inflames the Membrane and if the Inflammation increase it often Gangreens When the Trepans to be used If in Fracture of the Skull the Splints offend the Dura mater either by pressing pricking or rending it we must needs trepan to prevent accidents or to diminish them to take away the Extravasated Blood separate the Pieces which hurt it and to have liberty to apply there convenient Medicines It 's therefore a Rule which we must follow that if the two Tables be broke we must always come to the Operation though there appear no accident for besides that the Operation is not dangerous The Operation not dangerous we have the advantage to hinder symptomes whereas if the Skull be not alter'd and some troublesome symptomes happen we must Trepan because the Skull being found it 's easie to see that the symptomes which follow are the consequences of some ill Concussion of the Brain besides we know neither the place nor existance of the Matter nor where the Brain suffers However some say that provided the Patient can fix with his Hand the place where he feels pain and heaviness we ought to apply the Trepan there Caution which nevertheless the most famous Practitioners dare not undertake lest they should find nothing there and so pass for Rash and Inconsiderate How to Cure Wounds of the Dura mater To Cure Wounds of the Dura mater we must Examine their Nature and Cause we must Bleed to diminish the Inflammation and apply upon the tumified and inflamed part Ol. Amigdal Dulc. Quor Violar Lillior Aquatic which we must mix with some Spirit Vini This attenuates the Blood that 's congealed and the other softens and relaxes the Fibres of the Dura mater You must also endeavour to make the Suppuration of the Exterior Wound very copious that the Vessels of the Dura mater which have communication with the Exterior parts may easily disengage themselves A great Concussion mortal As to what regards the affections of the Brain we know that a great Concussion is mortal and a little one cured with Bleeding and other Universal Remedies Extravasation of the Blood is somewhat more dangerous and it seldom happens that the Vessels are broke without the Brain receiving a great commotion In that case we have no other help than Bleeding and general Medicines observing a very exact Diet. For sometimes in taking these precautions Nature resolveth the Extravasated Blood and the Fever groweth less It 's not the same thing in Wounds of the Brain where the Skull is carried off and where there is Extravasated Blood I have said its necessary to Trepan if the Aperture permits us not to elevate the Pieces above the Extravasated Blood and conveniently apply Medicines We know by Experience that several Patients have been cured and yet a part of the substance of the Brain carried off It 's true that Wounds which enter only the Cineritious or Cortical part of the Brain may be cured provided the Patient be otherwise well disposed whereas those of the white substance of the Brain are mortal for Reasons which we have given CHAP. XXXII Of the Operation of the Trepan BEfore we give a Description of the Operation it 's important to examine all the Circumstances necessary to render the Operation successful It consists in Piercing the Skull and to make an Aperture near the Fractured part To execute these two Intentions it 's necessary to know whether all the parts of the Head can endure the Trepan I speak not here of the Bones which are most easie to break those that know the Asteology are instructed therein If the Fissure be simple apply your Trepan just near the Cleft if it be very little one might Trepan upon the Fissure it self to give an easier vent to the Matter nevertheless with this Circumstance A Caution to be observed in Trepaning which is to Anticipate a little upon the side that hath the most strength which must be observed in all other places of the Skull If you should meet with any strange body that were forced down into the body of the Bone so that it could not be pulled out you must apply the Crown of the Trepan upon the strange Body to carry off the Piece If it be a considerable Fracture where a part is forced down you Trepan upon that part where you think most convenient to elevate the Bone nevertheless you must apply the Trepan upon a part that 's firm enough to sustain it without breaking it down If the first Aperture be not sufficient to lift up all Pieces you must make a second and a third if it be necessary We must not Trepan the Sutures We never Trepan upon the Sutures especially upon that place call'd Fontanella lest we break the Vessels which pass a cross and tear the Dura mater which adheres to the Skull especially in its windings so that the Blood which is extravasated on one side hath no communication with the other Wherefore if the Fracture should cross a Suture and anticipate upon two Bones you must Trepan upon both sides Trepaning
mortified part is deprived of motion and feeling as because a great pain causeth an Inflammation and sometimes Mortification do not consider that the weight of the courser particles of the Blood which lies in a part presses the Nerves and so interrupts the course of the Spirits and the pulsation of the Artery is no more felt for as Nature delights to glue the Arteries to the Nerves Arteries for the most part joyn'd with Nerves and that she makes use of the pulsation to oblige all the little Nervous Fibres to discharge the Spirits which they contain so it will be always true to say that the Gangrene succeeds great pains and inflammations and that the privation of motion and feeling come chiefly from the Blood since it 's that which hinders by it's stay the distribution of the Spirits I deny not that the want of Animal Spirits in Paralytics may give occasion to a Gangrene to seise the sooner on a part as we shall see in the following Discourse After all I have said it 's easie to comprehend that the heat and life are precisely contain'd in the Blood since the dissipation and absence of it's spirituous and nourishing particles cause the Gangrene and that their presence and exaltation entertain the natural heat True and only cause of a Gangrene I say then in general that the cause of a Gangrene and Mortification is the dissipation absence or concentration of the spirituous particles of the Blood which must vivify the part or at least the interruption of the course of the same and it's coagulation These causes act for the most part separately it may also happen that they act together to cause a Gangrene as I shall make you observe Let us examine all these Causes and first see what is this alteration of the Blood that is deprived of its spirituous particles from which follows Gangrene and Mortification To give a just Idea of it let 's consider the changes that happen to Wine All the World agrees A Comparison that the good condition of Wine consists in the exaltation of its most subtil and spirituous principles as long as these principles have the upper hand the Wine remains in a state of gentle and natural fermentation and consequently of goodness But if it happen by what cause soever that they be weaken'd and dissipated and the acid salts or salt sulphurs take the upper-hand then it is that the Wine grows sower and at least sharp and very disagreeable It happens also very often that after the loss and dissipation of the spirits there remains nothing in the Wine but Earth and Phlegm it 's without taste and is nothing but a dead Mass and barren Liquor which in Latin is call'd Vappa Vinum pendulum which is as it were the Cadaver of the Wine Finally it happens that in cold Weather the spirits of the Wine concentre in the midst of the Vessel which contains it so that all the parts in the circumference being deprived of the spirits congeal I say that when the spirituous particles of the Blood are dissipated or concentred it receives almost the same alteration If the acid salt or salt sulphurs take the upper hand it becometh acid or rank Willis uses the same Example when he explains the alterations that happen to the Blood In tract de ferm p. 68. in comparison to those that happen to Wine Cum a longa fermentatione spiritus absumi actandum deficere incipiunt inducitur defectionis status quo vina aliique Liquores ant in vappam transeunt an t demum sale vel sulphure nimium exaltatis acetosi ant rancidi fiunt pariter sanguis dum in vasis circulatur juxta triplicem hujusmodi Diathesin considerari potest c. Finally when all the spirits are dissipated that the Blood degenerateth into a dead inspir'd mass incapable of any fermentation and whenever