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
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
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
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
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
from another whereas those of the Navel are not at all distinguishable because they shrivel up and the tendinous Fibres of every Aponeurosis twist themselves so one into another that all their parts seem to be continuous It must also be observed that the Navel is without Flesh about half the breadth of a Finger round about all this contributes to the formation of the Exomphalos CHAP. X. Of the Operation of Exomphalos AFter having us'd Bandages and all Medicines as well general as particular without success you must prepare the Sick to the Operation How to perform the Operation Being dispos'd the Surgeon must lay him on his Back without violating the tumor and endeavour to reduce the Intestine into the Belly pinching up the skin on one side whilst a Servant does the same on the other and with a Bistory incise all along the side of the tumor Danger of the Suspensorium Hepatis that he may avoid the Umbilical Vessels particularly the Suspensorum of the Liver for this Visera being no more suspended the vena cava would be comprest and the Circulation hindt'd which would cause Death If you are sure of the reduction of the Intestine you must softly incise still into the Cavity of the Belly and scarifie the Lips of the Wound in all its extension to procure a strong Cicatrix make the intersected stirch some pretend the Quill'd Suture is more covenient because it more strongly refists the motions of the Muscles and Intestines You must introduce the Tampion of Lint tied to a Thread to hinder the regurgitation of the parts and to give way to the Matter as it Incarns you must diminish your Tent proportionably till the Cicartrix be formed Here good Diet and repeated Clysters are to be preferr'd before other Remedies as in Gastroraphia This Operation includes other particulars which will more properly fall under the Discourse of the Bubonocele CHAP. XI Of the Operation of Bubonocele and Hernia Compleat THat I may not confound all the circumstances which accompany Bubonocele and Hernia compleat nor mistake in the order which I have propos'd in describing them I am forc'd to comprehend them both in one sole Operation These tumours are either wandring or permanent they disappear sometimes or remain always in the same condition If they are wandring 't is a sign of no adherance and that the Intestines suffer no compression than the Bandage alone and general Remedies well ordered may finish the cure If they be permanent it comes from the inflammation adherence or from some excrements hardned in the Intestines We know when the Epiploon is fastned there by the signs spoken of heretofore which induces us to make the Operation without irritating the tumour for it alters at the least impression and it is very hard to reduce into the Hypogastrium I have made you observe that the Inflammation and Strangulation succeeded the induration of the excrements contained in the Gut according as it swells and grows thicker by the flowing of them the ring of the external oblique which does not obey as the others for the reasons already mention'd restrain sit proportionably as it dilates which causes the Blood and Spirits not to circulate with the same liberty and the Inflammation of the Intestine to increase equally with the Strangulation You must also observe that the Gut never contracts any adherency but with the bag that makes the Hernia unless some sharp and strange Matter has corroded it This bag is sometimes adherent to the cover of the Spermatic Vessels sometimes to the Omentum or to the rings of the Muscles in all their circumference or in some part only to the Dartos or finally to the Membranes of the Testicles The most difficult part of the Operation so that the Intestine cannot return into the Belly unless separated by Incision which necessitates the Surgeon to use his utmost Prudence and Dexterity if he means to succeed in so nice an Operation the chief circumstance of it indeed being carefully to examine where the Gut is fastned not only because the oeconomy of the Operation must be changed but also because this Knowledge rules our Judgments and causes us to make a favourable or dangerous Prognostic A danger our Symptom The Hernia where the Intestine is adherent to the Testicle is very dangerous and for the most part mortal If it be an old one the happiest can't be rid of it without loss of the Testicle The true way to know whether there be any coherence is to question the Diseas'd how long 't was since the tumor did not disappear whether he feels vehement and pulsific pains and great weight on the Testicles Signs that the Gut adheres to the Testicles If the Intestine be one fallen down into the Purse and that it keep there some time without returning and there appear no Inflammation in the Groin it 's a sign that the Sack which contains it is joyn'd to the Testicle by the action of the viscous Humors which run from the