THE ART OF CHIRURGERY.
BOOK I.
PRAECOGNITA
Concerning the Definition and Parts of Chirurgery.
BEfore we come to treat of Chirurgery it self, there are several Praecognita fit to be known by him, that would be a Proficient therein. For these Praecognita are Introductory, and will clear the Way for the better Understanding of what shall afterwards be discoursed: And they are these:
- 1. Of the Antiquity and Dignity of Chirurgery.
- 2. Of such Authors as have written of it.
- 3. Of the Definition of it.
- 4 Of the Division or Parts of it.
And then my Intent is to pass through all the Parts of Chirurgery methodically, that so the Reader's Memory may more easily Retain what he peruses: And I shall give you nothing but what is warranted by the Authority of the most Learned and best Experienced Men in all Ages.
As for the Antiquity of Chirurgery, its Pedegree is as old as Adam. But if any Gentleman doubt it, I dare tell him, I can produce [Page 2]more probability for it, than perhaps he can for his Descent from his Great Grand-father, though he would oblige the World with a Genealogy elder and stouter than the Conqueror. For can we think, that Adam and Cain, after Fratricide committed upon Abel, would not both contrive how to ward a Blow, yea, and to cure a Wound, if need were? Certainly, when their knowledge of Evil had, through amazement and horrour at the first obliterated all recognition of Good, Prudence must needs take care to redress such Disasters; and Adam especially, if he were so good an Herbarist, as most Divines hold him to have been, must from his knowledge of Vulnerary Herbs, naturally proceed to the use of Plasters. Indeed concerning the Antediluvian Transactions Moses gives us but short Remarques; yet we find by those, that Lamech committed Murder, and gloried in it: And the Earth being filled with Violence, there must of necessity be Work for the Chirurgeon. And it cannot be imagined, but that when Men had received Wounds and Hurts, they would try to cure them. As for profane History, in it we find Chirurgery as ancient as any Records of that sort. Podalirius and Machaon, sons of Aesculapius, were Chirurgeons to the Grecian Camp before the Walls of Troy; yea, Cicero de nat. Deor. tells us, That Aesculapius himself drew Teeth, and dressed Wounds. Apollo was an Oculist; Mercury cut Aesculapius out of his Mother Coronis her belly; and Venus her self sometimes plaid the good old Woman in dressing the Wounds of her dear Diomed, and their Boy Aeneas, when Virgin Pallas had in these Heroes chastised the tricks of that wanton Goddess her Youth.
But secondly, to leave these more obscure and antique Times, and that we may come to the Men, who have left us the Monuments of their Skill in Chirurgery, let us descend a little lower, and we shall find Hippocrates, the seventeenth in a lineal descent from Aesculapius, to have been the first and the skilfulest of all who have written of this Subject, as his Books De Officin [...] Medici, De Articulis, De Vulneribus, &c. do testifie. From which Treatises it is plain, that Hippocrates not only understood Chirurgery, but also practised it. Several other Grecians have writte [...] of it, as Galen, Oribasius, Paulus, Aegineta, Aëtius, Alexander Tralianus, Actuarius, and others. Among the Latins Celsus has writte [...] skilfully, and expressed his Skill i [...] most elegant Latin: and he indeed is the only Latin Author among the Antients. But after the Partition of the Empire into th [...] Eastern and Western, when War and Devastations had made way so an inundation of Barbarism into these Parts, Learning began to flourish among the Arabians; and the Chief of them in Chirurgery i [...] Albucasis. After this some ski [...] ful Men arose, who having derive their Skill from the Arabians, a [...] well as the Greeks and Latins wrote in a most barbarous Style Amongst these Guido de Cauliac [...] is the most Eminent: for Fallopius (the great Anatomist, and Glory of his Age) makes no scruple [Page 3]to parallel Guido, notwithstanding his barbarous Style, with Hippocrates. There were several others, who wrote in a barbarous Style, who deserve to be read, as Brunus, Theodoricus, Rolandus, Lanfrancus, Bartepalia, R [...]gerius, and Gulielmus à Saliceto Placentinus, also Johannes de Vigo, but he had taken what he wrote from Guido; and Tagaultius turned him into more elegant Latin. Marianus Sanctus Barolitanus was one of Vigo's Scholars, who afterwards published a Compendium of Chirurgery. Constantinus Africanus, who lived, An. 1080. wrote something in Chirurgery. And Petrus de Argillata of Bononia wrote about 1490. But of Guido, Fallopius confesses ingenuously, that excepting Hippocrates and Galen, he not only excelled all the Grecians, Latins, and Barbarians, especially considering the barbarism and obscurity of Physick at the time when he lived, but that he added many useful & learned Things of his own to Chirurgery: He lived about the year 1363.
But to come to the Writers of the preceeding, and of this present Century, I think I may place the incomparable Fallopius in the first Rank. It were to be wished, that he had lived to give the finishing stroke to those excellent Pieces, that came out in his Name at Venice 1606. for then I know not what a Man could have wisht for more: for he discourses every thing, with that Candor, Judgment, Reason and Accuracy, that one may easily observe, he was no less a Physician and Chirurgeon, than that he was a most excellent Anatomist. Next to him comes Ambrosius Paraeus, Chirurgeon to the King of France, a Man who by his great experience in difficult Cases greatly enriched Chirurgery: But we must understand, that that huge Volume, which came out in his Name, was made by the Doctors in Physick of Paris, whom Paraeus furnished with an ample stock of Chirurgical Examples: They put them into Method, and to make the Work the bigger, they added many things superfluous and alien from the business of Chirurgery. But truly I think it had been more for this worthy Person's credit, had he in a less Volume published his particular Cures, and Observations of rare Cures, and their Remedies, as he found them by infallible Practice, and so many years Experience: As Gulielmus Fabricius Hildanus, the Honour of the Germans, whose Fame Ages to come shall celebrate, has to his immortal Glory done. For, as Seneca says, Longum est iter per praecepta, breve & efficax per exempla; and so in reality every man finds, what Impression is made in our Minds by particular Cases (in which Diseases appear to us far otherwise, than what Authors make them to be in their Writings, so that it is no marvel, if he be miserably gravelled, who has all he knows from Books) and the Cures, when the success of Remedies, as day by day they are used, the supervening Symptoms, and the good or bad Events, are faithfully related. And when all is done, if after the Patient's death, an accurate search of the Parts affected were made (which I wish the Patient's Relations would give way to, though the Physicians are hindred from [Page 4]doing it by the vain superstition of the dead parties Friends) the Business would be complete. Also Hieronymus Fabricius ab Aquapendente is a Learned Writer, and has done excellently well in his Books, entituled, De Chirurgicis Operationibus, wherein he endeavours to imitate Celsus, while according to the order of the parts of his Body, he accurately treats of the Names of Diseases incident thereto, the Signs, and the Cure which is performed by manual Operation, and so he frequently professes himself to be Celsus his Interpreter and Commentator. And with Aquapendent may be joyned Johannes Jessenius à Jessen, Stephanus Gourmelinus, and Vidus Vidius junior. And for a clear conception of the Operations, the Figures of. Scultetus with their Explications are excellent, in which the Manual Operations, used by others, are set before our eyes. In our English Tongue we have these, who have written well, Mr. Gale, Mr. Banister, Mr. Clowes, Mr. Woodall, Mr. Wiseman, and the Learned Dr. Reed (who so far as he has gone shall be my Pattern and Precedent.) And these have written of Chirurgery in general.
As for such as have written of peculiar Parts of Chirurgery, I shall select some of the most approved. Of Tumors Ingrassias has written, no unlearned Man: But he is too much taken up in the reconciling the Greek and Arabick names, and confounds his Reader in enumerating the Species of Tumors. Saporta is but an ordinary Author. But among Authors to be prized are Julius Caesar Arantius and Marcus Aurelius Severinus, who wrote a Book De Recondita Abscessuum natura, a Work certainly full of recondite Learning established by many years Experience. He it was who left us that Excellent Work De Efficaci Medicina. Of Wounds of the Head Jacobus Berengarius Carpensis has written, or, who is the same, Jacobus Carpus, for whose excellent Work we are beholden to the famous Conringius. But because in so noble a Part too great diligence cannot be blamed. Jo. Bapt. Carcanus Leo his Book may be perused, as may Andreas Alcasar a Spaniard, and Ludovicus Queirats, a late French Writer: for there is an infinite number, who have commentated upon Hippocrates de vulneribus Capitis, as Arantius, Parma, and Petrus Paaw a Dutchman. Guillemaeus has written of Diseases of the Eyes; but we owe the Chirurgical way of curing them to Durant Scach, and to Peter Franco, who both of them wrote also of the Stone in the Bladder, though the first Writer of that way of Cure was Marianus Sanctus Barolitanus: And Hildanus is to be preferred before all; who wrote a peculiar Treatise of Lithotomy, and Dr. Groenevelt in his Dissertatio Lithologica, who wrote since Hildanus died. Taliacotius is the only Man that treats of curing Parts cut off by Incision. Of Ruptures we have Franco, Scacchi, and Geigerus. Of Wounds, besides Alcasar and others, who have designedly made it their business, there is Matthias Glandorpius an Excellent Man, and one that has shewn himself a Physician in his Speculum Chirurgorum. Magatus also in a peculiar Treatise commends [Page 5]a rare Inspection of Wounds: But of Inspection and Judgment of Wounds mortal and curable there have written Bernhardus Suevus, Melchior Sebizius and Hieron. Welschius, to whom we may add Fortunatus Fidelis his Treatise De Relationibus Medicorum. And a Physician indeed ought to be well versed in this Affair; seeing usually according to his Judgment the injurious Party either loses his Life, or is acquitted. Although several have written of Gun-shot Wounds, yet they are most to be credited who have followed the Camp, such as Paraeus, Botallus, and Guillemaeus. But as particular Observations faithfully related do give a Man much Light, so they are to be abominated, who, when they communicate theirs to the Publick, either out of Envy or Malice conceal what Remedies were administred; of which Gulielmus Losellus is guilty. But such as Riverius, Borellus, Barbette, Sculterus and others, who have candidly imparted their Secrets for the common benefit of the Sick, are to be commended. Besides, Johannes Van Horne in his Microtechne has given an admirable Introduction to Chirurgery. And Johannes Muys in his Praxis Chirurgica Rationalis has begun to cultivate this Part of Medicine according to the newest discoveries in Nature, as the other Parts have been by other hands. Out of these and such other Authors as these, I shall give you according to my Abilities, a perfect Systeme of Chirurgery.
Thirdly, Chirurgery by virtue of its Etymology [...], signifies, Manual Operation, and by Learned Men is defined to be the third Branch of the Curative Part of Medicine, which teacheth how sundry Diseases of the Body of Man are to be cured by Manual Operation. By this as well as by Diet and Pharmacy doth the Physician attain his End, which is, his Patients Health.
Fourthly, The parts of Chirurgery, must be assigned according to the main differences of Operations. Those are four in number, and consequently so many parts: for either by Chirurgery, Solution of unity is removed, and union restored; or things unnaturally united are separated and disjoyned; or things superfluous taken away; or last of all defects are supplied. Now Solution of unity is either gathered by reason, or deprehended by sense. In Tumors, although the parts seem to the eye united; yet reason teacheth us, that there is a divulsion of them.
The doctrine of Tumors therefore ought to be the first particular Treatise. Solution of unity apparent to the senses, to wit, sight and touch, is either in the soft parts, or in the more solid and hard. In the soft or fleshy parts there be two differences of Solution of unity: vulnus & ulcus, a wound, and an ulcer. In the hard parts there are found a fracture, and a luxation; two distinct sorts of Solution of unity. This part may be called [...], or parts compositrix, the part joyning together.
The second part of Chirurgery opposite to the first, teacheth to separate parts unnaturally united: where either the comely composition of the Body of Man is defaced [Page 6]or impared, or the actions of the same hindred. Sundry have been brought into the World with the anus and vulva quite shut up. The consideration of that Membrane, which is found in the Neck of the Matrix of some Women, is in this place to be noted and considered: Seeing there have been, and yet are so many Concertations amongst both skilful Physicians and Chirurgeons about it. Here also is the Cure of the wry Neck to be set down. In this Grief the Head is drawn on the one side, by reason of one or more Tendons of the Muscles of the Neck being shortned towards the Claves more than on the other: whereby it cometh to pass, that the face groweth awry and distorted: and so the Beauty of the Countenance is much impared. To this part belongeth the curing of Tongue-ty'd Children, in whom Sucking and Speech are hindred. Not only Fingers and Toes cleave together in the same Person; but Twins also, and double Members of one Person. The consideration of such doth belong to the History of Monsters; not to any Art: seeing such things are to be ranged amongst raro contingentia, and so belong not to Art, which is of things necessary. This part may be termed [...], or separatrix pars, the separating part.
Now followeth the third part of Chirurgery, which sheweth the means to remove from the Body things superfluous, which may fitly be called [...] or ablatrix pars, the subtracting or removing part. Things superfluous are such, either by Event, or by their own Nature. Things superfluous by Event are several: And first a dead Child in the Womb, or staying too long to the prejudice of its own and tho mothers Life. Here shall be set down the manner how to bring Women to bed (as we term it) artificially and safely. Secondly, a falling of the small Guts into the Cod by enlarging or rending of the production of the Peritonaeum, which we call a Rupture. When I come to this Point, I will set down the diversities of Ruptures, and the means of curing of each: which are either Incision, or Truss, or application of Medicaments, sometimes used solitary, sometimes concurring most or altogether. Thirdly, the amputation of a Limb by reason of a mortification, or some other accident. Here shall be set down the most accurate method of dismembring. Fourthly, the extirpation of any part, as the Breast, when a Cancerous either Tumor or Ulcer doth possess it. Here you shall be acquainted with the safest way of extirpating a Cancer and a Lupus. Fifthly, Blood, offending either in quantity or quality, is drawn by Phlebotomy, Leeches, or Ventoses, of all which I will particularly discourse. Things by their own nature superfluous, are either somewhat familiar to Nature, or altogether adverse: Of the first sort, are Wens, and Strumae; when I come to them I will set down the diversities of them, and how they also are to be cured. Secondly, the couching of a Cataract offereth it self. Here I mean to set down the variety of Cataracts, the prognosticks of them, whereby it shall be known which are curable and which not, and the most [Page 7]exquisite manner of couching of such as are curable. Things adverse to Nature, are Stones in sundry parts of the Body; but chiefly in the Bladder. The Incision for extracting of it, is called [...]: of it I mean diligently to discourse; because it is a dangerous Operation, and many times scandalous.
Last of all, I come to the fourth & last principal part of Chirurgery, which is the supplying of the defects of the Body, which may be called [...] or additrix the supplying or adding part. Now things which are added, are either of the Body it self, as restoring of the Nose lost, or curing of the Hairlip. Of the first, I will set down the Method of several Physicians, and Chirurgeons; Of the second, many famous Mens Experiments in curing both the single and double Hair-lip. The matter of things, which is used for the repairing of the losses in other parts, as the Eye, the Ear, Arm and Leg, is no ways of the Nature of the Body. Nevertheless when I am come so far, I will make an end of the course of Chirurgery with touching these so much as shall seem sufficient, to instruct such as have not been verst in these practices. I have varied, I confess, from all who have written of this subject: Nevertheless I have the Light of Nature on my side, and the Experience of all skilful Practitioners. So that it is needless to take further pains, either to confirm those things which I have alledged, or to refute that which hath been said by others; Seeing I intend rather to frame an able operating Chirurgeon, than to set out a contentious disputing Theorician: Besides reprehending of others doth not so much instruct the hearers in the knowledge of Truth, as it sheweth that, which is not to be learned, but shunned. Neither is a Chirurgeon contented to have performed so many Duties to the Body of Man while it is alive, and the instrument of the Soul for performing actions; but when it is dead, the spirit rerurning to God, who gave it, he ceaseth not to be officious to it, in dissecting of it, for the instruction of himself and others, and preserving it from putrefaction and annoyance, until time and place fit for burying of it be offered: which he compasseth partly, by Encearing of it, and partly by Embalming: of the which two last, I mean also to discourse.
CHAP. I.
The General Doctrine of Tumors.
FIrst, I will declare what a Tumor is. Secondly, what the Causes of Tumors are. Thirdly, the main difference of Tumors.
Before I come to the essential definition of a Tumor, I will set down the denominations of it. A Tumor in Greek is called [...], that is, a prominence or protuberance in the Body. And from hence the Latin words uncus, a crook or hook, and aduncus, bended or crooked, are derived: Because things bended cause a sticking out. The Arabians and barbarous Physicians, who follow them, call all Tumors unnatural Apostemata, in Latin Abscessus: this word is derived from the Greek Verb [...] Abscedere: Because in Apostems there is a collection of Humors in any place which have left their own proper seat, &c. For Humors which cause Apostems come from the Veins, and so leaving their own natural receptacle, seat themselves in other parts of the Body, being dependant and weak. And Chirurgeons commonly call Tumors wherein there is collection of matter Apostems. Tumor which is a Latin word, and by frequent use made familiar in English Conferences and Discourses, is derived from the Latin word Tumco, to be raised or puffed up.
Now bunchings or stickings out of parts of the Body, are threefold: for either they are natural; and then they serve for the comliness of the Body, and further the actions, as we may see in the Head, Belly, Joynts, the Thighs, Calves of the Legs, and Arms: Or they only pass the ordinary dimensions of some parts, such are the Dugs full of Milk, and the Bellies of Women which are with Child: Or they are altogether unnatural, not only marring the comely composition of that part of the Body which they possess; but hindering the actions also. Such a Tumor, or eminence of the Body, is called by Galen [...], id est, Tumor praeter Naturam, a Tumor contrary to Nature. Having set down the denominations of a Tumor, I must come to the Definition of it. Of all the Definitions, two are chiefly to be noted: the one of Fallopius in his Treatise of Tumors, cap. 3. The other of Hieron. Fabricius ab Aquapendent. in operibus Chirurgicis, part 2. lib. 1. de tumoribus, cap. 1. That of Fallopius is gathered out of Galen. cap. 1. lib. 13. de method. medendi: and it is thus. It is a Disease, whereby the parts lose their natural bigness, exceeding it. So that extenuation is contrary to a Tumor. He will have it to be a disease of the instrumentary parts: for quantity is only an instrument, whereby the [Page 9]organical parts perform their actions, more strongly, or weakly, as we may see in Dwarfs, and tall Men. Galen lib. 1. de tumoribus praeter nat. c. 1. affirmeth, That in Tumors contrary to Nature, all Dimensions, that is, Length, Heighth and Breadth are increased. But the former Definition cannot be ascribed to every particular Tumor, and so it is not large enough: for in an Erysipelas, extream Heat rather offendeth, than the bigness is enlarged, which very often cannot be deprehended by the Senses.
The definition set down by Fabricius ab Aquapendente is this: A Tumor against Nature is a Disease for the most part compounded, which is to be named of that thing which hindreth the actions. And he to make his definition plausible to his Readers, will have all to mark some remarkable points in his definition. And first of all, in that he calleth a Tumor against Nature Morbus, or a Disease, he will not have Pushes in the Face, and such small Eminences of the Skin to be Tumors, because they hinder not the actions. He cannot deny that the equality of the Skin is altered, and besides this, the action of the Skin, which is Perspiration in that place is hindred. Let no Man think it harsh, that I ascribe action unto the Skin, being a simple and similar part of the Body: It cannot be denied that all similar parts have an use; which use sometimes is an action, as this of the Skin; to send out by its Pores suliginous Vapors; and superfluous serosity of the Blood, by insensible Perspiration and Sweat. And although such small Eminencies commonly are denied to be Diseases, because they hinder not the Actions; yet they be Passions, and Affections, which require the skill of the Physician and Chyrurgeon: yea, those Pushes of the Face are sometimes more hard to be cured than great Tumors, and Artists many times gain more by those, than these: Besides this, by reason of the matter, they are to be referred to one or other of the main Tumors. Howsoever, they are not to be neglected. According to Aristotle 1 Rhetoric. c. 5. & Galen, ad Thrasibulum, there be three Gifts of the Body, to wit, Health, Strength, Beauty, all which Medicine is to direct: Health is preserved by wholesome nourishment, Strength by convenient exercises: of the which [...] Treateth, whereof Hieron. Mercurialis hath written a Volume; [...] hath care of the Beauty: Now seeing by reason of the Face a Man is called Beautiful or Ugly, who can deny that they deserve the care of the Physician, and Chirurgeon? He addeth, that a Tumor is a Disease most commonly compounded; if he had said ever compounded, he had spoken a Truth: for in every one of these Tumors there is a Tumor conspicuous or latent; or a solution of unity, either sensible or imaginary. In an Erysipelas it self, wherein there appeareth neither quantity of part encreased, nor solution of unity procured, yet in it there are undoubtedly both: for the first, seeing there is so great a heat in the part possessed with this Grief, the Humors must be rarefied, and [Page 10]the part dilated, which will require a more spacious place than it had before, which is an evident Argument that the quantity is enlarged. As for the Second, the parts before arctly united, must be somewhat separated by stretching: Reason must teach us that which cannot be deprehended by the Senses. The last clause of the definition. That the Tumor is to be named from that which hindreth the Action; as Erysipelas a Disease of Distemperature, because Heat doth most hinder the action of the part: this is frivolous, because not Heat only, but the bedewing of the Skin with Choler, by the which it is stretched, hindreth the contraction and extension of the Skin, and so by a necessary consequence, the hindring of the motion of the Part organical, wherein it is seated. To conclude, This definition may be applied to other Griefs than a Tumor, as to the Headach, which is a Disease most commonly compounded of distemperature of the Humors, and solution of Unity, and may have its denomination from the diversity of the Humor causing it.
Wherefore seeing neither the definition of Fallopius out of Galen, nor the definition of Fabricius ab Aquap [...]nd [...]nte, can abide the trial of the Laws of a good definition, we must assay to give another; which shall be this: A Tumor against Nature is most frequently a Disease, sometimes a light Affection, for the most part incident to the organical parts, increasing their quantity above Nature, by reason of receiving of superfluous Humours sent from other parts. Here I will labour to yield a Reason for every point of this Definition. The Genus is a Disease, because it hindreth the Actions; sometimes it is a Passion, or light Affection, which hindreth not the action of the Part, as appeareth in small Oedematous Tumors, and Scirrhosities: And therefore these Modifications frequently, and sometimes are added. The subject of a Tumor is a part organical, sometimes by its own Nature organical, as a Finger or Toe, sometimes Organical only by Office, as when the use of a similar part is performed by an Action: as it appeareth in the Skin, one of the uses whereof [...] send forth by its Pores insen [...] Perspirations, fuliginous Vapors, and superfluous serosity of the Blood by Sweat, and Ichors of Humors in the beginning of Tumors and declination by discussive and resolutive Medicaments. The form of a Tumor is quantity increased, whereby it differeth from all other Griefs. The cause of increase of quantity, is receiving of superfluous Humors, which is done two manner of ways, to wit, Affluxion, and Congestion; Affluxion is, when an Humor offending either in quantity or quality suddainly with violence seizeth upon any Member, either by reason of the weakness of it, the rarity, loosness, dependency, heat, or pain, or because the whole Body is full, or cacochymical, and the parts sending strong. Congestion is, when a Humor is collected in any part by little and little, by reason of the weakness of the concocting and [Page 11]expelling Faculty of the same: So that a Tumor against Nature is a Disease always compounded, against Fallopius in his Treatise of Tumors, c. 3. For there is always a solution of Unity, either Manifest, or Latent and Occult, and this he granteth; for he saith, & de hac conveniemus: we shall agree concerning this. Besides this, the quantity is encreased, and that always to Reason and Imagination, although not to the Sense, as hath been said of an Erysipelas. Moreover, you shall hardly find a Tumor without some distemperature, either simple, or compounded. I have insisted somewhat the longer in clearing the definition of a Tumor against Nature, because there is great contention concerning it amongst Authors, both Ancient and Modern.
Now order of Doctrine requireth, that we speak somewhat of the causes of Tumors: These are either External or Internal. The Causes External are in number Eight. 1. The Air, if it be contagious, it causes Tumors, as Carbuncles, and Botches in the Plague time. 2. The touching of things exceeding temperature in the active qualities, as we see in the application of Vesicatories, and sitting long upon any cold Seat. 3. Too hard binding of the part, which causeth sometimes Gangreens. 4. The application of an attracting instrument to the Body, as Cupping-glasses, and Horns. 5. Whatsoever may cause a solution of Unity, as Wound, Fracture, Luxation, or Contusion. 6. Biting of Beasts, whether they be venemous or no. 7. Taking inwardly things offensive to Nature, whether it be by the excessive quantity, as when by too liberal drinking Wine, an Erysipelas seizeth upon the Head; or by a malign quality, as we may see fall out after the taking of Arsenick or Mercury sublimate. 8. Immoderate Motion, whereby immoderate Heat is procured, whereby the Humors become more subtil, and the passages to the weaker part more patent.
Now the part is weak, First, by Nature, and that either by reason of its substance, it being spongy and loose, as Glandules; so we see frequently Parotides behind the Ears, and Buboes in the Groins: Or by reason of the natural Humidity of the Part; so Tumors more often appear in the Flesh than in the spermatick parts. A Part also naturally is weak by reason of the situation; for the dependent Parts are more apt to receive influence of Humors, as the more high are to receive Halitus; so it is often seen, that it rising from the Stomach, or some inferior part, causeth in some the Falling Sickness. A Part, Secondly, is weak by accident, and that by reason of Errors committed in the things not natural, as Air, Meat and Drink, Exercise, and such like, whereof much is spoken in that part of Physick which is called Physiologia. So that to the causing of a Tumor in a Part, there be required the weakness of the part which receiveth, patent passages, preparation of the Humor, and the strength of the Part sending.
The internal Causes of Tumors are either Humors or Flatuosities; [Page 12]The Humors are either Natural or Unnatural: The Natural are either sincere, as Choler, Phlegm and Melancholy; or mingled, as some of these with Blood; for Blood is no where sincere, but according to the Humor mingled with it, which is predominant, it is called Cholerick, Phlegmatick, or Melancholy Blood. The Humor unnatural is Water, as in the Dropsie, for it never can become nourishment. Some add a Third cause of Tumors, the interposition of a solid Body, as in the Hernia intestinalis, zerbalis, exomphalos. Of Tumors which are caused by reason of strange things, as Worms, Lice, Bones, Nails, Hair, Grisly Substances, and such like, I will speak when I come to the Third part of Chyrurgery, called [...] or Ablatrix, which taketh away superfluities. But time admonisheth to come to the setting down of the principal differences of Tumors. In this matter I will leave all needless and fruitless distinctions of Tumors, from time, as that some are new, some old, some short, some long enduring: from the quantity, as that some are small, some great, some of a mean bigness: from the condition of them, as that some are mild, some malign, some curable, some uncurable, and such like; which either do not greatly further the knowledge and curation of Tumors, or else are to be set down to some purpose in the explication of every particular Tumor. Only now in my general Discourse of Tumors, which is to shew Light unto that which shall hereafter be spoken in the special Doctrine of each, I will meddle with the differences taken from the material Cause of Tumors, from whence spring the main principal Species of Tumors, unto which all others may be reduced.
All Tumors then are either simple or compounded. The simple are caused either of Humors or Flatuosity: the Humors are either Natural, or Unnatural: the Natural Humors are Four, Blood, Choler, Phlegm and Melancholy: If Blood, which neither in the Veins, nor without, is found sincere and unmixed (as hath been said) cause a Tumor, it is called Phlegmone or Inslammatio, according to Galen. lib. 2. ad Glaucon. cap. 1. Of the divers kinds of it, which have their denominations from their places, and of the diversities which arise from the complication of it with other Humors, I mean to discourse when I come to the particular Treating of it: For I mean not to confound Particulars with Generals, because this would breed Confusion, and so deprive Men of the Fruit of that which is delivered. Of all other Tumors a Phlegmone deserveth the first place, because it is caused of Blood, which is the Son of Nature, first begotten, and the Treasure of Life. If Choler cause the Tumor, it is called Erysipelas; these Two are hot Tumors. If Phlegm cause a soft and white Tumor like it self, it is called Oedema, unto which divers pituitous Tumors are reduced, of the which I will speak in their proper places. If a Tumor very hard be produced of the melancholy Juyce, and without pain, it is called Scirrhus; these two last [Page 13]are cold Tumors. If a Tumor be caused of Water contained in any part, it is called Tumor aquosus: If from flatuosity; Emphysema; these two last Tumors are the offsprings of Crudity, caused by the weakness and defect of the natural Heat. And seeing these have the material cause different from that of others, I will speak of these in several Chapters, as was done in every other particular Tumor. Besides this, they require other Medicaments than the rest of the main Tumors do, as shall be shewed when we come to the Curation of them, differing them from the rest. I see no reason why they may not be accounted several Tumors; one cannot truly say that either Hernia aquosa, or flatuous Tumors of the Joynts, can be reduced to the aforesaid Four principal Tumors, or that they can be cured by the same Indications of Curing, and Medicaments which are applyed to the other. You see how I have set down six simple Tumors, for fewer I cannot, if you consider either the diversity of the material Causes, or the diversity of the Topical applications, or the evidence of Doctrine. The combination of these begets the compound Tumors; in these compound Tumors, what Humor is predominant, that carrieth away the denomination: As for example, if Bloud abound more than Choler, the Tumor is called [...]. If Choler be predominant, it is called [...], and so in all other combinations of Humors in Tumors, which shall be presented to your view. When you have noted the Pathognomonical signs of each of the simple principal Tumors; it is an easie matter at the first sight to discern the kind of Tumor, and what compound Medicaments are to be applyed to it. Hitherto have I Declared unto you the Opinion of Hippocrates, Galen, and of the rest of the Grecians; as also of the Arabians, concerning the material Causes of Tumors.
Now I will shew you what Paracelsus and his followers think of this point: First then they acknowledge but Two Elements, Water and Earth; for if they should not grant so much, they could not be counted in the number of the Faithful; for in the very first Verses of Genesis mention is made of both. Secondly, they account the Humors parts of the Body, and so the causes of no Griefs, but erroneously; for if they were parts, they would be endued with Life, which they are not. Thirdly, they would have some Action, whereof they also are deprived: only they have an Use, which is to nourish the parts. Besides this, they maliciously dissemble the Doctrine of the rational Physicians and Chyrurgeons, for they make each Humor, contained in the mass of Bloud, either Natural, or against Nature: the Natural they make either, Alimentary, which nourisheth the parts, or Superfluous, which Nature reserveth for some other uses: of this abounding, Diseases proceeding of fulness are ingendred, called Plethora: of the Humor against Nature, causing impurity, Cacochymia is caused; so Choler in the Veins and Arteries is natural, [Page 14]and Alimentary. In the Cystis fellis, and in the Porus bilarius, the superfluous i [...] contained: if it leave the appointed Receptacles, and pass to the habit of the Body, it causeth the Yellow Jaundice; if by adustion, it become Bilis atra, it procureth Cancers and Wolfs; so that they hold not the natural, but those that are unnatural to be Causes of Diseases.
The Paracelsians appoint Three Principles of all things, Sal, Sulphur and Mercury, and not only by resemblance, or allegorically, but really: by Sulphur, they understand the fatty substance; by Mercury, the waterish substance: by Salt, the Earthly substance. Distil Cloves, there come Two Humidities, the Oyl and Spirit: in the bottom the Earthly substance stayeth, which hath Two Parts, Terra repurgata, the Crystalline Salt, and Terra mortua the Black Earth. The life of the Salt is a strong Water, which if it be by distillation drawn, it leaveth but a Terra damnata, only fit for the Dunghil. This Salt preserveth the Body from putrefaction. From Defects in these Three, they will have all Diseases to proceed, and concerning Tumors against Nature, the Hot they will have to proceed from Sulphur and Mercury; and the hotter the Tumor is, the more Sulphur to concur. The cold Tumors they will have to proceed from Mercury and Salt, and according to the loosness, or firmness of the Tumor, the more Salt or Mercury to be required, as in an Oedema more Mercury, in a Scirrhus more Salt. This is their Doctrine concerning the material Causes of Tumors. In my judgment it is the safest course to insist in the Footsteps of the Ancients, for their way is plain and easie; no Man can deny that there are Four Humors in the mass of Blood, as may appear when it is drawn out of the Veins: Choler swimmeth about the Blood, which is known by its bright Redness; Melancholy is in the bottom, which is deprehended by its grossness and blackness; now Phlegm uniteth these Two last Humors, and maketh them tough. The Puracelsian Doctrine is full of difficulties, which he maketh more obscure by coyning strange Words, as his Reader will perceive; so that his Discourses are but a kind of canting Philosophy. Nevertheless I thought good in plain terms to acquaint you with it, that when any Emperick shall make a shew of Learning, by using these terms, you may find him out, and esteem of him as he is: that is, Like that Head which the Wolf afar off espied, representing the Head of a living Man, but coming near, and seeing it but curiously carved, affirmed it to be Pulchrum caput, sed sine scientia, A comely Head, but without Wit.
CHAP. II.
Of the general Indications of Cure in Tumors.
HAving set down the Definition, Causes, and Differences of Tumors, I will set down the general Indications of cure in Tumors.
Now an Indication is That which sheweth what course is to be taken for the recovery of Health: The general Indications are taken either from the Matter, or from the times of every Tumor; in the Matter, we are to consider the motion of it, and its nature. As concerning the motion of the Matter; it is either in flowing, or it is received already into the Part. The Causes of Fluxion are Two, Plethora, or fulness and Cacochymia, an ill complexion: Plethora or fulness is twofold, Ad vasa, and Ad vires: Ad vasa is when the Veins are only full, and the Body notwithstanding quick and nimble; this is twofold, Pura, when there is a due proportion of the Humors of the Body; and Impura, when there is an excess of any of the Three Humors besides Blood, as Choler, Phlegm, or Melancholy. Ad vires, is when there is such a fulness, as causeth sluggishness of the Body: this requireth Evacuation by Phlebotomie, as Cacochymia by Purgation. As for Phlebotomie, Three things are to be observed concerning it. 1. The manner: In Fulness, Quoad vasa, at one time so much Blood is to be drawn as is requisite; but in Fulness, Quoad vires, because Strength is somewhat abated, you are to draw Blood by repetition, and not all at one time. 2. The quantity, how much then is to be drawn, the Weakness or Strength of the Party will inform you; for in a weak Body you are to draw less, in a strong Body more. Strength and Weakness are to be discerned by the Functions: The weakness of the natural Faculty is discerned by Crudity of Urine, and Excrements of the Body; the weakness of the vital, by a weak and small Pulse, as also breathing weak and Sick; the weakness of the animal Function is found out by defect in moving and feeling; by the integrity and Perfection of these Three Faculties, the strength of the Party is perceived: But we must diligently distinguish between languishing and weakness indeed, and oppression of the Faculties by reason of Fulness, making them dull and slow; for, as in weakness, great Moderation is to be used, so in Oppression we may more bountifully [Page 16]and boldly suffer the Vein to run. 3. The Third thing to be observed in Phlebotomy, is the end of it, wherefore it is instituted; the scopes of Blood-letting are Two; Derivation and Revulsion: Derivation is the drawing of the Humor to the part adjacent, or of the same side by opening of that Vein, or a branch of it, which is inserted into the part affected: as for example, if in Diseases of the Head or Neck, we open the Cephalica in the same side: and even in this there is a kind of opposition, to wit, high and low; for in Tumors of the Groyn, we open Vena poplitis: thus they do also who open this Vein in Podagra, if the Gout invade the Foot. This kind of interception we use, not only because there is a plentiful Fluxion to the part affected, but because a speedy Interception is required, lest the natural heat of the Part be oppressed, or the rupture of a Vessel ensue; so in Inflammation of the Lungs and Side, we open the Liver-Vein of the same Side, and draw Blood plentifully. Revulsion is a drawing of the Humor to a part opposite: Of this there are Four differences: 1. From the higher to the lower parts, as from the Head to the Feet. 2. From the Right Side to the Left. 3. From the Fore-part to the Back, which we shall do if we apply Leeches in Diseases of the Breast or Belly. 4. Is when we draw from the Center unto the circumference, as in applying Ventoses with Scarification to the Neck in Diseases of the Brain, as in the Apoplexy, and Lethargy. Vesicatories perform the same.
But one may ask, which are to be accounted high, and which low?
I Answer, That all those parts which are above the Navel, including also the Liver and Stomach, are accounted high: but the parts below the Liver are accounted low, as the Kidneys, and Genitals in Man and Woman.
This kind of Interception we use in Two Cases: First, if the Matter flow but slowly, and so a suddain Interception is not required. Secondly, If we are to open a Vein to prevent a Disease, as Vena cubiti for to free one of a Fit of the Gout. But this kind of drawing hath no place in contagious Tumors, if they appear either in the upper or lower parts; for whether they appear either behind the Ears and Arm-pits in the upper parts, or in the Groins in the lower, Revulsion must be by the Vena cava, which is inserted into the Right Ventricle of the Heart: Now whether any contagious Vapour or Humor can be sent by this passage safely; let every judicious Person consider.
Now there is a difference between Revulsion, Derivation, and Evacuation; for in the former two, Motion is required, but in Vacuation the Humors must be quiet. In the translation of Humors flowing from any part, we must mark according to Hippocrates, that it be done [...] Secundum rectitudinem, by observation of a straight course; and that is done two manner of ways.
First, by the rectitude of the parts, as the Left with the Left, and Right with the Right, and [Page 17]the hinder with the Fore-parts. Secondly, by the rectitude of the Vessels: As for example, The Liver-Vein of the Arm hath a kind of streightness with the Veins ascending to the Head: So if one bleed immoderately at the Right Nostril, by applying a Ventose to the region of the Liver, the Flux ceaseth: If it flow from the Left Nostril, it must be applied to the region of the Spleen.
Having set down how Plethora is to be abated, if it cause Fluxion, we are to shew how Cacochymia is to be removed, which is not so much, by reason of the quantity oppressing, as by reason of an evil quality offending a part. Now this Matter offending in quality, it either moveth from place to place, or it resteth where it had its first invasion; if it move from place to place, it is the safest course to abate the Humors wherein this quality is resident by Phlebotomy, lest it seize upon some principal part: if it be quiet, resting contented with the first place, then let us use Purging, expelling the Humor, whether it be Choler, Phlegm, or Melancholy, with appropriate Medicaments, which Physick prescribeth in that branch of the Curative part of Physick, which restoreth Health by the administration of inward Medicaments. Having set down the Indications which are taken from the motion of the Humor, we must come to those which are taken from the nature of it.
Now the Humor if self is either not contagious, or contagious: If it be not contagious, the Fluxion of it proceeds from Three causes: The First is the strength of the part sending the Humor, which it doth, either because it is burthened with the quantity, or pricked on by the quality; we have shewed what is to be done in these cases. The Second is the thinness of the Humor. The Third is the attraction of the affected part. When Fluxion is caused by reason of the thinness of the Humor, if we cannot use Phlebotomy, or Purging, as in Children, decrepit Persons, and in Women with Child in the First and Last Months: then we must use Revulsion, and this is done six manner of ways. 1. By Ventoses without Scarification, as when we apply a Ventose to the region of the Liver, when one bleedeth too much at the right Nostril. 2. Painful constriction, or binding of the Parts, as Arms and Legs: but we must first [...]rub the Parts hard which are to be bound; and if we bind the Arm, we must use a Ligature in three Parts: First, near the Arm-pit. Secondly, a little above the Elbow. Thirdly, about the Wrist. In the Legs we must use a Ligature near the Groin, a little above the Knee, and near the Ankle. 3. Painful Frications when we mean to revell from the Centre to the Circumference. 4. Bathing of the Parts with very hot Water. For First, by reason of the pain it doth revell. Secondly, it doth discusse, because it openeth the Pores. And in Fevers, by bathing the Limbs Sleep is procured, the Vapours ascending to the Head. 5. Vesicatories, which are used in an Apoplexy, Lethargy, and such like. 6. Fontanels, and they are of great use, applied to divers Parts, for [Page 18]the preventing and curing of sundry Griefs: If the Fluxion be procured by the attraction of the part affected, there are two Causes of Attraction: First, the distemperature of the Part. Secondly, Pain. If distemperature of the Part be the Cause, it must be removed by its contrary: but seeing it is most commonly a hot Distemperature, things cooling are to be applyed, as by applying Cloaths moistned with Oil of Roses or Violets cold; but when the Clouts become hot, they are to be removed, and cold to be applyed, or Cloaths moistned in the juyce of cold Herbs. If we apply Unguents, as Infrigidans Galeni, Resatum Mesuis, de cerussa Rasis, Populeon, we must not apply the Unguent immediately to the Skin; but on a thin linnen Cloth; for it keepeth the Unguent from drying, and doth not hinder the breathing out of the Vapours, which the immediate application of the Unguent would do, and so by stopping of the Pores, would increase both the Heat and Pain.
And in application of Pultesses, they are to be spred between the foldings of a Cloth dipped in some convenient Oyl or Liniment; for so it doth not hinder Perspiration, and the applications are removed more easily from the part. This in your practice is to be noted, and the inveterate Error to be shunned. If the ways by which the Humor passeth, be too ample and patent, and a hot Distemperature joyned, then things astringent and cooling are to be applyed, Roulers and other Cloaths being moistned in them. Wherefore in this case Myrtle-Berries, Red Rose Leaves dryed, Pomegranate Rinds and Flowers, Sumach, Sloes, Oaken and Owlar Bark boiled in Red astringent Wine, or Vinegar and Water, or new and fresh Tanners Woose, and strained, are effectual. The Parts therefore by which the Humor passeth, are to be rouled somewhat strait with the Rouler, Cloaths, Stupes, or Pledgets and Bowlsters being moistened in this Liquor, and wrung: You may also apply astringent and defensive Emplasters drawn upon Leather; such an one as this, ℞ rad. torment. bistort. symphyt. ros. rub. gallar. balaust. malicor. sang. drac. boli Armen. santal. rubr. ceruss. an. ʒ j. cerae albae ℥ iij. ol. myrtil. ℥ j. misc. fiat ceratum. So much then shall be sufficient to have been set down, concerning the attraction of the affected part, by reason of the Distemperature of it: Now we must come to the Second cause of the Attraction, which is Pain. There are Two causes of Pain, solution of Unity, and a venemous Quality: If the solution of Unity proceed from the affluxion of Humors hot or sharp distending the Parts, the Pain is to be eased with Medicaments convenient; these are of two sorts, Anodyne, and Narcotick; Anodynes gently contemperate the Part, by reason of the conformity which they have with the Nature of Man. They are hot in the first Degree, and of subtil parts; such are Milk, old Sallad-Oyl, Butter, Hogs Lard, Fat of Hens, Ducks, Geese, Eels, Man, Badgers, Bears, the Oyl of Chamomil, Lilies, Earth-Worms, Linseed, Dill, Sweet Almonds, Eggs, the [Page 19]Pulp of Cassia tempered with the Oyl of Roses, the Pulp of sweet Apples with the Powder of Saffron. Narcoticks deprive the part of the faculty of Feeling, such are Opium, Hemlock, Henbane, the deadly Nightshade, Mandrakes, and the Apple of Peru, or prickly Apple: these we are to use when the former will not prevail, and when by reason of Watching, a Fever, or Faintness is to be feared. Sometimes in extremities they are used Solitary, sometimes with their Correctives, to wit, things hot, if we fear stupefaction of the part, unto which they are to be applyed: Such things are Castoreum, Saffron, Cinamon, Cloves, Pepper, and such like. If the biting of a venemous Beast, as of a mad Dog, or a Viper, or Adder; or the stinging and pricking of any Beast, as of a Scorpion, or Insect, as a Hornet, be the cause of a Tumor, we must address our selves to meet speedily with the Poyson. If therefore a venemous Beast bite or sting, First, the part is to be scarified, and Ventoses to be applyed, then the part is to be fomented with Theriaca Andromachi, dissolved in strong Wine-Vinegar, and Stupes moistened in the same, applied to the same; or it is to be fomented with the Oyl of Scorpions, and a Pledget wet in it to be applyed: And above the Pledget, this emplaster of Fallopius De tumoribus, c. 14. is to be spread warm, ℞ pic. naval, ℥ j. sal. nitri. ℥ss. semen. sinap. ʒ ij. cepar. allior. sub prun. coctor. an. ʒ iij. assae foetid. sagapen. an. ʒ ij. stercor. columbin. ʒ j ss. aristol. rotund dictamn. alb. an. ʒ j. ol. lil [...]albor. ℥ ss. fiat emplastrum: Pigeons also, and Hens, and Cocks divided in Two parts, and applied hot, are available. Sometimes the actual Cautery is to be applied, to tame the malignity of the poyson, if the poyson hath continued above three days: Besides this, two things, more are to be done; First, according to Galen, 3. De loc. affect. 7. the Member is to be bound hard, three or four Inches above the part bitten or stung: Secondly, Antidotes inwardly are to be given; but chiefly Theriaca Andromachi, for many days together in a Liquor, fit for the constitution of the diseased Person: Now if the matter of a Tumor be contagious, we are by all means to draw it out of the Body, lest if it go in, it deprive the Person of Life, as in the Plague; or infect the Liver, as in the Pox; wherefore Ventoses and Medicaments attractive are to be applyed: Such is Fallopius his Emplaster set down before, for the attraction of Poyson. In the Plague we must not fail to minister Antidotes, even three times in a day, and to procure Sweat: Such are Theriaca, Electuarium de ovo, Electucrium Orvietani, or this of Fallopius, De tumor. 9. ℞. baccar. juniper. caryophyll. nuc. moscat. rad. enul. an. ʒ ij. rad. aristol: utriusque, gentian. an. ʒ vj. semen portul. acetos. doron. ben. rub. an ʒ j. spodii, oss. de corde cervi. ligni aloes. corallii albi & rubri, rasur. ebor. baccar. lauri. mastich. croci. an. ℈ ij. rut. morsus diabol. an. ʒj. Pulp. ficuum & dactylor. an. ℥j. cinamomi. liqiurit. an. ℥ss. tormentill. card. bonedict. dictanini albi. an. ℥ iij. amygdal. dulc. & pinear. excort. an [...] ℥ j. agaric. trochiscat, [Page 20] ʒ vj. rad. peuced. ʒ ij. terrae sigillat. & bol. orient. an. ℥ j. zedoar. ʒ ij. caphur. ʒ iij. spec. 3. santal. spec. diarrhod. abbat. an. ʒ ij. cort. citri, pulv. smaragdi an. ʒ j. moschi ℈ j. Theriac. Andromach. & Mithridat. an. ℥ j. fol. mali Armeniaci ℥ ss. cum syrup. de cort. citri. & de acetositate citri. an. triplo pondere, ad pulveres, fiat Electuarium. Ʋt Electuarium fiat magis efficax addi possunt cornu rhinocerotis ʒ iij. & cornu cervi praeparat. ℥ ss. Dos. a ʒj. ad ʒ ij. in conveniente liquore.
The stinging of Wasps or Bees is cured with Mallows stamped and mingled with cold Water, or Chaulk applied with the same.
CHAP. III.
Of the Four Times of a Tumor, and the Indications taken from them.
HAving spoken of the Indications Curative, taken from the Matter of a Tumor, now it followeth that we speak of the Indications taken from the times of a Tumor; The times of a Tumor are Four, the beginning, the increase, the state and declination. The beginning is thought to be, when a part beginneth to swell, although the actions be not hindred: in the beginning repelling Medicaments are required; repelling Medicaments are cold, and of gross substance, for they are to thicken the part affected, and to cool the inner parts of it; such are the Whites of Eggs, Plantain, Night-shade, House-leek; Prickmadam, Purslain, Rose-buds, dry Roses, Myrtle-berries, Pomgranate-flowers, and Rinds, Galls, Sumach, Quinces, Sloes, Bole, Sanguis draconis, terra sigillata, sowre Wine, Tanners Woose; which you may apply either single, or mingled according to your scope. But in six cases we are not to use repelling Topicks; First, if the Matter be vonemous or maligne, lest it being repelled, should assault some principal part. Secondly, if the Matter be critically turned to a part, so that it be not a principal part, by the error of Nature: for then it ought to be repelled; as when in a burning Fever, the Matter being sent to the Meninges, causeth Ravings. Thirdly, when the Body is either Plethorick, or of an ill habit. Fourthly, when the Humor floweth to the emunctories. Fifthly, If the Part have but little Natural Heat, we are not to use repercussives, lest the natural heat be extinguished, and the part mortified. Sixthly, when the pain is vehement, for then [Page 21] Anodynes are only to be used.
We are to think the Tumor to increase, when the part is stretched, and symptomes are increased; and seeing in the increase the Matter partly floweth, and partly possesseth the Part, you are partly to repell, and partly to discusse: but if the Matter flow with such force and plenty of Humor, that it threatneth corruption of the Part, or if the Humor which floweth be thick, and so hot that the Part feeleth a burning, as in a Carbuncle; then are you to use sensible Evacuation by Scarification; but where we cannot conveniently Scarify, Leeches are to be applyed, as in the Hemorrhoids, and other griefs of the Anus. Now discussion is an evacuation of a thin Matter gathered in a Part, by insensible evaporation, procured by the natural heat increased by proportionate Medicaments. In this description insensible is added, to distinguish it from Evacuation by Incision, Scarification, or Leeches, which evacuate sensibly to the Eye: the principal efficient cause is the natural Heat; the adjuvant discussive Medicaments; the Matter which is to be resolved, must be thin; for it is in vain to go about to discusse a thick substance, because it is not apt to yield Vapors. In the description, discussive Medicaments are said to help natural Heat by increasing of it; which being done: First, the Humor is made thin. Secondly, it is resolved into a Vapor. Thirdly, it is drawn from the Centre to the Circumference. And Lastly, expelled by the Pores of the Skin. Such Medicaments then must be familiar to Nature, and these perform their Office, by consuming superfluous Humidity: and so they must be hot and dry. They must then be subtil, that they penetrate to perform these Offices. There are three degrees of discussive Medicaments, they in the first Degree are hot and dry in the second, as dry Figs, Bran, Chamomil, Ammoniacum, galbaman, Leaven, Lilieroots, Melilot, the roots of Marsh-Mallow, Goos-Grease, and old Hens Grease; and because such asswage pain, we ought always to begin with them. In the second Degree are Calamint, Hysop, Penniroyal, Mint, Cummin-seeds, and Dill-seeds, Bean-flour, the Flour of Vetches, Fenugreek, Horchound; the root of Peucedanum, the roots of the Birth-worts, Lyons Fat, old Bear's Fat, old Badger's, Cat's. Dog's, and Man's Fat: these are somewhat dryer and hotter than those of the first. In the third Degree, are those which are dry and hot in the third Degree, as Niter, unslacked Lime, Sulphur vive, assa-foetida, &c. These are to be applyed according to the constitution of the Party, and as the skilful Chirurgeon shall see cause.
The state of a Tumor, is when it is come to such a Degree, as that it can go no farther in bigness, the signs of it are these: First, all symptomes, as Tension, Pain, Redness and Fever symptomatical are at the height, and remain uniform, neither increasing nor decreasing: Secondly, the Veins of the parts adjacent continue in the same fulness and dilatation. In the state we are to use Anedynes [Page 22]discussives by reason of the pain.
We are to think that the declination of the Tumor beginneth, when the aforesaid Symptoms begin to abate, and then strong discussives only are to be applied, whereof we have spoken before. In necessity we may use these which are found in the Shops, Diachylon cum gummi, Diachylon magnum Mesuis, Diachylon ireatum. Tumors end not only by Resolution, but often by Maturation; and sometimes by Induration and Corruption: and as Discussion is better than Apostemation; so Induration is better than the Corruption of the part: Fifthly, Tumors do end changing the place, as when in a Pleurisie the Matter falleth upon the Midrif, and causeth an Empyema.
CHAP. IV.
Of curing of a Tumor come to Suppuration.
HAving shewed the Method how Tumors are to be discussed: now order requireth that the means be set down, how a Tumor is to be handled, if it tend to Suppuration, or Maturation, which by our usual term is called Apostemation. And we are inforced thus to go to work: First, if the Humor be too plentiful; for then the natural Heat cannot well rule it, and so it must be seconded by foreign and external Heat, which working upon superfluous Humidity, causeth Putrefaction according to the Philosopher. Secondly, when it is crude; for then we must labour to concoct it with Medicaments, which are peptica or coquentia. Thirdly, when the Matter is hard, and then we must use emollient Medicaments. The Medicaments which procure Quittour, they are temperately hot and moist: and these help natural Heat, that it may the more easily elaborate the Matter, and make it fit for expulsion, and this we call Concoction. Emollient Topicks are used to soften any Matter indurated, and such are dry in the first degree, and hot in the first, and in the beginning of the second. But it is to be noted that there is a difference between Tension and Hardness, and Relaxation and Softness: a part stretched will yield to the Finger pressing it, if it be hard it will not; and where there is any Tension, relaxing Medicaments are to be applied, which attenuate and open the Pores, and therefore they must more discuss than dry, and so be drying in the first Degree, and hot in the second. A part indurated must have emollient means applied to it: whereof [Page 23]we will speak, when we come to discourse of a Scirrhus. In the Cure of Apostems, we are to do two things: First, we are to prepare the Matter; and make it fit for expulsion: Secondly, we are to evacuate it when it is prepared. To accomplish the preparation of the Matter, first, we are to remove Accidents: Secondly, to procure the maturation of the Matter. The Accidents are these, Pain, Tension of the Part, Hardness and Heat. As for the asswaging of Pain; narcotical or stupefactive Medicaments have no place here: For first, they extinguish the natural Heat of the Part; which is the principal efficient cause of Coction: Secondly, by thickning of the Matter, they make it more rebellious; wherefore we are to use Anodyne Medicaments, whereof we have spoken already: you shall do well to apply a Cataplasm of White Bread Crums, let the Apostem be dressed with this, or such a Medicament Morning and Evening.
If the part be stretched, use relaxing Topicks, such are those which are temperately hot, not drying much, and of subtil parts, as White Hore-hound, Archangel red and white, Mullen, Dill, Chamomil, Fenugreek, Mercury, Melilot, Turneps, the leaves of Marshmallow, the Flour of Barley, Beans and Vetches; of these you may frame to your purpose such a Cataplasm; Take of Chamomil-flowers beat to Powder ij. pugils, of Barly, Bean, and Flour of Vetches, of each ij. ounces, of Marsh-mallow Leaves and Flowers pounded a handful: boil these in Beef or Mutton Broth strained, and the Fat taken away, until they come to the consistence of a Poultess: Then add to it the oyl of Dill, Chamomil and Rapeseed, of each one ounce: dress the Apostem with this or the like, Morning and Evening.
If hardness hinder, use those things which are emollient, as all manner of Fats, the Dregs of Oyl, all sorts of Mallows, Colts-foot, Bugloss and Burrage, Quinceseed, Milk, the White Lilie, Linseed, Figs, Raisins, the Marrow of Beasts, Oyl of Sweet Almonds, Marshviolets, Ammoniacum, Bdellium: of some of these you may frame a Cataplasm after this manner: Take of Linseed Meal or Powder iiij ℥. of Marsh-mallow Roots, and Whitelilie Roots boiled in Water, and well bruised, of each ij ℥. of Violet Loaves and Flowers, and Colts-foot Leaves, of each an handful; boil these in new Milk, until they come to the consistence of a Cataplasm; unto the which add of Ammoniacum dissolved in Muscadine, of the pulp of Figs and Raisins of each j ounce, and so make up your Cataplasm.
If immoderate heat trouble you, apply things cooling: but let them be cold either in the second degree, or beginning of the third, for the Reasons yielded against Narcoticks, when I spake of Pain; such are umbilicus Veneris, or Navel Woort, Prick-madam, Sengreen, Barly meal, Endive, the pulp of the Pumpion, Sea-tong Lettico, Ducks-meat, the Water Lilie, the Water Archer, Plantain, Garden Night-shade: of these Herbs with Barly meal boiled in fair Spring [Page 24]Water make a Poultess, and to every pound of the Poultess, add ij ℥. of populeum unguentum, and ℥ j ss of unguentum rosatum Mesuis.
You may demand of me, how long the Application of these Topicks, prescribed for the removing of Accidents, is to be continued?
I answer, until the Accident be almost gone, with the which you encountrred, and then you may proceed to assist Nature, by increasing natural Heat by ripening Medicines, which was the second intention of curing Apostems set down by me: Now those Medicaments which help Nature, ought first to stop the Pores reasonably, only suffering the sharp Vapors to breath out, and to detain those which are mild and somewhat thick, which are the secondary cause of Coction. In this respect then they ought to be viscous and tough in substance, which are temperate Oyls, and Mucilages, which by Galen are called Emplastica; secondly, they ought to be familiar to Nature, and so temperately hot and moist. One thing is to be noted, that hotter Simples are to be chosen, according to the temperature of the part, if the Tumor seem somewhat cold: wherefore if the Tumor seem hot, only Maturatives in the first Degree are to be used, and those of the second Degree to be shunned: But if the Matter be somewhat cold, then you are to use Maturatives of the second, yet always mingling with them some of the first Degree. And the Reason is this, because the Medicaments of the second Degree dry too much; wherefore those of the first Degree are to be added, in the which there is much moisture, which is requisite to Coction and producing of Quittor. These Medicaments are called Concoquentia, and Pus moventia, and Suppurantia: such ought to be hot and moist, as the Body of a temperate Man is, and so they ought neither to dry or moisten, or to heat or cool immoderately, but only to preserve and increase the Natural Heat; for a Suppurative Medicament ought to answer the Constitution of him unto whom it is applied.
Of these Suppurative Medicaments there be two Ranks; In the first, are Mans-grease, which asswageth Pain, also Ducks-grease, Geose-grease, Hens-grease, Oyl of sweet Almonds, sweet sallet Oyl, Mallows, sweet Butter, Figs, Fenugreek, Lily-roots, Linseed, Wheatflour; a Cataplasm made of Wheatflour, Water and Oyl, an Emplaster made of yellow Wax, and Oyl called Cerelaeum, Violet-leaves and flowers, Saffron; For an Example, I will set down the description of a Suppurative. Cataplasm compounded of some of these of the first Rank: Take of Milk a pint, in the which boil of Wheat-flour a quarter of a pound, of Violetleaves, and Mallow-leaves stamped, of each a handful, of Lily-roots, and Figs boiled in Water, until they be soft, of each two ounces; when they are come to the consistence of a Poultess, add of Saffron beat to powder a dram, of the Oyl of Linseed, sweet Almonds, Lilies, and Mans-greese, of each one ounce, and so make up your Medicament, If the Tumor be immoderately [Page 25]hot, mingle always with your Suppuratives those things which are cold and moist in the first Degree, as Violet-leaves, Lettuce, the pulp of Pompions, Grownsil, Succory, Dandelion, and such like. If on a sudden you be called, and be required to dress a Tumor tending to Suppuration, you may have recourse to the Apothecaries shop, and with these things dress it. First, beat some Oyl of Violets and fair Spring-water together, taking two spoonfuls of Oyl, and one of Water, with the which embrocate the Tumor; then apply a Pledget moistened in this, upon the part which is like to break, or be opened: and above the Pledget, Diachylon simplex if the Tumor be hot, or Diachylon cum gummi if it be but a little exceeding the ordinary temperament.
Suppuratives of the second Degree are these; Terebinthina, Ammoniacum, Galbanum, Sagapenum, Gummi elemi, Pix navalis, Burgundie Pitch, Saffron, Leaven, Fenugreek, Onyons and Garlick rosted under the Embers, old Butter, Oyl of Chamomil, and Dill, old Hens-grease, Badgers-grease, and Bears and Dogs-grease, Wheatflour, Flour of Linseed. In the Shops there are Emplastrum de mucilaginibus, Dialthaea cum gummi, Diachylon cum gummi, Diachylon magnum.
Now I will set down a compound Medicament, framed of these Simples: Take of the Roots of white Lilies, of the Roots of Marsh-mallow, of Onyons boiled and bruised, with the Liquor of each iiij ℥. of Leaven ij ℥. of Linseed-meal j ℥. and a half, of Saffron beat to powder a dram, of Ammoniacum and Galbanum dissolved in Muscadine, and the pulp of Figs, of each j ℥. of Oyl of Chamomil and Lilies, so much as will make a Cataplasm of a good consistence.
In Strumes, and Bubo's venereal, use this: take of Diachylon cum gummi, and Emplastrum de mucilaginibus, of each j ℥. of Garlick and Onyons rosted under the Embers of each ℥ ij. of Dialthaea cum gummi, Mans-grease, and Bearsgrease of each ℥ j. make a Medicument. One thing I would have you to note, that Suppuratives of this Degree are fittest for all contagious Tumors, and that to all such, Onyons and Garlick rosted, and mingled with other Medicaments, are to be applied, for being thus prepared, they lose their sharpness, attract, and become familiar to the Natural Heat.
How Apostems are to be opened.
Hitherto you have heard, how that Tumors that cannot be discussed are brought to suppuration: Now I am to deliver unto you, how the Matter, which is suppurated, is to be discharged. This is done by opening the part: Now some things are to be considered before the Action, some in the Action, and some after the Action. Before we go about to open an Apostem, 1. We must be certain whether it be ripe enough; 2. We must resolve how to open it.
The signs of Maturation, are; I. The Tumor, by contracting it self, seemeth less than it was in the state; for while the Natural [Page 26]Heat concocts the Matter, Vapors are raised by the heat, and so the part is distended; but when the Matter is concocted, the Elevation of Vapors ceases, and the Tumor falls somewhat. II. The Tumor draws it self to a point, or prominence; because when Nature overcomes the Matter, it draws it together, and draws it to the skin. III. Hardness and tension are much abated; for Maturation being procured, many Vapors are discussed, which before stretched, and made the skin hard. IV. By pressing the Matter with the Finger, we find a fluctuation or coming and going of it: but we must be circumspect when a Tumor in a great Joynt is offered unto us, as in the Knee; for if we press lateral parts of it, a certain undation will appear. V. The party feeleth much ease in the part; partly, because some of the sharp Vapors are resolved; partly, because the Matter concocted doth make the parts more loose. VI. The vehement Heat ceaseth; for the Humor being come to Maturation, the unnatural Heat abateth, and the natural Heat resteth. VII. If the part inflamed hath changed the colour, and of red is become white, and chiefly in the pointed place. VIII. The Scarf skin becometh shriveled, and ruffled; and this is a good sign, for it sheweth that unnatural Heat hath left it.
The second thing which we said was to be resolved upon, was the Instruments with the which the Apostems are to be opened. They are three; I. The Lancet or Incision-knife, of the which there be divers forms set down by the Ancients: of the which we will speak, when we come to discourse of particular Operations for the which they are required. II. Is the Caustick or Pyrotical Medicament. III. The Actual Cautery, which we will leave willingly to Horseleeches, unless we be destitute of other means, and when we are to make a Fontanel, or to stay a great Flux of Blood, or to dry a Carious Bone, or to correct a Cancerous part after that it is extirpate.
As for the Steel Instruments, we are to use them. First, if Apostems be in the Face, to avoid the filthiness of the Scar, after the Curation. Secondly, in small Tumors: for so they will be the sooner whole.
As for Caustick Medicaments, we use two sorts of them: the first is made of the strongest Sope-lees, boiled to the consistence of a soft Stone. The second is made of the like Lee, and unslaked Lime, boiled to the form of a firm unguent. The first is best in Tumors which possess the convex part. The second is most convenient, if they be in parts concave or hollow.
These Pyrotical Medicaments are most fit to be used in five Cases: I. If we intend to keep the Tumor long open, as is requisite in all contagious Tumors, in the Plague, and Pox: for where the Caustick is applied, there is always loss of substance, and by it we make the Orifice round, which of all other Figures most slowly is cured. II. In large Apostems Causticks are fittest; for by them, making as large an Orifice as we will, we shall spare tenting and enlarging of it; besides, the stretched parts will the [Page 27]sooner be contracted. III. They are to be used in deep Apostemations, such as happen in the Belly and Back, for so the Matter shall have a readier way for Evacuation. IV. They are best, when a Flux of Blood may be expected. V. We apply them, when we will gratifie timorous persons.
When we are come to open the part, then these things are to be observed: I. The Nature of the Part: this teacheth us, to shun Veins and Arteries by reason of Hemorrhage; and Nerves, Tendons and Membranes by reason of the pain which ensueth. II. If the Skin only be to be divided, then the Apertion is to be made strait; but if a Muscle also be to be incided, it must be done according to the Fibres of it. III. Apertion must be made in the depending part, because the Matter will be more readily so drawn out. IV. It must be done where the part is thinnest, for so less pain is caused. V. The Apertion must be proportionate; for if it be too little, then the Matter, especially if it be thick or grumous, cannot be well drawn without expression, which maketh way for Callosity and Fistulation. If it be too large; First, the Scar will be the more ugly; Secondly, the parts subjacent will be made more apt to be altered, by receiving the impression of the cold air. VI. We are to know how much Matter is to be evacuated at one time: In great Tumors, and those which are in the Joynts, great moderation is to be used; for with the Matter many Spirits breath out, and so are spent: from whence extenuation of the Body, yea, and Death sometimes ensueth. The Chirurgeon who is to do this, ought to be resolute, chearful in countenance and speech, and no ways scrupulous: otherwise he shall make the Patient dismayed, and fearful, which doth much weaken and abate the courage of the Patient.
Things to be observed after the opening of an Apostem, are these: First, the removing of Accidents which most commonly fall out. Secondly, the manner of dressing. The Accidents are most commonly three, Fainting, chiefly if the parties be Children or Women, but above these, Effeminate Men. Secondly, Pain. Thirdly, a Flux of Blood.
As for Fainting, we may labour to prevent it by giving the Patient a Caudle, Aleberry, or some styptick Wine with a Toast, as Alegant and Tent; or if it be like to ensue, we may give them some Cordial Water with Sugar, as Cinamon Water, Treacle Water, or Aqua coelestis. If pain ensue, let the part be embrocated with Oyl of Roses, and the third part of Wine beaten together: yet the Oyl is not to touch the brims, if Apertion hath been made by Incision, lest it cause Spungeous Flesh to grow. As for staying of Blood, I will set down the fittest, and most effectual means to perform this, when I shall come to discourse of Wounds, for in them it doth most commonly fall out.
As concerning the manner of dressing after opening: If this hath been done by Incision, either a Tent, if it be small, or Dosels with Pledgets armed with some restringent Powder, as Bole, Frankincense, [Page 28]and Flour tempered with the Whites of Eggs, if it be large, are to be used: and so it is to remain for the space of four and twenty hours. If the Caustick be applied, then Dialthaea simplex, or sweet Butter melted in a Saucer, are fit to be used until the Eschare fall; then the Cavity is to be Incarnate: If in the mean time Spungeous Flesh appear, it is to be removed with Catheretical Medicaments, as Mercury precipitate alone in gentle Bodies, or mingled with Alume, taking the third part of this in harder Bodies: yea, you shall be enforced sometimes to use Pulvis sine pari, and other Fistula Powders with some Medicaments which cool and asswage pain, as Ʋnguentum Populeum, and Rosatum Mesuis: take my word, Basilicum and Aureum are not so fit.
Last of all it is to be sealed up with Epulotical Medicaments, as Diapalma, Emplastrum de minio, Ʋnguentum comitissae, and Desiccativum rubeum. If a Tumor end into an Induration, it must be cured as a Scirrhus, whereof I will speak in its proper place. If it end in the Corruption of the Part, the way of Dressing this shall be set down in my Discourses of Gangraena and Sphacelus. If a Tumor cease, because the Matter removeth from one place to another, as when Pleuritis endeth in Empyema, neither doth this belong to this place.
CHAP. V.
Of a Phlegmon.
HItherto I have delivered a General Method, common to the Cure of all particular Tumors: now it remains that the use of the General Method be shewed in every special Tumor. Of all which a Phlegmon doth first offer it self: First, because it is caused by the most excellent Humor, to wit, Blood, the Matter of Spirits, and the Store-house of life. Secondly, because it is most frequent. Thirdly, because very often, as a Symptom, it accompanieth other Griefs, as Wounds, Contusions, Ulcers, Luxations, and Fractures, as Galen noteth.
The word [...] is derived from [...], from whence flagro to burn, by reason of the heat of it.
A Phlegmon is a Tumor hot, proceeding from the affluxion of Blood to any part. In this Description, where it is said to be hot, in this it is distinguished from an Oedema and a Scirrhus; and in this that it is said to proceed from [Page 29]Blood, it is distinguished from an Erysipelas caused of Choler. The differences are taken either from the Material Cause of it, or else from some parts which it possesseth. The differences of it taken from the Matter are these: It is either Legitima, or Notha, either truly bred, or else bastardly.
A proper Phlegmon, is caused by good Blood, only offending in quantity: Good Blood is discerned by Colour, Taste and Consistence: In Colour it is Red, in Taste Sweet, in Consistence Mean, between Thick and Thin: of all other Humors it is most plentiful in the Body, because it affordeth nourishment to all the Fleshy Parts, as they have their being by it, next unto Blood.
The Signs of a true Phlegmon, are six. I. This Tumor begins suddenly, and increases speedily, because the Matter is plentiful, and the ways by which it is sent, very patent and large. II. It is very hot in respect of an Oedema and a Scirrhus, but yet not so burning as an Erysipelas. III. The Colour of the Part is of a fresh ruddy Colour. IV. In this Tumor there is great Pain with Pulsation. V. There is a great Tension in the Part, because the unnatural Heat raiseth plenty of Vapors which distend the Part. VI. The Veins, which before lay hid, become conspicuous and appear either ruddy or blackish.
Now as I said, there be many differences of Phlegmons taken from the parts which they invade: for if it siese upon the Meninges or Membranes of the Brain, it is called [...]; if the Conjunctiva of the Eye, then it is called [...]; if the Muscles of the Throat, it is termed Angina; if the Pleura, it is named [...]; if the Lungs, [...], if the Kidneys, [...], if the Emunctory of the Heart and Liver, Bubo; of the Brain, Parotis; of the Gums, Parulis; of the Almonds, Paristhmia, Tonsillae: Phlegmons in other parts have no proper Names, and even these I will refer to the particular practice of Physick, wherein they are handled, and rest contented with the Doctrine of External Tumors.
These Inflammations, if they possess the external Parts, and be but moderate, are healthful; as those which either by reason of the plenty, or Malignity of the Humor, threaten a Gangrene and Mortification, are to be suspected. A Phlegmon which happens in a young Body, in a hot and thin Part, the Body being not very Plethorick, and in the Summer time, is more speedily cured; but quite contrarily, if the conditions be opposite. The Indications curative of a true Phlegmon are taken from the times of it: The Means by which we cure are two, a convenient Diet, and Artificial Application of apt means for curing of the Tumor.
In the beginning therefore, we must prescribe such a Dyet as is able to hinder the increase of superfluous Blood, and the Fluxion of that which is already bred: wherefore the Dyet must be spare and slender, only sufficient to sustain Nature, and withal cooling: the Patient then shall rest contented with Chicken and Veal Broth with Bread, Calves-feet and Trotters stewed, and seasoned with [Page 30]Vinegar, thin Oatmeal-Gruel, Panadoes, Sallets made of Sorrel, Spinage, Purslain boiled in thin Chicken or Veal-broth, seasoned with some Vinegar, Verjuyce and Sugar; let his drink be small Beer or Ale, altered in the Summer with Burrage, Bugloss, and Burnet, Barley-water, fair Spring-water, wherein the crust of a Loaf hath been boiled, and made pleasant with Oxysaceharuin, or Oxymel diureticum, mingling with a pint of the Water one Ounce and an half of the Syrup. If the Party be weak, Almond-Milk made of Barley-water, or the thin Broth of a Chicken may be permitted: If we intend to make the Blood unapt to motion, and to detain it in its own receptacles, then we must institute a Diet, having these three qualities: First, it must cool: Secondly, it must make a constriction, and pursing up of the Vessels: Thirdly, it must be Diuretical, or move Urine, for much serosity being carried away by the passages of Urine, the Blood must be made thicker, and therefore not so apt to flow. But we must take heed that such a Diet be only prescribed to such as are in their constant age, and have large Veins; otherwise, we shall cause new obstructions, and multiply griefs: Now to this purpose you may ordain Broths, wherein Lettuce, Sorrel, Spinage, Purslain, Marigold-Flowers, Columbine-Flowers and Leaves have been boiled, Calves, Sheeps, and Lambs Heads boiled, with Green Sawce made of Sorrel, or Alleluja, beware of Alliaria, Jack of the Hedge, or those Simples which are hot. Young Chickens with Gooseberry sawce, are good, and such like. We must forbid Wine, Flesh, Eggs, fat things, and such as breed too much Blood; and Spices, because they heat the Blood; and piercing Drinks, as stale Beer or Ale, because they further the Fluxion of Blood. To procure Urine, an Almond-Milk may be made of a Ptisan, having an emulsion of Seeds of Pompion, Gourd, Musk-melon, Cucumber, Lettuce, Purslain, and Plantain. Now the Humor flowing immoderately we must labour to stay, by abating of it, and that by two manner of ways, by Phlebotomy and Purgation.
As for Phlebotomy, if the Inflammation be great, the Party young and strong, and full of Blood, in the Spring time we may take a pound at a time; yea more, and iterate it if occasion be offered. In others, moderation is to be used, according to the strength of the Patient. If a Phlegmon possess the parts which are above the Liver, then the Veins of the Arms and upper parts are to be opened: but if it invade the parts which are under the Liver, as the Kidneys and Genitals, then the branches of the Vena cava descending, are to be opened in the Hams or Aukles. One thing is to be noted in Phlebotomy; that we open not Veins too far distant from the part affected, as Vena frontis in diseases of the Feet; for we should evacuate too great a quantity of blood, before we should intercept any tending to the part affected. If a Phlegmon hath succeeded the staying of the evacuation of Blood from any part, as from [Page 31]the Nose, the Womb, the Haemorrhodes, means must be used to procure these accustomed evacuations.
As for Purgation, one may doubt whether it do any good, seeing no Blood, the matter of a Phlegmon, can be by this means spent. I Answer, That it helpeth by accident, and two manner of ways: For First, Purgation dryeth the Body, and so depriving the Blood of moisture, maketh it more unapt to flow. Secondly, By Purging sharp Humors, the part which sendeth the Humor is not irritated. But in this case, lenitives are better than eradicatives, because they rather cool than heat, and cause no ebullition in the Humors: such are Diacatholicum, Electuarium lenitivum, Electuarium de sebesten, or a Bole, or Cassia, Tamarinds and Sugar of Violets.
As for the Topical means, which respect the Part and the Humor, they are of three sorts: Revellentia, Defensiva or Intercipientia, and Repellentia: now Medicaments appointed for Revulsion, must be hot and attractive, and applyed to the parts opposite and remote, as I have set down in the general method of curing of Tumors. Of this kind are Fomentations, made of all sweet Smelling and hot Garden Herbs boiled in strong Wine, as Calaminth, Penniroyal, Mints, Lavander, Tansie, Time, Smallage, Feverfew, Sage, Savory, Pellitory of Spain; the Fomentation must be very hot, the use of them must be continued until the part become Red. Sometimes, if the affluxion of the Humor be fierce, and plentiful, we are to apply Vesicatories, as in Inflammations of the Eyes to the Neck: but seeing there is none who is but initiated in the practice of Chirurgery, who is not fitted with a Medicament for this purpose, I mean not to mispend Time in setting down any descriptions of them. But let me tell you, that some forts of Ranunculus, or Crow-foot green beaten and applied to the Part, are more secure than Cantharides; but the Bull-foot, which is found in most Pools by the High-way, is most excellent, being beaten, and applied in a Walnut-shell, or Muscle, or Cockle-shels, choosing the ampleness of the Shels, according to your purpose. If in the Winter time you apply Cantharides, you must correct them with Eupherbium, Mustard-feed, and Seeds of Ammi, or Dill; for if a Vesicatory of them be applied to thin and tender Bodies, it will cause difficulty of Urine, which will be removed speedily, if the Party drink of an Almond-Milk, made of Barley-water, wherewith the emulsion of the great cold Seeds hath been drawn, and that warm. Besides these local Medicaments, we are to use Cupping-glasses, sometimes without scarification, if the Party be timorous, and not very Plethorick; but if the affluxion of Humor be great, and the Party strong and couragious, let scarification be used. Frictions also are not to be omitted; but in this exercise we must begin at the Extremities, as Hands and Feet, and end at the Trunk of the Body, to move the Humor, and then to labour again from the Trunk to the Extremities, to bring it downwards.
As for Ligatures, in applying them you must begin at the Trunk, as about the Shoulder, and articulation of the Thigh, and end in the Hands and Feet, making three Ligatures in each Extremity; above the Elbow, and about the Wrist in the Arm, and above the Knee and Ankle in the Leg.
After revelling means, Defensives succeed. These are applied to stay the Humor from flowing to the Part, these must be cold, dry, and astringent, sit to purse in and contract the Vessels. These are applied to the parts adjacent, and which have less Flesh, as to the Joynts, and parts above the Joynts; for there the Vessels are most conspicuous, and so are most apt to receive the impression of the Medicament: so if the Foot or Hand be inflamed, let the Defensives be applied to the Wrist, and so forth.
Of these Defensives there be two sorts; for some are more mild, as Plantain, the White Rose, Night-shade, Red Poppy, or Water of the Spawn of Frogs, Red Wine, Vinegar and Water, Vinegar and Oyl beaten together, called Oxelaeum, Verjuice, and such like, and these are to be applyed to tender Bodies, and who have but small Veins. Others are stronger, as Bole, Sanguis draconis, Terra sigillata, Pomegranate-Flowers and Rinds, the Decoction and Pulp of Sloes, Sumach, Myrtle-Berries. These are to be applyed to Bodies of a strong Constitution, of ripe age, and who have large Veins, and in the Summer time, and when the Inflammation is fierce. Of such Simples we may make Compositions fitting our purpose: as mingling Mastick and Bole with the Oyl of Myrtles, and Whites of Eggs: The juyce of Housleek with Milk is good, or a Decoction made of Red Wine and Tanners Woose, wherein are boiled Red Rose Leaves, Myrtle-berries, Sumach, and Pomgranate Pills and Rinds: Ceratum Santalinum is good. It is not amiss to have in readiness, such a Defensive as this, Take of White Wax Ten Ounces, of the Oyl of Myrtles, and Quinces of each one Ounce, of Mastick powdered ʒ iij of Bole, and Sanguis Draconis beat to Powder, of each j Ounce and two Drams, make up an Emplaster: in the Winter you may add more Oyl.
Last of all Repellentia offer themselves, which beat back from the part affected, the Humor: The differences of such Medicaments, taken from their Substance are these. Some are cold and moist, as Housleek, Lettuce, Purslain, Succory, Ducks-Meat, the White of an Egg, Navelwort, Night-shade. These are mild, you may use either the juyce of these, or a Cataplasm made of Barley-meal, and these Juyces. There be some Simples which more strongly cool, as the Henbane, Mandrake, Hemlock, the deadly Night-shade, and the Apple of Peru: but these are only to be used, when the Party is of a flourishing age, in the Summer, and the Veins large.
Again, some of these repelling Medicaments are astringent, cooling and drying: these repell more strongly than the cold and moist, for besides cooling, whereby the [Page 33]natural heat flying its contrary, doth carry with it the Blood; they draw together the part, and as it were wring out the Humor: of these some are weaker, as Vine-Leaves, Plantain, Horse-tall, Perlwinkle, Bulls of Red Roses; Oyl of Myrtles: others are stronger, as Bole, Pomegranate Pills and Rinds, the Pulp of Sloes, Oaken and Owlar Bark, Red Wine with Alum, Galls, the husks of Green Nuts: These if they be untimely used, wrinkle the Skin, increase the pain, indurate the Humor in the Part, and sometimes return the Matter to some principal part.
Wherefore if we will use aright the Simples, and make good Compositions of them, we must diligently consider the temperature of the Party and Part, the measure of the Inflammation, the quantity of the Humor flowing, the Sense of the Part, the Passages and Air. Wherefore the hot Constitution of the Party and Part require gentler Topicks, because the excess is not great, only Heat being added to Heat; but if the Part be cold, and less fleshy, it requireth stronger Medicaments; because the Cause must be greater: So in Children and Women we use milder than in aged and strong Bodies: So the greater the Inflammation is, the stronger ought the Topick to be: So if the Part be very sensible, gentle means will serve, but if it be dull it will suffer stronger; so if the Veins be large, stronger Medicaments are to be applyed, because plenty of Blood must needs flow. Last of all, according to the constitution of the Air, the local means must be stronger or weaker.
Now it is time to determine, what Medicaments are to be used in the beginning of a Phlegmon: If therefore the Party be offered while the Blood is wholly yet in the small Veins, then repelling Medicaments are to be applyed. 1. Because the Humor as yet is but little and thin. 2. Because Nature as yet is strong. 3. Because the Matter is not as yet setled or impacted; If some of the Humor be in the small Veins, and some be without them in the distances of the Muscles, and Parts, or in the Porosities of the similar Parts, we are to apply Medicaments partly repelling, partly discussing, but more of the repelling.
Nevertheless, in cases repelling, Medicaments are not to be applyed unto Phlegmons beginning. 1. If the Parts be weak, lest their Natural Heat be quenched; such are Glandulous parts, for they are loose and flaggy. 2. When there is intolerable pain; for then repelling Medicaments would cause greater pain, and so perhaps cause Fainting and Swouning. 3. When the Cause is External, and causeth the Malignity, as the biting of a Mad Dog, or of an Adder; for so the Matter should be driven to the principal Parts. 4. When the Fluxion is vehement, and much Matter floweth; for then repelling Medicaments should be fruitless; the Part not being able to resist.
But seeing I have set down both the Simples, and some forms of compound Medicaments of the Two kinds of Topicks, I will abstain from all idle repetition, and pass to the Augmentum, or increase of a Phlegmon. In it then we [Page 34]are to apply discussing Medicaments mingled with repelling, yet the repelling during the whole course of the Augmentum, ought to have the Dominion; because until the latt [...]r end of the increase, the greatest part of the Matter is within the Vessels, and may be repelled; for when Blood is once slipt out of the Veins, it cannot be evacuated by repelling, but by discussing Topicks: These are called also [...]. They ought to be hot and dry in the Third Degree, and of a piercing substance: For First, they must make the Blood thin and fluxible: Secondly, They must convert it into Vapors; And Thirdly, They must evacuate by the Pores of the Skin, by insensible Perspiration. In thin and tender Bodies in the Summer time, mild Medicaments are most convenient, as Chamomil, Dill, Fenugreek, Bean-Flour, and such like. But in compact, and thick Bodies, strong are required, as, Sulphur vivum, Opopanax, Galbanum, Mints, Horehound, Wormwood, Calamint, &c.
When the Phlegmon is come to the state, or height of pain, Tension, and Heat, Medicaments equally repelling, and discussing are to be applied; because a great deal of the Humor is yet in the Veins, and much without them.
When a Phlegmon is come to the Declination wherein Tension, and Heat begin to abate, a discutient Fomentation, made of Chamomil Leaves and Flowers, Melilot, Dill; Tanlie, Sage, Lavander, Mints, Scordium, and such like, and the application of Diachylon cum gummi will serve, or a Cataplasm of Bean-flour, Chamomil, Dill, Melilot boiled in strong Ale-Lees, adding to the Cataplasm, Oil of Chamomil, Dill, and White Lilies; but if the Inflammation be great, the Pain vehement, the Heat intolerable; if there be Tension and Swelling, notwithstanding the following of the former course, then Suppuration or Apostemation is to be procured.
If the natural Heat in the Body of Man be prevalent, it turneth all things to nourishment, that are familiar to Nature; if any Excrementitious part be in them, it turneth that into Vapors, and expelleth them by insensible Perspiration. But if the natural Heat be inforced to encounter the unnatural Heat upon equal terms, then the natural Heat discusseth some part, and the unnatural Heat not able to corrupt the Part, suffereth a Mean to be wrought, that is, Generation of Quittour. Now unto which of them the Victory inclineth, may be gathered by the qualities of the Quittour. If the Quittour be good, it is White, because it is caused by the coats of the Veins, Arteries, Nerves, and Membranes, which are in colour White, and transmute the Matter into the same colour. Secondly, thick, because Concoction is performed by thickning. Thirdly, Uniform, because the natural Heat hath an absolute Dominion over every part of the Quittour. Fourthly, Not stinking, the natural Heat induring no putrefaction: If contrariwise the Quittour be pale, red, or black, thin, unequal, of divers substances, and stinking; then the unnatural Heat [Page 35]is prevalent. Now how a Phlegmon, which must be Suppurate is to be dressed, I have set down at large in the former Chapter of Apostumations of hot Tumors.
But because Examples are the most effectual Instructers, I will give you one out of Hildanus his Ob. Chir. Cent. 3. Ob. 100. ‘A Gentleman's Servant, a young Man, after over-violent walking, was troubled with a pain in his Foot, and not minding it in the beginning, the pain increased, and an Inflammation ensued. I was called, and found his Foot all swelled, and seized with a Phlegmon. The pain was great, and reached to the Hips, he was in a continual burning Fever, he was restless, delirous, and fainted away sometimes; I ordered his Cure in this manner. I prescribed him a spare Diet, and purged him with the following Potion. ℞ Elect. de succo rosar. Pulv. Passavanti cum Rhabarb. ℈jss. Syrup. ros. solut. ℥ j. Cum decoct. agrimon. veron. rad. Lapat. acut. cortic. inter. radic. frangul. & sem. anis. f. potiuncula. This purged him gently. The Evening of the same day, two hours after Supper, I gave him Laudani gr. vj. He rested well that Night, and was a little refreshed. Wherefore the next day I took away Ten Ounces of Blood from the Arm of the Side affected, (for he was Plethorick and strong). Hereupon his Fever, Pain, and Inflammation abated much; immediately after I anointed his Hip, Knee, and all thereabout, that was free from Inflammation, with the following Liniment ℞ Ol. ros. ℥ ij. Ol. Lumbric. Axung. human. a. ʒ ij. M. And because according to Galen l. 1. de simp. med. facult. Fat things ought not be applyed to the part affected, I applyed the following Cataplasm. ℞ Sem. Cydon. Foenugr. Alth. a. ʒ ij. Pulv. rosar. ʒ ss. Coquantur cum s. q. aquae adformam cataplasmatis. Postea admisce vitellum ovi cum albumine. Applicetur & renovetur quotiescun (que) opus videbitur. After these Medicaments were applied, the pain began to asswage very much, and the place of the Matter appeared, to which I applyed Emplastr Basilic. and the Cataplasm prescribed all over the Foot. And because the Sole of the Foot is very callous, I diligently fomented it with hot Milk, wherein Fenugreek Seeds, and Mallows, and Violet-Leaves were boiled. Then I shaved off the Callosity with a Razor, as I have written, Obs. 97. Cent. 7. in the Cure of a Whitlow. Thus in a short time the Aposteme broke in the Sole of his Foot, and he recovered. While I attended his Cure, his Mistress told me, that a Kinsman of his died in a few days of the like Disease. which need not seem strange to any Man. For the Part being Nervous, and endued with a most exquisite Sense, it must needs occasion most grievous Symptomes.’
Hitherto I have spoken of a true bred Phlegmon, engendred of sincere Blood. Now I shall take notice of a Bastard Phlegmon, which is caused by the admixtion of some other Humor with Blood: If Choler be mingled, it is called [...]. [Page 36]If Phlegm [...]: If Melancholy [...]. Seeing compounded Diseases are to be discerned, esteemed, and cured by the Diseases and Simples solitary, I need not say much of them. If Choler abound, we are to cool and moisten in a higher measure than in a true Phlegmon. If Phlegm he joyned, we must heat more. If Melancholy, we are to use things warming and softning. They who have written of Tumors after a Phlegmon, have set down Discourses of a Gangreen, Carbuncle, and a Pestilential Bubo, but immethodically: For a Gangreen is an Accident, which doth not only accompany Tumors, but Wounds, Ulcers, Fractures and Dislocations, and that more often; of it therefore I will discourse in its proper place. As for a Sphacelus Mortification, or Sideration of a Part, it belongs to the third part of Chirurgery, called [...], which teaches to take away superfluities: such as a Member is by Accident, when it is deprived of Life, and threatens Corruption to the whole, unless it be taken away.
A Carbuncle and a pestilential Bubo are symptoms of the Pestilence, as a Venereal Bubo of the Pox. Of these I shall treat, when I discourse of Diseases unto which they are to be referred.
Unto Phlegmon [...], that Tumor which is called Panus, Panis, or Panicula in Latin, from the Figure in Greek [...], is to be referred: It is a Tumor most commonly in the glandulous parts, somewhat flat, in the top whereof there is a representation of a Pustle: It hath a greater heat and pain than the bigness of the Tumor sheweth; it is commonly most discussed without Apostemation: Because it hath more Choler than Blood. But contrariwise [...] hath more Blood than Choler, for it quickly cometh to Suppuration. In form it is like to Panus, a Weavers Roul or Touch-wood, and hath this same seat, to wit, the Glandules in the Emunctories. As for furunculus or [...], it is engendred of gross Humors mingled with Blood in Fleshy Parts most commonly: If it be mild and come to Maturation without any great difficulty, it may be referred to [...]. If it be hard and stubborn to medicaments, it is to be referred to [...].
CHAP. VI.
Of an Erysipelas.
BEfore I speak of an Erysipilas, that I may make all things more plain, I will tell you first the signification of this term Choler: Secondly, the divers kinds of Choler: Thirdly, the Signs of a cholerick Person: For such an one is most subject to this Tumor. Cholera then in Latin, and [...] in Greek signifieth not the Humor, which in English is called Choler or the Gall; but a Disease, whereby this Humor is expelled vehemently by Vomit and Stool. Nevertheless in our Vulgar Speech, and with the Barbarous late Writers, it is taken for the Humor it self; and so I shall be inforced to use it. Thus much I thought fit to insinuate to you, that you should not be ignorant of the proper and learned significations of the terms of Art.
Now Bilis or Fel in Latin, [...] in Greek, Choler or Gall in English, is either Alimentary, or Superfluous: The Alimentary is the fourth part of the Mass of Blood dry and hot, which more properly might be called Bilious Blood: the Superfluous, which serves not for the nourishment of the Body, is either Natural or Unnatural: The Natural is that which in the Liver is separated from the Blood, and sent to the Vesica fellis. The Unnatural comprehendeth four sorts under it. I. Is the Vitelline, like unto the Yolks of Eggs yellow; but thicker and hotter than that of the Gall. II. Is Porracea, which in colour representeth the Leek, it is engrendred in the Stomach by reason of Crudity, and eating of such Meats as engender it: as Garlick, Onyons, Leeks, and Milk in Infants, who often by Stool discharge such an Humor. III. Aeruginosa, like Verdigrease engendred of more vehement Heat, and corrupt Aliments in the Stomach. IV. Is I [...] like unto Woad, it is more green than that which resembleth the Leek: It is caused of the Aeruginosa more burned, and cometh near to Atra bilis.
Now, a Man is thought to be of a Bilious Constitution, if he be Watchful, Nimble, Hasty, Angry, and dreams of Fire and Thunder, his Urine is thin and yellow, his Pulse strong, swist and hard, his Veins are large, the habit of his Body is lean and dry, his colour yellowish: cold things refresh him.
These things premised, I come to the Tumor Erysipelas it self; Of it I will set down five things: [Page 38]The Etymon of the Word, the Nature of the Tumor, the Signs of it, the Prognosticks of it, and last of all, the Indications of curing of it. 1. As for the Etymon of the Name of this Tumor it is called [...] in Greek quasi [...]: for the Antients for [...], which signifieth red, used [...]; and [...] signifieth near, wherefore [...] is nothing else but a Tumor in Colour, coming near to Red, and tainting often the adjacent parts: for thin and hot Blood, or Blood with which yellow Choler is mingled, dieth the Skin with the colour of a pale Rose: the Nature of an Erysipelas is discovered by setting down the Description, and Kinds of it.
An Erysipelas then is a hot Tumor proceeding most from Choler. In this Description Tumor is the Genus: for this is common to an Erysipelas with all other Tumors. In that it is said to be hot, it differeth from Oedema and Scirrhus: And whereas it is affirmed to proceed of most Choler, it is distinguished from all the rest of the Tumors.
But here it may be demanded, whether an Erysipelas be caused of Alimentary, or of superfluous Choler. I answer, that it is to be thought that it is caused of the alimentary Choler, if it be exquisite: otherwise how could the yellow Jaundise and an Erysipelas so much differ, if they both did proceed from excrementitious Choler? For first, the yellow Jaundise possesseth the Skin of the whole Body, but an Erysipelas one part only Secondly, an Erysipelas hath always a symptomatical Fever annexed to it; but the yellow Jaundise is most commonly free from it. Thirdly, in an Erysiypelas there is always pain, but in the Jaundise none. Fourthly, in the Jaundise the Skin is of a yellowish colour, but in an Erysipelas it is of a bright red colour.
There are two kinds of Erysipelas, for it is either exquisite or not exquisite, or a true, and a bastard one: As for an exquisite Erysipelas it is a Tumor of a bright Red tending to Yellow, causing little swelling, very hot, with a pricking pain, caused of alimentary Choler: this Choler abounding in the Body, if part of it be turned into any part, it causeth an exquisite Erysipelas. The parts which it most commonly invadeth, are the Nose and Face, for much thin Blood floweth to these parts. Secondly, the Legs: for Nature being moved by the plenty of this Choler, sendeth it first to the Emunctories of the Groins, and from thence it descendeth to the Legs; it happeneth in the Summer, because then Choler is multiplied; but in the Winter, because the Pores of the Skin are shut by Cold, and so insensible perspiration hindred; and because this Humor is thin, it spreadeth to a great part of the Skin.
As for the Signs of an exquisite Erysipelas, they are either taken from the Qualities of the Humor which causeth it, or from the differences between it and a Phlegmon. The Signs taken from the Qualities of the Humor are these: The Pain is great and urgent, the Heat notable, the Colour a bright red tending to a yellowness, the Tumor is small, only possessing the Skin, the Pulsation is very [Page 39]small, and less than in a Phlegmon, First, because the Parts in a Phlegmon are more compressed: and it reacheth deeper. Secondly, because in a Phlegmon the Humor is thicker, and cannot so easily be breathed out as in Erysipelas. The differences between a Phlegmon and an Erysipelas are these. I. A Phlegmon possesseth the Skin, and the Flesh lying under; but an Erysipelas the Skin only: the cause in an Erysipelas is the thinness of the Humor, which rather disperseth it self through the Skin than heaveth it up. II. The Heat in an Erysipelas is greater than in a Phlegmon: for sometimes the Cuticula is blistered. III. The symptomatical Fever is greater in an Erysipelas than in a Phlegmon: because Choler is hotter than Blood. IV. The pain in an Erysipelas is less than in a Phlegmon: because in it there is only a hot Distemperature; but in this a Solution of Unity, besides the Parts being stretched. V. In a Phlegmon, the Colour is of a dark red by reason of thick Blood lying deep; but in an Erysipelas the Colour is a brighter Red, tending to a Yellowness. VI. In an Erysipelas there is a pricking pain, but in a Phlegmon a heavy and stretching one. VII. The Skin in an Erysipelas being pressed yieldeth, but in a Phlegmon it doth not: The Causes are the thinness and thickness of the Humor. VIII. In an Erysipelas the redness vanisheth away from the Skin, and it becomes white, if it be pressed with the Finger, but in a Phlegmon it doth not so. IX. In an Erysipelas there is no stretching of the Skin, but in a Phlegmon there is. Last of all, a Phlegmon setteth it self in one place; but an Erysipelas maketh the parts adjacent red by spreading.
As for the Prognosticks of an Erysipelas: I. That which proceeds from natural yellow Choler is mildest: for no vehement Symptoms succeed: and besides, seeing it appears in the outward parts, it is to be thought that the inner parts are discharged of this Humor. II. As it is a good sign, if an Erysipelas be driven to the outward parts; so it is fearful, if it return from the outward to the inward parts, Aphor. 25. sect. 9. III. An Erysipelas appearing in the Head is more dangerous, than in other parts: because if the Matter pass to the Meninges, it causeth Phrenitis or Raving; if to the Muscles of the Neck, the Quinsie. IV. An Erysipelas appearing in Wounds, Ulcers, Fractures, and Dislocations, is commonly Mortal; if it proceed not from the Application of too hot local Medicines. V. If an Erysipelas tend to Suppuration, it is not good: for then the Humor must be thicker than ordinary, and the Obstructions stronger, and so the solid Parts are in danger to be corrupted. VI. If a Bone being bare, the adjacent fleshy parts be possessed with an Erysipelas, it is ill: For first, the Body must be troubled with sharp Humors: Secondly, Flesh cannot be restored by such Blood.
There are four kinds of helps, Dyet, Chirurgery, internal Medicaments, and local Means. As for the Dyet, our nourishment must be cooling and moistning. Let the Patient then eat thin Chicken [Page 40]broths, altered with cooling Herbs, Panadoes, thin Oat-meal Gruel, Sallets of Lettuce, Sorel, Purselain, and Spinage boiled. If the Choler be very thin, the party may eat fresh Fish, which live in clear sandy or rocky Waters, as Trouts, small Pickrels, Perches, and of Sea-fishes the Whiting-maps, and Smelts; he may eat also of the Brain of a Pig or its Petitoes, or Trotters with Vinegar and Sorel; let him refrain from all Meats which are fat and sweet. Let his drink be Spring-water, boiled with the bottom of a Loaf, made pleasant with some Oxysaccharum, or the distilled Waters of Endive or Sorel; he may use a plain Ptisan. Galen, lib. 9. met. c. 5. permits the Patient to drink as much cold Water as he will, for this cools the Body, quenches Thirst, abates the heat of Choler, and cooleth the Liver: but in this case the Season must be hot, and the Stomach good: with us Small-beer botled is best, all sorts of Wine are forbidden. In the Summer, let the Air be cool and moist, in Winter, let it be rather hot: for in this Season an Erysipelas is caused of the constriction of the Pores of the Skin, by reason of cold: let all perturbations of the Mind be banished, let sleep be procured; for watching drieth the Body. But if an Erysipelas be in the Face, watching is best: for immoderate and long sleep fills the Head full of Vapors, whereby the Grief is increased.
As for the Chirurgical helps, it may be doubted whether Phlebotomy be necessary or no: for the decision of this doubt, these Propositions shall serve: I. If an Erysipelas invade the Head, Neck or Face, the Cephalica always is to be opened: lest a Phrenitis or Angina ensue. II. In an Erysipelas Phlegmonodes, wherein Blood increaseth the heat, in what part of the Body soever it be, a Vein is to be opened. III. In an exquisite Erysipelas in other parts of the Body we ought not to let Blood: For first, by letting of Blood, the Blood which remains moveth more, and becomes more subtil: Secondly, the qualifier of Choler is taken away: Thirdly, by taking away both good and bad Blood together, the party is weakned.
As for the internal Medicaments, they ought always to go before the local, if you except two Cases: I. If an Erysipelas be procured by an outward Cause, as a Blow: II. If the Heat be vehement, and the Tumor be far from any principal part. In these Cases we may apply something cooling and moistning, before we give any purging Medicament. If an Erysipelas appear in the Head or Face, we must open a Vein, apply Leeches, give a purging Medicament, prescribe a slender Dyet, and use Revulsions by Frictions, Ventoses, Blisterings, and Vomiting if it appear in the Legs.
As for local Medicaments, we must look about us, for if we apply cold Medicaments, the Matter may be repelled to the Brain, from whence a Phrenitis may proceed, or to the Throat, which may cause an Angina: If you be inforced by the importunity of the [Page 41]Patient, or standers by to apply a local Medicament; Aëtius counselleth to apply a Swallows nest beat to powder, and tempered with Hony, that it may represent a Liniment with a Feather. This is a safe Medicament, for it only drieth and repelleth not: We may also apply the Decoction of Mallows with some Oyl of Violets, or sweet Almonds. Now the purging Medicaments which discharge Choler, these or such like will suffice, Rheubarb, Tamarinds, Cassia extracted, Electuarium lenitivum, Diacatholicon, Diaprunum solutivum, Electuarium de succo rosar. Caryocostinum. If it be but a mild Inflammation, sharp Clysters made of the decoction of cooling Herbs, with the aforesaid Electuaries will serve the turn.
Having set down the helps taken from Dyet, Phlebotomy, and the ministration of internal purging Medicaments, I must hasten to set down convenient local Medicacaments; for in these we are most imployed and busied: one thing is to be observed, that we must not in any case apply astringent Medicaments, which are cooling and drying: For seeing the Vapors in this Tumor are sharp, if they be kept in, they might erode and corrupt the part. Now as concerning local Medicaments; First, I will set down which they are: Secondly, how long they are to be applyed. These Medicaments ought to be cooling and moistning: but before I name them, let me warn you, that first you refrain from Narcotical Simples, unless exceeding great pain, and a part far from a principal part call for them. Secondly, that you apply not unctuous and fat Medicaments: For first, they most easily are inflamed: Secondly, they stop the Pores. Now the Medicaments which are to be imployed, are either Simple or Compound: The Simple are Navel-wort, Horse-tail, Knot-grass, both the Plantains, Ducks meat, Garden Night-shade, Lettuce, Purselain, the Poppies: First, the Juyce of them expressed may be applied: Secondly, the distilled Waters drawn from them, some Powder of Myrrhe having been infused in them. We may also apply Clouts wet in the Juyces of the aforesaid Herbs, being mingled with Verjuyce or Vinegar. The compound Medicaments are Ceratum infrigidans Galeni made of lb j. of Oyl of Roses, and ℥ iiij. of white Wax: this is to be washed with Water and Vinegar. You may add to it the Juyce of Night-shade. Heurnius hath three good Medicaments: The first is Castle-soap dissolved in Spring-water: The second, is Bulls dung boiled in a Frying-pan with Vinegar, and a few Flowers of Chamomil and Elder, until it come to the consistence of a Liniment: The third is made of two parts of Aqua Spermatis ranarum, and one part of Rose Vinegar, wherein some Myrrhe must be infused: these may be safely applied to an Erysipelas of the Head, Neck or Face: the Juyce of Horse-dung is not only good, being applied to this Tumor, but in Scaldings and Burnings also, if a little Camphor be added to it.
The Medicaments which are to [Page 42]be applied to an Erysipelas must be very liquid, actually cold, and often changed; for when they become hot, they will rather offend than profit, if they be not removed. The last thing which I promised to set down concerning the local Medicaments, was, How long they were to be applyed? This we may find out by two Signs. The First is, If the Heat be altogether abated, or almost: The Second is, if the Skin hath recovered its own colour. When you perceive these two Signs, you must desist from applying cooling Topicks, lest the Skin become livid, or black, which threaten a Gangreen, and sometimes Mortification. If this appear, What then is to be done? First, a Fomentation is to be used, made of Calamint, Scordium, Wormwood, Peniroyal, the lesser Centaury; and Betony boiled in a weak Lie made of ordinary Ashes: After the part is sufficiently fomented, you are to apply Hippocrates Cataplasm made of Barley-meal, Vinegar, and Oyl of Roses warm: or this, take of the Flour of Barley, Beans, and Vetches of each liij. ℥. of a weak Lie, iii j. lb. boil these to the consistence of an Emplaster, then put to it iiij. ℥. of Oxymel. If the discolouring of the Part pass through the Skin, and the part be immoderately cooled, it will not be amiss to scarify the part which only remaineth.
Hildanus Obs. Chirurg. 82. Cent. 1. gives good caution against using Oyls in an Erysipelas. He says, a certain Countrey fellow had an Erysipelas Phlegmonocides in his Left Hand, who by a Barbers advice, anointed his Hand and Arm for several days with Oyl of Roses; whereupon Pain and inflammation ensued, and all Symptomes grew worse and worse, till in fine his whole Hand Gangrened: When he came to me, I treated him with Scarifications, and other Remedies proper for the Cure of a Gangreen, and he was Cured. So that as Galen, l. 5. de Simpl. Med. has advised, Oyl is bad for Inflammations.
A Bastard, or spurious Erysipelas, is when with alimentary Choler another Humor doth concur. Now seeing Four other Humors may associate themselves to Choler, so many kinds of a Bastard Erysipelas may be accounted. If therefore some Blood be mingled with Choler predominant, [...] is caused: in this kind of Tumor the Redness is more dark, and the Swelling not so spreading. If a waterish Phlegm be mingled with Choler, then [...] ariseth: If gross Blood or thick Phlegm concur with Choler, then [...] is caused: Lastly, If Choler associate it self with the corrosive Salts of the serosity of Blood, it causeth Erysipelas ulcerosum, which breaks the Skin. But compound Humors are to be discerned by the Doctrine of the simple, and the Medicaments are accordingly to be applyed.
Of that Erysipelas which breaks the Skin, there are two kinds, Herpes miliaris, and Herpes exedens: Herpes miliaris is caused of a salt waterish Humor mingled with unnatural sharp Choler: the signs of it are these. First, many Pustules rise in the Skin like to Millet [Page 43]Seeds. Secondly, When they break, a Matter issueth out representing Quittour and Sanies. Thirdly, The place hath a mingled colour between Red and Pale: This is without danger, the Medicaments which are to be applyed to this, ought to be cooling and drying, as Knot-grass, Horse-tail, Plantain, Owlar, Willow and Oaken Bark, Pomegranate-Flowers and Rinds, Myrtle-Berries, Red Rose Leaves boiled in Tanners Woose, Ʋnguentum album Rasis, de cerussa, de minio, Diapompholygos.
Herpes exedens, called by Celsus, ignis sacer, and by some ignis Sancti Antonii: it is caused of unnatural Choler, hot and sharp, corroding the Skin only, by the which sign it is discerned from Phagedena, or [...]. Wherefore if many small Ulcers appear not, passing deeper than the Skin; you may pronounce this to be Herpes exedens. In the curing of this, minister the decoction of Sarsa, and after the fomentation of it with Tanners Woose, wherein cooling and astringent Simples above-mentioned have been boiled; apply this local Medicament. ℞ cerae flavae ℥ ij. resinae pini. ℥ j. ss. terebinth. ℥ j. ol. myrtini. ʒ vj. succi Nicotianae. ʒ iij. Coq. in ceratum molle. But here a question may be moved, why Choler which causeth the Yellow Jaundise doth not ulcerate the Skin? This falleth out: First, because the Choler which causeth the Yellow Jaundise is dispersed; but in an Erysipelas it is united. Secondly, Because the Choler is natural, and only excrementititious in the Jaundise, such as is contained in the Vesicula fellea, and discharged into the Guts. Thirdly, because thin Phlegm is mingled with Choler in the Jaundise: for this Disease endeth with much Sweating.
CHAP. VII.
Of an Oedema.
IN the subsequent Discourse of an Oedema, the Third general Tumor caused of Phlegm, I will use the same method which I did in the Doctrine of an Erysipelas. First then, I will set down what Phlegm is, Secondly, the differences of it: and Thirdly, the signs of a Phlegmatick Person, and then I will deliver the Doctrine of Oedema, for such an one is most subject to this Tumor.
Phlegm then is the Fourth part of the mass of Blood, Cold and Moist: As concerning the sorts of it, it is either alimentary, or excrementitious. The natural as it is cold and moist, so it is without [Page 44]any forraign Tast: as Oil and Butter are accounted Sweet, when as they have no rank taste. This Humor by the natural Heat increased (as in Famine) may become Blood, and serve for the restoring of natural Humidity: it ought rather to be called pituitons Blood, than Phlegm.
Unnatural Phlegm is that which cannot be turned into Aliment: of it there are three kinds. The First is Pituita acida, sowre Phlegm, so called from the Tast which it leaves in the Mouth, when it is spit out: This is a raw Phlegm, and bred in the Stomach, through defect of natural heat: so that being drawn into the Veins, it hardly can be altered. The Second is, Pituita salsa, salt Phlegm, this is caused by the admistion of a thin salt Moisture: For of bitter things, as Aloe, and Coloquint, mingle them with thin Humors as you will, a Salt Tast never can be procured. In Sweat, Tears, and Urine, this Tast is manifestly deprehended: a very Novice in Alchymie is able to make the Salt of Urine. The Third kind of unnatural or excrementitious Phlegm, is Pituita vitrea, representing in colour and substance, melted Glass. This is very cold, thick, and tough, and causes great pain, if it be detained in any part. Galen affirms of himself; that being troubled with a vehement pain of the Belly, by injection of the Oil of Rue, he was discharged of such an Humor, and so the pain ceased: whereas before he thought that a Stone had stuck in one of the Ureters.
Phlegmatick persons are slow and sluggish, their Senses dull, they are sleepy, they dream of Waters, Rain or Snow, they are not easily moved to anger, their Pulse is soft, small and slow: their Appetite is not great, they are seldom dry, they by the Mouth and Nose void many Phlegmatick Excrements: their Urine is White or Pale, sometimes thick, sometimes thin; their Stools often are raw and phlegmatick: The Blood, by what means soever it flow from the Body, is pituitous: their Body is Whitish, Soft, and Coldish, they are subject to cold and long Diseases, as the Dropsie, Lethargy, and such like: Lastly, they endure Fasting well. These signs shew natural and sweet Phlegm to abound in the Body.
Concerning an Oedema, or a Phlegmatick Tumor, I will discourse Five things: First, The signification of the term Oedema: Secondly, The differences of it: Thirdly, The Prognosticks of it: Fourthly, The Indications of Cure: and Lastly, What Tumors are to be reduc'd to it. As concerning the term [...] in Greek, in Latine, Oed [...]m [...]: With Hippocrates and all other Ancients, it is the same with [...], which signifies eminentia, eminence or bunching out: and so every particular Tumor may be called Oedema. But with Galen, and later Authors, it is taken more strictly for that Tumor which is caused of Phlegm. An Oedema is either exquisite or not exquisite: an exquisite is either primary or symptomatical: The Primary is caused of natural Phlegm, which is contained in the mass of Blood, and by reason of the too great quantity [Page 45]of it, incites the expelling faculty to discharge it into the weaker and depending parts. Natural Phlegm is cold and moist, thin in consistence, in colour White, in Tast Sweetish, or insipid. The signs of an exquisite Oedema are Five. 1. It is soft and loose, because it is caused of thin Phlegm. 2. If it be pressed with the Finger, it has either no pain, or very little. 3. If it be pressed down with the Finger, it yields and leaves a pit, which is the most proper sign of an Oedema. 4. It is White, representing Phlegm in colour, whereof it is bred. 5. It is cold without heat, because the pituitous Humor is cold and moist: Avicen calleth this Tumor Ʋndimia. The material cause then of this Tumor, is the pituitous Humor redounding in the whole body. This Humor is caused either of External or Internal causes: the External causes are Air, Cold and Moist, Phlegmatick Meats, Idleness, too much Sleep, stinging of Wasps, and such like: the Internal are a cold and moist Constitution of the Head, and Stomach, but chiesly of the Liver. This Tumor invades not promiscuously all parts, but such as are cold, weak, and loose, such are the Feet and Hands, the Cods, as in Hernia aquosa, the Eye-lids: and then in them appears an outward Tumor loose, without pain, not altering the colour of them; which being pressed with the Finger, quickly yields and returns. The material Cause being a waterish Humor mingled with Flatuosity: So the Heart and Liver cannot suffer any such Tumor, as neither the Kidneys, because these parts are firm and hot. As for the Prognostick, an Oedema is a long continuing Disease, because it is cold, and therefore the natural heat of the parts affected, must be weak. 2. It is not very dangerous, because the pain is none or very small. As concerning the Cure, it is performed either by Diet, or Internal Medicaments, or local means: As for the Diet of such as are subject to an Oedema, if it proceed from External Causes they must be removed: The Air, which is to be chosen, must be hot and dry, the Food must be drying: Wherefore roasted Meat is better than boiled; Fowls and Birds which live in dry Grounds, are better than Water-Fowls; Rabbets, Chickens, and Veal are good; Mutton is better than Lamb; Swines Flesh and Fishes are to be shunned, as also Heads, Brains, and Feet of Beasts: Sallets of cold Herbs are hurtful; use Biscoct-Bread, or good Houshold-Bread baked with Aniseeds, Fennel-seeds, and Coriander-seeds. Let the Drink be altered with the rasping of Guajacum, Sarsaparilla, Radix chinae, Sassafras, Yellow Sanders, Cummin-seeds, Corianderseeds, Fennel-seeds, Anise-seeds, Galingal, Nutmegs, Calamus aromaticus, some Ginger, Cinamon, Rosemary and Sage. A drying Dyet made of these, especially in the Summer time is good. Sweating in this case is very effectual, every other Morning after taking of the Diet: Fasting is good, as also Watching, Studying, and Labouring: for all these dry the Habit of the Body.
If an Oedema possess the Hands, [Page 46]then walking is good; if the Feet, then we are to prescribe sitting and working with the hands. Seeing then an exquisite Dyet will not serve to conquer this Disease alone, we are to entertain purging Medicaments for obtaining the victory. We need not to trouble the Patient with many preparative Medicaments, seeing the pituitous Humor which causeth this Disease is thin, waterish and in motion; First of all, no Medicaments internal are so effectual in this Grief as Mercurius vitae, and safe Medicaments of Antimony: For first, they discharge the Stomach of crudities by Vomiting, and so correct the cold and moist distemperature of it: Secondly, they dispatch the obstructions of the mesaraical Veins and Liver: Thirdly, they mightily evacuate waterish and phlegmatick Humors, and so correct the distemperature of the Liver and Kidnies.
As for ordinary internal Medicaments, Pilulae de hiera cum agarico, quickned with a grain of Elaterium, are good: Diaphaenicon, Diacarthamum, Diaturbith, Pilulae de Hermodactylis, de Aromatibus Cochiae. And the Pills of Galen made of Coloquint, Aloe, and Scammonie, with Syrupus Augustanus.
But here you may demand of me what is to be thought of Phlebotomy?
To this demand I answer, That in an exquisite Oedema opening of a Vein is to be shunned. I. Because in a Body cold and moist we open not a Vein; such is that which is tainted with an Oedema. II. Because in this Grief there is always Cacochymia, seldom Plethora: III. Because in an Oedema, there is neither a malign Matter, nor a horrible Symptom, and so it cannot be called Morbus Magnus, or a fearful Disease: and so Phlebotomy is not required. As for the local Medicaments, which are to be applied, they ought by drying and strengthning to alter the part.
In the beginning we are to apply such Medicaments as repell, and digest; but more digesting than repelling, because the Humor is cold; for in the beginning some part of the Humor is in the small Veins, some in the Pores of the Skin; but more in the Cavities, and greater Veins: towards the state of the Grief we are to use digesting means. Galen useth four Things. I. A Rowler with two ends, such as is used in Fractures; first the Rowler must bind the Tumor it self more straitly; but the parts on every side adjacent more slackly; for so the Humor is wrung out from the part affected, to the parts adjacent above and below. II. Is a Sponge; but in the use of a Sponge we must see that it cover all the affected part, otherwise at the next dressing we shall see that the Humor hath flowed to the bare part: Instead of a Sponge we may use Pledgets of Hemp-tow; yea, and double Cloaths. III. Vinegar; for it doth consume Phlegm, and because it is subtil it pierceth. IV. Some Water to moderate the sharpness of the Vinegar: If the Oedema be above Sinews and Tendons in a tender Body, less Vinegar is required. But in hard Bodies, [Page 47]and in other places more Vi [...]egar is to be applied: If you mingle some Alume with Vinegar and Water, the Medicament will be the more effectual. Avicen adviseth to apply Lime-water with the Juyce of Myrtles: but instead of the Juyce we may boil Myrtleberries in Lime-water.
If you boil Scordium, Myrtle [...]erries, Sumach, Red-rose Flowers, dried Calamint, Wormwood and Peniroyal, in equal quantity of red [...]stringent Wine, Vinegar, Tanners Woose and Lime-water, adding to every Pint of the Decoction strained 3. drams of Alume, you shall have an excellent Medicament. You may apply also an Unguent made of unslaked Lime, and old Swines-grease.
One thing is to be noted, that the Oedematous part is to be rubbed well with a Cloth before the Medicaments be applied, that they may penetrate more easily.
If an Oedema in the Belly according to Hippocrates after 60 days tend to Suppuration (which cometh to pass because the Phlegm by long staying in the part, is altered by heat, and turned to Quittour) then we are to hasten Suppuration by the Application of Diachylon cum gummi. Then to open it. Thirdly, to mundifie it. Fourthly, to incarnate it. And last of all to procure skinning.
Hildanus Obs. 91. Cent. 6. relates a strange History of a Woman, who from her Childhood was troubled with an aedematous Tumor, but hard, in her right Hand, which yet did not hinder the use of it, and she was otherwise very well in Health. Several things had been used, but without success. At last it was resolved to leave it to Nature. And about the thirteenth year of her Age, when her Friends never dreamt of Cure, it began to decrease of it self; so that in few days it was quite gone. But the Physician predicted some ill Event, and so it proved. For it fell into her Shoulder and tormented her most grievously. By using proper means she seemed cured; but in a little time it fell into her right Hip, and there tormented her again; till at length the Head of her Thigh-bone slipt outwards, which made one Leg shorter than the other, which could not be reposited. Afterwards, when all was thought to have been over, a pain fell into her right Foot, especially about the Heel, with a great Inflammation, which required a new course. She was Purged, took Apozems, Juleps and Sudorificks, had Topical Anodynes, moderately repelling applied at first, and then things to cause Pus. At last the Abscess broke in her Heel, out of which there ran a great deal of Matter. In a few days a piece of Bone like a Fishes Scale came away; when it was got out, she was cured; only she halted a little.
It falls out many times that an Oedema, is a symptom of another Disease, as I have said: but chiefly of the Cough of the Lungs, Dropsie, or Cachexia, or ill habit of the Body, and doth possess the Legs and Hands: First, because they are farthest from the Heart, the Wellspring of heat: Secondly, because they are framed of cold parts; seeing this Accident cannot be removed, [Page 48]unless the Disease which is the cause of it be cured, and seeing these Diseases are for the most part mortal, I will suffer such as are Empiricks, and prodigal of their own Credits, to follow their own courses, and to undertake such Cures.
An Oedema is thus engendred: when Nature is troubled with Phlegm, the expelling faculty thrusteth the pituitous Humor from the great Vessels to the lesser, and being kept in by the density and coldness of the Skin, is gathered in the Musculous part, and so causes this Tumor. Hitherto I have discoursed of an exquisite Oedema. Now it remaineth that I briefly dispatch that Oedema which is not exquisite. This is caused when some other Humor is joyned with the pituitous: if Blood then be joyned with it, it causes [...]: If Choler concur, it procureth [...]: If Melancholy or thick and glutinous Phlegm, it causeth [...]. In all these kinds of a not exquisite Oedema, the thin pituitous Tumor must be predominant. The other Humors concurring are found out by their own proper Signs, which are set down in the discourses of every principal Tumor, so that I should mispend time, if I should go about to set them down here. Some things I would have you to note. The first is, a primary Oedema is caused by congestion; for it creepeth on by degrees: But that which is Symptomatical, an Accident of other Diseases, as Tabes, Asthma, Cachexia and Dropsie, is procured by Fluxion: for it suddenly appeareth. The second is this: li [...] by reason of long keeping bed, either because one hath had a long and lingring Disease, or because h [...] hath received a hurt in the Leg, the Feet swell and become Oedematous: When by motion afterward the Natural Heat is increased, this flatulent Phlegm is discussed and the Tumor ceaseth. But it is time to set down those Tumors which are referred to an Oedema: of those some are enclosed within a Cystis or a Membrane; and some have no proper Membrane: those which have a proper Membrane are in number. 3. Atheroma, Steatoma, and Meliceris. But it may be doubted from whence this Cystis, Membrane, or Folliculus doth proceed: Undoubtedly it is framed of the tyes of the Cutis and Membrana Carnosa: for seeing the Natural Heat cannot concoct the Matter of these Abscesses, Nature doth providently separate it by its proper Cystis from the parts adjacent, lest it should corrupt them.
The Matter which causes these Abscesses and feeds them, proceeds from a Vein, which is not accompanied with an Artery; and so being destitute of Vital Heat, it is altogether unnatural, and cannot be assimilate to the parts unto which it floweth. Atheroma the [...] containeth a substance like unto Rice-pottage, or Curds: The Matter of this Tumor is thick and gross Phlegm.
Steatoma is a Tumor not so high as Atheroma, containing a Matter like unto Grease, or that which we call the Sweet-bread, Pancreas: Blood flowing by the Vein which [Page 49]hath no Artery, and so is destitute of Vital Heat, is easily turned into this fatty substance. Meliceris contains a Matter representing Hony: so the Phlegm which causes this Tumor is thinner than that which breeds an Atheroma, and hath some Choler mingled with it, the heat whereof maketh the Matter fluid and liquid.
The Tumors reducible to an Oedema which have no Cystis are three, Psydracium, Ficus and Talpa, Psydracium is a pointed white Pustule containing in it a waterish Humidity. Ficus is a Tumor so called; First, because it has a Root like unto a Fig; Secondly, because it contains small grains as a Fig hath. It is a Tumor red, round, and somewhat hard and painful; from whence issueth a Matter, like unto the seeds of a Fig, if it be broken and wrung. The Matter of this Tumor is gross Blood, mingled with Phlegm and some waterish moisture. Talpa or Testudo is so called, because as a Mole heaves up the Ground, so this Tumor lifts the Skin from the Peric [...]anium: This Tumor is larger than a Ficus, and is caused of more gross Humors; wherein there is little moisture.
So you have a brief description of the Tumors which are reducible to an Oedema: As for the cure of them, I will reserve it until I come to that part of Chirurgery called [...]; which sheweth how superfluities of the Body are to be taken away. The Modern Authors add to these Nata, which is a large Tumor so called, because it represents the Buttocks called Nates, without pain, consisting of soft and pituitous Flesh; caused of congestion of pituitous Blood: it is seated most commonly in the Neck, Shoulders and Back: it is only cured by excision.
Ganglium and Lupia are round Tumors of the Nervous Parts without pain: yet they differ; for Ganglium is hard but Lupia soft: Secondly, Lupia may be moved every way, upward, downward, and side ways: but Ganglium toward the sides only. Thirdly, Gang'ium is like to a knot of the Sinew; but Lupia possesses not the Sinewy Parts only, but other solid and hard Parts in the Hands and Feet.
CHAP. VIII.
Of a Scirrhus.
NOw are we to enter into the contemplation of a Scirrhus, the ugly progeny of muddy Melancholy, as we have discoursed of a Phlegmon, Erysipelas and Oedema, who deduce their Pedigree from Blood, Choler, and Phlegm, and ascribe their being to them. But that you may hereafter discern the better the nature of a Scirrhus, I will first set down the description of Melancholy: Secondly, the divers sorts of it: And thirdly, the proper signs of a Melancholick Person: which will both lead you to the knowledge of the Grief, and open the way of curing the person possessed with this Grief. Because the English Tongue doth promiscuously use Melancholy, both for [...] Melancholicus Succus, and [...], Atra Bilis, I must give you warning, that these two do much differ; for Melancholicus Succus is the feculent part of the Blood, like unto the Lees of thick Wines, as Allegant. It is one of the four nutritive Humors natural to the Body, and gentle, having no corrosive or stinking quality. But Bilis Atra is caused of immoderate Heat, and is Malign, for it burns and corrupts the Flesh, it is sowre and sharp, and being poured upon the ground, it boileth and raiseth it up, as Leaven doth Dough, and hath an unpleasant smell. There be three sorts of this: The first is caused of Blood burned, and of all others is the mildest: The second is ingendred of Succus Melancholicus burned; and it differs as much from the natural Black, as Lees burned from the unburned: The third is caused of yellow or vitellin Choler more burned, which of all others is the worst; because Choler, whereof it is bred, is more hot and sharp than melancholick Juyce.
None of these are engendred in a sound and healthful person, whereas the Succus Melancholicus is found in all persons of what temperature or state soever they be. Wherefore Melancholicus Succus may be thus described: It is the fourth Humor in the Mass of Blood, black and thick, yet natural cold and dry. This Humor natural is either Alimentary or Excrementitious. The Alimentary nourisheth the Melancholick Parts, which are cold and dry, as the Bones, Cartilages, and Ligaments. The excrementitious or superfluous is drawn by the Spleen.
Now these signs discover Melancholick Persons; they are silent, pensive, constant in their purposes, slow to Anger; but if they entertain it, they turn it unto Hatred: Their Sleep is troublesome by reason of fearful Dreams, as of black Things, dead Bodies, Death, they are sad, and given to fear without cause; their Pulse is small, slow and hard: their Colour is dark, their Appetite to Meat and Venus is more than ordinary: they seldom thirst, because they abound with much superfluous Phlegm, their Blood is thicker and blacker than ordinary, from what part soever of the Body it flow, the Urine is thin and white, if no Melancholy be mingled with it; but if Melancholy be mingled, then it is thick, black, or of a leaden colour; they Sweat much in their Sleep; the habit of their Body is lean, tough and hard: they are subject to Varices and Hemorrhoids: If such a one be presented to you possessed with a Scirrhus, it is easie to discern the Disease, and of what Humor it proceeds, and how the party is to be dealt withal. In my Discourse of a Scirrhus; I will set down first the Description of a Scirrhus: Secondly, the Signs of it: Thirdly, the Differences between it and other Tumors: Fourthly, the Kinds of it: Fifthly, the Prognosticks of it: And lastly, the manner of curing it.
To begin then with the Description of a Scirrhus, it is a Tumor hard, and without pain, caused either of natural Melancholy, or thick, tough and cold Phlegm. If the Cause be Melancholy, it hath a leaden colour; if Phlegm, it changes not the colour of the Skin: for Phlegm is white; As for the Signs of it; I. It is hard.
Now there are four Causes of hardness: The first is coldness, as appeareth in Ice; This is removed by moderate Heat, as by the Sun. The second Cause, is Driness, as we may plainly see in the hands of Sailers and Felt-makers. The third Cause, too great Repletion, which doth appear in the Stomachs of Gluttons. The fourth Cause, may be the Combination of these, and indeed all these concur to procure hardness in a Scirrhus. As for Coldness, it may be induced either by things external, as cold Air, and narcotical Medicaments: Secondly, from the part affected, for Scirrhositles chiefly appear in the beginnings of the Muscles, Ligaments and Tendons, and other cold Parts: Thirdly, from the Humor; so the melancholick Juyce, and thick, and viscous Phlegm, the material causes of a Scirrhus, are very cold.
The second sign of a Scirrhus is, that it is without pain; and this comes to pass, either because the animal Spirits, cannot pass through an Humor so thick and glutinous as that which causes a Scirrhus, or because it is benummed by the coldness of the Humor. This is the third Sign that it is fixt, and as it were nailed to the part, and doth not move by pushing, as Scrophula, or Ganglium.
Now I will shew how it differs from other Tumors. It differs from a Phlegmon; for in this, there is great pain; from an Erysipelas, because this is not hard; from an Oedema, because this yieldeth to [Page 52]the touch, and leaveth a pit. It is discerned from waterish and flatuous Tumors, because they have a thinner, and more clear Matter. The differences betweeen it and a Cancer are these. I. A Cancer is always painful, because it is caused of Bilis A [...]ra, or adust Choler; but a Scirrhus is without pain. II. A Scirrhus is cold, but a Cancer hot; this is caused by reason of the Humors whereof they are bred. III. A Scirrhus invades the solid and hard parts, as the Joynts, Tendons and Ligaments; but a Cancer the loose and slaggy parts, as the Breasts, the Privy parts, and such like. IV. In a Cancer, not in a Scirrhus, the Veins appear full of a black Humor: which for the likeness, one may call the Legs of the Crab, as the round Tumor the Crab it self. It is good to set down the predictions of the success of curing, which Scirrhosities are like to have, that when such Tumors are offered to you to be cured, you may be made circumspect and wary in taking of them in hand. An exquisite Scirrhus is uncurable; for seeing it is senseless, it is manifest that the part is deprived of the influence of the Animal Spirits; and seeing this Humor doth distend the Sinews, Veins and Arteries, the Faculty it self is strangled and choaked, so that it neither can direct, nor help the Natural Heat to concur with the means, to be applied for the dispatching of this Grief. Secondly, this being a cold Tumor, and the Natural Heat extreamly weak, what hope can there be, that it can at any time triumph over so great an Infirmity? A Scirrhus not exquisite, although it be not mortal, unless it be very great, yet it hardly admits any Cure, and by much difficulty. A Scirrhus which is extream hard is altogether uncurable: for gentle means avail nothing, and those which are strong make it more hard: A Scirrhus from Succus Melancholicus is warily to be dealt withal: because it has a great affinity with a Cancer, and so may degenerate into it, if improper Medicaments be applied. If a Scirrhus be caused of thick and glutinous Phlegm, you may be the more bold: for this cannot easily contract any Malignity. The differences and divers sorts of a Scirrhus are these: A Scirrhus then is either Primary, or Epigenematical. A primary Scirrhus is that, which is a Grief of it self, and not caused by reason of any infirmity preceding. This is twofold, for it is either exquisite, or not exquisite: a primary exquisite Scirrhus is that which at the first, is caused by collection of the Melancholick Juyce in a part. A Scirrhus is thought to be not exquisite, when another Humor is joyned with Melancholy. If therefore some laudable Blood be joyned with it, it causeth Scirrhus Phlegmonoides; if Choler, Scirrhus Erysipelatodes: if Phlegm, Scirrhus Oedematodes. But these are compound Tumors, and are to be dealt withal according to the doctrine delivered concerning simple Tumors, whereof they are bred.
A Scirrhus Epigenematical or Symptomatical, is that which ensues after another Tumor, not handled according to Art, as a Phlegmon or an Erysipelas: this [Page 53]happens two manner of ways. I. It may fall out by the immoderate use of local Medicaments too cold, and narcotic or stupefactive: for these condense, and as it were congeal the Humor. Secondly, this may happen by the too continual application of resolutive Topicks: for so only the subtil and thin parts are breathed out, and the thick and glutinous remain.
The Indications of Cure are taken from three things, to wit the Dyet, internal Medicaments, and external Applications. As for Phlebotomy it is here fruitless, because the Humor is cold, unless the Veins be very full, the Blood black, and Age and Strength conspire: for then it is expedient, because so the Humors in the Mass of Blood will be more fluxible; and the quantity being diminished, the Natural Heat will the more easily rule the residue. If a Scirrhus be caused in a man by reason of the Hemorrhoides stopped, then Leeches are to be applied; if in a Woman by reason of the Menstrues supprest, then the Saphaena is to be opened.
As for the Dyet then, the Meat must be of easie digestion, moistning and affording a thin Juyce: such are Chickens, young Pigeons and Mountain Fowl, Lamb, Veal, young Pullets and Cockrels, fed Rabbets, Poched Eggs, Asparagus Sallet, Spinage, Burrage, Purselain: Bread of good Wheat not too much leavened is convenient. Let the Drink be small White Wine, or reasonable strong Beer well boiled, clear, and neither too old, nor too new; good Cyder also with Rosemary, Burrage, Bugloss burned, and Sugar is good. Meats which afford a gross Juyce are to be shunned, as old Beef, all Meats dried in the Smoak, Venison, Fish living in muddy Waters, all Salt Meats, course Bread, the immoderate use of Vinegar is hurtful: Apple-tarts, and Warden and Pear-pyes baked with Fenil-seeds and Anniseeds will serve instead of other Sweat-meats. Let the Habitation of the diseased party be in a pure, hot and moist Air: too much Sleep, Idleness; Grief and Pensiveness are to be avoided. As for internal Medicaments, they ought to purge Melancholy, and thick and glutinous Phlegm; but both of these are to be prepared before they are evacuated. Those Medicaments which prepare Melancholy, ought to attenuate or make thin, and moisten, such are the Syrups of the Juyce of Burrage, Bugloss, the Syrups of Fumitery, Hops and Apples, with the decoction of Balm, Hartstongue, Scolopendria, Tamarisk, and such like. Those Medicaments which prepare Phlegm, ought to be of an attenuating, and mundifying quality, as the Syrup of Hysope, of Betony, of Staechas, Oxymel and Mel rosatum in a decoction of Calamint, Hore-hound Peniroyal, and such like. The Humors being prepared, they are to be purged: Melancholy is to be purged with Confectio Hamech, Electuarium Indum, Pills De Lapide lazuli, the extract of black Ellebor, Electuarium Lenitivum, and the like, which may be ministred in the infusion of Sena-leaves and Polypodie. Phlegm is to be purged with Diaphoenicum, Diacarthamum, [Page 54]Hiera Pachii, Pilulae de agarico & Hermodactylis, Diaturbith, and the like. Electuaries are to be ministred in a decoction of those Simples which prepare Phlegm.
One thing is to be noted, that nothing is more effectual in discussing these Scirrhosities, than the continual taking of the Decoction of Sarsa Parilla, and Guajacum instead of other Drink, using a convenient Dyet, and procuring every other Morning sweating: for L [...]gnum Vitae warmeth, and Sarsa dissolveth the hardness: if it perform this in Nodes, which are far harder than any Scirrhus possibly can be; why should it not perform this office in a Scirrhus?
Here it is no wonder if few be cured: for sundry are impatient if their expectation be not speedily answered; and besides this, they are unwilling to gain their health, by foregoing their sensuality and pleasure, being Ventris Mancipia, more careful of their Palate than health.
In external Applications, which are fit to be used in the Cure of a Scirrhus, you are to consider three things; their Faculties, their Differences, and the right use of them. As for the Faculties then of the local Medicaments, they ought to be discussing and softning, emollientia, and discutientia. Repelling Medicaments are not to be used, because the Humor is thick, and hard, and so unapt to motion.
Of emollient Medicaments there are four degrees: in the first are those which are gentlest; such are Mans-grease, Capons-grease, the Marrow of Harts, and Calves-bones, Ducks-grease, Swines-grease, sweet Butter. Galen advises to apply to gentle Scirrhosities, a Medicament made of sweet Butter, black Rosin; and new Wax. Dialthaea Simplex is of this Degree. In the second Degree are these, Goose-grease, Badgers-grease, Dogs-grease, old rank Oyl, Oyl of Linseed. In the third Degree, are, the Fat of Lions, Bears, Wolves, Foxes, Libards, and the Marrow of Horses, and Mansbones. In the fourth Degree, are Ammoniacum, Galbanum, Bdellium, Caranna, Tacamahaca, Opopanax, of these Simples you may frame unto your selves such Compositions as the quality of the Scirrhus, which you are to take in hand, shall require. Rases in all Scirrhosities commends a certain Cataplasm, and it is excellent indeed.
The Description may thus be framed, take of Bdellium, Ammoniacum, and Galbanum, of each 1 ℥. dissolve these in a hot Mortar with Oyl of Lilies, add of the Mucilage or Pulp of rosted Figs ij ℥. of the Mucilage of Linseed and Fenugreek, vj ℥. make up a Cataplasm, dress the Scirrhus with this Cataplasm once a day. Diachylon cum gummi, and Emplastrum de Macilaginibus are convenient. Riolan the Father commends this Medicament; Take of Ʋnguentum de Althaea, of Diachylon cum gianmi & Emplastrum de Mucilaginibus of each 1 ℥. of the Oyl of Lilies vj. drams: mingle these well together, you may add to these Medicaments some Vinegar to help penetration. If a Scirrhus be above a Nerve or a Tendon, [Page 55]instead of Vinegar you may use the Spirit of Wine.
One thing is to be observed, that before you apply any Medicament, the part affected is to be fomented with the decoction of Mallows, Marsh-mallows, Chamomil, Melilot, and Cowslip-flowers in Vinegar, unto which after it is boiled, some Spirit of Wine is to be added.
As concerning the right use of local means, these Observations following are worth the noting; The First is: If a Scirrhus be caused of the melancholick Humor, which is cold, thick, and dry, you are to apply a Medicament which warms, attenuates, and moistens. II. If the Scirrhus be engendred of cold, thick, and tough Phlegm, then the Medicament ought to be warming, attenuating, cutting, and mundifying. III. Tender Persons and Parts require milder; but Parts and Persons harder and stronger require more forcible means. IV. If a Scirrhus has been procured, because an unskilful person has applied Medicaments too much repelling or discussing to an Inflammation; then apply this mollifying Liniment; Take of Yellow Wax, and Ducks Grease tryed, of each j ʒ. of Oil of Lilies ij ℥. of the Marrow of Ox Bones ij ℥. mingle them well together. V. If immoderate use of drying Topicks hath procured hardness, then Medicaments moistning are to be used: such is a Cataplasm made of Mallows boiled, and Capons Grease, or Swines Grease. Hildanus Obs. Chirurg. 79. Cent. 3. relates how a Gentlewoman of Berne had grievously bruised her Right Hand, which put her to much pain in her Wrist, and caused her Hand to swell. Divers remedies were used; but it ended in a Scirrhus. She went to him, and he found a very hard Scirrhus on the inside of her Right Wrist, as big as a Hens Egg; she could not bend her Fingers, because the Scirrhus stuck fast to the Muscle, which bends the Fingers, and to that part of it where it is distributed into four fleshy parts. After using Universals, such as were requisite, he applied a potential Cautery; after the Eschar was removed, a thin Matter ouzed out for several days: Afterwards, when the Flesh was eroded deeper with Escharoticks, a thick, viscous, and yellowish Matter shewed it self, which he was forced to squeeze out with some violence, having first dilated the Ulcer with Sponges. This Matter, after it had been for some hours exposed to the Air, turned as hard as a stone. He extracted a great deal of such Matter at several times. For a passage was found from the Ulcer, which reached from the upper part of the Wrist towards the Elbow, to the Palm of the Hand under the transverse Ligament, and entring the Palm, between the extuberances of the Fifth and Eighth Bone of the Wrist. When the Ulcer was Mundified, he successfully cicatrized it.
Unto a Scirrhus these Tumors may be referred, Strumae, Warts, Corns, Leprosie. As for Strumae and the Leprosie, they will require several Tracts.
Warts, if the root be small and the top broad, may be taken away [Page 56]by Ligature; if the root be broad, they must be extirpate with Medicaments. There I commend unto you strong Aqua fortis, or Lapis infernalis relented; these must be applyed to the Warts with a Rush or a Straw. The Third is an experiment of Fabricius ab Aqua pendente, and that is this; of Purslain bruised, and the Powder of Savin make a Cataplasm and apply it.
Corns must first be artificially cut, and then only these Medicaments which I shall name, must be applyed: Ammoniacum dissolved in Vinegar, and brought to the consistence of Cerot, emplastorum de mucilaginibus, and Diachylon cum gummi.
CHAP. IX.
Of Aqueous Tumors.
I Have delivered what I thought most material concerning the Four principal Tumors, Phlegmon, Erysipelas, Oedema and Scirrhus, which are caused of the Four Humors in the mass of Blood; to wit, Blood properly so called, Choler, Phlegm, and Melancholy; and so might have concluded the Doctrine concerning the differences of Tumors, as sundry others have done who have written of this subject.
Nevertheless, seeing aqueous or watry and flatuous Tumors are often presented to Chirurgeons to be cured, I think it expedient to discourse of these, that the Doctrine of Tumors may be compleat.
First then I will discourse of the aqueous, and then of the flatuous Tumor. The material cause of the aqueous Tumor by Physicians is called Serum, or Serosus humor. Of this Humor there is but a small quantity in a healthful person; no more than is fit to make the Blood thin, that it may be the more readily carried unto all the parts of the Body to afford them nourishment. This being done, it is discharged through the Pores of the Skin, either by Sweat, or insensible Perspiration.
Wherefore Galen not without reason affirms all Serosity to be an Excrement.
This Serosity is not only of a moist and waterish substance; but of a salt quality in like manner; yea, this Serosity, Urine, and Sweat have the same Matter: yet they differ; for Serum is that aqueous Humidity which is contained in the Blood: and although Blood be [Page 57]drawn, yet it cannot be discerned unless the Blood grow cold and congeal, and this thin part by the concretion of the Blood be separarated from the thicker. But Urine is nothing else but the superfluity of this Serosity of the Blood mingled with the waterish Humidity of Meat and Drink, and separated from the mass of Blood, and drawn by the attractive faculty of the emulgent Veins and Ridneys, and by the Ureters sent to the Bladder, there to be detained until the convenient time of excretion. So that this kind of excretion purges the Blood from waterish Humidity, whereby it is made more firm, and so more fit to nourish the parts. As for Sweat and insensible Perspiration, they are nothing else but the excrements of the solid parts. Nevertheless, they carry with them some obscure signs of the constitution and temperature of the Body. Some preternatural Causes will increase the serosity of Blood; as Meats affording plenty of waterish Humidity, as most Fruits, cold Herbs, and immoderate use of Water, and other Drinks: for although some Drinks be hotter than others, yet all of them have more waterish Humidity than Spirit, and by reason of the distemperature and obstruction of the parts appointed for Sanguification, oftentimes this Serosity is not separated from the alimentary Humors; but is detained and increased, and not expelled by Urine and Sweat: from whence the Dropsie, Fevers, and Pustules of the Skin do proceed.
An aqueous or waterish Tumor then is caused of the superfluity of this Serosity detained in the Body, after that it has performed its Office, which is, when it has carried the nourishment through the narrow passages: such are the mesaraical Veins. If too much of this waterish Humidity be sent to the habit of the Body, and move the expelling faculty, then part of it is sent to the Skin, which causes waterish Tumors. Those which heave up the Cuticula, are called Sudamina. Those which arise in the night time are called Epinyctid [...]s. If waterish Humidity be gathered in the Cod, it causeth [...]; if in the Navil, [...]; if in the Head, [...]. And although neither Fallopius nor Tagaultius have made any mention of waterish Tumors, thinking perhaps that they may be reduced to pituitous Tumors, yet these Tumors wherein nothing else but waterish Humidity is contained, do plainly evince, that an aqueous Tumor is one distinct from all others. Superfluity of this Serosity is sent to the habit of the Body: partly because the weakness of the Kidneys, doth not suffer them sufficiently to draw it: partly because the Liver is too cold, and Lastly, by reason of some error committed in the use of the things not natural, as immoderate taking of Water, and other drink, as Wine, Ale, Beer, Cider. &c.
The signs of a waterish Tumor are these, First, It is sometimes more, sometimes less swollen, yet it yieldeth when it is pressed hard, whereby it is discerned from a Scirrhus. It is distinguished from a Phlegmon, and Erysipelas, because these are painful, but it not. [Page 58]It is discerned from an Oedema by this, That it being pressed, it admitteth no pit, as an Oedema doth. It being beaten it yieldeth no noise, as a flatuous Tumor doth, as appears in a Tympany. Last of all, when it breeds, there is always an itching in the part, by reason of the Saltness, which is in the waterish Humidity; These Tumors appear in the Navel, Cods, and the habit or compass of the Body: yet most frequently in the joynts of the Arms and Legs: because these parts being weak, cold, thick, are aptest to admit such waterish Tumors. As for the Prognosticks, that waterish Tumor which happens by reason of any imperfection of the Sanguification, is dangerous; not so much in consideration of the Tumor it self, as of the infirmity of Sanguification. Other waterish Tumors, although they be not so dangerous, yet by reason of the weakness, colddess, and thickness of the Skin, are not so easily cured. As for those Tumors which rise in the compass of the Body, like to Blisters, or small Bladders, and are called Sudamina, as they are no ways dangerous, so they are easily cured. As for the Cure of this Grief, Reason and Experience have found out four means to meet with it, to wit, a convenient Diet, internal Medicaments, external Applications, and manual Operation. If then an universal Humidity possess the whole Body, the Diet must be drying, wherefore roasted Meat is better than boiled. Immoderation in Drink is by all means to be shunned: For
And as Temperance and Sobriety have a promise of prolonging our temporal Lives, so are they powerful helps in curing Diseases; but chiefly those which are caused by the superfluity of moist and waterish Humors. Flesh then is better than Fish, and of Flesh Meats those are best which are dryest: Kid then is better than Lamb, Veal than Muton, Rabbets and Conies are good, Land-Fowl are better than Water-Fowl. Hippocrates himself commendeth Pork above Pigs-flesh: but neither of both is good; for Pigs-flesh is exceeding moist, and in Pork the Fat is moist, and dissolves the Stomach, but the lean is hard, and not easily concocted. All supping Meats are to be shunned, for they multiply moisture. Ludovicus Cornarus his Diet recorded by Lessius in his Hygiastieon, or Treatise concerning preservation of Health, is fit for such persons. For above the space of Forty years, he rested contented every day with xij ℥. of Bread and Meat, and xiiij ℥. of Drink: when he was 80 years of age, so able he was by the observation of this moderate Diet, that without any advantage of ground, he usually backt the fairest Italian Horses. One thing is to be noted, that seeing superfluous Humidity seldom possesses the Body, unless there be some fault in the Sanguification and Kidneys, you must by all means labour to reduce them to their natural temperature. The means to compass this are set down [Page 59]by every one who hath penned the practice of Physick, unto whom I remit you.
The internal Medicaments appointed for the expugnation of this Grief, are of three sorts: for either they purge by Stool, or by Urine, or by Sweat, and insensible Perspiration. To touch the Cathartick Medicaments, such are one grain of Elaterium with a scruple of Pilulae Cochiae, or de Euphorbio, or Aloephanginae: Two Drams of the Seed of Dwarf-Elder, or Ebulus beaten to Powder and ministred in White Wine, and a spoonful of the juyce of Ebulus, the Flour-de-luce, or soldanella mingled with ij ℥. of the Syrup of Damask Roses, dissolved in ij oun. of White Wine. The purging Diet is excellent, if you add to the ordinary Purgatives in it, the roots of Esula major, the Berries of Buckthorn, and Carthamus Seeds. Amongst all the Simples Mechoacan and Jalap are most commended, both for their efficacy in working, and safety in ministring. As for Diuretical means, I commend unto you this Medicament: Take of the Ashes of Broom, and Bean-straw burned, of each a good handful; strain through those Ashes, iiij. pints of Rhenish-wine three times: then infuse in this Wine of the root of Sassafras sliced ij ℥. of Nutmegs and Cinnamon, of each two drams; of Bay-berries, and Juniper-berries, of each six in number, of Cummin-seeds ijʒ. of Fennel-seeds, and Anniseeds, of each one dram and an half, of Sugar four Ounces, of the Spirit of Salt one dram. Minister every Morning four Ounces of this Wine strained, and so much about four of the clock in the Afternoon: the Decoction also of Penniroyal, Time, Calamint, with Seeds of the Melon, Pompion, Cucumber and Purslain, made pleasant with the Syrup of Althea, de quinque radicibus, and of Hysop ministred as the former, is good.
As for Diaphoretick Medicines, the Decoction of Guajacum Sarsaparilla, Sassafras, and China-root, with Agrimony, Betony and Coriander; sweet Fennel-seeds, and Anniseeds carry away the Bell. How effectual these Medicaments are, being judiciously used, not in this Grief only, but in moist Ulcers also, and other Diseases contagious, I need not to labour to perswade. When these Decoctions are ministred, a strict Diet must be enjoyned, and plentiful Sweat procured, according to the tolerance of the diseased Party.
The topical Remedies ought not to be repercussives, although the Humor be thin, because seeing Nature can make no use of it, it is to be evacuated: wherefore the Remedies ought to discuss and rarefie the Skin, that vent may be given to the Humor. Fabricius ab aqua pendente commends this Medicament; Take of Mallow Leaves an handful and a half, of the Meal of Lupines, j℥. of the Oil of Dill and Chamomil of each ij ℥. with f. q. of White Wine, make up a Cataplasm. The Lie of unslacked Lime, and branches of the Vine are good. Avicen out of Galen, against waterish Tumors describes thus the emplaster of Mustard, and affirms, that if this Medicament prevail not, there [Page 60]is but small hope that any other will. Take of Mustard-seed, Nettleseed, Brimstone, Aristolochia rotunda, of the Foam of the Sea, or Brine and Bdellium, of each j ℥. of Ammoniacum, old Oyl, and Wax, of each j ʒ. make a Cerot according to Art. Let me advertise you of one thing, that the part is to be fomented before either Cataplasm or Emplaster be applyed. The Fomentation is to be made of a Lie made of Bean-straw, Broom, and twigs of the Vine burned with some ordinary Ashes, wherein you are to boil common Wormwood, Sea-Wormwood, the lesser Centory, Calamint, Cummin-seeds, Bay-berries, Juniper-berries, Scordium, Chamomil-flowers, Melilot-flowers, and tops of Dill; unto the Decoction strained add the sixth part of Sherry Sack. Now to come to the last Remedy appointed for rebellious waterish Tumors, to wit, manual operation. If they cannot be discussed, as oftentimes Hydrocephalos and Herniaaquosa cannot; then the Humor is to be let out sometimes by incision, sometimes by a caustick Medicament: then the part is to be mundified: Thirdly, It is to be incarnate; and Last of all cicatrized. But seeing I have handled these points when I discoursed of an Apostem, and that I am to set down what is singular in every Chirurgical Operation, whereby superfluities are taken from the Body, in that part of Chirurgery which is called [...], here I desist, referring every thing to its proper place.
CHAP. X.
Of a Flatulent Tumor.
HAving set down the Doctrine of a waterish Tumor, I shall speak of a Flatulent Tumor; in Latin it is called Tumor flatulentus, in Greek, [...], or [...], for the Grecians call Flatuosity sometimes [...], sometimes [...].
The person in whose Body Flatuosities are multiplied, is often troubled with gudlings in his sides, he belches often, he is troubled with singing of the Ears, his Excrements come forth with Flatuosity, his Urine is frothy, he finds a stretching of his Belly, yet without any heaviness.
The causes of Flatuosity are Crudity and weak Heat. The Heat may be accounted weak two manner of ways. 1. Of its own Nature, and so it has some Power and Dominion over the Humor, and doth in some sort dissolve it, but imperfectly; and so it produces halituous Vapours, which are called Flatuosities, but is not able to discuss them; and so they remain in the [Page 61]part, and distend it, and that because the Flatuosities are gross, and the part thick: this appears often in the Knees, and troubles Chirurgeons and Physicians much. 2. Heat may be accounted weak, by reason of the Matter it self; when as the Matter is so plentiful, that the Heat cannot wholly overcome it, but leaves some Vapours undiscussed.
The causes of Crudity are Ebriety, Gluttony, a sedentary Life, and flatuous Meats and Drinks; such are Beer and Ale not well boiled, Pease, Beans, Chesnuts, Turnips, Radishes, green Fruit, Swines Flesh, water-Fowl, salt Fish, and such like. It is discerned from a waterish Tumor, whereof we have spoken by the lightness of it; for an Aqueous Tumor is heavy, but this not. Secondly, By distending the Membranes, and stretching of them, it causeth often intolerable pain, whereas in waterish no pain is felt. It is discerned from an Oedema by this, that it admits no pitting, although it be pressed: it is distinguished from a Scirrhus, because this is hard, but it not: it is discerned from a Phlegmon and Erysipelas, for in it the Skin is not discoloured, neither is there any extraordinary Heat felt; but in those both appear.
As for the Prognosticks, receive these; If these Flatuosities possess parts very sensible, as great Joynts, such are the Elbows, or Knees, which are compassed with thick Membranes, they are hardly cured, and will busie the most skilful.
As for those which invade other parts, they are not very easily cured. First, because these halituous Spirits are gross. Secondly, because the parts thorow which they are to be discussed are thick. Thirdly, Because the natural Heat is weak. Whosoever goes about to cure these flatuous Tumors; First, he must prescribe a strict Diet to the Patient, such as I have set down in the cure of a waterish Tumor. Secondly, he must bar him of the use of all flatuous Aliments, whereof I have made mention, and prescribe unto him Meats of easie concoction, and which afford a laudable Juyce. After Meals let him eat a slice of Marmalad of Quinces, with some Coriander, and Anniseed-Comsits, having but one covering of Sugar. The Stomach a little before Bed-time is to be embrocated with the Oil of Mastick, Wormwood and Rue.
As for the Topical Remedies, the part first is to be fomented with Sheres Sack, wherein Dill, Rue, Bay-leaves, Chamomil, and Melilot-flowers, Cummin-seeds, Annise-seeds, Fennil-seeds, and Bay-berries have been infused. Then the part is to be embrocated with the Oyl of Chamomil, Lilies, Dill, Rue and Bayes mingled with Aquavitae. Thirdly, apply to the part the Cummin emplaster, or that of Bay-berries: if the Patient do feel inflation in his Stomach, or in the region of the Spleen, minister unto him of the Confection of Bay-berries ij, ℥. in three Ounces either of good Hippocras, or Canary Wine, wherein Cinnamon hath been infused two hours before Supper, ii j. or iii j. drops of the Oyl of Pepper, or vj. of Fennel-seed Oyl in the Sack-posset drink, are good. Digestion is furthered in such [Page 62]persons, if they take a cup of Sack having a Toast in it, and afterward eat the Toast, being first besprinkled with Sugar. To such a remedy the meanest may attain, and it is very proper. Take it two bours before Supper.
CHAP. XI.
Of the Kings Evil.
THe King's Evil is in French called, as by Us, Le Mal du Roy; The Spaniards call it, Porcellanas, Lamparones; The Portugueze, Las Porcas; The Latins call it Strumae, Scrophulae, Scrophae, Sodellae; The Greeks call it [...], as the Latins Scrophae. This Disease, as Laurentius has defined it, is an obdurate Tumor of the Glands, enclosed in a coat of its own, bred of thick Phlegm dried, rarely simple, often adulterate and salt, and sometimes of a peculiar sort of indurate Flesh. Some would reckon the King's Evil among Scirrhi; but it may make a peculiar Species of Tumors, it having a peculiar Seat, the Glands. Now the Glands are of two sorts. One sort is connate with our Body and the parts of it: Another is adventitious and preternatural. The first have some use; the latter none. They either serve for the divisions of the Vessels, or to imbibe superfluous Humors, or to irrigate the Parts. Besides, there are Glandulous Bodies, which cannot properly be called Glands; so the Testicles, Breasts and other Parts are Glandulous Bodies, i. e like Glands. The adventitious and preternatural Glands are bred in almost all the Parts of the Body, most frequently in the Fat, and between the Flesh and vacuities of the Muscles; sometimes in Membranous and Exanguous Parts, often in the extremities of the Vessels, from Blood, Phlegm, Mucus, and other redounding Humors. And all these Glands are subject to Scrophulous Tumors, and by consequence the whole Body may be troubled with the King's Evil. The Matter of these Tumors is reckoned Phlegm or Serum (this being a new word Homonymous to the Ancients Phlegm.)
This Disease is either primigenious of it self, not following another Disease: Or Secondary, which follows some other Disease, as an Inflammation. It either proceeds from Fluxion of an Humor from some where else, generally from the Head by the Vessels: Or by Collection or Congestion, which is bred of the Reliques of the proper Aliment, which the Glands through weakness of heat and laxity of substance could not expel. The diversity of Matter whereof the King's Evil is bred, which is various Humors, makes several differences of it. There is a difference in quantity; sometimes [Page 63]there are many Knots, sometimes few, sometimes large, sometimes small; Sometimes it is mild, sometimes malignant. One is external, another internal. One is moveable, another fixt. One has Veins, Arteries and Nerves implicated, another has none.
The Causes external are a thick, soggy, moist Air, bad Water, such as comes from the Alps when the Snow melts, and intemperance in Meat and Drink. The internal Efficient Causes are Intemperature of the inner Parts, Cacochymy, a bad Liver, a weak Stomach or Brain, an ill made Head. The material Cause is Phlegm or Serum, with a medley of the other Humors.
The King's Evil is very like to a Gland, a Node, and to all those Abscesses which Practitioners call Phlegmatick. But the Evil is distinguished from a Gland, because a Gland is soft and without pain; the Evil, if it be touched feels hard and is painful. A Gland is single and only one; the Evil consists of many Knots. A Gland slips, when pressed, and returns again; the Evil gives not way to the touch. A Gland is usually Cutaneous, the Evil lies deep. As for a Ganglium it is indeed a round Body; but it differs from the Evil, because it is only in a Nervous Part. Nodes according to the Modern Latins, are pituitous Tumors, enclosed in Membranes, which gradually increase, as the Evil does; but they are separable from the subject parts, and the Evil sticks fast to the Flesh. A Node breeds in any; the Evil only in a glandulous part. As for the distinguishing of one King's Evil from another, the efflorescence of the Humor in the Skin, which colours it, shews what Humor causes the Evil.
The Prognosticks are these, I. Every King's Evil is difficult to cure, because it comes from a gross Humor, because it is contained in a Coat of its own, and because it is hard and scirrhous. II. Many Knots are more difficult to cure than one, the painful, than one without pain; the Melancholick than the Phlegmatick; the fixt than the moveable; in the fore part of the Neck, than in any other part. III. Celsus says, the King's Evil tires Physicians, because it occasions Fevers, nor ever comes to Maturation, whether it be treated with Instrument or Medicine; and therefore it often rises again in the very Scar it lest. IV. The Evil often ulcerates, when the Humor is putrid, when it is hot, or irritated with Applications; sometimes it turns Scirrhous, sometimes Cancerous. V. This Disease, according to Aph. 26. Sect. 3. is familiar to Children. VI. And in Coac. Praenetion. Hippocrates says, the Evil seldom comes after forty years of Age. VII. Such as have a narnow Forehead, flat Temples, broad and prominent Cheek-bones, and a narrow Neck, these are very liable to the Evil. VIII. Hippocrates, l. 2. Prorrhetic. says, that as to these, Biles turn to Pus; and indeed Strumous ones selfe many Children, and they go away again easily; but as they seldom grow in elder Boys and Youths, so they go away with the more difficulty. But in [Page 64]grown men such Swellings seldom arise.
The Cure of this Disease is twofold, Supernatural and Miraculous; or Natural. The Supernatural and Miraculous Cure of the King's Evil (waving all Metaphysical Speculations and Theogical Concertations about it) I dare affirm to be one of the Regalia annext to the Crown of Great Britain, the gift being no way obliged to any special Form of Religion; since our own Experience as well as History informs us, that Princes of different Perswasions in Religion have equally by their Sacred Touch in the Name of the Most High, cured multitudes of the Evil, called, because the King cures it, the King's Evil.
But since all People asslicted with this Disease have not the Opportunity to approach the Royal Presence, and receive the Blessings of his Hand, it is a Work becoming a skilful Chirurgion to supply a Miracle by his skill in Nature, and to save a Subject, where his Majesty is not present by his immediate Hand to do it. That it is possible to be done (tho difficult) there want not Instances of several in London cured of the King's Evil by a Method of Physick. For besides others, Doctor Willoughby at this present in London cures several of this pertinacious Disease, he having been very industrious to conquer it, and having spent much of his Medical Studies upon Enquiries into this very particular Malady. He has likewise some Arcana, whereby he effects strange Cures upon persons disaffected with the Evil; yet he frankly acknowledges that the same Method and Medicines, in several Patients have quite different Effects, and that without proceeding Methodically nothing i [...] to be done. Method therefore being the great Arcanum of a True Physician, I shall endeavour Methodically to lay down the Cure of the King's Evil.
As for the Diaetetick part, the Air must be thin, dry, serene, pure and open to the East. Avoid a thick, foggy, moist, rainy, fenny and a Western Air. If it be not naturally good, let it be rendred so by Art. Smell to a Pomamber. Fasting is good sometimes, because it dries. The Bread must be well baked and seasoned with Anise or sweet Fenilseed. Avoid all Milkmeats and Sweet-meats and Pulse. The Meat must be of good Juyce; Avoid all young, mucilaginous and fat Flesh, Pork and Feet of Quadrupedes. Sup little Spoon-meat. Eat roast Meat rather than boiled. Fish and Fruit are bad. Avoid much drinking, and corrupt Waters. But Spaw-waters are good. A Dyet drink altered with Rosemary, Thyme and Sage is good. And so is a China Drink. Mastich Wood strengthens all the nutritious Parts, invigorates the Blood and Humors, is amicable to the Brain, and keeps the Belly loose. Never sleep on the day. Use Exercise. Keep the Body loose. Purge the Head, and apply Bags to it. Use Sneezing.
In the King's Evil there are two Indications of Cure. The first removes or diminishes the Antecedent Cause. The second takes away the Conjunct Cause. The Antecedent Cause of the Evil is a pituitous [Page 65]Humor, either simple, or mixt with another Humor, which resides sometimes in the Veins, sometimes in the Brain, which Hippocrates calls the sent of Phlegm. Therefore the luxuriant and noxious Humor must first be evacuated, and then the Temperament and Strength must be restored to the Parts. Evacuation is either Sensible or Insensible. Sensible evacuation is made by Vomit, Stool, Sweat and Bleeding. A Vomit is good, if there be much crudities in the Stomach. One may be given de decocto raphani, semine atriplicis, floribus genistae, & Oxymelite, or Diasarum Fernelii, or this; ℞ Oxymel. simpl. ℥ ij. decocti sem. atripl. hord. flor. genist. ℥ iiij. M. hauriat tepidè. It is good to vomit in the Morning fasting. Purging with Diaturbith and such things is good. Sudorificks of the Woods are good: Mineral Waters are proper, such as the Spaw and Borbonne. Diureticks may be given, when the Body is well purged and clean. Venesection in this case is seldom proper. When the whole Body is purged, the Head may be likewise purged by Apophlegmatisms, Errhines, Sternutatories. Issues in the Neck and Arms, and Blisters are proper. Thus the material Antecedent Cause of the Evil may be removed by sensible Evacuation. It may also be insensibly evacuated by such things as by degrees soak up, ex [...]aust and dry the Phlegm contained in the Stomach, Veins and Brain. Such as Scrophularia, Ʋr [...]ica Mortua, Filipendula, Caryophyllata, Gladiolus, Enula Campana, and such things; of which various Forms of Medicines may be made. Radix Gladioli is good taken either in powder or preserved. Arnoldus Villanovanus commends this highly for the Evil, ℞ Pilae Marinae, Spong. Marin. Os. Sep. Pip. long. nigr. Zinzib. Cinnam. Sal. gemm. Pyrethr. Gallar. Spinae Rosarum a. q. s. Omnia subtilissimè pulverizentur, exceptâ spongiâ & Pilis marinis, quae prins secundum artem comburantur, postea carum cinis cum aliis rebus pulverizatis misceatur. This Powder must be held night and day in the Mouth, and the Meat may be seasoned with it. Vipers and preparations of them are good, as Celsus observes, against the Evil. Cephalicks must then be used.
The Conjunct Cause of Tumors may be thus removed. Every Tumor according to Galen is either dispersed, or suppurated, or it turns scirrhous, or it gangrenes. Hot Tumors are easily dispersed and suppurated, because the Matter of them is thin and capable of coction: Cold ones with difficulty: and the Evil is well known to be of such a Nature. Yet when it begins, it is capable of Resolution and Suppuration. One confirmed, and turned to a scirrhous substance, is sometimes cured by Emollients and Discutients. But one that will not give way to the foresaid Medicines, can only be cured by the Knife, Fire and Corrosives. Begin always with the gentlest means first. When therefore the Strumae are small and beginning, and are but inclosed in a tender Membrane, they are easily cured. For squeeze, bruise and rub them with the hand till they grow hot, at first they grow [Page 66]soft; then beat them with some wooden Vessel till they disappear, and swathe a plate of Lead hard over all the Tumor. In the beginning Resolvents are proper for the great ones, with which Galen mixes Astringents, because of the Laxity of the Glands, which admits defluxions. Here is a Cataplasm; ℞ Rad. Gladiol. ℥ ij. Lil. alb. ℥jss. Fol. Cupress. M. j. Sem. Foenugr. ʒ vj. Cymin. ℥jss. Flor. Melilot. Chamaem. Ros. Rubr. a. P. j. Coquantur omnia, pistentur, cribrentur, quibus adde Farin. Orob. aut Lupin. ℥ j. Mell. opt. ℥ ss. Ol. Aneth. q. s. f. Cataplasma. Langius describes a most excellent Remedy to dissolve the King's Evil. ℞ Ol. Philos. lb. ss. Thuris, Mastich. Gum. Arab. Terebinth. a. ʒ iij. Pistata simul per Alembicum distillentur, tandem adde salis ex cinere cerrae modicum, & iterum destilla, & in vitro serva. Here is a dissolving Plaster. ℞ Mass. Empl. de Melil. ℥ j. Bdellii aceto scillit. dissolut. dr. ij. Castor. Pinguis ʒjss. Pulv. Rad. Ireos, Fol. Cupress. a. ʒ j. Ol. Chamaem. Lil. Amygdal. Amar. a. q. s. f. Massa Emplastri. If the Evil cannot be dissolved by these Remedies, and some signs of Suppuration appear, it may be promoted by Diachylon, Ceratum Tripharmacum, a Cataplasm of Marsh-mallow Roots, and Sorel Roots boiled in Water, adding Wheat-Flour and Oyl. The Evil, when it is suppurated, must be opened with a Knife or a Caustick, then the Pus must be evacuated, and purged out, then the Sinus must be silled with Flesh by Ʋnguentum Iridis, de Betonica, de Tuthia, and the like. When the Evil is grown scirrhous, all means must be used to mollifie and discuss it. Aëtius takes equal parts of Sulphur and Galbanum, and makes a Plaster. These are mollifying; Emplastrum nigrum Galeni, de Meliloto cum Ammoniaco, Oyl of Lilies, and Powder of Iris Root. Emplastrum Vigonis cum Mercurio is good. Some commend this Unguent. ℞ Cineris Agni casti flore caeruleo, Senectae Serpentis a. ℥ j. cerae q. s. Ol. Amygd. Amar. ℥ j. f. Ʋnguentum. Rogerius commends this Plaster, ℞ Rad. Filic. Asphodel. Ebul. q. v. Coquantur in vino optimo, & tundantur in Mortario, addendo Sulphuris modicum & cerae q. s. f. Emplastrum. Some make an Oyntment of Scrophularia Root gathered in Autumn. If Ulcers arise, things good in malignant Ulcers must be used by the Chirurgeon. We shall refer the Chirurgical taking out of the Kernels to the proper place in the Parte Ablatrice. And thus we have compleated the first Book of Tumors.
THE PRACTICE OF CHIRURGERY. BOOK II.
CHAP. I.
Wherein the Authors, and Definition of Ʋlcers, are set down.
I Divided Chirurgery into four Parts: whereof the first was [...], which teaches to unite parts disjoyned. Solution of Unity I made twofold: either intelligible, to be apprehended by Reason or Understanding; or sensible, which may be perceived by the very Senses. The intelligible I named a Tumor, in which very often no Solution of Unity offers it self either to the sight or touch, as in many cholerick Tumors, and others in their beginning. Sensible Solution of Unity, I affirmed either to be in the soft parts or in hard. As for the Solution of Unity in the soft Parts, I appointed two Differences of it; to wit, Ʋlcus and Vulnus, an Ulcer and a Wound.
In my proceeding, I will handle these ten Points: I. I will point out the Authors who have written laudably of this Subject. II. I will set down the Definition of an Ulcer. III. The Causes of an Ulcer. [Page 68]IV. The Differences of Ulcers. V. The general Signs of Ulcers. VI. The general Prognosticks of Ulcers. VII. I will set down such Medicaments as are fit for all Ulcers in general. VIII. Of the general Indications of curing of Ulcers. IX. Of their times. X. I will discourse of every particular sort of Ulcers.
First then, to come to the Authors, I mean not to name all who are come to our hands, and have written of this Subjects but such as are famous for their Skill and Experience. Hippocrates and Galen, though they have not left to Posterity particular large Monuments of this Matter, yet when occasion is offered, they omit not to set down both the Indications of Cure, and Medicaments effectual to cure. Hippocrates in his 6. Sect. Of Ʋlcers and Fistulaes. Galen in those excellent Books of his, which he penned, De method. medendi, lib. 3. of a Simple Ulcer, lib. 4. or an Ulceer with Accidents, of the orderly way to cure Diseases, for the most part doth illustrate his Precepts by Examples borrowed from the Practice of Chirurgery.
If you demand why he did so?
I will tell you the Cause in Fallopius his words, in his first Chapter of Ulcers, Quoniamut ait Celsus, lib. 7. cap. 1. Quum cadem est, Seeing according to Celsus, the means which Physicians use in curing, sometimes take effect, sometimes avail not, it may be doubted whether Health may be ascribed to the good constitution of the Body, or to the means applied; but the effect of Chirurgery is most evident. O pregnant testimony to evince the certainty and excellency of Chirurgery! Let those Physicians who slight the Practice of Chirurgery, thinking themselves to be Chicks of the white Hen only, consider and weigh the weight of this Testimony of Celsus and Fallopius in the impartial ballance of Reason. Avicen, the chief of the Arabian Physicians, handles this Matter in the fourth Book of his Canon, and the third Treatise: although he writes confusedly; yet the reading of him will profit such as understand him, and will not be fruitless. Albucasis has some good things, but the number of the trifles are many more. Paulus Aegineta in his sixth Book, Of the Art of Curing, only touches some Points of this Matter, as a Dog doth Nilus when he drinks. Gabriel Fallopius follows, who has written an excellent Treatise of this Matter; but whosoever shall peruse him, shall find him in sundry things intricate enough: I will bring him a new Companion, but far surpassing all other Modern Writers, Minadous, one of the Famous Professors of that renowned University of Padua, in his three Books which he penned of the curing of the Deformities of the Body of Man: Whosoever he be who shall go about to make a parity between these two and others of the late Writers, I shall judge him worthy of Midas his Ears, and after that he hath proceeded, and been promoted in Germany, to be saluted a Doctor with four Feet. To these two Italians, I joyn the German Samuel [Page 69]Haffenreferus, in his Four Books of the Affections of the Skin, in whom there are many varieties, if one with judgment discern them. The rest that can be named are of the lower Bench, as Guido de Cauliaco, and he who hath only taught him to speak a little more cloquently, Joannes Tagaultius, in the Third Book of his Institutions of Chirurgery. Joannes de Vigo accounted the Father of Empericks. Marianus Sanctus in the Third Treatise of his Compendium of Chirurgery, and Angelus Bologninus in his two Books of Ulcers, shall bear him company. I must not omit that painful and judicious Chirurgeon Ambrose Parrey, unto whom Chirurgery is much beholding. Vesalius also deserves praise. The two latest who have written are the two Fabricii, Jerome and William: Hieronymus Fabricius in the Third Book of the Second Part of his Chirurgical Works: Gulielmus Fabricius in his Learned Chirurgical Observations, who in this course out-strip all their fellows. These Authors of all other are most to be perused; for in reading of them, one shall become both more understanding, and more able to perform the Cures which shall be committed to his care and skill. As for the rest, I leave them unto those who rather chuse to feed upon Acorns, than pure Mancliet. Riolan the Father, Jaques Guilmeau, Peccetius and Pigraeus, although they deserve their own praise, yet in my opinion they are to give place to those whom I have named. If any one would mispend good hours, let him read Paracelsus his great and little Chirurgery, which are like Clouds without Rain. If you would be furnished with Forests of Chirurgical Medicaments, peruse the Treatise of the Learned Hollerius de materia Chirurgica, of Chirurgical means, and Jacobus Dondus in his enumeration of Chirurgical Remedies, both simple and compound.
As for those Medicaments which in my proceedings I shall from time to time set down, they shall not be a confused heap, but a choice of the best approved, to ease you of the labour of Election.
Now are we to descend to the desinition of an Ulcer, which was the Second point: I will not stand upon the setting down of sundry descriptions of sundry Authors, and the examination of them, because this labour would take up too much time, and little edifie. An Ulcer in English is derived from the Latin Ʋlcus, and this from the Greek [...], because it disjoyneth the part which it possesseth; and so this term, in its general signification, comprehends every solution of unity: and so Hippocrates in his Treatise concerning wounds of the Head, doth entitle it.
But seeing solution of Unity may proceed from two Causes, to wit, an external instrument dividing, and a sharp Humor eroding, according to Galen: there must be two differences of solution of Unity likewise according to the same Author, de constit. art. c. 6. Vulnas, a wound, procured by an external instrument, and Ʋlcus, an Ulcer, caused of an inward cause eroding, Thus then an Ulcer is to be described: It is a solution of Ʋnity [Page 70]proceeding from an inward cause eroding the part. The subject of an Ulcer, I make not only the fleshy part, (whereby I understand, all the parts which cover the Bones) but the Bone it self also. Unto the Ulcer of a Bone the Author of the Book De constit. art. c. 6. gives a peculiar Name, calling it Teredo, [...], which properly signifies the little Worm which pierces Wood, and consumes it. I see no reason why the name of an Ulcer may not be ascribed to the solution of Unity in a Bone, if it proceed from an inward cause eroding, as the term of a wound is, if it be divided by an external instrument, as a Sword or Hatchet. An Ulcer then is a compound Disease; for in it there is both solution of Continuity, and loss of substance.
CHAP. II.
Of the Causes of Ʋlcers.
IN the third general concerning Ulcers, is set down by me the causes of Ulcers. These are either antecedent or conjunct: The antecedent causes may be reduced to three; to wit, Cacochymia or the evil habit of the Body; Contagium, or the communication or imparting of an infecting quality, Vapour or Humor, by the which an Ulcer is caused in any part; a venemous moisture, as in biting and stinging of Serpents; or lastly, the distemperature of the part it self.
As for Cacochymia, the speculation of it belongs to the practice of Physick! yet in my Discourses of Tuniors I set down the signs of every Humor redounding as much as was requisite for any to know, who only meddles with the practice of Chirurgery. While any of the three Humors (Blood being excepted) in the masse of Blood contained in the Veins is faulty, and peccant in quality, it is accounted the cause antecedent of an Ulcer. Sometimes these Humors are solitary, sometimes they are associate together.
Contagium, or Infection, it is communicated sometimes by a rotten and corroding Vapour; and so very often, if one visit often one having a Phthisis, such Vapours being mingled with the Air, infect the party who visits, especially if he draw too near to the diseased Party. So Ulcers of the Yard come from dealing with Women, whose Secret parts are touched with Venereal Ulcers: yea, the Itch it self, and scabbedness, is gotten by either lying with one troubled with it, or by sleeping in a Bed [Page 71]where a scabbed person hath rested.
As for the distemperature of the Part, it may be procured either by Cold, as appears in Kibes; or by Heat, as we may see in a Gangrene, because the Blood flowing copiously to the part pained, and not being concocted, it putrefies and erodes the part. Last of all, by biting or stinging, as of a mad Dog, or a venemous Serpent, a corruption of the Humors may be caused, the conjunct cause of an Ulcer: so that every Humor that is changed from its own natural temperature, whether it be by putrefaction, adustion, or commixtion of any thing unnatural, may procure an Ulcer, in whatsoever part it seats it self.
But the followers of Hippocrates and Galen, speak otherwise of these Humors than the Chymists do. The Galenisis make the three Humors of the masse of Blood; to wit, Choler, Phlegm, and Melancholy, to be the causes both antecedent and conjunct of all Ulcers, if they become contrary to Nature. So they will have Rheumatick Ulcers to be caused of salt Phlegm, Herpes exedens to be caused of aeruginous Choler; cancerous Ulcers of Bilis atra, which are the worst and most deplorable of all others.
The Chymists on the other part, affirm that the Discourse of Humors doth not manifest unto us the Essence, and proper Nature of any Disease. So Quercetan in his advice of curing the Gout, brings in the Stone, which he affirms not to be ingendred of the Galenical Humors. Petrus Severinus the Dane in his Idea Medici [...]ae Philosophicae, or Pourtraicture of the Philosophical Physick, wonders at the folly of those who make those phantastical Humors Blood, Choler, Phlegm, and Melancholy the causes of Diseases; wherefore they out of Minerals, Salt, Sulphur, and Mercury, fetch the causes of all Griefs. Although Galen sometimes calls the Humors salt, nitrous, and aeruginous; yet the Chymists have no reason to reject the ordinary names of Humors, and to call contumeliously dogmatical Physicians Humorists, and to deny any Disease to proceed from the ordinary Humors of the Body becoming unnatural: For seeing that according to Galen 1. De loc. affect. c. 2. that is to be accounted the cause of a Grief, which being present, the Disease continueth, and which being removed, the Grief ceaseth; and seeing we perceive Diseases to be caused of vitious Humors abounding, and these being expelled, the Grief to vanish, I see no reason why these Humors may not be accounted the true causes of Griefs; and that it is a meer folly, and an affection of novelty, to Baptize these by names of Minerals far fetched; as to call that which in Fevers is cast up by vomit, rather Sulphur than Choler. Besides this, the Chymists are injurious to dogmatical Physicians, in labouring to perswade Men, that they by the name of a Humor, understand nothing else but a waterish substance void of all other Faculty; which should be the principles of all Bodies, and the causes of all Diseases: whereas every rational Physician, by the term of a Humor, understands a liquid Body [Page 72]mixed with Blood: which seeing it is a several body of its own kind, and is more compound than water, so it has far more excellent qualities than water: The Physicians their own selves have set the Alchymists at work, while talking of Humors, and the causes of Diseases, they so much talk of the first qualities, Heat, Cold, Moisture, and Dryness. For although sundry Diseases are caused of Heat, Cold, Moisture, and Dryness, yet we shall find other qualities in the Humor, which may as well hurt the Body as these: For Hippocrates in his Book De prisca Medicina, or ancient Physick, affirms, not that which is hot, cold, moist, or soft, to be most powerful, but that which is bitter, salt, sweet, and sowre, unsavoury, and sharp, with some Sowerness; these and a thousand such, [...] being exalted in their Faculties, he will have to be the causes of Diseases, and not the first qualities only: and from these the differences of symptomes in Fevers of this same kind do depend. These whilst they are exquisitely mixed in the Body are harmless, yet when one of these is severed from the rest, and is exalted in its quality, it manifests it self, and annoys Man; so the corrosive Salt bewrays it self in Cancers and corrosive Ulcers. Neither is it to be thought absurd, that Minerals are in the Body of Man; for seeing Man is sed by Plents, and Beasts which seed also upon Plants; seeing also the Herbs have their Aliment from the ground, which is not alike in all places, but often is mingled with a salt Juyce, and other Mineral Spirits, which the Beasts and Herbs cannot perfectly convert into their own substance; one can hardly think that a Man can live upon these, and participate of no such thing. So we see what variety of Wines the diversity of Soils brings forth; and that in every Wine there is Tartar or Argol, which appears also very often in podagrical Persons. In vomiting sundry times substance like to Leeks, green, and aeruginous, exceeding hot and sharp, are thrown up, which being received in Basons, die them with a bright aeruginous colour. See Histories in Schenkius Med. obser. lib. 3. ob. 63 in the Third Book of his Physical Observations, the 62 Observation. Michael Doringius lib. 1 De Medico & Medic [...]a, in his First Book of the Physician and Physick reporteth, That a certain Lawyer made such Urine as did fret his Linings, as if it had been the Spirit of Vitriol; such Humors appear plainly in Scubbedness, fretting Ulcers, but especially in a Cancer. Wherefore Bertinus: in his Third Book and Eleventh of his Physick, doth rashly and inconsiderately assirm, that not one whit of Mercury, Salt, or Sulphur, lies hid in the Body; for in the Itch, Scabbiness, some Catarrhs, Inslammations of the Eyes, and fretting Ulcers, it may be perceived; but in Urine, which is also an excrementitious Humor, the Salt may be separated and presented to the sight: yea, besides the Salt in Urine, another substance the cause of Diseases may be marked: for if you take a clear Urine and suffer it to settle, a Matter like unto the powder of Brick, and sometimes [Page 73]a white muddy substance will so cleave to the sides of the Chamber-pot or Urinal, that it can hardly be sometimes washed away: of such a Matter Tophi in gouty persons, and Stones in the Bladder are ingendred.
Whoever shall go about to reduce the causes of all Diseases to Blood, Choler, Melancholy, and Phlegm, shall wrap himself into a number of difficulties: I will desire him to yield me a reason, Why he calls salt Phlegm so, seeing Phlegm is said to be cold, but this hot? Why is Atra bilis comprehended under Melancholy, seeing it is very hot, but this cold? Besides this, if any Physician go about to cure Diseases, procured either by Contagion, or Poison, he without any great respect to the Humors, presently goes about to minister Alexipharmica, as in the Plague, which is gotten by Contagion, to abate the force of it, and then he addresseth himself to the preparation and evacuation of the Humors. If Poyson be ministred to any one in Meat or Drink, which according to Cardan, commenting upon the 62 Aphor. of the 4. Sect. may be suspected, if he find griping in his Stomach, and if he Vomit and go to Stool, if within six hours the Skin become greenish or spotted, then Antidotes are ministred, and not such as respect Choler, Melancholy, or Phlegm. Let the Humors then which are ingendred in the Body, retain the accustomed names; but if an external cause make them degenerate from their Nature, let these be distinguished from the ordinary, and have their denomination from that which altereth them. If Salt, Nitre, Alume, Vitriol, Verdigrease be mingled with any Humor, let it be called from the Mineral mingled with it, salt, nitrous, aluminous, vitriolate or a [...]uginous. And for this cause some late judicious Physicians writing of malign and pestilent Fevers, and considering their notable differences, have affirmed some to participate of the nature of Arsenick, some of Mercury, some of Hellebore, some of Opium, some of Leopards-bane, some of Hemlock; some to participate of the poyson of a Viper, Scorpion, mad Dog and such like, noting the variety of Symptoms in sundry persons.
One doubt remains concerning the Melancholick Humor, whether it be only thin and waterish, as Reusnerus affirms in his Book of the Scurvy, Exercit. 4. out of sundry places of Hippocrates, who calleth Melancholy [...], as in his Book De morbis, and in his first Book De morbis Mulierum; or whether it be thick and earthy, according to the vulgar and received Opinion. Before this doubt be solved, some Propositions are to be premised. 1. In the Chyle there are two substances, one liquid and thin, the other thick and terrestrial, which can no more nourish than Ashes. 2. Nature mingles these which are not sent away by Stool, with part of the aqueous and superfluous Humidity, caused of Drink and liquid Meats. So in a Lie the Salt and some adust Parts are so mingled, that they are not discerned before separation. I say then, that this thick and feculent Humor tempered with much moisture, is to be accounted the superfluous melancholick [Page 74]cholick Humor, and that it is attracted by the Spleen. For First, Seeing this feculent Humor is altogether unapt to nourish, it must be separated from the Chyle, which cannot be performed by any other part besides the Spleen. Secondly, the Spleen is of a darker Red colour than the Liver is, which proceeds from the thick, feculent, and terrestrial Humor, which it imbibeth. Thirdly, Hippocrates de aere, aq. & loc. affirms, that such persons as dwell in Fenny places, are subject to passions of the Spleen. The cause is, because the waters are not pure but muddy. Fourthly, if the Spleen did draw only thin and waterish Humors, it could not be so subject to obstructions as it is. The feculent Humor mixed with much Humidity, is the cause of sundry Diseases, the thin parts sometimes ascend to the upper parts, the gross to the lower parts, as we see in the Scurvy, wherein the Gums are ulcerated, and the Legs tumefy. The Spleen being spongy, draws much Humidity to it, wherefore splenetick persons ought to drink sparingly; for if they bib too much, the natural heat of the part is easily oppressed, and so they become Hydropick. The waterish Humor of the Spleen is not insipid, but sharp and biting, and copious: so we see those who are troubled with Quartanes, about the end of each Fit to sweat plentifully; and those who are oppressed with Melancholy, to spit much. In the thick, feculent, and terrestrial blackish Matter, sometimes there is no excess of the Spleen: in qualities sometimes there is, and those are two: Acerbitas, an astringent sharpness, such as appeareth is green unripe Fruits; and Acidit [...], sowreness: from these qualities intended and exalted, atra bilis becometh so corrosive. So much I thought good to set down of Melancholy, to clear the doubts which are moved about it, and to shew one use of the Spleen.
To return then to the carbonary Cure of unlearned Alchymists, they object thus, The rational Physicians affirm the Body to be nourished by the four Humors, How can they then be causes of the Diseases?
It is strange that any Man should wilfully shut the eye of the Mind (Understanding I mean) that they may not see Truth, seeing Man, as Aristotle in the very first words of the Book of his Metaphysicks affirms, naturally covets knowledg, and our first Parents to their own and our loss, are witnesses. No dogmatical Physician ever affirmed any disease to be caused of any Humor of the Body, as long as it continues in its own natural estate; but then to stir up Griefs, when it is separate from the rest, when it putresies, when forraign substances and qualities are added, which make it of a familiar Humor a professed enemy to Health, consisting of the natural constitution of the Body, a result of the laudable commixtion of the four Humors natural. I have insisted somewhat long in the setting down of the causes of Ulcers, because he (whosoever he be) that goes about to cure Ulcers without the knowledge of the Causes, is like one, who being blind-folded, is set to thrash a Cock.
CHAP. III.
Of the general Differences and Signs of Ʋlcers.
NOw the fourth Point, concerning the differences, and sundry sorts of Ulcers, offers it self to be handled, and in Truth the course of Nature so requires: for the form of every particular Ulcer doth spring from the Cause conjunct of the same: for Example, a Cancer ulcerate is discerned from all other Ulcers by its proper and Pathognomonical Signs, all which, as effects, are ascribed to Atra bilis, impacted in the part, the Cause conjunct of the same.
Here of purpose I omit the idle and fruitless distinctions of Ulcers, set down by sundry Authors, which neither better the understanding, nor further the Cure. These only I will set down, which are material. The material differences then of Ulcers, are taken either from the Nature or Constitution of an Ulcer, or from the subject or part affected. From the Nature and Constitution, an Ulcer is either simple or compound.
In a simple Ulcer, nothing is offered which may stay the Chirurgeon from going about the consolldation of it, as the Cause conjunct, a cruel Symptom, Adjuncts, or some Disease.
A compound Ulcer wherein either some of these, or all are found, which must be removed before Unition be procured, is either of the milder sort, or malign.
The more mild sort of Ulcers yield to ordinary and usual Medicaments, if they be judiciously applied.
The Malign yield not, and besides have fearful symptoms: those Malign Ulcers proceed either from inward, or outward Causes.
From internal Causes spring a Cancer Ulcerate, Phagedaena, Nome, fretting Ulcers, and others which are called Chironia, or Telephia, which denominations insinuate nothing unto us concerning the Nature or Cure of an Ulcer, but bring only unto our Memory the Names of those who are celebrated by Poets, which belong more to Grammarians than Physicians or Chirurgeons to be known.
The external Causes, which procure Ulcers, are two, to wit, Contagium, Contagion, or a venemous quality, Vapor, or Humor, comprehended under the name of Venenum, or Poison.
The Differences taken from the Subject or Part affected are two, [Page 76]for either an Ulcer possesses the outward part, and is called externum or outward; or it afflicts the inner parts, and is named internum or inward. Other differences taken from the continuance, figure and quantity, are here impertinent, and further only predictions, of which I will speak in the Prognosticks of Ulcers.
As concerning the signs of Ulcers; an internal Ulcer is found out and discerned by the Excretion, or Matter expelled. As for Example, if the Urine be purulent, we conjecture the Kidnies or Bladder to be ulcerate. If purulent Matter be voided by coughing, it is like that the Lungs are ulcerate; if much of such Matter be rejected, and signs of an Apostem have gone before, it is an apostematous Ulcer; if the purulent Matter be but little, and no signs of an Inslammation have been noted, then it is but a primary Ulcer proceeding of Erosion, by reason of a sharp Humor separating the unity of the substance of the Lungs. These internal Ulcers I will leave to the consideration of Physicians, unto whom they are most commonly presented to be cured. Only I will set down such things as tend to the cure of Ulcers of the external Parts. I need not to busie my self about setting down of the general signs of such, seeing they are presented to the view of the Chirurgeon by the parts grieved. Only let me give you warning, that you mistake not a Wound for an Ulcer: into this errour you may easily fall, if you admit the most ordinary description of an Ulcer, strange even to judicious Physicians and Chirurgeons; which is, that it is a Solution of continuity in a fleshy part, yielding Quittour; it matters not, they think, whether it be laudable or illaudable. It is set down that there should be set down no other difference between a Wound and an Ulcer, than this, that the one is bloody, and the other purulent. Doth not, I pray you, a Wound become purulent of it self, although no Chirurgeon deal with it, and may not an Ulcer become bloody if Incision be used, as it may daily be seen? Frivolous it is also in my judgment, that a Solution of Unity inflicted by an Instrument that woundeth in a Bone, as a Sword, may be called a Wound; and that a Solution of Unity in a Bone, procured by an eroding Humor, may not be termed an Ulcer.
Seeing the Causes conjunct make the true differences of an Ulcer and Wound: which are an external Instrument dividing, and a sharp Humor eroding, the parts; Who can imagine that in a Venereal Ulcer, wherein there is corruption of the Bone, there should be two sorts of Ulcers specifically differing, to wit, one in the fleshy part, and another in the Bone, the same Humor causing both?
But a Solution of Unity in the Bone by a corroding Humor is called Terede, say they.
What then? Must a Malign Ulcer in the Face, because it is called Noli me tangere, be exempted out of the list of cancerous Ulcers?
No. Let this then be accounted an undoubted Truth, that a Solution of Unity procured in the [Page 77]Body by a Humor eroding, whether it be in the Flesh or Bone, may be, yea ought to be, called an Ulcer, as a Solution by an Instrument separating is called a Wound in both.
CHAP. IV.
Of the general Prognosticks of Ʋlcers.