the Spirits are concentred in great cold they abandon or forsake the exterior parts which are then only irrigated with Blood deprived of vital and spirituous particles This last state of the Blood answers to turn'd Wine whence depends the mortification of a part in certain cases which I am going to propose Cause of Gangrene in old People First we observe that old People dye very often of Gangrenes and that that it begins by the Extremities and follows through the whole Body in spight of all Remedies that may be used The same thing happens through long abstinence and after all sorts of too great evacuations To give an account of this Phenomena you must observe that the Blood can no more than other Liquors that ferment always remain in the same condition It 's active principles are yet intangled in infancy they get loose in our youth remain in a state of exaltation during a certain age but at last they are dissipated and begin to abandon their subject in old age therefore old People become by little and little incapable of their ordinary motions they loose insensibly their vigour till at last their life in loosing their heat and spirits This being so it 's not hard to explain why old People who dye after this manner are always troubled with Gangrenes in their last days the reason is because their Blood becomes a Languid Mass which no more contains any character of life and which in effect is no more than a Cadaver of Blood This kind of death one may call natural because it happens not but when the heat is extinguished of it self and by degrees Ideoque mori simul dicuntur extingui In this manner it is that a Mortification of the Blood and Spirits happen after an Hectick Fever long Fluxes great Abstinences too great Labour and generally after all sorts of great Evacuations because in these occasions the Matter designed for the entertaining of natural heat is dissipated or is not enough furnished to supply the loss of it which it actually suffers Of the rest though in this state of the Blood the Gangrene be almost universal and need no other cause to manifest it self yet sometimes it happens that the slowness of the circulation gives it occasion to attack certain parts there is a very particular case of it in the 46th Chapter of the Second Book of TULPIUS his Observations Observation Where he relates that an old Man was reduced to such a languishing condition and so great a weakness that the least impression caused him to have a Gangrene he dared not so much as sit down nor lean on an Elbow nor even set a Foot on the Ground or press any of his Members but there appeared some marks of Mortification which followed the Gangrene This Observation is rare and singular We must confess that his Blood was mightily exhausted of spirits since a slight compression only was capable to produce a Gangrene in a part We need not search any where else for the cause of a Gangrene which happens to the Legs and other parts of
utterly impeded in the part the Tumour increases the part retains all those particles which would have escaped through the Pores the Extravasated Humours being in a greater quantity proportionable to the part which contains it compresses the Flesh and Vessels and of necessity causeth a Mortification Behold the true cause of Gangrene which comes upon Inflammations Contusions Anevrisms and Erisipelas all these causes have been very well observed by Ettmuller when he says Hinc est quod vix saepius oriuntur Gangrene sphaceli quam ex Inflammationibus male curatis imprimis si partis Inflamatae per Emplastica imprudenter admota impediatur insensilis transpiratio tunc sanguis extravasatus stagnat corrumpitur ex toto putrescit partis Inflammate Gangrenam post se trahit In primis Erisipelata per ungt oleosa ac muilaginosa insulsae tractata subito serpentem inducunt Gangrenam But these causes having produced their effect there are that augment it and which give even occasion that it be communicated to the nigh parts it is the corruption of the Blood and Extravasated Humours in a simple Inflammation When the Blood is extravasated and cannot be discust it changes into Pus This change is not only caused by the action of the principles of the Extravasated Blood but also by the soft influence of the Blood and Spirits which are contain'd in the neighbouring parts This makes that the Pus is not altogether a strange substance and enemy to Nature But as I have shew'd that the access of the Blood is entirely press'd towards the Gangren'd parts and the circulation very often intercepted it so happens that the Extravasated Blood is so far from being converted into Pus that it degenerates into a virulent Sanies which first causeth Blisters upon the part and then by its acrimony gnaws the Gangrened parts and insensibly corrupts those that are sound which makes the Gangrene become so angry that it attacks even the parts that suffer no Inflammation Of the rest the Gangrenes which follow upon Inflammations attack rather the soft and fungous parts than other Why the soft parts Gangrenate sooner than other as the Gums Lips Vulva and Membrum Virile Intestine and Brain The reason is these parts being very soft and spongy imbibe a a greater quantity of Humours besides the most of them have no Muscles that might squeeze the Blood which makes it easily lie caking there Ulcers Wounds Scorbutic spots and sharp Medicines may cause a Gangrene Fifthly Gangrene comes upon Ulcers Wounds Scorbutic Spots and upon the Application of sharp and corrosive Medicines which happens two ways 1. When pain which accompanieth all these symptoms causes often great Inflammation on which followeth Gangrene 2. From the Actual Cauteries from Pus and Sanies coming from gnawing Ulcers from Scorbutic Spots and from sharp and Corrosive Medicines which cauterise the Cutis and Vessels so the Blood being no more sent into the parts they lose their motion and life Malignity may cause Gangrene Finally all Authors do admit a malign and occult cause of a Gangrene from thence they say comes the Gangrene in the Plague as Carbuncle which sometimes in 24 hours time causes an entire mortification of a part To the same cause they attribute the Gangrene which happens on Malignant Fevers and sometimes after the Small Pox by a depositum or Crisis of the Matter which the Disease makes in some part Lastly it 's this way which they pretend to explicate the Action of Poysons and Bites of Venemous Animals which they say will cause a Gangrene But without having recourse to the Malign and Occult qualities of the Plague are we to wonder at Carbuncles causing a Mortification in any part Why a Carbuncle mortifies since the Humours which produce them are in the highest degree of Sharpness and Corrosion It gnaws the Flesh and cauterises the Vessels so it 's evident the part must mortifie The same thing may be said of the Matter of Malign Fevers and of the Small Pox where the Blood is loaded with sharp and malign particles if so be that this acrimony cannot be overcome by Nature or by Medicines there is a depositum made of it in some part where the sharp and corrosive Humours do not fail to gnaw the Flesh cauterise the Vessels and even to rot the very Bones as we have seen in many Examples I say the same thing of Poysons that do not work but by their acrimony of which some are acid and others abound with lixivial salt but always they produce the same effect as we daily see it happen by the application of Acids and Potential Cauteries After the Explication of the Causes we must pass to the signs and differences of a Gangrene as for the differences it's easie to draw them from their Causes I pass to the signs which are of more importance Signs of a Gangrene from want of Spirits c. The signs of a Gangrene which attack old People and which comes from the want of Spirits are known by that they feel neither pain nor have Inflammation the parts fade away and are as it were deprived of sense and motion which makes them die insensibly Signs for the Dropsie In a Gangrene which succeeds the Dropsie there is but a slight pain in the beginning but afterwards the Legs inflame and the pain augments Signs from Cold. If it be caused from External Cold the pain is presently sharp the part grows red livid and then black at last the spirits forsake it and mortification seizeth accompanied with a shivering like that in an Ague Signs from Compression Tumours Luxation c. If the Gangrene be the consequence of some compression as of too narrow Ligatures Tumours Luxation Fractures or of too long lying on the Back it 's known by the benumming or by a total privation of feeling and motion according as the compression is more or less strong Signs from Inflammation c. If it be caused by Inflammation the pain and pulsation ceaseth the part which was red groweth pale and livid there are some little Blisters form'd upon the surface of the Skin fill'd with salt Water like muddy Wine the heat is extinguished the part groweth soft and withers so that being pressed with the Fingers the dent remains Finally if the Mortification be perfect the Patient falls into great weaknesses accompanied with a burning malignant Fever with Vomiting and several other symptomes which shew that the Mass of Blood is very much oppressed and Death must needs follow upon it Signs from Repercussives c. The Gangrene which is produced by the use of Repercussives and Emplastic Remedies is accompanied with the same accidents Signs from Caustic Medicines The Signs of that which comes from the use of actual Cauteries and Caustick Remedies are almost always the same as in that which proceeds from too strong Compressions Signs from Malignity As for the Gangrene which comes from
