The Interrupted Suture.

To make this Suture, you must begin to clear the Wound from all extraneous Bodies and Coagulated Blood. A Ser­vant must hold together the Lips. These Cautions are com­mon to all Sutures. You must pass the Needle with the Waxed Thread in it, into the middle of the wound from without inwards, leaving a moderate Distance between each Stitch. You must pierce deep enough, and go to the Bottom of the wound, least an effusion of Blood there obstruct the Reunion.

If a Wound have Angles, you must begin the Suture there. Before you tye the Knot, you must bring the Edges of the wound together, which if they are not Level, will leave an inequality in Cicatrizing. If Wounds have no Angles, you must begin to tye that Thread which is in the midst, and [Page 8]make a simple knot on the side opposite to the discharging of the Matter; on this knot you must lay a small Com­press of Linen Cloth Waxed, on which you must make a slip-knot, which may with ease be undone if any Accident happen.

If you intend to cover the wound after the Suture with an Emplaster, you must lay a small Compress on the knots to hinder its sticking to them, which creates a great deal of trouble to the Patient in taking off the Dressings.

If any Inflammation happen, you must dextrously loose the knots in such manner, that you may close all again when the Accidents are abated. But if the Accidents are so pressing as to oblige you to cut the Threads, you must pass a Cannu­lated Probe under them, and slide the point of the Scissars on the Cannula. After the Reunion is compleated, you must cut the Threads on the Probe, observing to put your finger on the knots to stay the Flesh; and draw out the Thread gently, to prevent tearing open the wound.

In Superficial wounds you must use streight Needles, in Deep ones crooked.

The twisted Suture is used in the Hare-lip, of which in its proper place.

The Dry Suture.

This is only made in Superficial wounds, in places where we must be careful to avoid Deformity, as in the Face or Hands of the Fair Sex. This Suture is not very much to be depended on, because most commonly it loosens. The Manner of making it is thus. Take two pieces of new Linen Cloth with their Hemms on, proportioned to the largeness of the Wound. The Hemms must be laid on the edges of the wound, then cut the Cloth into Digitations, at a convenient distance from each other. The number of Digitations must be equal to the number of Stitches you intend to make; to the end of each Digitation, sow a small Ribbon; then dip the Cloth in strong glew, and apply it a Fingers breadth from the edges of the wound; these Ribbons must be tyed to each other in such manner, that the edges of the wound may touch.

The Glovers Stitch.

This is made in great wounds of the Guts and Scrotum. To make it, Take a straight Needle with waxed Thread: then take the two Lips of the Wound between the [Page 9]Thumb and Fore-finger, whilst an Assistant holds the Gut at one end: Then stitch it length-ways, passing the Thread beneath and over the Lips of the wound, in the same manner Glovers use to stitch their Leather.

Wounds altered by the Air do not admit of Sutures, these are not to be cured without Suppuration, because the Nitre of the Air wasting the Unctuous parts of the Blood, which is the Balsam used by Nature for the uniting of Wounds, and keeping the Parts supple, the Fibres grow dry, the Pores are contracted, and dangerous obstructions ensue. Besides the Salts of the Air lodging in wounds, are changed into a Vitriolick Arsenical Matter, which corrodes and frets the Vessels, hinders the Cure, and causes a Gangrene.

Sutures are not convenient in contused Wounds, which must suppurate to con [...]rt the Blood extravasated between the Fibres and Vesiculae into Pus. Nor in wounds with great loss of Substance, whose Lips cannot be brought together to reunite. Nor in the Bites of Venomous Animals, as well up­on the account of their Contusion, as the continual irritati­on of the Venom, which molests the Part, infects the Mass of Blood, hinders the Reunion. In this case the external Remedies must be most potent Resolvents, and the Internal Cordials and Corroborants. Nor in Divisions of the larger Vessels, where the great Flux of Blood and Pledgits with Stypticks thrust into the wound; Nor in wounds of the Breast, where the perpetual Motion obstructs the Union. It is a question among Practitioners, if Sutures may be made on Bones laid bare. I shall declare in short my Opinion. If there be a Contusion or Fracture in the Bone, an exfoliation must be procured, and since there is no better way to ob­tain this, than to expose the Part to be altered by the Air, you must not make any Suture in this Case. But if the Bone be sound and entire, and you desire to preserve it from Exfoliation, a Suture must be made without delay, in which there is no danger; because the Threads may easily be cut, if any Accident shall press. In the last place Longitudinal Wounds do not require Suture, the Ʋniting Bandage being sufficient.

THE MANNER OF DRESSING is directed in each Operation, where Sutures are necessary.

THE CURE IN SIMPLE WOUNDS, consists in re­uniting the divided parts, in removing all external Obstacles, such as Coagulated Blood, and Extraneous Bodies, in bring­ing together the Lips, and applying Vulnerary, Agglutinating and Balsamick Remedies.

Since the Blood is the true Balsam which Nature makes use of for the Reunion of Wounds, the Surgeon must be careful to prevent all corruptions of this Noble Liquor, by extirpating the Seeds of Distempers, Rectifying its Fermentations and Digestions, and Restoring it to its Na­tural State.

To this purpose conduce Clysters to cleanse the lower Belly, Mild Purgatives, and lastly Diaphoreticks which pu­rifie the Blood, and sweeten the Nutritive Juyce, v.g. ℞ Dia­phoretick Antimony, ʒss. Crabs Eyes, ℈ij. Sperma Ceti, ℈i. Chalk, ℈ss. Salt of Lead, gr. iv. Give the Mixture in some proper Vehicle, as a Glass of Carduus, or any other Sudo­rifick Water. Or, ℞ Waters of Mint and Chervil, ℥ijss. Crabs Eyes, ʒi. Diaphoretick Antimony, ℈i. Salt of Wormwood, ℈ss. Treacle of Andromachus, Sperma Ceti, Elixir Vitae, Syrup of Speedwell, ā ʒi. Of this Mixture give some Spoonfuls from time to time till the Patient Sweat, and then cover him close.

The ill impressions of the Air, must be corrected by Bal­samick Applications, which must be Volatil, Saline and Oleous, Resembling the Blood which is the Natural Balsam, such are Balsam of Peru, Oyl of St. Johns wort, the Juyce from Peel of Elms drawn in Balneo Mariae, Oyl of Turpentine allay'd with Balsam of Peru, Balsam of Sulphur, and preferrably to all others of the like kind, the Bals. Samech of Paracelsus prepar'd with Salt of Tartar, vo­latilized with Spirit of Wine. But Oyls by expression without other preparation are dangerous, as well upon the Account of their Viscosity, which makes them hurtful to the Nervous parts, rotting them, stopping the Pores, and hindring Tran­spiration as by a certain latent Acid, able to corrode Iron and Silver.

Sharp Medicines must not be applyed to wounds, Experience shewing us they keep wounds open too long, waste the Flesh and Blood, and by their Acrimony bring Pain and Fluxion. Only Temperate Balsams are proper to parts Replete with Blood, and Temperate inclining to Acrid and Bitter for the Nervous parts, which last require more deterging Medi­cines, since they commonly produce more Filth than other parts. Add to these Vulnerary Potions made of Decoction of proper Plants, as Great Sanicle or Ladies Mantle, Ground-Ivy, Speedwell, St. Johns wort, Chervil, Crabs-eyes boiled in White-wine, and drunk every part of which is Vulnerary. We must not use these Balsams if it be necessary to keep the wound [Page 11]open, as in those which enter the Cavity of the Brest, for fear of any Matter which may happen to be lodged there, or any Inflammation or Contusion; for here if the wound be closed too soon, we have no means left to prevent accidents. Suppuratives must be used, which are ordinarily made of Turpentine, the Yelks of Eggs, with the Addition of a little Honey, Myrrh, Balsam of Peru, and Gum Elemi, and after a laudable Pus obtained, treat the wound like a simple Ulcer with Mundificants, Sarcoticks, and Aggluti­nating Medicines.

Wounds then are cured by applying Balsamicks, remov­ing extraneous Bodies, approaching their Lips, and retain­ing them by Bandage and Suture. Hares-grease is esteemed excellent to draw extraneous Bodies out of the wound, whether the Part be rubbed with it alone, or mixed with Ʋnguent of Betony, or made into an Emplaster with Gum-A­rabick. It is pretended Radishes, Dictamnus of Crete mixed with this Grease, have the same Virtue. Or ℞ Crabs-Eyes, Hares-grease, ā ℥ss. White Amber, ʒiij. Mix and ap­ply them. To these add, Savin, Periwinkle, Crabs-Eyes, which are proper Ingredients in vulnerary Potions, to ex­pell all extraneous Substances.

Tents dipt in some good Balsam, must be kept in deep wounds till their bottom be cleansed, that their Flesh may grow up to their sides, without which it would encrease too fast, the Orifice close, and the Pus and Filth lodge within, from whence Pains, Inflammations, Return of the Abscess, Fistula's, and deep Cystis's. But before any Tent be put in, it is necessary to consider well, if no Nervous part lie on the side of the wound; in this Case Tents too long or big, will inevitably create acute pain, which irritates the Nervous parts, corrupts their Juice, and causes a dryness and extenuation of the Part. The Tent must not be very big, except it be in the middle; not filling the wound that it may have room to swell; its point must be soft for fear of Hurting the Flesh, which begins to re­new and grow again. Tents must not be too long continu­ed, because they are apt to generate a Callus on the edges of the wound, which obstructs Reunion; but must be di­minisht by degrees, to give the Flesh liberty to grow.

A Serous Humour gleeting from the wound in the time of Cicatrizing, makes the Flesh Flabby and Soft, occasi­ons excrescences, hinders the Unition, and to Skinning Here Desiccatives must be used to absorb excessive [Page 12]Humidity, and moderate Astringents to correct the Laxity of the Flesh, and give them a firm consistence.

There happens at some times, an Inequal Roughness and Hardness in the Cicatrix after the Part is Healed, which proceeds from the Fibres of the Skin, not exactly meeting those which they are separated from, and the Pores and Chan­nels which before the Division were straight and answer­ing to each other, are confounded and displaced; and from hence the Nutritious Juyce being detained and stopped in the Part, produces a Callus in the Bones, and a Cicatrix in the fleshy parts, especially if Restringents and Desiccatives have been employ'd, which contract the Pores, make the Fibres firm, and harden the Part.

WOUNDS CONTUSED easily putrefie, and this ob­structs the Cure; for this Reason, if the Contusion be slight, you must have Recourse to Suppuratives to separate that which is mortified and bruised. But if the Contusion and Wound be very great, and you have reason to fear Gangrene before you can obtain a Sup­puration, you must make Incisions into, and Scarify the Part, to give issue to the Blood, and suppurate the rest with good Digestives, adding Aegyptiacum by way of pre­caution. From the first you must apply Topicks on the part, proper to prevent Corruption, such as Oyl of Wax, with which rub the part, laying on the Emplaster of Cum­min, Oyl of the Philosophers, Emplaster of Laurel Berries, Or ℞ Roots of the greater or lesser Consound, Flowers of Cha­momil and Melilot, ā ℥i. Saffron, ℈i. Flour of Beans, Fenugreek, ā ℥iss. Boil these in water first, putting in the Roots, then add Wormwood, Powder of Cummin ā ℥ss, mix these, and apply them outwardly. When the greatest part of the Contusion is overcome, rub in Spirit of Sal Armoniack de­stilled with quick-lime, which is an excellent Medicine.

WOUNDS CONTUSED easily putrefie, and this ob­structs the Cure; for this Reason, if the Contusion be slight, you must have Recourse to Suppuratives to separate that which is mortified and bruised. But if the Contusion and Wound be very great, and you have reason to fear Gangrene before you can obtain a Sup­puration, you must make Incisions into, and Scarify the Part, to give issue to the Blood, and suppurate the rest with good Digestives, adding Aegyptiacum by way of pre­caution. From the first you must apply Topicks on the part, proper to prevent Corruption, such as Oyl of Wax, with which rub the part, laying on the Emplaster of Cum­min, Oyl of the Philosophers, Emplaster of Laurel Berries, Or ℞ Roots of the greater or lesser Consound, Flowers of Cha­momil and Melilot, ā ℥i. Saffron, ℈i. Flour of Beans, Fenugreek, ā ℥iss. Boil these in water first, putting in the Roots, then add Wormwood, Powder of Cummin ā ℥ss, mix these, and apply them outwardly. When the greatest part of the Contusion is overcome, rub in Spirit of Sal Armoniack de­stilled with quick-lime, which is an excellent Medicine.

GUN-SHOT WOUNDS are always attended with Con­tusion, Laceration and Superficial Heat; for this Reason you must suppurate the Contusion, which commonly begins to appear on the third or fourth Day, during which time, it is enough to take off the dressings once in twenty four Hours. After Suppuration made, and the Abscess formed, and the contused Matter resolved, you must dress the wound with Mundisicants, and clear it from all extrane­ous Bodies. Spirit of Wine and Balsam of Peru, must be added to the Digestives and Maturating Applications, to prevent the bruised parts from mortifying. Spirit of Wine [Page 13]is excellent in Burns, and you ought to dip your Tent in it, before you lay Digestives and Suppuratives on them, be­cause Digestives are not always agreeable to the Nervous parts, and Spirit of Wine corrects their ill qualities. The Application must be laid on, so as to give vent to the Mat­ter on all sides, ¶ Ambrose Parry's Balsam is proper for Gunshot Wounds, which is made in the following manner. ℞ Oyl of White Lilies or Violets, lb iv. Boyl in this Liquor some young Puppies, till the bones are dissolved, add a pound of Earth-worms boyled in Wine; Boyl all again, adding to the strained Liquor Venice Turpentine, ℥iij. Spirit of Wine, ℥iss. Mix these and make a Liniment, which is excellent to appease pain, and ripen these Wounds. After Suppuration use the following Mundificant, ℞ Venice Turpentine, ℥v. Honey of Roses strained, Myrrh, Aloes, Mistick, Round Birth­wort ā ʒiss. Barley flower, ʒiij. Mix these for a Liniment, which imbibe and wet with Spirit of Wine. You must continue to mundifie till new Flesh grow up. If in the mean time any great putrefaction or corruption happen, you must add to the before-mentioned Remedies Precepitate well edulcorated, especially if the Nervous parts happen not to be hurt. If Pains happen below in the Bones, Oyl of Turpentine is an excellent Remedy, especially in the Caries of a Fissure.

WOUNDS FROM THE BITE OR STING OF VENOMOUS ANIMALS, require deep Scarifications of the part, applying to the wound Oyl of Nutmeggs, Vigo's Emplaster with Mercury. Juice of pounded Onions is excellent for the Puncture of Spiders. Scarification is not necessary if the wound be not deep, as the Sting of a Wasp, or some such like Insect. In the Bites of Vipers or Serpents, you must scarifie the part, and crush a living Toad on it; or a dry one, if you cannot get one alive; if you macerate it in Wine or Vinegar, it will be more efficacious: A red hot Iron applyed as near the wound as may be, is a Reme­dy experienced by Mr. Boyle. The Serpentine Stone found in Snakes of the East-Indies, or that compounded of it, is a very good preservative against the Bites of all Mad or Venomous Animals. Or in defect of this, the Magne­tick Emplaster of Angelus Sala, with the addition of an Ounce or two of Crabs-Eyes calcined. The contiguous parts must be rubbed with Oyl of Scorpions, with a little Sugar of Lead to prevent inflammation. The following Ca­taplasm against the Biting of Venomous Animals, is gene­rally [Page 14]reputed good. ℞. One sharp Onion, one Clove of Gar­lick, Balm, Venice Treacle, Common Leaven, ā ℥ss. Beat all together into the form of a Cataplasm. After the Venom is drawn out of the Wound, apply a good Balsam or a Di­gestive, with the addition of Aegyptiacum. Inwardly you must give Spirit and Volatil Salt of Vipers, Spirit and De­coction of Crabs to stop the progress of the Venom.

^*WOUNDS OF THE VEINS AND ARTERIES, are always attended with great Flux of Blood, to stop which, apply Crepitus Lupi, which is a sort of dryed Fun­gus, with a close Bandage. This may be soaked in a So­lution of Vitriol of Steel, with a moiety of Salt dissolved in some decoction of Mild, Vegetable, Restringents, and applyed Cold with Stupes. If the wound be large, you must throw in Bole-Armoniack, or the Caput mort. of Vitriol well edulcorated. You must observe that all Stypticks whatever are useless, except they be kept firm on the part with a streight Bandage. Oak Moss, or the Pith of Elder pulveri­zed and strewed on the Wound, stop an Haemorrhage, Moss of a Humane Skull is a certain Remedy. The following Re­stringent is good, ℞. Sharpest Vinegar, ℥i. Crocus of Steel, ℥i. Colcothar or dulcified Earth of Vitriol, ʒss. Beat all toge­ther very well, and dip Rags with powder of the Crepitus Lupi, and apply it to the wound. If these means are not sufficient, make a ligature on the Vessels, according to the manner prescribed in the Operation of the Aneurism. For the internal Medicines which stop Blood, those wherein Swines or Asses Dung are Ingredients are to be preferred, and to those which have Nitre prepared with Antimony, Tinctures of Sulphur and Vitriol, and the Astringent Tincture of Mars. If superfluous Flesh spring up, you must strew on Burnt Alome, Crocus Metallorum, or rub the part with Aegyptiacum. But the best way is to touch it with the Lapis infernalis.

^†WOUNDS OF THE NERVES AND NERVOUS PARTS. These parts are easily altered and corrupted, and contract a Gangrene by means of the external Air, and the Flux of that Synovia, [or thin Gleet] which obstructs their [Page 15]Unition. In Hurts of the Nervous parts, it is necessary to rub the Limb from the first Rise of the Nerves with Oyl of Earth-worms, heightned with Distilled Oyl of Lavender. Di­stilled Oyl of Lavender taken inwardly, removes Convulsi­ons, and so do's Oyl of Sage, Amber. All Unctuous and Mucilaginous things, all Greases and exprest Oyls are hurt­ful in Nervous wounds, which require penetrating Medicines, such as Balsam of Peru, Distilled Oyl of Turpentine, Oyl of Wax, Distill'd Oyl of Lavender, Oyl of the Philosophers, Distill'd Oyl or Balsam of St. Johns wort, Spirit of Wine and Gum Elemi. The following Composition is excellent, ℞ Dialtheae ℥iv. Distilled Oyl of Bays, ʒiss. Mix and apply this. The Fol­lowing Oyl is admirable to apply to the Fist, ℞ the Tops of St. Johns wort in flower, two Handfulls; Common Oyl, l. vi. Di­gest these together, adding Turpentine lb. Powder of Earth­worms, ℥iij. a little Saffron, Mix these and apply them to wounds of the Nerves. Tents must not be put into Ner­vous parts if it can be avoided, because they aggravate the Pain. To abate the Synovia or Gleet from the Joynts, ℞. Oyster shells calcined, ℥i. Powder of Skulls burnt, dryed Bones, Jaws of a Pike calcined, ā ℥ij. Burnt Ivory, Terra Sigillata, ā ʒiss. strew the Powder on the Part. Hogs-dung incorporated with the Blood of the Wound, Boyled and applyed in F [...]rm of a Cataplasm, is a Specifick to stop the Synovia, Distill'd Water of Pounded Crabs applyed with Raggs, does not only stop the Synovià, but takes off all other Inflammations, Erysipelas, and Pain in wounded Parts. If Convulsions pro­ceed from a partial division of the Tendons, cut them quite asunder, and stitch them as directed in the Operation of the Suture of the Tendon.

WOUNDS OF THE BREAST, if they hurt the Lungs, require internal Medicines to prevent and cure a Pleurisie or Peripneumony, which ordinarily happen in these wounds. You must put in Tents Capped, or with a Head, to give a free exit to the Blood and Sanies, which other­wise would create an Empyema. Internally you must give Diureticks and Vulnerary potions; We may observe Pus, Sanies, and Blood sometimes voided by Urine in these wounds.

WOUNDS OF THE HEAD, require the Body to be kept open, if they are superficial it suffices to use Oyl of St. Johns wort, Balsam of Peru, Emplaster of Betony. Or this following, ℞ Emplaster of Betony, Tacamahac ā incorpo­rate these with Balsam of Peru. If the wound hurt the [Page 16] Cranium, and do not pass through it, strew on it powder or Orrice Root, Aloes and Myrrh, impregnated with Spirit of Wine, or distilled Oyl of Turpentine, and lay dry Lint on it. Nothing which is oyly or greasy, is to be used in Fra­ctures of the Cranium. If wounds pierce the Cranium, stop instantly the Flux of Blood with Powder of Frankinsence and Whites of Eggs, with a little Bole Armoniack. Put into the Cranium Pledgits dipt in a little Oyl of Turpentine, with Bal­sam of Peru: You must never suffer Oyly or Greasy Medi­cines to touch the Brain; If the Brain or its Membranes begin to corrupt, use Honey with some few drops of Oyl of Turpentine, but never Honey alone. In contus'd wounds which are Superficial, use to the part affected Oyl of St. Johns wort, with a small proportion of Chymical Oyl of Aniseseeds; But if they are Deep, there will be a great swel­ling, and you must attempt to dissipate it by insensible Tran­spiration, or open it without farther delay, least the Pus cor­rode the Periosteum and the Bone by its Acrimony, and then heal the wound with Digestives and Suppuratives, of which kind is this Composition. ℞. Turpentine distilled, Gumm Elemi, ā ℥iss. Beavers Grease, and Stale Hogs lard, ℥i. Mix these and apply them.

The Operation of the Perfect Hernia.

To perform this, Let the Patient lie on his Back, and make an Incision with a Knife through the Skin on the side of the Thigh the whole length of the Swelling, raising the Skin as before, you holding one end, and a Servant the other, separate the Lips of the wound, and break with your Fingers or Fleam, the Coats which cover the Gut and Testicle. The Gut being discover'd, introduce a Dire­ctor between the Membranes of the Scrotum and it, and widen the Aperture with your Scissors, which you must slide on the Furrow, and when you have laid bare, disin­gage it from the Testicle, to which it adheres. Next let a Servant hold up the Gut, and draw it gently with his Hands toward the Os pubis, whilst you lightly draw the Testicle with your Hand, to get the liberty of breaking with a Fleam, or the point of your Knife, the Membranous Ties which unite the Testicle to the Gut.

But here observe if the Adhesion be very strict, it is more advisable to hurt the Testicle than the Gut, because that is not necessary to Life, whereas if the Intestine be cut, the Patient can hardly escape. You must have a great care likewise to avoid cutting the Spermatick Vessels, because the Flux of Blood will obstruct the Operation.

After you have separated the Gut from the Testicle, in­troduce the Director between the Skin and the Gut, and cut the Ring of the Muscle, which you must scarifie to de­liver the Gut from its Strangulation, in case it should hap­pen. In the last place reduce the Gut into the Belly in the same manner as in the Bubonocele, and when it is repla­ced, command a Servant to press the Belly with his Hand, to prevent its falling out again.

It is a ridiculous Assertion, that the Testicle must always be extirpated after the Operation; for this do's not conduce to the Cure of the Hernia; on the contrary it prolongs it, puts the Patient to unnecessary Trouble, and deprives him of the means of satisfying the Duties of his Sex; nay, if the Testicle happen to be affected, it is most advisable to defer the Operation till the Fluxion be abated, in which space per­haps that may be cured.

Sometimes the Omentum alone adheres and covers part of the Testicle, and sometimes the Gut with the Omentum lying over it. In this case you must dextrously free the Gut from the Testicle, and leave a small portion of the Omen­tum, adhering to either of them, rather than endanger the hurting them.

The Omentum is almost ever corrupted, and for this Rea­son a Ligature must be made, and the tainted part taken of. Sometimes indeed in Recent Hernia's, there is not time enough to admit of any alteration, and then you may re­place it in the Belly without farther trouble. If the O­mentum cleave to the Gut, and there be no change discern­able in it, reduce both together without taking off any part of the former. If both together adhere to the Bag of the Peritonaeum, take off part of the Peritonaeum, rather than touch the Gut, and if it cannot be otherwise disengaged, as when the Omentum adheres to the Bag, it is better to take off part of the last, than the first. But the Omentum being unable to remain long in that State without being altered, it sel­dom happens but that some part is requisite to be cut off.

In making a Ligature on the Omentum, you must be care­ful not to make it too straight, because it easily cuts through it, by reason of itssoftness. You must turn the Threadseve­ral times round, first passing the Needle through its Sub­stance.

THE DRESSING. Thrust into the Wound a long Tent of Linen capped at one end, and flat at the other; for if you use Lint only, the Guts which are always driving down, will not fail to dilate the Ring, and hinder a good Cicatrix, and the Intestines will fall down again after the Wound is healed. Here observe to pass a Thread through your Tent to draw it out at pleasure, and hinder it from sinking into the Belly. Next fill the Wound with Dossils armed with good Digestives made with Turpentine and Yelks of Eggs, over them lay a Triangular Emplaster, and a large Com­press of the same Figure, Embrocate well the Neighbour­ing Parts with Oyl of Roses, apply good defensatives to the Scrotum, and Hypogastrick Region made of Compresses dipt in Oxycrate very Hot. Lastly, keep up the Scrotum with a Bag-Truss, and make the Bandage called Spica.

This is made with a Roller rolled at one end, which must be six Ells long, and three Inches broad. You must begin to apply the end of the Roller on the Wound, then pass on to the Back, returning to the Belly, thence over the wound, thence between the Thighs, thence over the Wound, thence behind the Back, thence over the Wound, then over the Belly, then over the Thigh, then between the Thighs, then over the Wound, then behind the Back, continuing to make these rounds till the Roller is spent; and lastly fasten it with Pins at the extremities; every time the Roller passes over the Wound, you must leave small Interstices, in which a third part of the Roller beneath is seen. The whole figure some­thing resembling an Ear of Corn, from whence this Bandage derives it Name: We have described Trusses for the Scro­tum, in the Operation of the Hydrocele, where the Reader may take the pains to turn to them.

THE CURE. The Wound must be treated with good Digestives to procure Suppuration, and a firm Cicatrix. When the Pus becomes laudable, that is white, of a good consistence, and without any illscent, you must deterge and cleanse it like all ordinary wounds. The Patient must be nourished with good Broths, and from time to time Clysters given, with other general Remedies, as the nature of the Symptoms shall require.

A Machine to check the Motion of the Belly described.

^*Since nothing more impedes the Coalition of Wounds of the lower Belly than its continual Motion, nothing can be more serviceable here, than some Machine adapted to check this, and such an one may be made after this man­ner. Double a pretty thick Iron Wire, in such a Figure it may embrace the Wast. This Machine must have two Ca­vous Plates at each end, in short it must be like that Women use to stiffen their Commodes with. This is to be applyed in such a Manner behind on the Loins, that both Plates may extend forwards, and press by their elasticity the sides of Belly, which Compression prevents the Dilatation of the Wound. This Instrument must be covered with Dimetty or some such soft Matter, and stuffed with Cotton like Trusses to prevent galling.

In an Exomphalos's arising from Inflation, or when the Parts sometimes retire into the Cavity of the Belly, few Persons will be perswaded so submit to the Hazard and Trouble of the Operation.

A Machine for the Exomphalos.

The Machine I am now about to describe, is contrived to prevent the Parts from intruding into the Tumour, and differs very little from a Truss with three Branches. The Form of it is thus. Take a Thick Steel Wire, bend it and make a Truss like those commonly used in double Hernias. Then make another Branch which is to be sixed to the knob on each side, to which fit a round knob to be applyed to compress the Tumour on the Navil. This Instrument is pro­per for those Persons who have a Hernia on both sides, and an Exomphalos with it, and is more commodious than any Bandage, which in compressing the Belly obstructs Respira­tion, whereas these by their Spring complying with the al­ternate [Page 48]rising and falling of the Part in that Action, are not liable to the same inconvenience.

THE CURE. Digest the Wound with good Balsa­micks to procure a firm Cicatrix, and continue to treat it after the usual manner; Prescribe the Patient a good Dyet, nourishing him with proper liquids, frequently interposing Clysters.

If the Tumour arise from a Mass of Water collected there, attempt to disperse it, chafing the part well with Oyl of Turpentine, applying Hot Bags filled with Camomil and Elder Flowers boyl'd in Wine, or other proper Discuti­ents.

The first way of Searching.

Let the Patient sit in a Chair with a Back, on which he may rest or lie on his Back. Take the Yard by the Glans between the Thumb and forefinger, drawing it up straight, compress the Glans a little to open the Ʋrethra, into which introduce the Catheter with its Concave side downwards; when this is past in far enough for you to judge it is in the Neck of the Bladder, turn it quick and dextrously, and bring your Hand over the Patients Belly, and at the same time that you turn it, draw the Yard a little forward to keep the Ʋrethra streight and without wrinkles, which may hinder the entring of your Instrument.

If after turning the Catheter you find it did not enter, leave the Yard, and introduce your finger into the Anus, to guide the end of it into the Bladder. After this draw your finger out of the Anus, and quit the Yard to strike with the Instrument, turning it every way to hear what noise it makes on the Stone. If it happens that the Stone swims in Urine, (for the Bladder must be full when you pass the In­strument,) and you have reason to think this may hinder you from perceiving it, evacuate the Bladder by drawing out the Silver Wire in the Catheter, and after try as before.

Second way of Searching.

The following way seems more convenient, because there is no need of turning the Catheter. Let the Patient lie on his Back, and holding the Glans between your forefinger and Thumb, raise the Yard up, inclining it a little on his Belly, hold the Rings of the Instrument on the side of the Belly, and [Page 62]compress a little the Glans between your fingers to open the Ʋrethra; then introduce the end of the Catheter, continu­ing to push it on gently, till it enters the Bladder. By proceeding this way, you save the Trouble of passing your Hand over the Patients Belly, and turning the Instru­ment.

The way of Searching Women.

To Search a Woman oblige her to lie on her Back, with her Buttocks a little raised, and her Thighs divaricated; then separate the Nymphae with the left Hand and with the right; introduce the Instrument into the Neck of the Bladder, as in Men. When you are well assured there is a Stone, pre­pare the Patient for the Operation by General Remedies, Bleeding, Clysters, and other proper Medicines, to prevent any ill Habit of Body, having a bad influence on the Wound after the Operation.

The Lesser Apparatus in Men, or Cutting on the Gripe.

This manner of Operation is called lesser, because it do's not require so many Instruments as the former. To per­form this, put your forefinger into the Anus, to bring the Stone to the Perinaeum; make your Incision on the Stone it self on one side of the Suture, and extract it through the aperture with a Hook. This Operation takes place when the Stone is not too big, and you can bring it to the Peri­naeum with your finger.

The Way of cutting Women.

Put your forefinger and middle finger up the Vagina, or into the Anus in young Girls; with these two fingers bring the Stone to you, compressing the Bottom of the Belly with the other to make it descend: Put a Hollow'd Probe or Director up the Ʋrethra, which is to be held by some Assistant; then slide a Dilator on its Furrow, and ta­king out the Director, Dilate the Ʋrethra without cutting at all, and so extract the Stone with the Hook or Forceps. You must not put the Dilator too far up the Ʋrethra, because the Neck of the Bladder is short in Women, and by this means you may happen to lacerate the Sphincter, and so cause an involuntary efflux of Urine. This is called the les­ser Apparatus in Women.

The Greater Apparatus in Women.

The Patient being put into, and kept in the same posture with (Men described before) Introduce the Conductors into the Ʋrethra, and between them slide a Dilator, then with­draw the Conductors and so dilate, next introduce the Forceps, and drawing forth the Dilator, take hold of the Stone with it. If the Stone be too big to come forth, make a small Incision to the Right and to the Left, to make way for it. Instead of the Conductors, you may use the Gorget, if you like it better.

The Ʋrethra in Women dilates exceedingly, and it sel­dom happens that we are obliged to have recourse to Incisi­on. Besides, Women are more rarely attacked with this Distemper than Men; because their Ʋrethra is Wider, Streighter and Shorter, and the Urine more easily drives a­way that Sand which is lodged in the Bladder.

The Success of the Operation may be guessed at from the quiet repose which the Patient enjoys, the Freedom or Breathing, the Moisture of the Tongue, no Immoderate Drowth, Pain scarce sensible, little or no Feaver, no Swel­ling in the Hypogastrick Region, and a Cessation of Inflam­mation on the fifth or sixth Day.

Sometimes a Stone is voided out of the Bladder, and passes into the Ʋrethra, where it lodges and obstructs the Emission of the Urine. In this case if the Stone be near the Glans, press that with your Finger, and if it do not easily come forth, bring it out with the Extractor, if both fail, make an Incision on the side of the Ʋrethra to so take it out.

When the Stone is in the Neck of the Bladder, push it with the Catheter, or endeavour to bring it back by slip­ping the finger into the Anus.

When the Stone is in the Ʋrethra, if it be small stop the passage with your fingers (compressing the Yard beyond the Stone) then blow into the Ʋrethra to dilate it, and push the Stone forwards with your fingers, till you have brought it forth. This way succeeds better in young Children, than in Adults, their Ʋrethra being more easily distended.

The Stone may sometimes be drawn out by Suction, this succeeded well with Dr. Muys, who advised the Mother to suck the Yard of her Infant.

If a Stone be lodged in the Ʋrethra, and cannot be got out by any of the ways above mentioned, draw the Skin [Page 66]of the Prepuce upwards, and take the Yard between your fingers to hold the Stone firm, compressing it a little, and making the Incision on the Stone lengthways on the side of the Yard. When the Stone lies bare, press it out with your forefingers, or pick it out with the Extractor.