Peritonaeum or even from the Membranes of the Testicle these Humors growing thick by heat are like a kind of a Glew which ties them close together and if the Matter come to dry up by the reaction of the Blood and Spirits it 's impossible to sever them without offending the Body of the Testicles You must observe that if the Gut does not return into the Belly 't is not always a sign of adherence It may be inflam'd or contain some excrements which is the better distinguished because we know that it had the liberty to enter before the Inflammation We commonly undertake the Operation when the Inflammation hinders the Matter from entring the Intestines Having examined the different conditions of the Diseas'd if there be any of them which induces up to perform the Operation we must use this method How to perform the Operation Lay the Patient on his Back I suppose here that the intestine is stopt in the Purse fastned to the Testicle and Inflam'd then Incise with the Bistory the skin of the Scrotum near the Thigh all along the tumor then separate the two Lips of the Wound for to break gently with a Fleam or your Fingers all the tegaments of the Intestine and Testicles How to distinguish the Gut from the Sack As for the precautions which we must observe to distinguish well the Intestine from the Sack which forms the Hernia its brown colour I suppose is the most convincing Sign by reason of the many Blood Vessels which irrigate them It forms a kind of Arch which is sensibly perceived when discover'd besides if it 's the Gut the tumor lessens It 's always thicker than the Peritonaeum being composed of four Tunicles I agree that this Sign is equivocal so much the more because the Sack of the Peritonaeum grows often to a very considerable thickness There runs always frem the Intestine a thick and stinking Matter whereas from the Sack of
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
stony Matter The good or bad use of Food contributes much to its formation we observe that those who use too spiritous Drinks and dirty Food are more subject to it than others We see also that those who live on Milk Meats Fruit Pulse Rye bread and several other Impurities are often tormented with it The latter contribute to it because of their Impurity and the other by reason of their spiritous Particles the latter furnish the principles of the Stone and the other the Ferment which disposes the Excrements because working on the Colon which is near it gnaws and corrodes the Tunicles and after this manner opens a passage to come out this way Vomiting and Palsy of the Thigh and Leg are also concomitant the Diseased can't stand strait and the Testicle of the same side retires into the Groin Cause of Vomiting in Inflamation of the Reins The Vomiting proceeds from the mutual communication that is between the Nerves of the Kidneys and Stomach by the Irritation of the Spirits in the carnous fibres of the Stomach occasioned by the Inflammation of the Reins Cause of the Palsy of the Thigh c. in Inflamation of the Reins To give a reason for the Palsy you must observe that the Kidney is laid upon the head of the Muscle Psoas which it presses and inflames this Muscle being inflamed also presses a thick string of Nerves which passes through its body and distributes it self into the interior part of the Thigh and Leg from whence follows the stupor by the suppression or obstruction of the Spirits After this manner the Muscle Psoas reciprocally inflames the Iliac to which it 's join'd and seeing these two Muscles serve to bend the Thigh it can no more obey not follow the action of these Extensors which is the cause that we can't stand upright without cruel pain Cause of the contraction or shriveling up of the Testicle into the Groin The Testicle retires into the Groin by reason the Iliac Muscle is join'd to the Cremaster's which embraces the body of the Testicle so that its fibres being shortned by the Inflamation which the Iliac communicates to it the Testicle must necessarily mount into the Groin nevertheless all these Signs are equivocal seeing they may happen in the ordinary Inflamation of the Reins that is to say in the Nephretic Colic Signs of the Stone in the Bladder The Signs of the Stone in the Bladder are palsific burning pains in the time of making Water the Urine comes out by drops and reiterated turns as in Stranguria and as the Bladder is emptied and diminished in bigness its sides apply themselves so hard against the surface of the Stone which if it be rough it fails not to cause sufficient convulsions and break some vessels in which consists the burning pain one feels after pissing and the last drops are often bloody The Water is made by turns because the Stone which lies heavy on the neck of the Bladder Causes of these Signs of the Stone in the Bladder stops partly the passage of the Urine but the worst is that in the time of pissing and when the sides which before were extended come to touch rudely against this rough body its nervous fibres break and gives way to the Urine by its acrimony to prick them so causes convulsions cruel and pungent pains and imprints on the spirits an irregular motion