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, 'tis 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 AutumnIn 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.

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 Ʋnition 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 its 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 'tis 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.

If the Wound has but one Angle, you muſt begin at it, if two, begin in the more ſolid part; if three or four, begin always by the Angles with little Compreſſes, or Bolſters. The Balms, and Bandages are at the Surgeons diſcretion. If you apply an Emplaſter, you muſt lay little Compreſſes on the knots, leſt you move them in taking off the dreſſing.

If there happen any troubleſome Accidents, looſe the knots without any violence, ſo that you may tye them again when the Accidents ceaſe;How to cut and draw out the Thread. but if there ſhould happen any conſiderable Inflammation, ſo that we ſhould be forc'd to cut them, you muſt introduce your Probe under them on which you muſt cut the Thread: (We do ſo, when We find the Reunion is made, and that we are about to undo the Stitch with Dexterity) then lay your Finger next the knot, and draw the Thread ſoftly out, for fear you renew the Wound.

Theſe are the principle circumſtances which muſt be obſerved in performing the interrupted Stitch:In what part the Quill'd Stitch is moſt uſed. I paſs to the Spiral or Quill'd, which differs from the other, only in the manner of diſpoſing the Threads. We uſe it for the moſt part in deep Wounds, which happen to the great Muſcles of the Buttocks, and Thighs, tho' perhaps if well examin'd inferior to the interrupted: but ſeeing it may be uſeful, and has in all times been eſteemed ſo; I ſhall now deſcribe how it is performed.

How to make the Quill'd Stitch.The Surgeon muſt take a crooked Needle, Arm'd with a wax'd Thread, the two ends of which muſt paſs together through the Eye of the Needle, that there remain a ſort of Loop, having paſs'd it through the Fleſh, you muſt ſo diſpoſe two or three of them, according to the length of the Wound, in which you muſt put ſome pegs of Wood, arm'd with Lint, ſome ſtrong Tents of Lint, or a Quill, which muſt be Rankt all along the extremity of the Lips, which have been brought together by a Servant, who holds them while the Surgeon makes the knots upon the Tents; &c. as has been ſaid, except that we put no Compreſs on them.

There's one kind of Quill'd Suture, where you can cut the Threads and make the knots on both ſides.

TO make an end of the Sutures, I come to ſhew how that of the Tendons is performed: But before I begin, 'tis neceſſary to explain the Symptoms which ordinarily accompany its Wounds. In theſe kind of Accidents, the Tendon is wholly cut, or in part only, if the former, 'tis evident that the Symptoms are not ſo bad, and that it ſuffers neither Tenſion, Tumor, nor Fluxion, but withdraws ſomewhat into the Fleſh, and increaſes a little in thickneſs: But if the latter, the Symptoms are very dangerous, becauſe the Fibres that remain deſtitute of their wonted aſſiſtants, muſt of neceſſity be broken and torn in the ſenſible Contraction of the Muſcles, or at leaſt ſuffer ſuch violent tenſions, that cruel Accidents ſpeedily ariſe; beſides that, the Blood ſpilt,Accidents attending wounded Tendons. in the Intervals of the Fibres, does Ferment the Saline Particles, and working upon the Tendinous Fibres divide them, on which follows ſharp Pain, Convulſion, Syncope, Vomiting, Diarrhaea, Fever, Coma, and often Gangreen, if the reſt of the Tendon be not ſpeedily cut.

Caſe of Pain.The Pain is not excited, but by the continual Divulſion of the little inſenſible Fibrils, 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.

You muſt not imitate certain Operators, who Scarifie to no purpoſe, the ſides of the Wound, to diſengage the part which always ſuffers ſome Tenſion, ſince we can remedy this inconvenience, by laying on the Cheeks ſome Compreſſes ſuſtain'd by the Bandage; you muſt order the Sick a very exact Diet, which conſiſts in uſing the firſt three or four Days nothing but Liquids, and avoiding all ſorts of motion.

The Wounds of the Belly, are either big or little, Superficial or Penetrating, are made with or without the hurt of the contein'd Parts, which very often come out of the Cavity, according to their indiſpoſition; greatneſs of the Wound, more or leſs motion as we are going to explain.

We conjecture there is ſome part damag'd according to the Figure of the Inſtrument wounding; you may judge what Parts are hurt by the Situation of the Wound, and by that in which the Patient was when received.

Signs of the wounded Viſcera.But the true Signs which indicate the diviſion of ſome Internal Parts, are acute Pains, Inflammation, Fever, or ſome Matter coming forth; nevertheleſs, all theſe Signs are equivocal, except the leaſt, which is known by the Colour, Smell, and conſiſtence of the Matter, which is diſcharg'd out of the Wound, or flows in the Cavity of the Belly.

After what manner the Viſcera get out of the Belly.But as the moſt of theſe parts are floating and always Relax'd, they get out of their Cavity at the leaſt impreſſion, or diſorder, particularly at the time of expiration, when the Thorax contracts: Though it ſeems that they ſhould rather eſcape in the inſpiration when the Diaphragm is level'd, puſhing back, as the Antagoniſt of the Muſcles of the lower Belly, all the parts that are under it, yet its certain that the Muſcles of the lower Belly oblige them againſt their natural motion and inclination, to come out of the Wound in time of expiration, when they preſs all the conteining parts of the Belly: This being ſo, 'tis evident that it's neceſſary for the part, that is under the Muſcle and out of Action, to regurgitate and ſhew it ſelf out of the Wound, as a piece of Paſte does between the Fingers, when ſqueez'd with the Hand, whereof depend thoſe frequent Strangulations, and dangerous Inflammations.

You muſt alſo remark, that theſe parts are extream ſpungy and greezy, whoſe Texture is very looſe, humected with a quantity of Humours, bedewed with an infinite number of Veſſels, and conſequently very ſubject to Putrefaction, for the Air coming to ſtrike and penetrate their Subſtances, they fail not to Tumefie and Condenſe the Blood which animates them, if they be too long expos'd to it: Theſe Parts being therefore depriv'd of the motion of the Blood, in which conſiſts their Heat and Life, there muſt needs happen a mortification.

Beſides the action of the Air, we know that Inflammation is capable of cauſing the ſtrangulation and mortification: It's eaſie to conceive that the parts being inflam'd and ſwell'd muſt take up more room than before, and preſs the Inteſtine and Omentum, which is commonly found in the paſſage,Cauſe of the Inflation of the Inteſtia. from which muſt follow interruption of the courſe of the Blood and Spirits in thoſe parts, and conſequently Gangreens. It often happens that the Inteſtine is inflated, the cauſe of which proceeds from the Inflammation, which the Wound communicates to the Gut, and the Air Obſtructs the Pores; beſides, the return of the Venal Blood, is in a manner ſtopt by the Strangulation, and the little motion which is to be ſeen there.

The Inflammation which attacks the Gut, is capable of Rarifying a part of the Seroſity, (and the other Juyces which are contain'd there, whoſe motion is made more ſlow) not being able to eſcape, by reaſon of the Air which ſtops all the paſſages, and ſhuts the Pores of the Inteſtine, ſo that 'tis impoſſible for the Surgeon to reduce them without dilating the Wound.

How to Dilate when too narrow.To perform which, the Surgeon muſt paſs a hollow Probe between the lip of the Wound and Inteſtine, and ſlip a Biſtory all along the hollow of the Probe; but before he makes the Inciſion, it will be convenient to examine whether the Gut be not engaged, leſt he wound it: This being known, he may boldly dilate the Wound, and cut as much off the Peritonaeum as of the Muſcles, &c. becauſe the Strangulation is every where equal, againſt their Opinion who pretend 'tis more conſiderable without, than within. I ſhan't here ſpeak of the precautions which the Ancients took, in applying Fomentations, and ſeveral other Medicines: But ſuppoſe it neceſſary to Foment, and warm the parts with hot Clothes, or with Wine.