THE DRESSING. When the Patient is Cut, Apply a great Compress on the Wound, and let some Robust Fellow carry him to his Bed. If there be any fragments of the Stone remaining in the Bladder, or you have ground to think there are more Stones; put a Tent dipt in some Digestives into the Wound to prevent it from closing, and if there be a Flux of Blood, stop it with Restringents. If there be no Stone or Gra­vel remaining in the Bladder, put no Tent into the Wound, but a Pledget with some good Balsam, with an Emplaster over that, and a Compress both in the form of a Horse-shooe. The Dressing must be kept on with a Roller with four Tails or the double T suspended with a Collar, and the Leggs be­low the Knee, bound together with a narrow Roller, to keep the Wound from gaping.

The Roller with four Tails is made with a piece of Li­nen Cloath three inches broad, and an Ell long; slit this lengthways at both ends to the middle, leaving between four and five inches in the middle undivided. Apply the plain or entire part on the Wound, and then cross the two formost Tails, and fasten them to the Collar about the Ribs. (This Collar is a Band stitched at both ends, which is put about the Patients Neck, and hangs down to his Belly.) Then pass the two other Tails through the Collar, and bringing them back fasten them behind.

The TT or double T, is a Girth which goes round the Wast, with two Straps in the midst sown at some small distance from each other; apply the middle of the Girth behind, and tie its ends before, then bring the two Straps between the Leggs, crossing them on the Wound, and tie them be­fore to the Girth or Wastband.

The Dressing for the Incision made on the Yard.

Apply a Pledgit dipt in some good Balsam, and over it an Emplaster. The Bandage and all the rest, is the same as in the Phymosis.

THE CURE. We have observed before, that in case there be Reason to suspect there is Gravel remaining in the Bladder, you must not instantly heal the Wound, but put a large Tent into it with some good Digestive, to give [Page 67]leave to the Gravel to purge it self through the Orifice. If the Wound be contus'd, you must Suppurate till a laudable Digestion appear, every day lessening the Tent. But if after the Operation there be no Contusion, it suffices to put in a Pledgit arm'd with some good Balsam, and Dress it twice every day, till it be perfectly cured. The Patient must be fed with good Broths and Gellies, and must not eat any thing Solid for fear of a Feaver, which would obstruct the Coali­tion of the Wound.

To prevent the Stone from being reproduced in the Blad­der, the following Precautions must be used. The Person who is cut must lead a Regular Life; that is, He must not eat to Excess, for fear of creating ill Juyces, the Sto­mach not being capable of good Digestion, when it is over­charged with Meat. He must eat Wheaten Bread well ba­ked, for Rye Bread containing an Acidity, is apt to Coa­gulate the Humours, and produce the Stone. He must avoid all salt Meats, all sorts of Ragousts which ordinarily are high Season'd: All these Aliments heat, and are apt to petrefie that Glairy Matter, which is lodged in the Kidneys and Bladder. Milk Meats, Old Cheese, Hard Eggs, Sallets, Unripe Fruits, create ill Humours, which being mixed with Acids, acquire a coagulating property. The Use of Hea­dy Wines and Beer, is dangerous. G [...]sner has observed, that if you put Sand into Stale Beer, it forms a Stone. Muddy Waters, and Waters of melted Snow and Ice are very impure, and full of Bodies, which have a Coagulating property. Excessive Application of Mind, Debauches of Wine and Women, all violent Passions are very hurtful to Persons who have any Disposition to Gravel; all Excesses in any of these kinds sharpen the Blood, and wast its Unctu­ous and Balsamick part. Too long Repose is hurtful, be­cause the gross Feculent Matter subsiding, and not being dis­persed by Motion is collected together, and soon coagula­ted by an Acid.

For these Reasons the Patients Diet must consist of such Things as are sweet and easie of Digestion, as Veal, Lamb, Fowl, &c. or Broths, in which the Cooling Plants are boyled, as Succory, Sorrel, Parsly, Spinage, or others of the like Nature.

White-wine boyled with a Moiety of Water, &c. Sleeping and Waking must be moderate. The Patient must not sleep on his Back, for this posture is Heating. The Body must be kept open with Clysters, if Nature does not act her part, [Page 68]and gentle Purges given at proper times, of Whey, Manna and Cassia.

Those who are subject to Nephritick Colicks, may be cured by Emollient and Lenitive Clysters made with Mallows, Marsh-mallows, Milk, Sugar, and Oyl of sweet Almonds. These are Preparative to Diureticks, such as Ptisans made with Salt-Peter refined, ʒss. Dissolved in a Decoction of Rest Harrow, and Dogs Grass. There is not a more excellent Diuretick than Turpentine, ʒss. made into a Pill. To harden it, it must be boiled in some Diuretick Liquor, as Turnep Water, and so made up. To the part af­fected, apply Fomentations. ℞. Roots of Marsh-mallows, ℥ss. Mallows, Melilot, Chervil and Camomil together three Handfulls, Linseed, Parsley Seed, ā ʒi. Boil the Ingredients together, and apply the Cataplasm to the Part.

Baths made with Emollient Herbs, are very useful in Nephritick Pains, and Broth with Oyl of sweet Al­monds, ʒi. given to the Patient in the Bath. You may like­wise give Turpentine Pills, or a Dram of the Powder of Mille­pedes, both which are proper to expell Gravel by Urine.

If in Nephritick cases the Patient Vomit, give him the following Powder. ℞. Sperma Ceti, Crabs Eyes, ʒss. Cinna­bar of Antimony, ℈i. Volatil Salt of Amber iv. gr. Laudanum gr. iss. Torchisc. Alkekengi with Opium ℈ss. Mix these for four Doses.

Mr. Boyl in Nephritick Pains, commends Castile Soap dis­solved in old Oyl of Wallnuts, adding Oyl of Ginger three or four drops. This is a good Diuretick.

Of the Veins usually opened.

The Arteries are distinguished from the Veins by their Beating, whereas the Veins have no sensible Motion. The Blood in the Arteries, is of a more lively Florid Searlet co­lour, more Subtil and Spirituous than that of the Veins; it springs by repeated Jets, which the Venal Blood do's not. The Arteries lie more deeply conceal'd in the Part, and the Veins more shallow and superficial.

The Veins may be opened without any danger, if nothing be hurt besides the Vessels; but the Punction of the Arteries is ever attended with troublesom Accidents, as Aneurisms, Difficulty of stopping the Blood, and Death after, if these Swellings by neglect, or ill management degenerate and gangrene. The pricking of an Artery which lies deep, is still more dangerous, because no Ligature or Restringent Remedies can be applyed.

The Vein running through the middle of the Forehead, is called the Frontal Vein, or Vena praeparans. Hippocrates directs the opening this Vein in pains of the hinder part of the Head, and at present it is practised in inveterate Pains of [Page 104]that Part, whereever they reside. In the same case the Tem­poral Arteries are sometimes opened: These Arteries alone can be opened, because they are small, and may be compres­sed with a Boulster and Bandage; This advantage they re­ceive from running over the Bone, which with the External Applications, compose a double Compress.

The Veins in the greater Angle of the Eye, are opened to prevent their Inflammation; and the Veins between the Cartilages of the Nose, to take off the Copper Colour, and other Deformities in the Skin of the Face. The opening of the Veins on each side the Fraenum of the Tongue, com­monly called Venae Ranulares, is practised in Inflammations of the Throat, and Pains of the Teeth, when the usual Re­medies fail. Bleeding in the Jugulars, is very effectual to prevent all Quinsies, Apoplexies, and all stubborn Distempers of the Head, especially Inflammations of the Eyes.

There are four Veins in the Arm, in which it is common to let Blood, the Cephalick, Median, Basilick and Cubital. The First is in the upper and external part of the foreside of the Arm, near the bending of the Elbow. The Basilick is a little lower, and the Cubital at the bottom of the Arm on the Bone of the Cubit, or near it. When the Vessels lied [...]ep, and cannot be opened, there appear on the inner part of the fore­side of the Arm, from the Elbow to the Wrist, several commu­nicating Branches, which convey the Blood from one to the other, and these may be opened in stead of the principal Veins. On the Hand are two Veins, one between the Thumb and forefinger, and another between the last Finger, and the last but one called Salvatella, and sometimes opened in Quartan Agues.

There are several Veins on the Leg and Foot opened, to give Relief to the Patient. In the upper part of the Mus­culi Gemelli, there is one called Poplitea, the opening of which is useful in the Gout, and prevents Varicose Swel­lings of the Leggs. The Saphaena is opened above and below the Internal Ancle. This Vein continues its course on the Foot, quite to the Juncture of the great Toe, and may be opened there: In opening it above the Ancle, great care must be taken not to prick a Nerve, which terminates in that place, and on the Foot not to hurt the Tendons. There is another Vein which winds round the extremity of the same Articu­lation, called the Sciatica; from the opinion that, abun­dance of Blood drawn out thence, appeases pains of the Hip-Gout. The Saphaena and Sciatica, spread numerous [Page 105]Branches on the Foot, which may be opened when the great Trunks do not appear.

The opening of a Vein is done after two several ways, either by Pricking or Cutting. The larger are cut, but the lesser and those which lie deep, admit only of simple Punction; as the Veins of the Nose, where the adjacent parts would be hurt, if the Point of the Lancet were rai­sed. Incisions are made after three several manners, Length­ways, Transverse, or Oblique, and greater or lesser, accor­ding to the largeness and depth of the Vessels.

To open the Veins more conveniently; First stop the Re­fluent Blood with a Ligature, except there be a Varicose Swelling, where the Circulation of the Blood being inter­rupted, the Vessels are tumid enough without any Artificial Help.

In Bleeding Delirious Persons, the Vessels are so exceed­ing large, and Distended by the furious agitation of the Blood, that for the most part there is no occasion for Liga­ture, the Reason of which is plain from the Laws of Cir­culation.

The Frontal Vein may be opened lengthways when it is rowling, and Transversly when it is steady. But in what­ever manner it be opened, the Lancet must be held incli­ning, for fear if it were plunged Perpendicularly in, it might hurt the Pericranium, and the subjacent Bone.

The Veins and Arteries of the Temples, may be opened in two places, viz. on the Temporal Muscles, or under the Lobe of the External Ear, at the entry of the Meatus Audi­torius. On the Temporal Muscles, these Atteries must be opened lengthways, to prevent dividing their Fibres, which may happen to be followed by a huge Swelling of the Head, Delirium and Convulsions. The Fear of such bad Conse­quences, ought to make a Surgeon who values his Reputa­tion, cautious of hurting these Muscles.

The Vein in the Greater Angle of the Eye, must be o­pened lengthways, least a Transverse Section hurt the Ten­don of the Oblique Muscle, and cause a Deformity in the Part; But it is much better to forbear medling with this, for fear of hurting the Lachrymal Gland.

To open the Vein in the Nose, plunge a Lancer directly down, and pretty deep in the extremity of the Nose, be­tween the two Cartilages. This Lancet must be kept in its Scales, by a Tape wrapt round it, and only plunged in with­out raising its Point: For the Vessel lies so low, that if the [Page 106]Elevation of the point were answerable to the depth of the Punction, the Orifice would be very large, and leave a ve­ry unseemly Scar. The Veins on each side the Fraenum of the Tongue, are opened with a Lancet wrapt round with a little Tape to its point. The Tongue is to be raised with the left Hand, and with the right a small Transverse incisi­on made, which must not be too deep, for fear of opening the Arteries, which lie very near the Veins. If these hap­pen to be cut, the Flux of Blood will prove difficult to stop, since no Dressing can be applied to the Part. When the Patient has bled enough, let him wash his Mouth with cold Oxycrate; If this be not sufficient, apply to the Wound some Restringent Powders of Terra Sigillata, Dragons Blood, Vi­triol, or keep a small Compress dipt in Mons. Lemery's Styp­tick Water on it.

To bleed all the Veins of the Head, it is necessary to make a Ligature round the Neck, because the Blood sent to the Head by the Arteries, is conveyed back to the Heart by the Jugulars, and the Ligature causes them to swell. Sharp, strong Lancets are required to open the Veins of the Neck, because the Skin is very lax here, and more difficultly open­ed, than in other parts where it is more Tense, and the Veins must be opened lengthways, because they are large and unsteady.

In making a Ligature on the Jugulars, the middle of the Fillet is to be applyed behind on the Neck, the two Ends brought before, turn'd over each other, and put into the Patients Hand, to straiten them as he finds he can bear; or if he by any Accident be disabled, an Assistant must hold them for him till the Work be finished. In Apoplexies and Quinsies, no Ligature can be made without danger of Suf­focating the Patient. In stead of this, the Artist must order one of the standers by to keep his Thumb on the bottom of the Vein of the opposite side, in the Cavity of the Clavi­cle, and press the same side in which he Designs to bleed with one of his own Thumbs, thrusting in the Lancet with his other Hand. The two Veins thus Comprest Tumefie, and may be well enough opened, without straitning the Windpipe. To stop the Blood, apply to the Wound Ma­stich spread on Rags or Leather. The Reader will find a proper Bandage for bleeding in the Neck, described in the Dressings; because a simple Emplaster often is not sufficient to stop the Blood, when it is in a violent Commotion.

In opening the Veins of the Hands and Feet, the Parts are to be plunged in Water, as hot as the Patient can well endure it. This is done as well to make the Skin tender, as to raise the Veins.

The Veins of the Hands are to be opened lengthways, for fear of hurting the Tendons which abound there by a Trans­verse Section, and the Ligature is to be made above the Part intended for Bleeding. In opening the Veins of the Ham, or Vena Poplitea, a Ligature must be made above the Knee; The Orifice must be made Transverse, and proportioned to the largeness of the Vessel.

The Surgeon ought to have an especial care, least the Pa­tient faint: This happens sometimes in the Operation, and sometimes after. To avoid this Accident at the time of Bleeding, the Surgeon must enquire, If he be commonly sub­ject to faint upon the like occasion; If he has been long fast­ing; If he do's not find himself inclin'd to go to Stool. If he usually faint in Bleeding, he must be bled lying along in his Bed, take cold Water in his Mouth, be diverted from looking on his Blood, entertained with some agreeable Relation, have Vinegar put to his Nose to smell too, or some Spiritous Li­quor, as Spirit of Wine, Orange-Flower Water, Queen of Hun­gary's Water, or Lastly, take a Spoonful of Wine, or some other Restorative.

It is by no means convenient to bleed any Person imme­diately after his Stomach is filled with Meat; for the Weak­ness which the loss of blood causes, is followed by Vomit­ing, for fear of which Mischief, it is best to stay till Digesti­on is finished.

The Surgeon must bleed Persons subject to faint, lying down: The same Posture is proper for Persons weakned, and worn out with long Illness. But this is only to be un­derstood of Bleeding in the Hand or Foot; for bleeding in the Head or Neck, necessarily requires the Patient to be a little raised. A Stout Robust Man, who is not daunted with bleeding, may be bled sitting in a Chair, or in his Bed, what­ever the part be. Bleeding in the Veins of the Hams, and Varicose Swellings, must be done, the Patient standing erect, because then the Vessels rise best.

The Surgeon may Operate in three several Postures, Standing, Sitting, or Kneeling. He must be standing to bleed in the Head, Neck and Arm, sitting to bleed in the Foot, or kneeling if he cannot find a convenient Seat. Lastly, He is often constrained to kneel on the Bed to bleed [Page 108]such Patients as are exhausted by long Sickness, and una­ble to bear the least stirring.

Sometimes when a Surgeon is called to miserably poor People, all Conveniences are wanting, even so much as a Fillet to bind the part; in this case he must make the best shift he can, and accommodate himself to the necessity of the place.

A good Light is of wonderful Service to a Surgeon in all Operations, but especially in Bleeding, and the Success of this nice Operation, depends very much on the well mana­ging that. He must never if possible, do it by the light of the Sun; because his own Hand, or the Patients Arm cau­ses a shadow. If the Operation be done by the Light of a Candle, though a great Wax Taper give a better Light than an ordinary Candle, yet it is never to be made use of; least if a drop of Wax by any Accident should fall, it might scald the Arm, and the Patient draw it back, whereas a drop of Tallow would be scarce sensible, at least create no very troublesom Pain.

If the Person be very Hairy shave the part, especially if it be the Foot or Hand. When hot Water is necessary to bath the part before bleeding, all above the place intended for the Operation must be bathed, especially if the Vessels be large, and lie deep. And to make the Patient able to bear the hot Water, the part must be first plunged in warm Water only, and hotter still gradually pour'd in, till the Patient is no longer able to endure it. If the Veins of the Arms are difficult to find, the whole Limb must be bathed in hot Water. The most convenient Vessel for which pur­pose, is a long Kettle, such as is used to boil Fish.

The Surgeon ought to have an exquisite Sense at the ex­tremities of his Fingers, and to preserve this, must not use any Laborious or Mechanical Occupation, must not touch any rough Objects, must have a great care of Burns, (all which leave the Skin Thick and Callous,) and Wine and Women, which create Tremors.

The Surgeon must be provided with Ligatures, Lancets, and proper Vessels to receive and measure the Blood. He must have diverse sorts of Fillers, some longer for Persons of better Fashion, and some lesser for ordinary and mean People. He must never use the same to sound Bodies, and those who have any Cutaneous Disease, as the Itch, Small Pox, Meazles, Carbuncles, Malignant or spotted Fevers, for fear of communicating the Infection.

If the Vessels to be opened lie deep, a long, streight Lan­ce [...] is the most proper to be used; for if it should be broad, [Page 109]the Orifice would be too large. Superficial and rowling Vessels, must be opened with larger Lancets, whose points are firm and stable. Infants require lesser Lancets than A­dult Persons.

Surgeons who daily practise bleeding, may receive blood in any sort of Vessels, and guess pretty well at the quanti­ty, at least without being much deceived, but in great Dis­eases, and Feeble, Weak, Exhausted Subjects, they ought if possible to have Vessels to measure exactly the Blood, as small Porringers of three or four Ounces. It is proper for an Artist to practise the trying, how much two or three of these Porringers hold in any Houshold Vessel, that in defect of these, he may at any time guess the quan­tity of Blood emitted.

When the Blood is not received in Porringers, as in bleed­ing in the Hand or Foot in warm Water, the quantity of blood is guessed, computed by the largeness of the Orifice, the time of its running, and the Tincture it gives to Linen, found either by dipping Rags in it, taking up a little in the Hand, and dropping it on a clean Napkin.

If the Blood be received in any other Vessels besides Porringers, to judge aright of the quantity they must not be too wide, but of a reasonable depth, because these are less apt to impose on the Senses, than more shallow and wide ones, in which the Blood appears of a more Florid Scarlet colour.

Before the Artist proceed to open a Vessel, it is necessary to make a Ligature sufficient to stop the Refluent Blood. In performing his Work, he must alike shun the two Ex­treams of Boldness and Fear: For on the one Hand, some Timorous Men apprehending they may hurt the Contiguous parts, do not make a sufficient Orifice, while on the other, some rash Surgeons without Fear or Wit, commit very dan­gerous Errors.

There are four Particulars in this Operation, the Right pla­cing the Ligature, the well Holding the Lancet, the Searching for the most proper place for the Aperture; and lastly, the Artful opening the Vessel.

The Ligature is ever to be made above the intended a­perture, except in the Head and Neck, where it is below.

When the Vein lies deep, and difficult to come at, some Surgeons make two opposite Ligatures, or make three turns of the Fillet round the Limb, or sow a small Boulster of Linen Cloth, three or four times double, on the middle of the Fillet, or place where it is applyed, to make a more exact [Page 110]compression on the Part, and these sort of Ligatures they call Pontons. But all these are mistaken Methods, proceed­ing from ignorance of the Causes. The Ligature with the Boulster, fails of the intended effect; because some Vessels being less comprest than others, the Blood ascends by some, whilst it is intercepted in others; and for this Reason, one which equally compresses all, is to be preferred. The third turn is unnecessary, since the first two are sufficient to make any Constriction desired, by binding them streighter, and inconvenient, because when the bleeding is over and this undone, there remain two more to be loos'd. The two opposite Ligatures tend more to hinder, than promote the Rising of the Vein. The upper has no other effect in stopping the current of the Blood, after the lower is made, except it be to retain a small proportion of it, in the inter­vening space between it and the lower; but on the contra­ry, it puts some stop to the Blood passing through the Chan­nels of the Arteries into the Part, and so lessens the Rising of the Veins below the Ligature. So that doubtless the best way of making a Ligature on any part in letting Blood, is by two simple turns of the Fillet, exactly over one another; which may be constringed or relaxed at pleasure, by streight­ning or loosing the Ends near the Knot, which stays them.

The Ligature must be made at some reasonable distance above the place intended for bleeding; for instance, about the breadth of two Fingers. Thus in bleeding in the Arm, it ought to be placed about two Fingers breadth above the Juncture of the Elbow, at the same distance from the Fist and Ancles, in bleeding in the Hand or Foot. At the same Distance above the Rotula of the Knee, in opening the Veins of the Hamms, and in all bleeding of the Head and Jugulars, in the lowest part of the Neck.

The Gormans and other Foreign Nations, make use of the Fleam in bleeding; But our Lancets being more conve­nient, and this now grown obsolete, I shall omit describing it. But here the Invention of the Americans must not be forgot, who to supply the defect of Iron, unknown to them before their Commerce with Europe, made Lancets of sharpned Flints and Bones.

The Surgeon in bleeding must open his Lancet in such a manner, that it may make a Right Angle with its Scales, except in opening the Veins of the Tongue or Nostrils, where the Lancet is wrapt round with a Tape in such man­ner, that both it and its Scales stand in one right Line. [Page 111]The way of holding the Lancet is very different, some hold it very long, others short, for my part I prefer the middle way. If it be held too long, it is difficult to direct aright, especially if the Skin be dry and unsteady. On the other hand in holding it too near its Point, there is not room e­nough for a sufficient Punction in Fat Bodies, or such as have their Vessels lying deep. The Lancet is best held be­tween the Thumb and Forefinger, not the Thumb and two Middle-fingers, or Thumb Fore and Middle-finger, as some direct. The three last Fingers serve for a stay to the Hand, to keep it firm and stable, and are to rest a little on the part below, and on one side the Orifice, which is a more commendable way than Bully like, to run the Lancet into the Vessel, without regard to Security. The Aperture is to be made in the place which represents it self fairest, except some Neighbouring Artery, Tendon or Mem­brane forbid.

The Operation in opening a Vessel, consists of three parts; Punction, Incision, and Raising the Point of the Lancet. All these are to be so promptly done, that to the Spectator they may appear but one Action. The Surgeon ought to be provided with all Necessaries, and to have at least two As­sistants by him if possible, one to hold the Candle, (when necessary) and Porringer, and the other to do him any Ser­vice occasion shall require.

In Bleeding in the Arm, after the Patient is put in a good Posture, and the Bed covered with Linen to receive the Blood which springs out at first something impetuously, and (without this Care to prevent it) would be apt to stain the Bed-cloths. The next thing is to tuck up and fasten the Patients Sleeve, and cover it with a Napkin, for fear any Blood may happen to be spilt upon it. These little Pre­cautions, though not very Material to the thing it self, yet are apt to beget a Favourable Opinion of the Artist in the Mind of the Patient, who from observing these minute Cir­cumstances of his proceeding, is apt to conclude him care­ful and dextrous.

When this previous Business is done, the Surgeon must feel the inside of the Arm in all places where the Veins ap­pear, to discover where the Artery lies. This is discerned by the Pulse or Beating, which is not sensible after the Ligature is made; and therefore it is to be found before. The Ligature as I noted before, is to be placed two Fingers breadth or something more, above the Flexure of the Elbow, to pass [Page 112]twice round the Arm, and be tyed with a Bow knot on its out side. The first round must not be altogether so strait as the second, and the Skin not forcibly extended, by drawing it up or down, least upon relaxing a little, the Li­gature to give way to the Blood issuing out, the Orifice close and obstruct the Passage.

After the Ligature is made, some little time must be al­lowed for the Veins to swell, during which the Surgeon may open his Lancer, put it in his Mouth, take again the Patients Arm in his Hand, and (making several Frictions, drive up the Blood towards the place intended for the In­cision;) feel the Vessels with his Fingers, and chuse out some place for the Aperture, which answers best. This Answering is a gentle Resistance, which yields to a mode­rate Compression, and Resists the Finger, if the Compressi­on be very slight. But observe here, this answering of the Vein may be very deceitful, especially in the middle of the Flexure of the Arm, when numerous Scars have made a sort of small Sinus, which may impose on the sense, and ap­pear like a Vein on the Surface, when the Real Vein lies much deeper.

After a long while feeling too and fro, if no Vein ap­pear which can be opened with any tolerable Security, Frictions with hot Cloths are to be used, and continued for a considerable time. Or the Ligature taken off, and the Arm plunged in hot Water bound up again, and Frictions us'd as before. If after all these ways tryed, no Vessel ap­pear capable of being opened, it is more advisable to desist, than bleed at all Adventures, as some Rashly do on the Scars of old Orifices. This Practice is occasioned by the hopes of finding the same Vessels, which is a mistake, since the Veins change their Situation under the Skin, according to the Age or good Case of the Body; nay, some Vessels are so lessened by frequent Bleeding, they at length be­come scarce sensible.

If after a Careful Tryal, the Surgeon comes to discover a Vessel which lies deep, he must assure himself well of the Place by several feelings, and rub the part with a lit­tle Oyl to supple it, and facilitate the entring of the Lancer, especially if the Skin be dry, rough and scurfy: Lastly, to secure the place of the Vein, he must make an impressi­on with his Nail, which may serve to guide him.

After the Artist has observed these Circumstances, gras­ping the Patient Arm in one Hand, he must take the Lan­cet [Page 113]in the other, and holding its Blade firmly in the middle, between his Forefinger and Thumb (staying his three re­maining Fingers on the Patients Arm) thrust it in precisely in the lowest part of the Impression made with his Nail, and curcing a little Transversely, raise up its Point to cut through the Vessel and Teguments, and widen the Orifice. If he suspect the Lancer to be plunged in too deep, he may draw it a little back, before he brings up its point. Cutting Transversly is the surest way not to miss the Vessel, and large Orifices are to be preserred to small ones, for the free emission of the Blood. The largeness of the Orifice is more necessary in Vessels which lie deep, be­cause the Flesh and Fat is apt to choak the passage, and hinder the Evacuation. Add to this in the last place, that small Orifices are apt to leave Thrombu's behind them.

In Bleeding in the Arm, the Surgeon must feel all over it with his Forefinger for the Artery, which commonly lies under the Basilick Vein. I observed before, that this Search is necessary before the Ligature be made, because after it the Veins are Tumefied, and the Pulsation is not sensible. The next Search is after the Tendons, which are discovered in bending the Arm by their Rigidity. When the place of the Artery and Tendon is certainly known, the Ligature is made two Fingers breadth above the Bending of the Elbow, and place of the intended Orifice. The middle of the Fil­let is to be applyed on the Arm, and passing twice round it, to be tyed behind: The knot is best placed above the Joynt, least if it be below it incommode that Hand which holds the Patients Arm; The Ligature must not be so strait, as to compress the Arteries which import Blood into the part; it is enough if it be sufficient to stop the Re­flux of the Blood in the Veins.

In Bleeding in the Right Hand, the Surgeon must take the Patients Arm in his Left Hand, and prick him with his Right; and on the contrary, in the Left he must take it in the Right, and bleed him with his Left. Before the Opera­tion, it is necessary to consider well which Vessel is fairest, that is largest, and which has least danger in it; for in case the Artery adhere to it, it is better to prick the lesser, than run any hazard in the greater. The Cephalick is the most secure of all the Veins of the Arm, having no Artery or Tendon accompanying it, and yet Surgeons are not very willing to bleed in it; because the Skin on the upper side [Page 114]of the Arm is pretty thick, and the Blood do's only flow down the Arm without springing, which do's not so well please the Patient, who when the Blood springs out, thinks the Operation better performed, and is fond to have it thought he has a great deal of Vigour. If the Vessel lies deep, and is not Visible, which often happens in the thick Arms of some Women, in order to find it, he must grasp the Arm in one Hand, compressing the place where the Vessels ought to appear with his Thumb, and with the other Hand make several Frictions upwards, pressing the Vessels all along to see if he can discover any Blood strike against his Thumb. When he finds any Vessel under his Thumb, he must take it instantly off, marking the place with his Nail, and then prick a little below the impression.

The Punction is made with the Lancet, either with or without raising the Point. In the first way the Surgeon takes the Lancet between the Thumb and Fore-finger, meeting even (not too long, because it would not be steady, nor too short, because it would be Troublesom;) and then resting his three other Fingers on the Patient's Arm, plunges his Lancet into the Vessel, a little on one side, and when he is in raises its Point, and so cuts through it. This is the best Method of Operating, when there are no Rea­sons against it, but it is the most Painful.

In bleeding without raising the Point, the Lancet is held in the same manner as before, plunged directly into the Ves­sel a little beneath, and so brought forward without turning up its Point; This way is less painful that the former, but in some Cases is not without Danger. If the Tendon or Artery lie directly under the Vein, this last Method is ne­ver to be used, because it requires deeper Punction, and there is great Danger of hurting one of them; On the con­trary, if either lie on the side, there is ground to fear they may be cut by raising the point. But observe which so­ever of these ways be practised, the Lancet must be held something inclining, and not too Perpendicularly over the Vein, least entring in this Manner, it prick the Membrane of the Muscles, from whence great Pain and Inflammation would ensue.

In Veins running over great Muscles, the Puncture is made obliquely upwards; for in pricking directly down, it is scarce possible to avoid hurting the Membranes, which invest the Subjacent Muscle, which will be attended with Pain and Inflammation.

If one Vessel only appear fair, and that be accompanyed with a Tendon or Artery, the best way is to trace it through its whole Progress, till it leaves them, and where it appears alone, there make the Puncture. This is the way of Bleeding in the Arm. The Dressing I shall describe below, in its proper place.

For Bleeding in the Leg, the Part is to be kept in warm Water to the mid Leg. This is done to bring the Blood more copiously into it, and soften the Skin which is very thick in that place. When the Part is well heated. the Ar­tist searches for the Vessel above or below the Ancle, makes a Ligature about two or three Fingers breadth above it, ties it streight enough to compress the Vein without pres­sing the Artery, puts the Foot again into hot Water to give the Vein time to Swell. Then (the Patient sitting on the side of his Bed, and he in a Chair before him) he lays the Foot on his Knee, grasping it in one Hand▪ and Bleeding with the other. In Bleeding in the Right Fo [...], the Lancet is to be held in the Left Hand, and on the con­trary in the Right in Bleeding in the Left, according to the Rules before prescribed.

The most convenient place for pricking is below the An­cle. There is no Attery, Nerve, or Tendon to fear ther [...] The Part is carnous, and there is room enough to [...] the Lancet without pricking the Periosteum; But abov [...] [...] Ancle there is little Flesh, and there is great dange [...] pricking that Membrane, or some Nerve dispensed to the Part; the ill Consequence of which, would be violent In­flammation and Pain. On the side of the Ancle there are diverse Tendons, which ought to make the Surgeon cauti­ous: When the Vessels on the Internal Ancle are not fair, they appear for the most part fair on the Foot▪ but I would not advise bleeding here, upon account of the numerous Tendons which are in great Danger of being pricked, but if it be necessary, he must enter very obliquely.

For Bleeding in the Jugulars, a Constriction must be made with a Handkerchief, sufficient to make the Vessels rise, and the Orifice be made lengthways of the Vessel, in its middle.

In all Bleeding this may be accounted a General Rule. If the Vessel be very large the Aperture is to be made in its mid­dle lengthways; If of a middle size, as in the Arm, a little on one side, and something obliquely from above down­wards; If very small, as in Infants, then it is to be cut Transversly.

It is a general Rule likewise, That in what ever Veins of the Head the Evacuation be made, the Ligature must ever be about the Neck. In Distempers of the Head, the great Vein in the midst of the Fore-head, and the Veins under the Tongue are often opened, but doubtless the Jugulars are best in most of these Cases, to make the most prompt and copious Evacuation.

In Bleeding under the Tongue after the Ligature made, it is raised, held against the Palate, and then the Vein open­ed, and the Blood stopped with a good Restringent Garga­rism, if it do not cease of it self.

Arteries are opened in the same manner as Veins, but these are never to be pricked, unless where they immediately pass over some Bone, which no other Arteries in the Body do, ex­cept those of the Head; the Principal of which for this Operation, is the Temporal. Dr. Willis pretends, Arteries are opened more Successfully than Veins, in Obstructions and Inflammations, as for instance of the Eyes, because they contract and retire within the Flesh, are Cicatrized there, and cease from their Office of conveying blood to the Part.

After Incision made, when the Impetuosity of the Blood begins to abate, the Ligature must be a little relaxed; that as much Blood may pass into the Part by the Arteries, as will suffice for the intended Evacuation. Farther for promoting the Discharge, some little round thing as a Lan­cet-case, or the like, is to be put into the Patients Hand, to turn about with the extremity of his Fingers only; This Action causes a Contraction of the Muscles of the Arm, viz. the Sublimis and Profundus, which are Flexors of the Fin­gers, and by this means they express the Blood in the Ves­sels running on their inside, and accelerate its Motion to­wards the Orifice. In Bleeding in the Throat, the same thing is effected by gently moving the lower Jaw, and in the Foot, by stirring the Great Toe. All the time the Blood is running, the Surgeon must hold the Patients Arm with one Hand, in which there is a double Convenience; First, the easing and supporting the Part, which is heavy by the great quantity of Blood and Spirits stopt in it: And Secondly, the advantage of bending and extending it as occasion shall re­quire. With his other Hand he may distend the Skin, drawing it upwards, downwards, or on one side, to make the outward Orifice answer to that Vein.