THe next thing I shall proceed upon concerning Ulcers is their general Prognosticks. The consideration of these will make one circumspect, when an Ulcer is offered to him to be cured, in the election of his Cure: for whoever takes in hand a grief uncurable, he discredits himself, and causes the Art to be contemned by those who are simple and ignorant, imputing the Error of the Practicer to the insufficiency of the Art. Let this be the first prediction: an Ulcer in a Body of an evil complexion, which may be conjectured by the colour of the Skin, if it be of a tallowy whiteness, yellow or swarthish, is not easily cured: for it is likely, that corrupt Phlegm, Vitellin Choler, and feculent Melancholy do abound, which Humors hinder the regeneration of Flesh: but on the contrary, an Ulcer is easily cured in a person of a good complexion, who digests well and does not increase superpersluous moisture. II. Ulcers in Bodies which are either very moist or dry, are hardly cured. This is plain in the Bodies of Hydropical persons, and those who are aged; for as superfluous Humidity contrary to desiccation hinders the healing in those first: So in the latter the defect of Radical Moisture is an impediment. III. Ulcers in Children by reason of their excessive Humidity, and in Women with Child, because the most laudable part of the Blood is turned to nourishment of the Child, are not easily cured. IV. Ulcers which fall out after critical Apostems in the Sphondyls of the back, or great joynts of the Body, for the most part are mortal: because after sickness, and Apostemation Nature must be exceedingly weakned, the Natural Heat much abated, and the Radical Moisture almost spent. Such Apostems do fall out when as sharp Fevers end not critically in the decretory days by some Evacuation, as Bleeding at the Nose, Vomiting, Sweating, Purging by Stool and Urine, but extend themselves to the fortieth day. V. If the place wherein the Ulcer is seated be blackish, blewish, or greenish, it hardly can be cured: for the Blood must be naughty, and the flesh corrupt. VI. Ulcers with a [Page 78]round figure are cured with difficulty; the reason is this, Consolidation is procured by unition of the parts; the farther the parts are asunder, the more slowly it is procured: but a round Figure, of all other within the same bounds, is most ample. VII. Painful Ulcers in Children are dangerous, because their Bodies being raw, and the Spirits subtil, they are easily spent, which is the cause that they are much weakned, and so disposed for death it self. VIII. If an Ulcer become either blewish or pale, the party being ill, death is not far off; for these colours in the Natural Moisture shew the Mortification of the part; and driness shews, that is gone. IX. If an Ulcer be complicate with a Disease which maintains it, the Ulcer, according to the Nature of the Disease, is either of easie or hard cure. So a Venereal Ulcer in a succulent and strong Body is easily cured, but if the party be in a Marasmus, neither the Ulcer nor the Disease can be cured: Because the use of the desiccatives, which only avail in these Infirmities, will only hasten death, increasing the extenuation of the Body: In like manner Ulcers in Hectick and Hydropick persons are hardly cured, in these because superfluous Humidity hinders Desiccation of the Ulcer; in those because laudable juyce flows not to the part ulcerate. X. If Tumors in Ulcers suddenly vanish without any evident and manifest Cause, as Bleeding, or application of a discussive Medicament, they portend no good; but Convulsions, if they appear in the hinder parts, because the Spina is very Nervous; and Madness, Pleurisie or Suppuration, if they were red, and i [...] the forepart. XI. Soft Tumors in Ulcers are laudable, because they will yield to Medicaments; but hard, not easie to be cured, because the Humor is more rebellious. XII. If the Hairs fall in places of the Body about the Ulcer, it is an evil sign: For then there must be great Acrimony, and Corruption of the Humors, as in quartane Agues, the Pox, and Leprosie. XIII. If in an Ulcer where there is Cariosity of the Bone, the colour of the Flesh be livid, the party must be in danger; for it is a sign of extinction of the Natural Heat. XIV. Ulcers that afford Quittour which is white, smooth, and uniform, and not stinking, promise an easie cure; for these qualities in the Quittour shew the dominion of the Natural Heat, and the soundness of the solid parts. XV. A Flux of Blood coming in an Ulcer after strong pulsation is ominous, according to Hippocrates, sect. 7. Aph. 21. for there must be a strong Phlegmon, and the Arteries must be much pressed, so that a Gangrene may be expected: however, of such furious Blood no Flesh can be regenerate. XVI. If an Erysipelas appear, the Bone being bare, it is no good sign, Hippocrat. Sect. 7. Aphor. 19. for Flesh cannot be regenerate by such a sharp Humor as this, that causeth so hot a Tumor. XVII. From malign Ulcers two sorts of Quittour flow; One thin, and it is called Ichor or Sanies; such a virulent Matter issues also from the pricking of the Nerves, and corruption of the [Page 79] Periosteon. The other sort of Quittor is thick, and is called Sordes. XVIII. In Ulcers which have continued a Twelve-month or longer, the Bone must be scaled, and the skinning be hollow, Hip. lib. 6. Aph. 45. But to make good this Aphorism of Hippocrates, some conditions are to be required: The First is, that much Flesh above the Bone be not in the part ulcerate. Secondly, the Humor which flows to the part must be very corrosive. Thirdly, it must not have been dealt withal by any Physician or Chirurgeon. If one or more of these Conditions fail, the Aphorism must miss of its prediction. What Galen and late Writers have set down in the explication of this Aphorism, clears not the truth of it: only these Conditions set down by me do. The signs which lead you to the knowledge of a Bone corrupted, are these. 1. If the Ulcer, having been skinned, breaks out again: for it is likely that the Bone casts out an ichorous substance, which is the cause of this recidivation. 2. If the Ulcer yield more and thinner Matter than the bigness of it requires. 3. If the brims of the Ulcer will not come in. 4. If the brims become reddish. 5. If the Bone, being presented to the Sight, appear rugged, and of a blackish colour, not smooth, or a ruddy white colour. XIX. Whatsoever Ulcers cast out much Sanies or ichorous Matter, which is too thin, of a leady, pale, or black colour; or glutinous, or stinking, and which frets the Skin adjacent, are hard to be cured, for this Humor keeps the Ulcer moist, and cannot easily be dryed, even if you apply powerful Topicks. XX. Inveterate Ulcers which cast out a Quittour called by the Greclans [...] like unto white Oil, are hardly cured; for this signifies a colliquation of the part, and an extenuation of the rest of the body.
CHAP. V.
Of the general Cure of Ʋlcers, and their Times.
THE Universal Cure of Ulcers is comprised in this one Proposition: All Ʋlcers ever desire desiccation, So Hippoc. in princ. lib. de Ʋlcer. & Galen. lib. 3. Method. c. 3. for whether we go about to ingender Flesh, or to seal up an Ulcer by cicatrisation, desiccative Medicaments are still required.
There are four times to be observed in Ulcers.
I. Principium, The beginning; In it the Quittour is thin and waterish.
II. Augmentum, the proceeding; In it the Quittour flows more sparingly, and thicker.
III. Status, The consistence; In it there is no ichorous Matter but Pus, yet it appears somewhat thinner.
IV. Declinatio, When the Ulcer is on the mending hand; then laudable Pus shews it self. It is white, being altered by the natural temperature of the Veins, Arteries Nerves and Membranes, whose substance is white. Secondly, It is uniform, not grumous, or cruddy, natural heat working equally upon every part of it. Thirdly, It is without all ill smell, seeing the natural heat has corrected all the evil qualities of it.
The Cure of Ulcers is performed by two means; The First, is the removing of the Causes antecedent. The Second, is the artificial dressing of them.
The Causes antecedent are four, Cacochymia, Contagium, Venenum, and the distemperature of the part.
The ill habit of the Body is to be removed by alteration and evacuation, if an Humor abound.
Contagion is to be overcome by Alexipharmaca.
Poison is to be contemperate by Antidota.
The distemperature of the part is to be removed by things contrary unto it. And that we may the more easily attain to these scopes, a convenient order of Diet must ever be prescribed.
The cause conjunct, which is the eroding Humor, that is setled in the part, is surprised by such Medicaments, as suit the four times of an Ulcer before-mentioned.
In the beginning then Suppuratives or Digestives are to be applyed. First, because the Matter which has left the Vessels, and has insinuated it self within the porosities, putrefies: wherefore it [Page 81]ought to be concocted, that it may become laudable Quittour.
Secondly, good Flesh cannot be procured by sarcotical Medicaments, unless the Matter be concocted; For so the Ulcer is made apt to admit the Generation of Flesh. These Suppuratives ought in the first qualities to be proportionate to the temperature of the part to which they are to be applied; so to parts hot in the First or Second Degree, Suppuratives hot in the same degrees are to be applied: for if they exceed, they are so far from strengthening the natural heat, that they rather pervert it, making it Aguish and unnatural: if the part be temperate, let temperate Suppuratives be applied.
But Digestives ought not to be applyed, First, to putrid Ulcers: for seeing Suppuratives are hot and moist, if they should be applyed, they would cause the greater putrefaction.
Secondly, they are not fit for Rheumatick Ulcers; for such Medicaments relax the part, and make it more subject to receive the Matter that flows, and so a Tumor might be caused. And since Suppuratives are to be applied to the parts ulcerate, because the Humor, which is hot and sharp, would inflame the part, if it were not suppurated and cleansed: So repelling Topicks are to be applyed to the parts about the Ulcer, to repell the Matter which flows.
1. That the heat of the Suppurative Medicament draw nothing from the parts adjacent.
2. To strengthen the parts, that they may resist Fluxion.
3. Because by the repelling of the Humor, the desiccation of the Ulcer is furthered.
4. Because the heat of the part ulcerate is intended and strengthened, it being kept in by the coldness of repelling Medicaments.
And for as much as I affirm, that Ulcers always require desiccation, it is not amiss to mix with Suppuratives some driers; yet, that in the beginning the Suppuratives have the upper hand, but in the end the Desiccatives.
After that the Ulcer is well digested, and yields laudable Quittour, Mundificatives are to be applied: for if you apply sarcotical Medicaments, before the Ulcer is well digested, spongy and naughty Flesh will grow, which will admit of no cicatrization. In mundifying we must not use too sharp Medicaments, for these may cause an unskilful Physician or Chirurgeon to believe that it is a corrosive Ulcer. The pain which the Patient feels in the part ulcerate will bewray this error. These three scopes being compassed to overcome the Cause conjunct, nothing remains but to seal up the Cure by Cicatrization.
Seeing most ordinary Ulcers proceed from Fluxion, it is to be withstood, First, by Revulsion. Secondly, by Repulsion. In Revulsion, wherein the Matter is drawn to parts far distant, the rectitude of the part and vessels is to be observed. So if the Ulcer be in the Right Leg, Revulsion is to be procured in the Right Arm, if you respect the rectitude of the part; but if you consider the rectitude of the vessels, Revulsion is [Page 82]to be used in the Left Leg, if the Ulcer be in the Right: for so the communion of vessels is kept.
Revulsion is performed by attractives, and these are three; Heat, Pain, and the shunning of Vacuity. Hot things which procure Attraction, are hot Inunctions, and Baths: strait Ligatures cause pain; but both pain and heat are caused by Ventoses, and Vesicatories. Fontanels attract by reason of the shunning of Vacuity; for they sending out still some substance, some other must be drawn to fill up the place of that.
Repulsion, wherein the Humor is staied in its passage, is performed by applying those Medicaments which commonly are called Defensives: these Medicaments are astringent and cold, and rather dry than moist in Ulcers. Now that you may know whether you proceed according to Art in the curing of Ulcers, receive this Aphotism: When Medicaments applyed to Ʋlcers do good, or at least hurt not, it is a sign that they are convenient; but if they do harm, by making the Ʋlcer hotter or colder, dryer or moister than is fit, then you may gather that such are to be changed, and their contraries applyed.
To conclude this Point, nine things make Ulcers hard to be cured.
1. The defection of good Blood in Bodies extenuate.
2. The impurity of Blood in Cacochymical persons.
3. The filthiness of the Ulcer.
4. Soft and cadaverous Flesh about the Ulcer.
5. The malignity of the Humor.
6. The hardness of the brims of the Ulcer.
7. A secret cause in the Air of some places, it being hot and moist.
8. When the Bone is corrupted.
9. The application of unfit Medicaments.
CHAP. VI.
Of Medicaments befitting Ʋlcers in general, and First of repelling Medicaments.
IT is not unknown how many sawcy and malepert Empericks there are in London, who basely and irreverently speak of those who are skilful indeed, and deserve well of the Art of Chirurgery, (purchasing unto it credit, and to their own selves profit and renown, by their methodical and successful practice) and so impudently boast of their Secrets, and exalt themselves as if they had no Forehead. That you may be the more able, not only to encounter with these consident Cowards; but to overthrow them also, I will endeavour, according to that talent of Skill which I have, to furnish you with competent, both Theorie and Practice. It is a shame for a Chirurgeon not to be furnished with admirable variety of Medicaments; seeing Nature hath been so provident for him. Turn your Eyes whither you will, and behold the fertility of Nature, and you shall see and find that in her Works she has not been unmindful of you. As for Plants, you have Dioscorides and Galen, yea all who have written of them, witnesses; that the greatest part of them have fallen to your share. As for the things which lye hid in the bowels of the Earth, as Metals, Spirits, Marcasites, do they not serve your turn? The Metals for your instruments, the rest for your Medicaments. Let no Man think then, that a skilful and industrious Chirurgeon can by his Art, perform no other Cures, but such as may be compassed by the compositions in his Salvatory. These he must have in readiness, other Medicaments he is able to fetch out of the Treasure of Nature, which he has at his Command. This I will make good by setting down only those Medicaments, which are known to belong to the cure of Ulcers. Of these there are two Orders or Ranks: for some serve for ordinary Ulcers, some for those which have a Malignity annexed. Those that serve for ordinary Ulcers, are of five sorts, for some are Repelling, some Digesting, some Mundifying, some Incarnating, and some Cicatrizing, and the Medicaments which perform these Offices, are either simple or compound.
The Simples Repelling are these that follow.
Of these, some are of an Aqueous substance, as Water it self, [Page 84]Lettuce, all sorts of Succory, Knotgrass, Horse-tail, Periwinckle, Nightshade, Comfrey, Purslain, Navelwort, Housleek, these four yield not their Juyce easily; wherefore they must be beaten in a Mortar, and some Verjuyce, Vinegar, or joyce of Quinces mingled with them. There be some Simples not so waterish as these are, as Plantain, Milfoil, Vine-Leaves, astringent Red Wine, Verjuyce, Vinegar, the fruit of the Berbery, the fruit of the Quicken-beam, Sloes, Myrtle-berries, Pomegranate-rinds and Flowers infused in Red Wine, which is astringent, Tanners Woose, which will be more effectual, if these Simples together with Red-Rose Leaves dried, be boiled a little in it; but the Woose must be taken when it is newly made, and before any Leather be put in it. The Leaves and Apples of the Mandrake, the Henbane, the Leaves of Stramonea, black Poppy, and deadly Nightshade are more cooling than the former; but they must be left before the part become livid, or of a Leady colour. If you use the Juyces or Decoctions of the aforesaid Simples, which you shall be enforced to do, if the cure of Ulcers and Wounds be presented unto you, being in the Countrey, where no Apothecary is, by whom you can be furnished with Medicaments which are fit to repel, then you must apply to the parts adjacent to the Ulcer, Pledgets of Wooll or Tow moistned in them; then above these Stupes of linnen or woollen Cloaths, according to the temperature of the Party, and the season of the year, moistned in the same and wrung, are to be applied.
Last of all, the part ulcerate is handsomly to be rowled, the Rowler having been moistned in these Juyces or Decoctions. One thing is to be noted, that it is the best course still to mingle some Astringents with those which have a waterish juice: for as these cool best, and repress the Fluxion and Inflammation; so these by wrinkling of the Skin repel more effectually. As you rowl up Fractures, so must you rowl Parts Ulcerate. Of this kind of rowling I will speak in its proper place.
The compound Medicaments that repel are these.
1. Oyls, as the Oyl of Roses made of green Oyl, the juice of unripe Grapes, and the juice of Red Roses, boiled together over a simpering fire, until the juices are consumed. Last of all, infuse some Roses picked in the Oyl; the Oyl of Myrtles, the Oyl of Quinces, the Oyl of Mastick, the Oyl of Henbane, Poppy, and Mandrake. Sallet Oyl, whereof these compound Oyls are made, must not be old or rank. If an Inflammation hath possessed the parts adjacent, use not Oyls; for they are easily set on fire.
2. Cataplasms, made of the aforesaid juices, and Barley-flour, with some of the forenamed Oyls, or Bole, Terra sigillata, or Amber tempered with some of the forenamed Oyls, and Whites of Eggs beaten, Vinegar or Verjuice.
3. Unguents, as Tripharmacon; Ʋnguentum album, Camphoratum either of it self, or mingled with Ʋnguentum populeum.
4. Emplasters, as Emplastrum de Minio, the Sope-Plaster, Diapalma made with the juices of Plantane, Horse-tail, Knot-grass, Yarrow, Comfrey, and Perywinckle. When you make your Diacalciteos, reserve one part for the Juices, which must be added by little and little, as you bring your Emplaster to a consistence. This Medicament is second to none.
Of Suppuratives or Digestives.
Being furnished with Medicaments repelling, which are to be applied to the parts adjacent to the Ulcer, to hinder Fluxion, you are to look for Medicaments which are to be applied to the Ulcer it self: Amongst them Suppuratives offer themselves first; Those as the former, are either simple or compound.
The Simples are these, which are to be temperately warm and moist.
The Flour of Wheat and Barley, Swines-grease, sweet Butter, Capons-grease, Calves-tallow, rape Oyl, Black Rosin, the juice of the Flowers of White Lilies, the pulp of Figs and Raisms, the mucilage of Marsh-mallow, Fenugreek, and Linseed. These are convenient, if any hardness or callosity be in the Ulcer, Saffron, Bird-lime, Pitch, Storax, Galbanum, Gummi Elemi, the Burr-Dock, Mell [...]ot, the Flower-de-luce, new Wax.
Of Compounds.
Tetrapharmacum of the Ancients, which is made of Pitch, Rosin, Wax, and any of the forenamed Fats: Dialthaea simplex, Basilicum majus & minus, Ʋnguentum aureum: if a little Mercurie precipitate washed in Plantain, and Rose-water, be mingled with these Unguents, as a Scruple with an Ounce, they will be the more effectual: for the precipitate doth excellently thicken and digest any ichorous Matter. Above these, applied unto the Ulcers, either upon Lint or Tow, lay Emplastrum diachylon simplex in the Summer, and cum gummi in the Winter, if the brims of the Ulcers be hard: otherwise use your Diapalma cum succis; for there is no Emplaster comparable to this.
Of the fore-named Simples, as your Flowers, or Meals, Pulps, Mucilages, and Juices, you may frame unto your selves sundry Suppuratives, according to the temperature of the party, the condition of the Ulcer, and season of the year. Let this be an example; Take of the pulp of Figs and Raisins, of each an Ounce, of the Mucilage of Marsh-mallow, Linseed, and Fenugreek, of each two drams; of the juice of the Flowrs of white Lily, two drams and a half; of Barleymeal, three drams; of Saffron beat to powder, half a Scruple; make up a Medicament, This is powerful in callous Ulcers.
Of Mundificatives.
When the Ulcer is well digested, which you may conjecture, if the Quittour be somewhat laudable, if the brims of the Ulcer be soft and well coloured; and Lastly, if you find no ill damp to rise [Page 86]from the Ulcer; then you are to address your selves to the application of Mundificatives; for if you use sarcotick or incarnative Medicaments before Mundification, only loose Flesh will arise, which will admit of no cicatrization.
The Simples that Mundify are these.
Aristolochia or Birthwort, whereof there be two sorts, the long and the round; Hore-hound, Smallage, Vitriol calcined to redness, Verdigrease, Orpiment, Arsenick natural and sublimed, Mercury sublimate, and precipitate; the yellow Turbith, if you use it before it be washed, it is as powerful as Arsenick, or Mercury sublimate, but much more safe; for it dispatches its operation sooner, causes not so great Inflammation, and is more familiar to the body of Man. Honey also mundifies, Savin, Cockle-shels burned, Alume burned or calcined, the flour of Vetches. All Vegetables calcined mundify, by reason of the Salt in the Ashes, but some more powerfully than others, as the Ashes of Tobacco, Vine-stalks, and the stalks of Beans: joyn to these the juyce of Celandine, the root of Arum, Wormwood, Century the lesser, Carduus Benedictus, Beet, Colewort, Gentian, bitter Almonds, Scordium, the white and black Hellebore.
Compound mundifying Medicament.
L. 15. of Fabricius ab aqua pendente: ℞ Terebinth ʒ ij. syrup. ros. vel mel, ros. ℥ ss. succi apii ℥ i ss. farin hord. & lupin. aq. q. s. ut spissentur. That which is called Paracelsus Mundificative, is second to none: It receives these things; Take of Honey ℥ iiij. of Turpentine ij ℥. boil these with a very soft fire, until they come to the consistence of a soft Unguent; then take them from the fire, and mingle with it the yolk of an Egg; incorporate all well together. If a foul Ulcer be offered unto you, mingle with an Ounce of this Unguent, a dram of Mercury precipitate, washed with Plantain and Rose-water, and you shall find it to excel all other Mundificatives. In the Shops you have Ʋnguentum Aegyptiacum, and Apostolorum; Aegyptiacum is good to be injected into sinuous Ulcers, being mingled with White-wine, and Mel rosatum: Ʋnguentum Apostolorum is best for plain and superficial Ulcers, If you mingle with Basilicum and Aureum, precipitate mingled with Alume calcined, you shall have a Medicament which will both digest and mundify. Take of your precipitate two parts, and one of Alume, and grind them upon a Painters-stone, until they come to an impalpable Powder. From the enumeration of these Medicaments, you may gather of what qualities Mundificatives ought to be; They are drying without astriction, without any notable cold quality, or great heat; but of a subtle substance: by reason of the dryness they consume the humidity of the Ulcer: and by reason of their siccitie and tenuity, they take away the glutinousness of the Quittour. These must not pass the second degree of dryness: otherwise they [Page 87]would consume the Flesh it self. Extersion then is the removing of filth cleaving to the Ulcer, by drying of it, and abating the viscosity, by which it cleaves to the part.
Of Incarnatives.
When the Ulcer is sufficiently mundified, which you shall learn of Celsus lib. 5. c. 20. If the Ulcer appear red, sensible and clean, and neither too dry nor too moist, then it is sufficiently mundified: but on the contrary, if it appear pale or whitish, or of a livid or black colour, and want sense, and be either too moist or too dry, then it is not cleansed sufficiently. These signs may be seen in a plain and open Ulcer.
But you may ask, how shall we know when a sinuous Ulcer is sufficiently mundified?
Galen will tell you, l. 4. [...]. cap. 2. That you shall conjecture a hollow Ulcer to be clean, when the part begins to be more sensible of the Mundificatives than it was before.
When these signs of sufficient Mundification appear, then you must go about incarnating of the Ulcer. And although Incarnation be the effect of Nature principally, that is, of the temperature of the part, from whence the faculty of the part, the cause of all the ordinate actions of the part doth flow: yet it is requisite that the Physician and Chirurgeon should help Nature now, being weakned by the grief, by removing the Impediments and Lets which hinder the natural constitution of the part. Nature when she is in her vigor, cannot totally convert the Aliment into the substance of the solid parts, but after she has had a care of the preservation of them, hath a task to expel both a waterish or thin, and a thick Excrement by the pores of the Skin to the outward superficies of it, (as is manifest in the Morphew,) when she is disabled by a Solution of Unity; much less can she effect her purpose, whereof the thin Excrement a humid Ulcer is procured; but of the thick a sordid. Wherefore if you will go about to cure an Ulcer, you must labor to dry the humid Ulcers by desiccatives, and the sordid by Mundificatives; and because in all Solution of Unity Nature is ever vigilant and busie, and in Ulcers to regenerate flesh, in perfecting of which work these two Excrements must be separated; it is manifest that there cannot be one moment designed in the curing of Ulcers, where drying and mundifying Medicaments are not required. Now Medicaments indued with these two qualitles of desiccation and mundification in a temperate degree, are called sarcotical or incarnative Medicaments.
The Simples are these.
S. Johns-wort, Clown's-panax, Milfoil, Knot-grass, Hors-tail, the garden and mountain Avens, our Ladies mantle, Sanicle, Salemens-seal, fresh Galls, Barley-flour, Mastich, Myrrhe, Aristolochia rotunda, Harts horn calcined, Bones calcined, Sarcocol, Rosin, Pitch, Gummi Elemi, Butter, Turpentine, [Page 88]Swines-grease, Sheep's, Goat's, and Deer's-shet, sweet Tallow, Olibanum, Frankincense, the powder of Snakes and Adders: these most effectually. Green Tobacco.
The Compound are these.
And amongst the first of these, suffer me to commend unto you this of mine: Take of Swinesgrease eight ounces, and Rosin ℥ iij. of Wax, and Gummi Elemi, of each one ounce, of the juice of the aforesaid Vulneraries one pound, of the Leaves of Tobacco stamped two handfuls: boil all these over a soft fire until the juices be consumed, then strain the Unguent. Make trial of this, and leave it when you have found out a better. You have in the Shops Ʋnguentum Basilicum majus & minus, and Aureum set out with glorious Titles. But I will shew you anon, how these cannot fit all Bodies. Ʋnguentum de tutia is in much use. You may use these Compositions if you will, or you may frame unto your selves, of Sarcotical Simples, such Compositions as you shall think most fit for your purpose.
But let me warn you, that your Incarnatives must not exceed the first Degree in drying; yet seeing there is a Latitude in this Degree, for some are mild, some more harsh; you are to apply them according to the constitution of the party, temperature of the Part, and the quality and quantity of the Ulcer it self. So if the party be of a tender and soft constitution milder driers are required to ingender soft flesh: but if a party b [...] offered to you to be cured who hath a firm and dry flesh, more strong desiccatives are to be applied. If the Ulcer be in a place not so fleshy, as in the Joynts, the beginning or tail of the Muscles, then your desiccatives must be forcible. Last of all, if the Ulcer be large and moist, more strong desiccatives are to be used in it, than in small and not very moist Ulcers.
When you go about your Compositions of Incarnatives for Ulcers, observe these Rules: The first is, That they be neither too soft, nor too hard, for if they be too hard, the weak part cannot easily take benefit of them; if they be too liquid, the heat of the part will cause them to spread, and fall from the Ulcer; besides, these are apt to ingender spongy flesh.
The second is, that they be smooth, and equal: otherwise they will cause pain in the part.
Of skinning Medicaments.
The Ulcer being filled with good and laudable flesh, now are you to skin the part ulcerate. Nature in the Womb doth frame first the Skin, but it being afterward lost by any accident, she cannot repair it any more, lacking seminal Matter: wherefore here, there is need of the help of Art to supply this defect. This is done by hardning and thickning the upper part of the flesh regenerate, until it be able to supply the office of the Skin.
The Epulotical Medicaments which bring this to pass, must be,
1. Cooling, for so the thin parts are wring out, and the thick parts are brought together, as we may see in Ice.
2. They must be drying; for these consume the thin parts; so the hands of Sailers, and Feltmakers, become dry and hard. Then a Cicatrix is nothing else, but flesh thickned, dried and made callous.
These Medicaments ought to be drying in the third Degree: for Incarnatives are dry in the first Degree, because they only are to dry the Excrements, which are superfluous in the generation of Flesh. Glutinative Medicaments are dry in the second Degree: for they are not only to dry the Excrements, but whatsoever else flows to the part, although it be alimentary. But cicatrizing Medicaments are dry in the third Degree: for these are to dry not only Excrements, and what flows from other parts, but the natural humidity of the part it self also. But Catheretical or Corrosive Medicaments are drying in the fourth Degree; for these consume not only the Excrements, and that which flows to the part, and the natural humidity of the Superficies of the part, but the flesh subjacent also. These Epulotical Medicaments are in like manner simple or compound.
The Simple are these.
Aes ustum, Lead made to Powder, the Amalgama of Lead and Quick-silver beat to Powder. When you would make this, melt two ounces of Lead in a Crucible, then take it from the Fire, and put to it an ounce and a half of Mercury; these will incorporate together; when the Mass is cold, you may beat it to a Powder. The Pumice-stone and Cuttle-bones calcined, Stags-horn calcined white, all bones well calcined, the Head of Vitriol after the Spirit is drawn, well washed and dried; it is called by the Chymists Henricus Rubeus, and indeed it is a potent desiccative. Chalk powdered is good; to drive it into Powder, you must rub it upon a broad Tile somewhat fine, and then scarce it; otherwise you shall hardly do it. Terra sigillata, Bole-Armenick, Umber, are good; and unslaked Lime, well washed and dried, Alabaster beat to powder, Minium, Litharge, Cerusse, Calaminaris, Tutia, Regulus of Antimony, Crocus Martis, Galls, Pomegranate-flowers and Rinds, Comfrey Roots, Sandarach of the Grecians, Egg-shells calcined, the Roots of Tormentil and Bistort, Swine's-grease, Dear's and Sheep's-suet.
Skinning compound Medicaments.
Sundry very effectual Medicaments may be made of the aforesaid Simples; wherewith I mean not to burden you, only I will commend you unto one of Fallopius, and another of my own. That of Fallopius is thus described, ℞ Ol. Ros. & Ol. Omphacin. an. ℥ vj. Ol. Myrtin. & Ʋnguent. popul. an. ℥ iij. fol. Plantag. & Solan. Hortens. incis. an. man. j. Bulliant ista ad consumpt. succorum, ac colentur: [Page 90]colaturae adde cerae ℥ jv. Spatha lignea misceantur: Quum incipiunt frigere, adde litharg. auri vel argenti ℥ vj. Cerussae, tutiae praeparat. ʒ ij. Plumbi calcinati ℥ i ss. Ducantur ista in Mortario plumbeo per hor. 2. The ingredients do shew what is to be thought of this Medicament. That which I use is this, ℞ Sevi Ovilli lib. ss. Axung. Porc. ℥ iij. Cerae, Vernicis, Colophon. an. ℥ ij. liquescant ista simul. Amotis ab igne ac coeuntibus, adde litharg. auri, aeris usti, tutiae praeparat. Henrici rub. an. ℥ss, Calaminaris ℥ j. Fiat ceratum ex l. a. You have in the Shops Diapalma, Emplastrum de minio, Ʋnguentum comitissae, Desiccativum rubrum, & Emplastrum contra rupturam Fernelii. Now seeing amongst these, some do more weakly, some more strongly dry, the gentlest are to be applied to tender and moist Bodies, but the strongest to solid and hard Bodies: wherefore neither are mild Skinners to be applied to the Bodies of Clowns and Artificers; nor strong to the Bodies of Children, and dainty Women: to these use Emplastrum album coctum. Before I conclude this Point, two things are to be set down: the first is when these Epulotical means are to be applied. Secondly, how they are to be applied.
As for the first, they are to be applied before the Flesh be even with the Skin, according to Galen. 13. method. c. 5. otherwise the Cicatrix will be higher than the natural Skin, which will cause deformity: wherefore they are to be applied while there is some cavity.
As for the second, seeing always in skinning there is lest a greater cavity in the middle, than about the brims of the Ulcer, stronger desiccatives are to be applied to the brims; but milder to the middle, that the Flesh be not too soon dried. Wherefore Powders and Cerots are to be applied to the brims, but only Cerots or Unguents to the middle. When you have cicatrized an Ulcer by Methodical proceeding, there be some persons who will not rest so contented; as Ladies (who make much of their Skins) and Whores (who gain much by theirs) but will desire to have the Cicatrix made by any means somewhat beautiful to the Eye. I will furnish you with two Medicaments, that you may be the more enabled to fulfil their desires.
The first is this, ℞ Ʋnguent, Rosat. Mesuis ℥ j. Ol. de Been. ʒ ij. Talci Pulv. ʒ iij. Fiat linimentum.
The second make thus, ℞ Axung. Porc. aquae florum fabar. lotae ℥ j. Spermatis Ceti, ʒ ij. Ol. Amygdal. dulc. ʒ i ss. Talci praeparati. ʒ ij. Fiat linimentum.
Every night a little before bedtime anoint the Cicatrix with some of either of these liniments, and apply a soft linen rag moistned with the same.
CHAP. VII.
Of the cure of a plain and hollow Ʋlcer, being Simple.
HAving passed thorow the ten Points whereof I intended to write, before I was to meddle with the Cure of any particular Ulcer; now it is time to set down the Method of Cure of Ulcers in particular. I would have you to call to remembrance the material differences of Ulcers delivered by me in the third Chapter, which were taken either from the Nature and Constitution of an Ulcer, or from the parts affected: from the Nature of the Ulcer I deduced two forts of them; some I called Simple, some Compound. Now the Simple Ulcer is to be accounted such an one, as hath neither a Disease, Cause, or Symptom annexed to it, or complicate, besides the Solution of Unity caused by Erosion. Of these simple Ulcers there are two kinds; for some are plain and equal to the natural Skin, wherein only the Cuticula and Cutis are lost. Some are hollow, cava, wherein, besides the Cuticula and the Cutis, a part of the Flesh is lost. It is not needful severally to set down the Cure of Ʋlcus planum, or aequale, a plain, or even Ulcer; because in prosecuting the Indications of cure of Ʋlcus cavum, a hollow Ulcer, I must set down the means of curing a plain one: for this is contained as a part in the other.
Seeing then there are two affections in a hollow Ulcer, to wit, Solution of Unity and Cavity; three scopes of Cure offer themselves, Unition, Incarnation, and Clcatrization. Wherefore if the Quittour be white, smooth, small in quantity, reasonable thick, and not evil smelling: If besides the Ulcer it self be red, and sensible, then we may go about to ingender Flesh, by applying Sarcotical Medicaments. But on the contrary, if the Pus be black, uneven, grumous, rough and stinking, and if the Ulcer it self be not red and sensible, the Ulcer cannot be incarnate, before it be prepared by Suppuratives and Mundificatives. Besides Pus, which is reasonable thick, three sorts of Excrements appear in Ulcers.
The first is thin, and waterish, like to Water wherein Flesh has been washed: this has received no alteration, but has flowed pure, as it is in the Veins and Flesh; and is [Page 92]called Ichor. The second is thin too, but it has received some alteration by the temperature of the part; this is called Sanies or Virus. The third is very thick and glutinous, and is called Sordes.
Now the Excrements which are thin, moisten the part ulcerate, that it cannot sufficiently discharge it self by breathing out the humidity. Wherefore Desiccatives are to be used, to consume this superfluous moisture: but the Excrements which are thick cleave to the part, and hinder the addition of Flesh. These are obviated by Abstersives or Mundificatives. The Ulcer being prepared by Suppuratives and Mundificatives, you are to ingender Flesh by incarnating Medicaments. There are two Causes of this Flesh, which is to be procured. 1. Is the efficient Cause: This is Nature it self, not only of the whole Body, but of the part it self also, which is called Temperies, the natural Temperature or Constitution of it: whereby it attracts, concocts, applies and assimilates the nourishment to it self. 2. Is the material Cause: this is sincere and pure Blood. If the part ulcerate enjoy such, then nothing remains but to maintain it: If the Blood be not pure, then it is to be altered; if it be too hot, it is to be cooled; if too cold, it is to be warmed; if it be too thin, it is to be thickned; if it be too thick, it is to be attenuated; if there be too great plenty of it, it is to be diminished; if it be too little, then it is to be increased by convenient order of Dyet.
To come nearer to the Cure of of a simple Ulcer: First, we must discreetly order those things which are called not natural: seeing a convenient Dyet preserves and maintains the good Constitution of the whole Body, and temperature of the part. Wherefore all those Meats and Drinks that make the Blood too hot, too sharp, too thin, or too thick, are to be shunned; and those only to be permitted, which afford good Juice, and are of easie concoction, especially if the diseased party be tender and weak. Besides this, they must be taken moderately, and at convenient times. The part it self must be kept quiet; for motion heats the part. Care also is to be had of sleeping and watching: for as watching dries the Body, and consumes superfluous humidity, so sleeping moistens the parts; but those chiefly which are nervous or sinewy, as Membranes, Tendons and Ligaments. If then the Ulcer be humid, enjoyn watching; if it be dry, command sleeping. As concerning vacuation of the Excrements, let it be appointed, that they may answer in quantity the Food which the diseased party takes. If he proves costive, either minister unto him a Clyster, or give him an ounce of Electuarium lenitivum in Chicken Broth. As perturbations of the Mind change the state of the whole Body, so the tranquillity of it maintains the same. A special care is to be had of the Air; for it wonderfully preserves the temperature of the part. Southerly and Northerly winds are not fit for Ulcers: for as the first moistens and heats, so the second doth much cool and dry: but cold is an Enemy to Ulcers. So it is observed [Page 93]that the Air in Angien is hurtful to Ulcers in the Legs, but in Paris good. So in Pisa and Ferrara it is hurtful; but in Florence wholesome.
As for the Prognosticks of the simple Ulcers: If I should set down any, you might justly think I did abuse the time; for there is none so simple, who may not gather out of the very denomination of them, that they are most easie to be cured, and that great skill is not required to compass the same: only let me give you warning that the Cure may be either more easie or hard, according to the Nature of the part ulcerate, and the Dyet of the Patient. So simple Ulcers are more easily cured in a fleshy part, than in a Joynt or a Nervous part; for in these stronger Desiccatives are required, and in them the natural Heat is not so powerful to make use of the Medicaments applied. In like manner a simple Ulcer is more easily cured in the Body of a temperate person, than it is in the Body of one given to debauchery. Having set down the right use of the things not natural, as Dyet, Sleeping and Watching, evacuation of the Excrements, the perturbations of the Mind and Air; I shall set down some local Medicaments for the accomplishing of the Cure of these Ulcers, according to the general Indications of Cure, set down in the fifth Chapter.
As for the Digesting, Mundifying, and Incarnating of a simple Ulcer, if it be hollow, these Intentions and Scopes shall be performed by the Application of my Basilicum; The description of it is this; ℞ Cerae & Resin. an. ℥ vj. Picis Navalis ℥ iv. Gummi Elemi ℥ ij. Ol. Olivar. ℥v ss. Vernicis clarae ℥ iv. Sevi Ovil. ℥ ij. Terebinth. ℥ ij ss. Olib. Myrrh. pulv. an. ℥ j. fiat Ʋnguentum ex l. a. If you make trial of this, you shall find it not a little better than the ordinary two, bearing this name, to wit, Basilicum magnum and parvum. If an hollow simple Ulcer prove sordid, mingle with an ounce of this my Basilicum, two scruples of the Catheretical Powder made of Precipitate and Alume calcined; or if you apply Paracelsus his Mundificative tempered with the same, you shall haply Mundifie it; but if a plain or equal Ulcer be unclean, yellow Turbith or Precipitate washed, besprinkled, and covered with a Pledget of Lint will serve. Above these Medicaments apply Diapalma cum Succis, and above this a double cloth moistned in red astringent Wine, having some Alume dissolved in it. If you be in the Country, apply to the parts adjacent to the Ulcer, Clouts moistned in the Juyces of cooling and astringent Herbs, as Plantain, Garden-Night-shade, Knot-grass, Purselain: if you anoint the parts with Tripharmacum, and Ʋnguentum populeum mingled together, you shall prevent Fluxion and Inflammation.
When you have fill'd an hollow simple Ulcer with flesh, nothing remains but to cover it. Now the cover of the Flesh is the Skin it self: and as the Flesh lost is to be repaired, so is that which covers it. But seeing the Skin is framed in the Womb of a seminal Matter, it, being lost, cannot be restored, by reason of the defect of Matter: Wherefore we must find out another cover. This cover is called by Artists [Page 94] Cicatrix. This is nothing else but the uppermost Supersicies of the Flesh so dried, that it represents the Skin. And as in ingendring of good Flesh in an Ulcer laudable Blood was the material Cause of it, so good Flesh is the material Cause of the Cicatrix.
This Cicatrix is procured by three means; by Nature it self, the Air, and epulotical Medicaments. That Nature has an hand in this Business it doth appear many ways: for we may see daily Ulcers skinned with these same Medicaments by Empirlcks, which they used in incarnating, so that Nature must be the chief efficient Cause. Secondly, many times a Scab covers such Ulcers being incarnate, which being removed, or falling away of it self, the place appears skinned. Only Nature is the cause of this; for no Medicament was applied. Thirdly, if Nature had not a hand in this Business, such an order would not be observed, that the brims of the Ulcer should first be skinned, and then the middle. Fourthly, Nature works in her actions to the period appointed: so in an Ulcer she not being hindred fills the Ulcer with Flesh, even unto the uppermost Superficies; which being done, she ceases from affording any more Matter of Flesh; whereby it comes to pass, that the upper Superficies, being deprived of further nourishment, must become dry.
What power the Air has, doth manifestly appear in the Bodies of Infants newly born; their whole Skin is soft and red; the cold Air afterward repels the Bloood, dried the Skin, and makes it more hard.
But seeing Nature very often in such an action proves slow, so that if you would wholly rely upon her, and expect her leasure, you should seem of purpose to protract time, and be in danger to lose your Patient, it is the safest and best course to aid Nature by assisting her with convenient and good epulotical or skinning Medicaments. In the Monuments both of Ancient and Modern Writers one shall find great variety, whereof notwithstanding a discreet and judicious choice must be had, if he mean to make good use of them; for I dare be bold to affirm, that there are almost infinite descriptions of Medicaments, whereof the first describers never made any trial, but set them down, being induced only by imagination. And amongst these Medicaments, you shall find not a small number, which are either ridiculous, or superstitious, or both. Seeing then the case stands thus, I will only commend unto you three Medicaments fit for skinning of simple Ulcers: The first is, Diapalma cum Succis. The second my Epuloticum, which I described in the former Chapter. The third shall be Heurnius his Sparadrap. The description of it, is this, taken out of his Method of Practice, Lib. 1. pag. 81. of the Leyden Edition. ℞ Ol. Omphacin. & Axung. Porcin. an ℥ iij. Lythargrr. Auri vel Argent. ℥ iv. Cerussae ℥ j. Coq. ista lento igne ad Emplastri consistentiam: tum adds Cerae, Picis, an. ℥ i ss. Colophon. ℥ ij. [Page 95] Plumbi Pulverizati ℥ i ss. Fiat Emplast. sec. art. Sparadraps made of this help not only simple Ulcers, but parts of the Body excoriate by reason of long lying in bed, caused of weakness brought by Chronical Diseases.
CHAP. VIII.
Of compound, but milder Ʋlcers, in General.
IN the former Chapter, I set down what did belong to the Cure of simple Ulcers, as well plain as hollow, wherein no other offence besides the loss of the Skin and Flesh is found. Hereafter I am in like manner to write of compound Ulcers, wherein besides Soution of Unity, caused by Erosion, there is somewhat else that hinders the consolidation of the ulterated part.
These compound Ulcers are either of the milder sort, or else Malign. Those of the milder sort, have annexed either a Disease, or a Cause, or Symptoms, which hinder the Chirurgeon from going about Unition of the part ulcerate. Sundry Diseases in the Body of Man may keep Ulcers from healing: some corrupting the Humors, as the Leprosie and Pox: I mean the French; some hindering of laudable Blood in sufficient quantity to be sent, as Phthisis, and a Hectick Fever: some by sending too much waterish Humidity with Blood hinder the Unition of the part ulterated. If Ulcers in such persons be presented to you to be cured, you are seriously to ponder in your mind, how hard a task is put upon you, if any of the former Diseases be complicate with the Ulcers, if you only except the French-pox in a reasonable strong Body. But if the Body of one troubled with the French-pox be extenuate much, then permit the Cure of him also amongst the rest, to the charge of such as are only [...], or Citizens of the World, having no permanent habitation; and resting contented at the first with half the bargain made for the Cure, willingly (tho not honestly) commit the second payment to the arbitration of Fortune. They during their life time, continuing scandals to Art and Artists, it is strange, if at the hour of their Death, their Consciences for the present seared, grow not tender, and fearfully accuse them. Seeing the practice of Physick and Chirurgery are severed in England, I hold it to be the safest course for you to leave the Cure of Diseases to learned Physicians, and to assume only to your [Page 96]selves the methodical dressing of Ulcers: for so the whole discredit, (if any redound) will fall to the Physicians share, who cured not the grief, the only hindrance of the cure of the Ulcer. This is my advice, If an Ulcer complicate with a dangerous Disease, come at any time to your handling: (It is not your desire, I know, that I should set down the manner of Cure of any inward disease: for then I should be be busie with my Sicle in the harvest of other Men) that then in this case you have recourse unto some Author who hath written most Learnedly of the manner of curing that Disease which is annexed to the Ulcer, and follow his Indications in dealing with the Disease, if you have not the opportunity of a Physician, whose advice you may follow.
In the cure of the French Pox, if you intend to use the Unction, be directed by Ambrose Parry, Mr. Clowes, or Mr. Wijeman. If you resolve to insist in the cleanly way of curing this Disease by Diet, then follow renowned Fallopius or Capivaccius. There is a Volume in Folio, wherein are contained the Monuments of such as have written of this Disease, according to the Talent of skill granted unto them: I rather would have you acquainted with these, than to range much, and imitate the Swallow, which flies much, but preys only upon flies.
As concerning the Dropsy, the Cough of the Lungs, the Hectick Fever, or Marasmus, and the extenuation of the Body: if these being complicate with an Ulcer, hinder the cure of it, have recourse to the Learned Works of that famous modern Writer Daniel Sennertus, the late Professor of Physick in Wittenberg, who hath couched in his Learned Books, what almost can be spoken, either by Galenists or Chymists, concerning these and other diseases. The Plagiary Bar [...] in his method of Physick, and Bruel are but like unto rotten Reeds, appointed for the ruine of impotent, and lame persons, if they rely upon them.
From a disease joyned to an Ulcer, I will descend to the causes hindring the cure of an Ulcer. These are two: the Humors that slow, and the distemperature of the part.
As for the Humor, if it be in slowing, then you are to obviate it with ordering the things called not natural; as Air, Meat and Drink, Sleeping and Watching, Evacuation and such like, and by Purging of the Humor offending; whereof I spake sufficiently in the doctrine concerning Tumors. If it hath flowed to the part, and be impacted in it, then it is to be removed by three means; to wit, by drying, expressing, and removing of the causes of the Fluxion.
You shall dry the Hunior, if you use sarcotical Medicaments drying at the least in the third degree, as Bones calcined, Hartshorn calcined, and made up in Trochisces with Plantain, and Rosewater, Aes ustum, the Pumicestone calcined, Calaminaris, Borax, the powders of Tormentil, Bistort, Comfrey, and such like; whereof I have spoken sufficiently before; yet Nunquam satis dieitur qual nunquam sat is discitur, a thing remarkable [Page 97]can never be too much pointed at; so fluxible and gliding are the objects of our memory.
You shall express the Humors: First, by using such repelling Medicaments as I have often spoken of, which are to be applied to the parts adjacent to the Ulcers.
Secondly, by rowling the Ulcer, as Hippocrates prescribes in his Treatise of Fractures, that it begin about the Ulcer, using so many revolutions, or windings of the Rowler, as are fit, and ending in the sound part.
As for the causes of Fluxion, they are three; Transmission, Attraction, and the furious motion of the Humor it self. A part sends, either moved by the superfluity of the Humor, or urged by an offending quality, or both. If the Humor offend in quantity abounding, then it is to be abated by Phlebotomy, Purging, slender Diet, and such means as have been delivered by me in the Treatise of Tumors, to lessen plenitude, or Pletbora, the signs whereof I delivered there also, so that I need not to repeat them here. If the Humor offend in quality, urging and pricking the part to the expulsion of it, as the Liver, which being tainted with the French Pox, sends the Humor to the Groins, Yard, Matrix, the Fundament and Throat. When we have observed and noted the quality and nature of the Humor, then we are to go about the expulsion, or alteration of it, or both.
If the Humor offend both in quantity and quality, then are we to use both purging and altering. Now to find out the Humors in quality offending, seeing I have set down their Pathognomonical and proper signs, when I discoursed of every special Tumor, I will remit you to the places where they were set down. If Humors do flow by reason of the attraction of the part, it is procured either by the heat, or the pain of the part. If a Humor flow to the Ulcer, neither being sent from a part, nor received by a part, but because the Humor it self is eliquate, either by the vehement perturbations of the Mind, or an aguish Constitution, or the exhibition of an eradicative or strong Medicament: then the tranquillity of the Mind is to be procured, the aguish heat to be abated, and the exhibition of such Medicaments to be stayed. Having discoursed of the fluxion of Humors so much as is fit for our present purpose, now I am to touch briefly the other cause of mild, yet compound Ulcers, to wit, the distemperature of the part.
The single distemperatures are in number four, to wit, too dry, too moist, too hot, too cold. A dry distemperature is found out by these signs: the colour of the ulcerate part is ill-savoured, not lively, little or no Matter flows from it. in touching it seems hard and dry.
This distemperature is removed by two means: First, by drawing out the natural Humidity to the part affected, by opening the passages, which before by reason of immoderate dryness were drawn together. In this case Friction is excellent.
Secondly, dryness is removed by the application of humecting Medicaments. Two such are commended [Page 98]by the Ancients pure Spring-water, and Water and Oyl mingled together.
As for the use of Spring or Riverwater, it must be applied lukewarm, not very hot; for if it be very hot, it discusses; because the Humors having been attenuate by it, they are turned into vapours, and so resolved: but if it be temperately hot, and the part fomented by it, it moistens.
The Second Medicament composed of Water and Oyl, by the Ancients is called [...]. The ulcerate part immoderately dry, is to be fomented with this Medicament warm: Take either two parts of Water and one of Oyl, or equal; warm them in a single Vial-glass, then shake them well together that they may be mingled, and apply the Medicament. This is a convement Topick in the winter; for though warm water warm the part during the time of Fomentation; yet after Fomentation it leaves the part cold, because it drew out the heat to the Superficies of the Body: wherefore Oyl is excellent, for it stops the Pores, and keeps in the heat. These two Medicaments are to be applyed to the ulcerate part by stupes, sponges, or pledgets.
One thing you are to look to, and to provide before fomentation, that the Body of the party, unto which they are to be applyed, be neither plethorick (for then too much moisture may he attracted) nor cacochymical (for then corrupt Humors may be drawn) both which will hinder the cure of the Ulcer. Use therefore first of all Phlebotomy, or Purgation, according as you shall see cause.
But you may not without cause ask, when Fomentation is to be left?
I answer, that two things shall declare unto you the period of Fomenting: the First is the substance of the part, the Second is the colour: wherefore when you see the part a little tumefied, soft and moist, and of a ruddy colour, defist from Fomentation; otherwise the Humor attracted will be discussed.
If a moist distemperature hath possessed the part, then the flesh of the part will be moist; spongy flesh will be apt to grow, and plenty of excrements will flow from the Ulcer: In this case strong Desiccatives, or Sarcoticks mingled with Basiticum aureum, or Arcaeus his Liniment are to be used: with an Ounce of any of these Unguents you may use one dram and a half of these Desiccatives: such are the Regulus of Antimony, Lead calcin'd, Lapis Calaminaris, Bones and Horns calcin'd, the powder of the root of Iris, Mastick, Olibanum, and such like. Aes ustum, the Pumice-stone calcined, and Henricus rubeus are excellent. If the part be distempered with heat, then the part ulcerate will be somewhat tumesied, hard and red; and besides the relation of the diseased party, your own feeling will assure you. In this case use Aqua caleis vivae, so called; but more properly Lixivium calcis vivae, wherein some litharge of Silver hath been boiled: you may use also Snow-water, wherein some of your Vitriolum album or white Copperas hath been dissolved: In a quart of Epsome water, dissolve [Page 99]two drams of Roman Vitriol, you shall have a water of the colour of a light Emerauld fit for your purpose. In a pint of Plantain water dissolve two drams of ordinary Vitriol or Alum; and this also is a [...]t Medicament. Let me acquaint you with one thing, that in Redriffe a Copperas is made of Mars or [...]ron, which is most fit in the cure, not only of ordinary Ulcers, but of those also which are in the Eyes, Bladder, Throat, and the Intestinum rectum. Make trial as I have done, and you shall find that true which I say. You see how plain I am with you, concealing nothing, which may purchase unto you credit and gain.
If Cold distemper the part, which you shall discern by its colour, hardness, sense of the Patient, and your own feeling, then apply to the ulcerate part Basilicum magnum, my Basilicum, Arcaeus his li [...]iment upon Pledgets, and above these Diachylon cum gummi, Emplastrum de mucilaginibus, or Paracelsus his Styptick Emplaster. But before the application of these, soment the part with a Fomentation made of Sack and March-Beer, wherein Calamint, Centaury, Wormwood, Spike, Chamaemill. Tansey, Scordium, Rue, and Bay-Leaves have been infused and boiled.
The Third thing which we affirmed to make up a compound Ulcer, was a symptome annexed to an Ulcer. Now of all other, Pain it the chiefest: for First, pain by attraction brings much moisture to the part, and so hinders the Cure. Secondly it inflames the parts. Thirdly, it causes watching, Fainting, and oftentimes Convulsions. Pain is removed two manner of ways. First, by taking away the cause of pain, which is affluxion of Humors: How this is to be done we have spoken already. Secondly, by application of Anodyne Medicaments. These ought to be temperately hot, and subtil. Simples of this kind are the waters of warm Baths, Chamaemil, Dill, Millet, Linseed, Fenugreek, Marshmallow, the pulp of Casia, Raisins, sweet Apples, and Turneps, with a little Saffron, they are effectual, Milk, Butter, Oesypum, or the greasiness of Wooll, Sapa, new Wine boiled to the Third part, Swine's, Hen's, and Man's Grease, the fat of Eels and Calves, Oyl of Eggs, Earth-worms, Foxes, Swallows, Rue and Elder: the Oyl of Wax, and Sallet-Oil, Oil of Chamaemil, Dill and Roses: Of these you may frame unto your selves compositions, as occasion shall require. Take this for an example; ℞ Farin. Hord. Milii, Furfur. an. ℥ ij. Lact. recent. lb. ss. coq. ad consistentiam cataplasmatis, tum adde Pulp. Cass. & Passul. major. an. ℥ vj. Pulp. Pomor. redol. ℥ j. Ol. Ros. Lumbric. Aneth. Chamaemil. & Ovorum, an. ℥ j. Oesypi. ℥ i ss. Croci. ʒ j. Make a Cataplasm. Sometimes the pain will be so great that you shall be enforced to use narcotical Medicaments: The Simples are Opium. Henbane, Hemlock, the Apple of Peru, Mandrake: of these, adding White-bread crums, Milk and Saffron, you may make Pultesses: I will set one down as an example, after which you may frame others: ℞ Lact. recent. lb.ss. Mic. pan. albiss. ℥ iv. Hyoscyami, Solani. Cicut. Contus. an. man. 1. [Page 100] Buliiant ista ad cataplasmatis consistentiam: tum adde unguent. popul. ℥ ij. Dress the Ulcer with Plantain water, wherein some Alume is dissolved, or Roman Vitriol. Then apply Diapalma cum succis, and above it this Cataplasm. Drest this Ulcer at the least Morning and Evening until the pain be gone.
CHAP. IX.
Of the differences of the milder sort of compound Ʋlcers, and first of a sinuous Ʋleer without any callosity.
HAving discoursed in the former Chapter of those things which make the milder fort of Ulcers to be accounted compound; to wit, a sickness, cause or symptome complicate with an Ulcer; In this Chapter I will set down the differences of milder Ulcers, and the cure of them. These differences are taken either from the Figure or Adjuncts. From the Figure these. Of the milder compound Ulcers some are plain, some sinuous. I call that a plain Ulcer, wherein the Skin is eroded, and the subjacent flesh, and the whole Ulcer is presented to the sight, being bare and uncovered. No compound Ulcer is to be accompted of an easie cure: because both skill and experience are required in performing this.
And thô these plain Ulcers be fubject wholly to the sight, yet let no Man imagine that all of them are of equal facility to be cured; for according to the nature of Grief, the quality of the cause, and the invasion of the symptomes, the Ulcers with which these things are complicate, are either of more easie or difficult cure. A plain compound Ulcer has three scopes in the cure of it; for First, that must be removed which makes it compound, whether it be a disease, cause, or symptome: Secondly, That which is by erosion lost, must be repaired; and Thirdly, The part must be cicatrized: How all these three indications are performed, I have set down at large in the former Chapter, so that I need not to repeat any thing.
Ʋlcus sinuosum, or a sinuous Ulcer, I call that which is like to a Cony-burrow; for sinus, or sinuosity, is a cavity or hollowness of parts under the Skin, separate by a Flux of an eroding Humor, which [Page 101]according to Nature were united.
There be two causes of these sinuous Ulcers, to wit, Apostemes lying deep a long time, or not timely opened, although they be not so deep, and wounds not well cured: for Quittour lurking a long time, either in a Tumor suppurate, or in a deep wound not well cleansed, must needs corrupt and get a sharp quality, which makes to it self these cavities, which are not so easily filled with Flesh and united: for unto the part affected, now weakened, excrementitious Humors slow, not only from the parts adjacent, but from the whole Body also, which make the Ulcer hard to be cured. These Burrows are found out by Probes of Silver, or Lead, and wax-Candles: If there be more Orifices than one, by Injections. They sometimes are superficial, sometimes deep; sometimes streight, sometimes oblique; sometimes there is but one cavern, sometimes there be more.
Of these sinuous or cuniculous Ulcers, some have neither hardness nor callosity, such I will term Ʋlcera cavernosa, hollow Ulcers; some have both hardness and callosity, these are termed Fistulae. First, [...]hen I will shew you how cavernous Ulcers are to be cured, and then how Fistula's. There are two ways of curing of a cavernous Ulcer: the First is by Injection of Medicaments: the Second is by opening and dressing, according to Art. If you go about to cure such an Ulcer by Medicaments, without opening, then two scopes offer themselves; to wit, the filling of the Cavity with Flesh, and the agglutination of the parts disjoyned. The incarnatives must be drying without erosion, and the glutinatives must have astriction, besides desiccation. Both these intentions you may perform with the Injection of this Medicament following, ℞ Aq. decoct. hord. lb j. Mell is rosat. ℥ iij. Sarcocol. ʒ ij ss. Myrrh. Thur. an ʒ ij. Rad. Termentill. Bistort. Symphyt, an. ʒ j ss. Balaust. ʒ j. Baccar. myrt. ʒ ij ss. Sumach. ʒ i ss. Vini odorifer. ℥ vj. Bulliant ad consumptionem tertiae partis, ac coletur decoctum, cui adde Spirit. vini ʒ i. If you perceive that the Ulcer is not sufficiently mundified, which you may conjecture, if the Quittour be either stinking, reddish, pale, blackish, or thin and waterish, then apply this Medicament: ℞ Vini, in quo infusa sint marrubium album, Centaurium minus, Absinthium, Flores Hyrerici, & Carduus Benedictus ad lb, ss. Ʋnguenti Aegyptiaci ʒ ij. Mel ros. ℥ ss. misc. inject this. You can hardly devise more effectual Medicaments than these are for agglutination of a cavernous Ulcer: Yet whosoever shall apply them, not dressing and binding the Ulcer artificially, shall hardly cure any such Ulcer: Wherefore I think expedient that I shew you the way of dressing: First, lay upon the whole process of the Cavity Diapalma cum succis, or Emplastrum album coctum, or Emplastrum contra rupturam: Then inject your Medicament warm. Thirdly, in the Orifice put in a leaden Tent, or Pipe: but short, hollow, wider in the upper than lower part, and having the brims of the upper part turned. That it may be kept from [Page 102]slipping in, shut the Orifice and the upper part of the Tent or Pipe with an Emplaster; let it be one of those named before: the Emplaster must be snipt, that it may give way to the Quittour which flows out of the Cavity: above the Emplaster apply a piece of a Sponge, which must be soft, moistned with the Medicament with which you dress the Ulcer, and wrung out: for the Sponge sucks into it self the Quittour, keeps the brims of the Orifice dry, and preserves them from excoriation: above the Sponge lay a pledget of Tow: the lower Cavity, or from the bottom of the Ulcer to the Orifice, must be boulstered. Above all lay a double soft linnen Cloth. Begin your rowling at the bottom, where it must be somewhat strait, to bring the sides of the Ulcer together, both to express the Quittour, and to procure agglutination, but let it cause no pain; for it would distemper the part: towards the Orifice the rowling must be somewhat slack, that the Quittour may have way to issue out. Every third day (if much water flow not) dress it, loose first the Rowler, the turnings whereof are about the Orifice, take away the Sponge and Emplaster; First, that you may come to cleanse the Ulcer; Secondly, that you may make trial whether Nature goes about to agglutinate the parts: which you shall discern, if the excrementitious Matter abate, be laudable in colour and consistence, and have no ill smell, and if the Cavity be without pain, and without any remarkable Tumor. On the contrary, if the Quittour be plentiful, ill-coloured and stinking, if the Cavity be painful, and a conspicuous Tumor appear, you may perswade your selves that no unition is procured. Dress the Ulcer according to this manner, until perfect agglutination be caused, which yo [...] shall know by the signs afore said going before; if no Quittour or very little appear in the Orifice, ï the Cavity be equal without Tumor, and no pain be felt: when you perceive these signs, then address your selves for the cicatrizing of the Ulcer. If after a dressing or two, thin gleeting Matter appear, yet despair not; for oftentimes such Matter is wrung out of the parts by reason of the Medicament drying; the nature of the part, as being nervous, membranous, or glandulous; or Lastly, by compressing of the Ulcer by bolstering and rowling. As for the Emplaster applied to the Cavity it self, it is to be renewed, when it is defiled with Quittour, or leaves cleaving. Dress the Ulcer as seldom as you can, contrary to Empiricks; for often dressing gives way to cold Air, which is hurtful to Ulcers, and hinders unition. Thus you may proceed in curing of cavernous Ulcers, if the excrementitious Matter have way to flow from them freely; which will be, if the Orifice be in a depending part, or lateral, the Cavity or Sinus being lateral also; for then, such a posture may be appointed, as will further evacuation of the Matter. But if by reason of other Figures of the Cavity, the Cavity cannot discharge it self of the filth of the Ulcer, then until this impediment be removed, no [Page 103]expurgation, incarnation, or agglutination can be expected: wherefore way is to be made by incision or a caustick.
This you must do: First, if the Cavity be lower than the Orifice either directly, or obliquely, but not very deep: Secondly, if it go very deep also, as in Fistula's, and such Ulcers, penetrating in the Breast, where the Cavity most commonly is lower than the Orifice. Thirdly, if the hollowness be very broad. In these cases way must be made by these means for the Matter, that it may be expurged: otherwise, if it be kept in, it will erode the parts adjacent, and no incarnation or consolidation can be looked for. We may make way for the Quittour two manner of ways: First, by opening the lower end of the Sinus only; Secondly, by opening the whole Cavity.
The first course we are to take, if the Sinus be of an enormous bigness, or if it be in a great joynt; for great wounds in such Joynts are mortal, according to Hippocrates: or if there be great Vessels, Nerves or Tendons of Muscles in the way; which are like to bring fearful fluxes of Blood, or lameness: which things skill in Anatomy will teach you. If none of these cases hinder you, then it is the surest way to lay open the whole Cavity, which is the second way. These two scopes we may attain unto by two means; to wit, by a Caustick and Incision.
The Caustick we are to use: First, if the party be timorous, and will not admit Section: Secondly, if the Cavity be in a part, wherein a great sear may cause deformity: Thirdly, if there be fear of a great flux of Blood: Fourthly, if the diseased Party be sick and weak.
If a Caustick be to be applyed, if the situation of the part wherein the Sinus is, be in the upper side, then apply your Lapis internalis: for it corrodes soonest, deepest, with less pain, and will not be so apt by running and spreading to burn the parts adjacent, or to cause a greater solution of unity than we intended. But if the Sinus be in the lower side, as in the sole of the Foot, or in a part very depending; then I advise you to use a Caustick made of strong Sope [...]lees and unslaked Lime, which will not run. It is an ordinary practice of some to [...]ub the part with a Caustick-stone, and when the part is mortified then to open it: First, this is not to be done, but when the Skin is very thin; besides this, this rubbing causes far greater pain than the application of it to the part, being defended. Be ever of this mind in your practice, to use the mildest means; the fruits which you reap by so doing will be Respect, Love, Credit, and Gain. When you have perceived that the force of your corrosive Medicament has mortified all to the very Cavity, then procure the fall of the Eschar, with the application either of Dialthaea simplex, or Butter without Salt. There is no substance comparable to this for this purpose, When the Eschar is gone, then proceed in curing of the Ulcer, as hath been said, by mundificative incarnative, and cicatrizing Medicaments.
If the party be couragious and strong, use Incision: this is sooner performed; has less pain, and sooner will be cured. When you have made Incision, arm Dosils and Pledgets with a Medicament which strongly dries and mundifies; such is this: Take of Al [...]e Hepatica two drams, of black Rosin and Amber, of each a dram and a half, of Milldust two drams, of unslaked Lime two drams and an half, with this Powder, and the white of an Egg, and the yolk beaten together, make a Medicament in consistence representing an Unguent: then apply the Medicament to the Sinus incised, filling it well, that the brims may be kept asunder. Open not the Sore till the end of the Second day, at the least; for this Medicament will both dry the superfluous humidity of the Ulcer, and will excellently digest it. Afterward dress the Ulcer as the methodical indications of Cure shall move.
If you find these Ulcers so handled, do not heal to your mind, then hold your Patient to the decoctions of Sarsaparilla, Guajacum, and the China root, with which mingle some of your most effectual Vulneraries, as Agrimony, St. Johns-wort, Sanicle, Avens, Ladiesmantle, Virga aurea, Solomons seal, the roots of Comfrey, Tormentil, Bistort, Horehound, Borage and Bugloss. I will not conceal from you the description of a Decoction, wherof I have made often proof in Ulcers of the Breast, Joynts and Belly: ℞ Sals. paril. ℥ vj. Rad. Sassafras. ℥iss. Scob. Guajac. ℥ iij. Eupator. Scabios. Tussilagin. Sanicul. Hyper. an. man. j. Rad. Symphyt. Tormentill. Bistort. an. ℥ss. Rad. Borag. Bugloss. an. ℥j. Passul. major. enucleator. ʒ iij. Liquirit. ℥ ij. Infundantur infundenda per noct. in aq. font. fervent. lb. xxiv. Sequente die coquantur lento igne cum reliquis ad consumpt, lb. viij. Bibat aeger singul. dieb. lb. iiii. hujus decocti: Hauriat: lb. ss. mane, ac tantundem hor. quartâ pomeridiarâ: In prandio bibat lb. j. ac tantundem in coena: Quum sit it, superest. lb. j. haurienda. The Simples of this composition may plead for the efficacy of it. Let him continue the taking of this Decoction for the space of One and twenty days: during which time he is to use a spare Diet, and to eat Flesh affording a good juice, and of an easie concoction. As for the local Medicaments which are to be applyed to an Ulcer, I have spoken of them already: too much repetition will breed loathing.
CHAP. X.
Of the Palliative Cure of a sinuous Ulcer with callosity in general.
HAving already treated of a sinuous or hollow Ulcer, without a callosity or hardness of the inward Superficies of the parts disjoyned. Now the order of Doctrine requires, that I discourse of a sinuous Ulcer, which hath a callosity in these same parts.
In times past it was accounted such a master-piece in the practice of Chirurgery to cure such, that Mr. Boovie a Chirurgeon, who once dwelt in Tower-street, set up above his Door a new Sign, with this Inscription: Here dwelleth one who can cure a Fistula. And in truth not a small skill, or ordinary proceedings, is required to effect this matter: for the greatest part of such an Ulcer lies hid, and little is offered to the Eye. Besides this, ordinary means are for the most part here ineffectual, and so magistral means are required. Wherefore I have diligently laboured to couch in this my Discourse whatsoever can be required in the curing of such an Ulcer.
First then, I will deliver the general Doctrine of this kind of Ulcer: then I will set down the cure of such in some particular parts of the Body, A sinuous or hollow Ulcer with a callosity or hardness in the inner Superficies of the parts disjoyned and separated, is called in Greek [...], from the similitude which it hath with the long and hollow windy instruments of Musicians: in Latine it is called Fistula, and so in the English Tongue for this same cause,
A Fistula then is a sinuous Ʋlcer, narrow and long with callosity. Here you are to observe, that a Fistula besides sinuosity, must have callosity and narrowness. It happens most commonly, when Apostemes have been opened, that the inner Superficies of the parts, kept asunder by a sharp Humor, become in progress of time callous. The Humor which causes this callosity, must be more astringent than sharp; for it rather tanus the part by reason of its acerbity, than erodes it by reason of its acrimony? besides this, Fistulas are for the most part indolent, unless they end in parts very sensible, as Nerves, Tendons, Membranes, and Joynts. Wherefore the Chymists will have this Humor to be the Saltpeter of the little World, or Man, separate from [Page 106]the natural Salt of the Balsam, or radical moisture of the Body. That this Salt is cooling and anodyne, Practicers of Physick do bear Witness: for in burning Fevers it is added to Juleps, which are appointed for cooling, and asswaging of pain, under the name of Sal prunellae: It doth also, by reason of its stypticity unite the Spirits, and stay the immoderate Exhalation of them.
The Signs are taken either from the Essence of a Fistula, or from the Accidents. Callosity then with a Fistula, or Whistle-like Figure, is the Pathognomonical Sign of a Fistula. The Signs taken from the Accidents are two sold: for they are taken either from the Quittour, or the manner of pain. In a Fistula the Quittour is ever virulent, ugly and stinking: as for the manner of pain, it is but small; unless it be by reason of the sensibleness of the parts named by me before.
As for the differences, or divers kinds of Fistula's, I will only set down those which further either the Cure, or Prediction. Let this then be the first difference: Fistula's either go shallowly along under the Skin; or they pass deeper to the subjacent parts.
Secondly, Fistula's end either in the Fleshy parts, or they pass to the Bones, or to the Cavities themselves. Thirdly, some are streight, some crooked. Fourthly, some are single, some manifold; yet proceeding from some one Orifice. These are the most material, or profitable differences of Fistula's.
Now it follows, that I speak of the Signs of these Differences. 1. Whether there be more callous Sinuosities than one, you may conjecture by the quantity of the Quittour; for if more copious Quittour flow from a Fistula, than can be expected from one Sinus, it not passing to any remarkable Cavity, it is likely that there are more than one. The changing also of the position of the Body, and compression of the part will shew this; for the flowing of the Matter having ceased, if after the changing of the position of the whole Body, or one Member, it run out again, it is probable that there are more Sinuosities. Moreover, if variety of Quittour flow, it is an Argument that sundry parts are affected, and more Sinuosities like to be. But to what parts the Fistula passes, receive these Signs: If it pass to the fleshy parts, the Quittour appears white, smooth and plentiful; besides this, thy part whereon the end of the Probe stays, seems soft. If it pass to a Nerve, a fatty and oleous Matter issues out, the motion which is caused be that Sinew is impaired, and the Fistula is more painful than others are; besides, the Probe touching the Sinew, causeth a pricking pain with a certain numness. If the Fistula pass to the Veins and Arteries, yet so that the Coats of them be not eroded, then the Matter which it yieldeth is like unto the Lees of Claret wine; for Blood, sweating thorow the coats or porosities of the Vessels, mingled with the Quittour, causes such a substance.
If the Coat of a Vein he corroded, Blood issues thick, of a [Page 107]dark Colour, and without quavering and leaping; but if the Tunicles of an Artery be pierced, then the Blood is redder of a more bright colour, and comes forth with ejaculation.
If a Fistula reach to the Bone, that which the end of the Probe toucheth appears hard, and yields not to the Probe, neither is any pain felt. If the Probe being pressed slip, no Cariosity has seized upon the Bone; for a sound Bone is smooth and slippery: If the Probe stay upon it, appearing smooth, it is disposed to Cariosity; but if the Bone appear unequal and rough, then it is undoubtedly carious, Besides this, the Quittour which flows from a corrupt Bone is thin, yellow, and ill smelling. So much then concerning the Signs, which shews us the divers kinds of Fistula's.
Now let me give some remarkable Presages or Predictions touching the curing of them, that Men may become circumspect in undertaking the Cure of such as shall be presented to them. Let this then be the first.
1. No Fistula is of easie Cure. First, by reason of the unaptness of the part to admit convenient application of Medicaments: for unless they reach to the very extremity of the Fistula, which is not so easie a matter (as you shall find by practice) no good can be done. Secondly, by reason of the quality of the Medicaments, which are able to remove the Callosity; for these must be sharp and biting, and so cause pain: from whence come symptomatical Fevers, and fainting very often, especially in tender and young Bodies. And thirdly, by reason of the Humor, which causes a Fistula, which yields not to ordinary and vulgar Medicaments. Let this be the second.
2. Fistula's which are shallow, passing no deeper than the Membrana Carnos, or at the furthest than the Membrane of the Muscles or Muscle subjacent, are more easily cured than those which pierce deeper; for those by Incision may easily be cured, but these not so.
3, The third shall be this: Fistula's wreathed, or with multiplicity of Sinuosities, require incision, that Medicaments may be conveyed to all the parts.
4. The fourth, if a Fistula not passing further than the fleshy parts, be not of a long continuance, and that in a young and a strong Body, it affords good hope of curing: Imagine the contrary event, if contrary circumstances be accompanied.
5. Receive this as the fifth. If the extremity of a Fistula end in the Tunicles of the Veins or Arteries, or both, (the Signs whereof I have delivered, when I spake of the differences of Fistula's) then you are to meet with the Symptom of Haemorrhage, the Coats being eroded; for if you labour either to enlarge the Orifice, or to take away the Callosity by sharp Medicaments, the Flux will be encreased. This accident happens most commonly in Bubo's of the Groyn, not speedily cured, and Parotides under the Ear, and Phlegmons in the Arm-pits: These [Page 108]parts being Emunctorious, and near to the divarication of the great Vessels, to wit, the Vena cava, and the Aorta, descending and ascending.
6. Fistula's ending in very sensible parts, as Nerves, Tendons, the Bladder, the Intestinum rectum, and the like, are carefully and mildly to be handled, by reason of the Symptoms which often ensue, as accidental Fevers, Lipothymies, loss of Appetite and Sleep: all which are apt to bring an extenuation unto the whole Body, and so to defraud the part of more than requisite nourishment, without which Consolidation cannot be effected.
7. Fistula's in remarkable cavities, as the Throat, Brest, Belly, are hard to be cured, because the end is more dependent than the Orifice, which exceedingly hinders Consolidation.
8. If in Fistula's of the back the Spina be carious, shun the Cure, for these at length bring an extenuation of the Body, the animal Spirits not being in requisite plenty communicated to the extremities of the Body.
Fistula's in the Joynts are dangerous; for if great Wounds of the Joynts, even in Bodies of a good habit, be pronounced by Hippocrates to be mortal: what shall we deem of Fistula's in these parts, where besides the enormous dilations, that must be procured in Cure, there is of necessity an ill complexion of the Body?
Secondly, seeing the Joynts are framed of parts very sensible, as Tendons, Nerves, Membranes and Ligaments, exceeding great pain must be caused by the application of Corrosive Medicaments, without which a Fistula cannot be cured, and so the party must exceedingly be troubled and perplexed. Thirdly, seeing the Joynts are seated in depending parts, and are not fleshy (and so, as they are apt to receive Humors attracted by pain, they are less able to discuss the Humors received, partly by reason of the thickness of the Membranes, partly by reason of the weakness of Natural Heat) who may not easily perceive the difficulty of curing of Fistula's in these parts?
9. Fistula's having sundry Sinuosities are more hardly cured than those which have but one; both because the labour is the greater, and Medicaments cannot so conveniently be applied.
10. Fistula's which have continued a long time, seated in a depending part, remote from any principal, by which Nature hath been accustomed to discharge superfluities of the whole Body, and not painful, but rather slovingly or sluttish, are rather to be kept open than cured; for they preserve the health of the Body, and hinder the assault of other Diseases.
I know a Gentleman who had a Fistula in a [...] about twenty years, yet unknown to his Wife, who lived notwithstanding very healthful to be [...] period of his life: having sent for me a few days before his death, he acquainted me with it. Having taken a view of it, and perceiving that it was dry, and of [...] colour; I pronounced [Page 109]his end to be at hand, which accordly fell out.
Now it is time to hasten to the setting down of the Cure of Fistula's in general. In the sixth Section of the Treatise ascribed to Hippocrates, there is one of Fistula's: In it he speaks somewhat particularly of a Fistula in ano, and of the curing of it by Ligation. Whatsoever is delivered in that Treatise, seems to be an exscription of notes out of his Adversaria or Notebook, rather than a deliberate or methodical Discourse of the Subject. Howsoever, it is to be embraced rather as a Pledge and Sign of his willing mind to pleasure his Posterity, than a Patrimony to enrich the Knowledge, and further the Practice of any one who shall go about to cure any mean Fistula. Peruse the Treatise, and you shall find me to speak a Truth, if you shew your selves impartial Censurers. Seeing I have delivered unto you in the presages of Fistula's, that sometimes it is most expedient to leave some Fistula's uncured, I must make mention of a twofold manner of curing them: The one shall be called palliative or cloaked; the other true and real.
The first affords some consolation and ease to the Patient; but the second procures perfect health. A palliative Cure, I would have you to understand, to be when a Sinuosity is inwardly dried for a time, and the Orifice seems to be shut up by a thin Skin, until fresh and new Humidity bedew the inward Sinuosity, and open the Orifice again. This kind of Cure is most sit to be used towards those in whose Bodies a Fistula supplies the place of a Fontanel, to discharge superfluous Humors, which Nature turns out from the principal parts, for the preservation of the health of the Body.
You shall know this manner of Cure ought to be used, if the party immediately before the opening of the Orifice find some distemperature, and afterward, the Orifice being opened, ease. To compass this manner of Cure, three intentions are required.
First, a convenient Diet must be observed: This is performed by feeding upon such meats as are of easie concoction, and afford good Juice, and in such measure as Leonardus Lessius in his [...] prescribes; and Lodovicus, Cornarus observed from his constant to his decrepit Age. They advise moderation both in Meat and Drink. Patients now a days would think themselves hardly dealt with, if they should be stinted every day to eat no more Bread and Meat than a pound, and to drink no more Drink than fourteen ounces. It is an easier matter to satisfie Nature, than the Appetite.
Secondly, the Body is to be purged, not by an Eradicative Medicaments, wherein Scammonie, Ellebore, or Colocynth enters; but a purging Diet, or a purging Ale; I will deliver unto you a Pattern of both. Let your purging Drink be thus Dispensed: ℞ Sars. ℥ iij. Rad. Tormentillae, Bistortae, & Symphyti, an. ℥ i. Polypod. querc. ℥ iij. Hermodaclyl. fol. Sen. & Semin. Carthami, an. ℥ ij. Rab. ℥ j. Semin. [Page 110]Anisi, Coriandri & faenicul. dulc. an ʒ iiij. G [...]ycyrrhiz. ℥ iss. Infundantur infundenda in aq. font. fervent. lb. x. per noctem: deinde, additis reliquis, lento igne coq. ad med. atque Ar [...]matizetur decoctum cinam. ℥ j. ac coietur: Sumat aeger manè. lb. ss. calid. hyeme. ac tantundem hor. quartà pomeriduanà. As for the purging Ale receive this description. ℞ Scob. Guajaci & Sars. paril. an. ℥ iv. Rad. Tormentill. Bistort. & Symphyti, an. ℥iss. Polypod. ℥ iij. Eupat. Sanicul. Alchymill. an. man. j. Fol. Sen. Hermodactyl. an. ℥ v. Rab. ℥ j. Semin. Anisi. Coriand. & Fenicul. dulc. an. ʒ vj. Glycyrriz. ℥ ij. fiat ex omnibus pulvis crassiusculus indendus sacculo laneo rarae texturae, qui suspendatur in gadon. duobus Zythi non lupulati recentis & fortis. Let the Patient begin to drink of this Ale the fourth day. He is to take half a pint in the Morning, and to sleep upon it; and so much about four a Clock in the Afternoon. When either of these Purgatives are ministred, let the Patient about Ten a Clock in the Fore-noon take some Broth without Bread, made of a Chicken, Mutton or Veal, wherein Mallow, Parsley, Fennil, and Succory Roots, with some Raisins, Prunes and Dates have been boiled. Let him Dine on the boiled Meat; but Sup with rost Meat. The purging Ale is more convenient for aged persons, than the Decoction, and for such as have a weak Stomach.
Thirdly, convenient local Medicaments are to be applied, to further the drying of the Sinuosity, and skinning of the Orifice. I will only set down two Injections for the first. The one is this: Take of Aqua caicis, wherein some Litharge either of Gold or Silver hath been boiled ℥ iij. and of the Syrup of red Rose leaves dried, or of Myrtil Berries one ounce: mingle these together. The other is this; Take of Plantain water ℥ iij. of Roman Vitriol beat to powder, a dram and a half: let the Vitriol dissolve in the Water: inject these Medicaments warm; apply to the Orifice a pledget of lint, wet in either of these Medicaments warm; and above the Lint Diapalma cum Succis. Dress the Fistula every other day only, unless the Quittour which flows from the Fistula be plentiful. So you have the palliative Cure of a Fistula.
CHAP. XI.
Of the true Cure of Fistula's in general.
NOw I will set down the Method of Curing truly and really Fistula's in general, and the practice of the same in curing of some Fistula's in some special places of the Body, which require some extraordinary considerations. Such are Fistula's in the the great corners of the eyes, Fistula's in the Breast, Fistula's in ano, and Fistula's in the Joynts.
The means to attain to this manner of Cure are threefold Diaetetical, Pharmaceutical, and Chirurgical.
As for the Diaetetical, I have set it down amongst other things which are required in the Cure of an Ulcer in general. It shall be sufficient to insinuate now only, that the Diet of those who are troubled with Fistula's must be very sparing, and of Meats and Drinks which afford a laudable Juice, and are of easie concoction, that Crudities and sharp Humors flowing to the affected part, hinder not the Cure. And undoubtedly too liberal Diet, unto which the Inhabitants of these parts are too much accustomed, is the cause of the Recidivation of these, and other Griefs.
As for the Pharmaceutical means, they are of two sorts, to wit, Purgative and Consolidative.
If the Body of the diseased party be Cacochymical, with some Plethora, minister the purging decoction, or Ale, for the space of a Week, described by me in the former Chapter. And while these are in preparing, you may for the better operation of these, minister this or such like a potion: ℞ Garyocost. & Electuarii de Succo Ros. an. ʒ iij. Syrup Ros. solut. cum Agarico ℥ j. Aq. Cichor. ℥ iij. M. ut fiat potio, sumenda cum corporis custodia. These two Electuaries purge the Body of thin, hot; and sharp Humors; the Syrup and Water correct the malignity of the Humors.
The Consolidatives are either Simple or Compound. The principal Simples set down by most authentick Authors, and tried by practice are these; Gentian and the Roots of round Birthwort, a dram of either of these mingled with three ounces of white Wine, and ministred every other day in the Morning, and fasting three hours after taking of the Medicament. The lesser Centaury, Osmunda regalis the Root of it, Agrimony, Virga aurea, white Horehound, [Page 112]the Roots of Borage, Tormentill, Bistort, and Comfrey, Sarsaparilla, the rasping of Guajacum, Plantain, Vinca Pervinca, and Equisetum. Of the Juices of these Herbs, mingled with Ale, you may make Possets: the Drink whereof strained and sweetned with some Saccharum rosatum, or the Conserve of red Roses, you may minister Morning and Evening to young persons, and those who are either weak, or abhor all Physical means, whereof there is no small number now adays, who hasten by their own misdemeanors to bring on griefs; but when they are to use means, esteem them harsh: not knowing that God of his infinite goodness and providence towards Mankind, hath appointed the means of recovering of Health to be unpleasant to Nature, that Man should refrain from Sin, the primitive cause of Griefs.
Of these Simples aforenamed, you may frame unto your selves sundry Compositions: for a Pattern, I will set down one decoction: ℞ Sars. Paril. ℥ iv. Scobis Guajaci, ℥ vj. Rad. Tormentill. Osmund. regal. Bistor. Symphyt. an. ℥ j. I ipat. V [...]rg. aur. & si nil restat praeter consolidationem & cicatrizationem. Summitat. Hyperic. & Sigill. Salomon. an. man. j. Passular. major. exacinat. ℥ iij. Liquirit ℥ ij. Semin. Coriand. & Fenicul. dulcis, an. ʒ v. Infundantur infundenda in aq. font. fervent. lb. xx. deindo coq. lento igne, additis reliquis, ad consumptionem lb viij. ac coletur decoctum. If the party be strong, let him drink three pints aday: One half pint in the Morning, and another about four a clock in the Afternoon, for Dinner and Supper there remaineth a quart. If the party be young, or cannot take such a quantity, by reason of weakness of Stomach, make half of this quantity, which being vj lb. add to the decoction of Sugar and Hony, of each j lb. and by gentle evaporating away some Humidity, bring the Decoction to the consistence and taste of a pleasant Julep, which minister according to the toleration of the party. This Pharmaceutical course you shall (I dare assure you) find effectual, to your own credit, and the patient's comfort.
The Chirurgical means afford unto us five intentions.
First of all then, the Fistula is to be dilated; for seldom doth it fall out otherwise, that this Indication is not requisite, unless it be in a Fistula in the Cheek, which was caused and maintained by a corrupt Tooth, which being drawn, the Fistula will heal of it self, a consolidative Emplaster being applied to keep out the Air.
A Fistula may be dilated three manner of ways, by Incision, by putting in Tents framed of such things, as swell, after they have imbibed the humidity of the Fistula; and last of all by the Fistula tent.
As for Incision, it is to be used in strong Bodies, if the Fistula be not deep, and only runs along under the Skin, no deeper than the Membrane of a Muscle, if it be in a fleshy part. Secondly, if the Fistula have many Sinuosities before the Incision is made, the Fistula is to be dilated by some of the other means, which I will deliver [Page 113]presently: Secondly, the Medicaments which remove Callosity (whereof anon) must be applied; both these Intentions must be performed before Incision; otherwise you shall hardly know how far your Incision is to be extended, and shall leave some part of the Callus still, which will make way for Recidivation and Relapse.
The second way to dilate a Fistula, is to use instead of Tents such things as swell, whereof there be sundry, as Gentian root, the pith of the Elder; or Danewort; but the Sponge twisted with Thread, after that it is wrung hard and wreathed, far exceeds all these: for it both imbibes more moisture, and dilates much more. I will acquaint you with a preparation of the Sponge, which is excellent: and this is it: Melt a rowl of your simple Melilot Emplaster; when it is very hot, let a thick Sponge imbibe it. This Sponge having so drawn unto it self the Emplaster, put between two Trenchers, which Trenchers with the Sponge put into a strong Press, and press them hard. After an hour or two, when you think the Sponge to be cold, unscrue the Press and take out the Trenchers with the Sponge, you shall find the Sponge become a firm substance, resembling Green Cheese. Of this substance you may cut out Tents of what fashion you will: This will not only exceedingly dilate the Fistula by sucking unto it the Humidity; but will also digest the Callosity.
The third way of dilating a Fistula, I set down to be by the Fistula-Tent. It is this way to be made; Make good store of sine Lint, from which draw away all the Threads, that nothing remain but the Fluet, or the soft Down of it; of this soft Down, with the white of an Egg beaten, make your Tents of what thickness or length the Sinuosity of the Fistula requires, by adding still some of the Down: Do this upon a piece of Deal-board smooth and eve [...]. If you still enlarge the quantity of the Tents, you may dilate the Fistula as much as you will; for these Tents being dried, will pierce into any Cavity, as a Probe, without bending (if they be well made) by reason of their stifness. Of this manner of Tent there is great use, in taking away the Callosities of of some Fistula's, and in healing of them, besides this use, as you shall hear anon.
The second Chirurgical intention is to remove the Callus: this is bred by reason of the influxion of an Humor, not of an uniform substance: for besides the thin parts, which are discussed or dried by both the natural and extraneous Heat, it must have a thick substance to cause this Callus, it being indurated: this must be either Phlegm, if the Callus be white; or Melancholy, if it be livid, according to the dogmatical Physicians; the Chymists appoint it to be Saltpeter, as I have said.
In the beginning this Callosity is bred rather in the external Orifice, than in the inner Sinuosity: For first, the Skin, which is thick of it self, sooner grows hard than the Flesh which is soft; Secondly, because Nature still labours to thrust out Excrements to the Skin. In progress of [Page 114]time Fistula's having become inverate, the whole passage contracts Callosity.
You shall know by this, whether the passage be fistulated or no: If by the intrusion of the Probe great pain is selt, and Blood issues out, the Callus is not confirmed; but if no Blood follow, and little pain is selt, be sure then that it is confirmed.
The Callosity is removed either by Medicaments, or an actual Cautery. The Medicaments are of three degrees: for some are more mild, and these are of an emolliting and digesting quality, first if the Callosity be but small in a fleshy part and young body: such are Dialthaea cum gummi, and Ʋnguentum de poeto. Every ounce of either of them having a dram of Turbith mineral, or Precipitate mingled with Alume with it, is effectual.
Secondly, some are more harsh, for they must mundifie strongly, if the Callus be somewhat hard, and the party somewhat aged; such are Ʋnguentum Apostolorum, Avicen. having Precipitate and Alume or Turbith with Alume mingled with it. Egyptiacum is stronger than this, but I should rather use Ʋnguentum Apostolorum than it, adding more of the aforenamed Cathaeretical Powder to it; for it causes greater pain, and procures not so good Quittour as the Apostolorum.
Last of all, the Medicaments which are to remove an inveterate Callus, are Caustick; and even of these some are more gentle, some exceedingly fierce. The more gentle are these. I. ℞ Auripigmenti Sulphur. vivi, & Calcis vivae an. ℥ j. siat Pulvis subtilis. II. Is Pulvis sine pari, cujus haec est descriptio. ℞ Auripigmenti, & virid. Aeris, an. ℥ ss. Vitriol. catcinat. ℥ j. Almin. usti. ℥ ij. siat Pulvis sabtilis. III. ℞ Turbith. Mineralis non leti, Vitrioli vomitivi, & Boli orient. optimi, an. partes aequales.
Of the strongest of all I will deliver unto you two magistral descriptions only, far surpassing all others. I. Is M. Hale his Powder, who was famous in his time for curing of Fistula's: this is the composition of it: ℞ Aquil. mineral. Vitrioli vomitivi, & Terrae rubr. oriental. an. part. aequales. II. Is this, which I use in Fistula's and Struma's: ℞ Realgar. albi, Atripigment. & Calcis vivae, an. part. aequales.
You may enquire how these are to be used; If you have dilated the Fistula by Incision, besprinkle the Callus with some of the Powders; but if you have done it by the second way set down by me, then use the Powders mingled with Ʋnguentum Populeon, wherewith ann your Fistula Tent, or apply a Trochisk made of these Powders and Populeon, and afterwards dryed.
After the application either of the Fistula Tent armed with the Unguent, or of the Trochisk, two things you are to observe: I. That you apply an Anodyne Cataplasm; the fellow to this which I shall now deliver unto you, shall not be found. It is also matchless in raging pains of the Gout: ℞ Lact. Vaccin. lb. j. Mic. Pan. albi, ℥ vj. coq. ad Cataplasmat. consist. tum adde Ʋngnent Popul. ℥ ij. Sem. Hyosc. ℥ ss. Croci-pulo. ʒjss, fiat Cataplasma; quod applicetur [Page 115]parti affectae mane & vesperi. [...]I. You must not force out either the Tent armed, or the Trochisk, before they pop out of their own accord: for so they bring the Cal [...]us out with them, and the Tent with the Callus will present a Finger within a Glove. If there be many Sinuosities, yet do not pierce to any remarkable Cavity, as of the Brest and Belly, then you are to dissolve these Powders in some Liquor, as in Aqua calcis, Plantain water, Metheglin, a gentle Lee; Alume water, or Vitriol water. Alchymists exceedingly commend in this case the Spirit of Nitre.
The second way to remove a Callus by an actual Cautery is an Invention of Ab aqua pendente: He will have an Instrument like to [...] setting Iron to be made, the case to answer the wideness and [...]ength of the Fistula, and to be [...]hrust into the bottom of the Fistula, then must the other round Iron sill the Cavity of this, toward the point only, and be round an much long, and be put in red hot. It is not to stay long where pain [...]s caused, because there is no Callus; but to be rubbed up and down where the place is indolent, until pain be caused by reason of the removing of the Callus by the Fire. And although he highly commend [...]ectual Fire, and discommend the potential: yet I am not of his mind in sundry cases: As for this Invention, whosoever shall go about to practise it, I shall hold him much like to him who is to throw at a Cock blind-sold.
The Third Chirurgical Intention is, to mundisie the part: this medicament will perform it: ℞ Vini albi lb ss. Ʋnguent. Aegyptiaci ℥ss. Spirit. vini, ʒ vj. misc. Inject this warm, but once a day. You may conjecture, that the Fistula is sufficiently mundified, if the Quittour have no ill smell, if it be uniform, thick and white.
Then you are to address your selves to the fourth Intention Chirurgical, which is to unite and consolidate the parts disjoyned. To accomplish this: first draw by an Alembick the Spirit of these Herbs following, putting so much Spring-water, as will be three inches above the Simples, to them; The Roots of Aristolochia rotunda, Tormentil, Bistort, Comfrey, the lesser Centaury, Virga aurea, Burnet, Plantain, Knot-grass, Yarrow, and Solomons Seal. Reserve the Spirit by it self: take the decoction remaining in the Pot from the Herbs by straining; for every quart of this Decoction take half a lb of Hony, and so much Sugar: This mixture being clarified with the whites of Eggs, and strained again, let it be boiled by a soft Fire to the consistence of a Syrup. Take two ounces of the Spirit, and one ounce of the Syrup; which mingle and inject into the Sinuosity, and deal with it as I prescribed, when I delivered the manner of dressing a sinuous Ulcer. If any man deliver a more probable way than this, to consolidate a Fistuld after the extirpation of the Callus, I shall willingly lend him mine Ears.
The last intention Chirurgical, is to skin the Orifice, which requires no new directions. You [Page 116]shall know the Fistula to be near whole, when the Humor which flows is little, thick, concocted, and the place void of pain and tumor: If it be altogether dry, you may pronounce the Orifice to be skinned, and the Fistula perfectly cured.
From the Premises you may gather that four things hinder the Cure of a Fistula. I. Is the Afflux of a vitious Humor. II. Is the natrowness of it, which hardly admits the Application of convenient Medicaments. III. Is the deepness which hinders the conveying of the Medicaments to the bottom. IV. The Callosity which contents ordinary Medicaments. I have shewed you the way to remore these Lets and Impediments. I [...] the next Chapter I shall discourse of the Cure of Fistula's in particular places, which when I have done, I will put an end to this Treatise of Fistula's.
CHAP. XII.
Of Fistula Lachrymalis.
BEfore I put an end to this point, I will set down the Cure of some particular Fistula's, differing only in the parts wherein they are seated, wherein some special directions are required. I will only speak of three, to wit, of Aegilops in the great corner of the eye, of a Fistula in the Breast, and last of all of a Fistula in ano.
First then I will deal with Fistula Lachrymalis, the Fistula in the great corner of the Eye. In Paulus Aegineta, De arte meden. lib. 3. c. 22. there are words in sound much like [...] and [...], but in signification different: He will have [...] to be a Tumor or Apostem before it is opened. but [...] he affirms to be when the Tumor is opened, whether it be fistulated or no: his words are these: Aegilops abscess [...] est, qui inter majorem oculi angrlum & nares fit: qui ruptus singligatur, usque ad os Fistulam aperit. Idem, priusquam ruptum exulceretu [...]r, Apostema Anchilops appellatur. So according to the version of Albanus Torinus, Thus it may be Englished: Aegilops is a [...] Apostem between the great comer of the Eye and the Nose; which it it be neglected, it makes way to a Fistula, even to the Bone: this Apostem is called Anchilops, before it is broken. All modern Authors, who have left any Monument of Chirurgery, follow him. This kind of Fistula is called by the Neoterick. Chirurgeons Fistula Lacrymalis. By Avicen lib. 3. can. sen. 3. [Page 117] tract. 2. c. 14. the Apostem is called Kaktius, or Akilas, and the Fistula it self Garab or Alstarab. Fabricius ab aqua pendente, de operat. chirurg. part. 1. c. 21. purposely handles this matter, and Ambrose Parey lib. 6. c. 15. and Taliacotius in chirurg. curtor. lib. 1. c. 15. The place then wherein this kind of Fistula is seated, is the inner corner of the Eye: although it begin first at the holes of the upper and lower Eye-lid, from whence the Tears flow.
The signs are manifest to the Senses: for First, the Orifice offers it self to view: Secondly, by compression the Quittour issues out: Thirdly, a small Probe may be thrust within the Cavity to the very end of the Sinus.
As for the Prognosticks: First then, all these Fistula's are hard to cure; for the moistness of the place hinders desiccation, which is required in the cure of Ulcers, Secondly, the part, (while one is awake) is in continual motion, Thirdly, by reason of the niceness of the part, choice of Medicaments must be had. II. If the Quittour hath made way for it self to the inner passage of the Nose, by that hole which passeth thorow the Bone of the Nose from the corner, then we are only to procure the shutting up of the upper Orifice, and not to go about the scaling of the Bone by a fruitless labour, which will notwithstanding cost the Patient great pain and grief. III. If a Fistula in this place become cancerous, which you shall conjecture by the hard and livid brims, a stinging pain, and stinking virulent Matter, you are only to use a palliative cure, applying those Medicaments which are fit for a cancerous Ulcer, whereof in the cure of a Cancer I will speak at large. IV. If this continue long, it causes a Consumption of the Eye, called [...] sometimes blindness of that Eye, and corruption of the Air, which we draw by the Nostrils, if the Quittour pass from the Glandule, thorow the bone of the Nose to the Nostril.
Now to come to the differences of these Fistula's; some are malign, the signs whereof I have delivered in the Prognosticks. Some are not malign. Of these wherein there is no malignity, some are without cariosity of the Bone, and some with cariosity of the Bone. You shall know that there is no cariosity of the Bone. 1. If the Apostem was not long continuing before it brake; for it the Tumor was first an Oedema Scirrhodes, and continued a long time so before it brake, then it is likely that the Humor corrupted the Bone before it brake. 2. If the Probe rest not upon a part hard and rugged 3. If after dilatation of the Fistula, the cariosity be not presented to the sight. If circumstances contrary to these be offered, you may conjecture that there is a cariosity in the Bone.
To hasten to the cure of these Fistula's: If a Fistula lcebrymalis, without corruption of the Bone, be offered to you to be cured, proceed after this manner: First of all you are to dilate it: Secondly, you are to remove the callosity: Thirdly, you are to mundifie it: Fourthly, you are to consolidate it: And lastly, to cicatrize it.
You shall dilate it by the Fistula Tent framed (as I taught in the former Chapter, according to the proportion of the sinuosity in the beginning: then you shall enlarge it more by Sponges prepared with Melilot Emplaster, which I likewise set down there. This manner of dressing will discover all corners of the sinuosity. The Fistula having been thus dilated, you are to go about the removing of the Callus. Now in performing this, there is not so great liberty granted, as is in Fistula's of other parts. For First, stuid and running means having a remarkable acrimony are not safe: for passing unto the Conjunctiva, and from thence to the Cornea, they are able to erode it; from whence an Ulcer may ensue, and so the grief be doubled. Secondly, even means solid carefully must be applyed, that they go no further than the sinuosity of the Fistula. It is not unknown unto you, what horrible symptomes oftentimes afflict the Eye, by reason of a familiar Humor only exalted in degrees of acrimony: What mischief then is to be expected, if heterogeneal Bodies, endued with extraordinary sharpness, as these must be which remove a Callus, do seise upon the Membranes of the Eye, adjacent unto the part affected.
Some there are who cure these lacrymal Fistula's with liquid Medicaments, as with the water of Elder, or Wall-wort flowers, in every pint of these dissolving two drams of Mercury sublimate, or more, according to the hardness of the callosity. The proportion of mixture you must conjecture by the continuance of the Fistula, by the age of the party, and constitution of the Body. If therefore a Fistula be offered to be cured in a body young, of a short continuance, and of a tender constitution, then the water is to be mild; if contrary conditions do offer themselves, then you are to make it more strong according to discretion. If you take two parts of Plantain water, and one part of the Spirit of Niter, you shall have an excellent Topick according to the Principles of the Chymists.
One thing is to be observed, that these liquid Medicaments be sparingly applyed to the sinuosity, that no part of them touch the Membranes; to avoid the accidents whereof I spake before.
As for mine own part, I more commend the solid Medicaments than these stuid: for First, their faculty is more durable: Secondly, they are more secure, because they are not so apt to spread: If the Body be young and tender, this Medicament will serve. Take Mercur. Praecipitati, aut Turbith loti ʒ ij. Aluminis caicin. ℥ j. Exquisitè misceantur; postea ℞. Ʋnguent. pop. ℥ j. Pulveris praedicli ʒ ij. Mis. ceantur, ut resultet vnguentum. When you apply this Medicament, arming a Tent with it, pull it not out forcibly; but suffer it to pop out of it self. Continue the application of this Medicament until the Callus be removed, which you may guess, if the process of the sinuosity appear soft, and th Quittour which cleaves to the Tent appear landable.
The Callus being thus removed, you must mundifie it: To this [Page 119]purpose you shall use this local Medicament: ℞. Aq. Chelidoniae aut Rutae. ℥ ij. Syrupi è succo rutae, aut Mellis rosati ℥ i. Misc. applicetur calefactum. Dress the Fistula but once a day.
The part being mundified, which you shall know by the redness and tenderness of it: Then go about the consolidation. This you shall procure by this Medicament: ℞. Aq. Plantag. ℥ ij. Syrupi Myrtillerum. aut. Ros. rub. siccat. ℥ i. Misceantur. Apply this, and renew it but every other day, if no remarkable store of Quittour flow
As for the skinning: Diapalma cum succis, de minio, or Emplasirum rubrum astringens will serve.
If in an Aegilops or lachrymal Fistula, the bone of the Nose be corrupted by the Humour staying in the embosement, then two ways of curing are offered unto you.
The First is by actual cautery, the Second is by incision. Peruse all who have written of the curing of this kind of Fistula's, and you shall find that all with one accord subscribe to the actual cautery.
The actual cautery must represent in Figure the stone of an Olive: The parts adjacent must be defended from the fire, either by an hollow Plate according to Parey, or a Cane according to Ab aqua pendente; you may make choice of which you will: you must effectually impress it, to dry the Humidity, and the sooner to procure the scaling of the Bone. And although Authors, after the application of the actual cautery, prescribe fatty things to hasten the separation of the eschar, yet I advise you not to use them; for the part is moist of it self, and so the application of such Medicaments would procure a sordid Ulcer: Apply therefore only Pledgets or Tents dipped in Red Wine, and above all Diapalma or Emplastrum de minio, or de Smegmate. When the Bone hath cast a scale, then consolidate and skin it, as I have set down before.
It is not unknown with what difficulty Patients admit the application of an actual cautery, to a part much distant from any of the principal, and wherein there is but small sensibility. What will a Patient troubled with this grief do, if you make mention of cauterization to be made in this place, so near the Eye and the Brain it self? If at any time you make mention of such a kind of cure to a Patient, to try how he stands affected to this operation; let me intreat you not to urge it too much, as if the cure of the Fistula could not otherwise be compassed, if you find the Patient averse, lest you drive him away, and so you loose both credit and gain. When in the Countrey I practised Chirurgery, sundry times this kind of grief having been presented unto me, I ever found the Patients strucken into a terror and amazement, as soon as mention was made of Cauterization; wherefore I set my imagination at work, to find out a way to cure a Fistula lachrymaliss, less terrible, but more sure and effectual, which I will not conceal from you, because this grief doth often come to your hands, and both great credit and gain is purchased by performing the Cure.
My manner of cure is this: First of all, having with a small [Page 120]Probe bended, found out the Cavity both upwards and downwards, I draw a line with Ink between the Glandule of the Eye, and the Trochlea or the Pulley, through which the small Tendon of the first oblique Muscle called Superior, or Ma [...]or, the uppermost and greatest, passes, and ends obliquely in the uppermost part of the Cornea: then I make incision to the Bone; the part incised I divide with the Nails of the fore-singers, until the incision be so much dilated, that it will without difficulty admit a pretty Pledget: this being done, I thrust in a small Trochisk made of Turbith mineral before it be washed, the vomitive Vitriol, and the best Terra sigillata wrought with Populeum to the form of a stiff Paste, and afterward dried. About the Trochisk I apply a Pledget armed with Populeum, which I keep to the Fistula by an Emplaster of Diapalma cum succis, malaxed with the Oil of Henbane. Afterward filling the orbit of the Eye with little bolsters made or soft Linnen-cloth folded, and moistned in Aqua spermatis ranarum caphurata, I rowl up the Eye. The same dressings I use Morning and Evening, until the Trochisk with the Callus fall out of its own accord: which when I perceive, I diligently view the Bone, to see how much is carious, unto it I apply the Powder of Euphorbium, if the diseased party be aged, and of a firm constitution of Body; but if the party be young, and of a tender constitution, I besprinkle the Bone with Pulvis Cephalicus. The cavity of the part incised I fill up with a piece of the Sponge dressed with Melilot Emplaster, as I delivered in the former Chapter: about it I apply a Pledget armed with Popúleum, all which I couch down close, with the Emplasters and Bolsters kept to the Eye with a Rowler.
This manner of dressing I continue until the scale of the carious Bone casts, which most commonly falls out about the Twentieth day. When the scale is removed, I mundisie the part with Mel rosatum, or Mel rutaceum; then I procure consolidation by the Syrup of Myrtles, or of red Roses dried, And last of all I cicatrize the part affected with some epulotical Emplaster, whereof I have set down sufficient store heretofore, and shall hereafter, when I shall discourse of an Ulcer which hardly admits skinning. I have made sufficient experiment of this manner of curing an Aegilops in sundry persons. And I truely affirm, that I never missed of the Cure of any one with whom I thus dealt: neither shall you (I hope) if punctually you observe these observations in your proceedings.
And this Practice is confirmed by Hildanus, Obs. 23. Cent. 5. Who cured a Fistula lachrymalis in a Boy about Thirteen years old; he had been troubled Four years with it in his Left Eye: the Bone was not only carious, but tears, when he cryed, trickled out at the Fistula, the Gland was so much eroded. This Boy was so impatient and peevish, that an actual Cantery (which Hildanus accounts the best remedy for a lachrymal Fistula) could not be used. Therefore, having ordered his Diet, he [Page 121]purged the Patient, and made a Seton in his Neck. A few days after, when the Seton run, he applied his potential Caustick, which causes no pain. When the Eschar was fallen, he dilated the Fistula to the Bone with an escharotick Unguent, and prepared Sponge. Then he strewed good store of powdered Euphorbium on the Fistula, and upon it applied a Plaster of Gum Elemi; when these things had been used for some weeks, the Bone scaled; and when the Scale was extracted, half a drop of Balsam of Tolu was applied once a day to the Ulcer, which quickly healed up, and continued sound and firm. And a little after the Seton was dried and healed up. And by the way observe, that Hildanus in this Cure ascribes most to Euphorbium.
It may fall out that the whole substance of the Bone of the Nose subjacent to the Fistula may be carious, being of its own nature thin, and the Head of the party besides very rheumatick, so that being often cured in the opinion both of the Chirurgeon, and diseased party, yet it breaks out again. In such a case you may demand of me, how you shall fall off from such a Cure with your own credit. To this I answer, that there is yet a Subterfuge; and a way left to give contentment to the afflicted Patient: To compass this, first dilate again the sinuosity, until the corrupt Bone appear, as hath been shewed heretofore. Secondly, pierce the bone of the Nose with a Gimlet, that the Quittour may have recourse to the Nostrils, which are appointed as shoars to discharge the flegmatick excrements of the Brain, and to draw in fresh Air for the refrigeration of the Lungs: and then cure the superjacent fleshy and skinny parts, as I taught you, when I set down the palliative manner to cure a Fistula. This manner of cure being the last refuge, it will undoubtedly give contentment to the Patient: for the eyes of the beholders shall observe no deformity external in him, and he himself shall not be able to discern the turning of the Quittour from the Glandule outwardly, to the Nostril inwardly: besides this, he himself shall perceive no smell that shall offend him; the smell of Garlick is not offensive to those who have eaten of it.
Now to conclude this my discourse of a Fistula lachrymalis, if you perceive any such Fistula malign, or to tend to a cancrosity, which you shall discern by the signs set down, when I delivered unto you the Prognosticks: then use this Medicament of Heurmus the Father, set down in methodo ad praxin. lib. 1. p. 106. which he purchased both with Money and Entreaty, of one who got much Money by it.
This is the description of it: ℞. Ca [...]imin. ter [...]sti atque in vini aceto extincti ℈ j. myrrhae, plumbi usti ac loti an. ℈ ss. creci gr. v. opii gr. ij. aeris usti ℈ iiij. decocti fe [...]ugraeci ℥ j. Misceantur exquisitè omnia super lapidem picter [...]m. If you mean to make an Ointment to continue long, instead of the Mucilage of Femgreek, use new Swines-grease washed in Rosewater; [Page 122]this is an admirable Eyesalve in all Ulcers of the Eyes: (whereof I have made often trial) whether they be malign or no.
CHAP. XIII.
Of Fistula's in the Breast.
NExt to Fistula lachrymalis, Fistula Thoracis; a Fistula in the Breast doth osser it self. Of which Cornelius Celsus l. 7. Ambrosius Paraeus l. 9. ca. 31. and Fabricius ab aqua pendente de operat. Chirurgic. part. 1. c. 47. have written.
This kind of Fistula happens two manner of ways: First, by reason of a penetrating wound of the Breast.
Secondly, by a Phlegmon possessing the intercostal Muscles, and the Pleura.
It is a superfluous matter to set down any figus, seeing they appear to they Eye. and are easily found out, by applying the signs set down in the general method of curing of Fistula's, to every Fistula in particular.
As for the differences; a Fistula ensuing a wound penetrating to the Cavity of the Breast, hath but one Orifice, the passage and sinuosity whereof is according to the penetration of the wound; but a Fistula following after an Aposteme, hath frequently more Orisices than one; whereof some pass to the Cavity of the Breast directly, some windingly.
To come to the Presages. All Fistula's of the Breast are hard to be cured, and that for seven reasons.
1. For First, the Breast is in continual motion by reason of its dilatation and contraction caused by the intercostal Muscles: now, that motion hinders the curation of any Sore, it is so manifest, and confirmed by experience, that it needs no proof.
2. Secondly, because in penetrating Fistula's of the Breast, the Pleura is always ulcerate; which being thin, without Blood and membranous as the Bladder, hardly admitts any consolidation.
3. Thirdly, seeing the Virus of the Fistula doth often corrupt the Rib; and seeing the internal substance of the Rib is cavernous and so apt to lodge corrupt Matter, the difficulty of curing is increased.
4. Fourthly, in Fistula's of the Breast, the end of the Fistula is often lower than the Orifice, which hinders the expurgation of the superfluous matter.
5. Fifthly, the Sinuosity within, in penetrating Fistula's doth frequently extend it self between the Pleura and the upper Rib, to the distance between it and the lower Rib. Now how hard a matter it is to cleanse this Cavity, I refer it to your own consideration.
6. Sixthly, that liberty of applying of Medicaments, which is permitted in sundry other parts of the Body, is here denied, the Lungs and Heart being lodged in this Cavity, whereof special regard is to be had, seeing upon the safety of these parts the life of the Individuum depends.
7. Seventhly, because Fistula's bring an extenuation of the Body, and a Hectick Fever.
Let this be the second Prognostick: If the party afflicted with a Fistula in the Breast, be fallen into a Hectick Fever, and his Body begin to be extenuate, pronounce the grief to be incurable; for if you use desiccative means, which are required in curing of Ulcers, you shall increase these symptomatical griefs, and hasten death.
The third prediction Celsus delivers unto us in these words, Solent quoque, &c. Fistula's use sometimes, when they have passed by the Ribs, to corrupt the Midrisf; which may be gathered by the place affected, and the greatness of pain; in this case there is no hopes of cure.
As for the cure of a Fistula of the Breast; to it three means are required; a convenient Diet, pectoral Decoctions, and local Applications. In a Fistula, which hath caused neither a Hectick Fever, nor extenuation of the Body, a greater variety of Meats is permitted, than when these symptomes are annexed. Howsoever Meats of easie concoction, and which afford laudable nourishment, are to be appointed for the Patient, and a moderate use of them is to be prescribed: of these two means I have spoken amply enough, when I set down the general cure of Ulcers.
As for pectoral Decoctions, upon the use of which the greatest part of the cure of such Fistula's depends, you shall find divers descriptions of them in divers Authors.
The Simples whereof these Decoctions are made, are these; The Flowers and Leaves of Colts-foot, Maiden-hair, white Horehound, Comfrey, Tormentil, and Bistort-roots, Violet-flowers, Borage roots and flowers, Elecampane-roots, Hyssop, Germander, the flowers and roots of Mallows, the roots of Parsley and Fennel, Liquorice, Scabious, Valerian, Burnet, Sarsaparilla, Guajacum, China-root, Raisins of the Sun, and blew Figs: of these Simples you shall find sundry Decoctions set down by Authors, who have written of Wounds and Fistula's of the Breast.
Amongst all others, the Pectoral Decoction of Franciscus Arcaeus you may most safely and securely trust unto: He, while he lived, was so fortunate in the practice of Chirurgery, that he drew that eminent Linguist and Divine Arias Montanus, very often to be a spectator of his Operation. The Decoction I need not set down, because you may fetch it out of the Author himself, who is translated [Page 124]into the English Tongue.
I will not stick to commend unto you one of my own, whereof I have sundry times made experiment. This is the Composition of it. ℞. Sars. paril. ℥ vj. scob. guajac. ʒ v. rad. Chin. ℥ iij. rad. enul. campan. 1. capil. vener. scabios. fol. tussilag. scolopend. summitat. hyper. an. man. 1. flor. borag. buglos. viol. beton. an. pug. 1. polypod. ℥ iij. liquirit. ℥ ij. passul. major. exacinat. & sicuum pinguium incisar. an. ℥ ijss. Infundantur ista per noct. in aq. font. ferventis lib. 24. deinde lento igne coq. ad consump. lib. 8. ac coletur decoctum. Bibat aeger fingulis diebus lib. 4. Let the Patient every Morning about five a clock, drink half a pint of this Decoction warm, and so much about four a clock in the Afternoon: at Dinner let him take a Pint, and at his Supper another: the third Pint he may drink between Meals. Marvel not at this quantity, for a less will little avail; for strong desiccation is required in this Cure.
Three things hinder the cure of these Fistula's:
The First, is the inconvenient situation of the Orifice, when it is higher than the ending of the Fistula.
The Second is the extenuation of the Body.
And the Third is a Hectick Fever: Of these in order.
If then the ending of the Fistula be lower than the external Orifice, a lower Orifice is to be made by incision. In this operacion two things are to be diligently noted: The First is the place. The Second, the cautions to be observed in the Section.
As for the regions of the Breast: The Left Side is safer than the Right: for in this Side the Liver by its gibbosity beareth up the Diaphragma, and insinuates it self to the cavity of the Breast: If then either one of these, or both should be wounded imprudently, it is an easie matter to prognosticate the tragical event of this operation.
As for the determinate part of the Breast, which is to be opened, let it be about the beginning of the next Rib, and not at the lower end of that Rib, above which the orifice of the Fistula shews it self; for under it are couched a Vein, a Nerve, and an Artery.
In your Section proceed thus: First, divide the Skin towards the upper part of the lower Rib, then make way thorowout the intercostal Muscles: These things being done, dry all things with a Sponge, and put into the new Orifice a swelling Sponge, both to dilate it, and to draw to it self the Quittour. If you go thus to work, you need not fear any danger, if you pass no further than the division of the Pleura: so that neither the Diaphragma, nor the Lungs, nor the Pericardium be touched.
If with a Fistula of the Breast a Marasmus or Hectick Fever be complicate, the difficulty of curing is exceedingly increased; two Diseases joyntly conspiring to the ruine of the diseased Party, which notwithstanding for their Cure require adverse indications, the Fistula requiring Desiccation, and Marasmus, and the Hectick Fever craving Humectation. If then a Fistula of the Breast be offered to any one, First of all be sparing in [Page 125]your promises, lest ye be accounted Clouds without Rain: who but an Ignorant will give free reins to liberal promises to cure a Fistula of the Breast, complicate with other Deutero-pathetical griefs, of their own nature hard to be cured, when as it is a difficult matter to cure a Fistula of the part?
Marasmus, in Latine Authors Marcor, is an immoderate driness and consumption of the whole body. by reason of the defect of the substantial Humidity, according to Trallianus. According to Galen. li. de marc. there are two degrees of it: The one is when this extenuation of the Body is in Fieri, in consuming; the other is when it is in Facto esse, or consummate.
If it be in Fieri only, the Muscles begin to fall, the Skin bebecomes flaggy and loose, strength and agility decay, and the party finds a manifest defect, and impotency in all the actions of the Body, whether they be animal, vital, or natural. Against this degree you may contend by instituting a Diet moistening.
If a Marasmus be in Facto esse, or consummate; then the Eyes grow hollow, and seem to be hid in the pits; the lively colour of the skin fades, the skin of the Forehead seems dry, and stretched like the head of a Drum; the Eyelids seem heavy, and scarce able to lift themselves up, as it happens to those who are wearied by reason of watching; the Temples are hollow: in the cavities of the Breast and Belly, one would think that there were neither Viscera, Members contained, nor Guts: for the Muscles are so consumed, and the Cavities so drawn in, that nothing seems to remain besides the Fibrae and the Skin. To conclude, one having a consummate Marasmus seems to be nothing else but a walking Skeleton. Whosoever shall undertake the cure of such a one, and perform it, I will give him leave to give himself out for another Saviour, and to publish a Fifth Gospel.
A Marasmus is two-fold: for one is accompanied with heat, and may be called a dry Marasmus, and this is nothing else but a Hectick Fever, which has consumed the radical moisture of the solid parts, and it is called [...], or an extenuating Fever.
The other is accompanied with Cold. This is two-fold: The one is natural, and it is decrepit old age: for old age is defined by driness and coldness.
The other is unnatural, and it is called Senium ex morbo, a decay by reason of sickness: old age comes by the course of time.
This last is of a violent cause, for it follows after a burning or a Hectick Fever; and that by reason of the sickness it self, or by reason of Medicaments used in the curing of the afore-named griefs: for a Hectick Fever does not only wast the natural Humidity, but the natural Heat also seated in the Humidity: wherefore the Heart it self, the wel-spring of this heat, must become colder than it ought to be. In this case the Pulse is small and weak, and slow: in like manner the breathing is weak, slow and cold. By reason of the use of refrigerating Medicaments appointed by the Physician in curing of a Hectick, or a Febris [Page 126]Marasmodes, many times Senium ex morbo succeeds: and this is more intolerable, because, the heart being somewhat immoderately cooled, the less of the Radical Moisture is spent, than would be, if the Hectick had its full course.
A Hectick Fever, is an unnatural heat which has seized upon the solid parts, and wastes the Moisture of them. But seeing there is a three-fold Moisture in the Body: to wit, Blood in the small-Veins and Arteries of every part, a dewy substance in every part by which it is nourished, and gluten which keeps together the Terrestrial substance of each part, moistens it, and keeps it from falling to dust:
There are also three degrees of a Hectick. In the beginning when the two first Humidities begin to fail, the Hectick Fever is not easily discerned, although it may be without great difficulty cured: But if the Radical Moisture be consumed, as it is easily discerned, so it is hardly cured. As long as this Moisture is somewhat plentiful, sufficient to entertain the Natural Heat, the Body seems well coloured, of a comely Figure, and of a decent quantity.
If therefore you perceive the Body of any one having a Fistula in the Breast, by reason of the defect of this gluten, or Radical Moisture, become discoloured, the Figure to be altered, some parts bunching out, some growing hollow, and the thickness of the Members to become slenderer, the Flesh colliquating; leave such a one to himself, that he may march peaceably to the period of his life.
Having treated of a Marasmus or extenuation of the Body, and a Hectick Fever (so much as is expedient for you to know in your Chirurgical Practice) without the knowledge of which, you cannot possibly proceed, warily and circumspect, in curing Fistula's of the Breast, I am to shew you what uses you may make of what hath been delivered.
If therefore one having a Fistula in the Breast, be brought unto you, whose Body seems to be nothing else but Skin and Bone, (as the vulgar proverb is) acquaint him with the danger wherein he is, lest death seize upon him unprepared. Nevertheless if he implore your aid of Christian Charity, withdraw not what comfort you are able to procure unto him; appoint then a Diet moistning and nourishing, if no Physician be at hand, which I will set down anon; and dress him with those Medicaments, which are anodyne and healing. Inject into the Fistula Plantain-water, having some red Rose-leaves dried mingled with it; cover your Tent and Pledget with Diachylon simplex. If you perceive that there is so much of the Radical Moisture remaining as is able to cherish the Natural Heat (which you shall discern, if the colour of the Body be fresh, if the Figure be decent, if the proportion of the parts be according to Nature, and the diseased party can in some good measure perform all actions) you may conceive some hope of his recovery.
Wherefore if a Marasmus has extenuated his Body, appoint for him a Diet which is likely to repair [Page 127]the Natural Moisture impaired. Let him then take Broths made of Mutton, Veal or Chickens, wherein Damask Prunes, Raisins of the Sun stoned, Currans washed and bruised, Mallow-flowers and Roots, Marigold-flowers, Cinquefoil, Cowslip-flowers, and Colts-foot-leaves and flowers have been boiled: Gellies are good, made of young Cockrels, and a Knuckle of Veal; use no other Spice to it than a little Mace and Nutmeg. Let him between meals take Almond-Milk made of Broth of a Chicken boiled with French-Barley. It is good for him also every Morning and Evening, to take a draught of Asses or Goats Milk: or in want of these, of Cows Milk, milked thorow the Conserves of Borrage, and Bugloss flowers; Calves and Sheeps-feet stewed with Currans are good: sometimes let him eat Pigs-flesh. If he have a mind to Fish, grant unto him Whitingmops, Smelts, Perches, young Pickerels, Trouts, yea sometimes Eels: the Sole, Flownder and Plaice may also be permitted; poched Eggs, and sweet Butter without any Salt, or Almond-Butter, are good for break-fast.
If an extenuation of the Body do proceed from an Hectick Fever, then you must not only moisten the Body, but cool it also. In the Broths then boil Borage, and Succory Roots, common Sorrel, wood Sorrel, Primrose, Violet, Borrage, and Bugloss-flowers: let his Sallets be Lettuce, Spinage, and Purselain boiled in Chicken-broth. An Almond-milk made of the decoction of French Barley, wherewith the Emulsion of the Seeds of the Pompion, Musk-melon, Cucumber, Purselain, and White Poppy has been drawn, is excellent taken Morning and Evening. Permit no Milk but Butter-milk, and that when it begins to be a little sowrish, with a little of Sugar, or Borage, or Bugloss. If the diseased party complain of immoderate heat, and watching, give him twice a week Philoninum Persicum, with Syrup of white Poppy, red Poppy, Gilly-flowers, Maiden-hair, Colts-foot, or of the juice of Limons, or Citrons in Aqua Spermatis Ranarum or red Poppy. If you perceive that by the following of these courses the party has recovered his strength, and a good habit of Body, then you may conceive a good hope of his recovery, and put him in good comfort, and so boldly proceed in the Cure, still endeavouring by following the Indications (as Thescus did the Thread of Ariadne to come out of the Labyrinth) to restore perfect health to the Patient.
In setting down of local Applications I will be brief, because they little differ from the general, if you except a few observations. You may safely dilate a Fistula of the Breast, with the Fistula Tent and Sponge; but in removing of the Callus you must he wary; for if you apply the Trochisk, it must not reach to the Cavity of the Breast; for the point of it will relent, break, and fall upon the Septum transversum, which undoubtedly will erode it, cause an Inflammation, procure a sharp Fever, a Paraphrenitis, and at last death it self. Apply then a Tent armed with Populeon, wherewith [Page 128]the Fistula Powder must be mingled, as hath been taught. The Callus being removed, mundifie the Ulcer with Aqua calcis, and Mel rosatum mingled together: Take heed that you inject no bitter Medicament, for such Medicaments are easily sucked in by the Lungs, from whence by the Trachaea Arteria they easily pass to the Throat and Mouth, from whence there is felt a horrible bitterness, a desire to vomit, and an overthrow of the Appetite, Paraeus lib. 9. c. 13. affirms this to have happened unto him twice, be you ware by the example of others. The Ulcer having been mundified, proceed to consolidation; for sores in this part are not to be long kept open: This you shall procure by injecting two or three days the Syrup of red Rose-leaves dried, mingled with Plantain-water; and then only moistning a Pledget wet in this Syrup, or the Syrup of Myrtles. Above the Pledget apply Paracelsus his Styptick Emplastrum; for in this case it exceeds all others: because it not only draws the brims together, but it skins also.
CHAP. XIV.
Of Fistula's in the Belly and Joynts.
FIstula's of the Belly are two-fold: for they are either in the Inguinal parts, or else in Ano.
Of these in the Groins I will discourse; because they most frequently fall out, being Accidents, for the most part, which ensue after Venereal Bubo's, either neglected, or ill cured; yea, they fall out in Plethorick and Cacochymical Bodies very often, wherein there is no Neapolitane Seed: and that somewhat above the Emunctory it self; the Matter not coming to the Emunctories themselves, which receive the Excrements of the Liver; but being hindered, either by reason of the weakness of the expulsive faculty, or by the crossing and thwarting of the Muscles, oblique and tranverse in those places, as they who are skilful in Anatomy well know. It is no wonder that both Abscesses, and Fistula's often fall out in these places, seeing the Belly is as a Draught or Sink in a House, or a Keel in a Ship, whither all impurities flow. Yea, such plenty of sharp Humors sometimes flows to these parts, that perforation of the Guts is caused, and that the Excrements come out at the Orifice of the Fistula; a lamentable case, noisome to the diseased party, and intolerable [Page 129]to the company. It falls out sometimes that some of the Vertebrae of the Spina are corrupted.
As for the Presages: Fistula's in these places, which pass to the Cavity of the Abdomen, are hardly cured.
First, because the Liver is still apt to afford new Matter.
Secondly, because great circumspection is to be used, if you shall use either Incision, or Corrosive Medicaments, by reason of the Fibrae of the Muscles, and the branches of the Vena cava, and Aorta descending.
The second Presage is this: If the Vertebrae of the Spina be corrupted, pronounce the Fistula to be incurable: you shall conjecture the Vertebrae to be foul, if extraordinary store of stinking Sanies issue out of the Fistula, and the party daily grow weaker, and more extenuate, notwithstanding that you use all convenient both internal and external means.
The third Presage shall be this; If the Guts be eroded, and the Excrements come out at the Orifice of the Fistula, the life of the diseased party is in great hazard: because the Guts are thin, membranous, and destitute of store of Blood.
Secondly, because the Fistula is apt to creep thorow the distances between the Muscles, which in those places are many; to wit, the oblique and transverse, one placed above another.
Thirdly, because in curing such Fistula's, we find little help of Hand and Eye.
Fourthly, because topical means can hardly be kept to the Guts, to help consolidation.
As for the Cure of these Fistula's: If they be not deep, but run along superficially, the best course is to make incision, and then to apply one of the Fistula Powders described by me, care had of the age and constitution of the party.
As for the Mundification, Consolidation, and Cicatrization of such, seeing no special observation is required, you are to have recourse to that, which I have copiously delivered heretofore. If the Vertebrae of the Spina be foul, you are to promise no Cure.
Nevertheless, if persons of worth will (upon good consideration) entertain you to dress them, they finding a comfort by your pains, make an injection of Plantain, or Carduus Benedictus Water, adding some fragrant Water of Medow-sweet, the Syrup of red Rose-leaves dried, and the Spirit of Wine, having the tincture of Aloe, Myrrhe, Mastick, and some Saffron. Let your Emplaster be Diachylon cum gummi, or Paracelsus his Styptick. If the Guts fall out to be perforated, having acquainted the friends of the party with the danger, yet despair not, but go on, and use Methodical means. Let the party eat Calves and Sheeps-feet stewed, Sheeps and Calves heads; for they afford a glutinous juice; Rice boiled in Milk, wherein Steel hath been often quenched, is also good. Every Morning and Evening let the party take a draught of Allegant, warmed with a Wheat Toast, when he has drunk off the Wine, let him eat [Page 130]the Toast. Make injection of red Wine, having a little Alume dissolved in it, and some of the Syrup of Myrtle-berries: keep the Orifice open with a Sponge, until the Gut be consolidate: then proceed to the extirpation of the Gallus, Mundification, Consolidation, and Cicatrization, as has been heretofore taught. Event oftentimes falls out above expectation.
Not long ago a Country Youth, who had an Enterocele, was bound to a Barber in Aldersgate-street; one applying to the Rupture a Truss somewhat strait, caused a Sideration or Mortification of the part, so that the Excrements came out plentifully, with much stinking Matter out of the Cavity of the Belly. Notwithstanding, by diligence and application of convenient means, the Gut was consolidate and the Youth kept alive. So much I thought good to deliver concerning the Cure of Fistula's, which happen in the Inguinal Region.
Now it follows, that I speak of Fistula's in Ano which was said to be the second kind of Fistula's invading the Abdomen, or the lower Belly.
This kind of Fistula very often follows after a Plegmon in the Anus, broken and ill cured.
There be two sorts of these Fistula's, for some pierce not the Intestinum rectum, and some do: and both these are either shallow or deep.
You shall conjecture the Fistula to pass thorow the Intestinum rectum: First, if after breaking of Wind, part of it make way thorow the Sinus of the Fistula.
Secondly, if the Excrements appear mingled with the Quittour, or if the Quittour smell as the Excrements use.
Thirdly, injection being made at the outer Orifice of the Fistula, if part of it pass within the Anus.
Fourthly, the foregoing being put into the Anus, if you feel the Probe bare, it being thrust thorow the Sinus of the Fistula, this is an infallible and certain sign.
As for the Presages of these Fistula's: First, no Fistula ani is easie to cure: for this part being the Jakes of the Body, it affords great plenty of Impurities, and much superfluous Moisture, which hinder the Cure.
Secondly, if a Fistula in this place be not very painful and noisome, by reason of much stinking Quittour, but shuts and opens it self sundry times. It is expedient for the health of the Patient, if such a one be left uncured: for by this means the Body is discharged of superfluous Humors, and the Body kept in health. I have known this Accident to have happened to sundry, and to have continued to the end of their lives.
Now to come to the Cure of these Fistula's: The means to attain this are five: Diet, internal Medicaments, Incision, Deligation and Topical means.
As for the Diet, and internal Medicaments, I have discoursed sufficiently heretofore.
As for Incision and Deligation, they have place when the Fistula is shallow; but if the Fistula be [Page 131]deep, neither of these means are to be attempted.
If therefore the Fistula be shallow, and pass not to the Intestinum rectum, after you have dilated it, and removed the Callus, upon a Tent, incise all the hollowness: then fill it with Dosels, armed with a Medicament made of a restrictive Powder, and the white of an Egg, to keep the brims of the incised parts asunder; for if you go about to unite the parts too soon, it may be feared that a Cavity will still remain, and make way for Recidivation: wherefore it behoves you, to see that sound and laudable Flesh be ingendred in the bottom. Let not your incarnative Medicaments be satty, for such will cause loose and spongy Flesh: use therefore the Sanative Syrup made of vulnerary Plants, having some Pulvis cephalieus mingled with it. If the Fistula go deep inwardly, so that you cannot use conveniently incision, dilate the Fistula with the Fistula Tent, and the Sponge: then remove the Callus with a Fistula Trochisk; the Trochisk being come out, and the Callus quite spent, mundifie it with Mel rosatum, mingled with Aqua calcis: when you perceive laudable Quittour, endeavour to consolidate the part, by applying the Sanative Syrup, and Pulvis cephalicus upon the Tents, which you must day by day shorten, until at last the whole Sinus of the Fistula is shut up; which you shall conjecture by the little and laudable Quittour which the Fistula yields. Then nothing else remains, but to cicatrize the part with your Diapalma, or Ʋnguentum de minio.
If the Fistula penetrate to the Intestinum rectum, then cutting asunder of the whole Sinus of the Fistula by deligation is most fit. But first of all, you must dilate the Sinus, and remove the Callus (as has been said) for so the part which is to be bound will be more thin, and so more easily cut asunder. As for the Thread wherewith you are to bind the Sinus, two I commend unto you: First, Sealing Thread, which is made of the best Hemp, unboiled, and unwhitened: For is is exceeding strong, and will not rot before it hath wrought its effect. The second, is a strong Thread of Silk, twisted; there is no great Matter in the colour, whatsoever scrupulous Authors affirm: you may use either of these as opportunity shall be offered.
When you go about to bind the Sinus, put in one end of the Thread in the Eye of a small and flexible Probe, then thrust the Eye with the Thread thorow the Sinus into the Intestinum rectum: this being done, put into the Anus your Finger, and with it pull the Thread out of the Eye of the Probe, and draw it out at the Anus, or having bent the Eye of the Probe, bring it without the Anus, and then putting the Thread into the Eye, draw that end thorow the outer Orifice of the Fistula. If the Sinus be not very thick and long, you may by one strong Deligation bind off all the Sinus; but if the Sinus be thick and long, you must use sundry constrictions, tying still the ends of the Thread with a running knot, that it may be the more readily loosed. Some [Page 132]after one Deligation only more and more draw in the ends of the Thread, with a round piece of a Stick turned about. When all the Sinus after division by Deligation, lies open, go forward in the Cure, as has been set down, when the Sinus was incised. Job à Meek'ren in his Obs. Medico-Chir. Cap. 61. recites the following Case: ‘Francis Volkertsen, a melancho [...]k Man, after a great commotion of Mind, felt a defluxion run along his Back down to his Rump, and from thence to the meeting of the Buttocks, where the Intestinum rectum lies upon the Os Caude. Presently a swelling arose, which perforated the fat, the edge of the Muscle Glutaeus, and the Intestinum rectum. When I came to the Patient, besides the Fever I considered the violence of the Pain, the hardness of the Tumor, its redness and extension. And because I knew these and other symptoms must be ascribed to the Tumor, I presently applied this Cataplasm, to promote Maturation; ℞ Rad. Alth. Bryon. Lilior. alb. an. ℥ jss. Fol. Malv. Bismal. Violar. a. M. j. Flor. Chamaem. M. ss. Sem. Lin. ℥ ss. Coquantur & contundantur, addendo Faenugr. Sem. Lin. a. ℥ ij. Axung. porcin. q. s. Butyr. recent. ʒ j. Vitell. Ovi n. j. M. f. Cataplasm. I applied it hot to the Tumor. The second day I thought it advisable to open it, and a great quantity of foetid purulent Matter ran out. Afterwards I observed Wind and Excrements to come out at the Tumor, whence I concluded, the Gut was perforated. I applied several things to regenerate Flesh; but to no purpose. Therefore I was forced to Incision, in which I was obliged to cut the rest of the Gut that was sound, the Skin, and a Musculous portion of the Gut. When the dissection was done, because there was a grievous flux of Blood after opening of the Haemorrhoidal Veins, I applied an ordinary Astringent to the Wound. The next day I found less Pus than usual in the Wound. All things promised well and so they succeeded: for he was perfectly sound.’ Now nothing remains to conclude these discourses of Fistula's, but to speak somewhat of the curing of Fistula's in the Joints. These griefs, what pains they procure to the Patients, and troubles to the Chirurgeons who dress them, it is so well known to those who have been imployed in such businesses, that I need not use many words to perswade any to believe this: experience hearing witness.
The differences of the Fistula's are these. Some are without corruption of the Bones and Cartilages, and some have these annexed.
Again, some of these are without any Tumor of the adjacent parts, and in some there is a remarkable swelling of the parts adjacent; so that the Skin it self is either brawny and hard, or loose and Oedematous; and some of the Tendons of the Muscles are foul, and corrupted very often: such Tumors often fall out, when Fistula's happen in the Wrists and Ankles.
Thirdly, in some of these Fistula's the Joint abides firm; but in some it becomes loose and weak [Page 133]by reason of the relaxation of the Membrane which covers it, and the Ligament by which it is strengthened.
Before I come to Prognosticate of the Events, let me acquaint you with one thing, and that is this; that if ye be called to Children or Young Persons troubled with a Fistula, or Fistula's in the Joint or Joints, that you make trial of the Sinus with a Mallow stalk answerable to it; for this kind of probation is of all others less painful, and will incourage the diseased persons to commit themselves to your care, when they perceive that you searched the Sores so easily, hoping that your proceedings will be according to your beginning. The small stalk of the Mallow next to the Leaf is always slimy and flexible, and so is apt to slip into the Sinus, causing either no pain, or very little.
As for the Presages: 1. No Fistula of the Joint, although it be without corruption of the Cartilages or Bones, is of an easie Cure: for first by reason of the pain, which is caused by reason of the sensibleness of the part, and the increase of it by reason the sharp Medicaments which must be applied to remove the Callus, symptomatical Fevers, loss of Appetite, watching, extenuation of the Body, and at last a Hectick Fever may be procured.
2. If a Fistula of the Elbow or Knee have corruption, either of the Cartilages or Bones, annexed, it will require long time to have it cured: for the joints themselves being very sensible, it must be gently dressed.
3. If in Fistula's of the Wrist the bones of it, or of the back of the Hand, be carious, you shall find the Cure to be difficult: for these Bones are very spongy, apt to receive superfluous Humidity, and so are hard to be scaled.
4. For these same Reasons, the Bones of the Joint of the foot, and the Instep are hard to be cured.
5. If Fistula's in the Wrist or Instep be accompanied with large and hard Tumors of the Bands and Feet, pronounce the Cure to be uncurable: for then the Membranes, Tendons of the Muscles, and Bones commonly are corrupt.
6. If an extenuation of the Body, or a Hectick Fever do accompany Fistula's in the great Joints, shun the Cure: for the Indications of curing, which prescribe drying and cooling, in drying increase these griefs. Besides this, complicate Diseases are more hardly cured then those which are solitary.
If you shall demand of me, what course is to be taken with those who are possessed with such incurable Fistula's, If you be intreated of the diseased party, or the parties friends to do your best?
I answer, that if after some trial, you perceive the party to be incurable, you ought to move the party to suffer extirpation and dismembring of the Limb, whether it be Foot or Arm, before he grow weak, and become unable to endure any such operation. In young persons you may attempt this operation (for I have adventured it with good success) but in aged and crasie persons be not too [Page 134]bold; for the loss of the Radical Moisture is more easily, by Diet and Medicaments, restored in those, then these: the other may, but these must die.
Now to come to the Topical means, which are convenient for the curing of Pistula's in the Joints (for as concerning the Diet, and internal Medicaments, I have spoken of them sufficiently already) you must note that you must have good Anodyne Cataplasms to asswage pain, and good, easie, and effectual means to remove the Callus. If you apply Mercury sublimate, or Arsenick to remove the Callosity of Fistula's in the great Joints, you shall always cause a symptomatical Fever, and sometimes a mortification of the part, if the party be of a Cacochymical constitution.
As for the means which mitigate pain, I commend unto you Fallopius his Cataplasm, which he describes in his Treatise of Ulcers, c. 17. And it is this: ℞ Ol. Lumbric. Chamaem, & Aneth. an. ℥ ij. Furfur. flor. Chamaem. Farin. hord. Oesypi. an. ℥ ij ss. Vini Allcgant. ʒ x. Etat. Cataplasma. Renew it every twelsth hour.
As for the removing of the Callosity, no Medicament is comparable in parity with the Powder of Turbith Mineral before it be washed, being mingled with Terra Lemnia sigillata, Oriental bole, and the vomitive Vitriol; this composition may be applied, being made up in form of a Trochisk, or mingled with P [...]puleon, and applied upon a Tent. This Medicament, neither procures extraordinary Inslammation, nor any horrible symptom.
As for the Mundification, Consolidation, and Cicatrization of any Fistula in the Joints, after the removing of the Callus, seeing these intentions may be compassed by the means which I have delivered to you before, I will cease to trouble you with the Repetition of them, and so will conclude this Treatise concerning Fistv [...]a's.
If in Fistula's of the Joints there be Cariosity of the Bones, I will deliver the means to obviate this Accident, when I shall discourse of the Accidents of Ulcers, before I make an end of this subject.
CHAP. XV.
Of an Herpes exedens.
HAving delivered unto you, what I thought pertinent of compound Ulcers without Malignity, Method requires that I speak fully in like manner of Malign Ulcers.
Malign is that, which differing from ordinary Ulcers, is not easily cured. By Gal. de Crisib. l. 1. c. 3. not Ulcers only, but all Diseases which have a Malignity annexed to them, are called [...], and [...]. As a mild Grief has a mild Cause, and no horrible or extraordinary symptoms, and yields to ordinary Medicaments; so that which is Malign has a fierce Cause, extraordinary symptoms, and yields not to ordinary Medicaments. These Malign Ulcers do happen, when such a [...] hath possessed the ulcerate part, that it corrupts the good nourishment which is sent to the part affected. The Aliment sent to the part is corrupted, either by putrefaction, or a venenious quality communicated.
First, Then the signs of a Malign Ulcer are three: First, it corrupts the part which it invadeth, either by Putrefaction, or a Malign fretting quality.
Secondly, It causes extraordinary Symptoms, as pain and plenty of virulent stinking Matter.
Thirdly, It yields not to ordinary Medicaments.
The differences of Malign Ulcers are these: First, these Ulcers are either Ancient or Modern. I call these Ancient, whereof mention is made by the Antient Authors: those I call Modern, which were only known to late Writers: such are those Ulcers which appear in scorbutical, and pocky persons, whereof I mean not to speak in this Doctrine of Ulcers, because they are symptoms of the Scurvy and Pox, which cannot be cured unless the Griefs themselves be cured. Now the setting down of the Cure of the Diseases, will require large and particular Treatises.
Of malign Ulcers known to the Ancients, some are less Malign, some more Malign.
Of the less Malign there are three sorts: Herpes exedens, Phagedaena and Nome. Herpes exedens, [...] in Greek, being caused of thick and sharp Choler, it corrodes the Skin even to the subjacent musculous Flesh. It differs from Phagedaena, because [Page 136]it erodes the skin only; but Phagedaena, both the skin and subjacent flesh. Celsus lib. 5. and c. 28. thus describes it: Herpes. fit cum cutis exulceratione, & est sine altitudine, latus, sublividus, inaequalis tamen, mediumque sanescit, extremis affectis, &c. That is, a Herpes is caused when the skin is ulcerate. It is not deep, but broad, of a livid colour, uneven notwithstanding, and the middle heals, the bruns remaining sore. Wherefore if you perceive an Ulcer to spread and cause sundry other small Ulcers, which reach no deeper than the skin, you may pronounce it to be Herpes exedens, or Formica ambulativa; or Corrosiva.
One thing is to be noted in the words of Celsus, that a Herpes exedens may be of a livid colour; and so with thick and corrupt choler that melancholy must be joyned, which is bred of Bilis atra, and so it must somewhat participate with a cancerous Ulcer. And in truth such Ulcers often shew themselves in old persons about the beginning of the tails of the Muscles of the Legs; and from these a moist, noisome and stinking virulent Matter will flow, and the Ulcer it self will be very painful, and rebellious.
The signs then of a Formica corrosiva are these: It only corrodes the skin, and so is not deep, but broad; uneven it is, and sometimes of a livid or leaden colour, if Melancholy caused of Bilis atra be joyned with thick and putrid choler: otherwise the brims of this Ulcer, and the parts adjacent are of a yellowish colour, bewraying the Humor, which is the material cause of this kind of Ulcers.
As for the Prognosticks: First, that Herpes exedens, which is caused only of thick and putrid choler, is not easily cured. For First, the Body which is troubled with such an Ulcer, is not so soon altered; for the Liver, the Gall it self, and the Porus bilarius must be much out of frame, when they cannot make shift to dispatch this Humor, by the passages appointed for the Evacuations of it; to wit, by the Guts, and passages of the Urine; but suffer it to pass by the habit of the Body by the Vessels which carry nourishment; to wit, Veins and Arteries.
Secondly, because this Humor being altogether contrary to Nature, it causes a [...], or ill Constitution of the part, by which the profitable nourishment which is sent to the part, for preservation of it, is corrupted: and so not only the part affected is defrauded of Aliment, but the parts adjacent also are drawn to the same society of corruption.
Let this be the third Prognostick: If a sincere Herpes exedens proceeding only of thick putrid Choler, be hardly cured, as hath been proved; then if Bilis atra be annexed, surely the cure must be much more hard; for this is a Humor, which causes more fearful symptomes; as extream pain, greater corrosion, and rebellion to ordinary Medicaments: and if the Body has gotten a habit of breeding of it; it is hard, without regeneration, to reduce it to its natural constitution, and to hinder the provent and increase of it. Alchymists promise much, but for [Page 137]the most part they prove Clouds without Rain.
The Alchymist will have the efficient and material causes of all Ulcers, to be the superfluity of the Salt of the natural Balsame of the Body, consisting of a due proportion of Salt, Sulphur, and Mercury.
This superfluous Salt being separate from the natural Balsame by the expelling faculty, it is turned sometimes to one, and sometimes to another part of the body, according as it is apt no be moved, according to its thinness or thickness, volatility or fixation.
It setling in the part, is more coagulate and calcined (the expelling faculty not being able to expel it by the Pores of the Skin) and so it acquires a certain corrosion, and is the cause of those Ulcers, which have no maligne quality accompanying the Salt. They will have a volatil and subtil Salt, such as is in the Nettle, and crowfoot, to be the cause of an Erysi [...]elas, and Herpes miliaris; but a thicker and more fixed Salt, such as that is of Vitriol, to be the causes of these Ulcers which corrode the parts adjacent: such a Salt then as is not very thick, and throughly fixed, they will have to be the cause of Herpes exedens: but such a Salt as is dense and thick, and throughly fixed, having some malignity, to be the efficient cause of a Phagedena and Nome. This is their Philosophy, concerning the efficient and material causes of these Ulcers. And in truth it doth sit [...]ly represent to the eye of the understanding the nature of the Humor, which dogmatical Physicians will have to be the causes of Ulcers. It is no heresie to maintain either opinion; but he deserves both credit and gain, who shall perform the cure of those Ulcers, which he takes in hand. Most Patients require rather speedy and easie cure of their griefs, than learned discourses of them. Howsoever, these discourses are requisite for you, who meeting sometimes with scrupulous Physicians and Patients, shall be drawn to shew your Theorical as well as your Practical parts.
As for the cure, Three intentions are required to cure a Herpes exedens: The First is, that the Humor which slows to the part be stayed. The Second is, that the Humor which is impacted in the part, be evacuated. The Third is, the Cure of the Ulcer it self by convenient means.
The first intention, which is the staying of the Humor from flowing to the part affected, is performed by purging of the Body from thick choler, and Bilis atra, if the Formica corrosiva be of a livid colour. To this purpose prescribe such a Potion: ℞ electuar. lenit. ℥ vj. pulver. sancti. ʒ j. aq. endiviae ℥ iij. Misc. ut fiat potio. Or if the Patient be of a dainty tast, and loath Electuaries and Powders, then such a potion as this which I will set down will be convenient: ℞ rhab. ʒ j. fol. sen. ʒ iij. zinzib. ʒ ss. spicae ℈ ss. Infundantur ista per hor. 2. in aq sont ferventis ℥ vj. deinde lento igne exhalent ℥ iij. ao coletur decoctum, in quo dissolve mannae & syrupi de cichor. cum rhab. dut syrup. Augustan. an. ℥ j. [Page 138] Misc. ut fiat potio. If the Body of the party troubled with the Ulcer, be plethorick and cacochymical, it is convenient that he take a purgative Decoction for sundry daies together. I will set down such a one as a pattern; according unto which you may frame unto your selves, others like unto it in efficacy. ℞, rad. cichor. malvar. borag. an. ℥ j ss. polypod. querc. ℥ j. flor. borag. bugloss. viol. an. pug. 1. sol. sen. & hermodactyl. an. ℥ ij. semin. anisi & foenicul. dule. an. ʒ vj. rhab. ʒ vj. liquirit. ℥ jss. Infundantur infundenda per noctem: in aq. font. fervent. lib. 8. sequente die adjectis reliquis, coq. ad medias, ac coletur decoctum, quod aromatizetur cinam. ʒ vj. sumat aeger mane lib. ss. ac tantundem hor. quartâ pomeridianâ. Between ten and eleven a clock in the Morning, let the Patient take some broth without Bread, or a Caudle, or Aleber [...]ie. These Medicaments must be ministred cold in the Summer time, and warm in the Winter.
The Second intention in curing of Herpes exedens, was said to be the vacuation of the Humor impacted in the part. This is effected by cathaeretical Medicaments, or such as correct spongy flesh: they are sharper than the strongest Mundisicatives.
In the Monuments of the Ancients, we find the Trochisk of Andron, Polyides and Musa, exceedingly commended in such fretting and creeping Ulcers: which I will set down both to ease you of the enquiring of them, and the better to apprehend and understand them. The Trochisci Andronis are thus described: ℞. malicorii. ʒ x. alumi [...], ʒ iv. vitriol. ʒ xij. myrrh. ʒ iv. thur. aristol. rot. gallar. an. ʒ viij. sal. ar. moniac. ʒ iv. siat ex omnibus pulvis, Trochisci Polyidae are thus set down! ℞. malicor. ʒ vj. myrrh. ʒ viij. alumin. ʒ v. thur. ʒ iv. vitriol. ℥ iij. The Trochisci Musae receive these things: ℞. alum. aloes. myrrh. vitriol. an. ʒ vi. croci. ʒ iij. malicor. ʒ iv. I should advise to calcine both the Alume and Vitriol, which enter into those Trochisks; because they more strongly dry than those which are uncalcined. No substance is so fit as Ʋnguentum pepuleum to make up the Troch [...]sks; When you are to use these Trochisks; you are to beat some of them to a subtil powder, and to mingle some of the Powder with some convenient Unguent, taking a dram of the powder for every ounce of the Unguent: but what Unguents are most fit you shall hear anon. These are the magistral means which the Ancients used in curing spreading Ulcers.
The modern and neoterick Chirurgeons, not contented with these, have found out other means not inferiour to these: The one is Mercurie precipitate, first nobilitated by John de Vigo, and since his time much used by all famous Chirurgeons. This powder being washed with Plantain and Rose-water, and mingled with sarcotical Unguents, doth admirably heal rheumatick Ulcers in tender persons. If it being unwashed be mingled with Alume calcined, taking two drams of it, and one dram of Alume, it is a catheretical Medicament, and fit to be applied to foul and spreading [Page 139]Ulcers, such as Horpes exedens, Phagedaena, and Nome are. The other Medicament invented by the [...]ate Chymists, is the Turbith mi [...]eral precipitate by the Oil of Sulphur, or Vitriol; it is now much used both in the practice of Physick and Chirurgery; it is ministred with good success to persons, infected with the Neapolitane Lues; if they have either Cephalaea Gallica, ex [...]ream pain in their Heads or venere [...]l Ulcers. After that precipitate and [...]alcined, it is very white, and is on [...]scharo [...]ical Medicament, far surpassing either Mercurio sublimate or Arseniok: for it is more safe, and [...]s not so painful; besides this, it doth not cause such inflammation as these do, neither doth it pro [...]ure so promptly symptomatical Fevers. Being washed, it is used to work these effects which Mercury precipitate doth, but much more effectually. To cause these Medicaments to evacuate the peccant Humors out of the parts affected, [...]ou are to mingle these with Pa [...]acelsus his Mundificative; taking for every ounce of the Unguent, a dram either of the Mercury precipitate, or of the Turbith mineral washed, if the parties grieved be of a tender constitution: or a dram of either, washed and mingled with Alumen ustum, in that quantity as hath been said, if the bodies of the persons who are troubled with the Ulcers be firm and hard, such as labouring Men have. You are to continue the use of these topical me [...]ns, until the Ulcer spread no more, and be red, and very clean. Having the two first Indications required in curing of Herpes exedens, the Third Indication follows; which is the cure of the Ulcer it self.
To this effect two scopes are required: The First is to fill up the Cavity caused by the loss of the skin. The Second is to cicatrize the Ulcer.
As for the First scope, those Medicaments are to be used which dry strongly, yet have no corrosive faculty. Paulus Aeginot. de art. medend. lib. 4. cap. 20. has sundry Medicaments for this grief: if you peruse the Author, and consider the descriptions; you will esteem them but sorry ones. Tagaultius in institut. Chirurgici [...] lib. 1. de tumoribus praet. naturam, has transcribed them, whom you may see: he has done this, for no other cause (as I suppose) than this, that he had no better of his own. Ambrose Pa [...]eus, lib. 6. cap. 84. hath some Medicaments for this grief, which are not to be contemned, The First is this: ℞. ceruss. & tut. prepar. an. ℥ j. ol. ros. & adipis caprae an. ℥ ij. cort. pini. ℥ ss. cer. q. s. fiat unguentum. If you add to these things some lead calcined, Pomegranate-rinds and flowers beat to powder, the Unguent will be more effectual. The Second is, Ʋnguentum enulatum cum Mercurio, which he commends as an infallible Medicament, if to every ounce of it you add a dram of the flower of Brimstone, you shall not miss of your purpose. He gives one good note, that if you perceive the brims of the Ulcer more and more to be eroded, you touch them with Aqua fortis, Oleum Vitrioli, or Sulphuris, for by these means, Sores which seem uncurable are often healed. Hieron. [Page 140]Fabric. ad aquapend. part. 2. lib. 1. cap. 28. advises to minister inwardly either Goats-milk, or the decoction of Sarsa-parilla; and without all doubt both are good; but there is no parity between Goatsmilk, and the decoction of Sarsa: there is no Chirurgeon, who is ignorant of the faculty of Sarsa in curing all malign and creeping Ulcers: Goats-milk may have some place, if the party be extenuate, and a Hecttick Fever feared.
As for the local Medicaments, he commends this cerat. ℞. succi de peto, ℥ iij. cerae citrinae. ℥ ij. resin. pini. ℥ jss. ol. mrrtini ℥ j ss. terebinthin. ℥ j. Bulliant ista donec consumptus sit succus tobaccae, ac fiat ceratum molle. I will not stick to communicate with you the description of an unguent of Tobacco which I use mine own self, neither am I ashamed to prefer it before all others of this kind; the description whereof I have seen. Thus then it is to be made; ℞. axung. porcin. viij. unc. colophon. ʒ iv. cer. ℥ iij. succi de paeto lib. 1. peti contus. man. ij. coq. baec. ad succi consumpt. tum adde Gummi ele [...] vernicis alb. terebinthin. an. ℥ [...]. ac coletur unguentum. It is an ercellent incarnative in wounds as well as Ulcers: besides this no better Mundificative can be devised [...] tender bodies; if one dram [...] Mercury precipitate washed, or [...] the yellow Turbith be mingled with an ounce of it. When you perceive the Ulcers to be filled up: then skin them with this Desiccative of mine: ℞. Sevi damar. lb. ss. Axung. porcin. ℥ iij. Cer. ternic. colophon. an. ℥ ij. hisce [...] igne amotis insperge calaminar. i [...] vino albo ter extinct. ℥ 1. Lyth [...] gyr. Plumbi calcin. Aeris usti, H [...] rici rub. an. ℥ ss. fiat ceratum. The two prime Medicaments which are set down in Antidotaries to effect this, are Desiccativum rubrum, and Ʋnguentum de minio, otherwise called Ʋnguentum rubrum caphuretum. Your Emplaster de Minio doth not come near to these in efficacie. Let this serve for the discerning and curing of Herpes miliaris, or, Formica ambulati [...], or corrosiva.
CHAP. XVI.
Of Phagedaena and Nome.
BEcause Phagedaena and Nome do much resemble one the other, I will treat of them jointly, and deliver unto you what the Grecians, the Parents of Physick, and of all other Liberal Arts and Sciences, have delivered Methodically: As for the Medicaments that are to be applied, I will pick [...]ut the best, which either the Ancient or the Modern Writers have [...]evealed to us: neither will I conceal from you what I have found effectual in mine own practice.
[...] then is a Greek decomination, derived from [...], which is edo, to eat: so that [...] may be called in Latin Ʋlcus exedens: in English an eat [...]g Ulcer.
It signifies two things: First, [...]t is taken for all manner of corroding Ulcers, which seize not upon the Skin only, but upon the subjacent Flesh also: In this sig [...]ification it is taken by the Ancient Physicians, who flourished before Galen's time. Secondly, it is taken for a special kind of Ulcer by the latter Physicians, as Galen com [...]ent. in aphor. 45. lib. 6. Hip [...]x. witnesseth. And it is fit, that in discourses and writings all things be set down distinctly, for this much helpeth the Memory.
It being taken thus for a particular kind of Ulcer, it may be described an Ʋlcer tumefied without putrefaction, deep and corroding the parts adjacent; In that it is said to be an Ʋlcer tumefied, it is distinguished from [...], the third kind of eating Ulcers, which corrodes the sound parts near unto it, without any remarkable Tumor, as more at large you shall hear anon. It is said to be deep, because it frets not only the Skin but the fleshy part also under the Skin. And by this circumstance is distinguished from Herpes exedens: which is an exulceration of the Skin only. So this kind of Ulcer is not without cause called [...], or Ʋicus exedens, because it eats and frets the sound parts near unto it, making them of the same condition with the diseased.
It is caused of a bilious adust Humor inclining to that Melancholick Humor, which is superfluous and not natural; yet it is not to be thought that it is very thick, as is that which procures a Cancer: nor so thin as that which [Page 142]causes Erysipelas and Herpes. This Humor, by reason of the plentifulness of it, fills the brims of the Ulcer, and causes a swelling to appear; but by reason of its Malignity and Acrimony, it fre [...]s the parts adjacent, which are sound. Nevertheless this Humor is without Putrefaction, which is always in the Ulcer called [...], or Ʋlcus depascens, an Ulcer which feeds upon the parts adjacent that are sound; for in Phagedaena there is erosion proceeding of a malign quality without Putrefaction, or Corruption of the whole substance, which is always joyned with Maligrity in a [...].
Then the Pathognomonical signs of a Phagedaena are these: First, it corrodes not the Skin only, as Herpes exedens doth, but the subjacent Flesh also: The second is this, that in Phagedaenical Ulcers the brims are tumefied. The third is, that tho there is Erosion of the sound parts adjacent, yet there is no Putrefaction: And by these two last signs it is distinguished from [...], Ʋlcus depascens, a consuming Ulcer.
[...] in Greek, in Latin Ʋlcus depascens, in English a feeding or consuming Ulcer. It is derived from [...] Depascor, I feed upon: for passing from the diseased parts, it seizes upon the found and whole parts, and feeds upon them by communicating unto them both Malignity and Putrefaction. It may be thus described.
[...] is a corrosive Ʋlcer, without any Tumor in the brims, endued not only with Malignity, but Putrefaction, or Corruption of the part, also feeding upon the adjacent sound parts, and that deeply. I [...] that it is termed a Corrosive Ʋlcer or Malign, it agrees in this with Herpes Miliaris and Phagedaena. But whereas it is said to be without any Tumor in the brims, I mean remarkable, and to have Putrefaction annexed, by these two signs it is distinguished from Ph [...] gedaena, or Ʋlcus exedens, an eating Ulcer: for so I think fit to name it; that in denomination also it may be known from [...], Ʋlcus depascens, a consuming or feeding Ulcer. Last of all where it is affirmed that it corrodes not s [...] perficially only the Skin, but the subjacent fleshy parts also: as it hath this common with Phaged [...] na, so by this it is known from Herpes exedens; for this cause [...] exulceration only in the Skin.
But seeing there is often mention made in the Monuments of the Ancient Physicians, of [...] and [...], of Chironical and Telephian Ulcers, as Galen, Paulus Aegineta, and others who follow them, it will not be amiss to discourse a little of such Ulcers; that you may know what is meant by these denominations, and be able to answer any, if you be demanded what is meant by these terms.
Of these Ulcers thus speaketh Galen. de tumorib. praet. nat. c. 13. [...], &c. whose discourse may be thus English: Those Ʋlcers which consume and medd [...]e with the sound parts adjacent, [...] about, corroding them; all these are called Phagedaenic. So that Phagedaena is framed of the Ʋlcer and the Tumor. Herpes in like [Page 143] [...]inner erodes the parts about it, rests in the Skin only: but Phagedaena extends it self as well to the subjacent parts as to the Skin. But it is to no purpose to call Ʋl [...]ers Chironian, or Telephian. It is sufficient to call such Ʋlcers [...] Malignant: that is, of an evil condition or quality. By this passage of Galen translated by [...]e, you may gather three conclusions.
The first is, that in a Phagedana there is an Erosion not only of the Skin, but of the fleshy [...]arts subjacent also, by which it is distinguished from Herpes exedens, or Formica Ambulativa, whereof I discoursed in the former Chapter.
The second is, that in a Phaged [...]na there is a Tumor in the brims of the Ulcer, whereas there is none in a [...], or a consuming Ulcer, called by Latin Authors, Ʋlcus depascens, to distinguish it from Ʋlcus exedens, an eating Ulcer.
The third is, that the denominations of Chironian and Tele [...]an Ulcers, do signifie Malign Ulcers in general; but no special [...]ird of Ulcer in particular. In P [...]dus Aegineta de art. medend. [...]ib. 4. c. 46. bearing this inscripti [...]n of Ʋlcers of an evil condition, [...]hich are called Chironian and Telephian by Physicians: these [...]ords are read as I have transla [...]ed them. Old and inveterate Ʋlcers, which hardly admit skin [...]ing, which are named [...], [...]r malign, some call Chironian, as [...]f they did require the hand of the Certaure Chiron, the most excel [...] in the Art of Curing; others call them Telephian, such as Telephus was troubled with which required the helpful hand of Achilles, who cured him. So he jumps with Galen, that these Titles were ascribed to all malign Ulcers; but did point at no particular kind of Ulcer.
Now it cannot be amiss briefly to shew, what men Chiron and Telephus were, seeing they are so famously recorded by the Poets: They who are Scholars cannot but be delighted, when the Studies of Youth are brought to remembrance. Chiron then was one of the Centaurs, who were a People that inhabited the places near to Pelion, a Hill of Thessaly. These first began to break Horses, to sight on horseback: wherefore the neighbouring People, when it first saw them, believed them to be strange Creatures, composed and framed partly of Humane, partly of Horses Members: O strange simplicity! this Chiron was the Son of Saturn and Philyra. It seems that he was called Chiron, because he had a singular dexterity in the Manual Operations of Chirurgery: for [...], in Greek is an hand. He taught Aesculapius the Art of Curing: Peleus, Achilles his Father, was his Son-in-Law, of whose Daughter Thetis he begat Achilles, so much commended for Valour and Strength by the Heathen Poets. He taught Achilles, being his Grandchild, Chirurgery, Playing upon the Cithern, and Horsemanship. The two kinds of Centaury, the greater and the less, Centaurium majus & minus are named of him, whereof there is great use in Practice both of [Page 144]Physick and Chyrurgery. It is like, that he was fortunate in the curing of malign Ulcers, by reason of the great Skill which he had in the knowledge of the faculty of Plants. He lived but two 2690 years after the Creation of the World, that is, 77 years before the destruction of Troy, which fell out Anno mundi 2767. Then 2685 years are expired since famous Chrion lived. This may serve to prove the Antiquity of Chirurgery. posterity for his worth named the ninth Sign of the Zodiack Sagittarius (who rules the Thighs) from him. From whence Vngil of these twelve Signs:
By this we may gather how Vertue and Learning were regarded in the rude and simple Ages, which are very little esteemed in these Civil Times, wherein most Men are given to enjoy their pleasure, which will cost them too dear, when the general accompt shall be made.
Telephus was one of Hereules his Sons, who being adopted by the King of Mysia who then reigned, after his death, succeeded him in Government. When he would have hindred the Grecians marching towards Troy, from passing thorow his Country, in Combate he was wounded by Achilles; but afterward being reconciled to Achilles, he was cured by him; he mingled with either an Unguent or a Cataplasm, (for Malagm [...] signifies both) the rust of his Spear. And it is not unlikely; for most Chirurgeons know the faculty of Crocus Martis in cicatrizing of Rheumatick Ulcers, it drying strongly without any sharpness; unto which the rust of old Iron washed and prepared comes very near. So Achilles made sufficient proof of his Skill in the Art of Chirurgery, which he learned of his Grand-father Chiron. Go to then, let effeminate Hind-calves despise the Art of Chirurgery, which, so eminent a Person as Achilles was, was not ashamed to practise. From Achilles Millfod is called Sideritis Achillea, Achilles his Star-woort: and it may be that it was one of the chiefest ingredients in the Cataplasm; surely it is an excellent healing Plant. To conclude then this Point; malign Ulcers which are not easily cured, are called Chironia, because Chiron was able to cure them; and Telephia, because Telephus was troubled with such an one.
Now time calls to go forward in the handling of these corrosive Ulcers: but before I set down the manner of Curing, the Predictions of Events which are like to fall out in the course of Cure are first to be set down. I. Neither of these corrosive Ulcers are of easie Cure, upon what Body soever they light; and upon three Causes: For first, there is a [...] an ill constitution and temperature of the part, by which the Aliment, which is sent to the part, too it be good, is corrupted. Secondly, a fresh supply of noxious [Page 145]Humors is sent most commonly to maintain the Grief. Thirdly, because the ordinary Medicaments, which are applied with good success most commonly to other. Ulcers, in these Ulcers are ineffectual. II. If these Ulcers light upon a Cacochymical Body, the case is yet worse: for the Constitution of the Body must be altered before these Griefs can be cured, which is a matter of no small difficulty. III. If these seise upon decrepit Persons, the case is in a manner desperate: for in such the natural Heat is weak, and the Radical Moisture almost spent: so that great store of corrupt and saltish Humors are bred in the Bodies of such, which being sent to the weak parts ulcerate, increase these Griefs.
The Cure is performed by three means: to wit, a convenient Diet, internal Medicaments, and local Applications: As for the Diet, those Meats and Drinks must be used which afford a landable Juice; whereof I have spoken before: and in that measure that the natural Heat may be able to concoct them, that no superfluities be bred. Besides this, Meats which are easily corrupted in the Stomach are to be shunned, as Milkmeats, Summer-fruits, and Salt Meats: slimy Fishes, and Swines flesh are to be shunned, because they afford no good nourishment.
Of internal Medicaments I mean not to speak much. If a person troubled with an ordinary Phagedaena or Nome, be of strong Constitution, and Plethorick, you may minister unto such Hiera Diacolocynthidos Magistralis; or Pilulae aggregativae Majores. If the party be weak, you may minister Pilulae Stomachicae: Those which I use are these: ℞ Aloes ʒ ij. Rhab. Agar. Trochisc. an. ʒ j. Myrrhae, ℈ ij. Mastich. ℈ j. Syrup. Augustani, q. s. ut fiat massula. dos. Pilul. 2. pond. ʒss. a primo somno; vel sumat unam paulo ante coenam, alteram paulo antequam ineatur somnus. Whether the parties be strong or weak, who are troubled with these corrosive Ulcers, they are to use Decoctions made of Sarsaparilla, Guajacum, Radix Chinae, Tormentil, Bistort and Comfrey Roots, with which you are to join some Vulneraries, as Agrimony, the tops of S. Johns wort, Sanicle, our Ladies Mantle, Mountain and Garden Avens, Solomon's Seal.
Nomae of the privy parts were known to the Ancient Writers, as we may perceive by Paulus Aegineta de art. med. lib. 40.44. sub finem. In our times they seldom are seen to proceed from any other Cause, than impure Copulation. Such are often seen, in the which the whole Praeputium doth sometimes rot away. These corroding Venereal Ulcers require the general Cure of the Neapolitan disease, besides effectual Topicks.
Now follows the last indication of curing these corrosive Ulcers; which is the Application of local Medicaments. In a Phagedaena wherein there is a Tumor of the brims, you are to apply Ʋnguentum populeum, and Ʋnguentum albion caphuratum, mixed together in equal quantity, to them. [Page 146]The second thing which I would have you to observe is this, that N [...]me, or Ʋlcus depascens, doth require stronger Topicks than Phagedana, or Ʋlcus exedens. Mark then these Medicaments which I have picked out of Aegineta; ℞ Caleis vivae, Vitriol. Vomit. an. ʒ ij. Auripigment. ʒ j. fiat pulvis subtilis ex his. For a Phagedaena apply the Unguent of Tobacco, having some of this Powder mingled with it, as ʒ ij. for an ounce of the Unguent. If you have to do with a Nome, make a Liniment of this Powder and Oxymel, and apply it to the Ulcer. ℞ Vitriol. albi ℥jss. Crcci Martis, ℥ vj. Gahar. ʒ viij. Crocus Martis well prepared far exceeds Squama ferri, the Scales of Iron. Receive this Medicament of my description: ℞ Calc. Viv. Vitriol. aibi, Auripigmenti an. ℥ j. Malicor. Balaustior. cornu Cervi ust. Gallar. Pumicis calcinati, Alum. usti, rad. Aristol. rot. an. ℥ss. Croci Martis, Plumbi calcinati, aeris usti, an. ʒ vj. cum melle despumato fiat elect [...]arium. Let me commend unto you an A [...]gyptiacum, which is not the vulgar: Primo infundantur absynthium, Carduus benedictus, Centaurium minus, Scordium, Chamaedeys, Malicorium, Ba [...]at stia, Gal [...]e, & rad. Aristol. rot. in acct [...] fortissimo: ℞ hujus Aceti colati ℥ vij. Aerug. ℥ v. Mel. ℥ xiiij. ceq. lento igne ad unguenti consistentiom. This Medicament is effectual in Venereal Ulcers of the Throat, and Privy Parts, and in all sordid Ulcers.
You are to continue the Application of these Medicaments, until you see the corrosion stayed, and the Ulcers red and well mondified. When you have perce [...]ved this, incarnate the Ulcers with some of the Consolidatives before set down by me. Last of all, [...] catrize the Sores with such Epalotical means as I set down in the former Chapter.
But to shut up the delivery of these Ulcers, which are of the mildest sort of the Malign, so much as concerns the knowing and curing of them; let me advise you that you promise no suddea Cure of any Ulcer, if it hath continued but one Month: For the Bodies of the Inhabitants of this Island are for the most part Plethorick; they will observe no good Diet, and will not be estranged from the sacrifice of Venus. It is a strange thing to see what corrupt and ugly stuff is covered by the Curtains of a beautiful Skin, in a number of them. I make no doubt but many, who are least imployed in practice, have had sundry Patients, who have come to them, pretending that they were only troubled with a Pimple on the Forehead, a red Eye, a difficulty of swallowing, shedding of the Hair, watching in the Night time, and pains between and in the Joints: whereas indeed those Griefs were Venereal Pustules, the Neapolitan Opthalmia, virulent Ulcer [...] of the Throat, Alopecia Gallica, the Vigils of Venus, and last of all the Pocky-Joint-Ague. It is no hard matter to those who are judicious to find out the symptoms of that Grief, which Vigo the Father of Empiricks doth affirm to be able to bring the Accidents of all Diseases in particular, according to [Page 147] [...]e diversity of the Constitution of [...]e Bodies upon which it seiseth. [...] then you see any Ulcers, in what [...]arts soever, more painful than the [...]lution of such an unity requires, [...]at they yield not to ordinary Me [...]caments appointed for Ulcers, [...]en suspect that there is a latent [...]alignity. Value not therefore your [...]redit for a trifle, be not too [...]ountiful in promises, lest they be [...]equired at your hands: suspect [...]nd pronounce in doubtful Cases [...]ways the worst: for the best will [...]ve it self. Thus doing, you shall [...]ing in no new practice. Many [...]racticers there be, it is uncertain whether of Ignorance or Policy, who aggravate the Grief of those who wholly commit themselves to them, that the greater Credit and Gain may redound unto themselves, if the Persons diseased escape, and the less blame may be laid to their charge if they die. In these proceedings there are two excellent Teachers, Skill and Conscience: The first is to enable, the second is to direct practice. So much I thought good to deliver of the three mildest kinds of malign Ulcers, to wit, Herpes exedens, Phagedaena, and Nome.
CHAP. XVII.
Of a Cancer and a cancerous Ʋlcer.
NOw am I to discourse of those Ulcers which are accompted most Malign, and are so [...]deed. Of these there are two [...]orts, a cancerous Ulcer, and a [...]ep [...]ous Ulcer: Of purpose I re [...]erred the handling of a Cancer [...]nd a cancerous Ulcer to this place, [...]ecause it fits them best, as you may perceive anon. First then, [...] will discourse of a cancerous Tumor, and then of a cancerous Ulcer. A cancerous Tumor is [...]alled by Galen. de tumor. praet. nat. c. 12. [...], in Latin Cancrosits Tumor; It may be but defined:
It is a Tumor proceeding of Bilis atra, round, hard, unequal, of a leaden colour, hot, very painful to the Patient, and having full Veins implanted in the adiacent parts. For as a Crab, in Latin Cancer, hath a Body and feet of a livid colour, and whatsoever it claspeth with the claws, it holds it firmly; so this Grief is of a livid colour, and so girds the part which it possesses, that it seems to be nailed to the part, and about it the full Veins exquisitely imitate the Feet of a Crab: and from these similitudes the Tumor has its name.
In the description the Tumor is said to proceed from Atra bilis, or Melancholy, or Choler adust; for it signifies both: for there are two sorts of Atra bilis: the one is caused of natural Melancholy adust: the other is caused of yellow Choler burned, and it is much more Malign than the former, See Gal. lib. 3. de atra bile.
There are sundry efficient causes which ingender these Humors in our Bodies: First, a strong hot distemperature of the Liver, which burns the natural Melancholy and yellow Choler, and so hatches this Bilis atra. Secondly, according to Gal. c. 10. lib. 2. ad Glaucon. the Spleen by reason of its weakness and distemperature, doth not draw unto it self the superfluous natural Melancholy, and so staying long without its own proper place, it is inslamed and burned. Thirdly, sometimes this Humor is caused of the Menstrual. Courses, and Hemorrhoids stopped. Fourthly, very often an ill Diet breeds this Humor, as when one uses Meats of an ill Juice, and of a thick substance and hot quality, as Garlick, Onions, Leeks, Snails, Venison, Pease and Beans, and such like. But there is nothing more pernicious than the immoderate use of potent and strong Wines, such are all kinds of Sacks, and Greek Wines, which exceedingly burn the Humors in the mass of Blood. An hot Air and perturbations of the Mind set forward also this Humor. But seeing there are degrees of Malignity in Atra bilis; the cancerous Tumor, or Cancer not ulcerate, is caused of the milder sort of it; but a Cancer Ulcerate is procured of that kind which i [...] most Malign.
Take heed that you imagine not any sort of Cancer to be engendred of natural Melancholy, which G [...] len. de art. curat. ad Glaucon. c. 10. lib. 2. affirms to be that part of the Blood which represents the Wire Lees, when it is made by the liver, which is drawn by the Splece, wherewith it is nourished: for f [...] persluons natural Melancholy causeth only a Scirrhus. Of the material cause of a Cancer th [...] speaketh Galen. De tumor. prae [...] nat. c. 12. When Bilis atra seatech it self in the flesh, if it be sharp it corrodes the adjacent flesh, and causes an Ulcer; but if it be milder, it procures a Cancer without ulceration. Aeginet. lib. 6. c. 45. has these words: A Cancer is a Tumor unequal, with tumefied [...]rin [...]s, ugly to behold, of a leaden colour, indolent, sometimes not ulcerate, which Hippocrates called [...], or hidden; sometimes ulcerate: And seeing it has its beginning from Atra bilis for the most part it becomes ulcerate: So he,
Where you are to note, that h [...] affirms a Cancer to be indole [...] or without pain, which is contrary both to experience and reason Celsus also, lib. 5. c. 28. seems to grant some Caucers to be without pain. For first, there is a Solution of Unity, by reason of plentiu [...] Matter stretching the parts, and pressing the sensible parts, Secondly, there is a very hot distemperature, by reason of the Humor, that cannot be discussed which of necessity must cause pain. The explication of the rest o [...] [Page 149] [...]he particulars set down in the description, shall be set down [...]n the delivery of the Signs, to a [...]old tedious repetition of the [...]ame things.
The signs then of a cancerous Tumor are these: 1. According to Galen, lib. 14. method. c. 9. a Can [...]er in the beginning is hardly discerned: for the symptoms are but mild, and sometimes it is no bigger than a Pease, or Bean, or a Filbert-nut. 2. It is hard, by reason of the the thickness of the Humor, which withstandeth the [...]ouch. 3. It is of a leaden colour, representing the colour of the Hu [...]nor whereof it is bred, yea, the more Malign it is, the more livid and black it appears. 4. The Tumor is very painful: First, because Atra bilis the material Cause of it is hot: Secondly, because no heat can breath out, the substance of the Cancer being so compact. 5. It is round, because the matter being thick, is not so apt to fleet abroad. 6. It is unequal, by reason of the ebullition of the Humor, which notwithstanding is not equally active in all parts of the Tumor. Last of all, a Cancer bath black or livid Veins extended to the adjacent parts: for this atrabilious Humor cannot sueat out of the Veins, which is the cause that they appear very full.
As for the parts which a Cancer invades, tho it may breed in all parts of the Body, yet it is most often seen in the Breasts and Matrices of Women, and in the Lips and nose of the Face. I have seen it also in an [...], and in the top of the [...]ard.
The Breasts most promptly receive this atrabilious Humor, because they are of glandulous and loose substance. Besides, the Mammariae Veins meet with the Ʋterinae under the strait Muscles of the Belly, so that the Matrix may discharge it self of adust and secuient Melnncholick Blood by regurgitation, which may cause a Cancer if it pass to the Dugs.
A Cancer in like manner appears very often in the Matrix by reason of the detention of the menstruous Blood, which staying above the ordinary time is burned. The lips also are spongy and soft, and so apt to receive Atra bilis, the material Cause of a Cancer, Gal. de art. curat. ad Glauconem, lib. 2. c. 10. hath these words: Cancerous Tumors may be in all parts of the Body, but chiefly in the Paps of Women, which have not their purgation accerding to Nature, Aeginet. l. 6. c. 45. saith, A Cancer happens to sundry places of the Body, but chiefly to the Matrix and Paps of Women.
As for the Predictions before Curing, receive these: 1. Although Cancers may appear in all the Quarters of the Year, yet most commonly they shew themselves about the ending of the Summer, and during the whole time of the Harvest: because in these Seasons Melancholy exceedingly increases, and Humors become adust. 2. No Cancer is easily cured; for if all ulcerate Cancers be incurable, according to Galen, c. 5. lib. de Atra bile; no cancerous Tumor can easily be cured, it having the same efficient Cause. 3. A Cancer not ulcerate, if it [Page 150]hath possessed any deep cavity of the Body, as the Matrix or Anus, it is not to be dealt withal, according to Hippoe. lib. 6, aphor. 38.
You must understand that he meaneth the curing by excision, caustical means, or ustion: for the Ulcer will not admit cicatrization, and so the diseased parties live in continual pain and filthiness, and at the last die miserably. But he forbids not the application of local means, which asswage pain and gently mundifie. 4. Cancerous Tumours in the outward parts, and only superficial in the beginning, may be cured according to Galen, lib. 2. c. 10. ad Glaucon. 5. When cancerous Tumors are come to a remarkable bigness, they only can be cured by extirpation. 6. If a Cancer not ulcerate hath possessed the Matrix, the party feels great pain in the Groins, and hath often a difficulty in making of water: If the Cancer be ulcerate, it sends out a loathsome and cadaverous smell, the vapour whereof ascending to the Heart and Brain, causeth sometimes fainting. 7. If the afflicted party be weak, and the cancerous Tumor be inveterate, or of a long continuance, it is not to be dealt withal with excision, adustion, or potential cautery: only lenitives are to be used, to procure a palliative cure: for sundry have continued even to their decrepit old age, with a Cancer not ulcerate.
Now it is time to address my self to the setting down of the cure of a cancerous Tumor: The means appointed for it are three, Dietetical, Pharmaceutical, and Chirurgical.
As for the Dietetical means, a [...] thick and strong Wines are to be shunned, course Bread, Cabb [...]g [...], and Coleworts, Cheese, old and salt flesh, old Hares, and Venison: Watching, immoderate Labour and Grief are to be shunned; as also all other things which thicken the Blood, and inflame the Humo [...] Let the Diet be cooling and moistning. Barley-cream is good, and prisan, Mallow-flowers and roots, Borage, Bugloss, Violet-flowers, Endive, Spinage, Purslain, and a [...] sorts of Sorrel in Broths are good, young Mutton, Veal, Kid, Capo [...], Pullets, Chickens, young Leverets, Partridges: Fishes which live i [...] clear and gravelly Rivers, and poched Eggs are permitted: let the Drink be Beer or Ale of a reasonable strength, not too new not too old: small white Wine with Sugar, Borage, and Burnet, is be [...] of all others.
As for Phlebotomy, it has been observed, that the most conve [...] ent time for bleeding is the f [...]ll Moon; for it miraculously stays the ebullition of the Blood, asswages pain, and hinders the increase of the Tumor. But you may demand of me what Veins are to be opened? I answer: If the Tumor be in the Lip, open the Cephalica; if it be in the Breasts, open the Basilica of the Right Arm, if it be in the Right Breast; and of the Left Arm, if it be in the Left Breast. If the Tumor be in the Matrix or Anus, open Vena poplitis, or the Saphaena.
As for purgation, minister Hiers diacolocynthidos, or Electuarium lenitivum in Whey; the infusion of Sena in Endive-water, and ministred [Page 151]with the Syrup of Succory, with Rhubarb, is very effectual: yea ʒiss. of Pulvis sanctus, with an ounce of the Syrup of Damask Roses in Whey is excellent. It is not sufficient to give these Medicaments once; but at the first they are to be ministred twice a week, and afterward, either a day before or after every Quarter of the Moon and Full: for so not only some part of the Humor will be drawn from the Tumor; but new Matter also will be hindred from flowing.
Now having set down the cause of the name of a Cancer, the description of it, the Signs, the Prognosticks, and the Dietetical, and Pharmaceutical means of curing of a Cancer not ulcerate, only the Chirurgical or Topical means remain to be set down.
But seeing the constitution of Bodies is not uniform, and the grief it self is of a most malign quality, variety of local Medicaments is required: I will labour therefore to answer your expectation in this: But first of all, seeing in a Cancer there is a double poison, as learned Heurnius upon the 36. Aphorism of the Sixth Book noteth: for the one is putrefactive, the other corrosive: If you apply hot and moist Medicaments, which usually bring maturation in Apostemes, you shall procure putrefaction: if you apply corrosive Medicaments, you shall assist the other poison, and increase the Grief. Wherefore those which repel and digest, are aptest, as Galen hath noted, 14 Method, Wherefore no emplastick Medicaments can be good; for it hindreth Perspiration.
Of all things which give a consistence to juices, Rye-meal and the Flower of Lupines are the best: for by a secret faculty they tame the fierceness of a Cancer. To proceed then in the setting down of local means, you may apply a Cataplasm made of the juice of Nightshade, Rye-flower, and some Ʋnguentum populeum, or the juice of Comfrey with the flower of Lupines: you may use in like manner the juice of Horse-tail, Knot-grass, Plantain, Perwinckle, Shave-grass, Millefoil, Tapsus barbatus, Clowns all-heal, and Dracontium.
A cataplasm of Snails and ground-Ivie is excellent. If the Tumor be very painful, apply a cataplasm of the pulp of the roots of Henbane and Hemlock, with Rye-flower and some Oil of My [...]tles: or a cataplasm of the flower of Lupines; the water of the sperm of Frogs, and the Leaves of Herb Rebert, which is a kind of Cranes-bill, exceedingly commended by sundry. If you take ℥ ij. of the Oil of Quinces, and one ounce of the Vinegar of Roses or Elder, and work them in a leaden Mortar, until they become of a Leaden colour; you shall have an effectual Medicament; you may also dissolve Diapalma cum succis with Oil of Roses, that it may be brought to the consistence of a Liniment. Goats-dung with Honey brought to the form of an Unguent is commended: as also Radish-seed beaten and mingled with Vinegar. Many commend a cataplasm of Raisins stoned, Rue. and the Leaves of Night-shade. This Fabricius ab aq. pendent. commendeth; ℞ Solan. hort. virg. aureae, sonchi, an. man. ij. [...]ctis [Page 152]in aq. & contusis. adde far. siligin. lb. i. Ol. ros. ℥ v. fiat cataplasma. The Chirurgeons in Italy had, in Fabricius his time, a Medicament of green Frogs effectual against a Cancer, and in the Gout: thus it is made; Take a good number of green Frogs, whose Mouths sill with sweet Butter, afterward put these Frogs in an earthen Pot well glazed, having a cover, and the bottom full of holes: place this pot in the mouth of another earthen Pot placed in the ground; lute these well together, and the cover of the upper Pot: then for the space of three hours, let a gentle fire of Charcole be set about the upper Pot, to drive down all the moisture and fat to the lower: when the pots are cold, take up the Frogs out of the upper pot, and beat them until you feel no roughness, between your fingers: Last of all, mingle the Fat and moisture in the lower pot, with this substance, and keep this mixture in a clean Gallypot. Receive also this Medicament from Parey, Lib. 6. de tumor. praet. nat. c. xxx. ℞ Theriac. veter. Succi. lactuc.e & ol. ros. an. ℥ j. Succi cancrorum ℥ss. Vitellos ovorum induratos numero ij. Ducantur in mortario plumbeo ad unglienti consistentiam. He also in this same Chapter commends a thin plate of Lead anointed with Quick-silver. The Cancer is to be dressed Morning and Evening. So much then of a cancerous Tumor, or of a Cancer not ulcerate; now am I to deliver the cure of a Cancer ulcerate.
A cancerous Ulcer is an ugly Ʋlcer, having a most stinking smell, thick Lips, and turned outward, greenish and fretted, which yields a Sanies black, or of a d [...]k yellow colour, and is exceeding painful. Riolan the Father in his Chirurgery, in the Second Section of Ulcers, c. 13. affirms this sanious matter to be a strong poison. No death could be devised too cruel for such a one as should give it to a Man.
The particulars of the definition contain the signs of a Cancer ulcerate, so that I need not to insist longer in the explication of this point.
Of a cancerous Ulcer there are two differences, Lupus and Noli me tangere: that is in the Thigh or Leg, this in the Face. A Cancer in other parts of the Body has no particular denomination; but detains the general appellation, with addition of the part affected, as a Cancer of the Breast.
One thing is to be noted, that in other Countries, if a Lupus be troublesome, they apply the flesh of a Hen, Chicken; Pigeon, Whelp, or Kitling, out asunder, according to the length; for so the fury of the Disease ceases, the malignity of the Sanies is eased, and the corrosion is stai'd: See Riolan and Ambrose Parey in the places before cited.
As for the Prognosticks: First, if a Cancer not ulcerate be of hard cure, an ulcerate must be of an harder. Secondly, if the Party be weak and Feverish, the matter is desperate.
As for the cure, the Diet, Phlebotomy and Purging, which I have set down for the curing of a cancerous Tumor, will serve here also; wherefore this only remains, [Page 153] [...]o set down the local Medicaments.
This then shall be the first: ℞ Phumbi usti & loti, Tutiae & Thuris, an. ℥ v. Absynthii ℥ i. ol. Ros. lb ss. Cerae ℥iss. Succi solani, q. s. Ducantur in mortario plumbeo ad unguenti consistentiam. Apply this upon Pledgets of Lint, or sine Tow: above this, to asswage pain apply a cataplasm of the Leaves of Succory, Marsh-mallow, and white Poppy beaten, and tempered with Oil of Roses.
The Second shall be the application of the Juice of Night-shade, out of Tagault [...]us, tractat. 3. ulcer. c. 19. Moisten a double cloth in the juice of Night-shade, and apply it to the Ulcer; then apply above this Cloth a Pledget of Tow or Wooll moistened in this same Liquor. You may keep the juices of Herbs all the year long, by putting them in a glass, having a Faucet in the bottom, and pouring Oil upon the juice, that it may be three inches thick above the juyce.
You may also use the juice of our English Tobacco, and those which I named in the cure of a Cancer not ulcerate.
The distilled water of the Herbs with Camphore, applied after this manner is effectual.
If you dissolve the Camphore first in the Spirit of Wine, it will mingle the better with the waters: ℞ Mell is verbascini ℥ ij. pulv. Malicor. ʒ iij. ol. Nuc. ℥ j. Misc.
This Medicament of Fallopius is excellent: ℞ ol. Ros. & Omphacini, an. ℥ vj. ol. Myrtini & unguent. popul. an. ℥ iij. fol. Solan. & Plantag. an. man. ij. bulliant lento lentissimo igne ad Succorum consimptionem, tum colentur: colaturae adde cerae. ℥ iiij. hac eliquacâ, omnia amoveantur, ab igne. Quum adhuc tepent, adde lithargy [...] ℥ vj. Cerussae, ℥ ij. Tutiae, ʒ ij. Plumbi usti ʒ ij. ss. Ducantur in mortario plumbeo per duas horas. All these Medicaments which I have set down, only are to stay the increase of a Cancer, and to a bate the raging pain in those Cancers which are large and deep.
If a Cancer be but superficial, it may be eaten out with Arsenick sublimed: The manner of the sublimation of it and use, I did shew when I discoursed of Fistula's.
A Noli me tangere in the Lip; if it has not eroded a great quantity, it may be cured as an Hare-lip, with little deformity.
As for a Cancer in the Matrix or Anus, use this Medicament: ℞ Stercor. bubül. lb. iiij. herb. Roberc. Plantag. Sempervivi, Hyosc. Portulac. Lactuc. End. an. man. i. Canc. fluviat. numero 12. Contundantur omnia, ac distillentur in: Alembico plumbeo. Imbuatur caphurâ ac frequenter injiciatur, aut sola aut cum aqua spermat. ranar. As for the method of the extirpation of a Cancer, I will reserve it to that part of Chirurgery which teaches the way to remove things incovenient to Nature, called [...].
The Medicaments in the Apothecaries Shops fit for Cancers, are Ʋnguentum de tutia, de lithargyr. de minio, Desiccativum rubrum. Fabricius ab aq. pendent. de tumor. c. 3. sets down a method whereby an Emperick cured sundry Noli me tangere's and Cancers in other [Page 154]places: and it is this, ℞ Vitriol. lb iss. Auripigment. Sulphur. vivi, an. ℥ iiii. Sal. gem. ℥ iii. cum aceto fiat pasta. In olla terrea probè lutaeta siccetur in furno. with this powder he consumed the Cancer, but by divers applications.
You shall know that the Cancer is quite extirpate, if laudable flesh appear, like to the seeds of the Pomegranate, if it yield good Quittour, and no sanious and stinking Matter: then he healed it with this Unguent: ℞ Mell. despumat. ℥ iiij. Sevi hirein. [...]imatur. chalyb. an. ℥ iss. Litharg. auri. ℥ i. Misc. Another in Essex some years ago, in curing of Cancers, used only the green Treat and white Vitriol, for every ounce of the Treat taking ℥ i. of the Vitriol: and by all likelihood the Medicament of one Payne a Smith, with the which he went about to cure Noli me tangere's, was but a Medicament composed of Arsenick, Orpiment, unslaked Lime, Bole and sweet Butter. You see how I conceal nothing.
Hildanus Obs. 88. Cent. 3. gives a History of a cancerous Ulcer cured in an old Woman. The Ulcer was upon the concourse of the Sagittal and Lambdoeidean Sutures very painful, foul, foetid, unequal; the Lips were hard, and as big as ones Fist. She was prepared by Diet, Purging, and Bleeding. He shaved off the Hair, and cut off the exulcerate mass, and all that seemed tainted with Malignity, to the Cranium; and because the C [...] nium was carious, he abrased it a while after. Then he strewed on it some Pulvis Catagmaticus, treated it as other wounds of the Head, cicatrized it, and she lived long after. till she was decrepit, and then died of the Plague.
The Chymists will have Arsenical, realgarian, and orpimental substances separated from the ratural Balsame, or composition of the Body, to be the causes of these cancerous Tumors and Ulcers, when they settle in the parts, and cannot be discussed: however they represent fitly the nature of a Cancer: for as it is, so are they of a putrefactive quality. Let no man marvel, that sundry Minerals may be in the Body, seeing we see stores in the Gall, Ridnies, and Bladder.