If the Omentum be altered, cut off the mortified part.Before you reduce them, you muſt examine whether they ben't hurt, and if the Omentum be not mortified, which is known by its Lividity, then without delay, cut off the Gangreen'd part, after having made the Ligature of that which is ſound.

If there be a little Wound in the Inteſtine, it requires no Suture; if it's big, uſe the interrupted, for the Skinner's Stitch is not approv'd of.

In my Opinion, there's nothing that ſooner cures the wounds of the Guts, and procures quicker unition, than a true and exact Diet; and I find nothing contributes more to it, than in ordering the Patient to lie on his Belly, taking care to have a kind of Bolſter under the Wound, to facilitate the running out of the Matter: Every one knows,In wound of the Belly, a ſpare Diet to be uſed. there's nothing more contrary to union, than motion: By the Diet we leſſen the Action of the Inteſtines, and by the Situation, that of the Muſcles of the Abdomen: the reaſon is, that in this Situation, all the parts within, lie heavy on the Peritonaeum and Muſcles, and ſo diminiſh part of their motion. You muſt Obſerve, that Wounds of the Guts are never Reunited, except to the ☜ Neighbouring Guts, and other nigh parts, as Peritonaeum, &c. for which reaſon, 'tis convenient to paſt a Needle arm'd with wax'd Thread under the Body of the Gut through the Meſenterium, chuſing a place moſt free from Veſſels, to pull it gently towards the Peritonaeum, to which it will eaſily adhere.

Having obſerv'd theſe circumſtances, ſearch for that part of the Gut which is neareſt the Mouth of the Wound,How to reduce the Gut. and reduce it with your Fore-finger into the Cavity of the Belly, and before you pull that back, introduce the other; and after this manner puſh it ſucceſſively till in its natural place. The Ancients uſed to ſhake to the Patient, that the parts might return to their former Situation. We always leave out of the Wound a part of the Ligature of the Omentum, which we place on that ſide where the Matter runs leaſt, and we make the interrupted Suture; hence come the name of Gaſtroraphia.

How to make the Suture of the Belly.You muſt have two crooked Needles arm'd with the ſame Thread, then with your left Hand hold the Peritonaeum, and the other integuments, and taking a Needle with your right, paſs it from within, outwards, on one lip, and without lifting your Finger, paſs the other on the oppoſite ſide as the firſt. You muſt make as many Stitches as are neceſſary, leaving ſome ſpace to put a Tent in, on that ſide where the Matter takes its courſe, if there be any appearance of Suppuration, which commonly happens, if the Omentum or Inteſtine be any way alter'd: Having examin'd all theſe circumſtances, you begin with the middle Stitch, and ſo of the reſt.

The Sutures being made, you muſt apply a Pledgit dip'd in ſome Balm, or ſpirituous Liquor, making a light embrocation with Ol. Roſ. and Spirit Vin. on the region of the Belly, then a convenient defenſative ſuſtain'd with the Napkin and Scapuler. The next day inſtead of uſing Aſtringents, 'tis good to uſe Emollient, and reſolving Fomentations to hinder Tenſion,Tenſion a dreadful Symptom. which is a dreadful Symptom; for the edges of the Wound endeavouring to retire, cauſe extream pain, and often break the Thread; therefore you muſt diſpoſe it ſo, as to be able to ſtraiten it after the Inflammation's over.

Emollient Clyſters are of great uſe, not only becauſe they relax the Fibres, and evacuate the Matter, but alſo becauſe they refreſh, and ſerve as a Balneum Marie, to calm the motion of the Blood and Spirits, and hinder the progreſs of Accidents. 'Tis ſufficiently known, that Bleeding and general Remedies are not to be neglected.

If the edges become Callous, digeſtives are wonderful, becauſe they relax the Fibres, take away Obſtructions, and facilitate the generation of the fleſhy Veſicles, and conſequently the cure of the Wound.

Concerning this Operation, 'twill not be amiſs to tell you further, that a wounded Perſon that has a Portion of the Inteſtine carried away, wou'd Die infallibly, if the Surgeon by his induſtry does not ſo diſpoſe the Gut, to let the contain'd Matter run out; that is, he muſt ſhew the Gut to the Peritonaeum, and Teguments which make a kind of Anus, that gives the Excrements liberty to come forth through the Wound, unleſs Nature ſhould work by its ſelf, as it happen'd to a Soldier in the Invalids at Paris, which ſerves us for an Example.

THE Dropſie, as all the World knows, is a Diſeaſe,Definition. whoſe parts where it is made, are (as it were) overflow'd with a great quantity of Seroſities.

Diviſion into general and particular.We make ordinarily two ſorts of them, the general, and particular: The particular (which we will examine after we have Explain'd the Univerſal) receive different names according to the parts which they attack, as the Hydrocephalus of the Head, Hydrocele of the Strotum, &c.

General twofold.The Univerſal are commonly divided into Aſcites, Timpanites, and Anaſarca vel Leucophlegmatia we will not ſpeak here of the Tympanites, ſince ſcarce ever ſuch was ſeen, and it differs from Aſcites, but ſecundum majus & minus, being always accompanied with many Seroſities. I ſhall ſtick only to the Arſcites and Anaſarca, tho' if well examin'd, this laſt might be reduc'd to a kind of Univerſal Aſcites, In ſtrictn ••… but one ſo •… of Dropſie. or might very rationally be comprehended under the general notion of it.

Aſcites true or falſe.Aſcites is true or falſe, the true is cauſed by a great quantity of Water, that fills the whole Cavity of the Belly, which ſwells and tumefies it to the laſt degree of Tenſion:True. Theſe Waters fall often into the Scrotum, and make an Hydrocele, and when they grow ſharp, and pungent, cauſe ſeveral troubleſom Accidents, as we ſhall ſhew in the following diſcourſe.

Falſe. Difference between falſe Aſcites and Anaſarca.The falſe differs from the Anaſarca in this, that the laſt affect ordinarily the whole habit of the Body, and the other is only confin'd to the Cavity of the Belly. The Anaſarca conſiſts in the ſwelling of the whole Body, and the other only in one part: You muſt obſerve, that in Anaſarca and falſe Aſcites, the teguments only are alter'd, whereas the true Aſcites poſſeſſes the whole capacity of the Belly: When I ſay the teguments are only alter'd, 'tis that you may obſerve, that the Body of the Muſcles is not penetrated: Tho' 'tis true, the water ſwims on the Surface, and it's obſerved in the opening, thoſe who Die of a Dropſie, that their Fibres are whitiſh, as well as the Neighbouring parts, becauſe they have been too long humected with the water, but the reſt are as firm and ſolid as thoſe which have not been touched at all. It muſt alſo be obſerved, that in Anaſarca, and falſe Aſcites, the water is ſweet, unſavory, and without Acrimony, for which reaſon, it is not ſo penetrating, and the Patient is without Thirſt and Fever, his Urin is ſweet, crude and thin; but contrariwiſe in true Aſcites, the Urin is red, muddy and lixivious, the Patient having exceſſive Thirſt, ſlow Fever and difficulty of Urin.