When the intended quantity of Blood is drawn out, the Arm must be unbound, and the Surgeon with his Finger [Page 117]must press around the Orifice, least any Blood happen to Stagnate under the Skin. The Wound must be exactly stop­ped by closing it on both sides with the Forefinger and Middle finger; but if the Fat come out, this must first be put back by a Compress in one Hand, with the other Hand pinch­ing together the Lips of the Wound, between the Thumb and Forefinger.

While the Surgeon is busied in stopping the Orifice, the Servant who held the Porringer which received the Blood, must set it down on the Table gently, and strike it over with a Feather, or some other light thing to take off the Froth. This Trifling Circumstance has its use, to discover the true Colour of the Blood, and amuse the People who most commonly are admirers of such Mysterious Mat­ters.

THE DRESSING. This consists only in applying a little, thick, square Compress on the Orifice, and keeping it on by binding up the Arm. Before this be laid on, the Sur­geon must clear the Wound from Coagulated Blood, which if neglected, will hinder Coalition: Then keeping the Lips of the Orifice together with his Fingers, he must speedily apply the Compress, Staying it on with his fore and middle Finger. If any little Flatulent Tumour appear on the Ori­fice, which is not uncommon when it is too small, the Com­press dipt in cold Water disperses it. For binding up the Arm, he must take a Fillet of about an Ell long, and an Inch and a half broad, and gathering into his Hand three or four Inches of one end of it, and (laying the Thumb, fore and middle Finger of his left Hand, in bleeding in the Right Arm, or the Thumb and the same Fingers of his Right in bleeding in the left Arm, on it) apply that part which he holds between his Fingers, on the Orifice, and so make several Crosses over the bending of the Elbow; and Lastly, when the Fillet is spent, bringing back that end which he held in his Hand, he must tie both ends behind the Arm. Some place the Knot behind the Arm, above the bending of the Elbow, and others below. If the Fillet be of a firm and strong Cloth, and there be no reason to fear the Patient will make use of his Arm, the Knot is best placed above, on the contrary, if the Cloth be weak and much worn below, for fear when the Patient shall come to open his Arm, the Fillet break. In the last place, observe the Fillet must never be rolled.

For Bleeding in the Foot.

The Artist must bring together the sides of the Orifice, cleanse the Wound of Blood, lay a small, thick, square Compress on it, and keep this on with a Fillet of an Ell and half long, and an Inch and half broad, rolled at one end. To apply, he must lay a good length of the Fillet on his Knee, and place the Patients Heel on it, then with the other end he must make a Circular Turn on the Compress, and an X on the Foot; After divers Circumvolutions, he must bring the Fillet obliquely over that end which is un­der the Heel, and then bringing this back, form a sort of Stir­rup from the resemblance to which, this Bandage takes its Name.

For Bleeding in the Fore-Head.

The small Compress applyed on the Orifice, is kept on by the Handkerchief folded cross, or Diagonalwise, in the form of a Triangle: The Artist takes the Handkerchief thus folded in both Hands, with his Thumbs above, and Fingers below, and in this manner applies its Middle di­rectly over the Wound, then slides his Hands on the Handkerchief thus placed behind the Head, and brings both ends as far forward as they reach, and pins them at the end; In placing the Handkerchief, care must be taken to avoid Wrinkles as much as possible.

There is another Bandage used in Bleeding in the Fore­head, called the Discrimen. In this the Compress is kept on by a Roller or Fillet of an Inch and an half broad, and three Ells in length, rolled at one end. The Method of making which is thus. The Artist applies one end of the Roller to the Top of the Nose, and measures a length from thence to the Nape of the Neck. This he lets hang down over the Face, then he passes the Fillet along the Sagittal Su­ture, brings it to the Nape of the Neck, and back over the Parietal Bone on one side, over the Parietal Bone on the other; then lifts up the end of the Fillet over the Face, lays it over the Sagittal Suture, leaving it to hang behind, then returning to the other end, brings it over this depending part, engages it under it, so continuing his Circular Turns round the Parietal Bones till the Fillet is spent, and then pins it at its ends.

There is a third Bandage for bleeding in the Forehead, called the Scapha, from its resembling a little Boat, and is thus made; The Artist takes a Fillet or Roller of an Inch and half broad, and three Ells in length, rolled up at one end. After a small Compress laid on, he applies the Fillet obliquely on it, lets fall about a Foot in length, and with the other end passes over the Parietal Bone, behind on the Nape of the Neck, over the other Parietal Bone, and so o­ver the Wound; then he takes up the end hanging before, lays it over the Head, leaving it depending behind, then returns to the end of the Fillet which he left, continues his Circular rounds (over the Parietal Bone, the Wound, the Parietal Bone on the other side, behind the Nape of the Neck) and pins it at the End.

There remains still a fourth Bandage for the Forehead, which is called the Royal Bandage. To make this, the Ar­tist takes a Roller of an Inch and half broad, and three Ells in length, rolled at one end, as in the two former, there he Measures twice the length or distance from the top of the Nose, to the Nape of the Neck, this he leaves hang­ing down before on the Face from the Compress, and with the other or Rolled end, he proceeds over the Sagittal Suture, descends behind the Head, returns before, passes under the Chin, then reascending on the Cheek, passes near the lesser Angle of the Eye, then over the Head, descends behind, returns before, passes under the Chin, reascends on the opposite side on the Cheek, passes as in the former very near the lesser Angle of the Eye, and so continu [...]ng upwards pas­ses over the first turn on the top of the Head, and makes a cross with it Salterwise. Then he delivers the Roller to an Assistant to hold, whilst himself makes three Pleats, each gradually longer than other, in that end of the Roller which hung over the Patients Face, and lays the remaining part o­ver the Sagittal Suture, leaving it to hang behind his Head. When this is done, he returns to the Rolled end of the Fil­let, and makes several Circular Turns round the Head pas­sing over the Fore-Head and Parietal Bones) and in the last place pins the end of the Roller.

A Bandage for the end of the Nose.

The Ancients bled at the extremity of the Nose, between the bifurcation of the Cartilage, being extremely careful not to cut it. This Bleeding is very ridiculous, since there [Page 120]are so many places more commodious for this purpose; but those who practise it, use the Bandage called the Discrimen, with this difference, that here they begin to apply the Bandage on the Nose, whereas in the former case they began on the Forehead.

A Bandage for the Temporal Artery.

In bleeding in the Temporal Artery, a Compress dipt in some Styptick Water is applyed on the Orifice, and the Ban­dage called the Discrimen made, which is the same used in opening the Frontal Vein; but with this difference, it is first applyed in this last Case on the Temples, as in the for­mer on the Forehead.

A General Bandage.

The following Bandage is adapted to bleeding in the Forehead, Neck, or Temporal Artery. The Artist takes a Fillet of three inches in breadth, and an Ell long, this he doubles in the midst, and slits it lengthways with a pair of Scissars, leaving about three Inches square in the midst plain and undivided. When it is thus divided, it is called the Fillet or Roller, with four Tails. He applies the plain undivided part on the Orifice, brings the two upper Tails downwards, and the two lower Tails upwards, conti­nuing them each respectively, circularly over the o­ther, and pinning them at their Ends The Reader may observe here as a general Rule, in applying these divided Rollers; That the two lower Tails must ever ascend, pass over the upper, and be fastned above, and the two upper must descend cross with the lower, and be fastned be­low.

These slit Rollers are exceedingly useful, and adapted to keep Applications on all parts of the Head, except in the Operation of the Trepan, where the Great Cap is in use, which shall be described in its proper place.

A Bandage for the Jugulars.

The Artist takes a Fillet of half an Ell long, applies the middle of it on the top of the Head, and leaves the two ends hanging on each side of the Neck; then he takes ano­ther Fillet of a competent length, and near three Inches [Page 121]broad rolled at one end, with this he makes several circu­lar Turns over the Compress, as far as the Fillet reaches, and then pinns it where it ends; Next he takes up the two ends hanging on the sides of the Neck, and fastens them on the Head, these are very serviceable to suspend the Fil­let rolled about the Neck. This is called the Contentive Bandage of the Neck. There are some Cases which will not admit of any Bandage on the Jugulars, and here it is necessary to lay some Glutinating Emplaster on the Ori­fice.

THE CURE. After the Bleeding is over, the Patient may lie down and drink off a glass of Water, which mixing with the Blood dilutes and cools it. The Patient is suffer'd to rest for the space of an Hour, and after takes some Re­storative Draught. It is customary to forbid the Patient sleeping, till he has taken this; but I profess I am a stran­ger to the Reason of this Practice, for in sleeping immedi­ately after Bleeding, Transpiration is free; and there arises a certain Dew on the Surface of the Body, which is very refreshing. Besides this is the most gentle, easie, and agree­able Slumber that can be imagined, Nature requires it, and seems to have Violence done her, when this Satisfaction is denyed her. However since Custom prevails to the contrary, and perhaps some Accidents may have attended sleeping at this time, I would not advise any Person to recede from the common and received Practice.

If the Physician has directed the Patient to be twice bled on the same day, the Surgeon may put some Oyl or Grease on the Orifice, to prevent its closing, and by this means save the trouble of making a second Puncture. The lesser Dressing is not commonly taken off under twenty four hours, or a longer time, if the Orifice be not disposed to heal. For when the Limb is too soon unbound, the Wound is but half clos'd, the Air insinuates into it, creates a little running Ul­cer, which is difficultly healed, and molests the Patient ex­ceedingly. The Dressing is left on much longer after open­ing an Artery, than a Vein; because the Blood being pro­jected with great Impetus, would forcibly open the Orifice, before the Coalition be perfected. When the Compress is to be taken off, if it adhere to the Orifice, it is better to leave it on, or Humect it with a little warm Wine, and so gently separate it, than remove it by Vio­lence.

If the Patient fall into a Swoon during the Operation, the Surgeon must cause him to be carryed to his Bed, if he be not already in it, fling a little cold Water in his Face, or give him some to drink, must open the Chamber Win­dows, and draw the Curtains, if the Disease and Season of the Year permit. He must apply to his Nose some Odoriferous things, as good Vinegar, Queen of Hungary's Water, Spirit of Wine, must call him frequently by his Name in his Ear, with as loud a Noise as possible, and unloose whatever is tyed about any part of his Body. When the Patient is come to himself, the Artist must place the Limb in a con­venient Posture, which is as various as the parts concerned. For instance, after Bleeding in the Head, the Patient must remain quiet, and have his Head supported with some soft Pillow, and lie a little inclining rather than erect: After bleeding in the Arm, the Patient must avoid all stirring, re­posing on his Bed, or some convenient Couch, with his Arm suspended in a middle Posture, between Bent and Ex­tended: After Bleeding in the lower Parts, he must keep his Bed for the space of twenty four Hours, to prevent any Fluxion or Suppuration on the place.

Most Persons after Bleeding, are in some Disorder, in which I would recommend boldly drinking a large Draught of Water, as a proper means to recall the Blood and Spi­rits determined, by opening the Vein towards the extream parts, besides Water mixing with the Blood, allays its Heat. The grand Objection against sleeping after Bleeding, is that Nature is always offended by two praecipitate a Change from one Extreme to another; That it must unavoidably be injurious, to put the Blood into two such contrary Motions at once, as in Bleeding and Sleeping; in the First of which it is brought from the Center to the Circumference, and in the latter, from the Circumference to the Center of the Bo­dy. The Second Objection is, That this concentration of the Blood in the time of Sleeping, frustrates the effect of the Evacuation, which is the Principal Intention of Bleeding. Others without assigning so many ridiculous Reasons, only pretend if the Patient be permitted to sleep, there is dan­ger by some Motion of it, the Bandage of the Arm may be loosned, and others are so positive, as to affirm they have found Persons sleeping after Bleeding, actually dead. For my part, none of these Reasons prevail with me, or hinder my believing, sleep after bleeding very wholsom, no­thing cooling the Body more effectually, (which is one of [Page 123]the principal ends of Bleeding) or calming the Blood more, after the disorder it is put into by the Evacuation. Bleeding is a proper Remedy in want of sleep; and after bleeding, most Men find a greater desire of sleeping, than at any o­ther time, without any inconvenience attending it. As for the danger of losing Blood in such Persons as have unquiet and disturbed Sleeps, they may be well enough secured by a close, well-made, double, Bandage, or by placing some Servant by the Patient, to observe all his Moti­ons.

It is commendable, to refrain from eating immediately af­ter Bleeding, or till such time as the Blood and Spirits have resumed their ordinary Course, which is a little irregular at that time; because all the Fermentations conducing to Di­gestion, operate better in their Natural State; than when they are put in any commotion. The ordinary time of ear­ing after bleeding, is the space of an Hour, except the Pa­tient be very weak, in which case he may take some Resto­ratives immediately, as a little Wine, or some other Spiri­tuous Liquors. The Nourishment after Bleeding ought to be light, and easie of Digestion, as some good Strengthning Broath.

The Porringers must be set in some place where there is no Smoak, Wind, or Dust, or where the Rays of the Sun do not beat, because all these Accidents change the Surface of the Blood, and hinder the right judging of it. Vessels of Silver, Pewter or Glass, are more proper to keep the Blood in, than Brass or Copper. The Vessels must be washed, and wiped clean, because a little Moisture remaining, im­parts to the Blood a more florid Vermilion Colour.

Observations on the Blood in Porringers.

Since most Patients are Sollicitous about the State of their Health, they are generally inquisitive concerning their Blood, and frequently asking the Surgeons Opinion of its Colour, Consistence and Tast.

The Blood is a Heterogeneous Liquor, compos'd of a Multitude of Particles, supplying proper Materials for the Reparation of the Body, which is in a constant Con­sumption. The differing Particles, have each a different Configuration, and Disposition of Surface, which make a various Reflection of the Light. Now that visible ap­pearance called Colour, being nothing else but the Impres­sion [Page 124]which the Rays of Light returned after a various manner make on the bottom of the Eye, it is consequently true, the least alteration in the Disposition of the parts of a Body, must produce an Alteration in its Colour. This be­ing admitted, no reasonable Man will deny the Colour of the Blood in a State of Health, to be the undoubted Stan­dard, and all others to be judg'd better or worse, as they approach to, or recede from it; and those Colours allowed to shew the most Vitious Disposition of the Blood, which are most distant from the Natural.

Blood then is pronounced good, and of a Natural Co­lour, when it is Florid and Vermilion, which Colour it ac­quires in passing through the Lungs, as Dr. Lower by seve­ral Experiments has Demonstrated. Whoever observes, that the Blood drawn out of the Vena Cava, before it enters the Right Ventricle of the Heart, and that drawn out of the Pulmonary Artery, is of a dark, brown, Red; and on the contrary, that drawn out of the Pulmonary Vein is of a Bright Red, and that drawn out of the Artery of no better a Co­lour, after having past through the left Ventricle, must neces­sarily conclude this effect proceeds from the Nitre, diffus'd through the Mass of Air, which is incessantly drawn into the Lungs in Respiration, and so communicates its bright and lively Tincture. This Operation is still farther con­firmed by the following Experiment. If Blood stands for some time in a Porringer, the Surface will be of a Florid Colour, but the bottom of a Dark red; but if the Coagulum be inverted, and the lower side for some time exposed to the Air, it becomes of as bright a Red, as its Surface before was. Which effect, undoubtedly proceeds from the Saline parts of the Air, which insinuate themselves, change the Disposition of the Parts of the Blood, and so cause them to reflect the Rays of Light, after a different manner.

There is ground to pronounce the Blood bad, if it ap­pear Blue, Whitish, Yellowish, or of very different Colours at once. The Ancient Physicians pretended from the Colour of the Blood, to determine which of the four Humours, Choler, Phlegm, Melancholy, or Blood taken in a strict Sence (which they thought to be the Ingredients of the Mass) were predo­minant. Chymical Physicians derive the various colours of the Mass of Blood, from the several Exaltations of the Active or Passive Principles, which they believe to exist in the Blood. They ascribe the Sound and Healthy State of the Blood, and its laudable Colour, to the equal Mixture of its [Page 125]Spirits, Salt, Sulphur, Water and Earth, and its Deprava­tion to the effort in these Principles, to disingage and sepa­rate themselves from each other.

It is a Problem among the Learned, why the Blood in Malignant Fevers, should appear of so fine a Colour. This noble Colour is reputed an ill Sign; Because (say some Authors) the corrupted Blood is destitute of Spirits, moves with difficulty through the Arteries next the Heart, and scarcely arrives at the Extreme Parts of the Body.

If it be askt whether a Florid Vermillion Blood be al­ways good, the Answer ought to be, this depends very much on the Colour. Orifice of the Vein, the Manner of its is­suing out, and the Vessel which receives it. An Orifice too great or too small, are both faults in Bleeding, and make the Blood appear different from what it would be, if the Orifice were proportioned to the Vessel. If it be too little, the Blood spins out in a thin Thread, and is a long time in discharging it self, and its Particles are much more changed by the Air, than when it comes forth in a larger Stream, and less Time: On the contrary, if the Aperture of the Vessel be large, instead of springing out, it runs down the Arm, and the Surface is larger, which likewise gives room for the Air to act on it, and create a lively red Co­lour. Again, if the Aperture of the Vessel be too great or too small, and by this means the Blood must cake and coa­gulate too soon, and the different parts have no time to se­parate, and rise to the Surface which appears Red, from the impression of the Nitre of the Air, which gives it a dis­position proper to excite such a lively Sensation in our Eye.

The Vessel which receives it, contributes very much to the Colour, for if it be wide and shallow, it appears of a brighter Red, than if the Vessel be deep and narrow; in the first it soon coagulates and cools, and leaves a greater Sur­face exposed to be impregnated with the Aerial Nitre, the contrary happens, when it is received in narrow and deep Vessels, in which it preserves its Motion and Heat for a lon­ger time, which gives its Parts liberty to separate, and rise towards the Surface, where they shew their proper Colour. If the Blood be much stirred, the Air acts on more of its Parts, and it cools soon, which makes it appear more red. Lastly, if the Porringer or Vessel which receives the Blood, have any Water left in it, with which it was washed, it cools soon, and its Motion ceasing, there is not time for the [Page 126]diversity of its parts to separate, and rise to the Top, for which reason its Colour is finer. From these considerations it appears evidently enough, the Florid Red is not a certain sign of good Blood, since this Beautiful Colour may be the effect of the different manner of letting out, or receiv­ing this Noble Liquor. On the other Hand, the same Co­lour is not a sufficient Reason to condemn the Operation, as ill performed; since the Blood ought to appear good in a State of Health, or Slight Indisposition, where there is no Distemper sufficient to communicate an ill Colour to the Mass. In Persons reduced to extreme Weakness, or after long Abstinence, or when the fear of Bleeding, and the Terrour upon sight of the Blood creates a depression of the Spirits, in these Cases the Blood is of a Beautiful Colour, because the Spirits wanting force to project it to a distance, the Air has more power over it to impregnate it with its Salts; And for the same Reason, it ever has a Beautiful Colour in Malignant Fevers. On the other Hand, the bad Colour of the Blood is not always an Argu­ment, the Operation is well performed; because in some Bodies the Blood is so corrupt, that it will appear bad, not­withstanding it be ill let out, or ill received; In fine, a Right Judgment can only be performed from the duely com­paring all Circumstances before-mentioned.

Great Regard is to be had to the Consistence of the Blood when it is cold, and has stood for some time in the Vessel, and Observations of this kind will inform us, of its good or ill Condition. If the Blood preserves its Liquidity after it is perfectly cold, it do's plainly discover its corruption, and the entire separation of its Principles; on the contrary, if the Blood Coagulates soon, it is a Mark of its Thickness, and a Deficiency of Spirits: for which reason it is deprived of its necessary Motion in the Vessels. The due consistence of cold Blood, is such as may preserve a Moderate Union of its parts.

The Blood has rarely any Scent, unless it be entirely cor­rupted, its parts separated, or it Stagnates in the Veins, and wants Agitation, as in Leprous Persons, or is vitiated by the Remains of an Old Pox, in which cases it sometimes has an ill smell. Where the Blood is thus Tainted, the Patient can­not expect long Life. But in this place I think it pertinent, to give the Surgeon this necessary notice, That however the Blood may be free from any ill smell, it is very dange­rous to draw in its Steams in Respiration, and constant Ex­perience [Page 127]shews us, that Surgeons in Hospitals who bleed of­ten, are more frequently attacked with Malignant Fevers, than those who dress Ulcers which exhale the most foetid smell. From which Observation it evidently follows, that in Breathing through the Mouth or Nose the Poyson is received, which after circulates with the Blood, and infects the whole Mass. To tast the Blood is both dangerous and disgustful, and therefore very little information can be gained from this Head of its good or ill qualities; However the sweet Tast is reputed best, and any other as Salt, Bitter, or Acid, con­demn'd as a Mark of its Depravation.

To conclude this Subject, those who pretend to know the Patients Distemper by his Blood, are Impostors; there is in­deed sufficient ground to pronounce a Man to be indisposed when the Blood has a bad appearance, but to assign the Dis­ease and its Nature, is an impossible Matter.

Of Accidents happening after Bleeding.

Bleeding is the most Trivial, the least Gainful, and yet most dangerous Operation, which an Artist is ever employed in. If well performed, no Reputation is gained by it, if any Accident happen after it, it is sufficient to ruin his Ho­nour by the Slanders of the ignorant Multitude, who never regard what they talk, and the Envy of his Fellow-Surge­ons who are ever busie in defaming one another. A young Surgeon therefore in point of Prudence ought to be well instructed in the Accidents which happen after Bleeding, and as well versed in the Method of curing them, to pre­vent having recourse to his Treacherous Friends.

The Principal Accidents in Bleeding are these which fol­low. In the first place it sometimes happens the Vein is not prickt at all, or at least very ill opened, and the Blood comes out with difficulty. The missing of a Vein proceeds either from its unsteadiness when it is not fixed enough under the Skin, to abide the Lancet, or from some extraordinary Concern and Apprehension in the Artist, who when it lies deep is a­fraid of having some Membrane, Nerve, Tendon, Artery, or other dangerous part, or lastly, some Deception of the sense, when he believes he feels a Vein in a place where there is none. A Vein is said to be ill opened, when the Incisi­on is either too High, or too Low, or when the Surgeon do's not keep a rolling Vein steddy, for in this case the Vein slipping under the Skin, the outward Orifice does not answer to the inward, and the Blood is stopt. A Vein is likewise re­puted [Page 128]to be ill opened, if the Orifice be too small; but whether this be a fault or not, is not yet decided, and it remains a controversie amongst the Learned, whether a small or a large Orifice be best. I shall not pretend to de­termine this point, only here it concerns the young Artist to observe, that if the Orifice be too large the Blood will not spring out and make an Arch, and the Patient by con­sequence will never be well contented.

If the Surgeon fail in his first attempt to open the Vein, because it flies from his Lancet; He must subject it again directly on the Incision first made, and endeavour to prick it in the same Orifice, or if he like not that, in some other place above or below, or in any other Vein which presents it self fairer; but whatever he do's, he must be sure to have a presence of Mind, without discovering the least Fear or Surprize, and not like some timorous Men appear out of Countenance upon missing Bleeding, which alarms the Patient and Standers by, and makes them think this, which is a very slight or no fault at all, a very great one. If the Surgeon misses the Vein, and do's not make his Incision deep enough, he may plunge his Lancet deeper in the same Vein, or make attempt to open it in another place, with better Success. I think it better to do this in a new place, than to prick again in the same, and this is less apt to disgust the Patient, who feels a Pain still remaining in the first Puncture. If the Surgeon be deceived in feeling, he ought to examine the Patients Arm with greater exactness, to discover the place where the Vein lies, and if after feeling and searching for a considerable time, he cannot find any greater certainty than at first, it is better to defer Bleeding till the Evening or the next Morning; because the position of the Veins may shift in that time, and all who have any Experience in this mat­ter, know very well they are sometimes obliged to quit their work, and yet sometime after Bleed in the same place, with the greatest ease imaginable. If a Vein be ill opened, and the Blood comes so badly from it that the Patient cannot hope to be relieved by it, the Surgeon must Bleed in the o­ther Arm, or defer the Operation, if the Nature of the Di­stemper require it to be done in the same, especially if the Vein lies deep, because these once beginning to evacuate, ne­ver rise after, not to mention the Blood running down which blinds the Operatour. If the Incision be too small, the O­peration ought to be deferred till next day, or at least the Patient ought to bleed on the other side. If the Orifice be [Page 129]too large, and the Patients indisposition be slight, the Sur­geon may permit the Blood to run down the Arm, but if the Disease be violent, and the Physician pretend to judge of that by inspecting the Blood, he must streighten it a little, the better to give the Blood its Natural Co­lour.

Sometimes there happens to be a small Collection of Blood under the Skin, which forms a Thrombus, and after a little Inflammation and Pain, ends in a slight Suppuration. The same consequence sometimes happens upon a Lancet not being sharp enough, for this makes a sort of Contusion, and the edges of the Wound do not easily unite to each o­ther. The extention of the Arm or other Motion of the Patient after Bleeding, sometimes impedes the Coalition, and some little quantity of Blood getting between the Lips of the Orifice, forms a small Ulcer which proves troublesom to the Patient for some time. The Method of preventing these inconveniences, is first applying mild Digestive Me­dicines, and after them Desiccatives; for instance, using a warm Liniment with Oyl of Roses and Vinegar, laying a lit­tle Basilicon on the Orifice, and over that Galen's Cerate, or Rags several times doubled dipt in Oxycrate a little heated, and after the Inflammation is over, and the Suppuration compleated, a small Emplaster of burnt Ceruse, Diapalma, and de Minio to dry the Ulcer, and confirm the Cicatrix. Sometimes there is an Appearance of a Contusion on the Arm, in Persons who are nice and difficult to Bleed, which pro­ceeds-from more than ordinary handling the part in feeling for the Vessel, or a small Suffusion of Blood under the Skin, but this accident is not attended with Pain, and easily removed by chafing the Part well with Spirit of Wine.

In Bleeding, the Membrane investing the Muscles some­times happens to be hurt with the point of the Lancet, which Accident is ever attended with Mischievous consequences, such as a Fever, a very great Inflammation, which in a very little time extends over all the inner side of the Arm, a hard Swelling which arises on the place of the Puncture, and terminates in a great Abscess, (and sometimes more than one) between the upper part of the Arm, and the Extremity of the Hand. This Accident is ever worst, when it happens in Hospitals of Great Cities, or Camps, where the Air is cor­rupted, or in foul Bodies, or such as are over-heated by Fatigue, or Disorderly living. Sometimes these Symptoms are not so violent, and the Patient only feels a considerable [Page 130]Pain from the place quite down to the Thumb, on the same side, which incommodes him most in turning the Wrist round. This Symptom proceeds from a Hurt of the Ten­dinous Fascia, assisting in this Motion, and this remains for a long time. This Accident is soon perceived by a vehe­ment pain in the instant of Pricking, extending from the Place to the Thumb, where the Tendon terminates. The ill Consequences which attend it are prevented in great mea­sure by Defensatives, as by unction of the Part with Oyl of Roses and Vinegar, or the same beat up with the White of an Egg, Bole Armoniack, Galen's Cerate, and repeated Bleed­ing in the other Arm. When the Pain, Inflammation and Swelling encrease, it is proper to use an Anodyne Cataplasm made of Milk, Crumbs of Bread, Saffron, Populeum, and Oyl of Roses, and attempt to break the Suppuration on the Orifice by some proper Application to the Part, as Emplast. Divi­num, Diachylon with the Gums, or a Cataplasm made with Sorrel, Lily Roots, and Basilicon, or Rags dipt in warm Oxycrate. If an Abscess happen in any other part besides the Orifice, it is to be opened where the included Pus pre­sents it self, and treated in the ordinary Method.

If none of these Accidents happen after the Puncture, and the Patient only complains of a Pain extending from the Orifice to the Wrist, without any fear of Inflammation or Suppuration, it suffices to use a Liniment made of Oyl of Roses and Spirit of Wine mixed, heated and repeated thrice a day, and after if occasion require, Oyl of Earth-Worms, with Spirit of Wine, or Queen of Hungaries Water, or rub well the whole Arm with Oyntment of Marshmal­lows, and Ʋnguen. Martiatum melted. During the Cure, the Prudent Surgeon ought to visit him several times a day, and perfect it with all possible speed, to secure his Friendship, and prevent his being offended at the Accident.

Of an Erisipelas after Bleeding.

The Surgeon is not always blameable, when an Erisipe­las arises after Bleeding, for however the Puncture of the Muscular Membrane, or some Nerve or Tendon, may cause the effusion of a Hot, Bilious Blood the common Ma­terials of an Erisipelas; yet it is no less certain, the same effect succeeds sometimes on the opening Veins which are so very large, that the most unskillful Surgeon cannot hurt any other Part, or fear the least Accident. In such Cases [Page 131]the Cause of the Erisipelas is to be ascribed to the ill Dispo­sition of the Patients Blood, which upon opening the Vessel is conveyed thither by the Arteries with great impetuosity, and in greater quantity, than can conveniently return by the Veins. This Conjecture is confirmed, by observing that at the same time this boyling impetuous Blood causes an ex­traordinary Inflammation, and very great Tension of the Arm, it has the like effect on the Lungs, and causes great Difficulty of breathing, Spitting of Blood, and all Symptoms of a Peripneumony, which ordinarily proves fatal after the Erisipelas is vanished: Add to this, the Inflammation is ordi­narily less near the Orifice, than in more distant Parts.

THE SIGNS of an Erisipelas are manifest enough, viz. a large visible Swelling of the Arm, extending from the Shoulder to the Hand, with a Train continuing from the Arm-pit to the Elbow, the Skin appears Red and Inflamed, which is sometimes greater in one place, and sometimes in another. A continual Fever is kindled, the Patient feels a great pain with Tension and Burning, which will not suffer him to rest; a Difficulty of Breathing ensues, the Spit turns red, and there is a sensible heat in every part of the Bo­dy.

THE CURE. Bleeding on the opposite Side is very Servicea­ble in remedying these Mischievous Accidents, especially if re­peated seven or eight times soon after one another (to make a prompt and effectual Diversion) in conjunction with ex­ternal and internal Medicines, to abate the Fervour of the Blood. The Patient must be confined to a strict regular Di­et, to Cool, Purifie and supply a competent stock of Moisture to the Mass; such as Veal or Chicken Broths, with Leaves of Succory, Lettuces, Chervil, Borage, Bugloss, and a little Gelly, but not too Nourishing. The Patient may drink Ptisans with Roots of Scorzonera, Marsh-mallows, Nenuphar, Dogs grass, Liquorice, and every Night two Doses of an Apozem, with cold Seeds boyl'd in it, adding some good Sy­rup and Diacodium ā. ℥i.

If the Erisipelas spread much and extend to the Breast, it is very proper to give powder of Vipers in the first Draught of Broth, or in some Cordial Water, as Scabious, Scordium, Carduus, Scorzonera or Wood-sorrel to abate its Violence, and fortifie the parts against the ill effects of the Malignant Bile, which infects all the Humours of the Body. The Diseased Part must be fomented with a Decoction of Roots of Marsh­mallows, Leaves of Marshmallows, Violary, Pellitory of the [Page 132]Wall, Groundsil, Betes, Herb-Mercury, adding after Boyling a little Vinegar of Roses, and so using it thrice or four times a Day, soaking Stupes in the Decoction, and applying them hot on the part, which ought to be rubbed likewise with a Liniment made of the Juices of Nightshade, Plantain and Housleek, the Mucilage of the Seeds of Psyllium, Linseed and Fenugreek drawn in Rose-water, Oyl of Poppies, Camphire, Saf­fron and the Cerate of Galen, or lastly, let an Anodyne Cata­plasm made of Crumbs of White-Bread boyl'd in Milk be us'd, adding Yelks of Eggs, Saffron and Oyl of Roses, and in extreme pain the Liquid extract of Opium.

If the Pain and Inflammation are moderate, a Discutient or Resolvent Cataplasm may be applyed, made of Meal of Wild Vetches, Lupins and Linseed boyled in Oxymel, adding Flowers of Roses, Chamomil, Melilot, together with Oyl of Dill, and St. Johns wort. If the Erisipelatous Swelling Ul­cerates in any part of the Arm, a Detergent lotion is proper, of Birthwort, Periwinkle, lesser Centaury, Gentian, Worm­wood, Sanicle, using after this, Ʋnguent. Nutritum, Pom­pholyx, Desiccativum rubrum, Ʋnguent of Ceruss, the Santaline Cerate, or other drying Medicines.

Doubtless the most dangerous Accident which happens in Bleeding, is the pricking a Nerve or Tendon, whose Symp­toms and Method of Cure are very much alike. The Nerves of the Arm lie so deep, it seldom happens they are pricked, but it falls out too often in opening the Vena Mediana, that the Tendon of the Biceps Muscle (which together with the internal Brachial bends the Cubit) is hurt, because this Vein most commonly runs over, or at least very near it. If the Nerve or Tendon be hurt, it is soon discovered by the vi­olent pain, which the Patient feels at the time of the Puncture, as well as by the ensuing swelling in the Arm, which is very large, attended with strong pulsation, great Inflammation, a continual Fever, and without speedy care to prevent them, Convulsions, Delirium, a Gangrene and Mortification of the Part, which cruel Accidents kill the Patient in a small time.