all the Blood that should run out You must take care in pulling off the Dressings not to handle them with too much violence lest you pull also off the Ligature You must take care after suppuration to press the Stump a little by means of the Compress to hinder the generation of fungeous and superfluous Flesh which ordinarily happens after long Suppurations Caution to be used in applying the Vitreol Button Those that use the Vitriol Button must precisely apply it to the mouths of the Vessels and take care it doth not fall in applying the Bolsters Nevertheless though we have disapproved its use for several Reasons yet those that will make use of it ought to lift the Stump up a little and hold the Hand upon it for 3 or 4 hours until the Vitriol hath begun to produce its effect In happens sometimes that after the Operation the part suffers some Convulsive Motions Cause of after Convulsions occasioned by the Spirits being irritated by sharp corrosive or Vitriolic Matters or by the trouble of the Spirits themselves in the part For if we consider that the Brain actually prepares a certain quantity of Spirits which run through the Nerves to serve the Functions of the whole Body we shall agree that those which are designed for the motions and sensation of that part which is no more existent but separated from the others must needs run back It 's perhaps this unlucky reflux which excites these irregular Convulsions and the involuntary Contractions pull along with them the Arteries and so gives occasion to the Ligature to break and the part to bleed which often causeth Death Therefore in these Occasions a Chyrurgeon must not stand searching for the Artery he must only lay upon it the Vitriolic Button with Bolstâ—…â—oaked in some Styptic Liquor These are the measures which you must take in such Occasions CHAP. XXXVII Of Paronychia PARONYCHIA is a very painful Tumour which possesseth the Fingers ends caused by the alteration and effervescency of the Bilious and Sulphureous Particles of the Blood Two kinds of Paronychia They ordinarily make two kinds of it in the one the Matter lies between the Periostium and the Bone accompanied with a burning heat acute pain and deep pulsation great Tention and burning Fever The other is only in the Flesh with less heat and pain lighter pulsation less Tention and hardly any Fever at all Cause of the Heat and Pain The heat and pain come from the strong ebullition of the Blood and many irritations whiâ—â—â—he sulphureous particles that â—…elt and are â—â—rn'd into Sanies excite at the Fibres of the Periostium Cause of the Tention The Tention proceeds only from the fermentation of the Humours it 's easie to comprehend that when a Liquor boils it extends it self more in length and breadth than when it is at rest and must consequently dilate the Vessels in a great manner that contain it Cause of the Pulsation The Pulsation is nothing else but a more exquisite and lively feeling that we have of the Arteries beating in the inflamed part caused by a great Tention and Effervescency of the Blood Cause of the Fever The Fever comes from the mutual agitation of the different particles of the Blood that fight against one another with great strength and tear one another in a thousand little particles of a different bigness and figure which being moved in the mass of Blood excites the Fever but after a long struggle the Pus is made the Vessels burst the Matter Extravasates the Tumour grows softer the Fever and all other symptomes diminish then we give the Pus Issue by Incision Where to make the Incision which we make at the side of the Finger to avoid the Tendon we then use those Medicines ordinarily used for other Ulcers I will no longer insist upon the Paronychia though it would furnish us with Matter for a long Discourse and seeing most Authors have given their Opinion of it any one may be Instructed by them CHAP. XXXVIII Of the Use of Cupping-Glasses MOST Practitioners of Physick are wont rather to approve the use of Cupping-Glasses and Leeches than condemn it be it that they either found themselves upon that pretended Attraction of the Ancients Cupping-Glasses of very little use or that they think to discharge sooner a part loaden with the weight of some strange Matter It 's true they use them but with little success besides this Attraction is just a Chimera and is the most cruel and temerarious practice that can be imagined What appearance is there to scarrifie the Back to dissipate Inflammation of the Eyes To slash the Loyns to hinder the progress of malign Fevers No such thing as Attraction to cut the Skin and Flesh in 20 different places to draw one or two Ounces of Blood I do not believe that those who have an Idea of the Circulation of the Blood can shew me by Experience or any other way that the division of some Cupillary Vessels are capable of curing the least Cutaneous affect Nevertheless there are some that do authorize this practice maintain that the Scarifications do determine the Blood and Spirits to repair in abundance to the scarified parts and that in moving the Humours after this manner the afflicted part is disengaged and the Inflammation lessen'd It 's to be wished for the Partisans of this practice that the Inflammation would favour their Opinion For we cannot believe that the Blood and Spirits running into a part in a greater quantity than the used to do without causing some Inflammation which is not observed here besides Inflammation caused only by the interruption of the Blood that the Inflammation comes not but because the motion of the Blood is intercepted by the divulsions of the Vessels as it happens in all new Wounds and not at all by a determination occasion'd by the Pains Lastly all the Vertues which are attributed to Cupping-Glasses shall not hinder me from disapproving their use for I say that they are not only useless in many Diseases where they are employed but also in Venereal Sores and Bites of Venomous Animals since it 's certain that the Poyson of these Animals which consists in a strange acid manifests it self in a moment to the Brain in spight of the influence of the Spirits and that the Mass of Blood is presently oppress'd with it by the Laws of Circulation from whence I conclude that once Bleeding or the least Sudorific in what Disease soever will always do more good than all the Cupping-Glasses you can apply Leeches very often the cause of Fistula's You must observe that in the Hemmorhoides Emollient and Discussing Remedies are to be preferr'd before Leeches which are very often the cause of Imposthumes and Fistula's in the Anus as I have shewed you in the Treatise of Fistula's Where and how to make an Issue by Caustic I also say by the bye that Caustic's