I ſhall not trouble my ſelf to tell you the Ancients Opinion concerning the cauſe of the Dropſie,Four chief cauſes of the Dropſie. but ſuppoſe theſe four things contribute to its Formation; viz. 1. Indigeſtion of the Chyle. 2. Looſe texture of the Parts. 3. Slowneſs of the Bloods Circulation. 4. A general diſſolution of its whole Maſs.

1. Indigeſtion of the Chyle.I begin, firſt with Indigeſtion of the Chyle, which almoſt always proceeds from the alteration of the diſſolvents that ſerve for the preparation, and the conſummation of their Oyl and Viſcoſity; when the Chyle is well temper'd, prepar'd and freed from the courſe Particles, it's nothing but a Buttery Maſs which paſſes into the venae Lacteae, and from thence into the right Ventricle of the Heart, to be united with the Blood which comes from all parts deprived of its Oyl and moſt active Principles, and ſerves for a Vehicle and Balm for new nouriſhment. It is this Lactaceous Liquor well depurated and extreamly fluid, which entertains the parts, and which by its mixture unites and ties in the Heart the two ſubſtances of Blood, viz. the white part to the red; which ſubſtances well joyned make a whole, neither too fluid, nor ſolid, but ſuch as Nature judges moſt proper to circulate without Obſtacle in the Veſſels. But if by chance, the Oyl of the Blood, and other Humours (with which it's furniſh'd) ſhould happen to be diſſipated, either by violent Exerciſe, too ſerious Meditations, extream Grief, or by the abundance and exaltation of the Salts; the Chyle muſt of neceſſity grow ſour, become Indigeſted, ſerous, and incapable of any Union; then it's ſo far from preſerving the conſiſtence of the Blood, that it rather Diſſolves, Liquefies, and diſpoſes it to make Obſtructions, Rheumatiſms, Dropſie, &c. Becauſe the Arterial Blood, not being able to receive, through this Indigeſtion, and the preparations and triturations neceſſary for the Life of the parts, it's courſe muſt be in a manner intercepted, paſſing into the Veſicles, or rather ſpaces between the Poroſities of the Arteries and Veins, where the little Oyl frees and diſengages its ſelf from the other Principles, which it had taken hold of before, to change into our proper Subſtance; ſo that the ſeroſity of the Blood being at full liberty, and having loſt a part of its motion, pours it ſelf into the ſpaces which it meets with, 2. Looſe texture of the parts. and ſo cauſes the Dropſie; according to the texture of the parts, which we have ſuppoſed more or leſs lax.

3. Slow Circulation.We muſt now explain that cauſe which proceeds from the ſlow Circulation of the Venal Blood. That we may have an Idea of it, we muſt examine by what Mechaniſm this Blood is carried back to the Ventricle of the Heart, which is the focus of its ••• ion.

VVhat Hernia ſignifies.The word Hernia, ſignifies ſomething that's troubleſome to bear: I'll uſe the Etymology in oppoſition to their opinion, who pretend it ſuits not with the Humeral Hernia, and I believe every one will agree with me, that they are inſupportable as well from Humors as Parts: Hence I conclude the word Hernia may fit all kind of Tumors which happen to the Belly or Scrotum. I confeſs the word Rupture is only applicable to thoſe in the Groin and Scrotum, from the Omentum, Interſtines, or ſome other part. But omitting a uſeleſs multiplication of imaginary names, I paſs to its ſpecies and differences.

And theſe are drawn from the parts which they attack, and the different cauſes which they produce;Names. by reaſon of the Parts they are call'd Exomphales, viz. of the Navel: Bubonocele, of the Groins: Oſcheocele of the Scrotum: and Ventralis Hernta, of which hereafter.

By reaſon of the cauſes which produce them, the one are made by parts,Diferences. the other by the humors: The firſt are call'd Enterocele, when the Inteſtines come forth, Epiplocele when the Omentum, and Enteropiplocele when both.

The latter are call'd Hydrocele, Pneumatocele, Sarcocele, Varicocele, and Circocele, from Water, Wind, Fleſh, and other Liquors, which are capable to dilate the Veſſels.

Thoſe made by the parts are call'd true, the Humoral falſe; compleat, true, or Lips of the Womb; not compleat, when they don't paſs the Groin.

Cauſes, External.Cauſes are external or internal; the external are violent blows, great ſhakings, long courſes or running, dancing, leaping, continual crying, vehement coughing, exceſs of venery, too frequent and forced breathings, and generally all the exerciſes, and ſtrong efforts to which we are ſubject.

The Internal come firſt from the influx and depoſition of a great many Seroſities, Internal. 1. which ſometimes come from the Glands of the Inteſtines, or the Groin, but principally from thoſe Glands which garniſh the interior Surface of the Peritonaeam, all theſe ſources make that abundance of Lympha which actually Humects, Relaxes, and Lubrifies theſe Parts: and conſequently 〈1 page duplicate〉 〈1 page duplicate〉 puts them into a condition to yield the more to the frequent and reiterated Impulſions of the Inteſtines.

The ſecond, I ſuppoſe, depends on the great Diſſipations of the oily Particles, for if we conſider that the Peritoneum is near the Omentum and Meſentery, the two chief Repoſitories of the Fat, by which it is actually ſeparated from the Parts, by the heat, it's eaſie to underſtand that theſe Parts continually greaſing the Fibres of the Peritonaeum, ſo ſoften and extend them, that at the leaſt action or motion they give way very eaſily to the blows, and to all motions which may contribute to their formation.The People of Provence mighty Subject to Hermat. Hence the People of Provence, the Religious eſpecially, who eat nothing but Oyl in their Food are more ſubject to Hernias than others.

To the third, abundance of wind may contribute, whether we ſwallow it with our Food, or it be contain'd in it, or produced by the ſetlings and heap of a conſiderable quantity of diſſolvents, which by an exceſſive heat rarifie, and may be truly ſuppoſed capable of extending the Inteſtines like a Bladder, and of blowing them up to a certain degree of Tenſion, ſo that taking up more room than uſual they impel the Surface of the Peritonaeum, and neſting themſelves in theſe productions form the Tumor.

For the fourth, the Dropſie and Fatneſs in Women may be admitted, this laſt puſhing all the Parts againſt the Diaphragm, and determinating them rather to form the Exomphalos than Bubonocele, the other Humects and Relaxes the Peritonaeum ſo conſiderably, that after the diſſipation of the Water it can no more reſiſt and ſupport the Motions of the Inteſtines.

I paſs to the Conſequences which we muſt draw from the Cauſes of Hernias, relating to the Structure of the Parts where they are form'd, which depend as well on the diſpoſition of the Peritonaeum as the. Mechanick motion of the Diaphragm, Muſcles of the Abdomen, and Inteſtines.

Hook on the Peritonaeum as a Membrane of a conſiderable thinckneſs diſpos'd in the ſhape of a ſack, containing all the Parts of the lower Belly; 'tis ſo long as to reach to the Navel and groins,What's to be conſider'd in the Peritonaeum. to accompany the Umbilical and Spermatick Veſſels which run between its Duplicature; this is in ſhort the Idea you muſt have of it.

VVhat about the Muſcles.Let's now examine the Muſcles of the Abdomen, whoſe carnous Portions garniſh the Lateral Parts, and their Aponeuroſes occupy the forepart of the three Regions; three of which Muſcles are perforated towards the Groin for the paſſage of the Spermatic Veſſels: The firſt hole is of an Oval Figure belonging to that Aponeuroſe of the external oblique, and being dilated well enough, repreſents the handle of a Hamper, whoſe two extremities are faſtned to the Os Pubis reaching a little towards the Creſt of the Os Ilium.