The Prevention of these Accidents is attempted by bleed­ing, and the same Regimen which is prescribed in the Erisi­pelas of the Arm, together with Ptisans, Cooling Draughts, Laxative Clysters and Apozems. The Surgeon must have an especial care in treating the Wounded Part; to apply to the adjacent parts as well above as below, good Defensa­tives made of Oyl of Roses, Whites of Eggs, Bole Armoniack, [Page 133]Juices of Solanum, Housleek, Vinegar, Oxycrate made with Waters of Plantain, Mulberries, Roses, Henbane-seed, and a greater proportion of the sharpest Vinegar, than is common­ly put in the Composition. Ancient Writers direct the pouring in hot Oyls, to absorb the Moisture issuing from the Wounded Nerve. This Gleet, unless prevented, soon turns sharp and acrimonious, and acquires an exceeding Malig­nant quality, Guido de Cauliaco, calls it a Nitrous and Aeru­ginous Sanies, and commends Oyl of Savin preferably to all others. In Defect of this Oyl of Turpentine, with the addi­tion of a little Spirit of Wine may serve, or Oyl of St. Johns wort, Lilies, Foxes, Castor, Euphorbium, or Oyl of Eggs, if the Pain be excessive; Lastly, in want of all these. Oyl of Dill or Rue, made by the Decoct on the Ingredients in common Oyl.

The whole Arm is to be rubbed for a long time together with Oyl of Roses, Camomil or Lillies, or pretty sharp Vine­gar. These Oyls are to be applyed very hot, and the whole Arm covered with the Cataplasms prescribed above in Erisipelatous Tumours, or Emplastrum Diachalciteos or Oxycroceum dissolved in Oyl of Roses and Vinegar, or E­mollient and Discutient Fomentations, with a little Sal Ar­moniac.

If these Remedies fail of the intended effect, the Surgeon must dilate the Wound to give the included Sanies (which is lodged on the Nerve or Tendon) a free discharge, and open a way for the more effectual applying Medicines to its bottom. This Method is used by the best Practi­tioners, and amongst the rest Guido de Cauliaco, who in treat­ing of Wounds of the Nerves and Tendons, directs a Sur­geon in these cases principally to aim at, discharging the virulent Sanies, by making an incision through the Tegu­ments, and laying the bottom open. Ambrose Parry gives the same advice, and indeed all who understand the Nature of these Wounds, know it is by no means convenient to defer the laying them open, and discharging the acrimonious Matter pent up, nor is this ever done so Successfully after some time, as in the beginning.

When the Wound is sufficiently dilated upwards and downwards, with an Incision Knife or crooked Scissars, (and made rather too great than too small) good Digestives must be put in it, as Liniment of Arcaeus melted pretty hot, or a Digestive Unguent of Turpentine washed in Spirit of Wine, Powder of Myrrh, Oyl of Eggs, and Gum Elemi, and the [Page 134]Wound filled up with Pledgits (without forcing any in) and the same Oyntments, Cataplasms, Emplasters and Fo­mentations continued on the Tumefied part as before, till a good Suppuration is procured and all Accidents cease, and then it must be incarn'd, dryed and cicatrized after the usual manner.

In these cases a Prudent Surgeon will conceal his Fault to preserve his Fame; but if he finds the Patient is like to run any Risque of his Life, or there be the least hazard in the Case, he must Sacrifice his Reputation to the Patients Health, and by this means make him some sort of Repara­tion, and instantly lay open the Wound, if there be the least danger in deferring it. If the Apertion has been too long procrastinated, and the Tension, Fever and Convulsion do continue, and the Natural Heat of the Part is extinguished, which is discovered by the Rising of the Vesiculae or little Bladders, the change of the Red into a Dark colour, tend­ing to Livid, by the decaying and withering, and weight of the Part, and by a certain putrid Cadaverous Stench soon discernible in approaching the Patient. There is no time to be lost, and the Surgeon must use all his endeavours to take off the Convulsion, abate the Tension, recall the Na­tural Heat, and prevent the entire Mortification of the woun­ded Part.

To prevent the Convulsion, Authors advise the cutting the Tendon or Nerve asunder, whose Fibres are apt to be torn by the contraction of the Muscle. But sometimes even af­ter cutting the Tendon asunder, the Convulsion does not cease. To abate the Tension, the swelling is to be Scarifi­ed to the quick, throughout its whole Extent, especially in those places where it is Vesicated, or the Scarf-skin separa­ted, or the Skin discoloured. That the Scarification is deep enough, may be known from the Patients crying out, and Blood issuing from the Orifice. The Scarification must be­gin beneath, and be continued up to the highest part of the Swelling in such a manner, that the lower Angles of the upper Incision may intersect the upper Angles of the lower, and the Skin by consequence suffer no constraint.

The Scarifications may be multiplied according as the Disease encreases, and made longer and deeper if the Gan­grene do's not stop, in order to apply Medicines to the bot­tom of the putrefied Slough. All Medicines are to be ap­plyed very hot to restore the Natural Heat, and stir up the remaining Spirits to a Vigorous Action. Fomentations may [Page 135]be made with Venice Treacle, dissolved in Spirit of Wine, strengthned with Spirit of Sal Armoniack, or the yellow Wa­ter made with Quicklime, and Sublimate corrosive. A Fo­mentation made with a good quantity of Common Salt dis­solved in very strong Vinegar, with the addition of Spirit of Wine, Honey of Roses, and Aegyptiacum is a good Medicine if applied hot to warm the Scarified part. Those who have Experience, may compose variety of these Applications ac­cording to their Opinion of their Virtue, and dip Pledgits in them to put in the Incision, taking care to lay on some good Liniment to procure a laudable Suppuration, and a quick Separation of the gangrened and corrupted part.

This Liniment may be made of Turpentine washed in Spi­rit of Wine, with Powders of Myrrh, Aloes, Aegyptiacum, Basilicon, Oyl of Wormwood, and St. Johns wort. After the incisions are filled with these and other like Medicines, it is convenient to apply on the part some Cataplasm, to put a stop to the progress of the putrefaction, to discuss, dry, and abate Pain. This Cataplasm may consist of Meal of Beans, Barley, Wild Vetches, Lupins, boyl'd in Oxymel with com­mon Salt, Honey of Roses, Juice of Wormwood, and Hore-hound, Powders of Myrrh, Aloes and Mastich, with a little Spirit of Wine added at last, to give the whole a soft Consistence.

Cataplasms are very good on these occasions, tho' some Practitioners condemn them, upon a pretence they load the Part, stop the Pores, and hinder Transpiration; for this rea­son they prefer Compresses dipt in some of the before men­tioned Liquors, with some Aromatick Spirit of Wine, with Bottles of hot Water, Bricks and Tiles applyed to the part to preserve the Warmth. These Bricks and Tiles are to be wrapt in Linen Cloth several times doubled, to prevent burning the Patient. This is the more necessary, because the Parts being in a manner insensible, will endure very con­siderable burning before the Patient complain of it.

These Applications must be renewed twice or thrice a day, to work more effectually. In the mean time the Patient must take several Cordial Potions; such as are before prescribed in the Cure of the Erisipelas, applying on the Heart some Epithem of Carduus, Bugloss, Borrage, Rose and Treacle Water, Juice of Citron and Nightshade, Vinegar of Roses, Powders of the three Sanders, Diamargariton frigidum, Confection of Alkermes, Hyacinth and Troches of Camphire.

If all these Methods fail of their intended effect, and the part appears to be from little shivering Fits, Nauseas, [Page 136]and heaving of the Stomach, and malignant Vapours arising from the putrid Flesh, infest the Heart. The only remaining remedy to preserve the Patients Life, is a speedy Amputation of the Part, the Method of performing which, I shall shew in its proper place.

How to fetch away the After-burthen.

When the Child is born the Artist taking the String, must wind it once or twice about one or two Fingers of his left Hand (for instance, the Fore and Middle Finger joyned to­gether) the better to hold it, or he may take it in his left Hand, wrapping it in dry Linen, to prevent it from slipping between his Fingers; having done this, let him draw it mo­derately, and with the right Hand take another hold of it above the left near the Privities, drawing likewise with that very gently, resting the while the forefinger of the same Hand extended, and stretched forth along the String towards the en­try of the Vagina, always observing to draw it from that side where the Burthen cleaves least. In performing this, he must avoid the Membranes of the Infant, which sometimes hang out after the Birth, and investing the String hinder him from keep­ing it Firm. But above all things, let him be careful to draw the Burthen gently, for fear of breaking the String, [Page 196]or drawing down the Womb with it, or causing a Flood­ing, which would be of dangerous consequence. In the mean time the Woman may blow strongly into her Hands shut, or stop her Nostrils, or she may put her Finger into her Throat, as if she would excite Vomiting, or else strive as if she were going to stool, bearing down and holding her Breath, all which Motions have the same effect, and serve to loosen the Burthen, and facilitate its expulsion. If this do not suffice, after you know on which side the After-birth is situated, bid an experienced Nurse-keeper press the Belly lightly with the flat of her Hand, bringing it gently down­wards by way of Friction: When the Burthen is come a­way, it must be considered whether it be entire, and if the least part remain behind, so much as the Skirts or any Clods of Blood, the Hand must be put up into the Womb to bring them out.

When the String is broke and the Placenta is retained, you must speedily introduce your Hand into the Womans Bo­dy, and before the Womb can close (having first anointed it with some Grease or Oyl, and pared your Nails close) bring it away. This is easie to be done, if it do's not cleave to the Womb; but if it do's adhere, you may easi­ly distinguish it from the Womb it self, by the several in­equalities in its Surface, and then by trying with your fin­gers on which side it cleaves least, begin to disingage it there, thrusting the end of your Fingers between it and the Womb, continuing so to do till it be entirely freed, and then gently draw it out. You ought to be careful in separating the Burthen, to avoid scratching the Womb, for fear of a Flooding, Inflammation or Gangrene, and it is better to leave some part of it behind, than endanger such Accidents.

If the Womb be not open enough to receive the Hand, anoint the Womans Privities, and introduce two or three Fingers, with which apprehend that Portion of the Burthen, which almost always presents it self at the internal Orifice, and draw it gently, and a little obliquely on one side and the other, and so proceed forwards, keeping what you first seized in its Membranes.

If all these Methods fail, and you cannot fetch it then away, you must have recourse to Injections made with De­coctions of Mallows, Marshmallows, Pellitory, Linseed, with the addition of Oyl of sweet Almonds, Lilies, or a bit of fresh Butter, these injected into the Womb are proper to [Page 197]suppurate, and so bring it away. Strong Clysters are very Serviceable, because the Patients striving to go to Stool, ve­ry much assists the expulsion of the Burthen.

Bleeding in the Foot or Arm is necessary as occasion re­quires to prevent a Fever; but if the Woman be free from it, good Restoratives may be given her, as Broths made of Veal or Poultry, with a little Juyce of Orange, or Wine and Water.

Of Difficult and Ʋnnatural Labours.

You may be assured the Child is living if the Woman has received no Hurt, if she has labour'd under no very great inconvenience during the time of her going with Child, if she has enjoyed a good Health, and finds the Infant stir within her.

If you doubt whether the Child be alive after the Waters are broke, pass your Hand gently up into the Womb, and take hold of the String as near the Navil as may be, to feel the Pulse of the Umbilical Arteries, or put the Tip of your Finger into its Mouth, to feel the Motion of the Tongue.

You may conclude the Child to be Dead, if he has not stir­red for a considerable time; if there be a Flux of Faetid Matter from the VVomb; if the Woman feels great pain and weight in her Belly; if the Womb be not staid, but falls like a Ball from one side to another, on which ever side she happen to lie, if she have frequent Syncopes and Convulsions; if the Navel-string or Burthen, have for some time been out of the Mothers Body; if putting the Hand into the Womb the Child be cold, the Navel have no Pul­sation, and the Tongue remain unmoved; if the Head feel soft, and the Bones move too and fro, riding over one ano­ther in the Sutures; if the Woman has received any Hurt, or lost a great quantity of Blood, or she be not arrived at her due Term; if the Waters have been broke for a con­siderable time; if her Face be of a Leaden Colour, her Eyes sunk, her looks faint and dejected, her Breath ill scen­ted, her Breasts decayed, her Belly fallen, without any Wa­ters coming away from the Womb. If diverse of these Signs happen together, there is good reason to believe the the Child is Dead.

When the Child presents with the Feet First.

When this happens, the Artist must introduce his Fingers [Page 198]into the Womb to dilate it by spreading them. When the passage is wide enough, introduce your Hand into the the Womb, and if only one Foot present, consider well whe­ther it be the Right or the Left, and so you may better judge on which side the other Foot lies, which you must search for, and so draw forth both together; but before you pro­ceed thus far, you must be well assured that this is not the Foot of another Child, for you would sooner kill both Mo­ther and Children, than deliver her after this manner; you may easily prevent Mistakes of this kind, by sliding your Finger along the Leg and Thigh to the Twist, till you find the two Thighs joyned to one Body, and this way has this convenience, that at one and the same time, you find the other Foot in order to bring it away with the former. When one Foot is found, tie it with a Ribbon, that so you may not lose that again, in searching for the other. When both Feet are found, taking them with both Hands above the Ancles, and holding them close together, draw them till the Thighs and Hamms of the Child are come forth; as soon as the Knees are come out, take hold of the Thighs above them, wrapping them in a Napkin to prevent the Hand from sliding, and then proceed to draw the Child to the upper part of the Breast. Then bring down the two Arms of the Child on the sides of the Body, taking hold of his Hands near the Wrist, rather than in any other place. This is the best way to disengage them in the passage, and here care must be taken to prevent breaking them, by for­cing them too much. You must be careful the Childs Belly and Face be downwards, to prevent the Chin from stopping on the Sharebone; wherefore if it be not in this Posture, you must reduce it, which may easily be done. To effect this, slide the flat of one Hand to the Pubes of the Child, and with the other hold the two Feet, turning the Body till the Breast and Face be downwards; having in this Posture brought the Child to the Shoulders, you must proceed to draw it out in the mean time, advising the Woman to bear down, that the Head may succeed in the place of the Shoul­ders, and not stop in the passage.

When the Head stops in the passage.

In this Case, put the Childs Thighs into the Hands of some one of the Assistants to draw gently, whilst you by degrees disengage the Head from the Bones of the Passage. [Page 199]To do this, slip one or two Fingers of your Left Hand into the Childs Mouth, to disengage the Chin, and with your Right Hand embrace the hinder part of its Neck above the Shoulders, and so draw it out above. This must be done as promptly as is possible, for fear the Child be Suffoca­ted.

If the stopping of the Childs Head in the Passage, arise from its ill Position, turn the Face downward, sliding the flat of the Hand over its Face to cover its inequalities, for the more easie turning and putting it into a more commodi­ous Situation; but the Head and Body must be turned to­gether, for fear in turning one without the other, the Childs neck be twisted round. After these Circumstances observed, the After-birth must be fetcht away as before.

How to fetch away the Childs Heal when it is separated from the Body, and remains behind in the Womb.

If the Head be small and soft as in Abortions, it may be easily drawn out, but if it be big, the Artist must put his right Hand up into the Womb, and search for the Mouth, and putting one of his Fingers into it, and his Thumb under the Chin, take hold of the lower Jaw and draw it out.

But if the lower Jaw come off from the Head, he must draw his right Hand out of the Womb, and slip in his left, and with this stay the Head; and in his right, he must take a streight strong Hook or Crotchet with one Branch, and slide it all along the inside of his Hand, keeping the point towards it, for fear of hurting the Womb. Having i [...] tro­duced it in this manner, he must turn it to the Head, and strike it into one of the Eyes, or Holes of the Ears or Occi­put, or between the Sutures, and so bring away the Head, making way for it with his left Hand, when he has brought it near the Passage, he must withdraw his other Hand, which would be apt to hinder its coming away, however he must leave two or three of his Fingers on the side of the Head, to prevent the Wombs being Wounded by the Instrument, if it happen to lose its hold.

If the Artist decline using the Crotcher, he may take a Fillet of soft Linen, three quarters of an Ell long, and three Inches in Breadth folded double, let him hold the two ends with his Left Hand, and the middle with his Right, being first anointed with fresh Butter, let him introduce the end of [Page 200]this Fillet into the Womb, and pass the middle over the Childs Head, then drawing the two ends of the Fillet toge­ther, let him bring the Head out.

If these means fail, the Artist must thrust his left Hand in­to the Womb, and then slide in a crooked Knife with his Right, with the point turned toward his Hand, for sear of wounding the Womb. When it is in he must turn it to the Head, and make an Incision in that to evacuate the Brain, and lessen its bigness. The Knife must be thrust in with the left Hand to prevent hurting the Hand, and must be small with a long Handle. If the Burthen be loosned from the Womb, it must be brought away first of all; on the contrary if it adheres firmly, the Head must first be drawn forth.

When the Childs Head thrusts the Neck of the Womb out be­fore it.

When this Accident happens, the Woman must not be obliged to walk or stand up, but must be kept in her Bed with her Body lying even, and not so much raised as in a Natural Labour. You must omit giving sharp Clysters, and all such things as may moisten and relax the Womb, and when the Child thrusts forward, the Artist must have one Hand on the side of the Head, to put back the Womb to its proper place, continuing to do this till the Child be born, without drawing the Head as in Natural Births. But if the Child be stopt in the Passage, and be in danger of be­ing Suffocated, he must draw it gently out by the Head, whilst some other Person thrusts back the Womb with his Hands, and when this is done, he must fetch away the Placenta.

When the Childs Head comes first, and cannot come forth, be­cause it is too big, or the Passage not sufficiently dilated.

In this Case the Bearing part must be fomented and relax­ed by Oyls and Emollient Greases, and all endeavours used to bring the Child into the World. If these prove useless, and it be certain that the Child is dead, the Artist must no longer scruple to fix his Crotchet into the Head, and so bring it out. Before this be done, let him introduce a Ca­theter well Oyled into the Bladder to evacuate it, putting the Childs Head a little aside, for the more easie slipping it [Page 201]in. After this, let him slide the flat of his Right Hand into the entry of the Womb to the side of the Childs Head, and with the left let him introduce a Crotchet, which ought to short and strong, and in entring it must be turned to the in­side of the Right Hand; after it is in, let him turn it and strike it into the middle of the Parietal Bone, and draw it gently till it has taken fast hold; then let him take out his Right Hand, and introducing his Left Hand to guide it, fetch it out with the Instrument. If there be occasion, the Artist may use another Crotchet to the opposite side of the Head, to draw the whole more equally. In the last place (drawing out his Instruments,) let him take hold of the Head with both his Hands, to bring out the rest of the Childs Body.

When the Child presents the side of the Head or the Face to the Birth.

To prevent the Childs advancing farther in this Vicious Posture; Let the Woman lie down, and cause her to lean a little on the opposite side, to the Childs ill position, then let the Artist slide up his Hand to the side of the Childs Head, to bring it right. If this do not succeed, he must put his Hand up to its Shoulders, that so thrusting them back a little into the Womb, he may give it a Natural and Convenient Situation, after which he may proceed to deli­ver the Woman in the usual manner.

If this succeed not, let him search for the Feet, and bring them out first.

When the Child's Head is born, and the Body stopt in the pas­sage by the Shoulders.

Draw the Childs Head gently, sometimes by the sides, sometimes taking it with one Hand under the Chin, and with the other on the Top of the hinder part of the Head, alternately drawing one side and the other to facilitate the Birth. If the Shoulders cannot pass, slide one or two fin­gers of each Hand under the Armpits, and so draw out the Child. If it be stopt by a Hydropick Belly, introduce the Left Hand into the Womb, quite to the right side of the Belly, and pierce that with a Crotchet (for the introdu­cing which, you may make use of your Right Hand) and when the Waters are let out, bring away the Child.

When the Child comes with one or both Hands together with the Head.

As soon as this ill Position of the Child is perceived, it must be prevented from proceeding farther. The Woman must be placed on her Bed, with her Hipps raised a little higher than her Head, and the Artist must put back the Childs Hand, guiding it as much as may be, to give way to the Childs Head, which having done, if the Childs Head be on one side, it must be reduced to its Natural Posture in the middle of the Passage, and so brought away as in or­dinary Births.

When the Child presents one or both Hands foremost.

The Hand or Arm must be thrust as speedily as may be into the Womb, and the Artist must introduce his Hand under the Childs Breast and Belly so far, till he sinds the Feet, which he must gently pull towards him to turn it, and draw it forth, observing to do this with as little Violence as may be.

In introducing the Hand into the Womb, observe to slide it within the Membranes, that so it may turn more easily without hurting the Womb.

If the Arm come too far out, and cannot be put in with­out great difficulty by reason of its bigness, and it be certain the Child is dead, it is then advisable to take it off as high as is possible, beginning with an Incision around it, and cutting through the Bone with sharp Pincers, as is practised by Ambrose Parrè. But I think it better to twist it once or twice round; for by this means it will easily separate from the Body in the Articulation, and there will be no danger of hurting the Womb by the Asperities of the Bone.

When the Child presents Feet and Hands together.

When the Womb is sufficiently dilated, let the Artist slide his Hand into it far enough to reach the Childs Head, and put back that together with the Hands, to the bottom of the Womb, leaving the Feet in the same place where he found them, to draw the Child forth by.

Observe that whenever the Child or any part of it is to be thrust back into the Womb, the VVoman must have her Hipps raised.

When the Child presents with the Knees first.

It must not be suffered to advance far in this Posture, wherefore having placed the VVoman aright, put back the Childs Knees, and to unfold its Legs, put one or two of your Fingers under the Ham, directing them by little and little all along behind the Leg, until you reach the Foot, that so having disengaged one, you may do the same to the other, proceeding in the same manner as with the first; after which having brought both together, deliver the VVoman in the same manner, as when the Feet present first, observing to bring the Face of it downward, and such Circumstances as are noted where we treat of that Labour.

When the Child comes with the Shoulder, Back or Breech.

The Artist must thrust the Shoulder a little back, that so he may have the more liberty of introducing his Hand into the VVomb, then sliding it along the Childs Body on the Belly or Side, as he finds it easiest, and searching for the Feet, he must turn it and bring them to the Passage, and so deliver the VVoman.

If the Back present, he must slide his Hands along it to­wards the lower part, till he finds the Feet, and then draw it forth, as if it presented with the Feet first.

If the Child come with the Breech first, he must gently thrust it back, and sliding up his Hand along the Thighs to the Legs and Feet of the Child, he must bring them gent­ly one after the other forth of the VVomb, by folding, stretching, turning and drawing them gently towards the side on which it comes easiest, being careful not to wind them too much, or cause a Dislocation, and then let him draw forth the rest of the Body, as if it came with the Feet foremost.

If the Childs Buttocks happen to be so far engaged in the passages, that it is impossible to thrust it back, the Artist must draw it out in this Situation, by sliding one or two fin­gers of each Hand on each side of the Buttocks to make his way to the Groin, with as little Violence as may be, and then having crooked them inwards, let him draw the Breech just out to the Thighs, and so by drawing and wagging from side to side, he will disingage them from the Passage, as also the Legs and Feet one after another (being careful [Page 204]not to Dislocate any part) and then he may extract the rest as before, when coming with the Feet.

When the Child presents Belly, Breast or Side.

VVhen the Child presents the Breast or Belly, let the Ar­tist slide gently the flat of his Hand (being first well anoin­ted) towards the middle of the Childs Breast, and thrust that back to turn it, then let him slip up his Hand under the Belly till he finds the Feet, and bring them to the passage to draw it forth, observing always to turn it, so that the Breast and Face may come downwards.

VVhen the Child presents the Side, the Artist must thrust back the Body of the Child, and introduce his Hand into the VVomb, sliding it along the Thighs till he has found the Leggs and Feet, and then turn it and draw it forth.

If several Children present to the passage together, the Artist must carefully heed which Members belong to each Child, for fear he draw them both at once; if two or three Feet come forth, let him take two, viz. one Right and one Left, and slide his Hand along the Legs and Thighs up to the Twist if forwards, or to the Buttocks if backwards, to find if they belong to the same Body, and when he is certain of this, let him thrust back the Foot of the other, to facilitate the passage, and draw forth the nearest, obser­ving the same Circumstances as when the Child presents with the Feet first, remembring likewise not to fetch away the Burthen, till the Second Child be born; for sometimes there is but one common Placenta to both Children, which being separated from the VVomb, would cause a great Flooding, and be apt to incommode the Operator, nor can any reme­dy avail to remove this, till the VVoman be delivered of both her Children.

VVhen one Child is come away, the Artist must tie the Navel-string and cut it, and after that is done, bring away the other Child by the Feet, and fetch away the Burthen as in a Natural Delivery.

If the Child present any other part besides the Feet, the same Method must be used, which is above directed in each different Situation, observing to draw forth that which is farthest advanced in the passage.

VVhen the first Child is come away, and the VVaters of the second are not broken, the Membranes must be torn with the Fingers to let them out, because the Passage being [Page 205]dilated by the Birth of the First, the Second will come a­way without any difficulty.

When the Navel-string comes first.

Let the VVoman be laid very warm in her Bed, and the String replaced in the VVomb as soon as is possible, to pre­vent its cooling. The Artist must endeavour to put it back behind the Childs Head, and keep it there with his Fin­gers till the Head be fully come forth, which will hinder the coming down of it again.

If it be necessary to draw the Hand out of the VVomb before the Head be past, let him put a very fine Rag be­tween the Head and the side of the VVomb, to stop the place where the Navel-string passed, leaving one end of the Rag without, to draw it out when he pleases; and let a Compress dipt in VVine well warm'd be applied externally to the VVomb, to defend the Navel from the injuries of the external Air.

But if the String yet come forth upon every pain, then without further delay let the Artist bring the Child away by the Feet, which he must search for, though it should come with its Head; and let him gently thrust that back, provided it be not too far advanced; for in this Case it can­not be done without great Violence, Pain and Hazard of the VVomans Life.

To search for the Feet, let him slide his Hand on the Childs Breast and Belly, and when he has found them, turn the Child and draw it out. VVhen the Navel-string comes first, the Child must be Baptized immediately after the Birth, if it be not already done whilst it^* remains in the Passage.

When the Burthen presents first, or is come away before the Child.

VVhen the Placenta presents first, nothing can be felt but a soft Body; there is a Flooding and concreted Blood comes away, and the VVoman faints.

VVhen this happens, the VVoman must be delivered with all Expedition, and if the Membranes are not broken, the Artist must put a little on one side that part of the Burthen which presents, and break the Membranes with his Fingers, and let out the VVaters, and turn the Child at the same time, [Page 206]if it be in any other posture than with the Feet foremost, and draw it forth immediately.

But if the Burthen be almost come forth, and the Mem­branes broke, he must bring away the Placenta before the Child, not amusing himself with tying and cutting the string before he draws out the Child, to prevent losing one mo­ment of time in delivering the VVoman, because the Infant is in great danger of losing its Life, and the Mother has a continual Flooding.

When there is great Floodings and Convulsions in Labour.

The best Remedy in this case, is to deliver the VVoman immediately, without the least delay, fetching away the Child by the Feet; if the Flux of Blood be very moderate, and nothing else require it, you must not forward the Labour, and the VVoman may go out her Natural Term.

If the Membranes are not broke when the Flooding ap­pears, they must be torn as soon as the VVomb is a little di­lated, because the Burthen is fixed to those Membranes, and these being extremely agitated and moved by the Pains of the Mother, the Placenta must consequently be moved, and a Flux of Blood ensue. If a Convulsion happen, the VVo­man must be delivered immediately. This is the best expe­dient in this case, for the saving the Lives of both Mother and Child, if the VVomb be open; but if it be not, then let the Artist have recourse to the usual Remedies; for in­stance, Bleeding in the Arm or Foot (if the Accident arise from Repletion) giving sneezing Medicines or Clysters to cause Throes and dilate the VVomb, in the mean while hu­mecting it with Emollient Fomentations.

To deliver the VVoman let the VVaters be broke, and the Child drawn out by the Feet, unless its Head be engaged in the Passage, and then fetch it by that. If the Child be certainly dead, let it be drawn out with the Crotchets, as was before directed.

When the Child is Hydropical or Monstrous.

If the Dropsie be in the Head, let the Artist gently intro­duce his left Hand, on the right side of the Childs Head, which he will perceive to be very big, and the Sutures se­parate from each other; when he finds this, let him with his right Hand slide a crooked Knife all along the inside of [Page 207]his Hand, with the point turned towards his Hand, for fear of hurting the Womb, and having conveyed it very near the Head to the place of the Sutures, turn it in that place, and make a sufficient aperture to let out the Waters, and draw forth the Child. The same Method may be used to let the Water out of other tumefied Parts.

But if the Child be of any Monstrous Figure, or too big, or two grow together, they must be dismember'd, without which it is impossible to fetch them out of the Womb. To perform this, let the Artist introduce his left Hand into the Womb, and conveying in the crooked Knife to the parts he intends to separate, let him cut them off as near the Joynt as possible. If two Bodies are joyned together, let him se­parate them in the place of their cohaesion, and draw out one after the other by the Feet.

When the Infant is dead in the Womb.

Give strong Clysters to the VVoman to excite her Throes, and then deliver her as soon as is possible. In order to this, evacuate the Bladder of its Urine, and if the Child pre­sent with its Head first thrust it back, and introduce the Hand into the VVomb, sliding it under the Childs Belly, and search for the Feet, and turning it by them draw it forth, as we have so often directed. But here the Artist must have an e­special care that the Head do not remain behind, because the Child is most commonly rotten; and when this happens, it must be drawn out in the manner above directed.

If the Head be too far advanced in the passage, it may not be thrust back for fear of doing Violence to the VVomb, but the Child must be drawn forth fixing Crotchets in his Head, and proceeding after the manner we have elsewhere described.

If the Dead Child present an Arm, bring it away from the Body by twisting it once or twice round, and do the same in other parts of the Body; and after the Child is thus brought away, collect all the parts of the Body, and com­pare them to see if any be missing. Observe here to avoid using Crotchets, though you are certain the Child is dead, if it can possibly be brought away by any other means; be­cause the Assistants and Midwives are most commonly very censorious in this case, and will not fail to impute the Childs Death to the Artist.

Of a Mole and False Conception.

A Mole is a Mass of Flesh without Bones, Joynts or Di­stinction of Members, or any regular or certain Figure, Moles have no Burthen or Navel-string, but adhere to the VVomb, and draw Nourishment from it, and are sometimes contained in Membranes. If VVomen cast them before the second or third Month, they are commonly called false Con­ceptions, and Moles if they are retained in the VVomb for a longer time and grow larger.

There is little difference in the Signs to enable us to distinguish between a Mole and false Conception; except that the Belly in VVomen who have Moles, is harder and more painful, and appears equally extended on all sides, not rising to a point before, and tumefies sooner than if she were really with Child. Moles are void of Life and Mo­tion, are not encompast with VVaters, and attended with more inconveniences, than a Natural Conception, and the VVoman has no Milk in her Breasts, tho she can press some Serosities out of them.

VVhen you are assured the Big belly do's only proceed from a Mole, try to bring it away as soon as is possible, giv­ing the Patient some Purgative Medicines, in case there be no Fever or Flooding; and when these begin to operate, give a sharp Clyster to excite her Throes, and when the VVomb begins to dilate, relax it with Grease and Emollient Oyls. Bleeding in the Feet, and half Baths are very ser­viceable in this case.

If a Mole be not too large, or adhere too firmly to the VVomb, it will come away without the Assistance of any Remedies; but if it cleave strongly, or be exceeding large, when the VVomb is sufficiently dilated, the Artist must slide in his Hand and fetch it out, or make use of a Crotchet or sometimes a Knife, to divide it into pieces.

If the Mole cleave to the VVomb, he must separate it from the part with his Fingers, which he must by de­grees insinuate between them, beginning in that place where it adheres least, and proceeding till it be entirely loosned, having great care to have his Nails pared close, for fear of hurting the VVomb.

If it be a False Conception, slide one Finger into the VVomb, and bend it on one side and another, till you can enter a Second and a Third, or a Fourth, and then taking [Page 209]it between the Fingers, fetch it away together with the con­creted Blood; and if no Portion happen to remain behind, the Flux of Blood will soon cease. But if the Orifice be so small, that the Artist cannot possibly introduce more than one Finger, let that be the Fore-finger of the Right Hand, and let him thrust that as far as he can, and turn it about to loosen the False Conception from the VVomb, and bring it away with the Finger; and if he cannot do this, let him make Injections into the Womb to suppurate it. The Flood­ing will undoubtedly cease, if no part of the Conception be left behind: But if the Internal Orisice cannot be more dilated than is mentioned, and the Flooding be so violent as to endanger the Womans Life, the Artist having introdu­ced the Fore-finger of his Left Hand, must take with his Right a Cranes Bill or Forceps, and sliding this along his Forefinger, extract the Unnatural Body in the Womb, ta­king care not to pinch the Womb it self, which he may prevent by guiding the Instrument with his Finger.

What is fit to be done to a Woman newly laid, and her Child.

THE DRESSING OF THE MOTHER. When a VVoman is Delivered, lay to her Privities a Closure of Li­nen six or seven times doubled, which must be chan­ged upon account of her Cleansings, but first those must be removed, which received the Child in her Labour. As for her Posture, place her in her Bed with her Head and Bo­dy a little raised, to give way for her cleansing and free breathing, and let her put down her Leggs and Thighs close by one another, with a little pillow under her Hams; and let her lie on her Back, that so the VVomb may re­sume its Natural Situation. After the Closure is removed, let an Anodyne Cataplasm be applied, made of two oun­ces of Oyl of Sweet Almonds, with the Whites and Yelks of two New-laid Eggs, beat and stirred together with a Spoon over warm Embers, till it be of a due consistence. Let this Cataplasm be applied hot, and continued on for the space of three or four Hours, renewing it if there be occa­sion; it appeases pain in the bearing part after Labour.

In the next place make a Decoction of Barley, Linseed, Chervil, Marsh-mallows, and Violet Leaves, and with this fo­ment the part three or four times a Day, for the space of five or six Days together, to cleanse the Privities from Clods of Blood, and other Filth which proceed from the Cleansings.