For the curing of Cancers, they commend Antimony so prepared, as it doth not vomit, or trouble the Body; but either procures Sweat, or purges downward: and indeed it is an excellent Medicament: for it changes the constitution of the Body, and mundifies the mass of Blood.
As for Topicks, use the Oil of Arsenick, or whereof Mercurius vitae is made, mixed with Oil of Roses in due proportion, and these two have no fellows; for I protest I have often made experiment of both. If any be desirous to know, and make use of any thing which I have delivered, I will not be nice to impart it.
CHAP. XVIII.
Of the Leprosie and Leprous Ʋlcers.
NOw follows the Second kind of Ulcers most malign; to wit, a Leprous Ulcer. But first of all I will discourse of the Leprosie it self, and then of the nature of a Leprous Ulcer.
The Leprosie in Greek and Latine Tongue is called [...] from [...] scaber, rough: for it makes the skin rough and uneven: or from [...], squama, or cortex a scale or bark, because it sends out scales, and makes the skin rough like to the bark of a Tree. There be two sorts of Leprosie: to wit, the Grecian and Arabian Leprosie.
The Grecian Leprosie may be thus described: It is a Tumor with a confirmed hot and dry distemperature of the skin, both in the outer and inner part of it, wherein scales, like those of fishes are sent out: so that Pruritus, Scabies, and Lepra Graecorum the Itch, Scabbiness, and the Grecian Leprosie differ only in degrees of Tumefaction: and distemperature.
In itching there is no remarkable Tumor, neither doth any thing fall away from the Cuticula, unless it be fetched away by hard scratching. In scabbiness there is a remarkable Tumor, and whether we scratch or no, both sanious Matter and Scales like to the cast skin of a Snake come away. In the Graecian Leprosie, there are greater Tumors than in scabbiness, and Bodies like unto the scales of Fishes, fall from such as are possessed with this grief: so that Avenzoar fitly calls scabbiness Pruritum vesicalem, a blistery or powky itching; but the Grecian Leprosie Pruritum squamosum, a scaly itching.
The signs of this Leprosie are these: the skin is dry, rough, and full of small knobs, which itch exceedingly, and send out bodies like to the scales of Fishes.
The causes of it are either the external efficient causes, or the internal material.
The external efficient, are, 1. Unwholesome Meats and Drinks.
2. Slovenliness, Sluttishness, and Filthiness. Villanovanus the Poetical Physician hath comprised these two causes learnedly in two Hexameter verses, thus;
Sweat not washed away, and want of good food often do make rough the limbs being taken with noisome scabbiness.
3. The menstrual courses, or Hemorrhoids, which were wont to flow, being suppressed, may cause this disease.
4. Fontanels, which have long been kept open, being shut up, may procure the same.
5. Varices, the Veins tumefied by reason of melancholick Blood, being cured, sometimes are the causes of this grief.
The material causes are discerned by the colour of the grief: for if the knobs be of a livid or lead colour, superfluous impure melancholy is the cause; if they be white, or of a greyish colour, then salt Phlegm is predominant, which is mingled with Melancholy: and because aged persons multiply salt Phlegm, they are often troubled with this grief.
As for the presages, let this be the first: this grief, if it be habitual, and of a long continuance, it is not easily cured.
Secondly, if it be neglected, it may turn to the Leprosie of the Arabians.
Thirdly, the scabbiness is more contagious than this grief; for it is more superficial, and so the contagion is more readily communicated, if any lying with a person infected lay his skin to the others.
This Grief is cured by a convenient Diet, purgation of the Body, and local means. The Diet must be cooling and moistning, and afford a laudable juice, whereof I have spoken sufficiently before in several Chapters.
As for the Purgation, minister Electuarium lenitivum, or Diacatholicum, or Manna with pulvis sanctus, or diasenna: for an example receive this prescription, ℞ Electuarii lenitivi, diacathol. aut mannae ℥ i. pulveris sancti ʒ i. aq. cichor. aut endiv. ℥ iij. Misc. ut fiat potio.
As for the local means: One Topick cannot be convenient for all bodies: for some have a tender habit of Body, and some an hard and firm: for those which have a tender, these two of Minadous will serve: ℞ lithargyr. acerrimo aceto ros. diluti, ac siccati, semin. althae. rad. lil. alb. contus. an. ʒ ij. ol. ros. butyr. op. an. ℥ i. succi limon ʒ ij. caphur. gr. iiij. pulverizand pulverizatis, fiat ung. s. a.
II. ℞ Elleb. utriusque, salis petr. an. ʒ ss. unguent. ros. ℥ j. succilimon. ʒ iij. farin. lupin. ℥ ss. fiat. unguent. s. a. If you add ʒ j. of Sulphur vivum beat to powder, to either of these Unguents, they will be the more effectual.
This of Renodaeus antidotar. l. 5. sect. 1. cap. 9. is good: ℞ axungiae suillae in succo scabios. saepius lotae lib. ss. rad. oxylapathi in aceto ad putrilaginem coct. & per setaceum traject. sulpbur. vivi in succo limon. ablut. an. ʒ i ss. unguent. popul. ℥ ss. succi rad. enul. ʒ iiss. ex omnibus probe in mortario subactis fiat linimentum. If it be a stubborn scabbiness, or the Greek Leprosie, use Ʋnguentum enulatum cum Mercurio duplicate. So much I thought good to deliver of Pruritus, Scabies, and Lepra Graecorum, of itching, scabbiness, [Page 157]and the Greek Leprosie.
Now I will proceed to the Arabian Lepra; with the which whosoever is troubled, he is called a Lazarous person.
This grief is called by the Grecians Elaphantiasis, and that for three causes.
First, because the skin is deformed with rough wrinkles; yea the chinks being sometimes deep, appear like furrows in a Hide, representing the skin of an Elephant.
Secondly, because if it possess the Legs, it makes the Leprous person go stiffe, as an Elephant doth.
Thirdly, because as an Elephant of all Beasts is the mightiest; so this grief is most rebellious: so that it was called Leontiasis according to Aëtius, because it is invincible as a Lion; and because the Forehead is wrinkled like to a Lions.
It is also called Satyriasis, and that for two causes: First, because Leprous persons Faces represent in Figure the Faces of the Satyrs, as they are described by Poets: for their Lips are thick, their Nose swells; wherefore in the ridge it seems low, their Cheeks seem red, and the Tumors in the Forehead look like horns, all which express the Face of a Satyr, feigned by the Poets.
Secondly, because in the beginning of the Disease the persons affected are very lecherous, as the Poets feign the Satyrs to be: See Galen. lib. de caus. morb. cap. 7. In the Introductory Book ascribed to Galen it is said, that it was called Dracontiasis, because as the Dragon is said to be the worst of all Serpents, so this Disease is said to be the worst of all other griefs. Amongst us Christians it is called the grief of Lazarus.
As for the causes of the Leprosie, I will divide them into the external efficient, and the internal material cause.
To the external efficient, I refer the continual use of Aliments apt to breed atra bilis; and for this cause the Germans have many Lazarous persons, and Habitations appointed for them: for thorowout the whole year they eat Cabbage salted, much Cheese, old Butter, and Flesh dryed in the Smoak, but most of all Bacon. In like manner it is familiar to Aegypt: because there they eat much Asses flesh, and drink standing and corrupt Waters, if you except those who inhabit places near to Nilus. [...]ucretius learnedly expresseth this, lib. 6. de natur. rerum.
The Leprosie is a Disease which is bred by the River of Nilus, in the middle of Aegypt, and no where else.
Hence it is, that Moses threatens the disobedient Jews thus, Deut. 28. vers. 27. The Lord will smite thee with the botch of Aegypt, and with the haemorrhoids, and with the scab, and with the itch, whereof thou canst not be healed. In the Hebrew Text, it is with the Ulcer of Aegypt, whereby is meant the Leprosie; by the Scab, he means the Greek Leprosie, whereof I have spoken. In [Page 158] Spain and Africk it is more common than any where else. In Provence of France, the Delphinate, Languedock, and in Aquitane it is more frequent than in other parts of the Countrey, Paraeus l. 9. cap. 6. Before the time of Pompey it was not seen in Italy, as witnesseth Plin. nat. hist. l. 26. c. 1.
Secondly, the Leprosie may be taken by having carnal copulation with an infected person, see Gordon. l. med. particul. 1. cap. 22. and Philippus Schopsius in his Treatise of the Leprosie.
Thirdly, the Arabians, Avicen, Albucasis, and Averroes, think that if a Woman conceive while her Courses flow, the Child will prove Leprous, but it is not likely: for that Blood in sound Women is good, and after Conception it is retained to nourish the Child: so that if that Blood were venemous (as some think) no Man or Woman could be sound. Fourthly, this disease being often hereditary; it is propagated from the Parents to their Children.
Fifthly, continual conversation with Leprous persons cannot be but very dangerous; for if one may become Pthisical by often receiving the breath of one who is troubled with that grief, according to Classick Authors, much more may one be infected by receiving the Air, infected with the breath of a Leprous person, which is most corrupt and stinking: wherefore Lazarous persons in every well-ordered place dwell by themselves, that they infect not others; and so God himself commanded, Levit. 13.4. and Numb. 12. 14.
The internal material cause by all is concluded to be Bilis atra. Now seeing this Humor is caused of three several Humors altered from their natural qualities, three sorts of Leprosie do spring.
First, it is caused of the superfluous Melancholick juice burned; this Leprosie causes the skin to be of a ruddy black colour. This kind of Leprosie comes on but slowly, and has milder symptomes.
The Second is of yellow vitelline choler adust: This speedily corrupts the inner parts, chiefly the Liver and Spleen, and from thence passing furiously to the habit of the Body, produces horrible symptomes: in this kind of Leprosie the Skin is o. a yellowish colour tending to Green.
The Third is caused of salt or nitrous Phlegm burned: In this, the colour is a palish white colour; the Leprosie which is caused of this Humor, is not so flerce as the former. There be two other differences taken from the progression of the Disease: for a Leprosie is either in the beginning, or consummate.
The signs of a Leprosie beginning, are these: The Face seems to be of a livid reddish colour, the breathing is with some difficulty, the voice seems to be somewhat hoarse, livid spots appear in sundry parts of the Body, the Skin begins to lose its exquisite feeling, the Urine is muddy and thick. Plinie affirms, that it was not seen in Rome before the time of Pompey, and began first in the Nostrils, not exceeding the bigness of a lentil, and from thence passed to the whole [Page 159]body, producing spots of divers colours, making the skin unequal, and raising scurfs, and hard scabs.
The signs of a confirmed Leprosie are these: 1. The Skin loses altogether its feeling, so that you may thrust a needle thorow it, without any offence to the diseased party; this happens because the Humor, by reason of its thickness, stops the Nerves, and so hinders the animal spirits from passage. Nevertheless, the Muscles move, although sluggishly; because they have Veins and Arteries, by whose Blood and Spirits they are fed.
2. Knobs appear in sundry parts of the Body, but chiefly in the Face, about the Forehead; the Ears become thin, the Nose flat upward, the Lips thick.
3. The Face is of a leaden reddishness.
4. The voice becomes very hoarse, the Lungs and Windpipe being affected.
5. The Eyes become round, the thickness of the Humor bearing in the corners.
6. When the grief is consummate, Warts very often do appear thorowout the whole body, like to hailstones, as we see in measly Hogs.
7. Levinus Lemnius affirms, that the powder of Lead calcined, will swim in the Urine of Leprous persons, but sink in the Urine of all others.
8. They are troubled with much belching.
9. Their Sweat and Breath is most stinking, their breathing is with difficulty and stinking. by reason of the constriction of the Breast.
10. The Hair of the Head begins to fall, that of the Beard to grow thinner, and those of the Eyebrows and Eye-lids to fall also: this falls out, because corrupt nourishment is sent to the Hair; for if you pull out a few of their Hairs, you shall also pull out with the roots a fleshy substance.
11. The Nostrils without are tumefied, but within they are narrow, and ulcerate.
12. The Veins under the Tongue seem varicous, small knobs also like to hail-stones appear there.
13. The skin is unctuous, and will not admit water.
14. The skin is full of wrinkles and chops; as an Elephants skin is.
15. The Muscles of the Thumb wast.
16. If the Body, the Fingers, and Toes have stinking Ulcers, and Chops, you need not much to doubt.
17. If you open a Vein, it will be thick, burned, seculent, and have as it were fat upon the top, and it being strained thorow a cloth, leaves a greety substance behind it.
Now it is time to address my self to the Prognosticks, whereof this shall be the first: A Leprosie in the very beginning is hardly cured; for the material cause of it is Atra bilis: now all diseases of Bilis atra are hard to cure.
Secondly, a Leprosie consummate is altogether incurable by Art.
Now the means of curing a Leprosie beginning, are three: Dietetical, Pharmaceutical, and Chirurgical.
As for the Diet, that which I delivered for a cancerous Tumor and [Page 160]Ulcer, in the former Chapter, in this Grief is also effectual. It is fit that leprous Persons eat of the biggest Snails dressed, as Wilks, or Perwinkles, and Frogs, and that for a Month together; for this food doth exceedingly contemperate the Heat of the Blood: the Water also distilled off them is good to be drunk: Rodericus Fonseca commends this Drink: ℞ Rad. Chin. ℥ j. Succi Limon. ℥ iij. aq. Cichor. lib. vj. Infund. per diem natural. deinde coq. in B. M. per hor. iv. vase bene clauso, decoctum postquam refrixit, coletur: The same China will serve a second time, but to the third Decoction you must have new China. The Flesh of Vipers or Adders eaten, is good: let them be boiled in Water with some Salt and Oyl; eat both the Flesh and Broth, but the Heads, Tails and Intrails must be taken away: the Trochisks of Vipers or Adders are good, being ministred in Cichory Water: Poultry also fed with Paste made with the Flesh of these and Barley flower is good, if it be used a long time; Coral and Pearl prepared, ministred in Broths, are excellent; young Hares in March are good. Galen commends Viper Wine, and sets down the Histories of sundry who were cured by the use of it. And Aretaeus lib. 4. cap. 12. de signis ac causis acutorum: but as for preparations of Vipers ministred in a confirmed Leprosie, Erast. part. 4. disput. cont. Paracel. and Palmarius lib. de Morbis contag. witness them to be ineffectual; for they made trial of them.
The Pharmaceutical means are of two sorts: for either they are Cathartic, or Specific. Amongst the Cathartic means, ℈ j. of the extract of black Ellebore is excellent: the next is Purgative, or Diaphoretick Antimony: the third is the Flowers of the Regulus, ministring gr. viij. in conserve of Roses: The fourth is the infusion of the Glass it self, mingling with it a spoonful of the Syrup of Violets; Mercury precipitate with gold is admirable; gr. iij. are enough for a Dose.
As for the Specifical means, these are commended; the Decoctions of the Elm, Larix-tree, the Roots of Tamarisk, Ceterach, Fumiterry, and Juniper-berries, boiled as Guajacum is, and drunk for a long time; ℥ iij. of Strawberry water or of Cuscuta, Dodder, taken Morning and Evening. Crolli [...]s commends ℈ j. or ℈ ij. Spiritus Tartari in aqua conveniente, or gr. vij. of the Spirit of Salt ministred after the same manner, gr. vj. Bezoar similiter laudatur, for it withstands Malignity.
As for Chirurgical means, they are two; Phlebotomy, and local Applications: If Phlebotomy be required, open the Saphaen [...] about the change, or the Haemorrhoides, but take not much Blood at a time, for leprous persons are weak.
As for the local means, they are either Baths or Liniments; this Bath is commended. Take of Crow-foot ten handfuls, of Coltsfoot five handfuls, of Tobacco two handfuls and a half; boil these in a sufficient quantity of Springwater; use this Morning and Evening, until the Body yields no filth.
Of all other Liniments Rodoric. Fonsec. consult. 1. commends this. ℞ Viperas duas, quas, nullâ parte rejectâ, inde phialae vitreae continent. lb ij. Ol. Veter. exponatur phiala aestivis solibus: tandem sub sinem aestat. evadet Ol. rubrum & foetens. hoc oleo inungantur axillae, inguina, & carpi. Intus autem exhi [...]eatur ʒ j. Trochisc. ex Viperis, [...]el colubr. in ℥ iij. aq. Card. Benedict. & ℥ j. Syrup. acetosit. citri, per dies xiv. To these Ulcers apply a Liniment made of this Oyl, and Goats-suet, taking equal quanties of both. We may make an effectual Oyl of our Adders to this same purpose. Cardanus used to anoint the Spind, Joynts, and Pulses of the Hands and Feet with the Fat of Vipers, for the space of seven days in a Hot-house, and affirms, that he not only did mitigate the Leprosie, but did cure also Consumptions of Body, and the Pthisis it self. If you have not these Medicaments at hand, you may apply such as I set down for the curing of a Cancer, in the former Chapter, which requires no repetition.
CHAP. XIX.
Of abating superfluous Flesh.
HAving set down the main differences of Ulcers, and the Method and Means how to cure [...]em, I must discourse in the like [...]unner of the Accident of Ul [...]ers, which may hinder the prime [...]tentions of curing them, and so [...]rove a let and impediment to you [...] your proceedings.
These Accidents are taken ei [...]er from things familiar to Na [...]re; or from things contrary to Sature.
Things familiar to Nature hin [...]er the cure of Ulcers, when they [...]ecline from that which is accord [...]ng to Nature. From these four [...]fferences of Ulcers do arise: for [...] Ulcer is either with excrescence of superfluous Flesh, or with cariosity of the Bone, or with the colour of the part altered, or varicous. Thus you see, that although Flesh, Bones, Veins, and colour be required to the natural Constitution of the Body; yet they may become domestick Enemies, being altered by the unnatural temperature of the part ill affected.
First, then I will handle an Ulcer wherein superfluous flesh grows. The Flesh it self is either soft and loose, or hard. The soft Flesh is either but beginning to increase; or else it is much arisen. If it do only offer to increase, then strong Desiccatives will serve, such [Page 162]are Galls, Terra sigillata; Terra Lemnia, Bole Oriental, Umber, Olibanum, Aloe hepatica, the Roots of Tormentil, Bistort, Comfrey, the Flower de Luce dried. Metallic things, or Minerals, afford greatest variety, and are most effectual, chiefly if they be prepared and washed; such are Crocus Martis, Calaminaris, Tutia, Aes ustum, Lead calcined with Brimstone, the dead head of Vitriol calcined, being well washed, Minium, Cernss, Litharge, chiefly of Gold.
As for the use of Vegetables, although these which I have named may be used in the form of Powders, yet they are not so effectual as the Decoctions: and then you may add to these, Plantain, Knot-grass, Shepherds Purse, Yarrow, Horse-tail, Bark of Oak, Owlar, and Willow. If you add to the Decoctions strained a convenient quantity, either of Alume or Roman Vitriol, you shall not only suppress the soft and fungous flesh budding, but shall incarnate the Ulcer also, and bring it to Cicatrization.
Receive this Decoction, which I will deliver unto you as a Pattern, according whereto you may frame the other, having a regard of the Age, and Constitution of the party. ℞ Rad. symph. Tormentill. gallar. an. ℥ j. fol. plant [...]gin. Pelygoni, Bursae Pastoris, Millefol. equiseti an. man. ij. Rut. Sylv. si malignitas aliqua subsit. an. man. ss. Bulitant ista in lib. xij. aq. font. ad med. ac coletur decoctum: Decocto colato si addideritis aluminis ℥ vj. habebitis decoctum colore vinum Malvaticum referens: si verò addideritis tantundem Vitridi Romani, decoctum nigrescet. And although the black Decoction be not pleasing to the Eye, and stains the Clouts and Rowlers; yet it is more effectual than the other, but chiefly in malign Ulcers. You may add to such decoctions as these are, Sumach, Myrtleberries, red Rose leaves dried, Pomegranate-pills and Flowers.
If you mean to use these Decoctions, moisten either Pledgets of Tow or Lint in them, warmed and wrung; and dress the Ulcer Morning and Evening. In your practice you shall sind such Decoctions much more effectual than either Unguents or Emplasters.
As for the use of Minerals, if they be applied in form of a Powder, tho they are more effectual than Vegetables, yet they procure more pains to the Chirurgeon to make clean the sore, and are not so pleasing to the Patients, as when they are applied, being reduced either to the form of an Unguent or Emplaster.
If an Unguent be fittest, as in a hollow Ulcer, receive this as a good one: ℞ Minii, Litharg [...] auri, ceruss. an. ℥iss. Calaminar [...] aeris usti, an. ℥ j. Tutiae ʒ iij. Caphur. ʒiss. Ol. Ros. & Myrtin. a [...] lib. j. & ℥ iv. Cerae alb. ℥ iij. fia [...] Ʋnguentum s. a.
If you will have for a plai [...] Ulcer an Emplaster, let this be [...] Pattern unto you: ℞ Sevi O [...] lib. ss Axung. Porci ℥ iij. O [...] Myrt. ℥ ij. Cerae Alb. ℥ iv. Cal [...] min. ℥ j. Litharg. auri. Aeris ust [...] [Page 163]Tutiae, Henrici rub. an. ℥ ss. fiat Emplastrum ex p. a.
If the proud Flesh be grown to that height, that it will not stoop to Desiccatives, then you are to have recourse to those Medicacaments, that are called Cathaeretica; Auferentia, which take away superfluous fungous Flesh. These are not so hot as either escarotical, or septick Medicaments, and those which blister: yet hot they are, and burn, tho gently: being then hot and dry in the fourth Degree, they are of a thick and astringent substance; wherefore such Medicaments pierce not deep, partly by reason of their thick Substance, partly by reason of their rebated Heat; wherefore these only superficially dry and corrode the Flesh. Neither do they cause any great pain, because their Heat is not very intense, unless they be graduate by the admixtion of some other things. So we see Mercury precipitate, or burnt Alume, if either of them be applied to any sore, do cause no great pain; but if they be used being mixed, they both cause pain, and a small eschar. Such are A [...]me calcined, Shells burned, the Powder of Hermodactyls, Asphodell, Verdigreese, but Mercury precipitate excells, and exceeds all these: for it works with small pain, and by Concoction thickens thin and ichorous Quittour: yea, being washed, and mingled in small quantity with incarnative Unguents, it furthers their Operation. Yellow Turbith M [...]eral exceeds it in faculty, the Oyl of Vitriol or Sulphur, whereof Turbith Mineral is precipitate, is more familiar to Nature, and astringent, than Aqua fortis, or Aqua regis, whereof the precipitate is made.
Two Catheretical Unguents are much used, Ʋnguentum Apostolorum, and Ʋnguentum Aegyptiacum.
Of these two, Aegyptiacum is the strongest: In plain Ulcers I would not advise you to use it, for it spreads, and by touching the sound part causes great pain. It is effectual in fretting sores of the Mouth and sinuous Ulcers, being dissolved either in decoctions, or distilled waters convenient for the kind of sores.
As for Ʋnguentum Apostolorum, if it be made according to Art, it is a Catheretical Medicament in tender Bodies; but only a Mundificative in those who have a firm and solid constitution of Body.
It falls out many times, that the supersluous Flesh is so hard and compact, that it contemns all Catheretical Medicaments, and cannot be abated by them. In this course we are to have recourse to those Medicaments which are called [...], or Putrefacientia, or rotting the part; and to those which are not named [...] or Crustam inducentia, which leave an Eschar or Crust after they are applied.
As for Escharotical Medicaments which are called Exedentia, or eating Medicines, seeing they corrupt the natural Heat, they must be hot above the third Degree, and have a thick, viscous, and terrestrial Substance, the Heat is to be durable and permanent. And [Page 164]we see that Pepper, Onions, and such like, tho they be hot above the third Degree, yet they are not caustick; and the reason is, because although they inflame, yet because their Heat is placed in a thin and subtil Substance, it is more easily dissolved, and at last overcome by the natural Heat of our Bodies.
So, when Causticks are applied, notable pain is caused: First, by reason of their extraordinary and exceeding great heat.
Secondly, because by reason of their Terrestrial Substance, they are long in piercing thorow the part.
Of these same Medicaments two are most used: the Lapis infernalis, and the white Caustick. I mean not to trouble you with the setting down of their preparations, because they are sufficiently known unto all who have profited any thing in the study and practice of Chirurgery.
Of these two the Lapis infernalis is most effectual, and works most speedily; wherefore it is most fit for making of Fontanels, where it may be conveniently applied to the upper part of the Member, and be hindred from spreading: but if a Caustick Medicament be to be applied to a depending part, and when there is fear of running, then the white Caustick is most convenient. Besides these two, two other Escharotical Medicaments I will commend unto you.
The first is Mercury sublimate, mingled with Roman Vitriol calcined, until it become red, and the true Terra sigillata.
The second, Turbith Mineral mingled with these same; but whilst it is white and not washed. These do work more gently, if they be mingled with any Narcotical or anodyne Unguent, than when they are applied to any Sore without mixture. But Turbith Mineral far exceeds Mercury sublimate, because it is more familiar to Nature, and doth not cause such pain; besides, it is not so volatil and piercing as the sublimate is, which in tender Bodies assaulting the Heart it self, doth cause sharp Djaries, although they be but Symptomatical.
For the suppressing of rebellious excrescent flesh in Ulcers, the second means I appointed, were called [...], or Putrefacientia, corrupting Medicaments. These are not so hot as those Medicaments which procure an Eschar, or Crust, they have a more thin substance, and subtil, and hare not so much Terrestreity, or Astriction. These do more easily pierce, and so cause not so great pain: the pain which these Medicaments cause is pungitive, as if needles did prick being red hot, and it quickly ceases. And as caustick Medicaments leave the part corrupted in manner of a Crust, so these leave that which they corrupt, soft, moist, and of a blackish colour. If you will require Medicaments moist, endued with such a faculty, have recourse to the Oyl of Vitriol, the Oyl of Sulphur, Aqua Fortis, and Aqua Regis. But if you will have solid and hard Medicaments, the [...] call to aid all sorts of Arsenick, a [...] the white, yellow and red, passing [Page 165]under the names of Ratsbane, Orpiment, and Roses ager.
As for the Septick Vegetables, because they rather mortifie the inward parts, if they be ignorantly or maliciously ministred, than abate proud Flesh in Ulcers, as Dryopteris, the Fern of the Oak, and Aconitum or Leopardsbane, and such like, I will leave them to the consideration of villainous Poysoners.
But having only made mention of abating of superfluous Flesh in Ulcers, by the Application of Topical Medicaments, you may demand of me whether this may not be effected by Chirurgical Instruments, as actual Cauteries, and Incision Knives and Razors? Truly hitherto I have deferred the mention of this Kind of curing, because God of his bounty in these later times hath in all faculties revealed many things which were kept from our Forefathers. If a Patient resolute offer himself to a skilful Chirurgeon to be cured, let the Chirurgeon, in Gods name, in extremities use Iron and Steel: yet let me advise him not to be too forward in three Cases. 1. If the party be of a tender Constitution, and unwilling: for if a Chirurgeon do altogether urge these extremities, he may lose his Patient, who is prompt to hearken to the Syrenian speeches of deluding Knaves and Queans. 2. If you cannot handsomely come to the part, as if the Ulcer be sinuous. 3. If the superfluous Flesh require not only abating, but drying also, it being marvellous moist, then a Medicament is better than the Instrument, because it dries more powerfully:
Now I will deliver unto you a Medicament of famous Fallopius, which is effectual both in correcting of stubborn superfluous Flesh, and in curing of Cancers: the description of it is this: ℞ Arsen. Crystallin. O. Citrin. an. ʒss. Aristol. rot. Aerugin. ʒ j. Opij. ℈ij. Axung. Porein. ℥jss. Misc. ut fiat Ʋnguentum. One thing I had almost let pass, to wit, the description of Cathaeretical Lint; use this of Fallopius his description: ℞ Aq. Plantag. Ros. Solam. an. ℥iv. Opii, ℈ j. Medullae panis, ℥ ij. Mercur. sublimat. ℈ iv. super Porphyritidem triti. Omnia haec commixta bulliant ad consumptionem medietatis: deinde colentur p [...]r pannum crassiusculum. Fila excerpta bulliant aliquandiu in hoc liquore, postea eximantur, siccentur, exprimantur, siccentur, ac serventur ad usum. So much then concerning a bating of superstuous flesh in Ulcers
CHAP. XX.
Of Scaling corrupt Bones.
HAving in the last Chapter set down the Fountains from whence all the Accidents of Ulcers do spring, and having discoursed of the manner of curing an Ulcer, wherein there is Excrescence of superfluous Flesh, which was set down to be the prime Accident flowing from things according to Nature, I must be carried to the second Accident, proceeding from things according to Nature, which is the Cariosity of the Bone.
Now seeing the Bones are the stays and props of the Body, appointed not only for local Motion; but for the parts also which further this Action, as Muscles, Veins, Nerves, Arteries, I am with the greater care to set down the Cure of an Ulcer with the Cariosity of a Bone, seeing so many things of importance do depend upon the Cure of such an Ulcer. In running over the whole course of Chirurgery, I have resolved upon this first Trial, to set down only the general Practices, which they who are judicious may apply to all Persons and parts in special. In handling of this Accident, I will set down these four Points. 1. The Causes which procure the Cariosity of the Bones. 2. The Signs of a corrupt Bone. 3. The Prognosticks of an Ulcer, wherein there is a Cariosity of the Bone: And 4. Of the means which are to be used for removing of this Accident.
Now the Causes which procure the corruption of the Bones, are either external, or internal.
The external Causes are two, to wit, too great Cold, and too great Heat: for as too great Cold quenches the natural Heat of the Bone; so immoderate Heat, by discussing the natural Humidity, dries and corrupts the Bones.
The internal Causes which most frequently produce this Accident, are in number three. The first is a glutinous and superfluous Humidity, first sostning, and then corrupting the Bone, which oftentimes causes a distortion of the Member, and a protuberance of the Bone, which I have sundry times seen, and have noted not to have proceeded from any Venereal Cause. Such an Humor seised upon one, whose name was James Wilkinson, who dwelt near to me, when I practised in the City of [Page 167] Chester, and caused a bending outward of both the Shin-bones, or Ossa tibiae: this happened to him when he was above sixty years old: neither did this Accident either cause Nocturnal or Diurnal pain, or hinder his going. Before this did besal him, he had a great evacuation of Blood (by reason of the Rupture of a Vessel in his left Kidney) together with his Urine, of the which I cured him by the Decoction of some of the Myrobalans.
The second inward Cause of the Cariosity of the Bones, is a sharp and Malign Matter, which by touching corrupts the Bone: this happens most commonly in old and inveterate Ulcers: the Periosteum being once eroded by the Acrimony of the Sanies, it presently corrupts the Bone. It is no marvel that a sharp Humor is able to corrupt Bones, in other parts of the Body, when we see the Teeth to be hollowed by a sharp Rheum, which a File of tempered Steel doth with some difficulty rase.
The third inward Cause is an hidden and strange quality of the Humor, adverse to the Bones, seising not only upon some particular Bones, but upon some parts also of these Bones: for if it did with any manifest quality corrupt the Bones, it would first have eroded the Flesh: this being most subject to the impression of any sretting Humor. But the Bones very often are found to be carious, when the parts covering the Bones, as the Cuticula cutis, and Membrana carnosa are found whole. So when Nodes invade the Citizens of Naples, they appear most commonly in the Os frontis, or in the Ʋlna, or Tibia, and that between the Joynts: Who is able to give a demonstrative Reason of this Invasion? He undoubtedly, who is able to shew, why the Loadstone draws Iron, and Amber and Jet Chaff.
The signs discovering the Cariosity of a Bone, are either Sensual, or Intellectual.
The Sensual are in number Five.
1. Is, if the Bone appear black and fretted: Blackness is caused by the corruption of the natural Temperature, by which it is kept always white with a ruddy glimps, or of an Horse-flesh colour almost. Cariosity is caused by the Acrimony of Humor, fretting the substance of the Bone.
2. Is, when the Bone, being felt with a Probe, doth not appear smooth, but rugged.
3. Is, if the Probe slip not, being guided into the Bone, for then the Periosteum must be gone, and so the Bone either more or less corrupted, partly by reason of the Air, partly by reason of the Quittour settling upon the Bone.
4. Is, if the Flesh ulcerate above the Bone appear soft and spongy, or of a livid colour, it is to be doubted that the Bone is corrupted: for when the Bone is carious, the Flesh is made soft and corrupt, so that any one may thrust a Probe thorow it, without any great annoyance to the party.
5. Is this: If a Tent or Pledget reaching to the Bone stink [Page 168]the next day when it is taken out, there is just occasion offered to suspect that the Bone is carious.
The Intellectual Signs are in number Four.
1. Is, if more Quittour flow, from the Ulcer, than the bigness of it seems to afford.
2. Is, if thin and stinking Sanies flow from the Sore, it is probable that the Bone is foul.
3. If an Ulcer admit skinning, and often break out again, it may not without cause be doubted that the Bone is foul: for an Humor still flowing from the corrupt Bone causes a new inflammation, whereby the Skin is broken a new.
4. Is this; If an Ulcer hath continued a long time, and is rebellious to proper Medicaments, it may be thought that the Bone is carious, being much moistened, and so made soft by the Quittour: and therefore must be scaled.
As for the Prognosticks of such Ulcers as are accompanied with Cariosity of the Bone, receive these.
1. No Ulcer accompanied with Cariosity of the Bone is of easie Cure: for it has a Mallgnity annexed to the Solution of Unity.
2. If there happen a Cariosity passing the first Table in either of the Bones above the Eye-brows, it will be an hand matter to cicatrize it. If this be a true Aphorism in Wounds dividing these parts, how much more true in Ulcers; those only causing a Solution of Unity by an external Cause; but these eroding the parts by an inten [...] Humor, which for the most part is still supplied by some notable Distemperature of some noble part?
3. Shall be this; If any of the Vertebra's of the Spina prove foul, shun the Cure: for first the substance of the Vertebrae being hollow, they will hardly scape: Secondly, It is an hard matter to come to apply a Medicament unto them, by reason of the Muscles placed above them. Thirdly, because it is a hard matter to shun the pairs of Nerves, which spring from the tranverse Processes of them.
Let this be Fourth; If in Ulcers of the Breast, the Sternum or Ribs be foul, be not too forward to meddle with them; for the Acrimony of the Quittour may easily corrode and pierce thorow the intercostal Muscles and the Pleura, and so lay open to the Air the Vital Parts, which ere it be long must cause an extinction of the natural Heat, and so death it self.
The Fifth shall be this; Ulcers in the great Joynts, as the Elbows, Knees or Ankles, wherein there is Cariosity of the Bones, with loss of the Cartilages, are for the most part uncurable, because the pain in the Joynts is great, depriving the diseased persons of their natural rest and sleep, and so of good digestion and concoction of their Food: besides this, they seldom fall out alone, but bring with them a Marasm [...]s, or extenuation of the Body.
Having set down the Causes, Signs and Presages of the Ca [...]iosity of a Bone. I am to shew [...]he way how the Cariosity is to be [...]enoved. To perform this Task, two things are to be done: First of all, the Bone is to be laid bare, and no less of it than is to be scaled: Secondly, the scaling of [...]t is to be procured by convenient means.
The discovering of the Bone is [...]o be procured three manner of ways; to wit, by Incision, Exe [...]son, Dilatation.
As for Incision: we are not to [...]se it where the Bones lye deep, [...]nd have Muscles, Tendons, Veins [...]nd Arteries above them, as in the Thighs and Arms, chiefly in the [...]ener parts. Secondly, although [...]he Bones lie not deep, if they [...]are many Tendons above them, [...]e cannot use Incision safely: such [...]e the Bones of the Metacarpi [...]m, or the upper distance between the Wrist and Fingers, and the Bones of the Metapedium or Metatarsus, which are articulate with the Toes.
Exesion is performed by potential Cauteries; as Lapis inferna [...], the white Caustick, the Powders set down by me, where I discoursed of Fistula's and cancerous Ulcers.
These are not to be used where many Tendons or Nerves are, lest they deprive some parts of their motion, and cause Contusions, by reason of their great [...] which they procure, as also symptomatical Fevers. Potential Cauteries are most convenient, when there is Cariosity in the Cra [...]am, the Ʋlna, or Tibia.
Dilatation; or enlarging of a narrow Sore, by stretching out the Circumference of it, is performed by such things as swell, when they have imbibed any Moisture, as the Roots of Gentian, the Pith of Elder, and Sponges brought close together, either by Thread, or Melilot Emplaster.
These are fit to be used in Ulcers which possess the back of the Hand, or the instep of the Foot. The Bone being by some of these means laid bare, I am to shew you how the Bone is to be scaled.
This is to be performed three manner of ways, to wit, by Medicaments, Instruments, or an actual Cautery.
The Medicaments which procure the Scaling of a Bone, ought to be very drying, and of a subtil and thin substance: for the sound Bone, being assisted and strengthned by such drying Medicaments, sends forth of its self Flesh, which being increased, separates the corrupt Bone from the sound.
These Desquamatory Medicaments are of three degrees.
For some are mild, as the Root of Peucedanum or Sow-fennel, Aristolochia rotunda, the Root of Iris and Myrrh: these will serve if the Cariosity of the Bone be but Supersicial, and the Constitution of the Party soft and tractable.
Some again are yet more drying and strong, as that Medicament of Avicenna, which is composed of equal parts of Aristolochia rotunda, Iris, Myrrh, Aloe, the rind of the [Page 170]Plant Opopanax, whereout the Gumm issueth, the Pumice-stone calcined, the refuse of Brass melted, and the Bark of the Pine-tree. All these being beat to powder may be applied alone, or mingled with Honey. Of this Nature also are Aqua vitae, and the root of Dracontium or Dragons. Fallopius has two Medicaments to this purpose: the first is this, ℞ Rad. Peucedani, Iridis, an. ℥ j. Euphorb. ℈ j. fiat ex omnibus pulvis, qui excipiatur pastâ panis molli, atque ossi corrupto applicetur. The Second is this, ℞ Rad. Peucedan. Aristol. rotund. Opopanac. Euphorb, an. ʒ ss. Terebinthinae ℥ j. Cerae ℥ ss. Aceti ʒ j. fiat cerat. ex p. a. These and such Medicaments are to be used, when the cariosity is somewhat deep and the party of reasonable firm constitution of Body.
Lastly, some are strongest of all, as Euphorbium, beat to powder, Aqua vitae having the tincture of Euphorbium, the Oil of Cloves, or Petroleum wherein some Camphore is dissolved, Aqua-fortis, Aqua regis, Oil of Sulphur, and Oil of Vitriol, and Roman Vitriol calcined. These are to be used when the cariosity is deep, and the constitution of the diseased party stubborn and strong. When these Medicaments are applied, the fleshy parts adjacent must be very well defended, otherwise pain and inflammation will be caused. If the Sores be well dressed, and these Medicaments judiciously applied, the Bones will scale within the space of Forty daies.
Sometimes the cariosity of the Bone is very deep, so that a long time will be required for the scaling of it: wherefore in this case we must have recourse to instruments: the chief of these instruments are the Mallet and Chissels, and Raspatories: First then, the corrupt part of the Bone is to be knocked off with the Mallet and Chissel until you come to the sound Bone; which you shall know, if the Bone bleed, and appear white and firm, according to Celsus. Secondly, the Bone is to be made even with the Raspatories, and smoothed. In this case a Leaden Mallet is best: for it is weighty, and causes a lesser noise: this being done, some of the aforenamed Medicaments must be applied according to the constitution of the party; for by it you must be led.
In Ulcers of the Head it often falls out, that both tables of the Scull are foul, so that you shall be forced to remove a great piece of the Cranium: here you must use the Trepan and Headsaw, the use whereof shall be delivered, when I shall set down the Cure of the wounds of the Head.
The Third way to scale Bones, I named to be the actual Cautery: of it I will set down three documents: The First shall be, when it is to be applied? The Second sh [...] direct, where it shall be applied? The Third shall teach, how the Sore is to be dressed after the application?
As for the First: it is to be applied when superfluous Humidity flows to the Bone; this we may conjecture; First, by the moist and cold constitution of the body of the person affected: the signs of such a constitution I delivered unto you, when I discoursed of a [Page 171]waterish Tumor: whither I remit you.
Secondly, if after the application of the desquamatory Medicaments, the Bone still appear moist and soft, not changing its colour.
The Second document shall be, where it is to be applied? You may apply it safety to the Ʋlna and Tibia laid bare.
Secondly, you may use the actual Cautery in those places, where dilatation only is permitted, and not incision, or potential Cautery, as in the back of the Hand, and instep of the Foot: but this operation you must do thorow a pipe of White Iron, to save the circumjacent parts from burning.
Thirdly, you may apply the actual Cautery to the Joints: if the cartilages be foul, and way be made. This practice Ambrose Parey used when he had dismembred one in the joynt of the Elbow: the dismembred party found great ease and comfort by the application of it: See the History, Lib. xi. cap. xxv. What forms of Cauteries you are to use, the sigure of the Ulcer will shew you. When the actual Cautery is applyed, you are to be acquainted with the manner of dressing of the Bone, which was the third document.
How this is to be done Guido à Cauliaco shall teach you in his own words: ‘I (quoth he) after the application of the Cautery, apply for the space of three daies Oil of Roses tempered with the white of an Egg, and for three other, it mingled with the yolk of an egg; and afterward Butter with Mel rosatum, and ever above these applications some mundificative, until the bone scale. Afterwards, I incarnate and consolidate the part with Avicen's Medicament, which I delivered unto you amongst the Medicaments exfoliative of the second degree.’ Fallopius counselleth after cauterization to use Pledgets moistned in Rosewater and the white of an Egg, to hinder inflammation for some few dressings: then to apply to the Bone Medicaments exfoliative. Beware of the use of an actual Cautery, if the Scull, or any of the Vertebrae of the Back be foul, by reason of the Brain contained in the first, and the Spinalis medulla contained in the second; which being inflamed by the heat of the actual Cautery, will bring alienation of Mind, and Convulsions.
CHAP. XXI.
Of a discoloured and varicous Ʋlcer.
THE two last differences of Ulcers taken from things according to nature, were said to be an Ulcer, wherein the natural colour is altered; and an Ulcer varicous. First then I will discourse of the Ulcer, wherein the colour is altered, and then of an Ulcer varicous.
As for an Ulcer having the skin adjacent, and the substance of the part altered; The unnatural colours which possess the part altered are most commonly four; red, yellow, livid, and black.
The red colour proceeds always from heat, causing an Inflammation.
The external efficient causes of it are superfluous hot garments, too thick boulsters, rowlers made of Wooll, or of hard and stubborn linnen Cloth, the hot season of the year, too strait ligature, the use of hot Meats and Drinks, surfeting, venery troubling the masse of Blood, extraordinary motion of the part, perspiration hindred by reason of the suffocation of the part, or incunneation of the Humor, and solemn evacuations suppressed, as of the flowing of Blood from the hemorrhoidal Veins in Men, or the menstruous Blood from the veins of the Matrix in Women, by the error of the Chirurgeon, applying things actually and potentially cold.
The material cause of this colour is Blood offending: Now the Blood may offend two manner of ways, to wit, in quality, if it be too hot or fervid; or in quantity, if the Body be plethorick. In removing then this red colour, one of the symptomes of Inflammation, our first care must be to remove the external efficient causes.
The Diet must be moistning and cooling, until this accident be removed: wherefore Broths made of Chickens or Veal, wherein Sorrel, soure three leaved Grass or Allelujah, Endive, Succory, Purslain, Lettuce, and such like have beed boiled, are very convenient. If the diseased party delight in roasted Meat, let him use for his Sauce Sippets with the juyces of the common and Wood-Sorrel, with a little Vinegar and Sugar.
If the season of the year be extreme hot, let the room wherein he remains be hung with Sheets, which must be still moistned with spring-water: In this case it is good to garnish the windows with Medow-sweet, called in Latine Regi [...] [Page 173]prati, and Gaul called Myrtus [...]rabantica.
Let his Cloaths be neither heavy, [...]or heating: let the Rowlers be [...]f soft linnen Cloth, and moist [...]ed in Rose, or Elder Vinegar [...]d fair Spring-water, taking two [...]rts of Water and one of Vinegar: [...]et the rowling be somewhat slack, [...]oly to keep the local Medica [...]ents to the Ulcer; for strait ligature causes pain, pain attraction of Humors, and the attraction of [...]ot Humors Inflammation. The party must abstain from sacrificing [...]o the Cyprian Dame: yea, he must [...]andon every violent motion. If this Symptom be caused by reason [...]f the suppression of any solemn [...]acuations, as the staying of the [...]enstrual causes in Women, or the suppressing of the Hemor [...]hoids in Men, the accustomed [...]owings of these are to be procu [...]ed again.
The menstrual Courses are to be brought down; First, by opening of the Saphaena in what foot it is most conspicuous; and Secondly, by exhibiting the power of Steel, either in the form of Lozenges, or of an Electuary, or infusion in White-wine.
The Hemorrhoids must be opened by application of Leeches, and m [...]nistration of Aloetical Medicaments. That Medicament, which by Paracelsus is called Elixir proprietatis, and by others Pilulae pe [...]ilentiales Arabum, composed of Aloes, Myrrh, and Saffron, are excellent. These may be taken sundry Mornings together. But seeing these things are at large set down by those who have written of the Practice of Physick, I have only pointed at the best Indications, which serve for the curing of these griefs, and the rather because the speculation of them doth belong to another Faculty and Art, to wit, Physick.
If the material cause of this symptome, which is Blood, offend in quality, being too hot, then it is to be cooled by a refrigerating Diet, which I at large set down, when I discoursed of a Phlegmon, to which place I remit you. If in quantity it offend, first Phlebotomy, or opening of a Vein is to be used, and Blood drawn, as the age, constitution of the party, and nature of the grief shall require. Secondly, the part it self is to be scarified, and either Ventoses or Leeches to be applied, that the Blood may issue out plentifully to discharge the part.
A livid, or leaden colour in an Ulcer follows: Two causes produce a livid colour in Ulcers: the First is black Blood impacted in the part: The Second is external cold, or defect of the natural heat.
This livid colour doth happen most frequently by reason of black and corrupt Blood setled in the part: for as a bright red colour under white, causeth a lively blue, or azure colour, as we may see in the Veins of sound and healthful persons; so black under white causeth a livid, or a leaden colour. This accident is to be removed by scarification, and application of Cupping-glasses, Horns, or Leeches. Afterward the scarifications are to be fomented with Oxymel dissolved in Carduus Benedictus water.
If the lividity proceed from cold: you shall perceive it by the cold [Page 174]constitution and temperature of the part. In this case you are to apply such local Medicaments as are able to reduce the natural Heat and Complexion. Fallopius in his Treatise de tumoribus, c. 26. de Gangraena, affords a notable one, and a parable, which is this: Take an ordinary Turnep; and a Raddish-root of reasonable bigness, grate or scrape these two, and add to them of powder of Mustard Seed ℥ j. of powder of Cloves ʒ iij. of Oyl of Lin-seed and Wall-nuts very old, so much as is sufficient, and make a Poultice, which apply warm; he calls this Cataplasm, Medicamentum optimum & divinum; A most excellent and divine Medicament; with which he affirms himself to have cured many: so that you need not doubt of the efficacie and certainty of it: and the Ingredients seem to promise no less.
The last unnatural colour is a black colour: this may proceed either from Heat or Cold. If it hath proceeded from Heat, then an inflammation went before; if from Cold, then lividity did precede. The first betokens Adustion; but imperfect: so we see Wood, before it be perfectly burned, and incinerate, or turned to ashes, to become black. And in a Carbuncle the lower part is of a dark red, the middlemost black, and in the top thereof is a white Pustule, the Heat beginning the Adustion in the lowermost, increasing it in the middlemost, and perfecting the Adustion in the top: for it is the property of Fire to heat or mount up, and to be most effectual aloft. If before blackness lividity did appear, it is to be feared, that the part begins to be mortified at the least, if any feeling or heat remain: if these cannot be perceived, then you may boldly say, that a Sphace [...]s or Mortification has possessed the part.
In both these Cases, first the parts are profoundly to be scarified: Secondly, they are to be fomented with a Decoction of Worm-wood, the lesser Centaury, Scordium, Carduus Benedictus, the Flowers of Chamaemil, Melilot, and tops of Dill boiled in a gentle Lixivium. Thirdly, fill the Incisions of the scarifications with some of the Medicaments following, using a Feather: ℞ Oxymell. simpl. ℥ ij. Ʋnguent. Aegypt. ʒ iij. Spirit. Vini, ʒ ij. Misceantur. Fourthly, this Cataplasm is to be applied warm. ℞ Farin. fab. herd. & Orobi, an. ℥ iv. Lixivii mitioris, lb. iv. coq. haec ad Cataplasmat: consistentiam; tunc alle Oxymel simpl. ℥ ij. Ʋnguent. Aegypiaci, ℥ j. Omnia probe misceantur. Continue the use of this Medicament, until the parts be brought to their natural temperature and colour: then proceed as hath been set down, when I spake of the curing of a compound Ulcer.
Having set down the methodical Cures of the three first Accidents taken from things according to Nature; to wit, of abating superfluous Flesh, removing of the Cariosity of the Bone, and reducing the natural colour to the parts, I am to shew how the fourth Accident Varices, the Tumefaction of the Veins by reason of superfluous [Page 175]gross Blood, are to be cured.
This Accident is called in Latin Varix, from the similitude and likeness which it hath with the protuberances that are seen in Trees above the Bark; called Va [...]ices: according to Avenzoar, lib. 2. tract. 7. c. 25. Albucasis Chirurg. part 2. c. 93. called this affection Vitis, or the Vine, because these pass along the parts by windings, as the Vine doth: In Greek it called [...] or as it is found in Pollux [...]. It is called by Hippocrates [...], and by Aristot. 3. de histor. animal. 11. and in sundry other places.
This affection may thus be described: A Varix is a Dilatation of a Vein causing a Tumefaction of it, with windings and tortuosity arising in one or more parts of the Body. It is called the Dilatation of a Vein, because the Dilatation of the Artery is called [...]. This Particle [causing a Tumefaction]. is added, to exclude Veins which are naturally big. Galen de method. medend. lib. 14. c. 13. numbers this affection amongst the Diseases which proceed from the Quantity increased. It may be accounted a Disease, because the Actions of the Parts which it possesses are hindred; for if it possess the Legs, they become extenuate, and by reason of the heaviness of the Humor, they become slow in motion. If this affection invades the Stones, the party becomes barren.
The Causes of it are either internal or external. According to Aristotle, the material Cause is Blood, being impregnate with Spirit; he affirms it proceeds from Blood, lib. 3. de histor. animal. c. 19. where he notes, that Women are not troubled with Varices; because they turn out their superfluous Blood by their natural Fluxes, and that they are less troubled with the Hemorrhoids in like manner. And the this doth prove true in most Women, yet there may be sundry Women found, who both have Varices, and are subject to the Hemorrhoids. He thinks, that the Blood in the Varices is full of Spirits; and therefore pronounces, Sect. 6. Problem. 3. & Sect. 4. Problem. 21. that they who have their Testicles varicous are barren, because the Spirits of Generation pass to the Varices, and so leave the Seed unfruitful, being deprived of Spirits. But Hippocrat. 3. de Articul. Text. 4. & 6 Aphor. 21. & Galen. 4. de compos. Medicament. think the material cause of Varices, to be gross and flatuous melancholick Blood: yea, both Galen and Avicen are of the opinion, that Varices may sometimes be caused of laudable Blood, only offending in quantity, and dilating the coats of the Veins.
The antecedent Causes are in number Four.
1. Is a melancholick and pituitous temperature: so they who have a bad Spleen, are most subject to this Disease.
2. An hairy and an hard habit of the Body.
3. The Masculine Sex: for Women are not so frequently troubled with this affection, because monthly they discharge all superfluous [Page 176]Blood, if they be healthful: as hath been said out of Aristot. 3. de Histor. Animal. c. 11. & Sect. 10. Probl. 29.
4 Either ripe or old Age: for according to Hippoc. in Coac. praenot. they happen not before the fourteenth year of the Age, in the Legs; although even Children may have Varices in the Testicles. Why Eunuchs are not troubled with Varices, Arist. Sect. 10. Problem. 29. yields a reason; because they are deprived of Seed and Spirits. Avicen adds to these, sharp Diseases going before: for in these the thinnest part of the Humors being spent by sweat, insensible perspiration, and discussion procured by Art; the thicker part being turned to some particular places, may procure Varices.
The Primitive Causes are these.
1. A thick and impure Air; because it weakens the Legs, and makes them more apt to receive superfluous Humors. And for this cause Hippocrates affirms, that men who dwell in the Western part, are frequently troubled with this affection, and Ulcers in the Legs.
2. Immoderate Exercise; so we may see Foot-men and Porters often to have Varices.
3. Long standing: according to Averr. 6. collect. 2. From hence Juvenal saith; Fiet varicosus aruspex: He shall become a varicous Sooth-sayer: for they who took upon them to find out future contingences by the flying of Birds, were enforced often to stand a long time.
4. Thick Wine and gross Food: such are old Flesh salted, or smoaked, Pease and Beans.
As for the Presages, let this be the first:
1. If Varices appear in those who are mad by reason of the melancholick Humor; the Grid ceases.
2. The Varices mitigate Gibbosities, or bunching in any part of the Body: for the Humor which causes them, is by these means averted from maintaining of them.
3. The Varices appearing either in the right or lest Testicle, help a squeaking Voice; the Humor being turned from the Breast to the Testicles, according to Hippocrates, in the fifth Section of his Epidemicks. This may happen for two Causes. 1. By reason of the consent which is between the spiritual and genital Members. 2. Because Baldness, Stutting, Lisping, and a Squeaking Voice, according to Hippocrates in the same Book, are melancholick affections.
4. They who never become bald, have not large Varices. And again, if in those persons who are bald, large Varices appear, Hair will grow again, Hippoc. 6. Aplxr. 34. & Arist. 3. de Histor. Animal. 11. But you must understand this of the Varices of the Testicles called Hernia varicosa, The cause of this is the consent of the Brain, and of the genital Members, which is so great, according to Avenzoar, lib. 2. tract. 3. c. 1. that Castration impairs both Wit and Courage. Then Humors melancholick [Page 177]being gathered in the Testicles, Vapors ascend to the Head, which afford sufficient Matter for producing of Hair. And in Women, their Courses being stopped, Vapors ascend to the Chin, from whence a Beard doth bud out. As Hippoc. 6. Epi [...] Of Sect. 8. doth report of P [...]usa the Wife of Pytheus, who got a Beard by reason of her Husbands absence from her.
5. Varices caused by reason of some grief of the Spleen, are not to be cured, lest the diseased party fall into some melancholick Disease, according to Avicen. 22.3. tract. 2. c. 18. for seeing the Matter is lodged in the Spleen, and the Varices of the Legs are stopped by Cure, the Humor must be turned to some other parts.
6. Varices are hardly cured by Medicaments, according to Avenzoar, lib. 2. tract. 2. c. 22. Although they may be cured by Chirurgery without danger of Life, according to Celsus, lib. 7. c. 22. This is true, if the Varices be caused of too copious laudable Blood; otherwise not, for the reason before assigned.
The Cure, which is the last Point, is performed by two Indications, to wit, by discharging the Body of the thick and melancholick Humors, and taking away the tumefied Veins.
The first is performed by appointing a convenient order of Diet, and administration of fit Medicaments.
The second is performed by Chirurgery.
As for the Diet, gross, tough, flatuous Meats are to be shunned, as Beef, Goats flesh, Venison, Oysters, Fishes fed in muddy Waters, old Cheese, Beans and Pease, Lettuce, Colewort, Cabbage, and all those things which Galen forbids in melancholick Diseases, lib. 3. de loc. affect. c. 7.
As for Phlebotomy, the Liver or Median is to be opened in the Arm directly opposite to that Leg wherein the Hemorrhoids are; or Leeches are to be applied to the hemorrhodal Veins, chiefly if Blood was wont to issue from them.
As for purging, Lenitives mixed with those which purge gross Humors are to be ministred: Take this for a Pattern, ℞ Electuar. Lenitiv. ʒ vj. Pulv. Sancti ʒ j. Syrup. de Cichor. cum Rhab. ℥ j. Misc. ut fiat potio.
The Chirurgical Cure of Varices is performed by two means, Ustion, and Exection; Ustion is to be used when the Varix is streight, and not much tumefied.
The manner of Ustion is this: Incise the Skin until you come to the Vein, and separate it from the parts adjacent; then shunning the brims of the Wound, cauterize the coat of the Vein; four inches from this Ustion do the like, and so still, until you come to the end of the Varix. This being done, dress these Ustions as you use to dress parts burned.
Excision is to be used when the Varix is crooked, and hath windings, according to Celsus: but in my judgment a streight Varix is better cured by Excision than that which hath windings and creeks, [Page 178]because it is more easily separated, and will admit a more beautiful Cicatrix: whereas in cutting the other there must be horrible pain, and an ugly Cicatrix must be left.
The manner of Excision is this: you are to begin at what end of the Varix you will, and to separate the Vein from the adjacent parts, until you come to the other end; then bind the Vein hard at each end, and cut off what remains between the two Ligatures: this being done, the brims of the Wound are to be brought together, and to be healed with glutinative Medicaments. Plutarch in the life of Marius writes, that he having this Grief in both his Legs, submitted himself to this manner of Cure; and when he had put forth one, did constantly endure the Excision of the Varix in it, that no Man should have doubted of his Valour; but when the Chrurgeon would have done the like in the other Leg, Marius answered flatly, that he meant not to buy Beauty with such pain; it is not to be thought that any in this our tender [...] Age will admit either of [...]or, two operations.
If a varicous Ulcer be offered unto you, which contemns ordinary means, my counsel is, that you take up the Varix above and below, as you do the Veins of the Temples in inflammations of the Eyes, and open [...] between the Deligations, that the Blood may be discharged o [...] of it. This Operation any [...] will admit, if he be not too tender.
CHAP. XXII.
Of a verminous and lousie Ʋlcer.
HAving delivered unto you the two last differences of Ulcers taken from things according unto Nature, yet changed from the natural Constitution, to [...]uit, of a discoloured and varicous Ulcer; now I am to set down the differences of Ulcers taken from things alien to Nature, and Strangers. These are two; Worms and Lice; from the first an Ulcer is called verminous; from the second, lousie. The Worms which [...]reed in Ulcers may more fitly be called Maggots, in Latin Termites and Galbae, as those of the Guts are called [...] in Greek, or Lambrici in Latin; as we find set down in a learned Epistle of Alexander Trallianus entituled [...], de Lumbricis, of Worms in the Belly, translated by that famous and learned Physician Hierymus Mercurialis, which he annexed to his Treatise written of the Diseases of Children.
They are ingendred of putrid Humors, in unclean and sordid Ulcers negligently dressed, but most frequently in hollow, deep, and sinuous Ulcers: for in such the Quittour is longest lodged, and the putredinal Heat is greatest. And for this cause they are seen in Ulcers of the Ears, for the Quittour is there long detained by reason of the windings and labyrinths of the Ear
The material cause of these Maggots for the most part is a pituitous Excrement, as Paulus Aegineta witnesses, lib. 4. cap. 17.
The efficient cause is Heat, and that of two sorts: The one is extraneous, and putrefactive, causing corruption of the Humors.
The other is Natural: seeing, according to the Philosopher, lib. 3. de generat. animal. cap. 2. nothing can be produced of Putrefaction only, unless Concoction put to its helping hand; then in a verminous one which is preternatural, there is Putrefaction, Heat and the Ulcer it self, besides Worms, the effects of the first two.
As for the Signs, they are three: The first is the sense of Sight, for oftentimes they are seen, if either the cavity of the Ulcer be ample, or that they are voided with the Quittour.
The second is the motion of them felt by the Patient: their motion is called Motus undesus, like unto the waves of the [Page 180]Sea, contracting and extending it self.
The third is a pinching pain now and then: for living they must be fed, and their feeding must of necessity cause more or less pain.
The fourth Sign is horrible stink, by reason of great putrefaction.
When you go about to cure such an Ulcer, attempt not the taking out of the Maggots with any Instrument, for your labour will be fruitless, and the pain of the Patient great; and grant that you take many away with your Instrument, yet you must leave the putredinal Heat, and the corrupt Humor, for the breeding of more.
I wonder, that even great Authors make mention of application of the actual Cautery in this Case: they might be born withall, if these Ulcers were plain, and shallow; for so the superfluous Humidity might be dried, and Putrefaction removed: but they with an unanimous consent confess, that these Maggots are most commonly bred in sinuous and hollow Ulcers, (as hath been said) and most frequently in the Summer time, and Southerly winds blowing: and so a great heat would be induced, and the Patient put to great pain, if they could reach to the cavity of the Ulcer, which cannot be.
These Worms then must first be killed, and then they will issue out of the Ulcer without any difficulty.
Those things which kill these Worms, do it either by a manifest, or hidden quality.
They which kill them by their manifest quality must be bitter, such are Wormwood, Southernwood, Calamint, Aloe, Fern, Bulls gall, Meal of Lupines, Leaves of the Peach-tree, Capers, the Roots or the distilled Water of the Roots of Couch-grass, called Gramen caninum, Horebound, Scordium, Mugwort, Centaury the lesser, Mints. Of these you may make Decoctions, whereof you may find sundry descriptions in the Monuments of those who have written of this Subject. Ambrose Parcy, lib. 12. cap. 8. sets down this Medicament: ℞ Absynth. centaurij minor. & Marrub. an. M. j. decoq. in lib. j. aq. font. ad lib. ss. decoct. coletur: In quo. dissolve Aloes ℥ ss. Ʋnguent. Aegyptiac. ʒ iij. He puts in the decoction ℥ ij. of Aloe, and ℥ j. of Aegyptiacum: but who may not perceive the quantity of these to be too great? This of Ricla [...] the Father, in his Chirurgery, d [...] Ʋlcerib. cap. 8. is excellent: ℞ Ellebor. alb. rad. cappar. gentlan dictamni alb. an. ʒ ij. centaur. mi [...] nor. scord. Absynth. Marrub. Calaminth. an. man. ss. decoq. i [...] sufficiente quantitate aquae fen [...] ac coletur decoctum. In lib. j. [...] laturae dissolve Mellis ℥ ij. Aegypt [...] aci ℥ j. Above the Ulcer he advises to lay Ʋnguentum Apostol [...] rum. If a Tent may reach to th [...] bottom, use this commended b [...] Fallopius in his Treatise de Ʋlceribus cap. 21. ascribed to Arch [...] genes, as also Ambrose Parey, [...] the place aforementioned: ℞ Cerussae, polii montan an. ℥ ss. pic liquid. q. s. ut fiat linimentum [Page 181]This cannot chuse but be effectual, for the faculty of Tar is known even to Hunts-men and Shepherds.
As for those Medicaments which kill Worms from a hidden quality in Ulcers; they are taken either from Minerals or Vegetables.
Amongst Minerals all Waters indued with the quality of Mercury or Antimony are effectual: wherefore you may use Aqu. Aluminis Magistralis of Fallopius, set down by him in his Treatise of the French Pox thus, ℞ Aq. Plantag.& Ros. or lib. 1. Alum. & Mercur. sitblmat. an. ʒ ij. Pulverizat. These are to be mingled together, and being put into a separating Glass, half of the Water is to be evaporated away. Fallopius counsels the Glass to be set upon a Gridiron, and Coals to be put under: but the safest way is to have this done in a Pan, with some Sand set upon a little Furnace. After that half is evaporated away, the separating Glass is to stand five days, and then the clear Water is to be poured off, and kept for [...].
It is not to be used alone, but ringled sometimes with a double, sometimes triple, sometimes quadriple quantity of Rose, Plantain, or Night-shade-water. These A [...]tions of Crocus Metallorum, precipitate, and Turbith Mineral, are effectual: Vitriols of all sorts, Reolved in fair Spring-water, and [...]ing some Champhore added, [...]re very good: for they not only [...]ill Worms, but powerfully correct Putrefaction in Ulcers.
Amongst Vegetables which kill Worms by a hidden and unknown quality, Tobacco carries away the bell, and not only the Juice of the green, but the decoctions of the dry also, do effect this, being applied to the Ulcers by injection, or moistening the Tents or Pledgets with the same. Seeing you may find this Medicament, whose faculty and operations are certain, I will not trouble you by setting down a rabble of uncertain toyes, Ʋnguentum de Paeto, having some Mercury precipitate mingled with it, is excellent in such Ulcers.
Seeing Worms in the Belly by Erosion cause Ulcers in the Guts, in so much that Worms have often come out at the Navel and Groins, whereof you may read memorable Histories set down by Schenkius in his third Book, Pag. 407. titul. de Lumbricis, it will not be a thing impertinent to discourse briefly of them, seeing they often tro [...] Children, and procure sometimes death.
These Worms are called in Greek [...] and [...], ferae, because they cruelly torment the Body; in Latin Lumbrici.
The efficient cause is the temperate heat of the Guts: for intemperate heat rather burns the Humors, than produces any thing of them.
The material Cause, is the inconcocted part of the Chyle sent away to the small Guts from the Stomach, and left undrawn by the mesaraical Veins. This part of the Chyle, being crude, and left in the Intestines, mixt with the pituitous Humor, is elaborate by the temperate heat of the Guts; and [Page 182]the form, which lay hid in this Matter before, is brought forth afterward by this heat; and according to the diversity of the latent forms, sundry sorts of Worms are bred. In the aforenamed Title of Schenkius, you may read of the stupendous figures of Worms, set down by learned and famous Men in their Monuments, who have seen them.
As for the differences of them: they are either ordinary, or extraordinary.
Of the ordinary there are three sorts: The First is Teretes, the round ones, not unlike to Earthworms in Figure; but in colour different: for they are whitish.
The Second are called, Ascarides: these are like unto Worms which grow in Cheeses, and Maggots in Flesh: they are for the most part bred in the Intestinum rectum.
The Third kind is called Lumbricus latus, the broad Worm; and Taenia, which in Greek is called a Swadling-band, by reason of its Figure, for it is broad and long, and it has sundry joynts. This Worm will be of a strange length. Plin. lib. 11. nat. histor. cap. 33. affirms, that some have been thirty foot in length. Conciliator diff. 101. saies, one voided such a one fifteen Foot in length. Alexand. Benedictus, in prooem. lib. 21. Practicae, saies he saw the like. If you desire greater variety of such Histories, peruse Schenkius his observations, lib. 3. pag. 412. I my self when I was in the Newry, a Town in the North part of Ireland, being desired to visit a young Man who had a Fistula in Perinaeo, and whose Body was exceedingly extenuate; when I had ministred a dose of 2 gr. of Mercur. vitae to him, he voided such a Worm, tucked like a crabtree cudgel, about the thickness of a Childs finger, he kept it in a little pewter Basin for my coming: when he was in voiding of it, he was in great fear, thinking that his Guts came out.
As for the signs of Worms; you shall know any one to be troubled with round Worms by these signs: the party finds gnawing and pinching pain in the Belly, has gnashing of the Teeth, chiefly in sleep; is troubled with a dry and continual Cough; the Nostrils itch: wherefore Children having them, are still picking their Nose; the Face is evil coloured, the Cheeks are sometimes of a red, sometimes of a livid colour: the Eyes are hollow; the Mouth is waterish; the Breath is strong; there is a desire to vomit; the Hicket oftentimes; Hunger; and heaviness of the Head; Drowsiness; Convulsions; starting in the Sleep; stretching of the Belly: an extenuation of the rest of the Body; horrible Dreams, looseness of the Belly; ugly and stinking Excrements do fall out. This is holden for an experiment, if water be poured upon the stomach in the Morning, the party being fasting, he or she shall find a drawing in of the Belly, by reason of the shrinking of the Worms, shunning cold. All these signs are not found in every person, but some in sundry.
If Ascarides, or small Worms be bred in the Intestinum rectum, a horrible itch troubles the party, and they are often seen in the Excrements.
If Taenia, or the long broad Worm be in the Guts, the party has an insatiable appetite, the Body consumes, and some substance comes from it like to the seeds of a Cucumber. The falling Sickness oftentimes proceeds from the round Worms, but seldom from the broad and the Ascarides.
Let us now come to the presages which the diversity of Worms afford.
1. Ascarides, if they be small, they are of all sorts least dangerous, for they are farthest from the noble parts, and are most easily killed, by Clysters, or injections of bitter things; it is otherwise if they be big, for then they are ingendred of a worse matter.
2. The Taenia is of all others the worst, because it is biggest, and hardest to be killed.
3. The bigger are worse than the lesser, and many more dangerous than few, and the red are worse than the white.
4. If in the beginning of sharp diseases round worms come out alive, they betoken pestilent diseases.
5. It is good if round Worms come out, even when the Crisis is at hand, or in the declination of the Disease.
6. If in persons not sick, Worms come out either at the Mouth or Nose, it betokens no harm; because this they do for lack of food.
7. If this happen in sick persons, it is an ill sign, for it argues the malignity of the Matter, which the worms labour to shun.
8. If Worms expelled, seem to be sprinkled with Blood, it is an [...] sign; for it shews the Guts to be ill-affected.
As for the Cure, it is performed by two Indications; the First is by killing of them; the Second by expelling of them killed.
They are killed either by internal Medicaments, or external Applications.
The internal Medicaments are either simple or compound; the simple are either Vegetables, or Minerals, or Animals.
The most powerful amongst the simple Vegetables are these; Corallina, the Dose of it is ʒ j. The seeds of Tansie, and common Wormseed, the dose of them is ʒ j. the juice of Vervain; give a spoonful, the juice of Scordium, Wormwood, the lesser Centaury, Cardnus Benedictus, or Beer or Ale brewed with these, Garlike, the roots of Grass.
As for compound Medicaments, let this be the first: ℞ Corali [...]n. lumbric. terrest. rasurae cornu cervi, semin. Santonici, & tanaceti an. ʒ j. rad. dictamni albi, rhabarb. agaric. trochiscat, an. ℈ ij. fiat ex. omnibus pulvis: dos. ʒ j.
The Second shall be that Medicament, which Quacks in Germany call Panis vitae; the composition is this, ℞ mustacei ℥ iiij. semin. santonici ʒ v. mellis puri q. s. ut siat pasta: dos. ℥ ss. ad ℥ j.
The Medicaments taken from Minerals: Mercur. crudus, dos. ℈ ij. Mercur. dulcis, dos. à gr. iiij. ad xx. secund. ratienem aetatis & virium. Mercur. vitae, cujus dos. à gr. ss. ad gr. j. vitrum antimcnii, crocus metallorum, in pulvere vel infusione.
As for external Applications, receive these as patterns:
1. ℞ Aloes hepat. ʒ ij. fellis tanrini ℥ iiij. absinthii contus. ℥ ij ss. [Page 184] siat cataplasma applicandum umbilico.
2. ℞ farin. lupin. ℥ j. myrrhalces an. ʒ j. pulp. colocynth. ℈ iiij. croci ℈ j. fell. boum ℥ j ss. aceti acerrim. ʒ ss. mise. Applicetur cuminum pultum cum felle tauri, quod commendat Sebastian. Austrius lib. de morb. infant. morb. 42.
The efficient cause of Lice, is the natural temperate heat, mixed and concurring with the heat putrefactive.
The material cause, is the excrements of the third concoction, or assimilation, which are hot; but not sharp or malign. This is the opinion of Galen, lib. 1. de compos. medicam. secund. loc. cap. 7. and Avicen. lib. 4. fen. 7. tractat. 5. cap. 26. That you may the better understand this opinion, you must understand, that when Blood is turned to the nourishment of the parts, divers excrements are produced; of which some are discharged by insensible Perspiration, some by Sweat, some cleave without to the Skin, as the Morphew and the filth which cleave to the soles of the Feet, called Strigmenta; and scales in the Head and other parts: some stay within the Cuticula, and these are either sharp and of a malign quality, and these cause shedding of the Hair; or they are destitute of both these qualities, and they produce Lice.
The disserences of these Lice are two: for some are most commonly without the Cuticula, and some within the Cuticula; of those that are without, some are familiar as the common sort; some are called [...], feri, wild and cruel ones.
As for the ordinary and familiar, most commonly in Boys and Girls, they swarm in Ulcers in the Neck below the Suture Lambdoides: but sometimes, and in some persons, they possess the distance between the Cuticula and the Cutis, divelling and separating the one from the other. If one will know what store of these moveables may issue out of the Cuticula of one person, let him read Amatus Lusitanus cent. 3. curat. 58. & schol. ad curationem eandem; where he reports, that one of good note in Lisbon, called Tabora, was so troubled with them, that two Negroes had enough to discharge him of them, and to carry them to the Sea; and at last they procured his death.
The [...], or feri, Crab-lice, are most commonly engendred in the Arm-pits, and in the Forest of Venus in nasty Men and Women.
These which are always found under the Cuticula, are called Sirones, unknown to the Grecian Physicians: they draw a trench a [...] Moles do in the Earth, under the Cuticula, leaving Pustules behind them, as they march: their seat (when they rest) is easily discerned at the end of the Trench, where when the Cuticula is opened, they may with the point of a sharp pin or needle be taken out: they resemble Nits in Cheese.
As for the Prognosticks, 1. They who are troubled with any kind of Lice are nasty persons.
2. In an Hectick Fever, they shew that one is entred into the third degree of it, and so is incurable.
3. In persons not diseased, if they abound, you may advise them [Page 185]to keep their hands from their Mouth, and to labour to be cleanly.
When Lice swarm over the whole Body, the disease is called [...], à pediculis, from Lice.
Three Intentions are required for the cure of them: Phlebotomie, Purgation, and local Applications.
As for Phlebotomie, the Sex, Age, Constitution of the party, and Strength, with the rest of the Indictions are to be observed.
When you purge, use rather Miterals than Vegetables, because they more strongly evacuate, and are of a more subtil, durable, and penetrating Faculty. These same will serve to hinder the increase of these, which I set down as powerful to kil Worms.
As for local Applications, Amatus Lusitanus in the place afore [...]med, affords two: the one is a medicate Vinegar; the other a Liniment: The description of the Vinegar is this: ℞ Lupin. amar. pug. iij. Staph. agriae pug. ij. Let these be boised in a sufficient quantity of Vinegar, with it moisten the whole Body. The Liniment is thus made: ℞ Staph. agr. part. 2. Sandarach. Gran. part. 1. salis petrae partem dimidiam, postquam ista fuere infusa in Olei Raphanini part. 2. & Aceti acerrimi part. 3. fiat linimentum, quod illinatur toti corpori. Paulus Aegineta affirms, that he found good success in the application of Oil and Vinegar.
As for Crab-lice, the waiting Maids of Venus rest contented with the application of an Unguent made of sweet Sope and Quicksilver. If any one be desirous to know more of the mystery of these moveables. I will advise him to repair to the Pilgrims of the tribe of Gad, in the Summer time to be found by Hedges, and in Barns. If any be desirous to read a learned and Philosophical discourse of this Subject, let them have recourse to Minadous, lib. 2. c. 9. de turpitudinibus.
CHAP. XXIII.
Of Ʋlcers of the Hairy Sealp.
SEeing I have set down the general Doctrine of Ulcers, sufficient to instruct any one, how every Ulcer in particular parts is to be cured; yet seeing some Ulcers in these parts require some special consideration, I will run thorow them, and not omit any thing which shall shall seem material. I will begin at the Ulcers of the Head, partly because some of them are incurable, and that it is necessary that you know which be such; partly because it were a foul shame that Women should go beyond a Chirurgeon in this business, who confidently take upon them the cure of these Ulcers.
Ulcers of the Head are of two forts: for some are moist, and some are dry.
The moist are two, Achor and Favus. These dispositions of the Head are called by the Arabians, Sahafati, by Avicen. 7.4. tract. 3. c. 1. Serap. lib. 1. tract. 1. c. 3. Avenzoar, lib. 1. tract. 1. c. 7. and they are nothing else but small ulcerate Tumors of the whole skin of the Head, caused by sharp excrementitious Humors. All small Tumors, in Latine, Tubercula, by the Arabians are called Bothor. So then as the Cuticula, or the scarfskin, is the seat of Pthiriasis or the Lousie Malady, so the place of these griefs is the whole Skin, both the Cutioula, and the Cutis.
The material cause is a sharp excrementitious Humor.
Now sharp Humors are of two sorts: for some are sharp of their own nature, as Choler: and some by accident. By accident, Humors may become sharp two manner of ways. First, by exustion and putrefaction, as Bilis atra, and Melancholy not natural but excrementitious. Secondly, by admistion of a sharp Humor. These ulcerous Tumors of the Head may be caused not only of simple sharp Humors of their own nature, but also of Humors made sharp by accident.
The Chymist will have a Vitriolick Salt to be the material cause of these Ulcers. See Joan. Faler. Chirurgiae Spagyricae, c. xv. Acber so called according to Alex. Trallianus, lib. 1. c. 8. because from it a sanious Quittour called [...] doth flow. Galen in his book of Tumors thus discourses of it; Acher also is a small Ʋlcer in the skin of the Head; you may think that it is caused of a salt and nitrous Phlegm; out of it flowes a sanious Matter, which is not altogether waterish, nor so viscous and thick as Honey, which appears in those Ʋleers [Page 187]which are called Favi [...] for in these there is a certain Tumor, and sundry holes, out of which floweth Metter like unto Honey. He also in his Lib. 1. de compos. Pharmacorum secund. loc. affirms the holes in this Tumor to be less than those are which are called Favi, and that out of them floweth a thin Humor with some clamminess. Oribas. lib. 4. ad Eunap. c. 4. thus speaks: Achor is seated in the skin of the Head, and hath but small boles, out of which a thin and reasonable viscous Sanies doth flow. That affection which is called Favus is like to this; but it hath greater holes, which contain a matter like to Honey. Trallianus lib. 1. c. 9. subscribes to these in these words: We must know also that Cerion, (which is Favus in Latine) is a grief like to Achor, yet differing in bigness; for the holes out of which to Humor issues, represent the Honey-comb: wherefore by the Ancients it was called [...]. The like hath Paulus Aegineta, lib. 3. c. 3.
So that Achor differs in three points from Favus: For First, in it the Tumor is less: Secondly, in it the holes are less: And Thirdly, the holes in a Favus are conspicuous; but in Achor not. Aëtius lib. 6. c. 68. hath these words, Achor is seated in the skin of the Head, and hath but small holes, out of which a thin and viscous Sanies doth flow. The grief called [...] or Favus, is like to this, wherein there are large holes, out of which issueth a Matter thick, like unto that which is contained in Honey-combs: wherefore it is called [...]. As for Favus, [...] in Greek, Actuar. lib. 2. de dignosc. morb. c. 5. thus describeth it: Small Ʋlcers arise in the Head thick, and red like little dugs, of which, that which is called [...] has but small holes, which sends out a clammy Sanies; but [...] or Favus hath greater holes, which contain an Himor like to Honey.
Out of these passages, which have been alledged out of those ancient and learned Authors, these descriptions of these two Ulcers may be gathered: Achor is an ulcerous Tumor of the skin of the Head, red and dug-like, having small holes, out of which issueth a thin and viscous Sanies. Favus is the like Ʋlcer; yet wherein the holes are larger, containing an Humor in thickness resembling Honey, from whence it hath its name.
The primitive causes are in number two: corrupt nourishment and contagion: of the first I have discoursed heretofore; of the second there is doubt to be made: for it may be daily seen, that these griefs are communicated by contact and frequent conversation.
The material cause is a sharp and fretting Humor, viscous in both these Ulcers, yet thinner in an Achor, than it is in that which is called Favus. Galen and Aegine [...]a in the places afore-cited, affirm it to be a salt and nitrous Phlegm. The Chymists affirm them to proceed from the vitriolick salt of the lesser world, or Man.
The cause conjunct is the same humor impacted in the skin of the Head.
The signs of these two are these: First, in both these Tumors there is an itching and a Tumor. Secondly, holes appear in both, but in an Achor less, in a Favus greater. [Page 188]And although Lice are often seen in both; yet it is proper for Favus to have scales.
As for the Prognosticks receive these.
1. Young persons are most subject to these griefs, and amongst these Children most frequently: The causes of this may be two. First, because they may have received many impurities in the Mothers womb, which when they are come to the light, the natural heat increasing, they labour to expel; or it may happen by reason of the corrupt Milk of the Nurse, who useth an ill Diet.
2. These Ulcers, if they have continued long, and have much altered and corroded the Skin, when they are cured, they leave behind them baldness of the parts affected.
3. These griefs free Children from the Falling-sickness, according to Hippocrates, Lib. de sacro morbo, Avicen, lib. 1. 3. c. de Epilepsia. For the Humor which might cause this disease, is sent from the inner to the outer parts.
4. If these griefs be hereditary, they hardly can be cured: feeing this is true in all other Maladies, how much more certain, when to the Humor a malignity is joyned, as in these, as all must confess?
The means which are appointed for the cure of these griefs are of two forts, Physical and Chirurgical.
The Physical are three; A convenient order of Diet, Phlebotomy and Purgation.
As for the Diet, that is most fit which was set down in the Chapter delivered concerning the cure of the Leprosi [...] for by some this is accounted a particular Leprosie. All surfetting, strong and sweet Wines; sharp, salt, and fried Meats are to be shunned; and such as afford a gross impure juice, as hard Eggs, Fishes living in muddy waters: Purslain, according to Avenzoar, exceedingly furthers these griefs.
As for Phlebotomy, two Indications may induce you to use this: First, a Plethora of the whole body: Secondly, much corrupt Blood setled in the vessels of the Head. If there be a fulness in the whole body, then it is fit to open the Medians of both the Arms: it matters not much at which you begin: Let some daies pass between the opening of the one and the other. Let the strength, age, time of the year, and the like circumstances shew you what quantity of Blood is to be drawn. If much impure Blood be congested in the Head, open the Cephalica, the Veins under the Tongue, the Venafrontis, yea, and the Arteries of the Temples; for they powerfully derive corrupt Blood and foul Spirits from the Head.
As for Purgation: if this must be general, then no Medicament is better than Confectio Hamech, or Hiera Diacolocynthidos, with Syrup of Roses solutive with Agarick in Betony, Eye-bright, Strawberry, Cowslip, or water of Black Cherries. Receive this description as a pattern: ℞ Confect. Hamech, aut Hier. Diacolocynth. ʒ iiij. Pulv. sancti ℈ ij. Pulv. Holland. ℈ j. Syrup. ros. solut. cum Agaric. ℥ j. Aq. praedict. ℥ iij. Misc ut fiat potio. If the party affect Pills, these, [Page 189]or such like you shall find very effectual: ℞ Pilul. aurear. & aggregat. an ℈ j. Trochiscor. Alhand. pultorum gr. vij. spirit. Vitriol. gutt. 5. Formentur pilul. ʒ j. quae deaurentur. These purgative Medicaments are to be ministred once every week, until the party be cured.
If you go about particularly to purge the Head, use Sternutatories made of white Hellebore, and the best and strongest Tobacco, with a little of the powder of the seeds of sweet Majoran and Lavander; or use Gargarisms: This water drawn by a Quill into the Nostrils, which I will set down, is very effectual: ℞ Pulv. Lap. mag [...]et. & calamin. an. ʒ ij. Virid. aeris & Euphorb. an gr. vj. Lap. hamatit. ʒ j. Succini albi ʒ ss. Aq. major. ℥ j. Misceantur. Let this Medicament be kept in a Glass, and drawn into the Nostrils every Morning, or every other Morning, at the Patient is able to endure.
The Chirurgical means are the artificial dressings of the Ulcers with local Medicaments. To attain to this, two things are to be noted: The First is, what Meditaments are to be applied. As for the qualities of the Medicaments, they ought to be astringent and repelling: when I discoursed of Tumors, I set down an ample catalogue of them, whither I send you.
But seeing some magistral compositions are required in the cure of these griefs, which often prove very obstinate and stubborn, I will not leave you unfurnished, but will deliver unto you some which are very effectual. The First is this of mine own: ℞ Butyri recent. lb ss. Axung. porc. ℥iiij. ol. Scorpion. ℥ij. Sulph. vivi. Helleb. alb. & nigri. Rad. Enul. pulveriz. an. ℥ss. Calcis vivae ʒiij. Mercur. cr [...] di ℥jss. Misc. ut fiat linimentum. The second is that of Gordonius, described by Renodaeus, Dispensator. med. l. 5. sect. 1. thus: ℞ Elleb. alb. & nigr. Sulphur. viv. Auripig. Litharg. Calc. viv. Alum. Gallar. Fulig. Ciner. Clavellat. an. ℥ ss;. Mercur. & virid. aer. an ʒij. pulveriz. & pulv. coq. in Succ. Botrag. Scabios. Fumar. Oxylap. & Aceti, an. ℥ iij. ad Succorum consumpt. deinde addantur Ol. veter. lb j, Picis liquid. ℥ ss. Cer. liquat. q. s. ut fiat linimentum. I have made trial of it, and have found it effectual. If you but consider the ingredients, you cannot but allow of it. The Author commends it in a scald Head, in all manner of Scabs, and in Malum mortuum it self.
When you are to apply these Unguents, which was the Second point of the Chirurgical means: First, you are to mark whether the roots of the Hairs be corrupt or no; for if the roots be corrupt, they must be pulled out: you shall know this by pulling out of a few, and observing the roots: for if the roots be thicker than ordinary, and moist, you may be assured that they are corrupt: they are to be pulled out in Children, that you may the better apply your Topicks: In aged persons, not only to this end, but to open the Skin also, and to make it more perspirable, that the corrupt Humors may be the more easily corrected and spent.
The Hairs are readily pulled out, by application of an Emplaster of [Page 190]red Wax new made, drawn upon Leather, and lying to the Ulcers twelve hours. Secondly, above the Unguents you are to apply Sparadraps made only of Wax, to save the Unguents, and keep them to the Sores without much waste. Thirdly, you are to foment the Sores with red Wine, or Tanners woose, wherein Pomegranate Flowers and Rinds, Myrtil-berries, and Sumach, with red Rose-leaves dried, have been infused in a Pot set by the fire-side, before you use the Unguents.
If Children be offered to you to be cured, you must have a care that you use gentle Medicaments to them, and that their Caps be so tied to their Heads, that they cannot pull them off. For Children, receive these Topicks: the first shall be that of Minadous, in his Treatise De turpitudinibus, l. 2. c. 10. which he learned of a Woman, who professed the cure of these Griess, ℞ Suiphur. vivi, Litharg. Argent. pu [...]verizat. an. ℥j. cum aceto ros. terantur ac levigentur; tum add [...] Terrae Lemniae pulv. ℥ss. Succi Plantag. & Limon. an. ℥ j. Ol. Lentisein, & Myrtini. an. ℥ j. Misc. ut siat linimentum. If Ulcers in Children prove obstinate, use this of mine: ℞ Pomati, Ʋnguent. Pop [...]. & Ʋng. albi caphurat. an. ℥ j. Ol. de vitell. ovorum ℥ ss. Ol. Scorpion. ʒ ij. Mercur. crudi ℥ss. Misc. in Ʋnguentum. You may add ʒjss. of Alume calcined and beat to powder, if you will have it stronger. These Ulcers are to be dressed once in twenty four hours, and towards night: for then the Medicaments will prove most effectual. If these Ulcers be very moist, and apt to be enflamed, by the application of an Unguent, then you are to use a Medicament made of abstersive Powders, which the Ancients called Smegmata contempered with Oxymel simplex: such are the Ellebores, Sulphur vivum, Staphesager, the Pumice-stone, Cuttlebones, the Roots of Iris, and Aristolochiarotunda, and Barley-meal: these being beat to powder, and by the admixtion of Oxymel simplex brought to the consistence of a liquid Electuary, must be applied to these Ulcers, and above the Medicament a Cap of Ivy-leaves sowed together must be set.
Having spoken sufficiently of the two kinds of moist Ulcers, which are found in the head, Achor and Favus, it is time that we reason of the dry Ulcer of the head, which properly is called Tinea.
This is a crusty Ʋlcer, fretting the skin like a Moth (from whence it has its denomination) without any great store of moisture, cerrupting the roots of the hair, and sending out of the Skin a dry fillb which stinks: Videatur Hieron. Mercurial. c. 14. de morb. cutan. But Petrus Joan. Faber, in his Chirurgia Spagrrica, thus describeth it, c. 15. de Tinea: It is a peculiar phagedaenical and cancerous Ʋlcer of the Head, caused of the salt of the Vitriol of the Body of Man, which frets the Skin, and produces Scales, sometimes white, and sometimes yellow. The material Cause, and the manner of the generation of it, he thus prosecutes. Vitriol in the great World, while it is calcined in the Fire, it is coagulate into a mass; either [Page 191]white, if the calcination be but modetate: or yellow, if the Fire be intreased. So in the little World (he meanrith the Body of Man) the Vitriol, when it is separated from the Balsam of the Body, it marches [...]ards the Skin of the Head, which it corrodes, and above it produces a crasty and scaly substance. Thus he: and I protest very probably.
And if it be true, which Galen ard Aegineta affirm of the material Cause of Achor and Favus, that it is a sharp nitrous Phlegm, as hath been said, it may very probably be affirmed, that the material Cause of Tinea is Phlegma viniolatum, Phlegm endued with Vitriol, yet grosser than that which is the cause of Achor and Favus. Avicen, Mercurialis, and the rigid Galenists affirm the melancholick Humor to be the material Cause, accompanied with some sharp Humidity, which pricking the expulsive faculty, moves it to drive out the Humor to the Skin of the Head, and so to cause this Ulcer: but this opinion carries no shew of truth: For first, this Grief most commonly selses upon phlegmatick persons; Secondly, it cannot be apprehended, how Melancholy, either by the admixtion of any Humor, or by any degree of b [...]at in the Body of Man, being of it self black, can produce such a coloured Ulcer, to wit, white or yellowish.
The Primitive Causes are four; Error committed in the things not natural; Heredity; the corrupt Milk wherewith Children are fed; and Contagion and Infection.
The Signs are dry crusty Scales, most commonly white, sometimes yellowish, or of an ash-colour, or greenish, never black altogether.
As for the Presages: let this be the first.
1. This Ulcer is hard to be cured, because it is Malign and Venemous.
2. Inveterate Ulcers of this kind are more Malign, and harder to be cured, than those which have but lately invaded any person.
3. When they are cured, they often leave behind them an Alopecia or Ophiasis.
4. Sometimes they end in the Leprosie, and pedicular or lousie Disease.
5. If in a Tinea the Skin be hard, or of a shelly substance, and send out many Scales, and the Hairs fall by reason of the corruption of the Roots of them, it is of all others most hard to be cured.
6. If this Ulcer being once cured, return, pronounce it to be hard to cure: for there must be some Seed of this malign Malady firmly impressed in the Brain.
In the Cure of this Grief, two Indications offer themselves: The first is the removing of the Causes; but seeing the Causes are Primitive or Conjunct: The Primitive Causes are removed, by rightly ordering those things which are called Res non Naturales: The Cause conjunct is taken away by Purgation and Phlebotomy. As for Phlebotomy and Purgation, although that may suffice which I have delivered in setting down the healing of Tinea [Page 192]and Favus; yet let me insinuate this unto you, that it is expedient that once a quarter you open the Cephalica two days before the full of the Moon, and that for Purgation you call Mercurial Medicaments to aid, when Vegetables will not serve. Parcy is of opinion, that the means which are used in curing of the French Pox are effectual in curing this Grief: use these then, Mercurius sublimatus duleis, Turbith Mineral, Mercury precipitate dulcified, Mercury coagulate, and fixed by Gold and Silver.
The second Indication is the cure of the Ulcer it self by local means.
But before you go about to apply any local Medicaments, observe these passages: First, that you meddle not with tender Children, if they have a malign Tinea, until they be able to abide sharp Medicaments; for you shall vex both them and their Parents, and so shall procure a dismission to your selves. In the mean time you may use a Liniment made of the Oyl of Eggs, Crocus Martis, and calcined Harts-horn to the part, laying above it either a cap of Ivy-leaves or Colewort-leaves. Secondly, that you apply no repercussives to the Malady: for the Humor causing it, is so thick that it cannot be repelled. The third is that unto new Tinea's and mild, you apply mildder; but to those which are old and malign, sharper and fiercer Medicaments.
In the Application of the Topicks, three things are to be done: First you are to procure the separation of the Scale: Secondly, you are to pull out the Hairs by the roots: Thirdly, you are to hed the Ulcer, You shall procure the fall of the Scales, by embrocating them with a Medicament made of the Oyl of Trotters, and the Mucilages of the Root of Althaea, Linseed and Fenugreek, adding some Oyl of Arsenick or Mercury. How the Hair is to be plucked up by the root, I have shewed before. To cure the Sore, anoint it with Ʋnguent. Enulat. cum M [...] cur. duplicato, and above it lay Emplastrum de ranis Vigonis [...] Mercurio itidem duplicato. Or use this of learned Mercurialis: ℞ Succi Fumar. Scabios. Berag. Oxylapathi, aceti, an. ℥ iij. Ol. antiq. lb j. coq. omnia ad [...] consionptionem: postea inspergetur hi pulveres. ℞ Ʋtriusque Hellebor. Sulphur. vivi. Chalcanthi; Auripigmenti, Cale. vivx, Alum. Gallar. an. ʒ ss. virid. aeris ʒ ij Picis liquid. ℥jss. Cerae, q. s. ut. si [...] Ceratum. Apply this to the part affected: while you are thus busied, purge the party every eighth day.
Galen and the Greek Physicians, who wrote after, have made mention of other affections of the Scalp. And tho they be not of that moment, of which the other are, yet I thought good to acquaint you with them, to the end you may take notice of them when they are named by Physicians: These are four: [...] according to Trallianus, lib. 1. c. 5. are small knobs, like unto pushes, which are above the Cuticula; but [...] are superficial exulcerations of the [Page 193]Skin, somewhat red and rough, ibid. [...] according to Actius, are certain small Ulcers, thick and reddish, like unto Teats, out of which flows an ichorous substance. [...] seu Ficatio, is a suall Ulcer, round, somewhat red, sometimes painful, like unto a Fig, from whence it is so called, wherein flesh buddeth: See Aegin. lib. 3. c. 3. Galen lib. 11. de simpl. med. facultatib. Celsus, lib. 6. c. 3. makes two sorts of it: The one hard and round, out of which a little glutinous Matter issues, which is seen in the Beard: The other moist and unequal, out of which more comes, and hath an ill smell. This appears in the Hair of the Head.
The material Cause of these is pituitous Blood, but the Phlegm is saltish; when you go about to cure these, you must first make them level with the Skin by rubbing of them with the Caustick, or some Catheretical Powder. Afterward they are easily cured with Ʋnguentum Enulatum cum Morcurio simplice, and Emplastrum de ran [...]s of the same kind.
CHAP. XXIV.
Of Ʋlcers of the Ears, and Ophthalmia.
IN the foregoing Chapter, I set down the divers kinds of Ulcers of the hairy scalp, and the [...]re of them, Empirical, as well as Methodical. Now the course of proceeding requires, that I set down the Ulcers of the face. And feeing in it are placed the Instruments of four special Senses, to wit, of Hearing, Seeing, Smelling and Tading; I will, according to these, teasure the diversities of the Ulcers of it: I will begin first with Ulcers of the Ear, because in it are seated the Instruments of Hearing. And tho the sight be more te [...]essary, if we respect the pleas [...]e which redounds from beholding the multiplicity of Objects, or the commodity which it affords, in espying things which might hurt the Body, that we may prevent and shun them: yet Hearing excels it, for it is Disciplinae sensus, the Sense of Learning, according to Aristotle; and the entertainer of Faith; for Faith is bred by Hearing, according to the Apostle. And as the Sight furthers Invention, so by the Hearing things invented are commumcated to others. Besides, by Hearing, the perturbations of the Mind, as Anger, Envy, Wondering, and such like, are most stirred up.
The Causes of Ulcers of the Ears, are either antecedent, or conjunct.
The antecedent are either External, or Internal.
The External Causes are two; to wit, a blow, or a fall: for by reason of either of both these the part may be contused, and from hence Quittour bred, which being stayed long within the cavities of the Ear, and having the Ear-wax, and other sharp Excrements of the Brain mingled with it, may erode the parts.
The Internal Cause is a sharp Humor sent from the Brain to the cavity of the Ear, which first of all causeth Apostemation.
As for the Prognosticks, let this be the first: These Ulcers are not to be neglected, for if the Cure be prolonged, deafness may ensue.
2. If greater plenty of Matter issue out of the Ear than the part of its own self is likely to afford, then you may pronounce, that the greatest part of it is sent from the Brain ill affected.
3. If before Matter issue out of the Ear, the party feel pulsation, and great pain, you may pronounce, that a Phlegmon has invaded the part.
These Ulcers are either without any excrescence of Flesh, or they have excrescence.
In the Cure of Ulcers of the Ears, it is requisite that ever before the Application of any local Medicaments the Head be purged by Cephalic Pills. Receive a Description of those which are very essectual. ℞ Pilul. aggregat. aurear. an. ℈ j. Trochiscor. Alhandal. & diagrid. an. ℈ss. Spirit. Vitri [...]. q. s. ut formetur massula. Ex hi [...] massa efformentur pilul. iv. Deglutiat duas hor. v. Matut. sequente die sumat totidem. Exactis iv. horis à sumptione pilula. rum capiat jusculum sine pane, prandeat autem horâ consuetà.
In the Application of local Medicaments, these five Points are to be observed, according to Petrus à Largeleta, Medicus Beneniensis.
1. Let no sharp Medicament be put into the Ear before the Body be well purged, lest we procure a Fever, and cause an attraction of Humors.
2. Let all Medicaments which are poured into the Ears be neither too hot, nor too cold; for they being (for the greatest part) framed of spermatick parts, they can hardly endure any excess in heat or cold.
3. Let all the Medicaments, that are to be poured into the Ear, be of a liquid substance, that they may enter the deeper.
4. After the party is dressed, let him or her lie upon the sound Ear, the ill affected Ear being stopped with Cotton or Wooll for a good space of time.
5. Let not fatty Medicaments be either poured, or injected into the Ear, for it is composed of spermatick parts, and such things will cause a fordid Ulcer.
The local Medicaments which are fit to be applied to Ulcers of the Ears, wherein there is no superfluous Flesh, are these: Trochisci Andronis in aceto sambucino [Page 195]dissoluti: Haec autem est eorum descriptio: ℞ Balaust. Vitriol. Aristol. gallar. an. ʒ ij. Alum. Myrrh. [...]is Ammon. an. ʒ j. Excipiantur [...]nia Melicrato & fiant Tro [...]sci. If you boil Crocus Mar [...]is in strong Wine Vinegar, till both come to the consistence of a Li [...]iment, it is a good Medicine. A Sinative Syrup made of the [...]erary Plants, as, Self-heal, [...] Ladies-Mantle, Avens, Sanicle, Solomons-Seal, Plantain, Horse-tail, [...]row, Knotgrass, is very effectu [...], [...]ot only in Ulcers of the Ears, [...]t in all hollow Ulcers; in like [...] Balaustia, Pomegranate [...], Sumach, Myrtle-berries, and [...]d Rose-leaves may be added. [...]ee Medicaments are sure, and [...] has you may trust unto. In [...] Winter time, if you boil a suf [...] quantity of dry Tobacco [...] strong Ale, and boil the De [...]cton strained, you shall have [...] effectual Medicine, chiefly if [...]e Ulcer be foul, and have Worms; [...]th you may conjecture by in [...]eable itching, that they will [...] by their motion. If these [...] afford great store of Qui [...], they must be dressed every [...] and twentieth hour; but if [...] yield but little Matter, it will efficient to dress them once in [...] days.
I [...] falls out sometimes, if Ulcers [...] Ears continue long, that [...]perfluous Flesh doth so increase [...], that it sills up all the [...] of the Ear, and causes deaf [...]. This happened to a Gentleman of the Race of the Fit [...] in Chester, when I pra [...]ed Physick and Chirurgery [...].
I thus cured her: First, I ministred unto her Cephalic Pills.
Secondly, This being done, I consumed the spongy Flesh by often Application of the Fistula Powder, so that it did not touch any part in the Circumference. The Powder I set down in that Chapter, wherein was set down the methodical cure of a Fistula.
Thirdly, I made Injection into the Ear, made of two ounces of white Wine, one drachm of Aegyptiacum, and half an ounce of Mel rosatum.
Last of all, I healed, and cicatrized it with my vulnerary Syrup dissolved in Plantain-water.
If such an Accident come to your hands, proceed thus methodically, and you shall undoubtedly bring to pass that which you shall go about. So much I thought good to deliver unto you concerning the dignotion, and cure of the Ulcers of the Ears, which often prove troublesome to the Patient and Chirurgeon, and loathsome to others, who approach to the party grieved, by reason of the evil smell, which the Ulcer sometimes sends forth.
Now I will come to the Ulcers of the Eyes, which ought exquisitely to be handled, seeing the sense of Sight, the Instrument whereof is the Eye, is so pleasing and necessary to all Persons. Of all the Ulcers of the Eye, Fistula lachrymalis, or Aegylops, first offers it self; but seeing I amply discoursed of it, when I delivered the Doctrine of Fistula's, I will remit you to that Chapter.
In this my Discourse of the other [Page 196]Ulcers of the Eyes I will first set down the general Doctrine of them, and then descend to the particular handling of each one of them.
In the general Doctrine, I will deliver three Things: to wit, their Causes: Secondly, the Prognosticks; And thirdly, the Indications of curing them.
The Causes are either External, or Primitive, or Internal.
The external Causes are two; to wit, a Blow, or a Contusion by reason of a Fall.
The internal Causes are sharp and eroding Huniors.
As for the Prognosticks, let this be the first: Ulcers of the Eyes in Persons of an ill habit of Body, seldom end without leaving some scar, or infirmity.
2. For this Cause be wary what you promise; for bountiful promises can hardly be called back; and the Patients, being for the most part careful of the comeliness of their parts, will undoubtedly expect the performance of them.
3. If Children, or disordered Persons, be presented to you to be cured of Ulcers in the Eyes, ever pronounce that the Cure will prove difficult and hard.
The methodical general intentions of curing these Griefs are in number four; Good order of Diet, Phsebotomy, Purgation, and the Application of a Seton or Fontanel, for Revulsion and derivation.
Having dispatched the three Points, which the general Doctrine of Ulcers contains, I am come to set down how each one of these Ulcers in particular is to be cured.
As for the differences of them, they are either mild, or Malign. The mild are either of the Adnata, or Coniunctiva, or Cornea, or Ʋvea. The Ulcers of Conjuncti [...]s most commonly proceed from Ophthalmia.
Of it then I will speak, because it most frequently seises upon the Eye: [...] in Greek, but Lippitudo in Latin, according to Galen 4. de Medicam. local. cap. 4. is an inflammation of that Tunicle of the Eye, which is called Adnata.
There be two kinds of it: One properly so called, proceeding from inward Causes.
The other proceeding from external Causes, which properly is called [...], or Perturbatio.
Again, Ophthalmia vera is either more mild, when only the Conjunctiva is inflamed, or vehement, when as the Eye-lid besides, is red, turned up, and somewhat ulcerate.
This Grief is thus bred, according to Cassius Medicus 66. Prebl. medic. When Humors are impacted in the Eye, they stop the passages, and keep in the heat: the heat kept in, burns when it cannot breath thorow, and inflames the Humors; and these inflamed, cause an Ophthalmia, and hinder the sight: for the Conjunctiva being inflamed, great pain and heat are felt in the Eye. They draw Humors into the Eye; the Humors attracted being dispersed thorow the Eye, trouble the Humors and Spirits; and these being troubled, of necessity hinder the sight. The Eyes are subject to these affections, according to Arist. Probl. 7. [Page 197] Sect. ultim. & Alex. 1 Probl. 35. because they are moist and [...] very passible.
All sorts of Humors may cause a true Ophthalmia, but sundry ways; for hot Humors, as Blood and Choler of themselves cause great Inflammations; but small Inflammations may be caused of cold Humors mixt with hot.
The primitive causes are the heat of the Sun, pain of the Head, a burning Fever, Dust, Smoak, great Cold binding the part, blows upon the Head, blustering Winds, Ebriety, Venery, and according to Paulis, Oil. It brings an Ophthalnia, because it cleaves fast to the Tunicles, and so stops the Pores, and so the heat is kept in, and inflames the Eye.
Hippocrat. lib. de aer. aquis & lxis, writes, that they which inhabit the South, and hot regions, are easily assaulted by such diseases, and easily cured: and on the contrary, that they who dwell in the Northern parts are not so easily tainted with this grief, but are more hardly cured. Avicen yields the reasons for this, saying, that they who dwell under a hot climate, have their Heads full of vapours and Humors, which being resolved by the hot air, fall to the Eyes, and being there staied, cause an Inflammation, which afterward is easily cured. First, because their Bodies are more perspirable. Secondly, because they have still a loose Belly. But in cold regions, thô they have plenty of Humors in their Heads, yet they are congealed, and do not so promptly flow to the Eyes; but if they come to the Eyes, and be there impacted, they cannot so readily be discussed, by reason of the thickness of the Skin, and constriction of the Pores. So inflammations of the Eyes happen more frequently in the Summer to those who have their Heads stuffed with Vapours and Humors, the heat colliquating them, and turning them to the Eyes. In like manner in those diseases, wherein there is an ebullition of the Blood, Ophthalmiae are forerunners, as in the small Pox, Measles, and sometimes the Plague, hot and sharp vapours being carried up to the Head.
As for the signs of an Ophthalmia; they are general, or particular.
The general are these: according to Galen. 4. de medic. loc. 4. & lib. de totius morbi tempor. & Rhazes lib. 9. ad Almans. a swelling of the Eye, a redness of it, pain sometimes pricking, sometimes corrosive, sometimes tensive, flowing of tears.
The particular signs of a true Ophthalmia are these: a great tumor and pain, horrible heat, turning up of the Eye-lids, which shew a great Inflammation.
These accidents, in a more remiss degree, shew a milder Ophthalmia: if the Humor proceed from the Stomach, then the party will desire to vomit; if from the Head, the Headach vexeth him and seeing the Humor may be sent both from the vessels within, and without the Cranium, if the veins of the Forehead, and the rest of th [...] Face be full, if the Arteries of th [...] Temples beat, and if the Eye-lids be heavy, then the Humor come from the vessels without the Cranium; but if none of these symptomes [Page 198]appear, and yet the party often sneezes, and finds itching in the Nose, the Humor or Vapour is sent from the vessels within the Cranium.
Signs of the Humors sent are these: If Blood be it, the Eyes and Face will be red, the Veins will be full, the pain will be gravative, the matter that flows will not be very sharp. If it be a vapour or flatuosity, there will be a singing in the Ears, and a tensive pain. If it be pituitous Blood, the Tumor will not be very red, but whitish, less heat and pain, great heaviness of the Eyes and Eye-lids, the Eye-lids in the night time will be glued together.
This happens for three causes: First, because in the day-time the Eye is still in motion, and suffers not the Humor to cleave to the Eye-lids.
Secondly, because moisture is multiplied in the night-time.
Thirdly, because the Humor concocts in the night-time, grows thick, and so is more apt to cleave to the Eye-lids, they then being immoveable. If Choler be the cause, there will be but little redness mingled with yellowness; the Humor which runs from the Eyes will be thin, the pain will be pinching. If flatuosity or a vapour, then none of these signs will appear, yet the Eyes will be somewhat swelled, and a noise will be noted in the Ears, and no humidity will flow from it.
As for the predictions: 1. An Inflammation coming of external causes, is more easily cured than that which comes of an inward.
2. When a continual pain of th [...] Head is joyned with an Ophthalma [...] and continues long, blindness mo [...] commonly ensues.
3. If in an Inflanimation of the Eye, the Humor which flows from it be thick, it will not long continue: for it betokens the benignity of the Humor, and strength [...] Nature.
4. If a mild Fever, or a fla [...] seize upon one troubled with an Ophthalmia, it ceases within a short time, the Humor being discussed by the first, and revelled by the second.
5. If the Tumor of the Eye be great, the pain vehement, and the matter which flows from the Eye be copious and thin, the Ophthalmia is like to continue long; but short, if signs contrary to these appear. Thus much then concerning the causes, signs, and Prognosticks of an Ophthalmia vera shall suffice.
Now it remains, that we speak a word or two of Ophthalmia sp [...] ria a Bastard Ophthalmia: This is caused only by external means, whereof we have spoken sufficiently before, when we set down the primitive causes of Ophthalmia vera. And if the accidents, as inflammation, redness and the like, be but moderate, it will easily cease, and without great difficulty, by removing the extrinsecal causes, and applying cooling waters, as Rose-water, or Plantain-water, with Camphore.
In the cure of Ophthalmia vera, some Precepts are to be observed before the application of local Medicaments.
1. The party must eat and drink sparingly, abstain from Venery, and keep the Body soluble.
2. Let the party be kept in a dark room, and let his sleep be moderate; because immoderate sleep draws vapours to the Head.
3. Let the objects, which the party beholds, be green, blew, or back.
4. Let anger, serious cogitations, and motion be shunned.
5. If the Hair be too long and heavy, let it be polled.
6. Let the Drink be small Beer, or Barley-water, wherein Fennel-seeds, Coriander-seeds, and Eye-bright have been boiled.
7. Let Meats salt, vaporous, sharp, and hard of digestion be shun [...]ed.
8. If the party be strong, open [...] the Median, then the Cepha [...], then the Vena frontis, and those behind the Ears; and in the Temples, if the Inflammation be great: if circumstances will not admit Phlebotomy, apply Ventoses to the Shoulders, and Thighs; and Frictions and Ligatures to the Arms and Legs.
9. Purge according to the Hunor offending, as Choler with Pi [...]cechiae, or Electuar. de succo ros. Folegm with Diaturbith cum aga [...], or Diaphoenicum, or Diacar [...]mum.
10. If you use Fomentations, these five things are to be observed.
1. That the Body be clean, otherwise the matter (being scattered by fomentation) will run to the Eyes.
2. The Matter must be discharged into the Eye, and not in motion.
3. That it be used when the Matter is thick, for it attenuates it.
4. That it be used in the declination of the grief.
5. No astringent Fomentations are to be used; for they wedge in the Humor, and exasperate the grief.
11. To stay the fluxion, you are to apply a strong defensative to the Forehead and Temples.
12. Opiate Medicaments not well corrected, are not to be used; for if they be but weak, they may procure a little case for the time, but the fluxion and pain will return more fiercly: if they be strong, they may cause inevitable blindess, by hindring the influence of the visive spirits.
The local Medicaments must have three qualities: they must be somewhat astringent, cooling, and anodyne; such are the water of the white of an Egg, the mucilage of Fenugreek and Quince-seeds drawn with Rose and Plantain-water, with a little Saffron, Trochisci albi Rhasis sine opio (unless the pain be very great) dissolved in Violet, or Succory, or Eye-bright water. What I have spoken, I would have you to understand it of an ordinary Ophthalmia.
If you perceive it to be Venereal, or a symptome of the Pox; you must first cure the Disease, and then the accident will cease. If after the using of these means, the Ophthalmia prove rebellious, you must blister the Neck.
If this will not serve, you must apply a Seton, or make a Fontanel in the Neck or Arm. But a Seton is most effectual: For First, by reason of the great pain which it brings, it makes a stronger revulsion: Secondly, it discharges the Humor more plentifully, it having two Orifices; but a Fontanel only one.
Hildanus Obs. 16. Cent. 5. gives us an eminent Instance of an Ophthalmia, cured by him in a curious Limner and Graver above Seventy years old. ‘He was (says he) afflicted with a grievous Ophthalmia in his Left Eye. The Inflammation which was high, had not only seized the Eye and Eye-lids, but halfe the Face. Besides, there arose a Protuberance as big as a Bean, in the Cornea, towards the greater corner, over against the Iris. His whole Head aked; but the pain was most violent, acute and pungent about the tubercle. Wherefore to hinder the afflux of Humors thither, having ordered him a cooling and spare Diet, I gave him the following Pills, ℞ mass. Pil. aur. ℈ i. Luc. major. ℈ ij. trech. Alhand. Didgrid. an. gr. iij. ol. faenic. gutt. vi. cum syr. res. f. Pilulae vij. involvantur pulvere cinnamomi. After I had purged him, I bled him in the Left Arm, and dropt the following Collyrium into his Eye. Aq. ros. plantag. fragar. an. ℥ ij. sem. cyd. contus. faenugr. an. ℈ j. M. maneant (que) in infusione horas 4. in expressierae dissolve Tutiae prepar. CC. preparan. ʒ i. Caphur. ℈ss. M. f. collyrium, instilletur & applicetur calid [...] quater ant quinquies in die. When the Inflammation was laid, instead of Strawberry and Plantain-water, I put Fennel and Eye-bright-water into the Collyrium. The next day after his Bleeding, I ordered Ventoses with much flame to be applyed. Then I gave him the Pills again, and breathed a Vein a second time, and applied Ventoses likewise. By these means the Tubercle wasted by little and little, the Eye grew well, and his Sight was restored, and grew more acute, especially in his Left Eye, than before. For whereas before this illness he had used Spectacles above Twenty years, he was then able to Read and Paint without Spectacles.’
CHAP. XXV.
Of the rest of the Ʋlcers of the Eye.
NOw Order requires, that I should set down the Doctrine touching the Ulcers of the Cornea.
These are either supersicial, or deep, corroding the substance of the Cornea.
The superficial are four, whereof the First is called [...], which signifies a troubling of the Air: and it is a very thin, and superficiary [...]ulceration, of a blush colour, resembling a dark air, and possessing the greatest part of the black of the Eye: the Latines call i [...] Caligo, a Mist in English.
The Second is called [...], i [...] Latine Nubecula: this is deeper than Achlys or Caligo, yet narrower and whiter.
The Third is called [...], it [...] an Ulcer which grows about the circle Iris, possessing part of the white, and part of the black of the Eye: without the Iris it appears red, but within the Iris white.
The Fourth superficiary Ulcer is called by Aetius [...]: this is a superficiary Ulcer also, which makes the Cornea rugged by erosion, and to be of an Ash-colour, resembling a lock of Wooll, for which cause it is called of Avicen, the woolly Ulcer.
Of the deeper Ulcers of Cornea there are three sorts.
The First is called [...], and it is an Ulcer of the Cornea, hollow, narrow, without filth, like to a round puncture: In Latine it is called Fossula; for [...] in Greek signifies Fovea, a pit.
The Second is called in Greek [...], and it differs from s [...] [...]etor, in that it is wider, thô not so deep.
The Third, of the deeper Ulcers of the Cornea, is called [...] by Aetius; by Scribonius Largus ustio; and by others inustio, it is an impure, and crusty Ulcer of Cornea; thorow which sometimes the Humors of the Eye come out, when it is made clean by cleansing Medicaments applied.
These Ulcers of the Cornea of the Eye, whether they be supersiciary or deep, are not to be slighted, but carefully to be dressed; but those especially, which have deeply seized upon the substance of the Membrane, lest they corrode thorow the whole Membrane, and so the Humors issuing out, the Eye sink, and both deformity and inevitable blindess ensue.
For the material cause of these Ulcers is a salt and nitrous Humor, as Paulus Aegineta speaks, Lib. 3. c. 22.
If the Cornea be quite thorow corroded, then the Ʋvea falleth down, this disease of Ʋvea is called [...] procidentia.
Of this disease there are four kinds.
If it fall out but very little, it is called [...], caput muscae, the head of a Flie, and of Avicen formicalis, like the head of a Pismire.
If it fall down yet more, and equal a Grape in bigness, it is called [...], Ʋvea, or Ʋvatio.
If it fall down yet further, and hang out like a little Apple; it is called [...] malum the Apple-like Rupture.
But if the Ʋvea fall down and grow hard, brawny and flat, it is called [...] clavus, the nail-like Rupture. All these four kinds of the Rupture of the Ʋvea for the most part are uncurable: only the Apple-like, and Grape-like Rupture, if the roots be small, and the party be of a good constitution, may be by binding cured, to take away and mitigate the deformity of the Eye. For if the sight be taken away before by these breaches of the Ʋvea, Deligations will not restore the sight; which must be intimated to the party before you go about these operations, that he think not himself deluded, having hoped for the recovery of his sight, as the reward of his patience, in enduring the manual operations.
Seeing all Ulcers of the Eyes argue a cacochymical Body (for they are caused of sharp corroding Humors) the constitution of the Body must be altered, not suddainly labouring to remove the whole cause at once: but [...], and that is, according to Gal. 9. meth. medend. when by little and little that is discharged, which is faulty, that that which is good may succeed in its place. Wherefore you are to shun all strong Cathartical means, lest they procure Vomiting, which is very prejudicial to weak Eyes, such as are those which are ulcerate. The Body having been gently purged, Nature very often corrects the residue of the Humor, by turning that part which is benign into nourishment, and expelling that which is superfluous, by Stool, Urine and Sweat. Those twelve Observations which I set down in the delivery of the Cure of an Ophthalmia vera, I commend unto you in the curing of Ulcers of the Eyes also, which need not any repetition.
To set down all the local Medicantents, which are delivered by the Ancients in curing Ulcers of the Eyes, were a fruitless labour.
Nevertheless, I will furnish you with a few approved Medicaments. Then in superficial Ulcers of Cernea, use these, 1. ℞ Succi n [...]t. Foenicul. Chelidon. Euphragiae an. ℥ ij. Vini Albi potentis ℥ iij. Sa [...] char. Cand. ʒ iij. Aloes, Sarcoce [...]. an. ℥ss. Fellis Capon. ʒ ij. Distil these, and use the Water.
2. ℞ Aq. Chelidon. & rate an. ℥jss. aq. ros. ℥ j. Croci metall. ʒ j. siat infusio.
3. ℞ Sucei Foenicul. rutae an. ℥ iij. Mell. optimi ℥ ij. Exponantur soli incliesa vitro stricti orificii probè obturato per mensem temp [...]e aestivo. Ʋtendum hoc Medicamento, abjectis foecibus.
4. ℞ Axung. Porci, aq. ros. ablatae ʒ ij. Caphurae ℈ss. Tutiae [...]epar. gr. x. Aloes pulv. ℈ j. Sacdati Cand. gr. xvj. siat collyrium.
In deep Ulcers of the Cornea T [...]nica use this of Heurnius, which he bought at a dear rate, and which he hath set down Meth. ad Praxin, lib. 1. pag. 106. ℞ Calareinar. ter usti ac bis in vini aceto [...]tincti ℈ j. Myrrhae, plumbi usti [...] [...]ti an. ℈ss. Croci gr. v. opti gr. ij. aeris usti ℈ iv. decocti Foe [...]gneci ℥ j. terantur omnia super lapi [...]m pictorum, ac fiat collyrium. Having first made clean the Eyes with a Sponge dipped in the macilage of Fenugreek and Lin-seed, dress the ulcerate Eyes twice in the Forenoon, and as often in the Afternoon.
C [...]llyrium de plumbo described by R [...]us, set down by him in Impensatorio Medico, lib. 5. cap. 11. d [...]collyriis, is an effectual Me [...]ment: ℞ Plumbi usti, Anti [...]. Tutiae lotae, aeris usti, pummi Ar [...]ici, tragacanthi an. ℥ j. opii ʒss. fiat ex omnibus pulvis, ex quo [...] Aqua Rosacea formentur Tro [...]ci: dissolve one of them in Fantain and Purselain Water, and dress the Eye with this Medicament. When you are dressing Ulcers of the Eyes, minister once a Week a purging Medicament. If you use Pills, minister (according to the advice of the Arabians) Pi [...]e Aloephanginae, or Pil. lucis majores & minores, or de agarico, minister a drachm made up into four Pills, which are to be covered with Silver Foil: or use this Pill. ℞ Specier. hier. ℥ss. Diagridii ʒ ij. Trochiscor. Alhandal. ʒ v. Cum Syrupo Augustano fiat massa. One Pill of this composition weighing twenty grains, will purge sufficiently. If the party cannot swallow Pills, minister to him this Portion: ℞ Caryocostin. & Electuar. lenitiv. an. ʒ iij. Pulv sanct. ℈ iij. Pulv. Holland. ℈ j. Syrup. Ros. solutiv. cum Agarico ʒ vj. aq. Beton. Foenicul. aut Euphrag. ℥ iij. Misc. ut fiat potio.
To these Medicaments both inward and outward, the right use of those things which are called Non naturalia must be joyned, or else the Cure will be protracted and prolonged.
The Air then must be temperate in its first qualities, as being neither too hot, nor too cold, too moist, nor too dry. It is not good to abide in the heat of the Sun, nor the Beams of the Moon, nor any open Air: the party is to shun Southern and Northern Winds: for the Southern Wind, according to Hippocrates, troubles the Sight, causes hardness of hearing, an heavy Head, dull Senses, a lazy Body, it begets gross Spirits. And the Northern Wind is very sharp, and therefore it stings and pricks the Eyes; neither must the Air be too lightsome: for it scatters the Spirits.
The Bread must be made of clean Wheat, well leavened, and somewhat salted, wherein may be put Fenil, Anise, and Coriander Seeds, for unleavened Bread [Page 204]is accompted hurtful to the Eyes.
As for fresh Meats, these are good: Chicken, Capon, Hen, Partridge, Pheasant, Pigeons, Larks; the Pie, the Swallow, and Gooseflesh are accounted good for the Sight.
As for Fish, Trouts, Roches, Perches and Pickerels, of freshwater Fish, may for variety of Diet be admitted: of Salt-water Fishes, Whiting-mops, and Smelts are accounted the best. Baked and fried Meats, strong Spices, as Pepper, Ginger, Mustard, and Roots of Horse-radish are not to be used. To Meats minister this composition instead of Salt: ℞ Euphragiae, Semin. Poenicul. an. ʒ j. Cinnamomi & Macis, an. ℈ j. Salis communis ℥ j. siat ex omnibus pulvis. All bulbous Roots, as Onions and Garlick; and Pulses, as Pease and Beans, are to be rejected; as also moist and raw Fruits: Stewed Prunes, and Pears or Quinces preserved, are permitted after Meat, to stay the ascending of Vapors to the Head, and Marmalade of Quinces, with some Aniseeds, Fenilseeds, and Corianderseed Comfits.
As for Drink, no Liquor is more convenient than six shillings Beer, neither too new, nor too stale, having had a bag of Boultingcloth hung in it, filled with Eyebright, Fenilseeds, Betony, Rosemary, sweet Majoran, and Sage.
If the party hath been accustomed to Wine, let him use some small Wine, not sharp or vaporous, wherewith some good Spring Water must be mingled; and Borage-flowers, and Burnet-leaves are to be put into the Cup: and this will serve for two purposes: for the colour will comfort the Eyes, and the Herbs by their property will repress the vaporousness of the Wine. The less one doth drink, the better will the Patient be, and the sooner cured. A small kind of Meath made after this manner will not be amiss. ℞ Aq. font. lb xv. Mellis optimi lb j. Foenicul. Euphrag. an. man. j. Macis ʒ j. Coq. ad tatiae partis consumptionem, semper spamam auferendo, ac tandem colands. Immoderate sleep fills the Head full of Vapors, and immoderate watching spends the Spirits, cools the Brain, and hinders the Sight. It is good to go to Bed three or four hours after Supper, and to rise early, and to walk softly up and down the Chamber, to comb the Head, pick the Ears, and to empty the Excrements. Much reading is not good, especially after Meals, and weeping is very hurtful.
The Body must still be kept soluble with lenitive Clysters of Diacathol. Syrup of Althaea, and Oyl of Lilies dissolved in the ordinary Decoction appointed for Clysters. Take this for a pattern, ℞ Diacathol. ℥jss. Syrupi de Althaea ℥ ij. Ol. Lil. Albor. ℥ ij. Decoct. communis pro clysterib. ℥ viij. Misc [...]t siat clyster. If the party will not admit a Clyster, then mingle half an ounce of Electuar. lenititum, in seven spoonfuls of Broth made of a Chicken. After Meals use this or the like digestive Powder: ℞ Semin. Foenicul. & Coriand. Saccharo semel incrustatorum, an. ℥ j. Cort. Citri, & Myrebalan. Kebul. condit. an. ʒ iij. Euphrag. [Page 205]siccat. ʒ j. Macis ʒ j. Sacchari Resat. Tabellat. ℥jss. fiat ex omnibus pulvis: Dos. cochl. j. à singulis pastibus.
Hitherto I have delivered unto you the differences of mild Ulcers; now I will treat of the divers kinds of malign Ulcers of the Eyes. These are either not contagious, or contagious. The not contagious are two; Nome, and Ʋlcera cancrosa. The contagious are three; Carbunc [...]lesa, Venerea, Morbillosa. Of these in order I will discourse briefly.
Nimae or Ʋlcera depascentia are malign Ulcers, which sometimes begin at the corners of the Eyes, sometimes at the white, and sometimes seise upon the horny Membrane. In corrupt Bodies they fret exceedingly, and go forward in such sort, that oftentimes they consume the parts adjacent, as the Musoles and Lids of the Eye: from them flows a stinking slimy Matter, the pain is grievous, and the diseased party has an accidental Fever.
This Ulcer is dangerous, and seldom cured without deformity and loss of the Sight: wherefore my counsel is, that you foretel the darger, if such an Ulcer be offered to you to be cured.
Only I will acquaint you with some local means, having spoken sufficiently of the general Intentiers. Apply then to the Ulcer the Juice of Plantain, Horse-tail, Knotgrass, Night-shade, and Yarrow chrified with Hony, and the whites of Eggs: Dress these Ulcers Morning and Evening dropping a few drops into the affected Eye, covering the Eye with a Cataplasm made of Ʋnguentum rosatum, the pulp of a Quince boiled, and some Oyl of Poppies. If these Ulcers prove very malign and corroding, you may correct them by instilling some Oyl of Vitriol, or Sulphur, mingled with Plantain-water, taking only the fourth part of it. To asswage the pain, use this Cataplasm; ℞ Mala Cydonia numero 2. Sedi major. & Solani bortens. ana man. ij. coq. in s. q. Lact. muliebr. vacc. capr. aut asin. addatur Croci scrup. j. ac fiat Cataplasma.
Ʋlcus crancrosum, a cancerous Ulcer follows; which the Chymists pronounce to be caused of an Arsenical Salt, and it is like to be so: for in this Ulcer, besides corrosion, there is a septick or putrefactive quality. It begins in the black of the Eye.
In it the black and white of the Eye are reddish, Lines seem to be sent from the Black to the Temples: the Patient refuses Food, by reason of the exceeding great pain, a thin darkish and sharp Humor flows from it, and it is exasperated, by reason of the application of sharp Medicaments.
You can only promise a palliative Cure of this malign Ulcer, by the Application of anodyne means, after you have used the general Indications before specified. Paulus Aeginet. lib. 3. c. 22. affirms it to be an uncurable Evil. He counsels to feed the Patlent with Milk, Panado's, and other Meats of a good Juice, and of an easie concoction.
Milde Eye-salves are also to be applied, as this: ℞ Mucilag. Semin. Cydon. & Paliur. Aq. ros. [Page 206]extract. ℥ j. Trochisc. albor. Rhas. cum opio ʒ j. fiat collyrium, quod tepidum applicetur. Renovetur mane & vesperi. Desuper applicetur hoc Cataplasma. ℞ Poma cocta num. 3. Cassiae recent. extract. ℥ss. Croci ℈ j. Lactis mulieb. ℥ j. Albumen ovi unius: siat Cataplasma. So much then concerning the handling of malign Ulcers of the Eyes, wherein there is no contagion.
Ulcers which are caused of contagious Diseases follow, as the Small Pox, the French Pox, and the Plague: If you fear that the Small Pox are like to cause Ulcers in the Eyes (which you shall conjecture, if there was an Inflammation in the Eyes, before any did appear in the Body; if the party feel pain in the Eyes, and cannot open the Eye-lids) then are you to apply gentle Fomentations to the Eyes, and the Breast-milk of a sound Woman, having a little Saffron mingled with it; or the Mucilage of Fenugreek, Lin-seed and Quince-seeds, drawn with Rose-water, having some Safforn added to it. You shall not need to look for any other Medicaments in these Ulcers.
If the Ulcers be Venereal, caused of the great Pox: then with all expedition are you to go about the cure of the main Grief, lest blindness quickly ensue, and then to labour to cure the Ulcers of the Eyes, which are but only symptoms of the Disease, Renod. in dispensat. med. lib. 5. c. 11. sets down an excellent Eye-salve for this purpose, ascribed to Lanfrank by the Neotericks, which he could not find in the Works of Lanfrank (as he confesses) so that by all likelyhood it is a magistral receit. The description of it is this: ℞ Vini albi lb. j. aq. Plantag. & rosarum an. ℥ iij. Auripigment. ʒ ii. Virid. aer. ʒ j. Aloes, Myrrh. an. scrup. j. Terantur ista subtilissime, & siat collyrium.
I will add a little of the Ulcer of the Eye caused of a Pestilential Carbo, or Anthrax, and so end. In this Case, first there arises a small Tumor in the Eye, hot, hard, painful, and contagious, caused of a thick, burned and venomous Humor: It is hot, the unnatural heat causing an ebullition of the Humor. It is hard, because the heat burns the Humor: It is contagious, by reason of the venemous Humor which causeth it: when it yields Matter, it stinks by reason of the putrefaction of it.
It is accompanied with watching, drought, internal heat, raving, and the Urine is sometimes of a fiery colour, sometimes thick and troubled.
If these Symptoms appear, then are you first of all to minister such Antidotes as are fit for a pestilential Fever, as Theriac. Andromachi, Antidotus de sanguinibus, Electuarium de ovo, and such like, to tame the venenosity of the Matter, and then to proceed to the curing of it. If you perceive a Pustule in the top of it, open it with a Lancet: then to extinguish the immoderate heat, soment it with Aqua spermatis ranarum, wherein Champhore is dissolved, and lay a Cloth moistned in the same, to the Eye: above this Cloath apply a Cataplasm made of Goats, or Cows Milk, Bread made of Bran, and the Juice of Plantain: when the [Page 207]crust is fallen, mundifie and fill up the Ulcer, by applying Mel rosatum dissolved in Plantain-water.
Last of all, skin the Ulcer with this Medicament: ℞ Vin. albi lb. j. tut. praep. Aloes, an. ℥ss. Sac [...]har. cand. ℥ ij. Haec inclusa vitro [...]uctiorificii probe obturato, expo [...]tur soli omnibus diebus cani [...]duibus. Guilmeau in the fifth Section, c. 11. of his Treatise of the Diseases the Eye, confesses this Salve to have been given and communicated to him, as an undoubted experiment, in skinning the Ulcers of the Eyes, and procuring a comely Scar in the Cornea.
If it fall out at any time (as it often does by the negligence and [...]ki fulness of the Chirurgeon) that the Eye-lids grow to the external Membranes of the Eye, to [...]it, the Conjunctiva and Cornea: when he has not a care in the time of curing to keep them asunder, then the natural motion of the parts of the Eye is hindred, a deformity ensues, and the Sight is much diminished.
It is called [...], and [...], [...] Galen. lib. de desinit. medicis, [...] according to Aeginet. lib. 4. cap. 55. and [...]; In Latin Coalitus, or Intik [...]tio palpebrarum, in English the Cleaving or Growing together of the Eye-lids, Galen. then in [...] medic. c. 15. thus speaks of [...]. The Eye-lids grow to the [...] of the Eye (he means the C [...]junctiva, or the black, which be names Cornea elsewhere.) If they cleave to the black, the Sight [...] altogether hindred; but if they cleare to the white only, the Sight is less impaired. Celsus lib. 7. cap. 7. thus discourses of this Disease: ‘Sometimes one of the Eye-lids grows to the other, so that the Eye cannot be opened: unto which Grief this inconvenience is often annexed, that the Eye-lids cleave to the white, as when a Sore in each, or both, has been negligently cured: for he has joyned them together in curing, which ought to have been kept asunder: both these Griefs the Greeks call [...].’
Out of these words of Galen, and Celsus, we may gather, that there are two kinds of this Grief. The one is, when the Eye-lids cleave one to another: The other is, when the Eye-lids grow to the Conjunctiva, and Cornea. Guilmeau notes that the first happens from the Nativity, as the Matrix is often shut up. This I will leave to that part of Chirurgery, called by me [...] which teaches to disjoyn and separate those parts which are unnaturally united. As for the second, seeing it is an Accident which hath happened to an Ulcer of the Eye negligently cured, I am not to let it pass.
I marvel that Guilmeau, in the Book and Chapter aforenamed, pronounces out of Celsus and Mesue (not noting the places of the Authors) this Grief to be uncurable: Seeing not only Celsus and Aegineta, but he himself sets down the manner of curing it, which he might well have spared, if he thought his labour lost. Yea, Fabric. ab aq. pend. operat. chirurg. part. 1. c. 8. who in all Chirurgical Operations is very wary, injects no such scruple; but boldly proceeds in the Cure: you are not to [Page 208]be daunted then by his discouraging. If the Eye-lid cleave to the Cornea, against the Apple of the Eye, the Sight never will be perfect; because the Scar will hinder the passing of the Species visibiles to the crystalline Humor.
As for the manner of Cure; it is performed by Manuul Operation only: in this Operation go on thus: Having placed the Patient in that posture as you shall think most convenient for your hand, lift up the Eye-lid, which cleaves to the Membranes, and put between the Eye-lids and the Membranes, in that part which is free (for never doth the Eye-lid wholly cleave to the Tunicles, as Aq. pendent. well observes) an Instrument, like to that which you call the capital Instrument, the Gibbous or arched part being blunt, and having a back; but the belly being as sharp as a Razor: when you have compassed all the part united, having turned the back of the Instrument towards the Eyelid, cunningly separate the parts united, neither offending the Eye-lid, nor any Tunicle of the Eye. But if either of these must be touched, it is best that the Eye-lid, suffer, than any Tunicle: for it may more securely suffer the injury. When this Operation is performed, if you be not vigilant in keeping the parts separate afunder, they will easily unite again, as Celsus notes.
In setting down the Operations, Celsus calls the Instrument Specillum. As for that Instrument, which goes commonly amongst the Ancients under the name of Specillion; it did absolutely represent your ordinary Spathula's, being on the one end narrow and round, to serve for a Probe; ending in a round small button, to hinder it from offending, when you are to try the depth of an Ulcer, or Wound, and on the other broad and flat, to spread your Unguents: of the broadest end Galen speaks, Method. 13. c. 5. where he advises to besprinkle an Ulcer with the Powder, using lats Specilli mucrone, with the broad end of the Specillum, or Spathula.
One thing is to be noted, that if (in putting in of the Instrument into the Eye, to comprehend the parts united) you fear to hurt any part with the point, then it is requisite to arm it with a little Wax, that it may be like the end of a Probe.
To the parts thus separated, apply a Collyrium made of Plantain-water, and Trochisci albi Rhasis sine opio: dissolving in an ounce of the Water, a drachm of the Trochises. Keep the parts asunder with small dosils of Lint put between the parts disjoyned, laying upon the Eyes a couple of Boulsters, cross-ways, moistned with the afore-named Medicament, and then rouling it up. Dress the Eye Morning and Evening, to hinder Unition; and hasten the Cure, untill the incised parts be cicatrized, and no fear left of cleaving together again of those parts, which by Mannal Operation were severed.
CHAP. XXVI.
Of an Ozaena.
HAving set down the Ulcers which ordinarily possess the Ears and Eyes, I must not let those pass which sometimes trouble the Instruments of the other two Senses, to wit, Smelling and Tasting, which are the Nose and the Mouth. Of all the Ulcers of the Nose, I will only speak of Ozaena, omitting the rest; because they require no singular consideration: for the general Indications of curing of Ulcers, will serve to lead any man to the cure of these.
Ozaena hath its denomination from [...], which according to Celsus, lib. 3. c. 11. is Faetor oris, the stinking of the breath.
Of it Galen, de comp. medicam. sec. lic. lib. 3. c. 3. so discourses: ‘Polypodes are bred in the Nostrils, which are Tumors unnatunl; but Ozaenae are a kind of Ulcers, &c.’ First of all, I will speak of the Ozaenae, which are produced of the influxion of sharp, and putrid, or rotten Humors. These Humors, if they be only sharp, they produce Ulcers hard to be cured, but not of a grievous smell: Out of Galen then you may gather, that Polypodes are only Tumors in the Nose, but Ozaenae are Ulcers. Secondly, that there are two sorts of Ozaenae; the one is of those which erode, being caused of the influxion only of sharp Humors, but stink not. The other is of those which smell grievously, and are caused not only of sharp Humors, as the former, but such also as have Putrefaction annexed to the Erosion, Actuar. lib. 2. [...]. c. 10. so speaks of this kind of Ulcer. Ozaena manifests it self by its very name, which it has taken from the stinking smell which it sends out. It is caused when rotten and corrupt Humors gather about the Meatus colatorii, or the holes of of the Ethmoeides, and communicate their Malignity to the adjacent part, and infect others, which flow thither, with their ill smell. And tho at all times the breath of the Patient stink; yet it is chiefly observed in strong expiration. Cel. lib. 6. c. 6. thus writes: But if Ulcers be about the Nostrils which have crust, and an evil smell (which the Grecians call Ozaenae) you are to understand, that this Grief can hardly be cured: so that you see, that to Erosion and Putrefaction Celsus adds crusts in an Ozaena. Gorraeus definitionum med. [Page 210]lib. 13. affirms that this Grief is more frequent in our times, than it was when the ancient Authors lived and practised: by reason of the Lues Venerea, or Pox, which hath gotten sure footing in all Nations, and may be accompted the badge and character of wandring Lusts, and Gods judgment inflicted upon some for this heinous offence.
The Ozaena of the Ancients was only a malign Ulcer: but Ulcers of the Nose which are seen in the Pox, are symptoms of that Grief which is contagious, and by contact may infect others. Aegineta, lib. 3. c. 24. affirms Ozaena to be a carious and rotten Ulcer, bred of sharp Humors flowing to the Nostrils, and eroding them.
Out of the Discourses of the Ancients, this description of an Ozaena may be framed, Ozaena is a malign Ʋlcer in the Nostrils, about the holes of the Ethmoeides, caused of sharp Humors eroding the parts, if no evil smell be adjoined; or having a putrefactive quality, if a noisome smell accompany the Ʋlcer, sometimes without, sometimes having crusts.
The Causes antecedent are corrupt and sharp Humors flowing from the Brain, but sent thither by the Veins and Arteries, wherein such Humors are contained.
The Causes conjunct are these same Humors impacted, and settled in the part.
An Ozaena is two-fold: for it is either not contagious, such as the Ancients knew, or it is contagious, a symptom of the Venereal Disease.
As for the Prognosticks, receive these:
1. All sorts of Ozaenae are of a malign Nature, because such is the Humor, which produces each one of them.
2. All such Ulcers are of hard cure: First, because the Brain still affords plenty of these corrupt Humors. Secondly, because the part affected is of a moist temperature. Thirdly, because the faculty of internal Medicaments, which are prescribed for correcting of the malignity of the Humors, is much abated before it come to the Head.
3. An Ozaena, a symptom of the Pox, is more easily cured, than that which is a Disease it self: First, because the last comes nearer to a cancerous quality than the first: Secondly, because we have more sure Medicaments against the first than we have against the second: if this kind of Ulcer continue long, it takes away the Sense of Smelling.
4. That which is apparent is of easier cure than that which is hid or latent: seeing then ancient Authors, with unanimous consent, pronounce the cure of an Ozaenae to be difficult, in setting down the Method of curing this Grief, my part is to shew what means Modern Practisers by their industry have found out to remove this hardness of curing.
The means then which are appointed for the cure of this Malign Ulcer are either Physical or Chirurgical.
The Physical are in number [Page 211]three: to wit, observation of a good Diet, Phlebotomy and Purgation.
As for the Diet, that is most convenient which I set down in the two former Chapters, wherein I discoursed at large of the curing of Ulcers of the Eyes. If any one offer himself to be cured of such an Ulcer, let him be tied to these Observations: First of all, that he shun all sorts of Meats, which are either of an hard concoction, or afford a corrupt and evil Juice. Secondly, that he use great moderation in the use of wholsom and convenient Food.
Fasting often in this case is very requisite; First, because it dries the habit of the Body: Secondly, becauses it furthers concoction: Thirdly, because by fasting those Vapors are digested, which otherwise would mount up to the Head. And tho in the beginning, while the Body is fraught with sharp Humors, the Sore may be exasperated by fasting; yet after that the Body is clean, and discharged of such Humors, by frequent evacuations, you shall find the commodity of fasting: howsoever, the Dinner must not be riotous, and the Supper very spare.
The second Physical means is Phlebotomy: If the Body be pletherick. First, open the Cephalica of the right Arm in Spring and Sammer; but of the Left, in Harvest and Winter. Then three or four days afterward, open the Veins under the Tongue, which will serve for derivation of the Humor, as the former did for revulsion of the same.
This must much further the Cure: For first, Phlebotomy impairs the quantity of the Humors contained in the mass of Blood: Secondly, it makes way for the receiving of better Blood into the Vessels, which of necessity must ensue after the appointing of a convenient Diet, and exquisite purging of the Body, which immediately after Phlebotomy is to be performed.
The third Physical mean appointed for the cure of an Ozaena, was said to be purging of the Body by Cathartical Medicaments: for vomitive Medicaments are not so convenient as Cathartical, in the Diseases of the Head, unless the Stomach be foul, and pestered with raw and corrupt Humors, which require a long time for concoction: Vomitions (as is confessed by all Practisers) send up Vapors to the Head.
These purging Medicaments are of two forts: for they are either Vegetable or Mineral.
As for the Vegetable Medicaments, they must be of the strongest, which are appointed for disburdening of the Head of ill Humors: such are Agarick, Turpetum, Coloquint, Scammony, black Ellebore. But seeing the purgative Simples are seldom ministred alone, I will shew unto you what compound Medicaments are sittest to be used in this Case. The compound purgative Medicaments are either Pills or Potions.
As for Pills: If the Humors be mixed, then use Extractum Panchymagogicum of Paracelsus, or the Pilul. extract. Rudii; of them minister half a drachm for a dose: [Page 212]Let the Patient use this Medicament twice a Week. If Choler and Phlegm corrupted be the material cause of the Ulcer, then minister the Pills called Sine quibus esse nolo. If thick and gross Humors be the cause, minister Pilulae anreae, & Cocciae, if corrupt Phlegm be the cause, minister Pilulae de Agarico. Of these Pills minister one drachm for a dose: let the number of the Pills be according to the swallowing of the Patient.
If the Patient be hard to be moved to stool, you may actuate, and make the Pills more effectual, by adding to every dose of the Pills four grains of the Trochises of Albandal, and three grains of Diacrydium.
If the party cannot swallow Pills; then you are to minister Potions. The Electuaries most fit for this purpose, are Diacatholicum, Caryocostinum, Diaphaenicum, Electuarium de succo Rosarum, Confectio Hamech, Diacarthamum, Of these Electuaries, and convenient Syrups, distilled Waters, or Decoctions, you may make Potions fitting the constitutions of the parties grieved.
For one of a cholerick Constitution minister such a Potion: ℞ Caryocestin. & Electuar. de succo Ros. an. ʒ iij. Syrup. de Cichor. cum rhab. ℥ j. aq. Endiviae ℥ iij. Misc. ut siat potio.
If the party be of a phlegmatick Constitution, minister this Potion: ℞ Diaphaen. & Diacarthami, an. ʒ iij. Syrupi Ros. solut. cum Agarico ℥ j. aq. Beton. ℥ iij. Misc. ut fiat potio.
If the diseased person be of a melancholick Temperature, then minister this Potion: ℞ Confect. Hamech. ʒ iv. Diacartham. ʒ iij. Syrupi Augustani. ℥ j. aquae Fumariae ℥ iij. Misc. ut fiat petio.
Thus you may purge the Body with vegetable Medicaments, if the Body of the diseased party be weak, or if you fear the use of Minerals. But let me insinuate so much unto you, that Mineral Medicaments, if they be well prepared, are most effectual, and if they be ministred by a skilful Practiser, howsoever they are sleighted and despised by those who glory of the denomination of Galenists, amongst whom some may be found, whose Skill is inferior to the Envy of an Understanding Man.
Mineral Medicaments are more subtil and piercing than Vegetable, and sooner alter the complexion of the party unto whom they are ministred. These Medicaments are most commonly taken from Antimony and Mercury.
Antimony which purges most by stool is excellent. The Sulphur of Antimony drawn by Art from the Recrements of the Regulus is good; as also the Regulus it self calcined and sixed with Saltpeter, and brought to a white Powder. The Glass of it, and Crocus Metallorum, are not so convenient and secure, because they procure strong Vomitions.
There be divers preparations of Mercury which are very effectual; as Mercury precipitate with Aqua Fortis, the Oyl of Vitriol or Sulphur, with Gold or Silver, or precipitate, alone without the addition of any thing. There is [Page 213]scarce a Chirurgeon, who is not able by one preparation or another of Mercury to procure Saliration.
These Mercurial Medicaments are effectual, as well in an Ozaena which is a primary Disease, or of it self, as in that which is a symptom of the Pox. You have seen what Diet is most convenient, and what internal Medicaments are most effectual in curing of an Ozaena: The last point which I propounded unto my self, to attain the Cure of this Ulcer, was the right use of external Medicaments.
These are in number two; to wit, local Medicaments, and an actual cautery.
As for local Medicaments, they are either Waters, or Decoctions, or Unguents: But before you apply any Medicaments, to mundifie, incarnate, or cicatrize, you must labour to remove the crusty substance, which doth fix it self in the forepart of the Ethmoides, or Os Cr [...]iriforme: and that for two causes: First, because the Brain is hindred from discharging of the residue of the malign Humor, which causes the Ulcer, and so the Cure is protracted: Secondly, because the Medicaments cannot touch the affected parts, and so no alteration can be procured.
For the removing of the crusty substance, I commend unto you two Medicaments:
The first is this: ℞ Ol. Amygd [...]um dulcium ℥ j. Spermat. Ce [...] ʒ ij. exquisitè misceantur.
The second is this: ℞ Axung. Ʋisi ℥ j. Pinguedin. Taxi ℥ss. Ol. Senm. lin. ʒ iij. Misc.
You must thus dress the Patient: Turn his Face upward, and let his Head be bent backwards, then Morning and Evening with three Feathers tied together, drop still some of these Medicaments warmed in a Sawcer, into the Nose, and let the party grieved still draw in his breath, until he feels the taste of them in his Mouth.
When you have perceived, that the crust is soft, Morning and Evening let him snuff up into his Nostrils some of this sternutatory Powder: ℞ Ellebor. albi. Nigellae, Tobac. an. ℈ j. Rorismar. Salv. an. ℈ ij. Moschi, gr. ij. fiat puivis subtilis. Let him snuff a little up into his Nose every Morning, after you have moistned the crust with some of the Medicaments set down before. When part of the crusty substance is fallen out, dress it still after this same manner, untill all the crust is spent; then proceed to Application of these Medicaments named by name.
Use these Waters.
First, the preeminence shall be given to Aqua Aluminis magistralis of Fallopius allayed with Plantain or White Rosewater.
The second shall be this: ℞ Aq. Plantag. Card. Benedict. Ceras, nigror & fragor. an. ℥ iij. Spirit. Vitriol. ℈ j. Misc.
The third shall be this: ℞ Aq. Aurifabror. & gemmar. quercus an. ℥ iv. Alum. ʒ ij. Exquisitè misceantur & depurentur.
The fourth shall be this: ℞ [Page 214] Aq. Alum. & Plantagin. an. ℥ iv. Mercur. dulcis ʒ ij. Digerantur in cinerib. calidis per hor. 2.
As for Decoctions, I commend unto you these:
1. ℞ Flor. Ros. rub. pug. ij. Balaustior. ʒss. Rad. Tormentill. ʒ j. fol. Plantag. Polygon. & Vincae pervinc. an. pug. 1. Boil these in six ounces of Spring Water, until half be consumed; strain then the three ounces remaining, and dissolve in them one ounce of Mel Rosatum.
2. ℞ Rhois Coriar. lb. ss. Alumin. ʒ ij. coq. ista, ac clarificentur albumine ovi unius, ac colentur. Colaturae adde Mellis Rosat. Syrup. Myrtill. & de Ros. rub. sicc. an. ℥ j. I will not trouble you with great variety, as I might out of the Monuments of the Ancients; seeing these will suffice, or else none.
The Waters and Decoctions you must inject by a Syringe warm, to make your Topicks answerable to the Air, which is drawn by the Nostrils, in the first qualities, to wit, moist and hot: moist, I say, actu; but potentia, drying; because Ulcers require such Medicaments: seeing both Water and Decoction, being applied, do quickly evaporate, and leave the part affected dry, and thirsting for other Topicks.
Unguents now offer themselves; I will not supererogate in this point, but will deliver unto you such as shall be effectual; and what is deficient in number, shall be supplied by efficacy. Receive this as the first, out of David Sennert. med. pract. lib. 1. part 3. sect. 4. c. 1. ℞ Plumb. usti, [...] thargyr. an. scrup. j. Ceruss. [...] Armen. balaust. an. scrup. ss, O [...] Ros. Myrtin. an. ʒss. C [...]rae [...]. scrup. j. Ducantur ista in m [...]rtario plumbeo, donce acquirant Ʋnguenti consistentiam. The second shall be this; ℞ Ʋnguent. de T [...] tia, & Ʋnguent. Albi Caphurati, an. ℥ j. O [...]. Myrtil. & Cydon. [...]n. ʒ ij. Mercur. dulcis ʒ j. ss. p [...] rizati, Misceantur. These Ulcers are to be dressed twice a day, Morning and Evening.
Cancerous Ulcers also seise upon this part. This Grief hastened the end of that famous Mathematician, Mr. Hariot, with whom I was acquainted but a short time before his death; whom at one time, together with Mr. Hughes who wrote of the Globes, Mr. Warner, and M [...] Turperley, the Noble Earl [...] Northumberland, the Favourer of all good Learning, and M [...] nas of Learned Men, maintained (while he was in the Te [...]) for their Worth and various Literature. But seeing those Documents, which I delivered for the cure of Cancers already, may suffice, I will only set down the description of an effectual Water in this Grief, which is this: ℞ Spermat. Ranar. & Iamae [...] an. lib. ij. gemmar. quercûs & hederae terrest. an. ℥ iv. Ex [...]lletur aqua è stillatorio c [...]mmuns, unde [...] prolici solet Aqua R [...]sacca in recipiens, cui immiss. sint C [...] phurae calcinatae ℈ ij. Inject this [Page 215]Water into the Nose, and lay to the Sores either double Clouts, or Lint moistned in this Water, as you shall think most fit, Morning and Evening.
It only now remains that I speak a little of the Application of an actual Cautery, which was [...]d to be the second external mean in the curing of an Ozaera: this mean is only used when the Sore is rebellious to powerful onlinary means; which happens either by reason of malignity or supersluous Humidity; for according to Hippocrates, lib. 1. Aph. 6. Against extreme Griefs, extreme Remedies are last.
The actual Cautery is applied for two purposes.
First, to cause an Eschar by impressing of it upon the Ulcer.
Secondly, it is used only to dry the Ulcer, by often applying of it, still desisting before the party feel any pain, by reason of extreme heat.
If you mean to procure an Eschar, both the ends of the Pipe by which the Cautery is carried, must be open: but if you intend desiccation, the end which you apply to the Ulcer, must be shut.
If you have procured an Eschar, the fall of it is to be procured, as I did shew in removing of the Crust: this being done, proceed in curing of the Ulcer as hath been taught.
If you have only caused Desiccation by Iteration of the Application of an actual Cautery, the manner of Cure is not to be altered.
CHAP. XXVII.
Of Ʋlcers of the Mouth.
NOw am I to discourse of such Ulcers as befall the Instrument of Taste, which is the Mouth.
It begins at the Lips, and reaches to the beginning of the Windpipe, and the Gula, or Mouth of the Stomach.
It hath four Uses: 1. It serves for Breathing, by sending fresh Air unto the Lungs, and discharging suliginous Vapors sent from the heart by the Arteria venosa.
2. It receives the Food, and having prepared it by the chewing of the Teeth, and the Mandible, it sends it to the Stomach there to be chylified.
3. It serves for Speaking: the external and internal parts of it serving for the framing of the Voice.
4. It serves for discharging of the excrements of the Brain, by spitting out the excrements of the Lungs by expectoration, and by discharging the excrements of the Stomach by vomiting.
Seeing then the Uses of it are so manifold and necessary, it behoves me to discover such Diseases (belonging to our purpose) as deprive us of one or more of these Commodities which it [...] us. But seeing some of the parts of it are external, as the Lips; and some internal, as the Teeth, Gums, Roof, the Tongue, the Almonds, the Ʋvula; I will only meddle with the Ulcers of the Lips, Roof, Tongue, Almonds, Ʋvula, and the Ulcers of it beyond the Ʋvula, as only being proper to my intention.
I will begin first with the Ulcers of the Lips: how hurtful the Ulcers of the Lips are, you may gather from the Commodities, which they (being sound) afford to Man.
The Lips afford a sixfold commodity to the Life of Man.
1. They serve for the conveniency of Eating and Drinking, for they keep in the Meat until it be chewed.
2. They beautifie the Face, if they be well fashioned.
3. They keep in the Spittle of the Mouth.
4. They keep the Teeth and Gums from external injuries.
5. They serve for the framing of the Speech.
6. They serve for Kissing.
And tho the benefits, which re [...]end to us by the Lips, being well affected, may be hindred by s [...]ndry means; yet I will touch only but two sorts of Solution of Unity befalling the Lips, as p [...]per to the Subject that I have in hand, which are the Chaps of the Lips, and the Ulcers of the s [...]e.
Fissurae labiorum, or the Chaps of the Lips, proceed from a salt, [...]p, and drying Humor, which [...] these narrow, but long small Ulcers, which are hot and painful, chiefly when the party speaks, eats or laughs.
These Chaps, (tho they may without any great difficulty be [...]ed in persons of a laudable con [...]tion,) yet in Cacochymical bodies they will give you somewhat to do: insomuch that the Patient will wonder and fret, that such Toyes and Trifles cannot [...] speedily be cured; for so they term such Griefs, considering not the quality but quantity of the Grief.
For the cure of these, I will commend unto you two Medica [...]s of my own; which I fami [...]ly use: The first is this: ℞ C [...]. Flav. ℥ ij. Ol. Ros. Mell. & Ax [...]g. Por [...]. in Aq. Ros. lot. an. ʒ [...]. Litharg. Argenti. Myrrhae, Zuzib. pulv. an. ʒ j. fiat linimentar s. a. First moisten the part affected with the Liniment: it is effectual, not only in Chaps of the lips, but in other Chinks or Fis [...] in what part of the Body [...]er they be, and it cures spee [...]y.
The second is a Pomatum, the description whereof is this: ℞ Poma numero iij. quibus insige Caryophyll. ℥ss. Styrac. Calamit. ʒ iij. Benzoini ʒ ij. Ladan. ʒiss. Calam. Aromat. Cinamom. an. ʒ j. Axung. Porc. lib. [...] Lavendul. & Ros. an. ℥ iv. Moschi, civetae an. gr. iss. Indantur ista vasi terreo satis amplo, ac calore B. M. evaporentur aquae, & coletur Pomatum, quod in vase puro servetur. You may conjecture the efficacy of this Medicament by the ingredients.
As for the Ulcers of the Lips, they are either mild, or malign.
As for a mild Ulcer, this Ointment described by Rened [...]s, Antidot. lib. 5. sect. 1. cap. 11. which he calls Ʋnguentum de minio, or Ʋnguentum rubrum caphur [...]tum, is very effectual: compos. haec est: ℞ minii triti ℥ iij lithar. argent. ℥ ij. cerussae ℥ ssj. tut. ʒ ij. caphur. ʒ ij. ol. ros. lb j. cer. albae, ℥ iij. siat ung. ut ars praescribit. This Unguent is effectual against even old and inveterate Ulcers, in what part soever of the body they be.
If you perceive an Ulcer of the Lip to be malign or cancerous, (which you may conjecture if the colour be livid, or blackish, if the brims be hard, if the heat and pain exceed the quantity of the Ulcer, and it yield a sanious and ill smelling Quittor;) then you are to look about, and to espy which are the most powerful Medicaments.
When I discoursed of a Cancer, a Neme, and a Phagedaenical Ulcer, I set down choice of local Medicaments: for such Ulcers, if they happen to invade the Lips; here I will only give you a description of a distilled water, and of a magistral Unguent.
The water is thus to be made: [Page 218]℞ fol. plantag. solani hortens. veronic. sempervivi major. & minor. an. man. iij. albumina ovorum conquassata numero xij. alumin. contus. lib. ss. caphur. ʒiss. Excoletur aq. calore balnei: fomentetur cancrosum aut malignum ulcus hae aquà, quae & faciei ruborem tollit. The description of the Unguent is this: ℞ plumbi ʒ iij. fundatur in crucibulo, eique addatur Mercur. ʒiss. postquam refrixit, in pulverem vertatur massa, cui adde unguenti de tutia ʒ vj. cerae ʒ ij. terebinthin. ʒ j. myrtil. ʒjss. fiat ung. quod ulceri post fotum applicetur. Delinatur ulcus singulis diebus, qu [...]ties opus est. If you find the Ulcer to be rebellious, and not to yield to these very convenient and effectual means, then are to you apply such Medicaments as I have set down for the cure of a Nome, Phagedaena, and Cancer, whither I remit you, to shun tedious and fruitless repetition.
To the Ulcers of the Lips, the Ulcers of the Palatum, the roof of the Mouth, must be annexed. It is vaulted, that the Air being repercussed, the voice should be the sharper: it is wrinkled and rough, where it covers the Bone, that it might the more firmly cleave to it. and the better stay the Meat whilst it is in chewing.
Now seeing all the internal parts of the Mouth are indued with the sense of Tasting, but chiefly the Membrane which covers the Tongue; and have the exquisite sense of Feeling by reason of the nervous Fibres, whereof they have great store, you are to have a care that your local applications be not distastful and loathsome, seeing the parts will abhor them. If then the wrinkled skin, which covers the Os palati, be ulcerate: First, touch it with Aqua Fallopii, allayed with Plantain water, if it be foul; or with this: ℞ aq. plant. card. benedict. & sperm. ranar. an. ʒ iij. mallis ros. ℥ ij. ol. sulphur. aut vitriol. ℈ j. Misc. Having touched the Ulcer with either of these waters warmed sufficiently, apply this Medicament; ℞ syrup. è ros. rub. siccat. è baccis myrti, & de su [...]es granatorum an. ℥ j. ol. vitriol. ℈ss. Misc. Seeing the part is moist, and will not admit the deligation, you are to dress it the oftner. If you perceive the Os palati to be bare, then mingle some of this Powder following, with these Syrups: ℞ far. hord. rad. irid. s [...] phyti, tormentil. an. ℥ss. mastiche [...], b [...]racis, sarcocoll. an. ʒss. fiat ex omnibus pulvis. If the rough skin unite, as I have often seen, then have you obtained your desire.
If a small piece of the Os palati fall out; using these incarnative means, and keeping the brims of the Ulcer raw, you may bring them together; but if a large piece of the Bone come away, there is no hope of unition. In this case you are to cause the party to wear a plate of Silver to supply the defect of the Bone, that his speech bewray not the loss of it.
The third internal part of the Mouth, which uses to he ulcerate is the Tongue.
The Tongue affords four benefits to the Body.
1. It is the instrument of Tasting, by the benefit of the Membrane wherewith it is covered.
2. It utters the Speech, by which we communicate our wants to others, and implore aid in time of distress.
3. It helps chewing, by gathering of the Meat together, tossing [...]it to and fro; it turns also the [...]eat down to the Stomach.
4. It serves for licking. To omit, that in our insancy we could not s [...]ck without it: so we see, that if the fraenum of it come too near to the tip of it, the sucking is hindred, [...]d it must be cut. Children who [...]e this infirmity are said to be T [...]gae-tyed. The flesh of it is [...], that it might receive the [...] of the Sapors, and more [...]rately judge of them.
If the sores of this part be but [...]ry and mild, this Medica [...] will serve, if it be often [...]shed with it: ℞ hord. mundat. ℥ iij. rad. alth. ℥ ij. liquirit. ℥iss. B [...]ant. ista in lib. v j. aq. font. [...]dias, ac coletur decoctum, cui [...]isce syrup. viol. tussilag. & sca [...]sa an. ℥ j ss. ac serva mundo vas [...]d usum.
It falls out sometimes, that Sores i [...] this Member prove malign and very fretting, causing one of these Ulcers which are called [...] and [...], as it once happened to the Lord Mayor of London, R [...]ph Freeman. He lacked neither Physicians nor Physick, yet old age, weakness, and the malignity of the Sore hindred the pro [...]ing of his Health, which his [...]ysicians and Chirurgeons aimed at and wished for. The Ulcer was so corrosive, that it fretted asunder the Veins and Arteries of the lengue, on that side which it possessed, and caused a great flux of Blood, which exceedingly weakned him, for that present causing a strong Syncope, so that afterward Nature could not recollect her self. When such griefs befall great personages, their case is worse than that of the poorest in the like infirmities, because Physitians and Chirurgeons are not permitted to use the like liberty in the application of Medicaments to the one, as to the other. If the like case fall out hereafter at any time, I advise you so to use Medicaments borrowed of Vegetables, as that you contemn not Minerals: What hurt I pray you can come from the use of Merc. dulcis, and Merc. praecipitate with Gold? None I assure you, for these Medicaments are familiar to Nature, and are true Balsames for malign Sores.
But you may ask what was the reason that these Medicaments were not used?
I answer, because there was no mention made of these Medicaments at the first, and it was too late to minister them at the last, Nature being surprized; for this only would have made the Medicament odious, and the Physician (who should have advised this course) obnoxious to calumny and reproach.
Now time admonishes me to come to the Ulcers of the Ʋvula or Gargarion.
If they be mild and ordinary, the former Medicaments set down for the cure of the Tongue will be sufficient.
But if it be a fretting Ulcer, first you are to admonish the Patient of some accidents, which may ensue: [Page 220]and those are Two in number.
The First is, That if the Ʋvula be wholly fretted away, the party shall hardly be able to speak clearly and distinctly. Howbeit both Bauhinus in his Theatr. anatomicum, and Gulielmus Fabricius cent. 2. observ. 21. do affirm, that in some they observe it to have been lost, not leaving any defect in their speech
The Second accident is, the danger of a Phthisis, or Cough of the Lungs; for this is to be feared, seeing the member which did hinder the rushing in of the cold Air into the Lungs, and put back from the Breast Humors distilling from the Head, is wholly taken away.
Having acquainted the Patient with the Prognosticks, I proceed to the Cure.
This is performed either by the application of convenient Medicaments, or else by cutting it away.
As for the Medicaments, use first this Clargarisme: ℞ fol. plantag. veroni [...]. & sigill. Solom. an. man. j. scord. orig. centaur. minor. an. man. ss. Bulliant ista in lib. ij. aq. font. ad consumpt. lib. j. & coletu. decoction, in quo dissolve oxymellis simplicis ℥ iij. Then touch the Sore Morning and Evening with this liniment: ℞ ung. Aegypt. ℥ss alum. pulv. ʒ ss. mel. ros. ℥ i ss. Misc. applicetur mane & vesperi.
If it proceed from a Venereal cause, use this Topick twice a day: ℞ aq. card. benedict. & plantag. an. ℥ vj. aq. fort. ℥ j. Misc. You may also use the blue Water, which you may buy for three pence a pint after the Silver is separate, after solution, and hath no other metal in it, but a little of Venus. If these means will not prevail, then you must wholly cut it away.
But according to Valescus de Taranta, you must observe these five things before you go about this operation.
1. You must purge the Body well.
2. No Humor must be in flowing to the part.
3. You must not attempt this operation as long as there is hope, that other Medicaments will prevail.
4. Go not about this operation, unless it be small about the root; for if it be thick, and red, or blue, such a flux of Blood may ensue, as will strangle the party, and cause fainting.
5. Mark, how much of a necessity must be cut off; for a little remaining will both further the Speech, and repell the cold Air from the Lungs. If after the cutting of it off, a flux of Blood ensue, either apply astringent powders to it, or else cauterize it with an Ʋvula Spoon made hot.
If the Tonsillae or Almonds be ulcerate by reason of the influxion of sharp Humors, which your Eyes can discern, the Tongue being pressed down by your Spathula, carry in mind these prognosticks.
1. If these Ulcers be without a Fever, they are the more safe.
2. If these Ulcers happen in the Summer, they sooner spread.
3. If the Almonds become Scirrhous, they are hardly or never cured.
4. These Ulcers (as all other Ulcers of the Mouth) require stronger desiccatives than Ulcers of the external parts. First, to hinder them from spreading. Secondly, because they are still kept moist with the spittle.
For the cure of these Ulcers, I [...]ill deliver unto you two local Me [...]caments: The First is the de [...]oction of the root of the Devils [...]it, to be used instead of a garga [...]. The Second is a liniment [...]o be applyed after gargarization [...]ed by Sennertus, and set down [...]dicin. pract. li. 2. c. 22. ℞ cen [...]r, minor. rad. irid. stercor. carini. an. ℥ j. cum melle despumato fiat electuarium. As for the faculty of a white Dogs-turd, read Galen. li. 10. de simpl. med. facult. c. de stercore canino.
If the Throat beyond the Ʋvula be ulcerated, use this water instead of a gargarism as a certain experiment. ℞ aq. plantag. l. 1. ros. rub. flor. aurantior. an. ℥ j. pulv. Merc. subli. ʒ ij. digerantur in arena per horae quadrantem, ac coletur aqua, quae in vase vitreo servetur ad usum. If by reason of these Ulcers the party cannot swallow any solid meat, minister to the Patient Mercurius dulcis for four Mornings together, and you shall perceive a wonderful effect. Give it in new Milk.
CHAP. XXVIII.
Of Ʋlcers of the Lungs.
SEeing the Lungs very often become ulcerate, a solution of [...]ty in the substance of them, or [...]apertion of the vessels of them, [...]ch are the branches of vena arai [...]sa and arteria venosa, being [...]sed by a wound: I must not [...]et such Ulcers slip untouched.
Two causes of such Ulcers of [...]e Lungs after a wound inflicted [...]ay be assigned: to wit, a solu [...]on of unity in the substance and [...]essels of the Lungs, and effusion [...] Blood into the hollowness of the Breast. You shall discern the Lungs to be wounded.
1. First, if srothy Blood issue out of the Wound and Mouth by coughing, which shews some of the vessels to be wounded, and opened.
2. Secondly, difficulty of breathing troubles the party wounded.
3. Thirdly, pain of the Sides is grievous, which he felt not before.
4. Fourthly, It is more easie for the Patient to lye upon the wounded, than the whole Side: [Page 222]so that often he can speak readily so lying; but being turned upon his sound Side he can but with pain and difficulty speak.
You shall perceive and gather, Blood to have been poured out into the capacity of the Breast by these signs.
1. If a heavy weight seem to press down the Midriff.
2. Secondly, if the party breath with great difficulty.
3. Thirdly, if the Fever increase.
4. Fourthly, if the wounded party void Blood at the Mouth.
5. Fifthly, if the breath of the party stink after a while: for that betokens the Blood to be turned into Quittour.
6. Sixthly, the wounded person can only lye upon his Back.
7. Seventhly, the party has a desire to vomit, and strives to rise, from whence fainting ensues; for noisome vapours arising from the clotted Blood turned into Quittour assault the Heart, and weaken it exceedingly, and dissolve the faculty of the Stomach.
After that the wound is inflicted, and that you have dressed it so long a time as you have required in former times for healing of a penetrating wound of the Breast, (which will be shorter in the Summer, than in the Winter: for heat helps digestion) you may fear that a Fist [...]la at the least, or a putrid Ulcer of the Lungs will ensue: chiefly if a thin Sanies, and not a laudable Quittour flow out, far in quantity exceeding the bigness of the wound.
Why in wounds of the Lungs, so much Quittour every day is [...]t out, these are the causes.
1. The vicinity and nearness of the Heart, which being the welspring of Blood, sends too much of it to the part affected: And when as it cannot make use of all of it, by reason of weakness, it turning the remainder by its [...] ral heat into Quittour, discharg [...] it by the orifice of the Wound.
2. Because the sound parts se [...]d unto the diseased Blood and Spirits without mean or measure.
3. Because the Lungs draw more nourishment to themselves by their motion, heat, and pain, than they are able to digest,
4. Because the Ulcer like a devouring Wolf by its malignity and filth, presently corrupts the Blood sent for nourishment unto the Lungs, turning the greatest [...]t into Quittour, and defrauding the part affected of maintenance: from whence ensues an extenuation of the whole Body.
Now that you may the better foresee and foretell to the Patients the events of such Ulcers, I would have you to mark these Progrosticks, which I shall deliver unto you.
1. All Ulcers of the Lungs are hardly, or with great difficulty [...] red, and that for four causes.
1. Because the Muscles of the Breast, Lungs and Heart, are in perpetual motion: now motion hinders consolidation, as all by erperience know.
2. Because the Lungs are onely [Page 223] [...]nvironed by the Pleura, the skin inwardly investing the Ribs, which is endued but with small store of Blood, and being a spermatick part, to wit, a Membrane, is not easily united: and that only by the second intention.
3. Because local means cannot be kept to these Ulcers, by rowling, boulstering, and emplastering, as they may to Ulcers of the external parts.
4. Because the orifice of the Ulcer is not commonly in a depending part; but either parallel, or higher than the Ulcer. How hard a matter it is for Quittour to ascend, I leave it to your consideration.
5. If the party pine not away, if he expectorate easily, if he sleep reasonable well, if he digest his Meat, if his Stools be orderly, if the Quittour be indifferent good; you may conceive some hope of a Cure.
6. But if the diseased parties Breath smell ill, if he consume, if the Quittour which flows from the Ulcer stink, if he hath a grievous Cough, and difficulty of breathing, if a [...]ngring putrid Fever troubling Ear [...] chiefly toward night, and hindring his sleep, follow him, if his [...]ppetite decay, and concoction of the Aliment be empaired; if a [...]otten piece of the Lungs, or of the branches of the Windpipe, be thrown out at the Mouth, if he have a whistling voice, as if he [...]ke thorow a Cane, his case is desperate.
7. If his Hair fall, which happens by reason of the want and corruption of the nourishment: if the [...] grow crooked, the flesh of the tops of the Fingers being spent, if the Cheeks grow to be of a leaden colour; but when after meat they seem ruddy, vapours mounting thither; if the Feet begin to swell, the natural heat being spent, if Lice multiply by reason of the corruption of the Humors, you may pronounce that a Diarrhoea or humoral Flux ensuing, the party shall depart.
8. Although some have lived many years who have had an Ulcer of the Lungs, as Avicen reports, that he saw a Woman who lived twenty three years, or thereabout, with an Ulcer of the Lungs. And as Matth. de Gradib. in 9. Rhas. c. 54. affirms, that he saw a Woman who still was busied about the fire, who lived twenty eight years; yet be not you too forward to take in hand such persons as have ulcerate Lungs; for the cure is uncertain, and that for four causes.
1. By reason of the symptomes which ensue, as a lingring Fever, and Consumption of the Body.
2. Because the Quittour which is contained in the spongy substance of the Lungs, cannot be voided by expectoration without coughing; which much troubles the Lungs, and exasperates the Grief.
3. Because the Medicaments which are ministred to cure these Ulcers, cannot come to the Lungs in their full force.
4. Because the Fever and Consumption of the Body require those things which are moistning, but the Ulcer those things which mundify and dry.
If it chance, that by Art and good luck you cure an Ulcer of the Lungs, charge the party that he walk circumspectly in the course of the residue of his life; for many times when the Ulcer has seemed to have been cured, yet the Cicatrix being removed by the ill carriage of the Patient, the Ulcer has gotten footing, and been the cause of untimely death, as Oalen witnesseth, lib. 4. de loc. affect. c. 5.
When you go about to cure such Ulcers, you are to propose three Indications curative to your selves.
The First is, the appointing of a convenient Diet.
The Second is, the ministring of fit pectoral Decoctions.
The Third is, the artificial dressing of the Ulcer.
As for the Diet: the party having an Ulcer of the Lungs, must eat meat of an easy concoction, because Nature is much weakned; of good juice, lest putrefaction be increased; and Lastly, of much nourishment, because the Body in this Grief is most commonly much extenuated only I will briefly touch some kinds of Food, which are endued with these qualities
The First that offers it self is Milk, for it nourishes the Body, it affords matter for Bloud, it corrects the acrimony of corrupt Humors; with the Wheyish part it mundifies the Ulcer, with the Curdy part it consolidates, and with the buttery part it moistens, and staies the desiccation of the Body; Womans Milk is most familiar: By the sucking of a Womans Breast I saw a Weich Gentlewoman, called Mrs. Price, recovered of a Phthisis, who could not turn hee self in her Bed, by reason of weakness, and could not take any other food. Asses Milk is thinner and more wheyish, and so more apt to mundify. Goats and Cows Milk obtain a mean between these two.
But lest it corrupt in the Stomach, you are to dissolve some Sugar or Honey in it.
You are to minister it only when the Stomach is empty, and no other Meat is to be taken before it be digested; otherwise it will curdle, become sowre, and be corrupted.
So much of it is to be given, as the Stomach of the party can well digest: wherefore first prescribe a less quantity, and ascend to a greater.
Abstain from appointing of it, if the party be Feverish, have the Head-ach, and be troubled with flatuosity.
Snails and Crabs are much commended in this grief; nevertheless seeing they are of a thick, tesrestrial, and slimy substance, and afford corrupt and excrementitious juice, it may be doubted whether they be good or no: to omit, that they are of hard digestion; the broth of them boiled in Milk, and sweetned with Sugar, and mingled with other broths, may be good: for so the nourishment will be the more solid.
As for pectoral Decoctions, I will not trouble you with any great variety of them; only I will set down a few, but the paucity thall be recompenced with the efficacy.
8. ℞ rad. enul. ℥ ij. scob. guaiact lb. ss. hyssopi, marrub. a b [...], an, [Page 225]man. ij. Polypod. Liquirit. an. ℥iss. Fic [...]um incisar. passul. major. excinat. an. ℥ iij. Insundantur infundend: per noctem in Aq. Font. servent. lb xviij. deinde, addit is reliquis, coq. ad consumpt. lb vj. a [...] coletur decoctum, quod clarisicetur, edditis sacchari & Mellis an. ℥ ij. Creci ʒ j. atque iterum coletur: ut [...]tur aeger hoc decocto loco consueti p [...]ûs.
2. ℞ Rad. Chin. ℥ iv. Symphyti, T [...]mentill. irid. an. ℥ j. Capill. Vener. Tussilag. scabios. Marrub. alls, Hyssopi, an. man. j. Flor. Viol. B [...]ray. buglos. an. pug. j. Flor. Herbae Para [...]s. pug. ij. Flor. Alth. pug. i. ss. Caricar. ping. ℥ iij. Liquirit. ℥ ij. Sonin. Ceriand. Anis. an. ʒ vj. Inf [...]antur ista, ut superiora, in pari quantitate aquae, ac decoq. ad [...]s [...]pt. lb vj. ac coletur decocton, quo utendum loco consuets paûs.
Every Morning the Patient is to take half a pint of either of these Decoctions warm, and to eat a logerge of Saccharum rosatum [...]ell [...]tum, or two drachms of the Conserve of red Roses, being a [...]elve-month old.
Now I am come to the artif [...]il dressing of Ulcers of the [...]est.
The Medicaments which are sit [...]ct for the dressing, are Injections [...]y a large Syringe.
As for the Simples whereof the Injections are made, they must not be of bitter things, as Worm [...]ood, the lesser Centaury, or Car [...] Benedictus; for as judicious [...] d [...]gent Ambros. Paraeus notes, [...] lib. 9. c. 31. these bitter [...] being injected, are first drawn in by the spongy substance of the Lungs, and from thence are sent by the Trachaea Arteria, to the Throat; where such a bitterness is felt, that it causes a desire to vomit, so that they rather hurt than profit.
These Injections are either abstersive or consolidative.
Of abstersive Injections I will set down a few, as a Pattern, by which you may make others.
1. ℞ Marrub. alb. Hyssopi, Scabios. an. man. ss. Coqu. in lb iij. Aqu. Font. ad medietat. consumptionem. ac coletur decoctum; quod postea clarificetur addit. mell. lb i. ss. atque iterum coletur.
2. ℞ Aqu. hord. lb j. Mellis Ros. ℥ ij. Sacchari Rubri ℥ iij. Misc. bulliant 3 aut 4 ebullitionibus, ut injectio clarificetur, quae postea coletur.
If you perceive, that the Ulcer is sordid, and affords much matter, you may add either of Ʋnguentum Aegyptiacum, or the Oyl of Sulphur, or Vitriol, so much as you shall find fit to cleanse the Ulcer.
When you perceive that the Ulcer is sufficiently mundified; which you may gather, if laudable Quittour flow, and in no great quantity; then hasten to consolidate the Ulcer: I will in this case surnish you also with effectual Topicks, and but few: the first shall be this:
1. ℞ Decoct. pectoral. ℥ iv. Syrupi è Ros. rub. sico. ℥ j. siat injectio.
2. ℞ Hed. terrest. stor & sol. [Page 226]Symphyt. Sanicul. Plantag. Polygon. Millefol. vinc. pervinc. Equiseti, Hyper. Eupat. Beton. Valerian. an. man. ij. Limaces numero xl. Cancros fluviatil. numero x. Addità Aqu. pluviali, instituatur distillatio in alembico, ut extilletur Aqua. ℞ Aqu. hujus lb ss. Syrup. Myrtil. & è ros. rub. siccat. an. ℥iss. Syrupi Granat. ℥ j. ss. Misc. ut siat injectio.
These Injections must be warmed, when they are to be used. Into the Orifice, which is in the Breast, somewhat must be put to keep it open: this then is to be performed either by a Tent, or a Pipe made either of Gold or Silver.
The materials of the Tents are three; Lint, fine Tow, and a Sponge. Lint is altogether unapt, for it is apt to fall asunder after that it is made up into a Tent: if therefore a piece of it part, and rest upon the Diaphragma, it must putrefie there, and send noisome sents unto the Heart, which cannot but bring Faintings, and at the last shorten Life.
Good Tow then is better than it, because it cleaves fast together; but the Sponge is best of all, because it doth not only cohere sirmly, but draws also strongly the Quittour, and imbibes it.
It is good so to form the Tent; that the outer end being broader than the inner, it may be staid from slipping: it is not amiss to halter them with thred for this same purpose.
A Pipe is best of all; it must be of thickness proportionate to the Orifice, having two stays to hinder the slipping of it into the cavity of the Breast; and sundry holes somewhat large about the end, to give way to the Quittour. It must also be somewhat arched lest the Lungs butting against it, should suffer any hurt. The outer hollowness is to be stopped with a Sponge dipped in Aqua Vitae and Wine mingled together, and warmed, and wrung. Above the Teats and the Pipe apply Emplastramd [...] menio, or Diachalciteos.
[...] the Ulcer run much, it must be dressed twice a day; but if it run little, once dressing will serve.
You may demand of me, when the Tents and Pipe are to be left?
I answer, when the Ulcer yields but a small deal of Quittour, and that good; and seems to be almost dry: for siccum est sano pronimum, that which is dry comes near to that which is whole.
If you keep the Orifice of the Breast too long open, it will fistulate.
It falls out many times, that it Ulcers of the Breast, the diseased person grows lean. In this case you are to permit the party to drink some Almond Milk made o [...] Chicken broth, wherein have bee [...] boiled Pompion, Cucumber, and Muskmelon seeds, with Mallow roots, Cowslip flowers, Succo [...] slowers, and Marigold flowers, between Meals, and in the Night time after two a Clock; or min [...] ster a drachm and a half of the Powder which I will set down every Morning and Evening, in s [...] ounces of one of the pectoral D [...] coctions, which I described [...] the beginning of this Chapter.
The description of the Powder is this: ℞ Semin. Papav. albi. ʒiss. Gummi Tragacanth. Far. Oro [...] an. ʒiiss. Semin. Alth. Portul. C [...]en. Melon. Pepon. Plantag. H [...]am. alb. an. ʒ iij. Coral. rub. [...]eparat. Perlar. praeparat. Succini [...]i. preparat. an. ʒiss. Liquirit. ʒ iv. Sacchari rosat. Tab [...]llat. ad pondus omnium: siat pulvis.
If these courses being used faithfully; do not prevail, acquaint the diseased parties friends with the dangerous estate wherein he is; for no other Medicaments are like to prevail.
CHAP. XXIX.
Of Ʋlcers of the Back, the Abdomen, and Joynts.
ALthough one might rest contented with what has been [...]eady delivered concerning Ulc [...]s; yet that none may justly say, that anything absolutely necessary has been omitted, and to further the practice of those which are [...]t so well versed in the curing of [...]p [...]ticular Ulcers, I will briefly [...] down some notes concerning Ulcers of the Back, the Abde [...], or lower Belly, and of the J [...]s.
Ʋlcra dorsi, or Ulcers of the lack, most commonly fall out after [...], or [...]lematous Phlegmons, wherein Merbi acuti ex decidentia [...].
Now that you may the better understand what I mean, I must degress a little, and shew you what D [...]eases are termed Morbi acuti, and how many kinds of them there are.
Mer [...]i ac ti, or sharp Diseases, are properly called such as with great expedition, force, and danger go on to their status and extremity of the symptoms, as may be gathered out of Galen. 2. Aphor. 19. & 23.
Now there be three kinds of these Morbi acuti, or sharp Diseases; for they are either peracuti; very sharp, acuti simpliciter, simple sharp, or acuti ex decidentiâ, or sharp Diseases ending into other Griess.
Peracuti end at the furthest on the seventh day, and they are of two sorts, exquisitè peracuti, of perperacuti, or exquisitely very sharp, which end on the fourth day, and non exquisitè peracuti, which are not exquisitely very sharp, which continue till the seventh day.
Now the simpliciter acuti in like manner are of two kinds: for they are either exactly so, and end for the most part on the fourteenth [Page 228]day; or not exactly so, which may continue till the twentieth day. You may, and (I make no doubt) do see examples of these in burning and pestilential Fevers almost every Week. Last of all are acuti, [...], ex deerdentia, which may be prolonged unto the fortieth day: Diseases which continue longer than forty days, are called Morbi Chr [...], or Diuturni, long or lingring Discases. Some of these Chronical Diseases may end in sixty, some in eighty, some in an hundred, some in two hundred days: some may continue a whole year, some seven years, some twice seven years.
1. I law a Scotch-man, whose surname was Johuson, a Sadler by profession, who followed the Court in Queen Elizaboth's Reign, who was troubled twelve years with a Quartan Ague without intermission; neither can I affirm, that it left him during his life time.
2. Being in the Isle of Shepp [...], in Minster-street, curing one Clover an Aged Man, whom I dismembred, there was a Girl brought to me, of seven years of age, which for the space of six years was grievously tormented with an exquisite Quartan. The Lives of these Persons may be well termed living Deaths. Some of these lingring Diseases again continue in Boys untill the fourteenth year of their Age, and in Maids until their courses flow: as the Falling Sickness.
Now to come to Apostems of the Back, which leave Ulcers after they are brought to suppuration and opened; They are for the most part critical Translations of Humors, sent in Morbis acutis ex decidentia, sharp Diseases which continue until the fortieth day; or in Chronical Diseases, the continuance of which is uncertain, sent from the inner either noble or ministerial parts from within outward; the Physicians say, this is done per diadosin: whereas if noxious Humors be turned from without inward, as in pestilential and Venereal Buboes, they affirm this to be done per metastasin.
Critical endings of Griess, are either performed by Excretion or Translation of the Grief.
1. By Excretion Nature exp [...]s the peccant Matter sundry ways, as by Vomit, Siege, Sweating, Bleeding at the Nose, the flowing of the Menstruous Courses, and the Apertion of the Hemonholdal Veins, as you may observe every day in the termination and ending of sharp Fevers.
2. In Translation, the peccant Matter is not altogether discharged out of the Body; but is sent from the part affected unto another part by provident Nature.
But seeing the Humor may be sent from the outward parts to the inward, and from the inner ports to the outward, this last Trans [...] tion is most secure; for if the first be done in malign and contagices Diseases, as in the Pox and Plague, all understanding Practisers pronounce either Death, or pro [...] ction of the Cure.
When therefore these Apostems appear either in the Back, or one of the great Joints, which afterward degenerate into Ulcers, the motion of the Matter by Nature is laudable, doing it by Translation; seeing she cannot by Excretion, partly by reason of the weakness of the principal parts, or by the plenty, or hard concoction of the H [...]mor.
But this is the misery, that the F [...]aends or Kinsfolks of such a dise [...]sed person think him or her to be [...]together safe and secure, when they see them eased by the translation of the Humor, and therefore to spare charges call not for [...]ilsul Physicians, and Chirurgeons, by whose Skill and diligence the motion of Nature might be furthered. And so it falls out many times, partly by reason of the thickness of the Skin, as in the Back, or by reason of the thickness of the Skin and compactness of the Mem [...]anes, as in the Joints, that the Vert [...]ae of the Back are corrupted, and the Cartilages, and Tendons of the Joints, before remedy is sought for.
But that you may meet with these hide-bound Patients, and keep your selves from incurring d [...]nger of discredit, mark these Prognosticks, which I will deliver unto you.
1. If after Inquisition you find that a Tumor in the Back conti [...]ed a long time before it did break of it self, or was opened, suspect the Ulcer to be of hard Cure: for it is likely that the Vertebrae of the b [...]k are foul.
2. If the Vert [...]brae be foul, which you may easily find out by your Finger or Probe, the case is desperate: wherefore take heed, that you promise not a Cure.
3. If in Ulcers of the Back you see the parties Body day by day to become more and more extenuate, advertise the Parties Friends of the danger: for it is an evident Argument that the principal Parts are weakned, and cannot wholly discharge the Humor which offends.
4. Ulcers in the upper part of the Spina dorsi are more easily cured, than those in the Loyns [...] Because the Abdomen or lower Belly sends out more superfluities than the Thorax or the Breast, which is the middle Cavity. Secondly, because they are nearer to the Heart, the Sun of the little World, who by his heat is able to consume much superfluous Humidity.
I think it will not be unpleasant to you for me to confirm my last Prognosticks, by true relation of the Events which besell me when I practised in Wales in the like Griefs: seeing Examples leave a deeper impression in the Mind, than Precepts, and lead best to the Cure of external Griefs.
In Denbigh-Town there was one Richard Pryce an Haberdasher, son to John Pryce, who kept the principal Inn of the Town, who after he had been troubled with a Chronical Disease, felt in his Back a little below the Shoulderblades, a Tumor still increasing in the outward parts, as he was eased in the inward, until at last it grew to the bigness of a Penny Loaf. I having been called unto it, by opening of the Apostem, and using [Page 230]Methodical Indications, cured the Patient. This Man (as I hear) having given over his Trade, still keeps the Inn, which his Father did.
In this same Town about the same time, a lusty young man, whose sirname was Owen, whose Father was a retainer to Sir John Salisbury, had the like Tumor in the Vertebrae of the Loyns, after a lingring Grief: I having been entreated by the truly Worshipful Sir John Salisbury, (who had not an ordinary Skill in the knowledge of Plants, and in performing Chirurgical Cures) took a view of the young Gentleman. After mature deliberation, I told Sir John and the young mans Friends, that there was much Quittour in the Tumor, which must be discharged; and that the event of the Cure would be uncertain, if the Matter were let out, for the Reasons above specified. At the entreaty of Sir John Salisbury, and the young Man's Parents and Friends, I opened the Apostem which was in the Vertebrae of the Loyns: And tho no means were omitted, which seemed to us effectual for the recovery of the young Man's health, and that the Verte [...]rae of the Loyns were not foul; yet he fell into a Marasinus, or extenuation of the Body, being otherwise a proper and valiant young Gentleman; and so ended his Life before Age called for his dissolution, to the great grief of his Parents (having no other Son but him) and the commise [...]ation of the worthy Knight. I have delivered unto you my Observations in this Grief, whereof I hope you will make good uses you having occasion ministred to be wary, by the Examples of others, which is no mean benefit.
How I performed the Cure of the first Patient, now I will declare unto you: First, I purged his Body with a gentle Medicament: It was this: ℞ Electues. L [...]nitiv. ʒ iv. Electuar. de s [...] Res. ʒ ij. Srrup. Ros. solutsci [...] Agarico ℥ j. Aq. C [...]cher. Mise. [...] fiat potio. Secondly, I applied the Lapis infernalis to the depending part of the Tumor: Thirdly, I opened the Apostem, making [...] a small Orifice thorow the Esch [...]. Fourthly, every day I dressed the Sore, still suffering a little of the Quittour to flow out, untill all was discharged. Fifthly, I used a m [...]ndifying Injection, untill I per [...]e [...] the Sore to be clean, not slia [...] ing, and so to afford both laudable, and small store of laudable Quittour. Sixthly, I used a [...] solidative Injection, and Bo [...] sters somewhat thick, to comp [...] the Sore.
The mundifying Injection was this: ℞ Vini albi lb. j. M [...]s Rosati ℥ iij. Ʋnguent. Aegyp [...] ℥ss. Misc. ut fiat injectio usapanda caada. The consolidati [...] Injection was this: ℞ Aq. Phetag. ʒ iv. Srrup? Myrttni & [...] Ros. rub. siccat. an. ʒss. Tro [...]se aiber. Rhas. sine Opio. ʒ ii. Mis [...] fiat injecsin, applicanda item ca [...] All such Injections must be wauned; for cold, as Hipp [...]es witnesseth, is hurtful to the S [...] na [...]s Medulla. The Emplister which I used was Diach [...] cum Gummi. By these mears I cured the party in three Weeks space.
Now Ulcers of the Abdomen, or of the lower Belly, do offer themselves only to be but compendiously touched. Seeing there are three parts of it, Regio Epigastrica, Ʋmbilicalis, and Hypogastrica, the upper, the Umbilical, and lower Region; I am to shew unto you what parts in these Regions most commonly suffer ulceration.
I saw the Stomach of one Mishess Ferne, together with the Muscles perforated by the Erosion of a sharp Humor, in the Howlt, a Town distant from Chester five Miles: the Meat, Drink and Chyle came thorow the perforation: the Ulcer also smelled strongly. I being unwilling to deal with her, prescribed some local means, which wrought but small effect; for she died of a Marasmus, or extenuation of the Body, within a short time: the Ulcer hindring the Chylification of the Aliment, and so defrauding the Body of nourishment. My Opinion was then, and now is, that Ulcers penetrating into the cavity of the Stomach are mortal, tho Wounds of this kind be sometimes cured: for in the second there is but a bare Solution of continuty; but in the former there is a Solution of continuity having annexed to it the sharpness and malignity of a Matter. Here in London, in an Inn a little above Fleet-conduit, one Richard, who was Tapster of the Inn, had for a long time a great pain in the right Side of the Epigastrical Region of the Abdanen: In progress of time there appeared a great hard Tumor, causing a sharp Fever: at last the Plegmon breaking of it sell, sent out great store of Quittour. I then lodging at the Sign of the Naked Boy, a little below the Conduit, was sent for, finding him in a strong Fever, and having difficulty of breathing, the Tumor of the Liver hindring the free motion of the Septum transversum, the Instrument of Natural Respiration, I pronounced his Grief to be mortal, and so it fell out: for tho no rational means were omitted, fit to have recovered the party, if the Grief had been curable, yet the party died. It were but fruitless labour to set down the Medicaments which were used, seeing they prevailed not.