by occasion of which the carnous fibres contract and embrace the Stone faster the diseased thinking in that moment to ease himself and desiring to suspend the course of the spirits augments on the contrary the violence of the pain and retards the course of the Urine and so causes some of it to remain always in the Bladder which grows acid and at length becomes stinking by its stay there so renews much sharper and insupportable pains Cause of Itching One feels an Itching in the region of the Perineum which irritating the sphincter of the Anus excites a Tenesmus the Itching continues even to the extremity of the Gland which obliges the Patient to rub it often Cause of Heaviness about the Perineum The Heaviness about the Perineum can't proceed but from the weight of the Stone and the itching from the acrimony of the Urinc Sometimes there happens a Priapism or an involuntary erection of the Penis caus'd by the irritation of the fibres and inflamation of the bladder and urethra which communicates it self to the cavernous bodies It 's easy to see that the irritation of the part join'd with some slight indisposition can awake and hasten the course of the blood and spirits design'd for the functions of the Yard and adjacent muscles which being swell'd by the spirits compress the veins which are distributed in it to hinder the return of the blood the blood and spirits filling all the vacuum or empty spaces of the hollow bodies the Yard must needs grow stiff and extend it self We observe that the Urine is sometimes white sometimes bloody troubled and muddy and is charged with a mucous and sandy sediment HIPPOCRATES in his Aphorisms reports That when the Urine is extreme clear and you find Sand in the bottom of the Urinal it 's an infallible mark of the Stone 's existence in the bladder A certain Sign of two or more Stones in the Bladder When the Stone is smooth it 's a sign that it 's accompanied with some other Stones which by their continual atrition become polished and smooth If the Stone be big and lies heavy on the neck of the bladder it dilates in such a manner that in time it grows as big as its bottom If it adhere to any part or is contain'd in a cistis the Patient may carry it all his life without any detriment or manifesting any of the signs which we have spoken of especially when it 's suspended at the bottom of the bladder An Observation VAN HELMONT assures us that he knew a Priest who going to reach a Book in his Library at the same moment felt a great weight in the Hypogastric Region which was presently followed with all the Symptoms we have describ'd 't was the Stone which was then separated from the bottom of the bladder by this simple effort so that he was obliged to come to the operation but the most sure and certain sign of the Stone is the Probe which convinces us of it by the resistance it makes and noise which we hear when we strike upon it this is also the sign which causes the necessity of the operation if the age season and strength of the Patient permit No Medicine so powerful as to dissolve the Stone Here it is where Mountebanks triumph who by their Impostures endeavour to persuade People that they have infallible Secrets to dissolve the Stone in the Reins and Bladder these sweet hopes flatter the minds of those who are troubled with it but when we shew them by evident demonstration that
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
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
Mortification These are more or less mortal according as the malignity activity and penetration of the Acid Humour wherein consists the Nature of Poyson are more or less great and fatal CHAP. III. Of Wounds of the Tendons I Have made you observe speaking of the Suture of the Tendons that when it 's quite cut there happens no troublesome accident but that it retires towards its Origine and that one is obliged to soften their Fibres with Oyls drawn without Fire that their reunion may be the easier I have also made you observe that the Stitch being made it was necessary to Humect the Tendon with Oyl and Spirit of Wine the Oyl resists the Impressions of the Air and the Spirit of Wine penetrating the least Porosities deobstructs their Channels in driving out the Humours and by this means the concourse of Symptomes particularly that of Pain is stop'd Suppuratives must follow next immediately forasmuch as they hinder that the Inflammation may not cause long suppuration which would infallibly rot the Tendons in spight of all the care that might be taken as it happens in all great Fluxions where the Tendons are discovered This is the reason which obliges us to stay till the Suppuration be accomplished and the Tendon covered before we use Dissicatives as Tinct Aloes Spirit Vini with several others because in drying the part too soon you hinder the dissolution of the Juice stops Suppuration and retains the Inflammation which is the true cause why the Tendon rots The Inflammation which comes upon Wounds of the Tendons that lie but shallow under the Skin is not dangerous but since the Juice which exudes out of it is corrosive it awakes the Pain and all other Accidents