are not applied upon Nervous parts nor upon the great Vessels but always between the Muscles You first rub the part with a warm Cloth to open the Pores and to make the part in a manner insensible you put a Plaister on it with a hole in the middle to put the Caustic in which you cover with a Compress and with a little Fillet A GENERAL IDEA OF WOUNDS CHAP. I. Of Incised or Contused Wounds of the Flesh TO finish this Treatise I thought fit to relate the most Important Observations which regard the Cure of Wounds and to clear the stiffest difficulties which puzle most Chyrurgeons in the Method of discussing them well without which we cannot obtain our wish'd for end Those that hitherto have treated of them have been satisfied to hold long Discourses about their several Kinds Differences and Prognostics but seeing these sorts of useless Discourses serve only to tire the memory of those which seek to be Instructed I will not repeat them I begin first with the most simple and known Symptomes To stop the Hemorrhage in Wounds Being the Hemorrhage is the first and most dangerous Symptome of Wounds it 's that which the Surgeon must quickly correct in closing the vessels from whence the Blood flows For if you stop them the Blood runs no more that is to say you must put into their Apertures some Medicines which hinders the effusion of the Liquors they contain or in tying or compressing them These two last Methods are the surest because one may order them as one please so that the Intention for which we make the Ligature or introduce Lint into a new Wound is to hinder the flux of Blood in pressing the Lint a little to oblige the sides of the Vessels to approach and resist the Impulsion of the Blood yet so that the Compression excite not Inflammation A Wound having been so dressed it 's of importance to prevent the Inflammation and Pain which are the two accidents which always accompany it Cause of Inflammation The Inflammation or Tumour proceeds from the Circulation in the part being impeded by the division of the Vessels the Grumous cloded Blood and the Dressings These strange Bodies are as so many Sluces which oppose the course of the Blood obliging it to stop and excite Inflammation Cause of Pulsative pain I conceive two sorts of Pain The first is a Pulsative pain which depends on the Arteries that creep about the Nerves which at that time are so extended that they strike the Nerves more rudely than they used to do and make them suffer so great distentions that they break and it 's this plurality of divisions which cause the Pain Cause of the quick and burning pain The second is a quick and burning Pain caused by the suppression of the course of the Blood which by the motion and frequent shocks of its most active principles bursts the Vessels and extravasateth between the porosites of the Flesh where it 's rarified by the great quantity of concentred Spirits which penetrate the most insensible Porosities Then doth the Blood by its irregular action shake and violently prick the little Nervous Fillaments from whence proceeds this second kind of burning pain 2. To prevent pain We commonly prevent these two Accidents by repressing the motions of the Blood which comes to the part with too great precipitation by Repercussives and gentle Astringents Bandages are of the first rank which we use very successfully in binding the Wound up gently as also the neighbouring parts whereas too tite a compression would augment the Inflammation It 's for this end we readily employ Defensatives as we call them because they are compounded of a Desiccative Matter which insensibly shuts up the porosities of the Vessels as Terra Sigillata Bole mixt with the White of an Egg or common Water You must observe never to leave them longer on then 24 hours Caution for Reasons which we shall alledge hereafter You must at the same time sweeten the acrimony of the Blood and empty the Vessels by Phlebotomy Clysters and a good Diet. A thin Diet exceeding good in Wounds If the patient would be prudent in his way of living and use only a thin spare Diet he would suffer much less pain and his cure would be quicker because Salt Meat is capable of thickning the Blood and making it fit for fermentation whereas sweet Liquids by their insipidness dissolve and charge themselves with the salt and precipitate it by Urine after this manner the intemperies of the Blood is corrected and the affected part relieved Benefit of Clysters Clysters are also of great use because they hinder the Excrements from heating and boiling back again in the Intestines they dilate the Matter moderate the heat of all the Viscera and contribute much to the cure of Wounds Repercussives used only in the first Dressing You must observe that at the same time Repercussives retain the most subtil and agitated salt particles of the Blood they grow sowr gnaw the Vessels and excite a fermentation upon which a Fever soon follows They are therefore only used in the first Dressing and prefer Discutients which open the Pores and causes the volatile salts to perspire and so empty the part It 's easie to see if one continues the use of Repercussives the salts endeavouring to escape fail not to excite Inflammation and to corrupt the nourishing Juice of the parts in disuniting the principles of the Blood which depend one on another which by the frequent encounter and shock of their particles change figure from which depends the generation of a new Matter and all the changes which happen Discutients and Suppurations must work together If in such an occasion Discutients which causes perspiration and Digestives which excites a quick suppuration should not work together to disengage the part it would tumifie so much as to fall into Gangrene Cataplasms which have Oyls and Fat 's in their composition have almost the same effect as Repercussatives for which Reason good Practitioners disapprove their use We observe that in great Wounds Discutients excite often a fermentation which increases the Inflammation In that Case a Cataplasm made with Crums of Bread Milk the Yolk of an Egg Mallow Roots c. is very proper We ordinarily blame those who let the Pus lie too long in the Wound because it always gets some malignity corrodes the neighbouring Vessels which presently produces Inflammation Putrefaction or else the Veins absorb it carry it to the Heart from whence it diffuseth it self into the whole Mass of Blood and causes the Fever and according to the different alterations which it receives in passing through the parts it obstructs the Liver Lungs or some other part so causes an Imposthume there as we have observed in Wounds of the Head This demonstrates to us that we ought to dry up all the Matter that is in the Wounds and press the Dossels
drain the source of it If you fear you should not succeed this way you must hinder the Vessel from shedding the Lympha into the bottom of the Wound by drying up its extremity and procure the generation of Flesh as fast as you can If a Wound be accompanied with contusion you must use the strongest Discutients as Spirit Vini alone or Aromatised or a Lixivium which shall be described in the Chapter of Wounds made with Fire-Arms If the Matter discuss not and that it increases you must disingage the parts by Scarification and use Medicines which awaken the particles of the Blood that are at rest and force them out by perspiration or to re-enter again in commerce with the Liquors This is the method which you must follow in great Inflammations where the Gangrene is apt to succeed The Medicines are the Decoction of the chiefest Vulneraries which we have recommended afore The Tinctures of Aloes Olibanum Myrrh made with the Spirit of Wine all Medicines where the preparations of Mercury enter Urine Sea Water Cataplasms made with Meal of Lupins Beans and Lentiles Tops of Wormwood and Scordium boiled in Oximel Simp. These are the chiefest Remedies which are to be employed in deep Scarifications some destroy and blunt the Acids some sweeten and correct the Acrimony of the Lixivial salts others strengthen the part and all together contribute to retain the spirituous particles which are ready to escape or to disengage them when concentred and produce a fermentation which separates the Morbid Leavens and restores the heat and spirits again into the part If a great flux of Blood follow upon the Wound or if any considerable Vessel be opened you must make the Ligature if the place permit or use the Vitriolic Button or some Styptic Water as that in Mr. Lemery's Chymistry and some drops of Spirit of Turpentine When to dilate the Wound If the Orifice of the Wound permit not the entry of your Dossels you must dilate it avoiding the great Vessels and Tendons This is the surest and most important practice to succeed in all Wounds where one cannot apply Boulsters because in discovering the bottom of the Wound you have the advantage to use Boulsters and reject the use of Tents which are only Beneficial in deep Wounds of the Thorax and Belly you may also better wipe the lesser corners of the Wound fill it with Dossels and hinder the Matter from cakeing or lodging it self in any corner and to hinder the formation of any Sinus I have made you observe that many Compresses and too narrow Bandages are kinds of Ligature which stop the course of the Blood and which