This History I thought good to set down, that you may imagine what the Event is like to be, if you should be called to the like Grief.
It falls out sometimes, that superfluous flesh grows above the Navel, if it be slackly bound, and be left somewhat long, which doth become ulcerate: This I saw once in Tavestock, a Town in the West Country, in Devonshire, in a Child of Master Moon's, a Draper of that Town. I having been called to the Cure, first bound off the Navel by a strong Ligature, afterwards I cured it by the Application of Ʋnguentum de cerussa.
In the Groin after a Phlegmon of it opened, oftentimes an Ulcer is left, penetrating thorow the oblique and transverse Muscles of the Abdomen: If you perceive such an Ulcer, pronounce it not to be of easie cure, chiefly if it fall out to be after a Venereal Babo: For first, there is Morbus cum causa, a Grief having the cause annexed: Secondly, it corrupts the Fibres of [Page 232]the Muscles: Thirdly, it corrupts sometimes the Vertebrae of the Loins, in which case all Medicaments are fruitless, because the grief is mortal: This happened to a young Woman, who dwelt with the Lady Lucie, whom Master Napkin dressed, and opened after her death. Both Dr. Gifford and I were called to view the Sore sundry times; and thô means were used for her recovery, yet they did not prevail; so that she died of a Marasmus, the Body becoming extremely extenuate; although she seemed to be of a firm and thick habit of Body, when the Tumor first appeared. If any such Tumors come to your hands, after they are brought to maturation, use the general means prescribed for the cure of a Lues Venerea, lest the like event happen to you.
I will touch briefly the cure of Ulcers of the Joints, which differeth but very little from the cure of Ulcers in other parts, saving that they require Medicaments of more desiccation without any sharpness, and more powerfull anodyne cataplalins for asswaging of pain, which is, an inseparable accident of Ulcers, seizing upon these parts.
Apply then to the Sore Desiccativum rubrum, and annoint the brims with this liniment: ℞ Ʋnguent. popul. & albi Caphurati an. ℥ j. Ol. Cydonit. & Papaverin. an. ℥ss. Mise. ae fiat liniment. ex arte. Before you apply your Medicaments, foment the part with a fomentation made of Sumach, Pomegranate Pills and Flowers, red Roses dried, and Myrtle-berries infused in astringent red Wine, being put into a long and narrow Gallypot, and set it in a warm place, or in a Posnet having in it boiling water.
In curing of these Ulcers often purging is required, to stay the flowing of sharp Humors; but seeing every purgative Medicament is not of like efficacy, I will set down one as a pattern, after which you may frame others: ℞ Car [...]ocestin. & Elect. de succo ros. an. ʒ iij. syrup. ros. solut. cum Agaric. ℥ j. aq. Cichor. ℥ iij. Misc. ut siat petie. You may either detract from the quantity of the purging Electuaries, or add to them what you shall think sit, after you have diligently considered the strength of the party.
THE PRACTICE OF CHIRURGERY. BOOK III.
CHAP. I.
Of the description of a Wound, the differences, and general fountains of special Prognostications.
I Having completed the Doctrine of Ulcers, which was the Second Treatise of the First part of Chirurgery, called by me [...], which teaches the unition of parts d [...]oined; now order of Doctrine requires, that I discourse of Wounds in like manner, whereby the appatent solution of the unity of the soft parts of the Body is procured, as well as by Ulcers.
Of this Treatise there shall be Two parts. In the First I will set down those things that concern Wounds in general. In the Second Part I will shew how Wounds of the several parts of the Body, which require special consideration, are to be cured.
In the general Doctrine concerning Wounds, I will set down these three things; The First shall be of the nature of a Wound: The Second of the general Prognosticks of Cure: The Third shall be of the last scope of the Chirurgeon. The Nature of a Wound is made manifest by setting down, First, what a Wound is; Secondly, [Page 234]which be the main differences of Wounds. In shewing what a Wound is, First I must deliver the denomination of it: Secondly, the description of it.
A Wound so called in English, in Latine is termed Vulnus, and in Greek [...]. Now to set down the variety of descriptions that are assigned by Authors, who have delivered Monuments of this subject to posterity, it would prove a task more laborious than fruitful: and the examination of them would serve rather for ostentation, than edification. Most of them which are set down by modern Writers, will not endure the trial of the Laws required by Logicians in a good Definition. Wherefore I will leave the refutation of the escapes committed by Authors in this matter, which only teaches what is not to be learned. Hieron. Fabricius ab aqua pendente Chirurgiae suae part. secunda lib. 2. c. 1. thus defines a Wound.
It is a solution of continuity caused in a soft part of the Body by an external instrument: for explication of himself he adds. By a seft part, whereby I understand every substance of the Body, the Bones being excepted.
But by his good leave, as a solution of unity in the Bone caused by erosion and putrefaction, is called [...] or caries, and if it be caused by a violent but blunt external instrument, it is called [...], or fractura; so if a solution of unity be procured in it by a sharp incising instrument it may be called [...], or [...]bius, a Wound. Truely Hippocrates in his sixth Section in his Treatise of Wounds of the Head thus speaketh: Vulnerum ossis capitis tot sunt genera: Of the Wounds of the [...] of the Head, so many sorts there are, &c. Besides this, in adding to a cariosity of the Bone caused of a corrupt Humor, and to a fracture procured by the violence of a blunt instrument, a Wound inflicted by a sharp instrument intising, the discourse will be more methodical and plain: To the end then that you may fully know the nature of a Wound, receive this description of it.
A Wound is a Solution of Ʋnity, caused by an external Inst [...] ment incising in any part of the Body. In this description you are to note these four things; The First is the Genus; The Second is the efficient Cause of it; The Third is the Subject of it; The Fourth is the manner of making a Wound. The Genus is comprehended in the first words, where it is said to be a Solution of Ʋnity; for this is common to a Tumor, Uker, Wound, Fractures of the Bones, and Luxations of the same, because in all these there is a Solution of Unity; The efficient Cause is said to be an external Instrument: An external Instrument, I call that which is without the Cuticula or scarf-skin, and has no coherence or familiarity with the parts of the Body, as a Sword or Knife. By the efficient Cause it is distinguished from an Ulcer: For as an Ulcer is procured by a sharp internal Humor eroding; so a Wound is caused by a sharp ext [...] nal Instrument incising. The Subiect wherein the wound is received, I assi [...] to be any part of the [Page 235]B [...], whether the part be exterral, as when the Head is woundal with a Sword; or internal, as when the Stomach is cut, either by a piece of Glass, or a Diamond swallowed, they being sharp edged or peinted. And if the Bone b e incised, as well as the soft parts, a Solution of Unity in it is called [...]nus, a wound, against Fab. ab [...]a pendente. The manner of inflicting a wound is termed by me Incision, or Division by cutting: and this term makes the difference between a Wound and a Contusion: for as a Contusion is caused by a blunt Instrument forcibly separating; so a Wound is inflicted by a sharp Instrument incising. Thus you have the description of a Wound, and the explication of every part of it briefly set down: By which you may examine the desiuitions of others who have written of this subject, when you shall take them into your hands.
The Second point which I affirmed fully to make up the nature of a Wound was, of the differences of it. And in setting down of these, expect not the full enumeration of all which may be named, as those taken from the quantity, whereby a Wound may becalled great or small; or from the time and continuance, from whence a Wound may be said to benew or old, and such like, which must be touched in the Prognosticks of every particular Wound. Onely I will deliver such as are taken more inwardly from the nature of a Wound. Then a Wound is either such a one as was known to the ancient Writers, or was unknown: the Wounds known to the ancients are either simple or compound: the compound are either mild or malign: the malign are either caused by a poisoned weapon, or bitings, or stingings of venemous creatures. The Wounds which were not known to the ancients, are those which are made by Gun-shot. Here you have the requisite and necessary differences of Wounds, which do cause some variation in the cutting, represented to the Eyes of your Mind, as in a Table which in my proceeding I mean to handle exquisitely. So much then shall be sufficient to have been set down concerning the nature of a Wound, which I affirmed in the beginning to be manifested, by delivering the description of a Wound, and the divers kinds of it: Now it followeth that I speak of the Second general point, to wit, of the general Prognosticks of Cure in Wounds. Whensoever then a wounded person is presented unto you to foretell the event without error, you are to consider that Wounds are two-fold: for they are either mild, which are easily cured, as a small wound in a fleshy part; or they are grievous, and cured with some difficulty at the least. Grievous Wounds are either periculosa, or malefica, or lethalia, or difficilia, Periculosa, or dangerous Wounds, are such as sometimes are cured, thô for the most part they bring death; such are superficial wounds of the Brain. Difficilia, or Wounds of hard cure, are such as may be cured, if they be skilfully dressed; but if they be not handled by a cunning Chi [...]urgeon, remain uncured, as some [Page 236]penetrating wounds of the Breast, Malefica, or mischievous Wounds, are such as leave a hurt still after them, when they are cured: such is a Wound by which a Muscle is cut transverse quite asunder; for then the use of that part is taken away, which was moved by that Muscle.
Lethalia, or deadly Wounds, are such as bring inevitable death: such are Wounds which divide the great vessels near to the Liver or Heart. So the noble D. of Buckingham was dispatched by a wound which he received in the Arteria venosa.
If you would know to which of these a Wound (which is offered to you to be cured) is to be referred, you must diligently examine these four things: First, the part affected. Secondly, the adjuncts of the Wound. Thirdly, the habit of the Body. Fourthly, the things not natural.
As for the part, you are to consider, First, its Dignity: Secondly, its Substance: Thirdly, the temperature: Fourthly, the situation of it: Fifthly, the quantity in the bigness and number: Lastly, the use of the part.
Adjuncts to be considered in a Wound are these: the bigness, the Figure, the Situation, the Symptomes, and last of all, other diseases complicate with the wound, as the French pox, or Dropsie.
As for the habit of the Body, you are to consider, whether it be good or ill, of a loose or a firm substance, whether it be full or extenuate: neither is the temperature of it to be neglected.
As for the things not natural, as Air, Meat, and Drink, sleeping and Watching, and the rest of them, I will shew the use of them when I am come to the consideration of every particular Wound.
Now it follows, that I shew you the use of these Prognostical Springs or Fountains, by setting down some Predictions derived from them.
First, a noble part, the Origination of a Faculty, in continual motion, the Body being of an ill habit, receiving a great wound, must of necessity cause death: By Induction I will make this manifest.
Secondly, the Heart being deeply wounded, causes either a sudden or speedy death. First, because it is a principal part: Secondly, because the natural Faculty proceeds from it: Thirdly, because it is in continual motion: Fourthly, because it is of a hard and compact substance, and so not easily united: Fifthly, because it is a very hot part, and so very subject to inflammation: Sixthly, because it is single, and there is no other part which can perform the function of it.
Thirdly, Wounds of the Brain in like manner are deadly, if they penetrate to the Basis: Because it is a principal part, the well-spring of the animal faculty, in continual motion: and because Inflammation, and a sharp Fever ensues. If a wound of the Brain be only superficial, it is to be accounted only dangerous; partly because the motion is gentle, partly because the substance of the part is soft, and so apt to receive Consolidation.
Fourthly, small Wounds of the Liver, thô they be dangerous; [Page 237]yet they may admit Consolidation: First, because the substance of the Liver is like coagulate Blood, and so may easily be united: Secondly, because if one part of it be wounded, the other will do its Office; as we may observe in those, the part of whose Liver is possessed with a scirrhous Tumor.
Fifthly, a Wound received in the Vena cava, within the Belly or Breast is deadly: First, by reason of its substance; for being nervous, it hardly admits Consolidation:
Secondly, by reason of the situation of it; for a Chirurgeon can hardly come to it to apply any local Medicaments.
Sixthly, Wounds in the fleshy parts of the Diaphragma, or Mid [...]ff, are dangerous: First, because we cannot come to dress them: Secondly, because it is in continual motion: Thirdly, because the parts within the Breast are easily inflamed. But if it be wounded in the nervous parts, inevitable death ensues, because a delirium by reason of the inflammation always ensues, and sometimes a Convulsion.
Seventhly, Wounds of the Lungs are sometimes deadly, if a great vessel in them be divided, as the Vena arteriosa. Yet if the party live, they prove most commonly m [...]chievous, leaving a Fistula: of the cure of which I discoursed in my Treatise of Ulcers.
Eightly, Wounds of the Spleen, if they be not great, and procure not an Hemorrhage, they are not deadly: Because it is neither a principal part, nor the Origination of any Faculty; but only appointed by Nature to be a Receptacle of saeculent and black melancholick Blood.
Ninthly, Wounds of the Costis fellis bring death at last, thô slowly. First, because we cannot come to it conveniently to apply sit Medicaments. Secondly, because it is of a nervous substance, which doth not easily admit unition. Thirdly, because the Humor which it ought to contain until the time of excretion; corrupts the parts, unto which it is sent.
Tenthly, a Wound in the mouth of the Stomach is grievous: First, because it is of an exquisite Sense. Secondly, because fearful symptomes, and swoundings and faintings ensue. Thirdly, because there must be a difficulty of swallowing.
Eleventhly, Wounds of the Kidneys, if they pass not to the Cavity, bring not inevitable death: yea, some are of opinion, that [...], that is, extraction of stones out of the Kidneys by incision, may safely be administred. Of this operation I will speak in its own place.
Twelfthly, Wounds of the small Guts are for the most part deadly: First, because they are of a membranous substance: Secondly, because they are of an exquisite Sense. But Wounds in the thick, Guts are more easily cured; because their substance is more thick and so admits more promptly agglutination; and being not so sensible as the small Guts are, faintings and other fearful symptomes do not so frequently invade.
Lastly, if one be wounded in the Mesentery, inevitable death must ensue: First, because there must be a great Flux of Blood by reason of the multitude of Veins in it: Secondly, because we cannot easily [Page 238]come thither, to apply local means: Thirdly, because the Chyle is stayed from passing to the Blood; and so Sanguification is hindred, without which the Body cannot subsist.
I did affirm some Wounds to be maligna, or mischievous, which leave some hurt or imperfection in the parts after they are cured: of such receive these Examples following.
First, a Wound above the Eyebrows, with a Fracture of the Scull, when the Wound is incarnate, can hardly be brought to a cicatrice.
Secondly, if the Brain be remarkably wounded, the party remains foolish, and more stupid than he was before.
Thirdly, if the bottom of the Stomach be wounded, imbecillity and weakness of Concoction ensues.
Fourthly, if a Nerve or a Ligement which ties Bones together, or a Muscle be transversly cut asunder, motion is hindred.
Fifthly, when the Glarea, or the substance which is found in the great Joints to moisten them, resembling the Whites of Eggs, is let out by a Wound, the Joint grows stiff; and so the motion is impaired.
CHAP. II.
Of Symphysis and Syssarcosis, and the means of staying an immoderate Flux of Blood in a Wound.
HAving in the former Chapter set down the two first Points of the general Doctrine of Wounds, to wit, the Nature of a Wound, and the Fountains from whence Prognosticks of Wounds are fetched; and having by propounding some Examples shewed the Practice of them: Now I am to set down the third general Point, which is the last scope and end which the Chirurgeon proposes to himself, when he goes about to cure any Wound; and that is the Unition of the parts joyned.
First, then I will set down the divers sorts of Unition or Union of the parts; then the Causes which procure this Union.
Of Union then there are two kinds; the first is called Symphysis, or Agglutination, or Concretion. The second is named Syssarcosis, Colligation, or Concarnation. Symphysis is the Ʋnition of parts [Page 239]disjoyned, no middle substance concarring.
This kind of Union is said by Chirurgeons to be performed by the first Intention. And if the team of the first Intention or Scope were not so to be taken, that would be absolutely false, which Hippocrat. 6. Aphorism. 19. affirms, that the Praeputium or Foreskin being cut asunder, doth not admit Unition. But it is not to be doubted, but that it will admit Consolidation by a fleshy substance [...]iting the parts disjoyned: tho this cannot be done by meer Agglutination. And whereas Galen, 90. Art. Medic. avers Union in the instrumental parts to be impossible; to make this good which he affirms, we must observe one thing, that in this place an instrumental part is not taken in its amplest signification, by which it comprehends all parts that are ministerial to other parts: and so Veins and Arteries are instrumental parts; because they serve the the Heart for distribution of Blood and Spirits for the maintenance and good of the Body. But an instrumentary part is here taken as it is opposite to a simple part: for all the parts of the Body are either simple, as the Flesh, Veins, Fibres, &c. or compound or instrumental, as a Finger; and so instrumental parts taken in this signification are not united by Symphysis, they being wounded; but by Syssercosis, that is, not after the first, but second Intention. And so Galen in 91. cap. following explains himself: where talking of a Wound in a Bone, he says, But if a Bone suffer Solution of Ʋnity, it cannot be united, as I said: And he addeth this Clause, Yet may be united by the second Scope. He means by the growing of a fleshy substance between the parts of the Bone severed.
But you may demand of me, what parts admit Unition by Symphysis, or the first Intention?
I answer, that the fleshy parts disjoyned admit this sort of Consolidation in all the Periods of Life, and the Spermatick Parts before the seventh year be expired, a Bone being excepted: but they are only united by the second Intention after the seventh year expired.
The second kind of Unition of parts severed by a Wound is called by Galen de comp. Med. secund. loc. cap. de plaga, Syssarcosis: and it is nothing else but the Ʋnion of parts disjoyned, by a middle substance. Now this Substance is sometimes like the parts which it unites, as in Wounds in fleshy parts: or it resembles not the part which it unites, as in Wounds of the spermatick parts after the seventh year.
Having delivered unto you the two kinds of the Union or Consolidation of parts separated by a Wound, now I come to the Causes of Unition or Consolidation of the parts separated. These Causes are either efficient Causes, or instrumental. The efficient Causes are two, to wit, Nature, and the Chirurgeon. Nature out of doubt is the chief efficient Cause; for she ever labouring to preserve her self, sends unto the parts of the Body so much of the natural Balsam of it as is sufficient to unite the parts [Page 240]disjoyned. If you would know what I mean by the term of the natural Balsam, I mean the Radical and Alimentary Moisture, the seat of the natural heat, by which two every individuum or singular person is maintained, and subsists.
Now there are four things which may hinder Nature from effecting of the Union of parts disjoyned: The first is an evil Conformation; as when the brims of a Wound are not proportionally and handsomly united and set together. The second is the continuance of this ill Conformation. The third is an unnatural Body remaining in the Wound: this unnatural Body is either unnatural by Event, as a shiver of a Bone separated from the whole, or by its own Nature; as when a piece of the Weapon which wounded doth stick in the Wound. The fourth is the Distemperature of the wounded part: for if it be either too hot, or too cold, the Distemperature must be removed, and the natural Temperature restored, before Unition can be expected or procured.
The second efficient Cause of Unition of parts severed by a Wound, I affirmed to be the Chirurgeon: he is the Minister, not the Lord of Nature, and is only to further her designs, and to labour to remove the Lets and Impediments which may hinder her from attaining her purpose, which is the Restitution of the parts disjoyned to their natural Union. The Chirurgeon then is to perform some Duties. Now these Duties are either common to both kinds of Unition, to wit, Symphysis and Syssarcosis, or they are proper to each. The common Duties are in number seven, First, the staying of Blood. Second, the removing of strange Bodies from the Wound. Third, provision that no such Bodies fall into the Wound. Fourth, that he maintain the natural Temperature of the part. Fifth, that [...]e restore it, if it be lost. Sixth, the consideration of the Quittour and Excrements, which flow from the Wound. Seventh, is the removing of general Accidents.
In the staying of Blood the Chirurgeon is to set two things before his Eyes: The first is, how much Blood he is to suffer to flow before he stay it, if the wounded person must lose any Blood? The second is, by what means the Blood is to be stayed?
As for the quantity of Blood which is to be suffered to flow; you may suffer it to flow plentifully, if the party be of a sanguine constitution, have a sleshy habit of the Body, if the Veins be large, and if the Season be hot; for this hinders Inflammation to ensue. If you find Indications contrary to these, then it must flow but sparingly; for it is the Treasure of Life.
The means of staying of the Blood are in number eight.
The first is, the application of Pledgets, or Dosils of Lint or [...]ow mo [...]stned either in the Whites of Eggs beaten, or in Vinegar and Water, taking in tender Bodies one part of Vinegar, and three of Water; but in hard Bodies you [Page 241]may take one part of Vinegar, and two only of Water. This mixture is called Posca: it must be applied warm; for cold Applications are hurtful to Wounds. Apply not dry Lint, or Two dry, to a Wound bleeding in any way; for they cleave so firmly to the brims of the wounded parts, that they procure often a new flux of [...]ood, when they are removed: seeing they must with some force be remored: Unless Fomentation with some moistning and malaxing [...]or be used, as with Milk or [...]tter, and Beer warmed: which [...]e not to be used in Wounds in [...]e fleshy parts.
The second is the Deligation of the Vessel, which sends forth [...]ood, whether it be a Vein or Artery: This is to be used when geat Vessels are wounded. Am [...]se Parey lib. 11. c. 20. would [...]e this mean to be used after the Amputation of a Member, [...] you may read: but in my [...]dgment his practice is but a [...]blesome and dangerous toy: a be shall find, who shall go to [...]de trial of it. In the Deligation [...] a Vessel, two things are to be [...]fidered.
The first is, that if a Nerve ac [...]pany the Vessel, which sends [...]uth Blood, (as you may see in the [...] Artery, which hath the [...]rent Nerve annexed to it,) [...] are with your Nails to sepa [...]e the Nerve from the Vessel; [...] the part into which the [...]e [...]e is inserted shall be deprived [...] [...]ing, and feeling; and ex [...]dnary pain will be caused.
The second thing to be considered, in the deligation of a Vessel is, that the binding be not too strait, because so the Vessel shall be cut asunder too soon, and so a new fluxion shall be procured.
The Thread, wherewith the Vessel is bound, must be either of strong Silk or Steel-hemp, as they term it, such is sealing Thread: For these are not so subject to putrefaction, and so there is less fear of a new Hemorrhage, which would prove more dangerous than the first.
The third mean to stay bleeding, is the application of Sarcotical, or Incarnative Medicaments. Such is that which Galen prescribes, 5. Method. 4. of Aloes, Frankincense, the Down of a Hare, and the White of an Egg, all being brought to the consistence of Hony. In tender Bodies, take one part of Frankincense, and two of Aloes: In hard Bodies, one part of Aloes, and two of Frankincense. In those, who have a mean habit of Body, use equal parts of both. Olibanum in guttis is better than Frankincense. Apply this Medicament upon Pledgets or Dosils of Lint or Two. The manner of dressing is this. Couch the Vessel with the Finger, then cleanse the Wound from the clotted Blood, and all moisture, with a piece of Sponge wet in red Wine, or any astringent Decoction. Afterwards besprinkle the parts of the Wound about your Finger, with the Powder of Aloe and Frankincense. Then apply a Pledget or a Dosil armed with the forenamed Medicament, which presently press down with [Page 242]your Finger. Last of all, keeping down the Applications either with your Finger, or with a Probe, fill up the Wound with Pledgets or Dosils armed. This being done, nothing remains, but to apply a double Cloth moistned in some astringent Liquor, and wrung, to the wounded part, and to roul it up; begin to roul below the Wound; when you are come to the Wound, compass it with three or four Circumvolutions: Then ascend and roul the part above the Wound, to press the Blood out of the Vessel, and so the flux of Blood will be stayed. You are not to open the Wound afterward, but either upon the third or fourth day. Then all the Pledgets or Dosils, except the last, which immediately cleaves to the Vessel, are to be taken away, and new ones to be applied; the wounded parts having been besprinkled with more of the Powder. Thus you are to dress the Wound every other day, until the part be incarnate, and no fear be left of any more bleeding.
The fourth way to stay bleeding, is the injection of astringent Medicaments; if we cannot come to reach to the Vessel with the Finger, by reason of the depth of the Wound, such are Bole Armenick, terra sigillata, marking stone, Hypocystis, sanguis Draconis, new Galls, Juice of Sloes, Plantain, Comfrey, Knotgrass, Milfoil, Horsetail, and Leeks; of these you may frame such Compositions as this is: ℞ Succi consol. Major. Poygon. Equiseti an. ℥ss. Succi fol. porri ℥j. Bol. Oriental. ʒj. Sanguin. Dracon. ℥ss. Misc. Such Medicaments are powerful, when the Menstrual Courses in Women flow immoderately.
The fifth way to stay bleeding is in the tranverse section and cutting asunder of a great Vessel, which pours out the Blood. Whensoever a horrible essusion of Blood follows after a Wound, you may gather that the Vessel is not cut asunder tranverse, unless there be an enormous separation of the parts wounded, not differing much from dismembring: for if the Vessel be cut tranverse wholly asund [...] by a sharp Weapon, that part o [...] it which is next to the radication of it, shrinks up towards its beginning, and is covered with th [...] flesh of the adjacent parts. If suc [...] a case be presented to you, follo [...] Gal. his counsel, who 5 Meth. [...] advises, that you lift up the Vess [...] from the subjacent parts with [...] silver Hook, and so divide it being separated; and that afterward yo [...] twist the upper part of the Vesse [...] which is easily done by laying ho [...] of that part of the Vessel which without the Hook. That kind [...] silver Hook which is used in Anat [...] mical dissections, is sittest: for th [...] wreathing of the Mouth of th [...] Vessel hinders the effluxion [...] Blood.
The sixth way to stay Bleedi [...] in a Wound, is to cause an Esch [...] Now this may be done either [...] an actual Cautery, or by an [...] charotical Medicament: But [...] ought not, but upon great nec [...] sity, to have recourse to Usti [...] First, because it is horrible to t [...] sight and apprehension; for it do [...] in a manner exanimate cowar [...] persons. Secondly, because the be [...] [Page 243]fit of it is uncertain: for oftentimes after that the Crust or Eschar is fallen, a new Hemorrhage [...]sues. If you be driven to use the actual Cautery, then you are to observe two things in the Action: The first is, that you cleanse the Wound from closted Blood, that the Vessel may plainly appear, otherwise you having burned only the coagulate Blood, you shall think the burnt Blood to be a Crust caused in the Vessel, which is not so; and so the next day it being [...]ffolved, will give way to a new f [...]ion. The second is, that you apply the Actual no more than [...]ce, or twice at the most: for by the first impression of the Cautery, the Vessel shrinks together; but by the second it is wrinkled, if you apply the actual Cautery a third time, it is turned into a Coal, which being dissolved by the [...]istore of the Blood in the Vessel, will fall away, and so [...]ke way for a new fluxion of [...]ood.
The Medicaments which stay [...]eeding by causing of an Eschar, [...]ethese, Vitriol, Alume, Ae [...]yptia [...] sharpened with calcined Vi [...], Oyl of Vitriol, and Oyl of S [...]phur, Aqua Fortis, and Aqua [...], the Trochises of Minium [...]bed by Vigo. But a Medicatant made of Umber, an Earth, which the Painters use, and Calx [...], exceeds all these: for it c [...]ses little pain, and mightily closes the Mouths of the Vessels.
About twenty years ago return [...]g from the Bath in Sommersetscare to the Howlt five Miles from Chester, where then I remained, having lodged in Newport in Shropshire by the way, I was called by the Lord Gerrard to Gerrards Bramley, to take a view of his Taylor, who had fractured both the Focils of the Leg, a little below the Knee, about the breadth of a palm, When I beheld a Fracture with a Wound, and an extenuation of Body (for the Accident fell out ten Weeks before) neither were the Bones united; and besides, there was a great Tumor in the Knee; I pronounced a lingring death to the party, unless he were out of hand dismembred above the Knee. Being intreated by the sick party and the Earl, to perform this Operation, I yielded unto their request; but having by me neither Instrument nor Medicaments, thus I supplied the defect of both: I made a Medicament of Umber and unslaked Lime, taking equal parts of both, which I found there, the House then being in reparation; I used a Joyners Whip-saw newly touched: And in the presence of two Chirurgeons, Mr. Cole, who dwelt in L [...]chfield, and Mr. Heywood, who dwelt in Newport, I dismembred the Lord's Taylor, to whom the Lord gave ten pounds a year during his life time; who lived many years afterward. When I dressed the Wound the fourth day, I found the Mouths of all the Vessels shut by incarnation, so powerful was the restrictive Medicament, made of equal quantities of Umber and unslaked Lime, rubbed to a fine Powder, and reduced to the form of a Liniment by the addition of the Whites of Eggs beaten, and the Down of an Hare. Fallopius in [Page 244]his Book of Wounds hath an ingenious device, which is this. He will have you to take a Reed, which in bigness is answerable to the capacity of the Wound. The one end being stopped with a Cork, he will have you to fill it with German or Hungarian Vitriol melted; when the Vitriol is cold, it is to be thrust in one end an inch without the Reed, and to be kept to the Vessel for the space of an hour; in which space of time the Mouth of the Vessel will be shut firmly.
Seventhly, a Flux of Blood is stayed by opening of a Vein in the opposite side, tho much Blood hath been lost; but the Blood must be drawn leisurely; Besides this, the extremities of the Body must be bound with reasonable strait Ligatures, where it shall seem best to the skilful Chirurgeon.
The eighth way to stay Blood, is to cool tho whole Body: for so the Blood is congealed, and made unapt to flow: This is performed two manner of ways: First, in letting down the wounded party, laid in a Sheet, into a Bath of extreme cold Water, to procure a Lipothymy or Fainting; and by this the Spirits return from the extremities of the Body to the Center. Secondly, this is performed by Narcotical Medicaments: Receive this one as a Pattern: ℞ Diascord. ℈ iij. Philon. Persici ʒ ss. Syrup. Papav. albi ℥ j. Aq. Papav. errat. aut spermat. ranar. ℥ iij. Mise. ut si [...]t P. sumenda frigida: After the Patient hath taken the Potion, let him be kept quiet, and let him compose himself for sleep. Although this Dose of Narcoties may seem too large, yet it may be given again after twelve hours are expired, if need shall require: These two last practices are excellent in immoderate Hemorrhages at the Nose.
CHAP. III.
Of removing extraneous Bodies from a Wound.
THe second Duty which a Chirurgeon is to perform for Nature, in assisting her, in furthering her inclination, and in procering Unition of the parts severel by a Wound, is, to provide that to external or strange Body be suffered to be in the Wound, which may hinder Unition. In this Point two things are to be set down: First, the differences of strange or extraneous Bodies: Secondly, the means by which they [...]e removed. As concerning the differences of these Bodies, they are extraneous either by Accident, [...] of their own Nature. Those which are extraneous by Accident, [...]e of three sorts: for they are either soft, as pieces of contused or squ [...]ted Flesh, and clots of Blood; or they are hard, as pieces of Bones or Cartilages; or they are of a mean substance, as pieces of Membranes, Tendons, Chords and H [...]t. Now these Bodies which [...]e extraneous of their own Nature, are either soft, as pieces of the wounded mans Garments; or [...]d; and these are either metall [...]e, as pieces of Steel, Weapons and Bullets; or not metalline, as [...] of Wood, Gravel, and such [...]
Having described, as it were in a Table, the divers sorts of extraneous Bodies (to help the Memory) which are able to hinder the parts disioyned in a Wound, as long as they continue in the Wound; I am now to deliver unto you the ways and means by which they are to be removed, and taken out of Wounds.
First, then, things extraneous accidentally, as clotted Blood, Hair, Dirt or Gravel, they may be washed away with Claret or white Wine warmed, Aqua vitae, Vinegar and Water, Oxymel dissolved in Water: or if you be in the Country, where these things cannot be had, you may use Milk, or Beer, or Ale warmed. You are not to omit cleansing of the Wound with a Probe armed with Lint. If splints of Bones, or pieces of Flesh, Membranes, Tendons, or Ligaments stick in the Wound, you are to take them out either with your Forceps or Ravens Bill.
Having shewed you, how things accidentally extraneous, which might hinder Unition of the Wound, are to be removed; now I must in like manner set down [Page 246]how Bodies of their own Nature extraneous, which stick in the Wounds and hinder Consolidation, as pieces of Weapons, Bullets, and such like, are to be taken out. In the extraction of these Bodies, you are to set before your Eyes these two things; to wit, the Circumstances and the manner of extracting of them; as for the Circumstances, these two are to be observed.
First, that you attempt not the extraction of such Bodies as cannot but with great difficulty, pain and danger be drawn out, and with the which remaining in the Body the Wound may be cured; such are Bullets sticking deeply in the great Joynts, as the Elbow and the Knee.
The second is, that you go not about the extraction of such Bodies, if you see the Wound to be Mortal, and that the Party must Die, the Prognostick of such Wounds I delivered unto you in the first Chapter of Wounds, whither I remit you: for if you draw out the Weapon wherewith a great Vessel of the Liver or Heart is wounded, you shall hasten Death: so the pulling of Feiton's Knife out of the Body of the Duke of Buckingham, the Arteria Venusa having been wounded, procured speedy Death. So much then of the Circumstances to be observed, before the drawing out of extraneous Bodies.
Now I will acquaint you with the means, by which they are to be removed: The means are two: Medicaments and Instruments. We use Medicaments; First, when the Extraction cannot easily be performed; as when we cannot lay hold upon the extraneous Body by any fit Instrument: Secondly, when there is no suspicion that the Weapon was poysoned, or that Apostemation is not like to ensue. If therefore a Thorn, or a Needle so stick in a part, that they cannot be taken out, without great p [...] and large incision of the part, it is best to have recourse to Medicaments. I saw one who carried a Thorn, which run into his Leg above the Tibia, between the Periosteum and the Skin, (when he thrust through a Hedge in Hunting,) five years. The Medicaments which have a faculty of drawing out those Bodies, which of their own Nature are extraneous, are of two sorts: for they are either Simple or Compound.
As for the simple Medicaments, they are of three sorts: for some effect this by an hidden or occult faculty: Of such Paulus Aegineta, lib. 4. cap. 52. writes thus: Pieces of Weapons, Ar [...]u [...]s and Thorns, which stick in the Body, these things under written [...] out; Both the Pimpernels, the Root of Aristolochia rotunda, Ammonlacum, leaves of Henbane stamped, and applyed in form of a Cataplasm, Root of the Reed leaten and mingled with Hony. You may add to these horned Poppy Leaves stamped, and used as Henbane.
Other Medicaments extract such Bodies by an accidental heat purchased by Putrefaction, as Birdlime, stinking old Pigeons durg, Leaven, and such like.
The third part of such Medicaments are hot in the second or third degree, and of subtil and thin parts, as Onions and Garlick rosted, Pitch, Rosin of the Pine, A [...]e Hepatica, Assa foetida, Elemi, Prep [...]is or Bee-glew, the green Leaves and Roots of Dittany, Sagap [...]nam, Galbanum, Euphorbium; but in a small quantity, and mingled with other matters.
Of these simple Medicaments, s [...]dry Compositions may be framed: but to omit superfluities, I will only deliver unto you three compound Medicaments, whereof the first two are set down by famous Fallopius in his Book of Wounds: The third is Empla [...]m Sacrum. The first of Fal [...]pius is this: ℞ Propol. rad. reward Diclammi, Sagapeni an. ℥jss. [...]manti. flercoris Columbin. putris, [...]. ℥ j. Cepam coctam numero uram, Picis liquid. & Mellis an. [...]ut comma acquirant formam Cataplasmatis, quae in mortario diligonter claborentur. The second of Fallopius more strong than this, receives these Ingredients: ℞ R [...]cent. Dictam. pulv. Dictamni [...]t [...]ei, Sagapeni, Assae faetidae, Eleni an. ℥ j. Visci ℥ ss. Resin. pim ℥ j. Euphorb. ℈ss. Sulphur. vivi. ℈ ij. P [...]. liquid. & Mell. crud. an. q. [...] metur Cataplasm. The third compound Medicament, which I promised to deliver unto you, was Emplastrum Sacrum. The description of it is this: ℞ Litharge. lb j. Ol. lb ij. Colophon. lb. ss. [...] ℥ iv. Ammon. ℥ ij. Galbani ℥ ss. Aristol. rot. ℥ ij. Thuris ℥iss. [...]g. [...]d. Dictamni Cret. Alees lepra. squamae Aeris, Propol. an. ʒvj. R [...]. Gentum. ℥ j. fiat Emplast. secundum artem. This is an excellent Emplaster also against malign Ulcers, and drieth moist Bones in Ulcers, wherein the Bones are carious. Paracelsus undoubtedly framed his stictick Emplaster after this description. Neither is it inferiour to his in Operation, with the which you may furnish your selves sufficiently, seeing it hath so manifold Uses. If you would have greater variety of such Medicaments, you may peruse Aetius, lib. 15. cap. 14. and Galen. de Composit. Medicament. secund. loca: But either these Medicaments which I have set down will serve, or else none.
Cornelius Schylander, a Physician of Antwerp in his Practice of Chirurgery, published anno Domini 1577. De vulnerib. lect. quintà, hath these words: If by reason of the Veins, Arteries and Nerves, the Wound will not admit any dilatation, then we are to use Medicaments, which digest, relax and draw; or Charms, which he calls Verba Constellata, by which he affirms, that all sorts of Weapons may easily be drawn out with the Fore-finger and the Thumb. He professes, that he saw this done; yet the Charm he sets not down. It may be that the party, whom he saw practising this, did not acquaint him with the Charm.
However, the use of Charms is very Ancient: For Homer, in his Hias, or Poem of the destruction of Troy, shews, that Poda [...]irius and Machaon, sons to Aesculapius, who went to the Siege of Troy with the Grecians, cured the wounded persons not only with Salves, [Page 248]but [...] with soft words also. Now near 3000 years are expired since the destruction of Troy. But seeing such practices are accompted by the judicious infamous, I will leave them to Empiricks.
Having then set down how extraneous Bodies, which stick in Wounds, and hinder Unition, are drawn out by Medicaments, it follows, that I acquaint you with the extraction of them by the help of Instruments. In this Operation I will set down these two Points.
The first shall be of the Occasions, which may cause you to go about the drawing of these Bodies out of a Wound.
The second shall be of the Circumstances remarkable in the drawing of them out.
The Occasions are three. First, if the Weapon may easily be drawn out. Secondly, if we fear Apostemation, which may corrupt the wounded part. Thirdly, if we fear the Weapon to be poysoned.
The Circumstances are twofold: for some are to be noted before you go about the Extraction of these Bodies, and some are to be observed in the Extraction it self.
The Circumstances which are to be noted before the Extraction are in number four.
The first is, that the Chirurgeon mark the form of that Body which is to be drawn out.
The second, that he observe how deeply the Weapon hath pierced.
The third is, that the Chirurgeon be a good Anatomist, and know the frame of the part; for so he shall be able to know which way Weapons, or such extraneous Bodies, are to be drawn out.
The fourth, the Symptoms of the part wounded, are to be considered, as well those which are to ensue, as those which are present: as for Example, if the wounded party find great pain, the extraneous Body is without delay to be drawn out. But if a fearful Flux of Blood must ensue after the Extraction, it is to be deferred.
In the Extraction of these extraneous Bodies four things are to be observed.
The first is, when it is most fit to remove these Bodies?
The second is, by what way they are to be taken out?
The third is, the Figure of these things which are to be extracted.
The fourth is, by what Instruments they are to be drawn out? I will discourse briefly of all these in order.
As for the time fit for Extraction, if the pain be intolerable, the Weapon is presently to be taken out, although we must not add pain to pain; for this being done, all pain will cease.
Secondly, we must not defer the Extraction, if the Weapon be poisoned, or cankered, although we must divide the Muscles, Vessels and Nerves: for we are to [Page 249]have a greater care of the whole, that it miscarry not, than of a part. Neither need we fear the Application of a Cautery: for Fire consumes Poison, and takes away all fear of a Convulsion: How you may conjecture the Weapon to be poisoned, I will amply and plainly declare in the proper place. In five Cases you are to delay the Extraction of the Weapon.
First, if there be a fear of a great Flux of Blood, which may endanger the life of the wounded party: This doth fall out, if the Wound be inflicted, where great Veins and Arteries are placed by Nature.
Secondly, if fearful Symptoms, as horrible pain, a Convulsion, a sharp Fever, or a Syncope, are like to ensue.
Thirdly, if the Weapon be round, we may more securely leave it in a Wound, than if it were flat: for the edges of it will cause pain of a recessity, whereas the other will not procure a pain so great.
Fourthly, if the Orifice of the Wound be made narrow by an Inflammation or a Tumor, we are to defer the Extraction of the Weapon, until those Accidents be removed: otherwise we shall torment the Patient, and procure f [...]oonings, and a Fever, and it may be a gangrene or sideration of the part.
Fifthly, let us not attempt the Extraction of any Weapon, or part thereof, unless we have at land a sit and convenient Instrument: Otherwise we shall vex the wounded party, without [...]ny fruit, and make him the more unwilling to suffer, when we are better prepared for the Action.
The second thing to be observed in the Extraction of these Bodies, is the way by which they are to be drawn out. In three Cases the Weapon may be thrust out the contrary way.
First, if it be almost through, but chiefly towards the depending part: for so less pain will be caused, and the Quittour will more promptly flow from the Wound.
Secondly, if the Figure of the Weapon will not suffer it to be drawn out the same way, by which it was sent in, as appears in barbed Arrows.
Thirdly, if there be no fear of cutting great Vessels, or Nerves, In other Cases we are to draw out the Weapons the same way they went in.
But you may demand of me, whether it be safest to draw them out whole, or by piece-meal.
I answer, that all things brittle which stick in a Wound, as Glass, and Bones, are to be drawn out whole, if it may conveniently be done: But if they cannot be pulled out whole, but with pain and fear of Symptoms to ensue, they are to be broken, and then taken out. As for Weapons, which cannot be broken, and are like in their Extraction to procure some mischief, as barbed Arrows, you are to take them out with such an Instrument as is able to desend the wounded parts from harm; Of which I will speak by and by.
The third thing which I wished you to observe in the Extraction of strange Bodies, was their Figure: for the Observation of this Point is requisite: Because the Figure oftentimes makes the Extraction more easie or difficult, as has been exemplified in a round and flat Weapon.
Now the fourth thing observable in Extraction of extraneous Bodies was by me said to be the diversity of Instruments. Of them I could make several Treatises; but I mean not so to mispend precious time. Necessity and Observation invented them at the beginning, when Man being enraged by the Instigation of the Devil, and the Perturbations of his own Mind, not contented with his own Members, which Nature had granted him for offence and defence, found out a mean, compendiously to send his Brother (the Image of God) to dwell with Pluto for all eternity, and to be estranged from his Creator. O that we could pack up injuries for the present, untill the Day of Judgment, the great Assises come! Then we should see a number of injured persons sufficiently avenged of their Oppressors (whom we shall see adjudged to Eternal Torments) because they bid Patience farewel, and would by entertaining Revenge become Judges of their own Causes, and deny God the Trial and Revenge. Many Instruments used in our Fore-fathers time, are become now out of use. Man in every Age doth devise new Instruments of Death. A Compendium we have in our Age, Gun-shot, the imitation of God's Thunder; but the Example is more fierce, and sends more Souls to the Devil, than the Pattern: Of Instruments, I will but only point at a few, as necessary, referring the rest to the industry of judicious Chirurgeons, which shall be employed in Military Affairs.
First, you must have a Blant book to lift up a Vein, Artery or Nerve, when a Bullet or Arrowhead is to be taken out of a Musculous part.
Secondly, you must have a pair or two of Forceps, hollow, strong, and of good Steel, to lay hold on barbed Arrows, or such Weapons as may hurt the parts, as they are drawn out.
Thirdly, Goose-bills round and hollow at the points, double and single, to take out Bullets in like manner.
Fourthly, the Ravens-bill, strong to squeese and take out Arrowheads, Bones, and such like.
Fifthly, the Forcipes incisorii, which cut being dilated on each side: These must be of good Steel, well tempered, and very sharp Some which are sold in the Shops, are worth nothing. These may have use, when a Wound is to be incised, to draw out of it any extraneous thing.
CHAP. IV.
Of the preservation of the Temperature of the Part, by the right ordering of things not natural.
IN the former Chapter I discoursed of the second and third Duty, which the Physician or Chirurgeon (called to cure a Wound) [...] to perform for Nature, and Those were his care that no extra [...]ous Body should be suffered to stay in the Wound to hinder the Union of the Parts: and if it by Fortune were there found, it should by his skill be removed.
In this Chapter, I am with the [...]e brevity and perspicuity to deliver unto you the third and fourth Duty, which belongs to a Chirur [...]geon or Physician, Natures friends, in assisting her in preserving her self, and labouring to shun wrongs offered by her adversary, which hath done the best to procure her overthrow and dissolution, by disjoyning parts united. These Duties are two; to wit, that the Physician and Chirurgeon first labour to preserve the natural temperature of the part wounded: And secondly, that he labour to restore it if it be lost.
The natural temperature of the Body, is preserved by two means. The first is, the right ordering of those things which are called not natural: The second is the Application of convenient Medicaments. But before I go about to deliver unto you the means, either to preserve the natural Constitution of the part wounded not being altered, or how it is to be restored when it is lost; I must describe unto you the natural Constitution, that knowing it aright, you may be able, using it as a Rule to see, as it were in a Glass, the defects which have seized upon Nature, and the degree of their declination from that which is secundum naturam, or according to Nature.
Now the natural temperature of the part is Naturalis ejus siccitas, or the convenient siccity or driness of it. So much we may collect out of Hippocrates, who in that Treatise which he hath left to us, de Ʋlceribus, or of Ulcers, affirms that siccum est sano proximum, that is, that which is dry comes near to that which is whole. In your practice by observation, you have learned to prognosticate to your selves health to every Patient having either Ulcer or Wound, when you see small store of [Page 252]laudable Quittour to flow from the Sore.
But you may doubt, and not without cause, why Hippocrates did ascribe the natural temperature of the Body to driness, a passive quality, and not to heat or coldness, which are active qualities?
I answer, that this cause moved him to think so; because if the natural siccity or driness of the part doth continue unviolate, the natural degrees of heat and coldness are preserved in the Body; But on the contrary you have observed, that if in the part wounded, by reason of pain, superfluous Humidity be attracted, and extraneous heat be increased, that the natural heat oftentimes is corrupted, and corruption of the part ensues; or else that it being more than the natural heat can rule and dissipate, doth cause a Schirrhus of the part, either wounded or ulcerated; for so you see, if the natural driness of the part wounded be maintained, that neither the natural heat is corrupted, nor the natural coldness is increased.
When I speak of natural coldness, I would not have you to think that I speak of an absolute coldness, which quite extinguishes the natural heat, and causes sideration or death of the part: but of a comparative coldness found in some parts, which is so great in them, that if it be compared with the heat of other parts, it may seem a privation of heat, thô not perfect. Such are the spermatick parts, if they be compared with the fleshy, and amongst those the Bones, if they be compared with the Muscles, your Senses will teach you so much. Having spoken thus much of what is meant by the terms of a natural temperature of a part wounded, as is needful for a Chirurgeon to know; I must labour to perform that which I promised in the beginning of the Chapter, and that was the setting down of the means by which it is preserved. I affirmed them to be two; to wit, the right ordering of things not natural, and the convenient use of local Medicaments.
As concerning the first point, receive these documents. Seeing then a special care is to be had of the Air, Diet, Evacuation, Rest, and Exercise, Watching and Sleeping, and last of all; of the Passions or perturbations of the Mind, which he that is dangerously wounded is to observe, if he be presented to you to be cured; I will briefly set down how every one of these is to be ordered.
As concerning the Air: That Air which is temperate, and so proportionate to the temperature of the parts of the Body, is most fit for wounded parts: Nevertheless some require both a hotter constitution of the Air, and warmer applications than others do. Will you know which these parts be? Hippocrates shall resolve you, Aphor. lib. 5. Aphor. 18. in whom these words are found: Cold is an enemy to the Bones, Teeth, Nerves, Brain, the spinal Marrow; but heat is pleasing to these. Heat principally delights the Joints, because naturally they are cold, being framed onely of spermatick, parts, as Tendons, Membranes, Ligaments, Cartilages, and Bones, [Page 253]and that as well in the Summer as in the Winter. A temperate Air is most convenient for other parts.
If any parts may endure cold, these are the Ventricles, according to Hippec. lib. de Ʋlceribus: for the confirmation of this his opinion, two reasons may be yielded.
For First, external Cold increases the natural heat, by keeping it in, by sealing up the Pores, by which it might breath out; and so it causes the better concoction, and makes them more able to expel all Excrements; but immoderate heat eliquates or melts the Humors, induces an unnatural heat, which dissipates the natural heat, and so makes the Ventricles unapt to excoute their Functions.
Secondly, in the Ventricles there are great vessels, that contain plenty of Blood and Spirits, which are able to resist any cold impression. In the Breast you have the Vena cava ascending, the Vena arterialis, the Arteria venalis, and the Aorta. In the lower Ventricle you have the mesaraical Veins, the Vena portae, the radication of the Vena cava, and the Aorta descending. What I have spoken of the Air, I would have to be understood of the Chirurgeons Hand, the Medicaments, and Linnens which are to be used about the dressing of the wounded party. If the season of the year afford not unto you an Air answerable to your desire, you are to procure it by Art.
Now it follows that I appoint a convenient Diet for persons wounded: As concerning the Diet, receive these Aphorisms. First, in great and fresh wounds, and in such as threaten an Inflammation, which happens most usually if the Body be Plethorick, a slender Diet is to be prescribed. Secondly, in wounds of the Ventricles and Joints, and in those which have been stitched, the like Diet is to be used. Two Questions here may be moved.
The First is, what Victus tenuis or a slender Diet is?
The Second is, How long this Diet is to be continued?
A slender Diet is that which affords but little nourishment, and cools; for such a Diet is most fit for contemperating the heat of the Humors, and staying the influx of the same.
This Diet is to be continued until the Seventh day be past, which is the first critical day in sharp diseases. Then the use of Wine, Flesh, and Eggs is to be forbidden: Let the wounded party take thin Broths altered with Lettuce, Spinage, Purslain, Endive, Succory, the common and Wood-Sorrel, adding the emulsion of the seeds of Musk-melon, Pompion and Cucumber. Thin Panadoes, and Oatmeal gruels are fit. Sallets of the aforenamed Herbs, boiled and dressed with Vinegar and sweet Butter, may be permitted: Apples and Pears, either roasted or baked, cold, may be granted. Let the Drink be small Beer or Ale to those who have used them in their health: But if you have in cure one, who cannot abide this Liquor; then you are to appoint for him Water boiled with the bottom of a Wheaten-loaf mingled with Oxysaccharum, or the Syrup of Endive, Succory simple, or [Page 254]Violets, taking three Ounces of Water, and one of Syrup. Receive the description of a parable Julep, which will serve all persons; ℞ aq. font. lb iij. vini albi ℞ j. avenae mundat. ℥ iiij. Bulliant ista ad consumpt. lb j. ac coletur decoctum, cui admisce aq. ros. cochl. iij. sacchar. opt. ℥ iiij. ut paretur julapium clarum. In Wounds wherein there is no fear of [...] accidents, you may grant poched Eggs, so that the wounded party eat as well the White as the Yolk. Having shewed unto you what Air and Diet are most convenient for wounded persons, I am in like manner to talk of Evacuation. Of it there be two kinds, Phlebotomy, and purgation by siege. As for Phlebotomy, the end of it is to procure siccitle, or driness to the wounded parts, according to Cels. lib. 6. cap. 16. Whether Phlebotomie be to be used or no, these things following will shew you: The wound it self, the habit of the whole Body, the passions of the Mind, and the Air it self: From the wound it self, in this operation receive these Canons.
First, in great Wounds from whence small store of Blood hath issued, and when weak parts are wounded, as the Joints (whither superfluous Humors may be turned) Phlebotomy is necessary. The reason of the first part of the Canon is this: If the Wound hath bled but little, the part not being sufficiently dried, Fluxion and Inflammation may be caused.
Secondly, If in a Wound, either deep or many stitches have been taken, a Vein is to be opened: for the pain which is caused by reason of the stitching, is like to procure attraction of Humors, and an Inflammation.
Thirdly, in Wounds wherein there is no great pain, and in which neither deep nor any stitches have been taken, you may spare Phlebotomy.
Fourthly, in Wounds of the fleshy parts which are strong, as also in those parts unto which a Humor can hardly be carried, as in the hairy Scalp and Face, you may abstain from blood-letting.
As for the habit of the Body, take this Aphorism: if the Body be Plethorick and Feverish, if Choler abound, boldly open a Vein; but not so, if the party be melancholick; for this Humor can neither be so easily inflamed, nor flow, to cause any Inflammation. You are in like manner to note the passions of the Mind. If the party wounded be furious and hasty, if he sleep not well, if the Spirits be extraordinarily moved, open a Vein; but if the wounded party be of a dejected Spirit and fearful, and be but little moved, you may spare Blood-letting.
Last of all, you are to observe the constitution of the Air: in hot weather then you may more boldly use Phlebotomy than in cold; and so rather in the Summer serson, than in the Winter; for in hot weather the Humors are h [...] ter and thinner than in cold, and so more apt to flow to the wounded part.
As for purgation by Stool, it is appointed for staying of Humors from flowing to the part wounded. But seeing the symptomes which arise by reason of a Fluxion, are [Page 255]most commonly two, a Phlegmone or Erysipelas, it is evident that those purgative Medicaments which evacuate Choler, called cholagoga are most fit: such are manna, tamarinds, cassia, Syrup of Roses and Violets solutive, Electuarium lemtivum, elect. de succo rosarum, Dicatholicum, Diaprunum, &c. In five eases such Medicaments are to be ministred: First, in wounds of the Ventricles. Secondly, in wounds of the Joints. Thirdly, if the part wounded be troubled with an Inflammation, or Erysipelas. Fourthly, if the wounded part hath been stitched. Fifthly, if either incision, dilatation, or rasping of the Bone have been used.
As for Rest and Motion, receive these admonitions: First, as in wounds of the lower Limbs, it is ill to walk or to stand; so in wounds of the upper Limbs, it is hurtful to exercise them. Secondly, if either the superior or the lower parts receive a great Wound, it is good to keep the party in Bed: but let the wounded party be placed in that posture, as is like to afford greatest ease. As for example: If the Hand or Foot be wounded, let them be placed somewhat high, to hinder flowing of Humors to them. If the member must be kept unmoveable, the use of it will shew the best situation: for some parts must be kept bended, as the Elbow and Fingers: but others must be extended, as the Knee and Foot: and from hence sprung this observation, Cubitus ad collum, crus ad lectum, the Elbow is to be tyed to the Neck, but the Foot to the Bed.
As for Watching and Sleeping, seeing Watching dries the Body, as Sleep moistens it, according to Hippoc. Aphor. it is not good for the wounded party to take immoderate sleep, in two cases: First, if we fear that Humors will flow to the part wounded, which we may conjecture they may do in plethorick Bodies. Secondly, if a wound fall out to be in a Joint; for Sleep cools the Joints: but if the pain be great, then it is good to suffer the wounded person to sleep; yea, to procure it by anodyne means, inwardly ministred, and outwardly applyed, if you see Nature of her self inclined to sleep; for so the Spirits being retired into the center, the faculty is at rest, and so the pain is eased.
Last of all I will conclude by speaking but sparingly of the Mind: we must labour to remove all perturbations of the passions of the Mind from those who are wounded. Wherefore no ill tidings are to be brought to those, who are come to the years of discretion, and Children by all means are to be kept from crying and weeping.
Above all other things, let Venus be abandoned: for it exceedingly hinders Consolidation: for by it the Blood and Spirits are inflamed, and by motion noxious Humors flow to the part: There are few Artists who have not by experience in Patients observed the incommodities of this action.
CHAP. V.
Of the fifth and sixth Duties belonging to a Chirurgeon in curing a Wound.
IN the former Chapter I shewed you as briefly and plainly as I could, how the natural Temperature of a wounded part is to be preserved by the right ordering of those things which are called Non naturales, or not natural. Now I am to shew you how this same is to be effected by the application of local Medicaments: for in Plethorick or Cacochymical Bodies, all means being used according to Art, will sometimes, but with difficulty prevail.
Seeing, as I shewed you, that the natural Temperature of the part is nothing else but the natural siceitie or driness of it: It is out of all controversie, that the Medicaments which are to be applied to wounded parts, ought to be siccantia or drying.
But seeing there are sundry degrees of drying Medicaments, [...]on may demand of me, in what degree of driness those Medicaments ought to be, which are to be applied to wounded parts?
I answer, that both the Temperature of the whole Body, and of the part affected, will declare this unto you. One thing is to be noted, that the Medicament which is to be applied to a wounded part, ought ever to be somewhat driet than the part it self.
As for example, if the Cheek of a Boy or Girl be wounded, you are to apply Medicaments which are drie in the first degree, at St. John's-wort, Avens, Chamaemil, Melilot, Saffron, Barley and Bean-meal: But if a Boy be wounded in a Joint, or Nerve, you are to apply such things as are dry in the Second degree. If these things happen to an aged person, or a strong clown; then you are to apply such Topicks as are drie in the Third degree. Wherefore in seft parts wounded, as in the bellies of Muscles, and fleshy parts, a Medicament is to be applied, which is of the strongest in the First degree. In parts which are hard, as in the Tendons, or Cartilages wounded, you are to apply to the parts wounded such Medicaments as are strongest drying in the Third degree. But to parts wounded, which are of a mean Temperature, neither too soft nor too hard, you are to apply [Page 257]for Medicaments the strongest Deficcatives in the Second degree.
From what has been said you may gather, that neither Spring-water nor Oil, are fit to be applied to wounds: because both do moisten and relax too much. Besides this, if cold Spring-water be applied, it may procure a Gangrene by too much refrigerating the part, and quenching the natural heat. Let me warn you of one thing, that these desiccative Medicaments must have a moderate astriction: for so the Blood being ingrossed, more shall fot flow to the part than is requisite for the nutrition of it. Seeing I have made mention of such simples as are fit to be applied to Wounds, to procure their unition, you will expect (no doubt) Thrief enumeration of such as are accounted the most effectual. I kill only name them, leaying their description and other effects, to be gathered out of the Monuments of such as have published Herbals, and have discoursed of Animals or living Creatures, and Minerals, from whence these means are fetched.
If you are desirous to know the nature of Plants, have recourse amongst the Ancients to Dioscorides, who was a stipendiary Soldier under Cleopatra Queen of Aegypt, who was overcome by Augustus Caesar in Fight by Sea at Actium the Promontory, about 42 years before the birth of Christ. As concerning Minerals, Fallopius hath left a Treatise of them, who hath delivered so much of them as is requisite for a Chirurgeon to know: If you have a mind to know what [...]fiety of living Creatures there be, peruse the Monuments of Conradus Gesnerus, Ʋlysses Aldrovandus, and Rondeletius, who have written of these Subjects. The Simples then which are most effectual for the consolidation of Wounds, are deduced either from Vegetables, Animals, or Minerals. As for those which are taken from Vegetables, I commend unto you these; St. John's wort, St. Peter's wort, Betonie, Agrimony, Birthwort, Vervein, both sorts of Avens, Pomegranate-flowers, Horse-tail, Plantain, Knot-grass, Milfoil, Lunaria the greater and lesser, Shepherdspurse, Perwincle, Larks-heel, both the Centauries (but the greater is more effectual) Dittanie, Comfrey, Ladies-mantle, Self-heal, Clowns All-heal, Serpentaria, Adders-tongue, Loose-strife, Horehound, Myrtil, Red Rose, Myrrhe, Mastick, Elemi, Olibanum, Frankincense, Solomon's Seal, Turpentine, Pitch, Rosin, Willow, Rue, Sarcocol, Borax, Ladies-Torch, Birdlime, wild bastard Saffron, Carduus benedictus, and Tobacco. Of these Simples taking the Juices and the Herbs stamped, you may make Balsams; and if you add Swines-grease, Wax, Rosin, and Gummt Elemi, you may make Unguents effectual for the cure of Wounds.
Living creatures put to their helping hands: of them you have Mummia, Earth-worms, Snails, the fat of a Horse, Sheeps Suet, Swines Grease, Deers Suet, Goats Grease, the extract of Mans Blood, the Spiders web, Bones burned to white ashes, and Harts-horns calcined; if they be brought to an impalpable Powder, being grownd [Page 258]upon a Painters stone, and made up into the form of Trochisces, with the distill'd water of Snails, and then being beat to powder, and mingled with Ʋnguentum Basilicum, or aureum, they exceedingly further the curing Wounds of the Joints, Nerves, and Tendons.
The Minerals also are no niggards in this case. The Litharges present themselves first, without which hardly can any Emplaster be brought to a laudable consistence. That which is called Litharge of Gold, affords a brighter colour to Emplasters, than that of Silver: yet the effect is all one. Copper affords Aes ustum, Squamma aeris, and Aes viride, all very useful in the practice of Chirurgery. Jupiter or Tin, yields his flowers by sublimation, or if he be dissolved in a convenient Liquor, Crystals: which being dulcified and brought to Powder, and mingled in a due proportion with convenient Unguents or Emplasters, further exceedingly the healing of Wounds and Ulcers. Mars or Iron affords unto us his Crocus, as 'tis termed: How powerful it is not only to hasten Consolidation of solution of Unity; but in loosnesses, Gonorrhaeas and other diseases also, there is none ignorant, who hath had but a reasonable practice in Physick or Chirurgery. What shall I speak of Minium, both the Corals, Tutia, Calaminaris, and the Load-stone. By the enumeration of these few means taken from Vegetables, Animals, and Minerals, for the curing of Wounds, you may perceive how bountiful Nature is to Mankind in supplying his wants. O that he were not wanting or deficient to himself▪ If we would take pains only to prepare those things, whereof Nature hath left us no small store, and judiciously according to the prescript of Art apply them, we should find in our practice a better success than sundry times falls out: Neither should we have need to blame the irregularity of Patients, and the ill correspondence of those things, which are called Non naturales, or not natural. Whosoever thinks that he may without any stop or stay, go through the curing of all wounded persons, in what part soever the Wound is inflicted, with the ordinary Unguents, carried about in Salvatories, he deceives himself.
These for the present use must be in a readiness; but if he find these after application not to answer his expectation, he must have recourse to others. Which Medicantents are sittest, the collation of the part wounded, and the Topicks will shew, as I have told you before.
Having delivered unto you, how the temperature of the part is to be preserved by the right ordering of those things, which are called Non naturales, or not natural, as Air, Meat, and Drink, Evacuation and Retention, Sleeping and Watching, &c. As also by the application of fit Topicks to the part, you may require according to my promise, how the natural temperature, if it be altered, may be reduced to its own tenor again? Let me tell you, that by the same means, it is to be reduced, by the which it is preserved. Only this is to be observed, that the means [Page 259]which cure, must be more forcible, and more intended in their qualities, than those are, which are applied to maintain the natural Temperature.
As for example, if a wound prove very moist, and send out much Quittour, you must labour strongly to drie the habit of the Body, by Bleeding, Purging, a slender Diet, Watching, and such like, and by applying to the wounded part Medicaments, which strongly dry, and are endued with a certain astriction. If other elementary qualities, as heat, cold, driness appear, they are to be removed by their contraries, but intended in their qualities above that degree which was sufficient to maintain the natural Tempetature of the part wounded.
Now the sixth Duty, which I affirmed to be required of the Physician or Chirurgeon, when he is called to cure a wounded person, was the observation of the excrements, which flow from the wound, and their true and natural causes: I will deliver first unto you the diversity of Excrements or Quittour, which a wounded part sends out, and then I will shew unto you the causes of them.
The Excrements which flow out of a Wound, are in number three; liber, Sordes, Pus: Ichor is a thin Excrement. The cause of it is Incoction. Of it there are two kinds: for either it is an Excrement, issuing from the Veins themselves or else it proceeds from the wounded part: If it issue from the Veins, then it is a waterish and thin Humidity, flowing from the capillary Veins not altered, and without my noisome smell, by its colour shewing which of the four Humours has dominion in the mass of Blood. Wherefore if the Blood be very pure, it has a certain bright redness representing Water, wherein flesh has been washed. If yellow Choler be predominant, then the Ichor is of a bright yellowish colour: If Phlegm abound, then the Ichor is whitish: if Melancholy surpass, then the Ichor or thin Humidity is of a darkish swarth colour. If this thin Humidity spring from the part wounded, because it is altered and corrupted by the part which sends it out, it has an unpleasant smell, being an Excrement of the part. As the first kind of Ichor is called serum Sanguinis, the waterishness of the Blood, which is mingled with the Blood, that so being made more fluxible, it may the more easily be distributed to the habit of the Body, to nourish it; so the Ichor which is an Excrement of the wounded part, is called Sanies and Virus, and according to the degree of the corruption of the part, it is more or less stinking. If it flow from a part possessed with a Cancer, it is wonderful malign and stinking: If it issue out of a part siderate or mortified by reason of a Sphacelus, it is cadaverous. By the exhalation which is breathed out of the pores of the Skin, raised from the serum Sanguinis by the natural heat, Dogs find out their Masters, and will constantly hunt after that game, which they are first set about: This be wrays the complexion of the Individuum; but Sanies and Virus shew the corruption of the part.
The Second kind of Excrement is called Sordes: This is a compact and viscous Excrement, so cleaving to the wounded parts, that it will not be removed without the use of a firm instrument: for lint upon a probe will not bring it away.
Of this thickness three causes may be assigned: the First is the drie constitution, both of the whole Body, and the wounded part also: the Second cause may be the error of the Chirurgeon, who hath applied too drying Medicaments to the affected part: the Third cause may be the cold Air, which having been let into the Wound, by the carelesness of the dresser of it, hath condensed, and thickned the Pus.
The Third Excrement which wounded parts fend forth is called Pus. This is an Excrement white, smooth and equal or uniform, without any grumous or knotty substance, having no ill sinell, not so liquid as Sanies, nor so thick and viscous as Sordes. See Hippocrates lib. de Praedictionibus. Galen. 2. ad Glaucon. 8. & 5. Method. 10.
Now to come to the causes of the Excrements which are sent forth from Wounds, which was the Second point propounded concerning these Excrements, note these Aphorisms. First, the causes of these three Excrements are either the efficient or material causes. Secondly, the efficient causes are two, the natural and unnatural heat. Thirdly, the natural heat is the cause of concoction, whereby a laudable Put is engendred: but the unnatural heat working upon Humidity, causes putrefaction, and an evil smell. Fourthly, the material causes are two, to wit, contused Flesh, which by digestives must be turned to Quittour, and a Humor, which most commonly symbolizes with the complexion of the party wounded, whether it be natural or accidental. If then the natural constitution of the party wounded be good, the Pus is laudable: but if by reason of errors committed in the use of those things which are called Not Natural, in the course of life a sickly Complexion be acquired: As for example, if one become Hydropick, Pocky, or Leprous; then the Wound is like to cast out no good Excrements; but either Sanies, Virus, or Sordes.
CHAP. VI.
Of the common Symptomes of Wounds.
AT last I am come to the last general Duty, which the Chirurgeon is to discharge to Nature in assisting her, in joyning disjoined parts procured by a Wound, and that is the Seventh Duty in number, as I set down in the Second Chapter concerning this subject of Wounds. This I affirmed to be the removing of some general accidents which ensue, and oftentimes invade the wounded parly, after that a Wound is inflicted: Now these are in number two; Pain, and Swooning, or fainting; I call them general, because they may accompany all forts of Wounds as well Simple as Compound. As for Pain, no Wound can be inflicted without causing some pain, either more or less: This is certain, in all compound Wounds, and agree'd upon by the unanimous consent of all Authors who have left Treatises of this Subject to posterity: besides this, seeing the Skin at the least must be divided in simple Wounds, who can imagine this can be done without pain, seeing the Skin is the instrument of touching and feeling? As for Fainting and Swooning, it also often falls out in both Simple and Compound Wounds: And in Simple Wounds daily observation doth evince this to be most true. Scarce an Artist hath been employed about Blood-letting, who has been so careful and Fortunate in performing the Operation, but that he has had sundry who have fainted under his Hand, before any remarkable store of Blood hath been drawn. Now what Wound can be accounted more simple, than that which is made with the Lancet or Flegm, which will be united within the space of a few hours after that the Vein is shut and bound up? It fell out once that I sate at the Table with sundry Gentlemen, amongst whom there was one noted for his Valour; he having but lightly cut his Finger, and by the advice of one, who sate next unto him, applied a little Salt to the part incised, with his knife, presently sunk down from the Table, and was carried away.
Of these two Accidents, I will first discourse of Pain, because it extends it self farther than Fainting or Swooning do; for no Wound, whether it be Simple or Compound, can be without more or less pain, when it is first inflicted, for the reason which I yielded a little before. Whereas sundry have received grievous Wounds, and yet have not fainted; for it must be not a small matter, which will cause a stout or magnanimous Person to faint: Besides this, pain very often is the cause of fainting; now the cause by Nature hath the priority of the effect. Pain then in Latin is called dolor, which is deduced from the Verb doleo, which signifieth to grieve or to feel pain. First, I wil describe unto you what pain is; Secondly, how this Accident is removed from the wounded party, as by the Application of convenient local means, which most properly is the Office of a Chirurgeon.
Pain is described by Galen to be tristis sensatio, a grievous feeling; this description of Galen rather shews how Pain is caused, than what it is; for Pain is procured by some offending Object, moving the Instrument of Touch: And in truth we must acknowledge, that Pain is not the feeling it self simply; wherefore Galen did not call Pain feeling absolutely, but feeling with a grief. In Pain two things are to be noted: First, the apprehension of the sensible Object, as it is sensible: The second is the apprehension of the same, as it is pleasing or unpleasant. If we further inquire in which of these two the nature of Pain doth subsist; we must confess, that Dolour or Pain is not the very apprehension of the sensible Object, but the Grief which is caused by the apprehension of the unpleasant sensible Object, and the corruption of the Organ. Wherefore, Pain may thus fitly be described; It is a grievousness, which is felt in the Instrument of the Sense of Touching, caused by those things which make a Solution of Ʋnity.
In this description, three Arguments of Logick are to be marked. The first the Genus, which is said to be molestia, or grievousness: for there are Griefs as well of the Mind as of the Body; as Envy at the Prosperity of another, which is Diabolical; and rash Anger, which is Bestial: but Pain is a Grief of the Body. The second Argument is the Subject wherein Pain is seated, and that is the Organ of Touch. The Causes make up the third Argument; and those are thought to be such things as cause Solution of Ʋnity in the Instrument.
Here a Question may be moved, whether Pain may not be felt in the Instruments of other Senses, as the Hearing, Seeing, &c. as in the Instrument of Touching?
To this I answer, that two kinds of troublesomeness may be deprehended in every Sense, besides Touching. The one is, when the Instrument of Touching it self is offended, which is imparted unto all the rest of the Senses: The other is, when the proper Sense it self is offended; as when a Scholar meditates and is hindred by the ringing of Bells; or when one [Page 263]having composed himself to sleep, it troubled with the unpleasant howling of Dogs, noises of Carts and Coaches, and clamors of Drunkards, which is frequent enough here in London, where the Hearing is offended; or when one with grief and commiseration beholds his dear Friend extinguished with an Apoplexy, who sat with him at Table immediately before his fall, which hath been often seen, where the Sense of Seeing is troubled. But there is a great difference between the pain in the Organ or Touch, and these troublings of the other Senses: The first truly deserves the name of Pain; but the second may be termed aversations or dislikings of the Objects, rather than Pains. This moved Galen to say, 1. desympt. caus. 6. Delight and Grief happen to all the Senses, but not with the like evidence. But as concerning Pain, which offends the Instruments of Feeling, thus he writes, de different. sympt. c. 3. The Sense of Touching, above all other Senses, hath obtained a most remarkable Symptom, to wit, Pain in its Action. And tho other Senses may feel Grief, yet this Grief only proceeds from their external proper Objects; but Pain may happen unto the Sense of Touching, not only from external, but from internal affections also resting within the Body, which sometimes have been so vehement, that sundry Persons have dispatched themselves. I will not go about to confirm this last Point, affirmed by Galen, seeing I am to deliver Chiturgical Doctrine, and not Historical Narrations. But who will give himself content, let him peruse and turn over the Volume of Schenkius his Observations, where he shall read Examples more than enough. Thus much I thought good to deliver concerning the nature of Pain, which is an Accident proper to the Organ of Touching: and although it be somewhat Philosophical; yet it cannot but be profitable for you, seeing it is able to enrich your Understandings, that you may be able to express what is meant by Pain, when it is named, and to discern when it is a proper Symptom of the Instrument of Feeling, and when by reason of the Instrument of Feeling it is communicated to other Senses. It is now full time to set down such topical Medicaments as are effectual to asswage Pain. These Medicaments are of two kinds: for either they are Narcotical, or Anodyne. Anodyne Medicaments by the Grecians are called [...] and by others [...], asswegers of Pain. These Medicaments are temperate, answerable to the constitution of our Bodies: and therefore they maintain the substance and natural heat of the Body: By their pleasant heat they gently open the Pores of the Body; by the subtilness of substance they enter into the pores, and make all the Humors uniform, they soften and loosen the part, and so it becomes less apt to receive Pain: And if they exceed in heat a little, they open the Pores more effectually, and discuss some of the thinnest part of the peccant Humor, which is most fierce, and so abate somewhat the cause of the Pain, The Simples of this order are [Page 264]Chamaemil, Melilot, Dill, Elder, Wall-wort, ordinary Mallow, Marshmallow, Roots and Flowers of Lllies, Fenugreek, Linseed, Barley, sweet Sallet-Oyl, Oyl of sweet Almonds, Mans-grease, Capons-grease, Swines-grease, Goose-grease, Butter without Salt, Marrows, Cream and sweet Milk. Of these Oyls and Cataplasms may be framed fit for your purpose. This parable Medicament I commend unto you, Reducatur Ʋnguentum album Caphuratum in formain linimenti Oleo Lil. Anethino, aut Chamaemelino, & applicetur.
Narcotical Medicaments neither take away the cause of Pain, nor asswage Pain; but stupefie the Part, that it cannot feel that which is painful: such Medicaments are cold in the end of the third Degree, and in the fourth, which drive away the natural heat and spirits from the part. Of this sort are water-Lily, Henbane, Hemlock, Deadly Night-shade, Mandrake, Apple of Peru, black Poppy and Opium, Darnel, and the Seeds of the former Simples, of which Simples you may make both Cataplasms and Oyls. In stead of all others you may use this liniment, ℞ Ʋnguent. Popul. & albi Caphurat. an. ℥ j. Ol. Hyoscyami & Mandragor. an. ʒjss: Misc. ut siat linimentum applicandum parti vulneratae.
Now comes the second general Symptom, which follows after that a Wound is received, [...] and [...] fainting or swooning: Syncope is derived from [...] concrdo, to cut together; because in it both moving and reeling are taken from the Body, so that it lies for a time as if it were dead. Lipothymia differs from it only in vehemency; for in this the party loses not altogether feeling, and cold Sweat bursts out. Because that which cures the great Grief, is able to cure the less in this same kind. I will only discourse of a Syncope, because the nature of it being known, and the Cure of it learned, the less Grief, Lipothymy or Fainting, is easie to be dealt withal.
Syncope then is a sudden decay [...] abolition of the strength of the Body, according to Galen, 12 Method. cap. 5. As Lipothymia is only an imminution of the same: the part affected is the Heart.
As for the Causes, receive these Aphorisms. First, a Syncope may happen when there is not Matter ministred for the generation of Spirits, as in Famine. Secondly, it may happen, when the constitution of the Heart is altered by reason of some Disease, as in Pestilential Fevers. Thirdly, when a malign Matter is communicated to the Heart, as it happens in a deadly mortification of a Member. Fourthly, when the Spirits are spent, and dissipated by too great Heat, Watching, Travel, or immoderate Evacuations. Fifthly, it may happen by Antipathy, so it hath been noted that some have swooned at the smell of a Rose. Sixthly, Fear also may be the Cause. Seventhly, it happens when the Spirits are suffocated by crude Humors or Vapors. Eighthly, it may invade, when a malign Vapor is sent from another part of the Body to the heart, as in Fits of the Mother. Ninthly, the [Page 265]sensibleness of the part wounded may be the cause, as if it be a Joint, Nerve, Tendon, or Membrane.
The Signs of a Syncope are these: First, the Face grows Pale, the Pulse is small, slow and unequal, a green or yellow colour is represented to the Sight, then the Sight becomes dim, the Hands and Feet become cold, Sweat breaks out about the Forehead, and at last the Pulse altogether ceaseth; Moving, Feeling and Speech are taken away, and the Body [...]es for a while, as if it were dead.
As for the Prognosticks, receive these: First, if a man come not to himself again after that he is rubbed with Rose Water or Aqua Vitae, hath Wine or strong Waters poured into his Mouth, and hath had strong sneesing Medicaments blown up into his Nose, the Syncope is accounted deadly. Secondly, if a Syncope surprise one, who before was feeble and weak, it is dangerous. Thirdly, a Syncope proceeding from an inward cause, is more dangerous than that which proceeds from an outward cause. Fourthly, a Syncope which proceeds from oppression of the Spirits is more easily cured, than that which proceeds from the dissipation of the same, by reason of inanition. Fifthly, they who often swoon without a manifest cause, at last die suddenly. Hipp [...]c. 2. Aphor. 41. Sixthly, that Syncope which is a primary affection of the Heart is more dangerous than that which happens by the consent of the other parts. Seventhly, when a Syncope happens by reason of immoderate evacuation of Blood in Wounds, we have no cause to despair, chiefly if the wounded party be of a good constitution: for Blood by a good Diet is easily restored. Eighthly, when one comes to himself after Swooning, if the Pulse and fresh Colour return not, he is like immediately to fall into it again. Ninthly, who goes not about to prevent a Syncope, when he sees a Lypothomy to have possessed the wounded party, he is to be accounted accessory to the death of him, according to some Authors.
Now as concerning the Therapeutical Point of this Discourse, expect not whatsoever may be said of it: for many things delivered would be impertinent, no way belonging to the Practice of Chirurgery: I therefore will acquaint you with those means only, which your Duty requires. The curative means then are either External or Internal. As for the External, these which follow are accounted most effectual: First, the Temples and Nose are to be bedewed with Odoriferous Liquors. If the party be hot, apply such as are either temperate or not very cold, as the Water of Orange Flowers, the Waters of Medow sweet, Balm, Roses, the ordinary sweet Waters. If the party be cold, apply the Spirits of Balm, Mints, Wormwood or Angelica. If the party wounded be a Woman, you are not to rub these parts with things Odoriferous, lest you bring on the Mother. To these then use the Spirit or Extract of Castoreum and Rue, which are excellent. Secondly, use shaking of the Body, frictions of the extremities, hard [Page 266]pressing the parts adjacent to the Joints of the lower Jaw under the Lobes of the Ears, shouting into the Ear, and calling upon the party by his own name, moistning of the Tongue with Theriaca Andromachi dissolved in Cinnamome Water, having added a few drops of the Oyl of Sage and Amber. See Paraeus lib. 8. de Ʋulnerib. c. 14. Sennertus pract. l. 2. part. 4. c. 6. If it be a strong Syncope, it will not be amiss to pull hard the Hairs of the Temples and Neck.
As for the Internal means, a Sop in strong Wine, as Aligant, Malmesey, Canary Wine, or white Bastard, is very good, so that the Wine be drunk together with the Toast. Confectio Alkermes dissolved in Cinnamome Water, or Treacle dissolved in Aqua Coelestis and ministred are effectual. If these Medicaments be not at hand, give Aqua Coelestis, Wormwoodwater, Balm-water [...], Mint-water, yea, the common Aqua Vitae must serve. I commend unto you this Composition. ℞ Aq. Card. Benedict. ℥ iv. Aq. Theriacal. & Cinamomi an. ℥ss. Confect. Alkermes ʒ ij. Diamargariti calid. ʒiiss. Lap. Bezoar oriental. ℈j. Syrupi Acetositat. citri ℥ ij. Aq. Ros. Odorifer. cochl. 3. Misc. ex l. a. Exhibeatur cochl. 1. 3ti• quâque horâ post agitationem. If these means prove not effectual, seek for no other; for you shall lose your labour.
CHAP. VII.
Of the Stitching of Wounds.
IN the second Chapter of this Subject of Wounds, I affirmed the last scope and end which a Chirurgeon proposes to himself when he goes about the curing of a Wound, to be the reunition of the parts disjoyned by an external Instrument. I set down also the differences of Unition, which were [...] or agglutination, and [...] or concarnation: give me leave to use these terms to express the Greek words.
Agglutination, I said to be the Ʋnition of parts separate, no middle substance concurring. This kind of Union Chirurgeons aver, to be performed by the first Intention.
Concarnation, I desined to be the Ʋnition of parts disjoyned, by the intervention of a middle substance: This is said by Chirurgeons, to be done by the second Intention: for the better procuring of Unition in Wounds, I proposed seven Duties, which a Chirurgeon is to perform to Nature, to further [Page 267]her endeavour in this Action: which I hitherto have prosecuted in six several Chapters. Now the Order of Doctrine requires, that I shew, by what means Unition is procured in Wounds.
First of all, I will shew, how Agglutination is brought to pass. Then I will shew how [...] be Concarnation is procured. And this Order I have chosen, for sundry reasons moving me thereto: For first, Agglutination is a more simple kind of Unition, because it is performed without any middle coming between the wounded parts severed. Secondly, because it is more speedily performed than Concarnation: Thirdly, because in it there is neither such Art and Skill, nor such choice of Medicaments required, as are in [...].
Now to bring [...] or Agglutination, the first kind of Union, to pass, three curative Indications offer themselves: First, the brims of the Wound are to be joyned together. Secondly, the parts joyned together must be so kept. Thirdly, Agglutinative Medicaments must be applied.
The first Indication is to be performed by the Chirurgeon: for he is to bring together with his hand the Brims or Lips of the Wound gaping: In bringing of the gaping Lips of the Wound together, five things are to be observed.
First is, that he bring gently, and by degrees, not violently or suddenly, the parts severed.
The second is, that the parts disjoyned be equally brought together, not stretching one more than another, unless one part will not admit dilating: as when it cleaves to a Bone, the other being fleshy for a great distance, and at liberty.
The third is, that if the Brims of the Wound have become stiff, by reason of the cold Air (they having for a space remained uncovered) they be fomented with Hydrelaeum, a Medicament made of Oyl and Water. The proportion of the Oyl and Water is to be conjectured from the constitution of the whole Body, as well as from the temperature of the part affected. As for Example: If the party wounded be of a dry and thin habit of Body, more Oyl than Water is to be taken, as one part of Water, and two of Oyl; but if the habit of the Body be fleshy succulent, more Water is to be used than Oyl.
Fourthly, in this Conjunction equality must he observed. So the Supersicies of the one part of the Wound must exquisitely answer the Supersicies of the other part: and there must be a due correspondence between the inner side: Otherwise the Cicatrix will be ugly and unequal.
Fifthly, no Dosil or Pledget must be put between the parts of the Wound separated, when you mean to consolidate the wounded parts by the first Intention, for then you shall cause flesh to grow, and procure the Unition of the parts according to the second Intention.
As for the second Intention, [Page 268]which is the keeping of united parts together, it is performed by three means. The first is by Laqueatio or dry Stitching, as it is termed: The second is by Sutura, or Stitching with a Needle: The third is Fascüs, by Rolling, Laqueatio or dry Stitching is, when pieces of Cloth being placed on each side of the Wound, the parts of the Wound disjoyned are brought together, by drawing the pieces of the Cloth with a Needle and Thred.
This kind of Stitching we use in three Cases: First is, if we cannot come conveniently to roll the wounded part, as in transverse Wounds. The second is, when the external Beauty is like to be impaired, by making of new Scars, as it happens in Wounds of the Face. The third is, when the parties wounded will not admit Sutura, or Stitching with the Needle; as Women, and eminent Persons.
In the Application of the dry Stitch, three things are to be observed. The first is the preparation of the pieces of Cloth. The second is the means by which they are to cleave to the wounded part. The third is the form of them.
As for the first; the pieces of Cloth must be strong, that they yield not unto the Thread, when they are drawn. Secondly, one must answer another: Thirdly, they must be hemmed, or doubled towards the Wound; but they must be ravelled where they are furthest from the Wound.
As for the second: The means by which these Clouts are to cleave to the Skin firmly, ought to be wonderful emplastick Medicaments: I will set down a few Examples of such.
The first shall be this; Dissolve Isinglass in Vinegar, and by boiling, bring it to the consistence of Glew.
The second shall be this: ℞ Farin. volat. Mastiches, Gypsi, cocti, Armen. Aloes, Gummi, Tragacanth. & Arab. an. ℈j. fiat ex omnibus pulvis, qui ovi allumini admistus consistentiam mellis referat.
The third shall be this, ℞ Mastich. ʒ ij. Bitum. Judaic. Carals. an. ℈ j. Colophon. ℈ j. Ad ecto pauco Vernice, paretur emplastrum d [...] rum, quod igne liquescat, quum usus venit.
The fourth shall be this: Agitetur exactè albumen ovi in patina stannea: pestea ita aspergat [...]r palvis calcis vivae albumini agitato, ut vix appareat. Si pulveris plus satis d [...]ciderit, spiritu oris difsletur: Imbuantur telae medicamento, ae partibus vulneratis applicentur.
As concerning the third, to wit. the form of these Clouts, let them be of the form of the wounded part. If therefore the part be Triangular, let the Clouts be Triangular. However, let the form be such, as is fittest to draw the wounded parts together. As for Example, if the Cheek be wounded transversly, because the upper Cloth must not be Quadrangular, (for so it should cover the Eye) it must be cut Triangular, and reach to the Temple of the Head.
Now the tyings of the Threads ought to be distant one inch from another: So much I have thought good to deliver unto you concerning Laqueation or dry Stitching. Now I am, according to the order of Doctrine, set down by my self, to discourse briefly de Su [...]ris or Stitching with a Needle or Needles.
Of Stitching with Needles these five Points are to be observed. First, what is meant by this Stitching: Secondly, the divers Kinds of it: Thirdly, the Uses of it: Fourthly, the Instruments which are used about this Operation: The last Point shall contain the Documents, which shall inform you, how this Operation is to be performed according to Art.
Sutura then or Stitching is the beinging together of the Lips of a Wound by a Needle threaded, and the keeping of them together by these two means.
Of Stitching there are two differences; for either the Brims of the wounded parts are kept together by the Thread only, or else the Needle also is left in them.
Of the first sort of Stitching there are three kinds. 1. Is Sutura continuata or the Glovers Stitch: This kind of Stitch we use in the wounded Guts, when the Excrements come out of the Wound, and the Guts must be stitched. We use it also when great Branches of the Aorta and Vena cava are wounded, and there is a great Flux of Blood; if we can conveniently come to the Vessels wounded.
The second kind of Stitching is Sutura non continuata: This kind is performed by taking, divers stitches each being distant from another, so far as the largeness of the Wound shall require, and the Chirurgeon shall think fit: So many such stitches may be taken, as shall be able to bring the Lips of a Wound to a proportionate smoothness and equality of the Skin. In every Stitch the ends of the Threads are to be cut off near to the Knots, that they stick not to the Emplaister.
The third kind of this Stitching is called Gastroraphia: This is used when the great Muscles of the Belly, and the Peritonaeum are divided by a large Wound. Of this I will discourse, when I come to the Wounds of the Abdomen.
The second kind of Stitching is, when both the Needles are left in the Wound, and the Thread also is used. In this kind of Stitching when the Needles are passed through the Lips of the Wound, and they are brought together, the Needles are left there, and twisted about both the ends as Taylors do when they fasten their Needles to their Sleeve: This Stitching is to be used in the cure of the Hare-lip, and when the Trachea Arteria is wounded. In stead of Needles we may use Silver or Brass Pins: And when they are twisted about, their ends may be cut off with a pair of small Nippers, made for such a purpose, to avoid the cumbersomeness of the sharp ends of the Pins.
The uses of Stitching are three; for either we use Stitching to procure a quick Agglutination of the Wound: therefore it is called Sutura [Page 270]incarnativa. And in this kind of Stitching the Brims of the Wound are to be brought near together.
Or the second use of Stitching is to keep the Brims of a Wound in a reasonable distance one from another. And it is called Sutura retentiva: this kind of Stitching we are to use when a Wound cannot be united after the first, but second Intention; wherefore in this the Lips ought not to be too far asunder, lest the Air cool the parts too much; nor too near, because the Agglutination is not to be expected.
The third use of Stitching is to stay Bleeding, as when a Vein or Artery is wounded. This kind of Stitching is called Sutura suppressiva.
Now the Instruments requisite for Stitching are Needles, Thread, and the Stitching-Quill. As for the Needles, they ought to be either of Steel or Silver. Those of Silver will bend best, but then they must not be hardned by beating upon the Anvil. The Steel Needles you may distemper by holding them lapped in brown Paper wet for a while in the flame of a Candle. But it is good to have still some in readiness crooked as well as streight.
Their Points may be round, slat, three square, or four square. The square-pointed Needles pierce best. They ought to have good Eyes, and well grooped, that they may receive the Threads readily, and couch them the better.
As for the Thread, we use most commonly White, or Crimfonsilk Thread: black is to be rejected; for it is most commonly rotten, and frets. But the Low-Country white Thread made of the best Hemp hath no fellow: for it swells in the Wound, and cuts not as Silk does, which grows small, and cuts too speedily.
The Stitching-Quill, called in Latin Canaliculus fenestratus, ought for the credit of the Chirurgeon to be of Silver. It hath two Uses. First, it keeps the Needles. Secondly, it stays the opposite part of the Wound, that the Needle may the more readily pass through the adverse Lip. Now it only remains that I set down, according to my Proposition, some Documents, which teach what remarkable things are to be observed, when you go about to stitch. These are in number thirteen.
1. We are to labour to stitch with the greatest ease that may be, that the Patient may the better endure it.
2. Let the Lips of the Wound be with moderation brought together: for if they be too straitly drawn together, the flowing of the Quittour will be hindred, and so a Tumor will be procured: But if they be left gaping, the inner parts will be cooled by the Air.
3. The Knots of the Threads must be sure: otherwise they may loose, and so we must be inforced to stitch the second time, which will be more terrible to the Patient than the first.
4. In Stitching we must beware of the Chords and Nerves: for if they be touched, great pain will ensue.
5. If Ligaments be cut asunder, [Page 271]we are not to stitch them, for it is but labour lost, because they are only united by the second Intention.
6. In all parts of the Body the Skin may be stitcht, yea even in the Joints, deep Wounds, and Wounds of the Bones, after they have been smoothed with the Raspatory: for by this means the Sperrutick Parts are covered, defended both the Air, the natural Heat is lept in, and the Cure is better performed.
7. A reasonable quantity of the Brims of the Wound is to be taken by the Stitches, otherwise if the Stitches break, we shall cause filthly tranverse Scars.
8. Let the Stitches be distant by the distance of the breadth of the Fore-finger; or the least Finger at the least: for if they be too thick, they will cause the more pain; if they be too thin, they will hinder Unition.
9. In deep Wounds of fleshy perts, we must take deep Stitches; for if the Skin only be stitched, the Wound will only superficially heal; and the Quittour setling in the bottom, will cause Apostemation and a hollow Ulcer.
10. In streight Wounds of the limbs we may spare Stitching: for the Lips may be brought together by Laqueation and Rolling: But if the Wounds be transverse, we are always to use Stitching, because the Flesh and all other Parts in such Wounds shrink towards the sound Parts, and so gape much.
11. If Wounds be in the Joints; we are to draw a good quantity of Blood. First, because the Joints are weak, and so apt to receive the influxion of Humors. Secondly, because they require strong Desiccations. Thirdly, because the Joints being weak, it may be feared that too much Blood may cause a suffocation of the natural heat.
12. In Wounds of the Ventricles Phlebotomy is not so necessary. First, because they require not great Desiccation. Secondly, because if we use large Phlebotomy in them, we take away the fewel of the natural heat, wherewith they abound.
13. In long Wounds we are to begin from one of the ends; but in short Wounds (as in curing the Hare-lip) we are to begin at the middle; for so we shall shun pursing together of the Lips of the Wound, which will cause inequality in the Skin, and so deformity.
CHAP. VIII.
Of Agglutinative Medicaments, and Rolling.
IN the former Chapter I affirmed, that the Lips of the Wounds, which are to be united by Agglutination, ought not only to be brought together, but to be kept so also: I set down in like manner three means by which the Brims are kept together, to wit, Laqueation or dry Stitch; Sutura, the Stitch with Needle and Thread; and Fasciae, Rolling.
Having amply discoursed of the first two, now I am to speak of the third mean, to wit, Rolling. Faseiatio aut deligatio per fascias, is when we labour to keep the Lips of the Wound, that they may the sooner and more firmly be united together by the means of Rolling. As concerning this mean, which industrious Chirurgeons have devised, to attain to their end and scope, which is the Unition of the parts disjoyned, I will set down these three Points: The first shall be of the matter of Rollers. The second shall be of the divers kinds of Rolling in Wounds. In the third Point I will shew how they are to be applied according to Art.
As concerning the matter of Rollers, they ought to be of Linnen: for woollen Rollers are apt to admit stretching, and so cannot make such constriction as those of Linnen do. Secondly, they cause itching, and heat the part too much, by which means attraction of Humors is caused, which alters the natural temperature of the part, and so hinders the Unition of the parts of it severed.
Now the Linnen Rollers must not be of Cloth too new; for then they will be too stiff and hard: nor of Cloth too much worn, for then they will be too weak. Neither must they be of Cloth too thick, for then they will be too heavy and boisterous; nor too thin, for then they will be most apt to receive wrinkles, which is unseemly. They must also be of even Cloth; not having unequal Threads; for so they will cause Pits in the Skin. Besides this, they ought to be clean; for filth in Rollers stops the Pores, and hinders the Perspiration, and so may bring Inflammation.
As concerning the Dimensions of Rollers, those which are appointed for the Trunk of the Body, ought to be broadest: Then those which are ordained for the Thighs: Next unto these those that are to be applied to the Arms: The narrowest are most fit for Fingers and Toes. As for the length, it is to be found out by the number [Page 273]of Circumvolutions as shall be found fit and requisite.
As concerning the divers sorts of Rollings, Galen hath left a whole Treatise of them; by his Pains and Labour he hath deserved a thankful Commemoration from all Posterity. But all what he hath set down, cannot be applied to this Subject which we have in hand: Only four kinds do serve our purpose, to wit, Incarnativa, Retentiva, Expulsiva and Aequans.
Fascia Incarnativa, or the manner of Rolling, appointed for Agglutination, is of two sorts.
The first is performed by a Roller with two ends. Now in this sort we must begin to roll in the sound part, opposite to the Wound, and roll upwards, and so return to the wounded part with one end; with the other end we are to roll downwards, crossing the former, that the Lips of the Wound may be artificially brought together. In this kind of rolling, the Wound must be twice as broad as the Roller, because by this kind of rolling, the Roller draws the Wound together two times: Once rolling upward, and once rolling downward, and so to avoid wrinkling, the Roller ought not to be as broad as the Wound.
The second kind of agglutinative rolling, is performed by one Cloth, which must be broader than the Wound. The middle of it we apply to the sound part, that the sides may meet above the Wound; then we are to sow the sides of the Roller together with a transverse Stitch: But this kind of Rolling is not so ready as the first, because at every dressing we must cut the former Stitches and use new.
Fascia retentiva, is that kind of Rolling, which is used to keep close to the wounded part, the Applications, as Pledgets, Emplasters, Boulsters, Clouts, and such like. A simple Roller will serve for this purpose. This kind of Rolling ought to be no stricter than is sufficient to stay the Applications; otherwise it may hinder the influence of the nourishment to the part, and so procure a sideration or mortification of the wounded part.
The third kind of Rolling is called Fascia expulsiva, or the repelling kind of Rolling. This manner of Rolling suffers not any thing to lodge in the cavity of the Wound. Now seeing defluxions most commonly invade the dependent parts, in this case, we are to begin our Rolling in the sound parts below the Wound, and so to proceed to the wounded part; whither when you are come, you are to use fewer or more loose Circumvolutions, and so to ascend to the sound part above the Wound, and then to use more strict rolling to hinder the descent of any Humor; and so by this same kind of Rolling we wring out the Matter which hath already flowed, and hinder the influence of any new Matter.
Fascia aequans, or a smoothing Rolling, is that which reduces unequal parts, whereof some are high, some low, to a decent equality: this is brought to pass by Boulsters and a simple Roller.
There are other sorts of Rollings besides these; yet either not so [Page 274]necessary, or belonging to other operations in Chirurgery, as fascia prohibitiva apostematis, that kind of rolling which hinders Apostemation. In this case we are to begin our rolling about the Wound, and to go upward to the joint of the sound part. Contrary to this is fascia apostematis factiva, that kind of rolling which causes Apostemation. There is also fascia disjunctiva, that kind of rolling which keeps parts asunder, and fascia directiva, that sort of rolling which reduces distorted and crooked Members to their natural Figure: Of these I will discourse, when I treat of those points wherein they are required.
Now concerning Rolling, this only remains, that I set down some Duties which are required of a Chirurgeon when he goes about to roll. The First is that he be nimble and quick in dispatching, that the Patient be not wearied. The Second is, That he carry a light Hand; for so he shall not hurt the Patient. The Third is, That he roll handsomely to content the Eye. To perform this, we are to have a care that threads hang not at the Roller, lest we might seem to have robbed Beggars of their rags.
In the former Chapter I affirmed that [...] or agglutination was performed by three Intentions: to wit, by bringing of the lips of the Wound together, by keeping them together, and by application of agglutinative Medicaments. Having set down how the two first Indications are artificially to be done; now am I to deliver unto you what agglutinative Medicaments are sittest to procure agglutination.
Of these Medicaments I will deliver these three points: the First shall be of their Matter: The Second shall be of the divers kinds of them: The Third shall set down the artificial application of them. As for their Matter, they ought to be cooling or temperate, to hinder Inflammations; and astringent, to resist the Influxion of Humors; and drying, to hasten consolidation. These Medicaments are of two sorts; for they are either simple or compound. These which follow are to be accounted simple: Hypericum, Sideritis Achillaea, Polygonum, Bursa pastoris, Equisetum, sigillum Salomonis, Consolida major, Bugula, Ophioglossum, Valeriana, Panax coloni, Contaurium utrumque, solidago Saracenica, Plantaginis species, Pontaphyllum, Tobacco, Cardnus Benedictus, Sanicula, Alchmilla, Cavyophyllata, Lunaria minor, Vinuin rubrum astringens, rhus coriaribrum, aqua Aurifabrorum, Albumina ovorum clarificata, Humor melleus vosicis, quae lateribus foliorum Ʋlmi monse Maio adherent, conclusus. It heals Wounds very speedily; thus it is to be prepared: Fill a glass with this Liquor, then stop it well; then bury the Glass a Foot deep in the Ground, and cover it with Salt; suffer it to remain there for the space of twenty or five and twenty daies; last of all, separate the clear Liquor from the Faeces. Natural Balsame is excellent; Of this kind are Burnet, Periwinckle, Bole, Terra sigillata, Lapis haematites, [Page 275]Coralium utrumque, Gallae immaturae, Mrrtus, sanguis Dracons, omnes Resinae, gummi Elemi, Sanguis Draconis. Of these you may frame unto your selves compound and effectual Medicaments. The compound Medicaments are either in form of Oils, which are called Balsanies, or in the form of an Unguent, or in the form of an Emplaster. I will acquaint you with some patterns of all the three forms: The efficacy of them shall recompence the paucity. This shall be the pattern of a Balsame: ℞. Ol. oliv. lb ij. succi Nicotianae lb. ss. gemmarum Hyperici, Sanic [...]e, Alchymillae, sigill. Salomon. Caryophylat. hortens. Ophiogloss. Pyr [...]. Valerian. Panac. colon. an. man. j. Herbae minutim incisae ad [...]isceantur oleo, & succo Nicotianae: p [...]steà coquantur omnia lento igne [...] consumptionem humiditatis aqueae, & coletur Balsamus, cui admisce ol. lumbricorum ℥ iiij. terebinthinae & vernicis clarae an. ℥ iij. Servetur Balsamus in vase stanneo [...] vitreo, sc. mundo. I need not commend this Balsame unto you, seeing the ingredients themselves do shew of what efficacy it is in consolidating Wounds, Fabricius ab aqua pendente exceedingly commends the green Spanish Balsame; But I mean not to mis-spend time in setting it down, seeing you may find the description of it in his Second part of Chirurgical Discourses. As concerning Unguents, of all that you use, Franciscus Arc [...]us his Liniment is the best. For this purpose: The Learning of the Author, and his extraordinary skill in the practice of Chirurgery, doth (I make no doubt) perswade you of the efficacy of the Medicament. Nevertheless this shall not hinder me from setting down the form of Unguents composed of the Simples before-named by me, which you shall find effectual, not in Wounds only, but in Ulcers also: I desire not to be credited, before experience shew the excellence of the one above the other: The description of the Unguent shall be this: ℞ Axung. porcin. lb. j. Colophon. ℥ vj. cerae ℥ iij. gummi. Elemi ℥ ij. succi Tobaccae ℥ ix. Sanicul [...] Alchymill. gemmar. Hyper. Card. benedict. Ophiogloss. vinc. pervinc. sigil. Salomon. Pimpinell. Valer. Centaur. maj. & minor. an. man. j. Herbae incisae misceantur cum praedictis: postea coq. omnia lento igne ad consimptionent humiditatis aqueae, & coletur unguentum: cui admisc. vernicis clarae, ac terebinthin. Cypr. an. ℥ j. Tandem reponatur unguentum donec usus poscet. The ingredients will shew you, what benefit is to be expected from the application of it to wounded parts.
As concerning Emplasters, I mean not to set down any curious description for the curing of a Wound by the first intention, seeing a familiar one will serve the turn; receive this then: ℞ resin. abiet. lb. iiij. cerae. lb. j. sevi ovilli ℥ iiij. gummi Elemi ℥ iij. succi Nicot. & melilot. an. lb ij. Nicotian. contus. man. ij. siat emplastrum secundum artem. This is not a little better than the common Melilot, cheap, and parable. As for other ways of curing, know first, that cold water is not fit to be used; although Celsus lib. 5. c. 26. affirm, that it may serve for such [Page 276]Wounds as Nature her self is able to cure. For First, Cold is hurtful for Wounds: Secondly, it may procure a Gangrene in Bodies which have small store of natural heat. Oil in like manner is not convenient, if it be simple, because it moistens too much. The whites of Eggs also are to be rejected, when we mean to glutinate a Wound: First, because they speedily dry: Secondly, because they do not penetrate; yea, if glutinative Powders be mingled with them, they hinder their penetration. But what shall we say of hallowed clean Clouts? I Answer, that they also are not to be used because they only drie the Superficies, and pass not to the cavity of the Wound: As for the hallowing or blessing, it is but a device of crafty knaves, abusing the credulity and simplicity of the common people.
Now, to speak a word or two of the application of these Medicaments, which was the last point proposed by me to be handled, concerning Medicaments: If the Wound afford but small store of Matter, it is only to be dressed every other day: but if plenty of Matter, it is to be dressed once every day: but never twice a day, for then the Air will do more harm than tho Medicament good. Wherefore they palpably erre, who think often dressing to further Consolidation. Secondly, if you perceive the Lips of the Wound to be consolidate or agglutinate, straightways cut the stitches, whether this happen the Second, Third, or Fourth day: For unition after the first intention is most commonly performed in this time: The next day following, when you see the Lips firmly to cleave together, pull out the threads with your Forceps or Fingers.
CHAP. IX.
How a Wound is to be cured after the Second Intention.
IN the former two Chapters, I have shewed you, how Wounds are to be handled, which are to be cured by Agglutination, or the First Intention: Now order of Doctrine admonishes me to go on, and to teach in like manner, how Wounds are to be dressed, which are to be united by the Second Intention, called by the Grecians [...], which may be expressed by this word Concarnation. It is not amiss sometimes to coin vocables of Art to express the matter which is in hand.
Now to cure a Wound after the Second Intention, three curative Indications do offer themselves. The First is, to procure the filling of the Wound by new flesh. The Second is, to abate the Flesh, if it become superfluous: And the Third is, to skin the part wounded, when sufficient flesh is grown.
As for the First Indication, which is the filling of the gaping of a Wound with flesh; of it you are to consider the Motives, which induce you to go about this manner of unition, and the means by which it is brought to pass. In five cases you are to go about the consolidation of Wounds by the Second Intention.
1. The First is, If there be loss of substance, whether it be flesh, or any other substance, as Bone, Cartilage, or Ligament. Neither is this a general rule: for if the parts be loose and flaggy, they may admit unition after the First Intention: as we may perceive in the curing of the Hare-lip, and Wounds of the fore part of the Neck.
Secondly, you are to attempt this kind of Cure, where you cannot conveniently bring the lips of the Wound together by stitching or rolling: as in great wounds of the Joints, and when the Ligaments are cut asunder, as the great Tendon, which is called Nerv [...]s Hectorius, and is inferted into Os calcis.
Thirdly, this is to be done when we look upon the scaling of a Bone, or the scparation of the piece of a Ligament or Cartilage.
Fourthly, we are to take this course, when otherwise a great and dangerous Flux of Blood cannot be avoided, as in wounds of the Neck, where the internal jugular Veins and soporal Arteries are divided.
Fifthly, we are to address our [Page 278]selves to this manner of Unition, when great store of Quittour is like to flow to the wounded part; and this falls out in four cases.
The First is, when we cannot hinder the influxion of Humors by rolling, as in wounds of the Armpits and Joints.
Secondly, in cacochymical Bodies.
Thirdly, in persons who have a scirrhosity in the Liver and Spleen.
Fourthly, if the wounded party have a contagious Disease, as the Pox. In these cases we are rather to attempt Unition by the Second, than First Intention, especially if we fear no deformity by reason of a scarr: As it happens in wounds of all the parts of the Body, if you except the Face.
The causes which ought to induce you not to attempt Unition after the first Intention, when there is loss of substance, are these: First, Pain and Inflammation will ensue, by reason of the violent bringing of the lips of the Wound together: Secondly, there will remain a great deformity in the part wounded, after that is cured. So much then concerning the occasions, which are to admonish a Chirurgeon, when he is about to cure a Wound, whether he ought to perform this by the Second Intention. Now I am to shew you, what means are most apt to generate new flesh: These means are in number three: the principal efficient cause: The causes adjuvant: The material cause.
The principal efficient cause is the natural Temperature of the whole Body, and of the parts affected also, which ought to incline to driness: If it be present it is to be maintained; but if you find it not, you are to procure it by Phlebotomy, Purgation, and the right ordering of those things which are called not Natural. But seeing I have amply discoursed of these points, when I set down the methodical cure of Ulcers, I will remit you to that Treatise, and will not trouble you with a fruitless repetition of the same things.
The adjuvant causes are two, to wit, the Chirurgeon, and convenient Medicaments. As for the Chirurgeon, he ought to dress the party with as much ease as may be. Secondly, he ought to have a care that the applications be applied to the Wound very neatly: for by want of this, a slubberer and sloven is discerned from a cleanly workman. This the Chirurgeon can hardly perform, if he be not cunning in fitting of Liniments, upon which the Medicaments are to be laid, which are to be applied to the wounded part.
Now the Liniments are of three sorts; Turundae, Tentae, and Splenia. Turundae or dosils represent in Olive in Figure Tentae or Tents are long, and somewhat small. Splenia or Pledgets ought to represent the Spleen of living Creatures, from whence they have their denomination.
The Pledgets, which are applied, ought first to be somewhat larger than the Wound: Secondly, they ought to be armed with Medicaments [Page 279]which have a moderate tenacity or clamminess, and which ought to have a faculty to stay an Inflammation, to asswage pain, and to repell Humors, which might flow to the part. Such are Diapalma dissolved in Oil of Myrtles, Quinces or Roses, Ʋnguentum de Tutia magistrale, Ʋnguentum de Minio. If for the present you be destitute of these compositions, you may use the red astringent Wine, or Tanners Woose, or Smiths water clarified, mingled with one of the Oils befor-named: and then it is good to moisten the Rollers in this Medicament. These Liniments are to be made of Lint or Tow; the Tow ought to be without shivers: It dries more than Lint, if it be of Hemp.
The material cause of the generation of new flesh is laudable Blood, answering the temperature of the part wounded. So if a spermatick part be wounded, the Blood ought to be somewhat cold, thick, and dry, which is to gender a mean to unite the parts severed. But if a fleshy part be wounded, the Blood is to be hotter and more humid. Having set down the part of the Chirurgeon, whom I affirmed to be the first adjuvant cause, in producing new flesh, now am I to to acquaint you with those Medicaments which are termed by Artists Sarcotical, or apt to engender new and tender flesh.
All Sarcotical Medicaments, as they ought to be of a drying faculty, so they ought to be void of a sharp and biting quality. The differences of drying Medicaments are either taken from the degrees of their drying quality, or from the diversities of their kinds. From the degrees of drying, these three differences are drawn: For either they are of a mean operation, and these will serve when the Quittour is Album, Leve, and Aequate, white, smooth, and of an equal substance, one part of it not being thin, and the other grumous. Or they are somewhat stronger, as when the matter which flows from the Wound is thin and ichorous; for then stronger desiccatives are required to incrassate or thicken this thin matter. The Third degree comprehends the strongest desiccatives: As when Sordes or a Sluch appears in the Wound, these Medicaments are called Medicamenta detergentia the Chirurgeon's Mundificatives; and those Medicaments according to Gal. 1 meth. 12. ought to be of a drying and penetrating faculty; For those things which are united in the bodies of living Creatures, are united by moisture: wherefore driness spending the Humidity, they are again separated; as we may for an example see in a Table glued together, if it be too much dried by the fire.
Now there be two kinds of these drying Medicaments, for either they are simple or compound. The simple drying Medicaments, according to Gal. 3. Meth. 3. are of three sorts.
The First, dry in the first Degree, for those who have had but a tender and soft constitution of Body, as are Children and young Gentlewomen. Children are esteemed to be of this constitution, untill [Page 280]they attain the Fourteenth year of their age.
The Second sort is of such as are dry in the end of the First degree, and the beginning of the Second.
The Third sort is of such as are drie in the end of the Second degree: and as these befit bodies of very hard and firm constitution of Body, such as Sailers, and Artificers of hard Trades have, as Smiths and Felt-makers: So the Second sort of Desiccatives are fittest for such as are of a mean habit of Body, neither too loose nor too hard, as Gentlemen in their consisting age.
Unto the First degree of Desiccatives these may be referred: Thus, Farina Hordei, & Fabarum, ut & Zeae utriusque, Mastiche, Olibanum in guttis.
To these of the Second degree you may refer all sorts of Resines, as the yellow, the black Ship-Pitch, and Elemi, clarified Honey, Farina Cicerum, & metallica quaedam; ut Mintum, Lithargarus, Phanbum vstum; sed omnia lota.
To the Third degree you may refer: Farina Orobi amari, Lupinorum, Iris, Aristolochia utraque, Myrrha, Sarcocolla, Lapis calaminaris, Tutia, Aesustum.
Thus those Simples which are drying in the First degree, serve for those who are of a soft habit of body: Those which are in the Second degree, serve for those who are of a mean habit: but those which are of the Third degree, are fit for those who are of a churlish habit of Body, as I have noted. Now what I have spoken of the habit of the whole body, I would have you to apply it to the habit of every several part: So the fleshy parts are softest, althô there be degrees: amongst them: The Lips are softest of all: The Sinews and Membranes are of a mean hardness, but the Cartilages and Bones are hardest of all.
Of these simple Sarcotical Medicaments, you may frame unto your selves sundry compositions, as occasion shall move you: Only I will set down one for a pattern, and it is this: ℞ Balsam. Hyperic. simpl. lb. ss. Resin. ℥ vj. Cerae ℥ iv. Picis navalis. ℥ iij. gum. Elemi. ℥ ij. Vernic. & sevi ovil. an. ℥ iij. Terebin. Cypr. ℥ iss. Olib. & Myrrh. pulveriz. an. ℥j. This I have termed my Basilicum Magistrale; I will not stand much upon the commendation of it; the effects will praise it: If variety of such compound Sarcosical Medicaments doth delight any one, let him have recourse unto the dispensatories of sundry Men, and Nations: If he be not by them satissied, I shall think that he hath an Appetitus caninus of the Imagination.
One thing is to be noted, that cathaeretick Medicaments, as Alumen ustum, A [...]s viride, and Vitriolum calcinatum, may become Sarcotics, if they be mingled in compositions with Sarcotics in a small quantity.
It is not enough in curing by the Second Intention to procure the growing of new flesh in Wounds; but we must be wary that it do not overgrow. If this happen, we must take order with it. The cause of superfluous flesh is too much Blood sent unto the [Page 281]part. This is abated by appointing a strict Diet, and the use of Aliments, which do not feed much. Secondly, cooling and astringent Medicaments are to be applied to the sound parts adjacent to the Wound. Thirdly, we are to use hard Frictions and strait Ligatures to the opposite part: for by all these means the immoderate influence of Blood is stayed.
Now superfluous or proud Flesh is taken away three manner of ways. First, by an Instrument, as an Incision-Knife or a Rasor, Secondly, by rubbing it away by a rough Linnen Cloth. Thirdly, it is removed by Cathaeretical Medicaments: such are Alumen ustum, Vnriclum calcinatum, Mer. praecititatus. If the party wounded be of a tender habit of Body. Merc. lotus will serve, being thus mingled: ℞ Ʋng. Basilic. magisiral. ℥ j. Merc. praecipitati loti ʒ j. exquisitè misceantur: But if he or she be of a hard and stubborn habit, let this Medicament be made: ℞ Merc. praecipitat. non liti ʒ ij. Aluminis usti ʒ j. Super [...]ar [...]r Pictorum levigentur: postea. ℞ Hujus compos. ʒ j. Ʋng. Basilici magistral. ʒ vj. Optimè Misc. If you apply the aforesaid Powders unmingled with an Unguent they will cause an Eschar if need be. Whoever he be that has brought a Wound to that pass, that the supercrescent Flesh requires a stronger Catheretical Medicament than these, he must be a novice in his Art.
The Wound being thus sufficiently incarnate nothing remains, but to cicatrize it. Concerning Cicatrizations these three Questions may arise. First, what manner of skinning is most laudable? Secondly, when we are to go about skinning? The third shall be of the causes which procure skinning. To the first I answer, that the Cicatrix which in colour and conformation best represents the natural Skin, is most laudable. To the second Question I answer, that we are not to go about the skinning of the Wound before the Flesh be somewhat higher than the natural Skin: for otherwise the Cicatrix will be hollow, which is unseemly. If a piece of a Bone either be taken out or cast, we cannot shun a hollow Cicatrix. As for the Causes;
The efficient Cause is a faculty resident in the sound Skin, adjacent to the Wound: So we see skinning to begin from the Brims of the natural Skin.
The material Cause is Flesh hardned.
The adjuvant Causes are Epulotical or skinning Medicaments.
As concerning the Medicaments, we are first to consider their faculty; Secondly, to set down their kinds. As for their faculty, they ought first to dry strongly, and to reach the end of the third degree of Desiccation; because such Medicaments ought not only to consume the extraneous Humidity, but the natural also. Secondly, seeing they [Page 282]are to stay the influxion of more Blood, which might ingender more new Flesh, they ought to be very astringent, so that it may be discerned by the Tongue and Palate. Yet they are to have no Acrimony, for then they would [...]rode.
These Medicaments are of two sorts; for they are either Simple or Compound. For wounded Persons of a soft Habit, these will serve; Frankincense, the bark of the Pine-tree, Lead calcined and washed, Oyster-shells burned and washed: for those who have a mean habit of Body these will serve, which are drying in the beginning of the third degree; as are unripe Galls, the Flowers and Rinds of wild Pomegranates, Sumach, Myrtil berries, Sanguis Draconis, Terra Ʋmbra, Rubrica fabrilis. For those who have a very hard habit of Body, use Aes ustum, Alumen ustum, Capue mortuum Vitrioli distillati ablutum.
The compound Epuloticks are in like manner of three degrees: For some are for tender Bodies, as Ʋnguentum de Minis, Ceratum de Minio, Ʋnguentum de Tutia: Some are for Bodies of a mean habit; these will serve for such: Diapalma, Ʋnguentum de Tutia magistral. cujus haee est compositio: ℞ Ol Ros. ℥ xij. Ol Myrtin. & Ʋng. Popul. an. ℥ iij. fol. Plantag. & Solan. hortens. contus. an. man. ij. evaporet lento igne humiditas aquea, atque instituatur colatura, in qua liquescat cer. alb. Quum incipit Medicamentum frigescere, insperge Litharg. auri ℥ vj. Tutiae praepar. ℥ j. Ce [...]uss. ℥ ij. Minii ʒ vj. Caphur. ʒ j. Omnia haec pulverizentur. Ducatur hoe Ʋnguentum per hor. 2. in mortario plumbeo. For those that are of a hard habit of Body, use this Ʋnguentum de Tutià magistrali, adding to every ounce of it, Abis usti ʒ j. or Vitrioli. ad rubed. calcinati ʒss. You have in the Apothecaries Shops Ʋnguentum de bolo Armen.
CHAP. X.
Of a Convulsion in Wounds.
HItherto I have delivered unto you such Precepts as concern all Wounds in general. Now the Method which I proposed unto my self in the beginning of this Treatise of Wounds, doth require that I set down in like manner such Points as concern all particular Wounds.
The Differences of Wounds are taken from three things. The first from their Accidents: The second from the Nature of Wounds: The third, from the parts affected From the Accidents, Wounds may be said either to have been known unto the Ancients, or not to have been known unto them. From the Nature of Wounds these Differences are taken: Wounds are either Simple or Compound. A simple Wound is that which hath neither any cruel Symptom, [...] any other kind of Grief, which may draw the Chirurgeon from going about the curing of it, according to the intention set down in the general Doctrine of Wounds. Thither then I send you: for I mean to avoid fruitless repetitions. A compound Wound is, that which hath either a cruel Symptom, or same Disease, or both annexed.
The Symptoms are in number five: Pain, Fainting, a Convulsion, a Palsie, and Crudity. Of Pain and Fainting, I have discoursed already; because they happen often, as well in simple as compound Wounds, as hath been shewed, Cap. 5. Wherefore I am only to speak of the last three: of which a Convulsion is the first: If you require a Description of it: receive this: A Convulsion is a contraction or drawing together of the Muscles or Parts which are appointed for voluntary Motion towards their beginning; which are either the Brain, or the Spinalis Medulla or Chine of the Back.
A Convulsion is two-fold: for it is either natural or unnatural: A natural Convulsion happens when one of two Muscles appointed for Motion is contracted, the other being tranversly wounded. This is to be seen in Wounds of the Head, when one of the temporal Muscles is transversly cut asunder; and in Wounds of the Fingers: for if the inner Muscle of a Finger be cut asunder transversly, the outward Muscle is contracted. An unnatural Convulsion is that which happens not because one of two Muscles, ordained to perform this same action, is tranversly [Page 284]wounded. This is two-fold, Motus convulsivus, and Convulsio vera. Motus convulsivus, or the convulsive Motion, is caused of a thin and halituous Matter, moving too and fro, tossing the Nerve: And it doth not continue long, for the Matter being kept in the part affected, the Brain and the beginning of the Nerves are so affected that they lose their Action; from whence ensues the Palsie on that side: then a malign Vapor being raised from hence, and passing to the beginning of the Nerves of the sound part not altother spoiled, the Nerves are shaken, and so Motus convulsivus is caused.
If any man demand, why a malign Vapor resting in the Brain procures not only a stupidity, but a Convulsion, if the beginning of the Nerves be affected?
I answer, that this happens, because no Body can have Motion in it self, which is not Fibrous: Seeing then the Brain is not Fibrous, it cannot have Extension, and Contraction: But the beginning of the Nerves may, although they be soft: for they are framed of many Filaments covered with a Membrane. Not unlike to this is Spasmus flatulentus or the Cramp. This is caused of a thin Humor or Flatuosity nipping the beginning of the Muscle: so you may observe, that they who are troubled with a Quartan Ague, or who increase windiness in the Body, are most subject to this Grief. This very often is a forerunner of a true Convulsion: Wherefore it seems only to differ from a true Convulsion, that in this the Matter is less sharp, and the Contraction endures not so long.
A true Convulsion is that which is caused either of a plentiful greasie Matter stopping the Nerves, or of a driness pursing of them; or by consent, a noisome Vapor being sent to the beginning of the Nerves of the Muscles, and nipping them. Of a true Convulsion there are four kinds, Emprostlxtonos, Opisthotonos, Tetanos and Spasmus cynicus. [...] is when not only the Neck, but the rest of the Body also is drawn forwards, so that the party cannot stand upright, the Nerves of the Neck, and of the rest of the Spina, which move the Body forward, being ill affected. [...] is when the whole Body is bent backward, so that it cannot be brought forward; which happens when the Muscles which bend the Body backward are hurt. [...] is when all the fore and back parts of the Body are equally contracted, and so kept. This happens when all the aforesaid Muscles are kept at a stay. In this kind of Convulsion the Body remains stiff as a stake, so that it cannot bend it self to any part [...] Seu oris tortura, aut oris distortio, according to Celsus, lib. 4. c. 2. is when the Mouth is pulled awry; 'tis caused by the contraction of the Muscles of the Face. Now the chief Muscles of the Face are those of the lower Jaw, the Nostrils, Lips and Cheeks, which have their Nerves for the most part from the third Conjugation.
As for the Signs of a Convulsion, it is easily discerned: for in it the Nerves and Muscles being drawn towards [Page 285]their beginnings against the Will, cause the Member also, which they move, to follow this depraved Motion, so that it continues stiff, and cannot be bent as the diseased person [...]. This is the only Pathognomi [...] sign of a true Convulsion. In a convulsive Motion this distension is not performed at once, and so continueth; but it comes and ceases then, and shakes the part sundry ways.
The Causes of a Convulsion are three; Fulness, Inanition and Con [...]t.
Plethora or Fulness, is thus discerned: The habit of the Body is [...]ick and fleshy, the Vessels appear full, the Pulse is strong, a constant Age, the Spring time, a temperate Region, a full Diet of much nourishing Meats, a ruddy colour of the Chin, and if the party bleed little at the Wound, shew the same: the sleep is sound and long, dreams of red things and blood present themselves: In motion the Body is not nimble, the Urine is laudable, and plentiful.
To cure such a Convulsion, both Physical and Chirurgical means are required: As for the Physical means, first, Bleeding is necessary: In Phlebotomy, what quantity of Blood is to be drawn, the Strength of the party, the Part affected, the Age, the Season of the year will shew, if no Physician be at hand to direct. A slender Diet is also requisite: for little Meat takes away Lassitude or Heaviness, and asswages Thirst, as it is noted. 6. Epid. com. 3. Text. 28. Purgation is not to be admitted: Begin first with Clysters, which must be reasonable strong, and have Anodyne Oyls mixed with them. Receive this as a Pattern: ℞ Diacathol. ℥ j. Confect. Hamech. ℥ss. Spec. Hier. Picr. ℥ ij. Ol. Lil. alb. & Chamaemel. an. ℥ j. decoct. communis pro clysterib. ℥ x. Misc. ut fiat clyst. If you be enforced to use Cathartical means, use these two, the descriptions of which are these: ℞ Caryocostin. & Elect. de succo Ros. an. ʒ iij. Syrup. Ros. solut. cum Agarico ℥ j. Aq. Lil. convall. flor. Tiliae, vel Ceras. nigror. ℥ iij. Misc. ut fiat potio. 2. ℞ Diaphoen. Elect. de succo Ros. & Caryocostin. an. ℥ ij. Antidoti convulsivae ℥ ij. Turpet. alb. & rad. è Salv. major. an. ℥ss. Diagryd. ℥ iij. Castor. ℈ ij. Costi Zinzib. Caryophyl. an. ʒ j. semin. Cumin. Rut. Croci an. ℈ j. Cum syrup. Ros. sol. cum Agarico s. q. fiat Elect. s. a. dos. ℥ss. in praedict. aquarum ℥ iij. The Composition of Antidotus convulsiva is this: ℞ Rad. Paeon. maris convenienti tempore erutae, & Visc. quercin. an. ℥ j. Castor. ʒ iij. Salv. ℥ v. Baccar. Lauri. Cranii humani an. ʒ j. Theriac. Andromach. & Mithridat. optimi an. ʒ vj. Cum Mellis despumati ℥ xij. Fiat Electuar. dos. ʒ ij. In aq. Salviae, Rorismar. Lavandul. aut aq. Epilept. Langii. aut aqua Hirundinum, cujus hanc accipite descriptionem. ℞ Pullos Hirund. numero 50. Forfice auferantur extremitates pennarum major. semin. Sesel. Card. benedict. an. ℥ss. Calam. aromat. Cyperi. an. ʒ ij. Fol. Majoran. Rut. an. man. ss. Flor. Til. & Lil. convall. an. pug. ij. Visc. quercin. rad. Paeon. lunâ decrescente collect. an. ℥ j. Castor. ʒ vj. Infundantur [Page 286]isti per dies iij. in vini Malvat. lb viij. Postea instituatur distillat. in B. Mariae: dos. ab. ℥ss. ad ℥ j. in aq. praedictarum ℥ iij. Give also ℈ss. Extracti. Castorei in aq. Salviae, Electuarium ad Spasmum. This following Electuary is excellent: ℞ Castor. Sagapen. Opopanac. an. ʒ j. succi Laseris vel Assae. faetid ʒiss. Acori, Scord. an. ʒ ij. Trium Piper. Schaenanthi. Carni. an. ʒ ij. Asari. Scillae assat. an. ʒiss. Rad. Irid. semin. Apii. Mastich. an. ʒ j. Staechad. ʒ iij. Cum. Mell. despumat. & Mellis anthosati an. ℥ v. fiat Elect. dos. ʒ j. singulis diebus in aq. mulsa. Cardanus de curdt. admirand. c. 15. affirms that he cured one troubled with Opisthonos thus: He caused him to refrain from Flesh, Wine and Eggs: he applied to the Neck, the whole Spina, and parts convelled, Clothes moistned in Oyl of Chamaemil and Lilies. Inwardly he ministred Mithridate with the Electuary of Musk, with the which he mingled Pearls, the Jacynth and Emerauld prepared. These things being done, we are to come to the Topical means: These must resolve and discuss: such are Oyls, Liniments, Unguents; Fomentations, Bathes. Ʋtendum his Oleis, Ʋulpino de Castor. de Catell. pinguibus, Philosopher. Juniper. Laurino, Rutaceo, Terebinth, Petrol. de Spica, Lumbric. Hyper. cum Gummi, de Costo. Irine, Lil. albor. Chamaemel. pingued. Ʋulp. Taxi. Anserum sylvest. humano, & ursino. As for Ʋnguents you have Aregon. Martiation, Dialthaea cum Gummi: of these and the Oyls you may frame unto your selves Liniments: as ℞ Axung. humanae, ursi, taxi, anser. sylv. an. ℥ j. Ʋng. Dialth. ℥ ij. Ol. Lumbric. Ʋulpin. Hyper. cum Gummi. Lil. alb. & Castor. an. ʒ iss. fiat linimention s. a. If great Desiccation and Discussion be required, you may use this Liniment: ℞ Ʋng. Aregon. & Martiat. an. ℥ j. pingued. human. & ursin. an. ʒ ij. Ol. Terebinth. Philosoph. & Petrol. an. ʒ j. Ol. Salv. ℈ j.
As for the Fomentations, boil Mallows, Fenugreek, Scordium, Sage, Lavander, Tansey, Germander, Thyme, Chamaemil, Dill, Bay-leaves, Flowers of white Lily, Woodbind, and Betony, in Sack and Muscadel, taking equal measure of each.
Bathes you may make also of these Simples, boiling them in Water and Milk. Last of all, let the parts be lapped with Fox, wild Cats, Conies, or Hares skins dressed.
Having discoursed of a Convulsion proceeding from a Plethora or Plenitude; I am to shew how a Convulsion from Inanition is to be dealt with: whether it proceed from Inanition or no, you are to examine those Signs which I set down to find out a Convulsion caused of Fulness. If you find in the part wounded Signs opposite and adverse to those, you may boldly pronounce that it proceeds from Inanition.
In such a Convulsion abstain from Phlebotomy and Purging; only keep the Body soluble with emollient Clysters, as this: ℞ Lactis, cui incoxeriut Althaea, Violae, Parietaria, Rosae pallidae, bonus Henricus mercurialis, ℥ x. Ol. Viol [Page 287]& Lini an. ℥ j. Sacchari rubri ℥ ij. Misc. ut fiat clyster. As for local Medicaments, they must be of a remollient and moistning quality.
The Oyls of this kind are, the Oyl of Violets, Linseed, Quinces, Reats-foot and Trotters, Eggs, of [...]eet Almonds, new Sallet-oyl, you may use also May-Butter, new S [...]ines-grease tried: Of these you [...]ay make Liniments; take this Discription as a Pattern: ℞ Butyri [...]lis & Axungiae Porcinae re [...]tis an. ℥ ij. Ol. ovor. Cydon. [...] Viol. an. ℥ss. Misc. ut fiat lini [...]tum.
As for Baths, you may boil in [...] and Water a Sheeps Head and feet, Mallow-leaves and flowers, [...]et-leaves and flowers, Pellito [...]y of the Wall, Linfeed and Fe [...]greek: when the Bath is [...]de, you may add to it some [...] Neats-feet Oyl, and Oyl of Trot [...]ers.
Now last of all, a Convulsion [...] consent offers it self: This [...]ay happen three manner of [...]ays:
First, by a malign Vapor offend [...] the beginning of the Nerves, as [...] happens in poisoned Wounds. [...] these the Wound is to be di [...]ed, that the venomous Matter [...]ay have a free vent. Then [...]pping-Glasses are to be appli [...], to stay the ascent of the Va [...]s.
The Medicaments which are to [...] applied to such Wounds must [...] a liquid substance, that they may the more readily pass to the bottom of the Wound. They must also be of a drying and digesting quality, to resolve and draw out the virulency of the Matter: such are Theriaca Andromachi, and Mithridate dissolved in the Spirit of Wine, or Aqua Theriacalis. It is not amiss to add some of the Powder of Mercury precipitate well washed in Plantain and red Rose Water: for in such Wounds it is an excellent Antidote. Now I only point at the Cure of such Wounds, setting down but a few general Indications of Cure, because hereafter I am to discourse of all sorts of poisoned Wounds in particular.
Secondly, a Convulsion by Sympathy or Consent happens, the Nerves drawing themselves towards their beginnings, by reason of the great pain, which is felt in the wounded part: In this kind of Convulsion Anodyne Medicaments, or such as asswage Pain, are to be applied. But seeing I have at large discoursed of such, Chap. 6. I will remit you thither, not willing to use idle repetitions.
Thirdly, a Convulsion by Consent may happen by reason of immoderate Cold, making the Nerves stiff. In curing of this Symptom. 1. You must keep the wounded party in a warm Room; 2. You are to use warm Medicaments, as Oyl of Chamaemil, Dill, Rue, Bayes, Lilies, Rape-Oyl, Dogs grease, Bears grease, Horse grease. Of these you may frame unto your selves Liniments, as this: ℞ Pingued. caninae, ursi, & equinae an. ℥ ij. Ol. Raporum, Chamaemelin. & rut. an. ℥ss. Misc. [Page 288]ut paretur [...]nimentum. In this case it is excellent to foment the part with the decoction of Turneps being very warm; for it is a superficial Medicament in this case.
Before I end this Chapter, I will set down a few Aphorisms concerning Convulsions in Wounds, which will serve for Prognosticks.
The first shall be this: A Convulsion or Raving, which ensueth after immoderate bleeding, is ill, according to Hippocrat. Aphor. 3. not only because the Nerves are dried, but because Choler and corrupt Humors offend the beginnings of the Nerves after the evacution of Blood.
Secondly, if a Convulsion ensue after a Wound, it is most commonly deadly 5. Aph. 2. partly because sharp Humors nip the Nerves: partly because the Nerves must be enflamed. Heurnius writing upon this Aphorism, sets down a dainty Medicament in this Case, which I thought good to impart to you; and it is this: first, press out the Oyl out of the Seeds of Saint Johns-wort; next infuse the Flowers of the Herb in the same Oyl, This Oyl apply warm.
Thirdly, whosoever are taken with a Tetanos, they die within the space of four days; but if they pass these, they escape, 5. Aph. 6. For first it is a most sharp Disease, and such do end the fourth day: Second, Nature cannot longer endure the horrible pain, which is caused by the strong Tension of the Nerves, both of the fore and back part. One thing is to be noted, that they which die of a Convulsion, remain long hot, because they die being stifled, the Muscles appointed for respiration being also convelled: for the Muscles of the Neck being distended, the Septum transversum also must suffert; for Nerves springing from the fourth Vertebra of the Neck are inserted into the Midriff, and so the Neck suffering a Convulsion, Respiration is hindred.
CHAP. XI.
Of a Palsie, and crudity in a Wound.
HAving delivered unto you in the former Chapter so much as was fit for a Chirurgeon to [...]ow concerning a Convulsion, in the first proper Symptom of a compound Wound: now I am [...] descend to the second, which [...] a Palsie, a Symptom opposite to the other. Paralysis is deduced from [...], which is to be resolved; because the Nerve, and the Muscle into which the Nerve [...] inserted, are so resolved, loosened and weakned, that they become [...]fit Instruments for voluntary Motion: This Particle [...] doth in this composition signifie a Diminution; so that [...] may be termed such as are taken lame in one side, or any [...]ce part: but [...] and [...], such as are taken throughout the whole Body with such a Grief; such are Persons taken with an Apoplexy, or are a dying: of which Hippocrates speaks, 2. Aphor. 47. It is called by Avicen and his Interpreters Mollificatio, because the Nerves in this Grief seem to become softer. [...] torpor aut stupor, Numness comes near to this Disease. And tho this affection seems [...]ly to be a Dulness in Feeling, yet it is taken for a Passion compounded of the difficulty as well of Moving as Feeling. It is often a fore-runner of the Palsie, and only differs in the degree of the Cause, it being milder. Paralysis, or a Palsie, is the privation of Motion always, and sometimes of Feeling also in one or more Parts, proceeding from the stopping or intercluding of the animal Spirits, which are the efficient Causes of voluntary Motion. By those who have written of this Disease a Question is moved:
How it comes to pass that in a Palsie, sometimes both Moving and Feeling are taken away; sometimes the Motion and not the Feeling, and sometimes the Feeling and not the Motion?
In those parts wherein there are divers Nerves serving for Motion and Feeling, the Answer is easily made; for in such parts if the Nerves appointed for Motion be only affected, then the Motion is hindred, the Sense remaining sound, and if the Nerves appointed for the Sense be affected, the Sense is hindred, the Motion remaining: So in the Eye, if the Optick Nerves, the first pair be hurt, the Motory, the second pair being safe, the Sight is taken away, the moving of the Eye remaining; and [Page 290]in the Tongue, if the third and fourth Conjugation of Nerves of the Brain be offended, and the seventh pair be found, the Taste is offended, the Motion of the Tongue continuing, and on the contrary. If the same Nerve do afford both Moving and Feeling unto a Part, the Matter is not so plain. Authors do ascribe this to the defect of the Animal Spirits; so that Moving may be abolished, Feeling remaining: for fewer Spirits are required for Feeling, than Motion, which must have greater strength of the Faculty; and therefore if Feeling be abolished, the Motion cannot be safe: for it is not likely that the weaker Operation being taken away, the stronger should remain. If a Nerve inserted into a Muscle be so affected, that the influence of the Animal Spirit is stayed, it may fall out that both Feeling and Moving may be taken away: but if a Nerve being inserted into a Membrane or into the Skin, be so affected, the Feeling may be abolished, the moving of the Member remaining; for these similary Parts are not appointed for Motion.
The immediate cause of a Palsie, I reckon to be some unnatural affection of the Nerves, which are inserted into the parts, which are by Nature destinate to voluntary Motion: for from the Nerve every Muscle hath the faculty of moving, which carries to it Animal Spirits.
Now a Nerve hath a two-fold consideration; for it may be considered, first, as it is a similary part concurring to the composition of a Muscle; or secondly, as it is an organical part carrying the Animal Spirit from the Brain to it, which is the principal efficient cause of Motion.
As it is a similary part, it may suffer Distemperature, this Distemperature all Practicers agree to be a cold and moist Distemperature; for such a Distemperature relaxes the Nerve, and makes it altogether unapt to receive and carry the Animal Spirits.
The external Causes of this Distemperature may be the cold Air, the North wind, immoderate Venus, narcotical Medicaments, lying in Snow, or in Water, Galen 4. de Loc. affectis, c. 4. affirms that one who in the Winter Season, in cold and rainy Weather, had lapped his Neck with a wet Cloak, and kept it somewhat too long, became paralytick in one hand, the Nerves of the fifth, sixth and seventh Vertebrae of the Neck having been offended.
The internal Cause which brings a Palsie, is a phlegmatick, moist and cold Humor; moistning and cooling the Nerves too much, and relaxing them, and so altering their natural temperature, and making them unfit either to receive th [...] influence of the Animal Spirits, o [...] to bring them to the Parts ordained for Motion. If the Nerves [...] the Spinalis Medulla be so altered it is to be thought that the Humor primitively falls from th [...] Brain; for the Spanalis Med [...] is nothing else but a prolongatio [...] of the Brain. So we see that [...] Appoplexy which kills not, end in a Palsie of one side, the Humo [...] being turned down from the Hea [...] [Page 291]to the cavity of the Vertebrae of the S [...]i [...]n, wherein the Spinalis Medulla is contained, and moistning the Nerves which proceed from [...]ence. Neither is it to be denied, fort the Marrow of the Back hath two parts, as the Brain it self, from whence it proceeds, to wit, the right and left, and that one [...]e may be affected, the other retaining sound. This Humor doth primarily affect the Nerves, and secondarily the Muscles.
Nothing doth more promptly p [...]create this Humor, than frequent Ebriety, chiefly if it be pro [...]ed by Wine. One Ralph Fea [...]estone an Atturney at Law, by once being drunk with Wine, the second day afterward became Pa [...]ytick in his right side, and so continued as long as life did last. [...]cletius thinks Wine to pro [...]e this effect, because it is hot, and of subtil parts, and so is able [...] dissolve such Humors, and to [...]ing them to the Nerves: Rudi [...] thinks this to come to pass, because the Wine becomes sharp and [...]ger in the Nerves. Platerus is [...] this opinion, that Wine hath a [...]cotical faculty in it, and Fernel. [...]5. de part. Morb. & Symptom. up. 8. affirms, that he saw one those whole Skin became stupid by drinking himself drunk with Wine, and sleeping long. In the [...] the Limbs become lazie, because the Nerves and Muscles are no much moistned with a thin and [...]terish Humor.
Now if you consider a Nerve [...] an organical Part, appointed [...] the carrying of Animal Spirits to the Muscles, the Instrument of [...]ntary Motion, it may be the cause of a Palsie, if it become thicker and narrower, and so unapt to receive the Animal Spirits.
This narrowness may be induced three manner of ways: By Obstruction, Compression, Densation, and Solution of continuity.
By Obstruction it may come to pass, when as by a thick and a tough Humor the Nerve is so stopt, that the Animal Spirits cannot pass.
The Causes of a Compression of a Nerve are sundry. First, from Humors bearing down the Nerve. Secondly, from a Tumor doing the like. Thirdly, from a Contusion. Fourthly, from a Laxation; yet if this Laxation, be not suddenly performed, but by degrees, it brings not a Palsie, as we may see in those which are Crook-backed. Fifthly, from a strait Ligature. Sixthly, too long leaning upon a part, as when we Sleep leaning our Head upon the Palm of our Hand. Seventhly, Cold may be the cause; for if it be able to bring a Mortification of a Part, it may more easily cause an Infirmity or Weakness of the same.
Densation or thickning may be procured by two means; First, if the party hath been nourished by thick and slimy Meats: Secondly, if immoderate Cold hath congealed it.
Last of all, a Palsie may be caused by Solution of Unity, when the Nerve, which brings the Animal Spirits to the Part, is either cut transversly, or torn, or eroded with a sharp Humor.
The Signs of a Palsie are manifest, [Page 292]to wit, the privation of Moving, and sometimes of Feeling also.
The part primarily affected is not so easily found out: But that you may attain to this, receive these Aphorisms.
1. If one side of the Face be affected, and the Speech hindred, as well as one side of the Body, both the Brain and the Spinalis Medulla are affected.
2. If only one side of the Face be troubled, the rest of the Body being untouched, the Cause is only in the Brain.
3. If all the parts of the Head being sound, either of the sides be Paralytick, the Cause is in one of the sides of the Spinalis Medulla.
4. If the Arms only be Paralytick, the Cause is in the fifth, sixth and seventh Vertebrae of the Neck.
5. If the Disease be only resident in the Legs, then you are to conjecture that the Cause is in the Vertebrae of the Loins and Os Sacrum.
6. If any several Part be Paralytick, then the Cause is not in the Brain, or the Spinalis Medulla, but in the Sprig of some Nerve inserted in that Part.
As for the Differences of a Palsie; it is either Universal, when all the Parts under the Head are seised upon; or of one side only, and then it is called Hemiplegia.
As for the Prognosticks, receive these.
1. If a Palsie happen because the Nerve is transversly cut asunder, it is incurable; Hippoc. 6. Aphor. 19.
2. Every strong Palsie proceeding from an inward Cause is hard to be cured; because it is caused of a gross, cold and viscous Humor, which hardly can be removed.
3. A Palsie taking an old Person in the Winter, is hardly cured; because Diseases in the Winter are more rebellious, and the natural heat in such persons is weak.
4. A Palsie which follows after an Apoplexy is hardly cured, because the Cause is vehement, the Parts are weak, and there is still a fear of relapse.
5. A Palsie wherein both Motition and Feeling are taken away is more dangerous, than that wherein only one of these Symptoms happens.
6. A Palsie ensuing after a strong and sudden Luxation of the Vertebrae of the Spina, is dangerous; because the Nerves are much bruised: and by reason of the Inflammation following, they hardly can be reduced.
7. A trembling after a Palsie is good: for it shews that the passage of the Nerves by which the Animal Spirits do pass, is somewhat pervious.
8. If the Paralytick Members be actually hot, there is some hope of cure.
9. If the Paralytick Member be extenuate, and the fresh colour thereof be changed, it can hardly be cured; because the Spirits must be few and the natural heat weak.
10. If the Eye of the Paralytick side be weak, the Disease is incurable: for this argues the defect of the natural heat, and of the Animal Spirits.
11. A Fever following after a Palsie gives good hope of Cure, because it warms, dries and discusses the Matter.
12. A Flux of the Belly happening by the benefit of Nature may further the cure of a Palse; it discharging the Nerves of Matter impacted.
In the cure of a Palsie, you must set down a convenient Diet: It must be such as dries and warms the Body: The decoction of Gua [...]on is good, used in stead of ordinary drink, for it digests and discusses the material Cause: [...] the Party like not this Drink, let a Bag be hung in good Beer or [...]e stuffed with Herbs, which strengthens the Nerves, as Cowslip-lowers, Chamaepitys, Sage, Rosemary, Stoechas, Betony, Hypericon, Calamint, the lesser Centaury, Nut [...]egs, Cloves, Cinnamome, and Calamus Aromaticus. Metheglin [...]d Meath may be permitted. Wine is not convenient, for according to all Authors, it is offensive to the Nerves. Let the bread be Biscoct: the flesh of Partridges, Phesant, Chickens, Pige [...]s, and of other Mountain Birds r [...]sted, is good, Sauce being made with Cloves and Cinnamome.
Phlebotomy hath here no place, because Paralytick Persons are [...]ost Cold and Phlegmatick: and because they are subject to costive [...]ess, Clysters are to be admini [...]ed: In this case then dissolve D [...]phoenicum, Benedicta laxativa, [...] Hiera Diacolocynthidos, in the [...]coction of Sage, sweet Majoran, dissop, Calaminth, the lesser Cen [...]ry, Bay-berries, Cumin-seeds, the Flowers of Stoechas, Melilot and Chamaemil. It is expedient that the Paralytick be purged sometimes; but first you are to prepare the Matter by ministring the Syrups of Stoechas, de 5. Radicibus, Bizant. de Hyssop. with the decoction of Paeony, Ruscus, Asparagus, Iris, Betony, Sage, Savory, Peny-royal, Chamaepitys, the flowers of Sage, Rosemary, and Cowslips, aromatized with Nutmegs, Cloves and Cinnamome. Then purge with Pilulae de Hiera, de Agarico, Assaiereth, Aloephanginae, Mastichinae. If you would use stronger, give Pilul. Cocciae, and Faetidae, and extractum Panchymag [...]gon. If the diseased party require Potions, minister Diaphoenicum, Diacarthamum, Hiera Diacolocynth, cum Agarico trochiscato. Inwardly, to strengthen the party, give the Conserves of Rosemary Flowers, Sage Flowers, Betony Flowers, Cowslip Flowers, Paeony Flowers, and the Clove-gillover, Nutmegs preserved, Ginger preserved, Diambrae, Mithridat. Of these you may frame Electuaries, adding the Syrup of Stoechas.
As for local Medicaments, ever rub the affected part with warm Cloths; but gently, lest the Spirits which are attracted be dissipated. Secondly, apply Ventoses to the head of the Muscle of the affected part; but let it be but narrow, and stay but a little while. Thirdly, apply an Emplaister of Pitch and Resin of the Pine-tree. Fourthly, touch the stupid Parts with quick Nettles. Fifthly, rubefying Medicaments may be applied, to attract the Spirits. Sixthly, Fomentations of the Nervine Herbs [Page 294]above specified may be used. Seventhly, you may embrocate the part with these Oyls following, Ol. Ʋulp. Lumbric. Chamaemel. Lil. alb. Rut. de Euphorb. Castor. Spica, Oleo Juniper. Cerae, Succin. Salv. Rorism. Thymi, Lavend d. Cariophyll. Chymico. Ol. de lateribus, sinapi per expressionem factum. Eighthly, apply Ʋnguentum Martiatum, Aregon, Agrippae; then apply the Spice, Emplaster, or any one of that faculty. Last of all, lap the Member in hot Furs. Many commend the holding of the Paralytick Member for the space of an hour every Morning, for the space of sixteen days, in the Husks of the Grapes, left after the Wine is pressed out, in Harvest time. They in this Country use instead of these, warm Grains, and Oxes Bellies newly killed. Natural sulphureous and bituminous Baths are excellent in this case: This Country ought much to exalt the benignity and bountifulness of God, who hath furnished it with the Waters of the City of the Bath profitable in this and other Griefs.
Of crudity in Wounds.
The second thing which hinders the Unition of a Wound and makes it compound, I affirmed to be erudity in a Wound. A crude Wound I call that which doth not afford laudable Quittour, which must be white, smooth and uniform: This happens by six means. First, by reason of a continual flux of Blood. Secondly, by an Instrument bruising, as in Wounds made by Gunshot. Thirdly, by reason of the Nature of the Parts, such as deep Wounds in the Joints. Fourthly, by reason of the coldness of the Air. Fifthly, by the Application of unfit Medicaments, as cold Water, Bole, &c. Sixthly, by reason of too strait binding. How Blood is to be stayed, I have declared in the second Chapter of this Subject. Contused Wounds are to be digested: Medicaments drying without mordication are to be applied to the Joints, to preserve the temperature of them: The Air is to be corrected: Fit Medicaments are to be applied to the wounded part: And a mean Deligation neither too strait, nor too slack, is to be used. Of all which seeing I have already discoursed amply, I will repeat nothing.
Of the Disease complicate with a Wound.
The last thing which makes a Wound compound, is a Grief complicate with a Wound, as the Dropsie, French-Pox, and Leprosie; but seeing they belong to the Practice of Physick, I will leave them to those who have written, and list to write of that subject, lest I might seem to reap the Corn of another mans Field.
CHAP. XII.
Of a Wound made by a poisoned Weapon.
HItherto I have delivered you the Intentions which serve for the cure of mild compound Wounds. Now am I to acquaint you with the means by which ma [...]gn compound Wounds are to be cured. Such Wounds are commonly termed poisoned Wounds. But before I descend to the hand [...]g of the particular Differences of them, it will not be amiss to speak of Poison and poisonable Diseases ingeneral: for this will make way for the better understanding of the particulars.
Venenum is nothing else but Med [...]amentum mortale, a deadly Medeament. The Greek Authors call it [...] Hippoc. 6. Epidem. C [...]m. 6. text. vocat [...], maleficum, a mischievous Medicament: In his Oath he calls it [...] deadly: Theophrastus, Dioscorides, and Galen call it sometimes [...], modo [...], modo [...], cer [...]pt [...]rium, or letale. Aristot. 1. Probl. 36. calleth Poisons [...], Medicaments which procure death. It may be thus described.
Venenum or a Poison is a compound Substance, not a natural, adverse to the Heart, and which corrupts the nature of Man. In this description it is called a Substance, and so it is: for contraries are contained in this same Predicament: Now seeing alimentum or a nourishment is in the Predicament of substantia, venenum or a Poison must be in the same, seeing it is contrary to nourishment: for this maintains the nature of Man, the other destroys it. Gal. 3. de temper. 4. assigns this difference between these two, that alimentum is that which is overcome by Nature, and turned into its Substance; but Venenum or a Poison is that which overcomes Nature, and destroys it. In the description it is said to be a compound Substance: for seeing according to this Philosophical axiom, actiones sunt compositorum, actions are produced by things compounded; a Poison must be a thing compound, seeing the actions of it are manifest. It is a folly to think that a Poison is only an Accident, for an Accident may either be in the Subject, whereof it is an Accident, or absent from it without the destruction of it, which cannot be affirmed of a Poison; for being ministred it kills the Party, unless it be hindred by Antidotes. One may think that the Poison by the biting of a mad Dog, or by the stinging of a Scorpion, are Qualities, rather than Substances: [Page 296]but in truth they are compound substances, thô the Body seem small, and scarce to be discerned by our Senses. Gal. 6. de Loc. affect. cap. 5. seems to intimate so much to us, when he saith, that the poison of a Scorpion is most forcible in efficacy, thô it be but small in quantity.
In the description, a poison is said to be a substance not Natural, or Preternatural: for things natural are always good; but things called preternatural are always of their own nature ill, as Diseases, and the Causes of them. Poison is said to be adverse to the Heart; because it aims chiefly at the Heart: for as soon as one has either taken poison inwardly, or is outwardly touched with it, he presently is taken with a palpitation of the Heart, weakness of the same, and last of all Swooning and Fainting. In this they differ from purgative Medicaments, because these only offend the Stomach: wherefore their correctives ought still to be mingled with them. Last of all in the description of a Poison, it is said to corrupt the Nature of Man, for whether Nature according to Aristotle 2. Physic. be taken for the matter, form, or the whole frame of Man, it corrupts all. The materials of the Body of Man are the Humors, the Spirits, and the solid parts: that these are corrupted by poison, no Man doubts. If in a Man you take the form to be the Temperament, or what ever is different from the Temperament, it is overthrown in like manner by Poison.
Last of all, a Man by Poison being deprived of Life, becomes a Cadaver, or a dead Carcase.
But here a doubt arises, to wit, How it comes to pass, that some are not hurt by Poison?
Sundry reasons may be alledged for this. The First, is the property of some particular persons: for some have obtained such a constitution from Nature, that hardly any thing can hurt them. [...] Empiricus. 1. Hypot [...]se [...] [...]onpiricarum writes, That there was an old Woman, who without receiving any harm, could take ℥ xxx of Hemlock at one time; and that there was one Lysides, who would eat half an Ounce of Opium safely. Athenagoras was not hurt by Scorpions. The black Moors, who dwell by the River [...], are said to feed upon Scorpions and Serpents, without taking any harm; which falls out by reason of a strange and hidden constitution of the Body.
The Second reason may be the preparation of the Body by Antidotes: So Mithridates King of Pontus could not be poisoned; because he armed himself against Poison, by often taking the Mithridatical Confection.
The Third reason may be the taking of slimie or fat Meats, or Drinks, before the taking of the Poison; for these are apt to keep in Poisons, and to abate much of their strength.
The Fourth reason may be the vomiting of the Poison before it could take hold.
The Last reason may be the small quantity of the poison; for Galen 3. de simp. Medicam. cap. 23. writes, That all Medicaments whether they be deadly or purgative, [Page 297]require a certain measure for the effecting of their operations. We are to consider also why some poisons kill presently, some slowly?
The First cause is the strength of the poison it self. Nicolaus Flo [...]ertinus, serm. 4, tract. 3 summa 2. c. 9. & tractat. 4. c. 6. writes, that one Franciscus Ordelaphus, a Captain, had a certain kind of poison, which if it had been cast upon burning Coles, presently did [...] all the standers by.
The Second reason is the disposition of the Bodies; for they who have but a weak Heart, are more easily killed by poison. They in [...] manner who have hot bodies [...] soonest offended by poison; for they have wide and large passages, and so the poison passes more promptly to the Heart.
The Third reason may be the quantity of the poison ministred, for a great quantity sooner dispatches than a small.
The Fourth reason may be the time when they are gathered. Theophrast. l. 9. de hist. plant. c. 15. writes, that poisons gathered in the Summer time, are stronger than those which are gathered in the Spring time.
The Fifth reason may be the taking of a poison fasting; for then it killeth sooner, than when the Body is full.
The Last reason may be the composition of the poison. All Medicaments set down in Dispensatories shew, how requisite the manner of composition is: so The [...]ph [...]ast. in the aforesaid Book and cap. 17. rejecting the composition of Hemlock, which the Inhabitants of the Istand Chi [...]s used for poisoning, sets down a more sure and quick way,
There is a question moved by those who have written of poisons, whether a poison may be made, which not suddenly, but slowly, and at a determinate time may kill, as within the space of a Moneth, or a quarter of a year, or a whole year? Some are of opinion, that such a poison may be composed: as Theophrastus lib. 9. de hist p [...]ant. cap. de Aconito: who writes, that it was wont so to be prepared, that it was able to kill within the space of a Moneth; sometimes within the space of two or three Moneths; yea, after a year expired.
For the determination of this question, it cannot be doubted, but that a poison may be so prepared, that it may either sooner or more slowly kill; but that it may kill at a determinate time, it seems altogether absurd: for actions which are produced at a determinate time, proceed from a faculty that works by discourse and judgment: But who can affirm that there is any such faculty in poisons? Secondly, seeing poisons are contrary to the nature of Man, I see not how they can be contained any long space of time within the body of Man, not doing him any harm. Thirdly, it is more likely that a purgative Medicament could be ministred to work at a definite time, seeing it is more mild than a poison, but no such Medicament could ever hither to be found out. Only then poison may be dressed to [...] more speedily or slowly. This we may perceive in the biting of a mad Dog, and in the Pox, which in some [Page 298]bodies shew their forces speedily, in some slowly.
It may be, that you may ask by what means these Poisons and Deleteries do kill?
I Answer, that they neither kill by their excessive qualities, seeing we use Medicaments hot in the Fourth degree, as Euphorbium, and Cantharides; nor by their Temperature, resulting from a certain mixture of the Elements; but they work by a more hidden and secret form, and by a certain nature or form infused after the Temperature, which is not known to us by the constitutive causes, but by the effects, as many other things are. This Nature (whatsoever Philosophers say) they had from the Creation, and not from the Stars, or any new celestial Influence, as Aponensis lib. de venenis.
If you demand what things in Man they chiefly assault?
I reply, that those things are chiefly the natural heat, and the radical moisture; for they extinguish the First, and corrupt the Second. One then would think it a strange thing, that the natural heat of the body of Man should stir up this propriety of poisons, its professed Enemy, to quench it self. But Nature has ordained, that the natural heat must go about the elaborating of every thing which enters into the body of Man, to find how it may be made profitable for preservation of the life of Man. Wherefore it finding poison, goes about to digest it, not by the intention of Nature, but by the necessity of its action; for it cannot be idle.
Now the subjects wherein this deletery Property is lodged, are three: a Vapour, a Juyce, an Humor, or a terrestrial substance; for what ever poisons are taken either from Plants or Minerals, or living creatures, they are resident in one of these three substances.
Now as for the divers kinds of poisons; some are artisicial, some natural: If I could shew the innumerable differences of both the kinds, I would not: for it were a hainous crime to further the wicked intentions of some malicious persons of this desperate age, in this business.
One may wonder why God and Nature have ordained and brought forth poison. This wonder we may easily qualifie, if we say, that poisons may be considered two manner of ways.
First, as they are natural Bodies, and so they concur to the constitution of the World, and they have good uses. First, they are requisite in some Crafts or Trades, especially in Painting and Dying. Secondly, they are appointed for the feeding of some Creatures: So Starlings feed upon Hemlock, Swallows upon Cantharides, the Quails upon Hellebore. Thirdly, they serve for the curing of some Diseases in Man; so Hellebore cures Madness, Libbards-bane the stinging of a Scorpion; Cakes made of Arsenick are used in the Plague-time.
Secondly, poisons may be considered as they are adverse to our Bodies, and deadly, and so they have no use; but are abused by perverse and wicked persons: Thus innumerable sorts of weapons are [Page 299]made of Iron and Steel, devised by the wit of Man, furthered by the Devil, the enemy of Mankind, for the killing and dispatching o [...] Man.
As for the signs of poison, Gal [...]n 6. de loc. affect. c. 5. expresses them briefly in these words: ‘When a Man having sufficient store of good Humors, and li [...]ing healthfully, dies suddenly (as it falls out when one hath ta [...]en a deadly poison,) and that afterward his Body becomes of a livid colour, or black, or spotted, or that it runs by reason of moisture, or sends out a noisome smel, they say that such a man hath taken poison, and not without cause.’ Mercurialis de [...]rb. venenos. & venen. lib. 1. c. 16. adds these; ‘Fainting, a panting of the Heart, filthy Vomits, casting of black Blood, the Hicket, Trembling, Stupidity, retention of Urine, a weak Pulse, burning in the whole Body, a little before death Coldness, and casting of cold Substances, Spots throughout all the Skin, Pustules, Tumors, gnawing in the Stoma [...]h; griping in the Guts: These are signs of poison taken within the Body.’
As for the Prognosticks of pois [...]n, two shall suffice: First, if the poison cannot be driven out of the Body, either by Vomit or siege, [...] remedies prevail nothing, but that the symptomes continue, as [...] Fainting continue, the whole Body grows cold, Cold Sweats break out, and the Pulse ceases, and the whites of the Eies turn up, [...]co [...]ding to Arist. 4. Probl. 1. there is no hope of escaping, and death it self approaches. Secondly, if the poison be expelled by vomiting or siege, if Antidotes bring ease, and the Symptomes cease, then there is hope that the poison'd party will escape.
Besides these poisons, which do kill, being inwardly taken, there are some which offending first the external parts, by degrees pass from thence by the Veins to the Heart, and bring at last those symptomes, whereof I have spoken, and death it self. There are two sorts of these external poisons, which properly belong to the subject which we have [...]n hand, to wit, Wounds: which are solutions of Unity by a poisoned weapon, and by the bitings and stingings of venemous Beasts.
Wounds inflicted by poisoned weapons, are thus discerned: First, they cause unaccustomed and intolerable pain in the part wounded. Secondly, strange Tumors appear. Thirdly, the part wounded becomes discoloured, of a livid, black, or spotted colour, the part notwithstanding having not been contused. Fourthly, the part putrefies in progress of time, and sends out a stinking sanious Quittour. Fifthly, having passed from the affected part to the Heart, those fearful Symptomes which I have set down do ensue.
As for the presages, no Wound made by a poisoned weapon can be secure; for poison of its own proper nature is so adverse to the nature of Man, that it ever threatens destruction. Secondly, if after the using of methodical and convenient means the Symptomes begin to be abated, there is [Page 300]some hope of recovery left.
If you would know what these means are; If the poison hath not passed further than the part wounded; if the party be not of an eminent quality, tender or fearful, it is good to use the actual Cautery, for it doth much stay the activity of the poison. But that the Eschar may speedily fall, you are to use deep scarifications, which must reach to the sound part: Then you are to use Medicaments, which are fit to procure the fall of the Eschar, that the poison may have vent to issue out. If the poison hath passed deeply into the Body, beware of using of the actual Cautery; for this were to add grief to grief. If the party be tender and fearful, use Ventoses after scarification. To the part use convenient Medicaments, such as Ʋnguentum de paeto is, or the Basilicum described by me: But with these you must always mingle Mercury precipitate, or Turbith Mineral washed, with some Theriaca Andromachi, or Mithridate or Antidotus de sanguinibus, or Athanasia, or Electuarium de ovo. To the parts adjacent, apply attractive Emplasters, as Oxycroceum, and such as receive the hot Gumms, as Galbanum, Opoponax, Elemi, &c. This do, unless the wounded part be so hot that it threatens a Gangrene: for then you must go about to obviate this Symptome, leaving the cure of the Grief for a while.
In these Wounds, until three days be expired, you are to refrain from Bleeding, Purging, Vomiting, and Clysters: The Party must sleep sparingly, and use a moderate Diet, eating such meats as are of easie Digestion, and afford a good juyce. During this time you are to minister every day, Morning and Evening, one of the Electuaries afore-named, giving a drachm or more, according to the person of the party, in some convenient Liquor, as Carduus-water, Strawberry-water, or Black-cherry-water, adding some Aqua theriacalis.
CHAP. XIII.
Of a Wound by the biting of a mad Dog.
IN the former Chapter, having first discoursed of Poison in geteral, I set down the method of curing such Wounds as are made by a poisoned weapon. Now am I therefore to descend to the other branch of malign compound Wounds, which are procured by the biting or stinging of venemous Beasts: of these there are two sorts; the biting of a mad Dog; and the biting or stinging of Serpents.
I will then first begin with a Wound caused by a mad Dog; because it most frequently happens in these parts, and Physicians and Chirurgeons are oftenest employed about the curing of this kind of a Wound. And thô other Beasts besides Dogs may be mad, as Wolves, Foxes, Cats, Horses, and sundry other, and by biting kill a Man; yet by most who have written of this subject, this kind of poison hath its denomination from the Dog, because he, of all other Beasts most frequently runs mad. This poison, which is the cause of the Madness, doth not consist in the first qualities heat or cold, moisture or driness; for Dogs and Wolves run mad, as well in extream cold weather, in the middle of Winter, as in the Summer in the Dog-daies.
Wherefore it must be a specifical kind of poison which most frequently is engendred in a Dog by a peculiar property, and inclination to this kind of madness,, and to communicate it to other living creatures. Baccius in tractat. de venen. writes, that he saw a Man killed by a mad House-Cock.
This poison is communicated two manner of waies: First, by biting and the slaver: Secondly, by slaver without biting: This slaver is easily imparted by kissing any mad Beast; for the skin of the Lips of Man are very thin and tender, and so apt to admit this kind of poison; yet, sometimes this poison is received by the thick skin of any part; Matth. de grad. consil. 82. affirms one named Johannes Coquinartus, by putting his Hand in a mad Dogs mouth, after many daies to have become mad.
After that this poison is received, some sooner, some more slowly become mad; for some rage within the space of a few daies, or a week; some a long time after. Brassav [...]l. lib. 2. Aphor. comment. 23. writes, that in some this poison hath lurked Seventeen [Page 302]years, Guainerius in tract. de v [...] nen. cap. 12. protests, that he heard of one of credit, that one was taken with madness the eighteenth year after the poison was received; yea, Alzaharavius affirms, that he found by experience this poison to have lain lurking in the Body Forty years.
The reasons which may induce us to believe this to be true are sundry. First, the variety of the parts offended: As for example: If a Nerve, Vein, or Artery be hurt, the poison may more promptly be communicated by these conduits to the noble parts, from whence they spring, than by other parts ignobler, which have no such consent with them. The Second, is the nature of the poison it self, which sometimes is stronger, sometimes weaker, and so more or less active. The Third, is the weakness or strength of the party bitten: and so if sundry persons about the same time be bitten by the same Dog or Wolf, neither do they all sustain the like harm, neither do the Symptomes appear about the same time in all, because the bodies of some are stronger, and of some weaker to resist the poison.
The Fourth is, because the poison is more fierce in one Beast, than in another: and so two being bitten by two several Dogs, the one may sooner die than the other, by reason of the vehemencie of the poison. Fifthly, the season of the year, and the constitution of the climate may much further, or hinder the Symptomes: And so the poison of Serpents in hot Countries, and in the Summer time is most fierce. Sixthly and lastly, the Diet of the diseased party may much further or hinder the appearing of the Symptomes: for if he use a Diet which abates the force of the poison, they must of a necessity appear more slowly.
That the Dog that bit is mad, you shall know by these signs; A mad Dog doth refuse both Food and Drink; much slaver issues out of his Mouth and Nostrils: He looks wild, his Eies are red and fiery: he barks but little, and that hoarsly: he becomes lean: he carries his Tail under his Belly: he hangs his Tongue out of his Mouth, which appears either Yellow, as if it were dried with choler, or blackish, or reddish: other Dogs shun them: sometimes they run mainly, sometimes they stand still: in running oftentimes they strike against Trees or Blocks: He knows not his owner, but runs fierc [...]ly upon all indifferently.
If we cannot have the Dog to examine whether he be mad or no, Authors have set down some means to find this out by the Wound it self. The First is, we are to beat some Walnuts, and to apply them to the Wound, and to suffer them to lie to it for a nights space: when they are taken away, they are to be given to a Cock or a Hen. If the Dog hath not been mad, they shall live; but if he was mad, they shall die the day after. Secondly, others lay Wheat to the Wound: others draw Blood and Quittour from the Wound, and adding to it flower make a paste, which they give to a Hen; If the Dog was mad, the Hen dies. Thirdly, Avicen and Rhases advise us to rub the Wound with the [Page 303]crum of a loaf, that it may imbibe the Blood and Quittour of the Wound, and to offer it to a Dog; if the Dog refuse to eat it, or to smell unto it; and if after eating of it he become mad or die, it is [...]kely that the Dog was mad.
Having set down the means by which we may find out whether a Dog which hath bitten a person, was mad; it is requisite also that I set down the Signs by which you may find out, whether the party bitten is like to be mad.
The signs of madness beginning are these: The party becomes discontented and angry without any just cause; he feels a gnawing and heaviness in the Stomach: he complains of unseasonable weather, although it be fair, his Body becomes heavy and lumpish: he is given to watching; and if he do sleep, his sleep is troublesome, he fears without cause: he drinks less than he was wont: he begins to murmure, and to speak to himself: he desires Candle-light by day: In the part wounded, thô skinned, a pain will be felt, which mounts up towards the Head: whither when it is come, a giddiness is caused, that the party cannot walk steadily forward. When these last signs appear, be assured that mad [...]ess is at hand.
These are the signs of madness confirmed: the Face and Body become red: the party becomes troublesome, he foams at the Mouth, he hath wild looks, he spits upon those which stand by: amongst such persons some do bark like Dogs, and offer to bite: It is common to all those who become and by the biting of a mad Dog, to hate water, and all liquid things: the true cause of this, is the antipathy between this poison and liquid things: for by such things it becomes more fierce, and the diseased parties are more offended, the Pulses of such are small, and inordinate: their Members become more and more lumpish; they become costive: Their Urine comes away by dropping: their voice becomes hoarse: they are troubled with difficulty of breathing; they put out their Tongues; when the grief increases they vomit either yellow or black Choler: A day or two before they die, some of them are troubled with the Hicket, and a little before death with Convulsions, and a fearful gnashing of the Teeth.
As for the Prognosticks of such Wounds, receive these: First, if the Wound be not deep, and hath not offended a Nerve, Vein or Artery, there is great hope that it may be cured, if Art be used. Secondly, if the party bitten become mad and fear water, there is small, or rather no hope of his recovery.
As for the Cure, the Chirurgeon is to set three Intentions before his Eies: First, that he labour by all means to draw the poison out of the Wound, that it go not deeper into the Body. Secondly, the principal parts are to be strengthened, that they may the better withstand and repell the poison. The Third is, that he labour to overcome the malignity of the poison.
The First he shall attain to, if first he apply a Ligature three or four Inches above the Wound; yet [Page 304] Celsus lib. 5. cap. 27. will not have this Ligature to be too strait, lest the part be benummed: But if the part will not admit a Ligature, then is he to apply a Defensive to the parts adiacent made of Bole, Terra sigillata, Sangu [...]s dracenis and such like; tempered with the whites of Eggs. Secondly, he is to scarifie the Wound, if it be not large enough already, and to apply Cupping-glasses with a large flame to make the stronger attraction: If the part cannot be cupped, yet it is always to be scarified, and the Blood to be drawn by a dry Sponge, not wet in water. Thirdly, it is not amiss to pull the feathers from the vents of Hens or Cocks, and to apply them often to the wounded part, or to apply young Pigeons or Chickens hot being cut asunder.
After this he is to apply attractive local Medicaments, as cataplasms made of Garlick, Onions, Pigeons-dung, Mustard, Walnuts, Treacle, Rue, Leaven, Salt and Honey. Gal. lib. 2. de antidot. c. 1. highly commends an Emplaster made of Pitch, Opopanax, and Vinegar, and affirms that he never saw any that died, unto whom this Emplaster was applied: the composition is this: ℞ Picis lb j. liquescat, cui adde opopanacis in aceto acerrimo soluti, atque ad justam consistentiam reducti ℥ iij. formentur deinde m [...]gd [...]leones. These attractive Medicaments are to be applied before a week at the furthest be expired, otherwise they will prove unfruitful. See Dioscorid. l. 6. c. 39. & Paulus Aegeneta l. 5. c. 3. You shall know the poison to be overcome, if you use the Experiments set down by me to know by the Wound it self, whether the Dog was mad.
Bleeding is not to be used, because it weakens the Patient, and stirs the poison.
Purgation in like manner in the beginning is not convenient; for it is like that it will draw the poison to the inward parts: If the poison hath possessed the inner parts, then it will not be amiss to use evacuation sundry times before the 40th day be expired: for Wounds caused by the biting of mad Dogs, must be kept open 40 days at the least. The purgative Medicaments which are to be used in such cases, ought to be strong according to all Authors: as Antimonie, white Ellebor, Mercurius vitae, pilulae de lapide lazuli, confectio Hamech, hiera diacol [...]cynth. Electuarium Indum majus, &c.
I affirmed that the Second Intention of the Chirurgeon in curing of these Wounds, was to strengthen the principal parts for the repelling of the poison, with Antidotes contrary to this poison: in the exhibition of these, you are to give twice as much in curing as preventing. In the shops you have always in readiness Theriaca Andromachi and Mithridatium. You may minister every Morning; ʒiss. of either of them for the space of 40 days in the Morning; but Theriaca is most effectual: At night you may minister some other Antidote: I will only set down three approved ones.
The First is Scaliger's the Father ℞. Mithridat. & pulv. rad. aristoloch. rut. an. ℥ ij. terr. sigil. ℥ss. muscas quae de napelli fructibus [Page 305]victum quaerunt num 20. cum siaeci succi recentis s. q. fiat mistura. dos. ʒiss.
The Second is set down by Pal [...]lus lib. de morb. contag. thus: ℞. fol. Rut. Verben. Salv. Plantag. P [...]p [...]d. Absinth. Vulgar. Menth. Ar [...]s. Melyssophyll. Beton. hyperic. Centa [...]r. min. singul. aequale pon [...]s. colligantur justo tempore, ac s [...]centur, postea in pulverem redig [...]tur. d [...]s. ʒiss. in principio sing [...]is diebus ʒ horis ante cibum, sed ʒij. aut iij, si post septimanam voce [...]ini. This is a parable and effectual Antidote. He advises also to foment the Wound with Wine or Mead, wherein ʒiss. of this powder hath been dissolved, and then to apply your other local means. He adds in like manner, that neither M [...]n nor Beast ever died which [...] this Medicament, although it were ministred long after the Wound was received; so that the Wound was not in the head or those parts which are above the Mouth, and not washed with cold water as soon as it was received.
The Third is Antidotus de can [...] [...]l [...]tilibus, commended by [...]. li. 6. c. 37. and Galen 2. [...] Antid [...]t. cap. 11. [...]. 11. de s. [...] facul. Galen affirms, that none [...] dyed who used the powder of these Crabs rightly. They must be gathered after the beginning of the Dog daies, when the Moon is [...] daies old, and calcined in a F [...]ying-pan of red Copper: then t [...]ey are thus to be ministred, ℞ ci [...]. cancror. ʒ lj. pulv. gentian. ʒ j. [...] merac. cyathos iiij. Misc. ut f [...]t petio bibenda singul. dieb. ma [...] per dies xj. See Galen. lib. 11. [...] facult: These Antidotes may be ministred not only in Wine, but in Posset-drink, and Broths also to give the Patient content.
Hildanus Obs. Chirurg. 78. Cent. 1. relates, how Anno 1602. Jul. 30. a young Man was wounded in the Arm by the bite of a mad Dog, and cured. ‘The young Man (says he) came to me the First of August. First of all I scarified the bite, and applyed a Cupping-glass with much flame, and extracted as much Blood as I could: Then I washed all the Arm in Posca, wherein Treacle and a little Sea-Salt was dissolved. For the slaver of a mad Dog, if it drie upon any part of the Skin, unless it be quickly and carefully washed, and wiped off, may cause madness. After this I cauterized the bite all over very deep with an actual Cautery. And by the way I would advise young Chirurgeons to take special care, that they cauterize not such bites only superficially, but rather to erre in excess than in defect. For since it is a desperate Disease, it must have a desperate Cure: I speak by experience; For the Daughter of Sebastian Cuisner received no benefit by an old Womans applying a Cautery to her; because it was not impressed deep enough. But to the case in hand. After burning, I was not so very solicitous to asswage the pain; because unctuous things, and such as relax the Eschar, as Butter, Oil, &c. (much less cooling and repelling Medicaments) are not much approved by me in such Ulcers. For they hinder the evaporation of venome, and these repell the [Page 306]Blood, and with it the venome to the noble parts. But since pain (as Galen testifies) attracts the Blood and Humors out of the Body to it self, it is probable that pain, if moderate, may do good in such Ulcers. Therefore after burning I applied Cotton wet in Aqua vitae, wherein Treacle was dissolved, to the Ulcer. Afterwards I laid the following Plaster to it, spread upon a Cloth. ℞ Cep. aliquantùm sub prunis coct. Ferment. Farin. Sinap. an. ℥ ij. Theriac. ℥ss. fol. Rut. Scord. an. M. ss. Misceantur in Mortario, addendo parum mellis. The next day I cut the Eschar every where, as much as might be, then I repeated the applications of the foresaid Medicines: and so I proceeded, till the fall of the Eschar. Afterwards, lest the lips of the Ulcer might close, I put Pease in it twice a day, as we do in Issues, and applied the prescribed Plaster: And thus I kept open the Ulcer for three Months. Yet in the interim twice or thrice a week I strewed the following Powder upon the Ulcer; ℞ Pulv. praecip. lap. Bezoardic. pulv. rad. Angel. an. ℈ j. Misce. For it wonderfully attracts the malignity from within to it self. Inwardly I gave Alexipharmacks, Treacle, Mithridate, burnt Hartshorn, Bezoar, and the following powder in Bugloss and Borage water, which is highly commended by ancient and modern Physicians. ℞ Ciner. Cancrer. Fluviat. ℥ x. rad. Gentian. ℥ v. Oliban. ℥ j. M. f. Pulvis subtilissimus. I neither Bled nor Purged him, lest I should draw the Poison inward. Thus by Gods blessing he was cured, and continues well till this day. By the same means I cured this young man's Brother, who was bitten by the same Dog, and lived in health a whole year after; and then died of a Pleurisie.’
CHAP. XIV.
Of a Wound made by the biting of an Adder.
I Have told you, how Wounds made by the biting of mad Beasts were to be dealt withall: In this Chapter I will shew how Wounds caused by the bitings and stingings of Serpents are to be cured. God hath created a strange variety of them: who, as they serve for the perfecting of the Ʋnivers [...]n or frame of the World; so they are employed by God for the punishing of sinners. Read a memorable Example of this, Numb. 21. vers. 5. ad. 9. where it is set down, that for the murmuring of the People of Israel, God sent against them fiery Serpents, by the biting of which much People died, untill at last Moses set upon a Pole the brasen Serpent, by the commandment of God; by beholding of which, the bitten persons were kept alive: This brasen Serpent was a figure of Christ crucified, as he himself testifies, John 14.15. in these words, vers. 14. As Moses lifted up the Serpent in the wilderness: Even so must the Sin of man be lifted up; vers. 15. That whosever believed in him s [...]ould not perish but have eternal life; for according to Isaiah, c. 53. [...].5. He was wounded for our transgressions; he was bruised for our iniquities: The chastisement of our peace was upon him; and with his stripes we are healed: Lucan the Poet in the ninth Book of his Pharsalia sets down the journeying of Cato and his Souldiers through the desart of Lybia, where, out of Nicander the ancient Greet Poet and Physician in his Theriaca, he makes mention of sundry Serpents. Lucan's Verses are thus turned into English Metre by Mr. Thomas May, an eminent English Poet of his Age.
O, fearful Brood armed against the sinful sons of Adam! We who are born in these parts ought to glorifie God, who hath freed the Soil of such mischievous Creatures. I mean not to insist on the description of every one of these Serpents, the Symptoms which ensue after the Biting, and the manner of Cure, because it would be a fruitless labour, the Land being free from them, and so from their harm. In this Country only the Adder, and the Slow-worm are found, which oftentimes do great hurt. Of these then I will discourse, as also of the Toad, because here is great store of them, and their Poison is able to procure Death.
I will first deal with the Adder. It is called Coluber in Latin, either quia colit umbras, because it haunts shadowy places, or à lubricis tractibus, from her winding pace or path. It is long like an Eel, black on the Back, having yellow spots on the Belly: the Head is more flat than the Snake's Head. It is a crafty and venemous Serpent, biting suddenly those that pass by: whereupon Jacob in his Testament, or last Will, Gen. 49. v. 17. calls Dan, by reason of Sampson, who was of that Tribe, coluber in vià, an Adder in the way.
When the Adder hath bitten a Man, the part becomes of a leaden colour, and very painful, and if it be not presently cured, much black and stinking Quittour doth issue out from the Sore, like to that which flowes from Ʋlcus depascens, a fretting Ulcer. If it bite any Cattel, very often they die.
When I was in the City of Bathe in Sommerset-shire, nine years ago, a little Land-Spaniel bitch belonging to one Mr. Lloyd who dwelt three Miles from thence, being bitten by an Adder by the way, died the next day, having intolerable pain and swelling of the whole Body.
The Poison of it is hot, for an Adder is more hot than a Snake; which is not poisonable here with us, though it be in hot Countries, as Italy. The Adder hisse [...] and most nimbly moves the forked Tongue, as the Snake doth.
As for the cure of the biting of an Adder, the Ancients have set down many Medicaments, both [Page 309]Simple and Compound for the cure of Wounds inflicted by venemous Beasts: you shall find great store of Simples in Dioscorides, throughout the whole seventh Book, and Nicander in his Theriac [...], and Alexipbarmaca. Grevinus, l. 1. de Venenis, c. 36. and 37. hath gathered them together, whom you may peruse. Petrus de Abano in l. de Venenis, c. 4. sets down seven Herbs effectual against Poison, and the bitings of venemous Beasts, which are these, Hypericum, V [...]ncetoxicum, Enula campana, Raphanus, Dictamnus, Arist [...]chia longa & rotunda. He affirms these to have equal faculty with Treacle it self against Poison. The Ancient Physicians only used these and such like, before Treacle and Mithridate were invented. The Juices or the Powders of the Herbs they gave inwardly, to the Wounds or Sores they applied also the Herbs. As for compound Medicaments, you may use Mith [...]date, Theriaca Andromachi; Theriaca magna Esdrae, Diatessaren, Electuarium Orvietani.
If you be called to cure one bit by an Adder: First, apply Ligatures three or four inches above the bitten place; hold up the Member as high as may be, scarifie the part, and apply Cupping-Glasses: If you cannot apply them, apply defensives above the part.
Dress the Wound with Treacle dissolved in the Oyl of Scorpions, inwardly minister Treacle it self in Carduus, and Treacle Water, or Theriaca magna Esdrae, which he is said to have brought from Bab [...]lon, when he returned from his exile with other Jews to their native Country; Electuarium Orvietiani. The Juice and Leaves of the Ash are highly commended.
It is a very strange thing, that if a Viper be compassed with the Leaves of the Ash on the one side, and Fire on the other side, she will rather go towards the Fire than the Leaves of the Ash. Such an antipathy is between the Viper and the Ash.
Ambros. Pareus, lib. 20. c. 23. shews how he cured one bitten by an Adder: because the History is memorable, I thought good to set it down. ‘At what time (saith he) Charles the Ninth lay at Melines, I and Doctor le Fure, the Kings Physician, were sent for to cure a Cook of the Lady of Gastroperses, who was bitten by an Adder, as he was gathering wild Hops in a Hedge. The Cook as soon as he was bitten in the Hand, sucked the Wound with his Mouth, thinking thereby to mitigate the pain, and draw out again the Poison. But as soon as the Tongue touched the Wound, presently it so swelled that he could not speak. Besides this his Arm even to the Shoulder blade did swell, and caused such sharp pain, that he swooned twice while I was by him, his countenance becoming yellowish, and of a livid colour like to a dead man: and although I did despair of the recovery of the man, yet I forsook him not, but washed his Mouth with Treacle dissolved in white Wine, and ministred it to him, adding Aqua Vitae. I scarified the Arm with many and deep scarifications I suffered the [Page 310]Blood which was waterish and sanious to flow plentifully from the parts about the sore; I washed the scarifications with Mithridate and Treacle, dissolved in Aqua Vitae: the sick Person I laid in his warm bed, and caused him to sweat, but forbade him to sleep, lest the Poison should have been drawn to the inner parts. By these means I so prevailed, that the next day all the malign Symptoms ceased. Wherefore to finish the Cure I thought good that the Wound should be long kept open and washed with Treacle: Neither was I deceived, for within a few days he recovered. By it you may observe, that whether Poison be inwardly taken, or externally impressed, it is good to watch untill the force of the Poison be abated, lest it seise upon the inward part.’
They who catch Adders, apply the Powder of them to the part affected, if they be bitten, and take this same Powder inwardly; as they who catch Vipers use the Powder and Trochiscs of Vipers. Others commend the Powder of Tin, and commend it as a secret and specifical Medicament. But the Method set down by me is the safest way to cure: If you would make trial of the Powders of Adders, or Tin, I would advise you to mingle them with Theriaca. Now a days the Adder and Viper-Wines are in great request: But a Question may be moved, whether they be wholesome.
Nicolaus Florentin. 1. de Venen. following Rabbi Moses, and others, writes that Viper-Wine being often drunk, is effectual against Poison. Galen also Sect. 6.6. Epid. Text. 5. affirms both Wine, and Viper the Flesh to be good against Poison: So that Viper-Wine by these Mens Judgments, cannot but be good for healthful persons. When I travelled in Bohemia, I observed that the Earl of Rosenberg the younger, during the Summer time did eat the flesh of Adders, for preserving the sight, and staying of old Age: But Dioscorides and others give advice that care be had, that Serpents be not suffered to have access to Wine Vessels, lest they poison the Wine; which if they do, then surely the Wine is like to make a speedy way for the Poison to assault the principal parts.
This doubt I think may be thus resolved; If by chance Vipers or Adders be drowned in the Wine; because the whole Body lieth in the Wine, neither Head, Tail, Guts nor Gall being taken away: and no time of fermentation being granted, undoubtedly the Wine must be venomous: But if it be made by Art, these parts being taken away, and the flesh well prepared, and fermentation permitted; such a Wine must be wholesome, if a skilful Physician, unto whom Diseases and Complexions are known, do order the manner of taking it.
It is now time to come to the Slow-worm: it is called in Latin Coecilia and Coecula, because it is blind; and by Nicander [...].
It is a little slender Serpent, it hath a hard Skin of divers colours, For it is partly of a blewish, partly yellowish, partly of a light [Page 311]purple between these: It hath small Eyes, and covered with a thin Skin. It hath very small Teeth, but more to be seen in the lower than upper Gum. Its Tongue is cloven: It hath a chink in the Belly, which being opened it layeth Eggs: after the Eggs are laid, the chink doth consolidate again. They are in length about a span, and about the thickness of a Mans Finger; towards the Tail it is more slender: The Female is more black than the Male: The passage of the Excrements, and place of conception, is transverse: It comes abroad in July: It is harmless, unless it be hurt: It is seen most often in hilly places: In the Winter it lies in the cliffs of Rocks, and cavities of the Ground. Storks do much prey upon them.
It is very venomous, the bitings of it are very small, and scarce appear. The place bitten is red, and the whole Body becomes enflamed.
As for the Cure, you are to scarifie the part, and to apply a Ventose. Then you are to apply Mithridate, Treacle, or Terra sigi [...] lata, mingled with Oyl made of Vipers or Scorpions. Platerns affirms, that a Treacle made of the Trochiscs of it, instead of the Trochiscs of Vipers is effectual against the Plague.
I will conclude this Chapter with setting down of the Cure of the Poison of a Toad. In Latin it is called Bufo: The colour of it is blackish, mingled of black and a dark yellow; the black is bunched and full of knobs; the Skin is very thick; the Head is broad and thick, and the colour thereof about the Neck is somewhat pale; the Heart is in the Neck, and therefore it is not quickly to be killed, unless the Neck be cut asunder, or deeply pierced: Its Eyes are of a flaming yellow colour, like those of a Goshauk: It leaps not as Frogs, but creeps slowly, partly by reason of its short Legs, partly by reason of its sluggish Body; it is altogether dumb; it couples not only with Toads of its own kind, but Frogs also; it delights in dry places, as in Stables, Dung, Beds in Gardens, and Caves of the Earth; it feeds upon the Slime of the Earth, Earthworms and Bees, which it draws out of the Hives by its venomous Breath: It delights much to be in places where Sage is planted. It not only infects all things over which it passes by its poisonous pissing, but by bespattering He [...]bs with its venomous slaver. Wherefore, it is not to be wondred if Men die, who have eaten unawares Herbs, Strawberries, and Mushroms infected by Toads: If one do move it, it Swells, and looks ugly with flaming red Eyes, expecting opportunity to dart out virulent pissing, and a white Juice out of the Mouth; yea, if it can touch one, it doth bite by the hard brims of the Lips: Being pricked thorow the middle, it will live some days; and from it will drop a bloody Poison mingled with a yellow Water.
The Enemies of the Toad are the Cat, the Polecat and Viper. [Page 312]If one be infected with the Poison of a Toad, these Symptoms ensue. First, the colour of the Body is changed to an ugly pale colour, which is seen in Box Wood; the Party hath difficulty of breathing, the Breath stinks, the Seed flows sometimes against the will, the Hicket is troublesome: Caspar Schwenck feldius, in Theriotrophio Siles. tractat. d. Reptilibus adds a sudden Giddiness, Convulsions now and then, blackness of the Lips and Tongue, a froward Countenance, much Vomiting, dimness of the Sight, a Dysentery, loathing of Meat, raving, the falling out of the Teeth, a numbness of the whole Body, a deep sleeping, a cold Sweat, and at the last Death.
As for the Cure, Diosc. loco citato commends Vomiting, the drinking of strong Wine, running, and quick walking, and two drachms of the Root of the Reed or Cane; whereby we may gather, that both the temperament of the Toad and the Poison is cold. Schwenckfeldius loco citato, commends Womens Milk, Treacle, Mithridate, Harts-horn, Aqua Theriacalis; Oyl of Vitriol, Turbith Mineral, the infusion of Stibium. The Body is to be washed with such a Laxivium as is prescribed against Gangrenes: Often bathing is good, made of Sea-water, wherein Scordium, Hypericum, Art [...]misia, Worm-wood, Germander, Lavander, Thyme, Sage, Tansey, and such like have been boiled. It is not amiss to apply dried Toads to the Arm-pits, the region of the Heart, and to the Wrists. Many think the wearing of the Toadstone, and rubbing of venomous Wounds with it to be very effectual.
CHAP. XV.
Of Wounds made by Gun-shot.
HItherto I have discoursed of Wounds, which were known to the Ancient Physicians and Chirurgeons: now I am come to [...]eak of Wounds made by Gun [...]ot, not known to them. Ber [...]us Niger, Schwartz, or Black by sirname, anno 1380. a Fran [...]can Fryer, and an Alchymist, [...]und out the making of Gunpowder, and Ordnances which [...]ow are in use: He only perfected this mischief: for the use of Guns, although rude, was before: For in the time of Carolus Magn [...], Gamescus King of Frisland, [...]illed the Count of Holland, and two of his Sons, with a Peece. And Rog [...]r Bacon, who died about the year of our Lord 1284. makes mention of Gun-powder. Na [...] [...]us affirms Powder and Ord [...]ance to have been invented in the days of Otho the fourth, and In [...]centius the Third, in the year [...]f the Redemption of Mankind, 1213. Froissard anno 1340. and 1353. makes mention of Guns. Petrarcha, who died anno 1374. doth the like. You may read in the History of Alphonsus King of Castile; when he besieged Algezia, a famous Town of the Moors, 3. August. anno 1342. that they in the Town shot out of it Bullets of Iron out of Ordnances, according to Mariana. Yea, Petrus Matterus affirms, that Brass Ordnance have been used by the Chinoyse many ages ago: So that the Fryer was not the Inventer, but Perfecter of Guns and Gun-powder.
As for the Wounds which are made by Gun-shot, these Points concerning them shall be set down; First, their Nature; Secondly, their Differences; Thirdly, their Signs; Fourthly, their Symptoms; Fifthly, their Prognosticks; Sixthly, the Cure of these Wounds.
The Nature of them I will set down in these three Propositions: First, Wounds made by Gun-shot are not poisoned, if in the melting of the Bullets nothing be added to the Metal. This is the Opinion of all Authors, if you except Vigo, Alphonsus Ferrius, c. 8. and Franciscus Rota Bononiensis. This Proposition thus I prove: Neither the Gun-powder, nor the Bullet is poisonous; therefore the Wounds caused by them are not poisoned. As for Gun-powder, it is not venomous, whether you consider each Simple whereof it is made severally, or them all jointly [Page 314]in the Composition: For first of all, the Brimstone is not venomous, Galen. 9. simpl. 36. affirms it to be effectual against the Itch, and daily experience proves this to be true: It is good also in Diseases of the Lungs, according to Dioscorid. lib. 5. c. 73. Saltpeter is used in the cure of burning Fevers, there is none such a Novice in the Practice of Physick, unto whom the faculties of Lapis Prunellae are not known; yea, it may be safely used instead of ordinary Salt to Meat. The Coles either of the Willow, or Stalks of Hemp are only dry, and have subtil substance, whereby they are easily set on Fire, by the Match or Sparkles of Fire. Neither is the whole composition Poison, as Aqua Fortis, or Aqua Regis are, whose ingredients, severally used, are not venomous, for it may be ministred in Milk to kill Worms in Dogs or strong Children; yea, the German Soldiers will drink it before they Fight; and it is good to be applied to Scald Heads. As for the Bullet, it is in like manner harmless; for the Powder made of it is good against malign Ulcers, and if it be beat out into a Plate, it will stay the increase of Tumors in the beginning: Besides this, Bullets have lain long in the Bodies of some Persons, not procuring any harm.