which most commonly attend Wounds of the Tendons But if it happen that a deep Tendon be hurt the Inflammation and Obstructions are greater and more troublesome by reason of the many Sanguin Vessels which lie over it If the Accidents continue and the Tendon suppurates not it 's most convenient to dilate the Wound that the Remedies may be able to penetrate and ease the part by causing a speedy suppuration If the Flesh which is generated in these kinds of Wounds become callous it 's a sign that the salt abounds every where and that the fluxions will be great since the salt particles condense themselves in the very substance of the part We use only here Digestives and Balsams which are convenient till the Wounds be ready to cicatrise being capable of melting and dissolving the Juices by which we know that Dissicatives are noxious because they procure too soon a Cicatrix There 's sometimes generated a soft spongy Flesh which threatens the part with great Obstruction then it 's also necessary to continue the Digestives for Dissicatives glue and harden too much the nourishing particles and augment the abundance of the salts which cause faulty Flesh In this case SCHRODER's Green Balm is excellent You must observe that a Tendon may be hurt by a prick without any accident happening This is when the Instrument slips between the Interval of the Fibres without endamaging them But if by chance it divides some of the Fibres Obstructions follow which occasions the nourishing Juice to become corrosive gnawing the Fibres and Membranes which causes a greater Obstruction more violent Pain Besides the Spirits which are irritated by these sharp Matters augment the Inflammation which at first is not 〈◊〉 â—â—nsiderable but afterwards very dangerous To help this inconvenience you ought without scruple to open the Teguments and Flesh to find the place of the prick'd Tendon and to sweeten the Acrimony of the salts with Ol. Ovor. Cere and Spirit Vini not neglecting at the same time the use of Digestives and Balms If the Accidents cease not it 's a sign the Puncture is deep and that the Medicaments cannot penetrate then you must separate dexterously the Fibres of the Tendon according to their length to give way to the Balsamic Particles to soften the Fibres and the Spirit of Wine to discuss the Humours and cause a more easie Suppuration The Inflammation which follows upon the Puncture of a Tendon incroaches often upon the near parts as for Example if the Tendon of the Finger be prickt the Wrist and Arm swell so much that one is often obliged to Amputate it For seeing the Tendon and Belly of the Muscle contain nothing but a heap of Fibres of the same continuity the Convulsions 〈◊〉 consequently the Inflammation communicates it self not only to the Belly of the Muscle but also to all the neighbouring parts You must not be astonished if these parts have such a correspondence together and if they communicate so mutually one to another their alterations If there be any difference between the Tendon and the Belly of the Muscle it consists only in their Texture and in the more or less Inflammation Tention or Pain The most Specific Remedies to stop the Accidents of a Punctured Tendon is to give issue to the Wound If the Tendon lie high we use Balsamic's and Digestives but if deep you must add Spirit of Wine if the fluxion be great you apply upon the Tendon a little Boulster soaked in Brandy to secure it from the impression of the Purulent Matter As concerning Cataplasms it's known that we apply Emollients Discutients and Defensatives during the first 2 or 3 days according to the degrees of the Inflammation afterwards we prefer Discutients which are continued all the time of the Fluxion and during the rest of the Cure you must use Plaisters and Compresses soaked in Spirit of Wine warm'd If the Tendon of the Hand be hurt we lay not only Defensatives upon the part but also over the whole Arm. If the Puncture be made with a square or triangular Instrument it 's doubtless more to be feared than that which is made by a flat or round one because of the great number of the divisions it therefore requires more Circumspection Lastly if the Inflammation be great and there be appearance of a Gangrene you must Scarifie and use all that is capable to awake the motion of the Spirits CHAP. IV. Of Wounds of the Ligaments and Bones WOunds of the Ligaments differ not much from those of the Tendons but in the more or less sensibility and though they are not so painful nor dangerous nevertheless it happens very often that Putrefaction seizes it by the abode of the Purulent Matters upon these parts If the Ligaments of the Joynts be hurt I say that thickning Remedies are most contrary because we must by all means oppose the coagulation of the viscous and salt Juices which entertain these parts as also the formation of Ganglions and Anchilose which cannot be mollified nor dissolved by the most powerful Medicines If the Ligaments of a Joynt cannot be hurt without some Tendon receiving damage also it may be easily comprehended that the Inflammation hinders them from obeying the motion of the Muscles and that the Humours which