increase the fluxion and all other accidents A Wound ought to be dressed as soon as possible to secure it from the Appulse of the Air and free the It 's of great Benefit to Cleanse the Circumference of Wounds Patient from some Pain You must also take care to cleanse well its Circumference which is a very important Circumstance because the Cataplasms and Emplasters which are applied upon it stick to the Skin and form a kind of Scab which hinders the effect of the Remedies and retain those particles of the Blood which would transpire whereas if you free the Skin from this Scabbard the Remedies presently enter through the Pores as soon as they feel the heat they favour the transpiration the part empties it self the accidents diminish and the Wound unites more easily You must observe that Emplasters compounded of Fat 's Gums and Powders serve only to retain the Dressings and to oppose the Exaltation of the Juices For which reason good Practitioners condemn them In the time when the Wound begins to cicatrise and the Flesh groweth unequally we let it increase till all Inequalities are fill'd then we dry them with Lime-water How to Cicatrise Wounds or some other Dissicative Medicine to cause an even Cicatrice If the Flesh arise too high you pass gently the Infernal Stone over it To this Method of dressing a Wound I will yet add that the situation must favour the Circulation of the Humours and the running out of the Matter These are the chiefest Circumstances which must be observed in dressing Wounds in the Fleshy parts where the Inflammation Aperture of any great Vessel great loss of substance and the Contusion doth not permit us to practice the Sutures CHAP. II. Of Punctured Wounds or those made with a small and sharp-pointed Instrument WOunds that pass through are not so dangerous as those which have but one Aperture they are sometimes cured by the help of Bandage applied outwardly with some Boulsters soaked in Spirit of Wine Signs when to dilate the Wound If one be pain'd and the part inflamed it 's an evident sign that there are some Obstructions Extraneous Bodies which hinder the unition These two Accidents do also signifie the necessity that there is to dilate it for to carry Remedies to the part and give a greater vent to the Matter we most commonly introduce two Tents of Lint of a length and thickness proportionable to the Orifices we fasten Threads to them and dip them in some Digestive made of Ol. Ovor. Spirit Vini and Turpentine which we alter according to the different degrees of Inflammation if the Suppuration be plentiful the Spirit of Wine must predominate if suppressed by the Inflammation we must correct the Spirit of Wine by putting to it more Turpentine If the Pus be good and the most intimate parts re-unite themselves you must continue this Method but if it be black and Inflammation succeed Phlebotomy reiterated Clysters and cooling and opening Fisans must not be neglected we correct the Digestives with Ol. Rosar Traumatic Injections with Brandy in this occasion are admirable If notwithstanding these precautions the Inflammation incroaches upon the neighbouring parts with putrefaction you must dilate it sufficiently to discover the place where the Matter lodges by this means you discharge the part and dress all the corners where the Matter formerly was nestling and so prevent Gangrene and Mortification Where prepared Sponge is better to dilate with than Incision Concerning the Dilatation of Wounds there be some who pretend that the prepared Sponge may supply the want of Incision I own that in places where much dilating is not wanting and where the Cicatrices would deform as in the Face and am so far from condemning the use of it that I say it 's very necessary but in all other Occasions the Incision is to be prefer'd Though a Wound goes not through and through yet if the Probe enters almost through the part you must without delay make an Incision on the opposite side The Symptomes which commonly attend Punctur'd Wounds The most frequent Symptomes that happen in these kinds of Wounds are Fever and Looseness upon which sometimes follows Dysentery The Fever excites Inflammation and retards Suppuration that the part becomes so tumified that a Gangrene often follows it It 's known
that the different dgrees of the Fever rule those of the Inflammation as these do them of the Gangrene Bleeding Clysters Sweet and Liquid Food Emollient and Discutient Cataplasms made of the four Meals Honey and the Emollient Herbs boil'd in Wine as Fol. Malve Altheae Senessionis Violar Rarietariae Candilariae Chamomillae Meliot c. All these Medicines are very Efficacious here You must observe to let the Cataplasms be very moist lest they dry up and so instead of Humecting and Mollifying the Fibres they obstruct the Pores as Astringents and hinder Transpiration If in spight of all this care the Inflammation goes not off you relieve the part by some slight Scarifications if they be not enough you make others deeper that the Medicines may have room to work If the Wound be superficial you must dilate it but if it penetrate even to the most intimate parts I mean near the great Vessels or Bones you must keep to Scarifications and Injections made of Traumatic Plants Mel. Rosar and Spirit of Wine because you would be apt to ruine the whole part by the Incision which must afterwards be cut off It often happens that the Gangrene comes on the sides of these kinds of Wounds where the Obstruction is always most considerable in which case your Pleagets must be well charg'd with Digestives If the Inflammation goes not off either by Suppuration or Transpiration and the red colour of the Skin changes not you must use strong Maturative Cataplasms of White Lilly Roots Sorrel Leaven and the common Digestive provided the Inflammation communicates it self not to the adjacent parts Scarifications are not to be used but when the part is extreamly stretched and the red colour changed into a livid and when little Blisters arise which signifies a beginning Mortification and shews that the ferment of the Gangrene is very acid and malignant you must not stay till these little Blisters increase but as soon as you see that the Wound doth not suppurate and the Skin changes colour you ought to Scarifie and lay Compresses upon the neighbouring parts soak'd in warm Wine and Brandy The Fever is sometimes extinguished by Scarification because the Agitated Matter of the Acid ferment hath room to escape so the Inflammation is diminished Suppuration procured and the progress of Putrefaction stopped If the Lips of the Wound be of a Vermilion colour it 's a token that the salt particles prick the Membranes and increase the Fluxion it excites the Fever a-new for some time and the edges of the Wound grow white and dry This change proceeds from the salt Juices which by their too great motion separate themselves from the sulphurous ones so that they irrigate the Fibres and cause a new Obstruction which afterwards makes the Flesh foggy and white We often observe that though the Wound be often ready to Cicatrise yet if the Fever arises a-new it grows bigger and more dangerous than it was before because the Inflammation makes a greater progress in this case you touch the new form'd Skin with Aq. Calcis in which some Mercurius Sublimat has been dissolved but without using any remedy you may cut it off for the ferment of that Membrane infects the neighbouring parts Balsam of Sulphur is very good in this occasion especially in small Putrefactions Flux a dangerous Symptome If a Flux come upon a Flesh Wound it 's a very dangerous symptome because it only happens when the salt particles have left the part and enter into the Mass of Liquors Now as the Volatil salts maintain the motion of the Blood and other Humours and have a vertue of dissolving and making them fluid we are to search no where else the cause of this Symptome This Flux hinders Suppuration and weakens the Sick more than all other accidents together because of the great dissipation of Spirits that is made by the Stools We also observe that the Wound dries shrivels and becomes as it were mortified according as the Spirits abandon it and the stronger the Flux is the more the Inflammation lessens the Flesh dries up and the part becomes more faint adust and putrid You must foment it with Aromatic Wines and hinder the disunion of the salts by the help of Balsam of Sulphur but from the moment that the Spirits exalt themselves towards the surface the motion of the Blood slackens the Flux ceaseth and the Wound which before was inanimate as