This hole is lin'd externally with a little thin and delicate Membrane, which accompanies the Cremaſter Muſcles to the Teſticles, and is nothing elſe but an expanſion of the Tendinous Fibres. The other two are of the Separations of the fleſhy Fibres of the Internal Oblique, and Tranſverſe: Theſe three Rings don't directly anſwer one another, being ſeparate about three or four Lines. The firſt that preſents it ſelf to us in performing the Operation, is that of the external Oblique, which is the loweſt, and in which is made almoſt all the Strangulation of the Gut, becauſe the Tendinous Fibres don't obey ſo well as the Carnous, and are more ſubject to inflammation; for which reaſon 'tis that moſt don't ſcarifie this ring in the Operation; that of the Internal Oblique is a little higher, and that of the Tranſvers higheſt of all; it's eaſily obſervable, that if nature had plac'd them one againſt another, there wou'd at the leaſt effort happen a Hernia. The right Muſcle reaches from the Cartilago Enſiformis to the Os Pubis, lying all along the ſides of the Linea Alba, and ſeems to be divided into four Muſcles which are diſtinguiſhed by four Tendons call'd by the Antients Enervations; this Muſcle partly obſcures the Motion of all the others, which otherwiſe would ſo ſtrongly compreſs the Guts, that if it, like a movable Bar, did not oppoſe their powerful contraction, they would oblige the Parts every where to regurgitate out of the Belly.

What the Linea Alba is.I'll add a word or two concerning the Linea alba, which is formed by the union of the Tendinous Fibres of the Aponeuroſis of the oblique and tranſvers Muſcles which Aponeuroſis make a kind of ſeparation, and mark the interval between the right Muſcles; ſo that to ſhew theſe two Muſcles, we are forc'd to cut thoſe Aponeuroſes under which they are hid: I paſs now to the action of every Muſcle in particular. The external oblique paſs obliquely from above downward, according to the diſpoſition of their Fibres, juſt as the internal paſs from below upwards. The tranſvers preſs equally the Flanks, and the action of the right is felt all along the ſides of the Linea alba: Theſe Muſcles ſo diſpos'd, preſs equally all parts of the Belly, when they are contracted, in time of expiration, and maintain it in a level always united.

After all theſe reflexions, if we make a juſt application of the cauſes of Hernias, according to the Mechaniſm of the parts where they are felt, we ſhall find ſomething to ſatisfie our curioſity, confidering that violent blows, rude ſhakings, long courſes, exceſs of venery, dancing, leaping, and generally all efforts are capable, not only of moving the Guts, but alſo of relaxing their connexions, hence Poſts, Poſtilians, Dancers, Leapers, &c are troubled often with them; To theſe we have added Crying, vehement Coughs, and all too frequent expirations and inſpirations, hence, Muſicians, Singers, and Children (whoſe parts are ſoft and ſpongy,) are ſo much ſubject to them.

In all theſe efforts, the Guts are ſo preſſed, and repelled on all ſides by the Diaphragm and Muſcles of the Abdomen, which as ſo many Hands and movable Napkins, oblige the Omentum and Inteſtines to ſtrike and apply themſelves ſo ſtrongly againſt the ſurface of the Peritonaeum, that they are conſtrained to regurgitate through the weakeſt places, as a piece of Wax between the Fingers when it's ſqueez'd with the Hands, they puſh, I ſay, and dilate the interior Membrane of the Peritonaeum, where it's leaſt affiſted by the exterior, and ſink into the rings of the Muſcles forming a Sack, which is greater or leſs in proportion to the ſtrength of the Impulſe. This Sack neſts its ſelf all along, and at the ſides of the productions of the Peritonaeum,An Ancient Error confuted. which are form'd by its exterior Membrane, and not in the productions which invelop the ſpermatic. Veſſels. as moſt imagine: This Idea we muſt have of the formation of the Purſe, which includes the Inteſtine, and which makes the Hernias, if there be any little indiſpoſition in the Oyl, Water, Wind, and Tumours, which we have eſtabliſh'd for internal cauſes.

The Ventral Hernia remains now to be examin'd,Cauſe of a Ventral Mernia. which happens ſometimes between the right Muſcles, ſometimes between the Navel and Flanks, exactly at the Aponeuroſis of the Muſcles, to be convinc'd of which we are only to repreſent to our ſelves, how ſtrong the moving force of every Muſcle is, which occupies the Flanks, different from the Aponeuroſes which have no other motion than that, which their carnous part communicates to them; for though it be true, that all the Muſcles Reunite themſelves to one ſole point of the Navel, where the concourſe of their action is, yet it's probable that their carnous part is much ſtronger, and more vigorous, and by that means more capable of reſiſting divers ſhakes of the Inteſtines, as experience teaches us, unleſs it be bruiſed, or cut by ſome blow: We obſerve alſo, that that the Ventral Hernia never happens in the carnous part of the Muſcles, but always in the Aponeuroſes, or in the ſpace between the right Muſcles, particularly, in the courſe of ſome fatneſs. For in theſe kind of tumours, the Belly riſes, ſo that it obliges theſe two Muſculous bands to part, and the Inteſtines finding weak places, fail not by their impulſions, to dilate theſe parts, and ſo cauſe the Hernia Ventralis.

Hernia ventralis and Exomphalos, not ſo common as Bubonotele.If this, and Exomphales, are not ſo common as Bubonocele, 'tis becauſe the parts, and Humors are more inclining to be carried downwards towards the Groins than elſewhere; and the diſpoſition of the rings of the Muſcles, which contribute the more to it, as their overtures are widened and relaxed, ſo that if the parts are put in motion, they inſinuate themſelves, and ſlip inſenſibly through the opened paſſages, and where leaſt reſiſtance is made.

Fabritius Hildanus relates,Hernia cauſed by the deſcent of the Spleen. that he has ſeen a Hernia made by the deſcent of the Spleen, this curious remark ſhou'd move the Surgeons, call'd to this kind of Diſeaſe, to pronounce not always in favour of the the Epiploon and Inteſtines, before good examination, particularly, when the tumor is of an extraordinary bulk, 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.Varico ••… .

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 'tis 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.

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.

THE Patient being laid on his Back, the Surgeon Inciſes with a very ſharp Inſtrument, the Membranes of the Scrotum upon the Body of the Teſticle, to diſcover the carnoſity, which muſt be ſeparated from the Dartos, without offending the cover of the ſeminal Veſſels; being freed from the Neighbouring parts, you make the ligature of the Veſſels between the Rings and the tumor; you muſt cut them half the length of a Finger from the ligature, and take away the Teſticle with the Sarcoma; you leave an end of the Thread out of the Wound (avoiding to pull the Spermatick Veſſels to you,The Spermatick Veſſels not to be tied too hard. or compreſs them too hard, leſt the Patient ſhou'd fall into a Convulſion) that they may not ſlip into the Belly where they wou'd ſhed Blood, and ſo cauſe Death in a little time: If the tumor be conſiderable, ſcirrhous, inflam'd, painful, and poſfeſs both the Teſticles; and of continuance, the Operation is very dangerous.

A Hydrocele from Aſcites incurable. Ʋnleſs you cure the Aſcites.IF the Hydrocele be the conſequence of the Dropſie Aſcites the Operation is uſeleſs, becauſe there runs alway new Matter, which preſently produces another Hydrocele, ſo that unleſs you dry up the ſource, there's no hopes of cure: In this the waters occupy alway the tunica vaginalis, and run from the capacity of the Abdomen through the prolongations of the Peritonaeum. All other ſorts of Hydrocele proceed from the ſlow motion of the Blood,Other cures. or its diſſolution: Falls and Blows may alſo contribute to their Formation: The reaſon is, that the Blood Stagnates more eaſily in theſe parts, which cauſes the ſeroſity to ſeparate from it on the ſame principle, I ſay, that the circumvolutions and ſerpentine turns, which the Spermatick Veins form in their Root, are for the moſt part the cauſe of it, if the Blood be the leaſt diſpos'd to it, for ſeeing it doth not circulate here, but with much ado, the ſeroſities have time enough to ſeparate and diſtil into the Purſes.