The second Proposition: Such Wounds are never without Contusion in the Flesh, seldom without tearing of Tendons and Nerves, and often cause fractures in the Bones, by reason of the violence and blunt hard substance of the Bullets. This Proposition needs no confirmation: for these effects offer themselves to the Eye in these Wounds.
The third Proposition: A Bullet may be so made, that it may cause a poisoned Wound: it is the Opinion of Quercetan, Tractat. de his Ʋulneribus, c. 1. And it may be made good by three Reasons: First, Weapons made of Steel, the hardest of all Metals, may be made poisoned: much more than Bullets made of Lead or Tin, soft and porous Metals. That Steel Weapons may be poisoned, these Authors witness: Homer. 1. Odyss. Theophrast. lib. 9. de hist. plant. c. 15. de Scythis idem affirmat. Plin. lib. 12. cap. 53. de Dabnatis & Dacis. Aeginet. lib. 6. cap. 88. & generaliter de Barbaris Dioscorid. lib. 6. cap. 20. Secondly, experience teacheth us, that Metals may sundry ways be altered by mingling some things with them, or quenching of them in some Liquors: so Brass is made of Copper, Lead may be hardned, and Tin may be caused to leave its crackling, and Copper be made white by addition of Arsenick, and Iron may be hardned, if it be quenched in Vinegar, and the Juice of the Radish, or Smith's Water: It will on the contrary be made soft, if it be quenched in the Juice of Hemlock, and common Mallows, if a little Soap be added. The third Reason is this: poisonous Spirits, and Oyls drawn from Minerals, may be mingled with Metals, so that they may participate of their venenosity-Wherefore, if Bullets imbibe such, if they stay long in the Body, doubtless they may cause a poisoned Wound; for the heat which the Powder causes in the Bullet, [Page 315]is not able to separate them: such is the Oyl of Mercury sublimate rectified from Arsenick: And though this be true, yet it is strange that any Man should think every Wound made by Gun-shot is poisonous; seeing experience te [...]cheth that they may, yea and are cured by means which have nothing effectual against Poison, as s [...]all be declared anon. Besides this, they are not accompanied with s [...]h fearful Symptoms as venomous Wounds are.
The differences of these Wounds are taken from the diversity of the similary parts which they offe [...]d; for either they make a Sol [...]tion of Unity in the fleshy parts, or in both the fleshy and spermatick parts: The spermatick parts are either soft or hard: The soft are Nerves, Tendons, Ligaments and Membranes: The hard are two, Cartilages and Bones; the Nerves, Tendons and Ligaments are contused and torn, the Membranes are divided and bruised. If the Bones be affected, we are to consider what manner of fracture is caused by these Wounds. Then according to Avicen. fen. 5.4. Tract [...]t. 2. c. 1. there are three kinds of fractures; Transversalis, when a Bone is transversly broken, as it [...]appens in fractures of the Arms [...]nd Legs: Fissuralis, when a Bone is broken according to the longi [...]de of it, as appears in chinks of the Scull; and Frustalis, when a bone is broken into small pieces [...] shivers. Now it is manifest that the third kind of fracture is most commonly seen, when a Bone is fractured by a Gun-shot; seeing the Instrument causing the fracture is blunt, and very forcible.
As for the Signs of these Wounds; they are taken first from the Figure: for these Wounds are always orbicular: Secondly, from the colour, for the part is either of a livid colour, or of a blew colour mingled with green, or of a violet colour; sometimes the Wound is black, and the adjacent parts livid: Thirdly, from the feeling of the Blow: for when one is wounded he feels as he thinks a Stone, or a piece of some heavy and blunt Instrument entering into the part. Fourthly, from little Blood issuing out: for the part being contused, the brims quickly afterward so swell very often, that Blood is stayed from flowing. Fifthly, from the heat of the part; which happens by reason of the quick and vehement passing of the Bullet, or grievous contusion of the parts wounded. Sixthly, from the adjuncts, as if burning appear: this is discerned, if Pustules do appear, if a scorching heat, driness, wrinkling, hardness of the Skin, and burning of the Cloaths do offer themselves to the sight; burning is caused if the piece be discharged not far from the wounded party. These are the Signs of Wounds made by Gun-shot, if the Bullet be not poisoned.
If the Bullet be poisoned, these Signs will appear. First, an ugly colour will appear, as if it tended to mortification. Secondly, horrible pain, and pricking. Thirdly, great inflammation. Fourthly, a heaviness of the whole Body. Fifthly, a sharp Fever. Sixthly, Fainting. Seventhly, Raving, and especially [Page 316]if no evident Cause can be given for these Accidents. Eightly, the Bullet it self will shew the Poison; for if you put the Bullet into a sublimatory Vessel, and put a strong Fire under it, a black stinking smoak will rise from the Metal, and the upper part of it will be of a blackish or livid colour. If you cannot have the opportunity to do this, then cut the Bullet asunder; if it be poisoned, it will be of a violet colour.
The Symptoms of ordinary Wounds made by Gun-shot are these; Contusion, Pain, Inflammation, Convulsion, Heat, Palsie, (if the Instruments appointed for Motion be torn) the natural colour of the part altered, and sometimes a Gangrene, and a Mortification, if the Wound be great, and in or near to a Joint. If the Bullet be poisoned, all these Signs and Symptoms will appear; but sooner and more vehement, than if it were not. But because I have discoursed of most of these Symptoms in the general Doctrine of Wounds, I will remit you to the Chapter wherein they are handled; of a Gangrene and a Sideration, because they are Symptoms which may ensue after all sorts of Solution of Unity, I will handle them when I have spoken of Fractures and Luxations in their proper place.
As for the Prognosticks receive these, First, if a fleshy part be only wounded, and the Constitution of the party be laudable, and the Air favourable, the Wound may be cured without any great difficulty. Secondly, If the Spermatick Parts be violently torn or broken, if the Temperature of the party be not laudable, but Cacochymical; if the Air be hot and moist, which falls out when the South-wind blows; and if Signs of Poison do appear, it is to be feared that a Gangrene and Mortification will ensue. Thirdly, these Wounds yield a stinking Sanies, if the parts be much torn, and much Humor be sent to the wounded part, which quenches the natural heat. Fourthly, these Wounds are harder to be cured than those which are made by other Weapons, by reason of the Contusion which still doth accompany them. Fifthly, these Wounds come more slowly to Suppuration than others do; partly because the natural Heat is much abated, and partly because the Spirits are much dissipated by reason of the great Contusion.
It is now time to come to the cure of these Wounds. The first intention of cure is to remove from the Wound all extraneous Bodies, as the Bullets, pieces of Garments, Paper, pleces of Wood, or Metal, contused Flesh, clotted Blood, shivers of Bones, and such like: But seeing I have shewed in the third Chapter concerning this Subject, which I now have in hand, how extraneous Bodies are to be taken out of Wounds, let me desire you to have recourse thither.
The second Intention is to apply convenient Medicaments to the part affected. Joubertus commends this Topick, ℞ Axungiae suill. depurat. vel Butyri recentis ℥ viij. Praecipitati l [...]ti, ac in tenuem pulverem redacti ℥ j. Caphurae in aq. vitae solutae ʒ ij. exq [...]isitè misceant [...]. [Page 317]If instead of the Axungia you take Arcaeus his Liniment, the Redicament will be more effectual: yet the Medicament seems to be proper, for Axungia and Butter are suppurative, and Precipitate furthers Suppuration, causing little or no pain, and the Camphore helps Penetration, and resists Pu [...]ction.
Ambrose Parey commends Ole [...] Catulorum, or the Oyl of Whelps, cujus haec est descriptio, ℞ Ol. Lil. lb ij. Catulos Caninos d [...]s vivos, coq. haec simul quoad [...] ab ossibus abscedat, mox injiciatur vermium terrestrium in [...]o mundatorum lb j. qui eous [...]aelixentur quoad arefacti omnem [...]on in ol [...]o deposuerint: tand [...] fiat colatura olei, cui admisce ta [...]in. Venetae ℥ vj. Aq. vitae ℥ ij. [...]um si partes nervosae aut arti [...]s vulnerentur, plus terebinth. q [...]m olei usurpandum est, quia putes istae majorem quàm carnosae d [...]cati [...]nem requirunt.
In the dressing of these Wounds se [...]en Cautions are to be had.
First, we may use moderately, [...]cined Vitriol dissolved in Aqua Vitae if the Southwind blow, and we sear putrefaction; for although it be not Suppurative, yet it resists Patrefaction.
Secondly, we are to shun Escha [...]tical Medicaments, for three C [...]uses. First, because they procare Pain, Inflammation, Fevers, as [...]angrene, and such fearful Symptems. Secondly, because they hinder Suppuration. Thirdly, because the Eschar doth keep in putrid Vapors, which may pass [...] the lesser to the greater Vessels, and to the principal parts, and so cause a Fever.
Thirdly, the Tents at the first are to be made greater and longer, that the Wound may be sufficiently dilated.
Fourthly, if the Contusion be memorable, and possess much of the adjacent parts, they are to be scarified to discharge the part of congealed Blood, which is apt to putrefie.
Fifthly, if there be any burning, such Medicaments are to be used as are good against burning, such is this: ℞ Ol. Lil. albor. & lini an. ℥ ij. Infrigidantis Galeni. ℥iss. Ol. Laurin. ℥ss. Fol. Sempervivi Major. Plantag. & Cort. interior. Sambuci. an. man. j. Pingued. Ran. ℥ss. Bulliant omnia lento igne ad succorum cousumptionem, ac coletur Medicamentum, cui adde flor. aeris ʒj.
Sixthly, cooling and astringent Medicaments are not to be used after the first dressing, because cooling Medicaments quench the natural heat, and hinder Suppuration: and astringent Medicaments keep in putrid Vapors, which may bring a Gangrene. Wherefore Medicaments Anodyne, emollient, and suppurative are convenient: as this; ℞ Mic. pan. trit. ℥ iv. Lact. recent. lb j. Flor. Chamaemel. & Melil [...]t. an. pug. j. Farin. Hord. & Fab. an. ℥ j. Coq. omnia ad Cataplasmatis consistentiam: tum adde vitellos ov [...]rum ij. Ol. Viol. & Ros. an. ℥iss.
Seventhly, it is sufficient to dress the Wound once in the space of twenty four hours. If much Quittour flow, or if the party be severish and feel great pain, it is to [Page 318]be dressed every twelfth hour; when little Quittour issues, it is sufficient to dress it once a day. We may besides these Topicks use to these Wounds the Oyl of Linseed, Lilies, Eggs, Saint Johns-Wort, Elder, Earth-worms, and Chamaemil, with Yolks of Eggs and some Saffron, until the Wound come to digestion, which will be the fourth or fifth day. Then use abstersive Medicaments, as Paracelsus his Mundificative, or Mundificativum de Apio: the Wound mundified incarnate, and last of all skin it with Epulotical Medicaments, proceed thus, if the Wound hath only offended the fleshy parts.
If the Spermatick parts be wounded and torn, this Medicament is effectual: ℞ Terebinthinae Venetae, Ol. Terebinthin. & Hyperic. an. ℥ ij. Turbith. flavi ʒss. Tutiae, Euphorb. & Calcis vivae, an. ʒ j. misc. If the hard Spermatick parts, as the Cartilages and Bones be shivered: ℞ Praedict. composit. Terebinth. Ol. Hyperici & Terebinthinae ℥j. Pul. Cephal. ʒjss. applicetur medicamentum calefactum. This Medicament will further Suppuration, and procure the scaling of the Bone, if it must be so, and will save that which is found from cariosity.
If you perceive by the Signs set down by me, that the Bullet hath been poisoned, and so have caused a poisoned Wound; the brims are deeply to be scarified, Ventoses to be applied, and Mithridate and Treacle inwardly to be ministred in Carduus, Strawberry or black Cherry-Water, taking of Mithridate and Treacle an. ʒss. aquarum praedictar. ℥ iij. Let the Wound be dressed with this Aegyptiacum magistral. ℞ Decoct. Lupinor. ac Lentium an. lb iss. Aceti lbj. Salis communis, Aluminis an. ℥j. virid. Aeris ℥ss. Mellis lbss. coq. omnia ad Mellis spissitudinem, [...] adde Theriacae ℥. ss. Apply this Medicament, either upon Tents, or by way of injection, as you shall think fit. This Medicament is good in putrid Ulcers: Use this Medicament untill all fearful Symptoms cease: Then proceed with those Medicaments, which I have prescribed for such Wounds. In poisoned Wounds you are neither to purge, nor to use Phlebotomy, untill the force of the Poison be abated: but in ordinary Wounds made by Gun-shot, you are to open a Vein, if the party be Plethorick; and to use purgations, if the party wounded be Cacochymical.
CHAP. XVI.
Of the means to avert Humors from the wounded Head.
AT last I am come to the last Point, whereof I intended to discourse concerning Wounds; which is, the cure of the Wounds of particular Members, which reqaire any special consideration differing from the canons of Wounds in general set down by me hitherto. These Wounds are either of the Ventricles, or Extremities, or [...]mbs, the Ventricles are three, the Head, the Breast, and the lower B [...]y. Now Wounds of the Head either cause Solution of Unity in the very seat of the Brain, or in other parts appointed to be Orgats of the Senses. As for the Wounds, which are inflicted into the seat of the Brain, which is called the Hairy Scalp, they shall be dispatched in setting down three Points. The first Point shall be spent in discoursing of these things which are common to most of these Wounds. The second shall set down the particular explication of these Wounds. The third shall shew what symptoms ensue after fractures of the Scull.
The things which are common to most of these Wounds are in number four. First, the aversion of the Humor from the wounded part. Secondly, the general Prognosticks. Thirdly, the description of fit Topicks, which are to be applied to asswage Pain, and stay any Inflammation. Fourthly, shall be set down the manner of Rolling.
Aversion of the Matter which either hath already brought Symptoms, or is like to procure them, is performed by three means, to wit, by Blood Letting, Purging, and the right ordering of the six things not natural.
Phlebotomy is either universal or particular. The universal is performed by opening of a Vein. Of this kind of Phlebotomy these things may be demanded. First, whether a Vein is to be opened, and Blood drawn? Secondly, how much Blood is to be drawn? Thirdly, which Veins are to be opened?
As concerning the first demand, Blood ought to be drawn in three Cases. First, if a competent quantity of Blood did not flow out of the Wound, when first it was inflicted. Secondly, if it be a great Wound, and the party be strong. [Page 320]Thirdly, if a great Inflammation hath invaded the part, or a Fever hath seised upon the party.
As concerning the quantity, Blood is drawn either so much at one time as is requisite, or at divers times. If you go about to draw so much Blood at one time as is requisite, you are to stop the Vein. First, when the Pulse appears smaller, and flower. Secondly, when a faint Sweat issues out at the Forehead. Thirdly, when the colour of the Face is changed, and the Lips grow pale. Fourthly, when a pain of the Heart doth draw on, with yawning, and a desire to Vomit, or to go to Stool. If you are to draw Blood sundry times for this same Grief, you must continue the doing of this, untill all ill Symptoms, as Inflammation and Fever cease. See Parey lib. 9. cap. 14. Fallop. in Hippoc. de Valner. Capitis, c. 26.
As concerning the Veins which are to be opened, you are to take those of the same side, and those must be either the veins of the Arm, or the Veins near to the wounded part, as the Vein of the Forehead, the Veins of the Temples, and those which are under the Tongue. See Parey in the place before cited.
A particular detraction of Blood is when we take Blood from the part affected. This is performed by scarifying the brims of the Wound, applying Ventoses, or by laying to Leeches idem ibid. If the party be timorous, and loath to admit any kind of Bleeding, then you may use strong frictions of the whole Body, with course Linnen Cloths, or of other parts of the Body, the Head excepted: for these will discuss the superfluous Matter, and turn it into a halitus or Slime. For superfluities must increase, the wounded party omitting the accustomed exercises.
As for Purging, it is procured three manner of ways: First, by Cathartical Medicaments given by the Mouth. Secondly, by Clysters. Thirdly, by Suppositories. And as concerning solutive Medicaments which are ministred by the mouth, these Points may be asked. First, whether purging is to be used? Secondly, when such Medicaments are to be exhibited? Thirdly, of what hidden faculty they must be? Fourthly, of what force they must be?
As for the first demand, a purgative Medicament is to be ministred in three Cases. First, if the party have the Head [...]ach or Lumpishness. Secondly, if a Tum [...] or Inflammation appear. See Fal [...]op. in Hippoc. de Vulner cap. 27. Thirdly, if the Body be Cacothymical, so that there be strength, matter prepared, and the Body open and passable.
As concerning the time which was the second demand, Purgative Medicaments are to be minisied in the beginning. First, lest strength decrease. Secondly, lest the Fever increase. Thirdly, to hinder the Humor stirred from ascending to the Head. This H [...] pocrates advises in sharp Diseases, 4. Aphor. 10.
As for the third demand, those Medicaments which purge Choler, seem most fit in Wounds of the Head: Because the Symptoms [Page 321]which ensue after these Wounds, as Inflammations and Fevers, seem to be the effects of yellow Choler.
As for the fourth demand, we are to shun strong and eradicative Medicaments chiefly in the beginting, lest that by too strong a commotion of the Humors, a Pain, a Fever, and Inflammation be procured. See Parey lib. 9. cap. 14. Wherefore we must use gentle Molicaments, and which do not increase heat. Such are the infusion or decoction of Myrobalans mingled with Electuarium Lenitivum, or de succo Rosarum, aut Dieprunum Solutivum. The Dose must not be great, you may minister also the infusion of Rhub [...]rb, and Myrobalans, with the Syrup of Roses solutive with Agarick. Myrobalans strengthen the Stomach and Head, as also the Veins. See Fallop. in Hippoc. de Vidner. cap. c. 27. Arcaeus, lib. 1. c. 4. prescribes such a form. ℞ Syrup. Ros. Solut. ℥ ij. Aq. Plantag. ℥ iij. Ʋiere ut ars praescribit. He is of opinion that no other purgative Medicament is to be ministred, and that procuring Evacuations by Clysters or Suppositories will suffice: But you need not fear to give the Medicaments which I have set down.
Having delivered so much as may seem sufficient to clear the doubts which may arise concerning Bleeding and Purging: now am I to shew you how those things which are called not natural, are to be ordered; for the observation of this Point doth greatly further the Cure.
First then, as concerning the Air, it ought to be temperate, and thick, according to Fallop. in Hippoc. de Vulner. cap. c. 25. For a hot and thin Air doth eliquate and melt the Humors, and so makes them more apt for Fluxion. A cold Air is hurtful for the Brain, the Bones, the Nerves, and the Spinalis Medulla, or Marrow of the Back-bone. If then the Air prove cold, when you dress the Patient, hold at a convenient distance a Chafing-dish with Coals above the Head, to hinder the impression of the cold Air. See Parey lib. 9. cap. 14. Then apply the Medicaments being made [...] luke-warm. If the Air be very [...] then the room is to be cooled by hanging it with Sheets, and moistning them with cold Springwater, or you may garnish the Windows with Medow-sweet, Gaul, Burnet, Borage, Violets, Pri [...] roses, Cowslips.
One thing is to be noted, that Wounds of the Head are sooner and more safely cured in the Winter than in the Summer: and so concoct the Humors the better: whereas on the contrary, in the Summer time the Humors are apt to be made thin, Fuliginous Vapors are raised, and Inflammation doth invade.
As for the Meat and Drink, Wine is not to be granted before fourteen days be expired; for within this space all Symptoms usually cease.
In hot Regions where no Beer or Ale is, Barley Water is to be prescribed. If the wounded party be of a queasie Stomach, or weak or aged. Sugar may be added, or Oxysaccharum, or the Syrup of [Page 322]Violets, or of red Roses Simple, or of the Juice of Limons or Citrons. Small Beer and Ale will suffice in those Countries, where they may be had.
If there be a Fracture, neither Flesh nor Fish are to be permitted the first seven days. First, because the wounded party must keep his Bed; and so being deprived of wonted exercise, cannot so well concoct or digest the Food. Secondly, to avoid fluxion of Humors to the affected part. Vide Fallop. & Paraeum, lib. 9. c. 14. Let the wounded party eat Pauadoes and Ptisans; use not Almonds, because they procure the Head-ach by filling the Head with Vapors: stewed Prunes, Raisins of the Sun, Mallows, Asparag [...]s, Spinach, Succory, Endive, are good boiled. Lettuce tho it be not good for the Head, yet it may be granted, because it hinders the ascending of Vapors to the Head. After Meals it is good to take some of such things as hinder the mounting up of hot Humors, by shutting up and strengthening the Mouth of the Stomach: as old Conserve of red Roses, Marmalade of Quinces, or Quinces preserved, Saccharum Violatum, Boraginatum, Buglossatum, Pears stewed or baked; Coriander and Aniseeds, with one covering of Sugar, are good to be eaten with Quinces and Pears. If Flesh be permitted, then the Flesh of these Creatures following is to be eaten, Chickens, yoling Pigeons, Veal, Mutton, Kids, Leverets, Mountain-Fowls and Birds, as Partridges, Pheasants, Turtle-doves, Black-birds, Thrushes, Larks, and such like. If the wounded party eat of these boiled, then you may boil with them Spinach, Lettuce, Purselain, Sorrel, Borage, Bugloss, Endive and Succory; but if they will feed upon them rosted, then make Sippets unto them of Verjuice, the Juice of Oranges, Limons, Citrons, Pomegranats, or Sorrel with Sugar. If the party will needs eat Fish, then let him have Trouts, Pickrels, Smelts or Whiting-maps.
As for sleep let it be taken in the night time, and not by day, unless an Inflammation hath possessed the Brain, or the Meninges. The Signs of this you shall have delivered in its own proper place; for seeing according to Hippoc. 2. Epidem. Blood rules in the Spring, and in the Morning, in this case it will not be amiss to sleep from three a Clock in the Morning, till nine a Clock in the Forenoon: for so the Blood shall be staied, and kept from any extraordinary motion, which otherwise would ascend to the Head, and encrease the Inflammation.
If too much watching be troublesome, which corrupts the temperature of the Body, procures crudity, and causes heaviness and pain of the Head, and makes the Wounds dry and malign; then the Head, the Temples, the Ears and Nostrils are to embrocated with such Medicaments as cool and moisten, according to Galen. 13. Method. such are Ʋnguentum Pepuleum, Rosatum, Oyl of Poppies, Henbane, Mandrake, Oyl of Roses beaten together, taking two parts of the Oyl, and one of the Vinegar. Inwardly you may give an [...]mulsion of white Poppy Seeds in [Page 323]Barley-Water, sweetning it with Saccharum Violatum, Buglossatum, or Boraginatum: you may give also an ℥ and a half of the Syrup of white Poppy, in two ounces of Lettuce-Water, l. 13. c. 14. This is to be done four hours after Meat, to procure sleep; for sleep furthers concoction, repairs the loss of the triple Substance caused by watching, asswages Pain, refreshes the Weary, mitigates Anger and Grief, and restores reason troubled.
To this end you may minister also a small dose of Laudanum, but this must be done discreetly, and warily. First, because the Opium (if the Dose be often iterate) may cause a Stupidity or Lethargy. Secondly, because the Spices which are added to correct the Narcotical Simples in the La [...] d [...]um, by eliquating the Humors may offend the Head.
The room wherein the wounded party lieth, must be somewhat dark; for too bright a light dissipates the Spirits, increases Pain and the Symptoms, and strengthens the Fever. Let his Lodging also be far from places wherein there are immoderate ringing of Bells, roses of Carts and Coaches, and all sorts of Smiths.
Rest and quietness is most con [...]ient; for immoderate exercise moves and agitates the Spirits, weakens the Body, and troubles the wounded party; Wherefore soft walking will serve the turn.
Perturbations of the Mind are altogether to be abandoned; for the contraction and dissipation of the Spirits cause great alteration of the Body.
Venery above all other things is to be shunned in Wounds of the Head, chiefly if there be a Fracture; and that not only while the Wounds are in curing, but also long after they are cured: for great store of Spirits are contained in a small quantity of the Seed, the greatest part whereof flows from the Brain: Hence therefore all faculties, but chiefly the Animal are resolved and weakned. Parey in the place before quoted affirms, that he hath known death to have ensued in small wounds of the Head (even when they have been cured) by reason of Venery.
As for the Excretion of the Excrements, the Body must still be kept soluble, lest, if these should be retained, corrupt and noisome Vapors should ascend to the Head: wherefore if Nature be dull and slow, Evacuation must be procured by Suppositories and Clysters. If cathartical or purging Medicaments must be given by the Mouth, such as I have set down in the beginning of this Chapter, are to be ministred, whither I remit you.
CHAP. XVII.
Of the rest of the points common to most Wounds. of the Head.
THe Second general point concerning Wounds of the Head, shall be dispatched by setting down the general Prognosticks of them, which are these that here ensue.
1. Nulla capitis vulnera quantumvis exigua: No Wounds of the Head although they seem small are to be slighted and neglected; for oftentimes it falls out, that when a Wound is received without a fracture in the Head, a man may die, if fearful symptomes or accidents appear: as a Convulsion, a Palsie of one Arm or Leg, a Fever, Raving, Vomiting, faltring of the Tongue, Valeriol. lib. 3, obseiv. 1. [...]ungius tom. 1. ep. 10.
2. Wounds of the Head often become [...] easie or hard to be cured, bit reason of the Countries [...] Ch [...]tes.
This happens either because the Air is hurtful by its elementary quality only, as when it is cold and moist, as in Florence and Bononia, according to Amat. Lusitan. Cent. 6. Curat. 100. Quercet. de Vulnerib. Sclopet. cap. 3. and in Paris, according to Parey, lib. 10. cap. 8. Or this happens when the Air uffends by a malign quality, as is observed in Gallia Narbonensis, and those parts of Italy, which lie near to the Mediterranean Sea, by reason of malign Vapours raised out of the Sea, and dispersed through the Air.
3. Wounds of the Head received by persons who have the Pox, Leprosie, Dropsie, a Cough of the Lungs, a Hectick Fever, a Consumption, or ill habit of Body, are hardest to be cured; partly because the Blood is not sit for unition, being corrupt, as in the Pox and Leprosie; partly because there is not a sufficient store of it, as in a Hectick, and Extenuation of the Body.
4. Wounds of the Head in Children prove sometimes rebellious; partly because they are of a hot and moist constitution, which is most apt to admit putrefaction; partly because the habit of their Body is thin, and so ministreth occasion to the breathing out of the Spirits.
5. In deadly Wounds of the Head, the parties live longer in the Winter, than in the Summer: for in it unnatural heat is not so easily raised as in the Summer.
6. If in Wounds of the Head a [Page 325]Swelling suddenly doth vanish away, it is an ill sign, unless some e [...]aeuation hath gone before, or discussive Medicaments have been applied.
7. A Fever which invades while Suppuration is procured, that is, before the Seventh day, is less dangerous than that which invades after the Seventh day: for about that time all accidents use to cease.
8. If a Fever in these Wounds do appear the Eleventh or Fourteenth day, with a cold and groo [...]ing, it is dangerous, because it is to be feared lest some putrefaction bath possessed the Brain, the Merurges, or the Scull; which a pale [...] yellowish colour of the Wound, or like to Water, wherein raw flesh hath been washen, will discover.
9. Wounds contused are more flowly cured, than those which are ixised, because they require greater Suppuration.
10. Symptoms do sooner appear in the Summer, than in the Winter; for in the Summer we look for them the Seventh or Fourteenth day; and the reason is, because in the Summer the Humors admit sooner putrefaction, the unnatural Heat being more readily stirred up. Vide Hippocrat. 1. Aphor. 15.
11. It is an ill sign, if the flesh of the brims look livid, for that is a sign of the decay of natural heat: See Hippoc. Sect. 7. Aphor. 2.
12. If in Wounds of the Head Reason fail, if Speech cease, if Sight be lost, if the party labour to tumble out of the Bed, when he is not able to move the parts of his Body, if he have a continual Fever, if his Tongue be black and dry, if the brims of the Wound be blackish or dry, if he have an Apoplexy, Palsie, with an involuntary excretion of his Excrements, or an absolute suppression of Excrements and Urine, a Phrensie, or Convulsion, then you may pronounce death to attend at the Door.
13. Wounds of the fore-part of the Head, are more dangerous than those of the hinder-part. First, because greater store of Brain is contained in the part. Secondly, because the containing parts are thinner there. Thirdly, because the Meninges have Sinuosities or Cels in the fore-part, but not in the back-part: wherefore this inequality cannot but endanger the Membranes, which cover the Brain, to be offended, if the Wound pass thorow the Scull, or if the Trepan be to be applied. Fourthly, because if Wounds of these parts be deadly, he who hath a deadly wound in the fore-part of the Head, dieth sooner than he that hath a deadly Wound in the hinder-part. Fifthly, because more noxious Matter may be gathered in the fore-part, which may offend the Brain, than in the hinder-part, by reason of the multiplicity of the Cells. Sixthly, because the fore-part hath more Sutures than the hinder-part. See Fallop. in Hippocrat. de vulner. capitis, cap. 7, & 8.
14. Wounds of the Temples are very dangerous, First, because the motion of the joint of the lower Jaw, while we speak, eat, or drink, doth hinder unition. Secondly, because the passage of [Page 326]Hearing is in the Temples: now the instruments of the Senses are very sensible. Thirdly, because vessels of Moment, as the branches of the jugular veins, and soporal Arteries are distributed there: Fourthly, because the temporal Muscle is placed in the Temple, whose offence is not to be neglected. See Fallop. in Hippoc. de cap. vulnerib. c. 9.
15. A Wound in a Suture is dangerous: First, because the Scull is there parted, and so more apt to opening than one solid Bone. Secondly, because in the Suture there is a Ligament, by which the Memnges are tied to the Pericrani [...]m: Wherefore a Wound being inflicted there, an Inflammation may easily be communicated to the Meninges. Vide Fallop. in Hipp. de c. vuln. cap. 12.
16. Blackness in the parts near to the Wound, a Convulsion, Palsie, loss of Appetite, much watching, and colduess of the extremities of the Body, portend an evil event.
17. In these Wounds, if the brims tumesie not a little, it is an ill sign, according to Hipp [...]c. 5. Ap [...]r. 66. If the tumefaction be soft, it shews concoction; but if it be hard, crudity. Secundum eundem 5. Aphor. 67.
18. Flesh is easily regenerate in all wounds of the Head, if you except those wherein there is a feacture of the Scull a little above the Eye-brows: Three reasons may be yielded for this: First, because in those places there is a Cavity between the two tables of the Scull, which passes to the Sieve-like bones of the Nose, full of Air, by which the generation of flesh is hindred; for if you cause him, who hath a Wound with a fracture, there to breath strongly, his Mouth and Nostrils being shut, the breath which comes out at the Wound will blow out a reasonable Candle held to it. Secondly, because the thickness of the Bone will not suffer so much bloudy juice to breath out, as is sufficient for the generation of flesh. Thirdly, because there is a great affluxion of Excrements to the part, which otherwise would be discharged by the Eies and Nose, which hinder the desiccation of the Wound, and so cicatrization. Vid. Par. lib. 10. cap. 12.
19. In wounds of the Head you may hope well, if the Patient hath no Fever, if he be in his right mind, if he finds himself well when he takes any thing, if he sleep well, and have his Body soluble, if the Wound look with a fresh and lively colour, if it yield laudable Quittour, and if in fractures the Dura Mater hath its motion free, and be not discoloured.
20. In wounds of the Head with a fracture, we must not think that danger is past before an hundred daies be expired.
21. The Callus, whereby the parts of the Scull are united, thô it be sooner induced in young, than in old persons; yet most commonly it is procured in the space of 40 or 50 daies.
The Third common point to be observed in Wounds of the Head, I affirmed to be the appointing of Topicks fit for the asswaging of pain, and the removing and hindring of an Inflanmmation. Sundry [Page 327]Authors have set down sundry descriptions of such Medicaments, which if one should gather together and set down, a reasonable Book might be compiled.
To avoid tediousness, and not to leave you altogether unfurnished without the description of any such effectual Medicament, I will set down the Receipts of such Medicaments which will answer your expectation, and ease the Patient.
The First shall be this: ℞ farin. herd. ℥ iiij. poscae ℥ vj. coq. ad cataplasmat is consistentiam: tune add [...]ntur ol. ros. ℥ ij. fiat Cataplasma s. a. Si desit posca, substituendi in [...]ius locum acetum & vinum Rubeum, sumantur partes duae vini & [...] aceti: Acotum rosaceum aut simbucinum praest antius est vulgari. This Medicament of Hippocrates Fallopius extolls above all others, [...] lectionib. in Hippoc. de capitis [...]lnerib, c. 39. Let this Medicament be used until the Seventh, or Fourteenth day, as you shall perceive cause; Then apply other Medicaments, whereof I will speak when I come to discourse of the Cure of particular wounds of the Head.
The Second shall be this: ℞ Farin. bord. & Fabar. an. ℥ ij aceti res. ℥ vj. ceq. ista ad Cataplasmaus. consistentiam: tum addantur [...]. ros. ℥ ij. This Cataplasm cools, repells, dries, asswages pain, mitigates Inflammation, and hinders the affluxion of Blood or hot Humors.
The Third shall be this: ℞ Medullae panis albi ℥ iiij. lactis recentis ℥vj. coq. ista. ad cataplasmatis consistentiam, tandem adae unguenti popul. ℥ ij. croci pulv. ℈ ij. This Cataplasm is effectual, if the Inflammation and Pain be great, if the party be of a dry and hot Complexion, or be any way Feverish. These Cataplasms are to be applied above the Medicaments wherewith the Wound is drest, the hairy Scalp having been shaven for a reasonable compass about the Sore or Wound.
The last general point concerning all wounds of the Head, set down by me, was of dressing up of the Head after the application of the Medicaments. In the dressing two things are to be observed; the covering of the Head, and the rolling: As for the covering, A Cap must be made of a soft Linnen-cloth, basted with fine Chirurgeons Tow, but not quilted; and it must be of that bigness, that it may compass the whole Head: it must not be too thick, too heavy, or too hard; because the Head requires light, soft, and easie applications; yea, Topicks which are applied to Wounds of the Head must not be stubborn, as firm Emplasters; nor too viscous: because the First will cause pain, and the Second will not easily be taken off.
As for the rolling, it differs from the rolling of other parts because the Head is somewhat spherical or round.
Of the Rollers these doubts may be proposed; First, of what Matter they ought to be made? Secondly, of what breadth and length they ought to be? Thirdly, of what Figure they ought to be? And lastly, what mediocrity of constriction is to be used in the application of them?
As for the First, to wi [...], the matter whereof the Rollers are to be made; it ought to be of Flax and not of Wooll, because it would be too hot, and cause itching, which inconveniences would trouble the Patient. The Linnencloth whereof the Rollers are to be made, must not be too new, for then it would be somewhat too rough; nor too old, for then it would be subject to tearing: neither ought it to be too thick, for then it would be heavy and boisterous, nor too thin, for then it would be too weak.
As for the Second doubt, the Rollers ought to be three Inches in breadth, and of a Fathom and an half in length, or of such a length as is sufficient to compass the whole Scalp after manifold Circumvolutions and Rollings; for the Roller must keep on the local Medicaments, and make some constriction of the Head.
As for the figure of the Rollers, they must have two ends, that when they meet they may by natural linking be strengthened and kept from slipping.
As for the mean of Constriction to be used in applying the Rollers (which was the last doubt:) The Roller ought not to be too loose; for then it could neither keep to the Medicaments, nor any way bind the Head: Neither ought it to be too strait, for then these inconveniences might follow: First, the pulsation of the Arteries would be intercepted. Secondly, fuliginous Exhalations could not breath thorow the Sutures. Thirdly, the Blood would be driven from the wounded part to the Meninges and Brain, from the outward to the inward parts: from whence would ensue Pain, Inflammation, a Fever, Apostemation, a Convulsion, Palsie, Apoplexy, and last of all Death. Neither wonder at this; for Galen. lib. de Fasciis, relates, that one by too strait deligation of the Head, lost both his Eies; howsoever, great skill and circumspection is required to dress the Wounds of the Head artificially.
CHAP. XVIII.
Of Wounds of the parts placed above the Skull.
HAving set down those points which concern all Wounds of the Head in general, I must now according to my intention descend to the handling of every particular Wound of the same.
Wounds of the Head either offend the parts containing, or the parts contained also. The parts containing are either common or proper. The common parts are these, the Cuticula, the Cutis, and the Panniculus carnosus. The proper containing parts are these; The Muscles, the Pericranium, and the Cranium. The parts above the Cranium are subject to these offences, a Contusion, a Wound, and a Contusion with a Wound.
A Contusion is caused by a heary and obtuse, or a blunt instrument, as a Cudgel, or by a fall from an high place, the Head alighting upon some blunt Body: It is discovered by the Tumor without a Wound, and often a blackness or blewness: If the Blood, by the violence of the Contusion, be poured out between the Skin and the subjacent parts, it is called Ecchymosis.
If a Contusion without effusion of Blood be presented unto you, shave the Hair, and apply this Medicament: ℞ Albumen ovi unius, ol. myrt. & pulv. myrtin. an. ℥ ss. Misc. This Medicament is to be used until the part come to its own temperature and confirmation. Dress the party twice a day: See Arcaeus, lib. 1. cap. 1.
So you see, that repelling and astrictive Medicaments are in this case first to be applied: For First, by these means Veins and Arteries are straitned, and closed up. Secondly, the Defluxion is hindred. Thirdly, the part it self is strengthened. You may use also this Medicament of Ambrose Party, l. 12. c. 4. ℞ Album. Over. num. iij. ol. Myrtin. & ros. an. ℥ j. bol. Armen. ℥ ss. Sanguin. Dracon. ʒ ii ss. nuc. Cupres. Gail. Alum. usti. an. ʒ ij. aceti rosac. satis, ut paretur linimentum. If after the pain is gone, and the flux of Humors ceased, a Tumor remain, use discussive means, such as this: ℞ Emplast. de Mucilag. ʒ ij. Oxycroc, [Page 330]& Melilot. an. ʒ j. ol. Chamaemel. & Anethin. an. ʒ ij. fiat ex his ceratum. s. a.
If by the application of these Medicaments the Tumor vanish not away, because the effusion of Blood under the Cutis Musculosa hath caused a separation of the upper parts from the Cranium, which you shall discern by the fluctuation of the Tumor and a fixt pain in the part: First incision is to be made; then if the Skull be found, you shall finish the cure by moderate compression, and the application of Medicaments which dry and mundifie; for moist Medicaments are not to be applied to Bones, because they cause cariosity; use then such a Medicament as this is; ℞ Swup. è ros. rub. siccat. & de absinthio an. ℥ j. terebinthin. ℥ i ss. irid. Aloes, Myrrh. Mastich. & Farinae hord. an. ʒ ss. Misc. ex praes. art. If the Scull be not sound, which you shall perceive partly by the sight, for it will appear yellowish, livid or black, partly by the Probe, or Finger, for you shall find it rugged and uneven, whereas it should be smooth and slippery: First, you are to smooth it with the Raspatory: then to procure a thin scale, apply this excellent Powder following. ℞ Rad. Irid. Gentian. Aristol. rot. Dictamni, Farinae hord. an. ℥ ss. Aloes hepat. Sang. Drac. Myrrh. Mistich. Sarcocoll. an. ʒ ij. fiat. exemnib. pulv. s. a.
In great Contusions sometimes Gangrenes ensue, by reason of the extinction of the natural heat, which you shall conjecture if the part grow hard, and become to be of a livid and black colour; then thus you must go to work: First, the part is to be scarified. Secondly, Cupping-glasses, or Horns, are to be applied. Thirdly, such Fomentations and Topicks are to be applied, as are prescribed for a Gangrene, whereof I mean to discourse in a particularity, when I have made an end of Fractures and Luxations; for it is a Symptome, which most commonly accompanies solutions of Unity of all sorts. It shall suffice to have spoken so much concerning a Contesion of the parts placed above the Skull, now it follows, that we discourse of Wounds of the same parts.
Wounds then in the parts above the skull, are of two sorts: for in some of them the Skull is not laid bare, and in some of them it is bared. You shall know that the Skull is not bared, partly, by the Finger: if the Wound be large enough; partly by the Probe, if no hard substance can be felt, and if the Probe slip and slide, meeting with the Pericranium. As for such Wounds the observations, which I set down in the point concerning the general Cure of Wounds, will suffice for the curing of these.
Nevertheless, Wounds in the temporal Muscle require a special consideration, by reason of the fearful Symptomes, which ensue sometimes after it is wounded. The temporal Muscle then may be wounded three manner of ways: First, by a puncture: Secondly, by being divided transversly: And Thirdly, by being wounded according to the length.
If the puncture be deep, or the [Page 331]transverse Wound in like manner, it is a dangerous Wound, and so [...] be [...]accounted by the Chirurgon at the first, lest his security king unto him discredit, and fruitless repentance at the last: for [...]ch wounds bring Vomiting, a Convulsion, and deep Slumbering, recording to Fallop. in Hippoc. de [...] vulner [...]b. c. 9. The temporal Mascle being out athwart, it loses its proper action, which is to move and lift up the lower Jawe; and then the opposite temporal Muscle, being sound and whole, using its strength the wounded Muscle not being able to use any resistance, it draws the lower Jaw to it; whereby the Mouth, and all parts of the Face are drawn awry, and suffer a Convulsion towards the found part, the other being resolved and falling; for as often as the Muscles of one kind are equal in number, bigness, and strength on each side, the resolution of the one part causeth the Convulsion of the other. Be [...]les this, when we eat or speak, this Muscle is in perpetual motion: whereby it comes to pass, that being once cut, it hardly will admit unition; and the scaly Suture, Sutura squam [...]sa, which is the joyning of the Ossa petrost, or stony bones, so called from their hardness. If therefore there be a fracture in this Muscle, let not the Chirurgeon be too hasty to dilate it by incision, for the reason above specified; but let the Hair be shaved, and the Wound dressed with the Oil of Hypericum, and the Oil of Earth-worms mingled together, with some spirit of Wine, all being made warm. Take two parts of the Oil of Hypericum, and one of Oleum lumbricorum. If the temporal Muscle be transversly cut, then the brims are to be brought together, by using stitchings in the skin. Afterward dress either with the Medicament, prescribed in a puncture, or with Arcaeus his Liniment melted: above these wounds apply Paracelsus his stictick Emplaster, or Diachylon magman, brought to the consistence of a cerate, by dissolving of either of both in some good and approved artificial vulnerary Balsame. Although the wounded party be like to die, yet according to Celsus his counsel, the miserable Patient is not to be altogether left comfortless: for it is better to try a doubtful Medicament, than none at all [...] you may avoid scandal to the profession, and free your selves from discredit, by acquainting his friends, or whom it most concerns, with the danger wherein he lies.
If the temporal Muscle be wounded according to the length, then when you are called, you are to perform two offices; First, if the Hemorrhage be of moment, then you are to slay the bleeding, and then you are to unite the brims by ordinary stitching. If the bleeding will not be staied by the application of ordinary means, (whereof I have set down some choice in a proper place) then you are to pass a needle through the musculous Flesh into the Wound, and from thence to the outward part of the Wound, compassing the great vessels with a double thread in the needle: between the thread and the vessels you are to put a little dosil of Lint, to shun the cutting asunder of the parts [Page 332]compassed with the thread, and to avoid pain. This being done, cast a decent knot upon the thread, before you sow the Wound; First, cleanse the Wound from the grumous or clotted Blood, and all extraneous Bodies, and then few it, lest the part wounded be cooled by the Air, and a Convulsion do ensue: when you have dressed the party, let his Head be raised somewhat high with a Pillow.
It follows now, that I speak of wounds of the parts above the Skull, wherein the Skull is detected, or laid bare. In these Wounds the Skull is either not hurt, or hurt. If the Skull be not hurt, the Wound may be cured two manner of ways, to wit, by Agglutination, or by Incarnation: If you mean to cure the Wound by Agglutination, go thus to work: First, stitch the Wound according to Art, then apply Pledgets moistned in the white of an Egg. The next day anoint the brims of the Wound with Arcaeus his Liniment, or some good Balsame, warmed in a spoon; use neither Tents nor Pledgets: for these hinder consolidation. If the Wound yield much Quittour, dress it twice a day, until the Quittour abate; continue this manner of dressing until the Wound be agglutinate, which will fall out sometimes the fourth, sometimes the sixth day. See Arcaeus, lib. 1. cap. 1. If you intend to cure such a Wound by Incarnation, or filling of the solution of the Unity by ingendring new flesh: First, besprinkle the Bone with the Cephalick powder set down by me before. Secondly apply dry Pledgets; Thirdly, fill up the Wound with some Sarcotical Unguent, as Aureum, Basilicum, or Arcaeus his Liniment. It is far better to cure such Wounds by Agglutination, than by Incarnation; for the scar will be less, and the cure will be finished in a shorter time.
If the Skull be hurt, it falls out three manner of waies. First, if it be made extraordinary dry by reason of the Air, which will fall out, if the Skull lie bare two hours. Secondly, if the upper portion of the Cranium be divided from the lower, and cleave to the Cutis musculosa. Thirdly, if both the Tables of the Skull be cut, and cleave to the Cutis musculosa, not separate altogether from the parts adjacent. If the Scull hath become dry superficially only, which you shall perceive if it bleed not, being scraped with a Raspatory; this upper Superficies is to be removed with the Raspatory, that Blood may come from the found Bone: then the Wound is to be stitched, and the cure to be performed by Agglutination. If only a portion of the Cranium separate from the rest, stick to the Cutis musculosa, it is to be takenaway, and the Wound to be cured either by Agglutination, or Concarnation, as you shall see cause. If a portion of the whole Cranium be divided from the rest, so that the Dura mater offers it self to the view, and sticks to the Cutis musculosa, that portion is not to be separated from the Cutis musculosa, lest the Brain be deprived of its cover: but must be reduced into its place, and there kept, by bringing together the brims of the Cutis musculosa with so many [Page 333]deep and strong stitches as shall suffice.
I cured a Warrener of Mr. Holland's of the Verdry, Thirty two years ago, of such a Wound, by these means within a few daies. Bones of the Head will suffer unition being separate, as well as Bones of other parts of the Body.
At last I am come to the Third kind of Wounds, which happens to parts placed above the Cranium, which is a Wound with a contusion. Of this sort of Wounds there be two kinds; For either they are ordinary or extraordinary. These I call ordinary, which are not accompanied with strange Symptomes: Such Wounds thus you shall dress. First, you shall wash and soment the Wound with the spirit of Wine; having drawn into it self the tincture of Myrrh and Frankincense. Then if the Wound be great, stitch it with Needles: If it be not great a dry stick will serve. Dress the Wound either with Arcaeus his Liniment, or some good artificial vulnerary Balsame warmed. If the Wound be deep, a Tent must be kept in the depending part until it yield laudable Quittour, and then it is to be taken out: Then an Emplaster is to be applied: Emplastrum de gratiâ Dei will serve the turn.
An extraordinary Wound is such an one as is accompanied with strange, and unaccustomed Symptomes: such are a Fever, an Inflammation of the whole Head, Neck, and Shoulders; as also the Breast: the brims of the Wound swell much, and are of a livid colour. The Wound casts forth a virulent, sharp, black, and stinking Sanies, The party feels a great and pricking pain: Such accidents commonly ensue after the bitings of Men or Beasts, which impress a malignity into the Wound.
In such a case two things are to be done: First of all the malignity is to be drawn out. This is performed by scarifying deeply the brims of the Wound, and then applying either Leeches or Cuppingglasses. Then the Wound is to be washed and fomented with this Medicament: ℞ Theriac. Andromachi ʒ ij. Mithridat. ʒ j. aq. Card. Benedict. ℥ ij. Aq. vit. ℥ j. Misc [...]ex Art. Let Medicaments be applied hot. With all the Medicaments wherewith you dress such wounds, mingle still some Treacle and Mithridate, until all the aforespecified Symptomes cease, and the wound yield a laudable Quittour: Then finish the Cure with ordinary Medicaments.
Secondly, in such Wounds you are to strengthen the principal parts, (that they may be the more able to repel all malign vapours) with cordial Medicaments. Take this as a pattern: ℞ Ther. Androm. ℈ ij. Mithridat. ℈ j. conserv. Ros. Rub. & Bugloss. an. ʒ ss. Aq. Oxalid [...]s minoris ℥ iij. Misc. ut fiat potio. In ministring internal Medicaments you must have a care of the age and strength of the Patient. You must not forget to apply to the region of the Heart cordial Epithemes. Let this be one example; ℞ Aq. Ros. Rub. & Nenufaris an. ℥ iv. Acet. Scyllit. ℥ j. Coral. Rub. Sant. Alb. & Rub. Ros. Rub. Pulverizat. an. [Page 334] ʒiss. Flor. Cordial, Pultorum pug. ij. Croci ℈j. Mithridat. & Theriac. an. ʒj. Misc. Apply double Cloaths wet in this Medicament to the region of the Heart.
CHAP. XIX.
Of the general points to be observed in Wounds of the Scull.
IN the last Chapter I delivered unto you the method of curing such Wounds as may happen in those parts which are placed and lie above the Scull; now I am to shew how solutions of unity in the Cranium or the S [...]ull it self are to be handled. A solution of unity in the Scull is by all practicers called a Fracture by a peculiar denomination.
I will first set down the things which are common either to all or most Fractures, and then those things which are to be performed in every Fracture in special. The things common are two, to wit, the signs of a Fracture, and the Presages.
As for the signs, they are either found out by the Sense, or conjectured by Reason.
The Sense, (if the Fracture be not presented to the view at the first) doth find out a Fracture by two instruments, to wit, the Finger, if the Wound be large enough, and I a Probe. If then you perceive either by your Finger or a Probe an inequality, depression or ruggedness in the Scull, you may suspect that there is a Fracture. Ruggedness may deceive you, if the Sutures of the wounded party do vary from the ordinary, as if the sagittal Suture do reach to the Ossa cribriformia or Sieve-like Bones of the Nose. Some Idiots imagine the Sculls of Women in this point to differ from the Sculls of Men: but their imagination is erroneous: for this event is rare in either of both. That the Suture may deceive one. Hippocrat. Sect. 6. de vulnerib. capitis. acknowledgeth in these words: The Suture may deceive, being rougher than the rest of the Bone. So that it is not manifest whether there is in that place a Suture, or the point of the weapon, unless this be left somewhat large.
As for the signs which are sound out by reason, or rational conjecture, they are taken from four things: to wit, First, from the efficient causes. Secondly, from the manner of Wounding. Thirdly, from the wounded person. And last of all from the Symptoms.
To the efficient cause are referred, [Page 335]First, the party who hath inflicted the Wound. So that if he be strong, and in his fury did inf [...]ct the Wound, it is likely that there is a Fracture, if the Wound hath reached to the Skull. Secondly the instrument is to be reserred to the efficient cause, whose leenness and weight are to be consdered. Thirdly, a fall upon a [...]ard body from a high place, fourthly, a strong dashing of the Head against a hard body.
As for the manner of wounding, it is to be considered whether it was done violently, or moderately: For if the Wound was inflicted violently, it is probable that a Fracture was procured; but if it was done with deliberation and moderation, there [...] less fear of a Fracture. As for the signs taken from the wounded party, you are diligently to consider; First, whether he received the Wound being bare-headed. Secondly, whether the Skull be thin and weak, as it is in Children, and so apt to receive a Fracture. As for those signs which are taken from the Symptomes, they are of two sorts: for they are taken either from the Symptomes conjunct, or those which after ensue.
The Symptomes conjunct are these: 1. A singing of the Ears after that the Wound is received: 2. Falling after the blow: 3. Swooning for a time: 4. Slumbering after the Wound is received: 5. A dazling of the Eies: 6. A giddiness: 7. An issuing of Blood from the Nose, Ears, Eies, or Mouth. 8. Vomiting, peruse Hippoc. l. de vulner. cap. ac Fallop. on cundem c. 18, Paraeum lib. 9. c. 2.
The signs which are fetched from the after following are these: 1. A constant pain of the wounded part, so that the Patient often offers to touch it with his hand: 2. A vomiting of Choler with a Fever: 3. A Convulsion: 4. Palsie of one of the Arms and Legs: 5. Raving: 6. A faltring in the Speech: 7. Deafness: 8. The empairing of the Memory: 9. Dulness of the Understanding: 10. Weak judgment. Coiter. lib. observ. Anatom. & Chirurgicar. Fallop. in Hipp. de de vuln. cap. 45. 11. An Apoplexy, Par. lib. 9. c. 8.
Those signs that are taken from the crashing, which Hipp. affirm [...] the Patient to feel, if he chew Paper strongly with both the sides of the Gums, and from holding of a pack-thread strongly between the Teeth, if after jirking of it the party wounded feel pain in the part: As also those signs which are taken from the moisture of Emplasters, applied to the wounded part shaved, are all uncertain. See Fallop. in Hippoc. lib. de vuln. cap. c. 23. But it the Hair be cut asunder, and stick up in the Wound, the Skull of a necessity must be hurt; for it could not be cut asunder without the resistence of the Skull. See Hipp. in his former Book, and Fallop. upon him, cap. 18. & Parey lib. 9. c. 8.
It is sufficient to have spoken so much of the signs of Fractures of the Scull, I will deliver unto you the Prognosticks, by which you shall be instructed to foretel the event which is like to ensue after a Fracture procured in the Scull.
1. If one hath received a Fracture in the Scull, pronounce not [Page 336]all danger past before 100 dayes be expired; for many such wounded persons by experience have been found to have died about this time, when as all things might have been thought to have been secure. See Par. l. 9. c. 13. & Fall. in. Hipp. de vulner. cap. c. 48.
2. Every wound of the Head accompanied with a Fracture is dangerous, although no fearful Symptome doth at the first for many daies appear and discover it self: for the strength of the party, the uncleanness of the Body, an exquisite Diet, and the wholsomeness and temperateness of the Climat, are able to stay for a long time the appearing of ill accidents.
3. If a Fever ensue, after a Fracture; if the Head become very hot, if it hath been subject to distillation, if the party hath often been troubled with an Erysipelas, pronounce danger: if the brims of the wounds in the second dressing grow flat and do not swell, there is yet more danger: But if the Scull at the very beginning of the Cure appear blackish, and the Patient having a cacochymical Body cannot sleep, Death is like to ensue. See Fallop. in Hipp. de vuln. cap. c. 24.
4. When the reason is weak, the Memory impaired, the Tongue falters, the Eies grow dim, the Ears become deaf, if the party either cannot move himself, or falleth still from the head of the Bed, when a continual Fever with raving holdeth the Patient; if either the Tongue grow black, or clefts or pustules appear upon it; if the wound grow drie, and yield no Quittour, or becomes of a livid colour; if the Excrements be suppressed; if a Convulsion, Palsie, or Apoplexy do ensue; if the wounded party often faint and have a weak Pulse; if (I say) all these Symptomes, or most of them do appear, you may boldly prognosticate that death will ensue. These Symptomes, if they shew themselves even quickly after that the wound is received, they shew that the substance of the Brain it self is hurt: But if they appear about the Fourteenth day, or after, they proceed from the Inflammation of the Brain, and a Phlegmon of the same, by reason of the pouring of putrefied Blood upon it. See Parey lib. 9.12.
5. If one who hath received a Fracture of the Scull be altogether void of a Fever, if he digest his Meat well, if he Sleep well, if the Excrements be discharged, no waies offending in colour, quantity, time, other qualities, and the manner of discharging: if the Wound appear of a fresh and lively colour, if it yield laudable Quittour, if the Lips of it swell a little, and be somewhat soft, if the motion of the Dura mater be regular, you may hope well of the recovery of the Patient, Parey lib. 9. c. 13.
6. If the Scull be fractured, the parts above must suffer a solution of continuity, only this exception is to be admitted, if that kind of Fracture fall out which is called Resonitus or Contrasissura, a countercleft, which seldom happens, whereof I will speak when I shall deliver the manner of curing particular Fractures. Vide eund. lib. 9. c. 10.
7. If much Quittour appear upon the Cranium fractured, if Pustules appear upon the Tongue, by reason of a sharp Sanies falling upon it, having been sent down from the Brain through the holes of the palate of the Mouth, there is small hope of recovery, especi [...]lly if these accidents continue, and cease not. [...]id ibid. for these do snew, that the Brain it self is ill-affected.
8. If the flesh about the Scull scactured do appear of a leaden colour, it is an ill sign, according to Hippoc. 7. Aph. 2. for it is an argument, that the natural heat [...] the part is extinguished, by reason of a malign Humor, which hath caused a putrefaction of it, or that it is quenched by a vehement Inflammation or Phlegmon: if it hath not fallen out by reason of the greatness of the Contusion, if it become of a leaden colour by reason of the Contusion, it is not so dangerous, for it may be remored by suppurative Medicaments.
9. If in like manner the flesh about the Scull fractured be of a Rack colour, become drie, and afford not Quittour according to the amplitude or largeness of the wound, it promiseth no good: for it is a sign of the mortification or the part.
10. The Nowl-bone, and the O [...] petrosum or stony, or hard B [...]me, behind the Ears, are less subject to injuries, and so if they be wounded or fractured, the danger is the less: First, because the Nowl-bone doth only contain the Cerebellum, which is not so noble as the Brain. Secondly, because less store of Brain is contained in those places, than in other parts of the Scull. Thirdly, because the Bones in these parts are thicker. Fourthly, because they are more firmly covered, for the Skin in them is thicker, the flesh more plentiful; the chords more in number, and the Ligaments strong to strengthen the Bones.
11. The callous flesh, by which the portions of the Scull separate, are joyned together and united, doth require the space of 40 or 50 days for the strengthning and hardning of it. Yea, the age and temperament of the wounded party have great force in hastening and staying the confirmation of the same. See Par. lib. 9. c. 13.
12. Why some escape of grievous Wounds, and some die of light wounds, if falls out by reason of the differences of parts wounded; for some are more sensible than others. Secondly, by reason of the diversity of Bodies: for some are strong, some weak. Thirdly, by reason of the diversities of the Symptomes: for in some Wounds the Symptomes are more mild, in some more fierce and fearful. See examples in Hippocrates lib. 7. Epidem. peruse Bernhardus Suevus, in his Treatise de Vulneribus cap. 2. Where you may read sundry examples of those who died of very small hurts, and of sundry who escaped of grievous wounds.
13. The progressions or order of the Symptomes afore-mentioned is this: First, pain is caused by reason of solution of unity. After pain follow Watching, loss of Appetite, Weakness: Pain causes affluxion of Humors: affluxion of [Page 338]Humors causes Inflammation: Inflammation procures a Fever, sometimes a Convulsion, sometimes a Gangrene, and last of all a Mortification, if prevention be not used.
14. Wounds with a fracture of the Sinciput, or Bone of the Forehead are more dangerous than those of the Occiput, or Nowlbone. Six reasons may be yielded for the confirmation of this presage. First, because the Bones of the Forehead are thinner than those of the Occiput, and weaker, and so may be more easily contused or fractured. Secondly, because most Brain is there contained. Thirdly, because in the Bone of the Forehead there are sundry vaultings, so that the Brain may easily be wounded, if it pass through both the tables of the Scull. Fourthly, because the skin in this part is thinner than in other parts of the hairy Scalp: so that the Bones and the Meninges may the more easily be hurt. Fifthly, because there are many and large Veins in the Forehead, so that the greater Haemorrhage may there be procured. Sixthly, because in the fore-part of the Head there are two Sutures, Coronalis and Sagittalis: So that the Scull may there easily be fractured, and the Dura mater hurt, which sends Filaments through the Sutures to make the Pericranium.
15. Next to these the Parietal or Ossa temporum are most dangerous. First, because these Bones are thin and weak. Secondly, because there are remarkable Veins, Arteries, and Nerves. Thirdly, because the Pericranium doth clip the temporal Muscle, and the Muscle it self hath in the middle a Tendon of exquisite Sense. So that the wounds in the sides of the Head may by consent offend the Meninges, Brain and Nerves springing from thence.
16. Wounds without or with a fracture in the Sutures, are most dangerous. First, because the Bones are not solid there, but divided, and so least able to resist injuries. Secondly, because Quittour bred there may easily fall upon the Meninges. Thirdly, because in the Sutures the Dura mater may promptly be offended, which sends Filaments through them, for the framing of the Pericranium.
Of what moment certain predictions are, I will acquaint you with Hippocrates his words, lib 2. Prorrhet. I advise you that you carry your selves wisely in every point of the Art, and in the presaging part also, and that you call to mind, that if the event fall out according to the Prediction, you shall be had in admiration with the Patient; but if you do erre, you shall be both despised, and accounted fools. Wherefore I command, that you use discretion in these Predictions.
CHAP. IX.
Of the Section of the hairy Scalp, and opening the Scull.
HAving discoursed of the two general points to be observed in Wounds, accompanied with a Fracture of the Scull, what were the Signs and Prognosticks; hereafter I am to shew how every sort of such Wounds in particular is to be handled according to Art. Now the primary difference of Fractures of the Scull, is taken from the subjects, which are the wounded parties. These are either Children, which have not passed the seventh year of their age, or those of mature and ripe age.
Fractures then of the Cranium in Children, are either without a Wound, or they are accompanied with a Wound. If they be both without a Wound and a fearful Symptome, thus you shall go about to cure them. If then the Cranium be depressed, and Blood expressed out of the Veins, doth wave up and down under the Skin when it is compressed, (which sometime falls out in hard labour when the Midwise deals roughly with the Woman that is to be delivered) First of all the Hair is to be shaved off: then a triple or fourfold soft Linnen cloth, well moistned in the Oil of Rosos, mingled with the whites of Eggs beaten, and a little Vinegar is to be applied to the part: which must not be removed before 24 hours be expired. In the Summer time apply this Medicament cold, but in the winter time warm; for by this means the afflux of Huntors will be staied, and a part of those which have flowed already to the part discussed.
After this until the Eleventh day, this Cataplasm is to be applied warm: ℞ Ros. Rub. baccarum Myrti an. ℥ ij. Farin. Hord. & Fabar. an. ℥ j. Absynthii & Beton. an. ℥ ss. Semen. Cumin. ʒ ij. pidverizandis pulverat. coq. omnia in vini Rub. astringentis ℥ xij. ad Cataplasmatis consistentiam, tandem addantur Ol. Ros. ac Chamaemelin. an. ℥ j. mellis ℥ ij. ut paretur Cataplasma ex A. P. It must be applied Warm, and fresh, Morning and Evening. It must be applied large enough, that it may cover somewhat of the parts ad [...]acent. In the application let this moderation be used: Apply not too little of it, lest it grow too dry; nor too much, lest it offend the affected part with the weight. From the 11th to the 20th day, apply Diapalma softned with some [Page 340]Oil of Lilies, taking ℥ iiij. of the Emplaster, and one of the Oil. From the 20th. day till the Cure be performed, apply Stictick Emplaster relented in Oil of Chamaemil, taking the afore-specified quantity of the Emplaster and Oil.
Caesar Armitius in lib. Hipp. de vulner. c. & Arcaeus l. 1. c. 5. do advise us to dress Childrens Heads in this case, after this manner; for the first dressing they will have this Medicament to be used, ℞ Farm. Hord. & Fabar. an. ʒ iij. pulv. Bac. Myrti ℥ ss. Aceti ℥ ij. coq, ad Cataplasmat. consistent, tum adde albumen ovi umus un [...] cum vitello conquassata. Ol. Ros. & Myrtin. an. ʒ ij. Misc. Afterward they will have to be applied a Cerate made of Wax, Honey, Lapis haematites, Cumin-Seeds, Wormwood, the Pumice-stone and Bran beat to powder. But instead of this you may use Diachrlon maguum relented in Oil of Lilies: These Medicaments are to be applied as the former.
If there be a Wound with a Fracture, but no fearful symptom, Arcaeus will have no shiver, or part of the Cranium taken, if the Portions of it cleave together; but only the Fracture to be anointed with his Liniment warmed, and applied by three or four Feathers stripped, until you come within an Inch of the points of them, and tied together with a thread.
If fearful Symptomes, as a Convulsion, a Fever, vomiting of Choler, or a Palsie, &c. do appear, which shew an offence to be communicated to the Brain by the Cranium, then it is requisite that the Scull be opened. Vule Lang ep. 5. tem. 1. & Fallop. in Hippoc. de vuln. cap. c. 47.
The Scull being opened, children are no other ways to be dressed than Men are. How they are to be dressed, I will shew hereafter. It shall suffice then to have spoken so much concerning the cure of Fractures in the Sculls of Children.
Now I will declare unto you how these are to be cured in persons of ripe age. In handling of this matter, I will set down two points. The First shall contain those things which are common to every kind of Fracture. The Second shall deliver those things which are proper to every sort of Fracture. Those things which are common are two: the First is the Section of the soft parts placed above the Scull: The Second is the opening of the Scull.
As for the First, it is an artificial separation of the soft parts above the Scull, that we may come to dress the Scull fractured, to prevent the coming of ill accidents, or to remove ill Symptoms present. Of this Section these things may be demanded. 1. Whether it ought to be done. 2. Why it is to be done. 3. In what parts it is to be made. 4. Of what form it ought to be. 5. What is to be done after Section.
As for the First, three Reasons may induce us to administer it sometimes. 1. The Authority of Hip. in lib. de vulnerib. c. and of all other rational Physicians and Chirurgeons. Secondly, necessity it self: for if either Blood or Quittour descend to the Meninges or Brain, inevitable death will [Page 341]ensue, if way be not made for the expurgation of them, by making Incision in the soft parts, and opening of the Scull it self. The third Reason is daily experience, which shews by the death of sundry, who by reason of the omission of these Operations end their lives, that they are to be administred.
The Causes which admonish us, that Section is to be administred, are two, First, that the Cranium [...]ay be discovered, if dangerous Symptoms do appear, that the Chirurgeon may see whether it be hurt or no. Secondly, that way may be made to remove such things as offend the Meninges and Brain, as Blood or Quittour setling upon them, and pressing them down, as also pieces of the Instruments wounding, or portions of the Scull wounding or pricking these parts.
As concerning the places wherein Section is to be administred safely, receive this Proposition: Section may be made in all parts of the Hairy Scalp, if you except the Sutures and the temporal Muscle.
For first, Section is not to be made in the Sutures; because those filaments by which the Meninges are tied to the Pericranium, are of an exquisite sense, and being torn, may be inflamed, and communicate the Inflammation to the Meninges and Brain. See Hippoc. vulner. cap. & Fallop. upon him, cap. 19.
Secondly, Section is not to be made in the temporal Muscle, but chiefly a transverse Incision is dangerous.
First, because a resolution of that side of the Head, which is wounded is caused, and a Convulsion of the other side. By which an ugly distortion of the parts of the Face is caused. The cause of this Symptom is this. Whensoever one of the two brotherly Muscles, appointed for sundry motions of the same part, is transversly wounded, that which is wounded, must suffer a resolution, and that which is not cut a Convulsion.
Secondly, we must be wary in incising the temporal Muscle transversly; because it is still in motion, when we Talk, Drink or Eat.
Thirdly, because the Sutura squamosa, or the Scaly Suture lieth under it; but it wants not danger to make Incision in the Suture, as hath been said.
Fourthly, seeing many Veins, Arteries, and Nerves, are spread throughout it, it being transversly cut, many grievous Symptoms must ensue, as a great Haemorrhage, Pain, an Inflammation, a Fever, a Convulsion because of the inanition of the Vessels appointed for the containing of the vital and animal Spirits; to wit, the Veins, Arteries and Nerves being tranversly cut asunder. Vide Par. lib. 9. c. 19. Fallop. in Hippoc. de vulner. cap. c. 38. As for the form of Section, it is either streight, triangular, or cross ways.
One thing here is to be observed, that we make no tranverse Incision a little above the Eye-lid, lest the frontal Muscle being transversly cut asunder, a Palsie of the Eye-lid do ensue, the Muscle not being able to elevate or lift it up, wherefore the Incision in these places must be [Page 342]either streight or oblique, not transverse. See Fallop. in Hippoc. lib. de vuln. cap. c. 23.
Now this remains wherewith you are to be acquainted, that I shew unto you what is to be done after that Incision of the soft part is performed.
First of all, the pericranium is to be separated from the cranium, either with the Nails or the Splatter: you are to begin the separation from the Points of the Incision.
If the pericranium be not separate, it will procure great Pain, an Inflammation, yea, and a Fever, if it be torn either with a Raspatory or Trepan. See Par. lib. 9. cap. 4. Fallop. in Hippoc. de vulner. cap. c. 38.
Secondly, the brims of the Incision are to be kept asunder by Dosils and Pledgets of Lint, armed either with Medicaments apt to stay Bleeding, if it offer to flow plentifully, or only with the white of an Egg beaten, according to Arcaeus, lib. 1. cap. 4. or with both the White and the Yolk to asswage. Pain, according to Fallop. in Hippoc. de vulner. cap. c. 29. if there be no fear of any remarkable effusion of Blood. The Wound so dressed, must not be dealt withal, until four and twenty hours be expired.
Having delivered unto you those Points which are considerable in making Incision, to come to Fracture; now I must set down those things which are to be noted, when the Scull is to be opened artificially with sit Instruments, that you may come to remove such things as may offend the Meninges and the Brain. Concerning the operation these things may be asked: First, why it is to be opened? Secondly, when it is to be opened? Thirdly, what quantity of it is to be taken away when it is to be opened? Fourthly, with what Instruments it is to be taken away?
As for the first, the Cranium is to be opened in five Cases: First, that pieces of the Weapon may be taken away: Secondly, that a portion of the Scull may be removed, which is altogether separate, or offends the Meninges, if it cleave to the rest: Thirdly, that a part of the Scull depressed, which bears down the Meninges, and causes a stupidity, may be either reduced to its own place, or wholly taken away: Fourthly, that either coagulate Blood or Quittour may be removed, which hath fallen upon the Membranes, by reason of a breach of some Vessel. Fifthly, that way may be made to apply convenient Medicaments to the Fracture. See Fallop. in Hippoc. vuln. cap. 31. and Par. lib. 9. c. 4.
As concerning the second, it is good to open it before the fourth day, Fallop. ibid. c. 34. and Arcaeus. lib. 1. c. 4. and Par. lib. 9. c. 4. Yea, it may with good success be opened after the seventh day, both in Summer and Winter-season, if grievous Symptoms urge not. If therefore any one of you be called to one who hath a Fracture in the Cranium on the fourth day, (if ill Symptoms will permit) you may defer the opening until the seventh day be past; yea, the ninth: for on the [Page 343]fourth day the Putrefaction of the Humors begins, as also the insult of Nature against the Disease, and so it is not good to hinder the motion of Nature: But if for reasonable causes you fear lest delay will breed danger, you are presently to open the Scull, even on the Critical day.
As concerning the quantity which is to be taken away, either the whole fractured Bone is to be taken away, or only a part of it. The whole Bone is to be taken away: First if the Fracture be in an upper part, as the Crown of the Head, where no depending vent may be made to discharge the Blood or Quittour from the Meninges. Secondly, in a Fissure, or Sedes, if it be not wide enough, the whole Bone that you see is to be removed, at least to the second Table. Thirdly, all the shivered Bones which cleave not together, are to be taken away. Fourthly, so much of the Scull is to be taken away, as covering the Dura Mater becomes black, that way may be made for the application of convenient Medicaments.
In Fractures, wherein it will be sufficient to take away only a portion of the fractured Scull, to make way for the discharging either of Blood or Quittour, or removing of other hurtful things, let it be done in the depending part; which Rule notwithstanding is to be omitted in two Cases.
First, if you perceive that the Meninges are like to be inflamed: for then they should more readily swell above the Cranium in a depending part.
Secondly, if the Brain appear, the Membranes being wounded, we must shun opening in the depending part; for according to Galen, 6. Method. seeing the Brain is of a soft and fluid substance, it would easily fall down to the depending part. Vide Fallop. in Hippoc. de vuln. cap. 35.
The chief Instruments with which we open the Scull, are these: Raspatories, Levatories, Gemlets called Terebellae, the Trepan, and the Head-saw. Of the sundry sorts of Raspatories, you may see choice in Par. lib. 9. c. 4.
When you will use Raspatories, you must observe some things before the Application, some things in the Application, and some things after the Application of them. Before you use them, First, you must place the Patient in a good posture. Secondly, his Head being lapped in foulded Clothes, is to be staid, and kept immoveable. Thirdly, the Ears are to be stopped with Cotton, or Wooll, that the noise offend not the Instruments of Hearing. Fourthly, the brims of the Wound are to be covered with pieces of Linnen Cloth; First, to keep them from the Instruments; Secondly, to defend them from the Air, which otherwise would cool them.
In the using of Raspatories: First, we must begin with the broadest, and then the less broad, and lastly the narrowest. Secondly, they are often to be moistned with the Oyl of Roses; first, that [Page 344]they may serape the more lightly, secondly, that they heat not the Cranium: If Blood trouble the Work, use Vinegar and Water. After you have used the Raspatories, use these same Topicks which are used after the Application of the Trepan.
Raspatories are to be used in Fissures or Chinks, and in a Sedes, when the print of the Weapon is narrow. The second Instrument is the Gemlet, or Terebellum: Coopers use the like Instrument to raise up the Staves of Vessels, the point of it must be scrued. This hath a two-fold use; First, it serves to take out the Bone cut by the Trepan, whereas it is not safe to cut the whole Bone through, as in the Bones of the Forehead. Secondly, it serves for reducing a depressed part of the Scull into its own place, by first making a small hole in the Cranium with the Pin of the Trepan, and then scruing it in.
As concerning Levatories, you may see divers fornis in Parcy, lib. 9. c. 5. & 5. When you use them, have a care that you lift up equally every part of the Bone; for if any part be depressed, it may hurt the Meninges.
As for the Head-saw, First, it may be used when there is a depression or a Fracture on one side of the Bone; for one side being by a streight line divided by it, both there will be way made to the taking away of the Bone, and the discharging of Quittour, or Blood, with small loss of substance of the Cranium. Secondly, it will serve to cut asunder the distance of the Cranium, left after Application of the Trepan in divers parts.
The last Instrument: It remains now then, that I speak of the Trepan: Concerning it, these things may be demanded: First, to what end it is to be applied? Secondly, in what places it is to be applied? Thirdly, what is to be observed in the Application of it? Fourthly, what is to be done after the Application of it?
As for the first, the Application of the Trepan hath a threefold use: First, it serves for the raising up of a Bone depressing the Meninges and Brain. Secondly, it serves for removing of all things which hurt the Membranes and the Brain, whether they be Quittour, Blood, Splints of the Cranium, or pieces of the Weapon. Thirdly, it makes way for the Application of sit Topicks. As for the places, it must not be applied, First, upon the Fracture; for this will increase the evil, chiefly if the fractured portions be severed. Secondly, it is not to be applied upon a Suture, because the Nervous Fibres, and the Veins and Arteries, by which the Dura Mater is annexed to the Perieranium, and gives it nourishment, should be torn: from whence would arise Pain, Inflammation, and flux of Blood; which might be communicated to the Membranes, and Brain it self. Thirdly, neither is it to be applied to the places a little above the Eye-brows; for the Wound ever afterward would remain unskinned. Fourthly, it is not to be applied to the Temples, First, by reason of the temporal Muscle. Secondly, by reason of [Page 345]the Sutura squamosa. Fifthly, it is not to be applied to the lower parts of the Scull, if the Meninges be wounded, lest the Brain fall out through the hole. Sixthly, it is not to be applied to the Sinciput of Children, which are not above seven years old, seeing it is dangerous even in these who are of ripe Age, unless great necessity urge.
In the Application of the Trepan, these things are to be observed: First, that you take out the Pan, when you are come to the second Table. Secondly, it is be moistned with Oyl, that it may cut the better. Thirdly, the print of the Trepan is to be moistned now and then with cold Water, lest the S [...]ull be lieated by the rubbing of the Trepan. Fourthly, seeing it is impossible to cut all the parts equally, the Scull being of a Sphereal Figure, you are to remove the Blood, that you may perceive which part is most deeply cut, that you lean more to the other. Fifthly, when the part cut by the Trepan begins to shake, it is the sifest way to lift it up with the Levatory. Sixthly, if any ragged pleces appear, which may hurt the Meninges, you are to take them away by Scalper Lenticulatus, and the Mallet of Lead, after that the Trepan is applied above the Durd Meter, apply a piece of Tafety or S [...]ttin, of a white or crimson colour, moistned in Mel Resatum, and Oleum Rosatum, until the seventh day; afterward use the Oyl of Roses, and the Oyl of Hyperitum mixed; let the Crantum be anointed with Are [...]eus his Liniment melted; sill up the hole with Dosils and Pledgets, laying above such Topicks as heretofore I have set down.
If in the Application of the Trepan, any remarkable Bleeding ensue, some Vessel being cut, which did cleave to the second Table, then apply this Medicament of Galen. 6. Method. ℞ Alce. ʒ ij. Thuris, Mastiches, an. ʒ j. ex ist is pulverizatis, Pilis. Leporinis, & ov. Album. siat linimentum, quod applicetur. The Scull will scale, according to Arcaeus lib. 1. c. 4. within the space of four and twenty or five and twenty days, if his Liniment be applied to the Bone. But according to Parey, not before forty or fifty days, but in truth no certain day can be appointed, Hieron. Fabric. ab aq. pendent. part. 2. lib. 2. de vulner. cap. 18. counsels first to apply the Oyl of Roses to turn the Matter which falls upon the Dura Mater into Quittour; for Galen, lib. 2. [...], c. 2. affirms, that we ought to use Oyl of Roses, when we mean both to repell and suppurate. It will be the more suppurative, if it be Oleum Rosaceum Completum. He advises to mingle some Rosin with the Oyl of Roses; for in Digestives, according to Galen, lib. 5. Simp. cap. 19. there ought to be an Emplastick faculty, which the Oyl of Roses hath not of it self, but of the Rosin. In the first dressings, and in the Summer time, more Oyl of Roses, and less Rosin is to be used; but afterwards when we mean to dry and mundisie, as also in the Winter, more Rosin and less Oyl is to be taken. When the Wound is dressed, embrocate the parts of the Head [Page 346]with Oyl of Roses warmed, as also the Neck, chiefly where the jugular. Veins are, partly to asswage Pain, if any be; partly, to contemperate the heat of the Blood.
CHAP. XXI.
Of the cure of Fractures appearing in the wounded part.
HItherto I have dispatched those points which frequently are common to all sorts of Fractures, which do happen to those who are of ripe Age: now it remains that I shew unto you how all sorts of Fractures in such persons are to be cured.
Now a Fracture in these persons is two-fold: for it is either in the same part which hath suffered Solution of Unity, or in another part. If it be in the same part, it is either Simple, Compound, or Complicate.
A simple Fracture is, when one only kind of Fructure happens. Of these there are three sorts; Rima, a Chink or a Cleft, Contusio, a Contusion of the Scull; and Sedes, a Sitter, when the print of the wounding Instrument is left in the Scull.
Rima, or Fissura, a Chink or a Cleft, is two-fold; for it is either Conspicua, easily to be discerned by the sight, or Inconspicua, either hardly to be discerned by the sight, or not at all; which is called Capillaris, a hair-like Chink. Now a conspicuous Chink passeth through either one or both the Tables of the Scull. If it pass not deeper than to the spongy part between the two Tables, the Chink it self is so far to be dilated. If the Cleft pass through both the Tables, then the Chink is either to be dilated through both the Tables of the Scull, even to the Dura Mater, or through the first Table at the least, making way through the second Table also, leaving a competent apertion for the discharging of clotted Blood, or Quittour, for the depending part of the Head, through the second Table. Now the depending part is not to be taken from the situation of the parts of the Body, but from the position or posture of them.
You must deal after this same manner with Rima inconspicua, or Capillaris, or an obscure Chink. But it is not an easie matter to find it out. If therefore you cannot discern it either with the Eyes, or the help of a magnifying Glass, [Page 347]cuse the Patient to hold in his breath, and to stretch his Breast. If this be done, either a thin Humer, or a bloody Sanies do issue out, it is an excellent Sign: if this do not appear, then apply to the part most suspicious, Ink, made thin with a little Vinegar, to make it pierce. The next dressing, dry the Scull with a wet Rag or Sponge, and if you see any print of the Ink to remain in the Scull, follow the besiness untill you come to the uttermost of the impression of the Irk, although you must discover the Dura Mater. Now Chinks must not be dilated by the Trepan, but by Raspatories: for we ought not to take away more of the Scull than necessity urges. Peruse Par. lib. 9. c. 4. and Fallop. con. in lib. Hippoc. de vulnerib. cap. c. 3. When the Rima is dilated, dress the Wound, as you do after the Application of the Trepan; whereof I spake sufficiently in the former Chapter.
Sedes, or a Sitter, is a Fracture caused by a sharp Instrument, which leaves the print of it in the Scull: if it pass through both Tables, and no Splints of the Bone prick the Meninges, and sufficient way be made by the Weapon for the discharging of the Quittour, no further Apertion is to be made; but the Wound is to be dressed, as I prescribed, after the Application of the Trepan. But if either Splints of the Bones do offend the Dura Mater, or the passage be too narrow for the discharging of the Quittour, a further Apertion of the Scull is to be made by such Instruments as shall seem most fit for this Operation. If the Sedes pass not further than the first Table, the Cranium is to be smoothed with Raspatories, lest the Quittour setling in the Sedes cause a deeper cariosity. Then the Wound is to be dressed with Arcaeus his Liniment relented in a Spoon: It falls out many times, if the constitution of the wounded party be good, that the Cranium doth cast no Scale.
The third kind of a simple Fracture called Contusio, a Contusion of the Scull, resteth to be spoken of.
A Contusion is a Solution of centinuity in the Cranium, when as by the violence of an external Instrument, the small portions of it are brought nearer together than Nature hath placed them, yet have returned to their own positure after that this compression is caused.
This kind of Fracture is espied in the beginning, or in progress of time. In the beginning it is found out by the alteration of the colour of the Scull: The colour of a lively Bone is of a whitish colour, mingled with a lively ruddiness; but if it be mortified, it will be whitish without any redness: if it be carious or rotten, it will be of a livid or blackish colour. If therefore such a kind of Fracture happen, the pleasant ruddiness of the Scull will be gone, and white patches will appear in it, such as are seen in the Nails of some Persons Fingers. In process of time, if it be left untouched, it will become of a livid or blackish colour, being carious: In this kind of Fracture you are to take so much of the Cranium as is mortified by the [Page 348]Contusion with Raspatories, and then to heal the Wound by Incarnation. So much then of the three sorts of simple Fractures.
A compound Fracture is when some further inconvenience is annexed to the Solution of Unity in the Scull, as the loss of substance, or removing of some part of it from its own place.
Of this there are three sorts, Depressio, a depression, Concameratio, a vaulting, and Excisio, or an absolute division of some part of the Cranium from the rest.
A Depression is, when as the Scull is beaten down; in this kind of Fractures, shivers of the Scull are quite separate from the hole sometimes: Again, sometimes they cleave to the hole in one part, and are separate from the other. Those which are altogether separate, you shall remove with Levatories: If the fractured part cleave to the hole in one side, and if you cannot elevate it with a Levatory; then you are to apply the Trepan as near to the fractured part as you can, that as little as may be of the Cranium be taken away. Afterward either reduce the depressed part to its own place, or altogether remove it, as you shall think most expedient. In performing these actions, you are to use great caution, that the Meninges be not hurt by the sharp Splints of the Bones fractured.
Contameratio or vaulting is, when as the Scull by a sharp pointed Weapon with force being pierced, and with might being pulled out is pulled upwards, leaving an empty space or vacuity beneath. If this kind of Fracture go no further than through the first Table, you are to smooth the Scull, and to heal the Wound according to the Method set down before. But if it pass through the second Table, you must open the Scull in the most depending part with the Trepan, to make way for the discharging of the Quittour: for Sanies must of necessity be lodged in the lower vacuity, or void space, if the Weapon it self hath not made sufficient way: if any ruggedness prick the Dura Mater, you are to remove the whole Fracture, compassing it with a large Head of a Trepan, and then to cure the Wound as hath been taught.
Excisio is, when the part of the Scull wounded is altogether separate from the hole; if the fragment cut away stick to the Cutis Musculosa, and the Wound go no deeper than the first Table, it is to be separated from the Cutis Musculosa, and the Crantum is to be smoothed with a Raspatory: But if both the Tables of the Scull cleave to the Cutis Musculosa, they are not to be taken away, but to be reduced to their own place, the Wound having first been cleansed with Wine or Spirit of Wine warmed. Then the Cutis Musculosa is to be fastened to the rest, with so many stitches of four twists of Silk or Thread drawn through with a rolling Needle. See an Example of this in Parl. l. 9. c. 7.
A complicate Fracture is, when either sundry Fractures of one fort do concur, or more of divers kinds. Many Fractures of the same sort may happen, as sundry Chinks. So many Chinks as are perceived [Page 349]by the Eyes are to be dilated with Raspatories. In like manner sundry Fractures of divers kinds may meet, as a Chink with a depression. I [...] such complicate Fractures you are to proceed no other ways, than have been shewed in solitary Fractures; for a Chink is ever to be dilated if it be conspicuous, and the part of the Scull depressed must either be wholly taken away, I the Asperities of the second Table prick the Dura Mater, or if they do not, it is to be reduced to its own place, if it be not wholly separate from the sound parts of the Cranium, According to these Canons curative you may proceed hall Fractures of the Scull in what part soever they happen, if you except the Sutures, and that part of the Scull which lies under the temporal Muscle.
A Suture may suffer a Solution of Unity three manner of ways: by Separation, Depression, and Collision. Of a Depression I have spoken sufficiently already.
A Dissolution of a Suture is, when as those parts of the Cranium which are united by the Suture, gape, being separate by some external violence; if this separation be large, the Nervous Fibres, which make the Ligament by which the Dura Mater is tied to the Pericranium, must be torn, tho this appear not to the sight: from whence often ariseth Inflammation, and danger of death.
A Collision is a Contusion of the brims of the Suture, and of the Ligament which passeth through it, caused of a violent compression of the brims of the Suture. In these Cases if fearful Accidents, as a Fever, Vomiting, or a Convulsion, &c. do perswade you that the Scull must be opened, then you are to apply the Trepan on either or both sides of the Suture: for if you should set it upon the Suture, horrible Symptoms first would appear, and at last death ensue.
If a Fracture under the temporal Muscle be accompanied with a Wound, this Wound is either a Puncture, or an Incision, transverse, or according to the length: if it be a puncture, or transverse, it must prove dangerous, as hath been shewed. If the wound be inflicted long ways, it is to be dilated by Dosils or Sponges: If the Fracture be a Chink, it is to be dilated by Raspatories. But if it be a great Fracture, wherein the Asperities do prick the Meninges, or the depression of the Scull bears down them by its weight, then a triangular Incision is to be made a little above the Fractures, shunning the temporal Muscle, and the Trepan to be applied; then the shivers which are altogether separate from the sound Scull, are to be taken away, and the rest which are not separate to be reduced to their own positure.
After this, as often as you dress the wounded person, you are to cause him to bend down his Head, to stop his Mouth, and Nose, and to labour to breath strongly, that the Sanies may be expelled out of the Wound. When this is done, you must make Injection of a mundifying Decoction with a Syringe to wash out all impurities, which otherwise would lodge there. See a memorable Example of this in Parey, lib. 9. cap. 19. He [Page 350]advises to keep a leaden Pipe in the Wound, but seeing this by reason of the hardness must cause pain, and is not fit for the dilation of the Section, a Sponge compressed is far better: for first it is soft. Secondly, it sucks into it self the impurities: Thirdly, it dilates powerfully the Wound, and keeps it open untill the shivers of the Cranitan cast.
CHAP. XXII.
Of Fractures in other than in the place wounded, and those which happen when the Cutis Musculosa is not wounded.
IN the last Chapter I discoursed of Fractures, which may fall out in the parts wounded: now I am to shew, how Fractures in other parts than those which are wounded are to be handled, when they fall out.
Now Fractures, which fall out in the Cranium in another part than that which is subjacent to the Cutis Musculosa wounded, are either in a part of the Cranium adjacent to the Solution of Unity of soft parts of the Scull wounded, or in a part somewhat distant or remote.
If a Fracture fall out to be not in the part wounded, you shall find it out by these seven Signs. First, the Wound of the Cutis Musculosa, which covereth the Fracture, will not admit Cure in that part which is near the Fracture, whereas in the other parts it will admit Cicatrization. Secondly, out of the part near to the Wound, you shall perceive a thin and ichorous Matter to flow. Thirdly, more copious Matter will flow out of the Wound, than the bigness of the Wound can seem to afford. Fourthly, the Flesh which grows near to that part is spongy and loose, not firm. Fifthly, now and then the party wounded will be feverish. Sixthly, if you thrust your Probe between the Cranium and the Cutis, you shall find the Cutis separate from the Cranium. Seventhly, some tumor and softness will appear in the cutaneous part, which is placed above the Fracture.
A Fracture in a remote part, or much distant from the wounded part, is called Resonitus, or Contra-fissura, a counter-cleft: This falls out, when the Cranium is stricken upon one part, and fractured in another: This happens [Page 351]other in the self-same Bone, or in fivers Bones: If in the self-same Bone, it may fall out two manner of ways; to wit, either laterally, a when the right side of Os Frontis is beaten, and the lest side cleft or contrariwise; or perpendicularly from the upper to the lower part, as when not the upper Table which received the blow, but the lower is fractured. If a counterclest happen to be in civers Bones, this may fall out two manner of ways: First, if the right side be beaten, and the lest fractured, as if the right Parietal receive the blow, and the left be deft; or contrarywise. Secondly, this may happen, if the forepart be stricken, and the hinder part cleft, as if the Os Frontis be beaten, and the Os Occipitis be cleft, and contrariwise. This kind of Fracture which happens in the Cranium in a part opposite to the Solution of Unity, doth chance to to those, who either have no Sutures at all, or such as are very obkure and very close; for in such persons the Air may be carried more compact, and with greater nolence from the part contused, or wounded, to the opposite part: for when the Air which is within the Scull is strongly moved by a blow, and on every side is driven by the force of the blow, it is entirely carried through the substance of the Brain to the opposite part: when it meets with the Scull, which by reason of its firmness cannot yield, causeth a Fracture in the Scull; even as two men in a violent race meeting together are by this violent meeting beaten back. This is often seen in a Glass, which being knocked in one side is cleft in the opposite part.
That the Sutures are not uniform, these Authors bear witness: Vesal. lib. 1. c. 6. de human. corp. fabricâ. Sylv. comment. in lib. Galen, de ossib. Columb. lib. 1. c. 5. Par. lib. 4. c. 3. Hippoc. lib. de vuln. cap. & Fallop. in eund. c. 5. & in lib. Galen. de ossib. c. 13. That Sutures again are either hardly seen, being obliterate and worn out, or not at all, these Authors do affirm, Arist. de histor. animal. lib. 3. c. 7. Cels. lib. 8. c. 1. Aley Benedict. anatom. lib. 4. c. 7. Velsal. lib. c. 6. and Hippoc. and Fallop, in the place before specified.
And although Paul. Aeginet. lib. 6. c. 90. and Guido with others more, deny that a Resonitus or Contra-fissura can happen; yet these Authors against which it were temerity to except, do affirm that it may happen, Cel. lib. 8. c. 4. Nicol. Florent. Sermon. 7. Summa. 2. tractat. 4. c. 1. Valeriola append. loc. commun. c. 5. Hippoc. lib. de vulnerib. cap. Fallop. commentar. in eundem. c. 14. Par. lib. 9. c. 8. Although it be a hard Matter to find out this kind of Fracture, yet you shall go about to find it out by these means. First, if signs of a Fracture do appear; as a Fever, vomiting of Choler, and such like, and no Chink appear in the wounded part, then you are to take a view of the opposite part. If a Tumor or Softness do appear in any part of it; then you may be assured that the Fracture is in the Scull, subjacent to that part. Secondly, if no Tumor or Softness appear in the opposite part, shave the Head [Page 352]and apply this Emplaster following, ℞. Pic. Naval. & Cer. an. ℥ iij. terebinth. ℥ j. Mastich. & irid. pulverizat. an. ʒ ij. fiat Emplast. s. a. Draw this Emplaster upon Leather, and apply it to the opposite part, and let it lie 24 hours. If after you have taken it away, the Cutis musculosa appear in any place more moist, soft, and swelled than the rest of it is, it is likely that there the Fracture is. Thirdly, if the grieved person do often touch with his hand the part opposite to that, wherein the solution of unity is, not thinking upon any hurt done to it, you may suspect that the Fracture is where he toucheth. If the Second Table be fractured, the first remaining whole, then you must apply the trepan, partly that you may come to take away splints, which do prick the Dura mater, partly to make way for the discharging of coagulate Blood, and the Sanies. If any Patient having such a Fracture do die, the Chirurgeon is not much to be blamed: for a Chirurgeon may be excused, if the Patient die, in Four cases. First, if the Cranium by a violent Contusion be depressed, and the Scull presently return to its own place. Secondly, if the chink be only capillar, and hard to be seen. Thirdly, when the Second Table of the Scull is broken, the First remaining whole. Fourthly, when a Fracture happens in the part opposite to that which is wounded. In these cases the Chirurgeon may be excused, seeing the most skilful Artist may be deceived in these cases. If you find out a Contra-fissura, if it be but a meer Rima or chink, after you have made incision through the soft parts lying above the Cranium, dilate the chink with the Raspatories, that way may be made for the discharging of the coagulate Blood and Sanies: for these will be gathered, out of all doubt, in all chinks.
I have shewed how Fractures in a Wound happening in persons of ripe age are to be cured: now I am to shew you how Fractures in the Scull are to be cured, when as the soft parts above the Cranium are not wounded; yet the Cranium offended. If therefore by a contusion the Scull be fractured, the Cutis musculosa not being divided, you are to ask of the party offended, whether he hath vomited choler, whether he lost his sight, whether he could not speak, whether Blood did issue out of his Nostrils, and Ears, whether he seemed to be in a trance, whether he perceived a giddiness after the blow these Symptoms do shew that there is a Fracture. And although no accidents do discover themselves, yet you must not be secure, but ask whether the Patient in former times hath not had the Head-ach, for then there is less danger, or whether he was struck with a heavy weapon, by the hand of a strong man enraged, or whether he felt a noise in the Brain when he was strucken? If these signs appear, you must suspend your Prognosticks towards the best event. In this case so you are to go on. If no fearful symptomes after the blow received do continue; then shave that part of the Head where the blow was received: Then apply a Medicament which asswages pain; dries, and is astringent: These Intentions [Page 353]a Cataplasin furthereth made of Barley-meal, Vinegar and Water in the Summer, but Vinegar and Wine in the Winter, having added the powder of red Roso, Myrtle-berries and Mastick, and some Oil of Roses, when the Cataplasm is brought to a consistence: Secondly, you must minister a Medicament which doth purge Choler, as this: ℞ Caryocostin. & Elect. de succo ros. an. ʒ ij. Syrup. de Cichor. Cum. Rhab. ℥ j. Aq. Endiv. ℥ij. Misc. ut paretur potio. Thirdly, the cephalick Vein of the same side is to be opened, or Cupping-glasses with scarification, or Leeches to be applied. Fourthly, Oil of sweet Almonds is to be dropped into the Ears, that the Quittour which is gathered there may be discharged. In like manner the passages of the Nose are to be moistned with this same Oil. About the fourth day you are to use Gargarisms made of the decoction of Barley, red Rose-leaves, Cowslipflowers, Betony-flowers, Eye-bright Stoechas, and some Rue: With the decoction you are to mingle Mel rosatum and Oxymel simplex. About the seventh day you are to use discutient Medicaments, as Diachylon ireatum, or Emplastrum de Betonica, made soft in the Summer with Oil of Roses, and in the Winter with Oil of Dill. If having used these means, fearful Symptomes do appear after the 7th day you must not deferre the incision of the Cutis musculosa, and the opening of the Scull: for then it is not to be doubted but that Blood and Quittour are fallen upon the Dura mater.
Although the soft parts above the Scull be not divided, yet in three cases you must make incision, and open the Scull. First, if clotted Blood or Quittour be lodged between the Cranium and the Dura mater, which you shall perceive, if Blood did issue out of the Ears or Nostrils, after the blow was received, if he be sleepy, stupid, or have a heaviness of the Head. Secondly, these things are to be done when splints of the Scull do prick the Meninges, which the pain in the part doth discover. Thirdly, when a depression of the Scull remaining, bears down the Meninges, and causes a stupidity, and a pricking pain, when the party blows his Nose.
CHAP. XXIII.
Of Wounds of the Meninges and the Brain.
HAving delivered unto you in the last Chapters the method of curing those Wounds which may befall the external parts containing of the Head; now I intend to shew you, how Wounds in the internal containing parts, and the contained parts are to be cured.
The internal parts containing are two; the two Meninges, or Membranes, which compass and environ the Brain called by the Arabians Dura & piamater. In wounds of the Dura mater, there is alwaies a vehement pain. Five inconveniences may happen to the Dura mater, to wit, a Wound, Pain, Inflammation, Apostemation, and Discolouration.
If you perceive that there is an immoderate flux of Blood, the Membrane being wounded: then immediately you must make way to come to the Membrane, if the wounding instrument hath not made way enough; and Galen's powder set down 6. Meth. Medend. made of Aloe, Frankincense, Mastick, the white of an Egg, and the Down of a Hare is to be applied.
If in a puncture of the Dura mater or after unskilful dressing drowsiness and sleepiness seize upon the wounded party, death shortly will ensue. See Dodon. ebserv. medic. cap. 3. Now seeing great pain follows the Dura mater being wounded, you must with all expedition go about to asswage it.
In this case first Narcotical Medicaments have no place: for so both the Membrane it self, and the whole Body would become stupefied; Secondly, unctuous Medicaments which mollifie are not to be used; because these will cause the Membranes to become dull, to swell, and last of all to putiefie. Wherefore Oil of Roses warm is to be poured upon the Membrane, until the pain be mitigated, and Quittour appear in the Wound. Then Mel resation, or Syrupus è Ros. Rub. Siccat. are to be mingled with Oil of Roses, in equal quantity, until the Wound be perfectly digested. Last of all, the Dura mater is to be mundified and dried with fit Medicaments. Such are Mel rosatum, Syrupus è Ros. Rub. Sice. Syrupus Myrtin [...], or Sanativus alone, having no Oil mingled with them. And although the Pia mater, by reason of its softness, may be united and aggletinated; yet the Dura mater, because it is hard, nervous and thin, will not admit agglutination: for in agglutination the brims of the wounded part must be brought [Page 355]and kept together, which is performed by rolling and stitchings, which in this case cannot be used. Wherefore it must be cured by Incarnation, or procuring of flesh to unite the parts dis-joyned.
An Inflammation is a red Tumor of the Dura mater with a distention of the vessels of the s [...]me, so great sometimes, that it fills the hole of the Cranium, and grows above it. This accident is dangerous.
Wherefore, First of all, Phlebotomy is to be administred, and a slender Diet appointed: then the part is to be fomented with a decoction of Marsh-mallows, Linseed, and Fenugreek, adding groundsell, and Violet-leaves, as also other Herbs which are to be applied to a Phlegmon, if occasion shall require. This being done, the Oil of Roses, Myrtils▪ or Quinces is to be applied. If you prevail not by the application of these means, but you perceive that the Tumor rather increases than diminishes, then you are to dilate the Scull, by taking away more of it.
If Quittour be contained within the Dura mater, which you shall perceive by the extraordinary whiteness of some part of it, as in pustles of the Skin, then you are warily to open it, that you in no ways touch the Brain. Then you are to apply drying and abstersive Medicaments, as Mel. rosation, & Syrupus è Rosis siccis. Vide Fallop. Comment. in lib. Hipp [...]c. de vulnerib. cap. c. 43. & Parae [...]on lib. 9. c. 21.
Discolouring or blackness may proceed from five causes, viz. From the violence of the Contusion; From coagulate Blood; From the coldness of the Air; By the application of unproper Medicaments; Last of all, from Putrefaction.
If the blackness proceed from the violence of the Contusion it seldom continues above four daies. In this case use Oleum rosacetom, and Mel rosatum; or the Oil of Eggs, with a little Aqua vitae, and some of the Pulvis cephalicus, with a few grains of the powder of Saffron.
If congealed Blood hath caused a blackness, then apply this Medicament: ℞ Aq. vit. ℥ ij. Pulv. Gran. tinctorum. ℥ ij ss. Croci. ℈ j. Mellis. Ros. ℥ ij ss. Sarcocoll. ʒ. iij. leniter bulliant omnia: colaturà utimini donce evanuerit nigredo.
If unproper Medicaments have caused the blackness of the Dura mater, then it is to be cured by the application of such Medicaments as are in faculty contrary to those which have been applied; so if humid; unctuous, or fatty Medicaments have been used, you are to change these, and to apply those which are drying, as the Cephalick powders mingled with Mel rosation, Oleum rosation, or both mingled together. If sharp Medicaments have been applied, instead of these, mild and lenient Medicaments are to be used, as the Oil of H [...]pericum, or of Earthworms, with a little Saffron: for it is certain that moist Medicaments may cause blackness by increasing filth; and sharp Medicaments by their immoderate heat, may cause the same.
If blackness proceed from putrefaction, which you may discern [Page 356]by the strong scent of the Sanies flowing from the wounded part, then use these Medicaments which follow: ℞ Aq. vitae ℥ i ss. Syrup. Absrnth. & Mel. Ros. an. ʒ lj. Ʋnguent. Aegypt. ʒ ij. Sarcocoll. Myrrh. Alees an ʒ j. Vini albi potent. ℥ j ss. bulliant omnia leniter, colentur, ac serventur ad usum. It. ℞ aq. Plantag. ℥ j. unguent Aegyptiac. ʒ i ss. praecip. Mertur. ℈ i. Mise. applicetur istud Medicamentum calefactum post agitationem. If by these means the putrefaction cease not, but persevere, and the Tumor increase and grow above the hole of the Scull being immoveable, black, and dry; If the Eies of the Patient appear of a fiery colour, bunch out, and be still moving; if the party still tosseth and tumbleth himself in his Bed, and rave, the sick person will die, and the sooner if these Symptomes continue constant and uniform. This must of necessity ensue, both by reason of the. extinction of the natural heat, and likewise the Gangrene of a noble part: Vide Fallop. loc. cit. c. 41. & Par. lib. 9. c. 21.
The Pia mater is very thin, and cleaves so fast to the Brain, that it cannot be wounded, unless the Brain also be offended. Wherefore such Wounds for the most part are deadly; for the Brain being laid open unto the Air, easily is corrupted, by reason of the external cold, which extinguishes the weak heat of the Brain, and by reason of the moisture which both falls upon the Brain, and is gathered in the substance of the Brain it self, by reason of its weakness.
First then, if any memorable flux of Blood happen by reason of the multitude of Veins which are in the Pia mater, it is to be staied with Galen's Medicaments set down by him. 5. Method. cap. 4. whereof I have spoken heretofore. Then the part is to be cured with Medicaments warming and drying, which I have sot down in the cure of the Dura mater wounded.
Now Wounds which happen in the parts contained in the Head, are to be handled: These are two, Cerebrum and Cerebellum. To the Brain these griefs may happen; a Wound, Apostemation, Putrefaction, Sideration, a Concussion, a Fangus, and a Tumor by reason of Flatuosity.
Now as concerning Wounds of the Cerebrum, or Brain, these five points may be demanded: First, which are the signs of the Brain wounded? Secondly, what Symptoms do ensue? Thirdly, whether Wounds of the Brain be curable or no? Fourthly, how they are to be dressed? Fifthly, what Symptomes usually remain after that a Wound of the Brain is cured? Of these I will speak in order.
As concerning the First, the signs of the Brain wounded, are these which follow: First, a Fever, and vomiting of Choler. Hippoc. Aphor. lib. 6.50. saith, if any have the Brain wounded, they must have a Fever, and vomiting of Choler. The same he repeats, Coac. praenot. 500. & 507. This same Celsus delivereth in most cloquent words lib. 8. cap. 4. Secondly, loss of Speech. Hippoc. Sect. 7. Aphor. 58. They who have suffered a vehement Concussion of the Brain, immediately [Page 357]become dumb. Thirdly, a fall and slumbering. Coac. praenot. 499. Fourthly, Sensleiness, dimness of the Sight, Giddiness. 2. Prorrhet. & lib. de vulner. cap. Fernel. lib. 7. Pathol. c. 8. hath these words: If the substance of the Brain be hurt, the Reason becomes weak, and all Symptomes increase, and oftentimes a portion of the Brain comes out, not without danger of life. Fifthly, you shall pronounce the Brain to be wounded, if the Meninges being divided, a substance like to fat come out; which not withstanding doth neither swim above the Water, neither doth melt with the Fire, as fat doth. See Parey lib. 9. cap. 22. Sixthly, if the Bram be hurt, the Quittour will be thick, round, and like a Marrowy substance.
As concerning the Symptomes which ensue, the Brain being wounded, these are they; Foaming at the Mouth, Darkness of the Sight, Giddiness, a Convulsion, a Fever, Vomiting of Choler, Stupidity, Loss of Reason, Deasness, Dumness, a Palsie, a Lethargy, and last of all, an Apoplexy.
As for the third demand, all wounds of the Brain are dangerous at the least, and that for these reasons. The First is the Nobleness of the part, and the necessary use of the Functions of it. The Second is Motion of the Brain; but a wounded part requireth Rest, if it be to be cured. Hip. l. de Ʋlcerib. circa principium. The Third is the Humidity of the Brain; but the cure of Ulcers and Wounds is performed by Exsiccation, according to Galen, lib. 4. Meth. Med. c. 5. The Fourth is the Coldness of the Brain, which engendreth many Excrements, and the more when a wound happens which weakneth the part. The Fifth is the Consent of the Nerves which spring from thence. The Sixth, because Remedies pass not readily to the Brain wounded. Three causes may be alledged, why some persons escape sometimes, having received great wounds in the Brain. The First is, the wholsome and strong Constitution of the Body. The Second is, the artificial dressing of the Wound. For as sundry recover of great Wounds, if they be dressed according to Art; so many die of small Wounds, if they be negligently or ignorantly dressed. Thirdly, such strange events are to be ascribed to the providence and mercy of the Almighty God, who of his infinite Goodness by his secret Judgment prolongeth the lives of some, as he shortneth the days of others.
Although all wounds of the Brain be dangerous, for the reasons which I have alledged, yet great and dangerous Wounds have been cured. That this assertion is true, I will prove by the Testimonies and Experiments of famous Writers, both Ancient and Modern. Amongst the Ancients, Galen shall be the Ring-leader: He then writing upon the 18th. Aphorism of the 6th Book of Hippocrates, affirms that he saw one healed who had a remarkable wound in the Brain, in Smyrna of Ionia, while his Master Pelops was alive; he affirms this indeed to be very rare, l. 10. de usu part. He makes mention in like manner, of a young Man, who recovered when he had [Page 358]received a wound in one of the fore Ventricles of the Brain. Paulus Aeginaet lib. 6. c. 88. affirms, that sundry have escaped death, and have recovered their health, when they have been wounded in some principal part, above all expectation. Christophorus à Vega, Comment. in Aph. 15. lib. 6. Hippocratis, hath these words; ‘Wounds of the Brain, if they reach to the Ventricles, they are not cured; but we have seen many others cured, which passed to the substance of the Brain, and out of which some portion of the Brain came out.’ Herat. Augenius l. 9. Epist. 2. writes thus; ‘We saw once the whole substance of the Brain wounded, and the Ventricles cut asunder, and that a portion of the Brain came out of the wound as soon as it was made, and that notwithstanding the party was cured.’ The cause of this event was the strength of the Body Gem. ma l. 1. c. 6. Cosmog. saith, It greatly concerns Physicians to note, that even weak persons sometimes escape of grievous diseases, wherein the signs threaten imminent danger. So lately, an ordinary person was by our help healed, when as a shiver of the Scull passed through the Meninges, and some of the substance of the Brain came out. Joan. Andreas à cruce, l. 1. Chirurg. c. 14. a Venetian affirms, that he cured sundry whose Brains were wounded, and names sundry witnesses. Fallop. c. 45. de curatione vulnerum c. hath these words: ‘A great portion of the Brain may come out, and yet life remain: Wherefore forsake not the wounded persons, for I my self have made trial of strange things.’ Carpus tractatu de fracturâ cranii affirms, that he saw six persons who recovered, when as a notable quantity of the Brain came out of the wounds, and that They only deny such good events who have seen but a little. Brasavola in comment. ad Apher. 18. l. 6. Hippocratis, affirms, that he saw two who escaped after that their Brain was wounded. Nicol. Mass. com. 2. Epist. 11. hath these words: ‘I take God to witness, and many yet alive can witness, that I have cured sundry by convenient Medicaments and Art, whose Sculls, Membranes, and Brains have been wounded,’ and immediately he nameth sundry. Theedoricus lib. 2. cap. 2. Chirurgiae, affirms boldly, that he was as sure that wounds of the Membranes, the substance of the Brain and Ventricles may be cured, as he was of death. Volober. Coit. lib. Observ. Anatom. & Chirurgiear. brings sundry instances that wounds of the Brain may be cured. The like hath Iacotius Comment. ad Apher. 3 lib. 1 Sect. 3. coac. Hippocrat. Peruse also Arcaeus lib. 1. cap. 6. who doth alledge four examples of this truth; And Ambrose Parey, lib. 9. cap. 22. alledgeth some. And, Gulielmus Fabricius Observ. Chirurg. Cent. Observ. 13. sets down four. The Testimonies and Experiences of so many famous Authors may perswade any man, not contentious, that wounds of the Brain sometimes have been, and yet may be cured, or else none will.
Seeing I have laboured to perswade you, that the wounds dividing [Page 359]the substance of the Brain it self, may be cured; I think my self bound to acquaint you with the means, by which so dangerous a Cure is performed; which was the fourth point which I set down to be discussed concerning wounds of the Brain. Joan. Andreas à cruce Chirug. l. 1. c. 14. Until the 14th day be past, he will have Oil of Turpentine, and Spirit of Wine to be applied: then he will have the Wound to be filled with this Liquor following: ℞ Vim Montan. ℥ xx. sucet Beton. ℥ iiij. sucei Calaminth. ℥ ij. Myrrh. Oliban. Aloes, Sang. Dracon. Centaur. min [...]r. Semin. Hyperic. an. ʒ j. conumdead. contusis, macerentur omtia in vase probè occluso: tum lento et claro igne exhalet tertra pars, accoletur decoclum, cui admisce spir. Vici. ℥ vj. Ol. Terebinth. ℥ iiij. Reponatur Medicamentum in vase [...]trco probè obturato. Above this Liquor apply Pu [...]is Cephalicus, and cover all with some fit Emplaster, Coiter. l. Observ. Anatomic. & Chirurg. counselleth to foment the Brain with a convenient Decoction: such an one is this which is made of Betony, Calamint, St. Johns-wort, Chamaemil, Dill, Eyebright, &c. boiled in red astringent Wine. The Wound he will have to be dressed either with the natural, or some good artificial Balsame, whereof I have spoken sufficiently before. Fall. Comm. in Hipp. de vuln. cap. c. 45. will have Oil of Roses mingled with Oil of Turpentine to be poured into the Wound; and that not without cause, for the Oil of Roses is Anodyne, and the Oil of Turpentine warms and dries. This Medicament he will have to be applied until the 7th day be expired; about which time most commonly appears a sequestration of the corrupt portion of the Brain from the sound. If the substance of the Brain, it being wounded, seem to be of a livid colour, and a stinking Sanies flow from the Wound, then those Medicaments which are dry and warm, are to be applied, such is this which follows: ℞ Mel. Ros. & Ol. Ros. an. ℥ j. Aq. vit. ℥ ij. Misc. When the Wound yields a laudable Quittour, then the Oil of Roses is to be admitted, and only Mel. Resar. or Srrupus Myitinus, or Syrupus è Ros. Rub. siccatis, mingled with Aqua vitae, are to be used. As it is an evil sign if the substance of the Brain be of a livid colour; so if the portion which must be separate, represent whitish Hailstone, and have not a very stinking smell, it sheweth that Nature is strong. Huron. Fab. ab aq. pend. part. 2. Claring. oper. lib. 2. c. 20. delivers this Medicament as an experiment of his own: ℞ Farin. Milii ℥ ss. Ol. Hispani ℥ j. Mithridat. ℥ vj. Balsami nigri navalis ʒ iij. Aq. vit. ʒ v. Ol. de Chalcantho ʒ i ss. Misc. This is undoubtedly a good local Medicament, because the ingredients powerfully dry and resist putrefaction.
This Medicament I dare commend unto you: ℞ Balsami nig [...]i, Vernicis alb. & Ol. Hyperic. [...]bicundi facti ex mnltiplici infusione florum Hyperici an. ℥ ss. Misce. This Topick will warm, dry, resist putrefaction, and hinder the entring of the Air.
Now the fifth point concerning [Page 360]wounds of the Brain is to be touched, which is to shew what Symptomes remain most commonly after that a wound of the Brain is cured. These then are they; The faltring in Speech, and a Palsey in the Arms. Joan. Andr. â Cruce Chirurg. lib. 1. c. 14. Deafness, Par. lib. 9. c. 22. Decay of Memory, Stupidity, and a weak judgment. Coiter. lib. Observ. Anatom. & Chirurg. Et Fallop. lib. praedict. cap. 45. Brassavol. ad Aph. 18. lib. 6. Aphor. Hippoc. The yellow Jaundice. Ar. lib. 1. c. 6.
The Second inconvenience which doth happen unto the Brain, is an Apostemation. That this may happen, these under-written Authors do affirm; Valeriol. lib. 3. Observ. 8. Coiter. in Observ. Anatom. in Chirurgicis. Fernel de lue Vener. c. 7. Par. lib. 9. c. 8. And although most Authors do pronounce this event to be desperate; yet Arcaeus lib. c. cap. 6. relates of one, upon whose Head a stone of a Cubit in breadth and length, and in thickness twelve Inches, but in weight four and twenty lb. fell from the Engine, as it was hoisted up to the building of a Tower in Valverda, and bruised, depressed and shivered the Scull: when this Patient had lain desperate seven dales, the eighth day three Apostemes brake out, and within the space of four Months the party was perfectly cured, and afterward was married, for then he was but a young Man.
Putrefaction and Sideration are deadly Symptomes, which are not discerned but by opening of the Scull, and that for the most part when the party is dead.
The first accident which happens to the Brain is a Concussion or a commotion of the Brain: If it be vehement, it is alwaies dangerous, and sometimes deadly: If the commotion be violent, the party becomes speechless, according to Hip. lib. 7. Aphor. 58. where he saith; They who have suffered a strong Concussion of the Brain, must of necessity become dumb: read Galen in his Commentary upon this Aphorism. It is no other way to be dressed than a Fracture, when the Cutis Musculosa is whole. Guliel. Fab. Obs. Chi. rurg. Cent. 1. Observ. 7. in this case anoint the whole Scalp with Oil of Roses and Myrtils mingled together: open a Vein in the Arm, and inject sharp Clysters. After that a Concussion is cured, sometimes impediment of Speech, and Forgetfulness, may remain during the residue of Life, as witnesseth Parey, l. 9. c. 22. He will have Blood to be drawn plentifully out of the Cephalica vena, according to the strength of the wounded party, to asswage the Symptoms present, and to prevent the coming of more grievous. The Head he will have to be shaved: then he adviseth to apply a Cataplasm made of things cold and moist, as a Cataplasm of Barley-flower, Oil of Roses and Oxymel. Those Medicaments which are very astringent, as Ʋnguentum de Bolo, &c. are not to be applied, because they hinder the breathing of the fuliginous vapours thorow the Sutures, and other places of the Scull; and so they are so far from hindring of an Inflammation, as that they increase it, if it hath seized upon the [Page 361]part already, and bring one, if there be none: sharp Clysters he will have too injected to draw sharp Vapots from the Head, and to binder the ascent of them to the same, and the Vein of the Forehead, and those which are under the Tongue, to be opened after the second day, if Blood abound. He adviseth that strong Frictions be used downwards, and that Cupping-glasses be applied to the Shoulders. He will have the cooling and moistning astringent Medicaments to be used; of which Medicaments I have set down sundry forms oftentimes heretofore. If you apply discutient Fomentations, then see that you heat not the Head too much, lest you cause Pain and Inflammation.
The fifth inconvenience which may happen after that there is a Solution of Unity in the Brain, is a Fungus, or the Mushrome of the Brain.
This is a Tumor sometimes hard, without Blood, and of small sense; sometimes soft, of an exquisite sense, and of an ill smell, beneath narrow, and above broad, a kind of a malign wart growing of the glutinous and thick Humors which are half rotten, congealed in the part, partly by reason of the Air, partly by reason of the coldness of the Scull, the Scull being opened, and the Brain wounded: even as Mushromes grow upon Trees by a Juice which doth sweat through the Bark, Galen, lib. 1. de loc. affectis, doth make mention of this Symptom; & lib. 3. Ep. saith, that those Excrescences which grow in Wounds, and are called Fungi, are caused by the thickness of the Humor issuing from the affected parts.
Although it fall off of it self sometimes, which Coiter. lib. Observ. Anatom. & Chirurg. affirms that he saw the Flesh growing under it, depriving it of nourishment, yet if it increase, as it often doth, even to the bigness of an Hens Egg in one Night, as happened to Guliel. Fabric. as he witnesseth, Observ. Chirurg. Cent. 1. Observ. 15. you must go about to remove it with Medicaments, which strongly dry, and mildly fret; such are the Powder of Savin, Ocre, Hermodactyls burned, the Juice of Purselain; Powder of yellow Turbith, warily applied, surpasseth all these. If it grow above the Cranium about the bigness of an Hen-egg, then with a strong Ligature you are to bind it, to procure the fall of it; then that which remains is to be consumed with the means above specified. Beware that you use no strong Cathaeretical means. See Par. lib. 9. c. 19. Gulielm. Fabric. cured the Fungus, which happened to his Patient, within the space of fourteen days, with a Fomentation, and a Powder. The description of the Fomentation is this: ℞ Flor. & Folior. Beton. Salv. Chamaemil. Melilet. Aneth [...], Ros. fol. Major. Rorisinar. an man. [...]. semin. Anis. & Faenugr. an. ℥ j. coq. ista lento igne in aq. font. & vini rub. astringent. an. lb iv. ad consumptionem lb iv. deinde coletur decoctum. The description of the Powder is this: ℞ Rad. Caryophyllat. Angel. Calam. aromat. an. ʒ ss. rad. Aristol. rotund. Irid. [Page 362]Guajaci. an. ʒ ij. Salv. Rorismar. Major. an. ʒ ss. fiat ex omnibus pulvis.
The seventh and last Accident which happens when the Brain is offended, and the Scull fractured, is a flatuous Tumor. Of it Guliel. Fabricius in the place aforenamed so discoursed: A Tumor may be caused like to a Fungus of flatuosity. If the weak heat of the Brain go about to concoct the Matter in and about the Wound, it doth raise up flatuosity, and seeing it can breath out through the Pia Mater, it doth puff it up; For, I observed (saith he) that in all those in whose Wounds a Fungus grew, that the Pia Mater was whole, and only the Dura Mater torn; for when the Dura Mater is divided, Nature out of hand goeth about to engender Flesh upon the Pia Mater, to defend it from the Air: wherefore, if superfluous Humors and Flatuosities gather about the Wound, they lift up the Pia Mater and this Flesh, so that a Tumor like to a Fungus is caused: so he.
If you demand how it is to be cured? I answer, that the Fomentation and Powder, set down by him to cure a Fungus, will serve.
Now to put an end to my Discourse, concerning Wounds of the Hairy Scalp, seeing I have made mention of sundry Symptoms which ensue upon them; I will set down the Causes of the chiefest of them, and so conclude.
Of these, the first is a Fall; this hath two Causes: The first is the violence of the Instruments which do wound: The second is the privation of the faculty of moving, with the which Instruments of moving ought to be endowed.
The second Symptom is a Vertigo, or giddiness: this proceeds from the Circulation, or Circumvolution of the animal Spirits; so when the Clouds are driven, the Sun and Moon seem to move swiftly.
The third is dimness of Sight: the cause of this also is the dissipation of the animal Spirits.
The fourth is Slumbring: the cause of this also is the dissipation of the animal Spirits; but it must be both greater, and more durable than in dimness.
The fifth is Vomiting: this is caused by the communion of Vessels; for the Brain being troubled, the affection is communicated by the Nerves of the sixth Conjugation, which proceeding from the Brain, are dispersed through the whole Body of the Stomach. So the offence being communicated to the Stomach, it is drawn inward and pursed, and turned upwards: from this Inversion of the Stomach; first, those things which are contained in the capacity of it are rejected by vomiting; then those Humors which are drawn from the Liver and the Cystis Fellis; and seeing Choler is most light, it offers it self first, and is first expelled.
The sixth is a Fever; this is caused by an Inflammation, which hath seised upon the wounded part. This being communicated to the Heart by the connexion of the Arteries, it is sent from thence [Page 363]to the whole Body by the same Vessels.
The seventh is Torpor, or Stupidity; this is caused of ill Vapors, which by reason of Putrefaction, or some other ill quality, assault the Brain, and dissipate the animal Spirits.
The eighth is a Convulsion: this is caused of corrupt Vapors, which nip the beginning of the Nerves, which either a putrid or malign Matter hath sent out: in this case the Neck, and the whole Spinalis Medulla, is to be anointed with a convenient Medicament, such as this: ℞ Rut. Marrub. Rerismar. Ebuli, Salviae, herbae Paralysis an. man. ss. Rad. Irid. Cyper. Baccar. Lauri an. ʒ j. flor. Chamaemel. Meliloti & Hyper. an. pug. 1. Macerentur haec per noctem in vini potentis, lib. vj. deinde coq. cum Ol. Lil. albor. Lumbricor. & Terebinthin. axung. anser. & human. an. ℥ iij. ad consumptionem vini, igne lento, postea instituatur colatura, cui adde Terebinthinae Venetae ℥ iij. aq. vit. ℥ j. cerae flavae ℥ ij.
The ninth is a Palsie; this happens, when as by a Matter kept in the part offended, the Brain and the beginning of the Nerves are so affected, that all motion is taken away.
CHAP. XXIV.
Of the cure of Wounds of the Face.
HAving, delivered unto you, with what diligence I could, the Cure of the Hairy Scalp. Now I am to shew you, how Wounds happening in the parts, which are not so garnished with Hair are to be cured. These are two, to wit, the Face, and the Instruments of the Senses: By the Face I mean Skin, Membranes, Muscles, and Vessels of the fore and lateral parts of the Head.
And although that might suffice for the curing of Wounds of the Face, which I delivered in the documents concerning the curing of simple Wounds: yet because the Face hath two prerogatives above all other, which are not more principal than it self; it will not be amiss to speak somewhat of the Wounds of it in particular.
For the Face, first of all, is the seat of Comeliness and Beauty. Secondly, it is the surest mark by which one is discerned from another. Seeing then the Face doth afford unto the beholders of it such contentments, you ought to have a special care that you leave no foul cicatrix. after the cure of the [Page 364]Wounds of it, if you be called to cure them.
Wounds of the Face are two-fold; for in them either the soft parts only are wounded, or the Bones also. If the soft parts only be wounded, then they are wounded either according to the length, and the rectitude of the Fibrae of the Muscles and Skin, or they are wounded transversly.
If the Wound of the Face be according to the longitude, the brims of it are to be brought together by a convenient ligature, and glutinative Medicaments, refraining from stitching with Needles, for when we use Needles, new Solutions of Unity are procured, and so new Scars, and the Thread doth transversly cut the Skin, and causeth an ill favoured Cicatrix, if it be not speedily taken away; besides pain is caused.
As for rolling, the Roller must not be broad, but narrow, and with two ends, that by sundry circumvolutions, it may the better bring the brims of the Wound together.
As for glutinative Medicaments, or dry stitching, as they are termed. I will commend unto you two.
The first is an Emplaster, the description of it is this: ℞ Colophen. Pic. Naval. & Cerae an. ℥ ij. T [...]reboith. ℥iss. Mastich. Thur. farin. volat. cale. vivae an. ʒ ij. fine emplastrum secundum artem.
The second is a Powder, and it is this: ℞ Thur. Mastich. Bol. Armen. Sang. Dracon. Colophon. cale. viv. Alum. far. volat. an. ℥ss. fiat ex omnibus pulvis subtilis. This Powder is to be mingled with the white of an Egg, until it be brought to the consistence of Hony, and so to be applied.
One thing is be noted, that the Hem of the Cloath, upon which these Medicaments are spred, be applied towards the brims, and the raveled portion to the places distant from the Brims. If the soft parts be transversly incised, and the Wound be long, the brime must gape being far distant asunder. In this case you must use stitching with Needles to bring them close together.
In stitching you are to observe these four cautions: the first, that they be as thin as may be: the second is, that the Thread be rather of Flax than Silk, but smooth, and waxed, that it cut not; the third is, that the Needles be as small as may be, and either of Silver or of Steel distempered, which you may do by holding of them in the flame of a Candle: the fourth is, that when the brims of the Wound do abide together, and the Swelling and Inflammation of the brims are gone, we remove these stitches, and apply the dry stitches, which will fall out the third or fourth day: this you are to do to prevent ill favoured Scare. If the transverse Wound be not long, convenient rolling and dry stitching will serve; for the bringing and keeping of the brims together.
When you go about to cure such Wounds, apply not Powders; for when the brims are brought together, some small distance must of necessity be left, which [Page 365]most be filled with Flesh: If you then apply Powders which are loth actually, and in faculty drying, the incarnation will be hindred, the Powders drying both [...]o much and too soon, and so the Scar will be unequal being lower than the rest of the Skin.
Wherefore for the agglutination of such Wounds, apply Medicaments which in consistence are soft and moist; but in faculty drying; for by Application of such Medicaments, Nature hath time equally to agglutinate the brims, and the Cicatrix will be more fair: which is that you ought to aim at i [...] the curing of the Wounds of the [...]ace.
Such are Arcaeus his Liniment: The Spanish Balsam, Oyl of Hypericum, having some Turpentine or Vernice mingled with it, and tie natural black Balsam. In the Winter time use the stictick Emplaster, but in summer Diapalma, or Emplastrum de minio. If they be too hard, malax them with some of the Oyl of Hypericum. Frocure skinning after agglutinaton, with Ʋnguentum de Tutia, de cerussa, aut de bolo Armeno, or eratum griseum.
When the skinning is almost induced, anoint the part with Mans grease: for it procureth by a peculiar faculty a fair Scar. See Aq. pend. part. 2. lib. 2. c. 21.
Now if a Wound be received in the Face, wherewith both the soft Farts and the Bones are incised; we must in this case have a greater care of the security of the wounded person, than of the beauty of the Face. In this case no kind of s [...]tching hath place, if the Wound be large, and the offence of the Bone great. For the Bone must be smoothed with Raspatories, and the Wound be kept open while the Bone scale, and the part be incarnate, even as hath been taught in Wounds of the Halry Scalp, wherein there is a Fracture of the Scull, I will repeat nothing, because I am unwilling to lose any time.
If any enormous Wound fall out, whereby there is a Solution of Unity in the Jaw-bones, as happened to Arcaeus in one, whose upper Jaw fell upon the Chin: in this case all parts are to be reduced to their own posture, so that Bones answer to Bones, and the soft parts answer the soft; then the parts are to be kept in their natural position, with all manner of stitching, and convenient deligation. Read the Authors in the Book, cap. 7. I have acquainted you with the Methodical manner of dressing such Wounds before; so that now in this case I will be silent.
So much I have thought good to deliver unto you, concerning the Cure of Wounds of the Face in general. Now it remains, that I briefly discourse of the Wounds of the Eye-Brows, and Eye-lids, and Lips, before I handle the Wounds which cause Solution of Unity in the Instruments of the Senses.
Ʋulnus Supercilii, a Wound of the Eye-brow, is either caused by a simple Incision only, or by Incision with the loss of some of the substance of the part. If it be by simple Incision only, it is either according to the longitude or latitude of the Fibrae, or tranverse.
If the Wound be caused by simple Incision according to the length, without loss of substance, you may use the Cephalick Powders, and such as are astringent and drying, having no sharpness to hasten the unition, and procure skinning; for in this case you need not fear an ugly Scar, for the part is decked and covered with Hair.
If the Wound of the Eye-brows be transverse without loss of substance, then you must have a care that such a Wound be exactly agglutinate: and that the brims of the conjunction exquisitely answer one another: for if these Cautions be neglected, the wounded party shall not be able to lift up the Eye-lid, unless he use the aid of his Fingers, and the Eye shall still remain shut. In this case then, you must take deep stitches, and so many as shall seem fit. The brims having been thus joyned together, procure agglutination with such Medicaments as are able to reunite the parts severed.
If a Wound of the Eye-brow have caused a loss of Substance: then you must not hasten the consolidation of such a Wound: for if you do, the Scar will become so hard, that the Muscle shall pull up too much the Eye-lids, and so the whole Eye shall not be covered. In this case then you are to use such sarcotical Medicaments as are soft in consistence, as artificial Balsom, of which I have spoken sufficiently before.
If this inconvenience happen, that by reason of the hard Cicatrix, the Eye-lid cannot wholly be pulled down to cover the Eye; then you are to divide the Cicatrix by a semicircular, or half-moon-like Incision, according to the orbicular proceeding of the Fibrae of the Muscle of the Eye, which pulls down the Palpebra.
Neither need you fear to make such a half-moon-like Incision, although it come near to a transverse Incision: for this Muscle lieth within the Orbit of the Eye, near to the Muscles which move the Eye, and so it cannot be hurt by such an Incision; for the Incision must not reach to the internal Tunicle of the Eye-lid; but only divide the Cicatrix and the round Muscle, which motion is not taken away by such a half-moon Incision.
Spigelius, lib. 4. cap. 5. will have two Muscles to shut each Eye-lid, and to be of a semicircular Figure: the one is seated in the upper Eye-lid, and draweth it down, and is called the bigger: the second and lesser is seated in the lower Eye-lid, and pulleth it only upward. The upper Ely-lid is drawn up by the Muscle which proceeds from the upper part of the Fro [...]s, or Forehead, near to the temporal Muscle, where the Hairy Scalp ends. It goes directly down, and is inserted into the Eye-brow. This Muscle then being transversly cut asunder, the Eye-lid can hardly be pulled up, unless it be artificially united.
Wounds of the Eye-lids are either streight or transverse: Those are streight which reach from one corner of the Eye to the other: because this is the position of the Fibrae of the semicircular Muscles of the Eye, although they may seem transverse, if you behold only [Page 367]the Figure of the Face. Transverse I call those which reach streight down from the Eye-brow, or supercilium, towards the cavity of the Eye. These Wounds either divide the outward Skin and Muscles only, or they cause a So [...]tion of Unity in the internal Membrane of the Eye also.
If the Wound hath only divided the external Skin, and the semicircular Muscle: you may use stitching, but then the Needle and Thread must be very small, and the Thread well waxed. Agglufaction is to be procured by inspersion of sarcotical and drying Powders, as Bolus Orientalis, Terra spillata, sargias Draconis, Sarco [...]lla, &c. Thus you may mix them: ℞ Bol. Orient. & Terrae sgllat, an. ʒ ij. sang. Dracon. Sarcroll. an. ʒ j. siat ex omnibus p [...] [...]s subtilis.
Above the Powders apply a piece of a soft linnen Cloth, that it but not the Eye by its hardness, moistned with the White of an [...]g, which both hinders Inflammation, and staies the Powder. Above this apply Boulsters, moistned with Plantain Water, and red Wine mingled together. Last of all roll up the Eye.
If occasion move you to apply to the adjacent parts Oyl of Roses, or any other, then you are to have a care, that no part of the Oyl fall into the Eye; for Oyls do hurt the Eyes, and cause Inflammation.
If the Wound cause a Solution of Unity in the internal Membrane of the Eye-lid, which immediately doth cover the Eye, you are to stitch this. For if the Thread should touch the Body of the Eye, it would offend it, and procure an Inflammation. In this case then, a dry stitch is most convenient.
Wounds of the Lips either cut asunder only the Skin of the musculous Parts, or the Membrane also which internally covereth the Mouth. If the Skin and the musculous Parts be only cut asunder, then ordinary stitching will serve the turn, and the application of such Medicaments as unite Wounds inflicted in other parts of the Body.
If the whole substance of the Lip be separate, and gape; then you are to dress such a Wound, as a Hair-lip, when as the brims are made raw.
First then, you are to pierce both the brims of the Wound with a Needle, or a Pin, having on each side a thin and small piece of Lead: Through both these pieces of Lead, the Needle or Pin must pass, then the Thread is to be twisted about both the ends of the Needle or Pin.
Last of all, the point of the Needle or Pin is to be nipt off, that it hurt not, with a pair of small steel Nippers well hardned. The Leads suffer not the Needle or Pin, to break through the brims of the Wound: you must take this stitch somewhat deep, and about the middle of the Wound, that the brims may be the more surely kept together. Two ordinary stitches more will serve, one above the Needle or Pin, the other below.
The Pin you may take out the fourth, fifth, or sixth day, as you shall [Page 368]see the parts united. If you have Children in hand, it is not amiss to joyn to these the dry stitch, because they are unruly, and by their crying cause often the stitches to break.
The Medicaments Topical which procure consolidation in these Wounds, are these: The black natural Balsam, and not the yellow; In Winter you may use it alone, but in the Summer tempered with a little of the Yolk of an Egg. The Oyl of Hypericum, or Spanish Oyl mingled either with some Cyprian Turpentine, or the white Joyners Vernice, are excellent. When all parts are agglutinate, then you are to remove all the rest of the stitches, and to procure a comely Cicatrix by anointing the parts, wherein there was Solution of Unity, with Mans grease (as hath been said) if the wounded parties be Girls or Women: In Boys and Men, because one may have, the other hath Hairs to cover the deformity of the Cicatrix, you need not to be so scrupulous.
CHAP. XXV.
Of the cure of Wounds which happen to the Instruments of the Senses.
IT is time now to come to those Wounds which offend the Instruments of the Senses; and seeing the Sense of Seeing of all other is most admirable and noble, the Wounds of the Eye which is the Instrument of it, must first be handled: for it apprehends more excellent Objects, more in number, and of a greater variety, with a greater celerity, than any of the rest of the Senses doth, and in a farther distance. It is necessary for all living Creatures to espy and prevent Dangers and Enemies. Besides this, the eternal felicity of reasonable Creatures shall proceed from the intuitive knowledge of the Sacred Trinity.
As concerning Wounds of the Eye, two points offer themselves to be discussed. First, the difficulty of the cure of such Wounds. Secondly, the cure it self.
Five things make the Wounds of the Eye of a hard Cure. 1. Is the excellency of the part it self. 2. Is the exquisite sense of it. 3. The consent which it hath with the Brain: which you may easily gather; if either you respect the Optick Nerve, or the Motory, or the Muscles of the Bye, which have [Page 369]many twigs of the Nerves communicate from the first, second, third, and eighth pair of Nerves. Fourthly, the flux of Humors, which promptly falls into the Eye after it is wounded. Fifthly, the continual motion of the Arte [...]les.
In the cure of these Wounds too points are to be delivered. First, the differences of them. Secondly, the artificial dressing of them.
As for the differences of them, Wounds of the Eye are either Superficial or Deep. Superficial I from such as pass not through the C [...]nea: But deep, such as pass strough the Cornea.
In the cure of Wounds of the Eye, these two points are to be diserved in general: First, that you abstain from all Oyls, and fat things, for they inflame the Eye, and cause Pain. Secondly, that [...]hen one Eye only is wounded, you roll them up both; First, that the sound Eye may be kept from motion. Secondly, that darkness may every way be procured; for light offends all fore Eyes: Thirdly, that the Cure may be more easie; for when one Eye moves, the other of a necessity must move, and so the wounded Eye being moved at the motion of the sound Eye uncovered, the Cure will be hindred: for Motion causes Inflammation, and protracts Healing. The third is, that the Head lie somewhat high, not lending forwards: let the Pillow be of Turky Leather, filled with Chiff.
To cure a superficial Wound of the Eye, three intentions are required: First, to prevent all Inflammation and flux of Humors into the Eye. Secondly, to mitigate pain. Thirdly, to unite the parts separate.
To asswage pain, and repel the [...]fflux of Humors, use these things following: Ovi Candidum, aq. Spermatis ran [...]rum, [...] Plantagi Portulac. pluvialis, [...], Mucilag. semin. Cydon. Psyllii, Tragaranth. Papaver, hyoscyam. decoct. nuc. Cu [...]ressi, Gallarum, Balaust. Malicor. V [...]num Granator. Lac. Muliebre, Sarguis Turturum & Pullor. Co [...]ar. ex venis sub alis elicitus. Of these you may have sundry compositions unto your selves, as need shall require.
In this case it will suffice to apply these Medicaments above the Eye-lid, the Eye being shut, unless Qulttour abound, and the Eye run much: for the Skin of the Eye lid, the Muscle, and the internal Membrane, are thin; so that the Medicament may easily penetrate. Besides, some will pass between the Eye-lids. If the former Accidents happen, wash the Eye with Rain or Plantain-Water, wherein a little Alume, or white Vitriol hath been dissolved: then apply Boulsters made of old fine linnen Cloth, because it is softest, moistned in some of the Waters, wherein some of Stef album sine Opto hath been dissolved. If pain urge, use that which hath Opium in it.
To the Forehead, Temples and Cheeks apply some anodyne and astringent Cataplasm: such is this which follows: ℞ Pulp. Pomor. sub Cinertb. coctor. ℥ ij. flor. Cass. extract. ʒ vj. Muccag. semin. Psyl. [Page 370]Alth. & Cydon. an. ʒ ss. far. Hord. cribrat. Bol. Armen. sang. Dracon. an. ʒ j. Misc. ut paretur cataplasma.
One thing is to be noted, that if both the Eye-lid and the Conjunctiva Tunica of the Eye be wounded, that you have a care that they grow not together, which happens if it be not prevented: You shall hinder this inconvenience, if in tender persons you keep them asunder with some Leaf-Gold, but in other Bodies either with Leaf Gold, or Tin-Foil.
If the Wound be deep, then either the Weapon passed through the broad and long Chink about the ends of the Bones of the Orbita, through which the Nerves come into the Brain, or it goes not so far.
If the Weapon pass into the Brain, then the Wound is mortal, because by reason of the dissipation of the Spirits, Motion and Respiration are abolished. Nevertheless, he is to be drest, and the Chirurgeon is blameless, because he neither can see the Wound, nor apply any Topical Medicament to the Brain, unless he take out the Eye, which no wise man will attempt, nor can be suffered, in whom the Sense of feeling remaineth.
An Example of this I saw in Chester, in a young Gentleman, whose Sirname was Fletcher, who in a Duel being so wounded in the left Eye, died about the fourteenth day after he received the Wound. He continued well nine days, and the tenth day went to a Play. The eleventh day the left Nostril began to run as if it had been a Still, so that every night and day it wet a Pillow: and so it continued untill he ended this Life.
If the Wound be not so deep, then either the aqueous Humor only issues out, or the others, as the Crystalline and Vitreous also.
If the aqueous Humor come out only, then it cometh out wholly, or in part. If all of it come out, the sight will be lost. If a small quantity only come out, it may be repaired, and chiefly in Children, by reason of their moisture, and so the sight remains. This Wound is cured as a superficial Wound.
If the other Humors, as the Vitreous and the Crystalline, come out, then the sight must of a necessity be lost. In the cure of this Wound you are to use sarcotical Powders, but beaten very small, and past through a fine searce, such as Tutia prepared, Calaminaris quenched in white Wine, Terra sigillata, sanguis Draconis, Aes ustum, Sarcocolla, Sandaracha Graecorum, &c. When the Eye is healed, you may cause an artificial Glass-eye to be set in place of the natural, to avoid deformity.
It falls out sometimes that part of the wounding Instrument sticks in the Eye. If a portion of a wounding Instrument doth stick so fast, that it cannot be pulled out without the effusion of all the Humors of the Eye, and the procuring of great Inflammation, and that doth not prick the Eye-lids, then it is best to suffer it to remain, and to dress the Wound with anodyne [Page 371]Medicaments, untill the seventh day be past, and then to use agglutinative means. But if the piece cause pain, and a continual weeping, and hurt the Eye-lids, it is to be taken out, and dressed as deep wounds of the Eye. See an Example in Fabric. ab aq. pendent. Chirurg. operat. part. 2. lib. 2. c. 27.
Next to the cure of wounds of the Eye, I will shew how wounds of the Ear, which is the Instrument of Hearing, are to be cured.
The Ear is either wholly cut off from the Temple of the Head, or but in part divided. If it be totally cut off, first of all, it is to be skinned with strong Epulotical Medicaments, as the Cephalick Powder, Ʋnguentum de bolo, de minio, and such like. Then the deformity is to be covered either by wearing a long Lock, or a Cap under the Hat having a side latch. If it be divided but in a part, if the separation be but small, a dry stitch only will serve; but if it be large, a small Needle, and fine Thread must be used, that the part separate may be proportionally brought and kept together. Then strong desiccative Topicks are to be used, because the part it self is for the greatest part Cartilaginous.
In your stitching you are to observe two things: First, that the Needle only bring together the parts of the Skin, on each side of the Ear within and without, without wounding the Cartilage; for if this be done, an Inflammation and Gangrene may ensue, as witnesseth, Fabric. ab. aq. pend. oper. Chirurg. part. 2. lib. 2. c. 33. & Par. lib. 9. c. 22.
Secondly, you must observe, that if the Wound reach to the first cavity of the Ear, called Meatus Auditorius, the passage of Hearing, you still keep a Sponge-Tent in it, partly that no spongy flesh grow in it, which might stop it, and so hinder the Hearing; partly that no Quittour fall into it, which might exulcerate the parts internal, and corrupt the Tympanum, and so procure inevitable deafness.
Now I will briefly touch only the cure of Wounds with which the Nose (the Instrument of smelling) may be violated. Wounds then of the Nose may only cause a Solution of Unity in the soft parts, or in the hard parts also.
If a Wound happen in the soft parts of the Nose, a dry stitch will suffice: In these wounds we must, to the uttermost of our endeavour, labour to procure a fair Cicatrix, or Scar: seeing the Nose is the most eminent part of the Face, and but a small Scar will easily be discerned in it: wherefore you are to procure a fair Cicatrix with some Medicaments astringent: such is Ʋnguentum album caphuratum, if it be faithfully dispensed.
If the hard parts be wounded, then this must fall out either in the upper part, and then the Bone must be violated; or in the lower part, and then the Cartilage must be hurt.
Wherefore if a Wound be inflicted in the upper part of the Nose, wherein the Bone is cut, then there is a Wound and a Fracture. [Page 372]In curing of such a Wound, two Indications offer themselves: for, first, the Bones must orderly be set; then the consolidation of the Wound is to be procured.
In placing handsomly the Bones, you must put into the Nose a fit piece of Wood, lapped with soft linnen cloth, which must easily go in to bear up the Bones: then outwardly you are to set the Bones in their best posture with your other hand. This being done, you must put a pipe into the Nose of some light substance, as of the branches of Flder, the pith being taken out, or made of a thin plate of Silver: for the present necessity you may use a Goose-quill, or a Swans-quill, or a Quill made of a Reed, such as Weavers use. These Quils or Pipes must not be exquisitely round, but somewhat sharp above, and flat below, to preserve the natural figuration of the Nose.
When you use these, you must observe two things: First, that they be tied to the night-cap on each side, that they drop not out: Secondly, that you put them not too far up, lest they cause sneezing, which much hinders the consolidation of such Wounds.
These Pipes afford a four-fold use: First, they keep the Bones in their best position: Secondly, they give way to breathing: Thirdly, they discharge the excrements of the Brain: Fourthly, they make way for the sending of the Quittour from the Wound. These pipes must be lapped up in soft linnen Cloth, to hinder the sinking of the consolidating Medicaments into the Wound.
The Bones thus set according to Art, you must labour to bring the soft brims of the Wound together, either by a dry stitch, or with a small needle and thread, according as occasion shall be offered unto you.
This being done, apply a desiccative Medicament to the Wound, as Sangais Draconis, and Bole beat to a fine powder, and mingled with the white of an Egg beaten: let the consistence be like to that of Honey.
If such a wound be transverse, First, you must apply to each side of the Nostrils a fine little Boulster of soft, linnen Cloth, moistned in red astringent Wine, and wrong out: then you must stay these Boulsters with a roller; having a hole in the middle to give way to breathing, and to receive the tip of the Nose. This Roller must be sowed to the back part of the Head.
You must have a care of one thing, that it be no straiter than is necessary, for the keeping of the Nose from falling; for if it be too strait, it will procure a Polt-foot-like Nose steering upwards. Hard to the Septum of the Nose apply another very narrow Roller, which bring about to the Neck, as you did the other.
If the lower part of the Nose be deeply wounded, then the Cartilage must suffer solution of Unity; which if it come to pass, then the Cartilage is only divided, or quite out off. If it be only divided, then Unition is to be procered, a pipe to be used, drying Medicaments to be applied, and the like Rolling to be used, as I set [Page 373]down in the cure of a wound in the upper part of the Nose, wherein the Bone is incised. If the Cartilage be wholly cut off, then a new Nose is to be framed of the skin of the Arm. Of this Taliacitius hath written at large, and I will touch this practice in my [...], which I made the third part of Chirurgery.
To make an end of this Chapter, I must shew you briefly how wounds of the Tongue the instrument of Tasting are to be cured.
If a portion of the Tongue be altogether cut off, the loss is altogether irreparable: for being once deprived of life, being separate from the rest of the living Particles, it cannot by any created power be restored. Our Saviour restored Malchus his Ear cut off by St. Peter; but we know that he was both God and Man, the Lord of Life, able to give it, or to take it from any, according to his good pleasure. If the part separate cleave to the sound part, although it be but by a fleshy thred, so that it doth totter hither and thither, yet beware that you cut it not off, seeing the loss of Speech, (the mean of mutual conference) will so ensue.
Such a Wound is hardly cured; partly, because we can neither use dry stitching nor rolling; partly, because ordinary Topicks, as Balsame and Emplasters cannot be Employed.
In this case you are to use stitching with Needle and Thread. But first of all, the Tongue is to be pulled out, being holden by the hand, it having been lapped with a linnen Cloth, or by hollow and rugged Forcipes armed with cloth. Then so many and so deep stitches are to be taken as shall seem expedient to keep the parts united. Neither let us be too scrupulous with Celsus lib. 5. c. 26. who thinks that the less flesh the Needle pierceth, the Inflammation or pain will be the less; rather let us bind sure that we may still find sure. We may easily conjecture how the wounded party will be disheartened if the stitches should break. The Wound being surely stitched; we must first cut off the thread hard by the knot, lest the ends of the thread, being intangled between the Teeth, should cause a renting of that which you did sow.
Secondly, we must use astringent means, such as are Plantain-water, wherein the Syrup of Myrtles, or dry red Roses, with some Alum, have been dissolved. A decoction of vulnerary Herbs, with Syrup of Quinces: Saccharum rolatum holden still in the Mouth, &c. As for his Diet [...]he must be fed with liquid things, Almond-milk, yolks of Eggs dissolved in Broths, Gellies, Barley-cream, thin Oatmeal-Gruel, and thin Panadoes.
CHAP. XXVI.
Of Wounas of the vessels of the Throat.
HAving dispatched Wounds which may happen to the Head, I must now fall to those wounds which may offend the Neck. Now these Wounds cause solution of continuity either in the common parts of the Body, or the parts proper. The parts common are the Cutis, and Membra [...]a carnosa. The parts proper, are the vessels and the other parts. The vessels are three, the jugular Veins, the soporal Arteries, and the recurrent Nerves. The other parts are the Larynx or Windpipe, and the Gula, or the mouth of the Stomach, and the Spinalis medulla: Of these I will discourse in order, as they are set down. Those Wounds which happen to the common parts, the Skin, and the Membrana carnosa, require no particular tractation; for they are cured by joyning together the parts dif-joyned, and by application of agglutinative Topicks. Seeing these parts are loose and flaggy, you may stitch these parts, althô there be some loss of substance. The rest of the Wounds which befall the other parts of the Neck, requi [...]e a special consideration.
First then to come to the wounds of the vessels: If the internal jugular Veins, and soporal Arteries, be deeply and largely wounded, the wounded party can hardly escape. First, because the wounded party doth flux to death most commonly, before any Chirurgeon can come to stay the bleeding. Secondly, because no strait Ligature can be applied to these Wounds, because it might choak or strangle the wounded party. Cels. l. 5. c. 26. saith, Periculosa sunt vulnera ubicunque venae majores sune: those Wounds are dangerous wheresoever great Veins are. Hip. prorr. l. 2. affirms those wounds to be deadly, whereas the thick, that is the great and large Veins, are wounded in the Neck and Groins. Of the danger of these wounds, Forest. Obs. Chirurg. l. 6. c. 4. thus warneth us: The jugular Veins receiving a great Wound, hardly and very seldom are cured, because they deprive a man of the vital spirit, by reason of the large effusion of Blood; and because these Wounds will not admit such rolling for the staying of bleeding as is necessary. Guliel. [Page 375]Fabric. Cent. 4. Observ. 2. makes this manifest by an example: When a certain Empirick went about the cutting out of a Struma in the Neck of a Genevan Maid, which had inclosed the jugular Vein, and the recurrent Nerve, so great a flux of Blood issued, that the Maid died in the very operation. The like chance happened to one Mr. Blackwell, who going about the like operation in a young Gentlewoman, then lying in Alderman-bury, had no better success. Doctor Gwin and I were then present. Let these and the like examples procure wariness when you go about to deal with Tumors in the lateral parts of the Jugulum, or Throat.
In such Wounds, a Wound of the Artery is more dangerous than of the Vein. First, because the Blood of the Artery is more fluxible and more spirituous: Secondly, because the coats of the Artery are hard, and are in continual motion.
You shall know an Artery to be wounded by these signs: First, the Arterial Blood gusheth out sorcibly and leaping, when the Artery is dilated, but in the constriction the Blood is drawn back. Secondly, the Arterial Blood is thinner; but the Venal thicker. Thirdly, the Arterial Blood is of a bright red colour; but the Venal is blacker. Fourthly, the Arterial Blood is much hotter than the Venal. Fifthly, the Arterial Blood when it issueth out, is more full of spirits than the Venal.
As for the cure of such Wounds, the first scope is to stay the flux of Blood, which is the store-house of the vital spirit: the Second is, to agglutinate the Wound.
The Bleeding is staied two manner of waies; by Medicaments and by Deligation: The Medicaments are either restrictive or escharoticall.
This restrictive Medicament may serve instead of all others: ℞ Thur. ʒ ij. Aloes, Sanguinis draconis, Telarum aranearum, quae in molis plenae sunt farina volatili, Hypo. cystidis, Mastiches, Sarcocollae, T [...]rrae umbrae, pulveris volatilis Fungorum an. ʒ j. siat ex omnibus pulvis subtilis.
The escharotical means are either Medicaments which procure a Crust, or an actual Cautery. This Medicament which follows, shall serve for all other escharotical means, ℞ Pul. praedi [...]l. ʒ ij, Calc. vivae ʒ j. Arsenic, sub [...]mat. & Auripigmenti. ʒss. fiat pulv. s. a.
These powders, according to Galen, lib. 5. method. c. 4. must be mingled with the whites of Eggs, so that the Medicament be of the consistence of Honey: Then the hairs of a Hare are to be added; you must sill the Wound with dosils armed with these Medicaments, and apply large pledgets above the dosils, and about the Wound, armed in like manner with the same.
Seeing you cannot use strait rolling about the Neck for fear of choaking, you are to have in readiness three or four Servants to keep to the Wound the Medicaments, that they fall not off by their turns, these Medicaments must lie to the Wounds three days; then when you go about to removo them, when you are come to the [Page 376]lowermost dosils in the Wound, if they stick, you are not to remove them, lest a fresh flux be caused; only the rest of the Wound is to be filled up with fresh stuff.
As for the actual Cautery, it must be red and glowing hot; for then it procures a crust most speedily, and that the thicker. This being done, we are with all expedition to procure incarnation, lest the crust fall before flesh be engendred, and so the breach become greater, and the flux of Blood larger. If you labour to engender flesh above an Artery, you are to use sarcotical Powders, which strongly drie.
When the flesh is engendred, if you by applying your finger feel strong beating, you are to fear lest an Aneurisma ensue: when you have performed all these directions, it will not be amiss, above and round about the Wound, to apply this Cataplesm: ℞ Fol. Sola [...], Hyosc [...]ami, Mandragor. contus. an. man. j. Far. Hord. & Pulv. Malicer. an. q. s. ut parecur Cataplasma sine ullà coctione.
If these means will not prevail, then you are to bind the vessel which bleeds: First then you are to lift up the vessels from the subjacent and adjacent parts with a small silver hook; then you are to bind them above and under the Wound strongly, and to cut them asunder between the Deligations: This is the surest way, seeing there are innumerable Anastomoses of the vessels in the body of Man, and so Blood may easily flow from either side of the Wound: wherefore it is necessary that they both be bound. Seeing these Wounds are extreme dangerous, you cannot be too circumspect in curing of them: if therefore a learned Physician cannot be had, you must see that he use a convenient Diet.
His Diet then must be sleader, cooling, glutinous, and somewhat astringent, that no great store of Blood be engendred, that it may be cooled, made thick, and so less apt to flow; wherefore Flesh, Eggs, and strong Drink are to be shunned. The party may eat Lettuce, Purslain, Endive, Spinach, So [...]el, Barly-cream, Pompions boiled. As for Fruit, he may eat Quinces, Medlars, Pomegranates, Prunes baked or stewed, Sloes stewed. As for flesh, he may eat Calves and Sheeps-feet stewed, Calves and Sheeps-heads boiled, and their Brains with Green-sauce made of the common Sorrel, and Wood-Sorrel, Vinegar of Roses, and a little Sugar; Let the Bread be course and leavened: Let the Drink be Spring-water, wherein Steel hath been quenched, Beveredge of Vinegar and Water, the juice of Pomegranates, Barleywater, Juleps of Roses and Vi [...] lets, Spring-water and Verjuice. If the party be weak, let him, or her feed upon Mountain-birds, poched Eggs, Partridges. In Springwater, wherein the bottom of a loaf hath been boiled, dissolve Syrup of Succory, Purslain, red Roses, Myrtil, and such like: If Wine be required, let it be deep coloured and astringent: such are the red Wines, whereof here they make their Clarets and Allegant. The Body must be kept soluble, and all perturbations of the Mind, [Page 377]but chiefly vehement anger, are to be abandoned. If the party sleep not well, it is to be procured by Art: this Medicament which follows is very convenient and fit: ℞ Diascor. ʒ j. Philon. Persici ℈ j. Syrup. Papav. albi ʒ vj. Aq. Papav. cirat. ℥ iij. Misc. ut paretur petio bib [...]nda fri [...]ida horâ ix. vespertinâ you may minister this potion every third night.
The third vessel which is to be sound in the lateral parts of the J [...]gulum, or Throat, which is remarkable, is the Recurrent Nerve, so called, because it comes down from the sixth pair of Nerves, and returns upwards towards the M [...]iscles of the Larynx, using in the lest part the trunk of the Aorta, and on the right Side, the axillar Artery, as Pulleys. If one of the recurrent Nerves be cut asunder, the voice becomes house, but if both be divided, the Speech is taken away; and seeing they greatly further the Speech, if they be whole, and hinder it, if they suffer solution of unity, they are called not only Nervi recurrentes, Recursivi, and Reversivi, but Vocales also.
To consolidate these, and the wounds of the Veins and Arteries, this Balsame of Ambrose Parey set down, lib. 10. c. 29. is excellent: ℞ Ol. Hyperic. simpl. ℥ iiij. Gum. Elemi. ℥ iij. Terebinth. Venet. lb. ss. liquescant ista simul ac colentur. Cum frigere incipiunt, adde Boli Armen. Sang. Drac. an. ℥ j. Irid. Florent. Aloes, Myrrh. Mastich. Pulverizat. an. ʒ j. Aq. vit. ℥ ij. Misc. ex. l. a. Apply the Balsame warm. Above the Balsame apply Diapalma malaxed in Oil of Roses to hinder all Inflammation.
CHAP. XXVII.
Of Wounds of the other parts of the Neck.
HAving delivered unto you in the former Chapter, the method of curing Wounds which may happen to the vessels seated in the lateral parts of the Neck; I am to shew you how Wounds, which cause a solution of unity in other parts of the same, are to be cured. Now those members are seated either in the fore-part of the Neck, or in the back-part: In the forepart the Trachaea arteria, or Windpipe is placed; but in the backpart the Gula, or the mouth of the Stomach, and Spina dorsi, or Spinalis medulla, the marrow or pith of the Back-bone.
If the Aspera arteria, or Windpipe be wounded thorow: First, the breath will come out at the Wound. Secondly, Blood will issue out at the Mouth. Thirdly, the Speech will be hindred. Fourthly, Coughing will trouble the wounded party.
The Wind-pipe hath three parts: First, the uppermost part of it, called Larynx: The Second, Caudex, or the stump: the Third, the Branches spread thorowout the substance of the Lungs.
Wounds of the Larynx, although they be not mortal of themselves, yet by accident they may become such: First, by reason of the necessary use, for it doth receive and breath out the Air. Secondly, by reason of the fearful Symptomes, or accidents which accompany such Wounds; for this part is near to the jugular Veins and soporal Arteries: so that it can hardly be wounded, unless these parts be wounded also. It hath also sundry Branches of the recurrent Nerves, and besides sundry Muscles; so that a great flux of Blood, Pain, Inflammation, Pursing or drawing together, and at last strangling may ensue. Thirdly, because this part can hardly be cured; for Medicaments cannot easily be applied or kept to the part.
Wounds of the Caudex, vel Fistula, or of the Stump or Pipe, although they are not so dangerous as those of the Larynx, for the reasons before alleged; yet they are not without danger, for it is framed of a double substance; for the rings called Anuli are cartilaginous, but the substance which ties these together, is membranous. Now a Cartilage cut asunder, doth not admit unition, according to Hip. Aph. li. 6. Aph. 19. Who saith when the Bone is cut, or a Cartilage, or a Nerve, it neither grows again, nor is united; understand this by a middle of the [Page 379]like substance. He repeats this same lib. 7. Aphor. 28. Galen subscribes to this Aphorism, 5 Method. Med. c. 7. Three causes may be alleged for this: First, because a Cartilage is a part drie, without Blood, and hard. Secondly, because the cold Air doth continually pass thorow the stump. Thirdly, because it is seldom at rest, but still in motion. You may add another reason, because the Air doth not freely pass and repass by it, chiefly if the Wound be deep and large. Of these Wounds thus writes Vidus Vidius de curat. Morb. Membrat. l. 8. c. 6. Wounds which pass thorow the Wind-pipe most commonly cause speedy death, by reason of the Blood which issuing out of the jugular Veins, falleth upon the Lungs, and hindreth breathing: And Forest. Observ. Chirurg. lib. 6. Obs. 4. thus writeth of them: Large Wounds of the Aspera arteria, chiefly those which divide the cartilaginous substance of it, seldom are cured; for this part is hard, and without Blood: besides this, the wounded party draws breath by the Wound, which hinders consolidation.
As for the cure of such Wounds: if the Wound be transverse, then the wounded party must bend down his Head: if the Wound be streight, according to the length of the pipe, then the party is to hold up his Head, that the brims of the Wound may be brough. together: then the Wound is to be stitched as firmly and artificially as you can: Pins in this case are best, as also in curing a Harelip, for all kinds of thread will easily rot. This being done, agglutinative Medicaments are to be used. Arcaeus his Liniment is good, and the natural black Balsame: Above apply Dinchylon simplex malaxed with Oil of Myrtils or Quinces. In your dressing you must have a care that neither Blood nor Quittour fall upon the Windpipe, lest it procure choaking; but that they be outwardly discharged in the depending part. If after dressing, the party breath with difficulty, and there is danger of Suffocation, because the cavity of the Larynx, or Pistul [...], is filled with Blood, or Quittour, or both; or because it is straitned by reason of a great Imflammation: then the Wound is to be dilated, and a silver pipe, a little bended towards the point, that it hurt not, to be kept in it, until the wounded party be able to breath freely; then let it be taken out. In this Wound Gargarisms are good: Take this as a pattern: ℞ Hord. mundat. Cochl. iij. Flor. Ros. rub. Pug. 1. Sumach. Flor. Granat. an. ʒ ij. Passulonajor. exacinat. Jujub. an. ℥ ss. Glycyrrhiz. ℥ j. Bulliant ista. s. a. in lib. iij. aq. font, ad consumpt, medietat. ac coletur decoct, cui admisce Mell. Ros. & Syrup. Myrtin. an. ℥ ij. utatur Gargarismate calefacto. It moistens the Mouth, asswages pain, agglutinates the parts, and causes the party to breath freely.
Wounds of the Gula, oesophagus, or mouth of the Stomach do follow. That the month of the Stomach is wounded, you shall know by these signs: First, if the Wound be deep, the Meat and Drink will come out of the Wound, Secondly, the difficulty of swallowing. [Page 380]Thirdly, the Hicket and vomiting of Choler, Fainting, a faint Pulse, cold Sweats, coldness of the Hands and Feet, according to Fernel. lib. 7. [...]. cap. 8. Fourthly, the vomiting of Meat and Drink according to Celsus lib. 5. c. 26.
As concerning the variety of these Wounds, receive these kinds of them: First, either the whole Gula is cut asunder, or it is only cut in part. Secondly, if it be cut but in part, then it is wounded near to the Stomach, or far from it. Thirdly, it is wounded either streightly or obliquely.
Concerning wounds of the Gula, receive these Prognosticks. First, all wounds of the Gula are dangerous: First, because they cause difficulty of breathing: Secondly because it can hardly be wounded unless the Wind-pipe, the jugular Veins, the soporal Arteries, and the recurrent Nerves be wounded also. Thirdly, these Wounds which are but small, streight, and remote from the mouth of the Stomach; are less dangerous. Fourthly. Wounds great, transverse, and near to the mouth of the Stomach, admit no cure, according to G [...]udo tract. 3. Doct. 1. c. 1. First, because the passing of the Meat and Drink doth hinder the consolidation. Secondly, because the place is still moist. Thirdly, because its office, which is to carry Meat and Drink to the Stomach, is most necessary for the sustentation of the life of Man. Fourthly, because an Inflammation may easily be communicated to the upper orifice of the Stomach, which is very nervous, which the Grecians call [...] the Heart, and whose pains are called [...] or [...]. Fifthly, if it be wholly cut asunder, the Cure is impossible, for one part shrinks upwards and the other downwards. As for the cure of these Wounds; The first intention is by stitching, to bring the brims of the Wound together: yet care must be had, that an Orifice be left in the depending part, to be kept open with a Tent, that the Quittour may be discharged, and that Meat stick not there, which might cause Inslammation. Then such Medicaments are to be applied as I set down for the cure of Wounds of the Wind-pipe.
In these Wounds a special regard must be had of the Diet: seeing then the wounded party can hardly swallow, his Food must be liquid, and it must nourish much. Such are Goats and Asses-milk, wherein Saccharum rosatum, or Violatum are dissolved, Broths made of flesh wherein the yolks of Eggs are dissolved, Almond-milk, and Emulsions of the great cold Seeds drawn with Chicken-broth, &c.
If the party cannot swallow at all, then nutritive Clysters are to be ministred: But first of all the Excrements are to be driven out of the Guts by a purging Clyster. Receive this as an example: ℞ Elect. lenit. ℥ i ss. Mellis rosati ℥ ij. Sacchari rubri ℥ iij. deco [...]t. communis pro Clysterib. ℥ x. Mise. ut pa [...]tur Clyster. Then inject Clysters made of such things as have been set down for the Diet. Minister half a pound at a time, that the party may keep it the longer: Into these nutritive Clysters no Oil must enter, because it will [Page 381]too much lubrifie the Guts; nor Salt or Sugar, because they will procure too speedy expulsion of the Clyster.
Now I am come to the Wounds of the Spina dorsi, the Back-bone seated in the back part of the Body: If the Wound pass not to the Spinalis medulla, sometimes it divides the Muscles, and then the Wound is to be dressed, as those which happen in fleshy parts: If the Bone be hurt also, then it is to be dressed as Wounds of the Head wherein is a Fracture, of which I have discoursed heretofore at large.
If the Spinalis medulla, or the Marrow of the Back-bone be wounded, then it is either wholly cut asunder, or but in part only: If it be wholly cut asunder, then the whole Body is deprived of moving and feeling, and by consequence breathing it self must be hindred, and so death must ensue. If it be not wholly cut asunder, but wounded only, then a fearful Convulsion must of necessity ensue, and so for the most part death.
Celsus lib. 5. c. 26. hath these signs: A Palsie or Convulsion followeth, Feeling is lost, and after a while the party cannot retain Seed, Urine, or Excrements of the Belly, yea, a total suppression of the Excrements sometimes will ensue. The same signs hath Ferneh [...]s lib. 7. Patholig. c. 8. If the Spinalis medulla (saith he) be wounded, the inferior parts become paralytick, their Feeling, Moving, and Functions are lost; so that the Excrements, Urine, and Seed, now and then come from the party against the will. If the Convulsion happen to the Arms, then it is likely that the Nerves whick spring from the fifth, sixth, and seventh Vertebrae of the Neck are wounded; if the Legs suffer these accidents, then the Nerves of the Vertebrae of the Loins, and Os sacrum are offended.
As for the Prognosticks; seeing the Spinalis medulla is of the same nature whereof the Brain is, Gal. l. 3. de Temperamen. c. 3. and near unto the Brain, lib. 3. al. facult. and is derived from the Brain, lib. 16. de usu part. c. 2. and resembles a compact Brain, lib. 1. de mot. Muscul. c. 1. and seems to be as it were another Brain under the Head and Neck, lib. 12. de Ʋs-Part. c. 11. & 15. The Wounds of it are no less dangerous than those of the Brain. First, because it hath its original from the Brain. Secondly, by reason of its composition, because 'tis covered with the Dura and Pia mater. Thirdly, by reason of the Nerves which spring from it. Fourthly, by reaof the consent which it hath with the Brain. Fifthly, by reason of its action and use, because it doth communicate moving and feeling to the parts Sixthly, by reason of the situation of it: for it lies deep in the Body, so that the force of the Topicks can hardly reach to it. Seventhly, by reason of the Symptoms; for it being wounded, a Palsie, Convulsion, and privation of moving and feeling do ensue.
Forrest. lib. 6. Chir [...]ag. Obs. c. 6. de his ita promanc [...]at. If the Spina [...]is medulla be wounded about the beginning of it, death of a necessity must ensue, because a Convulsion of the whole Body [Page 382]will follow; but if it be wounded in the lower parts, the Wound is not always deadly, unless the wound be a large one, or it be a puncture, although a Convulsion doth alwaies ensue; so that it is not so dangerous as that which is received about the beginning; and Fallop. de Vulnerib. capit is cap. 2. hath these words: wounds of the Spinalis medulla are accounted deadly by Hippocrates in Coac. Praenot. yet I have seen them sometimes cured; but if the wound happen to be in the upper part, death and a Convulsion of the lower parts must ensue.
Howsoever, seeing the wounded must be dressed, thus you shall go to work: you are to pour into the wound such things as asswage pain, stay Convulsions, and which procure Digestion without biting and sharpness: Such are unctuous and fat Topicks, as this Medicament is: ℞ Ol. Hyper. & de luteis ovor. an. ℥ j. Terebinthin. ℥ss. Theriac. Andromachi. ʒ ij. Misceantur. Secondly, you must anoint the whole Back-bone with such a Medicament. ℞ Ol. Vulpin. Hirundinum & Lumbricor. an. ℥ j. Ol. Mastichini, & de Castor. an. ℥ ss. Misc. Thirdly, you must embrocate the whole Scalp with this or the like Medicament: ℞ Ol. Chamaemel. ℥ j. Ol. Lumbricorum ℥ ss. Misc. These means are to be applied warm.
CHAP. XXVIII.
Of Wounds of the Breast.
WOunds of the Breast are either not penetrating to the cavity of the Breast, or else they do penetrate. Those that penetrate, are either without offence done to any part contained therein, or some part or parts are wounded.
You shall know the wound to penetrate by these signs: If the Patient shut his Mouth and Nose, the breath will break through with a noise, so that it will move and dissipate the light of a Candle set near the wound; and the Patient will be troubled with difficulty of breathing. If the parts contained be wounded, you shall know which of them is wounded by the proper Symptoms, with which the Patient is troubled, as follows.
If the Heart be wounded, much Blood gushes out, a trembling possesses all the members of the Body, the Pulse will be small and weak, the colour of the Face will become very pale, a cold Sweat, [Page 383]and frequent swooning will assault the wounded party; and when the Limbs grow cold, Death is at the Door.
If the Lungs be wounded, it will be discerned by these signs: the Blood which comes out of the Wound is yellowish and froathy, a Cough ensues, the Patient hath difficulty of breathing, and a pain in the wounded side, which before he had not; he lieth at greater case when he lieth on the wounded side; but being turned on the contrary side, these easements are [...]bated.
When the Midriff is wounded, these Accidents follow: The party is troubled with a heaviness of that part; he is taken with a raving by reason of the branches of the Merves of the sixth conjugation of the Brain, which are spread through the body of it, difficulty of breathing, a Cough, a sharp Pain, and Fever will trouble the party wounded; yea, the Stomach and Guts sometimes by the vehemency of breathing, will be drawn up into the capacity of the Chest through the Wound, as once happened to Ambrose Parey, as he confesseth, lib. 10. c. 30.
That a Vessel is wounded, and Blood poured forth into the capacity of the Breast, you shall know by these Symptoms: there will be a difficulty of breathing; the Fever will increase; he will vomit Blood; after the Blood putrefying the Breath will stink; his Appetite will be lost; he will have a desire to vomit; he desireth not to sit up, and often fainteth, noisome Vapors assaulting the Heart, being taised up from the putrefied Blood.
As for the Prognosticks of Wounds of the Breast, receive these.
First, Wounds of the Breast which either pierce not to the cavity, or if they be penetrant, hurt neither Vessel nor Entral, are not deadly, but may speedily and easily be cured, if a me thodical course be taken.
Secondly, if the great Vessels (whether they be Veins or Arteries) be wounded, they cause death. See Celsus, lib. 5. c. 16. and Hippoc. prorrhet. lib. 2. because they spend a man by great effusion of Blood, which can hardly be staid for two Reasons: First, because they lie deep in the Body, so that neither can they be bound, nor Medicaments convenient be applied to them: Secondly, because the Coats of them are membranous, and so cannot be healed by the first intention: yet if the Arteries be divided, the Wound is more dangerous.
First, by reason of the Blood contained in it; for it is more spirituous than that in the Veins.
Secondly, by reason of the flowing of the Blood; for seeing the Blood of the Arteries is more spirituous, and hotter, it issues out leaping, so that it can hardly be staid.
Thirdly, because of the Coats of the Arteries; for they are harder than those of the Veins, and sometimes become Cartilaginous.
Fourthly, by reason of the hard consolidation of the Coats of the Arteries; for they are still in the motion of dilatation and constriction [Page 384]but consolidation doth require rest, as Galen observes, lib. 5. Method. c. 8.
Fifthly, by reason of an Aneurisma, which most commonly remains after that a Wound is cured, wherein an Artery hath been divided.
As for Wounds of the Lungs, they are either superficiary and small; or deep, wherein the substance of the Lungs are wounded, and the great Vessels divided: those may be cured; these are deadly for eight Causes.
1. Because they are in continual motion.
2. Because the Lungs are very moist, and so subject to Inflammation and Putrefaction.
3. Because the Medicament can hardly reach to the bottom of the Wound.
4. Because the discharging of the Quittour (which is requisite for Cure) is both hard and dangerous; hard, because it must be discharged by expectoration by the upper parts; dangerous, because this must be performed by coughing, by which the Wound is more torn.
5. Because a fearful flux of Blood must ensue, the Vena Arteriosa, and the Arteria Venosa being wounded, and so many Vital Spirits must rush out together with this spirituous Blood.
6. Because great plenty of Blood must fall into the capacity of the Breast, which first by its heaviness must press down the Diaphragm, and cause difficulty of breathing; and afterward, being turned to Quittour, acquires a malign quality, and so may procure a Fever, Raving, and Convulsion; yea, in process of time Empyema, and last of all a Phthisis and Hectick Fever, the Acrimony of the Quittour corroding the tender substance of the Lungs: That a Phthisis doth ensue after an Empyema, Hippoc. lib. 5. aph. 15. witnesseth.
7. Because the entring of fresh Air into the Lungs, and the expulsion of fuliginous Vapors from the Heart are hindred.
8. Because the Heart must of necessity be affected by consent, for the Lungs are instead of a Pillow, and fan to the Heart, to wit, Vena Arteriosa from the right Ventricle, and Arteria Venosa from the left.
Secondly, Forest. obs. 4. lib. 6. in Schol. hath these words. ‘It is to be noted (saith he) that if the Lungs be wounded in the fleshy part, wherein there is a remarkable branch of Arteria Venal [...]s, then a man must of necessity die, because he is choaked with Blood: You shall know this by the plenty of black frothy Blood.’
Thirdly, that dangerous Wounds of the Lungs have been sometimes cured, read Plater. lib. 3. observ. pag. 690. Horstius lib. 3. observ. Medicar. de Morb. Pector. observ. 11. Valeriol. lib. 4. observ. Medic. obs. 10. Acraeas, lib. 2. c. 1. Guilhel. Fabricius observ. Chirurg. cent. 3. observ. 36. & cent. 1. Epistol. epist. 52. Matthias Glandorpius in specul. Chirurgico observ. 24. See sundry in Schenkius observ. Medic, lib. 2. de Morb. pulmon.
As for Wounds of the Heart, other the Pericardium only is [...]ounded, or the substance of the Heart also.
If the Pericardium be wounded, the Wound of it self is not deadly, for it it but a ministerial and igroble part, and hath both few and and small Vessels and Nerves, and it doth not cleave to the Heart, but leaves so much distance as gives way to the pulsation of the Heart, and is fit to contain the waterish Humor; yet by accident it may become deadly, if it be so great, that all the waterish Humor [...]ows out: for this wanting, an Hectick Fever seizeth upon the wounded party; seeing it is appointed for the cooling and moist [...]ing of the Heart. See Example in Schenkius lib. 2. Observ. Medicar. & Cardan. comment. ad aph. 18. lib. 6. aphor. Hippoc.
Secondly, if the substance of the Heart be wounded, the Wound is so be accounted deadly. See Hippoc. lib. 5. aph. 18. & Galen. in comment. Cels. lib. 5. c. 26. & Aristot. lib. 3. de part. animal. c. 4. Vidus Vidius, tom. 2. oper. Medic. lib. 7. de curat. memb. c. 2.
First, because the Heart is the beginning of Life, and so it being spoiled, it can afford no help to the rest of the parts. See Arist. lx. citato. Secondly, because it is the laboratory of the Vital Spirit. Thirdly, because it is the shop of the vital Blood. Fourthly, because it is in continual motion, which hindereth consolidation. Fifthly, because it is a hot intral, and full of Blood, and so very subject to Inflammation. Sixthly, because it hath a substance compact, hard and dry, which doth not easily admit consolidation. Seventhly, because coplous Blood doth issue out into the cavity of the Breast, by the which a man is suffocated.
Thirdly, superficiary Wounds of the Heart do not so soon kill as deep Wounds.
Fourthly, Wounds in the left Ventricle sooner dispatch a man, than those in the right.
As for the Wounds of the Diaphragma; the Wounds of the Midriff, but chiefly in the Nervour Center, are deadly, according to Hippoc. lib. 6. aph. 18. & Galen in comment. & Cels. lib. 5. cap. 26.
First, because it is membranous and in continual motion.
Secondly, because the Wounds of this part are very painful, by reason of the remarkable branches of Nerves which it receives from the lower Vertebrae of the Neck, according to Gal. lib. 13. de us. part. c. 5.
Thirdly, because the Pericardium is tied to it; and although the fleshy circumference wounded may seem to afford some hope of recovery; yet Wounds in it are not without danger: First, because the principal parts must suffer also; the Brain by reason of the Nerves, which are inserted in it; the heart by reason of the vicinity, and the Arteriae Phrenicae; the Liver by reason of the contiguity, and Venae Phrenicae. Secondly, because the whole Midriff is in continual motion. Thirdly, because [Page 386]breathing is hindred. Fourthly, because Blood must issue out into the capacity of the Breast, which may cause suffocation. Fifthly, because fearful symptoms ensue, as the pulling up of the Heartstrings, pain of the Spina, which reacheth to the shoulder, difficulty of breathing, for it will be slow, great, and with sighing; a troublesome Cough, a Fever, and Raving, by reason of the affinity which it hath with the Heart and Brain. See Cels. lib. 5. cap. 26. Fernel. lib. 7. [...]. c. 8. Forest. Observ. Chirurg. lib. 6. observ. 47.
Now to come to the cure of Wounds of the Breast, those which do not penetrate require no special consideration, but are subject to the Intentions which have been delivered for the cure of Wounds in general.
In curing of penetrating Wounds, thus you must proceed.
First, you must lay the Patient in his naked Bed, his Feet being stretched out at length, and the Orifice of the Wound downward.
The Patient being thus placed, let him lie still untill the Chirurgeon hath made ready such things as are to be applied to the Wound: in the mean time let the wounded party labour to further the discharging of the Blood, without the Vessels fallen into the cavity of the Breast, by coughing, and holding in his breath.
When no more Blood issueth out, then put into the Wound [...] Flammula, dipped in the white of an Egg, so that the greatest part hang without the Wound: for this neither causeth Pain, nor letteth in the Air, and is sufficient for the discharging of any hurtful moisture, Whereas a Tent may be swallowed up by the Wound, hindreth the flowing of the Matter, grieveth the Patient, and being continued causeth a Fistula: whereas the Flammula may be continued untill the fortieth day, the longest time required for ordinary penetrating Wounds.
In stead of a Flammula you may use a Silver Pipe, such as is used when a Paracentesis is administ [...]ed; but it must have a stay on both the sides hollowed, to receive a Thread of a reasonable length, lest it be pulled into the capacity of the Breast, in the Diastole, Nature labouring to shun Vacuity: But when the Wound doth afford but a small quantity of laudable Quittour, it is to be taken out, and the consolidation of the Wound to be procured. The Wound and the Pipe are to be anointed, either with Arcaeus his Liniment melted in a Spoon, or with some artificial Balsam warmed. Above, apply Diachylon simplex: While you dress the Wound, it is convenient, chiefly in the Winter time, to hold a Pan with hot Coals above the Wound, to hinder the expiration of the natural heat, and the intermission of the cold Air.
One thing I would have you to observe, that both Blood and Quittour which is lodged in the capacity of the Breast, may be discharged both by Coughing and by Urine. If it be discharged by Coughing, first, the Matter is carried [Page 387]into the Pleura, then into the substance of the Lungs; afterward it is carried to the Windpipe, and from thence mounting up to the Mouth it is spit out. If it be evacuated by Urine, then it passeth first into the substance of the Pleura, then into Vena sine pari, near to the Diaphragma, where a branch of it doth pass by a streight course to the Emulgents, and so to the Ridneys and Bladder. See an Example of this in Fabricius ab aq. pendent. part. 2. lib. 2. c. 42.
One here may move a Question, why it is so dangerous a matter if Matter fall into the capacity of the Breast, and so light if it fall into the capacity of the Abd [...]men? Three Reasons may be alledged for this.
First, because the Matter which falleth into the cavity of the Breast, is easily inflamed; partly because it is still moved by the parts of the Breast; partly because it is lodged near to most hot parts.
Secondly, because the Breast doth require an ample and free capacity for inspiration and expiration, to cool and preserve the natural heat of the Heart.
Thirdly, because it is a hard matter to draw by any passage the matter from thence, unless it be in the depending part, even if you use a large and wide Syringe called by Galen, Pyulcus.
These things being done, if Indications of bleeding move you thereto, first, open a Vein in the contrary side, and then in the same side, as the strength of the party, and the symptoms shall require.
Arcaeus, lib. 2. cap. 1. will have this vulnerary potion ministred afterward: ℞ Rhab. ʒss. Rub. Tinct. Mammiae, an. ℈ j. Terrae sigillat: ℈ss. aq. Scabios. Bugloss. & Succi Granat. an. ℥ j.
After this he adviseth to prepare a decoction to procure easie breathing and ease, such is this: ℞ Hord. mundat. ℥ iv. Passul. major. exacinat. ʒ iv. Rad. Bugloss. ℥ iij. L [...] quirit. contus. ℥ ij. Jujub. n. xx. Pruna n. xv. Rad. Petrosel. contus. man. 1. fiat. decoct. in lb xiv. aq. Pluvial. ad consumpt. 3. part. Aromatizetur decoctum Cinnam. ʒ iij. ac coletur. In Colaturâ dissolve Penid. ℥ iij. syrup. Ros. simpl. & de duabus radicib. sine aceto an. ℥ ij. Sacchari Candi ℥ iv. Quartâ quâque horâ capiat aeger hujus decocti ℥ vj. This doth nourish, wherefore he is to take no other food for the space of three days, unless it be a Ptisan, having the Emulsion of the great cold seeds wherein the Roots of Fenil and Parsly have been boiled.
If any Matter offer it self to be purged by expectoration, then Galen adviseth to further it by the exhibition of Vinegar and Water warm; for it powerfully dissolves clotted Blood. If the Patient doth cough with difficulty, then minister unto him Syrup of Coltsfoot, and Liquirice, with Syrupus Acetosus.
Frambes. canon. & consultat. Medicinal. lib. 8. adviseth Morning and Evening to minister a vulnerary potion, made of the leaves and Roots of Comfrey; Plantain, Sanicle, Bugloss; [...] [Page 388]in Spring Water and some Vinegar. In the decoction strained some Saccharum Rosatum is to be dissolved, and some good Bole mingled.
He willeth also that injections be made of Barly Water, Mel Resatum and Sugar; as thus: ℞ Ptisan. ℥ iv. Sacchar. Rub. ℥ ij. Mellis Rosat. ℥ j. Misc. In your injections you must have a care of two things: First, that no bitter thing be put in them: for this would be unpleasant to the Taste, and overthrow the Appetite. Secondly, that all the injection come out, for if a part of it should be detained, it would putresie and annoy. It is not amiss for four or five days to lay upon the Pipe or Flammula, a Sponge wet in Aqua Vitae, and wrung, both to keep out the Air, and to extract the Quittour by its gentle heat.
Use not Pledgets of Lint, lest by breathing they be pulled into the cavity of the Breast; from whence would ensue putrefaction, and death at last. According to the small quantity of Quittour, or great which the Wound yieldeth, dress it once or twice a day. And when the Patient breatheth freely, sindeth little pain, and no weight toward the Midriff, but small store of Quittour, and that laudable, doth flow out of the Wound, it is time to shut it up.
CHAP. XXIX.
Of the cure of a Fistula of the Breast following a Wound thereof.
IF after you have diligently and carefully used the means set down by me, concerning the cure of Wounds of the Breast in the former Chapter, for the space of ten days, you see that the Wound tends not to Unition, you may imagine that a Fistula may ensue. That a Fistula will ensue (if it be not prevented) you shall conjecture by these signs.
First, if during the aforesaid time, you have used both inward and outward means, and yet the Wound sends out greater store of Quittour, than it did before, it is a great sign that the Wound is growing towards a Fistula, and that the Patient is entring into a Phthisis or consumption of the Lungs.
Secondly, if the Wound send forth a thin bloody Quittour, like to Water wherein Flesh hath been washed, the same is to be feared: for this is a sign that much coagulate Blood is lodged within the Breast, which must be turned to Quittour, and be discharged partly by expectoration, partly at the [Page 389]Wound; which will require a long time, during which, the Wound may become fistulate, if it be not well looked unto.
Thirdly, if the Quittour which issues out of the Sore, stinks vehemently, as the breath also, a Fistula may be expected: for this shews that there is a great putrefaction in some parts, which are contained within the capacity of the Breast, which is not easily overcome; first, because no bitter Medicaments which chiefly resist putrefaction, as Aloe, Myrrhe, Wormwood, the lesser Centaury, Carduus benedictus, &c. are to be injected, as hath been said: Secondly, because we cannot conveniently apply Topicks to the parts affected: Thirdly, because they cannot be kept to the wounded parts, by reason of the motion of the Heart, Lungs, Midriff and Ribs, in Inspiration, and Expiration: Fourthly, because the Body is like to fall into a consumption, so that it is to be feared, lest a convenient supply cannot be afforded by Nature to repair the Solution of Unity, which you have taken in hand to cure.
Fourthly, if a waterish substance, thô not bloody, do still come out at the Wound, (do what you can) you are to fear lest a Fistula ensue; for it is to be feared lest some Spermatick Parts, as Membranes or Fibres are wounded, which admit not Unition according to the first intention, or that there is some store of coagulate Blood in the capacity, which will require no short time for suppuration and discharging. When you shall see these signs appear, then are you to summon your Wits, and go about the prevention of a Fistula. This case hath been accounted very difficult, yea, desperate in great Wounds of the Breast, by most Chirurgeons both Ancient and Modern. Nevertheless, Franciscus Arcaeus arose in the last Age, a Spanish Physician, who by his Wit and Practice found out a way of curing, not only Wounds tending to fistulation, but such also as are de facto fistulate, and charitably hath consigned it in his Treatise of Wounds, lib. 2. cap. 2.
To compass this, he uses three Intentions: The first is a convenient Diet: The second is internal Physick: The third is external Application.
As for the Diet, such a one he prescribes, if the party be strong, for eight days and more, according to the toleration of the party wounded, he is to eat nothing but Bread and Raisins: for he affirms, th [...]t his pectoral decoctions do nourish; from hence untill the thirteth day, he is to eat Flesh to Dinner, and to rest contented with Bread and Raisins to Supper; from the thirtieth to the fortieth day, about which time Fistula's of the Breast are for the most part cured, he permits Flesh both at Dinner and Supper: If the party be very weak, he permits unto him, even from the beginning of the cure, to eat Flesh both at Dinner and Supper; but it must afford a good Juice, and be of easie concoction: such is the Flesh of Chickens, Mountain-Birds, Kids, Lambs and Rabbets. As for the internal Physick, it is of two sorts, Purging and Pectoral.
For purgation of the Body, he prescribes these Pills. ℞ Pil. Aggregativar. & de Agarico an. ʒss. Diagrid. Gr. iij. fiat massula ex qua formentur pilul. v. He is to swallow them about Six a Clock, and about Ten a Clock to sup some Chicken-broth, and to Dine about Twelve a Clock. This is a Dose large enough for the strongest person: you may detract from it as much as the constitution and strength of the party shall move you. As for the pectoral Medicaments, they are either meerly pectoral, or healing also. Out of the description of his Medicaments, one may conjecture that either he was not well verst in the composition of Medicaments, or that he was negligent in setting them down.
Wherefore I am to take some pains to set them down according to Art: his decoction meerly pectoral, thus you shall prepare: ℞ Polypod. Quercin. ℥ iv. Rad. Enul. ℥ iij. Hyssop. Capill. Vener. Recent. an. man. iv. Liquirit. ℥ ij. Epithymi man. j. Fol. sen. ℥ iij. Passul. Major. Exacinat. ℥ iv. Decoq. ista in lib. xxiv. aq. Font. ad Consumptionem lb viij. ac coletur decoctum: quod c ar [...]ificetur addit. Saccari rubri in decoct. soluti, ac mell. despumat. an. lb ss. Let the Patient drink half a pint warmed in the Morning, and so much about Four a Clock in the Afternoon: At Dinner let him drink a pint, and so much at Supper. Let this decoction be used eight days, within which time laudable Quittour is for the most part procured.
His healing Decoction thus you shall make: ℞ Scob. Gua jac lb. ss. Cort. ejusd. ℥ vj. semin. Cumin. ℥iss. Glycyrriz. ℥ ij. Passul. Major. exacinat. ℥ iij. Decoq. ista in lb. x. font. ac totidem, lib. vini albi ad consump. lib. viij. ac coletur decoctum. Sumat Aeger mane, lib. ss. ac dormiat: sumat tantundem horâ quartâ pomeridianâ. In prandio bibat, lib. j. ac tantundem in coenâ. If the party be dry, and desire more drink, then pour upon the Simples which remain after the first Decoction, six pints of Wine, and so much Water, and boil away half of the Liquor: this will serve for quenching of the thirst: let the wounded party continue the taking of this Decoction, untill the cure be finished. The Room wherein he lies, he will have still to be kept shut and warm, and he advises to lie in bed the first thirty days; if the Patient cannot endure to lie in bed so long, then let him sit up the warmest part of the day, and go to bed again betimes: by lying in bed the motion of the parts contained in the Breast is moderated, and the Wound is kept warm, which must be observed in all penetrating Wounds of the Breast.
If the party troubled with any such Wound be in a Consumption, or Phthisick, then he prescribed to him this Decoction: ℞ Herd. Mundat. ℥ iv. Passul. exacinat. ℥ iv. Rad. Bugloss. ʒ iij. Glycyrrh. ℥ ij. Card. Benedict. man. j. semin. Cumin. ʒ ij. Jujubas numero xx. Pruna numero xv. Rad. Petrosel. man. j. coq. ista pari modo in lib. xx. aq. Pluvial. ad Consumpt. lib. viij. utatur hoc decoct. ut praecedente. [Page 391]Verum, postquam decoctum est aromatizatum Cinnamon. ℥ss. addantur Penidior. ℥ iij. Syrup. Ros. Rub. simplic. & de duabus radicibus sine aceto an. ℥ iij. Sacchar. lib. ss. Now and then, whether the Body be costive, or no, he adviseth to take a Dose of the Pills prescribed before.
As for the Topicks he will only have an Emplaster laid to the Sore, and to be wiped often every day by the Patient himself for the hastning of the Cure. This Emplaster he setteth down: ℞ Ceruss. Litharg. an. ℥ iv. Oliv. Antiq. Aceti Fortiss. an. lib. 1. coq. omnia igne lento ad emplastri consistentiam. These Methodical proceedings of Arcaeus, are not only effectual in preventing a Fistula, but in curing of it also, if it be present. He deserves thankful commemoration of Posterity for the supplying of this defect, which often for want of Art and Means, did fall out in the Cure of dangerous penetrative Wounds of the Breast.