Nurse-keepers lay a Compress of a Triangular Figure, four or five times double on the Belly, to bear up the VVomb as they pretend, and two others rolled up on each side, to keep it directly in the middle; then lay a square Napkin all over the Belly, and after that Swathe it with a­nother Napkin three or four times double, and about a quar­ter of an Ell broad. But the Belly ought by no means to be comprest for the first fifteen Days, and if it happen to be so, the Bandage must be removed, to anoint it well with Oyl of Sweet Almonds, but after that time it may be a little streightned, to contract and keep the parts toge­ther.

If the New-laid Woman intend to Suckle her Child, lay a soft and fine Cloths on her Breasts to keep them warm, and prevent the Milk from Curdling. If the Milk begin to come too plentifully into them, embrocate them with a Mixture of Oyl of Roses and Vinegar, and lay on them a fine Compress dipt in it.

After the Cleansings are finished, strengthen the Womb with a Decoction of Provence Roses, and Roots and Leaves of Plantain in Smiths Water. After that use this astringent Lo­tion to close the Parts. ℞. Pomgranate Peel, Cypress Nuts, ā. ℥iss. Seal'd Earth, ℥ss. Provence Roses, ℥i. Roch Alum, ʒij. Infuse these Ingredients for the space of a Night in five half pints of Claret alone, or diluted with Smiths Wa­ter, (least the Wine alone be too sharp) boil all till it be reduced to a Pint, then strain it, and express it strong­ly, and with this foment the Parts well Night and Morn­ing.

THE DRESSING OF THE CHILD. Put the Child into a warm Blanket, and take a brown Thread four or five times doubled, of a quarter of an Ell long, with a knot at each end to prevent its entangling. This Thread and a pair of Scissars, must ever be in readiness against the time of Labour; then tie the Navil-string with this Thread about a Fingers breadth from the Belly, and make a double knot, then turning the Thread round the Navil, make two other knots on the opposite side, and so cut the string about [Page 211]a Fingers breadth more beyond the Ligature towards the Placenta. The Ligature must be so close that no drop of Blood may pass it, but not so strait as to cut the Na­vil.

The end of the Navil must he wrapt round with a small Rag, dry or dipt in Oyl of Roses, and another doubled Rag laid on the Belly on the upper side, to repose the Navil on with a Compress over this, and these lesser Dressings kept on with a Swathe of three inches broad, roll'd round the Body. The Navilstring dries and separates near the Belly, within five or six Days or thereabouts.

Let the Childs Body be cleansed with Wine and warm Wa­ter, especially the Head, Groin and Armpits, and wiped with soft Raggs, or a Spunge dipt in Wine lukewarm, or if the Excrements be very tenacious, in Oyl of sweet Al­monds. Let the Nostrils and Ears be unstopt with little Tents, and the Eyes wiped with a soft dry Rag.

VVhen the Childs Body is cleansed from all the adhering [...] view it well to see if no part be dislocated, and all the Passages be open for the voiding its Excrements; and if they do not come away, give him by the Mouth some Syrup of Violets or Roses.

After the Child is cleansed, cover his Head with a little Linen Biggen, with a Woollen Cap over that, but observe first to place a Compress the openness of the Sutures, and pin it without. Behind the Ears put Rags to dry the Filth, and then lay other Rags on the Breast, and in the Folds of the Armpits and Groin, and so Swath him in his Linen and Blankets well warmed binding him lightly on its Breast and Stomach. The Arms and Legs must be wrapt in the Blanket, and kept streight lying by each other, with a little of the Blanker between to prevent them from Galling, by rubbing against each other, and the Head must be kept stea­dy with a stay fastned on each side the Blanket.

How a Woman ought to govern her self during her being with Child.

The Air in which she breaths must be Temperate, and if it be not so by Nature, it must be reduced to due tem­per by Art, warming if it be too cold, or cooling it if too hot.

A Pregnant Woman ought to shun too warm an Air, be­cause it weakens and enfeebles the Body; on the other hand, [Page 212]she must with equal Care avoid an Air which is Cold and Foggy, which may cause Rheums and Coughs, which put­ting her Body into an Agitation, may make a Concussion of the Womb, and cause an Abortion. She ought not to live in strait narrow Lanes or Allies, or near common Sewers, or other stinking places; because ill Scents will make her apt to miscarry. She must avoid the noxious Fumes of Charcoal, especially when not burnt in a Chimney, and al­so all Perfumes and other sweet Scents, especially if she be Hyfterical.

If a Pregnant Woman has a longing after odd things, she must be indulged, though perhaps the things she desires are improper, provided she eat moderately. But if she have no extravagant Appetite, let her eat any sort of wholsom Meats, in such quantity as may suffice for the Nourishing her self and Child, in which her Appetite is to be a Rule. Fast­ing or long Abstinence is hurtful, because it heats the Blood, and conveys ill Nourishment to the Child, which renders it weak, and decayd, and often makes it strug­gle to free it self before its time, and seek for better Food. On the contrary she must not eat too great quantity of Meat, especially at Night, because the Womb in the last Months of going with Child possesses a great part of the capacity of the lower Belly, and hinders the Stomach from retaining much; and hence when it is overcharged, it cau­ses Belches, Indigestion, and difficulty of Breathing, pro­ceeding from a compression of the Diaphragm, which wants liberty of Motion. Let her therefore eat little and of­ten, and let her Bread be of the best Wheat, white and well baked, and not brown Bread or baked Crust, which swells in the Stomach. Let her eat good Nourishing Meats, as the most tender pi [...]ces of Beef, Veal, Mutton, Lamb, Fowl, as Pullets and fat Capons, or Partridge, Pidgeons boiled or [...]oasted as she desires; Newlaid Eggs are very good, and Pregnant Women seldom having good Blood, ought to put into their Broth such Herbs as purisie it, as Sorret, Let­tuce, Succory and Borrage. A Woman with Child ought to eat no Highseasoned Pies, especially the Crust which is difficult to digest; and if the eat Fish, it ought to be fresh and not salted, and such as is bred in Rivers and Running Waters, because Pondfith usually tastes of Mud, and breeds ill Juices. She may drink at Meals a little good old Wine diluted with Water. Red Wine is be [...]ter than White, and strengthens the Stomach, helping Digestion, which is always [Page 213]bad in the time of pregnancy. If she was not used to it before, she must gradually accustom her self to it, but must never have it coold with Ice, or any otherwise drink it too cold, for cool Liquors are apt to breed the Colick, and by consequence endanger Abortion. On the contrary, she must no less carefully avoid what is heating, such as all Salt, Sharp, Bitter, Aperitive and Diuretick things, which provo­king the Courses, are apt to make a VVoman miscarry.

VVomen with Child are apt to have a sharpness of Sto­mach, to prevent which they must refrain eating of Fruits, Salle [...]s, Sugar, and drinking of VVine, which extremely sours all their Aliment, and lastly keep their Bodies so­luble.

VVomen with Child must have moderate Sleep, that is eight Hours at least, and ten at the most in the Nighttime, and little or none at all in the Daytime. However VVo­men who are used to sleep in time Daytime, must be indulged in this bad custom, rather than do violence to Nature in breaking an ill habit too abruptly.

As for Exercise and Rest, these differ according to the times of Pregnancy. For the first four or five Days after Concep­tion, a VVoman ought to keep her self in Bed, and de­cline the embraces of her Husband. During all the remain­ing time of her going with Child, she must use no violent exercise, must not go in any Coach, Chariot, or on Horse­back, because these Agitations of the Body are apt to loo­sen the Foetus, and if she have occasion to go abroad, it must be in a Chair or Litter. She must not carry any great Burthen, or lift her Arm too high; and for this reason she ought not to dress her own Head. The lifting of the Hands has caused many Abortions, because the Ligaments of the Womb are relaxed by these violent extensions. Her shooes ought to be lowheeld, because the Rising of her Belly hindring her from seeing her Feet, she is apt to fall.

If a VVoman happens to stumble, fall or hurt her Belly by any other Accident, and she find her self to void Blood, or a Bloody Serum, or indeed any VVater from the Womb, let her repose her self some Days without seeing her Hus­band, till these evacuations cease, and she find no pain in the Reins or Bladder.

In short, she must govern her self so in all exercises, as to exceed in too much Rest rather than Motion, because a much greater danger attends the one than the other; and [Page 214]when ever a VVoman is advised to use exercise to facilirate her Delivery, it must ever be understood to be very mode­rate. A VVoman with Child ought to abstain from the embraces of her Husband, the two last Months before her Term, because in these Caresses, there is a great Agitation of the Body and Compression of the Belly, which often oc­casions a wrong Posture of the Child. A VVoman with Child ought to have a presence of Mind, and to be pre­pared against all Surprizes which may happen, as Claps of Thunder, Firing of Canon, and other sudden Noises, which Resolution is difficult to be obtained.

VVomen with Child are subject to a Constriction of the Belly, because the Foetus presses on the Rectum, and hinders a free discharge of the Excrements; besides there is usually in VVomen with Child a certain Heat of the Bowels, which disposes them to Costiveness. Let a VVoman who is subject to this inconvenience eat Boyl'd Apples, Stew'd Prunes, New Figgs, Mulberries, Honey with Bread, Rye Bread, Veal Broth, &c. and take a Clyster of Warm Water frequently to humect and relax the Gut. Let her sometimes take clean Cassia ℥ss. or Veal Broth with the Emollient Herbs, and an ounce of the best Honey. If these innocent Remedies are not suffici­ent, give her mild Clysters made of a Decoction of Mallows, Marsh-mallows, Pellitory, and Anise-seeds, with two Ounces of brown Sugar dissolved in it, adding a little Oyl, or a De­coction of Bran, adding Honey of Roses with a piece of fresh Butter, or any other thing as occasion requires. But here be cautious not to give sharp Clysters, or any thing which may excite a Diarrh [...]ea, and cause too great an Evacuati­on [...] because this will endanger an Abortion.

She must moderate her Passions, especially Anger and Jealousie; and care must be taken not to Surprize her with Fear, or the Relation of any Accident which may affect her with extraordinary Grief. These Passions put the Spi­rits into a Disorder, and often cause VVomen to fall in La­bour at that very instant.

VVhen a VVoman finds or suspects her self to be with Child, she must not as that Sex usually do's w [...] Bodies with VVhale-bone, for these hurt the Breast, and compress the Belly, and often causes the Children to come before their time, and sometimes mis-shapen. These Nice I adies out of affectation of shewing a good shape, spoil their Belly, which after they are laid is full of VVrinkles, because the Skin not having liberty to extend it self on all sides, forces its way [Page 215]towards the Thighs, where being exceedingly stretched, it can never after regain its pristine State, but hangs down like a Purse, and this Folly sometimes causes them to have Rup­tures. For this reason Big-bellied VVomen must have their Clothes loose without Buskins which compress the Bel­ly, and the Foetus in it. In the last place they must never bath for fear the VVomb open, and an Abortion ensue.

A VVoman with Child if occasion require may Bleed, but the Evacuation must be small, and there is no great re­gard to be had to the time, provided the quantity by not too large.

Of Vomiting in Women with Child.

A VVoman has most commonly an inclination to Vomit in the beginning of her Pregnancy, and at such times there is no great apprehensions; but if this continue it weakens the Stomach exceedingly, and it is more apt to corrupt, than digest the Food. These Vomitings continue till the third or fourth Month, which is the time the Child stirs most. After that time VVomen usually begin to regain that Appetite which they had lost the first Months, and this seems necessary, because the Child growing greater, requires a larger supply of Nourishment. Sometimes the Vomiting persists, and then the VVoman is in great danger of Mis­carrying, because these Commotions throw the Foetus lodg­ed in the VVomb downwards. Some Women are more af­flicted with this Accident in the latter Months, than in the first, because the Stomach is compressed by the distention of the VVomb. This Vomiting when it happens to VVomen whose Children lie high, do's not cease till their Deli­very.

You need not be concerned if a VVoman Vomits in her first going with Child, if this be not attended with any ex­traordinary straining, but if it persist after the fourth Month, some Remedy must be used; because the Foetus growing large, requires Nourishment as well as the Mother, and must necessarily be deprived of it, if she continues to cast it up, besides the commotion of the Body endangers an A­bortion, or a Descent of the VVomb.

This Vomiting cannot be stopt of a sudden, but must be abated and checked by degrees, by taking good Sustenance, and eating but a little at a time, because the Stomach be­ing repell'd by the VVomb, the Meat regurgitates. To this [Page 216]end let the Patient make her Meat palatable with Juyce of Oranges, Limons, Pomgranats, or a little Verjuice or Vi­negar, as her Appetite serves. She may take often a De­coction made of Flower of Barley, first baked a little in an Oven, and then mixed with Yelks of Eggs, to make it more Nourishing and easie of Digestion. She may likewise eat after her Meals, a little Marmelade of Quinces, or Jelly of Goosberries, and drink some old Red Wine mixt with Spring Water, or in want of that clear River Water with Iron quencht in it. Let her refrain from all fat Meats, which are apt to relax the Stomach and excite Vomiting, and so do all things which are sweet and prepared with Sugar. Let her give a grateful sharpness to whatever she eats, for all sharp things are Astringent, and preserve the Tone of the Stomach. A Spoonful of Aqua-vitae▪ or a Glass of Sack now and then, is very proper to take of Nausea's and Vomiting.

If Vomitings continue after a Woman is gone half her time, have Recourse to m [...]ld purges, as Sena, ʒi. Rhubarb, ʒss., and Syrup of Succory, ℥i. This is a good Medicine to attenuate and carry off the tenacious Humours lodged in the Stomach and Guts, or purge her with Manna, Cassia, Tamarinds, and such like Lenitives, never omitting a little Rhubarb and Com­pound Syrup of Succory. But a VVoman under these Circum­stances, must never use violent Medicines, as Antimony, Hel­lebore, or Scammony, for fear of an Abortion.

If notwithstanding the Woman continues to Vomit, it is best to leave the cure to Nature for fear of an Abortion, which will infallibly follow when she is seized with the Hic­cough.

Note here it is convenient to Bleed in these cases before purging, interposing some small interval of time between these Evacuations, for fear of putting the Blood into too great a Commotion.

The cold Air is a great enemy to VVomen apt to Vo­mit, and therefore they ought to go warm clad, and wear a Lambs Skin on their Breast and Stomach.

Of Pains in the Back, Reins and Hipps of Big-bellied Wo­men.

The Pains of these parts proceed from the distention of the Ligaments of the VVomb, which are inserted in these places. The best Remedy to appease these Pains is Rest, and a Big-bellied VVoman who in straining has distended [Page 217]these Ligaments, ought to lose a little Blood in the Arm, and keep her Bed for some time. If the Pains arise from a bear­ing down of the VVomb on the lower parts, the VVoman must keep her Bed, or at least her Belly must be suspended with a large Swathe till the time of her Delivery.

If there be any extraordinary excretions from the VVomb mixt with Blood during these Pains, there is great danger of Abortion, and it shews the VVomb begins to open. But to avoid being deceived in passing a Judgment in this case, consider well if there be a great Repletion of Blood, or the VVoman be subject to the Gravel, both which are capable of producing this Accident; and if either of these appear to be the cause, let proper Remedies be used, but with great Moderation.

Of Pains in the Breast.

VVhen a VVoman becomes Pregnant, her usual Monthly evacuations ceasing, and she breeding still new Blood it dows to the Breasts, and distending the Vessels there creates great Pain. A Woman at this time must be exceeding care­ful not to hurt these parts which are extremely sensible. She must not go with her Bodies strait laced, for fear of a Con­tasion, which may end in an Inflammation and Abscess. If the Pains of her Breasts continue after the third Month, let her Bleed in the Arm, forbearing all Repellent and Restringent Medicines, let her use a cooling Diet, moderately Nourish­ing, and keep her Body open.

Of Difficulty of Ʋrine.

When the Foetus compresses the upper part of the Blad­der, it necessitates a Woman to make Water every Mo­ment; but if it compresses the Neck, as in the first Months after Conception, it intercepts its Passage. Sometimes the sharp Salts of the Urine pricking the Bladder, stimulate a Woman to make water frequently, and inflame the Bladder, from whence a Suppression of Urine ensues.

If a Woman with Child have a Stone in the Bladder, it is exceeding troublesome, and the Womb pressing the Blad­der on it, creates insupportable Pain, if the Stone be rugged and unequal.

There is a necessity to help this Accident as soon as is pos­sible, because the Woman's straining to make water, forces [Page 218]down the Foetus, and hastens the Birth. If it proceeds from a Compression of the Bladder by the bigness and weight of the Womb, the Woman may in some measure help this by keeping up her Belly with both Hands when she makes water; or suspending it with a Swathe, or which is best of all keep her Bed. If it proceeds from the Acrimony of the Urine, which inflames the Neck of the Bladder, it must be abated by a cool Regimen, and drinking a Ptisan, refraining from Wine. She may use Emulsions Morning and Night made with the Cold Seeds in Barley Water, with a Spoonful or two of Syrup of Violets, or Nymphaea. If this do not a­bate the Inflammation, let her Bleed in the Arm, and fo­ment all the External part of the Neck of the Bladder with warm Milk, or a Decoction of the emollient cooling Herbs, as Mallows, Marsh-mallows, Pellitory, Violet Leaves, with a little Linseed; or inject the same into the Neck of the Bladder, adding to it a little Oyl of Violets or warm Milk; the Woman in the mean time must refrain from Copula­tion.

If these Remedies prove ineffectual, hold up her Belly and introducing a Catheter (being first well Oyled) thro' the Ʋrethra into the Bladder, by this means evacuate it, and if the Suppression return, use the Catheter again, as long as occasion shall require. If this inconvenience continue, let her use the Half-Bath, having an especial care that she be not moved by it; all hot Diureticks endanger an Abortion, and therefore she must shun the use of them.

If the Difficulty of Urine proceed from a Stone of the Bladder, thrust it back with the Catheter if it be large, but if it be small, try to fetch it away with an Extracter, putting the forefinger into the Vagina to keep it steddy, and hindring it from recoyling into the Bladder.

Of a Cough and Difficulty of Breathing.

Women whose Children lie high are subject to a Cough, because the Womb bears up the Diaphragm. A violent Cough is one of the most dangerous Accidents which can be fall a Woman with Child, and must be carefully preven­ted by a regular and cooling Diet, avoiding all sharp and high Seasoned Meats. If it arise from the sharpness of the Lympha, she must refrain from all four things, as Oran­ges, Lemmons, Pomgranats, Vinegar, Verjuice, which are to irritate the Part, and excite a Cough. On the contrary, [Page 219]let her use all such things as temper and sweeten the Blood, as Milk-meats, Decoction of Liquorice, Sugar-candy, Syrup of Violets and Mulberry's, some Spoonfuls of which she may mix with her Ptisan (made of Jujubes, Sebesten, Raisins of the Sun, French Barley, with a little Liquorice,) adding to all these a few Clysters. In the last place, if all these means prove ineffectual, and there appear manifest signs of Repletion, let her Bleed at whatsoever time of her going with Child it be, for moderate Bleeding can never be so dangerous as a continual Cough.

If her Cough proceed from taking cold, let her keep her self warm in her Chamber, and take some Spoonfuls of Syrup of burnt Wine. To make this, ℞. the best Wine half a Pint, Cinnamon grosly powder'd, ʒii. Cloves, n. vi. Sugar double Refined, ℥iv. Put these together in a Silver Por­ringer, and boil them upon a Chasing-dish to the consistence of a Syrup, of which let the Woman take at Night an hour or two after a light Supper, or let her take a little good Rosa Solis. It is requisite the Woman have her Body open, to which end she must sometimes take Clysters, have all her Drink warmed, speak little, and refrain from Copulati­on. If she want Sleep▪ that must be procured by mild Somniferous Juleps, and not by strong Narcoticks, which are dangerous in pregnant Women, and never to be used without pressing necessity.

Some Women bear their Children so high, that they have not liberty to breath, in this case Bleeding is necessary to discharge the Lungs, and make room for their expansion. If this difficulty of Breathing proceed from a Compression of the Diaphragm, the Woman must go loose in her Dress; must eat but a little at a time and often; must refrain from all viscous or windy Meats, as Pease, only feeding on things easie of Digestion, and Laxative; must shun all Melancholy apprehensions, and sadness of Mind; for these Passions are apt to divert the Blood, and determin it to the Heart in so great a quantity, as may endanger a Suffocation.

Of Varicose Swellings, and Pains in the Thighs and Legs.

In the last Months of a Womans going with Child, the Womb being very much distended, compresses by its weight the Iliac Veins; by which the Refluent Blood is hindred in its Ascent, and the Saphena and Crural Veins, together with all the Vessels of the Legs and Thighs, are tumefied by [Page 220]its Regurgitation, and the Blood it self stagnating, causes great Pains and Swellings. These varicose Swellings only admit of a palliative cure during the time of Pregnancy, viz. by laying a compress of Rags, and binding it on the tume­fied Vessels. Let the Roller with which the Part is bound, be about two or three inches broad, and begin to apply it below, ascending to the Varices, which being constringed by this Bandage, are incapable of farther Dilatation, and the Blood hinder'd from staying too long, and corrupting in them, whilst at the same time it finds a passage through the other Vessels, and by consequence the Circulation is not in­tercepted. Let the Woman during this keep her Bed as long as she can, because the Blood ascends to the Head more easily, whilst she is in this Posture, than when standing. If the Varices arise from Repletion, let her Bleed in the Arm. Bleeding in the Varices themselves is condemned by Practitioners; as being an equivalent to Bleeding in the Foot, a thing never to be Practised in Women with Child.

Some Women have only Oedematous Swellings (proceed­ing from abundance of ill juices) which retain the impres­sion of the Finger. These are to be cured by promoting Transpiration, by applying compresses dipt in Aromatick Tinctures, and repeated twice or thrice a Day; for instance, ℞. Rosemary, Bays, Time, Marjoram, Sage and Lavender, ā. one Handful, Provence Roses half a Handful, Balaustians Alum, ā. ℥i. Boil all in three Pints of Red Wine, to the consumption of one third, and then strain it through a Linen Cloth, and keep it for use.

Of the Haemorrhoids.

The Haemorrhoids in Women with Child, arise from the stopping of their Courses, which constrains the Superfluous Blood to seek that way for its discharge; oftentimes they proceed from great straining in going to Stool, Big-bellied Women being for the most part bound.

If the Piles are small and indolent, care must be taken (whether they be within or without the Body) to prevent their encrease by the use of Medicines, proper to hinder and prevent a Fluxion on the Parts, but if they are large and painful, the Pain must be appeased; for so long as that continues, the Fluxion necessarily increases. And therefore if there be an apparent Repletion, let the Woman Bleed to [Page 221]abate and divert the plenitude, let her Diet be Regular, moist and cooling, let her abstain from all high seasoned Meats; and refrain from the embraces of her Husband. If the Piles proceed from her being bound, and the Excrements are hard­ned in the Rectum, which frequently happens in Persons who have been a long time without going to Stool, give her a Clyster of Warm Water, or a Decoction of Mallows, Marsh-Mallows, Pellitory, Violet Leaves, Linseed with Honey and Nenuphar, mixing with it a little Oyl of sweet Almonds, and Fresh Butter, without any sharp Ingredients which will not fail to exasperate them, especially when the Piles are in­ward. To pass in the Pipe with less trouble in giving the Clyster, put the lesser end of a Pullets Gut on it. Let her keep to a cooling Diet, and Repose her self on her Bed till the Fluxion cease, and during this time foment the Piles with Warm Milk from the Cow, or Decoctions of Marsh-mal­lows, Tapsus Barbatus, and Linseed. Oyl of Eggs alone, or Oyls of sweet Almonds, Poppies and Nenuphar beat up with the Yelk of an Egg, for a long time together in a Leaden Mor­tar, are admirable to allay the Pain, and if the Inflammation be very great, a little of Galen's Cerate, mixed with an e­qual quantity of Populeon, may be put in. If the Piles do not go off, and the Swelling do's not abate after the use of these Re­medies, open them with a Lancet if they are hard, or if they are soft apply Leeches, which will serve well enough, and create less Pain.

If the Piles discharge Blood in great quantity, the Life of the Mother and Child are both very much endangered; and therefore to prevent this Mischief, foment well the part with a Decoction of Balaustians, Pomgranate Peels, and Provence Roses in Smiths Water, adding a little Alum; or ap­ply a Cataplasm made of Bole Armoniack, Dragons Blood, Terra Sigillata, and the White of an Egg. Bleeding in the Arm likewise is very proper, to turn the Course of the Blood.

Of a Loosness in Women with Child.

Women with Child are subject to divers sorts of Loos­nesses, all which are apt to make them Miscarry, if they be violent and last for any considerable time; but the worst of this kind is a Dysentery or Bloody Flux, because this is ac­companied with vehement and sharp Pains in the Guts, which cause Throes and great Straining to go to Stool, [Page 222]which often brings the Birth before the due term is accom­plished.

Timely care must be taken in these Fluxes of the Belly to prevent Abortion; and for this end their Nature must be considered; for instance, In a Lientery ensuing on conti­nual Vomiting, which frequently happens, the Woman must abstain from all sorts of unusual Food; must eat nothing but what is Nourishing, and easie of Digestion, and that in small quantity too, that the Stomach may more easily concoct it; she must drink a little Red Wine diluted with Water, in which Iron is first extinguished, instead of her Prisan which is not proper on this occasion, unless she have a high Fever (for except it be high, she need not refrain) and in this case she may take some good Cordial or Restora­tive before and after Meals, as a Spoonful or two of Syrup of Burnt Wine, a little Hippocras or Alicant. She may be­fore Meals eat a little Conserve of Roses, or Marmelade of Quinces, and wear a Lambs-skin on her Stomach, to pre­serve and strengthen its Natural Heat, which is necessary for Digestion. She must not take any purgative Medicine, for these are apt to destroy the Tone of the Stomach, and disable it from performing its Office.

When the Flux is no more than a simple gentle Diarrh [...]ea of no long standing, and the Woman is not much incom­moded or endangered by it, it is sufficient to moderate it without stopping it all at once; but if this Evacuation con­tinues above four or five Days, the Tenacious Humours lodged in the Guts, must be carryed off by some mild Pur­gative, as an Infusion of Rhubarb with Syrup of Succory, or an Ounce of Double Catholicon with Rhubarb.

But if the Loosness continue notwithstanding, and be­come a Dysentery, and she have constantly bloody Stools, great pains in her Bowels, and a Tenesmus, she is in very great danger of Miscarrying. The way to prevent this mischief, is to purge with the Medicines before mentioned, and prevent the breeding of ill Humours in the Bowels by a good Diet. To this end let her eat Veal or Chicken Broth, with the cooling Herbs boiled in it, with a Quince to al­lay the sharpness of the Humours; let her eat Rice boiled in her Broth, or let some New-laid Eggs be beaten in, be­cause these smoothen the inside of the Guts.

A Woman in this condition may drink Chalybeate Waters, with a little Wine if she have no Fever, or if she have, she may take a spoonful of Syrup of Quinces or Pomgranats in a [Page 223]glass of water, and eat a little Marmelade of Quinces, or Conserve of Roses, or some other Restringent and Corrobo­rating things after being well purged. To abate the vio­lent and sharp Pains in the Belly and Rectum, which arise from a discharge of sharp Humours on the Parts, and ex­cite continual Throes endangering an Abortion, give a Cly­ster made of the Decoction of a Calves or Sheeps Head, adding to it two Ounces of Oyl of Violets, or of New Milk, with the Yelks of two New-laid Eggs beat with it, and give the Pa­tient a little Laudanum in the Yelk of an Egg, to cause her to rest quietly. When she has retained these Anodyne Cly­sters as long as she can, next give her detersive ones made of the Decoction of Barley, Mallows and Marsh-mallows, with Honey of Roses, and after these Astringent ones (without Oyl or Honey, which are laxative) beginning with the weakest, as Lettuce or Plantain Water, and after giving stronger made of a Decoction of the Leaves and Roots of Plantain, Tapsus Barbatus, Horsetail, Provence Roses, and Pomgranate Peel boil'd in Smith's Water, adding Terra Sigillata, Dra­gons Blood, ā ʒij. and with this foment the Fundament. Be­fore the use of these Restringents, the Woman must be pur­ged with the Medicines above mentioned, for fear of en­dangering the Life of both the Mother and Child, by a Re­tention of abundance of vitious Humours.

But since Dysenterick Pains frequently proceed from a sharp Humour lodged in the Stomach, and the effect of Clysters do's not extend so high, it is convenient for the Pa­tient to drink half a Porringer of New Milk twice or thrice a Day, and this Remedy has often relieved Pregnant Wo­men in Dysenteries. But the Cow which gives this Milk must not be Heated, have a gross full Body, or have lately Calved, but ought to be sound and fed upon a good Pasture well watered.

Of the Menstrous Flux in Women with Child.

Sometimes Women have their Courses for the first four, nay six Months. When a Woman voids Blood downwards, it must carefully be considered whence it proceeds, and in what manner, whether it be the ordinary Courses, or a Real Flooding. If it be the Courses, the Blood comes a­way at accustomed times, and flows by degrees from the Neck of the Womb, and not from its Bottom, as may be discovered, if trying with a Finger if the Internal Orifice be [Page 224]exactly closed, which could not be if the Blood come from the bottom of the Womb; to all which add, if it be the Courses it will be small in quantity. Sometimes this Evacua­tion of Blood is not Menstrous, and yet must not be thought a Flooding, for if the Woman be full of Blood, and the a­bundance be greater than the Foetus can consume, this Eva­cuation is so far from being hurtful to the Mother or Child, that if the Womb was not discharged of that Superfluous Blood, the Foetus would be suffocated by it. On this occa­sion it is better to bleed moderately, than leave Nature to perform her Work.

If there be no visible Repletion, and [...]ne Courses continue after a Woman is with Child, it proceeds from an extreme fluidity of the Blood, which persisting during the whole time of her going with Child, makes her subject to miscar­ry, or if she escape, her Child will be weak, tender, and unhealthy. To prevent these Accidents, let her Repose her self in her Bed, refrain from all Meats which may heat the Blood; shun Anger, using a cooling Diet, and seeding upon Meats which breed good Blood, and thicken it, such as are good Broths made with Chickens, Necks of Mutton, or Knuckles of Veal, in which may be boiled cooling Pot-herbs, as Purs­lane, Lettuce, &c. New-laid Eggs or Gellies, with Rice and Bar­ley boiled in them are good. She may drink water in which Iron has been quenched, with a little Syrup of Quinces, she must refrain from Copulation, because by heating the Blood, it excites it to flow more. If all these Means are ineffectu­al, and the Flux continues, make a Revulsion by Bleeding in the Arm, if the VVomans strength permit, and apply to the Mothers Belly Compresses dipt in strong Wine, in which a Pomgranate with its Peel, Provence Roses, and a little Cinnamon have been boiled, but the best way is to cor­rect the Mothers Blood.

Of Floodings.

Floodings proceed from the bottom of the Womb with great Pain, and come of a sudden, the Blood runs away in great quantity without intermission, except when some clods seem sometimes to lessen the Flux, or stop it for a time, but soon after it returns with greater violence, and kills both Mother and Child, unless timely prevented.

When this Flooding happens to a Woman who is young with Child, the cause most commonly is some Mole or false [Page 225]Conception, which the Womb labours to expel, and in the ef­fort breaks the Blood-Vessels. In Women who are really with Child, it proceeds from a loosning of the Placenta, whose separation opens the Mouths of the Vessels. This most commonly is occasion'd by some Blow, Slip or Hurt, though sometimes it is caused by the Child twisting himself in the Navel-string, and so drawing the Placenta very strong­ly. This Flooding never ceases till the Woman be deliver­ed, and is more violent and dangerous in proportion to the largeness of the Foetus.

Every Evacuation of Blood do's not require the Wo­man to be Delivered immediately; for sometimes the loss is very small, and may be stopt by keeping her quiet in her Bed, bleeding her and confining her to a good Diet, and the Blood perhaps is only her Courses, or proceeds from some Vessel which opens it self on the outside of the internal Orifice, and keeps the Womb from being exactly closed. In this case it is necessary to try whether the internal Orifice is open on the inside, or whether the Child can be felt across the Membranes, for if so, it is a Demonstrative proof it is a Real Flooding, and the Woman will soon Miscarry.

If the Blood come away in small quantity, and the Eva­cuation do not last long, leave the Delivering the Woman to Nature, provided she have a competent degree of strength, and no dangerous Accidents happen. But if it come away in great abundance, or the Woman have Swoonings or Con­vulsions, it is absolutely necessary to deliver her at whate­ver time it be, whether she have the Pains of Labour or [...] and there is no other way to preserve the Life of the Mother and Child. To this end let the Artist place the Patient on her Back, and anointing his Hand with Fresh Butter or Oyl, by degrees insinuate his Fingers close together into the Womb, and spread them one from the other when they are in the Entry, and dilate it by degrees without violence. When he has his Hand in the Womb, if he finds the Waters are not broke, let him tear the Membranes, and slip his Hand in and fetch away the Child by the Feet, and after that bring away the After-burthen, which do's not adhere very firmly, taking care to leave no clods of Blood behind; for these will cause the Flooding to continue, which otherwise would soon cease.

Since in all great Losses of Blood, great Weakness must necessarily follow, let the Patient be strengthned with good Broths, Gellies, or a little Wine; for Liquid Aliments, have [Page 226]a more prompt effect than Solids. Let her smell to some Spiritous Liquours, as Aqua Vitae, Queen of Hungaries Water, or lay a Toast steept in Wine, in which Cinnamon has been infused, or Bleed her in the Arm if her strength per­mit, and she be not too much exhausted; observing to close the Orifice from time, to time, for the more easie di­verting the current of the Blood, without weakning her too much.