Having examined the ſigns of the two ſorts of Hydrocele, when we ſpoke of thoſe of the Hernia Inteſtinalis, we'll ſay nothing more of them than the Prognoſtick, which is only of ill conſequence when the waters are included in a Cyſtis.

We muſt now examine all the circumſtances of both kinds, which require two different ways of Operating: We have obſerv'd, when we Treated of the ſigns, that the firſt kind of Hydrocele, is diſtinguiſhed and known, when the waters extraordinarily ſwell and extend the Membranes of the Scrotum.

THis Operation conſiſts in making a puncture into the Scrotum with the Trocher, accompanied with its Canula, through which the water runs freely, and when 'tis emptied, you withdraw your Inſtrument, and the Cutis of the Cods becomes rugous as before, and the aperture ſtops exactly. This is performed without trouble or danger, but omit not drying up the ſource by the uſe of general Remedies, otherwiſe the tumor will not fail to return.

The ſecond kind of Hydrocele, which generally poſſeſſes only one ſide, ordinarily attacks the Tunicles of the Teſticle. It's alſo much more painful through the great tenſion of its Membranes.

The method of the Operation.The method requir'd in this, conſiſts in making the aperture deep and large enough, as well to give vent to the water, as to carry Medicines thither, which have the Virtue of diſſipating the Membranes that are imbued with them; we uſe to make the aperture at the ſide of the Scrotum with a Lancet,The Cauſtic better then a Lancet. or a Potential cautery, to avoid the Spermatick Veſſels, and ſeeing the cautery makes a great Eſchar, 'tis to be preferr'd before the Lancet, becauſe you are in leſs danger of offending the Teſticle, and you diſſipate inſenſibly the Membranes by Suppuration.

You muſt Note, That ſeeing the Waters hinder the action of this Remedy, in blunting its corroſive Particles, if the firſt that is apply'd makes not an Eſchar deep enough, it's neceſſary to apply another, when the Eſchar is off, you fill the Wound with Doſſils, and leave 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.

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.

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.

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 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 〈1 page missing〉 〈1 page duplicate〉 〈1 page duplicate〉 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.

HAving thus conſider'd the precedent Circumſtances, you may hazard the Operation; but before, it's neceſſary to ſtir the Stone by ſome motion, and to empty the Bladder of its Urine.

The ſcituation of the Patient in the operation.Place the Patient on the brink of a Bed, his back on an even ſloaping board, his thighs open, knees near his belly, his heels drawn up to his brich, and his hands hanging down on the ſides of his ankles.

To keep the Patient in this poſture, you have a band with which you ſupport the thigh, lower end of the leg and hand, and after ſome turns of the band, you paſs it upwards about the ſhoulder, and ſlipping it behind the back, you repaſs it about the other ſhould, to bind the hand; leg and thigh of the oppoſite ſide: this poſture is very proper to execute this deſign; for it upholds the bladder, and gives liberty to the muſcles of the Abdomen to relax and bend, as they formerly did.

The manner of cutting for the Stone by the Aparatus minor, or Gripe. The Patient being in this poſture, the Chirurgion diſpoſes himſelf to the operation; if it's by the little Aparatus, (which is not ſo much in uſe) he wetts his Index and middle finger in ſome oil, or other unctious matter, and introduces them a little obliquely into the Anus, not ſtretching them, till he has preſt gently the Hypogaſtrium with the other hand, then the Operator endeavours to puſh the bottom of the bladder towards its neck, to place it faſter between his fingers, and the Os Pubis; having fixt it, the Chirurgion with a Biſtory cutting on both ſides, makes an Inciſion on the Stone according to its bigneſs,The Place where the Inciſion muſt be made. on the ſide of the Raphe, and between the os pubis, about two fingers breadth from the Anus. The Inciſion being made, you extract it with fitting Inſtruments, of which ☞ we'll ſpeak in the Great Aparatus; ſometimes it will ſlip out of the Orifice, by only preſſing the fingers a little forwards towards the Orifice: ſo much for the leſſer Aparatus; for ſeeing we can't uſe it without making the Inteſtine and Bladder very livid, nor often without endamaging them, we ought to reject this method, and prefer the Great Aparatus, of which we will give the deſcription.

The manner of cutting for the Stone by the Great Aparatus. After we have regulated all that precedes this ſo important an Operation, and having plac'd the Patient in a convenient poſture, the firſt thing we muſt propoſe to our ſelves is to ſearch him well.

Several ways of uſing the Catheter. As for Probes, you ought to have ſome great, ſmall, and middle-ſized ones, for all ſorts of Ages; ſtrait and crooked for both Sexes, with canulas garniſhed with a ſtillett, to empty the bladder of the urine, and others hollow, as a Directory to perform the Operation with; you may uſe the Prob •… or Catheter divers ways.

In the firſt, the Chirurgion takes with his left hand the top of the Yard, (dilating its paſſage a little) and pulls it upwards, that the chanel of the urethra make a ſtrait line, to facilitate by that means the entry of the Catheter into the bladder; all the difficulty conſiſts in introducing it methodically, which is, that the extremity which is held in the hand be outward, and the convexity inward; and as its point approaches towards the neck of the bladder, you give it half a turn, by which means you make it ſlip under the Os Pubis, and cauſe it to enter into the hollow of the bladder, ſo that its point is within, and its convexity without.

Second way of Probing.The ſecond method is much more eaſy, and leſs troubleſom, becauſe you introduce the Probe quite contrary to the former; and without giving it a turn, you make it ſlip into the bladder.

Good Probing is not only neceſſary for extracting the Stone, but alſo in all carnoſities and inflamations of the bladder; it's of great uſe as often as the Urine is ſuppreſt in this paſſages, and very often one periſhes in all thoſe occaſions, for not knowing how to probe well.

How to perform the operation methodically.To make the Operation, you uſe a hollow Probe, which being in the bladder, the Chirurgion muſt bring it to the ſide of the belly, that its convexity may preſs the interior ſurface of the Perineum, and make it riſe in a hillock, and whilſt the Servant holds up the Yard, and top of the Probe with his left hand, and the Teſticles with his right, the Operator, with his thumb and forefinger, faſtens the moſt eminent part of the Probe to the right ſide of the Perineum, and with a Knife cutting on both ſides, he makes an Inciſion all along the hollow, more or leſs great, according as he judges the bulk of the Stone to be. To make the Inciſion regularly, he holds the Inſtrument like a Lancet, beginning to pierce the moſt elevated part of the Perineum ſtill to the hollow of the Probe, which ſerves to the Knife as a Directory, and without any ſtop paſs and repaſs it ſeveral times over the ſurface of the Probe, till it be quite diſcover'd, leſt you make divers Inciſions on the bladder. Before you withdraw the Catheter, feel with your finger, to know whether there remain any adherence which might hinder the entry of the Conductor, introduce its extremity into the hollow of the Probe as low as poſſible, the Conductor being as it were engaged in the Probe, as you withdraw it ſoftly out of the bladder, you puſh your Conductor, and make it follow the motion of the Probe, otherwiſe it might eſcape ſideways, and the Operation would not ſucceed with the ſucceſs one would deſire; when you'r ſure that the Conductor is in the capacity of the bladder, you ſlip over its ſurface ſtrait or crooked pincers, then withdraw your Conductor, and ſearch dexterouſly for the Stone on all ſides without violence; then take hold of it; if it's faſtned or ſticks, you turn ſoftly your hand on both ſides to break the ties which hold it, without cauſing Contuſion or Haemorrhagy.