it were revives again This Flux must be stopt with great Circumspection for it 's a sign that the salts are become very acid since they offend every part where they lie you must always stop it by degrees for fear a sudden suppression might again revive the Fever and render it more malignant and pernicious which would presently unite Putrefaction with Inflammation The Flux being stopt the Patient must be fed with sweet and thick Food The proper Medicines for stopping a Flux are Clysters made of White Broth Mallows Bran Lettice Knot-grass and the Yolk of Eggs. Tisans made of Bugle Sanicle Lemons and Liquorish are also of great help We observe that this Flux happens oftner in great Hospitals than any where else especially in great Wounds because the Wounded receive there an Air loaden with Malign and Pestilential Vapours which not only causes the Looseness but all the other troublesome Accidents which follow upon it We observe that the Wounds which happen to the Legs are most dangerous or of difficult cure but since the Circulation being more flow in them their Tendons and Membranes stretched and their Vesicles more narrow this disposition of parts causes the Humours to settle and employ themselves more easily and that only the serosity is able to disengage it self in time of their settlings by its abode changes into a Virulent Sanies which entertain the Wounds of these hard and callous parts They also require some Medicines capable of carrying off and melting the Callosity and destroying the Sanies which is the chief cause of it When Wounds are of difficult cure and as it were unconquerable with Medicines it 's the evil disposition of the Subject for the most part which contributes to it Some are naturally of an Ill Habit others affected with some Venerial Disease or some other as bad Finally others do not govern themselves and have a greater inclination for that which is hurtful to them and which is capable of heating and altering their Blood If in these kinds of Inconveniencies the Medicines which we have used produce not any effect Cardiac's and Medicines of a Purifying Quality favours their cure What to be used in Venomous Wounds as all Aromatic's Cordial Potions all Preparations of Mercury and Antimony Theriac Confections Powder of Vipers with their Volatil Salt Volatil salt of Hearts-horn and several Medicines of the same Nature which differently according to the different degrees of Corruption This is the Practice which must be followed in Venomous Wounds having applied upon the part all things that resist
supple the Ligaments and Glands are not entertain'd in their ordinary fluidity and as I have shew'd in thâ— Anevrism that it condenses at the least heat by the repose of its Particles and it forms an Anchilose so I say its formation must be much quicker here the heat being more excessive Now it 's evident that a concatenation of accidents of this nature may utterly destroy the part for if the Anchilose which grow about the Joynts and Ganglions which are form'd upon the Ligaments by the thickning and coagulation of the Nutritive Juice cause the loss of motion the alteration and mixture of several Liquors of different nature are very fit to putrifie it by their purulancy and acidity The Purulent Hmour corrupts and infects it the Acid pricks and gnaws it and the Viscous obstructs and makes it immovable It 's doubtless by reason of the contrariety of their principles which destroy one another in the actions of the Medicaments which causes them to be of so difficult a cure and so hard to prevent the Ligaments from rotting We have made you observe in the Examination of the Fistula in Ano that Wounds of the Joynts often degenerate into Fistula's because the salt Juice abounds there from every part and the Pus changes into a sharp and malignant Sanies which filters into the Porosities of the Nervous Fibres of the part making the Ulcer callous and fistulous This Humour becomes sometimes so biting that it destroys not only the Tendons and Ligaments but gnaws also the Cartilages and causes a Cariosity of the Bones To prevent all this you must follow the same Method which we have prescribed in Wounds of the Tendons that is to say you must use every thing that tempers sweetens and is capable to correct the acrimony of the salts When the Wound hath run well for some days and the swelling of the part a little gone down you use a Balm made of Ox-gall An Extraordinary Medicine in Wounds of the Joynts c. Spirit of Wine and Mel. Rosat which hath the faculty of discussing and resolving the Coagulate Matters After this manner you prevent the callosity of the Wound and all other accidents We commonly Cicatrise with Humecting Medicaments because Dissicatives make it deform'd The Bones differ from the Tendons and Ligaments in that their Contexture is more thick close and compact and are nourished with a more salt and subtil Juice If the Wounds which happen to them be simple the sole reduction of the Pieces maintained by Bandages is sufficient to cure them If the Fractured Bones press some Vessel or Tendon and the Contusion be considerable if you differ the reduction the part falls into a Gangrene and Mortifies If some pieces of the Bone be separated so that you cannot reduce them you must make an Incision to pull them out I know that this happens very seldom and the Splinters must the very much intangled in the Flesh if they cannot be reduced without Incision If the Bones be quite broke to pieces and some great Vessels lacerated you must cut off the Limb. I speak not here of the Dressings which are used in all sorts of Fractures I only recommend to you that the Bones be tied harder where broke then any where else to keep them reduced and to hinder the Callus from growing too abundantly We know that Compound Wounds comprehend both those of the Flesh and Bones and that besides the 18 tail Bandage they require the application of several different Remedies We use in the beginning Discutient Cataplasms to evacuate part of the Matter by Transpiration You must by all means Suppurate because we are obliged to wait for the generation of the Callus and exfoliation of the Bone besides a great Suppuration alters the Bones in a very little time It 's therefore necessary that Discutients be used in stead of Suppuratives and if in the first days we use Digestives Spirit of Wine and Hony must exceed you apply dry Lint upon the Bone till the Callus be form'd and after it's generation you apply Boulsters on it soaked in Spirit of Wine in which Sal. Armoniac and Camphire has been dissolved which is a most excellent Medicine to cure Ulcers of the Bone and to hasten Exfoliation You must observe that there never grows good Flesh upon a rotten Bone or that which is ready to exfoliate It 's always spongy and one may say that whenever they are of such a nature it 's a certain sign that the Bone must needs Exfoliate which most ordinarily happens in long Suppurations The formation of the Callus grows according to the Patients way of Living It 's observed that it grows too much and renders the part unequal when the Patient eats too plentifully and when they use too spare a Diet it grows not sufficient to reunite the part The Prognostic's of Compound Wounds are always very dangerous to Cachectical Persons Old and Pox't whose Bones rot oftentimes without any Wound coming upon them CHAP. V. Of Gunshot Wounds GUnshot Wounds are always very dangerous as well by reason of the great Contusion which accompanies them for the most part as because the passages of the Blood are utterly stopped We know that the Bullet's passing through a part scatters the substance and breaks the Vessels without any Hemorrhagy or Suppuration before three four five or sometimes six days the age temperament and nature of the part regulate these accidents the reason of it is grounded upon the great agitation of the Bullet and upon its round and blunt figure that enters with so much force and swiftness into the Flesh bruiseth and crushes the Vessels so that it forceth their Tunicles to glue themselves to one another and so opposes the flux of Blood unless some great Vessel be broke and the Blood force a passage by its Impulsion Obstruction great in Gunshot Wounds Of all Wounds there 's none where the Obstruction is greater than in these and which consequently are more capable of Inflammation and Gangrene The contain several Particularities to which the Chyrurgeon ought to give his attention The first is to consider whether they be in any of the Venters or the Limbs if superficial or penetrating if the Bullet hath passed through and through if it has touched some important part tending to the functions of Life in its passage which may be known by the succeeding symptomes But whether it has passed through or found some obstacle in its passage it 's well known that these kinds of Wounds are almost always accompanied with troublesome accidents Accidents accompanying Gunshot Wounds as rupture of some Vessel fracture of a Bone or Contusion which is of least consequence If the Orifice of the Wound be of a round figure and grown less by the fluxion the first Intention which you must satisfie is to dilate it you excite by that means Suppuration and procure a more equal Cicatrice you discharge the part in letting the Wound bleed as much