Sennert. part. 2. lib. 2. c. 18. holdeth these Fistulations to be of hard Cure, and that not without cause: For first, the parts of the Breast, as the Muscles, Ribs, Lungs and Heart, are in continual motion. Secondly, because the Quittour cannot be promptly discharged. Thirdly, because much Quittour is gathered: And they are more hardly cured, if the Orifice lie upward, and not in the depending part: Two means he appointeth for the cure of these; and because they are very rational, they are not to be passed over in silence.
The Injection is this: ℞ Flor. Ros. Rub. Summitat. Hyper. Equiseti, Cariophyllat. Rad. Ireos an. ℥ j. Veron. Valerian. Millefol. Pilosel. Eupat. Sigil. Salomon. an. man. j. He advises to add to these the lesser Centaury, the Root of Aristol. and Gentian, as also Myrrh and Frankincense; but seeing the Myrrh and Frankincense must be used in Powder, and it is not sit to use any Powders in the Injections which are appointed for the Breast, because the internal parts are very tender, and because they, and the lesser Centaury are bitter, which by reason of their bitterness may offend the Taste, they are to be left out of the Injection. After a Nights infusion, then you shall boil the Simples set down by me, in a Gallon of fair Spring or Rain Water to the half, that is, until a Pottle remain. You shall first clarifie every lb of this Decoction with two ounces of Hony, and so much Sugar, adding the white of an Egg beat to water. Last of all; having strained it, you shall reserve it in a Glass Vessel to your use.
As for his vulnerary Potion, he will have it made of these Simples: Plantain, Agrimony, Fluellin, Scabions, Hypericum, Betony, Lungwort, Ground-Ivy, Harts-tongue, Sage, Avens; you may add the white Hoar-hound, Sanicle, [...]nd our Ladies Mantle. Of these you may s [...]ame unto your selves such a Decoction: ℞ Eupat. Seabios. Cariophyllat. Sanicul. Plantag. Pulmonar. Ling. Cervin. Alchimil. Tussilag. an. man. j. Rad. Consol. Major. & Borag. an. ʒ j. coq. ista in lib. x. aq. font. aut plu [...]ial. ad [Page 392]medictat. consumptionis, ac coletur decoctum. Postea addit. Sacchar. ac Mel. an. ℥ iv. &c. Albuminib. ovorum clarificetur decoctum, atque iterum coletur. Capiat Aeger singulis diebus horâ quintâ matutinâ lib. ss. Calid. ac dormiat: capiat tantundem borâ quartâ Pomeridiquâ. If you well consider the faculties of the Simples, which enter into the Injection, and the vulncrary Potion, you must confess, that it must be a very obstinate Grief which refuseth to be cured, if these means be methodically used, and the Sore be dressed according to Art.
All Authors almost, who have discoursed of Wounds of the Thorax have made mention only of Wounds received in the fore part of it; but have made no mention of Wounds inflicted into the back, which pierce also into the cavity or hollowness of it: whereas these are most dangerous by reason of the Spinalis Medulla, which is placed there; and the multitude of Nerves which proceed from thence. If such an event do fall out, first you are to dress the Wound in the Back, as I have set down in the six and twentieth Chapter. As for the Wound of the Breast, it is to be cured by Injections, and vulnerary Potions, set down by in me the six and twentieth Chapter.
CHAP. XXX.
Of Wounds of the Abdomen, or lower Belly, which penetrate, and yet without any hurt of the parts contained.
THese Wounds either pierce to the cavity through the Muscles and the Peritonaeum, or else they do not penetrate. If they pierce, then either some part starts out of the Wound, or else none doth. The parts which start out, are either the Caul or the Guts: if no part start out, then either some part contained is wounded, or none at all.
You shall conlecture a Wound to penetrate: First, if the Probe, or a Wax-candle go deep in streight-ways: in searching you must first see that the Wound be not inflicted obliquely: for in this case you may thrust the Probe a great way between the Muscles, the Wound notwithstanding not penetrating. 2. You must diligently search, that the passage of the Wound be not stopped with any of the super-jacent Bodies, as [Page 393]the Fat, the Membrana Carnosa, or the Muscles.
Secondly, if the Injection be made with Wine warmed, if the Wound penetrate, the Wine will be received within the cavity; but if it pierce not, it will return.
Thirdly, we may conjecture by the Figure of the Weapon, whether it penetrate or no: for if it grow broader from a rush point, and the Wound be broad in the outer part, it is likely that the Wound is penetrating.
Fourthly, if the Caul, or one of the Intestines start out of the Wound, then no doubt is to be made of the penetration of the Weapon.
As for the presages, receive these: First, a Wound of the Belly, not penetrating, is void of danger, unless it be extraordinarily large; for in such a Wound many parts must suffer Solution of Unity, the pain must be great, many Spirits must be dissipated, and the party must be more subject to fainting.
Secondly, a Wound received in the middle part of the Belly, is more dangerous than that which is received in the sides: First, because in the middle it is more tendinous, and so the more sensible and subject to Inflammation and Pain. Secondly, because the Intestines roll towards the middle part.
Thirdly, all penetrating Wounds are to be accounted dangerous: First, because they are most commonly large, but always deep. Secondly, because the Air hurts the Guts. Thirdly, because Quittour falls into the capacity.
Fourthly, when in a Wound of the Belly, any of the remarkable parts contained are wounded, it is to be accounted a deadly Wound most commonly. Of such Wounds Celsus thus pronounceth; ‘He cannot escape who is wounded in the basis of the Brain in the Stomach, in the Portae of the Liver, and to whom the middle of the Lungs, the Jejunum, the small Gut, the Kidneys or the Bladder are wounded.’
As for the cure of such Wounds, First, a Wound not penetrating is cured without any difficulty, as Wounds in other fleshy parts of the Body.
Secondly, if the Wound be penetrating, and any part contained start out, four Intentions are required. The first is, that the part be situate in its own place. The second is, that the Wound be stitched. The third is, apply convenient Medicaments. Fourthly, that a course be taken for the removing of ill Symptoms.
If the Gut start out, and you be presently called to it, then you are to thrust it in with Hands and Fingers. But if it hath long hung out, and by reason of the cold Air be filled with flatuosity, and swelled, so that it cannot be reduced; first of all you are to use an incarnative Fomentation to discuss the Flatuosity, and then to try the reposition of it. The Fomentation must be made of Chamaemil, Melilot, Dill, Peny-royal, Germander, Tansey, Lavander, Wormwood, Mints, Bay-berries, Cumminseeds, Fennil-seeds and Aniseeds, boiled in red astringent Wine, or Milk, if such a chance fall out in the Country. [Page 394]If after sufficient Fomentation you cannot put in the Gut, then you are to dilate the Incision.
If the Caul come out, and by reason of the cold Air it be much cooled, which you shall discern by the unnatural hardness of it, or if it be black, or of a livid colour, then it is to be bound up near to the warm and sound part, and the corrupt part must be cut away. Let the Thread hang out at the Wound, until the corrupt part separate from the whole. Then draw the Thread wholly out of the Wound. If the Caul be nothing altered, it will be sufficient to thrust it within the Peritonaeum without binding. It is requisite that we use deligation, when we cut away any portion of the Caul: otherwise much Blood would fall into the capacity of the Abdomen: for the Caul seemeth to be a texture of Veins and Arteries enterlaced with fat.
The second scope is to stitch the Wound. This kind of stitch is called [...]. Before you stitch, you must perform these three things. First, you must have a elear light, that you may have a perfect view of the Wound: Secondly, you must lay the Patient upon the side opposite to the Wound, that the Guts trouble you not, while you are stitching: Thirdly, that you have your Servant by you, to hold up the parts which you are to stitch.
These things being provided, go about your business: of this kind of stitch there be three usual sorts.
The first is thus performed: First, the Needle is thrust through the Skin and the Muscles, even to the Peritonaeum, not touching the Peritonaeum on that side: then from within outwards, the Needle is to be thrust through the Peritonaeum and Muscles of the opposite side. Then within the distance of an inch, the Needle is to be thrust through the Muscles of the same side, leaving the Peritonaeum. Afterwards from within outwards the Needle is to be thrust through the Perltonaeum and the Muscles. So you are to proceed until sometimes piercing the Peritonaeum, and sometimes sparing it, you have sufficiently united the parts disjoyned. Some, of four stitches make one Ligature, cutting the Thread, and tying the ends of it firmly together, and use as many Ligatures as are sufficient.
The second is done by stitching the Muscles together, and the sides of the Peritonaeum together. In this sort of stitch, first, the Needle is to be passed through the Skin and the Muscles to the Peritonaeum: then the opposite side of the Peritonaeum is to be joyned to the side lying under the Muscles pierced: this being done, the opposite Muscles are to be pierced, this course is to be followed until all the brims of the Wound be decently united.
The third differeth not from the stitch which is used in other parts of the Body: For the Needle is to be thrust through two sides of the Muscles, and so many of the Peritonaeum still, until sufficient stitches be taken. The first is accounted the best. After stitching you leave an Orifice in the depending [Page 395]part to admit a Tent, that the matter procured by supparation may be discharged. This kind of stitch is used, because the Peritonaeum being a Membrane would not admit Consolidation without the entercourse of flesh. And if it were left unconsolidate, an uncurable Tumor would be left in the outer parts, the Guts insinuating themselves into the Cavities of the Muscles.
One thing is to be observed, that you second and strengthen this kind of stitch, by a drie stitch, and that very firm: for within a few days the thread will cut asunder the brims stitched, and the stitches will become loose, because the intestines continually do butt upon the Abdomen; wherefore the drie stitch is requisite, as it is in the cure of the double Hare-lip.
The Third Intention was said to be the application of convenient Topicks. Such are all choice vulnerary Balsames, whereof I have spoken sufficiently before, and agglutinative Emplasters, such are Diapalma, and Emplastrum de minio newly made, and not too drie in the Summer-season. In the Winter Emplastrum sticticum is the best.
The description of it is thus set down by Crollius: ℞ Ol. lini & Oliv. an. lb j. Ol. Laurin. lib. ss. Litharg. auri & argent. an. lib. ss. Minii ℥ iiij coq. ista ad Emplastri consistentiam, tum adde Cerae, Colophon. an. lib. 1. Istis Liquefact. injice Gum. sequentia in aceto scluta, atque ad justam consistentram iterum reducta. Opopan. ℥ ij. Galban. Serap. Elemi, Anom. Bdel. an. ℥ iij. Istis incorporat. injice sequentia in alc. redacta, Calaminar. ℥ iiij. Arist. long. & rotund. Carab. Magnet. Lap. Haematit. Coral. Rub. & Albor. Vitriol. alb. terrae Jigil. Croci Mart. Ceruss. Antimon. an. ℥ j. Oliban. Myrrh. Aloes hepat. Mummiae, Sanguinis Dracon. an. ℥ ss. Istis probe commistis adde Terebinthinae ℥ ij. Vernicis ℥ j. Caph. ʒ iij. paretur Emplastrum, ex quo formentur magdaleones manibus Ol. Hypericon. inunctis. I have altered the Doses of the Simples, I confess, Art so requiring, and have set down the artificial Composition. The faculties of it you may read in himself; for they belong not to the subject which we have in hand. Fab. ab Aq. pendent. Chirurg. part. 2. lib. 2. c. 45. adviseth to use astringent Powders as this: ℞ Sang. Dracon. Bol. Armen. Mastiches, bac. Myrti an. siat ex omnibus pulvis. If Sarcocol, the root of Comfrey and Borax were added, the Medicament would be the more effectual. The last Intention of curing of these Wounds penetrating, wherein no contained part is wounded, was said to be the shunning and hindring of evil Symptoms. Now these Symptoms are two: The pain of the parts adjacent being continual, and the collection of Quittour or Blood in the hollowness of the Abdomen.
To avoid the first, Gal. 6. Meth. c. 4. adviseth us to embrocate all the parts from the Arm-pits to the Groins with Sallet-Oil warmed: But it were better to embrocate those parts with the Oil of Chamaemil, Roses, and white Lilie, if they be to be had: for so the Inflammation [Page 396]would be prevented, Pain would be eased, and the parts kept soft and pliable.
As for the second accident, Blood and Quittour may fall from the brims of the Wound into the hollowness of the Belly, and may offend, not the Guts only, but all other parts contained also: for sometimes a Tumor is caused, and sometimes the Dropsie is procured. You shall know that these things are contained in the hollowness, First, by the Weight which is felt there, the Pain, the Tension of the part: Secondly, if you crush the Belly, you shall perceive the Matter to shift from place to place under your hands. Seeing this Matter cannot be sensibly emptied, because the wounds of the Belly must not be kept open, for the reason set down before, when I spake of the stitching of these Wounds; we must labour insensibly to dissipate it by Medicaments; which rarefie the parts, and dissipate and draw out the Matter: wherefore you may embrocate the Groins with Oil of Rue, Dill, Euphorbium, Wax, Castoreum, of Tiles, Then you may apply Diachylum magnum cum Gummi sostned with Oil of Scorpions, or Oxycroceum, and de Mucilaginibus mixed together.
CHAP. XXXI.
Of penetrating Wounds of the Belly, wherein some of the parts contained are wounded, and First of the Wounds of the parts appointed for Chylification.
NOw the contained parts which are wounded, are either appointed for nutrition or procreation. If for nutrition, then they either procure Chylification, or help Sanguification. Those which procure Chylification are the Stomach and the Guts. The Stomach hath two parts, the Orifice, which is called Oesophagus, and the bottom which is called Ventriculus.
If the Oesophagus be wounded, then the Wounds are either superficiary and small, or else deep, and passing to the Cavity of it: And both these are either streight or transverse, and these either near to the Stomach, or somewhat remote from it.
Wounds small, streight, and which are somewhat remote from the bottom of the Stomach, are less dangerous; But those which [Page 397]are great, transverse, and neer to the bottom, are deadly; and admit no consolidation. See Guido Tract. 3. Doct. 1. c. 1. for this these reasons may be given. First, because the passing of the Meat and Drink doth hinder consolidation. Secondly, because it is continually bedewed with moisture descending still, either from the Head, or from the Almonds. Thirdly, because its Office is absolutely necessary for the preservation of life, that is, the carrying of the Meat and Drink to the bottom of the Stomach. This carrying of the Aliment is performed by impulsion and attraction. The external Membrane, which is fleshy, and hath transverse Fibres, doth thrust it down; but the internal Membrane, which hath streight Fibres, doth attract the nourishment. Wherefore the Fibres of both the Membranes being cut asunder, the passing of the nourishment is staied, and so the party defrauded of Aliment. Fourthly, because the Meat and Drink must be discharged by vomiting, seeing it cannot pass to the bottom of the Stomach. Fisthly, when the upper nervous part of the Gula is wounded, which is nervous and of exquisite sense, which the Grecians call [...], death doth most commonly suddenly ensue.
Celsus. lib. 5. c. 26. hath these signs of it wounded: Ʋbi stomachus autem percussus est, &c. But when the Stomach is wounded, the Hicket and vomiting of Choler doth ensue. If Meat or Drink be taken, it comes up again speedily, the Pulse grows weak, thin Sweats break out, and so the extremities of the Body grow cold. Fernel. lib. 7. Pathol. cap. 8. addeth Fainting. Although I have set down the methodical curing of such a Wound, Chap. 27. yet I thought good here to touch a few things necessary to be known.
Wounds in the Oesophagus are more dangerous than those of the Ventriculus for these reasons; First, because it is of a nervous and membranous substance, and so is not easily united. Secondly, Because the pain is exceeding sharp, and so depriveth one of rest and sleep. Thirdly, Because it hath a great consent with the Brain, by reason of the Nerves descending from the sixth Conjugation, which are bestowed upon it. Fourthly, Because Topicks cannot conveniently be applied to such a Wound; yea, if you minister vulnerary potions, either they return by vomiting, or slipping down make no stay, or else they issue out at the Wound. Fifthly, Appetite is lost, and so the desire of Meat and Drink, without which the life of Man cannot long continue. Sixthly, because Convulsions may ensue, which are deadly, according to Hippoc. Aphor. Sect. 5.2. Seventhly, because vomiting of Choler doth ensue, according to Celsus, loco citato, which may enlarge and tear the Wound.
Now as concerning the Wounds of the bottom of the Stomach, they have the same differences which those of the Orifices have, which after the Prognosticks, and manner of curing these wounds, receive these presages.
First, small and superficial wounds are easily cured; but penetrating [Page 398]Wounds are accounted deadly by Hippoc. Aphor. 18. Sect. 6. & Celsus lib. 6. c. 26.
Now this word Deadly hath a threefold signification; for First, it signifies, that bringeth inevitable death; Secondly, it signifies, that which most commonly bringeth death; Thirdly, it signifies that which is dangerous, and may bring death. Now Wounds in the bottom of the Stomach penetrating, are not always deadly in the first signification, although they be in the second and third signification.
Secondly, penetrating wounds in the bottom of the Stomach are hard to be united: First, because it is of a membranous substance. Secondly, because Meat and Drink keep asunder the brims of the Wound. Thirdly, because vulnerary potions slip out at the wounds. Fourthly, because a convenient Ligature to keep the brims of the wound together, cannot be applied. Fifthly, because the Stomach is very sensible, from whence ensue Pain, afflux of Humors, Watching and Inflammations. Sixthly, because the Body cannot be without the benefit which it affordeth to it, for it is the pot wherein the nourishment of the whole Body is boiled.
The Second presage: Penetrating wounds in the Ventriculus, are not so dangerous as those of this kind in the Oesophagus. First, because the bottom is more fleshy. Secondly, because vulnerary potions and other Medicaments may longer stay here. Thirdly, because the dignity of this is not so great; for the Orifice is the seat of the Appetite. Fourthly, because the bottom is not of such an exquisite sense as the Orifice. That Wounds in the bottom of the Stomach may be cured, read Crollius in praefat. Basil. Chymic. Schenkius, and others. It were too tedious to set down their narrations.
You shall know that the bottom of the Stomach is wounded, First, if the Wound be under the Diaphragma, or the Mucronata cartilago: Secondly, if the Chylus come out at the Wound either sincere, or mingled with the Meat unaltered.
As for the cure of these Wounds, you must not suffer the Tent to enter into the wound of the Stomach: it must only keep open the parts lying above the Stomach. Let it be armed with a Digestive made of the Oil of Hypericum, Turpentine, and the yolk of an Egg; for this asswageth pain, procureth Quittour, and is glutinative. The Stomach outwardly is to be embrocated with Oil of Mint, Myrtils, Quinces, Wormwood, and Oil of Roses; Let him drink the juice of Pomegranates and Quinces, or Syrups of them in the decoctions of Horse-tail, Mouseear, and Periwincle or Plantainwater sugared. To poor people you may prescribe Posset-drink, wherein these Herbs have been boiled: Let the party Drink and Eat very sparingly; for the Wound will better unite when the Stomach is somewhat empty and wrinkled together.
If the Guts be wounded, then they are either the small or great Guts. If the small be wounded, the Chylus comes out at the wound, [Page 399]the Flanks swell and become hard, the Hicket troubles the Patient; be vomits Choler; he hath great gripings in his Belly; oftentimes a cold Sweat breaks out, and the extream parts cold.
If the great Guts be wounded, the Excrements come out at the Wound. Now the wounds of the Guts are either superficiary, or they pass to the Cavity. If they pass to the Cavity, then they are either streight or transverse, and these either great or small.
This being noted, you may thus correcture of the event: First, if the Wound be but superficiary; yet it is not altogether without danger; because all the external parts of the Abdomen are divided. Secondly, great Wounds of the Guts, but chiefly if they be transterse, for the most part prove deadly.
First, because they are of a membranous substance, which hath but little Blood. Secondly, because the Chylus and excrements do continually pass by them. Thirdly, because local Medicaments cannot conveniently be applied to them, partly because they lie deep in the Body, partly because they conti [...]ally change place. Fourthly, because the brims are kept asunder, they being distended by flatuosity, the Chylus and the Excrements. Fifthly, because their Office is absolutely necessary for the preservation of the life of Man; for either they distribute the Chylus, which is performed by the small Guts, or else they contain and discharge the Excrements, which the great do: But these are hindred, the Guts being wounded. Sixthly, because they are very sonsible, and so Pain, Inflammations, Fevers, and Watching may ensue.
The third presage: Wounds of the small Guts are more dangerous than those of the great: First, because they are more nervous and membranous than the great. Secondly, because they are of a more exquisite Sense. Thirdly, because they are nearer to the Stomach. Fourthly, because they have more mesaraical Veins. Fifthly, by reason of their excellent Office; for they distribute the Chylus, and more resine it, according to Galen 4. de us. part. c. 17.
The fourth presage: Amongst these are the Wounds of the Jejunum. First, because it hath more mesaraical Veins than the rest, which makes it look red. Secondly, because it may be soon inflamed, by reason of the plenty of Blood. Thirdly, because it is next to the Liver, and so soonest inflamed. Fourthly, because it hath a tenderer substance than the rest. Fifthly, because it receiveth immediately and in full force, the sharp Choler from the Gall: whereas the rest receive it but mediately, and the sharpness of it being much abated.
The fifth Presage: The great Guts are more apt to receive Consolidation than the small; partly because they are of a more fleshy substance: partly because they are not so sensible: And Thirdly, the Excrements contained in them are solider than the Chylus, and so not so apt to flow to the wounded part, and so to keep the brims asunder.
As for the cure of these Wounds, they require four Intentions. The First is to stitch the brims of the Wound with the Glovers-stitch; if the Gut be not without the Wound, it must be drawn out gently: Let it be sown with good flaxen thread not waxed; for then it will swell and not so soon cut the brims of the Wound asunder.
Secondly, to reduce the Gut to its own place, but it must first be fomented with red astringent Wine warmed: Secondly, an agglutinatory Medicament is to be applied to the Wound, such is this: ℞ Mastich. Sarcecoll. an. ʒ j. Borac. & Myrrh. an. ʒss. fiat. s. a. pulvis. qui aspergatur.
Thirdly, the external parts of the Belly are to be stitched, as I have taught in the former Chapter. Better it is to stitch these parts than to leave them open. First, because you cannot any more apply local Medicaments to the Wound; for the Guts still shift. Secondly, because the Air will cause pain and griping. Thirdly, because the cold Air may breed flatuosity, which distending the Guts, may break the stitches. Fourthly, because the natural heat being kept in, the Gut is sooner consolidated.
The Fourth Intention is; you must have a care that the Excrements hurt not the Wound, they becoming hard by staying. To this purpose you must feed the Patient with moistning Meats, and minister emollient Clysters, made of the decoctions of a Sheeps-Head and Feet. In curing of these Wounds, you must not admit the ministring of vulnerary potions.
CHAP. XXXIII.
Of Wounds of the parts that help Sanguification and Procreation.
WOunds of the Liver, which is a part assisting Sanguification in the separation of Bile, are either superfciary, lightly hurting the outer part, or they are deep and great, p [...]ercing even to the trunks of the Vena porta, and the Vena capa. Celsus lib. 5. cap. 26. sets down these signs.
These are the signs of the Liver wounded, a great flux of Blood in the right Side, the Sides all drawn towards the Spina: the Party de [...]ghts to lie upon the Belly; prickings and pain even to the Neck, and to the side joyned to it: The Shoulder-blade stretched, sometimes vomiting of Choler doth also happen.
Peccetius lib. 2. cap. 8. Oper. Chirurg. adds, after Meat they feel a heaviness in the Side, they are unquiet, they have a sharp Fever, sometimes they piss a bloody Urine: After some daies also they discharge by siege rotten Blood, the Face becomes discoloured and wan.
What will befall, the Liver being wounded, these Aphorisms following will shew you. First, supersiciary wounds of the Liver may admit cure: but great and deep Wounds will not. Hip. Aph. 18. lib. 6. hath these words: If the Bladder, or the Brain, or the Heart, or the Midriff, or a small Gut, or the Stomach, or the Liver be wounded, it is deadly.
Sundry reasons may be alledged for this. First, is the great Flux of Blood which follows. Secondly, the Inflammation which possesses it being wounded; for it is a Member hot and full of Blood. The Third is the difficulty of Cure: for Vulnerary potions lose much of their strength before they come to the Liver.
Topicks cannot well be applied, it lying deep, and the Quittour cannot be well discharged, and so it may corrupt the substance of the Liver, and so Sanguification is disturbed, from whence ensue the Consumption of the Body, or the Dropsie.
If you object that good Authors have in their Monuments set down Examples of some who have been cured, who have received a deep Wound in the Liver.
I answer, that those Examples [Page 402]are rare, and come near to Miracles, God his providence concurring with the extraordinary strong constitution of the Body: wherefore let not these draw from you any bountiful promise of recovery.
The Second presage, If cold Sweats burst out of the Forehead and Neck, if the wounded party often faint, if the Extremities grow cold, and the party become very weak, then death attends.
Touching the Cure, let it be dressed with astringent Trochiscs dissolved in Plantain-water, adding thereto Syrups of dry Roses, Myrtils, and Poniegranates: for a doubtful hope is better than a resolved despair.
The Second part helping Sanguification, which may be wounded, is the Spleen: for according to Arist. lib. 3. de part. animalium, it is a bastard Liver. The wounds of it as of the Liver are either superficiary or deep. Signs of the Spleen wounded deeply, are these according to Celsus lib. 5. c. 26. Black Blood doth issue out of the left Side, the Side it self and the Stomach become hard, great Thirst ensues, and the pain reaches to the Neck.
Concerning these Wounds receive these Prognosticks, First, deep Wounds of the Spleen are for the most part deadly. Celsus lib. 5. c. 26. affirms, that they who are so wounded hardly are ever cured: for this Prognostick these reasons may be given: First, because a searful flux not only of the venal, but of the arterial Blood also doth ensue. Secondly, it is a worthy and necessary part, it furthering Sanguification, and being a second Liver, if it perform not its Duty.
Thirdly, because it being a part full of Blood and hot, it may be easily inflamed. Fourthly, because it hath a great consent with the Heart, by reason of the multitude of the Arteries communicate with it: for noisome vapours may be sent to the Heart, from the Quittour and putrefied Blood.
The second presage; although deep wounds of the Spleen be deadly, yet I am of the opinion that the Spleen may be cut out of a Man, or a Woman, and the party may live. The experiment of this exsection in a Dog, Mr. Gillam and I made in Dr. Bonham's House. First, incilion was made in the left Side, hard under the short Ribs, four Inches in length through all the containing parts of the Abdomen: then the Spleen was drawn out: Thirdly, all the vessels by which it was bound to the adjacent and contiguous parts, we bound, to prevent the immoderate flux of Blood: Fourthly, we cut away the Spleen near to the substance of it. Fifthly, we stitched the parts of the Abdomen, and left the healing of the parts to Nature; all the wounded parts were in a short time healed. But about six weeks afterward the Cur became Mangie, the Spleen belike not drawing unto it self the saeculent Blood. Vidus Vidius de curat, memb. li. 10. c. 10. thinks this operation to be impossible with keeping of life, by reason of the immoderate flux of Blood which must ensue. But the binding of the vessels doth remove this scruple, which I wonder he did not consider.
The Third Presage: By reason of the Spleen wounded, the Sto [...]uch, Liver, and the whole Body may become ill-affected: so that the Dropsie, Scabbiness, Melancholy, and such Diseases may ensue.
The wounds of the Spleen are cured as those of the Liver: It falls out in wounds of the Liver and Spleen, that much Blood falls into the Cavity of the Abdomen. But this Blood is either discussed by the natural heat, or else it causes an Aposteme in the Groin.
The Third part assisting Sunguification is the Kidney; This may be wounded either superficially, or deeply; and so either where the Carunculae papillares only are; or to the Pelvis also, and this last either without any hurt done unto the Vein and Artery emulgent, to they being wounded also.
If the Kidnies be wounded to the Pelvis, clots of Blood will come with the Urine: there will be a great pain in the part affected, and will reach to the Groin and Testicle. See Celsus l. 5. c. 26. Fernel. li. 7. Patholog. c. 8.
If the Kidney be wounded through the Back, then it is not like that the party can escape: for the Wound must pierce the Pso [...], and the Nerves springing there from the Spinalis medulla can hardly be free.
If the Wound be inflicted by the Side, and pierce but only to the Carunculae papillares, it may be cuted, and yet not without difficulty, because the Muscles of the Belly must be wounded, and the Peritoneum also, between the Membranes of which it is lap [...]ed.
If the Wound pierce to the Pelvis, the Wound most commonly falls out to be deadly: First, because the draining of the Serosity from the Veins and Arteries is absolutely necessary: otherwise if it be staied in the Body, it would hinder the unition of the Wound, and procure waterish Powks and the Dropsie. Secondly, because the substance of it hardly doth admit consolidation, partly by reason of the compactness of its substance, partly because it hath within it self the Carunculae papillares and the Pelvis, which are spermatick parts.
If the Vein and Artery emulgent be wounded, there is small hope of recovery, because a fearful flux of Blood must ensue.
The Cure is performed by sanative injections, vulnerary potions, and the ministring of Trochisci de alkekengi cum opio; or if the pain be not great, sine opio in new Milk, having Saccharum rosatum dissolved in it.
The fourth part appointed for Sanguification, which may be wounded, is the Bladder. It may be wounded first in the Neck, where the sphincter Muscle is, which i [...] fleshy: Secondly, in the body of the Bladder. If the Wound be in the body of the Bladder, then it happeneth either in the sides about the Groins where the Ligaments of it are, or in the other membranous parts.
The signs of the Bladder wounded are these, according to Celsus lib. 5. cap. 26. and Fernel. lib. 7. Pathol. c. 8. The Urine comes bloody and sparingly: if the body of the Bladder be wounded, then [Page 404]the Urine falling into the Cavity of the Abdomen, it will seem to be an Ascites, and the pain will be communicated to the Groins and Stones in Men.
As for the Prognosticks, receive these: 1. Wounds in the Neck of the Bladder, where it is fleshy, are curable. This needs no confirmation, for we may see frequent experiment of this in those who are cut for the Stone. 2. Wounds in the lateral parts about the Groin are curable also in those who are young, and of a good constitution of Body. 3. Wounds in other parts of the body of the Bladder, which are membranous, are uncurable. See H [...]ppoc. A [...]h [...]r. 18. Sect. 6. and Galen in his Commentary upon this place: He yields this reason, because the Bladder is nervous, thin and has but little Blood. Of this same opinion is Aristotle lib. 3. Histor. Ammal. cap. 15. who saies, that the Bladder being cut, cannot unite, unless it be in the beginning of the Neck.
Celyus [...]b. 5. c. 26. subscribes to these, affirming, that they hardly [...] be healed whose Bladder is wounded: For the confirmation of this Opinion, these reasons may be yielded: First, because it is membranous: Secondly, because the Wounds of it are very painful, whence affluxion of Humors, and an Inflammation do proceed: Thirdly, because it easily mortifieth: Fourthly, because it being the Chamber-pot of the Body, the Urine contained in it, will not suffer the Wound to consolidate, by reason of its Acrimony nipping, by reason of the Quantity distending, and by reason of its Humidity relaxing. Fifthly, because fearful Symptoms ensue after such Wounds, as Fevers, Watching, the Hicket, dejection of Appetite, Convulsions and Faintings. Sixthly, if in Wounds of the Bladder, a Fever continue, if the Wound become black, or of a livid colour; if the party cannot sleep, or continually slumber, and if a Convulsion do happen, and the party become weaker and weaker, you may prognosticate that the party will die.
When you go about to cure Wounds of the Bladder, minister vulnerary potions: This which follows is excellent: ℞ Cydon. Incis. num. iiij. Equiseti, Sumach. baccar. Myrt. an. ℥ iij. Ros. Rub. siccat. P [...]g. ij. Balaust. ℥ss. coq. ista in lib. 16. Aq. Font. aut Pl [...]vial. ad 3. partis Consumptionem, a [...] coletur, decoclum. In colaturâ disso v. Sy [...]up. è Ros. Rub. siccat. & Mell. Rosat. an. ℥ vj. Syrup. Myrtini ℥ iij Gummi Tragacanth. ℥ss. Nil capiat aeger praeter istud d [...] coclum ante [...]iem decimum si constent vires. Although the party be very dry, yet let him not drink any water, for that will bring inevitable death.
As for the Topicks, Anodyne and agglutinative Medicaments are best, as a Digestive made of Cyprian Turpentine, the yolk of an Egg, and some of the Oil of Eggs: you may use your artificial Balsames brought to a reasonable thick consistence, with the white Joyners Vernice, and Turpentine.
Now only remains, of all the Wounds in the parts of the Abdomen, to speak of those which [Page 405]happen to the parts destinate for procreation.
Those are the Matrix in Women, and the Genitals in Men. If the Matrix, then it is either wounded in the Neck, or even into the capacity of it. If the Wound pierce to the capacity, then Blood will issue out at the privy part, and the pain will be about the Groins.
Celsus esteems these Wounds to be of difficult Cure: These Reasons may be yielded: First, it is thin and membranous, unless the the Woman be great with Child. Secondly, because it is of an exquisite seeling; and so Pain, a Fever and Inflammation may ensue. Thirdly, because it hath a notable consent with the principal parts of the Body. Fourthly, because it is a moist place. Fifthly, because it is, as it were for the sink of the Body to receive impurities, which is the cause that these Wounds may become cancerous Ulcers. Ordinary Wounds, even of the body of the Matrix, are not to be accounted deadly, because Infants have been by Incision taken out of the Matrix, the Mother remaining alive. This kind of delivery is called Partus Caesareus; And the whole Matrix hath been taken out from the body, the party living long afterward. Peruse Shenkius of this matter, lib. 4. Observat. de uteri affectibus, where you may read of sundry examples. Dresse the Matrix as the Bladder.
Seeing the Genitals of Man may be wholly taken away, and yet the party live, and that the Wounds of these are not deadly, as appeareth in those who have been gelt, and have lost their Prick, I think it superfluous to discourse of them, and the rather, because the dressing of them doth not differ from that which is used to other parts of the same nature.
CHAP. XXXIII.
Of Wounds of the Nervous Parts.
BY the Nervous Parts, here I understand three sorts of parts: to wit, Nerves, Tendons and Ligaments.
That a Nerve is wounded, you shall know first by the part: If great and many Nerves be in the place wounded, or pass by it; Anatomy teacheth this. Secondly, you shall know this by the Symptoms, for there will ensue a Pulsation, Inflammation, Convulsion, Raving, if it be cut asunder, and at last sometimes Mortification.
The Solutions of Unity which happen unto Nerves, are four; a Puncture, an Incision, a Contusion, and a Distortion.
Of the Wounds of Nerves receive these Prognosticks: First, Wounds of the Nerves are dangerous. First, because they are of an exquisite sense or feeling, both because the Membrane, wherewith they are covered, proceeds from Meninges, and that they are impregnate with plenty of Animal Spirits. Secondly, by reason of the consent which they have with the Brain, and the Spinalis Medulla: For according to Galen, lib. 12. de usu partium c. 11. the Brain is the Well-spring, the Spinalis Medulla the River, and the Nerves the Creeks. Thirdly, by reason of the fearful signs, which follow after that a Nerve is wounded, which are extreme pain, afflux of Humors, a Gangrene, a sharp Fever, Raving, and a Convulsion.
As for a Puncture, it is either not conspicuous, not to be discerned by the sight; or it is conspicuous: The first is called Punctura Caeca; the second, Punctura Aperta: of the two, the Caeca is the worst; for local Medicaments cannot so well be applied to the part wounded.
Before I come to the cure of this particular Solution of Unity in Nerves, I will acquaint you with the general indications required in the cure of Wounds of Nervous Parts in general: First, Blood is to be let. Secondly, the Body is to be purged: See Galen, c. 2. lib. 6. Method. Aeginet. lib. 4. c. 54. these prevent the afflux of Humors. Thirdly, the party must use a very slender Diet. Fourthly, we must provide that the Air which the Patient doth enjoy, be warm; for if Air be cold, a Convulsion must ensue. Peruse Apher. 15. Sect. 5. Wherefore when you dress [Page 407]such Wounds, you are to use warm Cloaths and Stupes, and the Medicaments warmed.
Now to come to the cure of a Puncture in particular: if it be Punctura Caeca, these local Medicaments are apt. These Medicaments must be hot, drying, of subtil parts, to digest, dry putrefaction, and attract. See Galen, lib. 6. Method. c. 2. & l. 3. secundum genera: such are Ol. Rutaceum, Chamaemelinum, Anethinum, Costinum, Liliorum Alh [...]rum, Ʋulpiman, de Castoreo, de Euphorbio, Lianbricorum, Hyperici cum Gummi, de Scorpionibus, Terebinthinae. Galen advises, to use Sallet Oyl warmed, and applied with Wooll; old Oyl is best. Paraeus lib. 9. c. 38. [...]dvises to add to it Aqua Vitae; for the thin and virulent Humor, which issues from the Nerve, is spent and dried the more. Galen, lib. 6. method. c. 2. & lib. 3. secundum genera, commends a Medicament made of Buphorbium, which is this: ℞ Cer. part. 1. Terebinthin. pic. an. part. dimid. Euphorb. part. 12. According to the tenderness or the hardness of the Body, more or less of the Euphorbium is to be used. You shall know your Medicament to be proportionate to the grief; First, if the party feel a pleasant heat, as is that of the Sun in temperate weather: Secondly, if the party do pleasantly itch. If the party feel no heat, then there can be no attraction; if it be immoderate, it will attract Humors, and cause Inflammation.
If by the Application of these Medicaments, the Pain and other Symptoms cease not, then cross incision of the Skin is to be made, that the Medicaments in their full force may be applied to the punctured Nerve. When the Puncture is either thus laid bare by Incision, or at the first by the wounding Instruments; it is not requisite to apply to it Medicaments so hot and drying, and when it is hid to shun Inflammation: Wherefore your ordinary artificial Balsam dropped in warm will serve; for by this Unctuosity they smooth the part, by their Heat they make attraction, and so mitigate Pain by discharging the place of the Sanies, and by their Moisture they open the Orifice, and keep it open.
The Incision of the Nerve is either streight and direct, or transverse. If it be transverse, it is either quite cut asunder, or but in part.
A Nerve quite divided is less dangerous, than that which is but only cut in part, according to Guid. Magn. Chir. tract. 4. docl. 1. c. 4. See Galen. l. 6. methed. c 2. Av. [...] cen. l. 3. c. 4. Fen. tract. 4. c. 1, 2, 3, 4, 5, 6 & 7. The reason of this is, because a Nerve being quite cut asunder, cannot send any harm to the Brain.
A Nerve quite cut asunder cannot admit any consolidation, according to the first intention. See Hip. Aphor. 19. sect. 6. where he saith, when the Bone is wounded, or the Cartilages, or a Nerve, or the thin part of the Cheek, or the Praeputium, it doth not grow again or unite. He hath the like Aphor. 28. lib. 7. Arist [...]t. lib. 3. Histor. Animal. subscribeth to him: for these Parts are spermatick.
As for the cure of such a Wound, the Topicks which are used ought to dry with little mordication or biting, according to Galen, lib. 6. method. c. 3. & lib. 3. secundum genera. c. 2. such are Ʋnguentum de ca [...]ce lotà, & Ʋnguentum Diap [...]mpholygos. If the whole Nerve be cut asunder, no Convulsion can ensue, because both the ends give way. This kind of Wound is cured easily by sarcotical Medicaments, whereof I have spoken heretofore sufficiently. In this kind of Wound the motion of the part into which the Nerve is implanted to move, is abolished. If the Nerve be cut asunder but in part, first it is to be dressed with the Medicaments before prescribed; but if the Symptoms, as Pain, &c. and a Convulsion he like to ensue, the best course is to cut the Nerve or Tendon quite asunder rather than by deferring of the Incision to expose the party wounded to the danger of death. This being done, use Anodyne and desiccative Medicaments. When you have thus dressed the Wound above your Pledgets, either in Diapalma or Diachylon simplex in the Summer malaxed with the Oyl of Roses, Quinces, or Myrtils; for the tenderness of the part will hardly admit the application of any firm Emplaster. Last of all, you are to roll up the part with Fascia Expulsiva, whereof I have spoken in its proper place, partly to express the Santes which doth gather in the place, partly to stay the affluxion of new Humors.
Now it is time to come to the Contusion of a Nerve. This may be either a solitary, or with some Solution of Unity. If it be solitary then you are to foment the part with Sallet-Oyl hot, and to apply it with Wooll. If the Skin be divided, then Medicaments drying and uniting the parts are to be used. Such is Emplastrum Fodicationis malaxed with Oyl of Hypericum.
Last of all, a distortion may happen to a Nerve by a fall, extraordinary motion, or some other violent external cause, which may hinder the motion of the part. In this case apply Emplastrum de mucilaginibus, or Diapalma, having Gummi Ammoniacum added to it.
After Contusion and Distortion of Nerves, a hardness often remains, which causes a numness of the part. This proceeds from the setling of gross Humors in the place. In this case you are to use Medicaments which soften and digest, as the Oyl of white Lillies, Goose-grease with Bd [...]llium; but the Oyl of Sheeps and Neats-feet impregnate with the Mucilage of Marsh-mallow, Linseed and Fenugreek, exceeds all other Medicaments. Let the part be embrocated with this Medicament warmed; and let Emplastrum magnum cum Gummi malaxed with Storax liquida be applied. Now it remains that I speak somewhat of accidents which usually fall out when a Nerve is wounded.
The first of these is an Inflammation: you must meet with this by applying Medicaments, which are cooling and drying; for these both abate the Inflammation, and correct Putrefaction, such are [Page 409]Bean-meal, Barley-flowre, the Meal of Vetches, Cich-pease, or Millet boiled with sufficient store of Oxymel, until they be brought to the consistence of a Poultice. But before you apply this Medicament to the Member, embrocate it with Oyl of Elders, having mingled with it a little Rose-vinegar.
The second Symptom is Pain: Here you must use liberal Phlebotomy, purging, and a spare Diet. If the party cannot admit Bleeding, then Ventoses with Scarification, Leeches, Vesicatories in the opposite parts; for a local Medicament, use a Cataplasm made of Bean-flowre, Mallows, Grounsel, Violet-leaves boiled in Milk, and having Ʋnguentum Populeum mingled with the Cataplasm, when it is taken from the fire.
The third Symptom which may trouble both you and the Patient is a Convulsion: Of this Accident Hippocrates Aphor. 2. Sect. 5. so pronounceth: If a Convulsion ensue upon a Wound, it is deadly. But this must happen after too great effusion of Blood, as he explaineth himself in the next Aphorism; for if a Convulsion fall out by reason of repletion, it is cured by bringing the Body low, by using the general curative means in that measure as the circumstances shall shew. If a Convulsion happen, then you must embrocate all the Spinalis Medulla from the Head to the Coccyx with Sallet-Oyl warmed, and afterwards applying Rolls of Wooll, or a Sheeps-skin, newly killed, to the part: Then the Member wounded is also to be dressed; so if the Wound be in the hand, you must begin to foment in the Arm-pits, by which the Nerves march, and then to proceed to the Vertebrae of the Neck and Breast with Oyl and Wooll. But if the Foot be wounded, then you must begin the Fomentation at the Vertebrae of the Loyns, and Os Sacrum, and so proceed to the ends of the Toes. It is not amiss to hold the whole Member in warm Oyl, as in a Bath, if it may conveniently be done. So much then of Wounds of a Nerve.
If a Tendon be wounded, you shall perceive it by these two Signs: The first is, if the Wound be near to the Joints, for the Tendons are the endings of the Muscles, and the ends of Muscles ever end either at the Joints, or near to them. The second is, if the Wound be received in parts which are not fleshy: such are the Backs of the Hands and Feet. As for the cure of these Wounds, the indications set down in the Cure of the Wounds of a Nerve will serve.
If Ligaments be wounded, seeing they are not so sensible as those of the Nerves and Tendons, they procure not so fearful Accidents: only drying Medicaments, and not too hot, are here to be used to consume the Sanies, lest the Ligament rot. Stronger Medicaments may here be used, because a Tendon is not so sensible; in this case use Oyl of Mastick, the natural Balsam, artificial Balsam, and drying and consolidating Powders; above apply Emplastrum Fodicationis. In curing of these Wounds which happen to the Nervous parts, take heed that you use not a Fomentation: [Page 410]for that moistens and increases Putrefaction.
This one thing let me insinuate unto you, that if one be offered to you, who hath the great Tendon, inserted into the Heel wounded, that you suffer him not to walk before it be perfectly united and skinned, for otherwise it will break open again.
CHAP. XXXIV.
Of Wounds of the Joints.
A Joint is the setting together of Bones for the performing of free motion according to Galen, lib. de Ossibus in Principio.
Now Wounds of the Joints are made either by a Puncture or Incifion; and these are either in the upper compassing parts, or else they pierce to the cavity of the Joint. The Solution of Unity in the Joints is apparent to the Eye: wherefore it is needless to set down signs.
As for the Prognosticks receive these: All Wounds of the Joints are dangerous: First, because they are of an exquisite sense; by reason of the Nerves, Tendons, and Membranes: wherefore sharp pains do ensue, which procure affluxion of Humors, from whence spring Inflammations, Fevers, watchings; loathing of Food, Thirst, Convulsions, Gangrenes, weakness, and sometimes Death. Secondly, as all Wounds of the Joints are grievous, so great Wounds piercing to the cavity are most dangerous, yea most commonly, if they be inflicted into great Joints, and the Aqua Articularis, the Jointwater issue out. Of this Water, see Cels. lib. 5. c. 26. Par. lib. 9. c. 39. Lang. lib. 1. ep. in praef. & lib. eod. ep. 4. Plat. tom. 2. prax. fol. 782. & 933. & 737. After that this natural Humor is let out, then succeedeth the issuing of an excrementitious Humor. Celsus affirms it either to be a thin whitish Ichor, or to be a glutinous and whitish Humor, like to white Honey, which he calls Meliceria. This term by him, lib. cod. 5. cap. 28. is taken for a kind of Ulcer. Pareus saith that this Excrement is sometimes thick and white, and sometimes thin. Langius likeneth it to Whey. Platerus averreth it to be a waterish Ichor. This diversity doth proceed from the diversity of the temperature of the Bodies of wounded persons. It is cold and moist, and is caused of the elementary Juice, which is sent to no [...] rish the Joint: but it is corrupted by the weakness and distemperature of the Joint wounded.
A Question may here be moved, why a greater quantity of Quittour doth flow out of a Joint wounded, than out of another part, if the quantities of the Wounds be equal.
Many reasons may be alleged for this: First, the Pain which follows after a Wound in the Joint, is so grievous, that it makes a greater attraction of Humors: Secondly, the Joints are of a substance without Flesh and Blood, and of temperature cold, so that they cannot concoct the superfluous Humors which do flow thither, nor turn them to a laudable Quittour: Thirdly, by reason of their weakness they cannot so forcibly repel the Humors flowing, as other fleshy Members can, by reason of their heat: Fourthly, their situation furthers the admission of superfluous Humors much, they being seated in a dependent part.
As for the Cure, if it be a Puncture, it is to be dressed as the Puncture of a Nerve or Tendon: Shun cold, relaxing, moistning and unctuous Topicks, unless Pain enforce you to use Anodyne means. Cold nips Wounds, hardens the Skin, hinders Suppuration, extinguishes the natural heat, causes blackness, brings Aguish Fits, and Convulsions. Peruse Hippoc. Aphor. 20. Sect. 5. If the Wound be procured by Incision, then either the brims are reasonable near one to another, or else they gape much, being much separate. If they be far asunder, then you must use stitching fust of all to bring the brims together; you must only stitch the Skin in Persons of ripe Age, but in Children you may stitch the subjacent parts; for in such they will admit Unition.
Galen. 2. de fractur. Affirms, that all parts of the Body delight to be covered with the Skin, which Nature hath provided for an universal cover. If this may be affirmed of any, it may be most justly pronounced of the Joints, for they have but small store of natural heat, which may be extinguished, if the cold Air be suffered to pierce unto them; which is hindered by bringing the brims of the Wound together by stitching. When the Wound is stitched, there must be left a small Orifice in the depending part to admit a Tent, that the Quittour may be discharged.
This being done, if the Wound pierce not to the cavity of the Joint, dress the Wound with some good artificial Balsam, having mingled with it a drying and healing Powder; such is this; ℞ Thur. san. Dracon. Myrrh. Aloes Hepat. Mastich. an. ʒ ij. Rad. Symphyt. Centaur. Major. Borac. Sarcocoll. an. ʒj. fiat pulvis, capiat Balsami ℥j. & pulv. ℥iss. Above apply Emplastrum Fodicationis, or this Cataplasm: ℞ Furfur. macri, far. Hord. & Fabar. an. ℥ ij. flor. Cham. & Melilot. an. pug. ij. Lixi. vii communis, lib. 1. Acet. Sambucin. ℥ iv. coq. ista ad. cataplasmatis consistentiam, tum addatur Ʋng. popul. Ol. Ros. & Myrtil. an. ℥ j. This is excellent to prevent Pain, or to asswage it if it be present. All the Applications must be actually hot: for actual heat doth concoct and discuss excrementitious Humors in the Joints and strengthneth them. If the [Page 412]Wound pierce to the cavity of the Joint, the Medicaments must be very drying: first, because the Boues and Ligaments whereof the Joints are framed, are of their own nature very dry, and so require dry Medicaments: Secondly, because they have not feeling, and so may suffer very strong Medicaments: Thirdly, because plenty of thin Quittour is gathered in Wounds of the Joints, a very drying Medicament is required.
Use then greater quantity of the former Powder with the Balsam, or mingle it with Arcaeus his Liniment, and above apply the former Medicaments.
Let me give you notice of one thing, that in curing of a Wound of the Joint you have a special care of the position of the Member, for a perverse posture increaseth Symptoms, and bringeth Distortion, Numness, and Contraction sundry times, after that the Wound is cured. Wherefore if the upper part of the shoulder be wounded, a large Boulster must be put in the Arm-pit, and the arm carried in a Scarf to bear up the lower part of the Arm, that the brims of the Wound may the more aptly consolidate. If the lower part of the Arm be wounded, you must carry it in a posture, mean between extension and contraction. And when the lips of the Wound begin to unite, you must cause the Patient to use a moderate motion of the Arm, lest it prove less plyable to motion, after that the Wound is cured. If the Joint of the Elbow be wounded, it must be so placed that it be neither too much contracted, nor too much extended.
The German Chirurgeons here are very scrupulous in Wounds of the Musculus biceps, which they call die Mauss, or the Mouse, for the likeness it hath with a Mouse, for it hath a small tendinous beginning and ending, but a thick fleshy Belly. They esteem the Wounds of this Muscle, which with the Brachiaeus doth bend the Elbow, to be deadly: Thus I would have you to distinguish. It may be wounded both in the beginning or Head and Tail, and in the Belly also. Wounds in the beginning and insertion of it are most dangerous, because these parts are tendinous, and so of an exquisite feeling; it is double in the beginning. If a Wound be inflicted in the Belly of this Muscle, it is less dangerous, because it is fleshy, yet a great flux of Blood may ensue, because it hath remarkable Veins and Arteries, and great pain, because it hath not small Twigs of the Nerve. If the Wrests or Joints of the Fingers be wounded, they must be kept half shut, moving a Ball in the Palm of the Hand; for if they be kept still extended they may prove unable to gripe when they are healed.
If the Articulation of the Hip be wounded, the Thigh Bone must be kept in its cavity, which may be done by laying the Patient on his back, and applying fit Boulsters and Rollers. If the Knee be wounded, it must be kept extended, if the party will not have the Member contracted after the Wound healed. When the Joints of the Toes are wounded, they are to be in their natural posture, not bending of them inwardly or outwardly. [Page 413]To conclude the Method of curing of Wounds in the Joints, if they pass to the Cavity, although they be cured, yet the Member will remain stiff.
Seeing Wounds are accounted great for four respects: First, by reason of the greatness of the Solution of Unity. Secondly, by reason of the Excellency of the part. Thirdly, by reason of the ill Constitution of the party wounded. Fourthly, by reason of the grievous Symptoms. In the first and two last respects Wounds of the Joints may prove great.
And seeing Wounds may four manner of ways cause Death. First, if the office of the part be necessary, as that of the Lungs. Secondly, if the part be excellent, as the Brain. Thirdly, if the flux of Blood cannot be staid, as are the Wounds of the Liver, and the great Vessels. Fourthly, if evil Symptoms do follow, as appeareth in Wounds of the Bladder. Wounds in the Joints, most commonly prove deadly for the fourth cause.
Before I put an end to this Treatise of Wounds, wherein I have persisted the longer, because it is an object whereabout Chirurgeons are most frequently busied, I will speak somewhat of Vulnerary Potions, because I have often made mention of them, and have set down the description of some in the cure of some dangerous and great Wounds.
As for their qualities they are drying, familiar to the natural heat, and radical moisture, and by a secret faculty they correct malignity.
The operations of them are these, they do purifie the Blood, cleansing it from all impurities, and excrementitious Humors, they cleanse Wounds and Ulcers also, they agglutinate broken Bones, and unite Nerves, they hasten the scaling of Bones; they procure the expulsion of strange Bodies in Wounds; they dissolve clotted Blood; they dry up superfluous Humidity, and withstand Putrefaction.
Let no man wonder, that they have such admirable effects. We know that there are Meats and Drinks, yea Medicaments which are hurtful in some Diseases, and at some times, as in a burning Fever to drink Wine, or to minister hot or obstructing Medicaments: Shall we not then think that Nature hath provided means helpful and profitable in Griefs, unless we will take her to be rather a Stepmother than a loving Mother?
But seeing GOD, by his Providence did fore-see, that Man would fall and become mortal, and that Diseases (the means to bring a Man to his end) would increase; of his own goodness, he, from the beginning, created means to second Nature against Diseases, and to defer Death by prolonging Life by use of such things as are familiar to Nature, and contrary to the Grief: such are Vulnerary Potions in Wounds.
The chiefest of the Simples are these: Scabious, Sanicle, Bugle, Mouse-ear, Burnet, Madder, Tansey, Comfrey, Vervein, Bistort, Tormentill, Periwincle, Centaury the greater, Borage, Here-hound, Adders-tongue, Betony, Valerian, Ladies Mantle, Avens, Carduus [Page 414]Bertedictus, the Cordial Flowers, Sp [...]edwel; Agrimony; the capillar Herbs, Prunella, Osmund, Clarey, Gentian, Herniaria, Scordium, Cats-Mint, Cinquefoil, Mead-sweet, Colts-foot, St. Johns wort, Plantain, Knot-grass, She epherds-purse, Yarrow, B [...]ds of Briars and the Oak, Pyrola, Lunaria, &c. Amongst these some are hot, and some temperate.
Those which are hot are not to be used until the seventh day be past, when Symptoms most commonly cease, and Concoction appeareth: For they would heat and attenuate the Blood, and cause defluxions. These Simples you may use two manner of ways: First, in Decoctions: Secondly, in Infusions, using Wine, Ale or Beer, as shall be thought fittest.
Let this be a Pattern of a Decoction: ℞ Sanicul. Bugul. Scab. Beton. Nepetae, an. man. ss. Rad. Centaur. Majoris, Symphyti, Borag. an. ℥ss. Passul. Major. exacinat. ℥ ij. Liquirit. ʒ vj. semin. Hyper. & Card. Benedict. an. ʒ iij. flor. Cord. pug. ij. Coq. ista in aq. font. lb viij. ad Medias, ac coletur decoctum: Aromatizetur. decoct. Cinamom. ʒ v. Illíque addantur. Mel. Ros. & syrup. Myrtin. an. ℥iss. Vini albi lb. ss. Dos. ℥iv. mane, & tantundem horâ quartâ pomeridianâ. Some of the forenamed Simples may be boiled in the Patients Broths. Thus you may frame to your selves Decoctions fit for the constitution of the party, the time of the grief, the part wounded, and the time of the year.
AN APPENDIX Concerning Chirurgeons Reports Before a MAGISTRATE, Upon their View of a Wounded PERSON.
SCET. I.
Whence the Reason of Mortal Wounds is to be taken, what Wounds are safe, and what indifferent.
SEveral there are, who upon a slight, or however not a Mortal Wound, contrary to all expectation die, which Case, when it comes before a Judge and Jury, may not a little perplex them, in determining the true Cause of the Parties death. Now if in the Verdict and Sentence the Aggressors are pronouced guilty of uncertain Murther, Justice and the Laws are violated: But again should the Guilty be acquitted, it would also be unjust not to give a Murtherer his desert. And because in such Difficulties Physicians and Chirurgeons are often consuited, that Courts of Judicature may be their assistence proceed [Page 416]more clearly in such Trials; my design in this Appendix to Wounds is, to shew by what Means and Methods it may be deprehended, whether the Party upon whom an Inquest sits, died of a wound received, or the intervention of some other evil. Now, that this enquiry may be full, I shall first say something of the Mortality and other differences of Wounds. Afterwards, how it comes to pass, that sometimes Men die of very slight Wounds. And last of all; how the Partie's death may be laid not so much to the Wound, as to several other occasions of it.
First therefore, in reference to my purpose, I make a triple difference of Wounds. Some are mortal: Some safe: And others are of a middle nature, which may be called dangerous. As for mortal Wounds, though Hippocrates and Galen have plainly declared, what are so, and whence they are such: Yet because there are some, and those men of Note, who have introduced I know not what differences of Wounds, whereby perhaps some might be perverted in their judgment of things, I shall say the more concorning this matter. These men, as Franc. Valeriol. gener. med. cap. 8. write, that Mortal Wounds proceed not only from the nature of the wounded Part, but also from the Essence of the Wound, from its Magnitude, from a complication of Symptoms, and from the proper differences of Solution of Unity. But upon my consulting the great Masters of Medicine, and mature consideration of things themselves, it appears that Wounds may not improperly be judged and called Mortal from the nature of the Parts alone. And indeed it is sufficiently evident, that the Essence of a Wound, which consists in the fresh Solution of Unity of some soft part, is the same every where: for a Wound is as much a Wound in the Buttock as in the Heart, and bears the same Character and Nature. Wherefore, were it true that any Wound were in its Essence Mortal, all Wounds would always be Mortal, and none Salubrious. Nor likewise is any Wound mortal from its magnitude; but only great or little; [...] which differ much from Mortal: for oftentimes a great Wound may be safe, and a little one destructive. Yet, whereas they say, a Wound may be called Mortal from supervening Symptoms, this bears some semblance of Truth: for if grievous Symptoms supervene, every one knows, such a man is mortally affected. But in very deed no Wound has from the Symptoms any thing why it should be mortal: For suppose one were wounded in his Finger, and an Inflammation or Convulsion arising upon it, he should die, must the Wound therefore be called mortal? So all Wounds might be said to be mortal: For, as Hippocrates truly writes, 2. Praedict. Men die of all sorts of Wounds, though in ignoble places, and that they seem in nothing grievous. Therefore supervening Symptoms may bring Death; but they can never alter the nature of a Wound. For the same reason also, if after a man has received a mortal Wound in his Brain, he for all that recovers; yet a Wound can [Page 417]never be constituted mortal for the presence of Symptoms, nor safe for their absence. And upon that score I conclude the nature of a mortal Wound from the Parts. Besides, Hippocrates, whose single judgment is to me worth a thousand, in 2. Praedict. circa medium, 6. Aphor. and in Coac. Praenot. discoursing much of Mortal Wounds, takes their differences from the nature of the wounded Part, and never from any thing else. And as to this thing, whatever I could hitherto get out of the nature of the things, the testimony of Authors, and my own observations, the sum of all is this. All Parts that hold a Principality in the Body, and are Fountains of the Faculties, namely, the Heart, Brain and Liver, If at any time they be wounded, they make a Wound Mortal. I may also among these reckon the Stomach, for the great necessity of its Action, since the Ancients, as Q. Serenus Sammonicus, calls it Rex Corporis. Nor would I exclude out of this rank the Spinal Marrow, as having much affinity with the Brain: For it is as another Brain to all the Parts below the Head. In the second rank I place all those Parts, which once divided never grow together again, and yet exercise some necessary action of Life; such as the Diaphragm, small Guts, and the Bladder. In the third I put such Parts as are endowed with an exquisite sense, such as is especially the Mouth of the Stomach. And in the last place I put all such Parts, as may by their large effusion of Blood or Spirits destroy Life, such as the Veins and Arteries. But here you may stick a little in the Mire. For since invisible Wounds in these parts scarce ever bring Death, without the intervention of Symptoms, you might justly suppose that the differences of Mortal Wounds might be taken from the Symptoms. To this I say, that these Symptoms, through whose intervention wounded persons seem to die, do always follow the nature of the wounded Part. For if the Mouth of the Stomach be wounded, Syncope, by necessary consequence supervening, destroys the Party; so the wounded Brain kills by a Convulsion, Apoplexy, or some such Symptom; Arteries and Veins by effusion of Blood. Wherefore the whole reason of Mortal Wounds depends upon the very nature of the Parts, and in their Wounds whatever Symptoms supervene, they follow some certain property of the same parts. Besides, Hippocrates and Galen their distinction of Wounds into Mortal of necessity, and Mortal for the most part, if you consider it aright, seems to be taken from the very nature of the Parts. For those Wounds are Mortal of necessity, which are inflicted on the more noble or very sensible Parts, or whose use is altogether expedient for the Animal: such are mortal for the most part, as are inflicted on less noble parts: And such are safe, as Galen says want danger, which tend, as much as in them lies, to recovery; but these have a great Latitude on the account of Majority or Minority. They that are in the middle place Galen calls dangerous; and he says, they are such as have an [Page 418]equal tendency to Life or Death: Hither Wounds termed Cacoethe, or malignant, may be referred, to wit, such as are contumacious to cure: And such as the Learned have called indifferent, and of a middle nature. To this kind also these Wounds may be reduced which we mentioned from Galen to be for the most part Mortal; but from which their slightness deducts much of the danger; such are they which slightly touch the extreme part of the Liver, or the Meninges. Thus much in general, now I proceed to particulars, where all things shall be made more clear.
SECT. II.
In what Parts of the Body Wounds are Mortal.
THat Wounds of the Heart are mortal is one of those things, Galen says, that are taken for granted, and if the Wound reach to the Ventricle, presently the man must of necessity die of a great flux of Blood, especially if the left Ventricle be wounded. But if it reach not to the Ventricle, and stop in the substance of the Heart, some continue that day, they were wounded, and the night following, and then die of the Inflammation.
Wounds of the Brain are mortal upon two accounts; because it is a principal part, and Original of the Animal Faculty; and because it usually causes many and grievous Symptoms. For because it is a principal part, the Spirits are quickly exhausted, and the harm is imparted to the whole Body: And grievous Symptoms proceed from inflammation, and from interception of the Animal Faculty. By Wounds of the Brain I understand such as reach to its substance, and such as only reach to the Meninges. And the Nature of them is such, that if the Wound be not all the bigger, they do not of necessity, but for the most part carry a Man off. And lest I should be thought to speak without Book, I will give you some Authorities. I have seen, says Galen, a wounded Brain often cured; and once in Smyrna of Ionia a very considerable one: But this is very rare. He writes also, that this person received the Wound in the fore Ventricle of his Brain, but that he could not have recovered, had he been wounded in both. Many such things have happened since Galen's time, which seem to exceed all Credit. For Marcellus Donat [...] de med. hist. mirab. recounts many instances of wounded persons, [Page 419]in whom not only the coats of the Brain were cut and wounded, but the Wound had penetrated to the very substance of the Brain, and which is wonderful, to the Os basilare. Nay, the very substance of it has sometimes been lost, to the quantity of a Hens Egg. I think, all things considered, wounds of the coats of the Brain are mortal (for the substance of the Brain must partake of their annoyance) yet not of necessity, but for the most part: For it has been observed, that several so wounded have escaped, unless they fell into the hands of bad Chirurgeons. Wounds of the substance of the Brain are in like manner mortal; but more dangerous, and so fewer escape of them. And if the Wound be large and with loss of much substance, then either none escape, or if any one does, it is by a miracle of Nat [...]re. Amatus Cent. 3. cur. 83. has a remarkable History of a young Man, that received a wound in his Forehead, the point penetrating to the ventricles of the Brain, who yet recovered, without any Symptome arising, because the Sword entred betwixt the very Ventricles of the Brain, its substance unhurt. For the Membranes that cover the Brain, under the right Suture of the Scull, descend double into the midst of the Brain, separating the right side from the left, by a manifest Interstice, so that if the Sword were thrust in just between these two Membranes, no wonder if the Wound were not mortal: for I suppose such Wounds to be of the same rank with those that only affect the Meninges, the Brain unhurt.
Some say, that not only a deep Wound of the Liver, but that part of it cut off has been cured. But such Wounds run much Blood, and therefore the party dies, who is so wounded, before the Wound can be agglutinated. For they that say shallow Wounds of the Liver, and the edges of it cut may be healed, seem in the right. Therefore Celsus saies, Wounds of the Liver are mortal only in the Portae, and that People seldom escape when the thick part of the Liver is wounded. And it is most certainly true, that a Wound is mortal only in the Convex or Concave part of the Liver: For as to the Limb, or edge of that Viscus (for a Man's Liver has no Lobes) a Wound there is only dangerous; and unless inflicted on a Cacochymick Body, or on one that commits some error, it may easily be cured.
For the Stomach to be cut; Hippocrates saies, it is mortal; thô Galen saies, some have made this Aphorism ambiguous: For some have been wounded in it, and rarely cured; yet if the Stomach be but slightly touched, it will agglutinate. You may consult Marcellus Donatus, who relates, how several wounded in their Stomachs, have recovered. But Cornelius Celsus writes that a wound in the Stomach is mortal. But I encline to Galen's opinion. And we must reckon accordingly in all these Wounds: For if only the outer coat be hurt, it easily heals; but if the Wound reach into the Cavity, the cure will prove difficult. Also a wound in the bottom has lefs danger: But in the mouth of [Page 420]the Stomach (which is very nervous) any considerable Wound is desperate upon several scores, viz. of the excellence of the part, its singular Sympathy with the Heart and Brain, and its exsanguous nature.
Wounds of the Lungs, if they be large, if they make a deep solution of continuity, if they waste the flesh of the part, and if they offend the great vessels, and notable branches of the Vena arteriosa and Arteria venosd, must needs take life away, by the dissipation of vital Spirits, and effusion of Blood, and by the clotting of the Blood which impedes circulation. If the Wounds be small or mean, but not treated artificially, the case is the same. When the great vessels are not wounded, but only the Assera Arteria, or the Brenchia, such wounds do not kill suddenly, but certainly: For several causes of death conspire, the sympathy of the Heart, dissipation of the vital Spirits, putrefaction of the Lungs, difficulty of cure, continual motion, and the Cough still enlarging the Wound. But if the less Blood-vessels be broke, or the flesh of the Lungs divided, the Wounds neither suddenly, nor of necessity kill a Man, unless the part be inflamed, thô more danger lies in a Wound of the substance, than of the vessels; because a firm Cicatrix cannot be made in it. But we must not forget what Galen 5. Meth. c. 2. saies, that wounds of the Lungs are incurable, not so much because the part is in continual motion (as those before him thought) as because, that Pus and Sanies are difficultly gotten out of the Lungs. Yet it has been observed, that when pieces of the Lungs have been brought up, the party has recovered. Celsus 5. l. c. 26. saies, the Wound is uncurable only when the middle of the Lungs is wounded.
Wounds of the Diaphragm, according to the variety of its substance, have various Events: for if a Wound be received in the nervous part, which is its centre, it proves mortal, its constant motion hindring consolidation. But if the Wound be in the fleshy part, which goes round the inside of the Breast, such an one has, as Galen saies, been observed to heal up, notwithstanding its motion: Thô he alwaies thought the cure difficult, at whatever time an Inflammation arose.
If any of the small Guts be wounded, Hippocrates 6. Aph. 18. saies it is mortal. And if the Wound reach into their Cavity, Galen saies, it is very seldom of the substance not only by reason of the substance of the Guts, but because we cannot so well apply a Medicament to inward as to outward Wounds. But above all, we find the Jesunum most incurable, if it be wounded; because of the magnitude of the vessels, the thinness of the coat, its nervous nature, vicinity of the Liver, and susception of Bile. Yet sometimes a Wound has been cured, when it has only touched the outside. But slight Wounds of the other Guts do heal up; because they are very carnous: And they seldom kill, unless an Inflammation, or an Ileus supervene: But great Wounds and [Page 421]transverse are mortal: because there is a great separation of parts, which are kept asunder by the continual passing of vitious Humidities: and because there is no convenience for application of Medicines.
Hippocrates 6. Aph. 18. sayes, A Wound in the Bladder is mortal. But here must be some grains of allowance. If indeed all its coat be divided, and cut through to the inside, with a notable Wound, the case is mortal; But a small Wound, experience has evinced; may heal up by the intervention of Flesh, and that exactly. If the Wound be incurable, it must be received in the nervous part: So we see daily that Wounds in the neck of the Bladder, where it is fleshy, made by cutting for the Stone, are cured. Yet it has been observed by some, that Wounds are seldom cured, if they be received in that part, where the Bladder is tied to the Os sacrum.
A Wound in the Spinal Marrow is as mortal as in the Brain: for Galen saies, it is a kind of Brain to all the parts that are below the Head. It is such therefore because of the Nobility of the part, and of its nervous nature: Besides, many and grievous Symptoms proceed from thence: Its sympathy with the Brain, and neighbouring parts is great: It is difficult to cure: And the Wound proves the more mortal, by how much the higher it is in the Spine. For, as Galen saies very truly, if the Spinal Marrow be totally hurt in any of the Vertebrae, all the lower parts are resolved: But if only one side is hurt, and the other remain whole, the resolution seizes only on those lower parts, that are on the same side. This holds good as to the structure of the Parts. But if you consider the nature of the part, Wounds received in the lower part of the Spine are far worse than in the upper, since the Marrow below is almost nervous; but above, it is far softer and perfect Marrow. As the excellent Anatomist Columbus has observed. But such Wounds must be very great, to make them mortal: For one may be saved, when the weapon has not run deep in the Spinal Marrow. If the Marrow be cut quite asunder transverse, it kills of necessity.
Wounds in the large Veins and Arteries, which are in the inside of the Body, prove mortal, such are the Vena cava, Magna arteria, the great Veins and Arteries about the Throat, in the Leg and Thigh, the great Veins in the Arm-pits, and Hams. Large Wounds in these must of necessity be mortal, by reason of immoderate effusion of Blood. And the party dies the sooner, by how much the less runs out of the Body; for then he is choaked. The nervous nature, and deep situation argue the difficulty of Cure, when no Medicine can arrive there in its full virtue, Little Veins cannot so much exhaust the vital Spirits when they are wounded.
Slight wounds of the Aspera Arteria are sometimes cured; great ones are altogether mortal. And people dye of such, not because the breath contained in the Breast, goes out at the Wound, but because being of a cartilaginous nature, and in perpetual motion, [Page 422]it can never be healed. It is observed, that they are the most grievous, if about the upper part of the Throat, where divers Nerves, Veins and Arteries encrease the danger. For if the Artery be cut any where else, it has a good event. And when people are taken with a dangerous Quinzey, some very grave Physicians do successfully prescribe cutting of it.
Wounds of the Kidnies, because many vessels are disseminated thereabout, and they receive a perpetual afflux of Excrement, and have a necessary use for conservation of life, are generally mortal. Thô Ceisus thin [...]s them incurable. But some skilful Chirurgeons have observed, these Wounds, if deep, are very difficult to cure; yet if they reach only to the thick fleshy part, and are slight, the party sometime recovers.
Many have thought wounds of the Spleen to be mortal. But since it has been experienced, that the whole Spleen has been cut out of Animals, they still living and surviving; and since Aristotle has reported, that an Animal may be born without a Spleen: Therefore unless some great vessels be cut, I do not think a wound in the Spleen mortal in its own nature.
Sect. III.
By what tokens Parts, whose Wounds are mortal, may be deprehended to be wounded.
WE have, according to the best of our skill, declared in what parts Wounds are mortal: Now we must produce some tokens, which set these Wounds before our Eyes. For instance, suppose a Wound received in the Head or Breast, but no conspicuous signs to shew, whether the Brain or Breast is wounded, then the cause of the parties death must be ascribed to some other thing than the Wound. Therefore we must not be ignorant of this in general, that marks of Parts disaffected are wont to be deduced from the Hurt of the action, Site of the Parts, from the Excreta, from the property of the Grief, and from proper Symptomes. So, if after a Wound Respiration be hurt, a prudent Physician will say, that either the Lungs or Breast, or the Vertebrae of it are hurt. But if Urine come out at the Wound, there is none but will acknowledge, either the Bladder or Ureters, or Kidneys [Page 423]must be wounded. If Excrements, the large Guts. If Chyle, the small. As for the Site; if the Wound be received in the right Hypochondrium, the Liver may justly be suspected to be hurt; if in the Peclen, the Bladder: and so in other places the subject part may be suspected. The property also of the pain will ascertain you of the thing; for if the pain be dull, the flesh of the Liver, or Spleen, or Lungs is hurt: if racking and pungent, their vessels and coats: but if violent, you may say the Stomach, Guts, and nervous parts are wounded. Regard also must equally be had to the proper Symptoms of each part: for a Phrensie, Epilepsie, and such accidents attend wounds of the Brain, Nauscousness, Vomit and Hickup, those of the Stomach: Respiration hurt, those of the Breast. But now to particulars.
When the Heart is wounded much Blood comes away: If it he the right Ventricle, the Blood runs black: If the Left, it runs more florid and light-coloured. The Arteries flag, the colour grows wan, Sweats cold and illsented, and at length, when the parts grow cold, speedy death ensues.
If the Brain or its Membranes be wounded, Blood comes out at the Nose, and in some at the Ears; generally vomiting of Bile follows: Some have their Senses stupefied: The Eyes turn strangely in the Head: On the Third, or the Fifth day a Delirium follows; Many have a Convulsion of their Nerves: A peculiar violent Head-ach follows a hurt in the Membrane: which is enraged by shutting the Jaws, and holding ones Breath. The Eyes are hot, the Tongue salters; the Mind doats: but when the Brain is wounded, the Patient falls down; the Voice is lost, the Face is drawn, there is vomiting of Bile, and a white Humor runs out of the Ears, like Pap.
When the Liver is wounded, much Blood comes out of the right Side; the Bowels are drawn to the Spine, there is a delight to lie on ones Belly, a pricking pain runs up to the Throat; sometimes there is vomiting of Bile, the Patient turns pale, coughs, and is in a Fever; Stool and Urine comes bloody; and the Body at last consumes away.
If the Stomach be wounded, the Hickup and vomiting of Bile follows; the Meat and Drink is thrown up immediately; there are Swoonings; the Pulse fails; small Sweat runs off; the extream parts are cold; a most violent Pain; especially if it tend upwards.
If the Lungs be wounded, there is difficulty of breathing; frothy Blood comes up at the Mouth; there is a noise in breathing; the Party likes to lie on the Wound and then he speaks; if he lie on another part he is dumb. Paul says, if the Wound be wide, frothy Blood comes out at it; if not wide, it comes up at the Mouth; the vessels of the Neck are raised; the Tongue is of a strange colour, they draw in much breath; they crave cold things; and if it continue long, a Fever and Consumption kill the Man.
When the Midriff is wounded, the Praecordia are drawn upwards, [Page 424]the Spine akes, they breath slowly. Paul affirms, that the breathing is large, with sighing, and pain all over the Shoulders.
When the Guts are wounded Meat and Drink come out at the Wound, the Praecordia swell; Sometimes Choler makes a way at the Mouth: If the lower Guts are wounded, the Excrements and Smell shew it.
When the Bladder is wounded, the Groins do ake, they swell above the Os Pubis; Blood comes away with the Urine, and Urine runs out at the Wound, the Stomach is disaffected; therefore they either vomit Bile, or have the Hickup; they are cold, and then dry.
If the Spinal Marrow be wounded, the Nerves are paralytick, or convulse; Sense is lost; at times the lower parts void either Seed, or Urine, or Ordure.
If the Veins or Arteries, which are deep in the Body be wounded, the Veins pour out abundance of black Blood, the Parties wax pale, and their death is sudden? The Arteries pour out thin, yellow, and frothy Blood, the Pulse alters, and Death quickly ensues.
When the Aspera Arteria is wounded, it bleeds but little; there is great pain backwards; the Throat is by little and little filled with Blood; the Voice is hoarse, and the Tongue is dry.
When the Kidneys are wounded, the Pain reaches to the Groin and Testicles; there is difficulty in making water, and it is bloody, or all Blood.
When the Spleen is wounded, black Blood proceeds from the left Side; the Praecordia and Stomach grow hard on that side; Thirst is violent, and there is Pain in the Throat, as when the Liver is wounded.
And these are most of the Signs, whereby you may easily find, whether the parts of the Body, whose wounds we have declared mortal, be wounded. If none of these signs appear, you may conclude none of these Parts are touched; and you must seek for the cause of the Disease somewhere else.
Sect. IV.
What Wounds may be called safe, and what dangerous.
WE said that those Wounds were safe, which are in their own nature without danger, and in general they are such, as are received far from the aforesaid parts: Of which kind Celsus makes those to be that only wound the flesh; but in the same Author's Judgment these same are sometimes worse, sometimes better. For whatever Wound is large, creates danger; and that is worst, which is beaten against a thing, or out of which something is cut; or when the flesh is part cut away, and part hanging on; a Wound is worst that is round; the safest, that is in a right line. Besides, a Child is sooner healed than a Youth or elder Person: a strong Man than an infirm; one of a middle habit, than one very gross or very spare; one of a sound habit, than corrupt; one of much exercise, than an idle person: a sober and temperate Man, than one given to Wine and Women. The most seasonable time for cure is the Spring, or such as is neither hot nor cold; therefore Autumn is most pernicious. And these are the things that render Wounds, which are in themselves safe, dangerous. Thô in reality they never change their Nature. For if only a fleshy part be wounded, the Wound is in its own Nature safe; and if any danger arise, something else is in the blame. Wounds of a middle Nature, if we may believe Guido, are such as are received in the heads of the Muscles, in the Scull, in the Breast and Belly. And Galen says, That all wounds of the Nerves and nervous parts are not indeed mortal, but only dangerous. In another place he says, they are dangerous, that have an equal tendency to death and life: and he calls them doubtful. It has been observed by many skilful Men, that Wounds under the Clavicle, and the inner process of the Scapula are formidable, and full of danger: for beside the Basilick Vein and Axillar Artery, there is the fifth pair of Nerves, which run from the Vertebrae of the Neck to the Arms. Of this kind are many of those Wounds, which Celsus writes, difficult of cure, viz. in the Arm-pits and Hams; about the Anus and Testicles; in the Thighs and among the Fingers: and any Wound that has hurt the head, or end of a [Page 426]Muscle, a Nerve, Artery, Membrane, Bone, or Cartilage, In this respect wounds in the Neck are dangerous; for often it so falls out, that some remarkable Nerve or Tendon is thereby hurt especially if the wound reach to the Spinal Marrow. It has been also observed, that wounds which are near the Navil (for thereabout lie the perforated Tendons of the oblique and transverse Muscles) are not without danger; thô they reach not deep. And such as are received in the back part of the Breast: for thô they reach not the Cavity; yet because thereabout no small Veins and Arteries, and many Nerves are dispersed, they are dangerous. Whenever Joints are wounded, they import danger, by reason of the Tendons and Ligaments that are found there, for wounds in these parts use to produce malignant Symptoms, especially if the inside of the Arm be wounded. Of this nature are the Arm-pits, the bending of the Elbow, the inside of the Wrist; and the outside of the Leg: for in these parts there are great Veins, Arteuies, Nerves and Tendons, which usually occasion Bleeding, violent Pain, and several other mischiefs. But if nervous parts are wounded (because this requires a skilful conjecture, and no small diligence in a Chirurgeon) you may easily know it in this manner. When a Nerve is either prickt or cut, Motion, and sometimes Sense is lost, or at least hurt; and there is a nu [...]ess in the parts under the wound; Pain is violent; the part [...] inflamed; and by consent with the Brain a Delirium often arises: A Convulsion often follows; and that oftner when the part is prickt, or partly cut, than when it is quite cut asunder. The same signs, but more obscure, happen in wounds of the Tendons and Membranes, which invest the Scull and the rest of the Bones, especially when the Ligaments of the Joints are cut. We said also, that many of those wounds, that are for the mostpart mortal, may be reckon'd among these, i. e. when they are small. If therefore the Lungs in any part, the thick of the Liver, the Dura Mater, Spleen, or Womb be but slightly wounded, they are in this rank. And whereas I say, Wounds of the Nerves are not mortal; because some Men doubt of the matter, I shall maintain it by Reason. In the first place we must take notice of this from Galen, that under the name of Nerves, both the Nerves themselves arising from the Brain and spinal Marrow, and the Ligaments and Tendous are comprehended, of all which he calls the Wounds malignant and dangerous, never mortal: And those that are so wounded, are so far from dying for the most part; that they oftner recover. ‘For (says he) not one died of a wound of the Nerves: wherefore he that joyns experimental Anatomy, and the use of Medicaments, he may always, as we do, cure wounds of the Nerves without any danger; so that no principal part may be drawn into consent; nor the wounded, or contused Nerve labour of an Inflammation; or if they should come, much less shall either Putrefaction, or Lameness, or Convulsion, or Death [Page 427]ensue.’ Besides it has been proved before, that mortal Wounds can be inflicted only on those parts, that are either principal, or afford a necessary use to the Animal, or such as are endued with an exquisite sense, or destroy strength by large bleeding. Now consider every particular, and you will find the Nerves none of them: For they are not of such an exquisite sense, unless where there is a concourse of many sensitive Nerves. You see an Hand, an Arm, a Leg and their Nerves cut off without loss of Life; therefore without doubt Wounds of the Nerves should not be ranked amongst mortal ones; but only among the dangerous. This also is to be observed, that the greatness and smalness of the Wound makes no small difference. For Nerves, which have their Original from the Brain immediately, or mediately from the interposition of the Spinal Marrow, are more apt to cause Convulsion, than Tendons, which are made up of a Nerve and a Ligament: But a wounded Ligament, if it be one that proceeds from one Bone to another is not so dangerous; but if it insert it self into a Muscle, the more of Nerve there is in it, except it be very carefully lookt after, the more danger there is in it, than in other Ligaments. Thô, I confess some people may be met with, who have such exquisitely sensible Nerves, that upon a slight Wound, especially in the top of the Spine, they not only die, but that suddenly.
SECT. V.
Of what nature Wounds of the Head may be reckoned to be.
A Question may arise concerning Wounds of the Head, that are only in the cutaneous part, or make bare, or break the Bone, but do not hurt the Menynges, what such they are, whether they be altogether safe, and without danger, or dangerous and of a middle nature? For it is an Argument they are safe, because inflicted in a carnous part, or in the very Skin, no Principal, or Nervous, or any such Part being offended: But it is an Argument they are dangerous, because near the Brain, and they put a Man in more hazard, than any other parts, when wounded. For my own part, I am of opinion, that Wounds of the Head have I know [Page 428]not what peculiar to them, and different from divers others, so that one must have a great care, how he gives his judgment in them. For they produce many and grievous Symptoms, the like whereof seldom occurs in others; so that the great Hippocrates might very well leave us a whole Book of Wounds of the Head. And there are several things, which admitting a parity in others, do shew, that these Wounds are worse and more dangerous than others; namely, the nature of the Part, aptness to mistake, and difficulty of Cure. For the Skin (to speak of that first) which is very thick, moist and rare, is exposed very much to the injuries of the external Air: For since the the ambient Air is in its own nature always moister and colder than the Skin of the Head and the Bone underneath; no wonder, while it is whiffling up and down the Wound, if it be able to convert the natural temperament of the part to immoderate moisture: Which is more readily done, if the wounded party live in moist and therefore unhealthy places; especially if the Skull be laid bare or opened, so as that the Menynx appears. Besides the Skin of the Head has a manifest connexion with the Pericranium, and receives Nerves from the first and second Veriebrae of the Neck, and from the third Conjugation of the Brain, which are disseminated all through its substance: for which reason Paraeus thinks, that Wounds, Contusions and Apostems of this Skin should be treated with all diligence. And the construction of the Head is such, that whatever Disease is contracted in the Skin, it may easily by a breach in the Skull, or by the next Sutures be communicated to the Menynges, and the Brain it self. Besides, its constitution is such, that, as Hippocrates writes, the Bone may be clest in another part, than where it is struck, which they call Resonitus cranii, or Contrafissure. Moreover Avicenna professes, that the Skull is often broken, the Skin remaining whole: And Celsus says, that the Bone is perfectly whole, yet by the blow some Vein in the Membrane of the Brain is broke, which bleeds. In these Cases the most diligent Physician is at a stand what to do. And Chirurgeons oftentimes are more then a little mistaken in curing such Wounds, unless they be both learned and well experienced. For it is usual with them, while they endeavour to alter the coldness of the Ambient Air, not only to stifle the room with woollen Curtains, but in the middle of Summer to kindle a fire in it, and omit nothing that may cause heat, which may easily occasion a Fever and Inflammation. Nor do they know that Hippocrates, when he had commended a hot Season for other Sores, yet for those in the Head he commends the time of Aequinox. Then they often rashly dilate the Wound with many Sections; cut the Veins, Arteries and Branches of the Nerves with Instruments and their Nails, and tear the Pericranium; which is of great use. This is a certain Nervous Membrane arising from certain Ligaments sprung from the very Menynx, and some thin Membranes [Page 429]which come out at the Sutures, and join the Dura Menynx with the Cranium. Mistakes also are often made about the Sutures; while they mistake the dents that are made by the Weapon for natural Sutures, and open them not, which is a work absolutely necessary. Thô in this fault they have Hippocrates for their companion, in the case of Autonomus 5. Epidem. which makes the mistake less dishonourable. They are much more to be blamed, who mistaking the Sutures for Dents left by a Weapon, rashly trepan; and so endanger the Patient. And there are other mistakes, common to other Wounds, which are of more danger in these. The difficulty in curing makes these Wounds also more dangerous: For, as Galen says, you cannot adapt that Ligature to the Head, which reason has invented to prevent Inflammation, especially in other parts: Therefore you can neither repress the affluent matter, nor express what is contained in the sick parts. Besides, since the Bone of the Skull is very dry, and adjoining parts moist, it is a difficult thing equally to preserve the natural temperature of them all. Which has caused a difficult controversie among Physicians, whether driers or midling Medicaments are proper in the cure of the Head? From all which things Hippocrates might very well determine, that no Wound of the Head should be slighted: for only a Contusion of the Skin, unless it be carefully handled, may cause a Fever, and create the Physician much trouble, and the Patient much danger. I conclude therefore, that Wounds of the Head are no ways safe, but altogether dangerous; especially such as reach to the Bone, and lay open the Menynx. For they have place among Nervous Wounds, which I have said are dangerous. Yet I advise you, in giving of your Judgment, diligently to observe the natures of Climes and Places, and other properties. For in a City low situated, and where many use to die of such Wounds, you must pronounce them dangerous altogether: But in a City high situated, and in a wholesome Air, you may say they are dangerous, but not so very dangerous.
SECT. VI.
How it may be determined, whether a Man died of his Wound, or of some other cause?
THings being in this manner stated, it will be no great difficulty to deprehend, what I propounded in the beginning, i. e. Whether a man died of his Wound, or something else occasioned his death? For if the Wound, under debate, be known to be mortal (whether of necessity, or for the most part it be such) without doubt the blame is to be laid on the Wound. If it be safe and without danger, the Man's death must be imputed to something else. But if Wounds be of the dangerous and middle sort; as they are of a doubtful nature, our judgment concerning them should be such: For if they be great, they themselves occasion death; if little, it must be imputed to something else. Thus therefore, if a great Wound be received in the Joint, which has cut or torn the Tendons, Nerves and Vessels, althô of it self it be not mortal; yet because it is full of danger, and admits of no errors without harm, and requires a most exact cure, to be managed with all care and diligence, which Physicians are not every where, thô they do their duty, able to perform (for never to mistake is above Humane Capacity) nor can the Sick every where observe an exquisitely-regular Diet. Therefore if the Party die, you will not do amiss, if you report the Wound to have been the cause of his death; unless some egregious error has been committed in the cure, whether the Chirurgeon, or Patient, or any thing else occasioned it. Then indeed the Aggressor is much excused: for tho without that error the wounded party might have died; yet because the case is dubious, and where any doubt is, the conjecture should always be in favour of the Criminal, whatever the error were, it must be said to have caused the parties death. Concerning Wounds of the Head, which have something peculiar in them, as we have shown before, you must make report in this manner. First, consider with your self, how the Air and Salubrity of the place stand affected toward Wounds of the Head; and if you find, that in all Seasons people die of these Wounds, all Wounds, where there is occasion [Page 431]to open the Skull, must be reckoned among the very dangerous; and such, unless some egregious and plain error have been committed, must be concluded to have occasioned death. Other Wounds, thô they be dangerous, draw nearer to the nature of safe ones. But when the Salubrity of the Clime abates the danger of these Wounds, then all Wounds of the Head, so that the Membranes be not affected, even if the Bone be broke and perforated, must by no means be ranked among the very dangerous: Except much of the Skull be taken away: For then, because it is impossible for the Membrane not to be hurt, you must account such Wounds dangerous. Hence therefore it may be determined, which I find to be the Opinion of grave Lawyers, (T. in. l. si ex plaga, ff. ad leg. Aquil.) if a Servant not mortally wounded die (by mortally, I mean very dangerously, as in great Wounds of the Joints) the Case will be an action of Battery not Murther. Wherefore Guido, an ancient and learned Physician thinks their Opinion vain, that say, a Man would never die, thô he offend in the course of his living, unless he had received a Wound: So that they seem to lay ones Death to the Wound, thô never so safe, and without danger. But I shall confute their error by and by.
SECT. VII.
How it comes to pass, that Men die of small Wounds, and such as are not mortal.
NOw I undertake to declare, how wounded Persons die, not so much of their Wounds, as of some other cause, which is a thing that falls most under Controversie. I find six causes of this unhappy event. The first is, when the wounded Party is of a Cacochymick Body. The second, when the wounded Part is some way weak and infirm. The third, when Men offend in their way of Living. The fourth, a bad constitution of the Air. The fifth, the Chirurgeon's negligence. The sixth, some uncertain Accidents, which cannot be reduced to Method. I shall demonstrate all particularly. As to the first; suppose a Wound be inflicted on a Body full of bad Humors, such as are the Cachectick, People troubled with a Leprosie, the Pox, Dropsie, Consumption, and such [Page 432]like; and that not in a principal Part neither, but in a carnous, and one not liable to danger: No Man is ignorant, what sharp Pain, great Inflammations, Fevers, Convulsions, and other bad Symptoms do thence arise, the Humors flowing in every way into the wounded Part. Nor can any Man doubt of the second: For if a Man, for instance, get but a little Wound in a Joint, which had not long before been troubled with a Defluxion: or if a Part once wounded, be offended in the same manner again: or if there be some peculiar disposition and constitution of Body, which naturally dispose a Man to some certain sort of Disease; is not a small Cut able to put such a Man into great danger of his Life? And errors committed in Diet, what do they not pervert and deprave, if after a Wound received, a Man cram himself and drink Wine; if he addict himself unseasonably to Venery; if he perplex his Mind with Cares, and his Body with unseasonable Exercise? But how frequently is there a sickly constitution of the Season abroad, which may irritate and exasperate even a small Wound, whether manifest intemperature, or the aspect of some unhappy Star occasion it? For from thence, even upon a slight occasion, Inflammations, malignant Fevers, and other formidable Symptoms are deduced. I remember this has happened even in my time; and several Ages before have seen it. Therefore Hippocrates does well advise us, to consider in Diseases the strength of Epidemick Diseases; and to know the condition of the Season. Perhaps Paul reckoned this among the latent occasions; for when he had said, that an Inflammation happens in Wounds from the strength of Liniments, from Cold, much Eating; or from drinking of Wine, he then subjoins, or from some other latent occasion; which I think may not be understood amiss of a certain constitution of the Heaven, which Hippocrates called Divine. I need not say much of the Chirurgeon's ignorance or negligence, I should rather condole the calamity of the Age, wherein a sort of unlearned Men, and ignorant Barbers are called to cure Wounds, who the less they know of Learning, the abler Practitioners they take themselves to be, impudently vaunting that Learning is a hinderance to their Business. The last Reason, that often exasperates a slight hurt, depends on fortuitous Accidents; as if the Weapon which gave the Wound were rusty; if the Lint, which was used to the Wound were infected with any bad quality; if any hurtful thing fell into the Wound; if bad Medicaments be applied; and several other things which I know very well put a Wound into a bad condition. And these are the Causes, why a small Cut may much endanger a Man. And Hippocrates does not obscurely intimate this, when he says, that Men die of all sorts of Wounds: for many Wounds are seen in ignoble, and no bad places, which yet cause death, and no wonder; for the Souls and Bodies of Men do much differ, and are of great force. But because [Page 433]these are Generals, I shall instance in some particulars of such as have died of slight blows. 5. Epidem. circa finem, Hippocrates says, that Philes son upon a small denudation of the Os Frontis, a Fever arising the ninth day, died. Besides, a fair Maiden, the Daughter of Nereus, being struck with a flat hand on the Forehead by a Woman, her familiar, as they were a play, died the ninth day. Also the Master of a great Ship, having broke a Finger with the Anchor, died of it. A Boy, the Son of Metrophantus, being struck by another Boy with an Earthen Pot on the Head, died, because he scratched the edges of the Sore. And some of the most learned Interpreters of Hippocrates do hold, that all these died, either through the mistake of the Chirurgeon, or because of a bad habit of Body, or by reason of an unwholesome Season.
SECT. VIII.
On what days the secret Malignity of Mortal Wounds uses to shew it self?
THat nothing may be wanting about this Affair, it will behove you to observe some term of days within which some latent mischief from a Wound, if it have lain lurking a few days, must shew it self. If Mortal Signs do long postpone; you cannot then of right blame the Wound; but something else. Guido, a man of great experience, in his general Speculation of Wounds sets three terms, wherein Mortal Signs show themselves; the Seventh, Ninth and Fortieth. Tagaultius in this, as in all things else, follows him; only instead of the ninth day he puts the fourteenth. Some of the most skilful among the Moderns for the first days of the Wound suspend their Judgments; nor do they give their opinion of the quality of the Wound before the ninth day is over: for they say, within that time gentle or horrid Symptoms usually shew themselves, according to the condition of the Wound, the party hurt, and the ambient Air. Nor without reason: for the ninth day, as Plutarch testifies, is judicatory of Diseases; and he says, that Achilles knew, the Pestilence in the Army had no vulgar cause, because it exceeded the ninth day. But thô I deny not these things to be true; yet they create not Science. Therefore the best way is to pitch [Page 434]upon some Method at the present, whereby a Chirurgeon may make perpetually a pretty sure conjecture concerning Wounds. Hippocrates, lib. de vulner. Capitis, affirms, if a man have broke his Skull, and commit an error, if it be neither raspt nor perforated, a Fever seizes him before the fourteenth day in Winter; but about the seventh in Summer; and if all things persevere bad, in Summer he will die before the seventh, and in Winter before the fourteenth day. From which passage, I think, I shall be able to gather the true way of judging: For he says, that bad Symptoms begin and death happens later in Winter and sooner in Summer. And as this is most certainly true, I am able to give no other reason for it, than that in Winter our heat is more vivacious and strong; and therefore resists nocent causes the more; for the Ventricles are by nature hottest in Winter. On the contrary, since our strength is easily spent by the ambient heat, it so happens, that then we are most liable to morbid injuries. For the same reason, if things happen otherwise than well, I say, that mortal Symptoms are longer in appearing in a strong Patient [...]han in a weak one: for as strength retards the approach of death, so does it of grievous Symptoms. However therefore as by Age, Complexion, Sex and Time of the year the Strength is firmer, the longer will the Symptoms and Death be in approaching. So if a young Man of a good constitution, and in perfect health receive a Wound in Winter, whose event may prove hazardous, I would wait for the beginning of the Symptoms on the fourteenth day before I would give my judgment; which if they persevere, I would predict death, on the next critical day, or on some other, according as the malady proceeded flower or sharper. On the contrary, if an old Woman be wounded, who is of a cold and dry complexion, and of a bad habit of Body; I guess the Symptoms in reference to the Wound would arise about the seventh day. And thô Hippocrates says, that in some Diseases, young people die sooner than old, it holds true indeed in spontaneous and violent Diseases: for old people generally die more of the tediousness of a Disease, and of a relapse, than of the violence of it. But in Wounds it is as we said before. And that you may not be rash in your judgment, we have given you both the nature and times of Wounds.
SECT. IX.
How one may know, whether a Man died of a Blow, or Contusion, and some Opinions about it.
THat many die suddenly of beating and Contusions, is so evident by several such sad Events, that I need say no more of that: But if the manner of ones death be unknown, it is not yet agreed by what way and means it may be found out. The vulgar Opinion is, that Wheals, and black and blew Spots (these marks are made, when the little Veins, that are disseminated under the Skin, being broken and cut, do pour out Blood, which afterwards being out of its natural Vessels, contracts a livid colour) are the only evidence of blows received. But I think, they are much out: for every bruised part does not always appear black and blew, unless it be endued with Veins, and those not lying deep. If a bruise happen (as Avicenna says) in Nervous places; or in any other but Fleshy, you shall neither find redness, nor any Ecchymosis. Besides, you may often find blackness and blewness in the Body of such as died of Poison, and of internal and spontaneous Diseases. And Hippocrates himself, l. 1. de Acutor. Regimine, says, in Pleuriticks, who die of taking Ptisan unseasonably, their side looks livid, like a bruise. And 4. Epidem. he says, one that died of a Dropsie, had his Hypochondria look red, as if his Body had been beaten with stripes. And 5. Epid. Nicolas his Son, when he had been ill of a burning Fever, and died the seventh day, his Posteriors appeared red, when he was dead. Now the cause of this Symptom (for I think it is worth the knowing) seems to me to be the effort of Nature; which she violently exerts in Extremity. For she thrusts the Blood thither, which being destitute of vivid Spirits turns livid. Paraeus also has observed, that in some, after death, spots (called Peticulae) appear before the Humors are cold, which are signs of Putrefaction. Therefore spots are no certain evidences of blows received. There are some also who think voiding of Blood is a perpetual sign of such a death. But they are out: for I have seen some, that died of an internal cause, who spontaneously bled, as they were about to be buried. Therefore we must ascertain our selves from something else, if possible.
SECT. X.
What are the chief Signs of such, as being beaten died, but of no conspicuous Wound.
NOw therefore we declare our Opinion of the Matter. Avicenna says, a Fall and hitting against a thing (hither you may refer Blows and Bruises) hurt Mens Bodies two ways, and cause death, namely, either because they tear the Bowels, the Coats, Nerves and great Vessels, or because they occasion Pain; to which I add a third, which is proper to a blow on the Head, because it produces most grievous Symptoms in the Head, an Apoplexy, Catochus, and the like, occasioned by the concussion and compression of the Brain, and interception of the Animal Spirits. Things therefore standing thus, my opinion is, when a violent blow upon a part, under which some great Vessel lies; as the Epigastrium, in which great Veins and Arteries are contained, that Blood will be voided by Excretion out of the Breast, or by the urinary Passages. But if it so happen that the Mouth of the Stomach receives a blow, because a hurt in that part uses to kill Men with the pain; it is not necessary that Blood come away; nor likewise must you expect such a Sign in every blow on the Head. For the Head may be so weak, that the slightest blow may endanger one. Such a constitution of the Head had he, that died of a box on the Ear Apoplectick, and the Maid in Hippocrates, mentioned before, who died of a flat blow given her in jest by a Woman upon the Forehead, being taken with a Vertigo and want of breathing. But it is otherwise, when one receives a violent blow on the Head; I grant Blood may come out at the Ears and Nose. Wherefore I think it is evident from what has been said, that they who die of a blow, do generally void blood; but this is not always necessary; for a blow on the Stomach or on the Forehead, which according to Hippocrates is the weakest part in the Head, and has most danger in it, and on the Temples, which are also weak, does not always bleed. Nor must we conclude there has been a blow, if blood do come; for I have often observed it in such as have died of internal Diseases, especially of malignant Fevers. Since therefore the true Signs of a Mans being beaten can neither be had [Page 437]from spots nor bleeding, we can determine nothing for certain. Thô when these two Signs appear, and there was no other manifest occasion of death, then there is suspicion of a blow.
SECT. XI.
How many ways People may be suffocated by an external Cause?
IT has been observed that several, who have been secretly suffocated by their Enemies, do not presently afford any sign of a violent Death. Wherefore he that is called to judge of such Persons, and is not well verst in such Matters, will either rashly flie to some internal fault, or he must need say much to little purpose. Therefore I will say something of this thing. By suffocation for the present I mean that sort of Death, which is accomplished by some external violence, hindring the Office of Respiration. This is caused either by drowning; or by a violent stopping of the Mouth and Nose; or by a String; or by inspiration of a strong and hot Air. And you may know them all thus:
SECT. XII.
What are the Signs of external Seffocation?
YOu geneerally find drowned People thrown upon the Shore, or lying in Wellsand standing Waters. But if the subtilty of Man should endeavor to remove all suspicion of the Crime; yet an unusual swelling and flabbiness of the whole Body cannot be hid; the Belly also will swell; some mucous Excrements will [Page 438]come out at the Nose, and froathy stuff out at the Mouth; the Fingers ends are worn: for they that are drowned, endeavour to get out, and scrabble in the Sand, and so wear their Fingers. Whereas, I say, that drowned Bodies are swollen; it is not so much by sucking in the Water, or by any Water contained therein, as by a Vapor, into which the Humors are turned by a putrid heat, therefore this swelling shows not it self, till after some time. There is another Suffocation, in some places more frequent, which is acted by shutting the Nose and Mouth violently, or by a strait cord. And that you may have no trick put upon you in this, take it as a general Maxim, that it is a Symptom common to all who have the use of Inspiration stopt, for them to froath at the Mouth: for the expiration of fuliginous Excrements being intercepted by a Cord, or otherwise, they are all violently impelled; whence it comes to pass, that part of the proper humidity is expelled together with them, as you observe in letting Blood. But if one be strangled with a Rope, the print of it will appear either black or red, especicially where the Rope crosses. The Head of the Aspera Arteria is often bruised, and there is a luxation of the second Vertebra of the Cervix; the Arms, Legs and Face are livid; the Breast is swollen, and the Urine is volded. Of all which things this Reason may be given. The swelling of the Breast is caused by much Vapor raised by containing the Breath within; the passage of the Urine by an unequal straining of the Muscles, which conspiring for the common safety are contracted towards their Original; and therefore make way for its passage. Also the Face is not pale, but of a violet or purple colour. But if you have a mind to search more narrowly, you will find the diffected Lungs full of purulent froath, and all the other Viscera in good order. And Anatomists in opening such Bodies do find the Head and Breast full of Blood. But if the Breath has been stopt any other way, you will find the same signs, except the print of the Rope. In these also you may observe spots arise in divers places. For the force of strangling is such, that the expulsive faculty of all the parts of the Body is irritated, and therefore it forces all the Blood and other Juices to the Skin; and especially to those places, that have larger and more capacious Vessels, as the Back, Face, and such parts.
SECT. XIII.
Of such as are suffocated by inspiration of a hot and strange Air.
AS for those that are killed by a hot and suffocating Inspiration, such as lye in a room newly plastred, because Fire is contained in the Plaster; or where burning Charcoal has no vent; or such as come into Pits, and stinking Caverns, or great Holes where Grain is kept: I will first shew you the nature of such a death, and then the signs, that you may not only produce the signs, but do it according to Art. Erasistratus, as Galen says, thought, that such as perished in Charonian pits, and in Houses new Plastred, by the steam of Charcoal, and the like; it was because their breath was so thin, it could not be contained in the body. But, says he, as there is a familiar quality of a liniment in Pulse, Pot-herbs, Bread, &c. and a foreign one in Cantharides, the Sea-Hare, &c. So Erasistratus might as well have said, that in some Air there is a quality familiar to our nature; in another there is one forein, and corruptive. Now here Galen seems of the opinion, that People dye by drawing in an Air of an inimicous and forein quality to us. But in another place where he treats more exactly of the thing; They says he, that tarry too long in the Bath, faint, and at last dye; because the natural heat cannot be maintained: Now it is maintained by Ventilation of its principle the innate heat, by a moderate refrigeration, and departure of that which is fumous, for People in Baths dye, not because the Spirits are evacuated out of the Body, but because of the heat. And the reason why People dye in stinking Caves, in Houses new plastered, and by the steam of Charcoal, is, because the cold Air is not attracted, which is absolutely necessary for Respiration. But if you demand what kind of death such People dye. Some famous Physicians think that all of them dye Apoplectick, and that the Brain is affected in its Ventricles, they being filled with a foetid and gross vapour, vellicating them by a malignant quality: for they say, the Animal is deprived of Sense and Motion, and froaths at the Mouth. Yet to me Galen's Opinion seems truer, who holds, that all who dye in stinking Caves, and Pits, and such like places, dye not of any fault in their Brain; [Page 440]but for want of cool Air, whereby the innate heat is ventilated and cooled. For whereas some say, that in suffocations the Brain suffers, because the animal Spirit cannot then be fed by the vital; Galen denies it, and shews, that to feed the animal Spirit, there is no great need of that Spirit which is sent from the Heart: but it is sufficient that there be an evaporation from the Blood; or which is of more moment, that there be Inspiration at the Nose. And since there are two things, which we attract by Respiration, namely, the substance and quality of the Air, and when hot Air is inspired, enough of the substance indeed is attracted; nevertheless the Animal is suffocated, as thô it inspired nothing at all; therefore it remains, that a cool quality in the Air is chiefly requisite to Respiration; for want of which, because the natural heat cannot be cooled and ventilated, when it is beyond measure heated, it kills the Animal; And Galen says, that frothing is a Symptom common to all them, that have the use of Inspiration intercepted. But as for the signs, which is the thing we here enquire after, I can find none, which all suffocated People have, but that of frothing: only swelling in the Breast, and profusion of Urine do not appear in this last sort: for they dye of a less violent death, than they that are strangled with a cord; or they whose Mouth and Nose are stopt, And thus much of suffocated Persons.
SECT. XIV.
Divers effects of Thunder, whence signs of it may be taken.
Some company walked abroad out of the City: A Storm arose, and the Thunder killed one of them. His Friends suspecting he was killed by his companions, indicted them of Murther; nor could they be quit, till by the report of Physicians it did appear, he must be struck with Thunder, and with nothing else. Therefore that you may not be left destitute here, I will give you my assistance: That therefore you may know the various effects of Thunder, so as to gather the certain signs of dying by it, I shall take something out of Seneca, which makes for our purpose. ‘Wonderful, says he, are the works of Thunder, and its wonderful power is also subtil: The Money is melted, the Purse remaining [Page 441]whole and unhurt: The Sword is melted, the Scabbard remaining whole: The Wood about Piles inviolate, all the Iron is run down: The Hogshead being broken, the Wine stands; but its rigor lasts not above three days. There are these sorts of Thunder, the terebrating, the discutient, and burning; The terebrating is subtil and flammeous; it pierces thorough the most narrow place, because of the sincere and pure tenuity of the flame. The dissipating is conglobated, and has the violence of a compact and stormy Spirit mixt with it: Therefore this Thunder passes and repasses frequently at the hole where it enters; the force of this being dispersed abroad doth break, not perforate. The Third sort which burns is very terrene, and has more fire than flame, and so leaves great signs of fire where it strikes. No Thunder indeed comes without Fire; but we call that fiery which imprints manifest signs of burning. That which burns or scorches, burns three ways. It burns, scorches, or blasts. &c.’ So Seneca, whose Opinion, thô it be not unknown to the more skilful; yet because there are some who do not so well understand his succinct way of writing, I shall periphrastically illustrate the Author's Sense, about the kinds and differences of Thunder. There are therefore three kinds of Thunder (for it is found to do hurt three manner of ways) The First is, that which terebrates, and makes as it were a hole in a body. The Second is that which discusses, i. e. dissipates and severs the Body into divers parts. And the Third, which only burns. As for the First, whose property we said it was to terebrate, it is subtil, and collected into it self, and not at all expanse. The Second, which dissipates, has compact and conglobated Spirits, it does its violence unequally, and like a storm tears and breaks all. The Third, whose property it is to burn, has a terrene substance, and is liker to fiery matter than to flame, and therefore leaves evident signs of burning. For thô other Thunders burn; yet we call this burning, because it shews more signs of Fire and burning than the rest. This is twofold, one chiefly burns, the other makes the Body black. That which burns is threefold, some burns slightly, and only blasts, i. e. as if a breath touched a body, and does little harm. The Second burns and consumes. The Third kindles, and sets on fire. It is common for all Thunder to burn, and to discolour, either changing the natural colour a little, or wholly changing the colour, into blew, pale, black, or some other colour.
SECT. XV.
Divers marks of such as have been slain by Thunder.
NOw therefore that we are instructed by Seneca; and that it appears, Mens Bodies are many ways affected by Thunder; yet two things are common to all (which to know is much to our purpose) namely, to contract a brown colour, where the Thunder strikes, and to be somewhere burnt, Besides, it smells like Sulphur, for, as the Learned Pliny observes, the flash of Lightning is sulphureous. Also they that are struck, lye on the contrary side; and, as Seneca observes, their Head lies from the Thunder. He that is awake, keeps his Eies shut, and he that is asleep, keeps them open. Bodies also struck with Thunder, as some Experimentators have observed, are colder where they are struck, than any where else in their Body. Some have written, that Bodies struck with Thunder, grow drie; but never corrupt. Therefore that Poet might very well be blamed, who fang, How Thunder-struck Phaëthon putrefied in some Valley. But I know not whether Seneca would grant this, who, l. de naturalib. affirms. That People struck with Thunder breed Maggots in a few days. Therefore, if you well observe what has been said, it will be no difficulty to find out, when People are slain by Thunder. But whereas some think, that Thunder must always batter, and that they who fall so, are always found with their Limbs broken, they are much mistaken. For, says Aristotle, if you consider the nature of Thunder, every sort of it is Spirit, which is either thin and clear, and therefore not burning; or thick and fumid, and such consumes by burning. And upon this place where Aristotle affirms, that all Thunder is Spirit, and of such, Alexander Aphrodisaeus adds, and not a Stone, or Bolt, or any thing solid, as some are of opinion. And whereas Iron, and the most solid of things is often broken and dissipated by Thunder; that is not done by any solid matter; but because the nature and violence of Thunder is such, that it only hurts things which resist, and put a check to it; and like a magnanimous Warriour, either it slightly touches, or quite neglects things that give way. Therefore, because Man is all over covered with a fleshy softness, you shall rarely find him bruised; but always burnt or blasted. For this reason Seneca might well be perswaded, [Page 443]that there was a pestilential power in Thunder: because People do not only fall by the blow, but likewise by blasting. It is also observed, that Bodies slain by Thunder, are for the most part light; because the moisture by that great burning from Heaven is dried up. And this shall suffice for the signs of People being killed with Thunder.
SECT. XVI.
How a Chirurgeon may be able to predict some hurts of the Functions in some wounded Parts? First, what is the Instrument of voluntary Motion?
IT sometimes so happens, that upon a Wound given, before the event be seen, our Judgment is demanded in Court, whether it will lame a Man, or make any part imperfect in its Functions? To which Questions it is not every one that is able to give a satisfactory Answer: He had need be a skilful Artist, who knows exactly the structure of the parts of the Body, and their use, and who has carefully observed the various events of Wounds. This Treatise also may be of use, thô you be far from any Court: For when, according to Art, you predict the events of great Wounds, you will leave no room for reprehension to those querulous people, that would lay the blame of the abolished Function upon the Physicians cure, not upon the Wound received. The knowledge of this thing is accounted very necessary to him that practises with his Hands, whether he be to take out sharp things, and points of weapons, or to take away any thing, or to cure Sinus's and Abscesses aright. Besides, it is so ablolutely necessary for a Physician to know by what Muscles the Arm, Hand, Thigh, Leg and Foot are extended, and again, by what Muscles they are bended, that an Empirick dare not condemn this knowledge; but must confess, it is very useful. But here I would have my Reader understand, that I shall not treat of all Hurts; but only of those which principally have respect to the animal Function, nor of all them neither; but of some external ones, whereby some conspicuous voluntary motion is hurt. For the harm that is done to the vital and natural Instruments, we do not meddle with here; because upon recovery of the Patient, no [Page 444]impediment is left in doing his civil Affairs. For if the Heart, Lungs, Liver, Stomach, or Veins receive a Wound, it either kills the party, or if he escape he can perform voluntary Motion, and go about his Business. But I have discoursed of this among mortal Wounds. Now therefore that I may have some foundation to build my Discourse upon, I take it for granted, that a Muscle is the instrument of that Motion, which is at the command of our Will, which we therefore call voluntary or spontaneous. Nor is there any part any where in the Body (if it have a spontancous Motion) but has Muscles inserted in it. Now there are three parts of a Muscle, the two ends which are nervous, and the middle carnous. And the beginning of a Muscle, which they call the Head and Rise, comes from the Bones; but the middle which they call the Belly, has many Fibres dispersed in it, which are derived from the Ligaments and Nerves. The end is called a Tendon, because its action is to extend, and the Muscle ends in it. It is made up of many mixt Fibres, and is inferted either into a Bone, or into another Muscle, i.e. into that part of it, which is to be moved. Nor is it any obstacle that Galen somewhere says, that a Tendon, not a Muscle is the instrument of voluntary Motion; and that a Muscle is made for the sake of a Tendon: for a Tendon is indeed part of a Muscle, and that to which action is principally owing: and the Muscle is the entire instrument, so that it makes little matter, whether the property of the Function be attributed to the one, or to the other. For the Eye by all Men is reputed the instrument of Seeing; yet all the action of Seeing is most truly ascribed to the Crystalline Humor, as to the chiefest part of the instrument.
SECT. XVII.
What Cuts of the Muscles do hurt what Motions in general?
SInce therefore it is plain, that a Muscle is the instrument of voluntary Motion; then the motion of that part, familiar to that Muscle, must needs be hurt, when such a Muscle is hurt. When Muscles are cut asunder and transverse, Motion must needs be lost in the subject parts: When they are incised, Motion is only hurt; and the measure of the hurt is proportionable to the measure of the Section; more Motion being lost in greater Sections, and less in less. And I would have what I have said, understood also of the Tendons: for if you cut them quite asunder, you destroy the motion of that part; if you make Incision, you will so far hurt it, as you make Incision. And the same may be said of the heads of Muscles. For Galen holds, that when the head of a Muscle is cut, it performs its Function no more. Therefore if a Muscle have but one head, it is a very easie thing by cutting that, to deprive it of motion; but if it have more heads, you must cut them all. And whereas we said but now, that all the Muscle must be cut asunder transverse, to deprive it of motion, I would not have you take it carelesly, because it is not every cutting of a Muscle, that takes away the use of a part; but only that which is transverse, and which (according to Galen) is made at right Angles. This a Physician must know, who has a mind to foreknow the hurt of a part, thô it be difficult: for all Fibres, as Galen says, are not always alike according to the longitude of the Muscle; but sometimes have a various composition: Thus some Muscles have a simple sort of Fibres, others have a double, so that they look like several Muscles, one lying upon another. Besides, sometimes the Fibres differ in length. And a Man ought exactly to consider these things, who would compleat himself in the predictions about them. Nevertheless, this manifold variety of Fibres need not trouble us much. For Muscles have generally their Fibres tending length-ways; you shall but seldom find them transverse or oblique, considering the multitude of those that run lengthways. And Vesalius attributes manifold Fibres only to three sorts of Muscles; namely, to those that draw the Arm to the Breast; to the Second, that moves the Scapula, which have twofold Fibres, and to those that move the Cheeks and Lips.
SECT. XVIII.
Some general Instructions very useful for Predictions.
BEfore I come particularly to speak of wounded parts, I would premise something in general, which will be of use to what shall be said afterwards. This therefore, First of all I would advise you of, namely that all Wounds received in the outside, and forepart of the Body, do always hurt Extension; and what are received in the inside, Flexion. For Galen has abundantly demonstrated, that the internal Muscles serve for bending a part, and the external for stretching it out. A Muscle so long operates, as it is contracted towards its beginning, and draws the part moved toward that: whether it be done by drawing the whole Muscle to that they call the Head, or when it is drawn in a lump. Besides, this is to be taken special notice of, that whether it be the external or internal Muscles that are cut asunder, in both, the figure of the part remains immoveable. For neither extension alone, nor flexion alone perishes in a part, but both thrive, and both perish together. Not that the operation really perishes, whose Muscles are entire; but because these motions succeed one another by turns. For if the internal Muscle, which bends the part, be whole, when the external which used to extend it, is cut; at first indeed it may bend the part; but it cannot bend it again, unless you extend it with something else; because Flexion is of a part extense. The case is the same, when the internal Muscle, which is the bender, is cut, if the external be not hurt; this will extend at first; but no more afterwards: Unless with your Hand you supply the lost operation of the wounded Muscle, by extending that which is bent, or by bending what is extended; for then the sound Muscle will perform its operation. This also I must not pass by in silence: since some parts of the Body are distinguished by many Joynts, that the function of that part where the Wound is made, is not always hurt; but of an adjoyning part, which is tied to the wounded part by Articulation. For Muscles are derived from the superjacent Bones, wherein there are Cotyle, and are inserted after the beginnings of the subjacent, which are to be moved: and by these intense Muscles, when the Heads are drawn upwards, the [Page 447]whole Member is drawn up with them. Wherefore if a Wound will hurt the Functions in the Cubit, it must be inflicted in the Brachium; if it will hurt those of the Brachium, it must be Inflicted in the Scapula, or parts thereabout. And you must remember this also, that the use of a part does not always perish by the cutting of one Muscle: for if the use be peculiar to some one peculiar Muscle, and competent to no other, we must believe the part will be made useless, because deprived of the action of that one Muscle. But if several Muscles conspire to one action, the detriment of one of them is not sufficient to destroy the whole action of the part.
SECT. XIX.
What harm Wounds of the Forehead and upper Eye-lid do?
IF one receive a Wound in his Forehead, especially near the Eye-brows, where the Fibres are carnous, if it be made length. ways, and according to the rectitude of the Fibres, after it is brought to a Cicatrix there is usually no hurt of the Function left. But if it be transverse, and more than superficial, you may say, that the Eye-brows and all the contiguous Skin shall be drawn downward; and thereby create no small trouble to the Eyes, which lye under these parts; because the Eyes cannot afterward open freely, nor perfectly do their Office. And this may be the bare and true report, as to the demands of the Court. But that you may not seem only to have reported the truth, but to have done it with judgment: It were best sometimes to shew the rise and insertion of the Muscle, which is the instrument effective of action, and the duct of the Fibres; and several other things besides, which may seem proper upon the occasion. If therefore at any time you are called to make a report concerning a Wound in the Forehead, you may accommodate these things, to what has been already said; Namely, that Galen calls this substance, which lies upon the Forehead, and sticks most tenacionsly to it, not a Muscle, but a Musculous Skin: And that Vesalius will have it to be not a Muscolous, but a Carnous Membrane, full of many carnous Fibres. But Fallopius is of another opinion, and says it is a perfect Muscle; because the Motion and Fibres attest as much. Realdus also holds there are two Muscles, and he sometimes [Page 448]saw one side of the Forehead Convulte, and the sound side intire in its Function: And in dissection he has found the same thing; and moreover he says, that these Muscles are terminated in that common Suture, which distinguishes the Bones of the Head from the Bones of the upper Jaw. And these Muscles have no Tendon; because it is not a Bone, but only a Skin that is to be moved. And Vesaiius says, that the Fibres which are principally to be considered, do run in a direct line from the top of the Nose to the middle of the Forehead. Cohonbus says, the Fibres are not streight, but oblique from the top of the Nose to the middle of the Forehead. The use of the part is, to draw up the Eyebrows. And thus what we have discoursed concerning Wounds of the Forehead, you may accommodate to the present occasion, as it shall offer it self. Thô here I must not omit what Hippocrates mentioned in Coac. Prenot. viz. That the Sight is darkned by Wounds which are inflicted on the Eye-brows, or a little higher; and the fresher the Wound is, the better they see; and when the Wound is, after a long time healed, the Sight grows duller. For, as Hollerius declares, the Eyes grow ill by reason of the vicinity, and consent in the adjoyning Bone by common Membranes, and certain Veins, and they grow duller in the process of the disease, that is, when the Ulcer is difficult, and flow in cicatrizing. Also the upper Eye-lid (for the lower is immoveable) if it be wounded in the space between the corners of the Eye; it is no difficult matter from the nature and site of the Muscles, if the Wound be transverse, to predict the total loss of the Function in the Eye-lid, if the weapon reach deep: But if the cut be not deep, you may say, that all the hurt which shall befall the Forehead, will be, that it cannot shut close. Now there are two Muscles in the upper Eye-lid: an oblique one reaches from the greater corner at the Nose, reaching half way of the Tarsus, and this draws the Eye-lid: And another oblique one arising from the Eye-brow near the less corner of the Eye, reaching along the rest of the Tarsus, whose Office it is to lift up the Eye-lid. And it behoved the rise of either Muscle to be such; because it is necessary that all Muscles tend towards their proper principle. And thô Fallopius does here observe, that the former Muscle arises not (as he says, Galen and Vesalius thought) For oftentimes that place uses to be hurt and cut, as in curing an Aegilops, and yet no hurt of the Eye-lid follows. Then he observes, that this Muscle has its original from the inner part, whence another also proceeds, which raises the Eye upwards. But Galen himself, 10 de usu partium, 10. First observed this; therefore Fallopius basely ascribes his Master's diligence to himself.
SECT. XX.
The Functions of the Cheeks and Lips; also of the lower Jaw and Mastication, by the wounds of what parts they are hurt?
ANd now to come to the hurts of the Cheeks: There lies a certain broad Muscle under the Skin in the Neck, which Galen first of all observed: It is thin and Membranous; which, if you please, you may call a Musculous substance, or a Musculous dilatation. It is spread round under the whole Skin, which is about the Neck: In the forepart it is carried downwards towards the Clavicle, and behind along the ridges of the Scapulae to the beginning of the back. The use of these Muscles is to draw the Cheeks from one another to the sides, without moving the lower Jaw, or openin the Mouth, which Functions must of necessity be hurt by a Wound of this Muscle. This sort of action is most apparently seen in the Convulsion, they call Spasmus Cynicus: for in it this Muscle is extremely stretcht, and contracted toward its original. But that you may make no slip in your Report; you must know, the Fibres of this Muscle do not every where observe the same duct: for they are partly carried upward to the Lips, as in that part of the Muscle, which ascends from the Os Pectoris, and the middle Region of the Clavicle: and they partly run obliquely from the same; as in the portion of it, which arises from the rest of the Clavicle, the top of the Shoulder, the Scapulae, and the Region of the Neck. So that now you may see, what way the wound must tend to cut the Fibres transverse, which sort of Wounds only, as I said before, hurt the Functions. So Galen; but Columbus a diligent Anatomist, disagrees with him: for he thinks, that the Muscles, which perform the motions of the Cheeks, are situate between the Jaws, and arise from the Gums, and end in the Gums; and that this broad Muscle only draws the Lips obliquely downwards, and serves to open the Mouth. The motions of the Lips are thus hart by a Wound. Whereas two Muscles descend obliquely from the Cheeks, and as many ascend from the end of the Jaw, where the Chin is; the former are constituent of and move the upper, and the latter the lower Lip. If therefore [Page 450]the spaces contained within the aforesaid limits be wounded, without doubt the said motions will be hurt. But here you must carefully consider, that the Fibres of these Muscles are interwoven and complicate one within another: So that let the Wound be given which way it will, it is always transverse, and breaks the Fibres. It is no difficulty to find by the hurt of what parts the Functions of the nether Jaw are hurt. For if you inflict a Wound in the Region that lies between the Ear, the Forehead, and the Os Jugale, making an imperfect Circle (it is called the Temples) you will then offend the attraction of the nether Jaw upwards, and the shutting of the Mouth. For ther [...] lies the temporal Muscle, called Crotaphites, which arising from the Os Verticis, Frontis, and Temporis, is fastned to the crooked point of the lower Jaw, and draws it up, and shuts the Mouth. And the Fibres of this Muscle run from the circumference to the centre, such as are in no other Muscle besides. Here I would have you be careful in your prediction: for a wound in this Muscle does not only spoil the action of the lower Jaw, but, if we may credit Hippocrates and Galen, causes Convulsions, Fevers, Sleepiness, and Doting: because these Muscles are near the principle of the Nerves. And if you give a Wound from the Os Jugate and root of the Ear at the beginning of the nether Jaw, you will manifestly hinder Mastication: for there the mansory Muscle, called Masseter, lies: This is a Muscle, which you may easily feel with your Fingers, when your Mouth is open, and arising from that part of the Head, where the Processis Styloeides are; it comprehends all the nether Jaw, and draws it round. But Galen is of opinion, that both these, and those that are called temporal Muscles, might as well be called Masticatory: for both of them conspire in the action of Mastication.
SECT. XXI.
By the Wounds of what parts the motions of the Head are hindred?
BY what Muscles being hurt the motions of the Head receive damage, take thus. There are seven Pair of Muscles, that are destined to the motions of the Head: Only one pair of these draws the Head forward: All the rest draw backward. But all of them lye under some other external Muscles, the exteriour under that they call the Musculous dilatation, which we said moved the Cheeks, the Posterior under the Scapular Muscle: Wherefore it must not be a superficial Wound, that hinders the motions of the Head. And we must not be ignorant of their Original and Progress. The two first, which incline the Head forwards arise from the top of the Breast, and the end of the Clavide; they are long, round and strong: They are apparent enough, before the Skin is taken off. They are inserted into the Mamillary process: If they are both moved, the Head is bent forwards; but if only one act, it is drawn on one side. But in the hind part Anatomists have observed six pair of Muscles: All of them tend from the Spines of the first five Vertebrae, and reach almost half way up the hind part of the Head. If then a deep Wound be inflicted in the Neck behind, so as to reach the parts under, you will manifestly hurt the motions of the Head, according as these or the other Muscles are wounded.
SECT. XXII.
What functions wounds of the Arms do incommode?
WOunds of the Arms are both frequent, and prejudice the Functions that are most useful to Man. Therefore that you may foresee the Event of each of them, it is best first of all to recount the proper Functions of the Muscles, which do diversly move the parts of the Arm: for so you may easily reckon with your self, what hurts will ensue, I will begin therefore with the extreme parts of the Arm. There are eleven Muscles in all, that move the Humerus or Shoulder (I call all that is between the Throat and the Elbow the Shoulder, and the Cubit all that is between the Elbow and the Palm) three ascending from the Breast to the Arm: two from the Region of the Ilia: five proceeding from the Scapula: And the eleventh lies upon the Epomis. All these Muscles grow together, and are implanted, where the Humerary is one. But these are their motions. That which lies upon the Epomis, draws the Arm right upwards. The two, that come by the sides of this, from the Scapula on each side, do raise the Arm up; but not streight; but they draw it backwards or forwards, according as they are on this or that side. The Muscles that rise from the Breast, draw the Arm thither. The rest of the Muscles turn it backwards, and that especially, which proceeds from the lower end of the lowest Rib under the Scapula. Now you see, by the Wounds of what parts what motions are hindred: for if the Muscles, that lift it up, be wounded, without doubt that Function will be hurt; and so in the rest. The Cubit is moved by four Muscles, which incompass round the Os Brachii; and the two former bend the Joint, not streight; but one enclines it inwards and the other outwards. It is extended by that Muscle which manifestly appears near the humeral Vein, especially in such as use much exercise, and it has two Heads, one upon the edge of the Head of the Scapula, another upon the Process, and it cleaves to the Os Brachii, and then to the Radius, and it has another under it, assistent in the same action. Therefore when that Muscle is wounded, the Arm cannot well be bended; but if a Wound be received in the hind part of the Arm, which is opposite to the foresaid Muscles, and touches their [Page 453]ends, then the office of bending the Elbow is lost: for upon that place the Muscle lies, which extends the Arm; and whether you call it one Muscle or two, Vesalius thinks it is no great matter. Moreover, if a Wound be received on the upper and forepart of the Cubit, between that and the end of the Radius, in that long, but narrow place, it will hinder the Radius from being raised supinely: for the long Muscle lies there, which arises from the Os Humeri, and is implanted in the lower Appendix of the Radius, and reckoned the second among them, that draw the Radius forward. But if you wound the lower part of the Ʋlna, along to the lower Bone of the Wrist, you will prejudice all the motions of the Wrist. For there all the four Muscles are extended, the Authors of all brachial motion: Of which nevertheless the two external, which are most liable to the injuries of Wounds, arising from the external swelling of the Humerus, are inserted in the first and second Os Carpi, and serve to extend it: Therefore when they are hurt, this Function especially must be hurt. But if a Wound be inflicted in the inside of the Cubit inclining a little back, then the second Joints of the four Fingers cannot bend. For there runs one Muscle, the first among the internal, which moves the upper part of the Hand, and which arising from the lower swelling of the Humerus, is hid under others, till it come to the Elbow: but there it starts out, and is seen under the Skin; except as much as the former Muscle (which makes the broad Tendon, where it is thin, and turns into a Nervous end) does pass over. This then having passed the Wrist, is divided into four Tendons, each of which being sixt to the second Bones of the Fingers, are their benders. But whatever of the internal Muscles you cut, which run down with the first to the Wrist, von will manifestly hurt the Function of Contraction. The Hand is manifestly extended by the external Muscles, i. e. by them that are placed in the back part of the Arm. The first of these having past the Elbow, starts up, and is conspicuous under the Skin; and if you remove another, which lies above it, and extends the Wrist, you would say it lay uppermost and foremost. This is most fiequently divided into four Tendons, which come to all the Joints of all the Fingers, except the Foresinger, and dilate them. And the second Muscle, by which the little Finger is drawn aside from the rest, and the Palm is formed, having the same original with the former, is to be seen under the Skin with the first: but it proceeds underneath to the Hand. Therefore in what place soever the seat of this Muscle is wounded; either the Function of the little Finger will be hurt, if the Wound be given in the lower Region, or the Function of the three next, if it be inflicted a little above. And so much for Wounds of the Arm.
SECT. XXIII.
What functions are hurt by wounds of the Hand?
BUt if a Wound be received in the Hand in the back part, where indeed not Muscles, but the very Tendons creep along, as they pass to their Joints; it will not be difficult to foresee, what harm will thence arise to the Fingers. For that Finger will be hurt above all the other, next to which the Muscle or Tendon is offended. Yet I have often taken notice, that when these exterior Tendons have been cut, the Fingers nevertheless were extended; thô indeed they were a little weaker in exercising their Function: For there are certain other Muscles arising in the Palm, which exercising the same Function of extension with the foresaid, make the loss of the foresaid less prejudicial to the Fingers. When the Palm of the hand is wounded, you will often find the motion of the Fingers hurt thereby. But thus you may foresee all. Under that Tendon, which they call the broad one, and which lies next the Skin, there are four Muscles, which are apt to be wounded from the middle of the Palm to the setting on of the Fingers. And Columbus observes, that these extend four Fingers, besides the Thumb, thô they be internal: Which makes Chirurgeons often admire, how it comes to pass, that when the outer Tendons are cut, nevertheless the Fingers are extended, not knowing that there are these besides, which partake of the same Function. And they arise from the Tendons of that Muscle, which, as we said before, bends the third Joint of the four Fingers: And then running to the external part, and being implanted in the third Joint, they extend it. But if you wound a man about the little Finger, that Muscle will be prejudiced which arises from the fourth Bone of the Metacarpus, and draws it aside from the other Fingers. If you wound the fleshy part of the Palm, which is the Ball of the Thumb, you will hurt the Muscles (there are three of them) that bend the Thumb. For the Thumb (as Galen says) has this thing peculiar to and remarkable in it self; that nothing comes to it from any upper part; wherefore the wound must be received either in the Thumb, or very near it, which must hinder its function.
SECT. XXIV.
What harm is done by the wounds of the Thighs and Legs.
BUt, to come to wounds of the Thigh, if a Man be wounded any where in the Buttock, in that region which reaches over half the Os Ilium from the Os Sacrum and Coccyx; unless the cut be shallow, it will hinder the extension of the Thigh. For this Muscle has its rise from the foresaid parts, ends at length in the greater Trochanter, and makes the Buttock. Observe, nevertheless, that since this Function requires much strength, other Muscles are assistent to it; lest by the hurt of one Muscle all the Function of the part should be lost. There are other Muscles to perform the rest of the motions of the Thigh; which because they run along the inside of the Loins, a place not seen by the Eies, I shall pass them by. But Wounds of the Thigh do often hinder motions in the Leg. If therefore you wound the Thigh in the fore-part between the top and the knee-pan, you will much injure the extension of the Leg. For under that place there lies the seventh Muscle of them that move the Leg, and under that the eighth [...] Muscle, conspicuous above the Knee: yet because it has other Muscles to help it in this common action, the perfect loss of extension in the part need not be feared from the detriment of one Muscle. And if you wound that part which descends obliquely almost from the Groin, like a border, along the inside of the Thigh, and ends in the Shin, the Leg will find a great impediment, when it is drawn toward the Groin on the other side, or to the Thigh. And if the hind part of the Thigh receive a Wound, between the end of the Buttock and the ham, it hinders contraction, especially if the cut reach to the Tendons, which are so manifest in the sides of the ham, that when the Leg is contracted, they may be plainly, felt by the Fingers. And here a History of Galen's concerning a Runner must not be forgot; which because it is worth the remarque, and that there are several opinions about it, I shall not think much to relate. It is concerning the fourth Muscle that moves the Leg, which is not indeed in the inside, but on the outside opposed to three others, and its carnous broad end [Page 456]is fastned to the outside of the Leg; its Function is to twine the Leg obliquely. I saw, says he, this Muscle broke in a certain excellent Runner, and broke in the middle, as one was contending with him: There was a hollow place in the middle, which the ends of the parted Muscle left, one being drawn towards its head, and the other towards the Tibia. Yet this Runner, after the pain was ceased, and the Inflammation abated, was not at all injured in walking; nay, he durst run again. And when he found no inconvenience in it, he ran Races again, and won them: Which might very well be; for in running there is no occasion to twine the Leg about; but only to stretch and bend the Leg. But Realdus has observed some wounded in this Muscle, who, thô they were cured, yet it troubled them to bend their Leg: wherefore contrary to Galen, he ascribes the Office of bending to it. But now to the damages of the Feet. If you wound the Muscles, which after their rise, coming up about the Knee, do by their ellies on each side of the Leg make up the Calf, and at last make the strongest Tendon in all the Body, which comes to the Heel; then the Foot cannot well stretch it self. But the hurt of this one Muscle is not sufficient to destroy the whole Function: for four other auxiliary ones lend their assistence. But between the Calf and the Os tibiae, viz. the Shin, two Muscles are to be seen; one next the Calf, whose Office it is to extend four of the Toes; but the other, which has in that place a tendinous Nature, runs by the Os tibiae, its office is to extend the end of the Foot: If you wound either of them, without doubt you will hurt the Functions that are peculiar to them.
SECT. XXV.
What Wounds of such or such Nerves, and of such or such parts of the Spine, do hurt the motions of this or the other part?
NOw I think. I have mentioned almost all places, which being extrinsecally hurt, use to hinder the motion of certain parts: so that, I suppose, I shall have acquitted my self of this particular, when I have added this one thing further; namely, that Motion of the parts is hindred, not only when the Muscles, but the Nerves likewise are wounded, which being distributed through the Muscles, are the chief Authors of that motion. For this (as Galen says) must be understood as a maxim in all Muscles, that whether you hurt their Nerves, or cut all their Fibres across, you will immediately deprive these Muscles of all motion. Therefore it will be very necessary for you to know the principles of the Nerves, that are distributed into them, and the site of their Fibres. It is then a thing sufficiently known, that strength and faculty of moving is derived from the Brain, as the Fountain, by the Nerves as Rivulets. Which Nerves, because they are not sufficient of themselves for motion, Nature has contrived Muscles, as a kind of Levers, that we may the more readily raise weights. Therefore every Muscle has a Nerve inserted in it, from whence it has its motion. If then you cut, press, bruise this, or any way intercept the pass of the Spirits, all motion and sense shall be taken away. But as much as remains after the cut, continuous to the Brain, so much will still conserve the virtue of the principle: and whatever is below, can neither assord Sense nor Motion to it: That therefore you may not be ignorant of the hurt Functions of the Muscles, which proceed from their Nerves, I will briefly declare what Nerves are derived into such and such parts, and from what Originals. But I shall not mention all, for that would be too tedious. This I will say in general, it is observed, that Nerves seldom come along the outside of the Body into the Muscles; but affecting rather a certain safeguard and protection, they run along the inside. Yet those that come to the Hand are observed to run along the inside [Page 458]of the Arm: but they do not so in the Leg: for they all run along the back part of the Thigh. You shall not therefore find a Nerve, neither at the Elbow, because it has no flesh on it, nor at the Knee or Shin, but always deep among the Fortresses of the Bones, Cartilages, Ligaments, or Flesh. As therefore to the Original of the Nerves; they that come to the Arm and Hand, creep from the fifth, sixth, and seventh Vertebra [...] of the Neck along the Armpit; and also from the first and second of the Breast, which if you reckon from the beginning, you may call them the eighth and ninth. But these Nerves from the very beginning do strangely cross and intermix one with another. Now if you wound any of these Pairs of Nerves, as they come out of the Vertebrae, it will certainly much hinder the motion of the Arms and Hands, according to the bigness of the Wound: Yet you cannot well tell, what pair of Nerves being in their original, will hurt such and such Muscles: for as their contexture is manifold, so it is uncertain what Nerves of the Muscles depend on such or such a hole of the Vertebrae. Yet it is sufficient to know, that Wounds received in the foresaid Vertebrae do promiscuously hurt the Hands and Arms. Nerves proceed from the Vertebrae of the Loins and Os Sacrum in the same complication and confusion, to the Thigh, Leg, and Foot, as we said they went to the Hands, and Arms. Wherefore whatever pair of Nerves proceeding from the foresaid Vertebrae, you hurt; you will likewise incommode some of the Muscles underneath. Furthermore (for this will not be useless to know) you may easily, according to Vesalius, find out in a living Man, the Nerves which come to the extreme parts of the Hand: For if you press hard with your Finger between the posterior process of the Ʋlna, and the brawn of the Arm; then you will find that there lies the fourth Nerve, which moves the Thumb, the fore, and middle Finger, by a kind of numbness in the same Fingers: And if you press the end of the brawn on the inside, you will for the same reason sind, that the fifth Nerve lies there, which moves the little, and middle Finger by branches divided to the Hand. If in like manner you press the forepart of the brawn of the Arm on the inside, you will find the third Nerve, which comes to the inside of the Thumb, the fore and middle Finger, if you consider, as we said before, the numbness in those Fingers. If therefore those Nerves receive a wound about the Elbow, you may easily foresee what Fingers will be hurt thereby.
Now there remains something to be said of the cutting asunder of the Spinal Marrow, which Galen 8. de administrat. Anatom, has recorded very opportunely for our purpose. If (says he) you cut the Spinal Marrow quite through in the region of the third or fourth Vertebrae, the Animal will presently be deprived of breathing, not the Breast only, but the whole Body below the Section, becoming immoveable. And it is plain, if you cut below the second or first [Page 459] Vertebrae, or in the very beginning of the Spinal Marrow, the Animal will suddenly fall down dead. But if you cut the Spinal Marrow quite through (for you must always understand this) all the Muscles of the Breast immediately loose motion: and the Animal then breaths only by the benefit of the Diaphragm. They allow that in cuts of the Spinal Marrow, lower than this Vertebra, many parts of the Breast may be moved: For the greatest conjugation of the Nerves of the upper Muscles of the Breast, has a twofold original of both Nerves. Therefore cuts about the seventh Vertebra hinder not the function of these Muscles: much less cuts under the eighth or ninth. And the lower you go, the more Muscles of the Breast will do their Office. Galen likewise says, if the Spinal Marrow be cut lengthways in a right line from above downwards, none of the intercostal, lumbar, nor crural Nerves will lose their use: but if it be cut cross only half way, all the Nerves derived thence perish. But what need a Man trouble himself with the hurt of the parts from wounds of the Spine, since they generally prove mortal? Because a Wound here is as dangerous as in the Brain. For the Spinal Marrow is a kind of Brain to the parts below the Head: and both Hippocrates and Celsus do account wounds therein mortal.
SECT. XXVI.
Of Maiming.
SInce we have an Act of Parliament, Ann. 22. & 23. Car. II. to prevent malicious maiming and wounding, wherein also disfiguring is comprehended, it will not be amiss to explain, what Maiming and Disfiguring are: for we have already shewn sufficiently what Wounding means, of which, the two other are effects. And First concerning Mai [...]ing.
Maimed, Mutilatum, curtum, decurtatum, descissum and truncaturn among the Latins; and [...] with the Greeks, signify the same thing; but what the thing it self is, does not sufficiently appear. Aristotle (to begin with the best of Philosophers first) in his discourse upon this subject says, that Maiming, or Mutilation comes not from the loss of every part (for if you take away Flesh or the Spleen, a creature is not thereby maimed) but of some extreme part; and that not every one, but such an one as being quite taken away cannot be generated [Page 460]again. So that you see Aristotle places the nature of Mutilation in the deficiency of the extreme parts, if they cannot be repaired again. But Galen says, that is maimed, of whose Body any part is cut off: And he says, that Mutilations are of the Lips, Ears, Nose, and of any fleshy parts, either violently taken away, or putrefied and cut off. He says, there is a Mutilation of the Tongue, when half of it is taken away, and of the Omentum and Privities, of the Nose and Ears. Wherefore if you will follow Galen, you must say, that is maimed, that hath any part of the Body cut off; but especially these three parts about the Face. Cornelius Celsus says, they are maimed, who have the Ears, Lips, or Nose cut off. So the Latins call a Ram or a Goat, without Horns, Mutili, i. e. maimed. In the same sense some have said, that Faemina veluti mutilus mas à natura est producta. These things I have gathered, out of several Authors; Now I will proceed to deliver my own Sentiments.
SECT. XXVII.
Three sorts of Maiming.
HAving well weighed and considered this subject, there seems to me to be three sorts of Maiming. The First truly so called and exquisite: The Second is true indeed, but not exquisite: The Third may be called improper. The true and exquisite has these three qualities- 1. Some extreme part of the Face must be cut off. 2. Disfiguring must arise from thence. 3. The action of the cut part must be hurt. As when the cartilaginous part of the Nose is cut off, the Lips or Ears, and (as some will have it) the Eye-brow. For in these, unless the loss of substance be very small, there is the first sort of maiming. For an extreme part is cut off; great disfiguring is caused it being in the Face; and the actions are a little hurt. If any one demand, why I call this especially exquisite Maiming, my reason is at hand: because in Maiming the savour must chiefly be hurt, as several Authors hold; without doubt a Maim in the Face must be the principal: for it disfigures the best favoured part. Of this Galen de Morb. differ. & in Meth. Cornelius Celsus, and Paulus Aegineta do treat. And this I observe, that when Authors treat closely and nicely of Maiming, they make it to consist in [Page 461]these three particulars. But thô three things are required to Maiming; yet Disfiguring is the main thing requisite; and in the next place the hurt of action. If therefore a piece of the Ear or Nose be cut off, so that the least prejudice be done thereby to the Hearing, or Smell: yet because a manifest disfiguring does result from thence, it is an exquisite Maiming. And that is a true, thô not an exquisite Maiming, which is not indeed in the Face, but in the extremities of other parts of the Body; as in the Hand, Foot, Tongue, Secrets, and Breasts. It is called not exquisite, because it reaches not any part of the Face, where because of the Favour exquisite Maiming consists: But there is this in it; it may some way or other offend the Actions, in respect whereof the Maiming may be slight or grievous. The Third is called Improper, because it cuts off none of the extreme parts, which is requisite to true Maiming: Nor does it disfigure: nay, sometimes it hurts no action; It is sufficient that any part is cut off. So Galen said, that the Omentum was Mutilum. Wherefore I cannot chuse but wonder at some famous Physicians, who in Maimed Persons require only a cessation and privation of use, without any loss of part. But how dissonant this is to the opinions of Philosophers and Physicians, (who must be judges in this case) may easily be understood by what I have already said. And they that consider the Force, either of the Latin or Greek words, will say as much. Since therefore thingstand thus, you must know, that not every loss of substance makes a Man maimed: For if any one from his Nativity want a Hand, Ear, or any other part, we may say he is lame, but not maimed. And if no part be wanting, but a Limb be made useless for action, it is weak or disabled.
SECT. XXVIII.
The opinion of Physicians concerning the signification of a Member.
THE Court does often consult us likewise about the appellation of a Member, in the case of Maiming, disabling, or any way hurting a part. Therefore lest we should report what the Lawyers will not admit in the case, it is best to treat of this distinctly. A Member, if you consult Physicians, is often used for any part of the Body without exception. For Flesh it self, a Nerve, a Vein, and any of those we call Similar parts, are styled by them Members. But what a strange thing would it be, should a Judge ask us about the name of a Member, if we should tell him a Man were maimed, who had only a piece of flesh cut out? For Lawyers, when they enquire about Members, mean only the compound parts of the Body. In this they seem to follow Aristotle, who l. 1. de Histor. Animal. calls only the compound parts, and such as have under them another subdivision of parts, and Offices of their own, Members: as the Head, Foot, and Hand. And what Aristotle calls a Member, Galen calls a Part: for 1. de usu partium he says, whatever Bodies have on every side a circumscription of their own, nor are on every side joyned to others, these are called Parts. And about these Members or Parts, which might more properly be called Instruments, you will not find all Physicians of the same opinion. For sometimes you will find that part called an Organ, or Instrument, which consists of similar parts; upon this account Galen called a Muscle, Vein, and a Finger Instruments. Besides, that part is by him called an Instrument, which is the principal cause of any action. So Galen called the Crystalline Humor the chief Instrument of Seeing. But of these Instruments in the appellation of a Member, you will find no account among Lawyers. Therefore, not to detain you with many words, you may, as far as relates to our present purpose, truly call that a part of a Creature (I mean the external) which is able to perform a perfect action. For so Galen l. 1. c. 6. Meth. describes it. And thus an Eye may properly be called a Member of an Animal, because it alone does entirely perform the action of Seeing: So the Tongue, because it is the instrument of Speech: And the Legs, because they perform Walking: And the Hands, because their proper office is to take hold of things.
SECT. XXIX.
A more exact account of the true signification of a Member.
BUT that the nature of a Member may be understood more exactly, and according to the Lawyers Sense; you must knows, that Action (which Galen calls Operation) is nothing else but the motion which the part exercises, while it is doing, and about its work. So when the Hand is moved to take hold of a thing, that motion is its action: And the end of the action, in which the motion of the Hand rests, is called Use: Wherefore Use is the end of the actions of the Body. Therefore whatever part it is in Animals, that is able to perform this perfect action of it self, and not by another, it may truly be called a Member. The Eye, Tongue, Hand, Foot are chiefly such. But you must take special notice of this, that there are many parts, which seem to be authors of performing actions, and nevertheless are not Members. Many parts, saies Galen l. 1. de usu part. are required to the performance of actions: For some are called great; as the Hands, Feet, Eyes and Tongue, which are made for the sake of the whole Animal: And others are less, which are subservient to the foresaid parts: For whereas the Eye is it self a principal Member, it has some parts by which it sees; others without which it cannot see; some for better Sight's sake; others for its conservation. Now all these Particles which serve the principal Member, are not truly Members, but only parts of a Member. And if you consider these things well with your self, it will not be difficult to find, what part in our body is truly a Member in the Lawyers sense, and what is not. For thô Galen said very truly, that the Tongue was a Member; because the instrument of Speech: yet he never called the Lips or Teeth so: because these only serve the Tongue to act the better, but are not able of themselves entirely to perform an action. For the Lips, says Aristotle 2. de part. Anim [...]. 16, are made chiefly for the desence of the Teeth; and they a little also help the Speech. But the Teeth do chiefly help the concoction of the Stomach, while they mince and grind the Meat. Also the Legs, since of themselves [Page 464]they exercise going, are truly called Members: But the Feet and Toes, because they only help the action, are Particles subservient to the Legs. Wherefore when a Finger is cut off, I cannot say that a Member is cut off: for the function of the Hand is not thereby taken away, its action is only diminished: For the same reason I cannot call either the Ears or the Nose Members: For the Ears are not the instruments of Hearing; but only the end of the passage, where it is joyned to the dilated Nerve: for all things beside, that are without it in the winding passage, only help the instrument of Hearing: Nor is the Nose the instrument of Smelling, nor therefore a Member: Because the sense of Smelling is contained in the anterior Ventricles of the Brain. For the cartilaginous part of the Nose, and the Bone it self, or the inner skin of the Mouth, only do this for the Ammal, that Smells may the better be perceived. Therefore if the Teeth, Lips, Ears or Nose be cut off, you cannot say a Member is cut off: for thô these parts were taken away, yet the Animal will be deprived of no action thereby. It is plain that Womens Breasts, because they are the instruments of making Milk are Members; so are Mens Stones, because they make Seed: And the Yard, because of the necessity of it to Generation.
SECT. XXX.
Of Disfiguring.
HAving sufficiently discomsed of Maiming, now I shall procee to Disfiguring. By which is meant the spoiling of ones Comliness, Beauty or Favour: so that Disfiguring is a kind of Ugliness, or hard-savou [...]edness canted by wounding. Now since Beauty is the opposite to Ugliness or Disfiguring, I shall make a little digression in shewing wherein Beauty or Comliness, or well-favouredness consists.
SECT. XXXI.
The general notion and explication of Beauty.
PLato tells us, that Beauty is a Gleaming or Ray of the Supreme Good, immitted first into Heavenly things; and then into Ment Minds, the Figures of their Bodies and Voices, which moves and delights our Minds by Reason, Seeing and Hearing. Here you see, Beauty is nothing else but the splendor of the Divine Essence, conspicuous indeed in all things; but shining more illustriously in the more noble, and in such as God has placed nearer himself; in other things it is less illustrious. This is that Beauty, which every where we desire in the things we love. And therefore Lovers are ever ignorant of what it is they love: because it is GOD. Now this splendor, which is altogether incorporeal, our Soul does not indeed perceive by Touch, Taste, or Smell, because these faculties are very much immerst in Matter; but rather by Reason, Sight and Hearing, which are more spiritual. And whereas this Beauty is discerned in three things, in the Mind, in the Body, and in the Voice; that of the Body (which we have a design only to treat of) is also a Gleam, or Ray of the Divine Essence: but conspicuous only in a matter apt and prepared. This preparation consists in three things, Order, Measure, and Features. By Order is signified the distances of the parts. By Measure, their quantity. By Features, the lineaments and colour. The foundation of these preparations, is a temperate Complexion of the four Elements. This then is the Beauty of the Body, which we perceive by the Sight: for that of the Mind we must perceive by the Mind, and that of the Voice by the Ear. And this is the Divine Philosophers Opinion concerning Beauty. But Aristotle does not derive its nature from so high an Original; only those things which Plato calls Preparations, them he calls Beauty. For 13 Metaphys. cap. 3. he says, the species of Beauty are Ordo, commensuratio & definitum, where he takes Ordo for the right disposition of the parts, whereby each is put in its right place: Commensuratio, for the mutual proportion and just intervalls of them: Desinitum, for the bound or limit of each part. So that with Aristotle that is a beautiful Body, which has its parts aright placed, at a due distance one from another, and of a just Magnitude. Thô the Philosopher [Page 466]has said these things learnedly enough; yet the agreeableness of colour, that Plato mentions, and which contributes much to Beauty, he mentions not at all. Wherefore I shall cite Galen, who has copiously and learnedly discoursed of Beauty. Beauty, says he, according to the opinion of all Physicians and Philosophers, consists in an apt connexion of the parts, viz. of a Finger to a Finger, of all the Fingers to the Palm, and Wrist; of them to the Elbow; of the Elbow to the Shoulder; and of all to all. And thô in this place he have expressed the proportion of pa [...]ts elegantly enough; yet of the determinate magnitude of the Body, and of the Features, he hath made no mention. Nevertheless, what is omitted here, he has supplied in another place. For l. d. def. Med. he says, that Beauty consists in a Symmetry and proportion of parts, with a probity of colour. And, c. 10. ad Thrasyb. he says, true Beauty consists in a fresh colour, moderate store of flesh, and in a congruous proportion of parts. Thus far Galen, who when he had discoursed as to the rest concerning Beauty very well; yet he makes no mention of the limits, and just magnitude of the Body; because perhaps it was not his design there, to give an exact notion of Beauty. If therefore you put Aristotle and Galen together, Beauty will be an order or, proportion of parts, with goodness of colour, and a decent magnitude. Nor were it much matter if you said, that Beauty is neither the order nor proportion of parts, but an affection of the whole, and a quality arising thence: for great Authors take an honest liberty in speaking, and make no difference between the order of parts, and an affection arising thence. But if you should still urge, that the thing ought to be explained in more proper terms, you may thus define it out of Plotinus, Beauty is an external perfection of the dissimilar parts of Bedies, arising [...]om their agreeable order, measure and bounds, accommodate to the Beholders Eyes. And these things briefly collected out of the best Philosophers may suffice for the general definition of Beauty, which might deserve a larger Treatise.
SECT. XXXII.
The definition of Beauty more particularly explained.
NOw I have a mind, for your sakes who desire to judge more exactly of things, more particularly to discuss, what order and proportion is required to render a person beautiful; lest while we are only in the contemplation of Universals, the more evident knowledge of the thing, which is more apparent in particulars, should be left to us unknown. Order therefore, or (if you had rather so call it) Commensurateness, is elegantly described by Vitruvius in this manner. ‘Nature, (says he) has so made the Body of Man, that the Scull to the top of the Forehead, and the lowest roots of the Hair is a tenth part, and the Hand from the Wrist to the end of the middle finger as much: from the Chin to the crown of the Head an Eighth part: as much to the bottom of the Neck: from the top of the Breast to the roots of the Hair, a sixth: to the top of the Crown a fourth. A third part of the heighth of the Face is from the bottom of the Chin to the lowest part of the Nose: the Nose to the middle of the Eyebrows as much: from thence to the roots of the Hair as much, which makes the Forehead. The Foot is the sixth of the heighth of the Body: the Cubit a fourth: the Breast also a fourth.’ The rest of the Members have their commensurate proportions, which ancient Limners, and noble Statuaries used. Besides, three Nose lengths make the length of the Face: the semicircles of both Ears joyned together, make up the circle of the Mouth open: the conjunction of the Eyebrows also does the same: the length of the Nose is the length of the Mouth, and of the Ear likewise. The two orbs of the Eyes are equal to one opening of the Mouth. Eight lengths of the Head make the talness of the Body: And the extension of the Arms sideways, shews the same; and so do the Feet extended. By following of which proportion Pythagoras found out the Stature of Hercules exactly; as you may see in Gellius. The goodness of colour in temperate Men, as Galen, Art. Med. c. 51. says, arises from a decent mixture of White and Red. For, because Blood is of all Humors most abundant in us, which is Red; and because Phlegm is next in quantity to it, which is White; it was meet that the colour [Page 468]of the whole Body should be made up of them two: for it is according to nature. And such a colour is required in the whole Body. Indeed in some certain parts there is a peculiar beauty of colour. For Aristotle commends Eyes coloured like Goats Eyes: because such Eyes are a sign of a good disposition, and are the best to see with. Galen also commends yellow Hair above all. But one cannot well determine the just length of Mans Body: for as to several Nations several Statures are more familiar, so they may seem more beautiful. So Hippocrates l. de aere, loc. &c. says, the Asiaticks are of a large Body: the Aegyptians and Scythians are well set. The Europeans are of a different stature. Moreover, Men are generally taller than Women. And as for ages, in young Men, as Hippocrates 2. Apli. 54. writes, tallness is comely and gentile: but in aged people useless, and worse than shortness of Stature. Wherefore the peculiar nature of the place, Sex and Age must be considered, before you can well judge of the just stature. But if you desire to find some certain stature of Man, which may be most exact, and as it were a rule, or standard for the rest (for all things that are, have their peculiar nature, and determinate magnitude) I shall in some measure gratify you, in acquainting you, that the measure of four Cubits is most convenient for a Man's length: under which a Man must be called short; and above which, over tall. Therefore the Spaniards, because they are shorter, and the Germans, because they are taller, cannot well be called handsome: But the Italians and Greeks, because they are of a stature between both, are upon that score accounted handsome.
SECT. XXXIII.
The nature of Beauty yet further explained.
AS for these things, wherein we have before said, that Beauty did consist, I think it is no great matter, whether you call them Species or Parts. For if you exactly consider Beauty, Order, Feature, and a just Magnitude will be its constituent Parts; none of which can be wanting in making up an exact Beauty. For let one be endued with order of parts, and a good colour; yet if he have but a little Body, he cannot be called beautiful. According to Aristotle 4. Mar. c. 3. who says, that little People may be called pretty, but not beautiful. And Galen, l. 1. ad Thra [...]b. plainly affirms, that these are the integral parts of Beauty. But if your judgment be not so exact and severe, and you think it sufficient, that what we call falt, have most or only some Ornaments, but not all; I shall readily grant you, that a good Colour, an exact proportion of Parts, and the rest have each of them severally their peculiar Beauty. And thus Men of a little Body may nevertheless be called Beautiful or Handsome. This also is worth the marking, that besides this Universal Idea of Beauty, different Ages, and different Sexes have their particular Beauties. For the same Favor is not requisite in Women, that is in Men. As ingenuity of Countenance, and assurance become Men; so a kind of Softness and Modesty becomes Women. Besides, a Beard is an Ornament to a Man, but not to a Woman. And as for Ages, Aristorse says it is the Beauty of a young Man, if his Body be so made, that it is able to endure labour, or to run, or to act violently: thô he must have a sweetness of Countenance, which may please the he [...]olders. That of a Man grown is, to have a Body fit for Military Employments, and a sweetness of Countenance mixt with something of Terror. That of an old Man is, to have a Body sufficient for necessary Employments, to shew no sadness, and to want those Diseases, that usually deprave old Age.
SECT. XXXIV.
Of a Cicatrix or Scar.
BEcause Disfiguring, or the spoiling of one's Beauty, is occasioned by a Cicatrix or Scar, it will be worth while, for avoiding obscurity, to declare what a Scar is. A Cicatrix or Scar, in the common acceptation is Flesh condensed and dry, and hard like a Callus, coming instead of Skin, which is not true Skin, but very like it: for the Skin, because it is a spermatical part, cannot be generated anew; and therefore something like it grows in its room. But this account of a Scar makes little to our purpose: therefore we must give another account o [...] it. A Scar therefore is a certain Sign or Mark left in the Face by a Wound, more or less spoiling the grace of it. It is either deform or apparent. I call that deform, which manifestly offends the natural comeliness of the Face; and that apparent, which does it but obscurely. The deform or ugly Scar requires two things. First, it must spread over a good part of the Face. Secondly, it must leave some unevenness in it, either bunching or hollow. If the Scar be broad in the Face, I think no Man will deny, that it is ugly, because so conspicuous; unless it is only in the Scarf-Skin: for in time that will grow out, and therefore cannot be termed ugly. And it is a manifest deformity, when some parts of the Scar stand out, and others fall in, and no equality is observed. The Scar apparent is so called, not that the deformed Scar is not apparent (for on that very account it is deformed) but because it does but just appear, without much prejudice to ones Beauty. It is the property of this Scar, that unless it be narrowly looked upon, it cannot be discerned: Whereas the deformed may be seen, if a man cast but his Eye upon it.
SECT. XXXV.
In what Parts, and for what Reasons, a Scar is more or less deformed?
VVHereas there are two notable differences of Scars; nevertheless the condition of each is not always the same: For the deformed is sometimes more, sometimes less deformed: and so the apparent is sometimes more, sometimes less apparent. Now the reason of this difference is grounded (to omit nothing material in the point) upon the parts of the Face, and the greatness of the Scar. A Scar therefore in the Nose is in my mind the most deformed: next to that, in the Cheeks: then in the Lips: next them, in the Eyes: then in the Forehead: and lastly in the Ears. Because such Scars dissigure the Face extremely. I put the Nose in the first place; not because it performs very noble Actions; but because it is principally exposed to view, as being in the middle of the Face, and prominent also. I know, some do maintain, that a Scar in the Eyes is most deformed: Indeed if the Use of them be considered, I shall not contradict them. But now, not the Use but the Beauty of a part is under consideration: for sometimes an Eye that has the Optick Nerve obstructed and sees nothing, may appear Beautiful to look on: so that Beauty depends not on use or action. As to the gracefulness of the Nose, Melet [...]s the Philosopher says well, [...]do natura hominis, where treating of the Nose, he says, ‘This part above all others renders the Face either handsome, or ugly. Indeed the necessity of the Nose on ones Face for action and use is small; only beauty and gracefulness is most apparent in it: On the contrary the Eyes are of less ornament, but of more use.’ And Virgil, who is extremely happy in expressing things by apt names, describing the Wounds of Deiphobus, calls only that of the Nose inhonestum or disgraceful, after he had excell [...]ntly well described the rest, 6. Aen.
And (which more confirms me in my opinion) we find it recorded in the Laws of the Lombards, that they who were caught in one Thest, should have one Eye put out: and they, who were found guilty of two Thests, should have their Nose cut off. So that from hence it is apparent, it is a greater punishment, and more a mark of disgrace, to be without a Nose than without an Eye. It is also said, that a certain King of the Aethiopians (according to Alexand. ab Alexand. l. 3. c. 5.) punished some delinquents not with death, but by cutting off their Noses; so that others beholding the ugliness of their Faces, might be deterred, from their crimes. Thus it appears, some people account it more grievous to lose their Nose than their Life. As for a blemish in the Eye, it does not near so much disfigure a Man. The Ears are put in the last place, because they are set behind the Face, and not easily discerned. As to the Magnitude of Scars, whether they be deformed or apparent, there are three degrees, vir. [...]arge, Small and Middling. A great one possesses a great part of the Face, is very hollow, or stands much up. A little one, takes up but a little part, and is almost smooth. A middling one is between the two former extremes. And so you may judge of Scars.
SECT. XXXVI.
Some Cautions in judging of Scars.
HAving discoursed sufficiently concerning the nature and difference of Scars, I must now caution you in giving your judgment about them, that you do not easily nor rashly judge of a fresh Scar. At first it always appears bigger and more deformed. Wherefore it would be better to tarry a while, till the reliques of the Fluxion, and the proper Excrements of the Part, which swell and discolour the Scar, are disperst, and the part returns to its natural state: for then the mark of the Wound will not lie; and so you may then make a true Report. But if time will not be allowed you, and you must give your opinion presently; You may say, that time will take off much of the deformity; especially when the Party is young, and of a good complexion. This also you must take notice of (as Celsus, l. 7. c. 4, has observed) thô a Cicatrix or Sear may be brought upon most places; yet it proves otherwise in the Forehead [Page 473]just above the Eye-brows, if the Bone be much hurt: for then an Exulceration will go near to last as long as one lives, which must always be kept covered with Lint and Plaster. Paraeus gives the Reason, viz. Because there is a cavity under the Bone, which teaches to the Os Cribrosum of the Nose, full of Air, which hinders the coming of it with Flesh: Or because the Bone is there so thick, that enough of alible Juice cannot have passage out thence for the regenerating of Flesh. Besides, there is a great conflux of Excrements into the Ulcer, which used to run out at the Eyes and Nose. This also you must not forget, that sometimes a foul Scar is left after a small cut. The blame whereof lies sometimes on the Chirurgeon, who either closed not the Lips of the Wounds as he ought; or applied improper Medicaments: Sometimes on the Patient's intemperance, and other external errors: And sometimes on the foulness of the Patient's body. And if sometimes we lay a mans death, though he were wounded, to the bad Humors in his Body, or to a bad Diet, or to some external error, why may we not do the same in Scars, when a small Wound leaves a foul Scar? One may say then, that he does acknowledge indeed, the Scar is deformed; but it is not so from the nature of the Wound, it being but small; but either from the disorderliness of the Patient, or from some other external error. Moreover, if the Scar be such as that it can be covered either by the Beard or the Hair; you may call it indeed deformed; but by accident it may be so far from being deformed, that it is not apparent. Since there is no deformity but what is seen. And so a Man may sufficiently be informed in his judgment concerning Disfiguring.
THE PRACTICE OF CHIRURGERY. BOOK IV.
CHAP. I.
Of the Definition, Differences, Causes, and Signs of Fractures.
HAving, as we promised in the beginning, finished that share of the Synthetick part of Chirurgery, which falls to the soft parts of the Body (comprehended in the Doctrine of Tumors, Ulcers and Wounds) it remains, that we proceed to the remaining portion of the Synthetick part, belonging to the harder parts of the Body, the Bones, which either suffer in their continuity, as in a fracture; or in their Contiguity, as in a Luxation. A Fracture in Greek is called [...]; and by Paulus Aegineta c. 89. l. 6. is defined to be a solution of continuity in a Bone, proceeding from some violent extrinsecal cause.
The differences of Fractures, according to Galen, c. ult. l. 6. Meth. are taken from the figure, magnitude, or diversity of Bones. From the Figure, a Fracture is streight, which is made lengthways; transverse, breadth-ways; Or oblique, which is compounded of both the former. From the [Page 476]Magnitude, according as the Fracture is great or small. From the Bones themselves, according as a Thigh, Arm or Rib is broke. Hippocrates says, a Fracture is made three ways. [...], or transverse; as when a stick is broken short off. [...], when it is split like a Plank. [...], when it is broken to powder, as Meal, or into many little pieces.
The External Causes are usually Contusion or Flexure; and whatever things may cut, bruise, break, shatter, or bend a Bone. Falls may be reckon'd among such causes. It is very rare, that an eroding instrument; as Fire; or a pungent one, does break a Bone.
A Fracture without a Wound i [...] known, First by feeling the pieces of Bones in handling the part. Secondly, if the broken Limb be handled, it makes a crackling and a noise in the broken part, by the rubbing of two hard bodies one against another. Thirdly, there i [...] a violent pain, by reason of the d [...]ulsion or straming of the Nerves, or the pricking of a nervous body by some part of the Bone that sticks out. The Fourth sign is an Impotency of using the fractured part, or of leaning upon it. The last sign is, if causes of Fractures have preceeded, and the fore-mentioned signs are present. These are perpetual concomitants of Fractures. And sometimes there is a crookedness, and a shortness in the part; but it is not always so.
If a Wound accompany the Fracture, besides the foresaid signs, the breach or roughness of the Bone may be felt. And so much for a transverse Fracture.
If the Bone be split lengthways, the part is thicker than in its natural state; and then there is pain, and an unevenness in it.
As to the Prognostick, No Fracture in the Bones is void of danger; because of necessity, the solution of the continuity must be great. In a fleshy part indeed, if a Wound be received, only so much is wounded, as the wounding instrument cuts, and no more; but if a Bone be broke, it must, by reason of its rigidity and continuity, be broke quite through. A Fracture also is dangerous; because it lies deep, where the Chirurgeon cannot come at it with his hands. But some Fractures are more dangerous than others: In a great Bone they are more difficult to cure, than in a small: Matilfold, than Simple: With a wound, than without one: And near the Joints, than far from them.
CHAP. II.
How an Inflammation in Fractures may be prevented.
THE Cure of Fractures requires Union. And Union can never be made, unless Bleeding and Inflammation be prevented, according to Celsus, c. 26. l. 2. In the Bones indeed Bleeding need not so much be feared, as in the fleshy parts, unless the Fracture be with a Wound: for no considerable Veins or Arteries go to the Bones: because they are hard Bodies, their heat is little, and little of their substance can be wasted. Yet here we are mightily afraid of an Inflammation, even more than in a fleshy part. The reason is, Pain causes attraction, then because of their weakness many Excrements are both received and bred there, which cannot be discharged by the fractured part. And that which increases the danger, is, the Bones often lye deep buried in much flesh. Now an Inflammation is prevented here, by removing its causes, as in a simple Wound, which we have already treated of sufficiently, and therefore we will not action agere.
CHAP. III.
Of curing a transverse Fracture, without a Wound; and First, of joyning together the parts of the broken Bone.
COme we now to these things that only respect the cure of the Fracture it self. This sort of cure is in Greek called [...], in English Bone-setting. First of all we shall treat of a transverse Fracture without a Wound. In this Fracture the Indication is the union of the Bone, which cannot be done by the first Intention, except in Children; but by the Second it may, i. e. by the intervention of a Callus, growing over, and surrounding the fractured parts. The intentions of Cure here are, First, to put together the parts of the fractured Bone aright. Secondly, to keep the parts so put together. Thirdly, to take care of the cure of the parts. Fourthly, to endeavour to breed a Callus. Fifthly, to correct ill Accidents.
That the parts may be rightly joyned together, there is need of extension and coaptation. For in Fractures, especially the transverse, because the Bones are distorted, and the streightness of the part is lost, it so happens, that some parts stick out, and others are hollow. And because one part of the fractured Bone lies upon the other, the Limb of necessity must be shorter: for the Muscles ever draw the Limb towards their Original. Wherefore Extension is necessary, whereby the Chirurgeon may set the ends of the Bones directly one against another, which lye not direct, and may put the risings up into their Cavities. And tho sometimes the Limb seem not to be too short, (as when there are two Bones, and but one broken, or when one end of the Bone rides not upon the other) nevertheless, if the Coaptation be made as it ought, Extension must of necessity be made in all transverse Fractures; for the shivers of the fractured Bone would be in danger of breaking off, should we without Extension direct and turn round the distorted Bone, or rub the ends one against the other. And if the shivers break off, then they either fall between the ends of the Bone that should be joyned, and so hinder Coaptation; or they slip [Page 479]besides the Bones, and then they cause pain by distending and pricking the Nervous Parts. And all these inconveniences are prevented in Extension.
However Measure must be observed in Extension: for if it be more violent than is requisite, it causes great Pain, whence Fevers, Convulsions and Palsies often ensue. Galen com. 1. l. 1. de fract. writes, that sometimes the Muscles have been pulled asunder. If the Extension be less than it should, the Shivers will rub one against another, and so break, or they will not be lodged in their proper Cavities. Therefore big Bones and great Muscles, which draw a part strongly toward their Original, require violent Extension: Such Bones are first the Thigh, next the Shoulder and Leg, then the Arm, then in the top of the Hand and Foot; especially if both the Bones be broke. The Radius in the Arm, that is, the upper Bone, requires but small Extension; because this Bone has not Muscles to draw upwards: for it moves any downwards and supinely. You must also observe a due figuration, i. e. that the Limbs be extended in that Figure, which causes the least Pain: And this is done, if the Fibres of the Muscles be stretched directly, and the Muscle be kept whole in some part of the Limb. Children, and such as are of a soft habit of Body, endure more violent Extension: Grown People and hard, on the contrary. Then we must consider the time of Fracture: for if the Chirurgeon come the first day, he may the more powerfully extend. But if he come after the first day, he must either not extend at all, or more gently; because of the influx of Humors, or for fear of Inflammation, according to Celsus, c. 10. l. 8.
The Instruments of Extension are threefold. First, the Chirurgeon's Hands, for a weak or small Extension. Secondly, Cords and Strings for a moderate Extension. Thirdly, Instruments and Engines for a strong one.
When therefore you have let go your extending Instruments, a good coaptation of the parts of the Bone must be made, which we may know by three Signs. First, if the fractured Limb be uniform in Figure with the sound. Secondly, if no hollowness, roughness, standing up, or inequality be observed in the broken Bone. Thirdly, if Pain abate.
CHAP. IV.
How the Parts of the broken Bone may be kept united.
THe second intention of Cure is, to keep the parts united. This is done by Bandage, which must be so made, as to keep the parts set together, and to keep them from Inflammation.
Hippocrates uses three Rollers of Linen, not too course, lest it press the part; nor too fine, lest it tear.
He rolls the first Roller thrice about the Fracture, a good way on the part, so as to make three or four or more turns. By this means the Fracture is fortified, while the Roller is turned thrice round it: Also the Humors are liept off from coming into it, especially from the upper parts: therefore the Roller is carried upwards.
The second Roller, which is twice as long as the first, he rolls the contrary way: for if the first were rolled to the right hand, this is rolled to the left, that if any Muscle were drawn too much to one side by the first Roller, it may be restored to the contrary by the other, which must be rolled once about the Fracture; then to press Humors out, it must be carried downwards a good way of the Limb, i. e. by making three, four or more rollings, if there be need; then it must return upwards again by the Fracture, making a Circumvolution upon the very Fracture, till he comes to the end of the first Roller, where the second also must terminate. This Roller, as I said, is first rolled about the Fracture, that it may press the Humors from it; then it is carried downwards, to stop the Humors, which might flow from the lower parts, as to a weaker: And because there is fear of a descent of Humors from the upper part; therefore Hippocrates does not end the Holler downwards, but rolls it upwards, that it may end where the first ended. These two Hollers do more prevent Inflammation, than strengthen the Fracture: for more Circumvolutions are required to this.
Having done thus, Hippocrates puts over the Bandage Compresses of linen Cloth three or more times double, of the form of a Roller, but narrow, that five or six or more of them may be applied lengthways round the Fracture, of [Page 481]the same length with it, as many of them, as are requisite about a Fingers breadth one from another. They are to be spread with a little Cerote (for if there were a great deal, they would slip, and not hold.) They are called Plagulae and Splenia, from their oblong form. They supply the place of a glutinative Medicine, and besides, they asswage pain, while they hinder the compression of the Rollers.
The third Roller fastens the said Compresses. The first turn of this Roller is made upon the fracture, then one head of the Roller is carried upwards, and the other downwards. This is to be observed, That the Rollers must be drawn straiter upon the fractured part, than any where else; that it may the better be kept from defluxions.
Celsus c. 10. l. 8: has another way of Bandage. For first, he applies about the Fracture linnen Cloth dipt in Oyl and Wine. Then he takes six Rollers, whereof the first is shortest, this is rolled thrice about the Fracture, and thrice also above the upper part of the Limb. The other Roller twice as long is rolled from the Fracture downwards; and then turning upwards, it must end in the upper part above the first Rollers. These are the two first Rollers of Hippocrates. Over these a broad linen Cloth spread with Cerote must be brought to fasten them. And where the Bone sticks out (for the broken Limb has always a propensity that way, which it had a propensity to in breaking) evermore a linnen Cloth three or more times double; dipt in the same Oyl and Wine must be applied over against the part whither the Fracture inclines. Sometimes I use Cloth, sometimes Tow, which I dip in rough black Wine, when I have a mind to strengthen the part, and prevent Inflammation; or in the white of an Egg, if the Fracture is without pain, and I have a mind only to keep it fast. Celsus dipt in Wine and Oyl of Roses, when Pain was grievous. Over this he brings the four remaining Rollers. So that the following must always roll contrary to the former, and the third must end below all the rest above.
Celsus his Bandage differs therefore from that of Hippocrates: For Hippocrates uses three Rollers; Celsus six: Hippocrates uses Compresses; Celsus broad linnen Clothes: Hippocrates uses Cerote; Celsus Oyl and Wine. If any considerable pain afflict the part, Celsus his Bandage is best: but if there be little or no Pain, Hippocrates his Bandage is better, which is most approved of by Galen, cap. 5. l. 6. Meth. The Moderns presently take a Roller, and roll the Fracture to both ends, not at all regarding what either Hippocrates or Celsus says. But it is our best way, to follow the best of Physicians.
The Patient's good tolerance must be the measure in binding. the bandage must press lightly, so as to keep the Fracture firm, and press out the Humors. But there are other signs, which appear the next day. For if the Patient, that day the bandage was made, found himself bound tight, and the next day a lax, soft and small Tumor [Page 482]appear (in the Hand, if the Arm were broke; in the Foot, if the Leg) the bandage is good: But if either no swelling at all, or a great and hard one appear in the Hand or Foot the next day, the bandage is bad; because the first does not keep the Fracture fast; the latter occasions Inflammation.
On the third day after deligation, Hippocrates unbinds the Rollers: for about that time they grow slick, which is one reason why they are unbound. Another reason is, because most frequently in Fractures, an intolerable Itch disturbs a Man, because of Humors and Vapors detained by bandage, and grown sharp; which itching usually ends in a painful and inslammatory excoriation. Then the Rollers must be unbound, and the part troubled with the Itch, must have warm water often poured upon it, to make the Humors and Vapours evaporate. Then the Limb must be bound up again. Good bandage being made, and the Itch being no more troublesome, the Patient must be kept bound from the third till the seventh day: On the seventh it must be opened again, be bathed in warm water, and bound up again.
But at this time, instead of Splenia or compresses, you must use Ferulae or Splints (so Hippocrates calls them.) In our time, because we have no store of Ferulae, Chirurgeons use thin slices of Wood called Scabbard, which they wrap in Tow: Some use Pastboard: others use pieces of Wood an Inch thick. The use of these is to keep the Limb not only immoveable, but streight: And this Fer [...] ke best do, which, as they are light, they do not press nor cause Inflammation; and as they are stiff, they keep the Limb streight, where Scabbard is easily bent, and Pastboard likewise, especially dipt in Oil or Wine; and thick pieces of Wood press and cause Inflammation. Hippocrates used these after the seventh day: because before the seventh day, the intention to prevent Inflammation was more considerable than that, to confirm the part: but after the seventh day on the contrary.
CHAP. V.
How the substance of the Bone may be kept sound.
THE third scope of curing Fractures is, to conserve the substance of the Bone sound: for Nature, i. e. the temperature of the part, cannot unite the Bone, except the part be sound. Because the fractured part then is weak, so as that the Excrements of the Body do easily flow to it, by reason of its weak action many Excrements breed, and cannot be expelled; and besides, because in a broken Bone, thô never so well sett, yet certain holes remain, that are afterward filled with Sanies: Therefore to keep the part sound, we have need of Medicines, that dry up the influxed matter, and repell the influent, which in a word, are called Astringents.
The matter of this remedy is various: for Hippocrates uses Cerote; Celsus, Linen dipt in Oil and Wine. Among the Moderns, some use Linen wrung out of black rough Wine: some, combed Flax, wrung out of black rough Wine: others take Oil and Wine, and with them mix equal quantities of Bol. Arm. Sang. Drac. Myrtil. Balaust. Rosar. Rub. Others, besides these Powders, mix the white of an Egg, and make a Medicine as thick as Honey, and apply it upon combed Flax, or upon a piece of Linen. Some take the white of an Egg, and black rough Wine, mixing the foresaid Powders without a Cloth or Stupe, and apply it round the fractured Limb: And these Medicines, because of the white of the Egg, grow presently dry, and stick fast to the part. Some wind Rollers, wrung out of black austere Wine round them, to make them stick the faster.
As to the use of these, the intentions to be considered are, First, to prevent Inflammation; Secondly, to preserve the tone of the part; Thirdly, to asswage pain. Also the season of the year, the habit of the Body, the Age, and Magnitude of the Fracture must be considered. If pain therefore be urgent, the Cerote of Hippocrates, spread upon a piece of Linen cloth is proper: But over this Cerote another Linen cloth, wrung out of black rough Wine, must be applied to prevent Inslammation. If the Cerote be made of Wax and Oil of Roses, or Myrtils, it will asswage pain by reason of the Oil; it will prevent Inflammation, and strengthen the Fracture by reason of Astriction, Thô the pain be but small, it must [Page 484]not be neglected: but our chiefest aim must be to prevent Inflammation, and strengthen the Fracture: therefore we take Oleum Ros. Vinum, & Ovi albumen, his pulveres dictos, ad mellis crassitudinem miscemus, & linteo aut stupâ apponimus. If there be no pain in a manner, then we use all our endeavour to prevent Inflammation and strengthen the Fracture; and therefore we abstain from Oil. If the habit of the Body be hard, the Summer time, the Fracture great, suppose in the Thigh, with the white of an Egg we mix the foresaid astringent Powders, additis corticibus granatorum, gallis immaturis, succo hypocistidis, quae stupis imponuntur: over this we apply a broad piece of thin cloth, wrung out of Wine; or if we care not to wrap so many cloths about the part, we wring the first and second Roller out of black rough Wine, and so roll them. And by these Medicines the substance of the part is kept sound: all which must be applied before bandage is made.
Next to bandage, succeeds the position or collocation of the Limb. This according to Hippocrates, must be soft, lest by pressing it cause pain; equal, lest it distort the part high; and, lest the Humors descend. Therefore Chirurgeons place the fractured Limb in Bed upon soft Bed-cloaths: or they tye a Pillow stufft with soft Flocks or Feathers to the fractured part: Or they make a Pastboard hollow, and line the inside with Tow, for the Arm, and such Bones as do not oblige the Patient to keep his Bed. But if the Patient be confined to his Bed, there is nothing better than to make a Case of thin boards, and fill it sufficiently with Tow or Wooll.
Besides, in the position, as also in the extension and bandage of a part, you must consider the proper figure or posture of the part, i. e. such as is void of pain, and keeps the Muscles entire on every hand: And this is a middle Figure, in which, when we have nothing to do, we keep our parts; as an angular figure in the Arm, a streight one in the Wrist, &c. that is, such an one, as is intermediate between the extreme motions of every part. Unless this posture be observed, in a little time the Limb will ake.
CHAP. VI.
Of breeding a Callusin Fractures.
THE fourth Intention is to breed Callus. This must be done, when all danger of Inflammation is over: usually about the seventh day, according to Galen c. 5. l. 6. Meth. thô it may sometimes be done sooner or later, according to the greatness of the Fracture, season of the Year, Age, habit of Body. &c. just as we said in the cure of a simple wound of the flesh. For while we are in fear of a Defluxion, we cannot thînk of breeding a Callus; because the nature of the part being hurt, it cannot breed Callus.
Now Callus is bred of the nourishment of the Bone, which owzing out of the edges of the Fracture, grows concrete about the fractured Bones: And though it be not Bone; yet it is so hard, that if that Limb chance to be broken again, it will rather break in any other part, than where the Callus is bred. Here are therefore two Indications, First, to supply congruous Matter, Secondly, to keep it from being washed, or any way got off the edges of the Fracture.
As to the matter of Callus, the Food must be thick (because the aliment of Bone is thick) and also viscid: wherefore we must use, Rice, Wheat boiled in Water, Barley, the Feet, Stomachs and Heads of Animals, especially of Calves and Weathers: The Skin also of a Kid or Weather may be given, and Neats-feet. Wine must then be given, and that black and thick. And the Diet from low must be altered to high.
Medicines also may be given inwardly, which are good to breed and harden the Callus. So Succus primulae veris may be drank for several days together, Pulvis radicum agrimoniae drunk in Wine, or Succus ejus drunk alone.
The applications must be Emplastick: wherefore for Children and Women we make a Plaster è Farinà volatili, & Ovi albumine. To grown persons we apply this Plaster; ℞ Boli Armen. Thuris, M [...]rrhae, Aloe's, Acaciae, Tragacanthae, Ladani, Gallarum, rucum cupressi, and part. aeq. in pollinem redacta, miscentur ovi albumini, cum modico farinae volatilis. We use for perfusions, è decocto Granorum & foliorum Myr [...], radicum uhni, & foliorum fraxini; also è succo foliorum vit is albae. These Perfusions are used when the bandage is untied, before [Page 486]the Plaster is applied, and the part bound up again. Among other things, Chirurgeons use Emplastrum barbarum, and Oxycroceum in Winter, Spring and Autumn, because they are hot; and Diapalma in Summer time. Thus therefore we provide Matter apt for breeding of Callus, both by Diet and Medicines.
But lest this Matter, of which Cailus should be bred, might be thrust forth, we must alter our bandage: for the part must not any more be so bound, as to press out the Humors, but so as that they may continue there, and grow together about the Callus. The Fracture therefore need not be bound so frequently as before; once in five days is sufficient. The Rollers also must be drawn looser. Yet in the first bindings, you need not tarry so long, but you may see how the Callus in the Fracture proceeds: It is long enough therefore to tarry two days between the openings: And then you must consider, whether as much, and such a Callus breeds, as is requisite. But how you may help a Callus, when it is less or greater than it should be, I shall shew you afterwards.
In a Fracture made length-ways, the same cure must be used as in a transverse: Only the bandage must be straiter, otherwise it would be apt to slip.
CHAP. VII.
Of Symptoms attending a Fracture; and of a Fracture of the Knee-pan.
NOw we are come to the fifth Intention, namely the correction of Accidents, which usually attend Fractures, and retard their Cure. And they are Pain, Inflammation, Itching, Excoriation, Callus greater or less than it ought to be, debilitation and slenderness of the Limb, the depraved Figure, a Wound.
If Pain then afflict, it must be asswaged by Anodynes, as Lana succida, infusa in Ol [...]o & aceto simul mistis, & coctis; Spongia ex Oleo Rosarum expresa, & imposita; anointing ex Oleo Chamaemeline, & Lumbricorum; then a Linen Cloth dipt in black austere Wine, and applied; All which must be used actually warm. Hippocrates uses a Cerote, which is best, if it be made with Oil of Roses. A Fomentation also with a Sponge is proper, wrung out of Water, in qua Malva & Chamaemelum Bullierint.
How an Inflammation not yet arisen may be prevented, we have [Page 487]shewn already. But if one be arisen, we apply this Medicament; ℞ rad. Althaeae, florum Chamaemel. violarum an. M. [...]. coctis in aqua & contusis adde Farinae Hordei ℥iv. sapae ℥ iij. Ol. Rosar. Violar. an. ℥ iij. Vini nigri, aut aquae Hordei q. s. Misce pro Cataplasmate. If the Heat be very violent, and the Inflammation in its state; ℞ rad. Alth. ℥ iv. fol. Violarum balaustiorum, Plantaginis an. M. iss. florum Chamaemel. M. j. decoquantur in aqua, & cum Oleo Rosar. ac Chamaemel. aequis porti [...]nibus simul mistis, fiat Emplastrum. If the Inflammation be in the declension, we use a Fomentation è flor. Chamaemel. & Beton. decoctis in Vino albo; also a Fomentation è Rosis & Calamintha similiter decoctis.
If the Itch trouble one, because of detention of the Humors or Wind, the place must be bathed with warm water, that when the Pores are opened, they may be dispersed: Or the place may be somented with a Sponge dipt in warm water, and wrung out. Bathing in Sea water is very good; which, by reason of the Salt, is detersive, and opens the Pores.
When this itching is neglected, it usually terminates in a painful, and sometimes an inflammatory excoriation, which must be cured by driers and coolers. In Summer time therefore Ʋnguentum de Cerussa is good; in great heat, Ʋnguentum de Cerussa caphuratum. If it be Summer, and the Body be excessive hot, Ʋnguentum Populeon is good; also that they call Linimentum simplex; if it be new made. At other times Ʋnguentum de Lithargyro, and Ʋnguen [...]an de Minio are proper. All these are cooling and drying; some more, others less.
The Callus sometimes is less or greater than it should be. The signs of its being less than it should be, are, if the part be weak in motion, and if, when the broken part is tou [...]ed, no Callus, or very little is selt. Now this comes to pass, because the Patient used too thin a Diet, or Meats either not thick, or not viscid enough, but friable: or because the Rolle [...]s wer [...] drawn over strait. It must therefore be increased by a fuller Diet, the bandage must be slackened, the astringent Medicines must be more gentle. The Humors must be attracted by bathing with warm water (not very hot, lest the attracted Humors evaporate again) till the part looks red, and swells a little; for then we must desist.
If the Callus be too great, the signs are, when it is handled it may be felt, and by pressing the Muscles and nervous parts, it causes pain. And then it is unapt for motion, by reason of the pain and compression. In this case the quite contrary course must be taken, as to Diet, Rolling, &c. Then the Callus must be softened and digested; for which purpose, these are good; Emplastra è Radicibus Althaeae, foliis Malvae, & Meliloti, decoctis in aqua, cum axungia anatis. But before the Plaster is appiled, Perfusion must be made with the same decoction. When there is an Emollition, Perfusions must be afterwards made of water, wherein Betonica, Scabiosa, Scordium & Parietaria have been boiled. These [Page 488]things must be done, not only till the part grow red, and swell a little, but till it fall away and corrugate.
If a Gangrene arise, we must immediately bath the part in a Lixivium, wherein Scordium and Plantain have been boiled: Then a Plaster must be applied, made è farina Lupinorum, pulvere Scordii, & Oxymelite, cum modico lixivio.
If the Limb grow too small, because of the over-straitness of the Rollers, too much bathing, too much motion, or scarcity of viscous Aliment; the Patient must be nourished; then a Bath of fresh water must be administred, wherein if a little piece of flesh be boiled, it would be better. Besides, Pication must be made, viz. Pitch must be spread upon a Cloth, and applied to the part, and then snacht off hastily for several times, that the plucking of the Hair may cause pain, and so attract nourishment to the part. Then warm water must be poured upon it.
But after Fractures are cured, oftentimes the part remains depressed in its Figure, and distorted; because there was not a good Co [...]tation of the Bones, either through, the Chi [...]urgeons ignorance, the Patients disorderly motion, or bad bandage. If the Limb be not hurt in its motion, the Patient must rest contented. If the hurt of the Limb in its Operations be considerable, the Patient old and weak, the Callus old too, and the fractured Bone great; the Patient must likewise rest himself contented. But if the Patient be young and strong, the Callus fresh, and the fractured Bone small, the only way will be to break the Fracture again; yet for several days we must, as much as we are able, soften the Callus by baths of Althaen, Malva, Lotura lanae, Oesypus, & Lutum thermale: much Friction must be used by the Fingers anointed with Oesypus, perfusions must be made of Water, wherein Hemlock was boiled. We may also use Emplastrum è foliis cicutae cum axungia porcina. Then the Bone may be broke again by the strength of the Hands or Fingers if the Callus be very hard, I break it with an instrument drawing different ways; then I cure it; as I have already shewn. Thô some good Chirurgeons are timorous (as Albucasis) lest the Callus should not, when broke, re-unite.