What's to be done when it ſticks to the bladder.If the Stone ſtrongly adhere, you muſt not offend the bladder, but move it moderately; if your ties be too ſtrong, you muſt uſe the toothed crow's-bill or inciſive pincers, always taking care leſt you offend the bladder.

When the Stone happens to be too big, enlarge the Wound with the Biſtory, and reject the uſe of the Dilatorium, by reaſon of the great Contuſions it commonly leaves in the parts.

What's to be done when any urgent Symptoms happen in time of the Operation.If any Accident ſhould happen in the time of the Operation, as Haemorrhagy, Syncope, or any other troubleſom Symptom, the Chyrurgion ought rather to correct them, than finiſh the Operation, and ſo leave the Patient in repoſe, till he has got new ſtrength, and the Accidents are ceaſed; for having •… eferr'd the Operation after this manner, the Stone very often preſents it ſelf at the orifice, and the Cure is much more eaſy and ſucceſsful.

When the Stone is extremely ſmooth, 'tis a ſign that it's not alone; then ſearch, and being convinc'd, you extract them with the Pincers. If the Patient has violent pain, uſe Injections of milk, or other Anodines; when the Stone is rough and unequal, and ſigns of Excoriation appear, uſe Dete ••• ves made of Whey, Decoct. Hord. Plantag. cum Syrup. de Roſar. Sicc. & ſimilia.

If the Scrotum be livid, and there be ſign of mortification, make uſe of the moſt violent Reſolutives and Defenſitives; when the Stone is extracted, put in the Spoon, to cleanſe it from the gravel and grumous blood which might be there, leſt by any ſtay it might cauſe ſome diſorder: Having diſcharg'd the Bladder of theſe ſtrange bodies, if the orifice be over-large, you may make ſome ſtitches, and leave a ſpace to put a little tent of lint in, (tied with a thread) in caſe you ſuſpect that there might yet 〈◊〉 any clods of blood, or ſome relicks of the Stone;Tents of Lead or Silver not to be uſed. never uſe thoſe tents chanel'd with Lead or Silver; for their contexture being too cloſe, cannot ſoak in, or imbibe any particles of the ſharp juice, which ordinarily runs from the lips of the wound; and ſince we know that the caloſity of any Ulcer depends only on the action of a ſaline and pungent liquor, as we ſhall prove, when we ſpeak of Fiſtula's, we muſt not be aſtoniſhed that the wounds where theſe kind of tents are introduced, degenerate always into a fiſtulous Ulcer; whereas the Lint, whoſe contexture is very ſpongy and looſe, ſoak up, and charges it ſelf with the points of the Salts and Acids, ſo by this means hinders a wound from growing callous: But if you'r ſure that there is no ſtrange body, the uſe of tents is abſolutely needleſs; you only apply ſome boulſters, plaiſter, compreſſes, and the bandage, after that you dreſs the wound as a ſimple one, and to haſten the reunion, you make the Patient lie croſs-leg'd, and tie his two knees together; ſome lay under the Patient's britch a little bag full of bran, to hinder the Urine which runs out from heating or fretting the skin of the parts.

If the Urine by its weight ſhould carry along with it ſome little Stone into the Ʋrethra which ſtops its paſſage, the Urine endeavouring to eſcape ſometimes, draggeth the Stone along with it; but if its largeneſs doth not permit it, the ſtream of the Urine forceth it to dilate, and extend the ſides of the Ʋrethra, which cauſeth a ruption of the veſſels, upon which followeth pain and inflamation.

How to cut the Stone from the Urethra. If in this Accident you cannot get it out, place it between your fingers, and make and Inciſion (according to the length of the Yard) upon the body of the Stone, which you muſt extract with a fitting Inſtrument, then you cloſe the wound, by the help of an uniting bandage, and other remedies.

Women not ſo ſubject to the Stone as Men.It's true Women are ſometimes troubled with the Stone, but not ſo often as Men, becauſe they have thoſe paſſages more open, not ſo crooked, and leſs long, ſo by this means the Urine by its ſtream precipitates eaſily the little gravels which gather together in the bladder, not giving the ferment time enough to produce its effect, which is the cauſe that they are much leſs ſubject to it; however if the Probe, and the other ſigns convince us of its exiſtence, you muſt undertake the Operation.

How to extract the Stone in Women.The Probes which we uſe for Women are ſtrait, only a little crooked towards the end. If the Stone be little, you may extract it with the finger or ſpoon. If it be big, make a little Inciſion at the upper part of the Ʋreter, to introduce the little duck's bill, to facilitate therewith the extraction. As for the ſuppreſſion of Urine, and all other circumſtances that regard the Operation, you have nothing to do but to imitate the method which we have formerly given.Signs of good ſucceſs in the Operation. I will only ſay, that we know the Operation to have good ſucceſs, when the Patient reſts well, has free reſpiration, tongue moiſt, thirſt moderate; little or no pain; Fever, but moderate; no ſwelling in the Hypogaſtric region, and the Inflamation abates on the fifth or ſixth day.

What a Fiſtula is.BY a Fiſtula, we underſtand a calous, deep and cavernous Ulcer, which from a narrow entrance, ends in a large and ſpacious bottom, yielding (for the moſt part) a ſharp and virulent matter.

What parts are moſt ſubject to Fiſtula's.Fiſtula's poſſeſs indifferently all parts of the body, eſpecially the Anus, breaſt, Os Lachrima, Joints, all ſpongy parts loaden with fat, and humected with many humours; all nervous parts, or at leaſt ſuch as are quite deſtitute of fleſh and fat, from whence it comes that wounds, which penetrate to the bones, almoſt always degenerate into Fiſtula's.

If Wounds happen in ſpongy parts, it's eaſy to conceive that nothing hinders the humours from finding out paſſages, and altering various parts, which is diſtinguiſhed by the colour, conſiſtence and acrimony of the matter that flows from them, which makes all the difference of Fiſtula's.

IN the Operation of the Fiſtula in Ano, of what kind or nature ſoever it be, you always obſerve the ſame Rules and Maxims.

How to perform the Operation.Firſt, You place the Patient on the brink of a Bed, laying him on his belly, his legs ſtradled; you diſpoſe a bandage about his body in ſhape of a T. if it be a Fiſtula that openeth inwardly, you introduce, if poſſible, the Stylet, or Probe, through the paſſage of the Inteſtine, and ſlip all along the Fiſtula to the bottom; when you find with your finger the end of the Probe outwardly, make a little carved Inciſion over it, that the end of the Probe may come out; bend it a little, and cut, not only all that the Probe embraces, but alſo a little under the bottom of the Fiſtula, that the re-union be more eaſy perform'd. If ſo you can't paſs your Probe through the Inteſtine into the Fiſtula, you make the Inciſion outwardly on the Tumor, as we have preſcrib'd, that the Probe may be eaſier introduced and paſſed into the Inteſtine.

When a Cauſtic is to be uſed.If the Tumor be ſomewhat diſtant from the brink of the Anus, you muſt prefer a potential Cautery before the Biſtory, for to leſſen the pain.