as is convenient and prevent accidents But first it 's important to extract the Bullet if you can since it is its progress which marks the place which is to be dilated If you cannot follow the track which it has taken without making an Incision How to extract the Bullet you put the Patient into the same posture he was in when wounded that you may easier trace the Bullet and observe the place where it stops you afterwards dilate the Wound minding two Circumstances 1. You must avoid the great Vessels 2. You must not discover the Tendons of the Joynts without necessity If the Bullet be engaged near some great Vessels When to leave the Bullet in or in the middle of the Muscles so that it cannot be extracted without causing some ill effect you may leave it in the part provided the Patient be not much incommoded with it If it be in any of the Venters you must leave it to Nature If it stick in the Bones you must gently move it to draw it out more easily because the Bone would of necessity putrifie If it be in the Nervous parts as in the Joynts you must hasten its extraction particularly when it 's sharp or of any corruptible Matter for then you must not only extract it from the Nervous parts but every part whatever You extract the strong Bodies by Attraction or by Impulsion with the Hand Instruments or Medicines according to the part they lie in If for Example a Bullet be passed the great Vessels you will be obliged to extract it from the opposite part but if it be on this side you extract it through its entrance Nevertheless that general Rule hath its exception for if some strange Body be upon the Carpus or Tarsus forc't from without inward and should have passed the Bones It would be a great temerity to Incise the bending Tendons of the Fingers to force a passage through the opposite In that case you must extract it by the same way it went it If the Bullet has ruin'd a Joynt you must cut off the part because the Ligaments and Bones being quite split to pieces and their Splinters irritating the Tendons it causes a Gangrene to seize presently on the part If the Bone of the Thigh be broken you must dilate the Wound as much as is convenient and advance the Suppuration that you may have the liberty of extracting some pieces of the separate Bones if there be any Of the rest you follow the same method as in other Compound Wounds If there be any Vessels open'd as the Subclavian Vessels you make the Ligature and if some Blood be diffused upon the Diaphragm you must come to the Operation of Empiema If the Bullet has carried off a great part of the Bone as we cannot cut proportionably so much Flesh as the substance of the Bone lost for to convey Remedies thither it happens that the Flesh that grows over it becomes callous and sometimes ossified forasmuch as the salt Juice which runs this way hardens it by little and little If the Trunk of a great Vessel be opened we are often obliged to Amputate the part because the part which receives no more Blood for its nourishment Gangrenates If the Wound be only in the Flesh you may bath it presently after the first dressing with Brandy you soak Boulsters in it and bind up the part with Compresses soaked in warm Wine strengthen'd with Spirit of Wine Accidents which attend The chiefest accidents that accompany Gunshot Wounds are Tumours Putrefaction and Hemorrhagy to dissipate the swelling we successfully use Traumatic Fomentations mixt with Spirit of Wine or Cataplasms made of Urine Rye Meal Hony and Infusion of Roses or a Lye made of Vine-Ashes in which you dissolve Sal Armoniac and Brandy If the Tumour be not big Suppuration is enough to carry it off If it be accompanied with hardness you make some slight Scarifications To excite Suppuration in these kinds of Wounds you use a Digestive made of Vngt Basilicon Linament Arcei Ol. ovor Spirit Vini If Corruption be joined you add Theriac Myrrh Aloes Sal Armoniac Ol. Absinth Anthi as you fear the Corruption you animate them the more If the Putrefaction happen to a fleshy and spongy part you dissolve Egyptiac in Spirit of Wine and mix it with the Digestive Egyptiac not to be used in Nervous parts For Egyptiac being entirely a Dissicative if it were used in Nervous parts that are wont to dry up it would dissipate the little humidity that remains there If you use Injections it 's best to use the two Aristolochias boiled in White Wine in which you dissolve Sugar Candy Camphire Myrrh and Theriac Bitter things not to be used in Injections of the Breast You must observe that Injections as well as other Remedies must be managed with prudence according to the parts where they are used Ex. Gr. If you Inject into the Breast of one troubled with an Empiema a bitter and sharp Liquor it would irritate the part so that they would augment the accidents in the like occasion we use with good success a Decoction of Barley Agrimony a very little Wormwood and Centaury Plantain Birthwort in which you dissolve Mel. Rosar If this needs to be fortified you boil them in Whitewine or Brandy The Tincture of Persicaria Maculata made with White wine is also good to resist Putrefaction if you intend to make it stronger you dissolve Myrrh Aloes and Sal Armoniac in Brandy and mix with it the Solution of Sal Armoniac in Spirit of Wine which produces the same effect and to hinder the generation of new Corruption you compass the Dressing with Spirit of Wine Camphorated The Solution of a Drachm of Mercurius sublimate or Arsnic in half a Pint of Spirit of Wine is excellent in great Putrefactions or one Ounce of Mercury in two Ounces of Aquafortis which we mix with Lime Water or Brandy We also use with very good success in these occasions the Solution of the Canstic Stone in Brandy which we mix with the same quantity of Spirit of Wine Camphorated All these Solutions are capable to waste and separate putrified and rotten Flesh and also to consume the Cariosity of Bones After the effect of all these Remedies you use Detorsive Decoctions made of red Roses Consolid Maj. Quinquesolium Plantain Agrimony Nettles Pimpernell Periwinckle St. Johns Wort Purslain Plantain and Poppy Seed with which you slightly siringe the Wound so separate the rest of the Impurities that are there When you use Detersives you ordinarily joyn Suppuratives with them as Turpentine Vnguent ex apto Balsam Arcei Ol. Hyperici If the Wound has long suppurated and the Flesh grows Luxuriant you consume it with the Spirit of Sulphure put in the Mundificative If it be the Humidity of the part which causes this proud Flesh to grow instead of the Mundificative you use Allom Water or the Aq. Phagedenica or the Decoction of the Traumatic Plants made with Lime Water or Lastly Linamentum Arcei mixt with Myrrh and Fine Bole in Powder THE END BOOKS Printed for and sold by Daniel Brown at the Black-Swan and Bible without Temple-Bar THE Secrets of the Famous Lazarus Riverius Councellor and Physician to the French King and Professor of Physick in the University of Montpelier Newly Transsated from the Latin by E. P. M. D. A Physico-Medical Essay concerning the late frequency of Apoplexies Together with a general Method of their Prevention and Cure In a Letter to a Physitian By William Cole M. D. Nova Hypotheseos ad Explicanda Febrium Intermittentium Symptomata Typos Excogitatae Hypotyposis Una cum Aetiologia Remediorum Speciatim vero de Curatione per Gorticem Peruvianum Accessit Dissertatiuncula de Intestinorum Motu Peristaltico Authore Gulielmo Cole M. D. Novum Lumen Chirurgicum Or A New Light of Chirurgery Wherein is Discovered a much more Safe and Speedy way of Curing Wounds than hath heretofore been usually Practised Illustrated with several Experiments made this Year in Flanders Authore Johan Colbatch Med. Novum Lumen Chirurgicum Vindicatum Or The New Light of Chyrurgery Vindicated from the many unjust Aspersions of some