You may try to stop the Flux of Blood by Napkins dipt in Oxycrate made with Plantain Water, applied to the small of the Back, or let the Patient lie on a Mat, and take two or three Ounces of Juyce of Purslane; if all these Remedies are ineffectual, deliver the Woman forthwith, though she be not above three Months gone, leaving nothing in the Womb, and this is the only means to save her Life.

Of the Weight or Bearing down of the Womb.

The Weight and Bearing down of the Womb, hinders a Bigg-bellied Woman in her walking, and causes a Stupor of the Hips and Thighs, Pains in the Groin, a Difficulty of making Water, and discharging the Excrements in the Guts, (because it compresses the Bladder and Rectum, and draws down the Ligaments,) all which Accidents are capable of making a Woman Miscarry. The best Remedy in this case, is to keep her lying a-bed, but if she be not in a conditi­on to do this, let her support her Belly with a large Swathe, to case the Ligaments, which are very much strained, and when she makes water, let her hold up her Belly with both Hands to keep it from pressing on the Sphincter.

If the Neck of the Womb be too much relaxed by the Humidities, let her purge at convenient times, and use a dry Diet, feeding much on Roasted Meats. Let her not go strait laced, for fear of compressing the Womb which bears down too much already.

Of a Dropsie of the Womb.

The Womb is sometimes swoln and distended with wa­ter, which is apt to impose on Midwives, who mistake this Distemper for a Womans being with Child.

Sometimes these Waters are inclos'd in a Cover, and some­times they are in the cavity of the Womb. When they have no Cover, they are often mistaken for a true Big-belly, and [Page 227]this errour remains till the usual Term is compleated. The longer any Woman retains these waters, the more she runs a risque of her Life, and sometimes they grow to so vast a bulk, that some have been found with 30 lb. in their Womb.

To distinguish between this Hydropical Swelling, and a true Great Belly, consider well the Signs of Pregnancy which are delivered above, that having nothing common with this, except a Distention of the Belly, and a Sup­pression of the Courses. In a Dropsie the Woman has her Breasts flaggy, soft and fallen, has no Milk in them, do's not feel the Child stir, perceiving only a Fluctuation of the Water, has a great pain and weight in the Belly, which is more extended in its circumference, and do's not rise to a Point, and the colour of her Face is worse, than when with Child. Barren Women are more subject to this Indis­position, than those who have had Children; and these have the Inner Orifice of the Womb, straiter and thinner than the other.

Dropsies of the Womb sometimes happen in Women who are with Child, and in these cases the Waters are without the Membranes which contain the Child. Sometimes too they are inclosed within the Membranes, and the Woman seems to be big with two or three Children, though she really have but one, and that very weak too. Sometimes abun­dance of these Waters come away two or three Months be­fore Labour, and in this case it is certain they are without the Membranes, for if the waters were broke, the Child of necessity must needs follow.

When this Dropsie happens to a Pregnant Woman, all the Relief she can have is the patient expecting her time of La­bour, and in the mean time using a drying Diet. But if there be nothing besides Waters contained in the Womb, let her use a Half-bath, Diuretick Medicines, and all such things as provoke the Courses, to evacuate them. Farther, let her Bleed in the Foot, and purge with strong Hydra­gogues. The Bourbon Waters are very good, especially if she Bath at the same time she drinks them.

Of Oedematous Swellings in the Lips of the Privities.

Sometimes the Lips of the Privities are so much Swoln, that Women cannot bring their Thighs together, or walk without a great deal of Pain. The Lips are Transparent [Page 228]as in a Hydrocele, which arises from the Waters which di­stend them. It is necessary to discuss this Tumour before the time of a Womans Labour, because it straitens the Passage, and hinders her Delivery. To this end give her a Ptisan made of Roots of Dog-grass and wild Succory, in three Pints of which dissolve a Dram of Chrystal Mineral, or a little Spirit of Salt dulcified; or make some slight Scarifications on the Lips to discharge the Waters. Apply to these Scarifications a little Oyntment of Roses, and Compresses steeped in some Aromatick Wine to strengthen the parts, confining the Wo­man to such a Diet, as may hinder the breeding of more Waters. Scarification with a Lancet, is much better than the Application of Leeches, because the Aperture made by these little Animals is so small, that it closes immediately, and Scarifications may be kept open as long as you think fit, by laying on unctuous Medicines.

These Oedematous Tumours are not very dangerous, when they are without Fever; but when they proceed from an Inflammation attended with a Fever, the VVomb is most commonly affected too, and it proves fatal to the Per­son.

Sometimes there are varicose Swellings on the Lips of the Womb, which causes a troublesom itching. Women who labour under this inconvenience, are Sanguine for the most part, and have their Body bound. To remedy this, let them bleed in the Arm, keep their Body open, refrain from Co­pulation, and use a cooling Diet.

Of the Veneeral Disease in Women with Child.

If a Woman with Child labour under the Venereal Di­stemper, and be in her last Months, she must wait till her Delivery before she attempt a Cure, for fear of dying if she happen to be in a course of Physick at the time of her La­bour. If the Distemper be not far gone, which is to be known by the Accidents, a Palliative cure m [...]st be attempt­ed for the present, using a regular Diet, and gentle purging. But if a Woman be in the first Months of her going with Child, and the Pox be very high, and attended with such Accidents as threaten her with Death, if her cure be deferred for too long a time, let a slight Salivation be raised by in­unction of the upper parts only, as the Hands and Arms; but observe here, you must never in this case give any Mer­curial Preparations by the Mouth, and use the utmost care [Page 229]least the Frictions throw the Patient i nto a Loosness, this by disordering the Womb and exciting Throes, cause an Abortion. Bathing which is sometimes used as a preparative to Mercurial Inunction, must be omitted in this case, but she may use Ptisans to humect and prepare her for a Salivation, by which (if it be prudently managed) she may be very well cured, and notwithstanding retain her Child till its due time.

Of Abortions.

If a Woman be delivered before her seventh Month, it is called an Abortion, but if at any time after the beginning of that, to the beginning of the tenth Month it is called a Birth, because at that time the Child can live, and never before it.

All acute Distempers cause an Abortion, because they kill the Child, and then it can remain no longer in the Womb. Intermitting Fevers sometimes make a Woman Miscarry, by causing a great pain in the Belly, and disorder­ing the Child, which commonly struggles very much in the time of the Fit. There are several Accidents which endan­ger an Abortion, such as are great Vomitings, which by the straining of the parts, compress the Womb, and force it to disburthen it self. Nephritick Pains, Colick and Griping of the Guts, Stranguries when the Woman labours much in making water, Great Loosness with a Tenesmus, abundance of the Courses from the opening of the Womb, excessive Bleeding, Flooding from a loosning of the Placenta, Drop­sie of the Womb; in short, whatever makes a great Agita­tion or Concussion of the Womans Body, as hard Labour, Falls, Leaping, Dancing, Riding, VValking, Loud crying Excessive Laughing, Blows over the Belly, sudden and surprizing Noise upon firing a Cannon or a clap of Thun­der, especially in the younger sort, long Watching which im­pairs the Strength, long Abstinence which weakens both Mother and Child, Stinks and ill Smells, as a Lamp of Oyl extinguished or the fume of Charcoal, the Callosity of the Womb, or its smallness which being comprest by the O­mentum, wants room to dilate it self, for the Reception of the Child, Compression of the Womb by strait lacing the Body to appear well shaped or conceal a big Belly, fre­quent Copulation, especially in the last Months, which opens the Womb. Flegmatick Women subject to the Whites are apt to Miscarry, because the Womb is moist and lax, and [Page 230]the Placenta easily separates. The great abundance of Blood which is carried to the Foetus too plentifully sometimes, suf­focates it. Vehement Rage which puts the Spirits into a great Hurry and Disorder, sudden Fear or the Relation of bad News, often cause a Woman to Miscarry on the Spot. When Children are Monstrous, they never come at their due time. The ill Posture of the Child in the Womb sometimes puts him on strugling, which loosens the Placenta, and opens the Womb. In the last place, Children are sometimes so large, that the Womb is not capacious enough to contain them, or the Mother able to give them Nourishment.

If after any of these Accidents, a Woman have violent Pains in her Belly and Reins, clods of Blood come away from the Womb, and the Waters are broke, it is certain an Abortion is near. If the Woman feel a great Weight in her Belly, and the Child fall as a Ball on which side soever she lie, and stinking Humours come from the Womb, she will Miscarry of a dead Child; especially if the Breasts, which before were hard and full, fall and decay. We have above directed how to prevent these kinds of Abortions, and there­fore shall remit the Reader thither.

A Woman who is subject to Miscarry ought to keep her Bed, use a good Diet, and refrain from Copulation, so soon as she perceives her self with Child, avoiding all Diure­ticks and Aperitives, and all Passions of Mind, go loose in her Dress, wear low-heel'd Shooes, and take care not to stumble. When a Woman with Child happens to receive a­ny hurt, let her keep her Bed, have Compresses steeped in some astringent Wine, applyed to her Belly, and let her be immediately bled in the Arm, without deferring it as usu­ally.

Observe here, that a Woman must never be Delivered, whilst she has a continual Fever on her, for in this case she will die immediately after her Delivery. It is a mistake to think her Cleansings will remove that, on the contrary it en­creases them, and the Cleansings are entirely supprest. And therefore all endeavours must be used to abate the Fever be­fore the Womans Delivery.

How to order a Woman when her Reckoning is up.

When a Womans term is up, she must abstain from all vi­olent exercises, least they cause a Flooding, occasion the Child to take a wrong Posture, or hasten the Birth some days [Page 231]before its time, all which is very prejudicial to the Woman: On the contrary let her walk moderately, repose her self more near the end of her time, than in the beginning of her pregnancy, and let go loose in her Dress. Let her ob­serve a Regular Diet, using Meats which yield good Juy­ces, and are easie of Digestion, rather roasted than boiled, to humect more, and keep her Body open, that so she may not be obliged to take Clysters, which are apt to hasten the Birth. For the eight or ten last days, let her anoint the bearing parts with Oyl of sweet Almonds, and Greases to re­lax and soften them, and open the Passage, especially if it be the first Child, because the parts are straiter. Women who are in years, and never had Children, must have a great care to relax the parts well with Greases, because they are dry, and do not yield so easily, besides the Articulation of the Coccyx or Rump-bone is very firm, and do's not easi­sily give way in Labour.

Women when they are near their time, may not bleed by way of prevention, unless they are subject to Flooding, nor in the seventh Month; because this creates a Disorder in the Body, and puts them in danger of Miscarrying.

Women near their time, ought to be provided with some able Midwife or Artist, whom they must send to as soon as they find any great Pains in their Belly, for some times the least Colick Pain or Gripe flings them into Labour.

How a Woman is to be ordered after her Delivery.

When a Woman is compleatly Delivered, and the Bur­then brought away, a Closure of fine Linen Rags five or six times doubled, must be applied to her Privities, to prevent the cold Air from entring her Body, which would shut the Vessels, and stop the Cleansings, and cause vehement Pain and Griping of the Guts, with an Inflammation of the Womb, a Fever, Pleurisie, and frequently Death it self.

After the entry of the Womb is clos'd, let the Woman who is newly Delivered, be carryed to a Bed provided for the purpose, and covered with Cloths to receive the Clean­sings. But if she be Delivered in her own Bed, which is best, to avoid the trouble of carrying her to another; let the Cloths and other things be removed, which were laid to receive the Waters and Filth in Labour, and let her be placed in a convenient Situation, that so she may take her­rest, [Page 232]and recover the Strength she has lost in Labour. Let her Body be raised for her more easie breathing, and the flowing of her Cleansings, which if they are retained cause great Pains. Let her put down her Thighs and Leggs close to each other, and have a Pillow under her Hams to sup­port them; Lastly, let her lie on the middle of her Back without turning either to one side or another, that so the Womb may resume its natural Situation.

As soon as the Woman is Delivered, give her an Ounce of Oyl of sweet Almonds drawn without Fire, with an equal quantity of Syrup of Maiden Hair to cool her Throat, which is heated with her cries in Labour, and take off her Gripes. However if, the Woman nauseate this Remedy, forbear it, and give her some good Broth as soon as she is a little reco­vered from the Fatigue of her Labour, and leave her to Sleep, suffering no noise to be made in the Chamber, draw­ing the Curcains, shutting the Windows and Doors, not imitating the Practice of some who forbid a Woman to sleep after her Labour; good Repose being the most proper means to recover her Strength, and abate all Accidents which happen.

Of Applications to the Belly and Breasts of a Woman newly Delivered.

As soon as the Womans Bed is fitted, apply to her Pri­vities an Anodyne Cataplasm made of two Ounces of Oyl of sweet Almonds, and two New-laid Eggs, both Whites and Yolks stirred together over warm Embers, to the consistence of a Cataplasm, and spread on a Rag, and laid on mode­rately warm. This Cataplasm is very good to abate the In­flammation of the Parts after hard Labour; when it has lain on three or four Hours, renew it if the Inflammation shall require it; Lastly, make a Decoction of Barley, Lin­seed, Chervil, Agrimony, Marsh-mallows and Violet Leaves, and wash the Lips of the part two or three times a Day, to clear it from Blood and other Filth proceeding from the Cleansings, and to appease the Pain, foment it with Warm Milk Barley and Chervil Waters.

Astringents are not proper till fifteen days after delivery, when the Purgations are come away, and then such as strength­en the parts may be used; as a Decoction of the Roots and Leaves of Plantane and Provence Roses, in Smith's Water. Af­ter the Cleansings are entirely over, which is about the space [Page 233]of three Weeks, to corroborate and close the parts, Water of Myrrh or an Astringent Lotion may be injected, v. g. ℞. Pomgranate Peels, 4. p. Cypress Nuts, ℥iss. Acorns, ℥i. Terra Sigillata, ℥ss. Provence Roses, ℥i. Roch Alum, ʒij. In­fuse all for the space of a Night in half a Pint of strong Red Wine alone, or diluted with Smith's Water if it be thought too sharp; or boil till it be reduced to a Pint; strain it through a Linen Cloth and express it, and with this foment the Part well Morning and Night.

As soon as a Woman is delivered, let the Skins of some Animal be laid on her Belly to keep it warm. If her La­bour has been very hard, let her be very gently Swathed, because her Belly is very sore; nor must these be straitned till her Cleansings are all over. Some Midwives and Nurse­keepers lay a Compress doubled on the Belly, and another large square one over that, and keep these on with a Nap­kin in three or four Folds, of a quarter of an Ell broad, and so straiten and compress the Belly, but these do only bruise and hurt it. It is better to lay a great square Compress on the Belly for the first fifteen days, to keep it in its right po­sition, undoing this Bandage several times a Day to anoint the Belly (if it be sore, and she be griped) with Oyl of sweet Almonds, which is better than all the Pomatums in the World. When that time is over, you may straiten the Bel­ly and bring the parts together, in which you have nothing to fear, because the Cleansings being finished, the Womb is diminished in its bulk, and there is no great danger of hurt­ing it, provided it be moderately strait, for if it be too strait the Womb is thrust down, and the Woman suffers great in­convenience by that means, and the Flux causes her Belly to remain big for a long time after.

If the Woman intends to suckle her Child, let her Breasts be covered with fine soft Cloths, to prevent the Milk from curdling in them. If the Milk flow in great abundance to the Breast, embrocate them with a mixture of Oyl and Vine­gar, and apply Rags dipt in it to them.

What Diet a Woman ought to observe during the time of her lying in.

A Woman newly delivered, must observe the same Diet as Persons in a Fever to prevent it. She must be very regu­lar and abstemious the three or four first days, taking only some Veal or Chicken-broth, New-laid Eggs, or some good Golly, refraining from all solid Meats.

When the abundance of Milk is over, she may be permit­ted to eat a little Broth at Dinner, or a little boil'd or roast­ed Chicken, by degrees encreasing the quantity of her Meat, which always must be easie of Digestion; Let her ordinary Drink be a Ptisan made with Dogs-Grass, Barley and Liquo­rice, or boyl'd Water, which she must not drink cold; she may drink a little White-wine diluted with Water, after the first five or six Days.

Women us'd to hard Labour, require more plentiful Nou­rishment than others; and it is sufficient for these to lessen the quantity of their ordinary Food.

Let the Woman keep her Bed and rest her self well, not disturbing her Mind with the concerns of her Family, and avoid all Talking, let her Body be kept open with Clysters, giving her at least one Ounce in two Days, and let her be careful to order her self in this manner, till her Cleansings are over. In the last place to finish all, and purge off the remaining impurities, let her take Cassia with the purgative Syrups, and bath and cleanse her Body to receive the Embra­ces of her Husband.

How to dry up the Milk.

If a Woman do's not intend to suckle her Child, apply to her Breasts a Mixture of Oyl and Vinegar, or Oyntment of Populeum and Galen's Cerate all spread on Rags or Brown Paper, or a Rag dipt in Warm Verjuyce, with a little Alum dissolved in it to make it more astringent, or the Lees of Wine, either by it self or mixed with Oyl. All these are re­pellents, and hinder the Humours which breed Milk from flowing too plentifully to the Breast.

To discuss and dissipate the Milk which is already gather­ed in the Breasts, apply a Cataplasm made of the four Meals (viz. Barley, Fenugreek, Linseed and Fitches) Honey and Saffron boiled with a Decoction of Chervil and Sage, or make a Cataplasm of Honey alone, or rub the Breasts with it, and lay on them Leaves of red Cabbage, having first cut off the great Ribs, and deadned them before the Fire. Or make a Decoction of Box-leaves and Sage in Urine, and fo­ment the Breasts with this, and let Rags dipt in it be appli­ed to them. In the Application of these Remedies, great care must be taken that the Woman do not take Cold, as likewise of inflaming the Breast for fear of an Apostem; wherefore Remedies must be changed as Symptoms alter. [Page 235]One good way to prevent the breeding of Milk in the Breast, is Purging, and keeping the Body soluble with Clysters. Much stirring of the Arms is apt to create a Pain in the Breast, and therefore the Woman must use them as little as possible.

About three Weeks after a Womans delivery, when the Milk is entirely gone off, Astringent Medicines may be used to strengthen the Breasts. To this end apply to the Breasts Cloths dipt in Myrrh Water, or anoint them with Oyl of Wallnuts, being careful not to cause hard and painful Swellings by the use of Astringent Medicines.

Of Flooding in Women newly Delivered.

When the Burthen is great the Vessels most commonly are very large, and if it be brought away with violence, a great Flooding follows. This Flux of Blood happens like­wise, when any Part of the Burthen remains behind in the Womb, or there is any false Conception in it; for Nature striving with its utmost efforts to expel any extraneous Body, breaks the Vessels, and pours a Torrent of blood out of them. Sometimes Serosities only flow from the Womb, and the Standers by are inclined to believe the Flooding is stopt, when indeed the Mouths of the Vessels are only blockt up by clods of blood; after the removing which the Flooding returns, and is often more vehement than before.

Flooding is the most dangerous of all the Accidents which befall Child-bearing VVomen, and the Blood some­times comes away in such large quantities, that there is no time to remedy it, and the Woman dies upon the Spot. If it proceed from some portion of the Burthen retain'd in the Womb or Clods of blood, or some false Conception, all en­deavours must be used instantly to bring away those extra­neous Bodies, but if after they are removed, the Blood do's notwithstanding continue to flow, bleed the Woman in the Arm if she have strength to support it, and whilst she bleeds stop the Orifice from time to time, and let her lie along (that is with her Head not too high) and keep her self still, that by this means the Blood may flow in less proportion to the lower parts, and a sufficient diversion be made without too much weakning the Patient. Her Belly must not be straitned with any Swathe or Compress, for all Bandages are hurtful, if the Belly be sore. Instead of this, let the Air of her Chamber be kept cool, and cover her lightly for fear of heating the Blood, and putting it into a Ferment, (and [Page 236]so encreasing the Flux) and give her some strong Clyster.

If in spite of all these Remedies the Flooding do's not cease, lay her upon fresh Straw with a single Cloth on it, and apply to her Loins Napkins dipt in cold Oxycrate, or if it be Winter a little warm'd. Let her take a little Juyce of Purslain alone, or mixt with her Broths, or make Injections of Plantane-Water. Some pretend that a Girdle of Knot-grass put about the Wast, stops all Fluxes of Blood:

Every half Hour to recruit her Strength, she may take a little strong Broth, or some spoonfuls of Gelly, or Yelks of New-laid Eggs at convenient distances of time, not eating too much at a time, for fear of overcharging her Stomach. Let her Drink be Red Wine diluted with a little Water, in which Iron has been extinguished, and let Cloths dipt in Aroma­tick Tinctures, or in defect of these in burnt Wine, be ap­plied to the Region of the Heart.

When the Flux of Blood begins to stop, and the Woman is a little recovered from her Weakness, let her use a Ptisan made of Burnet and Barley for her ordinary Drink. If these Remedies have not their due effect, the Patients Life is in great Hazard, and if she escape, you must expect in a few days a Violent Pain in the Head, with a continual Fever attended with cold and hot Fits, and this sometimes is inter­mitting. Women who recover after violent Floodings, have their Leggs ordinarily Swoln for some Months after, because the new Blood must of necessity be serous, and cannot re­cover its due Consistence in a considerable time. The first Courses which come after Flooding are very plentiful, and in greater quantity than usual, which makes the Woman fear the Flooding is returned; but this proceeds only from the Largeness of the Blood-Vessels, is not dangerous, and re­quires no other Remedy than Rest, and refraining from Co­pulation.

Of the falling out of the Womb after Delivery.

When there is a falling out of the Womb, the Woman feels a great weight at the bottom of her Belly, great diffi­culty in making Water, a Pain in her Reins and Back, and a Reddish Water comes away from the Neck of the Womb, which is relaxed and hangs out.

To remedy this indisposition, let the Neck of the Womb be forthwith reduced to its Natural place, and if the Wo­man be young, and the Disease be recent, she may be cured, [Page 237]but if it be of long standing, the Cure will be difficult to perform. If the Womb come quite forth upon a Womans delivery, and be not immediately reduced, her life is in very great danger. When this happens, the Artist must have a care not to mistake that large portion of Flesh which hangs between the Thighs for some extraneous Body, it be­ing the Neck of the Womb it self, which has lost its Ru­gosities by its Relaxation. If he draws this, there is great Danger of causing a Flooding, and killing the Pati­ent.

For the curing of this Disease, it is necessary to reduce the Womb to its Natural place, and retain it there. To do this let the Woman make Water, having first to facilitate the Work given her Clysters to evacuate the gross Excre­ments in the Rectum, then let her lie on her back with her Hips raised higher than her Head, and foment with Milk or Wine luke-warm, that which hangs out between her Thighs, and take the Neck of the Womb with a soft Rag, and reduce it to its Natural place, thrusting it with the Hand sometimes on one side, sometimes on the other. If the Neck of the Womb be so large that it cannot enter, a­noint it with Oyl of sweet Almond, to put it up the more ca­sily; and when it is reduced, wipe of the Oyl for fear it relax the part, and occasion its falling out again. If the Womb cannot be reduced, there is great danger of its gan­grening, and killing the Woman.

When the Womb is replaced, let the Woman be laid on her back, with her Hips a little raised, and her Legs crossed, and her Thighs close to each other, for fear of its falling out again, and put a Pessary into the Neck of the Womb to keep it there. These Pessaries are made of a thick piece of Cork covered with white wax to preserve them from rot­ting, and keep them from hurting the Neck of the Womb, and may be drawn out from time to time to cleanse them; The Reader will find the Figure of them in the Plates an­nexed at the end.

Whilst the Cleansings continue, there is no other way to strengthen the Womb, and keep it in its proper place, but by Pessaries, for Astringent Medicines suppress those pur­gations, and are of dangerous consequence, and compres­sing the Belly by Swathing it, forces the Womb still down. Let the Patient have the Pan given her in Bed, and in void­ing her Excrements, let her lay her Hand before to keep the Womb from falling out. When the Cleansings are over, [Page 238]Astringent Injections may be used, and the Pessary covered with Medicines of the like Nature, and the Woman be purged if occasion require. If she be newly delivered, she must not rise from her Bed in six or seven Weeks, during which time she must refrain from the Embraces of her Hus­band.

Of the falling out of the Fundament.

When the vehement straining of a Woman in her La­bour, has occasioned the falling out of the Fundament, if the Child be advanced in the Passage, advise her not to help her Throes so much, and defer the Reduction till after the Birth, because it cannot be done before without bruising the Gut. But so soon as she is delivered, reduce it in the same man­ner, and observing the same Cautions as in the falling out of the Womb. But omit on this occasion giving of Cly­sters, because they are apt to excite a straining to go to stool, and endanger a Relapse.

Of the Hemorrhoids.

Women are commonly troubled with the Piles during their lying in. To prevent this inconvenience, let them sit with their Fundament in a Bason full of Warm Water, for a quarter of an Hour at a time, or foment the Piles with Warm Milk, for the first Days, or Oyl of Eggs beat in a Leaden Mortar, either alone or mixed with Oyl of Popule­on, being careful to put in no Ingredients which may irri­tate them. By procuring a good Evacuation of the Lochia from the Womb, this Pain abates of consequence.

Leeches applied to the Piles in any of the first days, are apt to divert the due Evacuation of the Cleansings, and bring a Fluxion on the Piles, and for this reason if used, must be deferred till eight Days or more after Deli­very.

Of Contusions and Rents in the External parts of the Privi­ties.

The great Dilatation of the Privities which is made by the Child in making its way out, cannot fail of sometimes making Contusions and Lacerations, and if these Accidents are neglected, they degenerate into malignant Ulcers, by [Page 239]reason of the continual Heat and Filth of that Part. If there be only simple Contusions or Excoriations, there is nothing farther necessary than the applying a Cataplasm made of the Yelks and Whites of New-laid Eggs, with Oyl of sweet Almonds seethed over warm Embers, and stirred till they unite. Let this Cataplasm be spread on fine Stupes or Rags, and ap­plied warm, leaving it on for the space of five or six Hours. Next lay Rags dipt in Oyl of St. Johns wort on the Excoria­ted Lips, renewing them twice or thrice a day, bathing the parts each time with Barley Water, and Honey of Roses, &c. to cleanse them from the Excrements which come from the Womb. When the Patient makes Water, cover the Lips of the Privities with fine Rags, to prevent them from being ex­coriated by the sharpness of the Urine. If these excoria­tions are painful, the best Remedy is Oyl of Walnuts drawn without Fire.

Sometimes Midwives do so much violence to the Bear­ing part, that it is very much inflamed, and a great Abscess formed in it; when this happens, it is necessary to give vent to the Matter, and after that is discharged, to inject some vulnerary Decoction made of Barley Water and Honey into the Cavity, with a little Honey of Roses, and Spirit of Wine, and so treat it in the same manner, as all ordinary Ul­cers.

Sometimes the Perineum happens to be rent quite down to the Fundament in the Birth, so that the Anus and Privi­ties make but one common Hole. If this were left in this State, the Woman would be delivered with more ease of her next Child; but notwithstanding it is better to reunite the parts as soon as may be, because the Excrements com­ing that way disgust the Husband, and the Woman is by no means fit to receive his Caresses.

Wherefore having cleansed the Part with Red Wine luke­warm, let the Rent be stitched with three or four separate Stitches, according to the length of the Laceration, and take at each Stitch good hold of the Flesh, and then dress it with some Agglutinating Balsam, as Arcaeus Liniment, covering the Wound with Pledgits or Linen Cloths, to prevent the Excrements from falling on it, which would cause a great deal of Pain, and hinder its Coalition, and let the Woman keep her Thighs close till the Cure be perfected.

If she afterwards happen to be with Child, let her take care not to anoint those parts with Greases and Emollient Oyls, for some time before her Labour, that so the Parts giv­ing [Page 240]way in the Birth, may not be torn. A Woman who has once had an Accident of this kind, ought to employ a skillful and dextrous Artist, because in all Labours after, there is very great danger of Laceration, the passage being very much straitned by the Cicatrix.

If the Re-union of the Wound be neglected at first, the Callosity on the edges must be cut off with a pair of Scissars, and it must then be Stitched, as is above directed.

If the Child stop too long in the passage, there is a Re­tention of Urine which creates an Inflammation and Ulcer in the Bladder, which in time becomes a Fistula, and emits the Urine involuntarily. This Fistula when there is a loss of Substance, and great part of the Neck of the Bladder is con­sumed by the Suppuration, is incurable, otherwise it may be healed by due Care and Diligence.

Of Pains hapning to Women after Delivery.

After a Woman is delivered, she ordinarily is troubled with sharp Pains in the Reins, Back, Groins, and sometimes in the Womb, and all over the Belly. These Pains are some­times Continual, and sometimes Intermitting, and proceed from wind in the Guts, or some extraneous Body remain­ing in the Womb after Delivery, which Nature strives to expel with her utmost efforts. Some false Conception, some portion of Burthen, or some Clods of Blood in the Womb, may be the cause of these After-pains, which cease not till they are ejected, and are not like the Wind-Cholick alle­viated by giving of Clysters, but rather exasperated.

Sometimes these Pains proceed from a sudden Suppression of the Cleansings, and then the Womb is distended and in­flamed, the Belly is hard and Swoln, and the Woman is quickly killed by it.

Sometimes these Pains arise from an Excessive Distention of the Ligaments of the Womb, and then they are fixed in the Back, Reins and Groins, the places where these Li­gaments are inserted, and sometimes they reach to the VVomb it self especially when it has suffered much contusion in Labour.

To prevent these Pains arising from Wind, let the Woman take a mixture of Oyl of sweet Almonds, with Syrup of Mai­den Hair. Oyl of Wallnuts is better if the Tast be not too Nauscous These Medicines by their Unctuosity, make way for the Contents of the Guts to slip more easily through [Page 241]them. If the Woman have an aversion to any thing of this Nature, give her some very hot Broth, or half a Glass of Hippocras, provided there be no danger of a Fever. She must keep her Belly warm, must not drink her Ptisan cold, and must lay warm Cloths on her Belly, if her pains be very trouble­some to her, anointing it with Oyl of sweet Almonds, or ap­plying a Pancake of Eggs fryed with Oyl of Wallnuts, taking care not to Swath it too strait. The next morning give her Clysters made of a Decoction of the Emollient Herbs, with a little Linseed boyled in it, adding Honey of Roses and Oyl of sweet Almonds of each three Ounces, or a little fresh Butter, repeating these Clysters as oft as occasion requires. Some Women as soon as they are delivered, drink the Broth of an old Partridge boyl'd with Leeks, others take a Draught of Milk boiled, to which they put five or six Walnuts pounded with a little Sugar, and so strain all hot through a Linen Cloth, but these Remedies are insignifi­cant, if the pains arise from any extraneous Bodies retained in the Womb; for these must necessarily be expelled, and when that is effected, the Pains will cease of their own ac­cord, except the Blood happen to leave any Clods, and if so, these will not fail to produce as sharp Pains as those af­ter Labour.

If the Cleansings which were copious before, happen to be stopt on a fudden, vehement and sharp pains will follow, and care must be taken to procure an Evacuation of them by Clysters, Hot and Aperitive Fomentations applied to the Privities, and Bleeding in the Foot.

As for the Pains in the Back and Groins, which proceed from the great extension of the Ligaments, they are to be removed by Rest, and a Regular way of Living.

Of the Cleansings, and the Signs when they are Good or Bad.

Those Cleansings are good which are Bloody the first days, and after lose that colour, and by degrees become white. Their Consistence ought to be uniform without any concreti­ons or clods, farther they ought to be void of all Acrimony and ill Scent, and come away in a moderate quantity.

They must not continue bloody longer than the first days, otherwise instead of Cleansings, there would be a dangerous Haemorrhage. When they gradually lose their Red Co­lour, and grow White, it is a sign the Vessels begin to close, [Page 242]and when their Consistence is equal without any clods or concreted Matter, it is certain there is no mixture of any Heterogeneous Substance with them; when they have no ill Scent or Acrimony, it is evident there is no Inflammation or Corruption of the Womb; In the last place when they flow moderately, the Superfluities only are discharged, but when they flow in great Quantity, the Woman is exceeding­ly weakned, seized with Convulsions, Swooning Fits, is ex­tremely emaciated, and continues pale for a long time, and her Thighs and Legs swell, and become Hydropick.

Of the Suppression of the Cleansings, and the Accidents which follow thereupon.

When the Cleansings are supprest, the Humours corrupt by their long stay in the VVomb, or cause some Inflamma­tion. If the Cleansings happen to be supprest in the first Day, there ensues an acute Fever, a vehement Pain in the Head, Pains in the Breast, Reins and Back, a Suffocation and an Inflammation, which extends all over the lower Belly, and this becomes distended. Besides this, the Woman finds a great difficulty of Breathing, stoppage at Stomach, palpita­tion of the Heart, Syncopes, Convulsions and Delirium, and these Symptoms frequently prove Mortal to her. If the Sup­pression continues, there is great danger of an Abscess in the VVomb, or perhaps of a Cancer or Aposthumes in the lower Belly, Sciatica's, Lameness, or Inflammations, and Abscesses of the Breasts, according as the Humours take there cour­ses, and these Suppressions are more dangerous by much, than those of the Courses.

A Looseness sometimes is the cause of the Suppression of the Cleansings, and sometimes it proceeds from a disorder of the Spirits caused by violent Fear, Sadness, or Dejection of Mind, Anxiety, or any dismal Apprehension. Great Cold constringes the Vessels, and coagulates the Blood in the Womb, Cold Drink, and Restringent Meats have the same effect, and very much stirring, diffuses the Humours through the whole Body, and hinders their discharge by the VVomb.