When the Operation is to be omttted.If the Fiſtula anticipate the breadth of four Fingers upon the body of the Gut, and that it openeth above the Levadores Ani, you muſt not hazard the Operation, for Reaſons which we will alledge hereafter.

In the Fiſtula which opens outwardly, you paſs a Stilet through your Aperture, and pierce the Inteſtine, and make it come out of the Anus to bend it, or make a Handle, as hath been ſaid.

Some in a Fiſtula make uſe of Sciſſers, and others of a narrow Inſtrument like a crooked Biſtory, whoſe edge is arm'd with a ſheath of Tin, you introduce it through the orifice of the Fiſtula, and paſſing it through the orifice of the Gut, you cut at one flaſh the whole bottom of the Fiſtula; if the Caloſity be conſiderable, you ſcarify the ſides and bottom: the moſt to be fear'd are the Arteries; but if by misfortune you ſhould have cut any of them,Vitreobe's to be rejected. you muſt uſe ſome ſtiptic water, or the ligature if you can, and reject the vitriolate Button, becauſe of the Inteſtine.

The Operation being made, you introduce your fingers into the Fiſtula, to find if there be any adherence or ſinuſſes, which muſt be looſen'd, and open'd with the Sciſſers, (as well to facilitate the entrance of Medicines, as to give paſſage to the Matter which lurks there, and which would in time ſerve for a new Ferment to produce new Fiſtula's) avoiding always the Arteries, which are felt by their continual pulſation.

Now the Queſtion is, Objection. How the Excrements muſt be kept back, if the Sphincter be wholly cut away?

For to be convinc'd of it, Anſwer. you muſt only repreſent to your ſelf the diſpoſition of the muſculi levatores, which by their union form a kind of ring, that embraces faſt the body of the Inteſtine, performing the ſame office as the Sphincter. Moreover, I ſay that the Fibres of the Sphincter being cut, every Fibre coming from each point of the Cicatrice, as thoſe of the Sphincter from the Bladder, and from all the other, may, in contracting themſelves, perform ſtill the ſame office as before, provided much of its ſubſtance be not deſtroy'd by too great ſuppuration; for ſeeing theſe parts are extremely ſpongy, there might be ſuch a conſiderable paſſage made, which would cauſe the Excrements to come out againſt our Will; this being explain'd, you fill the Wound with a thick Doſſel, tied with a thread, dreſs the reſt with Pleagets, ſuſtain'd with a Plaſter, Compreſs and Bandage, of which we have ſpoken.

What an Empiema is.WE underſtand by the word EMPIEMA, a collection of matter and blood in the capacity of the Breaſt. It's taken ſometimes for the Operation, and ſometimes for the Diſeaſe; and tho HIPPOCRATES hath given it a larger extent, when he ſaid that it might be taken for every heap of Pus in what part ſoever, notwithſtanding it's certain, that it's only proper to this part alone.

Difference of Empiema's. The differences of Empiema's are drawn from the place where the matter lieth, and from the different Accidents which accompany them. Concerning the place of the matter, it lieth between the Plera and the Lungs, or in the ſubſtance of the Lungs it ſelf, both theſe proceed from an internal or external cauſe; from an internal cauſe, as an Impoſtumation formed in the Duplicature of the Pleura, or in the ſubſtance of the Lungs, which breaks and runs upon the Diaphragme. From an external cauſe, as a wound, or from a veſſel broke, by ſome fall, blow, &c.

The Matter doth not alway fall on the Diaphragma. You muſt obſerve that the Pus and Blood do not always fall upon the Diaphragma, by reaſon of the adherence which the Lungs contracts with the Pleura, ſo that they can communicate their inflamation and alteration to one another; and that the matter may paſs from the Lungs, through the aperture of the wound, without one drop of it being ſpill'd in the cavity of the breaſt, which is to be well examined before you ſeparate the Lungs from the Pleura with your finger or Probe, (as moſt Practitioners are wont to do) that is to ſay, if the matter run with eaſe through the Aperture, and without the Diaphragma being oppreſſed with it, you muſt no ways break the adherence of them.

A Quinſy can never cauſe an Empiema. I do not ſpeak here of diſeaſes of the Throat; we know well enough that never an Empiema ſucceeded a Quinſy; the reaſon is, that the Pus cannot fall upon the ſubſtance of the Lungs, without cauſing a ſudden ſuffocation, becauſe the Pus, by its weight, would hinder the play of the veſſels that compoſe them; wherefore there is only Pluriſies and Impoſtumes of the Lungs, which precede the Empiema that comes from an internal cauſe.

Cauſes of a Pluriſy.As for the eauſe of a Pluriſy, ſome ſay it's form'd by a boiling and impetuous blood, which is extravaſated in the Plura; others pretend it's caus'd by a bilous blood, which gathers and putrefies between the ribs and Plura.

Some others maintain that it proceeds from an extravaſation of blood that comes from the intercoſtal veins, and the Aziges; which is diſcharged between the duplicature of this membrane, where it changeth into pus by its ſtay there: though this laſt opinion be not over-well grounded, yet it is the moſt common, and moſt received.

It were to be wiſh'd that all theſe opinions were as true as they are authorized by their Partiſans; for beſides, that the blood being ordinarily ſpilt out of the veſſels only after ſome blow or wound, it's evident that the bilous particles are rather capable to diſſolve a matter than coagulate it, and that it's only the ſalt volatil alkalies of the Bile which tend to the exaltation; but there muſt needs be here a coagulating Agent, which diſpoſeth it to be obſtructed in this membrane. There is nothing more common,A common Cauſe of Pluriſies. than to ſee in the Summer-ſeaſon Pluriſies affect thoſe, who having over-heated themſelves by running, or ſome other as violent exerciſe, go imprudently to drink Iced. Liquors, or in a Cellar to cool themſelves, having moſt commonly their Breaſt open. You muſt conſider, that in the ſame moment the Pores being much dilated, the blood is in an extraordinary agitation, and furniſhes abundance of Swetts; this being ſo, it happens that at the ſame time as this cold drink chills, (as it were) the blood in the veſſels, the impreſſion of the external cold Air ſuppreſſeth the Swetts, in ſhutting up the pores, and they being quite diſingaged from the reſt of the maſs, ſtop in the duplicature of this membrane where they coagulate the blood, by the means of their urinous volatil Salt.

Urine and Swett analogous.Experience teaches us, that there is no liquor in the body has more analogy with the Urine than Swett; we obſerve alſo that it hath the ſame taſte, ſmell, and conſiſtence; we know that the Urine abounds in a urinous volatil Salt, and in a very aetherious Sulphur.

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.

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.

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.

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.

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 Aperture of the os lachrimale, without communicating its alteration to the neighbouring parts. I will not call this indiſpoſition a Fiſtula, When the Operation is not neceſſary. but Obſtruction, which nevertheleſs permits the ſeroſity to eſcape involuntary; which muſt be well diſtinguiſhed, becauſe the operation is not neceſſary if the lachrimal Bone be no way alter'd; for the Operation conſiſts in nothing elſe but to pierce the Bone, and conſume the Carioſity. We uſe in this occaſion general Remedies, and all Coliriums proper to deobſtruct and diſinflame theſe parts.

If the Matter which cauſes the obſtruction excoriate, and ſlightly ulcerate the nigh parts, one may call it a falſe Fiſtula, which yields to attenuating Medicines, and thoſe which are proper to conſume the Caloſity that comes upon it.