The operations in all simple Fractures are so exactly alike, that to instance in particular cases, would be but to repeat what has been already said. Only the Fracture of the Patella or Knee-pan differs from all other Fractures in cure, as that Bone differs from all others in site and connexion. Hildanus Obs. Chirurg. 88. Cent. 5. has this relation. A Man forty years old, strong, and of a good habit of Body, by a fall broke his Knee-pan transverse, with a great contusion of his Knee; but without a Wound. Though the Patient was all along treated according to Art; yet most acute pain, and other Symptoms followed. At length the pain and other Symptoms ceased; but he halted, and had an exceeding great weakness in that Leg, so that he had much a do to walk, and if he climbed [Page 489]any place, he could scarce lift his Leg up. Several things were used to strengthen the Nerves; but all to no purpose. And here it proved, as Paraeus has observed, that halting generally attends a Fracture of the Knee-pan. Some are of opinion, that the cause of the lameness is, because the Callus, which joyns the fractured Patella, fills the Cavity underneath, and so hinders the motion. But the extuberance of the Callus is rarely so great as to do this. And in this Patient the Callus could not be the cause of lameness, as by what follows will appear. It is therefore to be considered, that the Patella may be broke transverse, obliquely, or lengthways in a right line drawn from the Thigh to the great Toe. Now a Fracture lengthways will not cause lameness, if an expert Chirurgeon have the handling of it: for he may easily joyn the disjoyned Patella, and keep it in its place, by Bolsters, Pledgets, and Rollers, when joyned. He may do it easily, I say: for the ends of the seventh, eighth, and ninth Muscles, that move the Leg, do meet about the Patella, and terminate in a very strong Tendon, which Tendon does so involve the Patella, that if it is broke lengthways, the Fracture is apt to close of it self; because it is the property of Muscles to draw towards their Original. So when the Fracture is made, according to the rectitude of the Bone, Membranes, Muscles, and Tendons, it is consentaneous to Reason, that they must return to their place again; and when the edges of the fractured Patella are immediately joyned, and that exactly; there can be no extuberance of Callus, and therfore no lameness. Provided the Chirurgeon has done his duty in applying proper Topicks, and has obviated Pain, and other occurring Symptoms.
But when the Fracture is made transverse, the case is quite otherwise: for then the seventh, eighth, and ninth Muscles, draw towards the Hip, and the Tendon inserted in the Patella, draws downwards; and then it is so disjoyned in the middle, that the edges of the Fracture, by reason of the strong attraction of the Muscles and the Tendon can never be joyned. And that the Fracture was such in the foresaid Patient, both Ocular inspection, and Feeling with my Fingers convinc'd me. For it was so disjoyned in the middle, that one might lay more than ones little Finger in the Cavity. No wonder then, if from this disjunction of the Patella, lameness followed, and the Patient could scarce draw his Leg after him; since the Muscles that move the Leg, especially the seventh, eighth, and ninth, were deprived of their strength. Lameness likewise follows a transverse Fracture. For the foresaid Muscles and the Tendon draw the edges of the fractured Knee-pan up or down, or transverse, and so disjoyn them. Hence it is evident, that a transverse or oblique fracture of the Knee-pan, can never by Art or Industry be so cured, but the Patient will be lame. Yet Paulus Aegineta de re Medica. l. 6. c. 103. will have the Leg extended, and the Knee-pan joyned with the Fingers, and so kept till [Page 490]the edges of the fractured Bone touch one the other, and are grown together. This may indeed be tried; but I can scarce believe, that the edges of the Patella can be so joyned; or, if they were joyned, that the Leg can be kept stretcht, and the edges of the Fracture be kept together so long with the Rollers and Pledgets, by reason of the pain, as till a Callus be bred. But thanks be to GOD, as Avicenna says, this Fracture rarely happens. And thus we have done with simple Fractures.
CHAP. VIII.
Of curing a Fracture with a Wound, wherein neither the Bone is made bare, nor the coming away of any piece of Bone is expected.
IN a Fracture with a Wound, either the Bone is made bare, or not made bare: Besides, we either look for a piece of Bone to come away, or we do not. We will first treat of a Fracture, wherein neither the Bone is made bare, nor we do expect any piece of Bone to come away. In this case we must mind the Intentions of the Wound, and of the Fracture one after the other.
First of all the Bones must be put together by extension, as we shewed before in the first indication of Fractures.
Then we must answer the Second and Third Intention of Wounds, i. e. the Lips of the Wound must be closed, and then they must be kept close.
Afterwards we mind the Third Intention of a Fracture, and the Fourth of a Wound, i. e. we preserve the substance of the fractured and the wounded part found, by applying Medicaments to the Wound closed, and the Fracture set, which may asswage Pain, if there be any, and prevent Inflammation, i. e. which may repell the influent Matter, and may dry up what is gathered there already, and press out of the part; such as are astringents and glutinatives. Of which formerly. If there be Pain, and in Winter time, we must use Ceratum picatum: which according to Hippocrates asswages pain; In Summer we must use Ceratum; at other times, Ceratum simplex. If there be no pain, we must most endeavour the strengthening of the Fracture, and preventing an Inflammation. Therefore we must apply combed Flax, [Page 491]wet in the Whites of Eggs, or a Linen Cloth wrung out of black Wine, and Oil of Roses. If the part be void of pain, we may use the foresaid astringent Powders, mixt with the white of an Egg.
Then we must satisfy another Intention of a Fracture, i. e. the Fracture must be rolled, as we shewed before. But here we must observe, that the Rollers must be softer and broader than in a Fracture without a Wound, that they may reach over the edges of the Wounds on each side, and so may close, not press the edges of [...]he Wound. The Rollers also are not to be drawn so hard, as if there were no. Wound, lest by squeezing the Wound, Pain and Inflammation should arise. Wherefore Hippocrates and Ceis [...]s vse many circumvolutions; since it is better to turn often about, than to bind hard. The band [...] must be unbound every thi [...] [...], and must be bound loose, as long as there is fear of Inflammation. Splints must either not be used, lest they should press the Wound; or if they be applied, they must not be laid upon the Wound. In this case Celsus his bandage, which is made with six Rollers, is most proper.
CHAP. IX.
Of a Fracture with a Wound, wherein the Bone is not made bare; but we look for a piece of Bone to come away.
WE say, there is a recess or abscess of a Bone, when a piece of Bone is separated from the main Bone, and is thrust forth by nature. This comes to pass, First, when after an old Wound, the Bones are dry and withered; for then the perished Bone is separated by the expulsive faculty of the part, and so there is an abscess, or desquammation of the Bone: Which may likewise happen without a Fracture, as in Fistula's and old Ulcers, by reason of much San [...]es, tarrying too long upon the Bone, and corrupting it. Such a desquammation may also happen in a Fracture not Set, by reason of much Sanies gathering there. Secondly, Bones recede, when some piece by the violence of the Fracture, is cither quite separated from the rest; or so shattered, that it is in a manner separated.
The causes of this are either [Page 492]external violence, or corruption of the Bone, either by Sanies tarrying too long there; or by the alteration of the external Air, which corrupts the Bones, and destroys their natural temper.
The signs which shew that a Bone will recede, are various. [...] 18. l. 3. de Fracturis. The First is, too much Sanies comes away, not proportionable to the magnitude of the Wound, which shews the Bone is corrupt, and will come away. Secondly, the Wound looks as if it enclined to excretion, the the Lips of it do not close; but are rather inverted; and if the Patient narrowly mind it, he feels a tacit motion in the inside of his Limb. Thirdly, if the Bones have been deprived of Setting, then by reason of the continuance of the Sanies, which corrupts the Bone, a piece of the Bone will come away. The fourth sign is, if the Bone be made bare of Flesh, it must necessarily recede; because Aliment cannot be given, since neither Veins nor Arteries go to the naked part; and also because the Bone is exposed to the external Air, and is corrupted by it. The Fifth sign is laid down by Paulus Aegineta, c. cog. l. 6. If the Flesh, which grows about the lips of the Wound, be lax, dull and spongy: for Nature heals not the Wound, while it has something within it, which she cannot keep. A Bone therefore will come away, whereabout the Flesh is lax.
The signs of a very quick recession are, when there is a quick suppuration in the Wound, and an early and fair excrescence of flesh; for the way the Bone does recede is, when Nature creates Flesh in the lips of the sound Bone, which keeps off and thrusts forth the fractured. A great solid Bone, in a full grown Person, in winter time, recedes slowly, in threescore days or thereabout. A midling lax Bone in tender years, and Summer time recedes sooner, usually within forty days.
As for the cure; If the Bone that will recede, be quite separated from the rest of the Bone, and is fallen within the Wound, and sticks there, it must be taken hold of with a pair of Pliers, and drawn out. And if a piece of Bone be quite cleft from the main Bone, but remains in its place; yet nevertheless, because it will never glutinate with the rest of the Bone, it must be taken hold of and pulled out, if it can without violence. If it cannot be done without great violence, it must not be extracted; because Pain, Inflammation, a Fever, and Convulsion would be caused, and there would be a fistulous Ulcer when such a Cavity was filled, after the extraction of the Bone, with Sanies, which by corroding, hinders the flesh from breeding. Then therefore this business must be left to Nature herself, which by degrees breeds flesh in the lips of the sound Bone, and causes Bones to recede, as in the wounds of the Head.
It ought also to be considered, whether the piece of Bone, that is to come away, be great or little. This may be known by the intenseness or remissness of the fore-meationed signs. For if Suppuration proceed slowly, and great store of Sanies appear; also if much lax [Page 493]and dull flesh breed, a great piece is to come away; if on the contrary, a little one.
If a small portion of Bone be to come away; First, we must take care, that the gathered Pus tarry not long in the Wound, and so corrupt the sound Bone: The Pus therefore must be evacuated, not by pressure of bandage drawn tight (as in a Fracture without a Wound) for so Pain and Inflammation would arise; but the Pus must be so evacuated, that it may flow out of the Wound. The Second scope is, to help the recession of the Bone, which business nevertheless in a little Bone, must be committed to Nature; but in a great one must be promoted by Medicines. For these reasons Hippocrates approves of loose bandage, and frequent, that the Pus may not be stopt, but may pass freely: He does not apply Splints, lest by compression they might cause pain: The rest he leaves to Nature. This is to be observed, that thô you look for a recess of the Bone, nevertheless the Wound must be stitched: for Nature will not heal up the Wound, where the Bone is to come out. The Fracture may be confirmed by many Rollers, as has been formerly shewn.
If a great Bone be to recede, the Cure differs in two things from that foregoing: for Medicines are applied, and the manner of deligation is peculiar. The Indications are; that the Pus be not kept in, but run freely, that the Fracture be confirmed, Inflammation prevented, Pain not raised, and that a speedy recess of the Bone be procured.
To do all these things; as to bandage, many Plagulae are to be taken of double linen Cloth, longer than to go once round the Limb (for shorter would not keep the Fracture stable) but shorter than to go twice round the Limb (for longer would not be commodious, when the Limb is unbound, to renew the applications: for then the Limb must be lifted up and moved) that so both the Fracture may be kept firm, and without stirring the Limb, when both the Heads are loose, the Wound may appear in loosing. The breadth of the Plagulae must at least be half an hand; in some so great, as to take hold of both sides of the Wound. They are to be carried round, so as to cross one another. There must be as many Plagulae as are necessary, that no space may be left empty: I have often found, it is better to use too many, than too few, for confirming the Fracture; yet so, as not to press too hard. They must be wet in black, austere, and thick Wine; for so they stick the better, they prevent Inflammation, and conserve the substance of the part sound: upon which accounts, but especially to prevent Inflammation, Galen not only so wet the Plagulae; but day and night kept the part wet with such Wine; or he applied Cloaths and Sponges dipt in such Wine; but that the running of the Wine might not wet all the Chamber and the Bed, he laid underneath, a Leather made like a Canal, to carry the Wine off.
But before we apply the Plagulae, it is necessary to apply Medicines, which in the beginning, i. e. [Page 494]so long as the Inflammation lasts, may asswage Pain, and are good for Inflammation, such as Ceratum rosatum, Ceratum picatum is likewise commended, especially while Pus is breeding: for by helping Coction, and causing Suppuration, it prevents Inflammation, because when the Matter is Suppurate, no harm can ensue. Hippocrates sometimes uses Linen wet in Oil and Wine mixt together, when there is pain, and danger of a Convulsion.
When the time of Inflammation is over, we must use all our industry, that the receding Bone may with all speed be thrust forth; which though it may be done by Nature; yet it may be helped by Medicines. Things manifestly hot do this; ut Oleum vetus, Cera Citrina, sordities vasorum apum ad ignem liquata, cui admiscebitur pars una euphorb ii, duae tith mali, tres Aristolochiae: this Medicine must be used in Winter, in adult and hard Bodies, and it is commended by Avicenna. In other Bodies and Seasons Ammoniacum & bdellium, dissolutum cum oleo liliaceo, is good. Cinis lumbricorum terrae, melli admistus & impesitus extracts a Bone, that is to come away, by a specifick property. And Ceratum Sacrum does extract Bones.
CHAP. X.
Of a Fracture with a Wound, in which the Bone is made bare.
THe Bone made bare must altogether be defended from the alteration of the Air, lest it putrefy and recede. Therefore if the Bone made bare stick not up above the Wound, it must be covered, not with abstersive Medicines, which irritate and cause pain, nor with oily and mollifying Medicines, which make the Wound foul, but with the natural covering, i. e. the Skin. The lips of the Wound therefore must be drawn together till they touch, by stitching; then the Cure must be proceeded upon, as in a Fracture with a Wound.
If the bare Bone stick out above the Wound, if it can with any ease be restored unto its proper Cavity, by the benefit of due extension, without violence, it must certainly be done; then the Wound must be stitched, as we said but now. But if the bare Bone stick out to [Page 495]high, that it cannot without violence be put into its place again; then of two evils the less is to be chosen, and the Bone must be cut off with a File, a Saw, or some other Instrument, and made a little shorter, and then it must be put together, by making a moderate Extension: for this is better, than to leave such Bones not put together, or by violent Extension, to occasion a Convulsion and Death. If after the Bone is cut off it be difficult to put it together, and we fear violent Extension, wherein because of the Wound, many Fibres are extended, and great Pain is caused, so that a Convulsion may be expected: Hippocrates in this case replaces the Fracture as well as he can, and puts in a Chisellike instrument between the fractured Bones, and raises it like a Lever: and so the Bones are more extended than the Muscles, and may be replaced.
THE PRACTICE OF CHIRURGERY. BOOK V.
CHAP. I.
Of the definition, differences, causes and signs of Luxations in general.
LUxation, or putting out of joynt, is called Dislocation. It is the slipping of the Head of some Limb out of its proper Sinus, into another place. For Dearticulation, or a Joynt, which is designed for motion, consists of the head of a Bone, and a Sinus; In the head it is observable, that all Bones which have a round head, have all motions, as in the Thigh and Shoulder: In the Sinus, that all which have a deep Sinus, as the Os coxendicis, are not so apt to be put out of Joynt; on the contrary, in such as have a shallow Cavity, as in the Scapula. But lest the Bones might easily slip out of their Cavities, there are also Ligaments: and some of them are orbicular, which in all Joynts encompass the head and Sinus round: others are round, and are only in such Joynts as are made for strong motions, as in the Thigh and Knee. These out of a deep Cavity, are inserted into the head of the Bone. Now the Joynts that have both sorts of Ligaments, or that have only the orbicular, but [Page 497]very close, are difficultly dislocated. In the Joynts there is a sort of unctuous and viscid Humor, lest the Bones by their perpetual motion should grow hot and dry.
In general there are three sorts of Luxations. First, when Bones gape, which before were joyned. This happens in three places; when the broad Blade-bone parts from the Humerus; or the Radius from the Cubitus, or the Sura from the Tibia, as Celsus writes, c. 10. l. 8. Rhases 15. contin. calls it Disjunction. A Second sort is, when Bones are lengthened, through the laxity and distention of the Ligaments; whence it comes to pass, that the head of the Bone starts a little out of the Sinus; yet it is not quite out, but it may easily be put in. I have often observed this Luxation in Beggars, in the Wrist and Elbow. The third sort is properly called Luxation, when the head slips out of its proper Sinus, of which there are no differences; but according as it is more or less, Paul c. 11. l. 6.
If then the head do wholly and perfectly slip out of its Sinus, it is called [...], by Rhases Dislocation: If in part, and but imperfectly, it is called [...] by Rhases Distortura, or wrenching. The Joynts of the Arm, Hand, Leg, Foot, Fingers and Toes suffer both sorts of Luxation; only the Thigh and Shoulder suffer a perfect Luxation: the reason whereof is the roundness of the heads, and thinness of the Cavities; whence it comes to pass, that the heads do almost touch the edges in a point, and so either quite slip out of, or come in again to the Sinus. Yet Hippocrates says, the Shoulder and Thigh may be more or less luxated, which must be understood of perfect Luxation, while they are more less distant from their natural place. Moreover, this true Luxation may be made four ways, upwards or downwards, to the right hand or the left, Galen c. 4. l. de Constit. Art. adds forwards or backwards.
The first sort of Luxation is occasioned only by internal causes, i. e. by Humors, mollifying and relaxing the Ligaments. The other two sorts, namely; the wrenching and true Luxation, are occasioned both by an internal cause, to wit, the Humors, flowing to the Joynts, which by degrees fill the Cavity, and thrust the head of the Bone out of its place: and by an external cause, which by violence moves the Bone out of its place, as leaping, a fall, and violent running. But we shall only treat of those Luxations that proceed from an external cause.
There are divers signs of Luxation. First, when the motion of the Joynt is lost: for as long as motion is not lost, thô there be suspicion of a Luxation, yet there is no Luxation. But this sign is not enough, others must be added. The Second therefore is an hollowness appearing in some unusual place, and on the contrary an eminence on the opposite side: for the Tumor is ever on that side unto which the Bone slipt; and the hollowness, from whence it is slipt: This sign is discovered by the sight and touch, in the Joynts, [Page 498]which are either naturally without flesh, or emaciated. The third sign is, the Limb generally is shortned: for the Bone being slipt out of its place, since it finds no resistance, is drawn upwards by the Muscles; this happens in a perfect Luxation. The fourth sign is; the Limb out of Joynt is unlike the found one in figure, site and longitude.
A perfect Luxation is distinguished from an imperfect one, by the intenseness of the aforesaid signs. For if all the motions of the Joynt be lost, if the Limb be shorter, if there be a great Eminence, and a Cavity, if the Limb be unlike the sound one, it is a perfect Luxation: On the contrary, when it is imperfect. The most certain sign of a disjunction, where the Bones gape, is the thickness of the Limb above its natural pitch; and where the heads of the Bones meet, the extuberance is greater. That sort of Luxation, wherein the Limbs are made longer, because of the softness of the Ligaments is known. First, because the Limb looks, as if it were hung on by thread, and it dangles disorderly this way and that, because the Ligaments are relaxed, and the Bones do not then touch one another. Secondly, when the head of the Bone is put up, the Limb returns to its natural length; and if it be let go, it returns to its accidental length. Lastly, there is a Cavity quite round the Joynt, into which one may sometimes put ones little Finger.
The signs of a Luxation being removed, i. e. of a Joynt well Self, are contrary, which shew the natural state: If there be no more signs nor causes of Luxation. Besides, Avicenna brings another sign, namely the crashing, or snap which both the Patient and the by-standers hear, when the Bone slips back again into its Cavity. But this is neither a good sign, nor much to be desired; because it has two bad causes. For either the noise is made while the head of the Bone rubs against the edges of the Sinus, whereby those thin and cartilaginous edges are broken, and so go into the Cavity before the Bone gets into it again: and therefore true reposition cannot be made; because the head can no more turn round in its Cavity, which makes Men lame. Or the noise is, because the head of the Bone beats against the Sinus; which may cause an Ulcer, and make the part putrefie, the Cartilages may grow hard, and be separated from the Bone; and so the Bone remains rough, and difficulty in motion is occasioned.
CHAP. II.
The Cure of a Luxation in general.
THe Doctrine of Luxations is truly Chirurgical; because here all depends on the Chirurgeon's Hand, and nothing on Nature. There are four scopes in a Luxation; Extension, Reposition, Deligation, Collocation. Extension is necessary; because the Muscles contract the slipt Bone, and make the Limb shorter; because then it finds no resistance. Deligation is necessary, lest, because of the Relaxation of the Ligaments, and the Extension of the Muscles, the Bone might slip out again.
And the four aforesaid things must be so administred, that the due figure of the Limb may be kept, and Inflammation may be prevented. The Limb must be put in such a Figure, as that it may be void of pain. In Extension the Muscles must on one side be kept as they are, lest the head of a Muscle should be in the inside, and the end on the outside. In Deligation and placing of the Limb, we must observe such a figure or posture of the Limb, as is the mean between the two extreme motions of the Limb.
An Inflammation usually happens in Luxations by reason of the pain, that is caused, both when the Luxation is made, and after it is made; when the Bone, being out of its place, presses upon the nervous parts, and pain is caused in the Extension, when the Bone is replaced. And an Inflammation must be prevented, in respect of the part recipient, by proper figuration or posture; in respect of the part mittent. i. e. the whole Body, by Bleeding, Purging, and Diet.
First of all Extension must be made, as we have shewn in Fractures. Secondly, the Limb must be replaced gently, lest either Contusion, or Attrition of the Head and the Sinus one against another should be made; also twining about of the head of the Bone must be avoided, lest the edge of the Sinus be broke. Thirdly the Limb must be bound, lest it slip out again. The binding must be so made, as to keep the natural posture of the Limb, and prevent Inflammation, by pressing out the Humors that are got in; and by hindring others from coming in. But before binding be made, Medicines must be applied, which hinder Inflammation, namely Astringents, which besides this advantage, do contract the relaxed Ligaments, [Page 500]and strengthen the part, Such are Ceratum barbarum, Diapalma, de Minio, Oxycroceum, Ceratum simplex, Ceratum rosaceum, Ʋnguentum rosaceum, Vinum, Posca, Vinum granatorum, Succus hypocystidos, decoctum corticum granatorum; Balanstiorum, ovi Albumen. A compound Medicine may also be made è bolo Armena, Sang. Drac. Myrtill. Cortic. Granat. pulverisatis, & mistis ovi Albumini ad mellis cunsistentiam, exceptum hoc stupis pexis circa articulum imponitur. If there be pain, it indicates lenient and unctuous Medicines, i. e. things contrary to an Inflammation: wherefore we must proceed thus. If the pain be small, it must not be regarded, and astringents with unctuous Medicines, as Flax with the white of an Egg, must be applied. But if pain divert the Cure to it self, the part must first be anointed with things that asswage pain, which yet must have an astringent Virtue in them, such as Oleum Rosatum, Oleum Myrtinum, Mastichinum; then the aforesaid Medicine must be applied, or a Linen cloth dipt in Ceratum Rosaceum, over which the aforesaid Stupes must be applied. Cerotes must not be used in the beginning; because by their hardness they press and cause Inflammation: for which reason Galen before bandage applies Linen clothes dipt in some juice, lest by pressure they should cause pain; When these things are done, the Limb must be laid in a middle figure, lest it should occasion pain, The Posture must be soft, smooth, and high.
The Limb thus bound, must (as much as may be) be kept immoveable for three or four days; But then the Rollers being slackened, and an itching arising from the detention of the Vapors, the bandage must be unbound, and the itching part must be bathed with warm water. Yet lest the warm water should loosen the Ligaments, which rather want astriction, therefore, if there be no itching, we must not meddle with fomentation. At the Second Deligation, if there be no pain, we may apply some Ceratum, as in Winter. Ceratum barbarum: in Summer Ceratum de Minio, Diapalma. About the same time also, we may apply splints of Leather and thick Paper, to confirm the head of the Bone. And thus we must proceed, till the Limb seem strong enough: About this time it must be unbound, and fomented with a decoction of Wormwood, Roses, Chamaemel, white Oaken Moss, which do strengthen. Then having applied a Cerote, the Limb must be kept for some days without binding, and the Patient must be ordered to use his wonted exercises, but moderately. Thus much of the general cure of all fresh Luxations.
Old Luxations have the same Indications. Yet these must be preceded by sostning and discussing the matter, which is flowed into the Joynt, and about the Joynt. For which purpose, ℞ Rad. Althee ℥ vj. Rad. Cucum. asinini ℥ iij. fol. malvae M. ij. coctis in aqua & contusis adde farinae Faenugnec. & seminis lini ana ℥jss. Olei communis ℥ vj. axungiae porcinae ℥ iiij. Decocti praedicti q. s. misce & siat [Page 501]emplastrum. We likewise use Diachylon simplex, & cum Gummi, when the Callus is great and hard: But first we must rub the part with our Fingers wet in moist Oesypus, and we apply thick Oesypus. We often dip the Limb in the washing of Wooll warm, Morning and Evening for an hour or two. The Mud of hot Bathes is also good; Those are Emollients. After them we must use digesters, such as, in soft natures, Ceratum de betonica; in hard ones Emplastrum sacrum. Before the application of the Emplasters, Fomentation must be made è decocto Chamaemeli, Hyssopi, Betonicae, Staechadis; also è vino albo generoso. When the Humors are much, and very hard, if they be first softened, we must use a Fumigation è lapide pyrite or molari: also a Fomentation è decocto Rad. Cucum. asin. Altheae, ivae, colocynthidos; which both by their heat and driness discuss the matter, and by an innate property attract the Humors about the Joynt. The Limbs may be held in the water of hot Bathes, and in the steam of the same, which are very digerent: when these things are done, you may manage all the rest, as in a fresh Luxation.
CHAP. III.
Of particular Luxations: and First of Luxations of the Jaw-bone.
VVHen the Jaw-bone is out of joynt, Mastication and Speech are depraved. It is very seldom, that it is dislocated: because the head of the Jaw-bone, which is contained in the Cavity, is encompassed on every side with Bones. Then the Jaw-bone has many strong Muscles, which keep it in its proper place, and it has two heads, which are not so apt to slip out, as one is. Thirdly, it has two acute Processes. Fourthly, the Jaw-bone can only be dislocated one way, i. e. forwards, Fifthly, there are few causes of the Luxation of the Jaw-bone.
For the Jaw-bone can never be out, unless its acute Process slip under the Os jugale; and so cannot get back again: But this Process cannot slip downwards, unless the Mouth gape very wide, and it cannot get upwards except in a distortion of the Mouth. Yet I have often seen the Jaw-bone luxated: the cause whereof may be a frequent and constant motion of [Page 502]the Jaw-bone, both in Mastication and Speaking, whereby the Muscles are tired, debilitated, and so give frequent occasion to the luxation of the Jaw-bone.
Gulielmus de Saliceto, and some other Chirurgeons, not skilled in Anatomy, have written, that the Jaw-bone may be luxated to the left and right, but this is false; for behind, the Bone hinders, on the right, the left head of the Jawbone hinders; on the left, the right head of the Jaw-bone hinders. It therefore follows, that the Jawbone can be luxated only forwards.
And either both its heads are luxated, or only one. If only one, 1. That part of the Jaw is prominent only forwards. 2. The Chin enclines to the luxated part. 3. The Mouth is distorted towards the part, contrary to the luxated part, and the distorted Jaw-bone appears more eminent. 4. The Dentes canini stand underneath the fore-Teeth. 5. On the luxated side, the acute Process appears more eminent. 6. The Teeth cannot be shut. If the Jaw be out on both sides, these are the signs. 1. The whole Jaw is prominent forwards, and not distorted, but fore-right. 2. The Mouth keeps open. 3. The acute Process appears prominent on both sides. 4. The lower Teeth stand out far beyond the upper. 5. The temporal Muscles are very tight and hard.
Hippocrates writes, that unless it be replaced presently, there do arise continual Fevers, Sleepiness, Inflammation, Pain, Convulsion, voiding of Choler, and usually on the tenth day death. Thô I have had several such under cure, I never met with any that fared so: Yet I believe Hippocrates did; because it is rational enough, that such Symptoms may happen, by reason of the Muscles and Nerves being primarily affected, and the Brain by consent.
In the Reposition of the Jawbone, motions must be made contrary to them, that the Jaw-bone made, when it slipt out of its Cavity. First, the Jaw-bone slips forwards, it must therefore be thrust backwards. Secondly, in opening the Mouth it is drawn downwards; therefore it must be forced upwards. Thirdly, the Muscles draw the acute Process upwards; therefore the Jaw-bone must be drawn downwards.
If the Jaw be out only on one side; it must be forced to the contrary side. We must begin with the last motions first. Therefore if both sides of the Jaw be out; the first action of the Chirurgeon is Traction or Extension of it downwards; the Second backwards; the Third upwards. To do these things, he must put both his Thumbs in his Patient's Mouth, and with his Fingers he must take hold of the outside of his Chin: then the Jaw-bone must be forced downwards, backwards, and upwards. Thus it is easily and quickly replaced. But the Patient's Head must be held fast, that it give not way, when the Jaw-bone is forced backwards.
When the Reposition is done, things must be applied to the heads of the Jaw-bone, i. e. to the Temples, which may prevent Inflammation, such as Ceratum rosaceum: [Page 503]In violent distention, where there is more need of astringence, we may apply Stupes wet in whites of Eggs, adding, if there be need, astringent Powders. We must also anoint the parts of the Temples, i. e. the whole temporal Muscle, with Oleum Ros. lumbricatum.
Bandage is made in this manner; a Roller is applied to the Chin, where it must be slit a little, that it may take hold of the Chin on both sides; then on each side at the Ears, the Roller must be slit again, and the Ear must be drawn through; afterwards the Roller is to be fastered at the Crown of the Head. And the Patient must be kept thus, till the Jaw-bone be strengthened, which it is in one, two, or at most three days time: All which time, if there be any danger, the Patient had best abstain from Meat; nor must he omit Bleeding, and those things we have mentioned in the general cure of Luxations. But to speak the truth, I ever used to apply Medicaments to the place affected, and when there was occasion to eat, I ordered the Swathes to be loosened.
CHAP. IV.
Of a Luxation of the Shoulder.
THe Shoulder is a great Bone, with a round Head, which is inserted into the shallow Sinus of the Scapula. And this head is surrounded only with an orbicular Ligament, which is loose enough. This Sinus has some Buttresses; for on the outside of the Scapula it has a certain large Process, consisting of the Spine of the Scapula: on the upper part it has partly the said Process, and partly the Clavicle: in the inside it has the Processus anchoroeides. Hence it is apparent, that the head of the Shoulder may easily slip out: for this Joynt is uniform and simple, not, as it is the Knee, double. Then the head of the Shoulder which is round, is deprived of a long neck, is inserted into a Sinus, that has no depth in it, and therefore is more easily put out of Joynt, then the Thigh, which has a long neck, and is inserted into a deep Cavity. 3. This Ligament is only simple, viz. orbicular, (not round as in the Thigh) and it is very lax. Fourthly, the Joynt of the Shoulder is without flesh, and therefore it is more apt to slip out of its place, than a fleshy Joynt. But the Shoulder can slip no way, except into the Armpits downwards: because there are no Propugnacula there, as in other places, and the [Page 504]Shoulder is apt by its own weight to slip downwards. Yet Galen says, that five times he saw the Shoulder slip forwards.
If the Shoulder be slipt under the Armpit, it is in figure very unlike the sound Shoulder. Secondly, on the top of the Shoulder there appears an unusual hollowness, and under the Armpit, the round hard head may be felt. Thirdly, if the Shoulder be in its natural place, the upper Process of the Scapula appears round; but when the Shoulder is out, it appears acute: because the head which made the roundness is slipt down. Fourthly, the Arm sticks far from the Ribs, and cannot without much pain be brought to them. Fifthly, the Patient cannot carry his Arm to his Head, because the Humerus cannot move upwards: and several other motions of the Shoulder are hindred. Sixthly, the dislocated Arm is longer than the other, if the Shoulder only slip downwards; but it is shorter, if it be drawn upwards by the Muscles. Seventhly, the part is wrinkled at the end of the Axilla, in the luxated Shoulder, far lower, and both more forward and backward, than in the found Arm; which signifies that the head of the Shoulder is slipt downwards. If the Shoulder be luxated towards the fore-part, these are signs; in the fore-part there is an eminence, in the hindpart an unusual hollowness: besides the Cubitus enclines backwards, nor are there any signs of the Shoulder being out under the Arm.
Hippocrates says, that the Shoulder and Thigh can only be perfectly luxated: This is true, if the Luxation be occasioned by an external cause. But if there be internal causes, i.e. Humors gathering and hardning by degrees, these, while they force the head to give way by little and little, may cause an imperfect Luxation.
The ways by which the Shoulder slipt into the Arm-pit is replaced, are according to Hippocrates ten in number, l. 2. de art. but they may be very well reduced to three. The First way is by Circumrotation, or Circumvolution, while either the Patient or the Physician, puts the Hand clench't under the Arm-pit, so that the middle knuckles of the Fingers may force the head of the Shoulder into its Cavity. This way is used only in Children, and such as have very lax and moist Ligaments: But as by this way the Shoulder is easily reduced, so it easily slips back again. This way Hippocrates says, is not according to nature, because not so very safe. For while we turn round the head of the Shoulder upon the Scapula, some membranous and nervous bodies may easily be torn, and so may the edges of the Sinus, whereupon by reason of a conflux of Humors the Chirurgeon is frustrated in Reposition.
The Second method is by a way contrary to that, by which it slipt out. If the head of the Shoulder be dislocated; First, it goes out of the Sinus, and so moves forwards. Secondly, it slips downwards. Thirdly, it is drawn backwards by the Muscles. This way differs from the first, because in the first, motion is made by Circumrotation [Page 505]in crooked lines; in the Second, motion is made in right lines. In reposition therefore these three motions must be made by a way contrary to the slipping of it out. 1. From behind forwards. 2. From the forepart upwards. 3. Back again. First of all therefore the Chirurgeon puts his head to the Patient's Shoulder. Secondly, he puts his Fingers under his Armpits. Thirdly, he must press the Patient's Elbow with his Knee, the Patient sitting all the while. Let us see now, how these operations answer the foresaid Indications. The first motion, that must be made in reduction of the Shoulder, is forwards, and it is done by putting the Fingers under the Arm-pits. The Knee strengthens this motion, and makes it more easie, by pressing the Elbow towards the Ribs, which by the dislocation stuck too far from it: For as when the head of the Shoulder slips into the Armpit, the Elbow sticks out from the Ribs; so again, when the Elbow is forced towards the Ribs, the Shoulder moves forwards. By the benefit therefore of the Fingers and the Knee, the Shoulder is moved from behind forwards. And the Chirurgeon lays his Head on the Patient's Shoulder, lest, while with his Fingers he draws the Shoulder forwards, the rest of the Patient's Body might follow: Or rather (as I have learned by experience) lest the Scapula, which is moveable, should follow: for when the Shoulder is dislocated, if the Luxation be not new, it is very difficultly replaced, for this very reason, because when extension of the Shoulder is made, the Shoulder does not stir out of its praeternatural place, but rather the Scapula does move. Hippocrates therefore makes the first motion, i.e. he moves the Shoulder forwards: but he makes no mention of the two other motions, because they are effected by the Muscles: For while the Muscles are sound, and the Luxation newly made, they draw the Shoulder upwards, and restore it to its proper place, if that the head of the Shoulder be not hindred, as it is, while it lies behind under the Armpit. This way may also be administred in another manner: for because we cannot so well with our Knee force the Elbow towards the Ribs, instead of the Knee we substitute a Servant, who with his Hand must take hold of the Elbow and force it towards the Ribs. And this second way may be administred in a third manner; the Elbow may be brought back towards the Spina dorsi: for so the Shoulder is brought forwards: Then with one hand we must take hold of the Elbow, that motion may be made upwards; and we must lay the other hand hard upon the top of the Shoulder, lest the Scapula might give way, as we said before.
The Third general way adds to the Second, Extension, which is very necessary, if the head of the Shoulder be confirmed out of place; moreover the Muscles always draw upwards, whence arises an Indication of drawing downwards by Extension. This way is performed either with instruments or without.
Without instruments in a twofold manner. The First is, if the Patient lye, and the Chirurgeon sit upon the same level, taking hold of the luxated Arm with both his Hands, and putting his Heel under the Patient's Arm-pit (the right Heel, if the right Shoulder be out of Joynt, and the left, if the left be out) but before he put his Heel in his Arm-pit, it is necessary to put a hard Ball, like a Tennis-Ball under the Arm-pit. When this is done, a Servant must take hold of the opposite Arm, and draw it downwards: And another having a strong Roller or Girt (broad enough to take hold of the Ball) must take hold of both its heads, and draw them upwards towards the Patient's Head; and with his other Foot lean upon the top of the luxated Shoulder. Now let us consider, how the Shoulder may be replaced by these operations. The First, who draws the Arm downwards, and the other, who pulls the string upwards, make extension and motion downwards. Motion forwards is made both by the Ball and the Heel: wherefore the Heel must be put between the Ribs and the head of the Shoulder, or the Ball, that the head of the Shoulder may be prest forward: And the reason why the Ball is used is, that whither the heel cannot reach, because of the hollowness of the Arm-pit (which is made by the Muscles and Tendons placed on all sides) yet there, by the benefit of the Ball, the Heel may operate. Two motions are therefore made by the Chirurgeon, the first downwards, and then forwards. The Servant, who draws the string upwards, makes motion upwards, and pressing the top of the Shoulder with his Foot, he keeps the Scapula from giving way. The third person, who draws the sound Shoulder downwards, keeps the whole body from giving way to the Extension.
The other way without instruments is thus; A Man of a higher stature, than the Patient, must lift the Patient from the ground, and place his Arm-pit upon his own Shoulder, that so he may make Extension: Then he must bring the dislocated Arm towards his own Breast, that the Shoulder may move forwards. Afterwards a Servant putting both his hands behind him upon the Patients Shoulder, must draw and press that part, lest the Scapula might give way. Then a Boy must hang behind on the other side, so as his Feet may not touch the ground, that he may hinder the whole Body from giving way. Thus far of the ways of doing it without instruments.
Instruments proper for the reduction of the luxated Shoulder are, the Ladder, Coulstaff, Pulleys, Glossocomium, &c.
The way of Extension by a Ladder is, that the Patient climb up three or four steps of it, and put his lame Arm over one of the Staves, placing it between his Side, and the head of the Humerus; and that a strong fellow take hold of that Arm, and pull it forcibly down backwards, whilst the Patient hangs by it.
The way by a Coulstaff is safer. The Staff must have a Bunch in [Page 507]the middle, somewhat wedge-like, and be covered with a soft Boulster, fit to place under the Patient's Arm-pit. In order to the Extension, the Patient must be seated near some Post or Pillar, in which the Pulley must be fastned to extend his Arm; and the bandage must be made a little above the Elbow; which being fastned, and the Coulstaff placed, and supported by a couple of fellows, the Chirurgeon must stand on the contrary side, with his hands on each side of the Scapula, to press it downward, and keep the Patient firm in his seat, and govern the operation, taking care the edge be placed right whilst the Extension is making, lest they break the Bone, or otherwise mischief him.
The Glossocomium, commonly called the Commander, is of use in the most strong tough Bodies, and where the luxation hath been of long continuance, and will not yield to the other ways of Extension. There ought to be great care in the use of it, for many shrewd accidents have happened thereby.
The Humerus luxated by relaxation of the Ligaments and Tendons is restored to its place, after some of the ways abovesaid: but doth require your industry to retain it, after it is reduced,
If the Humerus be to be reduced, when it is luxated forward, the motion must be made contrary. And thô the Limb be not made shorter; yet because we ease the head of the Bone, and disintangle it, some little Extension must be made.
In general we must know, if the Shoulder be newly luxated, it may easily be replaced by the Fingers. But when the Luxation is old, it is very difficultly reduced: because the Shoulder has fixt it self fast there, so that it is grown something callous; and besides, the Cavity it self is filled with flesh, which when the Bone is reduced, does nevertheless cause it to slip out of its proper Sinus.
When the Shoulder is reduced, we must bind it up. But before binding, we must apply things, which prevent Inflammation, and knit together the lax and distorted Ligaments; such as we mentioned before; Bolus Armena, Sang. Draconis, Myrtilli, balaustia pulverisata ovi albumine subacta, ad mellis consistentiam, applied with Stupes or Clothes, And under the Shoulder-Joynt a Ball must be put, made of Linen or Tow wrapt together, it must be wet in the foresaid Medicines, and put under the Arm-pit, lest the Shoulder, by reason of its weight, and the laxity of the Ligaments, might slip down again. Then a broad linen Cloth, wrung out of black austere Wine, must be applied. Thirdly, a Roller must be brought about it, which must keep fast the Ball, and always draw the Arm upwards, or at least keep it so. First of all therefore the middle of the Roller must go over the Ball, and be carried once or twice round the Joynt, then both the heads must be carried round the Neck on the other side. When three or four days are over, the bandage may be loosed: and if all fear of Inflammation be not over, or if the Ligaments continue lax, the like [Page 508]Medicine must be renewed, till all fear of Inflammation is over, and the Ligaments are strengthened. And then you may leave off the Roller, and the foresaid Medicine, and apply some Plaster: in Winter Barbarum, and in Summer Diapalma.
CHAP. V.
Of Luxation of the Clavicle or Collar-bone.
THe Clavicle is a crooked Bone made in the figure of an S. one end of which being thicker, and almost three square, is inserted into a Cavity purposely sitted for it in the first bone of the Sternum, and bound in by a strong ligamentous Membrane. The other end being broad and flat, is joyned to the Acromium, where it not only serveth to keep the Shoulder at due distance from the Sternum, but also assists these several Processes, which are provided by nature to preserve the Shoulder-Bone from slipping upwards from its Cavity.
This Bone is capable of a double Luxation, one at the Sternum, and that only outwardly, where it rises from the Breast, and lies like a lump. The other at the broad end near the Acromium, which is also subject to a twofold Luxation, viz. upward and forward; being defended from all other distortions by its neighbouring Bones.
This Luxation is for the most part occasioned by a fall, and pitching upon the Shoulder. It is discerned by the Prominence it makes.
The Clavicle is not so subject to Luxation as other Bones; but being luxated, it is most difficultly retained after restitution, by reason of its smoothness of its heads, and the little hold they have upon the Acromium and Sternum. And if it be not restored, the use of the Arm is impaired in some of its motions.
The reduction of the Clavicle, which end soever of it is luxated, must be made by drawing that Shoulder backwards, and by pressing the luxated end even with the Acromium, or to the Cavity of the Bone of the Sternum, whence it departed. Neither of the places affords it much room, therefore it will require your greater care: for if you place it not exactly, it will scarce hold right till you make your applications. Therefore you must have ready Emplasticks, Compresses and Bandage. Splints are also of use, whether they be of Pastboard, Scabbard; or Tin. The bandage ought to be a Roller [Page 509]with two heads to come over the Shoulders, and under the Arm-pit, making so many circumvolutions as may retain the Dressings close. This being well made, his Arm must be kept up with a Napkin or Towel, and his hand placed under his Breast. If all be well you ought not to loosen the bandage till you judge it united, which may be guessed at by the ease and use of the Arm.
CHAP. [...]
Of the Luxation of the Elbow.
THe Elbow is very difficultly both luxated and reduced, according to Hippoc. l. 2. de Artic. Gal. l. 1. de Fract. First, because it is multiform and various, not round. Secondly, the Bones that make up the Joynt, do mutually receive, and are received one of another; wherefore this Joynt is called Ginglymoeides, because it is made like hinges. Thirdly, the Ligaments of this Joynt are very tight. Lastly, the Bones are not two, as in most Articulations; but three, the Cubitus, Radius, and Humerus, which are mutually knit one to another by membranous Ligaments.
Unless the luxated Elbow be quickly replaced, most violent pain ensues; because its great head presses the circumjacent Muscles and Nerves that run to the Hands, and the deep and sharp edges prick the said part. Besides, the Radius increases the pain; for if it be out, there are more pressures; if it be not out, there are great distensions of the nervous bodies. This pain is usually attended with a Fever, vomiting of Bile, Numbness, &c.
The Cubit is luxated forward or backward, outward or inward: and the Radius either follows, or abides in its place.
If the Radius follow, the parting of the Radius from the Cubit may be felt by the touch. If the Cubit be luxated forward, these are the signs; we cannot bend the extended Cubit, the Cubit is made shorter, an unusual Tumor appears in the fore-part, and an unwonted Cavity behind. If the Luxation be made backward, the signs are the same; but that the Tumor appears behind, and the Cavity before. If it be luxated outward, the signs are the same, but the Tumor appears outward, and the hollowness inward. If it be luxated inward, on the contrary.
The luxated Elbow must speedily be replaced, otherwise a great Inflammation arises, because of the [Page 510]pain, upon which the luxated Elbow is quickly grown callous, the thin Matter being dispersed; but especially because the Elbow is less nervous, and of a cold temperament. When the Elbow is grown hard, it cannot be replaced, unless it be mollified with Medicines.
If the Cubit be luxa [...]d forward, First, Extensio [...] [...]st be made in a proper Figu [...] [...]t directly, but obliquely, [...] the Caput humeri should touch the Cornix, i. e. the high edge of the Cubit, and by Circumrotation it might be broken. When this is done, the luxated Cubit may be replaced four ways. First, if the Luxation be imperfect, it is replaced by a quick bending of the Arm. Secondly, in a perfect Luxation, Extension must be made; then some hard and round body, as of linen Clothes wrapt up hard, must be put in the bending of the Arm, then the Elbow must be bent. Extension must be made by two Servants, one of which must draw the Humerus up, the other the Cubit down, but obliquely. And the round body put in the bowt of the Elbow, must be prest, that when Inflexion is made, Reposition may be made also. Thirdly, two Servants must likewise extend, and a Girt must be applied to the luxated Arm, and bound so long hanging down, that the Chirurgeon may put his Foot into it, as into a Stirrup; Extension therefore being made, and the Girt drawn down by the Chirurgeon's Foot, the Chirurgeon must then put his Hands to the Cubit, and pressing it backward must bend it. Fourthly, this is usually done with the Hands alone, taking the Cubit in one Hand, and the Humerus in the Other, the Cubit must be bended, and put into its place again.
If the Luxation be backwards, having made Extension obliquely, a fresh Luxation is easily replaced by the Hands alone. But because in this case extension uses to prove difficult (for the exteriour extending Muscles of the Cubit, are very strong) the Chirurgeon must anoint his Hands with Oyl, that the Muscles may be the more pliable: And if the Strength of the Hands be not sufficient to reduce the Cubit, we must use Hippocrates his Instruments, the Ladder, &c. If the Cubit slip inward or outward, it must be forced the contrary way. When reduction is done, Medicines must be applied to asswage pain; to contract and strengthen the lax and distorted Ligaments, and to prevent Inflammation: the first whereof is done by oyly things; the rest by astringents; where we must consider what is most urgent. If there be pain, we must mix Oleum Myrtinum or Rosaceum with astringe [...] Powders, and the white of an Egg. Or we must use Ceratum Rosaceum, spread on a broad piece of Linen, and then Stupes must be applied dipt in a Medicine è pulveribus astringentibus ovi albumine subactis. Then proper Bandage must be made, like that which we mentioned before in Fractures, always observing a middle posture.
The Radius usually slips outward. The Signs are, an apparent [Page 511]Tumor outward, the Cubitus and Radius gape one from another. When extension is made, it is easily forced in again.
CHAP. VII.
Of the Luxation of the Carpus, Metacarpus, and Fingers.
THe whole Carpus, or Wrist, considered in it self, and joyned to the Arm by Diathrosis, may slip inward, outward, forward or backward, but principally forward; the signs are a Tumor in the forepart, and the Fingers cannot be bent. If luxation be made backward, the Fingers cannot be extended, because the Tendons and Nerves are pressed upon by the Bones. If the Luxation be made either inward or outward, a swelling appears on one side, and an hollowness on the opposite.
If then Luxation be made either forward or backward, the Hand must be laid on a Table, the back downwards, if Luxation be made forward; and the back upwards, if the Luxation be made backwards: then extension must be made by two Servants, one pulling at the Arm, and the other at the Hand. While extension is making, the Chirurgeon must force the luxated part the contrary way, either with the Hand, or in robuft Bodies, by pressing it with the Heel. Celsus laies some linen Cloth rolled up hard, upon the Luxation, where it is to be prest most, that so the intrusion may be stronger, and the pain less. If the Luxation be outward or inward, as extension is making, the Chirurgeon must force it the contrary way.
A Luxation of the Bones of the Carpus or Metacarpus is easily replaced, in the first by making no extension; in the second, by a moderate extension, the Hand being placed on a Table, and some hard Body put under, and so the Bones being thrust by the Hand or Heel into their places, either forward or backward.
The Fingers are luxated either forward, backward, or to one side. The signs are very apparent, because the Joynts have but little Flesh on them. As extension is made upon a Table by two Servants, the Bone is easily thrust the contrary way. When reposition is made, Medicines must be applied, the Limb must be bound, put in a fitting posture, &c.
CHAP. VIII.
Of the Luxation of the Thigh.
THe Thigh has a round Head, growing in a long Neck, which is inserted into a very deep Sinus. The Thigh is bound to the Os Coxendicis by two Ligaments, the one orbicular, and the other round. Hence it is apparent that only a perfect Luxation can happen in the Thigh, and not an imperfect one, as we said before of the Shoulder. The Thigh slips forward, backward, outward or inward. But it is done with great difficulty. First, because of the very strong Muscles, and abundance of Flesh upon those Muscles, which keep the Thigh in its proper Sinus. Secondly, because of the depth of the Acetebulum. Thirdly, because of two tight and short Ligaments. The Thigh is seldom luxated forward or backward, because in these sides the edges of the Acetabulum are highest; sometimes outward, because there they are not so high; oftnest inward, because there the edge is lowest. And besides the lowness of the edge I may add the round Ligament, which is inserted next the inside, and therefore will more easily give way to Luxation of the Thigh inward.
If the Thigh be luxated inward; it appears longer than the other, because the Thigh desconds. Also the Knee, Leg and Foot stand outward; For if one end of a thing encline one way, the other end will encline the contrary: wherefore if the Head of the Thigh be displaced inward, the Knee, Leg and Foot encline outward. Besides, the Thigh cannot be brought toward the Groin; because the inflexor Muscles are straitned and hindred, that they can neither lift nor bend the Thigh. Another sign is, that on the Region between the Anus and the Testicles, a manifest Tumor appears in the outer side of the Sinus. If the Thigh slip outwards, the signs are contrary: for that Leg is shorter than the other, because the Head is more elate than its Sinus. Between the Scretum and the Anus there is a hollowness; and towards the Buttocks there is a swelling. The Knee, Leg and Foot stand inward. The Heel cannot touch the ground, because the Leg is shortned: but the Patient can draw his Thigh upward, because the inflexor Muscles are not hindred. If the Knee slip forward, the extended Thigh cannot be bent, because the inflexor Muscles are hindred and pressed by the head of the Thigh. [Page 513]Urine is stopt in such Persons, because the head of the Thigh presses upon the Bladder. The Groins swell, be cause the head of the Thigh is slipt into these parts. The Buttocks appear wrinkled and without Flesh; because the whole Thigh, together with the Processes, is slipt forward. If the Thigh be slipt backward, there are the contrary signs. The Leg cannot be extended, because the extending Muscles, which are behind, are prest; wherefore they cannot be drawn toward their proper Principles; the Thigh affected is shorter than the other, because the Head is got above the Sinus; the Heel cannot touch the ground. The Groin appears lax, and the head of the Thigh sticks out at the Buttocks.
It is very difficult to replace a dislocated Thigh; because, by reason of the very strong Muscles, extension cannot be made: and the difficulty is encreased, if the Luxation be not new, but callous by reason of Humors running to the Os Foemoris, and of the repletion of the Sinus. The Thigh being replaced, it is apt to slip out again, because the Muscles are so weakned, that they are not able to keep the heavy Thigh in its Seat; and because the round Ligaments is either la [...]ated, or broken.
The Thigh may be replaced, either without or with extension. Without extension two ways, but never unless the Luxation be new, and moderate, i.e. standing but a little way from its Sinus, and in a Child's Body. The first way is, to turn round the head of the Thigh about the Hium (as we did when the Arm was out of Joynt) and not to separate it, if it get into the Sinus. But this way is not safe, for fear lest the head of the Bone should rub against the edges of the Sinus, and so either bruise or break them. The other way is, to bend the Thigh suddenly: for so sometimes it is replaced according to Paulus, c. 98. l. 6.
But the Thigh is best reduced with extension. If therefore the Thigh be slipt inward, thô there seems to be no need of extension, since the Leg is longer than it should be (not shorter, as in other Luxations, wherein the Muscles moving the head of the Bone, have their Original far above it, and so draw the head upwards) nevertheless a little extension must be made, as much as is sufficient to stir and extricate the fixt head. This may be done with the Hands, if the Luxation be new, moderate, and in a Child's Body. It must be performed in this manner; one Servant must hold the Patient's Body by the Armpits very fast; another must take hold of the Thigh with both his Hands above his Knee, and extend it. In the mean time, while extension is making, the Chirurgeon must with his Hands force the Thigh slipt inward, outward. When the Head is thus extricated by means of this impulsion, the Muscles that draw upwards, will easily put it into its place again; or, if the Muscles be weak, the Chirurgeon may easily do it. If it be in a robust Body, we want stronger extension, which must be with Girts and Ropes. A Girt then [Page 514]must be put on the space between the Genitals and the Anus; but so, as that it do not take hold of the head of the Bone. Then another Girt must be tied above the Knee, or another above the Ankle: and these Girts must be drawn by the two heads, either with the hands alone, or with a Ladder, to one of the staves whereof the upper Girt must be tied, and the Patient must be laid on the Ladder, and the other Girt must be drawn downward. You may also use the Scamnum Hippocratis. But these violent Extensions are most proper in other Luxations of the Thigh, when it is put outward, forward or backward: for when Extension is made, and the head is forced the contrary way, the Chirurgeon may easily reduce it. After reduction, Medicines must be applied, to prevent Inflammation, asswage Pain, and to contract and strengthen the lax Ligaments.
CHAP. IX.
Of the Luxation of the Knee.
THe Knee is not easily put out of joynt: because it has two Ligaments, and it has a double head, and a Sinus. It undergoes an imperfect and a perfect Luxation, and it slips outward, inward, or backward: only Celsus adds forward; but so it is very hard for the Knee to be luxated, because of the Knee-pan, which being tied by very strong Tendons, does wonderfully strengthen the Knee forward, so that it cannot slip that way; unless there be a violent cause.
All the forts of this Luxation are manifested to the Eyes; because it is a fleshless part: for there appears an unusual Tumor on one side, and a Cavity on the opposite; the Figure is depraved, Motion is weakned and abolished.
If the Luxation be imperfect, little or no Extension is required, but only forcing it to the contrary side. If it be perfect, Extension is necessary; which may be made by the hand in a fresh Luxation, and in Childhood. One Servant must draw upwards, and another below the Knee towards the Foot; and the Chirurgeon must force the Bone to the contrary side. In a grown Man, and a great Luxation, there is need of Girts or Engines, especially to draw downward, and make sufficient Extension, &c.
CHAP. X.
Of the Luxation of the Ankle and Toes.
THe Ankle may slip out inward, outward, forward or backward. If inward, the Sole of the Foot turns outward: if outward, on the contrary. If forward, then the broad and strong Tendon in the Heel, is hard and tight: besides, that Foot is less; because the Leg and Joynt is moved forward, and takes up a great part of the Foot; whereupon the Foot is less and shorter. If backward, the Heel is almost hid, because the Joynt is slipt to the Heel: besides, the Sole seems greater, and the Foot longer. If these signs be manifest, the Luxation is perfect; if they are obscure, it is imperfect.
The Cure is not difficult, if due Extension be used; with the Hands, if the Luxation be fresh, and in a Child, one Servant must take hold of the Foot, another of the Leg above the Ankle; and the Chirurgeon must force it unto the opposite part. If good Extension cannot be made by the Hands, we use Girts, to the Foot, and to the Leg above the Ankle; about the small. If very violent Extension be required, we may use the Scamnam Hippucratis; or Paulus his way, l. 6. c. 121. which is, to drive a stake deep into the ground; then to lay the Patient on his Back, astride the stake, which must be driven in so deep and firm, as not to give way, when Extension is made.
When the Joynt is reduced, the Patient must be kept longer in Bed, than for other Luxations, viz. Forty days; because the Ankle supports the whole Body, and therefore unless it be compleatly restored, that is, unless the lax Ligaments and distended Muscles acquire their pristine strength, the Patients do either relapse into the same Luxation upon every slight occasion; or they find their Foot very weak for a long time. We must therefore use aftringent Powders, mixt with whites of Eggs, applied about the Joynt with Tow. If there be pain, then Lenients are required.
The Bones of the Pedium and Tarsus are so strongly knit together, that they never suffer Luxation. The Toes are seldom luxated, because they are held by many strong Ligaments and Tendons. They are reduced as the Fingers.
THE PRACTICE OF CHIRURGERY. Part II.
BOOK VI.
Of separating things unnaturally united.
CHAP. I.
Of Cutting Tongue-ti'd Children.
HAving in the First Part of Chirurgery shewn, how to unite solution of Continuity; in this Second we must on the contrary teach how to separate Continuity, when it is preternatural. This part of Chirurgery is called by some [...], by others [...], Distinction or Separation.
The fiest preternatural Unition, that I shall treat of, is of the Tongue to the parts under it, when the Membranous Ligament or Fraenum, which connects it, is either too short, or extended to the tip of the Tongue: Then Children are said to be Tongue-tied. But before I meddle with the separation of the Tongue from the parts under it, by cutting the Praenum, I must make some just Animadversion upon the temerity of some [Page 518]Midwives, who always wear one of their Nails of a great length and being thus ready with an incision instrument in their hand, wherever they come to do their office, they cut the new born Child's Tongue, and unless they did this, they believe the Children could never speak: As if Nature (O strange ignorance!) could not make a Man speak, which is to perform a proper action, designed by her to Man, without the helping hand of a silly Woman. Aquapendent says, he saw a new born Child, which was detained a pretty while, till they got the after-burthen away, and it neither cried, nor perhaps was sensible of any trouble all the while, till the Midwife cut the Fraenum with her Nail, and then indeed it cried, because of the pain. But if this were all, the matter were not great: The worst is, the Child, when this Chirurgery of the Nail has raised an Inflammation, cannot take hold of the Nipple, nor get any Milk, and so it dies. And which is yet worse, they impute the whole cause of its Death, either to the Birth, or to its [...]ability to take hold of the Nipple, or to any thing, rather than to the true, viz. the Midwives claw. Let all People therefore, that value their Children, have a care, that the Midwife meddle not with cutting then Tongues. If the Ligament be such as requires cutting, it may be cut in time enough; but this rarely happens. Because Nature had never designed Man to speak, had she not furnisht him with apt instruments. Of many thousands, that are born with this Ligament, searce one requires cutting.
But if it so happen, that the Tongue is too strait tied, the way to cut it is this; the Patient must put his Pongue out beyond his Teeth, then we must take hold of it with a Forceps (Celsus uses a Vosella.) But because we cannot use these instruments in Children, who either know not, or are not willing to put out their Tongue; we first make them cry, then with a thin cloth between the Thumb and fore-Finger of our left Hand we take hold of the Tongue and draw it out, then we hold it up, or turn it back, that the Fraenum may appear: and with our right hand we cut the Fraenum. We take an incisionknife, a little turning back at the point, then we cut the Fraenum transverse twice or thrice, and the parts on each side, taking great care, that the vessels thereabout be not injured, which a Chirurgeon that has any skill in Anatomy, will not do, because he knows the vessels under the Tongue. Then the place may be washt with a little Claret and Diam [...]ron, and it will heal of it self. Several when they are well again, speak readily, if the impediment depend only on the Fraemon; but if some inward and abstanse cause concurr, the essect does not follow.
Hildanus C [...]nt. 3. Obs. 28. says, that a Child of two years old, was brought to him to be cut under the Tongue. When he opened the Child's Mouth, and lifted up the Tongue, he found it very thick, but no nervous Ligament under it. Therefore he sent away the Child, and would not meddle with it. About a Month after, a [Page 519]Mountebank came that way. The Child was carried to him. He perswaded the Parents, that the Tongue was tied with a strong, nervous Ligament, and he boldly maintained that, if they would but give him a sum of Money down, he would make the Child speak in a short time. He got the Money. Then the Impostor places the Child in a Womans Lap, and slashes the Tongue deep before, and on each side; as the by standers told Hildanus. But the Child, who before could go alone, in the very moment skrieked out and was contracted, so that his Knees were drawn to his Belly, and his Hands to his Breast. And because of the continued pain, and want of due administration of Medicines, the Child was extremely wasted and weakned. When Hildanus visited him, his Legs and Arms remained contracted, and if they were by force extended, they were immediately drawn back again, and he could not go at all. He said he did recover a little; but does not give account what the final issue of the case was. He gives an account also of his own Brother, who when he was four years old could not speak a word, and by cutting of the Fraenum was able to speak.
He says, the operation has no danger in it, if it be rightly administred, and especial care must be had, that you cut not too deep; he lifts up the Tongue, and with the point of a pair of Sissers he snips the Ligament in two or three places: for so it is not so apt to grow together again, as when it is cut only in one place. Then he cuts all that is nervous, so as not to touch any thing that is fleshy. If enough be not cut at first, or if it grow up again, the same operation may be performed again. when the Ligament is cut, the Nurse must dip her Finger in Honey of Roses, or common Honey, and raise the Tongue gently with it: for thereby agglutination is hindred. This operation therefore ought not to be committed to Midwives, who with their Nails do not only tear the Ligament, but the parts adjoyning, which occasions Pain and Inflammation; then Children cannot suck, but grow froward, pine away and dye: wherefore we ought to act prudently, and this operation, thô it seem slight, ought not altogether to be neglected. And it ought especially to be consider'd, whether, when the Tongue is short, there be occasion for cutting or no: for oftentimes upon other occasions besides the Ligament under the Tongue, Children cannot form any articulate voice, even when the Tongue is not tied at all, which the preceding case confirms.
CHAP. II.
Of the growing together of Fingers or Toes.
THe Coalition, or growing together of the Fingers or Toes, but especially of the Fingers, falls next under our consideration. It is occasioned either by the error of forming Nature in the Mother's Womb, or by an Ulcer on the inside of two Fingers, negligently cured, or by burning.
The Cure may be performed by the Knife, or by an actual or potential Cautery. Dissection is the best way for Fingers that are joyned together by a narrow Interstice, and by burning. On the contrary, the actual Cautery, or potential Cautery, for such as are joyned by a broad skin. But especially the potential, for saint-hearted Men, Women and Children, who had rather venture the worst, than undergo such terrible means.
When you use an actual Cantery, the part must be defended with some Cataplasm. Cimolia, or Argilla mollis is the best of all.
By the potential Cautery it is done thus. First, they boil an Hempen thread in a Lixivium of Lime and Ashes; then they take it out of the vessel, and lay it upon a Marble, wetting it with a little of the Lixivium for an hour. The thread thus prepared, must be laid both on the upper, and under-side; in the interflice of the Fingers or Toes that are to be divided. Or the thread may be fastned to a wooden ring about the Wrist, to make it keep tight to the part that should be cut, without incommoding the sound parts. This is the way of cutting by a thread.
The way of separating by a knife is thus. First, one must feel with his Fingers, all along the coherence, especially in a natural one, whether there be any hardness, or suspicion of a Nerve or Vein, which must be avoided; afterwards, when the Section is marked with Iule length-ways, it must be made above half way towards the Fingers ends, and then the other half, viz. from the roots of the Fingers to the place where you begun before. The Knife must be long and small. The next thing is, with Liniments and Diapalma, to cicatrize the Fingers so separated.
CHAP. III.
Of Imperforation of the Hymen.
CElsus performs the cure of this by overthwart incision, in manner of the Letter X, taking great care, that the Urinary passage be not violated, which lies near above it. I shall give you Aquapendent's way, who saw and cured an imperforate Maid; and that I may be the more exact in it, I shall give it you in his own words. ‘In the space, says he, of so many years, i. e. of forty, which I have been Professor of Physick here at Padua, I only once saw an imperforate Virgin. And no wonder the case should be so rare, since Nature is seldom wanting or mistaken in things necessary, because of the many inconveniences and hazards of life which usually thence ensue. However, this Maid, from the very day of her birth, had the Membrane called [...], Hymen, imperforate, which closed up the the whole Orifice of the Womb. The Alae were so little, that scarce any appeared, because they were contracted by the continuity of the Membrane, and its Tension, caused by the internal repletion: But when the Vulva was perforated, immediately the Alae were formed, as by the Membrane loosed on either side. So that from hence we may conjecture, the use of these Alae is to take upon them the defence of the pudendum muliebre, which before was otherwise guarded by the Hymen. This noble Maid was very well till she was Thirteen; but from that age she began to be ill, which illness was occasioned by the keeping in of her Courses, which came down then about. She felt great pains about her Loins, and about the bottom of her Belly, which were communicated also to her Hips. Which made some of her Physicians treat her as in the Gout, and for the Sciatica. Afterward her Body began to pine away, and consume, she was continually feverish, and could not sleep, she had lost her Stomach, and was at last delirous; a hard and painful Tumor arose at the bottom of her Belly, in the region of the Womb, and all these Symptoms grew worse and more violent, when the time of her Menses approached, At last, when she was just at death's door, I being called, and having beheld [Page 522]her case with my Eyes, I made a simple incision upon the Membrane, whereupon, immediately a great quantity of thick, viscous, aeruginous and foetid Blood issuing out, she was forthwith well, to a miracle. But I made a simple incision lengthway of the Vulva or Scissure; lest, if I had cut Celsus his way, transverse in the form of an X, I might have hindred the forming of the Alae, which results from the Lips of the Hymen being cut, loosed on either side, and retracted to the place of the Alae. And this is the Chirurgery which I used with the greatest safety and success in a Maid imaginable, whose Hymen was not perforate.’ Hildanus also Cent. 3. Obs. 61. gives this account, how he opened the closed Orifice of the neck of the Womb. ‘There was, says he, brought to me a Girl half a year old, who had the Orifice of the neck of the Won [...] closed up with a very thick Membrane. This Membrane stuck on all sides to the Nymphe, or Carunculae cuticulares, and in the upper part had a little hole, by which she made water. The Parents therefore imploring my help, the next day I set the Child on a Table upon a Cushion, and drawing back and opening her Legs, I put in a Probe, made a little crooked, and hollow on one side, at the fore-mentioned hole, and brought it forwards towards the Perinaeum to the end of the Membrane, then with a little Penknife, resting in the hollow of the Probe, I cut the Membrane, without hurting the adjacent parts, which was prevented by running the point of the Knife along the hollow of the Probe. When I had made incision on the Membrane, thô no Haemorrhage followed, yet I put in a Tent of soft Town, dipt in the white of an Egg, mixt with a little Rosewater, and applied over it a folded cloth, wet in the same Liquor, to asswage Pain, and repel the afflux of humors. At last I put in a broad and thick leaden Tent, armed with Ʋnguentum diapompholygos. And thus the Child was cured in a few days.’
CHAP. IV.
Of the growing together of the Labia of the Womb.
SOmetimes a Woman, by reason of the glutination of the Orifice of the Womb, may be unsit for Marriage, whether she be born so, or it happen afterwards, by a foul Ulcer or Wound not well healed, as it happened to a certain Man's Wife, who when he came to lye with her, found no admittance, nor could not, till a Chirurgeon had made it for him by separating the Coalition of the Labia. And no wonder, if such a part, when ulcerated, grow up, since the Modesty of civil Women is such, that they had rather dye, than expose themselves to a Cure; but ‘Stultorum incurata pudor malus ulcera celat.’ In this Case the Chirurgery must be adminiured in this manner. The Woman must be laid on her Back, her Legs must be brought divaricated to her Hips; her Arms must be brought under her Hams, and tied with convenient bandage to her Neck (as Paulus Aeg neta advises) then with a Knite crooked at the point, very sharp on the edge, but blunt on the back, and a very long handle, Section must be made at once or twice; having first marked a streight line along the middle of the Labia, directing the instrument with the fore-Finger outwardly, and with a hollow Probe before-mentioned, or some such instrument, inwardly. And Midwives, Nurses, and all that are about Women in Childbed, ought to take great care, that if the Woman have received any such hurt in her Travel, it be immediately taken into Cure: Because Neglects herein often prove fatal, as the following instance will prove.
Hildanus, Cent. 6. Obs. 67. relates, how a Woman at her full time was brought to bed of a dead Child, with much pain and difficulty; and those pains most exquisitely tortured her, at least six weeks after. At last, when he was called to her, he found the Orifice of the Womb quite closed up, and the parts extremely swelled. under the neck of the Bladder there was a great hole, that reached into the Bladder, at which the Urine dropt out. The cause of this so grievous an evil had been the Inflammation of the genital parts, not regarded by the ignorant Midwife, which was turned to [Page 524]a putrid Ulcer, which had healed up more by Nature's assistance, than the Midwife's skill; but the Orifice remained shut up. He ordered her Clysters, Fomentations, anodyne Ointments, internal and external Medicines, whereby the pains were asswaged, the swelling abated, and her strength increased: But the mouth of the Womb could by no Art or Industry Chirurgical be opened again, so that she was ever after incapacitated for her Husband. She lived a long time after, and when he wrote this Observation, she had not her Menses the usual way; but was sometimes taken with the Gripes and a loosness, and voided Blood with her Excrements.
CHAP. V.
Of the Anus imperforate.
SOmetimes Children are born with the Anus not perforate, which happens in a twofold manner. Either some mark of a hole appears, or none. When it appears, the way to do it is thus. Cut cross ways at right angles, taking heed not to hurt the Sphincter Muscle, as you cut along the appearance of the hole, then put in a pipe of Lead or Silver, armed with some cicatrizing Medicament, till the part is cicatrized. In this case, thô the place of the Anus is covered with a Skin, yet there is some sign of an Orifice, which feels empty, if one touch it. Albucasis l. 2. c. 79. following Paulus l. 6. c. 81. says, it may be perforated with the Midwive's Finger; but it is better to do it with an instrument, as I have proposed, than to commit such a business to the virulent claw of an ignorant old Woman; unless the Pellicle be so thin, that the Chirurgeon may do it with his Finger without difficulty. Paulus mentions the cure of the Anus not perforate, through an Ulcer ill cured; But I cannot believe that ever such a case happened; because the Anus must be opened too often for an Ulcer ever to close it up in healing; because agglutination cannot be made in so short a time. Besides, such a mass of Humors and Excrements is always flowing thither, that it must hinder glutination. When a Child has been born with the Anus not perforate in this manner, it has been cured.
For Hildanus, Cent. 1. Obs. 73. has a case of this nature. He was called to a Child, which being born with the Anus not perforate, was till the sixth day grievously tormented with the Gripes, and in [Page 525]great hazard of its life. For its Belly wat puft up and hard, it fainted, and had cold Sweats; the Anus was covered with a hard Membrane, in which there was not any sign of an Anus, besides a little livid speck. He made an Incision, with an incision-knife (that the Sphincter might not be hurt) wrapt in a linen Cloth: then he put in a Speculum ani, and dilated the rest. The Child presently discharges a great deal of Excrements; whereupon the Belly immediately fell, and the rest of the Symptoms abated. He then for several days put in a pipe of Lead, armed with some Desiccatory, as Ʋnguentum de Cerussa, de Minio, Diapomphologos, &c. It cicatrized, andlie did well.
When no sign of an Anus appears, Aquapendent would not meddle with it. Who says, he once saw a Woman born without an Anus, that voided her Excrements at her Womb, there being a hole within near the Os Vulv [...]e. But he would not attempt a Cure, lest, not well-knowing where the Anus lay, he might have hurt the Sphincter-Muscle, and so have caused an involuntary excretion of Ordure.
CHAP. VI.
Of rectification, or setting streight parts that are distorted.
MAny parts of Man's Body are of a bad conformation: Some from their birth, others afterward, either from a Disease, or from some external violence; as from the Rickets and other Diseases, and from a hurt by a fall, blow, &c.
The parts affected are the Muscles, and in them the Nerves and Tendons especially; or the Bone.
The signs of a Distortion are so manifest to the Eye and Touch, that I need not mention any; however, it is good to observe rickety and morbid Distortions, when they first arise: for then they may with the greatest ease be rectified, especially when the Party is young, and consequently the parts more flexible to a healing Hand.
As for the cure of Distortions; such as come from wounds in the Muscles and their Nerves and Tendons, depend upon the right healing of those Wounds; and such as come from Fractures, or Dislocations, depend upon the proper reduction of those Fractures and [Page 526]Luxations: wherefore for such you must have recourse to the Doctrine of Wounds, Fractures, and Luxations. But when the Distortion is connate, or proceeds from the Rickets, or any inward cause, or from an outward cause, and which might have been cured, had it not been neglected; then the method of Cure is this. If the parts by continuance of time be grown hard and stiff, they must be made soft and limber by Emollients, as Fomentations and Bathings, ex radicibus & foliis Althaeae, Malvae, Fler. Chamaem. Melilot. sem. lini. Faenigraec. addit. Betomcâ, ivâ artheti [...], florib [...]s primulae veris, & hujusmodi, quae nervos roborant. Emollient Oils, Salves, and Plasters are likewise proper. When the hardened parts are sufficiently softned, we must have recourse to such things as strengthen the Nerves and Nervous parts Among things that strengthen the Nerves, Succus lumbricorum, and Oleum Hildani ex floribus are excellent, and so is the water of Betony, Sage, and Juniper-berries drawn without Wine. For Hildanus says, he observed it in himself as well as others, that Wine, even outwardly applied, is an enemy to the Nerves. When there is an Atrophy in the part, Succus lumbricorum is best, of which take this account. Johannes Wierus in tract. de Scorbuto takes fat Earthworms out of a Churchyard, these he washes first in water, then in Wine very well, he shreds them small, and puts them in a Glass covered with Paste, he bakes them in an Oven with Bread, when the Glass is cold he sets it in water, and when the Paste grows soft, and parts from the Glass, the Worms are found dissolved into Liquor. This Liquor strained must be preserved for use, but it must be renewed every other day: for it quickly corrupts, especially in Summer time. Nicolaus de Metri prepares this Liquor the same way, only he adds a little Oil Olive to the Worms. Cosmas Slotanus took these Worms, cleansed as aforesaid, put them in a large Receiver, and poured to them a good quantity of Oyl of Sweet Almonds and Violets, then he dissolved them into Liquor upon Embers, which after strong expression he used. This last composition seems to me the best, because so the Virtue both of the Oyl and the Worms is kept entire. The juyce of the Worms by its proper and peculiar virtue penetrates immediately, and passes to the Nerves, and all that is nervous, and therefore to the Veins and Arteries, whose coats consist of a nervous substance; and this juice strengthens, nourishes, and moderately heats these parts, by removing the obstructions that are there. Besides, in this composition there is a viscous quality from the Oyls, by means whereof, as soon as the juice has penetrated, the Oyls shut the Pores, and so the innate heat is kept in, and as it were pent up, in the part affected. But before these things are used, universals, as Purging, Bleeding, &c. to cleanse the Body, must first be used. Yet when all is done, the whole stress of the Cure lies upon the right contrivance, making, and application of Instruments. For unless [Page 527]Instruments be rightly adapted, all will be in vain, whether Emollients or Corroborators. Wherefore first of all you must get your Instruments made, and then as soon as you use your Emollients, your Instruments must be applied. Thus by the fore-mentioned Topicks, Bandage and Splenia, may a wry Neck be reduced.
CHAP. VII.
Of the reduction of the Fingers.
HAving in the fore-going Chapter given you the general method in curing of Distortions, I thought it in the next place necessary to apply this method to particular cases, which you will find exactly done in the following case by Hildanus, Cent. 1. Obs. 83. ‘There was brought to me, says this excellent Author, a Child fourteen Months old. He had, when he was about half a year old, fallen with his right Hand upon burning Coals: His four Fingers and the external part of the Metacarpus were so burnt, that the ends of his Fingers were drawn back to their first articulation, or roots. The Father had committed the Cure to unskilful persons, so that the Fingers, with the skin of the Metacarpus, were shrunk up into the form of a Globe, and grown together. About seven Months after the Cure was made, they brought him to me. I first purged him with Manna in broth, and then I proceeded to Chirurgical Topicks. Then I used the following Emollient Decoction, and Unguent for several days; ℞ radic. Althaeae cum toto, Rad. Bryon. lil. Alb. an. ℥ j. flor. Chamaem. Melilot. Hyperic. Chamaepit. Chamaedr. an. M. j. Sem. Faenigraec. lin. an. ℥j. coquantur in jusculo pedum & capitis vervecis aut vituli pro fotu. Then I anointed the whole Hand and Arm with the following Unguent; ℞ Ʋnguenti Dialthaeae ℥ j. axungiae humanae, gallinarum, anseris, ursi an. ℥ ij. succi lumbricorum ʒ ss. M. f. Ʋnguentum. Then I wrapt the Hand in Emplastrum de Mucilaginibus. By these means the Sinews and the Callosity contracted from the shrunk skin of the Metacarpus, and the Fingers grown together on the outside of the Hand, being sufficiently mollified; I then with a Razor cut away the Callus between the Fingers and the Metacarpus and [Page 528]next I separated the Fingers. Then I strowed on my Powder to stop Blood, and applied whites of Eggs mixt with Rose and Plantain water, and Oyl of Roses. I applied also a Defensative to the Wrist, and anointed the whole Arm with Oleum Rosacoum, Myrtillorum, and Lumbricorum. The next day I laid upon the Incisions the following Digestive with soft Lint, and anointed the Arm, as before, with the abovesaid Oyls, ℞ Terebinth. lotae in aq. Rosacea & Plantaginis ℥j. Oloi Rosacei & de vitellis ovorum an. ℥ij. croc. ℈ss. vitellum unius ovi. Misce.’
‘The Fifth day I applied an Instrument, and began by degrees to draw the Fingers to their natural site. It was made of a Splint three Inches broad, long enough to reach almost from the Elbow to the Wrist. At the end next the Wrist, it had a stick fastned across it with four round pegs standing up. The Splint was tied in two places round the Arm with a string. The Instrument therefore being tied on, and well guarded with Lint and Cotton, I put Finger-stalls of Leather upon the ends of the Fingers, with strings fastned to them. Then I drew the strings tight, and fastned them to the four pegs afore-mentioned: And every day I bent them more and more. And that I might the better do it; I anointed the Arm and Hand with the foresaid Unguent, as oft as I dressed the Wounds. But, that the Fingers might not grow together again, I put Plates of Lead between the Fingers. Thus by little and little the Fingers were reduced to to their natural site. In the mean time I healed and cicatrized the Wounds, not with very great Driers, but with Medicaments, that were also somewhat emollient. And by GOD's Blessing the Hand was perfectly restored.’
CHAP. VIII.
Of shrunk Sinews, and crooked Arms and Legs.
WHen, upon the falling down of some Humors the Sinews shrink, and the Joynts are bent, so that one cannot extend them, it ought well to be considered, before the Cure be undertaken, whether the Joynt be joyned with a Calius, or no, (the two ends of the Bones having been eroded by some Humor, and by an intervening Callus grown into one, as in Fractures) for then, let the Chirurgeon do what he can, he can do no good, as to the reduction of it; only if he perceive it in time, as it is in growing, he may keep the Limb in the most convenient posture; but it will ever after be stiff and useless. If it is not joyned by a Callus, the method of Cure is this. First, a good Diet must be observed. Then the Body must be gently purged. Thirdly, the Nerves and nervous parts must be mollified and moistned by all means possible. The following Fomentation will do good. ℞ rad. Althaeae, liliorum alborum, Bryoniae, ebuli an. ℥ss. foliorum & florum Betonicae, ivae artheticae, rorismarini, Majoranae an. M. ss. florum Chamaem. Melil. Sambuc. an. M. s. Sem. lin. Faenigraec. an. ℥j. ams. aneth. an ℥ ij. Incidantur & contundantur omnia grosso modo, coquantur (que) in jure capitis & pedum vituli aut vervecis. The disaffected Limb must be held an hour or two twice or thrice a day in this Decoction, as the Patient pl [...] ses. Or a Bag may be made of the foresaid Herbs, which may be boiled in the foresaid Broth, and applied hot, and left on all night. When the Bag is taken off, and the Limb wiped with warm Clothes, it may be anointed with the following Liniment hot. ℞ Olei de Ranis (cujus descriptio haec est, ℞ ranas viventes man. XII. lumbricorum in aqua lotorum M. iij. storum & foliorum Betonicae, ivae Artheticae an. M. ij. roris marini, Majoranae, Florum primulae veris, Lavandulae, Salviae, Chamaemel. Melilot. an. M. j. Omnia cuni ranis & lumbricis incid [...]ntur, & in mortario conquassentur, prosectis postea in cucurbitam assunde aq. Juniperi sine vino distillatae lb vj. Olei Olivarum lb. vij. a [...] ung. human. felis, canis, muris Alpini an. ℥ij. Maneant in infusione horas 24. postea cucurbita suo capitello tecta ponatur in arenam, & tamdin coquatur, donec tota fore aqua fit extillata. Oleum adhuc [Page 530]tepidum per praelum exprimatur, & reservetur ad usi [...]n) Ol. ex floribus an. ℥ j. Ol. Lumbric. vulpin. am [...]gdal. dulc. pinguedinis muris. Alpini an. ℥ss. Misce. Or, ℞ Ʋngu. de Althaeae ℥ j. pinguedinis humanae, anseris, caponis, an. ℥ ss. ol. lumbricorum ℥ j. Ol. granor [...]an Juniperi ℥ ij. M. After anointing, let some very emollient Plaster be applied, as Empl. de Meliloto, de Mucilag. cum Gum. Or Empl. Oesypi Philagrii. It must be dressed twice a day in this manner, till the Tendons and Joynt are soft enough. Then an Instrument must be fixt to it, well guarded with Tow, Cotton, or Lint, which must be kept on night and day, and as you think good, or as the Patient can bear it, it must be extended. But every, or every other day the Instrument must be taken off, the Limb must be anointed, and the Plaster also must be renewed. By means of this Instrument, the crooked Limb must be exterded; but gently, lest Pain and bad Symptoms arise. For all violence is dangerous. In the mean time, while the Instrument is fixt to the Knee, the Patient must walk gently upon it, if he be in any measure able. But if the Arm be crooked, then he must stie it sometimes forward, and sometimes backward. The description of the Instrument is thus. There must be a wooden case, or cradle made hollow, and fit to receive the Thigh about the middle, and the small of the Leg a little above the Ankle. Then there must be an Iron hoop fit to receive the Knee, with an hinge to open and shut, that it may let the Knee in, and with a Button, and several holes to straiten or widen, as there shall be occasion. Then a male Skrew must be put through a hole in the hoop, just in the Ham, and a hole in the wooden Cradle which is placed behind, and fastned with strings to the mid Thigh, and the small of the Leg. This male Skrew must rest by a Shoulder in the Hoop, then the female Skrew must skrew on behind the wooden Cradle, by turning of which the Hoop is brought to the Cradle, and thereby the Leg extended as much as the Chirurgeon shall desire. Hildanus says, that without the help of this Instrument he has reduced several crooked Elbows in the manner following. He ordered, besides the foresaid Emollients, that the Patient should every hour take some heavy things in his hand, as a Kettle full of stones, and walk about with it. Though this be an easie remedy, yet he would not have it neglected, because he has found the great success of it.
CHAP. IX.
The Cure of a distorted Foot.
HIldanus, Cent. 6. Obs. 90. has an observation of the Cure of a distorted Foot, which may serve as a pattern in the like case, viz. A Woman big with Child, as she was going in Pattens, stumbled, and was disturbed, and out of order at it. She was afterwards brought to bed of a Boy, whose right Foot was so Distorted, that his Toes, and all his Foot turned inwards towards the inside of his Ankle. So that when he walked, he trode more upon the out-part of his Ankle, than the sole of his Foot. Many means had been used by excellent Physicians and Chirurgeons, but all in vain. When he was above three years old, and all hope of restitution was past, they wrote to me, and begged that I would use my utmost diligence and skill about the Child. When I had viewed and considered the case well (to speak the truth) I despaired of restoring the Foot, the Distortion being now old and confirmed. However, at the Parents entreaty, I attempted the Cure in this manner.
First of all, because the Child was lusty and fat, I purged his Body with Manna, and Syrupus Rosarum solutivus by turns, lest by Bathings and Fomentations I might draw the superfluous Humours to the part affected. When the Body was purged, I every day twice or thrice used the following emollient Decoction, for ten or twelve days; ℞ rad. Althaeae, Malvae. an. ℥ss. herb. & flor. Betonicae, ivae artheticae. flor. Chamaem. Melilot. am. M. j. Sem. lin. Faenigraec. an. ℥ j. coquantur in decocto capitis & pedum vervecis, fiat (que) fomentum, cui bis in die ad semihoram us (que) pedem immergat. After Fomentation I anointed the Leg and Foot all over with the following Unguent; ℞ Ol. Lil. Alb. Amygd. dulc. an. ℥ss. Ol. Lumbric. ℥ j. Ol. Granor. Juniperi ℥ ij. Misceantur. Then I applied the following Plaster. ℞ Emplastr de mucilaginibus ℥ijss. Gummi Ammaniaci in Spiritu Juniperino dissoluti & percolati, iterúm (que) ad spissitudinem cocti ℥ j. cerae novae ℥ ss. Ol. de Vitellis ovorum ℥ j. dissolvantur lentissimo igne; deinde admisce pulv. flor. Betonicae, ivae Artheticae, Rosarum Rubrarum, an. ℈ ij. croci, pulv. Lumbricorum terrestrium, Masticis, Olibani an. ʒj. Misce, & fiat secundum artem Emplastrum, addendo parum [Page 532]Olei Rosacei, si opus fuerit. This Plaster wonderfully mollifies and strengthens the nervous parts.
The Foot being in this manner sufficiently mollified, I left off Emollients, and applied Corroborants.
In the mean time while I used Emollients. I applied a Serperastrum or Boot, hereafter described.
Moreover, althô the Foot was wonderfully distorted; yet after the use of Emollients, it was easily reduced into the natural form, and that without pain: but as soon as ever the hand was off it, it returned to its former monstrous Figure.
And whenever I extended the Foot (which I took special notice of) and reduced it to its natural posture, I felt a great hollowness between the inner Ankle and the sole of the Foot. For the Process of the lower Appendix of the Os tibiae, which makes the inner Ankle, because it had rested a long time upon the Os calcis, was depressed, and stood at a distance from the Os calcis. And the Process of the Fibula, which makes the outer Ankle, was preternaturally prominent, and twined the whole Foot inward.
Therefore to reduce the Foot to its natural posture and form, it was necessary to depress the Prominence of the Fibula, and a little to prolong the defect of the Process of the Appendix of the Os tibiae. That was done by Art and Industry; this by the benefit of Nature. And that Nature is wonderfully sollicitous for the maintaining her Individuum; I can visibly demonstrate by an instance in my Study. For there I have the Sceleton of a Capon, in which the wonderful providence of the Creator may be observed. This Creature had broke its left Thigh-bone short off, and the one end of the broken Bone grew over the other by a firm Calius, and therefore that Leg must have been shorter than the other: but provident and wise Nature made the Os tibiae of that Leg so much longer than the Os tibiae of the right, as the left Thigh-bone was shorter than the right; and thus no inequality or deformity was left. And if it was thus in Brutes, why not so in Children, while they are growing; especially if they be of a good habit of Body, as this Patient was? But to return to him; the Foot being thus sufficiently mollified, I was to think of something else. I then therfore anointed the Foot and all the Leg with Succus Lumbricorum, aqua Betonicae, ivae Artheticae, Sa [...]viae & Juniperi mixto, and applied the following Plaster, which strengthens admirably; ℞ Emplastri Slotani ℥ iij. Gummi El [...]mi purissimi, Cerae novae an. ℥j. pulv. Mastic. Olibani, pulv. lumbricorum aquâ communi loterum & exsiccatorum an. ʒ ij. Rosar. Rubr. Balaustior. nucum cupress. an. ʒ j. cum s. q. Olei Lumbricorum fiat Ceratum, quod supra alutam extendatur, applicetur, & renovetur, de sexto in sextum diem. Afterwards, having replaced the Foot in its natural posture, which, (as I said before) might be done without pain, I applied the following instrument so neatly to the Foot, that the Foot could [Page 533]not get back into its former praeternatural posture, unless the swathes and bandage happened to be loose. The Instrument was made thus of Iron; it was shaped like half a Boot, but parted about the mid Leg, and held together by two pins of Iron running into two Loops, and a Skrew between them, to let the lower part down, or to draw it up right, as there should be occasion. This lower part was so made, as to take hold of the Foot, and keep it from starting any way out of its proper place. This was for the outside of the Leg. It was fastened to a piece above the Knee by a pin to run on, for the motion of the Knee. The inside of the Leg was covered with Splints, lined with Tow or Cotton, and so the Instrument on the outside was fastned round the Leg by strings.
The Foot being tied streight and fast in this manner, the Prominence of the Fibula was depressed, or at least hindred from starting out. And the Process of the lower Appendix of the Os tibiae, since there was an empty place, might grow out, and so by degrees fill up the hollowness about the inner Ankle. Thus the deformity of the Foot was rectified, so that when he walked no deformity appeared.
But Cures of this nature require a long time and great care. For violence does no good, it is Nature's work to correct such deformities, with the assistance of the Chirurgeon's skill and industry. I found this true in the foresaid Patient. The case was inveterate and deplorable; wherefore he wore the foresaid Instrument a whole year. And I contrived another for him to wear afterwards. For Children when they are growing, must have new ones fitted to them, as they out-grow the old ones.
The reason why the former Physicians, thô expert persons, could do no good, was not for want of proper Medicines, but for want of Serperastra. Wherefore in such cases a Physician must set all his Wits to work to invent apt Instruments, without which, the best Medicines are used to no purpose.
CHAP. X.
The Cure of a crooked Back.
A Crooked Back most commonly proceeds from the Rickets, and may, if minded when the Party is young, be cured. But then it must be done by Chirurgical means. I shall therefore give you Hildanus his method of Cure in the following Process, viz.
A Girl of eighteen Months of age, had the Vertebrae of her Loins beginning to grow in a bunch outward. When some Barhers had for several Months endeavoured in vain to cure her by Ointments, Baths, and thin plates of Lead, but still the Spine grew more and more into a bunch; at length Hildanus was called. He found the third and fourth Vertebrae of the Loins extuberant, as big as a Ducks Egg, which were followed a little by the second and fifth; so that the Spine was grown into a huge bunch, especially towards the left Side: which made the left Leg far weaker than the right. In the Cure he proceeded thus.
First of all he chafed the Back, and the whole Thigh and Leg with the water following, to strengthen the Nerves. ℞ Aq. Granor. Juniperi sine vino distillati, Aq. Salviae, Betonicae, lavandulae, an. ℥ ij. Pulv. radic. tormentillae, Rosarum an. ʒ ij. Misce, fiat (que) infusio in ampulla magna per dies octo vel decem. Dein per inclinationem à pulveribus praedictis separata aqua ad usum reservetur. After chasing, he applied the following Plaster, which he often uses in Fractures of the Bones. ℞ Empl. Slotani ℥ v. Cerae novae ℥ ij. lapidis sabulosi, sive osteocollae ℥ j. Pulv. radic. consolid. maj. Terrae sigillatae an. ʒ iij. pulv. balaustiorum, nucum cupressi, Rosar. odoriferar. an. ʒ j. Misceantur lentissimo igne, fiat (que) Emplastrum addendo Olei Rosacei aut Masticis, q. s. But all the skill in curing a Gibbus consists in repressing the Extuberance of the Vertebrae. To this purpose therefore he made an Iron plate a little bent, long and broad enough to cover the whole Gibbus, and quilted it into a Bodice between two Clothes. But he covered it first with a course Cloth, that it might hurt the Child the less. The Bodice was worn upon the naked Body, and so sitted, as to comprehend all her Belly to the Muliebria. It was tied on with a long strap over the middle of the Belly. About the Breast it was tied gently, lest it might have straitned the Ribs or Midriff. But below the [Page 535]bastard Ribs to the bottom of the Belly, it was tied pretty tight, that the Iron plate might repress the extuberant Vertebrae. And lest the Bodice should have slipt upwards, two straps an Inch broad, were fastned on each side of the Groin, to go under the Perinaum, and to turn up again upon the Buttocks, and so were fastned by straps to the Bodice on each side. He renewed the Plaster and the Chasing every fourth or sixth day. But he ordered all from the Hip to the Foot, to be chafed with the aforesaid water every day. So by GOD's Blessing the Gibbus was cured in six Months. But she wore the Bodice and the Plate, by reason of the weakness and softness of the parts, two years, in which time she grew pretty well.
THE PRACTICE OF CHIRURGERY. Part III.
BOOK VII.
Of taking away things superftuous.
CHAP. I.
Of things superfluous in general; and concerning Women's Labours.
I Gave you in the beginning of the First Book, a designation of the whole Work; and therefore shall not here trouble you with a repetition of what I intend to treat upon in this Third Part. What I comprehend in this one, some divide into two, making one to be [...], or an extraction of hurtful things sticking in our Body; and the other [...], or a removing of what is superfluous. But I am of Dr. Read's Opinion, that these two may very well be comprehended in one, viz. in the removal of things superfluous. Things superfluous are such either by event, as a dead Child, a mortified Limb, &c. Or by their own [Page 538]nature, as Wens, the Stone in the Bladder, &c. The First thing superfluous by event, that I treat of, shall be a dead Child, or a living one staying too long, to the prejudice of its own, and the Mother's, life. And here I shall shew how to deliver, or bring Women to Bed artificially and safely, treating of Labours natural and unnatural, with the way how to help Women in the first, and the right means of remedying the last. It will [...]herefore be necessary to know what Labour is, and the differences of it, together with its different terms.
By a Delivery we understand either an emission or extraction of the Infant, at the full time out of the Womb. This definition may comprehend as well the natural, which is accomplished by Emission, when the Infant coming in a commodious and usual Figure, the Womb sends it forth without extraordinary violence: as the Delivery contrary to Nature, extraction by manual operation.
As to the general differences of Labour, we must take notice, that the one is legitimate or natural, the other illegitimate or against nature. To come to the knowledge of each, we say, that four conditions must absolutely be found in a Delivery, that it may deserve to be called Legitimate, or Natural. 1. That it be at the full time. 2. That it be speedy, without any considerable accident. 3. That the Child be living. 4. That it comes right in a good posture or situation. For if any of these four are wanting, the Delivery is against Nature; and the more, by how much the more of them are wanting.
As to the due time of Labour, most Authors assert, that Nature hath appointed to all other Animals a certain limited time of going with young, and bringing them forth; but that Women only, by a particular favour of the same Nature, have none prefixt, neither for Conceiving, going with Child, nor bringing forth. And as to Conception, 'tis most certain that a Woman can conceive at any time, night or day, Winter or Summer, or any other season whatsoever; because she can copulate when she pleases, which few other Animals can, who couple but at certain seasons, when they become lustful. But as to the time they are accustomed to go with young, it is no more precisely determined to them, than to a Woman; for as she may be brought to Bed either in the 7th, 8th, 9th, or 10th, Month (but for the most part in the 9th.) so likewise, for example, thô the ordinary time for a Bitch to puppy, is the 4th Month, or thereabouts, yet some puppy sooner, some later. And the usual time of Ews yeaning their Lambs is at five Months end: yet some advance or recede from that ordinary term, according to the ground where they feed, and other particular disposition; which happen to all others, as well as to Women. The first time that a Child may live when born, is the 7th Month compleat, and it may better from that time till the end of the 9th Month; but as soon as that is passed, the stay it makes afterwards in the Womb, is no way beneficial [Page 539]to it, because it hath then acquired all necessary perfection, and strength to resist all outward injuries. The Child born before the 7th Month, cannot live long, because of its weakness. But he that is born in the 8th, may very well live, yea, and more likely than one born in the seventh month (which is contrary to the general opinion of the World) because it is more perfect, as I shall demonstrate afterwards, where I will particularly shew the cause of this error.
The proper figure and situation of a Child is thus. It ought to come with the Head first, in a streight line, having the Face turned downwards, that is, towards the Mother's Back, the Arms couched along on its Sides, and the Thighs stretcht upwards; but any other part that may first present it self to the Labour, makes it unfortunate and against nature; in which case there is often great danger to the Mother or Child, and sometimes to both, if not suddenly and duly helped.
CHAP. II.
The signs that precede and accompany as well a natural, as an unnatural Delivery.
WHen Women with Child, chiefly of their first, perceive any extraordinary pains in their Belly, they immediately send for their Midwife, taking it for their Labour; who when she is come, ought to be well informed of the matter, and careful not to put her in Labour before there is a disposition to it. For many times both the Mother and Child lose their Lives, when (by breaking the Amnios and Chorion) it is excited before the due time. Those pains, which may be called false, are usually caused by a Colick, proceeding from Wind, which come and go griping the whole Belly, without any forcing downwards, or into the Womb, as those do which precede or accompany Labour: And this Colick is dissipated by warm Clothes applied to the Belly, and a Clyster or two, by which, true Labour-pains are rather furthered than hindred. A Woman may feel other kind of pains coming from an Emotion, caused by the flux of the Belly, which are easily known by the frequent Stools that follow.
The signs preceding a natural Labour few days before are, that the Belly, which before lay high, [Page 540]sinks down, and hinders a Woman at that time from walking as easie as she used; and there flows from the Womb slimy humors, appointed by Nature to moisten and smooth the passage, that its inward orisice may the more easily be dilated, when it is necessary; which beginning to open a little at that time, suffers that slime to flow away, which proceeds from the humors that strain through the thin substance of the Infants Membranes, and acquires a viscous consistence by the heat of the place, or from the Prostatae.
The signs accompanying present Labour, (that is, shewing, that the Woman is effectively in Labour) are great pains about the region of the Reins and Loins, which coming and reiterating by intervals, answer in the bottom of the Belly with congruous Throws. The Face is sometimes red and inflamed, because the Blood is much heated by the continual endeavours a Woman makes to bring forth her Child; as also, because that during these strong Throws her respiration is ever intercepted; for which reason much Blood hath recourse to her Face. Her privy parts are swelled, because the Infants Head (lying in the birth) often th [...]usts and causes the neighbouring parts to distend outwards, which thence appear swelled in this manner. She is often subject to vomiting, which makes many believe, who know not the cause of it, that the Women to whom it happens, are in danger: But on the contrary, it is ordinarily a sign of speedy delivery, because the good pains are then excited and redoubled every moment until the business be finished. This vomiting comes from a Sympathy between the Womb and Stomach, by reason of the ramifications of the Nerves of the sixth pair of the Brain, which are distributed both to the one and the other, and by which it communicates the pain it feels at that time, arising from the agitation, which the violent and frequent motions of the Child cause, and the strong compression the Muscles of the lower Belly make during the Throws, for to help the issuing forth of the Child. Besides, when the birth is near, Women are sometimes troubled with an universal trembling, and principally of the Legs and Thighs; not with cold, as at the beginning of an Ague-fit, but with the heat of the whole Body; and the Humors which then flow from the Womb, are often discoloured with Blood, which with the signs abovementioned, is an infallible mark of the nearness of the birth; 'tis that the Midwives usually call Shows: and if one then put up their Finger into the neck of the Womb, they will find the inner Orisice dilated, at the opening of which, the Membranes of the Infant, containing the Waters, present themselves, and are strongly forced downwards with every pain the Woman hath; at which time one may perceive them to resist, and again press towards the [...]inger, being by so much the more or less hard and extended, by how much the pains are stronger or weaker. These Membranes with the water in them, when gathered (that is, when they are advanced before the [Page 541]Head of the Child, which makes the Midwives call it the gathering of the waters) presenting themselves at this inward Orifice, do then resemble very well to the touch of the Finger, the abortive eggs which have yet no shell, but are only covered with a simple Membrane: after this, the pains redoubling continually, the Membranes are broken by the strong impulsion of the waters, which incontinently flow away, and then the Head of the Child is easily felt naked, and presented at the opening of the inner Orisice of the Womb. Now all these, or the greatest part of them met together, at what time soever of a Womans going with Child it be, whether full time or no, one may be assured she will soon be delivered; but great care must be taken not to hasten her Labour, before the necessity of it be known by these signs; for that would but torment the Woman and Child in vain, and put them both in danger of their lives.
Labour contrary to Nature is when the Child comes in an ill sigure and situation; as when it presents any otherwise than the Head first; as also when the waters flow away a long time before it is born, because it remains dry in the Womb, and they are absolutely necessary to moisten the passage, and render it more slippery. When the After-burthen comes first, it is an accident, which renders the Labour always dangerous, by reason of the great flux of Blood usually following, of which the Mother may dye in few hours, and the Infant (because it receives no more nourishment) is quickly smothered in the Womb, for want of respiration, which it then needs, if it stay never so little after. The Labour is also grievous, when accompanied with a Fever, or any other considerable distemper, which may destroy the Child in the Womb; as also when pains are small, and come slow, with long interval and little profit, by reason of which a Woman is extremely tired: but the difficulty most frequent and ordinary comes from the Infants wrong posture.
CHAP. III.
Of the several natural situations of an Infant in the Mother's Womb, according to the different times of pregnancy.
WHen we shall have explained the several natural situations of an Infant, those contrary to nature, causing for the most part all ill Labours, will easily be conceived.
It may be considered, that generally the Infants, as well Male as Female, are usually situated in the midst of the Womb; for thô sometimes a Woman's great Belly is a little higher on the one side than the other, yet that is, because the globe of the Womb inclines more that way; and this situation on the side must be understood only in respect of the Mother's Belly, and not of her Womb, in the midst of which it is always placed; because there is but one only Cavity in a Woman's Womb, marked with a small line in its length, without having two or more separations, as is seen in those of other Animals.
There are some who would have these two imaginary Cavities to be the cause why Women bear Twins, yea, and sometimes more; and that the Males rather lye on the right, and the Females on the left side; which is Hippocrates his opinion in the 48th. Aphorism of his 5th. Book, where he says, Foetus mares dextrâ uteri parte, faeminae sinistrâ magis gestantur, but without any certain reason for it; because some Women have the Males on the left side, others the Females on the right; and when there are Twins, sometimes both are of the same Sex, sometimes not, and indifferently situated on the right or the left. This is all can be said in general of the situation of the Child in the Womb.
But in particular, when we consider the several figures it makes, it differs according to the different times of pregnancy. For when the Woman is young with Child, the little Foetus, called Embryo, is always found of a round figure a little oblong, having the Spine moderately turned inwards, the Thighs folded, and a little raised, to which the Legs are so joyned, that the Heels touch the Buttocks, the Arms are bending, and the Hands placed upon the Knees, towards which the Head is inclining forwards, so that the Chin touches the Breast. It resembles, [Page 543]in this posture, very well; one sitting to void his Excrements, and stooping down his Head, to see what comes from him. The spine of its Back is at that time placed towards the Mothers, the Head uppermost, the Face forwards, and the Feet downwards; and it extends by little and little its Members, which were exactly folded in the first Months. It keeps usually this posture till the 7th or 8th Month, at which time the Head being grown very big, is carried downwards by its weight, towards the inward Orifice of the Womb, tumbling as it were over its Head, so that then the Feet are uppermost, and the Face towards the great Gut; thô some Foetus never turn before the time of Labour, some believe that only Males are so turned downwards when they are born, and that the Females are with their Face upwards; but both the one and the other are always turned downwards, with their Face towards the Rectum of their Mother, as is abovesaid; and when it happens otherwise, it is unnatural, for the Child's Face coming upwards will be extremely bruised, and the Nose wholly flatted, because of the hardness of the Os pubis in the passage.
It may be noted that when the Child hath thus changed its first situation, being not yet accustomed to this last, it stirs and torments it self so much sometimes, that the Woman, by reason of the pain she feels, is apt to believe her Labour is at hand. And if this circumstance be well considered, we may find it to be the first pretended endeavour, which Authors imagine the Child makes to be bor [...] in the 7th Month, and not being able to accomplish it, remains for till the 9th, and that reiterating it in the 8th, if it be born, it lives not long, because it was not able to endure two such puissant endeavours so near together. But it is a meer abuse, for if the Child turns it self so with the Head downwards, or rather is turned, it is but by a natural disposition of the weight of the upper parts of the Body, or by a natural propensity; and if it stirs much at that time and soon after, it is not from a desire to be born, but from the inconvenience it receives from this new posture, to which it was not before accustomed, as already hath been mentioned. And it begins to turn thus sometimes from the 7th Month, rarely before but by accident, oftnest about the 8th Month, and sometimes in the 9th only; and at other times also it turns not at all, as we may easily perceive in those that come in their first situation, that is, with their Feet foremost. From whence it is easie to conjecture, and I hold it for a certain truth, that the Children are the more strong and robust, and consequently may the more likely live, by how much the nearer they approach to the more natural and perfect time, which is at the end of the 9th. Month.
The Infant then is turned on this manner with his Head downwards towards the later end of the reckoning, to the end only that he may be the better disposed for his easier passage into the World at the time of Labour, which is not then far off: For in this posture [Page 544]all its Joynts are easily extended in coming forth, and the Arms and Legs cannot hinder its birth; because they cannot be bended against the inward orifice of the Womb; and the rest of the Body which is very supple, passeth very easily, after the Head, which is hard and big, being once born.
When there are many Children, they ought, if the Labour be natural, to come in the same figure, as when there is but one: but usually by their different motions they do so incommode one the other, that most commonly one of them presents wrong at the time of Labour, yea, and before; which is the cause that one comes often with the Head, the other with the Feet, or in any other worse posture, and sometimes both come wrong.
But however the Infant may be situated in the Mother's Belly, or whatsoever fashion it be that it presents at the birth, if it be not according to the posture above described, it is always against nature: and the natural situation is so necessary to a good and legitimate Delivery, that those which are against nature, do cause for the most part bad Labours.
CHAP. IV.
What is to be done when a Woman first falls in Labour.
A Woman's Travel is only many Pains with reiterated Throws, by which she endeavours to bring forth her Child. It is so called, because both Mother and Child suffer, and take much pains in this action.
As soon as it is known that the Woman is certainly in Labour, by the signs preceding, and accompanying Labour, before recited; of which the principal are Pains and strong Throws in the Belly, foreing downwards towards the Womb; and dilatation of the inward Orifice, perceived by touching it with the Finger; as also the gathering of the Waters, which come before the Head of the Child, and thrusting down the Membranes which contain them, through which between the pains one may in some manner with the Finger discover the part which presents, especially if it be the Head of the Child, by its roundness and hardness: Then must all things necessary to comfort the Woman in her Labour be got ready; and the better to help her, care must be taken, that she be not strait laced; a pretty strong Clyster may be given [Page 545]her, or more than one, if there be occasion; which must be done at the beginning, and before the Child be too forwards, for afterwards it is very difficult for her to receive them, because the Gut is too much compressed: They serve to excite it to discharge it self of its excrements, that so the Rectum being emptied, there may be more space for the dilatation of the passage; as also to stir up the pains to bear the better downwards, through the endeavours she makes when she is at Stool. And the while all necessary things for her Labour should be put in order, as well for the Woman as the Child, a Midwife's Stool, or rather a Pallet-Bed girted, placed close by the fire, if the season require it; which Pallet ought to be so disengaged, as to be turned round about, the better to help the Woman when there is occasion.
If the Woman be Plethorick, it may be convenient to bleed her a little; for by this means, her Breast being disengaged, and her Respiration free, she will have more strength to bear down her pains, which she may do without danger; because the Child being about that time ready to be born, hath no need of the Mother's Blood for its nourishment, which hath been often practised with good success: Besides, this evacuation often hinders her having a Fever after Delivery. In expectation of which hour she may, walk about her Chamber, if her strength permits; and to preserve her strength, it will be convenient to give some good Gelly Broths, new laid Eggs, or some spoonfuls of burnt or brewed Wine; from time to time, or a Toast dipt in Wine; avoiding at that time solid food. Above all, she must be perswaded to hold out her Pains, bearing them down as much as she can, at the instant when they take her. The Midwife must from time to time touch the inward Orifice with her Finger, to know whether the waters are ready to break, and whether the birth will soon after follow: She must likewise anoint all the Bearing-places with emolientoyls, Hog's grease, or fresh Butter, if she perceive that they can hardly be dilated; and all the while she must be near her Woman, to observe her gestures diligently, her complaints and pains; for by this they guess pretty well how the Labour advanceth.
The Patient may likewise by intervals rest her self on her Bed, for to regain her strength; but not too long, especially little, or short thick Women, for they have always worse Labours if they lye much on their beds in their Travail (and yet much worse of their first Children) than when they are prevailed with to walk about the Chamber, supporting them under their Arms, if necessary; for by this means the weight of the Child (the Woman being on her Legs) causeth the inward orifice of the Womb to dilate sooner than in Bed; and her pains to be stronger and frequenter, that her Labour be nothing near so long.
When the waters of the Child are gathered, which may be perceived through the Membranes, to present themselves to the inward [Page 546]Orifice, of the bigness of the whole dilatation, the Midwise ought to let them break of themselves, and not as some, that are impatient of the long Labour, break them, intending to hasten their business, which on the contrary they retard by so doing, before the Infant be wholly in the passage; for by the too hasty breaking of these waters, which ought to serve him to slide forth with greater facility, he remains dry, which hinders afterwards the Pains and Throws from being so effectual to bring forth the Infant, as else they would have been. It is therefore better to let them break of themselves, and then the Midwife may easily feel the Child bare, by the part which first presents, and so judge certainly whether it comes right, that is, with the Head, which she shall find hard, big, round and equal; but if it be any other part, she will perceive something inequal and rugged, and hard or soft, more or less, according to the part it is.
Immediately after (that being the right time when all Women ought to be delivered, if Nature perform its office) let her hasten to deliver her Woman, if she be not already, and assist the Birth, which ordinarily happens soon after, if natural, and may be done according to the directions in the next Chapter. But if the Child comes wrong, and she be not able to deliver the Woman, as she ought to be, by helping Nature, and so save both Mother and Child, who both are in danger of their Lives, let her send speedily for an expert and dextrous Chirurgeon in the practice, and not delay, as too many of them often do, till it be reduced to extremity.
Assoon then as the waters are broke, and the Midwife finds the Child to come wrong, she must advise the Woman not to forward her pains, lest by bearing down she engage the Child too far in the passage, and so give the Chirurgeon more pains to turn it.
CHAP. V.
Of a natural Labour, and the means of helping a Woman therein, when there is one or more Children.
WE have already taught, that there are four things requisite to a truly legitimate and natural Labour, viz. That it be at the full time. That it be speedy, without any ill accident. That the Child be alive. And that he comes right. All which being found to be so, and after the Waters be broke of themselves, as abovesaid, let the Woman be presently placed on a Pallet-Bed, provided for her to this purpose near the fire; or she may, if she likes it better, be delivered in her ordinary Bed. For all Women are not accustomed to be delivered in the same posture: Some will be on their Knees (which is a dangerous way) as many in Country villages; others standing upright leaning with their Elbows on a pillow upon a Table, or the side of a Bed; and others lying on a Quilt in the midst of the Chamber; but the best and sureft way, is to be delivered in their Bed, to shun the inconvenience and trouble of being carried [...]hither afterwards.
The Bed must be so made, that the Woman being ready to be delivered, should lye on her Back upon it, having her Body in a convenient figure, that is, her Head and Breast a little raised, so that she be neither lying nor sitting; for in this manner she breaths best, and will have more strength to help her pains, than if she were otherwise, or sunk down in her Bed. Being in this posture, she must spread her Thighs abroad, folding her Legs a little towards her Buttocks, somewhat raised by a small pillow underneath, to the end that the Coccyx, or Rump, should have more liberty to retire back, and have her Feet staid against some firm thing; besides this, let her hold some persons with her hands, that she may the better stay her self during her Pains. She being thus placed near the side of her Bed (with her Midwife by, the better to help upon occasion) must take courage, and help her Pains the best she can, bearing them down when they take her, which she may do by holding her breath, and forcing her self, as much as she can, just as when she goes [Page 548]to stool; for by such endeavours, the Diaphragm being strongly thrust downwards doth force down the Womb and Child in it; in the mean time the Midwife must comfort her, and desire her to endure her Labour bravely, putting her in hopes of a speedy Delivery. Some would have another Woman at that time to press the superior parts of her Belly, and so thrust gently the Child downwards; but I am not of their opinion, because such compressions will rather hurt than profit, by endangering the bruising of the Womb, which is extreme sore at that time. But the Midwife may content her self only (having neither Ring nor Bracelet on, and her Hand anointed with Oil or fresh Butter) to dilate gently the inward orifice of the Womb, putting her singers ends into its entry, and stretching them one from the other, when the pains take her, thus endeavoring to forward the Child, and thrusting by little and little the sides of the Orifice, towards the hinder part of the Child's Head, anointing these parts also with fresh Butter, if it be necessary.
When the Infant's Head begins to advance into this inward orifice, 'tis commonly said it is crowned, because it girds and surrounds it, just as a Crown; and when it is so far, that the extremity begins to appear manifestly without the privy parts, it is then said, the Child is in the passage, and the Woman in Travail imagines (althô untruly, and it may be is not so much as touched by her) that her Midwife hurts her with her Fingers, finding her self as it were scratched and pricked with pins in those parts, because of the violent distention, and sometimes laceration, which the bigness of the Child's Head causeth there.
When things are in this posture, the Midwife must seat her self conveniently to receive the Child, which will soon come, and with her fingers ends, her Nails being close pared, endeavour to thrust (as abovesaid) this crowning of the Womb back over the Head of the Child, and as soon as it is advanced as far as the Ears, or thereabouts, she may take hold of the two sides with her two hands, that when the pain comes, she may quickly draw forth the Child, taking care that the Navel-string be not then entangled about the Neck, or any other part, lest thereby the After-burthen be pulled with violence, and possibly the Womb also, to which it is fastned, and so cause Flooding; or else break the string, whereby the Woman may come to be more difficultly delivered. It must also be observed, that the Head be not drawn forth streight, but shaking it a little from one side to the other, that the Shoulders may the sooner and easier take its place, immediately after it be past, which must be done without losing any time, lest the Head being past, the Child be stopt there by the bigness and largeness of the Shoulders, and be in danger of being strangled in the passage: But as soon as the Head is born, if there be need, she may slide in her singers under the Arm-pits, and the rest of the Body will follow without any difficulty.
As soon as the Midwife has in this manner drawn forth the Child, she must put it on one side, left the Blood and Waters, which follow immediately after, should incommode it, or, it may be, choak it, by running into its Mouth or Nose, as it would do, if it were laid on the Back. After which there remains nothing but to free her from the After-burthen, which I will shew how in the next Chapter. But before that, let her be very careful to examine, whether there be no more Children in the Womb; for it happens very often that there are two, and sometimes more, which she may easily know, by the continuance of the pains after the Child is born, and the bigness of the Mother's Belly; besides this, she may be very sure of it, if she puts her hand up the entry of the Womb, and finds there another water gathering, and a Child in it presenting to the passage: If it be so, she must have a care not to go about to fetch the Afterbirth, till the Woman be delivered of all her Children, if she have never so many: For if Twins be fastned to the same Burthen, to which there are fastned as many strings and distinct Membranes, as there are Children; and if one should go to draw it forth as soon as the first is born, the rest would be in danger of their lives, because that part is very necessary to them, while they are in the Womb; and besides, it endangers Flooding. Wherefore the first string must be cut, being first tied with a thread three or four double, as we shall shew more exactly hereafter, and fasten the other end with a string to the Womans Thigh, not so much for fear that the string should enter again into the Womb, as to prevent the inconvenience it may cause to the Woman by hanging between her Thighs; afterwards this Child being removed, they must take care to deliver her of the rest, observing all the same circumstances as was to the first; which being done, it will be then convenient to fetch the Afterbirth, as we shall shew in the following Chapter.
CHAP. VI.
How to fetch the After-burthen.
MOst Animals when they have brought forth their young, cast forth nothing else but some waters, and the Membranes which contained them; but Women have an After-birth, of which after Labour they must be delivered, as of a thing useless and inconvenient: Wherefore as soon as the Child is born, before they do so much as tie or cut the Navel-string, lest the Womb close, they must without losing time, free the Woman from this fleshy mass, which was destined to furnish the Infant with Blood for its nourishment, whilst it was in the Womb, and which at that time is called with much reason the After-birth, because it follows the Child, and is to the Woman like another Birth; for being brought forth, she is perfectly delivered.
To perform this, the Midwife having taken the string, must wind it once or twice about one or two of her Fingers of her left Hand joyned together, the better to hold it, with which the may then draw it moderately, and with the right Hand she may only take a single [...]old of it above the left, near the Privities, drawing likewise with that very gently, resting the while the Fore-Finger of the same hand extended and stretched forth along the string towards the entrance of the Vagina; always observing for the more facility, to draw it from the side where the Burthen cleaves least, for in so doing the rest will separate the better; just as we see a Card, which is glewed to any thing, is better separated from the place where it begins to part, than where it is close joyned.
Above all things, care must be taken, that it be not drawn forth with too much violence, lest by breaking the string near the Burthen, as sometimes happens, you be obliged to put up the whole Hand into the Womb, to deliver the Woman; or that the Womb, to which this Burthen is sometimes very strongly fastned, be not drawn forth with it: As also in drawing it forth with too much violence, there may happen a very great Flooding, which would be of a dangerous consequence: Wherefore for these reasons, it must be carefully shaken, and gently drawn forth by little and little, after the manner we have just now described; and to facilitate the better its expulsion, the Woman may [Page 551]blow strongly the whilst into her Hands shut, just as one would into the mouth of a bottle to know whether it be broke; 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 always down, and holding her breath, as she did to bring forth her Child: All these motions and different agitations produce the same effect, and loosen and expell the After-birth out of the Womb.
When all these circumstances have been observed, if notwithstanding you meet with difficulty, you may, if need be, after that you know on which side the After-birth is situated, command an experienced Nurse-keeper to press the Belly lightly with the flat of her Hand, directing it gently downwards by way of friction, above all, being careful not to do it too boisterously. But if all this be in vain, then must the Hand be directed into the Womb, to loosen and separate it in the manner hereafter-mentioned, where we shew the way how to draw it forth when the string is broke.
As soon as the Woman is delivered of both Child and Burthen, it must then be considered, whether there be all, and care be had that not the least part of it remain behind, not so much as the skirts or any clods of Blood, which ought all to be brought away with the first; for otherwise being retained, they cause gréat pains: All which being done, things fit for Mother and Child in this condition must be provided.
When a Woman has two Children, she must be delivered in the same manner as if she had but one; observing only for the reasons given in the precedent Chapter, not to fetch the Burthen, till the Children be born; and then it may be done without danger, shaking and drawing it always gently, sometimes by one string, sometimes the other, and sometimes by both together, and so by turns till it come, proceeding in it according to the directions already given.
When the Infant comes right and naturally, the Woman is brought to Bed, and delivered with little help, observing what hath been taught in the two last Chapters, of which the meanest Midwives are capable, and oftentimes for want of them, a simple Nurse-keeper may supply that place: But when it is a wrong Labour, there is a greater mystery belongs to it; for then the skill and prudence of a Chirurgeon is for the most part requisite, which we intend now to treat of.
CHAP. VII.
Of laborious and difficult Labours, and those against Nature, their causes and differences, together with the means to remedy them.
FOr the easier and better explaining these things, we say, that there are three sorts of bad Labours; to wit, the painful or laborious; the difficult; and that which is altogether contrary to Nature.
The laborious is a bad Labour, in which the Mother and Child (though it comes right) suffer very much, and are harassed more than ordinary.
The difficulty is not much unlike the first; but besides, it is accompanied with some accident which retards it, and causeth the difficulty: But the wrong Labour, or that against Nature, is caused by the bad situation of the Child, and can never be helped but by manual operation, or the Chirurgeon's Hand. In the laborious and difficult Labours Nature always does the work, being a little assisted: but in that contrary to Nature, all its endeavours are vain and useless, and then there is no help but in an expert Chirurgeon, without whom she must certainly perish.
The difficulties of Labour proceed either from Mother, Child, or both.
From the Mother, by reason of the indisposition of her Body; or it may be from some particular part only, and chiefly the Womb: or also from some strong passion of the Mind, with which she was before possest.
In respect of her Body, either because she may be too young, having the passages too strait, or too old of her first Child; because her parts are too dry, and hard, and cannot be so easily dilated, as happens also to them which are too lean. They who are either small, short, or mishapen, as crooked Women, have not a Breast strong enough to help their pains, and to bear them down; nor those that are weak, whether naturally, or by accident; and crooked persons have sometimes the bones of the passage not well shaped. They that are teuden and too apprehensive of pain, have more trouble than others, because it hinders them from doing their endeavour: And they likewise who have small Pains and slow, or have none at all. Great Colicks hinder Labour also, by preventing the true Pains. All great and acute Diseases make [Page 553]it very troublesome, and of a bad consequence, according to Hippocrates, 3 Aph. Sect. 5. Mulierem gravidam morbo quopiam acuto corripi, lethale. As when she is taken with a violent Fever, great Flooding, frequent Convulsions, Dysentery, or any other great distemper. Excrements retained cause much difficulty, as a Stone in the Bladder, or when it is full of Urine, without being able to void it; or when the great Gut is repleted with hard Ordure, or the Woman troubled with great and painful Piles, and their ill situation sometimes retard it extremely.
As touching the difficulty proceeding from the Womb only, it must be either be from its bad situation or conformation, having its Neck too strait, hard or callous, whether naturally, or by any accident, as having had there a Tumor, Aposteme, Ulcer or superfluous flesh whether on the Neck or inward Orifice; or because of any cicatrice caused by a preceding bad Travail.
Bes [...]les, those things which are or may be contained in the Womb with the Child, do also cause difficult Travail; as when the Membranes are so strong, that they cannot be broken, which sometimes hinders them from advancing into the passage; or so tender, that the waters break too soon, for then the Womb remains dry. When there is a Mole, or the After-burthen comes first, which always causes Flooding, and certainly the death of the Infant, if the Woman be not presently delivered of them by Nature or Art; yea, and when the Navel-string comes first, the Child is suffocated, if not speedily born; strong passions of the Mind do likewise contribute much to it, as fear, sorrow, and others of the like nature. The Woman that miscarries has more pain than a Woman at her full time; as also than one that is hurt, althô she be very near her time.
As to the hindrances caused by the Infant, they are, when either its Head or whole Body are too large, when the Belly is Hydropical; when it is monstrous, having two Heads, or being joyned to another Child, Mole, or any other strange thing; when it is dead, or so weak, that it contributes nothing to its Birth; when it comes wrong, or when there are two or more: besides all these different difficulties of Labour, there is yet one caused by the Midwife's ignorance, who for want of understanding her business, instead of helping, hinders Nature in her work.
Let us now treat of the means, by which all these may be prevented, and the Woman succored in her bad and difficult Labour, as may easily be done, if we perfectly know all these causes and difficulties; as when it happens by the Mother's being too young and too strait, she must be gently treated, and the passages anointed with Oil, Grease, and fresh Butter, using these things a long time before the hour of Labour, to relax and dilate them the easier, lest there should happen a rupture in any part, when the Child is born; for sometimes there happens a dilaceration to the Fundament, by which both are rent into one outwardly. [Page 554]If a Woman be in years of her first Child, let her lower parts be likewise anointed, to mollifie the inward Orifice, and the Vagina or neck of the Womb, which being more hard and callous, do not easily yield to the necessary distension of Labour; which is the cause why such Women are longer in Labour than others, and why their Children (being forced against the inward Orifice of their Womb, which is, as we said, a little callous, and also for remaining long in the passage) are born with great bumps and bruises on their Heads. Small and mis-shapen Women should not be put to Bed, till at least their Waters be broke; but rather kept upright, and walking about the Chamber, if they have strength, being supported under their Arms; for in that manner they will breath more freely, and mend their pains better than on the Bed, where they lye all on a heap. Let those that are very lean, also moisten these parts with Oyls and Ointment, to make them more smooth and slippery, that the Head of the Infant and the Womb be not so compressed and bruised by the hardness of the Mother's Bones, which form the passage.
The weak Woman should be strengthened, the better to support her Pains, giving her good Gelly Broths, with a little Wine and a Tost in it; or other good things, as the case requires.
If she fears the Pains, let her be comforted, assuring her, that she will not endure many more, but be speedily delivered: On the contrary, if her Pains be slow and small, or none at all, they must be provoked by frequent and somewhat strong Clysters, that so they may be excited by strainings at stool; and afterwards let her walk about her Chamber, that the weight of the Child may also help a little. If the Woman Floods, or hath Convulsions (which is by many too long neglected) she must be helped by a speedy delivery. If she be costive, let her use Clysters, which likewise may dissipate a Colick, at those times very troublesome, causing great and useless pains, very hurtful, because they fleet to and again through the Belly, without bearing down, as they should do. If she cannot make water, because the Womb bears too much on the Bladder, let her try, by lifting up her Belly a little, or else by introducing a Catheter into her Bladder to draw forth her Urine.
If the difficulty or flowness of the Labour comes from the ill posture of the Woman, let her be placed in a better, more convenient to her habit and stature. If she be taken with any distemper, she must be treated for it according to its nature, with more caution than at another time, having always regard to her present condition. If it proceed only from the indispositions of the Womb, or from its oblique situation, it must be remedied as well as can be, by the placing of her Body accordingly. If it be by its vitious conformation, having the Neck too hard, and too callous, and too strait, it must be anointed with Oils and Ointments, as above directed.
If it come from a strong Cicatrice, which cannot be mollified, of a preceding Ulcer, or a rupture of a former bad Labour so agglutinated, it must be separated with a fit instrument, lest another Laceration happen in a new place, and leave the Woman in a worse condition than before; it must be made in that place, where the case most requires it; taking care that it be not upwards, because of the Bladder. If the Membranes be so strong, as that the waters do not break in due time, they may be broken with the Fingers, provided the Child be come very forward into the passage, and ready to follow presently after; for otherwise there is danger, that by breaking these waters too soon, the Child will remain dry a long time; and to supply that defect, you must moisten the parts with Fomentations, Decoctions, and emollient Oils; which can never be so well, as when Nature does its own work with the waters and ordinary slime, which always happen well, when they come in time and place.
Sometimes these Membranes with the waters, press three or four Fingers breadth out of the Body before the Child, resembling a Bladder full of water; there is then no great danger to break them, if they be not already; for when it so happens, the Child is always ready to follow, being in the passage; but above all, be careful not to pull it out with your Hand, lest thereby you loosen, before its time, the After-burthen, to which it adheres very strongly. If the Navelstring comes first, it must be presently put up again, and kept up, if possible; or else the Woman must be immediately delivered. But if the After-burthen comes first, it must never be put up again; for being come forth, it is altogether useless to the Infant, and would be but an obstacle and hindrance in the way; if it were put up in this case, it must be cut off, having tied the Navel-string; and afterwards draw forth the Child as soon as may be, lest it be suffocated.
If the Woman has had a fall, or is hurt, let her immediately keep her Bed and take her rest. If it be any passion that retards the Labour, and cannot totally be overcome, let them endeavour to moderate it. If it be shamefacedness or modesty, the persons who are the cause of it must quit the chamber. If it be timidity and fear of pain, she must be advised, that it is the will of GOD it should be so, and that her Labour will not be so bad as she imagines, perswading her to submit to the necessity, pressing on her the consolation of the unfortunate, whose pain always seem more supportable by the consideration that it is common; so she must be informed, that others endure the same pain, and greater than hers. If she be melancholick, let her be diverted by some good news, promising her such a Child as she desires. And in a word (thô she suffer much) she must consider it but as a bad journey, which one quarter of an hours good weather makes one forget all past, as she will, when she is brought to Bed; assuring her chiefly, that she is in no danger, especially when it is [Page 556]not very apparent, for then one ought to acquaint her with it, that she may settle both her temporal and spiritual Affairs.
When the difficulty is only caused by a dead Child, the method mentioned in the natural Labour must be observed; and besides, the Woman must do all she can to further her Delivery, because the Child can do nothing, nor can it when it is very weak. She must take in the-interim some Confortatives to prevent Fainting, because of the putrid Vapors, ascending from the dead Child. But when it has so great a Dropsie, either in the Head or Belly, as that it cannot be born, because of the great distention and bigness of these parts, then we are obliged to open these parts to let out the water. And if it be of an enormous bigness, either Head or Body, or if it hath two Heads, or is joyned to another Child, or to a big Mole, there is a necessity, for to save the Mother, either to dilate the passage proportionable to the bigness of the monstrous Child, if it be possible, or else, which is better, to draw forth the Child by pieces, to prevent the Mothers perishing with the Child, which else would certainly happen, if this course be not taken. And if there be two Children, the Rules given before in that case must be observed. But if the Midwife cannot remedy all these accidents, she must then readily send for an expert Chirurgeon, for his advice, or to do what he thinks fit. Let us now pass to Labours contrary to Nature, which can never be done without manual operation, and shew what is then to be done.
CHAP. VIII.
Of unnatural Labours, where manual Operation is absolutely necessary, and what Observations the Chirurgeon must make, before he goes about it.
THose Labours which absolutely require manual Operation are, when the Child comes wrong. A Child may come wrong four several ways, which are; First, any of the fore-parts of the Body. Secondly, any of the hinder parts. Thirdly, either side. And Fourthly, the Feet. All the particular, and different wrong postures that a Child may present, can be reduced to the above-named four general ways, according as they approach more to one than to any other of them. And as the number of several wrong Births is very great, [Page 557]we shall be contented only to treat of each of the principal of them.
Now the Chirurgeon (to behave himself as he ought) must make some observations, before he undertakes his work. First, whether the Woman has strength enough to endure the operation, which he may guess by the Pulse; if strong or weak, unequal or intermittent. Whether her Face, and chiefly her Eye be dejected, her Speech faint, the extreme parts of her Body cold. Whether she often faints away with cold Sweats, has Convulsions with loss of Sense. In short, if every circumstance perswades, that the operation would be in vain, 'tis better to let it alone, than she should dye under his hand, and he be blamed for it, and incurr the name of Butcher, as is most certain, when such a misfortune happens. However, if there be any hope, thô never so little, either for Mother or Child, we are obliged in Conscience to do what Art commands, and not as some Physicians, who will rather suffer a poor Woman to dye without assistance, than undertake a doubtful operation. Wherefore, 'tis better to attempt an operation of an incertain consequence, than to abandon the sick to certain despair; for sometimes Nature recovers beyond Hope; but before the Chirurgeon undertakes it, let him give his Prognostick, of the great danger of death both Woman and Child is in. When the Woman has strength enough, the Chirurgeon must not delay his help, for fear it abate, or be totally dissipated. To which purpose, being well assured of her strength, he must enquire of the Woman, her Midwise and Friends, whether she be at her full time, or has received any hurt, which he may also perceive by the signs, observing in what posture the Child presents, and what circumstances, whether alive or dead, and but one or more? All which being examined, he must try to perswade the Woman of the impossibility of her being delivered without his help; and to resolve to put her self into his Hands, which he may do by fair words without frighting of her, perswading her that the operation is nothing so painful as she may imagine; and in fine, that for GOD's sake, her own, and her Child's, she is obliged to suffer it; for else she and her Child may both perish.
The Woman being thus resolved, he must place her cross the Bed, that he may operate the easier, she must lye on her Back, with her Hips raised a little higher than her Head, or at least, the Body equally placed, when it is necessary to put back or turn the Infant, to give it a better posture; but if he resolves to draw it forth, he must place the Woman so as we have directed in the natural Labour, which is, with her Head and Breast a little elevated above the rest of her Body, that she may fetch her breath with more facility, and help to the exclusion of the Infant by bearing down, when the Chirurgeon bids her. Being thus situated, she must fold her Legs so as her Heels be towards her Buttocks, and her Thighs spread, and held so by a couple of strong persons. There must be likewise others to support her under [Page 558]her Arms, that her Body may not slide down when the Child is drawn forth, for which sometimes a great strength is required. The Sheet and Blankets must cover her Thighs for decency sake, in respect of the assistants, and also to prevent her catching cold, the Chirurgeon herein governing himself as well with respect to his own convenience, the facility and surety of the operation, as to other things.
Some would have the Woman bound in this posture, that (as they say) she being more firm and stable, the work may be done with greater certainty: but Ligatures are so far from that, that on the contrary they are very prejudicial; for the Woman being so fixt, and constrained as on a Rock, she cannot raise her self, nor slide down, or be lifted up, when the Chirurgeon finds occasion for it, to render his operation less difficult, which usually he does by partly putting back, partly drawing forth, sometimes directly, sometimes obliquely, for which reason her Body ought to be at liberty, only held in a posture to these several Intentions by her Friends, according to his direction. But if she must needs be bound, let it be with good reasons to perswade her patiently to endure her Labour, and to contribute her whole strength to the operation, promising her the speediest Delivery possible.
Let the Chirurgeon then anoint the entrance of the Womb with Oil or fresh Butter, if it be necessary, that so he may with more ease introduce his Hand, which must likewise be anointed, having the conditions above-specified. After which he must manage his operations, after the manner I shall direct in each of the following Chapters; having first recited the marks by which it may be known, whether the Child be alive or dead.
CHAP. IX.
The signs to know whether the Child be alive or dead.
IF there be any case, wherein a Chirurgeon ought to make the greatest reflection, and use most precaution in his Art, it is this, to know whether the Infant in the Womb be allve or dead; for there have been many deplorable examples of Children being drawn forth alive, after they have been thought to have been dead, with both Arms, or some other Limb lopt off, and others miserably killed by the use of Crochets, which might have been born alive, if they had not been mistaken. Wherefore, before he resolve on the manner of laying the Woman, to avoid the like misfortune, and the disgrace of being Author of such a pitiful spectacle, let him use his utmost endeavour not to be so deceived, and to be fully satisfied whether the Child be alive or dead; always remembring that in this case, timidity is more pardonable than temerity, that is, it is better to be deceived in treating a dead Infant, as if it were alive; than a living one as if it were dead.
The Child may be known to be alive, if it be at the full reckoning; if the Woman has received no hurt; if she has had her health well all her going with Child; if she be at present in good health, and very sure she feels it stir, which may be known by the Mother's relation: and the Chirurgeon may be better assured of it, if he feels it stir himself, laying his Hand on the Mother's Belly; to whose relation he must not always trust. If the Chirurgeon cannot be assured by the Infant's motion that it is alive, he may assoon as the waters are broke, gently put up his Hand into the Womb, to feel the pulsation of the Navel-string, which he will find stronger, the nearer he feels it to the Infant's Belly; or if he meets with a Hand he may feel the Pulse, but there pulsation is not so strong as in the Navelstring, by which it is best to be known. If then he finds thus the beating of the Pulse, he may be confident the Child is alive; as also if by putting his Finger into its Mouth, he perceives it to stir its Tongue, as if it would suck.
But on the contrary, the Child is dead, if it has not a long time stirred; if there flows from the Womb stinking and cadaverous Humors; if the Woman feels great pains, and a great weight in her Belly; if it be not supported, but tumbles always on that side as [Page 560]she lays her self; if she faints, or has Convulsions; if the Navelstring or Secundine has been a good while in the World; or if by putting his Hand into the Womb, he finds the Child cold, and the Navel-string without Pulse, and its Tongue immoveable; and feeling the Head, he finds it very soft, chiefly towards the Crown, where likewise the Bones are open, and riding the one upon the other at the Sutures, because the Brain shrinks, and is without Pulse when the Child is dead; which corrupts more in two days in the Womb, than it does in two days after it is born; which the heat and moistness of the place do cause, the two principles of corruption.
But we may only conjecture it, if the Woman has been hurt, or floods much, and be not at her full time; if her water broke four or five days before; if her Breasts flag; if her Complexion be of a Lead colour, her Countenance languishing and dejected; and if her breath stinks. We say that these things may only make us conjecture it, but not, as the rest, certainly conclude it; many of which hapning together in one person, assure us that the Child is dead, for want of which it cannot be very certain. Wherefore (as I have said) 'tis good to be very careful before they undertake it, that so they may avoid the abovesaid scandals.
CHAP. X.
How to fetch the After-burthen when the string is broke.
WE have placed the present way of extracting the After-birth amongst unnatural Deliveries, because 'tis not sufficient to esteem it a good Labour, that the Child be well born, unless also the After-birth be well come away. In respect of the Child it may be called Natural; because after his Birth he has no more need of his Burthen; but in respect of the Woman it is very unnatural. I would therefore first treat of this bad Labour; because it participates of a natural Labour, in respect of the Child, who is in no danger, being born. After that I will come to those in which both Mother and Child are in very great danger, if not specdily and skilfully helped.
I have already shewed, how a Woman must be delivered in a natural Labour, where you may find [Page 561]the means; but sometimes the Midwife by endeavouring it, breaks the string with pulling too strongly; or because it is very weak; or else so putrefied, when the Child is dead, that the least pull breaks it off close to the Burthen, which by that means is left behind in the Womb; or because it cleaves too strongly; or the Woman is weak and cannot expell it, being much tired by a long Labour; or because it was not speedily after Labour drawn forth, the Womb closes so as leaves it no passage, nor can it without much difficulty be again dilated to have it setch'd, because it remains dry, after the natural slime and humidities, which usually flow in Labours, are sometimes past.
Since it is a verity indubitable, that the After-birth remaining behind after the Child is born, becomes an useless mass, capable of destroying the Woman, we must take care that it be never lest, if possible. Wherefore having endeavoured to bring it away, and the Navel-string happening to break near the Burthen, you must immediately before the Womb closes, introduce your Hand into it, being well anointed with Oil or fresh Butter, your Nails close pared, to separate it from the Womb gently, and draw it forth together with the clods of Blood that are there. When the Navel-string is not broken, it will easily conduct the Hand, by following of it to the place where the Burthen is situated; but when it is broken, we have no longer this guide; wherefore you must be then very careful, that you be not deceived in taking one part for another.
As soon then as you have introduced your Hand into the Womb towards its bottom, you will find the Burthen; which you may know by a great number of little inequalities, which are always made there by the roots of the umbilical vessels, on the side where they terminate, which make it to be easily distinguished from the Womb; if it yet cleave to it, notwithstanding that it is then a little wrinkled and uneven; because its Membranes, which were very much enlarged, contract themselves immediately after the Child and its waters, which kept them extended, are excluded: But they that are expert in this Art, can easily judge of it. If you find the Burthen wholly loosened from the Womb, it will not be difficult to draw it forth, when you have got it in your Hand: But if it cleaves, find out the side where it sticks fast, and begin there to separate it gently, by putting some of your Fingers between it and the Womb, continuing by little and little to do so, till it be quite loose; and afterwards draw it out very carefully; observing always (if it cannot be otherwise) rather to leave some part of it behind, than to scrape or scratch the least part of the Womb, for fear of a Flooding, Inflammation, or Gangrene, which cause death; being also careful not to draw it forth, till it be wholly or the most part of it separated, for fear of drawing forth the Womb with it; And preserve it as whole as the circumstances will permit, because of shewing it to the company, that they may know the operation is well done.
When the Chir [...]geon finds not [Page 562]the Womb open enough for to receive his Hand immediately into it, let him presently anoint all the Womans Privities with Hogsgrease, that they may be dilated with more ease; afterwards let him by little and listle put up his Hand, but without much violence. The Woman may likewise contribute to this dilatation, as also to the exclusion of the Burthen, if she bears strongly down, holding her breath, and exciting her self to vomit, or snceze, and do those other things before directed: But if notwithstanding all this she cannot void the After-birth, and if the Womb cannot be dilated enough to fetch [...]t, or that it cleaves so fast, as it cannot be separated, we must leave it to Nature, assisting her with remedies which suppurate; Wherefore injections into the Womb are proper, made of Mallows, Marshmallows, Parietary, and Linseed, in which is mixed a good quantity of Oil of Lilies, or fresh Butter. This Injection softens and tempers, and by moistning and mollifying, makes the O [...]sice to be the easier dilated; and helps by suppuration the loosening of the Burthen. And to hasten the expulsion of it, give her a strong Clyster, that so by the motions to go to stool, it may cause the voiding of it; as it has succeeded with many, who have rendred it in the Bed-pan, and sometimes when they have least expected it.
CHAP. XI.
To deliver a Woman when the Child comes footling.
MOst Authors advise, when the Foot, or Feet come first, to change the figure, and place the Head so, as it may present first to the birth; but if they would shew how it should be done, we might follow their Counsel; which is very difficult, if not impossible to be performed, if we desire to avoid the dangers that by such violent endeavors the Mother and Child must necessarily be put in: Wherefore 'tis better to draw it forth by the Feet, when it comes footling, than to venture a worse accident by turning it.
As soon then as the waters are broke, and 'tis known the Child comes thus, and the Womb is open enough to admit the Chirurgeon's Hand into it, or else by anointing the passages with Oil or Hogs-grease, to endeavor to dilate it by little and little, using to this purpose his Fingers, spreading them one from the other after [Page 563]they are together entred, and continuing so to do, till it be sufficiently dilated; then, having his nails well pared, and no Rings on his Fingers, his Hands well anointed with Oyl or fresh Butter, as also the Woman placed as we have already directed, let him introduce his Hand, into the entry of the Womb, where finding the Child's Feet, let him draw it forth in that posture as we shall now direct: But if it presents but one Foot, he should consider, whether the right or lest, and in what fashion it comes; for these reflexions will easily inform him, on what side the other may be, which as soon as he knows let him seek it, and gently draw it forth together with the first: But let him be very careful, that this Second be not the Foot of another Child; for if so, he may sooner split both Mother and Children, than draw them forth; which may easily be prevented, if having slided his Hand up the first Leg and Thigh to the twist, he finds both Thighs joyned together, and depending from one and the same Body: which is likewise the best means to find the other Foot, when it comes but with one.
All Authors, for fear of losing hold of the first Foot, advise to fasten a Ribband to it with a running knot, that so it may not be sought a second time, when the other is found: but that is not absolutely necessary, because usually when one has hold of one, the other is not far off. They that will may use this precaution; but such as are expert, use it but seldom.
As soon then as the Chirurgeon has found both the Child's Feet, he may draw them forth, holding them together, he may bring them by little and little in this manner, taking afterwards hold of the Legs and Thighs, as soon as he can come at them, and drawing them so till the Hips be come forth: the whilst let him observe to wrap the parts in a single Napkin, to the end, that his Hands being already greasie, slide not on the Infant's Body, which is very slippery, because of the viscous Humors, which are all over it, and hinder that one cannot take good hold of it; which being done, he may take hold under the Hips so to draw it forth, to the beginning of the Breast, and then let him on both sides with his Hand bring down the Arms along the Child's Body, which he may then easily find, and be careful that the Belly and Face be downwards, lest being upwards, the Head be stopt by the Chin over the Share-bone; wherefore if it be not so, he must turn it to that posture; which is easily done, if taking hold on the Body, when the Breast and Arms are forth, in the manner we have said, he draws it, with turning it in proportion, on that side which it most inclines to, till it be as it should be, that is, with the Face downwards; and having brought it to the Shoulders, let him lose no time (desiring the Woman at the same time to bear down) that so in drawing, the Head at that instant may take its place, and not be stopt in the passage. Some Authors, to prevent this inconvenience, advise that one Arm only should be drawn forth, and the other left to prevent the closing of the Womb [Page 564]on the neck of the Child: this reason is plausible, yet if the Chirurgeon knows how to watch his opportunity, he will not need this shift to prevent this accident, which may sooner happen when one Arm is left above; for besides that by its bigness it would take up so much place, which is already too little, causing the Head to lean more on one side than the other, it will stop it certainly on that side where there is no Arm.
There are indeed some Children that have their Head so big, that when the whole Body is born, yet that stops in the passage, notwithstanding all the care to prevent it: In this case he must not endeavor only to draw forth the Child by the Shoulders, lest he sometimes separates the Body from the Head, but he must disengage it by little and little, from the bones in the passage, with the Fingers of each Hand, sliding them on each side opposite the one to the other, sometimes above and sometimes under, until the work be ended, endeavouring to dispateh it as soon as possible, lest the Child be suffocated; as it will certainly be, if it should remain long in that posture; which being well and duly effected, he may soon after fetch the After-birth, as above directed.
CHAP. XII.
How to fetch the Head, when separated from the Body, and it remains behind in the Womb.
NOtwithstanding all the care possible had in the fetching a Child by the Feet; yet sometimes one meets them so putrefied and corrupted, that with the least pull the Body separates from the Head, which remains alone in the Womb, and cannot be extracted, but with difficulty, forasmuch as it is extremely slippery, by reason of the place where it is, and of a round figure, on which no hold can be taken.
When then the Infant's Head, separated from, its body, remains alone behind, whether because of putrefaction or otherwise, let the Chirurgeon immediately without delay, whilst the Womb is yet open, direct up his right Hand to find the Mouth of this Head (for then there is no other hold) and having found it, let him put one or two of his Fingers into it, and his Thumb under the Chin, and then by little and little let him draw it, holding it so by the jaw; but if that fails, as it often will when putrefied, then let him pull forth his right Hand, and slide up [Page 565]his Lest, with which he must support the Head, and with the right let him take a narrow crotchet, but strong, and with a single branch, which he must guide along the inside of his other Hand, keeping the point of it towards it, for fear of hurting the Womb, and having thus introduced it, let him turn it towards the Head, for to strike it into either an Eye-hole, or the hole of an Ear, or behind the Head, or else between the Sutures, as he finds it most easie and convenient, and then draw forth the Head so fastned with the crotchet, still helping to conduct it with his left Hand; but when he hath brought it near the passage, being strongly fastned to the crotchet, let him remember to draw forth his Hand, that the passage being not filled with it, may be the larger and easier, keeping still a Finger or two on the side of the Head, the better to disengage it.
You may try for the same purpose an expedient (which came lately into my Mind) by which, without doubt, one may effect this painful and laborious operation, without tormenting the Woman so much as she is, when either the crotchet or crooked knife are used; which is a soft fillet, or linen slip, of the breadth of four Fingers, and the length of three quarters of an Ell, or thereabouts; then taking the two ends with the left Hand, and the middle with the right, let him so put it up with the right, as that it may be beyond the Head to embrace it, as a sling doth a stone, and afterwards drawing the Fillet by the two ends together, it will easily be drawn forth, the fillet not hindring in the least the passage, because it takes up little or no place.
But if the Chirurgeon cannot by either of these different means draw forth the Head, because 'tis too blg, he will be necessitated (if he will finish his work) to lessen it with a crooked knife. For to do this, let him slide up his left Hand into the Womb, and with his right guide up the knife, always observing that the point be turned towards the inside of the left Hand, for fear of hurting the Womb; and afterwards let him turn it to the Suture of the Head, and chiefly the Crown, where he must make the incision with this instrument, that having separated some pieces, he may the easier draw forth the Head, or at least having emptied some part of the Brain, by the orifice so made, the bigness of the Head will be much diminished by it, and consequently the extraction of it less painful.
The left Hand, being thus in the Womb, will be very useful to help, striking the knife into the Head, for to divide and separate its parts, as the Chirurgeon judges necessary; as also to hinder (by inadvertency) the Womb's receiving hurt; and the right without, for to hold the handle of this instrument, which therefore must be long enough, and will serve him to move and guide it on which side he pleases, in turning, thrusting, drawing, or slanting it, as the case requires. Ambrose Parey, and Gu [...]ltemeau, would have this knise to be so short, as to be hid in the right Hand, for to do the operation, after it is so introduced into the [Page 566]Womb; but it is certain, that when it is filled with a monstrous Child, or a Hend as abovesaid, the Chirurgeon's Hand will be so pressed in the Womb, that it will be very difficult for him to use it skilfully with one Hand alone, and do no violence to the Womb; which is the reason why this instrument ought to have a long handle, that being introduced into the Womb, it may be conducted to do the operation with the left Hand within, as we have mentioned, and governed by the right Hand which holds the handle of it without, which ought to be as long as the handle of an ordinary crotchet.
Now when the Head is thus fetcht out of the Womb, care must be taken, that not the least part of it be left behind, as also to cleanse the Woman well of her After-birth, if yet remaining. But a question of great consequence, and much to the purpose, may be here started, Whether the Child's Head yet remaining so in the Womb, and the Burthen also, the Head ought to be extracted before the Burthen? To which may be answered with distinction, That if the burthen be wholly separated from the sides of the Womb, it ought to be first brought away, because it may hinder the taking hold of the Head; but if it be still adhering, it must not be medled with, till the Head be brought away: For if one should then go about to separate it from the Womb, it would cause a Flooding, which would be augmented by the violence of the operation; for the vessels to which it is joyned, remain for the most part open, as long as the Womb is distended, which the Head causes whilst it is retained in it, and cannot close till this strange Body be voided. Besides, the After-birth remaining thus cleaving to the Womb, during the operation, prevents it from receiving easily either bruise or hurt.
CHAP. XIII.
How to help a Woman in her Labour, when the Child's Head thrusts the neck of the Womb forth before it.
IF we only respect the figure the Child comes in in this Labour, we may say it is natural: but when we consider the disposition of the Womb, which is in dauger of coming quite forth of the passage; or the extraction of the Infant, we shall find it not so altogether: for its Head thrusting it forcibly before it, may easily cause a falling out of the Womb, if the Woman be not skilfully succored in time. Here may be seen the Vagina, or neck of the Womb bear forth in great wrinkles, according as the Child advances.
Women troubled with a bearing down of the Womb before they conceive, and whose Womb is very moist, are much subject to this accident, because of a relaxation of the Ligamonts. The same method we have taught in the natural Travail must not now be observed; for in this case the Woman must neither walk, nor stand upright; but keep her Bed, with her Body at least equally situated, and not raised a little, as is requisite in a natural Labour. She must by no means use strong or sharp Clysters, lest they excite to great Throws; neither so much humect the Womb, which is already too much relaxed: but to aid her at the moment each pain takes her, when the Child begins to advance its Head, and consequently tho neck of the Womb, let the Midwife keep her Hands on each side of the Head, to thrust back by resisting the Womans pains, the Womb only giving way in the mean time for the Child to advance, doing the like at every Throw, continuing it till the Woman of her self has forced the Child quite into the World: for one must by no means draw it by the Head, as is meationed in the natural Labour, for fear of causing the Womb to fall out at the same time, to which it is then very apt.
If notwithstanding the Infant having the Head born, it yet stops there so long as to endanger its suffocation; then the Midwife must call a second person to her assistance, to draw it gently forth by the Head, whilst she keeps back the Womb with both her Hands, to prevent its following the Infant's [Page 568]Body so drawn forth. After the Woman is thus delivered, her After-birth must be fetch'd as is above directed, being still careful for the same reason, not to shake or draw it forth too rudely, and then let it be placed up in its natural situation, if it bears down.
CHAP. XIV.
How to fetch a Child, when coming right it cannot pass, either because it is too big, or the passages cannot be sufficiently dilated.
THere are some Women, whose Children (notwithstanding they come right) remain sometimes four, five, and six whole days in the passage, and would continue there longer, if they were left alone, without being able to be born, unless assisted by Art; to which we are obliged, if we desire to have the Mother's life. This happens oftnest to little Women of their first Children, and chiefly, if a little too much in years; because their Womb being very dry, cannot be so easily dilated, as others, who already have had Children, or are not so old. When this happens, after that the Chirurgeon hath done his endeavour to relaxe and dilate the parts, to facilitate the Child's birth, and that he finds all in vain, because the Head is much bigger than it should be, and that besides it is certainly dead (as it for the most part is, when it hath continued four or five days in this condition, after the waters are broke) which he may be more exactly assured of by the signs already described: He need then make no scruple to fasten a Crotchet to some part of the Child's Head, and rather about the hinder part than any other, to draw it forth by this means directly, if possible; if not, let him make an incision with a streight or little crooked knife, which is best, about the Sutures, to empty thence some of the Brain, and so lessen the blgness of the Head, and immediately after fix his crotchet fast to the Skull in the same place, whereby he will easily extract the Infant.
It is very certain when the Child is dead, one ought to do according to my direction, to save the Mother's life: But it is a very great question, Whether a live Child ought to be so dealt with to save the Mother's life, after there is no more hope that it can be born any other ways, because of the narrowness [Page 569]of the passage, which cannot possibly be sufficiently dilated for its birth; or, Whether one ought to defer the operation, until there is a perfect assurance that 'tis dead? In this case I am apt to believe, that, since the Infant cannot avoid death, neither one way nor the other (for staying in the passage, without being able to be born, it must dye, and being drawn forth by crotchets, it is killed) one must and ought to fetch it out alive or dead, as soon as there is opportunity to do it; and when all hope is lost that it cannot come any other ways, thereby to prevent the Mother's death, which could by no other means be avoided. Tertullian (as Riolanus very well notes in his 38th Chapter of the 12th Book of his Anatomical Manual) says upon this subject, ‘That it is a necessary cruelty, to kill the Child in this case, rather than to save it from the danger it is in of dying, and so certainly cause the Mother's death.’ Notwithstanding, this must not always be put in practice by the Chirurgeon, but in such an extremity; and then he may do the work as dextrously as he can.
CHAP. XV.
How to deliver a Woman when the Child presents the side of the Head to the Birth, or the Face.
WHen the Child presents the side of the Head, thô it seems a natural Labour, because the Head comes first, yet 'tis very dangerous both to Child and Mother, for he shall sooner break his Neck, than e're be born in that fashion; and by how much the Mother's Pains continue to bear him (which is impossible, unless the Head be first right placed) the more the passages are stopt up. Therefore as soon as it is known, the Woman must be laid with all speed, lest the Child advancing further in this vitious posture, it prove more difficult to thrust him back, which must be done when we would place the Head right in the passage, as it truly and naturally should be.
For to effect this, place the Woman that her Hips be a little higher than her Head and Shoulders, causing her to lean a little upon the opposite side to the Child's ill posture, then let the Chirurgeon slide up his Hand, well anointed with Oil, by the side of the Child's Head, to bring it right, [Page 570]gently with his Fingers between the Head and the Womb: but if the Head be so engaged, that it cannot be easily done that way, he must then put his Hand up to its Shoulder, that so by thrusting them back a little in the Womb, sometimes on the one side, and sometimes the other, as he sees occasion, he may give it a natural and convenient position.
It were to be wished that the Chirurgeon could put back the Infant by the Shoulders with both his Hands in this manner; but the Head does then take up so much room, that he has much ado to introduce but one, with which he must do his operation, with the help of his Fingers ends of the other Hand put up as far as necessary. Afterwards let him excite and procure the Child's birth, as directed in the natural Labour.
At other times a Child comes with the Face first, having its Head turned back, in which posture it is very difficult it should be born: And if it remain so long, the Face will be so black and blue, and swelled, that at first sight it will appear monstrous; which comes as well by the compression of it in that place, as by the Midwife's Fingers handling of it too rudely, when she would place it in a better posture.
Now to deliver this Birth, the same manner, as when a Child comes with the side of the Head, must be observed, being careful to work gently, to avoid as much as may be the bruising of the Child.
CHAP. XVI.
How to deliver a Woman when the Head of the Child is born, and the Womb closes about the Neck.
THe Child comes naturally with the Head first, because that by the hardness and bigness of it, the passage might be the better made and opened for the other parts of the Body, which usually pass afterwards without pain: but notwithstanding sometimes the Head is so small, and the Shoulders so large, that without a very great difficulty they cannot pass; which makes the Child often remain in the passage after the Head is born. This accident may likewisehappen sometimes, having not been careful, but losing time in drawing forth the Child by the Head, as directed in the discourse of natural Labours, to the end the Shoulders might at the same instant [Page 571]succeed in the place the Head possest.
When the Chirurgeon meets with this case, he must speedily deliver the Child out of this prison, or rather this collar, in which he is caught; for a small delay may there strangle the Child: to avoid which, let him endeavour to cause the Shoulders to follow, by gently drawing its Head sometimes by the sides of it, sometimes with the Hand under the Chin, the other behind the Head, and so doing by turns on the one side and the other, to facilitate the operation the better, being very careful the Navelstring be not entangled about the Neck; as also not to draw it forth with too much violence, for fear lest the Head be pulled from the Shoulders. If the Shoulders pass not with gentle pulling, slide up your Fingers on both sides under the Arm-pits, with which turning them inwards, you may by little and little draw forth the Shoulders; but when they are in the palsage, and totally disengaged, if he cannot then draw the rest forth, still keeping his Fingers under the Arm-pits, he may be confident there is some other hindrance, and that it is certainly monstrous in some part of its Body; or (as it for the most part happens in this case) that it is hydropical in the Belly, for which cause it is impossible it should be born, before the Belly be pierced to evacuate the waters, and then 'twill easily be accomplished.
CHAP. XVII.
How to Deliver a Woman, when the Child comes with one or both Hands together with the Head.
FOr the most part when an Infant presents any part of his Body together with the Head, it is usually one or both the Hands, rather than any other, which hinders its birth; because the Hands take up part of the passage, and for the most part they cause the Head to lean on one side. When the Child comes thus, it is quite contrary to Nature.
To remedy this, so soon as it is perceived that one Hand presents together with the Head, it must be prevented from coming down more, or engaging further in the passage. Wherefore the Chirurgeon having placed the Woman on the Bed, with her Head a little lower than her Hips, must put and guide back the Infant's Hand with his Hand as much as may be; [Page 572]or both of them, if they both come down, to give way to the Child's Head; which having done, if the Child's Head be on one side, it must be brought into its natural posture in the middle of the passage, that it may come in a streight line, proceeding farther, as I have directed before, in that Chapter which treats of the Child's Head coming on one side.
CHAP. XVIII.
How to deliver a Woman when a Child presents one or both Hands foremost, without any other part.
WHen an Infant presents only one or both Hands to the Birth, or an Arm sometimes out to the Elbow, and many times to the Shoulder, it is one of the worst and most dangerous postures a Child can come in, as well for himself as for his Mother; because of the violent force the Chirurgeon is oftentimes obliged to use both to the one and the other, in searching for the Feet, which are very far off, by which he must always in these cases, turn and draw him forth; which will often make him sweat in the midst of Winter, because of the difficulty in this Labour more than in all the rest, thô some others of them indeed are more dangerous for the Infant; as when it presents the Belly, and the Navel-string comes forth; but not so painful for the Chirurgeon, because the Feet of the Infant being near the passage, and not so hard to be found, as when he comes with a Hand; for then they are high, at the very bottom sometimes of the Womb, where he must seek them, to turn it and draw it forth, as I am going to direct.
When therefore it presents with one Hand only, or a whole Arm first; it must by no means be pulled forth by that part; for the Member will sooner be separated and rent from the Body, than the Child so brought forth, by reason the Child is pluckt obliquely and cross. And when both Arms present, if pluckt together, there would not be place for the Head to pass, which would by that means be turned quite back. Wherefore having placed the Woman as is tequisite, one must put back the Infant's Hand or Arm, which comes forth into into the Womb again. Some Midwives dip it in cold water, or touch it with a wet cloth, saying that the Infant will presently [Page 573]draw it in, if he be living; but he is usually so prest and engaged in the passage by this bad posture, that he has not liberty enough to draw back his Hands so easily, being once come forth; wherefore the Chirurgeon must guide them back with his own, which he must afterwards slide into the Womb under the Child's Breast and Belly, so far till he finds the Feet, which he must gently pull towards him, to turn and draw it forth by them, as hath been already directed; observing to do it with as little violence as may be, which is much more easy, sure and safe, than to busie ones self in putting it into a natural situation.
As foon as he shall have so turned the Child by the Feet, if he has but one of them, he must search for the other, that so he may bring it to the first; when holding them both, he must govern himself afterwards in bringing the Child, as I have shewed formerly, speaking of those Labours where the Feet come first: But if the Arm be so far advanced (almost to the Shoulder) and big and swelled (as it happens when it hath been a long time forth) that it cannot at all, or without great difficulty be reduced, Ambrose Parey in this case directs (provided the Child be certainly dead) to cut off that Arm as high as may be, first making an incision round the flesh, and then cutting off the Bone a little higher, with a pair of sharp pincers, that so the flesh may be left longer to cover the sharpness and end of the Bone, to prevent hurting the Womb, when the Child is turned, to draw it afterwards forth by the Feet as it should be.
Notwithstanding if the Chirurgeon, not being able to put it back, is absolutely constrained to cut it off (which must not be done but in such extremity) he may effect it without much ceremony, by twisting it twice or thrice about; for by reason of its tenderness he will easily separate it from the Body, in the joynt of the Shoulder, with the Shoulder-blade, by which means he will neither need Pincers nor other instruments to cut the Bone and Flesh, as the said Parey teaches, neither will there remain any sharpness, by reason the separation will be just in the joynt.
But above all, when the dismembring of an Infant is thus intended, or to draw it forth with a Crotchet, let the Chirurgeon take great care that he be not deceived; for what a horrible spectacle would it be, to bring a poor Child yet living, after the Arm has been cut off, or any other part of the Body? Wherefore let him make a double reflexion on his work, before he goes about it.
CHAP. XIX.
How to deliver a Woman when Hands and Feet come together.
IF the Infant presents both Hands and Feet together at the Birth, it is altogether impossible it should be born so. The Chirurgeon therefore guiding his Hand towards the orifice of the Womb, will perceive nothing but a many singers close together; and if it be not sufficiently dilated, he will be a good while before he can exactly distinguish between the Hands and the Feet, by reason they are sometimes so shut and prest together, that they seem to be all of one and the same shape: But when the Womb is open enough to introduce the Hand into it, he will easily know which are the Hands and which the Feet; and having well taken notice of it, let him slide his Hand, and presontly direct it towards the Infant's Breast, which he will find very near, and by that let him gently thrust back the Body towards the bottom of the Womb, leaving the Feet in the same place where he found them; having therefore placed the Woman in a convenient posture, that is, her Hips a little raised above her Breast and Head, which situation ought always to be observed, when the Child is to be put back into the Womb: Let him afterwards take hold of him by the Feet, and draw him forth, according to the way directed in its proper Chapter.
This Labour truly is a little troublesome, but nothing near so much as that we have mentioned in the preceding Chapter, where the Child presents only his Hands: for in that the [...]eet must be searched a great way off, and it must be quite [...]ned about, before it can he drawn forth; but in this they are ready presenting themselves, and there is not so much to do, but to lift and thrust back a little the upper part of the Body, which is almost done of it self, by drawing it alone by the Feet.
Some Authors who have written of Labours, and never practised them, do order all by the same precept often reiterated, that is, to reduce all wrong Births to a natural Figure; which is, to turn it, that it may come with the Head first: But if they themselves had ever had the least experience, they would know that it is very often impossible, at least, if it were to be done by the excess of violence, [Page 575]that must necessarily be used to effect it, it would go near to destroy both Mother and Child in the operation. A Fiat in this case is soon said and ordered; but it is not so easily executed as pronounced. For my part, I am of an opinion clear contrary to theirs; and such as are skilful in the Art will surely agree with me in it, that is, That (whensoever the Infant comes wrong in what posture soever from the Shoulders to the Feet) it is the best way and soonest done, to draw it forth by the Feet, searching for them, if they do not present themselves, rather than to try to put it in a natural posture, and place the Head foremost: for the great endeavors often necessary to be used in turning the Infant in the Womb, do so weaken both Mother and Child, that there remains not afterwards strength enough for to commit the operation to the work of Nature; and usually the Woman has no more Throws nor Halns fit for Labour after she has been so wrought upon; for which cause it would be very tedious and difficult; as also the Infant, which is already very weak, would certainly perish in the passage, without being able to be born. Wherefore it is much better in these cases, immediately to setch it by the Feet, searching for them, as I have already directed, when they do not present themselves, by which a tedious Labour will be prevented to the Mother, and the Child will be often brought alive, who without it will scarce escape death, before he can he brought forth by the strength of Nature.
CHAP. XX.
How to deliver a Woman, when the Child comes with the Knees.
WHen an Infant (not being turned towards the latter Months, as he ought, to come with his Head foremost) presents the Knees to the Birth, having the Legs folded towards the Buttocks, one may easily be deceived, touching but one of them, because of their hardness and roundness, and take it for the Head, especially when being seated a little high, it can be reached but with the end of a Finger only; but if it be touched and handled a little better, the Infant being fallen a little lower, it will easily be distinguished.
As soon then as it is perceived, [Page 576]it must not be suffered to advance further in this posture; having placed the Woman, the Knees must gently be put back, to have the more liberty to unfold the Legs one after the other, which the Chirurgeon may do, by putting one or two of his Fingers under the Ham, directing them by little and little all along behind the Leg, until he meets the Foot; and drawing always a little obliquely, to come the easier to the end of it, that so having disengaged one, he may do the same to the other, proceeding in the same manner as with the first; after which, having brought them together, he may finish the work, as when a Child comes footling; always observing to bring the Face of it downward, and such circumstances as are noted where we treat of that Labour.
CHAP. XXI.
Of a Delivery when the Child comes with Shoulders, Back or Breast.
THe most difficult of these three sort of Figures and Situations, in which Infants sometimes come, is that of the Shoulders; because it is furthest from the Feet of the Infant, and the Chirurgeon must find them to draw it forth. The next the Back. And the Breech for the same reason, causes least trouble, not only because the Feet are nearer, but also because by this Figure, the Head and Neck of the Infant are not so constrained and lockt, as in the other situations.
For to remedy this birth of the Shoulder, some advise that it should be put back, to make way for the Head of the Infant, that so it may be reduced to a natural birth: but it is much better for the reasons above alledged, to try to bring it by the Feet: to effect which, the Chirurgeon must thrust the Shoulder a little back with his Hand, that so he may have more liberty to introduce it into the Womb, and sliding it then along the Child's Body, either by the Belly or Side, as he finds it easiest, he shall fetch the Feet, and turning it bring them to the passage, and so deliver the Woman, as is already directed.
If it be the Back which presents to the birth, it is also impossible to be born in that posture, what pains soever the Mother endures; and besides, the Child having the Body folded inwards, and [Page 577]almost double, his Breast and Belly are so prest together, that he usually wants little of being suffocated: to avoid which, the Chirurgeon must quickly slide up his Hand along the Back towards the inferior parts, until he meets the Feet, to bring it forth the same way as if it came footling.
But when the Child comes with the Breech, if it be small and the Mother big, having the passage very large, he may sometimes with a little help be born so; for thô he comes double, yet the Thighs being folded towards the Belly, which is soft and gives way, it passes without much trouble. As soon as the Chirurgeon finds the Child to come with the Buttocks foremost, he must not permit it to engage lower in the passage; for it will not come, unless it be very small, and the passage very large, as we have already said. This being then in good time perceived, he must, if he can, thrust back the Breech, 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 Womb, by folding, stretching, wagging, and drawing them gently towards the Side, 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.
I have said that the Chirurgeon, perceiving the Child to come with the Breech foremost, ought to put it back if he can; for sometimes he will be advanced so forward in the passage, that you may sooner destroy both Mother and Child, than reduce it back, when once strongly engaged. When this happens, he cannot hinder it from coming in this posture, in which his Belly is so prest, that he often voids the Meconium by his Fundament. However, he may much help this birth, by sliding up one or two Fingers of each Hand on each side of the Buttocks, to introduce them into the Groins, and having crooked them inward, he must draw the Breech just out to the Thighs, and then by drawing and wagging it from side to side, he will disengage them from the passage; as also the Feet and Legs one after the other, being careful of dislocating any part; and then he may extract the rest as before, when coming with the Feet.
CHAP. XXII.
Of those Births, wherein the Infant presents Belly, Breast or Side.
THe Back-bone may easily be bent and turned forwards a little, but by no means backwards, without excessive violence. Wheresore, the worst and most dangerous Figure that a Child can offer in the Womb to the bi [...]th, is the [...]elly or the Breast; for then its Body is constrained to bend backwards, and whatever Throws or endeavours the Woman makes to bring it forth, it will never be accomplisked, for she will sooner perish with her Child, than ever advance it in this posture into the passage: wherefore it is in great danger, if not timely succored: And in case it should escape, which would be very strange, it would be a long while after its birth weak in the Back. But that which angments the danger much more, is, that for the most part the Navelstring comes forth when the Child comes with the Belly. Therefore as soon as it is discovered to be so, the Chirurgeon must apply the sole remedy of drawing it forth by the Feet as speedily as may be in the following manner.
Having placed the Woman, let him gently slide up his flat Hand (being well anointed for the easier entrance) towards the middle of the Child's Breast, which he must thrust back to turn it; this situation being already half altered, the Feet being as near to the passage as the Head, when it pesents the middle of the Belly; then he must slip up his Hand under the Belly, till he sinds the Feet, which he must bring to the passage, to draw it forth in the same manner as if it had come footling, being careful to keep the Breast and Face downwards, which must always be observed before the Head can be drawn forth, for the reasons often already given, which must never be forgotten.
When a Child comes with Breast or Belly, the Chirurgeon must always proceed after the same manner in both, inasmuch as they require the same circumstances. An Infant may likewise come with the Side, which way it is as impossible to pass as the two former: but it is not so much tormented, nor is the situation so cruel; for it may remain in it a longer time without dying, than in the two former, wherein it is much more racked than in this, in which the Body may be bended forward, and not backward, [Page 579]as in the other; neither does the Navel-string come forth so easy as when it comes with the Belly first. In this, as in the other two Births, the Chirurgeon must draw the Child forth by the Feet in this fashion: having placed the Woman as she ought to be, he may push back a little with his Hand the Infant's Body, the better to introduce it, which he may slide along the Thighs, till he finds the Legs and Feet, by which he must turn it, and afterwards draw it forth, just in the same manner as before, with the same Observations. Nor ought he to amuse himself in any of these three births, to place the Head right, that it might come naturally; because it is in great danger of dying in these unnatural positions, if not drawn forth with speed; which can never be effected, unless it be by finding the Feet, as I have directed.
CHAP. XXIII.
Of Labours, wherein several Children present together in the different postures above-named.
IF all the unnatural Figures and Situations, which we have hitherto described, that a single Child may come in, do cause those many difficulties and dangers mentioned; surely the Labour, wherein several together come in these bad situations, must be much more painful, not only to the Mother and Children, but to the Chirurgeon also; for they are then so constrained and pressed, that for the most part they trouble each other, and hinder both their births: besides, the Womb is then so filled with them, that the Chirurgeon can scarce introduce his Hand without much violence, which he must do, if they are to be turned or thrust back, to give them a better position than wherein they present themselves.
When a Woman has two Children, they do not ordinarily both present to the birth together; but the one is often more forward than the other, which is the cause why but one is felt, and that sometimes it is not discovered that the Woman will have twins, till going to fetch the After-birth, the second is then perceived.
We have already shewed, speaking of natural Labours, how a Woman should be delivered of Twins, coming both right: It now remains to direct what ought to be done, when they come either both wrong, or one of them only, as it is for the most part: [Page 580]the first coming right, the second footling, or any other worse posture: and then must the birth of the first be hastned as much as may be, that so there may be presently way for the second (which has suffered much by this unnatural position) to fetch it by the Feet, without trying to place it right, althô it were somewhat inclined to it; because it has been already so tired and weakened; as also the Woman by the birth of the first, that there would be more danger; that it would sooner dye, than come of it self.
Sometimes when the first is born naturally, the second offers the Head likewise to the birth: In this case 'tis good committing a work so well begun, to Nature to finish, provided she be not too slow; for a Child may dye, althò right, by lying too long in the birth; and the Woman who has been much tormented with bearing the first, is usually so tired and discouraged, when she thinks that but half her work is over, that she has no more Pains, or very few and slow, nor any considerable Throws to bear the second, as she had done the first. Wherefore if the birth of the second proves tedions, and the Woman grows weaker, let the Chirurgeon defer it no longer, but direct his Hand gently into the Matr [...]x, to find the Feet, and so draw out the second Child; which will easily be effected, because there is way made sufficient by the birth of the first: and if the second Waters be not broke, as it often happens; yet intending to fetch it footling, he need not scruple to break the Membranes with his Fingers, althô elsewhere we have forbidden it; but that must be understood with distinction: for when a Labour is left to Nature's work, they must break of themselves; but when a Child shall be extracted by Art, there is no danger in breaking them, nay contrarily they must be broke, that the Child may be the easier turned, which else would be almost impossible.
Above all, the Chirurgeon must be careful not to be deceived, when both Children together offer to the Birth either their Hands or Feet; and must well consider in the operation, whether they be not joyned together, or any other ways monstrous; as also which part belongs to one Child, and which to the other, that so they may be fetcht one after the other, and not both together, as would be if it were not duly considered, taking the right Foot of the one, and the left of the other, and so drawing them together, as if they belonged both to one Body, because there is a right and a left, by which means it would be impossible ever to deliver them: but it may easily be prevented, if having found two or three Feet of several Children presenting in the passage, and taking aside two of the forwardest, a right and a left, and sliding his Hand along the Legs and Thighs up to the Twist, if forwards; or to the Buttocks if backwards, he finds they belong both to one body; being certain of it he may then begin to draw [...]orth the nearest, without regard which is strongest or weakest, bigger or less, living or dead, having [Page 581]first put a little aside that part of the other Child which offers (to have the more way, and so dispatch the first whatever it is, as soon as may be) observing the same Rules, as if there were but one, that is, keeping the Breast and Face downwards, with every circumstance directed, where the Child comes Footling; and not fetch the Burthen, till the second Child be born; which if it were loosned from the sides of the Womb, would cause a Flooding, for the reasons already alledged, that the Orifices of the Vessels to which it was joyned, would continue open by this separation, as long as the Womb was distended by the other Child, yet within it, and never close (as it often happens) till being quite emptied of all, it begins to contract it self, and retire, (as a Man may say) within it self.
When therefore the Chirurgeon has drawn forth one Child, he must separate it from the Burthen, having tied and cut the Navel-string, and then fetch the other by the Feet in the same manner; and afterwards bring the Burthen with the two strings, as hath been shewed in the proper place. If the Children offer any other part than the Feet, the same course must be taken as is directed in the foregoing Chapters, where the several unnatural Figures are discoursed of; always observing for the reasons above-mentioned, to begin the operation with the Child that is lowest in the passage, and in the most commodious Figure for extraction.
CHAP. XXIV.
Of a Labour, when the Navel-string comes first.
AN Infant does not always present with the Belly, when the Navel-string comes first: for thô he presents naturally as to the figure of his Body, that is, with the Head first; yet sometimes the Navel-string falls down, and comes before it: for which cause the Child is in much danger of death at least, if the Labour be not very quick, because the Blood (that ought to pass and [...]epass through those vessels which compose it, to nourish and enliven the Child, whilst he continues in the Womby being coagnlated, hinders the Circulation which ought to be there [...]ade; which happens as well by the Contusion, as the Cold those vessels receive, being much pressed in the passage, when it comes together with the Head, or any other part; as also because the Blood does there coagulate (as is [Page 582]said) by reason of the Cold which it take; by the coming forth of the Navel-string.
But thô this accident may cause the Infant's sudden death, 'tis not so much for want of nourishment, without which he might pass a day or more, there being Blood enough in his Body for that purpose; but because the Blood can be no longer vivified and renewed by circulation, as it has continual need; which being obstructed, always causes the Creature's sudden death, sooner or later, according as it is more or less obstructed. Wherefore in this case the Woman must without any delay be delivered; which if Nature do not speedily perform, the Child must be drawn forth by the Feet.
Women that have great Waters, and a long string to the Burthen, are very subject to this mischief; for the Waters coming forth in great abundance at the breaking of the Membranes, do often at that instant draw the string, which swims in the midst forth, along with them; and much the easier, if the Infant's Head be not advanced very forward into the passage, to hinder the coming forth of it in this manner.
As soon as 'tis perceived, you must immediately endeavour to put it back, to prevent the cooling it, behind the Child's Head, lest it be bruised, as we have already noted, whereby the Blood may coagulate there; keeping it in that place where it was thrust back, until the Head being fully come down into the passage, may hinder the coming down of it again: which may be effected by holding it up with the Fingers of one Hand on that side it comes down, until the Head be advanced as abovesaid; or in case the Hand be taken away, to put a piece of fine soft rag between that side of the Head and the Womb, to stop up the way it came down by, always leaving an end of the rag without the Body, for to draw it forth by at pleasure.
But sometimes, notwithstanding all these cautions, and the putting back of it, it will yet come forth every Pain; then without farther delay, the Chirurgeon must bring the Child forth by the Feet, which he must search for, thô the Infant comes with the Head: for there is but this means to save the Child's life, which it would certainly lose by the least delay in this case. Wherefore having placed the Woman conveniently, let him gently put the Head which offers, back (provided it be not engaged too low among the bones of the passage, and that it may be done without too great violence to the Woman; for in that case it will be better to let the Child run the hazard of dying, than to destroy the Mother) and then slide up his Hand well anointed, under the Breast and Belly to search for the Feet, by which he must draw it forth according to former directions. This being dispatched, let him immediately take great care of the Infant, which is ever in this case very feeble.
CHAP. XXV.
Of a Labour wherein the Burthen first offers, or first comes quite forth.
THe coming forth of the Navel-string before the Infant, of which we have treated in the foregoing Chapter, is often the cause of his death, for the reasons there given: but the coming first of the Burthen, is yet much more dangerous; for besides that the Children are ordinarily Still-born (if they be not affisted in the very Instant) the Mother likewise is often in very great peril of her life; because of her great Floodings, which usually happen, when it is loosened from the Womb before its due time, because it leaves all the Orifices of the vessels open, to which it did cleave, whence flows incessantly Blood, until the Child is born: For the Womb, whilst any thing continues there, does every moment strongly endeavor to expel it, by which means it continually voids and expresses the Blood of the Vessels, which are always open, when the Burthen is so separated, as long as the Womb remains extended and cannot be closed, until it has voided all that it did contain, and comes by the contraction of its Membranous substance to stop them by pressing them together. Wherefore if we ought to be vigilant to succor an Infant, when the string comes first, we ought much more to be so when the Burthen comes forth first, and the least delay is ever cause of the Infant's sudden death, if the Woman be not speedily delivered, because the Infant cannot stay then long in the Womb without suffocation, standing then in need of breathing by the Mouth, the Blood being no longer vivified by the preparation made in the Burthen, the use and function of which then ceases, from the instant it is separated from the vessels of the Womb, to which it was joyned; for which reason there immediately follows a great Flooding, which is so dangerous for the Mother, that without speedy help, she soon loses her life by this unlucky accident.
When the Burthen is not wholly come forth, but lies in the passage, some advise to put it back before the Child be fetcht; but I am not of that opinion, for when it comes into the passage before the Infant, it is then totally divided from the Womb, at the bottom of which [Page 584]it ought ordinarily to be situated and fastned, until the Child be Born: but because (as soon as it is wholly loosned, as it always is when it comes first) it becomes a Body altogether unnatural; it must never be thrust back, but on the contrary, be fetcht away, and at the very moment after, bring the Child by the Feet, althô it come naturally with the Head first. For what reason can there be to put it back, since it is of no use to the Infant, from the moment it is separated from the Womb? And such a proceeding is so far from being useful, that this Burthen would much hinder the Chirurgeon from being able to turn the Child as he ought, to bring it by the Feet.
Wherefore when it presents in the passage, which may be soon perceived, if they find every where a soft substance, without the least resistance to the touch of any solid part; finding likewise the string fastned to the middle of it, and the Woman Flooding extremely, as is ordinary at such times. Then, instead of thrusting it back, the Burthen must be brought away, that so there may be the more liberty and room to extract the Child, according to former direction.
The Burthen being quite loosened from the Womb, and coming first in the passage, must not be thrust back into it again; much less must it be put back when it is quite come forth of the Body. Care must be only taken, that the string be not cut till the Child is born; not out of hopes of any benefit from it to the Infant during the Delivery, but that so much time may not be lost before the Infant be fetcht, which is then ever in great danger; as also the Flooding may be the sooner stopt, which happens for the most part, as soon as the Woman is delivered; for which reasons it must be with all possible speed dispatched.
Sometimes, notwithstanding this dangerous accident, the Child may be Born alive, if timely succored: but it is then so weak, that it is hard to discover, whether it be living or dead.
When it so happens, the Midwives do ordinarily before they separate the Burthen, put it into a Skellet of hot Wine, and imagine, with no small superstition, that in case it comes to it self, the vapors of the warm Wine was the cause of it, being conveyed by means of the string, into the Infant's Belly, and so giving it vigor. But it is more credible, that being almost suffocated for want of Respiration, as soon as it needed it, it begins now by means of it to recover from that fainting. But nevertheless, there is no hurt in keeping the custome, thô superstitious, since it can do no prejudice, and may satisfy preingaged Spirits, provided necessaries be not neglected, in being blindly carried away with this conceit.
CHAP. XXVI.
How to deliver a Woman, when the Child is Hydropical, or Monstrous.
A Child may in the Womb have either the Dropsie of the Head, called Hydrocephale, or of the Breast, or of the Belly. And when these parts are so filled with water, that they are much too big for the passage through which the Child must issue; then notwithstanding any Throws or endeavors, by which the Woman may attempt to bring it forth, 'tis impossible she should effect it without the help of Art; as likewise when the Child is Monstrous, either by being only too big in the whole Body, or in any particular part, or by being joyned to another Child.
If the Child be living that has the Dropsie, when the Woman is in Labour, it must be destroyed to save the Mother, by making a hole in either the Head, Breast, or Belly of it, where the Waters are contained, that being emptied by the apertion so made, the Child may the easier be drawn forth, or else he must necessarily dye in the Womb, not being able to be Born; and remaining there will also kill the Mother. Wherefore to save her life, the Infant must be by an indispensable necessity brought forth by Art, since 'tis impossible it should come of it self; which may be done with a crooked knife sharp at the very point, the Chirurgeon proceeding in the following manner.
After that the Woman is placed conveniently for the operation, he must slide up his left Hand on the right side of the inferior part of the Infant's Head, if the waters be contained therein; which he will perceive by the extraordinary bigness and extent of it; the Sutures much separated, and the Bones of it far distant one from the other, by reason of the distention made by the inclosed waters, of which being very certain, let him slide with his right Hand along the inside of his left his crooked knife, taking care that the point of it, [...]n introducing it, be always towards his left Hand, for fear of wounding the Womb; and having conducted it close up to the Head, against one of the Sutures, let him turn the knife towards it, and make an Apertion large enough to let out the water: And then it will be very easie to bring forth the [Page 586]Child; forasmuch as the other parts are then usually small, and much consumed.
If these Waters were contained in the Breast or Belly, then the Child's Head being no bigger than ordinary, may be born; but the Body being exceedingly swelled with the Waters, will stay behind.
The case being thus, let the Chirurgeon slide up his lest Hand, as aforesaid, and the instrument with the right, just to the Breast or Belly, to make incision, and to let out the Waters: after which, he may with much ease finish the operation.
You must know, that 'tis much more difficult to deliver a monstrous Birth, or two joyned together, than one that has the Dropsie: because the bigness of the Hydropick parts may be easily lessened by a single incision, which is sufficient to let out the Waters which distend; and then 'tis easy to dispatch the rest.
But when a monstrous Child, or a double one, is to be extracted, a single apertion is not enough, but sometimes 'tis necessary to take off whole Members from these Bodies, which makes the operation much more painful and laborious, and requires more time and skill to effect it; in which case the left Hand must be introduced into the Womb, and the sharp knife with the right just to the parts that are to be divided and separated, and there with all the care that may be, the member of the monstrous Child must, if possible, be taken off just at the Joynt. And when there are two Children joyned together, the separation must be made just in the place where they joyn; and afterwards they may be delivered one after the other; always taking them by the Feet, and if it hath but one, the same thing may be accomplished, after having lessened the bigness of it, by cutting off some one of the Members.
The instrument ought to be as long as an ordinary Crochet, for the more surety and facility; because that holding the handle of it with the right Hand, it may be thrust, drawn, sloped and turned, without pain, to any side at pleasure; and with the lest, which is within the Womb, it may be guided to cut and dismember more skilfully and easily those parts which must be separated. Wherefore it ought to have a handle so long, that the Chirurgeon's right Hand without the Womb may hold and govern it as abovesaid, and conduct it the better in the operation; which would not be so safely and conveniently done, if this instrument were so very short, as all other Authors recommend: because in this occasion the Chirurgeon's Hand is so constrained and pressed in the Womb, that he can hardly there have the liberty to move his fingers ends, which is the cause why he cannot without much difficulty govern such an instrument with one Hand only, unless he would very much force and offer violence to the Womb, and thereby exceedingly endanger the poor Woman's life. Let us now come to the extraction of a dead Child, and shew the several ways of doing it.
CHAP. XXVII.
Of delivering a dead Child.
WHen the Infant is dead in the Mother's Belly, the Labour is ever long and dangerous, because for the most part it comes wrong; or, thô it comes right with the Head, the Woman's Pains are so weak and slow in these cases, that she cannot bring it forth, and sometimes she has none at all; forasmuch as Nature, half overthrown by the death of the Child, which cannot help it self, labours so little, that many times it cannot finish the business it has begun, but most yield without the help of Art, of which at that time it has great need. However, before you come to manual operation, endeavour to stir up the Woman's Pains with sharp and strong Clysters, to bring on Throws to bear down and bring forth the Child: But if all this prevails not, she must be delivered by Art.
We have already declared the signs to know a dead Child in the Womb, of which the chief are; if the Woman perceives it not to stir, nor has a long time before; if she be very cold, much pain and heaviness in the bottom of her Belly; if the Child be not supported, but always falls like a mass of Lead to that side on which the Woman lies, if the Burthen or Navel-string has been a long time in the World; and if no pulsation be there felt; and that dark and stinking putrid matter comes away from the Womb. All these signs together, or most of them, shew the Child is assuredly dead; which when the Chirurgeon is certain of, he must do his endeavor to fetch it as soon as possible he can, and having placed the Woman according to former directions; if the Child offers the Head first, he must gently put it back, until he has liberty to introduce his Hand quite into the Womb, and sliding it all along under the Belly to find the Feet, let him draw it forth by them, as is formerly taught; being very careful to keep the Head from being lockt in the passage, and that it be not separated from the Body, which may easily be done, when the Child being very rotten and putrefied, the Chirurgeon does not observe the circumstances often repeated by us, that is, (in drawing it forth) to keep the Breast and Face downwards. And if, notwithstanding all these precautions, the Head, because of the [Page 588]great putrefaction, should be separated and remain behind in the Womb, it must be drawn forth according to the directions given in the proper Chapter.
But when the Head coming first, is so far advanced and engaged among the Bones of the passage, that it cannot be put back, then being very sure by all the signs together, or most of the chief of them, that the Child is certainly dead, 'tis better to draw it forth, than to torment the Woman too much by putting it back, to turn it and bring it by the Feet. But because it being a part round and slippery, by reason of the moisture, the Chirurgeon cannot take hold of it with his Fingers, nor put them upon the side of it, because the passage is filled with its bigness, he must take a crotchet, and put up as far as he can without violence, between the Womb and the Child's Head, where he must fasten it, endeavoring to give it good hold upon one of the bones of the Skull, that it may not slide, forcing in the point of it, which must be strong, that it may not turn; and after the Crotchet is well fixed in the Head, he may therewith draw it forth, keeping the ends of the Fingers of his left Hand flat upon the opposite side, the better to help to disengage it, and by wagging it by little and little, to conduct it directly out of the passage.
It were to be wished that it were possible to introduce the Crotchet so far, that one might fix it (for the better hold) in one of the Eye-holes, or cavities of the Ears; but very often there is not room at first to carry them beyond the middle of the Head, and then they must be fastned according to our directions; and rather, if possible on the hinder part than any other, that so it may be drawn forth in a streight line; and when by the first fastning of the Crotchet the Head is drawn lower, and begins to be disengaged, you may loosen it out of the first place to fasten it farther up, that stronger hold may be taken, and so successively removing and fastning of it, until the Head be quite born, and then taking hold of it immediately with the Hands only, the Shoulders may be drawn into the passage; and so sliding the Fingers of both Hands under the Arm-pits, the Child may be quite delivered, and then the Burthen fetcht to finish the operation, according to knowledge; being careful not to pull the Navel-string too hard, lest it break, as it often happens when it is corrupted.
If the dead Child (of which above all, there must be good assurance) comes with the Arm up to the Shoulders so extremely swelled, that the Woman must suffer too much violence to have it put back, 'tis best then to take it off at the Shoulder-joint, by twisting it three or four times about, as we have already taught in another place, by which means there is no need of either Knives, Sawes, or sharp Pincers, as some Authors will have it; it being very easily performed without all that provision, because of the softness and tenderness of the Body. After that the Arm is so separated, and no longer possessing the passage, the Chirurgeon [Page 589]will have more room to put up his Hand into the Womb to fetch the Child by the Feet, and bring it away as has been directed.
Althô the Chirurgeon be sure that the Child is dead in the Womb, and that it is necessary to fetch it by Art, he must not therefore presently use his Crotchets, because they are never to be used but when Hands are not sufficient, and that there is no other remedy to prevent the Woman's danger, or to bring the Child any other way; because, very often, thô he has done all that Art directs, persons present, that understand not these things, will believe that the Child was killed with the Crotchets, althô it had been dead three days before, and without other reasonings or better understanding of the matter, for recompence of his saving the Mother's life, requite him with an accusation, of which he is altogether innocent; and in case the Mother by misfortune should afterwards dye, lay her death also to his charge, and instead of praise and thanks, treat him like a Butcher or a Hangman; to which divers Midwives are usually very ready to contribute, and are the first that make the poor Women, that have need of the Men, afraid of them. So much they are in fear of being blamed by them, for having themselves been the cause (as some of them often are) of the death of Infants, and many ill accidents, which after befall the poor Women, not causing them to be helped in due time, and from the moment they perceive the difficulty of the Labour to pass their understandings.
To avoid therefore these calumnies, let the Chirurgeon never use these Crotchets but very rarely, and when there is no other way, as also to endeavour his utmost (as much as the case will permit) to bring the Child whole, although dead, and not by bits and pieces, that thereby the wicked and ignorant may have no pretence of blame. I say, as much as the case will permit, that is, with respect to the Woman under his hands: For to save her, he had better sometime bring the dead Child with instruments, than kill her, by tormenting her with excessive violence to bring it whole. But, in a word, we must in conscience do what Art commands, without heed what may be spoken afterwards: And every Chirurgeon, that has a well ordered Conscience, will ever have a greater regard to his Duty than reputation; in performing of which let him expect his reward from GOD.
CHAP. XXVIII.
Of extracting a Mola, and false Conception.
A Mole is nothing but a fleshy substance, without Bones, Joynts, or distinction of Members; without form and figure regulated and determined; engendred against Nature in the Womb, after copulation, out of the corrupted Seed of both Man and Woman. Notwithstanding, there are sometimes that have some rudiments of a rough form. It has no Burthen, nor Navel-string fastned to it, as a Child always has; forasmuch as the Mole it self adheres to the Womb, by which means it receives nourishment from its vossels. When Women miscarry of them before the second Month, they are called false Conceptions: when they keep them longer, and this strange body begins to grow bigger, they are called Moles.
Now since these things contained in the Womb, are totally Preternatural, their expulsion must be procured as soon as possible, which is very difficult, when these strange Bodies cleave to it, and especially the Mola, which not being drawn forth, will often continue two or three whole years, nay, sometimes the whole remaining part of the Woman's life, as Parey tells us in the story of a Pewterer's Wife that had one seventeen years, whom he opened after her death.
To avoid the like accident, and abundance of inconveniences, which a Mola brings, it must be endeavoured to be expelled as soon as may be, trying before you come to manual operation, to cause the Woman to expel it of her self: To which purpose give her strong and sharp Clysters, to stir up Throws to open the Womb to give way to it, relaxing and moistning it with emollient Ointments, Oils and Grease, not omitting bleeding in the Foot, and half Baths, if there be occasion.