To bring the Lochia well down, let the VVoman avoid all perturbations of Mind; let her lie in her Bed with her Head and Breast a little raised, (keeping her self very quiet, that so the Humours may be more easily carried downwards) let her observe a good Diet, something hot and moist; let her rather use boil'd Meats than Roasted, and if she be any [Page 243]thing Feverish, drink Broths only with a little Jelly, avoid­ing all binding things, and let her Ptisan be made with Ape­ritives, such as Roots of Succory, Dogs-grass and Asparagus, with a little Anise-seed and Hops, and every other time let her take a little Syrup of Maiden-Hair in a Glass of the Ptisan, and carefully shun Cold Drink. Let Clysters be giv­en her, and her lower parts fomented with an Emollient and Aperitive Decoction made of Mallows, Marsh-Mallows, Pel­litory of the Wall, Camomil, Melilot, Roots of Asparagus and Linseed, with which Decoction the Womb may likewise be injected, and with the remaining Herbs let a Cataplasm be made, adding a little Oyl of Lilies or Hogs-grease, and apply this very hot to the Belly. Besides this, let her Thighs and Legs be strongly rubbed down, bathing them with the same Emollient Decoction very hot. But here bleeding must by no means be forgot, and if the VVo­man be very Sanguine, first bleed her in the Arm, and af­ter when the Symptoms are abated in the Foot.

Of the Inflammation of the Womb after Delivery.

Very often the stopping of the Lochia, do's cause an In­flammation of the VVomb, and is the Death of most VVo­men to whom it happens. Sometimes this Inflammation ari­ses from some Hurt or Bruise.

An Inflammation of the VVomb may be known, by be­ing much more swelled after Labour than is requisite, the VVoman feels a very great Heaviness in the bottom of her Belly, and that is sweeled and blown up almost as big as before Delivery, she has a difficulty in making wa­ter, and going to stool, or she perceives her pain encrease in voiding her Excrements (because the VVomb presses the Rectum, and by its Proximity, communicates the Inflamma­tion, as well as to the Bladder) to which add, that in this case there is a high Fever, and great difficulty of Breathing, and a Hiccough, Vomitings, Convulsion, and Death soon follows if not timely prevented.

Contusions of the VVomb often cause Abscesses and Schirrous Swellings, which continue for a long time, and sometimes end in incurable Cancers.

As soon as the VVomb appears to be inflamed, extract or procure the expulsion of all extraneous Bodies, which may happen to be lodged in it, without doing the least violence to it for fear of exasperating the Malady; correct the Hu­mours [Page 244]by a cooling Diet, and let the Patient use Food that Nourishes little, drinking only Broth (but not too strong) made of Veal and Pullets, with the cooling Herbs, such as Lettuce, Purslane, Succory, Borage, Sorrel, or the like; let her abstain from Wine, and drink a Ptisan made of the Roots of Succory, Dogs-grass, Barley and Liquorish; let her keep her self very quiet in her Bed, and not be Swathed too strait; let her Body be kept open with simple Anodyne Clysters, without the least sharpness, for fear of causing Throes, which extremely pain the inflamed part, and of all Passions of the Mind, let her especially avoid Anger.

The Redundancy of the Humours may be evacuated, and diverted by bleeding; first in the Arm, and after in the Foot if there be occasion. It is convenient to cover the Belly with Galen's Emplaster to cool it, or embrocate it with Oyl of sweet Almonds mixt with a little Vinegar. In­jections may likewise be made into the Womb, but these must be cooling only, without the least Astringency, (such as are made of Barley Water, with Oyl of Violets, or warm Milk are very proper) observing to use nothing which is ex­cessively cold, avoiding all sorts of Diureticks, and keeping the middle way in the Cure, for fear of Inflaming the Womb by the use of hot things, which provoke the Flux. Bleeding is good for the making an Evacuation, without any of these consequences. But observe here, all Purges how mild soever, are hurtful in this Case, as well as in all In­flammations and Fluxions on the Womb, even the least that can happen.

Sometimes an Inflammation of the Womb is converted into an Aposthume, which yields a great quantity of Matter, in this case you must be contented with a good Regimen and Detergent Injections to carry off the Pus, and for this purpose you may make use of a Decoction of Agrimony with Honey, or Syrup of Wormwood, adding (if the Corrupti­on be great) a little Spirit of Wine.

If the Aposthume degenerate into a Cancerous Ulcer, it will only admit of a Palliative Cure.

Of Schirrosities of the Womb.

Schirrhous Swellings frequently proceed from the applica­tion of Cold and Restringent Medicines to the VVomans Belly, or injecting something of that kind into the Womb.

If the internal Orifice only is Schirrhous, the VVomb is not larger than the common size; but if the whole Body of it be affected, it is exceedingly tumefied, and this often happens upon an Inflammation after Labour, or upon some disorder or suppression of the Courses. For the more cer­tain knowing there is a Schirrosity in the Womb, lay your Hand on the Womans Belly, or introduce your Finger into the Womb, and you will find it big with an extraordinary hardness. The inner Orifice is larger, harder, shorter, and more unequal, than it ought if there be no Inflammation, or the Schirrus be not disposed to Cancerate, it is indolent, but if it be inclined to either of these, the Pain is very great.

If the Womb be Schirrous, the Woman finds a great Las­situde, a Weight at the bottom of her Belly, feels Pains in her Reins, Groins and Hips, and has a frequent Motion to make Water, and these Pains increase when she makes an effort to void her Excrements, because the Womb com­presses the Rectum and the Bladder by its Weight. The Courses are entirely supprest, or in very small quantity, or irre­gular, which is occasioned by the Obstruction of the Part.

The best way to begin the Cure, is by bleeding in the Arm, and gentle Purging, for violent Purging in this case is hurtful, and exasperates the Disease, Emollient Oyls, Grea­ses and Cataplasins applied to the Belly, and emollient In­jections into the Womb are serviceable, after which the Pa­tient may use the Whole or Half-bath. After she has for se­veral days been treated in this manner, let her bleed in the Foot, refrain from Copulation, and observe a cooling Diet to allay the Heat of the Blood. Thin Milk, especially that of Asses is good in this Distemper, but the drinking the Mi­neral Waters, is yet better.

Of a Cancer of the Womb.

This is commonly the consequence of a Schirrosity, In­flammation or Aposthume, after Labour. Ill conditioned Whites, and virulent Gonorrhoeas of long standing, con­duce very much to this, by the erosion of the Womb.

It sometimes happens to Women upon a cessation of their Courses, because the Vessels being stopt by degrees, the blood brought to the Womb, stagnates, corrupts and ulce­rates the substance of the Part, which soon becomes Cance­rous.

When a Woman has a Cancer in the Womb, she feels a pricking pain, and a heaviness which is caused by the sharp­ness of the Humours, and the bearing down of the Womb. This Pain extends to the Reins and Groins, and the Patient feels a great Weight at the bottom of her Belly, and a ge­neral Lassitude of the whole Body; she has a difficulty of Urine, and a Serous, Faetid, Virulent, Blackish Gleet comes from the Womb. Sometimes the Blood comes away whol­ly fluid, and sometimes it is concreted. When the Ulcera­tion is in the inner Orifice of the Womb, it may be per­ceived by the Finger, or may be seen by the help of the Speculum Matricis; but if it be in the bottom, there is no way to know it but by the condition of the Matter which comes from it, and by the Symptoms above mentioned. These Ulcers are very unequal, Sordid and Stinking, and the Corruption is sometimes so great, as to breed Worms.

Cancers of the Womb are incurable, and only admit of Palliating Remedies, which abate the violence of the Pains. The Patient must not take any thing sharp, either inwardly or outwardly, for fear of increasing the Disease and Pain, and hastning her End.

Women who have a Schirrhus or Apostem in their Wombs, or who are subject to Flooding, or have a Cessation of their Courses, especially when they are advanced in years, are most of all subject to Cancers. Such Persons as are threatned with this Disease, upon the account of the ceasing of their Courses, have no better Expedient than to bleed in the Arm at convenient times, to supply the defect of that Evacuation, and by this means prevent too great a Redundancy of Blood and Humours in the Womb; and this they ought to do for several years together, till those Vessels which convey­ed the Blood are very much diminished. If such a Wo­man has been very subject to frequent Haemorrhages, let her refrain from Copulation, because this Action brings Blood into the part; Let her observe a cool and moist Diet, and shun all Aperitive, Diuretick or Violent purging Me­dicines; Let her drink new Milk from the Cow to sweeten the Blood, and frequently drink Broths made of Pullets, whose Bellies were first stuffed with the cold Seeds. The Cow whose Milk she drinks must be sound and not overheat­ed, fed with good Pasture, and one who has not lately Calved; for all Errours of this kind are dangerous.

Of a Loosness hapning to a Woman newly laid.

A Loosness when it happens to a Woman soon after her Delivery is dangerous, because it diverts the Cleansings from flowing to the Womb, and by this means often proves fatal to the Patient. That which makes this case dangerous, is, that Remedies proper to stay the Flux, such as Astringents and Purgatives, are not to be admitted of, especially at first. In this case therefore give the Patient strong Broaths to strengthen her, and abate the Flux, give her Anodyne Cly­sters made of a simple Decoction of Bran, or the cooling Plants either alone, or with the addition of Milk, or the Yelks of Eggs to abate the Pain, or let her take some grains of Laudanum in the Yelk of an Egg. If the Loosness be accompanied with a Fever, let her bleed. However, if there be a visible Danger of the Womans losing her Life by the continuing of the Flux, use all common Remedies in this case, without the least Scruple, and when that is stopt, at­tempt to procure an evacuation of the Cleansings, which for a time were suppressed.

Of Ruptures of the Belly in Women with Child.

The Womb sometimes is distended to so large a size, that it breaks through the Peritoneum, and causes Ruptures so large, as to contain the Womb and Child in it. These Ruptures sometimes happen above and below the Navel, be­tween the Musculi Recti, in the Navel it self, and in the Groins, which are the weakest parts of the Belly. They commonly proceed from great Straining of a VVo­man in Labour, or vehement Vomitings, or violent and frequent Sneezing, or some accidental blow on the Belly. This Disease causes want of Digestion, Vomiting and se­vere Cholick pains, and often when the Gut which is fal­len cannot re-enter, Death is the Consequence, or at least there is a necessity of making an Incision into the Belly, as in a Bubonocele.

To avoid Accidents of this Nature, the Woman must be forbid to lace her self, or straiten her Belly, that it may have room to extend it self every way. But if she happen to have a Rupture, she must wear a Bandage with Compres­ses adjusted to the Part, to prevent the Guts from intruding themselves into the Swelling. If the Rupture be in a place [Page 248]into which the Womb can insinuate it self, the Woman must have an especial care to prevent this Fatal Accident, by the help of good Bandages, and she would do well to keep her Bed during her being with Child.

Of an Inflammation of the Breasts after Delivery.

If a Woman with Child has received a Blow on her Breasts, or compressed them by lying on them, or has left too great a quantity of Milk in them, without drawing them, an Inflammation will infallibly ensue, which some­times is the cause of Apostems or Schirrosities, which de­generate into Cancers. The Breasts being very sensible when they are inflamed, soon produce a continual Fever with Deliriums.

The best way to prevent an Inflammation of the Breasts, is to procure a good Evacuation of the Cleansings, and if they are supprest to provoke them, that so all the Humours which flowed too plentifully to the Breasts, may take their course downwards. For this purpose bleed her first in the Arm, and then in the Foot. In the mean time Embrocate the Breasts well with a Mixture of Oyl of sweet Almonds, and after that apply Galen's, cooling Emplaster, with a third part of Populeum, or a Cataplasm made of the Setlings found in a Cutlers Grindstone Trough, and Oyl of Roses with a little Vinegar, or if the Pain be violent, make a Cataplasm with the Crumb of White Bread, Milk, Oyl of sweet Almonds, and the Yelks of Eggs, and apply it to the Breasts, and over that lay Compresses dipt in Oxycrate or Plantane Water. But great caution is to be used in Astringent Remedies, least if they be too strong, they occasion a Schirrus, which in time may become Cancerous.

After the Height of the Inflammation is over, let Discu­tients be used to dissipate the Milk, which flows in too great abundance to the Breasts, but the best way in this case, is to draw them by Sucking; for if any great quantity be left in the Breasts, it will necessarily Suppurate. However it is necessary to use discussing Applications first, because Sucking brings Milk into the Breasts. But if the Milk runs off it self leave it, for this is enough to empty them. Milk may be re­solved by applying a Cataplasm of pure Honey to the part, or [...]ubbing them with a red Cabbage Leaf, having first deadned it by the Fire, and taking care not to straiten the Breast. The following Discutient is very good. Take a good Red Cab­bage [Page 249]and boil it in River Water till it be soft, and the VVa­ter evaporated. Pound this in a Wooden or Stone Mortar, and after pass it through a Sieve, adding Honey and Oyl of Camomil, and apply this Cataplasm to the Breasts.

Let the VVoman in the mean time use a cool Diet, not very Nourishing, to prevent breeding too much Chile. Let her keep her Body open, that so the Humours may discharge themselves downwards, while the Inflammation remains; let her lie in Bed on her Back, because when she is up, the Weight of her Breasts increases the Pain. On the fourteenth or fifteenth day after her delivery, when the Cleansings are pretty well come away, and she is free from a Fever, she may be purged as often as seems convenient. If notwith­standing the use of these Remedies the Pain do's not abate, there is reason to believe there is Pus in the Breasts.

Of the Curdling and Clodding of Milk in the Breasts.

About the fourteenth or fifteenth day after Labour, the Milk often is apt to Curdle, and then the Breasts become hard, unequal, and rugged, without any Redness, and all the Glands filled with curdled Milk, may easily be discern­ed; The VVoman finds a great Pain; and cannot Milk them as before, she finds a Shivering in her Back, which seems to be like Ice. This is followed by a Fever of four and twenty Hours continuance, and sometimes less, if the clodding of the Milk do not turn to an Inflammation of the Breast, which will undoubtedly happen, if it be not emptied or dissipated.

This clodding of the Milk, for the most part proceeds from the Breasts not being well drawn, either because she has too much Milk, or the Infant is too weak, or she has no desire to be a Nurse; for the Milk in these cases remaining in the Breast, sours and clods. This Accident may some­times happen from taking Cold, or keeping the Breasts not well cover'd.

The most certain Remedy in this Case, is to draw the Breasts speedily, till they are well evacuated, but because the VVoman is not soft Milcht, and the Child cannot draw them strongly enough, let another Woman draw them till the Milk comes freely, and then she may give the Child Suck; and to the end that she may not afterwards breed more Milk than the Child can draw, let her use a Diet that yields but little Nourishment, and keep her Body o­pen. [Page 250]But when it happens the VVoman neither can nor will be a Nurse, then her Breasts must not be drawn, for fear of attracting more Humours, for the Disease will ever recur, if they be not emptied; wherefore it is necessary to prevent the coming of any more Milk into them, and to resolve and dissipate that which is there. For this purpose the Woman must be bled in the Arm, have strong Clysters given her. Bleeding in the Foot and Purging, are very serviceable in this Case, and to resolve and dissipate the curdled Milk, apply some Cataplasm above recommended, as that of pure Honey, or the four Meals boiled in a Decocti­on of Sage, Mint, Smallage and Fennel, mixing with it Oyl of Chamomil, with which Oyl the Breasts may be well a­nointed. Cloths laid over pots of Salt Butter are very good, after having used all things proper to resolve the concreted Milk.

Of Apostems in the Breasts of a Woman new laid.

If a Woman feels a great Pain, and there be a stronger Pulsation in one place than another, a Hardness, a Livid Co­lour, with a softness in the midst, it is a sign the Breasts will Apostemate.

To suppurate the Apostem, apply on the Breasts an Emol­lient and Ripening Cataplasm made of Mallows, Marsh-mal­lows, with their Roots, Lily Roots and Linseed bruised, and boiled to a Pap, that it may be pulped through a Sieve, and so no hardness may be left to hurt the Breasts, which at that time are in great Pain, after mix a good quantity of Hogs-grease or Basilicon with it, or lay a little Cloth thick spread with the same Basilicon, upon the place where it is likely to break, and the Poultis all over it, renewing it twelve Hours after, or at farthest next day, continuing this Remedy till the Apostem be ripe. Or you may make use of the Emplastrum Divinum, malaxed with Oyl of Lilies; This is preferable to all others of the like Nature, for this purpose. As soon as the Apostem is Ripe, it must be open­ed, if it open not of it self. The time when it is sit, may be known by the ceasing of the beating the Woman felt be­fore in her Breasts, and that the Pain and Fever is very much abated, and then besides the middle of the Apostem is raised to a Point, and very soft, and the contained Matter may by the Finger be perceived to fluctuate. The Apertion must be made with a Lancet, or with a grain or two of some [Page 251]Caustick, making it large enough to evacuate the con­creted Matter. It is best to use the Lancet, because there is no loss of Substance, and the Scar is not so Disfigu­ring. The Orifice must be made in the most commodi­ous place, for the Evacuation of the Matter, taking care that none of the large Vessels near the Arm-pits be opened, After that, all the Matter and putrified clodded Milk is dis­charged, deterge the Apostem after the ordinary manner, observing not to make the Tents too long, or too hard, but of very soft Dossils of Lint, without thrusting them too far in, and fasten a Thread to the first to draw it out, if there be occasion, because these Apostems are most commonly deep. If there be great Pain, dip the Pledgits in Oyl of Eggs, or Basilicon mixt with some Digestive, if there re­main any thing yet to Suppurate; after this deterge the Ul­cer with Honey of Roses, or Ʋnguentum Apostolorum, laying on the Emplast. Divinum, to soften and discuss the remaining hardness.

If there be several Apostems in different places of the Breast, in this case there is no need of laying open every one of these small Holes, but it suffices to make one or two Apertures in some depending part large enough, because the Breasts are Spungy, and these Apostems communicate with each other. But the most prompt Remedy, is to drive the Milk quite back; and for this purpose give the VVoman Clysters, and purge her frequently, confining her to a Diet which is not very Nourishing.

You must not always stay till the Cataplasms break the Abscesses, and sometimes there is a necessity of opening them with a Lancet, because if the Matter Stagnate too long in the Breasts, it will corrode that Glandulous part, and form Sinuosities very difficult to cure.

Of the Excoriation and Loss of the Nipples.

Very often Women that are Nurses, and especially the first time, are subject to have their Nipples excoriated, for the small holes of the Nipples not being sufficiently open­ed, the Child takes more pains to Suck, than when the Breasts do almost run of themselves. Sometimes these Chaps and Excoriations, do so encrease by the Childs continual Sucking, that in the end it quite takes the Nipple off from the Breast, and the VVoman is no longer capable of giv­ing Suck, and there remains an Ulcer very hard to be cured.

This may sometimes happen from Childrens biting and mumping the Nipples, and sometimes their Mouths are so hot, that they make the Nipples sore, as when they have those little Ulcers called Apthae or a Thrush, and much soon­er if they have the Pox, with which they infect their Nur­ses.

These Excoriations if they are neglected, at length be­come very Malignant Ulcers. VVherefore as soon as they begin, let the Woman forbear giving her Child Suck, till they are perfectly cured, and in the mean time drive back the Milk, for fear of an Inflammation, from too great a­bundance of it. If only one Nipple be sore, she may give Suck with the other; to these sore Nipples, Desiccative Me­dicines must be applied, as Alom or Lime-water, or they may only be bathed with Plantane Water, laying on them small soft Rags dipt in those Liquours, or apply an Emplaster of Ceruss or Pompholyx, or Starch; but an especial care must be taken that nothing be applied which may disgust the Child, for which reason many only use Honey of Roses.

To prevent Hurts in these Parts, and hinder the Womans Clothes from cleaving to them, let a little cap of Lead be put on, as well to defend them, as to give Issue to the Sanies, which proceeds from those little Ulcers, or that the Milk which distills from the Breast, may pass that way.

If the Child has sucked off the Nipple, the Milk must then be quite dried away, because otherwise it would be impossible to cure these Ulcers, which in time would become callous and malignant.

If the Child be put to another Nurse, and the Ulcers in its Mouth have no Malignity, tis enough to wash them with Barley Water mixt with a little Juice of Citron, and let the Nurse use a cooling Diet.

When the Nipples are quite lost, the small Holes are clo­sed up by the Ulcers, but if notwithstanding she shall desire to give Suck, another Woman may by degrees make her new Nipples, after the Ulcer shall be perfectly healed, whose Sucking by degrees will draw them out, and by this means unstop the Root of the old Nipples, or if she have no Woman to Suck her, let her use a Glass Instrument, with which she may her self Suck them five or six times a Day, and to shape them and preserve them when they are drawn out, let her put on them a small cap of Wood.

Of the Swelling of the Legs and Thighs, in a Woman newly laid.

If the Swelling be very great, there be an Inflammation, and it proceed from Suppression of the Cleansings; if there be a Fever, difficulty of Breathing, a great Tension and Pain in the Belly, the case is dangerous. If there be but an indifferent Swelling only, without any of the above mentioned Accidents, there is no great difficulty in the Cure.

For this purpose, procure a good Evacuation of the Clean­sings, give the Woman an Aperitive Ptisan, made with the Roots of Fennel, Parsley and Dogs-grass, with a little Chrystal Mineral. Sometimes give her an ounce of Syrup of Maiden Hair in a Glass of the Ptisan, with five or six drops of the dulcified Spirit of Salt, and about half a dram of Sal Poly­chrestum. If she have no Fever, and it be fifteen days after her Delivery, she may be purged.

Of the Suffocation of the Womb after Delivery.

Some VVomen in Hysterick Fits have a high Pulse, others a very low one, as it were sunk in, others have scarce any at all; some became pale and motionless, others have a good colour in their Cheeks, and have several Convulsions, some have not the least appearance of Breath, and others Breath with great Difficulty, and great Heavings of the Breast; some are insensible, without remembring any thing they have done, or said; others never lose their Reason or Judg­ment, some are Gay and Merry, Langhing and Singing, o­thers are Sad and Dejected. Some are attacked with fre­quent Fits, others very seldom. The Fits sometimes last for several Hours or Days, and sometimes are suddenly over. The most ordinary Signs of the Hysterick Passion, are dif­ficulty of breathing, which causes a Suffocation with a great constriction of the Throat, as if the Patient had a Morsel which she could not swallow, and the Throat were griped with a Mans Hand. There is a great VVeakness and Palpi­tation of the Heart, Nausea's, and sometimes a Flux of VVa­ter and Serosities from the Mouth; frequent yawning, some­times is a Fore-runner of the Fit. The VVoman feels a Pulsation of the Arteries in the bottom of her Belly, a leap­ing and contraction of the VVomb, a Rusling of wind in the [Page 254]Stomach and Guts which distends them, and bears up the Di­aphragm, sometimes she is delirious in the Fit, and has Convulsive Motions preceded by a Pain, VVeight, and Dizziness of the Head, Dazling of the Eyes, Drowsiness and Forgetfulness. Sometimes after these Convulsive Motions, she is thrown into a Mortal Apoplexy, or a Palsie of one side, which continues for several years.

To prevent this Distemper, if there be a Suppression of the Cleansings, bring them down by relaxing all the parts round the VVomb, and the Thighs by a half-Bath, by bleeding in the Foot and purging. If it be a Big-bellied VVoman who labours under this Distemper, let her only bleed, and keep her Body open with Clysters. The use of the Mineral VVaters is admirable, to prevent the Hysteri­cal Passion, in case the Patient be not with Child. If the Suffocation proceed from any extraneous Body in the VVomb, extract it, or procure its expulsion by Medicines. Let the Patient avoid all sweet scented things, all Sweet-Meats, or any thing prepared with Sugar, all Melancholy and disturb­ing Passions, and keep her Body open. If she be a Marry­ed VVoman, let her often embrace the privileges of that State if not, let her keep a cooling Diet, using Emulsions and Bathing.

In the Fit which is ordinarily attended with difficulty of Breathing Suffocation, VVeakness, Palpitations of the Heart, it is usual to present to the Patient things which have a very ill Scent, as Partridge Feathers, or Soals of Shooes burnt. Some fling a Dram of lighted Camphire into a pot of VVa­ter, leaving it till it be extinguished, and give this VVater to the Patient to drink, or give two or three drops of Oyl of Amber in a Spoonful of Broath, or Orange-flower Water. But the best way is to unlace the Patients Cloths, and give her a Spoonful or two of Cinnamon-Water or Aqua-vitae; this is a good Cordial, and promptly dissipates the VVindi­ness in the Stomach, which is the cause of these Suffocations. A Spoonful or two of VVine alone is very good. Smelling to Spirit of Wine is better than Vinegar. The scent of burnt Paper, or a Musket Match is very good. If she be with Child, she may not smell too stinking Scents, for fear she Miscarry. If she be not with Child, let her take Sneezing Powders, with Powder of Betony, or Tobacco without Per­fume. You may put a grain or two of Salt into the Patients Mouth, to bring away the VVater and Serosities which slow thither in great abundance.

If any large Evacuations precede the Fit as a great Loos­ness, Flooding, or an immoderate Flux of the VVhites, or a great abundance of the Cleansings, and the VVomans Pulse be low and languid, her Face pale, and her Body cold, you must forbear bleeding; on the contrary, it she have a Flo­rid Colour in her Face, her Pulse be high, and there be a Suppression of the Courses or Cleansings before, and she have Convulsive Motions, I think bleeding is very proper, first in the Arm, and after in the Foot.

Of the Whites.

It is very difficult to distinguish VVhites in VVomen, from virulent Gonorrhoea's. In the VVhites the Matter is whiter, more serous, especially if it be copious, and less foetid than in Gonorrhoea's. On the contrary, in Venereal cases it is more stinking, thick, blackish, yellowish, greenish, and some­times is of a redish Colour, by the mixture of a bloody Se­rosity. VVhen a VVoman has the VVhites, the Courses become irregular; sometimes instead of her Courses, she has a Flux of Blood which becomes serous, and appears like the VVater in which Flesh has been washed; when it is a little abated, after some time some clods of black corrupted blood come away among the putrid Matter. A VVoman who has the VVhites, can lie with her Husband without pain, but she who has an Ulcer cannot. The Matter which comes away in the VVhites, most commonly is VVhite, Se­rous, not unlike VVhey, without any ill Scent, tho' some­times it is yellow, stinks, and by its Acrimony causes a great Smarting of the Parts. It is very difficult to distinguish the VVhites from Gonorrhaea's. VVomen with Child are more subject to this Distemper, which is occasioned by the Suppression of their Courses. Few VVomen are wholly ex­empt from this inconvenience, but at some time or other la­lour under it; but some are much more subject to it than others. Women who have not their Courses regularly, those who are Phlegmatick, have a soft Skin, are pale coloured, or lead a Melancholy Sedentary Life, are most of all subject to the Whites; but young Girls who are not of an Age to have their Courses, never have them. The Whites weaken the Woman, humect and relax the Womb to that degree it cannot contract and close it self, and by consequence cause Barrenness. The Womans Countenance becomes pale, her Legs swell, she loses her Appetite, has Pains in her Back, [Page 256]Weakness, Palpitation of Heart, and Hysterick Fits. If the Whites continue long the Woman is emaciated, and be­comes Hectical; Nay, sometimes such a Relaxation of the Womb ensues, that it becomes Cancerous if neg­lected.

For the Cure of this Distemper, Bleed and Purge the Pa­tient well, and prescribe a good Diet to her; let her go to the Baths, and after drink the Chalybeate Waters, or others of the like Nature. Phlegmatick Women whose Flesh is tender and soft, ought to drink the hot VVaters, as those of Bourbon and Vichy in France [or the Bath in England] or a Sudorifick Decoction made of the Roots of China and Salsa-parilla, taking for a fortnight before, a Glass of a Lax­ative and Diuretick Ptisan made of Maiden Hair, Roots of Dog-grass, Asparagus, Smallage and Fennel, with a Dram of Senna, adding every three days, four or five drops of the dulcified Spirit of Salt, or half a Dram of Sal Polycrestum; and during this time, let her observe a good Diet, refrain­ing from Copulation, and avoiding all Melancholy and De­jection of Mind. The most proper time to begin the use of Medicines, is immediately after the Courses are over. After these Medicines, the Patient may use Astringent Injections made of equal parts of Plantane and Myrrh Water, but she must forbear when the time of the Courses is near, for fear they cause a Suppression; for my part, I would not advise any VVoman to use Styptick Applications, because this part is the common Sink, where all the Filth of the Body is dis­charged.

When the VVhites are very Acrimonious, and cause a smarting of the Parts, Barley-Water or Whey, or simple Wa­ter may be injected three or four times a Day, (except in the time of the Courses,) to allay the Heat and Pain, pre­scribing a good Diet, and between whiles, purging her till the Cure be compleated.

Tho' the Patient may seem to be cured, and the Whites cease, or at least are very much abated, the VVoman must notwithstanding frequently take Medicines, and all her Life observe a good Diet, otherwise she will be in very great dan­ger of a Relapse.

Of Dieting and ordering a New-born Babe.

It is not usual to give a Child Suck, till ten or twelve Hours after its Birth, and then the Nurse must Milk a little [Page 257]into its Mouth and on its Lips to give it a Relish, and when the Child has taken the Breast she must squeeze it till it be accustomed to Suck of its own accord.

If a Nurse have plenty of Milk, give the Child no other Food for the first two Months; but for the first two or three Days, give it but a little at a time, for fear of overcharging its Stomach, and after encrease the quantlty. When the Child is grown a little bigger, you may give it either in the Day or Night, as much as it desires, a little and often, for if it take too much at a time, it vomits it up, the Stomach being too weak to digest it. But if you can govern the Child, it would be better to give it the Breast but once every two Hours, and never in the Night-time, unless when it wants Sleep.

After the Child has been fed the first two or three Months with Breast-Milk only, you may give him a Pap made of Flour and Milk, though but little at first, and not too thick neither lest his Stomach be overcharged. That this may be easier of Digestion, put the Meal in an Earthen Pan into an Oven, as soon as the Bread is drawn, stirring it often to dry it equally. Pap made thus, is much better than the common way; for being made with raw Flour, it is very difficult to boil it well, without consuming the best part of the Milk, leaving the thickest part behind, which by its long boiling loses its goodness. When the Child has taken Pap thus made, which must be but once a day, (especially in the Morning) or twice at most, the Nurse may give it Suck to wash it down into the Stomach, and dilute it there.

If Pap be given to a Child newly Born, as some Women indiscreetly do, it causes Obstructions, Difficulty of Breath­ing, Gripes, Swelling of the Belly, and Convulsions, of all which Death is the Result, and therefore it is best to forbear the three or four first Months, provided the Nurse do not want, Milk.

VVhen the Child has sucked its Fill, let the Nurse lay it to Sleep, not in the same Bed she lies in her self, for fear of over-laying it, but in a Cradle close by her Bed-side, and let her put a Mantle over the Head of the Cradle, to prevent Dust falling on its Face, and the Day-light, Sun-shine, Candle or Fire in the Chamber from offending it; let her lay it to sleep on its Back with its Head a little raised upon a Pillow, and to make it Sleep the sooner, let her rock gently with an equal Motion, without too great shaking; but that she [Page 258]would have him go to sleep, it is best not to use him to it at first. He may sleep at any time in the Day or Night, and ordinarily the better he is the more he sleeps; however if he exceeds in this respect, let his Nurse carry him in her Arms to the Light, sing some little Song to him, shew him some glittering thing, or dance him in her Arms.

VVhen he is in the Cradle, let it be so turned that the Light may be directly in his Face, that he may not be tempt­ed to look aside; for doing so often, his Sight will be per­verted, and he become Squint-eyed. But the best way is to let him see no Light at all.

The Nurse must open and change the Child, at least twice or thrice a Day, and sometimes in the Night too, if it be necessary to cleanse him from his Excrements, and shift the Blankets, which must be put into a Bucking-Tub, and not slightly washed, as most hired Nurses do; because there comes a certain Salt from the Excrements, which insinu­ates it self into them, and causes a great itching, smarting, and excoriation of the Childs Body.

The Child must always be opened before the Fire, and his Blankets and Clouts well warmed and dryed, before he be put into them, least their cold and dampness, cause a Cholick and Gripes. The Nurse must put Rags behind his Ears, and under his Arm-pits, to dry up the Moisture. Du­ring the first four or five Days, she must be careful not to make the remaining part of the Navil-string fall off too soon, before the Vessels be closed, and every time she opens the Child, she must see whether the Navel for want of being ti­ed fast do not bleed; and after the end is fallen off, let her still for some time Swathe the Navel, continuing to keep a Compress on it till it be well cicatrized, and something sunk in. Besides this, let her put upon the Mold of the Head under the Biggin, another Compress to keep the Brain warm, and prevent the Childs taking cold. Let her also be very care­ful not to suffer the Child to cry too much, especially at first, least the Navel be protruded outwards, and cause an Exom­phalos, or a Rupture in the Groin. The best way to quiet him is to give him the Breast, and to lay him clean and dry and present something to amuse and please him.

Some foolish Nurses use to suck the Childs Breast, to draw out the Serosities, and form a Nipple in Girls, but this is a ridiculous Practice; it suffices in this case to apply Rags dipt in Oyl of Roses and Vinegar, and forbear Swathing the Part too strait.

Of the Weakness of New-born Children.

Children sometimes suffer so much by a bad Labour, that it is difficult to know whether they are alive or dead, not any part of their Body having the least sensible Motion, and be­ing as Blue and Livid, especially in the Face, as if they were choaked. However, you may be assured a Child is alive, if laying the Hand upon the Breast you feel the Motion of the Heart, or touching the Navel-string near the Belly, a small Pulsation of the Arteries may be perceived.