But if the ſeroſity by its acidity excoriate the little Tubercle of Fleſh, which the Ancients took for the lachrimal Gland, and the other nigh parts; there comes upon it an Ulcer, which ſoon degenerates into a Fiſtula, by the action of the moſt pungent and acid Particles; as I have proved at length in the examination of the Fiſtula in Anc. So that this impure ſeroſity, being capable of Corruption, rots the Bone by its lying there, What a true Fiſtula Lachrimalis is. and ſtop the paſſage of the Tears. I will call this the true Fiſtula, where the operation is of great importance.

It happeneth often that the ſame Humor which waters the Eye, runs to the lachrimal Sac without producing its effect: The reaſon is, becauſe it beginneth only to enter into its firſt degree of Corruption. But this Sac being a production of the interior Membrain of the Noſe, which is extreamly ſpongy and penitrable; the Humor has ſtrength enough to penitrate it, and ſo cauſe an inflamation which ſtops the paſſage of the Tears, which by lying there wax ſour, and afterwards grow ſo ſharp, that they cauſe a Fiſtulous Ulcer, or a kind of Fiſtula which one might call complete, to diſtinguiſh it from the others.

The Matter of the Tears is not always the cauſe of this Fiſtula, as it is the effect of it: It's very often the conſequence of ſome Impoſthume, or even of the inflamation of the lachrimal Sac, without this pretended ſeroſity contributing any way towards it: It may truly by lying ſtill there, thicken and harden by heat, or it may degenerate, mixing with ſome other ſtrange Humor, and ſo contribute to its Formation.

You muſt obſerve, That in this laſt kind of Fiſtula, there is always ſome Pus in the lachrimal Sac; the moſt of them that are troubled with it, preſs every day the fide of their Noſtrils, to ſqueeze out the Matter, ſo they may avoid the pain of the operation, being rather content to have it as long as they live.

How to perform the Operation.WE have already ſaid, that the operation of the Fiſtula Lachrimalis conſiſts in piercing the Bone, and making the Matter which entertains it flow more eaſy, and in deobſtructing the paſſages.

For this you introduce the Probe to know whether the Bone be diſcovered or carnous; but particularly whether its hole be ſtopt.

If the exterior Orifice of the Fiſtula permit not the entry of the Probe,Caution. you muſt dilate it with a little prepared Sponge, or make an inciſion with the Biſtory, taking care not to cut the little Bridle, which makes the reunion of the two Eye-lids; which is nothing elſe but the Tendon of the Orbiculer Muſcle, that performs the office of a Ligament: for if by chance it ſhould be cut, the lower Eye-lid would be revers'd, which is an indiſpoſition much more troubleſome and deform'd than the firſt.

When you have made the Inciſion, you fill the wound with dry Lint to obſorb the Blood, and dilate the lips to ſee more eaſily the bottom of it. The Bone being laid bare, you introduce a little Canula into the hole of the Os Lachrimale, and with actual Cauteries of different Figures you pierce the Bone, which is very thin; lightly paſſing the Cauteries over its ſurface to haſten Exfoliation, and deſtroy the Carioſity, if any. After that you procure the ſuppuration of the would, and lay in the bottom of the Fiſtula Medicines proper to procure Exfoliation of the Bone.

What to be done to prevent Inflamation.You muſt obſerve, That before you make the Operation, it's neceſſary to apply on the Eyes ſome defenſative made with A que Plantag. Roſar. Album. ovi, Ol. Roſar. & tutiae, you continue to uſe it until there is no more fear of Inflamation.

When the Operation is finiſhed, you order the Patient to lie on his Back, that the Matter of the Tears may take its courſe through the Aperture that hath been made; you muſt have regard to two Circumſtances. The firſt, to ſtay till the rottenneſs be deſtroy'd before you procure the generation of Fleſh. The ſecond, to hinder the cicatrize from riſing too high, which would be a very diſagreeable deformity. Finally, you apply a Plaiſter, Compreſs, and a Handkerchief a-croſs, or the lachrimal Band.

FOR to have a Idea of the generation of the Polypus, you are only to call to mind what we have advanced, when we ſpoke of a Sarcoma; and to make, at the ſame time, ſome reflection upon the ſtructure of the part; viz. upon the nature of the inferor Membrain of the Noſe, which is very thick, ſpongy, penitrable, actually watered, and imbued with a viſcous glewy Humor; which are all the requiſite and neceſſary Circumſtances for to make us think, that it contributes much to the formation of the Polypus, by reaſon its Poroſities are ſo diſpoſed, that they let paſs nothing but the moſt craſs and fungous Particle of the Blood, which are very fit to produce ſome Excreſcence.

Several opinions concerning the cauſe of a Cataract. THoſe that have treated of the Cataract, are divided in their Opinions concerning the cauſe that produces it. The one have maintain'd, That its only an obſtruction of the apple of the Eye, form'd by the moſt viſcous part of the watery Humor, which is ſhut up between the Cronea and Ʋvea. Others thinking to hit better, have advanced, That it's a Web which is form'd before the chriſtaline Humor. However, I conceive, the Cataract to be formed after this manner.

The Author's opnion concerning the cauſes of a Cataract. All the World agree, That all the parts are form'd from the firſt moment of Conformation; and we can demonſtrate by theſe inconteſtable Principles, that there's never a Ciſt or Membrane generated abſolutely-againſt Nature; and that theſe Ciſts and Cataracts which come ſo frequently, or to ſay better, which appear and become ſenſible to our eyes, are nothing elſe than the unfolding of the Membranes, and the little Pellicles which compoſe the parts; from which I conclude, that the Cataract begins only to be form'd by a little Pellicle which ſeparates its ſelf from the Chriſtaline, and ſwims in the Aqueous Humor, which carries it from one place to another, according to the various motions we give to the eye.

The compoſition of the chryſtalline Humor.Which we may without pain conceive, if we conſider that this Humor is nothing but a compoſition of ſeveral little Pellicles one laid upon another, and which may eaſily be taken aſunder after it's boil'd; ſo that if we couch the Cataract when it's quite framed, you change, in a manner, the figure of the Chryſtalline, that is to ſay, of convex it's made flat.

Now this Humor being no more ſo convex as it ſhould be, there muſt a weak refraction follow from it, and conſequently ſome confuſion; I ſay,An inconvenience which always follow upon the couching a Cataract. that the beams which come from every viſible point of an object, and which enter into the eye at a certain diſtance, are never ſoon enough broken, by reaſon of the flatneſs of the Chriſtalline, to be united when they come to the Retina, which cauſes us to ſee the object confuſedly. We help this inconvenience by the means of a convex Glaſs, which regulates the diſtances that's neceſſary to make the refraction more favourable; and that the Retina may ſtand juſt at the reunion of the beams, which paint in Minature (upon this Coat) the Image of the object: From whence it follows, That thoſe whoſe Cataracts have been couched, never perceive objects ſo diſtinctly as others.

When firſt they begin to be form'd, and keep as yet their tranſparency, one ſees the object, as if it were through a Cloud; and then we call them Suffuſions. This little Pellicle changes colour and conſiſtence, and cometh to be more or leſs thick, according to the nature of the Juice with which it's water'd, and the mixture of the Humors which renders it opake and impenetrable to the light;Different colours of Cataracts. this makes all the differences of Cataracts; there are ſome white, ſome of a lead colour, ſome green, yellow, pearl-colour'd; others of the colour of Sea-water, or of burniſhed Iron.

A ſimple Wound of the Head may be cured by Suture, &c. WE have made you obſerve in the beginning of this Treatiſe, that a ſimple Wound of 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.

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.

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.

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 overcome them.

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 whi •• • he ſulphureous particles (that •… elt, and are •• rn'd into Sanies) excite at the Fibres of the Perioſtium.

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.

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.

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.

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.

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.