unknown Calumniators With the Addition of some few Experiments made this Winter in England By Jo. Coloatch Physitian Christian Practice Described by way of Essay upon the Life of our Saviour By Stephen Skynner Rector of Buckland in Hertfordshire and late Fellow of Trinity-College in Cambridge Rules for Explaining and Decyphering all manner of Secret Writing Plain and Demonstrative With Exact Methods for understanding Intimations by Signs Gestures or Speech Also an Account of the Secret ways of Conveying Written Messages Discovered by Trithemius Schottus Lord Fran. Bacon Bishop Wilkins c. With exact Tables and Examples By J. F. The Traveller's Guide and The Country's Safety Being a Declaration of the Laws of England against Highwaymen or Robbers upon the Road What is necessary and requisite to be done by such Persons as are robbed in order to the recovering their Damages Against whom they are to bring their Action and the manner how it ought to be brought Illustrated with variety of Law-Cases Historical Remarks Customs Usages Antiquities and Authentick Authorities By J. M. The Clerks Grammar wherein are laid down Plain and Easie Rules for the Making any Bond or Bill Obligatory or single with the several Conditions in most Cases also Instructions how to place the Names Sums and Dates of the same in true proper Latine Likewise An Exact Method of Drawing all manner of Deeds of Common use with Instructions how to Raise any Consideration Habendum Redendum Preservation or Covenant used therein made more Plain and Intelligible to the meanest Capacity than Scarron's Novels Vix The Fruitless Precaution The Hypocrites The Innocent Adultery The Judge in his own Cause The Rival Brothers The Invisible Mistress The Chastisement of Avarice The Unexpected Choice Done into English with Additions by J. D. Esq All sorts of Physick Books Latin and English
Ligature upon the Aperture of the Vessel instead of making it a little higher because the Blood by its impulsion would not fail to dilate the weaken'd part and to bleed afresh For this purpose you pass a Needle over the pipe of the Artery make first a single knot on which you place a little Compress which you fasten with two other knots Most make another knot in the lower part of the Artery because of the Branches of communication and since it being a precaution not to be despised one may use it The Ligature being made you loose the Tourniket If the Blood be well stopt you open the Tumour to empty the Blood and fill it with Dorsels arm'd with Astringent Powders as Vitriol alb to consume the Bag more easily you cover the rest of the wound with Boulsters accompanied with a Plaister Embrocation of Ol. Rosar Defensatives all along the Arm with Compresses temper'd in strong warm Wine with the Bandage Some time afterwards you must Bleed the Patient if his strength permit you stay two or three days without taking off the Dressings and you leave the Dossels at the bottom of the Sac 3 or 4 days longer lest in taking them out you bleed afresh and procure a fresh suppuration The situation of the Arm which seems a thing of little consequence must nevertheless be regarded as very advantageous for furthering the cure The Arm must be a little bended and the Hand elevated on the Pillow that the circulation be more free But you must particularly recommend the Diseased to bow and stretch it from time to time We daily see that several become lame for not having moved the Arm or Leg during such Indispositions The cause of this accident comes from the little motion of the slimy matter which bedaubs the Joints This Slime is of the consistence of the White of an Egg and which transpires from the Ligaments and Glands of the Joynts serving to entertain the supple Ligaments and to smooth the shining Cartilages as well to facilitate the motion as to hinder the parts from being wasted by their continual attrition but from the moment that this Matter is at rest and no more fluid or liquid by the diversities of motion it groweth thick and hard by the heat of the part so that the Ligaments and Cartilages being no more humected by that Liquor they dry up loose their Elastic Virtue and Humidity till at last they grow incapable of motion Sometimes it happens in old Rottenness and Fistula's of the Joynts that the Purulent and Malign Matters gnaw the Ligaments and Cartilages and gives occasion to the Saline Juice which exuds from the body Fibres to unite the extremity of the two Bones and frame a kind of Anchilose which is much more defectuous than the precedent CHAP. XXXV Of Gangrene and Sphacel which occasions the Amputation SEveral Authors have treated of the Gangrene particularly Willis Etmuller and Silvius and I believe no body doubts but that all whatever our new Discoverers have advanced upon this Subject in their Exercises is nothing but a perpetual pillage of what these great Men had spoken To speak of it methodically we must first give an Idea of the Vivification of the parts and of the Mortification which is its opposite we must relate all particulars which cause a Gangrene and seek all the means to illuminate them with Reasons grounded on the Oeconomy of the Blood and upon some Observations which Experience Authorises Cause of Vivification To know how the parts are Vivified you must consider that the heat and life of Animals consists only in the motion and fermentation of the principles of the Blood that this Fermentation and Motion as well Circular as Intestine are entertain'd by the pulsation of the Heart and Arteries by the motion of the Muscles and action of the subtil and penetrating particles of the Air which we breath It is in effect the spiral and nitrious particles of the Air which attenuate and subtilize the particles of the Blood in mingling themselves intimately together in the substance of the Lungs which make them wave upon their centre and which give them all their vivacity and influence which is necessary to the maintaining of their intestine motion and consequently of their heat and Life It 's certain then that it 's the Blood agitated by these means which vivify and animate the parts repairs the continual losses which they suffer furnishes the matter of the Spirits and of all the different Liquors that are subtilized in passing through a 1000 different Strainers In one word it 's the Master spring that makes the whole Machine go This being so it 's not hard to conceive that it is from the actual distribution presence and action of the spirituous and nourishing particles of the Blood in a part on which entirely depend its motion and life Cause of Mortification so that this dispensation coming to cease or be interrupted for some moments one feels no more there either heat motion or life To convince our selves of it we must only examine that which happens every day in Syncop's where we see that the pulsation of the Heart being hindred and the circulation of the Blood stopt all the Extremities grow cold the Face pale and sometimes lived and the whole Body deprived of feeling and motion but according as the Heart recovers its motion and the Blood conveyed into all the parts they recover their heat motion and life It 's therefore evident that the life of a part depends on the presence and motion of the Blood and on the contrary I say that the cause of a Gangrene and Mortification of a part is doubtless the absence and want of these spirituous and nutritive particles in the same part This is the Explication which the Illustrious Etmuller gives of it in Tome 1. operum pag. 587. where he says Causae Gangren sphaceli in genere sunt quae quacumque ratione sanguinis spirituum vitalium distributionem inhibere valent It is a question whether the Animal Spirits which run from the Brain through the Nerves are not likewise interessed in a Gangrene I say that the most causes which work upon the Blood for the production of a Gangrene may in the same manner work upon the Animal Spirits but in the mean time the Gangrene only depends on the alteration which happens unto the Blood This is proved because a Gangrene is a privation of Life or at least a disposition next to a Mortification now the Functions of Life depend chiefly from the Blood whereas the Animal Functions depend on the Animal Spirits The Nerves may be obstructed and the Animal Functions cease in a part without Mortification as is seen in Paralytics It 's true then to conclude that a Gangrene depends only on the default of the vital and spiritual particles of the Blood Those that will have the Animal Spirits to have much share in the Gangrene as well because a