The best-help in this case, is to lay him speedily in a warm Bed and Blanket, and carry him to the Fire, and there let the Midwife sup some Wine and spout it into his Mouth, repeating it if there be occasion; let her lay Rags dipt in warm Wine to the Breast and Belly, and let the Face be uncovered, that he may draw Breath the easier, let her keep his Mouth open a little, and cleanse his Nostrils with small Linnen Tents dipt in White-wine.

Of Contusions or Bruises of a New-born Child.

Children frequently receive Bruises on the Head in their Birth, and sometimes have a knob near as big as an Egg, e­specially if the Mother be in Years, and it be her first Child, because the inner Orifice of the VVomb is Callous, and cannot be dilated without great difficulty, and the Mid-wife sometimes do's much mischief by handling it too rough­ly.

These Tumours are often so large, that they hinder the Ar­tist from discovering which part presents, and often times make them think it is the Shoulder which they feel. But this Errour is easily discerned, because these Tumours though feeling fleshy, are notwithstanding harder than any Shoul­der or Buttock of a Child, which parts are always soft and without Hair, as the Head hath; besides the Bones may be easily perceived, if the Finger being anointed with Oyl or fresh Butter, it can be introduced into the inner Orifice, for the Parts within the Womb are not Swelled. If a Child comes with any part besides the Head, and they remain a long time prest in the Passage, they will swell like­wise.

The best way to prevent these sort of Tumours, is to pro­cure a speedy Delivery. To this end grease well the In­ternal [Page 260]Orifice of the VVomb to relax it, and dispose it to give way for the passage of the Child; and as soon as the Child is born, foment the Tumours with warm Wine or Spirit of Wine, and lay Compresses dipt in the same on them; some Midwives only dip a Compress in Oyl and Wine bear toge­ther. If a Tumour will not be discussed by this means, but comes to Suppuration, the Matter must be let out as soon as is possible, for fear it corrupt the Bones of the Head; In this case it must be opened with a Lancet, and an Em­plaster of Betony applied on the VVound. If it be any other Part than the Head which is swol [...], let it be wrapt in Com­presses dipt in a Decoction of Provence Roses, Camomil Flow­ers, and Melilot.

Some Male Children have the Scrotum very much swelled, which may proceed from a Contusion or VVaters contained in it. In both these cases, Compresses dipt in VVine with Roses boil'd in it, must be applied.

The greatest Mischief is, when by the badness of the Labour or unskilfullness of the Midwife, a Leg or Arm is broken or dislocated; if this happen a Surgeon must be cal­led, and the Part drest after the same manner as in grown Persons, having regard to the VVeakness and softness of the Bone.

Of the Mould and the Sutures of the Head being too open.

Very often Children who come before their time, have the Mould of their Head, and the Sutures open. This arises from the distance and separation of the Bones from one another, which are not steddy, but may be moved to and fro, and yield on every side. VVhen this happens, you must not think to bring the Bones together by binding the Head strait, for this would press the Brain which is very tender, and kill the Child. It is sufficient to bind them softly with a small Cross-cloth, to prevent the inconvenience of their being un­steady, and commit the rest to Natures Work, which in time will unite the Bones.

There are some Children which have the Mould open till they are three years old more or less, according to their Strength. In this case, 'tis convenient to cover the Part with a Linnen Cloth three or four times double to prevent taking cold, and to defend the Brain from external Inju­ries.

It happens sometimes, that although the Bones be big e­nough to unite in all Parts; yet they are separated from each other in the place of the Sutures, by a quantity of Waters contained between them and the Dura Mater, and some­times between the Skin and the Pericranium, or the Pericra­nium and the Skull, and sometimes in the Sinus of the Brain it self. If the VVater is contained between the Teguments and the Bones, and the Swelling be not very large, the Child may be cured by opening and evacuating the VVaters, or discussing them.

Of Gripes and Pains in the Belly of a young Child.

Many Children are so griped, that they cannot forbear crying out Night nor Day. This is the first Distemper which happens to them, and they often die of it.

The principal cause of these Gripes, is the Meconium which is contained in their Guts, which by its long stay there grows sharp, and pricks their Membranes, or becom­ing hard, the Infant cannot void it, nor the new Excrements, which proceed from the Milk which he first Sucks. It sometimes happens because the Child not being able to Suck with ease, he swallows in sucking the Milk with Dif­ficulty, much Air and VVind, which being retained in the Stomach, and sliding into the Guts does distend them, and cause a great deal of Pain.

This VVind is sometimes caused by a Child's taking a greater quantity of Milk than he can digest, or the Woman giving her Breast-Milk soon after Labour, before it be pu­rified, or perhaps because the Child has taken Cold. Very often these Gripes proceed from giving him Pap too soon, or not well boiled; because this is Gross, Viscous, and apt to engender VVind in the Stomach. Worms sometimes by their stirring and biting, do very much torment Children. In the last place, the Mid-wife may have caused this by for­cing back the cold and clodded Blood out of the Navel­string before it be tied.

To avoid these Pains, the Nurse must avoid giving the Child suck till the next Day, least the Milk mix with the Excrements, and so corrupt and grow sour, encreasing the quantity by little and little, till the Child be used to this sort of Food. If it be the Meconium, which by its long stay causes these pains; give them at the Mouth a little Oyl of sweet Almonds or Syrup of Roses, and put a Suppo [...]tory [Page 262]made of Beet stalks into the Fundament, or a Sugar Al­mond dipt in Honey, or a small Clyster.

If the Child cannot Suck, and this proceed from its be­ing Tongue-tied, the Fraenum must be cut in the manner shall be taught in its proper place, and if the Nurse be hard Milcht, change her for another.

VVhilst the Child is griped give it no Pap, because this Food do's create Obstructions, breed VVind, and often cause Convulsions.

If the Gripes proceed from VVorms, lay a Cloth dipt in Oyl of Wormwood mixt with Ox Gall on the Belly, or a small Cataplasm made with Powders of Rue, Wormwood, Coloquintida, Alees, and the Seeds of Citrons incorporated with Ox-gall, and Flouer of Lupines, and if it can take any thing by the Mouth, give it a small infusion of Rhubarb, or half an Ounce of compound Syrup of Succory, having be­fore given it a small Clyster of Milk and Sugar.

VVhen these Gripes are caused by VVind, or any sharp Humours in the Guts, anoint the Childs Belly all over with Oyl of sweet Almonds, or Oyl of Wallnuts, Camomil, and Me­llot mixed together (having first warmed them) in which also a Cloth may be dipt to lay upon it, or a small Pancake may be made with an Egg or two fryed in Oyl of Wallnuts, and applied to it, or you may give the Child a little Ano­dine or Carminative Clyster as occasion requires ever keep­ing him very warm.

Of the Inflammation, Ʋlceration, Shooting forth, or Rupture of the Navel of a young Infant.

If the Navel-string fall off before it be entirely closed and cicatrized, there happens an Inflammation and Ulce­ration at other times; (although it be outwardly healed, yet not being so within) it is dilated, and protruded out till the Tumour be as big as an Egg, which is called an Exom­phalos. This proceeds from the continual cries of the Child, or some violent Cough.

In this case ende [...]our by all means to appease the Childs Cough, and quiet it to prevent its continual Crying, with­out which the [...]umour would daily encrease. If the Childs un [...]smess pro [...]ed from the Gripes, they may be Remedied in the manner above directed. If the Navel be inflamed, apply Galen's Cerate mixed with a Moiety of Populeon, or a [Page 263]small Compress dipt in a Mixture of Oyl of Roses and Vine­gar, or Ʋnguent of Roses with Album Rhasis.

VVhen the Ligature is come away, and the Navel is Ul­cerated, apply Desiccative and Restringent Medicines, as Rags dipt in Lime-water, which is not too strong, or Plan­tane-water with a little Alum dissolved in it. If the Ulcer be very small, lay on it a little Pledgit of dry Lint, some add a little Powder of a rotten Post. These Medicines are better than Emplasters which are never so drying, by rea­son of the Greases and Oyls in their Composition, Ceruss Em­plaster, or Desiccativum Rubrum, or Diapompholygos are the best, in applying which, you must observe to lay a Com­press of Rags, and keep it on by Swathing the part, till the Navel be entirely formed, for the Child by its crying breaks the Vessels, or causes an Exomphalos.

As to the Rupture of the Navel in young Children, the cure of it must not be undertaken otherwise than by Swathes and Compresses sitted for the purpose, at least till such time as they are grown to a competent bigness, and then if these do not effect the cure, you may perform the Operation.

If after the Inflammation there ensues an Apostem, the Child most commonly dies; for if it be opened to dis­charge the Matter, the Guts protrude themselves out, as soon as the Child begins to cry. If the Surgeon be sollici­ted to make the Operation, let him deliver his Prognostick, that so the Childs Death if it should so fall out, may not be imputed to him.

But if the Apostem be small, and the Child has Courage and Strength enough to endure it, let him open it a lit­tle, which possibly may free the Child from this inconve­nience.

Of the Smartings, Redness and Inflammation of the Groins, But­tocks, and Thighs of an Infant.

If the Nurse do's not keep the Child very clean, the Acri­mony of the Excrements will not fail to cause a Redness and Smarting, and Inflammation of the Groins, Thighs and Buttocks. She must therefore keep it very cleanly, use a cooling Diet her self, and refrain from all things which are apt to heat the Blood, that so the Heat of the Childs Wa­ter may be allayed. Let her Bath the part inflamed with Plantane Water, adding a sourth part of Lime Water, or if [Page 264]the Pain be very great, foment it with luke-warm Milk. Many VVomen use Powder of a rotten Post, or a little Mill­dust which they strew on it. Album Rhasis, or Diapompholy­gos spread on a Rag in form of an Emplaster, is not amiss, but the best of all is a Lotion of Saccharum Saturni, the ef­fect of which, may be seen in an Hour after. VVhen the Nurse opens the Child, let her be careful to wrap the Infla­med parts with fine white Rags, that they may not by rub­bing together, be more galled and pained.

Of Ʋlcers or a Thrush in the Mouth of a Child.

Very often the Milk of a Nurse that is Red-hair'd, ad­dicted to Drinking, or very Amorous by its Heat and Acri­mony, causes small Ulcers in a Childs Mouth, which are called Aphthae, and sometimes Cankers. Some of these are simple and superficial, and are cured with much ease, some again are ill conditioned, and caused by a Pocky ve­nom, and happen after Malignant Feavers, or are Scorbu­tick and putrid; these spread themselves to the Throat, make deep Escars, and often are Mortal to Children, be­cause they want Strength to undergo the cure.

To cure Ulcers in the Mouth, you must take care to al­lay the Heat of the Nurses Milk, prescribing her a cooling Diet, (and Bleeding and Purging her if she be Plethorick) and wash the Childs Mouth with Barley or Plantane Water, and Honey of Roses, or Syrup of dry Roses, mixing a little Ver­juyce, or Juyce of Citron to deterge the Viscid Humours, and cool the Mouth. For this purpose, fasten a dry Rag to the end of a hule Stick, and dip this in any of the above men­tioned Medicines, apply it gently to the Ulcerated part, to prevent the Inflammation from being encreased by a vio­lent rubbing. During this, the Childs Body must be kept open.

If the Ulcers participate of any Malignity, let such To­picks be applied as will have a prompt effect. For this pur­pose touch them with Plantane Water sharpned with Spirit of Vitriol taking care to prevent the Child from swallow­ing it. The Remedies must be so much sharper and stron­ger, as the Ulcers are deeper and more malignant; as soon as they are cauterized with this VVater, let the Childs Mouth be washed with a Decoction of Barley, Agrimony, and Honey of Roses, or touch them with the same. As often as you shall think convenient, at least till a slop be put to [Page 265]their spreading. Some rather chuse to cauterize these with small Tents of Rags dipt in boiling Oyl, because they ap­prehend if the Child should swallow them, that they could not in the least prejudice it. It will not be amiss to purge off the ill Humours in the Childs Body, by giving him a little clean Cassia or Syrup of Succory with Rhubarb. If the Ulcers are Venereal, these Remedies will have little effect.

Of the Pain and other Accidents in breeding the Teeth.

The Breeding of Teeth is the cause of a great many Ac­cidents, and often proves fatal to Children. In the time of their cutting, they are troubled with Inflammations of the Gams, Feavers, Convulsions, Loosnesses, especially when the Dog or Eye-teeth cur, and the Child is large, full of Humours and Costive.

VVhen the Teeth cut, the Gums and Cheeks swell, there is a great Heat and Itching, which often makes Children put their Fingers into their Mouth to rub them, from whence some moisture Distils down into the Mouth, because of the Pain they feel there; the Nurse in giving them suck, finds the Mouth hotter; they are very much changed and cry every Moment, and cannot sleep, or but very little; and small points of the Teeth may be seen and selt through the Gums, which appear thin and pale on the top, and Red and Inflamed on the sides; and if it happens to be a long time, the Pain is so excessive, that it sometimes kills the Child.

To prevent these Accidents, the Nurse must keep a good Diet, and use all things that may allay the Heat of her Milk, for fear of putting the Child in a Feaver, who already is very much in Pain; and let his Body he kept open with Cly­sters if he be bound.

To help the cutting of the Teeth, let the Nurse from time to time pass her Finger over the Childs Gums, gently rubbing them; and give him a stick of Liquorice to champ, or a lit­tle end of a small new VVax-candle, which is very good to sof­ten the Gum; or a Silver Coral with small Bells to divert him from thinking on the Pain he feels. Some VVomen in­stead of a Coral, put a VVolfs Tooth in. If the Gums are hard and thick, these things do no good; some Nurses make an Incision with their Nail; but 'tis better done with a Lan­cet, because that is not so painful, and makes no Contusion.

If the Pain in cutting of the Teeth cause Convulsions, open the Gum with an Incision Knife, going so deep till you feel the Hardness of the Teeth with the Instrument; keep the Childs Body open, forbear giving him Pap, anoint his Belly with some Purgative Syrup, and the hinder part of his Neck with Oyl of Lilies, and let the Nurse observe a good Diet.

Of a Loosness in Children.

Children being wholly fed with Liquids, the Fibres of the Stomach are relaxed, which is apt to cause a perpetual Loosness. This often happens by reason of the great Pain which attends the cutting of the Teeth, and sometimes from the sharpness of the Milk which irritates the Guts.

A Loosness which is of no long standing, and without a Feaver, is not to be accounted dangerous, but if it conti­nue long, it will be convenient to put a stop to it, for sear the Child be too much weakned by it; for this purpose let him suck well purified Milk, giving but a little at a time, to the end he may the better digest it; give him an Infusion of Rhubarb, to purge away the ill Humours; gentle Anodyne Clysters may be likewise given with Milk, Yelks of Eggs, and Honey of Roses; but after purging, let them be made with Plantane Water. You may likewise mix the Yelk of an Egg in the Pap he eats, rub his Belly with Oyl of Quinces, and lay upon his Stomach Compresses dipt in Red VVine, in which Provence Roses have been boiled.

Of Vomitings.

Vomiting in Infants is frequently the occasion of other Distempers, if it proceeds too far. It most commonly pro­ceeds from their drawing more Milk than their small ten­der Stomachs can retain and digest. Sometimes the badness of the Milk, the Nurses dancing the Child too much, a vi­olent Cough, or too great a Compression of the Stomach, are the causes of this Accident; to all which the sweetness and luke-warmness of the Milk contribute much.

VVhen the Child sucks more than it should, the Nurse must not give it so much, and but a little at a time. If the Milk be bad, let the Nurse be changed for a better; if the Vomiting be caused by a Cough, some proper Remedies must be used to appease it; if by the dancing of the Child, [Page 267]the Nurse must forbear shaking it so rudely; if from a Compression of the Belly, care must be taken that it be not Swathed so strait. If there be any ill Humours in the Sto­mach, it will be convenient to purge the Child, with a gentle Infusion of Rhubarb, or half an ounce of compound Syrup of Succory; and after this, if judg'd necessary, it may take a little Syrup of Quinces, and Compresses dipt in an In­fusion of Provence Roses, Cinnamon and Cloves in Red Wine, may be laid on the Stomach.

Of Ruptures in Children.

The most frequent causes of this Accident are their vehe­ment Crying, and violent Coughs; besides the Moisture and Softness of their Bodies does not a little contribute to this: in the last place too strait Swathing by forcing down the Guts, often causes Ruptures.

This Mischief must be remedied as soon as discovered, because the continual descent of the Gut, dilates the place through which it falls every day more and more. Rup­tures in Children are more easily cured, than in grown Persons.

VVhilst Children are in Swadling Clouts, the cure of true Ruptures which happen to them, must not be under­taken but by a Swathe-band, which is sufficient. This is effected by a Roller, putting a Compress or Truss just up­on the Rupture, after having first reduced the Gut and O­mentum into their Natural place. To do this, lay the Child with his Head low, then with both Hands reduce them by degrees, thrusting the Tumour with one Hand, and putting in the Gut with the other; after the Guts are reduced, lay a thick Compress on the dilated place, and Swath it in the same manner as was directed in the Rupture of the Groin or Bubonocele. Because it is very difficult for a Nurse to make this Bandage, a small Truss may be us'd in stead of it, which must be waked to prevent being rotted by the Childs Water, and more than one must be had in readiness for change. For the better curing the Child, let him be kept in Bed forty or fifty days, and care be taken to prevent his Coughing and Crying, and his Belly must not be compres­sed. Some foment the place with Smith's Water, and then lay on Emplast. ad Herniam.

The Hydrocele or Hernia-Humoralis, is a Collection of Wa­ters in the Scrotum. To refolve these Tumours use Spirit [Page 266] [...] [Page 267] [...] [Page 268]of Wine, or a Fomentation made of a Decoction of Came­mil, Melilot, Rue, Marjoram, and Fennel, and apply Com­presses dipt in it to the part, and after this dry the Scrotum with a Solution of Alum in Lime-Water, and to strengthen the part, lay Compresses dipt in a Decoction of Roses and Alum in Red Wine.

If these Remedies are ineffectual, make an Aperture with the Lancet to evacuate the Waters.

Of Scabs upon the Head and Face of young Children.

These are seldom Malignant, and it is a mark that they are not so, when they are only superficial, moist and yellow, and when their Crust is removed, the Skin appears of a Flo­rid red Colour, without any notable Ulceration.

The Humours must never be repelled, because the dis­charge they make is useful to preserve the Body from ill Distempers, and the Child ever has its Health best when they come out. However to prevent the breeding of ill Humours, take care that the Nurse be a Sound and Healthy Woman, keep the Childs Body open, and purge it now and then with a little Syrup of Roses or Succory. The crust must be digested and brought off, to give the Matter a better issue; for which purpose you may make use of fresh Butter or Oyl of sweet Almonds, laying on a Cabbage or Beet Leaf after, which must be renewed twice or thrice a Day, to a­void the offensive Scent, Continue the use of these Reme­dies till the Child be cured, ever endeavouring to procure a plentiful discharge of Matter, after which Nature will finish the rest of the Cure. In the mean time keep the Childs Hands tyed to prevent his Scratching his Face, which would inflame it more, and bring down a Flux of Humours.

Of the Small-Pox and Meazles in Children.

The Small Pox is a Disease in which abundance of small Pustles do break out all over the Body, which grow white, and after ripen. The Symptoms of the Small Pox and Meazles are so very like, that it is difficult to distinguish them on the first, second or third Day.

The Signs which precede the Eruption of the Pox are a Feaver, Stupor, a great Beating and Pain of the Head, Lassitude, a Pain in the Back, Sickness, Vomiting, Diffi­culty of Breathing, Yawning, Sneezing, Itching of the [Page 269]Nose, Inflammation of the Eyes, a general weariness of the whole Body, and a Urine very turbid. As for the Erup­tion upon the third or fourth Day, a great many small Pu­stules arise, which encrease in bigness and number till the eighth or ninth Day; at which time they grow white, and gradually ripen; and the Face and Head Swell, the Eyes are closed by the distention of the Eye-lids, the Nose is stopt, the Voice grows Hoarse, there is a dry Cough, a Pain in the Throat, and a great Difficulty of Breathing; If there be abundance of Pustules, the whole Body is Swoln.

There is a sort of Small Pox void of Malignity, this at first is attended with a Feaver, which ceases immediately after the Eruption, the Pustules rise to a point, suppurate kindly, and are soon well. The Matter is white, uniform, and well digested: When the Distemper is Malignant, the Pustles are brown, flat, livid, or ill coloured, have little black spots in their middle, break out more slowly than when they are kind, have no Digestion at all, or at least a very bad one, are filled with a Sanious Matter, attended with a Malignant Feaver, Delirium, Difficulty of Breathing, Syncope, and Dysenteries; sometimes they leave behind them Malignant Ulcers, Cariosity of the Bones, loss of Sight, Deformity of the Face, or Lameness of some Limb.

If the Feaver be not very high, and abate in proportion to the Eruption of the Pustles, if they be not very nume­rous, and grow white and ripen quickly, the Distemper is not very dangerous, but if the contrary happen, it is a sign of Death. The Small Pox in Children, is not so dange­rous as in grown Persons, because their Skin is more soft and Porous, so that they break out more kindly than in those who have the Skin more compact, and the Pores not so open.

The Meazles are never so dangerous as the Small Pox, because the Peccant Matter Transpires more easily and quick­ly. These are most commonly over in three or four Days, after which the Pox sometimes appears, which occasions the one Distemper to be mistaken for the other.

For the more successful curing this Distemper, prescribe the Child a good Diet, let him forbear all solid Meats, and feed only on Liquids; such as Veal or Chicken Broth, or a little Gelly. Let him drink a Prisan of French Barley, Roots of Dogs Grass, Liquorice, and Raisins of the Sun. Never give Pap to a Sucking Child, till it be perfectly re­covered, [Page 270]and let the Nurse keep a cooling Diet. Do not suffer her to carry her Child into the open Air, but let her keep it close in the Chamber, neither too hot nor too cold; for too hot an Air dissipates the Spirits, and too cold an one stops the Pores, hinders Transpiration, and checks the Erup­tion. The Childs Sleep must be moderate, and his Belly kept open. If the Small Pox be attended with a High Fea­ver in the beginning, together with a Difficulty of Breath­ing, and other like Symptoms bleeding is necessary. Pur­ging in the beginning of the small Pox is not to be admit­ted, for fear of turning the course of Humours which tend toward the Skin, but after it is proper to evacuate the re­maining impurities.

From time to time give the Child all sort of Cordial and Strengthning Things, such are a pure Air, good wholsom Food, Juyce of Oranges, Syrup of Limons, and Pomgranats in the Ptisan, or a little Wine allay'd with Water, but if it be a suck­ing Child, Milk must serve in stead of all other Cordials.

As soon as the Pustles begin to appear, anoint them with Oyl of sweet Almonds, rubbing them with a Feather dipt in it. Some use Cream, fresh Butter, or Stale Lard melted and washed in Rose-water, and beaten up in a Marble Mortar, and with this they grease them till they are perfectly cured. When the Pustles are ripe, which may be known by their Whiteness and Itching, which usually is about the Ninth Day, the biggest of them may then be pierced (by a Gold or Silver Needle, or by cutting the cops with a pair of Scis­sors) to discharge the Matter, least by its too long stay, it ulcerate and corrode the Part too deeply. Afterwards to dry them up, anoint the Face with a Liniment made of fresh Cream, mixed with white Chalk, continuing this Reme­dy till the Scabs be quite fallen off, using it Night and Morning, or make use of Oyntment of Roses, with a little powder'd Ceruss mixt with it.

To prevent the Small Pox from causing too great a Defluxi­on on the Eyes, apply cooling Remedies, as Rose and Plan­tane Water from the beginning, Breast Milk is very good to bath the Eyes with; Let the Nurse from time to time un­stop the Childs Nose, that so he may breath with more ease. Give him sometimes a little Syrup of Violets to smoo­then his Throat, or give him a little Syrup of Limons or Pomgranats, but Milk alone is sufficient for a Sucking Child.

How to cure the Venereal Pox in Children.

If the Mother have the Pox when the Child is born, it will infallibly be infected by her, and this may be easily discovered when it is so, by Bustles and Ulcers in all parts of the Body, especially in the Belly, Fundament, Head, and between the Leggs.

If the Nurse who gives it Suck be Poxed, she will com­municate it to the Child with her Milk. In this case the Distemper first appears in the Childs Mouth, and the sharp­ness of the Milk makes several Ulcers in it. But we must not presently conclude the Nurse has the Pox, because the Child has Pustles in several parts of its Body, for these some­times proceed from the Milk being over-heated, and there­fore some other Symptoms must be lookt for before you can be assur'd of it.

There is nothing farther necessary for the cure of simple Pustles, than changing the first Nurse, and giving the Child to another whose Milk is sweeter, and who will take care to keep it clean. But Children who come into the World with the Pox on them, most commonly die of it, and those who receive it from their Nurses, are very difficultly cured, their tender Age being unable to support the Fatigue of Me­dicines.

If the Nurse be Poxed, take the Child from her and give it to one who is Sound, who must be confined to a cooling Diet. Let the Nurse wash her Nipple with Wine every time she gives the Child Suck, and let her Purge from time to time, for fear of being infected. If no Nurse can be found who will venture to Suckle the Child for fear of be­ing infected her self, take one who has abundance of Milk, and let her squeeze her Breast and drop it into the Childs Mouth, or let her Milk her Breast into a Porringer, and give it a Spoonful now and then, or let her put her Milk into a Funnel, at the end of which there is fasten'd a Rag rowl'd up, and put this into the Childs Mouth for him to suck, or dip Rags in her Milk and let him suck them. But the best way is to let him suck a young Goat, fed on purpose with good Hay, and other convenient things.

Let the Child be Bled and Purged, and after if he have Strength enough, anoint him with a Mercurial Oyntment, rubbing only the Pustles and Ulcers, in doing which and reiterating the Frictions a small Flux will be raised by degrees, which [Page 272]must be almost insensible, least the Humours being stirred and carried in too great abundance to the Mouth, cause it to Swell and Ulcerate, and hinder the Childs Sucking. Wherefore but a small quantity, of Mercury must be mixed with the Oyntment, and after one Friction or two, you must forbear five or six Days; and see how the Flux will rise, and then if there be occasion, give a few Grains of the Mercurial Panacea in the Childs Pap. Let the Nurse wash its Mouth with a Lotion of Barley Water, with the addition of Honey of Roses, or Syrup of Wormwood with White-wine, to clear it from the froth which is usually ga­thered about it, and that he may void the Drivel better, let him lie upon his Side and not upon his Back, least falling upon the Stomach or upon the Lungs, it should choak him. Let him be always kept warm without carrying him into the Air, and watch diligently the effects of the Medicine.

The common Way to make this Mercurial Oynment, is thus; Take half an Ounce of Quick-silder, pass it through a Leather to clear it from its adhering Filth, and then mix it in a Mortar with four Ounces of Hogs. Grease, till it be ve­ry well incorporated; then take two Drams of this Oynt­ment for each Friction, more or less in proportion to the Childs Strength.

How to chuse a good Nurse.

The Mother is doubtless the best Nurse that a Child can have, if there be no reason to the contrary. The best Age for a Nurse, is from 25 Years to 35, because about that time, a Woman is stronger and more healthy than at any other. The common Opinion is, that a Woman is most fit to be a Nurse, two or three Months after her Delivery, be­cause at that time the Milk is purified, and her Body pur­ged by her Cleansings, but she cannot be so much longer, because in this case the Milk would not continue so long, as would be necessary to suckle the Child. She must not have Miscarryed, but had her Child at due time. The Milk of a Woman who has been Delivered of a Male Child, is commonly thought to be best, and it is to be preferred if it be her Second Child, because she may then very well be supposed to have some Experience in the Ordering and Ma­naging her Infant. Mauricean prefers Milk of a Fortnight old, to that of three or four Months, and if it be for a Girl, he prefers a Nurse who has a Girl, to one who has had a Boy.

She must be Sound and Healthy, and born of Parents who were so, and never had the, Stone, Gout, Kings-Evil, Falling-Sickness, or any other Hereditary Distemper. She ought to have a clear Skin free from all Scabs, Itch or Scald; she ought to be strong and able to watch and tend the Child as occasion requires. It is convenient she be of a middle Stature, neither too large nor too little, too lean or too fat; but above all, she must not be with Child. Let her Complexion be Sanguine, and her Flesh plump and firm. She must not have her Courses, for that is a sign her Blood is too hot, or she is too amorous; she must not have the Whites, for these are a sign of a bad Habit, she must not be red Haired, or markt with any Spots, but her Hair must be black or of a Chesnut brown. She must be well shaped, neat in her Cloths, and handsom in her Face, having a Sprightly Eye, and Smiling Countenance; she must have good Eyes, Sound and White Teeth, and ought to have a Sweet Voice, to sing to and please the Child. She must have no ill Scent come from her, as usually red Haired Women have, and those who have black Hair and a white Skin, for their Milk is Hot, Sharp, and of an ill Tast and Scent; She must not have a strong Breath, as they who have a stinking Nose, and bad Teeth, because she would infect the Childs Lungs by often drawing in the corrupted Air.

Her Breasts ought to be pretty large to contain a sufficient quantity of Milk; they ought to be pretty firm and plump, and not flaggy or hanging down; for a large strutting Breast, is the Mark of a good Habit of Body. As for the Nipples they must be well shaped, not too big nor hard, nor callous, nor sunk in, but they must be raised, and have several small Holes that the Child may Suck without any great pains; she must have Milk sufficient, and not in too great excess, because the Child not being able to draw it, it grows stale in the Breast, and by its long stay there, turns sour and curdles; and therefore she may let another Child suck the remainder. Her Milk must not be too thick nor too waterish, which may be known by Milk­ing it into the Hand, and the turning it a little on one side, for if it run off immediately, it is a sign it is too Fluid, but if it do not run off at all, it is too thick; the good is of a consistence between both, which runs off gently in propor­tion to the inclining of the Hand, and leaves a Trace be­hind it. The whitest Milk is the best, and the farther any [Page 274]recedes from that the worse it is, it ought to have a pleasant smell, and ought to be well tasted, that is, sweet and su­gar'd without any Acrimony or Heat. But we must not for­get one principal condition of a good Nurse, and that is, that she be an Honest and Conscientious Woman, because these qualities will make her sober and careful of her charge, and preserve her from Drinking and Venery.

How to prevent Childrens growing Squint-eyed, Awry, Crooked or Lame.

To prevent a Childs becoming Squint-eyed, chuse a Nurse whose Sight is firm and straight, least by her ill ex­ample, he get a bad Habit, Children being wondrous apt to imitate what they see done. Let his Cradle be ever so placed, that he may always have the light before him, be­cause when it is on one side, the Muscles of the Eye are apt to act independently on one another. To redress this incon­venience, let the Child wear a Mask upon its Face with two small Holes right against the Eyes to see through, which will cause him perceiving no light but through them to di­rect his Eyes that way, and by degrees quit the ill Habit he has got of looking aside.

To prevent the Childs growing crooked, awry or lame, the Nurse must swaddle his Body strait, equally extending his Arms and Legs, and Swathing his Body sometimes one way, sometimes another, lest if she should swaddle it al­ways alike, the parts should retain an ill Figure. The Nurse must lay him on his Back streight and not bending, and when she holds him in her Arms, let her carry him sometimes upon one, and sometimes upon another, for hold­ing his Legs always in the same Fashion, it would be a great Hazard if they did not grow crooked, and this compressi­on especially about the Knees, is the cause why so many Children have crooked Legs.

When any Parts have contracted an ill Figure from what­ever cause it proceed, let this be remedied with Swathes and Compresses conveniently placed, to keep the Part in a good Posture, whilst the Child is in his Clouts. When he is grown a little bigger, small Leather Boots may be used to straighten the Legs; if the Foot only be awry, Shooes under­laid of one side higher than the other, will serve the turn. When the Breast or Back-bone are in fault, it must be helped if possible, or at least hinder from growing worse, [Page 275]by a little Bodice of strong Whale-Bone very well lined on that side where it jets out. A Cross made of Steel is now in use, the Traverse of which passes over both Shoulders, and the perpendicular lengthways of the Body, this Instrument is very convenient, and do's not appear.

Those who would seriously apply themselves to the Pra­ctise of Deliveries ought to have that excellent Piece of the famous M. Mauriceau on this Subject ever before them, and read it Day and Night. I dare engage the intelligent Reader will perpetually find new matter in it. This is a Noble, Use­ful and Lasting Monument, from which Posterity will reap great Advantages.

Of Ʋlcers in the Nose.

Though these are not Polypus's, yet it seems very proper to refer them to this place. These Ulcers are very diffi­cultly cured, all Mercurial Medicines are good in these ca­ses, which may be taken from 15 to 30 or 40 grains in Conserve of Roses, and must be continued from a long time, Sudorificks likewise are good. In short these Ulcers must be treated in the same manner as Venereal ones.

If these Ulcers are Scorbutick, you may make use of the following Liniment. ℞. Crabs Eyes, Sperma Ceti, ā ℈ss. Cinnabar, gr. 6. Sugar of Lead, gr. i. Cam­phire, gr. iij. mix these with a sufficient quantity of Balsam of Peru. Or you may use the following Injection if you please, ℞. Hydromel, ʒi. Juyce of St. Johns wort, Wormwood, Smal­lage, Spirit of Feverfew, ā. ʒi. Myrrh and Camphire, ā. ℈i. If the Bone of the Nose be carious, apply the actual Cau­tery.

Fumigations of Frankincense, Amber and the Gums are useful in these cases.