The Mola will certainly be excluded by these means, provided it be but of an indifferent bigness, or that it adheres little, or not at all to the Womb; but if it cleaves very strongly to the bottom of the Womb, or that it be very big, the Woman will hardly be rid of it without the help of a Chirurgeon's Hand; in which case, after that he has placed the Woman conveniently, as if he were to fetch a dead Child, let him slide his Hand [Page 591]into the Womb, and with it draw forth the Mola, using (if it be so big as that it cannot be brought whole, which is very rare, because it is a soft tender Body, much more pliable than a Child) a crotchet or knife to draw it forth, or divide it into two or more parts, as the case shall require. If the Chirurgeon finds it joyned and fastned to the Womb, he must gently separate it with his fingers ends, his Nails being well pared, putting them by little and little between the Mola and the Womb, beginning on that side, where it does not stick so fast, and pursuing it so, till it be quite loosened; being very careful, if it grows too fast, not to rend or hurt the proper substance of the Womb, proceeding according to the directions we have given for the extraction of a Burthen staying behind in the Womb, when the string is broken off.
As to a false Conception, thô it be much less than a Mola, yet it often puts a Woman in hazard of her life, because of great Floodings, which very often happen, when the Womb would discharge it self of it, and endeavours to expell it, the Floodings seldom ceasing until it be come away, because the Womb still endeavours to exclude it, by which the Blood is excited to flow away, and in a manner squeezed out of the open vessels.
The best and safest remedy for a Woman in this case, is to fetch away the false Conception as soon as may be, because the Womb can very seldom, without great difficulty void it without help: For it being very small, the Woman's impulse in bouring downwards cannot be so effectual, when the Womb is but little distended by so small a body, as when it contains a considerable bulk in it; for then it is more strongly compressed with the Throws. Many times 'tis exceeding difficult to fetch these false Conceptions, because the Womb does not open and dilate it self ordinarily beyond the proportion of what it contains, and that being very little, so is its opening. Which is the reason why the Chirurgeon sometimes is so far from introducing his whole Hand, that he can scarce put in a few Fingers, with which he is forced to finish the operation, as well as he can, proceeding in the following manner, when he has introduced them.
Having well anointed his Hand, he must slide it up the Vagina unto the inward Orifice, which he will find sometimes but very little dilated, and then very gently put in one of his Fingers, which he must presently turn and bend on every side, until he has made way for a second, and afterwards a third, or more, if it may be done without violence; but many times one has enough to do to get in but two, between which he must take hold (as Crabs do with their Claws when they take any thing) of the false Conception, which he must gently draw forth; and also the clotted Blood which he there finds. Afterwards the flooding will undoubtedly cease, if no part of this conception be left behind: But if the inward Orifice cannot be more dilated than to admit but one Finger, [Page 592]and that the Flooding is so violent as to endanger the Woman's life; the Chirurgeon then having introduced his Fore-finger of his left Hand, must take with his right, an instrument called a Crane's-Bill, or rather a Forceps, and guide the end of it along his Finger, and fetch with this instrument the strange Body out of the Womb, taking heed that he pinch not the Womb; and that the instrument be always conducted by the Finger first introduced, which will judge and distinguish by the touch between this Conception and the substance of the Womb: In doing which, there being no other way, he will certainly accomplish his business.
CHAP. XXIX.
Of the Caesarean Section.
WHen a big-bellied Woman is effectively in Labour, 'tis very rare but that an expert Chirurgeon can deliver the Child dead or alive, whole or in pieces; in a word, that he may do the work compleatly, if he behaves himself as the case requires, and according to the directions given in each particular Chapter foregoing, treating of the several unnatural Labours, without being necessitated in a very inhumane, cruel and barbarous manner, to have recourse to the Caesarian operation, during the Mother's life, as some Authors have too inconsiderately ordered; but never practised with success.
However, after the Mother's death, if there be any hopes to find the Child alive (especially in those Countries, where the Laws forbid the burying a Woman with Child, before it is taken out of her Belly) this operation may be undertaken. To accomplish which as it ought to be, when he perceives the Woman in the agony, he must quickly make ready all things necessary for his work, to lose no time, because delay will certainly be the death of the Infant, which else a few moments before might have been brought alive. There are some, that when the Woman is just a dying, would have somewhat put between her Teeth to keep her Mouth open, and likewise in the outer part of the Womb: to the end the Infant receiving by this means some little air and refreshment, may not be so soon suffocated: But all this mystery will avail but little; because the Child lives only by the Mother's Blood, whilst it is in the Womb; but if he will needs do [Page 593]so, it is rather to content the company, than out of any belief of the good it will do.
As soon then as the Woman has breathed her last, and that she is dead (to which all the company must agree) he shall begin his operation, which the Greeks call Embryulcy. Most Authors would have it made on the left side of the Belly, because it is more free from the Liver, which is on the right; but if my Opinion may be authentick, it will be better and more skilfully made just in the middle of the Belly; between the two right Muscles; because in this place there is only the coverings and the white line to cut; when on the Side it cannot be done without cutting the two oblique and cross Muscles, which being couched one under the other, make a considerable thickness, besides that it bleeds more than towards the middle of the Belly; not that the loss of Blood is of any moment (which will flow when the Woman is but just dead) but because it hinders by its flowing, the seeing distinctly how to make the operation as it should be.
To dispatch then with more ease and speed, the Chirurgeon having placed the dead Body, that the Belly may be a little raised, let him take a good sharp incision knife, very sharp on one side, with which he must quickly make, at one stroak, or at two or three at the most (if he will for the greater surety) an incision just in the middle of the Belly, between the two right Muscles unto the Peritonaeum, of the length and extent of the Womb or thereabouts; after that he must only pierce the Peritonaeum with the point of his instrument, to make an orifice for one or two of the Fingers of his left Hand, into which he must immediately thrust them to cut it (lifting it up with them, and conducting the instrument for fear of pricking the Guts) in proportion to the first incision of the coverings, which having done, the Womb will soon appear, in which he must make an incision in the same manner as he did in the Peritonaeum; being careful not to thrust his Instrument at once too far in, thinking to find the Womb a Finger or two thick (as all Authors affirm contrary to truth) in which he would be deceived, as these are that never well considered it. For it is very certain, that at the time of Labour, whilst it contains the Child and Waters in it, it is not above the thickness of a half Crown, although they have all sung to us, that by Divine Providence and a Miracle, the more it's extended with the Child, the thicker it grows, which is absolutely false; it being [...] true, that it is at that time a little thicker at the place where the Burthen cleaves, where its substance is then as it were spongy; but every where else it is very thin, and becomes the more so, by how much it is more extended, until being emptied by the birth of the Child, it begins to grow thicker in contracting, and gathering to it self all its substance, which was before very much extended. It being just like the Bladder, which being full, is very thin, and being empty, it appears to us half a Fingers thickness, which filling [Page 594]again, waxes thinner in proportion to the Urine that flows to it. Having then so opened the Womb, he must likewise make an incision in the Infant's Membranes, taking care not to wound it with the instrument, and then he will soon see it, and must immediately take it out with the Burthen, which he must nimbly separate from the bottom of the Womb: And finding it to be yet living, let him praise GOD for having so blessed and prospered his operation.
But the Children so delivered in these cases are usually so weak (if not quite dead, as it often happens), that 'tis hard to know whether they be alive or dead. Yet one may be confident the Child is living, if by touching the Navelstring, the umbilical Arteries are perceived to move; as also the Heart, by laying the Hand on the Breast; and if it prove so, means must be used to fetch it to it self, spouting some Wine in the Nose and Mouth, warming it until it begins to come to stir of it self, Midwives usually lay the Burthen very hot on the Belly of such weak Children; if that helps, 'tis rather because of the temperate heat of it, than for any other cause: for 'tis impossible the Infant should receive any Spirits from it, after it is once separated from the Womb, and yet less when the Woman is dead. The best and speediest remedy is immediately to separate it, and open the Child's Mouth, cleaning and unstopping all the Nose, if there be any filth, to help it so to breath freely, keeping it all the while near the fire, until it has a little recovered its weakness, spouting some Wine into the Nose and Mouth of it, that he may a little taste and scent it, which cannot hurt it in this juncture, if one observes some moderation in the thing.
CHAP. XXX.
Of Ruptures in general, their differences, signs, and causes.
THe next thing which in our proposed method we shall treat of, shall be a Rupture; in Latine called Ruptura, hernia, ramex; in Greek [...]. Now thô properly there be only two sorts of Ruptures, caused by the falling down of the parts, viz. Intestinalis vel Omentalis, of the Guts, or of the Caul; yet in regard of affinity, and of the place affected, other differences of Ruptures may be referred hither; which have got Names according to the variety of the illapsed matter.
These are the principal sorts of Ruptures. 1. Hern [...] incompleta, inguinalis, [...], when the Gut or Caulcomes down no lower than the Groin. 2; Hernia completa, when either of them falls down into the Cod, the Tunica vaginalis, or Peritonaeum being broke: And if the Gut come down, it is called Ramex intestinalis and [...]. 3. If it be the Caul, Ramex zirbalis, or Omentalis, [...]. 4. If it be a Tumor from a slimy watry Humor, it is called Ramex aquosus, [...], 5. If from Wind, Ramex flatulentus, or Ventosus, [...]. 6. If flesh grow about the Testicle, or in its substance, it is called Ramex carnosus, [...]. 7. If the veins being beyond measure full in the Cod and Testicles, be distended in manner of Varices, it is called Ramex varicosus, [...]. 8. Avicen adds [...], that is, the starting of the Navel, or a Rupture there. From these there arise several mixt or compound sorts, as [...], a falling down both of the Guts and Caul; [...], of the Gut and Water; [...], of Wind and Water; [...], of Water with Flesh, &c.
The common sign of all complete Ruptures is a swelling in the God.
Bubonocele, or an imperfect Rupture is known by a swelling in the Groin.
The signs of a Hernia intestinalis, according to Celsus, c. 14. l. 7. are 1. When the swelling sometimes increases, and sometimes decreases: It increases because either a greater portion of the Gut comes down; or it is over full, either of Wind or Ordure. If the swelling increase because Excrements are [Page 596]got into the Gut, then the Gut cannot be put back, there is a pain in the Cod, Groin and Belly, by reason of solution of continuity; the Stomach is disordered, and casts forth brown choler, then black, and last of all the excrements; There is also an Inflammation of the Stories. 2. The second sign of a Hernia intestinalis is, That the swelling is not painful. 3. The swelling sometimes is almost quite gone. 4. Being compressed, it easily gives back within the Abdomen, and then slips out again with a great noise. 5. The swelling is smooth, slippery and round.
The signs of a Hernia omentalis are 1. The swelling is always the same, 2. To the fooling it is uneven, soft and slippery, because of its Fat.
The signs of Hernia aquosa are 1. The swelling abates after fasting, 2. The veins in the Ser [...]um are swelled: And if it be squeezed, the Humor flows into the vessels, which before were not full. 3. It shmes, and is pellucid, and if you hold a Candle on the opposite side, it appears as if you lookt through Glass or Horn. 4. There is no pain. 5. It comes not on a sudden, but by degrees.
The sign of a Hernia ventosa are, 1. The Veins are swelled. 2. It looks clearer than a Hernia aquosa. 3. It comes on a sudden.
The signs of a Hernia carnosa are, 1. A schirrhous hardness. 2. It changes not the colour of the Stones. 3. It abides always at the same bigness. 4. The lower parts of the Testicle may be stirred.
The signs of a Hernia varicosa are, 1. The Veins are turgid on a cluster, and wreathen, like Vineclaspers. 2. The Testicle hangs lower down, because of the weight of the Humors.
The conjunct cause is the Gut or Cawl slipt down. The antecedent is either the distention or breach of the Peritonaeum. And it is distended or broke by causes, either internal, as the Humors that are contained in the Body; or external, as by a blow, loud crying, leaping, keeping ones breath, pressure of a weight, too much violence in embraces, especially when the Belly is charged with Excrements or Wind.
As to the Prognosticks, All Ruptures are difficult of Cure: Because a thin and nervous Membrane is very difficultly united; nor is it cured by Medicines, unless the Rupture be small, lately made, and in Children; but either with Searing-Irons, or by Section.
CHAP. XXXI.
The eure of a Hernia intestinalis, when the Peritonaeum is either distended or relaxed.
THE Gut comes down, because either the coat called Peritonaeum is distended, or broke. The signs of its being distended are, 1. The coming down of the Gut, not suddenly, but sticking in the orifice. 2. It comes not so low as the bottom of the Cod. 3. The swelling is equal. The signs of the coat's being broke are, 1. The sudden descent of the Gut. 2. An unequal swelling. 3. The falling of the Gut down to the bottom of the Cod.
In respect of the distention, two things are indicated, according to Avicen. First, the reduction of the Gut up again within the Abdomen. Secondly, the hindring it from sliping down again. The first design is easily accomplisht (if much of the Gut be not fallen, nor that filled with wind or excrements) for it may be put up, and prest back with the Fingers. But if it be full of excrements or wind, a bath of warm water must be got ready, then Lenients must be applied, and afterwards a Fomentation with a cloth warm. Some Oil may be added to a Bath of fresh water, or it may be made of Oil alone. Then some such lenient Cataplasin may be applied. ℞ Radicum althere coctarum ex aqua & contusarum lb ss. farinae sem, lini, butyri an. ℥iij. Olei communis ℥iiij. mulsae q. s. ad cut aplasma. If these means will do no good, the Patient must be taken by his Hands and Feet, and shaken that the Gut may fall back, he hanging with his Belly upwards, and his Head downwards.
We answer the second Intention i.e. we hinder the Gut from fliping down again, if we bind what is dilated, and remove all causes both internal and external. The principal of the internal is an humidity relaxing and mollifying the Tunica vaginalis; which must be dried, strengthened and bound. Care therefore must be taken of the whole Body. Moist and windy meats must be avoided, and exercise also. Bread must be used, that is well baked, adding some Anise or Cummin-seed. Dry flesh must be eaten. The Drink must be astringent. The Diet being ordered in this manner, the influent Humors must be evacuated both with Phlegmagogues, Agaricum, [Page 598]manna, mel rosarum solutivum, &c. and with Purges of serous Humors, Syrupus de Calamintha, de Hyssopo, de Betonica, cum decoctis faeniculi, Petrose ini, &c. And afterwards we must proceed to astringents, Glutinants and driers; such as are, Herniaria seu Polygonum minus, Betonica, symphytum, Rosae Rubrae, balaustia, plantago, nuces cupressi, cortex quercûs, radix sigilli Salomonis, Mastiche, bolus Armena, mumia, Sanguis Draconis, mala cydonia, cyminum, out of which, posions, powders, and electuaries both dry and soft may be made. And for greater exsiccation's sake Decoctum Sarsae parillae, cum modico ligni indici, ex aqua chalybeata is good; it must be taken for many days.
Local Medicines must be drying and astringent. Avicen makes a Medicine è nucibus cupressi, è foliis ejusdem, & sabina. Paulus cap. 35. l. 3. has this, ℞ cort. granat. ʒ x. gallar. immatur. ʒ v. vini astringentis ℥ v. decoquantur, & imponantur, priùs ablutoloco aquà frigidà: & quarto quolibet die renovetur. Avicen commends this; ℞ nucum cupressi, aeaciae, balaust. gallarum immatur. an. ʒj. myrrhae, thuris, sarcccollae, tragacanthae, gummi Arabici an. ʒiij. mumiae, sanguinis Draconis an. ʒij. terantur cum aceto. Another excellent one ℞ malicorii, boli Armenae, sang. drac. an. ʒj. tegulae pulverisatae ʒij. pulveris bislinguae ʒijss. cum ovi albo, modico aceto & colophonia fiat emplastrum. After this is applied Avicen and Celsus apply a Truss, to keep up the Gut. And thus a slight Rupture is cured in a young and tender body.
But if the malady will not give way to these things, the Patient must lye in Bed full forty days, applying an astringent Medicine and a Truss. Let him forbear much Laughter, Venery, and Bathing. Morning and Evening let him take this Electuary; ℞ rhabarbari asse, consolide majoris, nucis moschatae, nucum cupressi, cymini, trag acauthi, gummi Arab. mastiches, boli Arm. sanguinis Drac. mumiae, picis Graecae, an partes aequales: Pulverisentur omnia subtilissimè, & cum melle despumato fiat electuarium, cujus dosis ℥ss. Quidam pulverem leporis combusti addunt. Let him drink upon it some austere black Wine, water Chalybeat, or common, wherein Cypress or Myrtle Leaves have been boiled. After forty days are over, let him rise; but in the mean time let him wear the Plaster and Truss, till it shall be thought safe to leave them off.
CHAP. XXXII.
The Cure of a Hernia intestinalis when the Peritonaeum is burst.
THe intentions of Cure are the same here as in the former Chapter. The Gut must be put up, and care must be taken, that it slip not down again; which is done by uniting and glewing up the Rupture. It is united by astringents. And here these must not be purely driers, but they must have also in them a glutinous viscidity; such as this; ℞ Terebinth. ℥iss. cerae, thuris, myrrhae, ichthyccollae, carnis cochlearum, an. ℥j. Gluten. triduo in aceto maceretur, inde in mortario plumbeo laevigetur ac conteratur, post, igne liqueseat ac misceatur caeteris. Another, ℞ Resinae aridae, Ammoniaci, thuvis, bituminis, sulphuris vivi an. part. aeq. terantur terenda, liquefiant liquenda, deinde sulphur adjiciatur: Applicetur vel linte [...], vel corio, & sinatur donec sponte decidat. Aëtius highly extols charta, tribus diebus in aqua macerata: But it is doubtful what this Charta is, whether Parchment or Paper, which being wet stretches, and dry contracts, and by contracting may also deduce the parts to mutual contact, and unite them. The course of forty days is also proper.
If these means will not do, according to Avicen, the place must be seared with a hot iron. The searing must be strong, because so the skin is contracted, that the Gut cannot any more come down. But you must have a care that the Intestine feel not the strength of the fire, nor be burnt; for there would be danger of death. The Patient therefore must be laid on his back, with his Head low, &c. When the Gut is reduced, a Servant must lay his Hand on the bottom of his Belly, and press it hard. The Patient must be tied upon the Table with many Ligatures, on the Breast, Arms, Hips, Knees and Feet; the swathes of the Breast must be broad. It is a hard matter to desend the spermatick vessels, by hurting of which the generation of Seed is lost; but it is no prejudice to life. The searing-Irons must be of two forms, semicircular and pointed, that they may have a sharp point, and the figure of a Cone. We begin to fear at the upper part, descending along the whole region of the Rupture.
The Cure is also performed by incision, which is twofold, Chiturgical, or Empirical. True Chirurgeons [Page 600]cure it without extracting a Stone: Empiricks cut off a Stone. Without extracting a Stone, it is performed in this manner. First of all the Patient standing must hold his breath, that we may know how large the Rupture is. Then the tumefied part must be marked round with ink, according to the bigness of the place affected. Afterward the Patient must be tied upon a Table, and a servant must press the bottom of his Belly. The Chirurgeon must with his left hand lift up the marked skin, as much as he can, and with a Penknife cut the circle diametrically, through the Skin and Membranes, to the Tunica vaginalis, either burst or dilated, which must be sowed up afterwards, together with the Skin and Membranes. The seminal vessels must be kept unhurt. After the Patient must be put to Bed, having first applied pledgets cum ovi albumine, and then glutinants, as pulvis boli, &c. and things also that breed flesh, as Terebinthina, &c. applying over all Emplastrum barbarum. When a cicatrice is bred, the Patient may rise, and wear an astringent Plaster for several days, and a Truss likewise.
The usual and dangerous way, with extraction of a Stone, is described by Paulus, cap. 65. lib. 6. The Patient being laid on his Back, the Gut reduced, he tied, and a Servant pressing the part, they make an oblique mark in the Groin. Then they make a deep incision, so that the Stone and the spermatick vessels may be taken out. They hold these with their left hand, putting their singers into the hole, they separate all the Membranes, and extract the Testicle at the hole. Then they take hold of the parts with hooks made for that purpose, and sow all up. Then they cut off all above the Suture, and afterwards fear it with a hot iron, to prevent a Haemorrhage, and to glutinate the parts the sooner. Which done, they leave along thread, putting in some concocting Medicine. Afterwards, they make a hole in the same part of the Scrotum, and put in some concocting Medicine, they use Butter (which nevertheless putrefies) they mix thus, aut ovi vitellum, & modicum resinae terebinthinae. Then they endeavour to breed flesh, with Ʋnguentum de Betonica, aut Isidis, and bring a cicatrice with dry lint.
CHAP. XXXIII.
Of the Cure of a Hernia omentalis.
THis Rupture is not made by the breach of the Peritonaeum; because no great portion of the Omentum comes down, it being fastned to the bottom of the Stomach, the Gut Colon, and to the Spine. Therefore it is made by distention of the coat; especially because the Omentium is fat, which may very well therefore make lax and dilate, but never break.
The intentions of cure are two. First, the Omentum must be reduced within the Abdomen, which is done with the Hands: Then, it must be kept from coming down again, which is done by Astringents. And because dilatation is made by moisture, or by a relaxing fat: therefore Ramex omentalis requires greater driers than Intestinalis. This is commended; ℞ Aloes, malicorii in vino nigro elixats, succi hypocystidos, thuris, glutinis fabrorum, an. part. aeq. gluten passo incequatur ad integram dissolutionem, post teratur in mortario, & caetera addantur. As to the rest, this cure differs not from the cure of a Hernia intestinalis, and therefore here a Truss, the forty days course, Causticks and Incision will be proper. It is to be noted, according to Celsus c. 25. l. 7. That if a small portion of the Omentum come down, it must be forced up again: If a great one it must be seared, that it may dye and fall off: The readiest way is to bind, cut off and burn it. Yet we must not rashly and too soon proceed to Section; because oftentimes a Rupture is cured beyond expectation.
CHAP. XXXIV.
Of the Cure of a Hernia aquosa.
THe causes of a Hernia aquosa are either occult or manifest, according to Aetius cap. 22. l. 14. The manifest are percussion, collision, and breach of the vessels in the Stones: for the Blood that flows to the vessels is then turned into a watry substance, because of the weakness of the part. The occult cause is from the vessels being filled with a watry Humidity. Guido adds, some fault in the Liver, or Spleen, by reason whereof a Liquor gathers in the Hypocondria, which easily falls down.
Percussion, Collision, &c. are apparent of themselves. If the colour and habit of the Body be bad, the Rupture proceeds from a fault in some of the Viscera. If none of these, from Repletion: and Repletion proceeds from Drinking too much. Aetius distinguishes the Causes by the Humor: which if it be yellowish and pale, the Rupture comes from repletion of the Veins; if dull, from Percussion; if white, from some fault of the Liver or Spleen. We must know, that sometimes water is also gathered in the coat, which immediately involves the Stones; oftentimes between it and the Elytroeides; sometimes between the Elytroeides and the [...].
As to the Cures the causes must be removed, the faults of the Liver and Spleen amended. If it comes from too much drinking, we must abstain from it. The abundance of watry humor must be evacuated, both what is in the Hypochondria and the Abdomen, and what is redundant in the whole Body. For which purpose Sarsaparilla in decoctions is very efficacious. Besides, Diureticks and Purgatives are good; but Diureticks are best. Diureticks are known, which must be taken frequently; as also such Medicines as purge thin and serous Humors by stool, such as Syrupus è rosis laxativus pilulae cochiae, & mastichinae, vel aloephanginae, quarum scrupulus exhibere potest cum elaterri gr. ij.
As for local Medicines, the intent of them is to evacuate water contained in the Stones: which is done, if it either give back to repellents, or be brought out by Digestives through some patent place, or by Scarification. Digestives are hot and drying, which must be used before Scarification. Aetius commends this; ℞ Argenti spumae ʒvj. salis fossilis, atramenti sutorri, an. ʒx. cerusse ʒiiij. o'ci [Page 603] lbj. terebinthinae ʒxj. Spuma argenti, cerussa, sal, mista cum oleo cequi debent: addatur atramentum sutorium, cum aceto tritum, postea terebinthina adjiciatur. A Cataplasm may also be made è baccis lauri, farinâ fabarum, faenigraeci, sulphure, cumino, Ammoniaco, terebinthinâ, sapâ & oxymelite cum ol. laur. no simul mistis. This is excellent; ℞ stercoris bubuli lbj. pulv. cymin. ℥j. baccarum lauri, fimi columbini, castorei an. part. aeq. coquantur cum ol. ros. & pauca cera. Yet first of all the place must be fomented with a sponge dipt in decocto pulegii, calaminthae, origani, foenigraeci, anisi, dauci, cymini, rutae, ameos, salviae. And after fomentation, the place may be anointed with ol. de ruta, aut costo, aut cuphorbio, aut castor. aut etiam de baccis lauri. Also aqua calcis vivae digests very much. If there be water in the Hypochondria, we must the longer insist upon driers and strengtheners of the Stones. Avicen uses fearing Irons, in the region of the Groin, to corrugate the part, that the water may not fall down. Moreover, in opening there is a twofold intention, to let the water out, and to hinder it from gathering again. Apertion is made by incision or a caustick. If by a caustick, it must be applled to the place where the water is. Afterwards we hinder the water from gathering again by some very drying Medicine, such as this of Aetius; ℞ cerae ℥iss. picis ʒvj. Ammoniaci, thymiamatis ℥ ij. aluminis liquidi ʒiss. M. Galen c. 13. l. 14. met. keeps the part open a long time, by putting in a pipe of Silver or Lead. Guido makes a Seton, and keeps it long. Celsus shews the place for incision, where he says; ‘If it be a Boy that is ill, he must be opened in the Groin, and the water must be forced upwards: If an adult person, in the bottom of the Scrotum, and the water must be got out, and the place must be washt with salt water, or nitrous.’ But we must observe, that the water be not lost too long in the Scrotum, lest by carrying there, the Stone should be corrupted, or with the water there should grow a Hernia carnosa, and flesh.
CHAP. XXXV.
Of the cure of a Hernia ventosa.
THis is cured by Digestives alone, not with searing Irons, no [...] Incision. Paulus describes this; ℞ piperis grana centum, lauri baccas num. Lxxx. nitri ʒxx. cerae ℥v. olei ℥ iiijst. M. All things else may be administred here, as in a Hernia aquosa.
CHAP. XXXVI.
Of the cure of a Sarcocele, and a Hydrosarcocele.
A Sarcocele, or Flesh-rupture comes from a defluxion of thick Humors, which are gathered between the coats of the Testicles. The thick Humors are two, Phlegm and Melancholy, of which, Scirrhi, and fleshy hardnesses are bred in other parts as well as in the Testicles.
This swelling is hard, resisting the touch, indolent, and if it be an exquisite Scirrhus, it is without sense. If it come from Melancholy, the colour is sublivid: If from Phlegm, it changes not the colour of the skin: If from adust Melancholy, there is a pricking pain, and the swelling is not all alike, but here soft, and there hard.
This requires the same cure with a Scirrhus; of which we have treated sufficiently in the Doctrine of Tumors. Only here it is worth the observation, that Pulvis radicis anonidis taken for several Months, wasts a Sarcocele: which Matthiolus makes good by the History of a Patient, who by the constant use of the said root recovered his health, when before his Physicians had given over all hope in Medicines, and placed all they had in cutting and burning.
However, if the Disease do not give way to Medicines; you must proceed to cutting, which is not without hazard, whether the Stone be left, or it be taken out. And it must be observed in this operation, whether flesh grows about the coats, or about the very Stones; and whether it stick firmly or loosely, to the substance of the part. This being observed, you must cut quite through the Scrotum, till you come at the concrete flesh; which, if it be not strongly fastned, must by little and little be loosened with the Fingers ends, or the handle of the knife from the Stone, or coats, and taken away: But if it be grown firmly together with the part, it cannot be cured without cutting the vessels and the Testicle. In this case therefore the vessels and the Testicle must be drawn out, tied, cut, and seared. Some fear them with a red not Razor; and so out and sear at once. The rest of the cure is performed as in a Hernia intestinaelis.
The method is particular, when a watry Rupture is joyn'd with a fleshy. For then first of all, you must cut and make a hole in some part of the Sorotum about the middle, not in the bottom, not must it be very large. Having got out the water, put in a very long Tent arm'd with some suppur [...] tive Medicine, as Resina, terebinthina, cum thure, ovs vitello & hutyro. Apply an emollient and suppurative Plaster; as Diachylon cum gummi, & axungia porei. And when Pus is bred, it must not be evacuated at the hole, but kept within on purpose, that by its contact it may by degrees putrefy the flesh. Nor must the Medicaments be changed, unless all the flesh be turned into Pus, which requires a long time. Nevertheless this is the safest way: And it succeeds well, even in the greatest Ruptures.
CHAP. XXXVII.
Of the cure of a Hernia varicosa.
THe Rupture called Ramex varicosus, is, when the veins of the Testicles are dilated and wreathen like Vine-claspers, by some melancholick Humor.
The cure, as to the whole Body, is the same as in a Scirrhus. The part affected is holpen by Medicaments and manual operation. The Indications are three; To repel the influent Humor; To evacuate and dry it up, when slown [Page 606]in; and to astringe the dilated vessels.
Astringents answer all these intentions; for as they are cold and binding, they repell the influent Humor: As they are drying, they dry it up, when come thither: And by their binding quality, they astringe the dilated veins. These are approved Medicines; Succus hypocistidis, balaustia, gluten piscium, malicorium, bolus Armena, sanguis draconis cum ovi albo, &c.
If the disease will not give way to Medicines, we must have recourse to the knife and fire. Here we must observe in what place the Varices lye; whether in the veins of the Scrctum, or in the next coat, or in the Tunica vaginalis, or in the body of the very Testicle. If they lye in the Scrotum, the veins must be seared with thin and sharp irons, which must be fixt in the dilated veins, where they are conglomerated: Afterward things must be applied to take off the Eschar: Then Lonticula cum melle: And at last Sarcoticks. If the veins be tumid in the coat, which Paulus and Rufus Ephesius call [...], incision must be made in the groin, and at it the Memb [...]ane together with the Stone must be extracted. Afterwards the dilated veins must be separated from the coat, either with the Fingers, or the handle of the Pen-knife: Then the vessels must be tied in two places, and cut off above the Ligature. If the Rupture be in the Elytroeides or V [...]ginalis t [...]mica, and only a vein or two dilated, you must proceed in the same manner as when it is in the Dartos, viz. Having opened the Groin, and the veins being tied, and cut, the Testicle must be put up again: But if all the veins he swollen, they must be tied and cut out with the Testicle. If the Rupture be between the innermost coat and the Testicle, incision must be made in the Groin, the vessels extracted, the Testicle cut off, and the place seared. Paulus here uses a distinction according to the judgment of Leonides: If only some of the vessels that nourish the Testicle, are become varicous, they only must be cut off and separated, and the Testicle must be put up; but if all of them are so, then the Testicle, as well as the vessels, must be taken away; lest it, being destitute of nutrient vessels, should waste and [...]ot away.
CHAP. XXXVIII.
Of Amputation of a Member.
THE next thing, which in my proposed Method I am to treat of, is the Extirpation of a Part, when by a Gangrene, Wound, Fracture, or some other accident, it is become not only useless, but dangerous to the whole, Ne pars sincera trahatur. In this Case it becomes the Chirurgeon to acquaint the Friends with this kind of Remedy, and withall to make his Prognostick accordingly. But before we proceed in this Operation, we shall take notice of what some knowing Authors have writ hereof. For in those places where Amputation cannot be made, as in the Buttock, Shoulder, Back, &c. Fab. Hildanus proposes the use of potential Cauteries applied to the mortified Part, and often renewed, till the last Eschar reaches to the live Flesh. Yet he condemns Arsenick, as being venomous, and producing many dangerous symptoms. This method in Sarcomata has been used with good success: but in a Mortification there appear to me many greater inconveniences that attend it. First, from the Caustick it self, as he proposes it, of Salts: It will melt in the working, and is more disposed to spread in the Skin, than penetrate deep into the Flesh. This every young Chirurgeon knows in his making of Fontanels, that he cannot apply a bit of Caustick so little, thô he use all his Art in defending it, but that it will have spread much farther than he designed it. Then, the separation of such Eschars is too slow to effect the design: and in an ill habit of Body, such Medicaments are apt of themselves to procure a Mortification rather than Cure. Whereas on the contrary, an actual Cautery answers all Intentions: It not only consumes the Mortification, but dries up the venomous humor, thereby preventing its further progress; and also communicates warmth to the languishing parts, by vertue of which the separation is much farthered. But where An [...] putation it self is feasible, nay altogether necessary, as in the Limbs, there arises a new Question, whether it ought to be done in the sound part, or in the dead. Fab. ab Aquapend. advises, the dead within a fingers breadth of the live (as also do many others) then with a Cautery they burn up all the remaining Mortification. Others [Page 608]perform the Operation with a hot Knife. Aquapendent speaks so confidently of his success in the practice of this way, that utterly to deny the thing, were to give him the Lye. I shall only make this Objection, That the Sphacolus does seldom affect the Member so equally round, as that an Operation in the dead part is feasible: nay, which is worse, when once the Mortification seizes in the great vessels, it runs up so fast under the skin, that before any considerable part of the Member is outwardly gangrened on the one side beyond the Knee or Elbow, the other side will have reached to the Inguen or Axilla. This, I confess, frustrates all manner of Amputating, whether in sound or mortified parts. Yet generally speaking, the Gangrene grows not so fast, but that if you make Amputation two fingers breadth, more or less, within the live Flesh, you may prevent it; and that for better than it is possible to be done by the other way of operating. For if you work there by actual Cautery with a hot Knife, your Knife will stick fast in the Flesh till the moisture be wholly driod up, and then you must repeat many Knives and Canteries, in every one of which you will meet with the same inconvenience: yea, before you can cut through with your hot Knife, it is very probable that you will near the Bone meet with some parts that are alive and sensible, especially when you come to the Periosteum, (for the Membranes do not usually corrupt at the same rate of swiftness with the Flesh) and then all your pains and trouble will be as great or greater, than if you did it in the sound part. Hildanus mentions several other inconveniences, who has taken pains to confute this opinion.
Both these ways of Amputation seem to me much more difficult and painful than our common way; which makes me presume they proposed them, to prevent the effusion of blood.
But modern Chirurgeons have answered this Objection, by good bandages and deligation of the vessels, and when we cut above the knee by clapping Cauteries to the vessels only; which sufficiently answers that intention. Now I shall briefly deliver the whole Doctrine of Amputation.
In heat of Fight, whether it be at Sea or Land, the Chirurgeon ought to consider at the first dressing, what possibility there is of preserving the wounded Member; and accordingly, if there be no hopes of saving it, to make his Amputation at that instant, while the Patient is free of a Fever, &c. Therefore that you may the better make your judgment of the Wounds, I shall give you some few Remarques of such as require Amputation, viz. If a Leg or Arm he shattered by splinter or great shot, the loss of substance will direct you. If the principal Muscles be torn off, and the Bone fractured in pieces, or if the wound be with Musquet-shot in the inside of the joint of the elbow, or in the knee or ancle, with a fracture of the bones of the said joint, nay, supposing it has not fractured them, yet if the Bullet be so lodged that you cannot extract it, you shall then presently make extirpation of [Page 609]the part. If it be the Arm, cut it off in the place where it is so shattered, and saw off the end of the Bone smooth, your assistant the while pulling up the musculous Skin and flesh. If the Ankle be thus maimed, you shall then cut off the Leg within three or four Fingers breadth under the Knee, in regard so long a stump would be troublesome. But if the Leg be shattered off by the calf, do not put your Patient to the pain of new Amputation, for the shortning it a hands breadth, or a little more. Save what you can of a shattered Hand. And if the Toes with part of the Foot were shot off, cut off the lacerated parts smooth, but with care to save as much of the Foot with the Heel as you can; it being much better than a wooden Leg. But if the Arm or Leg be not so shattered, though the wound be large on one side, and hang gaping down with great fracture of the bones, yet be not discouraged; the largeness of the wound will make for your better pulling out those extraneous bodies, shivers, splinters, rags or ought else, and for the easier discharge of matter. Dress it as a wound by a splinter.
If the great joynt be so shot by Musket-bullet, that you think it not reasonable to cut off the Member, be sure you make extraction of the Bullet, and free it of all extraneous Bodies, leaving not the least shiver to prick the Nerves or Tendons: and make such way presently, that you may be able to dress the wounded Nerves, Tendons, &c. without making new incision, when the part is inflamed and unfit for it.
If after some days the wound do not digest, but inflame and Gangrene, and the Gangrene do not yield to your applications; then, as in a Sphacelus, you are to proceed with the extirpation of the rotten member, while the Patient is free from Delirium, and has strength to bear the operation.
Seat him so as it may be for your conveniency. At Sea they sit or lye, no great matter which; nor has the Chirurgeon any body to hold them; but with the help of his Mates, and some one or two that belongs to the Hold, he goes on with his work. Yet where we have convenience to proceed more formally, we always place the Patient to our most advantage, where he may be held firm, and in a clear light, and so that our assistants may come better about us. The Member is to be supported by some one, whilst another stands behind the Patient, and draws up the skin and musculous flesh. Then make your Ligature two fingers breadth, or thereabout in the sound part; so that if you amputate in case of mortification, you may be sure to quit your self of it.
This Ligature is omitted by many of our Chirurgeons here in the City, they only making a turn with a Tape, pinning it on as a mark to circumcide by: and instead of the Ligature I propose, they make a gripe, which gripe is commonly made by some assistent, who has strength to do it. Indeed this is good, where a shattered Membrane is to be cut off, to smooth the stump; in which case [Page 610]there is no great fear of bleeding. But in Amputations it seems to me to be very inconvenient: for I never yet saw any man so gripe, but that still the Artery bled with a greater force than was allowable. It being so, in what a huddle is the stump then drest? But suppose the uneasie posture, and the long griping tires the griper; or that his hand be crampt the while, what condition is the Patient then in? Whereas by this ancient way of Ligature, the vessels are secured from bleeding, the member benunimed, and the flesh held steady, ready to receive the impression of their crooked knife (or, razor, which many have amputated with.)
This Ligature made, the assislent strengthens it, whilst he draws up the musculous flesh. In the mean time the Operator, with a sharp crooked knife, by a turn with his hand, cuts the flesh off round to the bone; then with the back of it he scrapes the Pericsteum from the bone; if there be two bones, then with a dividing knife he scparates the fleshy Membrane from them. The bones freed of the Periosteum, Guido proposes a linen cloth, and Hildanus a kind of Purse, to be brought over the upper divided flesh, to pull it upward, and make more way for the Saw. But I think that needless. The flesh divided, the parts separate enough of themselves; besides, the assistents pulling up the musculous flesh and skin is sufficient. That done, you are at liberty, whether you will cauterize the vessels by a Button-cautery, or by Ligature stop the bleeding, or by agglutination. The use of Chalcanthum I do not approve. To apply escharoticks to the ends of the Nerves and Tendons newly incised, causes great pain, weakens the part, and makes way for Gangrene; it not being likely you can so apply them to the Artery, but that you must burn the parts about, which are, as I said, the Nerves, &c.
The way Hildanus proposes, by drawing the vessels out by a Forceps, is not a work to be done in heat of sight, nor without a clear day-light. If you attempt it on Land, his Arm would be bowed, and his Leg stretcht out, that the vessels may be the longer after extirpation, that you may the better take hold of them. Ambrose Parey proposes a more easie and sure way of deligation, by passing a Needle with a strong twisted thread through the skin near the great vessels, by piercing through the raw flesh and skin: then make your Ligature upon a fold of rag.
Thus you bind the Artery and Vein. These several ways have been practised by eminent Chirurgeons for the stopping the Blood in the Arteries in Amputation, but the late discovery of the Royal styptick has rendred them of less use. But in heat of fight it will be necessary to have your actual Cautery always ready, for that will secure the bleeding Arteries in a moment, and fortify the part against future putrefaction: they requiring after cauterization no such strict bandage, as that thereby you need to fear interception of the Spirits. When [Page 611]we cauterize the Artery, we do then touch the end of the bone, it hastning exsoliation.
The next thing is the loosning the Ligature, and bringing the Lips close over the stump. Then whether you should with a cross stitch hold them so, or content your self by bandage, as well as you can, is by some controverted. They that object against the former, say, it causes pain and inflammation. So does bandage also, if it be made too strait. Therefore they should object against that also. The most that are done without the cross stitch, are the next dressing broad stumps, some of them with Lips turned outward by the bandage; in the least of them the whole stump is bare: whereas in those in which the cross stitch is made, the Lips are found close to the bone at the next dressing, covering the great vessels, and a third part, or half of the stump is well digested; and oftentimes by the second dressing near agglutinated, so far as it lies under the skin, and without inflammation happily cured. Whereas the broad stump is a certain sign of a long cure, and commonly the death of the Patient. If the musculous flesh and skin are well pulled up in time of Amputation, and brought over by a moderate extension as far as they will easily admit, you will find it not painful. You ought to pierce the skin with a needle and strong brown thread, ceared about half an inch from the edges of the Lips.
Having made them cross from side to side equally, tie them with a moderate astriction, then apply a pledgit on the cauterized vessels with pulv. rad. irid. succ. cepar. cum melle. But if no cautery was used, then buttons of Tow spread with your restrictive, and dipt in pulv. Galeni, must be applied to the mouths of the vessels.
Afterwaads sprinkle the stump thick with this powder; ℞ b [...]l. Armen, farin. volatil. picis naval. an. ℥iiij. aloës, thuris, mastich. sang. dracon. an. ℥j. gypsi ℥jss. pil. lepor. corii raspats, an. ʒiij. Misce s. a. You may mix some of the same cum album. over. and apply it upon a thick round stupe, which has first been wet in oxycrate and dried; and over that another stupe spread with the same, so broad as to come over the first, and up a pretty height above the stump. This latter must be snipt deep in the edges, that it may lie smooth about the Member.
An Ox-bladder ready cut and wet is to be turned over [...]t, and a cross cloth next the Bladder, to hold the dressings [...]eady.
Then with a Roller with two heads begin upon the stump, and rowl up to the next Joynt, and so again about the Member, to retain your dressings firm. Then fasten it so as that it may not be capable of falling off.
But before you make this bandage, you ought to apply your defensative over the parts above the stump. Some apply it before they begin the Amputation: but then it is apt to wrinkle, and to sit uneasy. In the dressing of the stump you ought so to apply your Medicaments, that you may without much bundle rowl up the Member. Then place it to the ease of the [Page 612]Patient, one holding his hand some while upon the stump. Your Defensative may be such as is used in Gun-shot wounds, or, ℞ far. hord. bol. Armen. an. ℥iij. sang. dracon. ℥iss. Flor. ros. rubr. balaust. nuc. cupress. pulv. an. ʒij. acet. ʒx. album. ovor. num. viij. ol. ros. & myrtill. an. ℥j. cerae q. s. Boil these powders in acetum, then add the rest to it, to make it of the consistence of a Cerote.
The third day take off the dressings; and then you may cut the cross stit [...]h, and sprinkle the wound with pulv. Galeni, and dress it with this digestive; ℞ terebinth. lot an decoct. hord. ℥iij. ol. lumbr. ℥ j ss. gum. elemi dissolut. in praedict. ol. ℥ss. farin. hord. eribrat. ʒ ij. vitell. unius ovi, croci pulv. ℈j. Misc. Apply to the bone a pledgit of dry Lint, or prest out of spir. vini.
After the wound is digested, you may deterge with mundif. Paracels. or apii, or this: ℞ Terebinth. Venet. lot. in spir. vin. ℥ iij. pulv. rad. irid. aristoloch. rot. sarcocoll. thuris, mel. ros. an. ʒj. Then incarn and cicatrize, as has been prescribed in compound wounds.
CHAP. XXXIX.
Of the extirpation of a cancerous Breast.
IF notwithstanding all your enendeavors to cure a Cancer, the Tumor increase, and be like to ulcerate, you may do well to forewarn the Patient of the danger: and if it be loose, and in a place where it may be safely extirpated, propose it to them, lest afterwards they desire it when it is too late.
That you may be the more successful in the operation, I shall offer to your consideration these few qualifications. First, that the Patient be of a strong constitution, and of a tolerable good habit of Body, and not in a declining age, when the Menstrua are ceased. Secondly, that the Cancer be loose, and the axilla free from painful glands. It were also to be wisht, that the Cancer took its original from some accident, as a bruise, &c. Thirdly, that the operation be performed in the Spring, or Autumn of the year: lest through the great heat of the Summer the spirits be resolved; or by reason of the extreme cold in the winter, the native heat should be choaked.
In order to the operation you ought to have good rollers, compresses, restrictive powders, and defensatives, as in other amputations. The use of Chalcanthum or [Page 613]other escharoticks I do not approve: for you cannot apply them so to the mouths of the Arteries, but they will corrode the adjacent parts, and cause pain, which ought not to be, especially in a Cancer. Besides, they require a strict bandage, which is very troublesome on the Breasts. To avoid which inconveniences, I propose the stoping of the Blood by a small button-cautery; which I acknowledge is not done without some pain, but that is momentary, and serves to correct the indisposition of the part: whereas the other lies gnawing so long as it is upon the part, and renders it crude and indisposed. There ought to be actual cauteries of different sorts ready heated in some corner of the chamber, lest in the extirpation there happen to be lest some reliques of a cancerous gland behind. All things being ready, the Patient must be placed in a chair to the light, and held steady. It is then at the operators choice, whether he will make a Ligature about the basis of the cancerous Tumor, or pull it to him with one hand, while he cuts it off with the other. For the cutting into the Breast, and pulling out the cancerated knot, rarely succeeds well: nor indeed is every Breast so capable of being freed of the Cancer, when it is cut off by making a Ligature. If the Cancer be cut off clear, your business is then to stop the blood as you please: but if any scirrhosity remain, you shall do well to consume it by actual cautery. The Ancients used in these operations to permit them to bleed freely; nay, provoked them to it by crushing out the blood; after which, the actual cautery was applied all over, then they dressed the wound as a burn: but according to my method pulv. Galeni is most proper. Then palce the Patient in bed, and give her an auodyne draught that night, to quiet the ferment. The second or third day after you may dress her with some digestive, as that ex terebinth. cum vitello ovi; or, ℞ terebinth. lotae ℥iij. syr. de ros. siccis, ℥iss. succ. plantag. solani, an. ℥ij. succ. apii ℥j. coquantur ad dimid. succor. consumptionem; dein adde far. hord. & ciceris an. ℥ss. croci ℈ij. vitell. unius ovi. Misc. But if there be no pain, dress it with Empl. è bolo. After digestion proceed with detergents, and incarn and cicatrize as in wounds; remembring to keep the body soluble the while by Clysters, or purge and bleed as you see occasion. And if they had no Fontanels before, make them some now: for thô the Cure may seem successful, yet if there be any evil quality in the Humors remaining, the Ulcer will scarce cicatrize.
If in cicatrizing it the Lips do grow callous, attempt the eradicating timely by actual cautery, whilst it is within a narrow compass, and lies in the superficies: for if you defer it till it has siezed the Musculous flesh, it will be too late, it being then scarce capable of palliation. Yet some Authors have left us prescriptions, whereby they give us hopes to cure them or extirpate them. Those they have offered to us for the cure are much the same with what I have already set down, viz. ℞ ol ros. corae alb. an. ℥ij ss. succi granat [Page 614]& solani. an. ℥ ij. cerussae lotae ℥ ij. plumbi usti loti & tutiae praep. an. ℥ss. thuris, mastich. an. ʒ ij. fiat imguentum s. a. Or, ℞ unguenti tutiae Vigonis ℥iiij. theriac. Venetae ℥j. sacchar. Saturni ʒ j. succ. geranii q. s. ducantur in mortario plumbeo, &c. Others commend the juice of Mullein boiled with Honey. Riverius tells you in one of his observations, that he cured one by often dressing it with aq. ros. plantag. & rhoead. with a mixture of mel. rosat. Aetius proposes extract. Sumach: but that is more proper in Cancers of the Ʋterus.
Empiricks amongst us brag much of their skill in curing of them; and, by the giving of Matthews's Pills, or Opium mixt with some purgative, they do now and then alleviate pain, and thereby encourage diseased people to commit themselves into their hands, whom if they can perswade to an Amputation, they get some Money in hand: but their frequent miscarriages in that work, have taught the more prudent people to avoid them.
Some eminent Chirurgeons, I suppose, after a fruitless endeavor to cure them, have attempted the extirpating of them by Escharoticks. Guido has commended to us Arsnick powdered and sprinkled daily upon them, the Eschar being first pulled off. Riverius in his observations tells of a Cancer that was extirpated by this application. ℞ aq. fort. ℥ j. sublimati crudi ℥ viij. salis Ammoniaci ℥ ij. arsenici ʒ j. These are to be distilled ad siccitatem, then the caput mortuum powdered, and the like weight of Vinegar to be put thereto, and distilled again to the consistence of a soft paste for use. Ol. arsenici, aq. regia, ol. vitrioli, lap. caustic, &c. have been proposed. When such are applied, there will be need of good defensatives. By the Authority of some of these Authors, young Chirurgeons have been sometimes ingaged to their prejudice: and some years since an eminent Chirurgeon, since deceased, undertook the eradicating of an ulcerated Cancer in the Breast of a Woman that had strength and courage to endure it. He applied the strongest of the fore-mentioned Escharoticks: they penetrated deep and made great sloughs, which he pulled off, and by repeating the Escharoticks raised new; but the use of them was not long continued: for the gleet partaking of the corrosives, ulcerated the adjacent parts; and the Cancer was so enraged by the Escharoticks, as shewed there was no good to be done by them. Indeed if they had contrived Medicaments, that could have penetrated deep with little pain, there might have been some hopes of success. So cancerous excrescences and Ulcers in the Mouth are increased by touching them with Oil of Vitriol, Sulphur, &c. Upon which consideration there remain but two ways, either the actual Cautery, or palliative Medicines. If the Cancer be in such a place as you may hope to eradicate it, the actual Cautery is then a sure help: but not by applying it lightly upon the upper parts; but by thrusting at the root with a scoop, or chisel-like Cautery, carrying it away before you. If there remain any rags of it, with a proportionable [Page 615]button-Cautery, burn it down to a crust: but if this cannot be effected, then endeavor palliation by such Medicaments as above have been proposed. And in case the Menstrua or Haemorrhoids be stopt, bleed by venaesection or by Leeches, and make Fontanels: for by such means many people live tolerably well, who have Cancers ulcerated; when others, who ailed less, by their impatience are dead.
CHAP. XL.
Of taking away Blood by Venaesection, Scarification, and Leeches.
THô one would think that but little skill were required in opening a vein; yet it often so happens, that this very thing creates trouble to the Artist, and no small pain to the Patient, either when the Artist cannot undertake the work, or, if he does undertake it, when he cannot attain his intended end.
When he does not undertake it, it is either because the Vein that should be opened, does not appear, or the Chirurgeon cannot find it. In which two cases, as the first saves the Chirurgeon blameless, so the latter argues either want of skill, or dulenss of sense. In the int [...]rim however, thô not to undertake a thing upon occasion offered, discovers the slenderness of the Chirurgeon's skill; yet such an one is to be born withal, yea, in some measure to be commended: Since it is better to do nothing at all, than to attempt any thing timerously or rashly at another's peril.
But when he undertakes the thing, and attains not his desired end, this happens either because the vein was not touched, or if it was, not as it ought. It was not touched, either because it lay not there, or the Lancet reached it not, or divided it not right. Which soever of these things happens, it is absurd, and alien to Art; unless it happen through the Patient's fault in snatching the Limb away before the Chirurgeon has done his work. If the unskilfulness of the Artist be in fault, it is either because the bandage was too loose, or some way incongruously applied, by reason whereof the vein cannot be kept tight, but slips away from the hand: or because it is not full enough, but falls down flat, and resists not the instrument: [Page 616]or because the instrument is blunt, or wrong thrust in.
A vein is ill divided when the incision is too narrow or too wide, or not correspondent to the incision of the skin. When the orifice is too wide, bleeding in ones sleep may be feared. When it is too narrow, besides, that it bleeds not as one would have it, a Tumor arises about the wound, which the Greeks call Thrombosis. And the same thing happens, when the incision of the vein and skin is not the one correspondent to the other; which happens several ways. Either because the skin is drawn out of its place by the sillet; or by the Thumb which stays the vein: or because the Lancet is put in too obliquely.
But there are worse mistakes than any yet mentioned, to wit, when the Nerves are hurt, or an Artery is touched. And the mischief is, it afflicts the Patient the more, for that he finds his calamity and destruction to proceed from what he expected health or help by. Whoever therefore would be accounted a skilful Artist in this thing, he must endeavour all he can to avoid those mischiefs: Which he may easily do, if he will but rightly consider, what out of good intent, and confirmed by frequent experience, I here set down.
First of all, the Artist's hands must be warm, and the Patient must sit upon a Bed or in a Chair (but it is better in Bed, because of swooning) then either the Limb must be so brought to the light, or the light to the Limb, that the place of the vein may be so conspicuous, as that his hand, when he goes about his work may not be in his light. Some may think this caution about the light superfluous, but I have often observed Chirurgeons in a fault herein, and by consequence mistake. Then bandage must be made, so as that the vein may fill, and be extended.
But in tying the fillet two things must be observed, which are childishly neglected by many. The first is, that the hand (if the vein be to be opened in the Arm) be kept open till the fillet be tied as it should: for so it afterwards expresses the Blood out the better, when it is tied. Another thing is, that when it is sitted, the skin over the vein be neither drawn up (as most do) nor on one side, nor any other way out of its place. For this, when it returns to its proper place, stops up the wound of the vein; and it returns again presently, when the string is but a little loosened. In Bodies where the veins are full of Blood, little skill serves the turn and every Boy is reckoned an Artist sufficient: But in scarcity of Blood, or straitness of veins, or when they lie deep, or are inconstant, more skill is required, both to find out and know the vein, and to keep it, and also (which is the main thing) to open it right.
When the fillet is thus fitly tied, if the vein be eminent, or conspicuous to sight, or manifest to the touch, it must be opened as soon as there begins to be any renitency in it; for by tarrying it grows more obscure, whereby the work is also rendred more difficult.
The fittest place of Section is that which is safest, and most patent. I call that safest, which is farthest from the Nerves and Arteries; and that most patent, which is highest, and most manifest.
But when the fillet is tied, and the Limb a little rubbed, if the vein still lie hid, recourse must be had to hot cloaths, and somentations of warm water: and if it be not found out by these, it will scarce appear by any other means. Wherefore the Lancet perhaps must not be thrust in there; but some other adjoyning vein, if it be turgid, must be opened.
The narrowness of the orifice is holpen by inlarging the wound; and so the stoppage of it is holpen by removing of what stops it. But greater care is required in mending the narrowness, than if the vein had not been touched before: because the Blood is continually diffused between the skin and the vein, which by forcing up the skin disjoyns it from the vein. Therefore as soon as the skin at the wound rises into a swelling, it must presently be softly pressed with the Thumb, that the violence of the blood may be forced back, and the rising swelling deprost: Then the Thumb must by degrees be taken off a while, till the wound appears and gives room to the operating hand or instrument to operate. Then the Lancet must be gently and carefully put into the first Section, and the incision enlarged as much, as the first Section was deficient. But great care must be taken in this operation, that only the skin be not (as it often is) dilated without the vein; because then the labour would be to no purpose. The instrument therefore must be put again moderately into the cavity of the vessel, and the wound must be sufficiently enlarged according to Art. But if the return of the skin hinder the efflux of Blood, it must be gently reduced into the same place, where it was when the vein was cut, that the division of it and the vein may meet together, and it must be kept there, till as much blood is run, as you would have.
But it happens also, that the skin, or rather all that is over the vein, covers the wound of the vein, which nevertheless is not drawn out of its place; And this happens when the vein lies deep, and the Chirurgeon puts in his Lancet too much slanting, and does not raise the point, but pulls it out the same way he put it in. When this happens, if you would make the Blood run (supposing the vein sufficiently divided) you must with a very small Probe or a pin's head, either raise the skin, or depress it a little, till the Blood runs as you would have it: for by this means, either the vein is a little separated from the skin, or the skin from the vein, and way is made for the Blood.
When a sufficient quantity of Blood is taken, and the fillet is loosed, and the vein on each hand softly expressed, or exgurgitated (if I may use a Chirurgeon's word) that the lips of the wound may not gape, and may joyn the better, laying the Thumb of the ministring hand on one end of the Section (it is the best on the lower) the skin must be drawn according [Page 618]to the rectitude of the wound, and a small pledgit of Lint or Cotton must be laid upon it, and neatly tied, that it may not bleed again afresh, nor the Limb be pained by too strait binding. But if it be difficult to stop the blood, either because of its thinness (as when the blood is very serous) or because of the large orifice, then with the Thumb, the fore and middle Finger of the left Hand, the skin must be drawn to each extremity of the Section in a right line with the Section, and so the blood is stopt: or, if you list, the edges may be closed up by applying your Thumb and fore-Finger, not to the ends of the wound, but to the sides: but the first way, if it can be done, is the best, and fittest for the business.
When the blood is thus stopt, and the edges of the wound fitly joyned together, a bolster of Cobwebs, or (which is safer) half a Bean, or (which is best of all) a piece of bole Armenick, made into the form of half a Bean or half a hazle-Nut, may be laid upon the wound instead of a bolster; which being covered with soft Lint or Cotton, must be so artificially bound on, that the too great astriction hurt not, nor the too great laxity occasion its bleeding again unawares. When these things are done, all bodily labour and motion of the Limb must be forborn. This our advice may be contemned by several; but certianly by such as little regard their Patient's Life: for sometimes it has been known, that People have died through negligence in this very thing. Wherefore since a Bean, or a bit of Bole is not of any such weight of bulk, as to encumber a Chirurgeon much, no one should be without them, who frequently lets blood.
And if an Artery chance to be cut, and it cannot be stopt the foresaid way, nothing is more proper and safe for the Patient's safety, than to bring close together, and exactly to joyn the edges of the Section, then to cover it with the foresaid Bole, and carefully bind it, and then with the Hand gently and constantly to retain and press it till it grows together, and this cure must be used for several days.
We have already told you how to stop Blood, and how to rectify Venaefection, when it is performed amiss, how many ways one may mistake, and how mistakes may be avoided. Now it remains to shew (a thing worth the while not to be ignorant of) how an unexpected cutting of an Artery or Nerve, and the pricking of a Tendon may be avoided: how many ways of opening a vein, how the Lancet should be managed: and several other things.
We must therefore know that the veins, which Physicians order to be bled, have no where Arteries, or Nerves, or Tendons lying above them, nor lying at an equal height with them; but underneath them in several places, yet not in all, which (besides the assurance an Artist has from dissecting dead bodies) is easily seen in the Hands, Feet, Hams, Arms, and other parts of living People. From whence it is evident, that he who pricks a Nerve or Tendon together with a Vein, must have run his [Page 619]Lancet in deeper, than was necessary to let blood; since to perform the business required, it had been sufficient to have cut the upper part of the vein, next the Skin or one side of it, and not to have stab'd it through on both sides.
A Nerve indeed, when in this case it is wounded, can hardly be discerned, before it is hurt, and there is not another in the whole body, that I know of, which is usually hurt; besides that, in the middle of the bent of the Arm, that lies under the common vein (or rather the Tendon of the musculus biceps.) But Tendons, because of their frequency and magnitude, are oftner touched, but with less danger than when a Nerve is hurt. They are hurt sometimes by chance, when the Lancet is run in too deep, and sometimes when the Chirurgeon mistakes, and pricks a Tendon for a Vein. And as there are some who mistake a Tendon for a Vein, so on the contrary there are others, who sometimes, when the Vein appears not to sight, but only to touch, dare not open it, believing it to be a Tendon and not a Vein.
When therefore a Limb is tied, and the Vein is not apparent in the place, where it is usually found, and some round thing is perceived deep under the skin, of which you doubt, whether it be a Vein or no, presently loose the fillet: for when it is loose, the Vein will fall, and cannot be perceived again, till the fillet is tied. Therefore if what you felt, appear the same, both when the fillet is tied, and when it is loose, you must withhold your Lancet, since this must needs be no Vein, but a Tendon, or the head of a Muscle, or something beside a Vein. Wherever Arteries are, they beat; by which both their place and depth are declared to any Artist, who has but competent experience.
Swooning frequently happens in Blood-letting, which uses to create to the by-standers, yea, and to unexperienced Physicians more fear, than hurt to the Patients. Yet it happens through no fault of the Artist, but the faint-heartedness of the Patient, which disturbs the spirits in the Body, and checks them, which makes the Soul seem to depart. But this is immediately prevented; namely, if the Patient lye along, and hold some liquor, as water or wine in his Mouth till the blood runs. And if notwithstanding it seize one, stop the blood with your Thumb laid to the orifice, and presently throw some cold water in his Face: If it continue longer, you may also pinch the Nose; and when the fit is over, take off your Thumb, and take away what Blood in prudence you shall think sit, but stop it not, as some over-timerous persons are apt to do. If it take one sitting, he must be helped the same way the other was to be preserved from it: he must presently lie on a Bed, or be gently laid on his back upon the ground, and have cold water thrown in his Face, as was said before: For an Artist may easily perceive it coming, if he look in the Patient's Face, or if he observe his Pulse; for that is pale, and this alters its stroke. But as it may easily be perceived, and is raised on so slight occasion; so neither is it [Page 620]hard to get off, nor when a Patient is seized by it, is it difficult for him to be restored to his Senses, Thô at its coming it cause some terrible motions of the whole Body, quivering of the Eye-lids and Lips, and other things of that nature; yet they are presently over. Which is not so in Swoonings, which proceed from over emptiness.
Now we must speak of the form of Section, and its manner of performance. By the form I mean the manner of its position, and its magnitude. By this we call the Section either large, small, or midling: By the other, transverse, or oblique, or length-way of the vessel. Long Section is better than transverse. Oblique is the best, and easiest to be performed. As to the manner of doing of it this way or that way, tho it may more easily be apprehended by once seeing the work well done, and the observation of it, than by ten times reading it with the clearest voice; yet because every Scholar cannot have an expert Master, and reading (well understood) is of some efficacy to direct the Hand, it will not be amiss to subjoyn somewhat of these things.
The Limb being the way beforesaid tied with a Fillet, and the Vein appearing tense, either to the sight or touch, it must presently be opened with a well-pointed Lancet; not perpendicularly, running the Lance: in suddenly (as many do, who make more haste than good speed) but obliquely, and thrusting it in gently. When the Vein is perforated, the Lancet must not be drawn back the same way it went in: but suddenly the point must be raised, and the heel of the Lancet depressed, which Chirurgeons properly enough call elevation. And that you may do this the more commodiously, you must hold your Lancet at a good distance from the point, about the length of a long Bean; not that all of it should be run in, but to perform the thing the better, which when it is taken too short, cannot well be done. Besides, it makes well for this thing, that the operating hand, whilst it operates, be not pensil, but supported by the rest of the Fingers which hold not the Lancet, leaning on the Patient's Limb.
A sudden stroke is to be condemned upon this account, because, besides that it often fails the Artist, it is in danger of hurting a Nerve or an Artery, because there can be no aim or measure in a sudden thrust.
Now if an oblique pertusion do not please you, the Vein may be opened length-way or transverse. But as an oblique Section is preferable to all the rest, so a transverse is worse than any. The Section may be called broad, when it is broader than is necessary for a free efflux of Blood. Strait, when it is straiter than it should, and in this some Tumor presently arises. And that is midling, by which, without either Tumor, or superfluous Wound, the Blood passes freely.
That all these things should be done as they ought, the Artist must be Ambidextrous, because the Patient's right Arm and right Foot, and the left Temple require the left Hand, and the opposite [Page 621]parts the right. Yet all Veins may be opened, either with the right hand or with the left, if the Artist be but handy in either of them; thô not so commodiously. Wherefore it will become a good Chirurgeon, to have both hands ready and well exercised, not only in opening of a Vein, but in any other business proper for a Chirurgeon, which can scarce well be done, when one Hand is useless.
There are divers places in Man's Body, and many Veins, wherein Physicians advise Bleeding. In the Forehead, one at each Temple, which has often two branches, one in the middle of the Forehead, which has sometimes two, sometimes three branches. Behind the Ears, and at the Nose by the great corner of the Eye. Sometimes bleeding at the tip of the Nose by putting a Lancet about the depth of a Pumpion-seed between the cartilages, does good. Two under the Tongue. Two Jugulars, which sometimes also have branches. Three in the bent of the Arm, of which the Basilick or Hepatick Vein branches into several twiggs. In the left Arm this is called the Splenitick. The Cephalick has seldom any branches in the bending. The common arises from the Cephalick and Basilick, it is called the Median, Purple and Black Vein. From this comes that they call Funis brachii, from which comes the Salvatella to the Ring-Finger, and another to the Thumb. One in the Yard, and sometimes two. One at each Ham and each Ankle, where if they cannot be found, they must be sought at their ends, namely towards the Toes on the upperpart of the Foot. Of all these if that cannot be had, which is sought for, the next must be taken, and of those that are divided into several branches, the largest is to be chosen, except in the Jugulars.
The form and use of the fillet is the same, to demonstrate and keep tight the Vein, in all parts below the Neck. Nor is the other obscure, which is put about the Neck, for the Veins above the Breast. For the manifestation of which, a Towel is put about the Neck, and the ends of it brought forward, which are given into the Patient's Hand, and twisted like a Cord, till the Veins appear: Holding ones breath is also good for this.
Now we must treat of scarifying and Leeches. Scarification has one general cause, namely the discharging of the part, where it is made. Therefore according to the magnitude of the Part, the vehemence of the Burthen, the depth of that which should be got out and its faultiness, the wounds must be more frequent, deeper, larger, or straiter, shallower and thinner: for thin, small, and cutaneous scarifications are proper for Diseases, that lye not deep nor are grievous; but for stronger Diseases, as for a Gangrene, other Scarifications are more suitable.
There is no part of the body but may be scarified, if either it be Gangrened, or troubled with an old Inflammation. Scarifications are sometimes used, where there is neither Gangrene nor Inflammation, but where they are feared, as in venomous bitings and stings, suppose of the Aspe, Scorpion, [Page 622]or other venomous beasts; for which nothing is better, than to make speedy scarification upon the very sting or bite, and near about it, making two, three, or at the most four wounds. In the stinging of a Scorpion, if there be but one pricle, one scarification made upon the prick is enough. In the biting of Asps, because they bite with several Teeth, or in other bites or stings, in which more than one print of a sting or tooth is left, one may make a wound upon every prick or bite. When there is neither Gangrene nor Inflammation, nor suspicion of either, scarifications are used for derivation, with Cupping-glasses or Horns.
All scarifications are better made with a Rasor than with any other sort of instrument: But with Cupping-glasses, the German Lancet is the best.
The application of Leeches is not effectual enough for Gangrenes of the greater Limbs; thô it serves the turn well enough, when a Gangrene invades the less parts of the Body, as the Ears, Nose, Fingers, Yard, and the Piles either inward or outward; but scarifying is quicker and safer than Leeches: However, for soft and effeminate persons (who are affrighted at the very name of an instrument) they are often used instead of the knife.
They will not stick unless the skin be clean, and free from filth and ill scent. Wherefore if they be to be applied to any part, where there has been an Ointment or Plaster, it must be clean wiped, so that it may resemble nothing but pure flesh. Sometimes a slight scratch is made, like that where Cupping-glasses are applied, that the sense of the Blood there may make them stick. They will hardly fasten in winter time, unless they be kept in a warm place.
They are kept in a glass, or earthen vessel full of water, and well covered, that they get not out; but so as to admit the Air. They may be used at any time, namely, either the very day they are taken out of the River or Lake (unless they have been newly fed; for then they would not readily stick) or when they have been kept several days. They will hold good for half a year, but elder they are ineffectual, either through hunger or sluggishness, or for some other reasons. Wherefore, when you can renew them, it is better to do it every second or third Month.
When a Leech is fastned, it must be let stick, till it fall of it self, or if it must be taken off sooner, strew a little Salt or Ashes on it, and it immediately leaves the skin. If you would take away more Blood, than it can contain, snip the Tail with a pair of Scissers, and it will nevertheless suck Blood still, which runs out at the wound: Yet it will fall off of it self, or by laying Salt or Ashes on its Back.
CHAP. XLI.
Of the couching of a Catarrhact.
A Catarrhact is called in Latin Suffusio, in Greek [...], the Arabians call it water, it is commonly called a Catarrhact, the denomination, as I suppose being taken from Catarrhacta a Portcullis, which being let down stops all passage. For a Catarrhact falling down from the Head into the Eyes, stops all passage of the light and vision, whereupon the Patient afterwards grows blind.
This impediment is caused by a pituitous humor growing within the Eye like a tunicle, or a speck, or drop, or film, or water, which appears like a white coat to them that look on it, and this is so, when it is confirmed; for in the beginning when it is growing, it looks not like a coat, but like smoke, or vapor, or a mist; whence it comes to pass, that according to the various density of the humor, the Sight is hindred, as when one sees through a thick Air and Smoak, or through a Mist. The various position of the humor likewise makes a great difference; for thô it be always opposite to the Pupilla or sight of the Eye, yet it is sometimes exactly against the middle, and the space round about is free; then in the middle nothing is seen; but round, all things appear. In short, according as the humor possesses this or that part of the Pupil, so the sight must needs vary.
This humor grows in the Eye chiefly by reason of the weakness of the Eye, occasioned by a fall or blow, or some other cause, that weakens the Eye, which since of its own nature it is cold, by weakness it is made colder; wherefore no wonder if signs of coldness afterwards appear in it, to wit, the breeding of a cold humor, its concretion, density and obduration, I say, of a pituitous matter, which at length grows hard in the weaker part of the Eye, such as is the aqueous humor, which Galen makes to be the excrement of the Eye, so that from what has been now said, It appears why Phlegm becomes concrete in the Eye, and why in the aqueous humor, though there be various opinions in what part of the Eye exactly it does congeal. Celsus l. 7. c. 7. will have it grow between the two coats, the Cornea and the Ʋvea, where he holds there is an empty space, which I think not altogether so consentaneous to truth. Paulus l. 6. c. 21. holds it to be in the Membrana cornea, as appears from his own words, A Suffusion, says he, is the [Page 624]concretion of a superfluous humor in the Membrana cornea near the Sight of the Eye, which I take to be false, thô Paulus says otherwise, l. 3. c. proprio, namely, that a Catarrhact is an effusion of humors, which congeal between the Tunica ceratoides and the crystalloides. Galen de usu partum c. 1 & 4. writes that it grows between the Cornea and the Crystalline: which saying of Galen's is so general, that by it we are no wiser than we were. But it has been frequently observed both by operators themselves, and by such as have looked on, when the needle has been put in backwards behind the Ʋvea tunica, that it has appeared before the Suffusion; which perswades me, that the Humor congeals at the hole of the Tunica uvea, or about its circumference, or a little behind it in the aqueous humor. But since the hole of the Ʋvea is dilated, one would think, the concrete humor should lye just behind the hole of the Ʋvea, because if it grew in its circumference, it could not be dilated. However, this objection is answered by Paulus, who will have the suffused Eye prest with the Finger, and if after the compression and motion the pupil be dilated, it is a sign of no confirmed Catarrhact; if it be not dilated, it is a sign it is confirmed, which it is convenient to know in order to a cure.
The best way of cure is by Medicines, when it can be done; and it may well enough be done by them, when it is fresh, and not perfectly congealed. In this way of cure innumerable Medicines are found in Authors, called Eye-salves or Collyria; but all to no purpose, because whether they be Powders, Liquors, or Ointments, the Eye has such an aversion to them, that it will not suffer them to be applied, or if it be forced to receive them, yet in the twinkling of it they are turned off; for the motion of the Eye cannot be hindred. All which things considered, leaden rings have been invented, to keep the Eye steady; but to no purpose: for the Eye would have its motion, and then the Medicines slipt off. At length it was found possible to keep Medicines on the Eye, thô it should move. This is performed by a Glass vessel, or Cupping-glass, whose mouth is just as big as the ball of the Eye: In this Liquors and Waters, and with them Powders may be put; and the Cupping-glass may be applied first with the Eyes shut, and then by degrees opening the lids; by this way it is experienced, that Medicines will tarry long on the Eyes, and do good. This is a general course, whereby most diseases of the Eyes may be cured, whether external or internal. First of all, Cupping-glasses were used, which would let some of the Liquors run out; but afterwards oblong Glasses were more exactly sitted to the Eye, with Ears, through which strings are put and fastned behind the Head, And because Water, which is applied to the Eyes, ought to be lukewarm, to the end the cold may not offend the Eye, but may raresy it, and cause the Medicine to penetrate, and since warm water evaporates, and the vapour not finding a passage out, may draw the Eye, and [Page 625]bring humors thither; therefore the glasses were made with a pipe at the top, to let out the expiring vapor. And thus a most apt and convenient vessel is invented, viz. to keep a thin and watry medicine to the Eye, whose contact the Eye will easily endure: It is also useful to put in more Liquors at, as by a Funnel. Among those infinite Medicines, which are proposed by Authors for the cure of Suffusions, this is one of the best, used in manner aforesaid. It is this, Aqua eufragiae, chelidoniae, & rosarum cum medico Aquae vitae primae distillationis. In this there is a dissolving, attenuating, and penetrating faculty, which are the main intentions in the proposed case. So far the Medicinal part, now we proceed to the Manual operation.
When the Suffusion is perfect, then all are for having it cured by Chirurgery, because Medicines do but irritate the Eye, but do no good, because of the concretion and hardness of the Suffusion; whereas the Needle will do the work by couching it. But first, I say, the Cure must be tried by Medicines, while the Patient has some glimmering of Sight, as through Smoak, or a Vail, or Mist: For if there be any further loss of sight, the Suffusion is consummate, wherein because of the concretion of the Humors, and the thickness of the Membranes, the Sight is quite hindred, which can only be helped by Chirurgery. And this operation is one of the nicest in the whole Art. In Latine it is called Catarrhactae depositio, in English Couching of a Catarrhact. For, as I said, it so happens, that a Membrane or very thin pellicle, such as comes upon Wine or Beer, does sometimes stick to the inner part of the Tunica Ʋvea, where the hole is, that we call Pupilla, or the Sight of the Eye, and it covers the Crystalline humor, and hinders the inlet and the out-let of the rayes. This, when it has acquired a due consistence, and is neither too fluid, no: old and tough, may be taken away and couched by the benefit of the Needle. The Body therefore being purged, in the decrease of the Moon, on a clear and serene day, the Patient must be set on a seat in a clear place, against the light; over against him the Operator must sit, but a little higher: A Servant must stand behind the Patient, and hold his Head immoveable. The sound Eye must be bound up with a Ribband. And the Chirurgeon, after having chewed a little Fennel in his Mouth, must breath upon the Eye affected, and rub it a little with his fingers, and bid the Patient turn his Eye towards his Nose. Then the Needle being often prickt into a flannel or woollen cloth, to make it warm, must be forced (with the right Hand, if the left Eye; and with the left, if the right be ill) at one thrust through the Conjunctiva, about the thickness of a Crown piece, just by the Iris, and by degrees, as it were by drilling and turning it round, must be got through the Cornea. When it is come to the empty space, any who has but moderate skill, cannot be mistaken, because when he presses he feels no resistence. Then the Needle must be inclined towards the suffusion, and with its [Page 626]point must by little and little be separated from the edge of the Ʋvea, and then by turning it gently must be wrapped about it, and must be couched, and violently forced beneath the region of the Pupilla, to the outer corner of the Eye, till it stick there. When this work is done, the Needle must be drawn out gently, and the white of an Egg beaten up and mixt with Honey, to hinder Inflammation, must be applied between two fine silks, and so the Eye must be bound up. After this, Rest, Abstinence; and a moist and cooling Diet will be proper.
CHAP. XLII.
Of Lithotomy, or Cutting for the Stone.
THE next thing in our proposed method, which we are to treat of, is the Stone. And because the extracting it, or incision for it, called Lithotomy, is an operation so difficult, that Hippocrates by his Oath, obliged himself not to meddle with Lithotomy; but to leave it to Men skilled in that operation: I think we cannot do better, than in our discourse concerning it, to venture on nothing upon our own Authority or Credit, but to relye wholly on them who have made it their main business to cut for the Stone. And thô several have writ on this subject; yet I shall only make use of what one of my Collegues, Dr. Groenevelt (of whose Lithotomical administrations I have been an Eye-witness, and of whose success therein, not only I, but multitudes are witnesses) has made publick on this subject.
As to the Etymology, according to the Philosopher, [...], We must first enquire the names of things. Now the Stone, called Calculus, is derived from Calx, for it is a concrete body hardned like Chalk into a Stone. The Greeks call it [...], and the pain proceeding from it [...]; only the Stone in the Kidneys they call [...], because the Greeks call the Kidneys [...]. And thô any disease in the Kidneys might properly enough be called Nephritis; yet since the violence of the Stone causes the most exquisite pain, it is [...] peculiarly so called.
From what has been said it is apparent, that by the word Stone we mean a hard Body, grown into the form of a Stone, especially in the Kidneys and Bladder.
Here to be solicitously inquisitive, [Page 627]whether the Stone be a Disease,, or the cause of a Disease, or a Symptome, would be fruitless: For these are but mere curiosities about the name, and in a different respect may be differently resolved, I think, (thô Galen thinks otherwise) it can scarce be called a Disease, since it is no bad disposition of any part. It must be owned to be a cause, since it is apt to occasion obstruction, exulceration, racking pains, and the like: And when it is voided, it may be reckoned among symptomes.
What the subject of the Stone is, I suppose all Men know well enough, namely the Kidneys and Bladder, which, as if they were wombs designed for that very purpose, are found pregnant with Stones, and are often delivered of them with most violent Throws. Here a question may arise, whether the Stone be bred in the Cavity, from whence the Ureters proceed, and in the Tubuli, or in the very Parenchyma of the Kidneys? I know not how to deny either, because not only my own experience, but several great Men's experiments, such as Eustachius, Forestus, and others evidence the same. But it is to be observed, that the Stone which is bred in the very substance of the Kidneys, if it be of any bigness, cannot fall into the Pelvis, without dilaceration, since the Caruncles, which Anatomists call the Mamillary Processes, and through which alone the passage lies, are so small, that they will scarce admit a hair of ones Head. And what has been said of the Stone in the Kidney, the same in a manner may be understood of the Stone in the Bladder, to wit, that it has two places; one in the cavity of the Bladder, in the midst of the Urine, another in the ends of the Ureters, between the double coat of the Bladder, where falling small from the Kidneys, it sticks and sometimes grows: For the Ureters are implanted in the Bladder not far from its Neck, and before they come into the cavity of the Bladder, do pass the double Membrane of it a fingers breadth, in the ends whereof within the very duplicature of the Membrane a Stone sometimes grows, not floating in the Cavity, but sometimes firmly knit to the coats of the Bladder.
Yet here we will not deny, but that Stones may grow in other parts of the Body, since the Authority of Hippocrates 5. Epid [...]m. Hist. 25. makes it good, and so many experiments of famous Men, and my own experience evince the same. Joh. Van Horne of blessed Memory, formerly Professor of Anatomy and Chirurgery at Leyden in Holland, in my Memory and Presence also, took several Stones out of the Brain of Adam Stuart, who while he was alive was Professor of Philosophy. The famous Fernelius observed Stones of different hardness in the Lungs. Twice at an Anatomical Dissection here in London, I found divers Stones in the Gall-bladder. I saw a Stone as big as a Walnut voided by a Woman in her Stool, who before that had been continually troubled with the Heart-burn.
Mr. Tolet a Chirurgeon of Paris [Page 628]says, he saw a Man who twenty years before that, had voided a Stone at his Navel. Capiv [...]ccius. Parieus, Senn [...]rtes, S [...]ger, and other famous Men, will furnish the curious Readers with several such Observations.
The opinions of Physicians in assigning the Cause of the Stone, we found repugnant and contrary one to another; for some, who have raised their contemplations to things Divine, endeavour to fetch the cause of the Stone from the beginning of the Creation, inflicted as a punishment of our Aposta [...]e by the Almighty Power on Mankind, thinking it nothing strange, that what had its original from Earth should turn into Earth ‘Ʋndeg [...]nto d [...]r [...]on sum [...]s, —’
As O [...]d sang Met [...]m. 1. Fab. VII. Whence we are said to be of a terrene Constitution, and carry Bones about us equal in hardness and solidity to Stones, such as is the Os petr [...]s [...]m in the Organ of Hearing, and the Teeth, to which the most wise Creator has assigned a middle nature between Stones and Bones. But the most common and received opinion, both among the Ancients and Modern, is, That the cause of the Stone in the Kidneys must be ascribed solely and only to the burning heat of the Kidneys. For they will have it, that thick, viscous, pituitous, and tartarous excrements, as they call them, which they hold to be the material cause of its generation (for they assign a twofold cause, the material and formal,) are by little and little dried, and when the thin and moist parts are wasted, that they are converted into the form of a Stone; just as we see Chymists and Chirurgeons bake their medicamentous and corrosive Stones out of several juices of Herbs and Minerals, by exhalation in a gentle heat. But in how great difficulties this opinion involves Men, is apparent enough to all, but such as veneration for Antiquity has quite blinded: for does not daily experience shew, that Stones are bred in old Men, in phlegmatick Women, and in others of a cold Constitution? See Hippocrates Sect. 3. Aph. 31. They farther urge; If a viscous and tough Matter may by the heat of a Furnace be hardned into so hard and stony a matter, why may not a viscous matter he hardned into a Stone, by the preternatural heat of the Body? I Answer, First, is any mortal able to endure such a heat in his Body, as the heat of an Oven is, which is required to [...] the viscous Matter to so great a hardness? Secondly, is the case the same with the Stone, which is drowned in Urine, and with Bricks which are dried in a red hot Kiln? If Stones were bred only by a moderate heat, (as some are of opinion) they would dissolve again in water; as we see Clay, dried in a moderate heat, dissolves, if it be wet again. If they came from heat, Fevers Continual, Symptomatical, Habitual, and I may say Marasmoides, would ensue. And this Quirk gives but little satisfaction, An intense heat is perceived here, since the heat does not precede the Stone, but does occasionally arise from it, as we find heat, when a Thorn is got into the Finger, but the Thorn is not caused there by the heat.
To think here to recount the various opinions of dissenting Authors, would be superfluous; while some think the Stone grows from excess of cold, (thô in a Body, and in parts, hot enough) and congeles like Ice. Others fly to the refuge of occult qualities. And some, who like not such words, maintain that a certain saline l [...] pidisick Spirit, and the natural volatil earth of Urine, as they call it, are coagulated, and so a kind or new Entity, by Helmont called DUELECH, is produced in the Kidneys or Bladder; just as Wood, Plants, and Animals thrown into some waters, are said to be turned into Stone; and, as they say, whole Troops of Horse and Foot (if we may credit History) have in some places been turned into Stone by a certain Spirit expiring out of the earth; but in the mean while they consider not, that this lapidisick and penetrating Spirit (granting such an one to be in the Urine) does not so much produce the Stone in it, as it rather imbues the Kidneys and the rest of the Body with a lapideous Nature, and must, as in the example alledged, change it into Stone. Le [...] it suffice us now to add something, and (with deference to better judgments) briefly to lay before you the most simple and most intelligible Cause.
From the Analysis of Urine it is evident, that it consists of various parts, for besides the great quantity of water found here, which makes up the basis of the Urine, and a small portion of bile, giving it a golden, or rather a ci [...]on colour, and also a pituitous matter, swimming on the surface, and sticking to the pot, which makes that part, they call the Corona; there is moreover a saline and certain earthy portion, which from the necessary Aliment is mixt with the Urine, and by the t [...]ste and contents is found to be in it, and resides naturally in all Urine. Now this gross, earthy, and less agitated part (which we make to be the material cause of the Stone) with which, perhaps to make it thicker, a little Salt is mixt, whether it be over-luxuriant in the body through some taint in the Viscera of Chylification or C [...]mification, or that it is not sufficiently mixt with the [...]st of the parts of the Body, or that through the excessive quantity of it, in what it is taken in (where with many Aliments must needs abound) it cannot be mastered and separated in the Stomach, and that it passes thence with the Chyle through the Guts into the Veins, and being carried with the Blood through the ventricles of the Heart into the Aorta, it at length gets into the Emulgent as they call it; there this stops, either in the very little extreme branches of the Artery, or in the flesh next them, or if it be able to get out of the Caruncles, that are extuberant like little paps, it stops in the T [...]buli and the Pelvis, and is apt to stick there, it becomes contiguous, and at length continuous, and there it becomes first a small Particle, which (with Fernelius) we may call the Nucleus, and do believe, as he does, that it is the rudiment of a larger Stone, which afterwards a like matter and new food gathering [Page 630]there more and more, it daily grows one shell over another, till at last, no gluten intervening, besides the immediate contact of the least Particles, it becomes a Stone, made up as it were of many plates, as we see in peelings of Onions, and in the Bez [...]ar Stone, which is made up also of many coats, and so it increases gradually, as is evident to the curious searchers of Nature.
That arenous and calculous constitution of the Kidneys, which Fernelius and most of his Adherents insist upon, if you will give it a favourable interpretation, may be allowed, understanding by it not a certain occult quality, and lapidifick virtue (which some would make fiction of) differing from the manifest causes; but rather an over-straitness of the Pores, and it may be of the little vessels which are in the Kidneys, and through which the Urine ought naturally to be transcolated, whether one hath it so from the day of his birth, thither also we refer an hereditary disposition to the Stone; or that as he grows in years, he gets it by the res non naturales, as they are commonly called; for we may easily imagine, that this less moveable and agitated matter, since it is gross and of an earthy nature, whenever it finds the ways strait, through which it ought to have an open passage, is apt to stop, (Of this we have a familiar instance in the churning of Butter, where only by agitation the Butter is separated from the serous part of the Milk, because the particles of the Butter are less apt for motion than those of the Serum. The most ingenious Des Cartes Princip. Philosoph. part. 4. p. m. 14. does very learnedly shew, that such a separation is also made in Must) and at length, in process of time, after the manner aforesaid by further and further accretion it is formed into a perfect Stone.
As to the Stone in the Bladder, whose generation differs not from the formation of the former, we have no difficulty to struggle with; only we may observe, that it has not always its rise in the Bladder; but sometimes owes its rudiment to the Kidneys. About three years since we took two Stones from a certain boy, and when we had searched whether there were any more Stones in the Bladder, we found none: Two days after a third came out at the wound, the Boy was tormented with continual pain, and want of sleep, so that being troubled with a vomiting, a continual Fever, Looseness, and such like symptomes, he at length expired. We dissected him, and found the Pelvis of the right Kidney full of divers Stones, and the Ureter as wide as a small Gut. But to our business, a Stone grown in the Tubuli or the Pelvis, and sometimes a little one in the very Parenchyma of the Kidneys passing the canal of the Ureter, when at the end thereof it comes to the straits between the duplicature of the Bladder, it may sometimes stick, and there stopping that Cavity, thô it can scarce hinder the passage of the thinner and more slippery Particles, yet it retains the grosser, and being thus increased, does often stick very fast to the coats of the Bladder, [Page 631]and breeds a secondary Stone (if I may so call it) therein: The same we suppose may be done in the cavity of the Bladder. For if a small Stone of the Kidneys find passage through that narrow passage, we mentioned; and if it be detained in the Cavity, when it is not voided by the Ʋrethra, it acquires an increase through the continual apposition of new matter in manner aforesaid. As to the primary Stone of the Bladder, as they call it, I have no occasion to add much, since we must acknowledge the efficient and material causes to be the same with those of the Stone in the Kidneys; nor do they differ in any thing except in the subject. Yet some cannot chuse but admire, what way a Stone can be formed in the midst of that flood of Urine, by means whereof one should think a dissolution of the Stone must rather be promoted, (whereby perhaps Fernelius was enclined to derive all the rudiments of the Stone from the Kidneys) but the wonder will easily cease, if one have ever seen the tophous concretions, and sometimes the perfect Stones, which grow upon the Sea-shoar and Rivers Banks, not unlike the Stones that are formed in humane Bodies.
The remote and mediate causes, by means whereof a calculous matter is communicated to the mass of Blood and the Kidneys, are intemperance, and a disorderly way of living; for excess in eating alone, as in Children, is sufficient to afford matter for the Stone. Because it often so happens, that through this excess, abundance of Humors flowing through so many vessels, the Glands being filled beyond measure, and the passages of the Chyle being either obstructed or compressed, the publick coction is much endammaged; or there being a gathering of corrupt and putresied Juyces, the Mesentery becomes the seat of slow Fevers and stubborn diseases. And this corrupt mass does not only occasion an intemperature of the whole Body, but it also causes an ill constitution of the Organs, breeds matter for the Stone, weakens the Stomach, extinguishes its spirituous serment, and gives rise to soure belchings, fluctuations and rumbling in the Guts. Such a food I account Bread, not well fermented nor well baked, to be; and Cheese, which is hard of concoction, breeds sowre belchings and wind, it can scarce enter the passages of the chyle out of the Guts through the lacteal veins, it breeds obstructions, it makes the Blood tough, and out of its terrene salt breeds the the Stone. Hereby I do not prescribe to strong, found, and lusty Men, whose Affairs will not admit of a Medical way of living. To such (because according to Hippoerates, Sect. 2. Aph. 50. Things to which one has been accustomed, thô worse, use to giveless disturbance, than things to which one has not been accustomed, or because custome is a second Nature) I would recommend the best sort of Cheese in moderation. Beef, Pork, Goatsflesh, pickled, and smoak-dried Meats, are hard of concoction, and afford an earthy juice. Ducks, Geese, and other Water-Fowl breed superfluities and excrements. To [Page 632]these you may add all Pulse, raw Herbs, boiled Wheat, and Rice, unless they be mixt with inciders and detergents. Hard Eggs, stony Pears, Crabs, Cornelian Cherries, Medlars, and such like Fruits, of a gross and austere nature, straiten the passages very much, and afford an exceeding thick juice. Sharp Spices, as Pepper, Ginger, Cubebs and Mustard are bad. Among Drinks apt to breed the Stone these are of the number, new Beer, and too much hopped; for Alder boiled in large Coppers with Hops, and covered with Sand in a Cellar for three years turns to a hard Stone, of which we make the best Whetstones to sharpen Anatomica [...] instruments upon. Also sweet Ale, foggy and not fermented, thick and fenny water, or of melted Ice, and any that has a remarkable taste, which argues the nature of the place whence it comes, and brings along with it the virtues of Alume, Sulphur, Iron and the like, and therefore ought not to be accounted merely Drink, but medicated also. Drinking cold water is bad for such as sweat after labour. Wine that is red, troubled, sweet, the Moravian, Hungarian, Cretian, Italian, Malmsey and Spanish, in which a saline tartar never fails, gets into all the vessels of Man's Body, sticks to the Kidneys and Joynts, and breeds knots and stones. For in Wine there is a thick substance, which in tract of time sticks to the sides of the vessels, and is called Tartar, which is found in a great quantity in Rhenish Wine, and causes much hurt. But it is not the gross Tartar alone that breeds the Stone; for besides the Water and Tartar in Wine there is a Spirit, from whence all Wine has its strength, as the Austrian Wines have less Tartar than Rhenish, yet they do more mischief; and no wonder, because Spirit of Wine is nothing but Tartar resolved into its Principles; for this Spirit consists of a little Oil, much acid, and a volatil Spirit, which is the reason why tartarisate Spirit of Wine is far stronger than simple Spirit. And hence also a reason may be given, why Spirit of Wine, and several generous Liquors further the breeding of the Stone.
And besides Meat and Drink, the rest of the res non naturales breed the Stone. Neither satiety nor fasting, nor any thing else that exceeds measure, is good, according to Hippoc. Sect. 11. Aph. 4. Hither may be referred excessive study and care. And the use of Venus is exceeding hurtful. If you would know the reason, there is in us (according to Hippocrates) something that is salt, sharp, &c. which by the immoderate use of Venus is made sharper, so that thereby it is increased more in quality than in quantity: for the sweetest or fat part of the Blood is partly wasted with the Spirits, partly with the Seed, and what remains is made sharper and sharper, and so being separated and by it self, it is more violent, and does the more mischief. Hither you may add immoderate motion after eating, dancing, riding, fencing, &c. whereby rumbling in the Stomach is caused, concoction is hindred; crude Chyle is carried out of the Stomach, and the heat is forced outwards. Idleness does as much as excessive [Page 633]motion, the powers of the body are thereby as it were suffocated, the matter being retained within; whence it is, that we find slothful and fat Persons, and such as live a sedentary life, frequently subject to the Stone.
Travelling in Winter through stony and mountainous places; for it is well known that Travellers, especially upon an empty Stomach, and in winter-time, fall into a Bo [...] limus, which makes them subject afterwards to divers obstructions. Retention of the Excrements and Urine gather abundance of crudities in the Body, chill the natural heat, produce noxious vapors, and so cause the Stone. The Spaniards confirm the same, who void a great deal of Gravel with their Urine; and therefore are not subject to the Stone, as Riverius upon this subject writes, Violent passions of the Mind are bad, especially Grief, Anger, and Fear; Grief does insensibly, and by little and little, waste Men's strength, cool and dry the Body, hinder Digestion, and beed sower and bad humors. Anger breeds Fevers, moves Choler, and disturbs the Spirits. Fear breeds an Acid, wastes strength, and diminishes the vital effervescence. Boëtius gives good advice;
And an hereditary disposition derived from the Seed and Blood (as it were by right of Succession) contributes to the breeding of the Stone. This consists chiefly in a weakness of the expulsive faculty, and in an innate fault of the Blood. Astrologers add to these causes the conjunction of Saturn with Mercury in the eighth House, which, they say, disposes the Child so born to the Stone. But whether the influx of the Stars be able to effect so much in our Bodies, I submit to better judgments.
If we consider the differences of Stones, they are various and diversly distinguished. In regard of quantity, a Stone is said to be elther large or small. In respect of colour, red, yellow, ash-coloured or black. This diversity of colours depends on the external figure of the concurring Particles, or on some extraneous Matter putrefied, as Pus, Blood, or Slime. In respect of the Figure it is round, oblong, (such an one as I lately took from a Noble Countess's Son in this Land, in the presence of several Doctors of Physick) Angular, Triangular, Quadrangular, or slat. But the various figure of the Superficies is owing either to chance, or motion, or to the site of the adjoyning parts: hence the Bladder breeds round ones, the Ureters oblong ones, and some seem to resemble exactly the cavity of the Pelvis of the Ridneys. Yet the principal differences are taken, either from the Subject, hence it is called either the Stone in the Kidneys or Bladder; or from the Matter, which is either thinner or thicker, whereof there be four degrees, Sand, Gravel, Tophus, and the Stone. 1. Sand differs from the Stone only in Magnitude, and it receives its minute shapes in the pores of the Kidnies, which (as [Page 634] Fernelius says) gathering together and cementing makes up the Stone. 2. Gravel, which has its rise from coagulated Sand with a Mucus. 3. A Tophus, thô it has the form of a Stone, and is larger than Gravel; yet it is softer and more friable or b [...]ttle. 4. The Stone properly so called is solid, hard, and firm as a Rock, And the more plenty there is of a saline and earthy Matter, and the more exactly this is petrified, the harder the Stone is; and the softer, when otherwise.
Thô properly there be no Pathognomonick signs of the Stone in the Kidnies; they being aequivocal, and common to other diseases; yet these following may be observed in Practice, as discovering it most. 1. A fixt and standing pain in the region of the Loins; and this is dull, and causes a sense of weight, when the Stone is lodged in the very Parenchima of the Kidnies, it being endued with a dull sense; but when it is got into the head of the Ureter, the pain is sharp, cutting, and exceeding cruel. Not many years agon a Patient, who was ill of a stoppage of Urine, for he voided none but what he vomited, and that had an Urinous smell, was extremely weakened by it. He consu [...]ted several great Physicians, and took several Medicines, but to no purpose, for he died of it; and when his Body was opened, the Pelvis of his right Kidney was filled with a Stone, whose lower end was protuberant like a nipple, and quite stopt up the Vreter; a sharp Stone was so exactly fixt in the head of the left Ʋreter, that neither Kidney could do its office, and so he died. 2. There is a difficulty in stooping, the Nerves or Muscles of the Spine being thereby compressed and distended. 3. A very troublesome pain in the Back. 4. A numness of the Thighs and Leg on the same side, because of the compression (by the weight of a great Stone) of the Muscle called Psoa, or of the Nerve that is branched out into all the Muscles of the Thigh. 5. A retraction of the Testicle on the same side with the Kidney affected, because of the drawing up of the vessels, which proceed from the Kidnies to the Testicles. 6. Reaching and Vomiting, because of the consent of the Kidneys with the Stomach, not so much by means of the Peritonaeum, (as some would have it) of whole Membrane each participates, as because of that common Nerve, from the Stomachich branch of the sixth pair, implanted into the proper and inner coat of the Kidneys. 7. Urine oftentimes bloody, the little Veins; dispersed through the substance of the Kidneys, being torn and opened by the attrition of the sharp Stone: And sometimes about the beginning, the Urine, comes thin, watry, and in a small quantity, because of the obstruction of the Kidney by the Stone: but when it passes through the Ʋreters into the Bladder, then a thick, troubled and watry Urine is voided. 8. I would have this accounted a main sign of the Stone, when Stones or Gravel are voided by Urine, (which do not stick to the sides of the pot, but presently sink to the bottom) whereupon the [Page 635]Patient finds sensible ease. And because the Stone and Colick are so much alike, that not only an Emperick, but even a rational Physician may be mistaken; I would have these marks of distinction well observed. If the pain be above the Kidneys, it belongs not to the Kidneys, but to the Bowels. The pain of the Stone tends outwards, nor does it ever depart from that one place, unless the Stone be displaced and slip into the Ʋreter. The Colick wanders, changes place, runs through all the Guts, and comes down to the Twist. Those that have the Stone are better after Eating, and those that have the Colick are worse.
Hippocrates lib. 4. de Morb. does thus recount the signs of the Stone in the Bladder. When he would plss, he is afflicted with pain, and his Urine dribbles from him as in the Strangury, it is bloody, when the Bladder is exulcerated by the Stone, or inflamed. But this sign is not very manifest; however, the end of the Prepuce shews it. Sometimes he pisses Gravel. Boys troubled with the Stone rub and pull their Privities. But since these signs are a little obscure, I will produce other circumstances, that in so difficult a case the truth may better appear. 1. In the beginning when the Stone is but little, the Party troubled with the Stone, after making water, feels a dull pain in his Glans, which pain passes from the Glans along the Ʋreter, to the Bladder, just as if he had the Strangury. For thô the Stone be but little, yet by its asperity it pricks the neck of the Bladder, and so causes a pain in the Glans, which pain returns from the Glans to the Bladder. He that is troubled with the Stone does always in a manner, but especially when he is about to make water, rub the end of his yard with his fingers, squeeze and draw it; hence it is, that Children troubled with the Stone have always their hands on their Privities, and by plucking their yard, make it as long again as usual. 3. If the Stone be heavy, the Party finds a heavy pain, just as if there were a weight hanging at the bottom of his Belly between the Intestinum rectum, and the Os pubis, which pressed them down; besides, he then finds a pain about his Navil, because the bottom of the Bladder is joyned to the Navil by the Ʋrachus. 4. If the Stone does not quite obstruct the passage of the Urine, Nature is often irritated to discharge the Urine, but in vain; sometimes a little comes away; sometimes, whether he will or no, away it comes, but with pain all the time. 5. Turning the Heels upwards and the Feet to the ground, it often happens, that the Stone slips back to the bottom of the Bladder, and the Urine finds a free passage. 6. Out of the Fit, we often see him that is afflicted with the Stone sitting cross-legged; for by that means the Stone is in some measure raised from the neck of the Bladder, so that the Urine has a free passage. 7. The Urine being kept, and grown sharp and hot, by the excess of pain which it causes, draws spirits to the yard, and so the virite member both in [Page 636]Children and adult Persons is erect, not out of any Venereal appetite or Lust, as otherwise one would be apt to think. 8. From the consent of the Anus and Bladder, because of the communion and connexion of Nerves, which they receive from the same branch, the calculous Person has both a motion to go to stool, and to make water at the same time. But these irritations are in vain; and if any thing be voided, it is but little, and with great pain. In Infants there is often a violent falling down of the Arse-Gut. 9. Most calculous Persons are continually athirst, and often desire much drink: for thô they void but a little Urine at once, yet because they make water often, they discharge a great deal, and so the Scrum of the Blood is wasted, which Nature endeavors to supply, so as she may keep the inwards in that due temperament and symmetry. By reason also of their continual pains, watching and inquictudes arise, the salt part in the humors is made sharper, and the mass of Blood grows hotter every day than other, which requires much and frequent cooling: Sometimes the Jaundice, Dropsie, or some such disease does ensue upon it. 10. Calculous persons are better after Opiates, and worse after powerful Diureticks. 11. Hippocrates Aph. 79. Sect. 4. judges them to have the Stone [...], &c. and Johannes Zechius in consult. med. lib. cons. 58. by [...] understands thick Gravel, or a dirty Excrement (like snot) sticking to the bottom of the pot, which is a Pathognomonick sign of a large Stone in the Bladder, and that it has been growing there a long time. 12. It is good to be sure, when a Man puts his Finger into the Anus of Children, or a Catheter along the Ʋrethra into the Bladder of grown persons, and to search well, if there be a Stone, whether it be large or small, and whether there be not more than one. For it behoves a Man to know these things exactly. Here also the antecedent causes fall under consideration, namely, of what complexion the Patient is, what his Diet has been, and what Symptomes he has had; for without doubt he must have had cruel pain, if the Stone be great, hard, and uneven. Moreover, thô it be necessary to know, whether Stones be enclosed in a bag, and by it stick to the Membrane of the Bladder, yet it is very difficult, unless by searching with a Catheter or the Finger. And thus having briefly examined the Diagnosticks, we now proceed to the Prognosticks.
Children, as Hippocrates says 6. Epidem. are most subject to the Stone in the Bladder, and old Men to the Stone in the Kidneys. And Aph. 6. Sect. 61 Diseases of the Kidneys and Bladder are difficultly cured in old Men. A disposition to the Stone from Parents to Children, through some primigenial taint in the Seed does clude all Medicine, be it never so generous, whether intended for the prevention or cure; which made Aretaeus think it a thing much more difficult by the help of Art, to hinder the Kidneys and Bladder from breeding the Stone, when they have a [Page 637]disposition to it, than to prevent a fruitful womb from conception. The Stone in the Bladder in respect of Medicines is more difficult to cure than that in the Kidneys; but in regard of Chirurgery, it is much easier; however sometimes, the pain tending outwards to the Muscles of the Spine, and an abscess arising, it has been known that Stones have been discharged that way, and the Ulcer has been healed. The Stone is a violent and dangerous evil, causing Inslammations, Exulcerations, cruel Pains, Watchings, Fevers, stoppage of Urine, and other most violent Symptomes. If the Stone be not great but small, not in a Body cachectick, nor abounding with humors apt to breed the Stone, and if the disposition to it be not hereditary, we may draw a good Prognostick thence; if on the contrary, a bad one. If the Stone be considerably large and hard, the Patient must of necessity, if he will be eased of it, submit himself to Chirurgical operation, thô it be hazardous. But if the Stone be of an unusual bigness and weight, such an one as at the opening of one who died of it near St. Thomas's Hospital, I took out, which weighed nineteen ounces and three drachms, such are to be esteemed desperate, and must not be medled with, while they live. They that have the Stone inclosed in a coat, or without one, and sticking to the Membrane of the Bladder, are in the same predicament, as also are old Men, and young Children also, if they be infirm. On the contrary, if the Patient have strength, if he have good Viscera, if the Stone be not too big, though he have several, yet through GOD's assistance, the operation may be courageously undertaken, and good success may be expected. Stones in Women are voided and extracted with better success and security, than in Men, because they have a short and wide passage for their Urine.
Thus much in reference to the Theory being premised, we proceed now to such things as may be produced from Practice, the fountain of Cure, in order to prevent the invasion of the enemy, and to beat him out again, when entred.
To perform this methodically, we have a threefold care upon us. First, that the causes which are any way able to breed the Stone may be removed, and that so its generation and encrease may be hindred. Secondly, that when the Stone is bred, it may be got out. Thirdly, that the Symptomes, the cruel pain may be asswaged, and the difficulty of Urine which usually attends it, may be kept off. These things may be accomplished by means taken from Diet, Pharmacy and Chirurgery.
In the prevention we must first of all take care, that the bad Diet before-mentioned among the causes of the Stone be avoided; and on the contrary, that a convenient one be made use of. Meats therefore must be used which are easy of digestion, afford little excrement, and have an attenuating and inciding virtue. To this end Mutton or Capon-broth, boiled [Page 638]with Chervil, Sorrel, Barley, and the like, especially in Spring time, are very proper. And if Sobriety and Moderation be requisite in any disease, it is in this,
Moreover, the passions of the Mind must be so moderated, that their excess do no prejudice to the Body.
Now we proceed to the proximate matter, that is, the load of crude and gross humors imprudently gathered by a disorderly Diet, or from some other cause, which that it may not get to the Kidnies, must be revelled and evacuated; to which end it will be proper to give Purges, such as Manna, Cassia, Diaprunum, &c. Repeated vomiting also is good, (especially for such as are made for vomiting, and who perceive great crudities in the first concoction) which if it come of it self, must by no means be checkt; if not, Medicines must be given to provoke it; for by means of it a noxious humor gathered in the Body is often successfully carried off, and Revulsion is forthwith made, so that it falls not on the Kidneys. But if any such like Matter be gotten into the Kidneys, it must presently be discharged by means of Diureticks. For this Intention, Turpentine, and Medicines prepared out of it, are proper. Amatus Lusitanus reports, how a certain Monk by the use of it was cured of the Stone and Gout. The famous Bevarovicins in his Treatise of the Stone mentions an excellent preparation out of I evinus Lemnius; strong French White-wine, having red hot Flints often quenched in it, expels the tartarctis Matter out of the Kidnies, before it grows to a Stone. Also Mineral waters, Timbridge in England, and the Spa [...] beyond Seas are excellent, because they have an inciding, attenuating, opening, dissolving and abstersive virtue, Bathing also the Body in River water up till above the Loins, promotes evacuation of Gravel, before it grows into a Stone, especially if some proper Purge be given the day before, and the same day, if some specisique Diuretick be taken.
The next scope in curing is, to discharge the Stone, when bred. Yet here we must consider, that if there be a large Stone in the Kidneys, it ought not to be removed, but if there be a small one, especially in the Cavity, it must be got out quickly: For when a large Stone is got into the Ʋreters, by the violence of pain that attends it, it often causes Convulsions, and Swoonings, so that if the pain be not quickly asswaged, as well by internal Remedies, as external Fomentations, the Patient sometimes perishes. But before a little Stone be removed, Clysters must be given, which may mollify and smooth the ways, by which it is to pass, To which end Henry IV. King of France did often take a Bolus of fresh Butter and Sugar-candy, drinking after it a glass of small Wine. Some commend Oil of Sweet Almonds, or Oil-Olive, Cassia [Page 639]fistula, and fat Broths, drunk in large quantities. Physicians do with great success prescribe mollifying Clysters, made of emollient Herbs and Roots, adding sometimes Diureticks, or only Oil of Chamaemel, Lilies, Sweet Almonds, &c. Avicen believes, that the repeated injection of Clysters eases Nephritick pains. Externally they apply Cataplasms made of Emollients and Fomentations of the same, to which they add coolers, lest pains might be exasperated. They also use Oil of Sweet Almonds, and of Scorpions, with ointment of Marshmallows, for a liniment. It is evident also, that bathing in fresh water with emollient Herbs, adding things also that are good to break the Stone, is a most effectual remedy to make lax the passages. These things being done, Medicines are further prescribed to help the motion of the Stone, such as are, all that provoke Urine, and are properly called Diureticks, of which you may find a copious Catalogue in Authors, and therefore I shall forbear naming them. But we use to add to these, Anodynes, and lest any inconcocted Matter should be carried to the Kidneys, we a little before give some gentle Purge. And if this method does not dislodge the Stone, when bred, as in other cases, so in this, the utmost remedies must be tried, namely a Vomit must be prescribed: For by this means all the lower parts are exceedingly prest, and things are expelled, which could not by any former means be removed. But we must remember to add specisique Diureticks to our Vomits.
When the Stone is big, whereas we have already said, that we may not remove it, now it remains, that we say what we may do. Whether in nature any remedies are to be found, which perfectly dissolve the Stone, many doe dispute, and are at daggers drawing about it. If the Stone be brittle, of a loose and soft substance, and coagulated of Mucus and Sand, it is evident by manifold experience, that such an one may be broke and wasted. Matthiolus and Dodonaeus do for this purpose greatly commend Goldenrod, and the Chymists their Salts of Rest-harrow, Millet, Bean-shells, Salt of Egg-shells, Salt of Urine, of the Stone taken out of a Man, of Juniper, Ash, volatil Salt of Amber, &c. The Medicine made of Millepedes seems to excell all the rest, for which consult Hartman. I am certainly convinced by experience, that Spirit of Nitre does easily dissolve the Stone, when it is taken out of Human Bodies, to the admitation of the beholders. If there has been a calculous disposition lodged in the very Seed and menstruous Blood, no cure by Medicine must be used, but only by Diet. For the whole foundation of Health is laid as it were in the Conception, and the good or bad Principles of the future state of Health are thence derived to the off-spring.
The next Indication is answered, if the violent pain (the true rack and torment of Man,) be mitigated, which is commonly done with one trouble by the Medicines before prescribed to lubricate the ways; and if these prote ineffectual, [Page 640]in excessive violent pain we may have recourse to Narcoticks, such as Philonium Romanum, re [...]es Nicolai, Landanum optatum, &c. I happened to be called to a Woman above 40 years old, who at first had a great pain in the region of her Loins towards the Puves and Groin; shortly after bloody and purulent Urine followed, also heat and dribling away of her Urine, she had a violent pain when she made water, she had a motion to Stool and Urine both at once, yea sometimes her exerement came involuntarily from her, she was restless and awake night and day, she answered impertinently to what she was asked, she had a fierce wild staring look, which moved the bystanders to compassion the disease growing worse and worse (several Medicines, yea and Narcoticks, as in an extreme case, being often, but cautiously, given) she at last died. When we had opened her, we found her Bladder full of stinking slimy Pus, and very red, and eroded with an Ulcer besides. We found the U [...]eters more fleshy than usual, full of Pus and Stones, the right had four white, large, soft Stones, joyned with a saltish, viscid, and filthy Matter; and the left had little black Stones, but harder in it. But in her left hidney we found bloody Pus; and several small Stones, in figure like those in the Ʋreter of the same side. But now to our business; Difficulty in making water oftentimes occasions great trouble in this case, to avoid which both Diureticks inwardly (but with great caution) and liniments outwardly of Ointment of Marsh-mallows, Oil of Sweet Alinonds and the like; as also Fomentations and Cataplasms, accommodated to this end, may be used. But if it so happen that the Stone get into the neck of the Bladder, and so hinder the passing of the Urine, it must by lying on ones Back, with the Legs high, and by shaking the Body, be removed thence; and at length, if this will do not good, it must be forced back into the Bladder with a Catheter.
The Dimetick and Pharmaceutick remedies being thus briefly dispatched, it remains now that we discourse of the last remedy, namely the Chirurgick. We judge that letting of Blood, if there be a Plethera, or an excessive Fermentation of the Blood, may be of use. I have often by experience found that Cupping-glasses set to the Loins, have in a Nephritick Fit brought down one or more Stones into the Bladder. If the Stone in the Bladder be too big to be expelled, nor for want of a requisite Medicine can be dissolved; if the violence of the disease will yield to no Medicines, then a desperate disease must have a desperate cure. Here I cannot chuse but laugh at Mountebanks and Empericks, who brag, how they can break the Stone in the Bladder by giving Medicines inwardly; of whose fruitless attempts I could give you plentiful instances. But at length we are come to the last remedies, and if we will use them, we must proceed to Cotting (of which Paraeus, Schultetus, Hildanus, Cornelius Celsus and others have written) But for some days before, the Body must be prepared by Diet, [Page 641]he must eat but little, and that wholsome food and not glutinous; among other things let him use exercise, to the end the Stone may come further down to the neck of the Bladder, as Celsus advises. When we are certain of the thing, the body must for a day or two before be kept with a low Diet, and then the Cure must be administred in a warm place, which may be performed divers ways. The first is called the Apparatus minor. All things therefore being in readiness, the fore and middle Finger of the left hand must be put into the Anus, and with the right the lower Belly must be pressed towards the Bladder, (avoiding violent compression in the case, which might occasion cruel pain, Inflammation, yea, and a Gangrene,) whence it comes to pass, that the Bladder being squeezed into a narrow room, the Stone may the better be taken hold of, which being taken hold of, incision must be made in the Perinaeum, upon the Stone, and if the Stone be small, it may be thrust out with the Fingers; but if large, it must be extracted with an hook. Here we must make no more haste than good speed, for when the Bladder is hurt, it causes distention of the Nerves, with danger of death. The second way is Hildanus's, which is performed in this manner; all things being in readiness, the Operator puts in his Catheter (I mean not such an one as we use for suppression of Urine; but one that has a furrow or hollowness in it, such an one as is described in Paraeus l. 17. c. 44.) upon the Stone, then with a Razor half wrapt up he makes incision to the Catheter; afterwards upon the Catheter he puts into the wound a Director; that the Yard may be free, he takes out the Catheter; with the Director, if there be occasion, he di [...]ates the wound, and then by the side of the Director he puts in his scoops, and drawing out his Director, and putting his Finger into the Anus, he takes hold of and extracts the Stone with a hook, either whole, or piecemeal, if it be either large or brittle. The third way is, when the wound is made in manner aforesaid, and he puts a Forceps upon the Director; he takes out the Director, takes hold of the Stone, and so extracts it, this way is of use, when it cannot be gotten out with an hook. The fourth way of operation is called the Franconine Lithotomy, from its. Author Peter Franc, which is performed in this manner; Incision being made in manner aforesaid, the Lithotomist meddles not at all with the extraction of the Stone unless it appear in the wound, but binds up the wound after the usual manner. After a few days (except the Stone come away out at the wound, of its own accord, which Peter Franc the Author of this invention says, in his practice has often befell him,) he endeavors to extract the Stone, which operation ought to have place, when the Patient is very weak, as Hildanus judges. The fifth way is, when the Stone is so big that it cannot pass by a wound made in the neck of the Bladder, unless either the membranous substance of the Bladder, or its Sphincter be [Page 642]hurt. This, the Author Peter Frane does not propose for any Man to imitate; He only did it in a desperate case at the request of the Child's Parents, upon which he performed the Operation. The Patient was a Child of two years of age, who had a Stone in his little Body, as big as a Hen's egg, (the Author would have it observed, that this operation has no place in adult persons,) he made Section in the Groin, and the upper part of the Os pubis, as is usually made in a Caesarean Birth, and so cut the bottom of the Bladder, and extracted the Stone. The Child, thô he was much weakened, recovered, and the wound was cured. Hildanus also, in his Observations, mentions such another example. The sixth and last way is performed by an instrument, which Hildanus invented; Incision being made in manner aforesaid, he puts his instrument through the wound upon the Stone; this, when it is put in, may be dilated, (like the instrument which we call Speculum matricis) after dilatation, the Operator endeavors to take hold of the Stone, and to extract it, when taken hold of. The famous Lithotomist of Paris, called Collet, cut several very successfully this way; from a curious inspection of whom, and of others likewise, the Author of this Treatise has made such proficiency, that among the rest he has adventured on this way of operation, and daily continues to practise it. In the Female Sex, whether the Party be a Maid or Married, one may with far less trouble, and without Section or much effusion of Blood undertake and perform this operation. Because the orifice of the Bladder occurs presently to sight in the Pudendum; it is sufficient to put in a Catheter, and below its furrow to put in a Dilator, and then to extract the Stone with a Forceps. Sometimes nevertheless, because of the over-bigness of the Stone, a small incision must be made in the orifice of the Bladder, from which and a too violent dilatation, there is danger lest the Sphincter should be hurt, and an involuntary emission of Urine should follow.
Now it remains, the Stone being extracted, that we discourse, in what manner the Patient must be treated. He must not presently be put to bed. If his Body be strong, the Blood may be suffered to run a while, that the Inflammation may be less. Then he must sit in a Semicupe, so that he be up in it from his Ruees to his Navel, (all else must be covered with Cloths,) to the end his bleeding may be stopt. In a weak Body the Haemorrhage must immediately be stopt, sometimes a Cupping-Glass must be set to the Groin and Hips, and to the Pubes, if the bleeding cannot be stopt; which when it is stopt, the Patient must be laid on his back in bed. In the mean time the lower Belly from the Navel to the Loins, and the Privities also, must be well anointed with proper Oyls, made a little warm. A Linen Rag two or three times double, wet in some astringent Medicine, may be applied to the Wound. Sometimes a Pipe is put into the Wound, whereby Grave [...] and extravasated Blood may more [Page 643]commodiously be discharged afterwards: By it also a Syringe may be put in, wherewith, upon [...]gent occasion, the Bladder may be syringed, and so whatever preternatural is contained in the Bladder may be presently discharged. If a Lipothymy supervene, it may be removed by Cordials, and the Patient may be laid quietly to rest, which unless it come of itself, must be promoted by moderate Anodynes. And thus, if strength will permit, (Celsus expresly says it,) within four and twenty hours, he must be set again in the bath, and as he is able he must tarry in it; and if he sweat, he must be wiped with a Spunge. In the mean while, if sleep be kindly, breathing free, if the Tongue be moist and thirst little, if he goes well to stool, and but moderate pain with a small Fever, you may be certain the cure will succeed well. Finally, as much as is possible, we must endeavour, both in regard of Meat and Medicine, that Nature, which supplies the most wholsom Balsam, may be strengthned, and so the Wound may be healed.
And now, all things belonging to the Stone in the Kidneys and the Bladder being briefly described, one thing remains, namely, the way of taking a Stone out of the Ʋrethra, which we shall briefly describe. It happens sometimes, that it is voided out of the Bladder; but when it is gotten into the Ʋrethra, it sticks there, and stops the passage of the Urine. In this case, all means must be tried and applied, which are proper to bring away a Stone, without Incision. Among these, first of all occur Diureticks, Emollients, Fomentations, and Baths of a relaxing quality, by means whereof Stones of no small bigness have been brought from the Ʋrethra. The second way is, Extension of the Ʋrethra by Wind, tying that part of the Yard, which is next the Pubes, in the same manner as it was frequently used by the Aegyptians; for when the Ʋrethra is dilated, the passage is more free for the Stone. The third way is by sucking, when by drawing the breath with great violence, the Stone is drawn with it. The fourth way is to break the Stone by the help of a Forceps and Probe, which is often used with success, and therefore much to be commended. But if all these ways be fruitless, we must proceed to Incision. Among Authors there is a great Contest about the place, wherein Incision should be made. Some chuse the Side, for fear, if the lower part should be cut, there should be a Fistula. Others are for the lower part, lest the Nervous Bodies should be hurt. We have used both these ways, and found the cure easie, nor could we perceive any detriment accrue to the Patient, when we made Incision in the Nervous lateral part. After incision is made, the Stone may be extracted with a fine little Hook. When these things are done, the Wounds after Extraction of the Stone whether of the Bladder or of the Ʋrethra,) must be cured. But since we have already in the beginning of this Work treated sufficiently of Wounds of all sorts, we shall here sc [...]bear repetition.
THE PRACTICE OF CHIRURGERY. Part IV.
BOOK VIII.
Of supplying Defects in the Body.
CHAP. I.
Of supplying the Nose, Ears or Lips, when deficient.
HAving in our proposed Method finished the three first Parts of Chirurgery, we now proceed to the fourth and last, which is the [...], Additrix, or supplying Part. And we will begin with the addition of the Nose, Ears or Lips, when wanting. Upon this subject several both of the Ancients have written, as Galen, Paulus Aegineta, and Celsius; and of the Modern, as Alexander Benedictus, Vesalius, Ambrosius Paraeus, Stepha [...]is Gourmelius, and Johannes Schenkius. But Gasper Taliacotius, Professor of Anatomy in Bononia, was the first that ever I perused, who described this Operation in a plain [Page 646]and practicable way. The forementioned Authors indeed in general terms describe a method; but so ambiguously, that he, who upon their credit should undertake the reparation of any of these lost parts, would lose his own; and perhaps the Patient his life. Therefore without troubling you with what others say on this subject, I shall in short give you what Taliacotius says more at large thereon.
As that Man's Endeavours are to be admired, unto whom nothing seems hard or difficult, which upon Grounds of Reason, and by Industry is attainable: So he is to be pitied, who in attempting nothing betrays his Sloth, and not only is of the Opinion, that all things, especially in Physick, are so fully found out already by the Antients, that there can be no room for further Invention; but (which is more hateful,) does by Calumny and Detraction discourage, as much as in him lies, all laudable attempts. But not regarding ill-natured Persons, some Men of Ingenuity and Resolution, have ventured upon this difficult Operation; taking the hint from Horticulture, that, as Grafts or Buds are ingrafted or inoculated into Stocks, so in Animals one part might be ingrafted upon another, to supply a defect, where any should happen. And thô this Animal-ingrafting agree in many things with the Vegetable; yet they differ in several, and the Animal must be aided by the Artift's Industry. As in Vegetable-Grafting or Inoculation the Stock must be cloven, or the Bark perforated, so must the part in an Animal be wounded, upon which the traductive part is to be grafted. And the part, out of which restitution of what is deficient must be made, may be likened to a Tree or Scion from whence the Graft is taken. But in a traductive part of an Animal there must be moreover Conformation according to the part which it supplies. Now that we may the better comprehend our Business, we will consider what matter is proper to supply parts deficient; from what place this matter should be taken; the quantity of it; and the manner of agglutinating one part to another.
The matter, out of which the foresaid defects must be supplied, is the Skin, (which palpably detects the mistake of such as thought, a Nose must be supplyed out of solid Flesh.) If you ask, Why the Skin? I answer, All Physicians hold, when we would supply a lost part, that we must put in the room of it, somthing like in substance to it; or, if we cannot do that, somthing as near it as may be; as when we breed a Callus for a broken Bone, which supplies the room of a true Bone. Wherefore since the Lips, Nose and Ears do much resemble the substance of the Skin; and since, when part of them is cut off, it is impossible they should of themselves shoot or bud out again, so as to remove the deformity; therefore the first Authors of this Art, took the Skin of another part, and accommodated it to their use. This they thought, in imitation of grafting in Trees, was possible to be [Page 647]done: And they thought no part could with less inconvenience to Life be separated from one place, and translated to another, than the Skin. But since there be four sorts of Skin, it will be requisite to know, which of those sorts are for the purpose in hand. One sort of Skin is bare of Hair, of exquisite sense, difficultly separated from the Bodies underneath it, and will not fold as the rest will, such is the Skin of the Palms of the Hand, and of the Soles of the Feet. Another sort has a Muscle, and that but a thin one, immediately underneath it, such is the Skin of the Forehead. A third, by reason of the various and manifold Implication of carnous Fibres, you may either call it a Cutaneous Muscle, or a Musculous Skin, no matter which, such are the Lips and Cheeks. The last sort is the common covering of the whole Body, somewhere hairy, other-where without Hair, every where void of motion, and may without difficulty be separated from the subject parts. Of these four sorts the last is only proper for our use. For the first cannot well be removed, without hazard of Life; nor (were it possible) could it be shaped into the fashion of the lost Member. In like manner the two middlemost sorts are rejected, as alien, for they are to be met with but in few parts, nor can they commodiously be joyned to the defective part. But the last sort may, and therefore is the fittest for our purpose.
The place from whence the Skin is taken, must be covered with a Skin like the lost part, and big enough to supply the defect. And since it must have time to unite with the defective part, the Skin must be taken from such a part as may be brought to the other, and, with as little inconvenience to the Patient as may be, may continue there. The only part to supply the Nose and Lips, is the Arm above the Elbow; and to supply the Ears, the Skin behind the Ears. For neither disfigures a Man, since the Arm is covered with Clothes, and the new Ear does indifferently well cover the place behind it, whence it was taken.
What quantity of ingrafted Skin one should take, is hard to define. For it is observed, that the Skin after the second cutting from the Arm, somtimes shrinks an eighth, a sixth, or a fourth part both in length and breadth, by reason the Nutriment is not so plentifully brought to it, as when it was close united to the Arm, or because the Nutriment does not assimilate aright. But thô it be thus difficult to be exact in our quantity; yet we should take the best measure we can, proportionable to the part we are to supply, and rather encline to excess than defect.
The way to unite the parts, is by stitching, and by that sort which is called by some interscissa, and by us sutura non continuata, which we treated of in our discourse upon Wounds.
There remains one difficulty to be resolved, which is, Whether the ingrafted Skin should be taken from ones own Body, or from another Person's. There are good Reasons, why it may be taken [Page 648]from another Person's. Plants thô of different Natures may be ingrafted one into another; what then should hinder a piece of one Man's Body from being ingrafted into another's, seeing both are of the same kind, and nothing near so different as one kind of Tree is from another? But this supplying of a part from another's Body, having never been practised, nor likely to be practicable, we will conclude, that it is best to supply the defect from ones own Body. For a long time is required to unite the supplemental par [...]o the defective, and all this while the two Bodies must be fast bound one to the other. But I know not any contrivance possible, to keep two Person's Bodies so bound together, but that they would rend one from the other, long before Coalition were made, and so our Intentions would be quite frustrated.
These things being premised to general, we will now proceed more practically to the Subject here under Consideration.
CHAP. II.
Intentions of Cure in supplying Defects, and how the Body ought in general to be prepared.
THe main Intentions of Cure are, First, to prepare the Cutaneous Graft. Secondly, to insert it into the defective part. Thirdly, when it is ingrafted, to keep both parts bound together, till the time of Coalition. Fourthly, to cut the ingrafted part from its ancient seat. Fifthly, to shape the new parts. Lastly, to defend the parts from Injuries, and when the work is brought to perfection, to make it durable.
Before we meddle with the traductive Skin, we ought to consider the complexion of the Patient, and his habit of Body; and then we must cleanse him well. If the Body be healthful, and replenished with good Juices, we must abate their Turgescence by bleeding, lest the part might be inflamed. A low Diet will be proper; but not purging.
If the Body be Cholerick, the best way is to clear the first ways with a gentle Medicine, as Pulpa cass. ℥jss. vel Flectuarium Lenitivum, or Syr. Ros. Solut. or Violar. Solut. dilured with Decoctum Cordiale, or some cooling Waters. Tamarin [...]s and Prunes are good in Potions, and both more pleasant and safe for such Persons. This done, the Bile must be corrected with Syrup. Endiv. Oxalid. Cichor. Oxysacch. Simpl. &c. in Decoctis Herbarum ac Seminum; vel aquis ad ea destinatis, ut sunt Aq. Oxalid. Endvo, Capil. Ven. Rol. [Page 649]Cichor. Sonchi, &c. Whise we are preparing the Bill, we may [...]eed. About five or six days after [...]leeding we may purge the whole Body with some thing stronger than the first; such as Elect. Cathol. Diaprum. Solut. ad [...]ixto vel Elect. ex Succ: Rosar vel Rosar. Mesues. Or, if you like a Potion better, use Manna cum Rhabarb. Or Decoc [...]m ex Pu [...]p [...] Tamarind. Myrobal. Citrin, cum Rhabarburo per noctem insushm. The cour [...]e of Life must be such as hinders the encrease of Bile, and cools the Liver. All the Res non Naturales must tend to cooling and moistning. The Drink must be small. Barley Cream, Emulsions of Pumpion Seeds, boiled Rice and Gourds are good. Veal, Kid and Chicken boiled, and not roasted. Saxatil Fish. Sallets of Borage, Endive, Cichory and Sorrel. And in their season, Figs, Grapes, Damsens, and Pumpions. Pears and Apples are good, provided they be baked. Let the Patient avoid watching, care, and trouble of Mind; but Venus especially, as a thing that weakens the Body [...]reamly. If the Body be costive, eat Raisms, and use Lenient Clysters.
In a Phlegmatick Constitution give first some Hiera or Elect. Hier. cum polline Trochiscorum Agarici. Potions may be given of Mel. Rosar. Solut. & Cathol. ex decocto cymarum Absinth [...]i. But in this case avoid Cassia. Then the Phlegm must be cut, and Obstructions opened by Preparatives, such as Oxymel, Syr. de Beton. Mel. Rosar. Syr. Byzant. ex quinque Radic. &c. About three spoonfuls may be given at at me in decocto Beton. Abfinth. Ment. Grigan. S [...]aechad. vel sure Passulm. [...]el eori [...]dem aquis. Then stronger Purges may be given, as Mel. Rosar. cum modico Dinphoenic. vel [...]ect. Cathol. cum Didacarthami ℥ ss ver infusio agarici irochis [...]ati ex Oxymelite. I would not here exclude the use of Rh [...]barb. Some Pills may be taken once in eight or ten days, such as ex [...]era cam agarico, de tribus cum Rhabarb. Cochiae, and it there be pain, ex Hermodac [...]. We must streng then the Stomach by outward Applications. We must abstain from Phlebotomy, unless there be great occasion. The coldness of the inwards must be tempered with Diagalanga, Rotulae ex Aromatis Galeni, Theriaca, seu Mithridatium, alternis diebus. We must have a care of Diet. A cold and moist Air must be avoided. Meat must be roasted rather than boiled, and seasoned with Spices. Most Fish is bad. So are Beef, Pork, Lamb, Mutton, the Feet and Extremities of Animals, Cheese, Milk, horary Fruits, and the like. We allow a little generous Wine. The Patient must never eat his fill; it is good somtimes to go supperless to Bed. Venus is more pernicious than any thing. Motion and Exercise is good, if not presently after Meals, (for then it is bad,) but in the Morning, till one sweats.
In a Melancholick Constitution we proceed in the like course, beginning with Electuarium Diasen. Syr. de Polypod. sero ex infus. fol. sen. & passul. decoct. The next day we may give Syrup. de Borag. de Lupul. Fumar. in aquis cò destinatis, [Page 650]aut decoctis, ex Borag. Melissophyl. Callitrich. Glycyrrhiz. Asplen. &c: Purges may be given ex confect. Hamech, decocto Myrobal. Indor. ex infusione fol. Sennae, Syr. de Epithymo, aut Polypodio. It will be good somtimes to give Pilulae de Lapide Cyaneo, or de Fumaria. Bleeding with Leeches at the Haemorrhoids is good. If the Patient (as such People usually are,) be lean, he must use a Milk Diet. The Diet must be moistning, of Veal, Mutton, Pullets, small Birds, and the like, rather boiled than roasted. Borage and Capers in Sawce are proper. Apples and Pears coddled and strewed over with Sugar, are good. His Drink must not be thick and feculent. Sleep is good. Venus is naught. Thus the Cacochymy is to be removed from Bodies by peculiar remedies, accordding to the nature of the peccant Humour. When the Body has got a Venereal taint, the Patient must for about four Months be treated as such, that his Body may be rid of all impurities, and so be made fit for this difficult Operation.
CHAP. III.
An Enumeration of what things are necessary for the delineation of the traductive Skin, and the provision of all Implements.
BEfore we talk of the administration of this Work, we must first of all enumerate distinctly, what things are necessary for the performance of the Work, that Chirurgeons may be fully informed, with what Implements they must be furnished, before they undertake the delineation of the traductive Skin. For these things considered, and rightly ordered, they will perform their work with credit, and avoiding all confusion, they will prevent all occasion of mistake, which might otherwise arise. Some of these things respect the Artist; others the Patient's Wound. What respect the Artist, they are the Servants, and his fellow-helpers. For one Artist alone is not sufficient to perform this operation; because many things must be done at one and the same time, which require the assistance of several Persons. The Chirurgeon therefore must have at least two Servants; who must be, not only nimble in their Body and Hands; but of a vigilant Eye to observe their Master's Commands, and to perform them. These must of necessity be either well skilled in this sort of Chirurgery; or they must be very prudent and diligent. For the Chirurgeon does not only stand in need of their help in the preparation of Medicines; but in making Dissection, in deligation of the delineated graft, and then in inserting of the same into the curt parts, which one work is more difficult than all the rest, that are necessary to this sort of Chirurgery. Let the Artist therefore, if he cannot get such as are Learned and Experienced, at least procure such as are apprehensive in their Mind, quick in their Senses, and nimble of Body: And if they be raw in the business, before the operation let him inform them now and then, of all things that are to be done in the operation. For so he would have them more ready in his Service, more at his Beck, and exceeding Obedient. It is of moment besides, to chuse an opportune place, wherein to perform the operation, and to take care of a Bed for the Patient to lye on, with all things belonging to it. For it is of no slight concernment, what sort of Light there is, what its Position is, and what Pillows there are. First, therefore the Chamber, wherein the Bed is set, must be very light, because the Work requires a clear light: But the delineation of the [Page 652]traductive Skin, does especially require it; for thô other things might be done by Candle-light; yet the delineation of the traductive Skin must be done by daylight, and all People but the Operators must be put out of the room. The Patient most be placed on the Bed, with his Face against a large Casement, and the Bed must stand from the Wall on all hands, that the Operators may go round any way, as there shall be occasion. There must be three Pillows in readiness, whose use we shall shew afterwards: They must be stuft with Flocks, and not with Feathers; because Feathers are apt to grow too hot, and by reason of their softness, to give way. The Bed is better than any Chair or Seat.
And having reckoned up all things in respect of the Chirurgeem, we will now proceed to what things are necessary in respect of the Patient; and the delineation of the propaginous Skin. Some things are to be performed, before the work is undertaken; others in the doing of it, and others after it is finished. Among the preceding requisites, the principal is; to contrive by all means how to stop the Blood when we cut the Skin: Because in cutting the Skin, thô we wound no part else; Yet even this Wound may be feared, if an Inflammation, or an [...]r [...]sipelas, should arise. For Anatomy shews us, that several Vessels of all sorts run along the Arm, and lye under the Skin, which if we have not a great care, may be wounded. Beskles, there is danger in the largeness of the Wound, which the supplemental part must be of. For thô you make the wound at one cut, yet as soon as the Forceps is let go, a large Hiatus appears, and all under the propaginous Skin lies bare. Then the Air comes in, and the part lies bare to various defluxions. Wherefore, to avoid these dangers, no small care should be taken, and we must make provision aforehand against the worst. There are several things proper in this cafe, such as, Lacluca, Trifolium, Polygonum, Auricula muris, Lenticula palustris, Psyllium, Ʋmbilicus Veneris, sempervivum, portulaca, Ovi liquor; Omphacium, Solanum, Rubus, Capreoli vitium, Plantago, Sorbi, Corni, Mespili, Cydonia, Myrti folia co [...]um (que) fructus, Rosarum capita, Balaustia, Sumach, acaciq, Bolus Armena, Nuces cupressi, Galla immatura, &c. To these you may add the Posca Graecorum, which is nothing but Vinegar and Water, so mixt and proportioned, as that it may be grateful to the Taste; So Galen defines the Symmetry of it. As for the place where these things are to be applied, the nature of the thing shews, they must be applied near the Part, especially above it, (for so we hinder any conflux to the Parts below.) They must be applied round the Humerus; And because the Armpits have a vast in let of Blood into the Arm, (whence a vast inundation of Blood, upon these parts might be feared,) we must take the more care of this place; which is best done by cutting away the Hair, and plying it continually with Medicines for the purpose: [Page 653]It is best to do it half an hour before the operation, while other things are getting ready. We must take care to renew them before they grow warm. These may serve for Repellents; ℞ Ol. Ros. Omphac. ℥jss. Myrtin. ℥ v. Sang. drac. terr. sigill. an. ℥j, Bol. Arm. ℥ v. Camphor. ʒ j. Cerae albae ʒ vj. Contundantur quae contundenda simt subtilissimè, & cera cum oleo eliquetur ad lentum ignem, addantur pulveres, ubi parum refrixerit, & reficiantur s. a. We may make these things more cooling and astringent, if we wash them in Vinegar of Roses. Spread this on a Linen cloth, and apply it all over the Humerus. Or if you like a Liniment. ℞ Ol. Ros. ℥jss. Myrt. ℥ j. aceti nigri [...]cerrimi ℥ v. pulv. Bol. Armen. ℥ j. agitentur omnia in mortario plumbeo, quous (que) consistant, & oblinatur undiquaque humeri articulus. Or this, ℞ Succ. Plantag. Sempervivi, Solani, an. ℥ ij. aceti nigri acerrimi aq. Ros. vel pedunculorum Ros. plantag. an. ℥jss. Infundantur lintea in liquorem hunc, at (que) illis actu frigentibus universus articulus circùm latè foveatur. Or, if you like a Decoction, ℞ Sumach, Summitat. Rub. Myrtill. Gall. immatur. Balaust. Ros. an. M. j. f. decoctio in vini nigro austero, quous (que) tertia pars superfuerit, infundantur lintea, & dicto jam modo applicentur. And this may serve for things necessary before the operation.
As for things requisite in the performing the operation, they are these, viz. A Forceps, and Knives. The Chirurgeon must take care that they be sharp, and whether they be convenient this way or another, he must lay them in a dish for the purpose all in order; lest there might be any confusion in the operation, the blame whereof will be laid on the Operator, and not on his Servants.
When the work is done, these things must be in readiness, viz. Linen to put into the Wound; Stupes to defend it and the adjacent parts, store of Medicines to take up in the Stupes; a broad Linen cloth to lay over the Stupes and the Wound; and a Roller to roll over the Stupes, and to bind the Wound. I shall now briefly shew you the use of these things. First, there must be a piece of Linen cloth, to put between the raised Skin and the parts underneath, to keep them asunder, lest they should grow together again. And there is one benefit more in the Linen cloth; that one may lay Medicines upon it to stop and repell Blood. It ought to be exactly of the same dimensions with the Wound. You should have pieces of several dimensions in readiness, that you may take one which suits best. You must also have flaxen Stupes, to guard the Wound; some broad and long; others narrow and short, all of an orbicular shape, with their sides a little compressed. Of the larger there must be four at least, about three Inches broad, and six or seven long. They must not be over thick, for then they are cumbersome, as they swell with the liquid Medicine, and the Blood which they soak up, and when they once grow up, they inflame the Parts. The less must be two [Page 654]Inches broad and three long. It is convenient to lay all these on, and to guard the Wound well. But it may not be improper to make more than we have mentioned: For it is better to have too many than too few. Then it is proper to have a Linen-Cloth to go round all and stay the Wound. It must go round the Arm and the Wound, and it must be larger than the Wound: All these must be wet in Whites of Eggs, which must be well beaten, adding Rosewater, a little Dragon's-blood, and Terra Sigillata, mixing and beating them well together. Then you must have a Roller ready, thin, and all of an evenness, about three Inches broad and four Cubits long. Either to bind the Wound too tight, or too slack, is inconvenient: Wherefore we must so order the matter, that what it wants in tightness, may be suppliad by often rolling, and that there may be nothing, but the Roller takes hold of it, let the Roller be neither broader nor narrower than we have mentioned; if it be broader, we cannot straiten the Parts with it; if narrower, it will twine and twist like a Cord, and so hurt the Parts. It must not be rolled dry, but wet in Posca; for when it is wet, it will be more pliable, and will be instead of a Medicine, to stop blood. We have been the more copious and particular in these things; because it is an odious thing to have ought to seek, when we go about such an Operation as this.
CHAP IV.
In what manner the cutaneous Graft must be delineated.
WE have already discoursed of all things that should be in readiness for the Operation; now we will proceed to the Operation it self. The delineation of the Skin, is the Basis of all the rest. Therefore here we must be exact, and do all things by Polycletus his Rule. However it is hard to define the quantity of the Skin exactly, since it depends on conjecture. But diligence and prudent circumspection, will go far towards ascertaining it's dimension. And after mature consideration, let the Artist go couragiously about his Work. First, let him place the Patient on his Bed, and let him remove all Impediments, either to the Patient, or to himself. Next, let him appoint those that are to help him, their Stations and Places, every one in their order. Let the Patient lye on his Back upon the outer edge of the Bed. He may change this place, either for the convenience of the Chamber, or of cutting the Arm, if so be the light fall well. Thus he must be placed ready for the Chirurgeon and his Assistents, when they are about to begin the Operation. The Arm, whence the Skin is to be taken, must be made bare. The Assistents must be in their places. One must sit on the upper end of the Bed behind the Patient's Head, at the Artist's right Hand. He must with his right Hand support the Patient's Arm, and with his left, when there is occasion, hold the light, or do any thing else, as occasion requires. Another Person's Office is to lift up the Skin, to fasten the Forceps, to help the Chirurgeon, to hold up the Forceps, while the Artist cuts, and when the Work is performed, to take it away. And he must be at the Chirurgeon's left Hand, or on the contrary side, if the opposite Arm must be cut. For thus each of them by the opportunity of their Places, will be enabled more readily to do their Duties, and observe the Chirurgeon's beck; for several things, while the Operation is performing, must be intimated by a Nod, and not by Words. Because for the Patient's sake, Words must be forborn. In the Interim, the Chirurgeon having his Hands free from all Entanglements, must come near his Patient, always standing; that on any occasion he may turn which way he list, and buckle himself to his Work. And first of all, let him gently handle the Skin on the forepart of the Humerus, whence he [Page 656]means to borrow his Graft, let him lift it up and let it fall again, and in the same manner raise it, and let it go again, that by this gentle Contrectation, it may be prepared for Separation with more case, when we should cut it, and lift it quite up with the Forceps. But ever use moderation, lest too rough handling before Section, should make the Humors flow with greater impetuosity after it shall be performed: For great Veins and Arteries lye near this place. And since the main business is the Symmetry of the Graft, you would do well, (especially where the Operator is a Novice in the Practice of Addition,) to mark the Skin with Ink, and when he has taken up as much Skin as the case requires, he shall give it to his Assistent on his left Hand to hold, then he shall take the Forceps in both his Hands, and within the Assistent's Hands he shall fix it on the traductive Skin. Yet in the mean time, if he have departed from the prescribed quantity, he must raise it and take it up again, and having looked well on both sides, whether all things are right, he must straiten his Forceps, and fasten it there with an Iron Ring. He shall give this again to the Assistent on his left Hand, and then he may proceed to Section. Presently therefore let him take the Knife in his right Hand, and thrust the point in gently through the Skin, about the middle of the slit in the Forceps, and so cut on each side to the very corner of the slit, if need require. When Section is thus made, which is the first step in the Art, and as it were, the Rudiment of the whole Work, and when the Knife is laid down, or given to one of the Assistents, he must with the end of the Probe thrust a piece of Linen Cloth through the gaping skin. The Assistent on his left hand must get this ready. He may take measure by the slit of the forceps, and out of the great variety lying by him, may chuse the fittest. When it is put through, if it be wrinkled any where, it must be made smooth, and distended along the whole space, so as that the ends may hang at equal distances from the forceps. Then the Artist may loosen his forceps, by taking off the ring which held the two handles together, and give it to the Assistent on his left Hand to hold up gently, and presently let him put his right Hand under the Humerus, in the inside, and let him raise the Arm a little, that the place may lye better for the cure, which must be used to it by and by. In like manner, between the Plates of the Forceps, when it is opened, let him lay his Hand on the Wound, and with his Fingers expanded let him hold down the Cloth on both sides, which is still in the slits of the Forceps. For so he hinders the Cloth from being pulled out with the Forceps, when the Assistent takes it away, which he must do assoon as the Artist lays his left Hand on the Wound. When these things are done, the Artist must compose his Graft and six it in an even Situation. I call the Graft, all that Skin which is separated from the Muscles underneath, and which is circumscribed by it's internal and external Superficies, and on each [Page 657]Hand by the sides of the Section, This, for causes which we shall mention afterward, the Lips turning inwards, does somtimes swell strangely. It will therefore be convenient either with a Probe, or with the inside of the Hand to smooth down all unevennesses, and lay them right, that the Grast may be equally extended, according to all its parts, and presently to go about its proper Cure. For here any delay is dangerous: Wherefore the Artist must put the shorter stupes, which he has in readiness, to the Wound innermost, and others outwardly, and over these he must lay the large ones, one at each side, and one at each end. And when he has in this manner guarded the whole Wound, then he must lay a Linen Cloath double for a common guard to all, and that the Wound may be the better bound. But this must be done by Rollers. Therefore taking the Roller in his Right Hand, and opening the end of it, let him apply it to the upper part of the Grast, laying his Left Thumb on the end of it, and roll downward toward the inside of the Arm. When this is done, let him straiten the Arm a little, and [...]oll again, rolling gradually downwards, till the whole Graft, and the broad Linen Cloath, which is brought over it, be by rolling from one end to the other all covered. And the Artist must take care, that in binding, he neither straiten nor slacken the part too much. If it be over slack, the Blood will run to it, and the Medicaments off it. If it be over-tight, it will weaken the part, and destroy the i [...]ate heat of the Skin: Whereupon the Graft dies, because all manner of passage for the Aliment is stopt. And moreover, because strait binding causes pain, this will cause an afflux of Humors, and (which is the utter ruine of the Graft,) will occasion Inflammations, Erysipelas's, and other Swellings. Wherefore moderation must be used. Let him turn in the end of the last Roller about an Inch, then tie the end over with Thread; so there will be no fear of its undoing; and thus is the administration of the delineated Graft performed. But still there is a care incumbent on the Artist, to keep both the Arm and the Patient himself quiet and undisturbed. And for this, a middle posture is most proper; so the Arm must be bent. This I would have observed, that as the Humerus hangs down a little, so the Ʋlna may be gently raised, and in the same moderation the Hand must be above the Ʋlna. For this reason, as we said, care must be had of Pillows, Bolsters, and such Furniture. Therefore while the Artist lays the Pillows, both his Assistents must stay the Patient's Arm. He that is uppermost, and sits at the Artists Right Hand, must put his Left Hand under the Patient's Armpit, and lay his Right upon his Elbow; the other must with his Right Hand stay the Patients Cubitus, and with his Lest Arm go round his Body. By thus doing, they will on both sides keep the Arm steady and quiet, which is the principal thing we desire, because of the violent terdency of the Blood to any disturbed part. All things being in this posture, the Artist must bend the Arm, the [Page 658]Assistents helping, into a safe and opportune posture, and, according is the season is either hot or cold, cover it with Linen or Woollen. It will also be requisite for the Patient not to stir in the least, lest the quiet of the Arm be disturbed, and put the Humors in motion, which of themselves are too apt to be moved. Therefore a profound rest both of the Arm and the whole Body is absolutely necessary. But this is not all, we must likewise give check to the violent motion of the Humours. Therefore we must endevour to defend the part by pouring on refrigerants and repellents all over the Region of the Wounded Humerus, especially toward the Armpits for an hour or two. Of which sort of Medicines Posca is best, provided it be in quantity sufficient: For I have found by good success that it stops the most impetuous Fluxes of Blood.
CHAP. V.
The Cure of the delineated Grast.
NOW it remains, that we lay down the cure of the delineated Skin, as soon as the whites of Eggs are taken off, and what course of Diet the Patient ought exactly to observe, till all fear of Inflammation be over. And the Cure of the Wounded part does chiefly consist in suppuration, not neglecting the use of Repellents in the mean time. For since Humours are perpetually running thither, and abundance of them, through the weakness of the part, do gather there, the Chirurgeon's chief aim should be to disenss by Suppuraters whatever is gathered there, and to hinder by Repellents whatever comes from any where else. This Hippocrates does intimate, where he says, that an Ʋlcer the s [...]nest suppurated is the safest from Inflamation, and the soonest Deterse and siled with Flesh. Now since there are several sorts of suppuratives, there may be as many several sorts of Medicaments, which according to the Heat and Cold, and the several Seasons of the year, may as occasion requires be made choice of. In the later end of Spring, and all Summer, Sallet Oyl drawn from ripe Olives, pure Wax and Turpentine in equal quantities will be proper. For these mightily promote Pus, and I frequently use it. For the wealthy and delicate you may use this following. ℞. Terebinth. let. ex Rosac. ℥ v. ol. res. comp. ℥ j. Addatur cerae albissimae, quod par fuerit his omnibus excrpiendis, & ex arte conficiatur unguentum. But in a cold Season, when the heat retires inwards, we must use much stronger means. Therefore in the later end of Autumn and all Winter, you may use such a Medicine, ℞. cl. commun. [Page 659]℥ viij. cerae pune ℥ ij. colophon. picis naval. sagapen. a. ℥ j. mastich. thur. galb. terebinth. à. ℥ v. ubi oleum cum cera ad ignem probè liquata fuerint, injiciatur colophonia primum, deinde pix navalis, sagapenum, terebinthina, mox & reliqua, & refrigerata recondantur. This also is good, ℞. cer. alb. resin. pin. sevi vaccin. pic. naval. terebinth. th [...]. myrrh. à ℥ v. M. & in pulverem, quae convenit, redactis, cum ol. q. s. f. Ʋngu. ex arte. Next follows the use of Repellents, which (because they are applied only to the outside of the Wound, and the suppuratives to the inside,) may best be applied to the upper part of the Humerus. But before we proceed to them, we will discourse of the administration of suppuratives. Within a day or two, or after all fear of a Haemorrhage is over, in the Morning the whites of Eggs may be removed, and that very gently, lest any little branch of a Vein might upon a slight touch bleed afresh. Wherefore it were good to have some singed cotton to apply to the Wound. If the Cloaths be hard and dry, and do stick fast, they must be softned by moistning. Posea is good for this use, and then Oyl of unripe Roses. These may somtimes be mist and applied either cold or a little warm, having always regard to the Season, and other Medical Circumstances. For Medicines when they are moderately warm do better insinuate themselves, and by the moderation of their quality perform what we desire. But the Artist must have a care they be not too hot, lest the Blood being stimulated thereby, burst out again. Let therefore the Assistents stand on each Hand, one of which must hold a Bason to receive what comes from the Wound, and the other must have liquor, fit to moisten the Cloaths. In the mean while the Roller must be taken off, with all the gentleness imaginable, so as not to disturb the Arm or the Patient. Wherefore it were best to clip it with Scissars, not all the Rounds at once, but one by one, and rather on the outside than the inside of the Arm. For in so doing we shall neither disturb those parts by its motion, nor shall we come near those great Vessels of the Arm, which it is the best not to touch at all. When the Rounds of the Rollers are stiff with Blood, it is the Assistents part to irrigate them by dropping liquor from on high. Then he may take them off with a Probe, or, when joyned, he may gently sever them with his Fingers, and throw them into the Bason, and when the Wound is laid bare, he may cover it with a white Linnen Cloth made warm, while the Artist is making ready for the rest of his Work; who must take that Cloth off, and apply another to the Wound, spread with suppuratives. Where note, that the first Cloth must not be taken off, till the other is ready to clap on, which must be done as near the same instant as may be: Which is a rule ever to be observed. Then the Artist must take up the end of the Linen. Cloth, which is run under, in the outside of the Arm, and sew another of the same bigness to it, running the Needle along, and no where sewing double, lest [Page 660]by its bulk it might exasperate the Wound. Then with his Right Hand taking hold of the inner end let him raise it, and draw it through till all the old is come through, and the new is drawn into the Wound. Then one of the Assistents must clip off the Old, and throw it into the bason with the rest. But if the Lips turn inwards, then let the Artist with his Probe spread it again gently, and drop in a little Turpentine either alone, or mixt with Oyl of Roses, then let him apply Lint dipt in Suppuratives, and upon that Linen Cloths, wet in Repellents, warm; then in the same moderation that was formerly prescribed, let him bind all up again, and place the Arm in a middle posture. These Repellents differ nothing or but very little from the other. If they do, it is best to apply gentle ones to the Graft, and stronger to the Shoulder and Armpits. These are proper for the Grast; ℞. olei Ros. omphac. olei Ros. comp. à ℥ j. M. Or, ℞. olei ros. comp. myrt. à. ℥ j. M. These you may use singly, and, with a Cloth dipt in them a little warm, you may irrigate the Graft all over. For the Shoulder this is good; ℞. ol. omph. myrt. à p. ae. And this Liniment; ℞. Sant. rubr. gran. myrt. ros. rub. à. ℥ v. ungu. ros. Mes. ℥jss. redigantur in tenuissimum pollinem santali, mnti & rosae, pareturque ex arte linimentum.
As for Diet, it must be very spare in the beginning, and so continued for about four days, till the Humours are setled. The Drink must be small. Wine must not be touched. After the fourth day is over, you may advance a little. After the seventh is over you may indulge your self yet more liberally. And this may suffice for the cure of the Skin, when first delineated.
CHAP. VI.
The Cure of some Symptoms, which somtimes befall the delineated Skin.
THree sorts of Symptoms do somtimes befal the delineated Skin. A Mortification of some of the edge of the cutaneous Graft, an Inflammation of it, and of the parts adjacent, and profusion of Blood. There are several causes of Mortification in this case, a Diseased and Veneral habit of Body; a lax and thin Skin, where the innate heat is weak; too violent pinching with the Forceps, and too strait binding. Unless therefore the Patient be of a good habit of Body, especial care must be had, in taking up the Skin with the Forceps, to use such moderation as but just to keep it up, and not let it slip and hinder the operation. It is a good way to take enough of the Skin, that if a little Mortification should happen, there may be still enough to serve the turn. Great care also, as we have said before, must be had in binding, that it be neither too strait nor over slack. But when you have a suspition of this mischief, (as you very well may in the forementioned Bodies,) the Wound must be opened, and not let alone till the third or fourth day, you must look very narrowly to the edges, that timely care may prevent the worst. You may know it is beginning, when upon trial by a Probe, sense is either small or quite lost, and if the part look very pale or livid. It must therefore be resisted by things that dry strongly, and destroy Putrefaction. Such is Ʋnguentum Aegyptiacum, whereof there are several sorts; but this is the best; ℞. Alumin. virid. aeris, mellis, aceti acerrimi à. p. ae. M. Praecipitate is good either alone or in Oynment of Roses, and other Oyntments. Somtimes pulvis aloes strowed on the Skin has quite destroyed the Malady. It is best to use a decoction of Lupiues, wherein Aloes has been boiled. This is also a very safe Oyntment; ℞. terebinth. letae ex succo absinth. ℥ j. farin. bord. cretae ℥ j. pollinis aloes purissim. ℥ ij. mell, albi sincerissim. q. s. agitetur mel, excipianturque singula, & ex arte paretur extergens medicamentum. You may use it in Oyntments and apply them to the parts that are tending to Putrefaction. Great care must be had of the Patient's Diet, especially were the Body is Cacochymick or Venercal. All things therefore must be drying and consumers of excrementitious moisture.
The next Symptom, which somtimes ends in the former, is an Inflammation. For because the Blood runs plentifully to that part, all there about is swollen, red, and [Page 662]painful, and if not prevented, threatens certain ruine to these parts, especially to the Graft. This is most apt to arise in the Spring time, and when People have fared plentifully before; wherefore it is altogether proper to prepare Folks Bodies before the operation. When an Inflammation doth arise, the best way is to bleed in the contrary Arm. The Patient's strength must define the quantity. Diet must be prescribed. The Patient must abstain from all hot things; and things of a penetrating substance. Coolers and Astringents are best. No Drink at all must be used; Spoon-Meat is sufficient. Rubbing the lower parts with course Cloaths, Cupping either without, or with very small Scarification, when too little Blood has been taken away. Lotions of the extream parts are good, a little warm, with cooling Herbs boiled therein. Bleeding the Haemorrhoides with Leeches is proper.
The next Symptom is, profusion of Blood, which may be stopt by letting Blood in the opposite Arm, if the Patient's strength will bear it; by Cupping, Scarifying Ligatures and Frictions. It is good to roll several Rollers pretty hard, not dry, but wet in Posca, hereby I have known Bleeding several times stopt. In this case it is best not to open the Wound till the fourth day. Next of all, the whole Region of the Shoulder must be fomented with Posca, and Cloths wet therein, frequently renewed, before they grow warm. When the Wound is opened, it is good to have things in readiness that stop Bleeding, if it should happen, such as singed Cotton applied either to the Wound or close by it. Castane [...] cortex exiccatus, & in pollinem subtilissimum redactus, and gluten Galeni, quod aloos, thuris, mastiches aequas portiones continet, & ovi albumine excipiuntur, and Bol. Arm. sang. drac. & pil. lepor. in pollinem redacta. Abstinence both from Meat and Drink is here good. What is eaten should be Cooling and Incrassating. When the Patient rises he must keep his Arm steady in a sling made of a broad Roller. After the Seventh day is over, he may feed a little more plentifully till the Fourteenth, and then it will be time to take up the Graft.
CHAP. VII.
Why the taking up of the Graft is deferred, and not done at one Section, what time is proper for the Administration, and what Provision must be made for it?
THE reason why all is not done at one Section, but part of the Operation deferred, is, because the cutaneous Graft, if it were cut quite off at the same time that it is delineated, would shrivil up all on a heap, which might occasion a Mortification, for that Medicaments could not then so well be applied, as when it is explicated: Besides, the great Muscles would be laid quite bare, which would produce the like inconvenience, if they were exposed to the open Air. Wherefore it seems most proper to perform the Operation gradually.
As to the time, when the cutaneous Graft should be taken up, it cannot be desined by days or hours; it's requisite corpulence and the intermission of Symptoms will best determine that. For upon affluence of Blood, and it's being by heat compacted into carnous Fibres, the Skin grows thicker, so that when it is cut off it does not [...]ivle up together; which (as I said before,) was the reason why the Skin was not both delineated and cut off at one and the same time. We must therefore tarry till the Skin grow thick and compact enough, which (if we may set any certainty to things uncertain,) it usually is within Fourteen days. In which time the subject Parts have the benefit to be clothed with a new Skin, whereby they are fenced from the Injuries of the external Air. And another main reason for deferring it, is, the abatement of the violent Symptoms, which must needs fall out in that time, and which would otherwise spoil the whole business. A breathing time therefore is requisite for a second Operation, and Sat c [...]to, si sat bene.
And because it is good for an Artist to have his Tools about him, we will consider what Provision there must be made for the Operation. Now since the Skin must be cut at one end, and that somtimes Veins inter [...]ur, the same things therefore must be in readiness here, which were prepared for the Delineation of the Skin: Ovi aibumen rosacea dilutum in great plenty; it will be good to put some Sanguis draconis and Bole Armeni [...]k [Page 664]into it. Two broad pledgets of Lint; their quantity must be measured from the amplitude of the Section; they must be large enough to cover the whole Section, both of the Graft, and of the Arm, whence it was taken. Besides, there must be Medicaments and Liniments in readiness for the cure of the Wound underneath; the compass whereof, because it is the ground whence the Graft was taken, we call the Bed. That therefore we may heal it, there must be in readiness Cloths spread with Suppuratives, and a Cloth exactly of the dimensions of the Bed; there must also be other Cloths, for the inside of the Graft, and they for this time must be single, and spread with suppurative Medicines. There must likewise be two Rollers of the same bigness as before: One to keep fast the Medicines upon the Bed; the other for the Graft. This must be rolled over all the Arm, therefore it must be longer than the other. There must also be a smooth and sharp knife or two. There must be a Needle and Thread to sew the end of the Rollers; and so much may serve for the Apparatus.
CHAP. VIII.
The manner of taking up the Cutanous Graft.
IN the Graft there is a twofold Superficies, the natural, which is smooth, and well-coloured; and the ascititious, which is uneven and red. Therefore the Graft must be so applied to the curt parts, that the natural Superficies may be outermost. Besides, it is to be considered, at which end it must be cut, so as to be best fitted to the Part; If the Nose or upper Lip must be supplied, then the upper end toward the Armpit must be cut; If the neather Lip, then the lower end next the Elbow must be cut. But as to the administration of the Section, it is twofold; either it is right from the inner angle of the Graft, to the outer Superficies; or it is sloping from the inner Angle of the Graft, towards the Shoulder, somtimes so, as to take in an Inch and an half more of Skin. For when we find that the delineation of the Graft falls short, and that it shrinks, then is the time to eak what it wants by an oblique or slant Section. Because Nature endeavours Unition, as much as she can, at both ends of the Graft, which shorten it much. And when the Skin is loose and thin, this Section is proper, as we may gather by its shrinking in breadth. But when there is no ground for Fear, then a right Section, without any sloping is best.
The Patient must be set on his Bed, in the same place and posture, [Page 665]as we advised for the delineation of the Skin, against the Light, at a distance from the Wall, and on the side of the Bed, for the more convenience of the operation. The assistents must observe their stations; one at the Artists right hand, the other at his left. the one must hold the Patients Arm leaning on Pillows, with the Hand upright, from the Elbow: The other must handle the Humerus, according as the Artist shall direct, and as the Graft must be cut right or sloping. If the Artist make a right Section, he must order the Assistent at his right hand to compress the Skin next the Graft. For often the Skin gives way, and hinders the right Section. Now the Assistent will hold the Skin right, if he put one hand under the Armpit, and the other as near as he can to the Cutaneous Graft. Then the Artist must with a Probe lift up the Cutaneous Graft, putting his left Forefinger underneath, and carrying his left Thumb over against it, let him hold the Graft gently up. Then let him take the knife in his right hand, and cut even, and at a right Angle upwards. When the Graft is taken up, let him turn it back toward the Elbow, and guard it well with Lint, where it is wounded. For somtimes, when a Vein is cut, it will bleed much. And this is the manner of right Section. But in the oblique or sloping Section, the Assistent lays no hand on the Patient's Arm, only the Artist puts his knife between the Graft and the Muscle, underneath, and cuts slanting upwards. Assoon as he has considered how much he will add to the Graft, let him take it up between his right Thumb and Fore-finger, and give it to the Assistent at his right hand to hold. He must then put his Probe under the Graft, putting gently under it his left fore-finger, laying his Thumb over against it, and then he must raise the Skin gently, so as the knife may have room to go in. Which he must take in his right hand, and with some strength cut slanting, as far as he shall think good. When the Graft is taken up, he must turn it back to the Elbow, and where it was cut off, he must cover it with Lint, and fence it well. But he may immediately commit this to be done by his assistent. And the Artist himself may look to the other Part, may lay on Lint, and take care by all means to stop the bleeding. Then my advice is, to cover the whole Bed with divers Liniments, and then to lay on the broad linen Cloth. He may give the Graft to the Assistent on his left hand, who may conveniently hold it in his right, and, with warm linen Cloaths, keep it constantly from the injuries of the Air. In the mean time, the Artist must be covering the whole Bed, by rolling it with one Roller, whose end must be fastned with a needle and thread on the outside of the Arm. When this is done, let him lay some Ointment over the Roller, as far as the cutaneous Graft will reach, and then let him lay back the Graft upon it. Great care must be taken to spread it well both in length and breadth. When the Graft is turned back, laid [Page 666]smooth, and placed as it ought, the Artist must order an Assistent to lay his middle and fore Finger on the top of it, and bid him take care that it shrink not. Then let him take another Roller, and apply it where the Graft grows to the Stock, and there begin to roll, till he has covered the whole Graft, and bound it to the Arm. Here is the difficulty of the business: For if the Graft be bound too tight, it dies; if too slack, it shrinks. Therefore great care must be taken herein. And because it is difficult to hit right at first, the Artist, that he may be sure, must, whenever he opens the the Part, diligently take notice of the whole Substance of the Skin, whether it be as it ought, or whether it dies, or shrinks. This the Eye will shew; the other is known by paleness and senselesness. Because an Error herein is very hard to amend, therefore I would by all means advice the Artist to be careful in it. When all is done, he must place the Arm in a middle posture, as before. And so the Administration of this Operation is performed.
Here it will not be amiss to mark out the parts of the Graft, and assign to them, and to some other things, names, that when we have occasion to mention them, we may not use Circumlocutions. Horticulture directs us best in giving Names. For from it the best hints of any such operation were taken, and by it we have been hitherto directed. All therefore that is the subject of our operation, we call the Graft, the Cutaneous Graft, the Propagmous Skin, or the Brachial Skin. Its length and breadth are considerable; but so is not its depth. The length exceeds the breadth usually one Third. The length we may divide into three parts, the upper, middle and lower, and we may give every one its name. By the upper part we mean that, which was last cut from the Arm, which we call the top of the Graft. We might more properly call it the insititious end or top, because it is ingrafted into the cut parts. The lower part, which grows to the Arm, we may call the root of the Graft; for from hence Aliment is carried into the rest of the Graft, as from the Root into the Tree. What is between the Top and the Root, we may very well call the body of the Graft. As to the Superficies, we call it either Internal or External, the Inside or Outside, or the later we may call the Cutanous Side. The edges of the Graft we call either Interror or Exterior, or the Internal or External linear Confines, We may properly enough call them Lips; because both in roundness and thickness, they much resemble the Lips of the Mouth.
This we thought fit to mention concerning Names, that all confusion might be avoided, and obscurities cleared, which might otherwise arise about Names.
CHAP. IX.
Of the Cure of the New and Old Wound, both in the Graft, and in the Bed, and also of rearing the Graft.
WHen we took up the Graft, our care was first to stop bleeding. The next day it will be proper to open the Wound, and to look well about, what should be avoided, and what should be done further.
Now there are two Wounds in each part, viz. in the Bed, and in the Graft, altogether diverse, each whereof requires its proper Cure. That which was made at the first delineation, both in the Bed and Graft, is old: The other is new, both at the top of the Graft, and at the upper end of the Bed. Any one may see, these require different Remedies. The Part newly wounded requires Suppuration. But the old Wound, after the abundance of Humors gathered by Affluxion and Congestion is spent, dies by reason of the weakness of the Part caused by wounding, instead of Suppuraters were Driers, and these no ordinary ones, that all that is soft may turn into Skin or Callus. In the mean time care must be taken, that both the top of the Graft, and the upper edge of the Bed, be brought to perfect Suppuration, which is usually done in nine days, or at most in eleven, sometimes in seven. For here we do not allow so long a time for moving of Pus, as before, because we have another design now; and there were several sufficient reasons then to protract the Suppuration of the Wound. As the grievousness of the Symptoms, whose rage ought first to be appeased. And the thickning of the Skin, or at least, the hindrance of its decrease. For no small strength accrews to it from the growth of carnous Fibres, which put a stop to the decrease of the Graft. Wherefore you may sooner leave off Suppuraters, and use Driers, when the Parts begin to have a Callus or Skin. It is a sign, Wounds are sufficiently suppurated, when the Artist sees, what Celsus learnedly observes, An equal Redness all over, moderation in Driness and Moisture, and little or no pain. For then it is time to leave off Suppuraters, and to endeavor all you can to cicatrize the Wound, which is done both in the Bed and Graft by the same Remedies. Only the Bed, as Experience has taught us, requires stronger Medicines; because the Wound in the Arm is [Page 668]moister and fouler, by reason it is upon the Muscles, to which the adjacent Vessels give a liberal supply of Vapors and Humors, and so hinder the drying of the Sore, in which it's Cure chiefly consists: But where (a, in the cutaneous Graft,) there is but little moisture, it grows callous sooner; and therefore the Graft requires much gentler Medicaments, than the Bed. It is best therefore, when it is at the Artist's choice, (however his scope may be the same,) to protract the Cure of this a little, since each Part has now and then it's proper Symptoms. But let us pass the Cure of the Graft, and proceed to that of the Bed. There are several cicatrizing Medicaments; but this we have had Experience of, Ʋnguentum ex pompholyge. Here is the description of it, ℞ Cerae Albae, Ol. Ros. an. lb V. succi fructûs solani sat. ℥ iiij. Plumbi usti & loti, pompholyg. an. ℥ j. Thuris puri ℥ v. Coquatur oleum cum solani succo ad hujus consumptionem, tune adjiciatur cera, quâ liquatâ, addantur caeterarum rerum pulveres, [...]i (que) tenuissimi, subigantur in mortario omnia, & ad unguenti formam reducantur. This Unguent is spread upon Cloth, and applyed to the Wound. There is another, which I have experienced to be no less successful. ℞ Lap. Calamin. terrae Lemn. an. ℥ iiij. Litharg. aur. Ceruss. an. ℥ iij. Succi Semperviv. ℥ ij. cerae ℥ v. Ol. Ros. Omphac. lb j. M. & S. A. F. Ʋnguentum. Several other things are proper, as, Ʋnguentum ex minio, ex lithargr [...] ex cerussa, ex calce lota, and others of the like nature, which because they dry much, do therefore harden the Flesh into Callus. When proud Flesh arises either in the middle or edges of the Bed, it will be the part of a prudent Artist to have recourse to other means, whereby he may destroy this proud Flesh. This mischief is fomented by a too moist diet, and other Errors therein. Therefore a drying diet must be ordered; and such Medicaments as these may be used. ℞ Terebinth. cerae Alb. Resin. Ammon. an. ʒ xiiij. Flor. Aer. Opopan. an. ℥ ij. Aristoloch. long. Thur. mascul. Bdell. an. xvj. Myrch. Galb. an. ʒ iiij. Litharg. ʒ jx. olei si aestas fuerit lb ij. si byems lb iij. Bdellium, Ammon. & Opo [...]anac. in Acet. q. s. per unam noctem macerato, calefactis terebinthinam permisceto; in oleo, adjectâ cerâ, caeteris (que) in pulverem redactis, coquito & s. a. f. Ʋnguentum. Spread it on a Cloth and apply it to the Wound. For it wonderfully dries up moisture and wastes proud Flesh. Here is another as good and much experienced; ℞ Resin. Pin. lb j. cerae lb v. olei comm. ℥ iiij. aeruginis ℥j. ss. resinam & ceram in oleo liquato, aeruginem studiose terito, oleo addito, f. Ʋnguentum. This also is Excellent; ℞ Ʋngu. Ros. Mes. ℥ j. Praecipitat. Opt. Pulv. ℥ j. ss. M. It insensibly consumes the proud Flesh, and cleanses the Ulcer without pain. But it somtimes happens, That as the Bed is skinning over, Pustules do arise suddenly, which somtimes are painful and somtimes do itch. This happens in Cholerick Persons and in hot Seasons; and somtimes in [Page 669]Phlegmatick Persons, who have a sharp Serum. It often hinders the Cure; therefore we must endeavor to prevent it by a good Diet and Medicaments. This following I have had great Experience of: ℞ Ol. Ros. Comp. lb v. Ol. Ros. Omphac. ℥ iiij. Succor. Fol. Plantag. Solan. Hortens. Centaur. min. Lapat. an. ℥ j. ss. Olea bulliant cum succis ad eorum consumptionem. Adde Cer. Alb. q. s. f. Ʋngu. molle. Asperge domum Litharg. Pulv. ℥j. ss. Pompholyg. Praeparat. ʒ ij. Recrem. Pliambi. Pulv. ʒ iij. Pulv. hordei cremats ʒ j. ss. Bol. Arm. Pulv. Camphor. an. ʒ ss. Ʋngu. infrig. Galeni. Popul. an. ℥ j. M. F. Ʋnguentum. s. a. Here is another good one: ℞ Litharg. ℥ j. ceruss. ℥ v. cerae Alb. ℥ iiij. Ol. Ros. lb j. Album. ovorum recent. No. iiij. Liquefiat. cera cum oleo in olla vitreata, addatur Lithargyrum & cerussa, continuó (que) misceantur: Ʋbi autem refrixerint, ovorum albumina, ea (que) probe agitata, injiciantur, & f. Ʋnguentum. It cools the heat of the Humors, and by gently drying cicatrizes Ulcers. There is another very bad Symptom; viz. When upon a conflux of ill Humors to the Bed, it is eaten into several Ulcers. This is holpen by good diet, and purging the Body, and by good Medicaments outwardly applied. Among divers I shall mention but two: ℞ Resin. Pin. Terebinth. cerae citrinae, Olei commun. an. ℥ j. ss. Dissolve ceram & resinam in oleo, tand [...]m (que) terebinthinam, omnia colentur, & in cacabo ad lentum ign [...]m bulliant, a [...]ri (que) exposita demum refrigescant. The other is this: ℞ Terebinth. Mell. Ros. col. an. ℥ j. Thur. Alocs. Sarcocoll. Farinae Hord. cribrat. sub. an. ʒ v. Dissolutâ terebinthinâ cum melle, addantur pulveres, & agitentur in defesso, us (que) quo exacte commisceantur. These are the principal Symptoms, and they proceed from impurity of Humors, which must be corrected by good diet and purging. Wherefore it is best to prepare the Body well before the Operation be undertaken. If any Purgatives be given afterwards, they must be very gentle. But a well-ordered diet is the main thing, being both easiest and safest.
Now we will proceed to the Cure and rearing of the Graft. The chief of the Cure consists in breeding a Callus by good Medicaments. The rearing of the Graft consists in nourishing it by plenty of kindly Aliment. When the Cicatrice is bred, it is fit for ingrafting. But we must first suppurate the new Wound in the Graft, and then cicatrize it. The Medicaments are the same as before. So dry Linen Cloths, and those medicated, or Lint, are good, prepared in this manner. Take fine thin Linen Cloths, wet them in the Liquor, which we shall now describe, dry them in the shade, and so wet them and dry them three or four times. This is the Liquor: ℞ Gallar. immatur. Sumach, Myrtill. Balaust. Cortic. Granat. an. Mj. Acac. Hypocyst. an. ℥j. Alumin. ℥ij. bulliant omni [...] in vino nigro austere, quous (que) tertia saltem pars supersit, macerentur in co linteamina, & in umbra exi [...]centur. And because all things relating to the Cure are done in [Page 670]order of time, we shall distinguish the time of the cutaneous Graft into four Ages. For as the time of all Animals living is circumscribed by certain Intervals, wherein their Bodies receive notable Changes; so the time of the Graft may very usefully be distinguished into it's Ages, wherein it undergoes considerable Alterations. The Infancy of the Graft is the time from it's taking up till the Wound is dryed; so long as there is no driness in the Carnous Fibres, but they are all soft, flaccid and moist. For whereas before it was nourished at both the ends, now it receives nourishment but at one, and so must needs languish and be subject to divers Symptoms, Ulcers, Inflammations, and Corruption of part of it; all which are obviated, as we have taught formerly. The youth of the Graft is, when signs of Driness shew themselves; for then the Skin neither receives the Excrements of other Parts, nor breeds any in itself. This is a great sign of Strength: The Eggs grow callous first, and then the rest; and the top before the root. The Manhood of the Grafting is, when the Cicatrice is come to the root, and all it's inner Superficies is turn'd callous. The old Age is, when the Graft is all over callous.
Now it remains, that we treat of the ill Accidents that befal the Graft; And first of all we will treat of that which comes through the Artist's fault, viz. The decay of the Graft through the uneven laying and binding of it up. For when it is turned either to the right or left, and the Skin lies on rucks, Ulcers do arise and so the Graft is fretted. You may know it by the bandage being on rucks, or the Skin it self, for there Ulcers are most apt to arise. Whereupon the Graft is starved, the passage of it's Aliment being intercepted. Wherefore great care must be had in binding, about the Position of the Graft, that it lie even; and then Ulcers are prevented. But if any one should prove so supinely imprudent, as to commit such a mistake, he must help it thus. Suppose the Graft be turn'd to the left; this turning must be put even; it may be reduced by a Linen Cloth about an hand's breadth folded, till it be but an Inch in breadth; lay this on the Graft when you have laid it right, at the roof, then bind it up with Rollers, as before, thus with Bolsters you may reduce it; and when there shall be no further occasion, you may leave them off. The Ulcers, if there be any, may be cured as those in the Bed.
When the Graft fades, and grows more languid than it ought, this happens somtimes through too strait binding, somtimes from a Callus, obstructing the Passage of Aliment. When the fault is in the binding, the Artist may easily help it. But when the cause lies in some fault of the Graft it self, or of some other Parts, having well considered where it lies, we must endeavor to remove it. When it lies in other Parts, the remedy lies in carrying off Impurities by purgings. When it lies in the Intemperature, suppose in the Frigidity of the Graft it self; then it is best to use gentle Frictions [Page 671]to the Part: For that brings Nutriment into it from the root, by opening it's Passages. You may rub till the Part grows red, and swells a little, which are signs you have done it good. Whatever you do more, you do thereby but discuss and waste it's Nutriment. You must rub from the root towards the Graft. You may excite the languishing heat by irrigating the outer Skin with hot Oyls made actually warm. The Artist may do it thus, he may take some Cotton dipt in the said Oyls, and anoint the Graft over all the outside, then with his Hand he may rub from the root to the top several times, then wipe it, and bind it up. A Fomentation also of generous Wine may be prepared, especially in Winter Cold, and in Phlegmatick Persons. No moist thing, especially no Oyl, may be used to the inside of the Graft, because it hinders Callus.
We may soften the hardness of the Callus by Plaisters, such as Diachylon, Diapyritid. Diapahna, cum mucilag. rad. Althaeae, & rad. Cucum. agrest. Diadictamn. &c.
CHAP. X.
The time of Ingrafting, that is, of what Age a cutaneous Graft must be chosen, to ingraft withall.
VVE told you before, there were several Ages of the Graft, in one of which Incision must of necessity be made. No Man, I think, will grant, it may be made in all. For upon what account we deferred the taking up of the Graft after it's Delineation, upon the very same here we protract Incision. Because the Graft has not strength enough to undergo the violence of Incision, and to preserve it self likewise from sudden withering away, for the Flesh is not firm enough. And other Symptoms were to be obviated, Inflammation and Bleeding, whose violence were enough to distract the Operation. Wherefore it could by no means be, that as soon as ever it was cut off, and in it's Infancy, it could be implanted into the curt Nose. Nor is the time of it's youth proper, since the violence of the Symptoms is not quite asswaged, nor is it strong enough to endure the violence of Incision, nor, were it implanted, would it well unite. For it not being yet dry enough, but moist and continually moistened with Excrements from the Brain, no wonder, if it should putrefy, or at least heal with much difficulty. But it is not worth while to tarry for it's old Age. For we require a Graft firm and robust, not flaccid and feeble. For what, I pray, should we do with it? The Nose is perfectly to be repaired, which we can never do with a soft, wrinkled, pale, juiceless, and diseased Part, (for old Age is a disease to every thing,) nor can we imagine it. We must therefore take the Graft, and ingraft it into the curt Parts, when it is grown hard, and begins to decline, but is so strong as to endure the violence of the Operation well enough.
CHAP. XI.
Of things necessary for Ingrafting.
AMong things requisite for Ingrafting, some are for convenience, others for necessity; and these are necessary, either in the very operation, or after it is performed. We will begin with those that are for convenience. And first of all, the Head must be shaven, made clean from Dandriff, and kept from Lice. The Beard must be shaven. All this should be done the Evening before the intended operation. Things necessary for Ingrafting, are Knives, Scissars, Needles, Thread, Head-rollers, a Chair, Cloth, and Lint. The use of the Knives is, to excoriate the curt Nose, and the cutaneous Graft. They must be very sharp, and several of them; and those of several shapes, streight and crooked, according as the operation shall require. The Scissars must be sharp; their use is, to clip off the remains of Flesh or Skin, which cannot be cut off with a Knife. There must be a Roller, an Ell and an half long, and eight Fingers broad. This must be doubled, it must go round the Forehead and tye behind. Its use is, when the Graft and Nose are stitcht, to stick the Needles in order, lest they might otherwise be confounded and intangled. The Needles must be very sharp and triquetrous, such as Glovers use: They must be strong, and there must be three, or more, above the number you have occasion for, that, if any break, you may not want. The Thread must be midling and even; but it must never have been boiled. The Thread for each of the Needles should be about five Ells long. The Chair may be an ordinary one, without Arms to it, upright in the back, to the lowest Vertebrae of the Neck; but then it must be a little reclining, for the Head to lean upon: For it is better to perform this operation in a Chair, than on a Bed. There must be a Cloth to wrap about the Patients Neck and Breast, to receive the Blood, and to keep him clean. There must be Rags and Lint, to wipe the Blood off the excoriated Parts. These things are necessary in the operation.
Things necessary when the operation is performed, are either for the Cure, or for the Conservation of the Parts, when they are sewed. The first is performed by Medicaments. There are two Parts, which we must take care of, the Bed, and the Suture of the Ingrafted parts. There needs no alteration be made in the Cure of the Bed; but the same things may be used as before. And whatever is good for a green Wound, and [Page 684]for a Suture, the same is good to cure the ingrafted parts. We must therefore repress an afflux of Humors, and an Inflammation. This may be done with the white of an Egg and Rose-water in the same proportion as before. There must be two Pledgets of Low, about an Inch broad, and as long as the Nose, to guard the Suture. The other must be as long, but broader, to guard the adiacent parts from Inflammation. And because the Suture penetrates to the inside of the Nose, there may be two Tents made, big enough for the Nostrils, and long enough to help the Cure, but not so long as to cause Sneezing. Both the Pledgets and the Tents must be dipt in the whites of Eggs, when there is occasion to use them. Thus much for the Cure.
Now we proceed to the Rollers, and such things as are for the conservation of the Work, when performed. But before we say any thing of the Rollers, we will shew the posture of the Arm, which these Rollers are to keep it in. And it is thus; We must raise the Humerus as much as we may, and apply that part of the Arm, where the Musculus triqueter ends, to the Face, or near the Nose. Then the Cubitus must be bent in a little, it must also be brought upwards, and at the Wrist it must lye just on the top of the Forehead. The Hand must be clapt on the Head, along the S [...]tura Sagittalis, so that the Brachiale may be almost upon the Sutura coronaria, the Metacarpium upon the crown of the Head, and the middle Finger may almost reach the angle of the Lambdoeides. And because the Arm must be continued in this posture till the parts are united, and that without motion, (for otherwise the coalition of the Parts would be hindred,) it must be so contrived, that, be the Patient never so willing, he cannot move his Arm. But besides, the motion of the Head must be considered; for if the Head be not kept steady, the case will be the same. Now the Head may be kept steady by a Hood fixt to the Doublet behind, coming a little over the Forehead, down along the sides of the Cheeks, with holes for the Ears, and fixt tight to the Doublet again before. The Doublet must be well fastned to the Breeches, because there is the stay of all. There must be several Rollers, to bind the several parts of the Arm, of which that is the chief, which comprehends all the back part of the Arm; and from which, as branches from a Tree, all the other proceed. This may be called the Royal Roller. Its rise is from the Shoulder-joynt and Armpit, and it goes from thence along the Humerus to the Elbow; from thence to the Cubitus, and so to the Wrists and Finger's ends. Its office is, by the help of other Rollers fastned to the edges, to keep the Arm fast to the Head, and to give rise to the other Rollers, of which there are four in number. The First begins behind the Humerus, comes under the Armpit, and so goes along to the other Armpit: This may therefore be called the Axillary Roller. It must be three Fingers broad. Its office is to guard [Page 685]the Shoulder-joynt. The Second is the Elbow-Roller; it must be as broad as the former. It comes from the edges of the Royal Roller, and both on the right and left fastens the Arm to the Head going behind, and it is fastned to the Hood about the Lambdoeidal lines. And it is of such moment to keep the Arm fast, that there is another Roller, which comes from the infide of the Cubitus, a little above the Elbow-roller, and so goes across the Breast, and is fastned to the Doublet about the Hypochondria. This may be called the Pectoral Roller. Last of all, there is a Roller which fastens the Arm to the Head at the Wrist: It may be called the Brace-Roller. And these are the things we would have in readiness before Incision.
CHAP. XII.
The Administration of Insition.
VVHen the Artist has a mind to perform Insition, let him chuse the Forenoon for the time, because then Crudities are concocted. Therefore the Patient would do well to eat but a light Supper before. A Tailor should be at hand, to fit the Insititious garment to the Patient. Let the Patient therefore first put on his Breeches, then his Doublet and Hood, let him tye his Doublet to his Breeches with points; then let him button his Doublet. Then put on the Hood, put the Ears out at the holes, and fit it right to the Head. Then let the Artist raise the Patients Arm, (letting the Graft alone as it is,) and let him put it in the posture, we mentioned before. The Assistents must keep it thus, while the Artist fits the Rollers. Let him first open the Royal Roller, bring it behind the Arm, obliquely along the Face, and fasten it to the Hood upon the sides of the Lambdoeidal Suture. There must be two strings, and three or four Fingers breadth between each. These eyelet-holes must be overcast by a Tailor, lest they should tear, and give way. He must do the same on the other side. Then take the Second Roller, which we call the Brace-Roller, and tye it on each side to the Hood. Then take the Third, i. e. the Axillar Roller, carry it forward toward the Pap on the contrary side, and tye it with strings. Then carry the Pectoral Roller from the Cubitus to the opposite Hypochondrium, and tye it to the Doublet with strings. [...] let the Artist examine [Page 686]all things well, that nothing be loose or gaping, and see that all things be ready for Insition. When he finds all things sit, let him then loose and untie the Rollers, and put off the Hood, and throw it back on the Shoulders. The Assistents must set the Chair ready and the Cloth. The Artist must rid himself of all incumbrance. The Patient must sit right against the light of the window. The Assistent must tye the Cloth about the Patient's neck, to save the Blood from running down his Breast. The Artist must stand before the Patient, and appoint his Assistents their posts. One of them must stand behind the Patient, and hold back his Head, so that it cannot move any way: The other must stand at his right Hand, and reach the Artist his Knives on occasion. For they must be often changed, because this operation blunts them much. The Assistent should keep them, as much as he can, out of the Patient's sight. He must also reach Rags and Lint to wipe the Wound. Before the Artist sets upon Excoriation, he ought to consider the breadth, depth, and [...]renness of the Wound. And here take notice, that the amplitude of the Wound affords the greatest hope of Insition. The Wound must be deep enough to bleed well, since Blood is the only Glew and Cement to unite the Parts. It must be even on the edges, without notches or angles, in an even line, but oblique. Somtimes the Artist must put his Fore-finger into the Nostril, to keep it steady for cutting. The outside must be first cut in an even line, then he must go deeper on the inside; and if at the end of the Wound any thing stick which cannot be taken off with a knife, he may clip it with a pair of Scissars, and so bring it to an evenness on the inside. Then he must proceed to the cutting of the Graft, which he must not do at a venture, but in proportion to the curt Nose, He must therefore wipe the Wound, and clap a paper on the end of the Nose, which may serve, when fortified, for a pattern to cut the Graft by. Great exactness is required here. When he has fortified the Paper, let him give it to his Assistent. Let the Patient hold a linen Cloth to the Wound, to stop the Blood and keep out the Air. Then the Artist must open the Graft, and commit the Arm to one of his Assistents. Who must put his right Hand under the Elbow, and with his left keep the Ʋlna and the Wrist upright. The Artist must apply the Paper to the Graft, and well consider how the Section must be made. Let him cut off what is superfluous, let him take off the Callus within, and make it of an exact measure with the foregoing Section of the Nose. Here the greatest diligence and exactness imaginable is required: For there is no room to amend a mistake here. Then let him bring the Graft to the Nose, and try whether they exactly sit, so that there may be neither eminency nor vacuity in the edges of the Wounds. And when they are exactly made fit, [Page 687]by taking away all unevenness, he must proceed to stitching. Where observe, that the stitches must be all at an exact distance in the Nose, but both at less, and not at even distances in the Graft. When he goes to stitching the Nose and the Graft, let him set the Patient on a Chair in a clear light, let him put on the Hood, and then the Roller, as we mentioned before, over the Forehead, and fasten it behind in the Neck. This serves to stick the Needles on in order, to avoid confusion after stitching when the threads are tied, lest one might be taken for another. When this is done, let him pass his Needle through the Parts; First through the Graft, and then through the Nose. But before he passes his Needle, he must mark out the stitches. Let him begin with one in the middle of the Graft, and then take the rest equally on each hand of it. He must take care to observe just distances in his stitches, that all may exactly sit; for the certainty and speed of Coalition, and the beauty of the Cicatrice, depend all upon exactness in stitching. The Artist may begin his stitching, either on the right or left side of the Nose, first passing the Needle through the Graft, then through the Nose; let him bring it out directly towards the Forehead, and stick it in order on the Roller. When this is done, then comes the tying. But the Patient must first be laid in his Bed, lest moving afterwards should break or stretch the stitches. First, the middle stitch must be tied, and then the rest on either hand. The manner of it is thus. The Artist must turn the Arm into the posture, we mentioned before, when he cut the Graft equal to the Nose, he must bid the Assistent that holds the Patient's Head, to hold his Hand on the crown of his Head by the Wrist, the other must keep the Cubitus, and the Elbow steady, while a third takes up the Graft, and applies it to the curt Nose. The Artist must with his left Hand take the end of the Thread that hangs out of the Graft, and with his right, the Needle that belongs to it. Then let him draw the Thread gently, and see whether it be that which he designs to tye or no, let him tye it once tight, and tye another single knot, to keep it from slipping, and then cut off the thread almost at the knot. And thus let him do with the rest in order. When this is done, he must dip the Tents in the Whites of Eggs, and put them into the Nostrils, and then dip the Pledgets, and lay them on the Sutures outwardly. Then the Patient must be bound up with Rollers fastned to his Cloaths, so that he cannot stir any way. First of all, the Roller which fastens the Wrist to the crown of the Head, must be tied on each side with its strings, then the Elbow, then the Axillar, and then the Pectoral Roller. I would advise the Artist himself to do this, and not to commit it to Servants, be they never so skilful. This done, let him advise his Patient to lie as still as he can, not to stretch out, or pull his Arm, nor stir it any way, lest it should cause an [Page 688]Inflammation, which after so much slashing, stitching and tying, is apt enough to come of itself. Wherefore to avoid this, it would do well, for an hour and an half to clap some linen Cloaths dipt in Whites of Eggs and Rose-water in equal quantities to the place of Insition, changing them as they grow hot: For nothing is better to prevent an Inflammation. And so is Ingrafting performed.
CHAP. XIII.
The Cure of the Insition, and what Course of Life must be observed.
MEdicaments, proper for the Cure of the Ingrafted parts, are of a middle nature between such as cicatrize, and such as incarnate: For they must be drying, and moderately astringent, such as Ebulus, sambucus, sideritis, palmae, pini, tedae cortices, draconii folia recentia, quae fraga gignit herba, anagall is, salix, androsaemum, astragalus, philomunculus, telephium, symphytum petraeum, arancae tela, sed ea praecipuè, cui è pistrino pollen insederit, (haec enim valentiùs exiccat) equisetum, chamaepytis, arnoglossum (quod in jungendis vulneribus nulli remediorum cedit) isatis, centaureum minus, folia pentaphylli, mumia, folia bederae recentia, gummi ceu humor glutinosus folliculis ulmi inclusus, ceratum ex cerussa & emplastrum barbarum. Those are good for the Cure of the outward Wound; but that on the Inside requires another course; for you must for three days at least tent this with Suppuraters a little drier than ordinary, such as Ʋnguentum ex Pompholyge. It is good to strew Myrrh, Frankincense, and Dragon's Blood powdered upon the stitches, to keep them from ouzing. When the Pledgets are taken off, it must be done with all gentleness; therefore they must be suppled with some Liquor, but sparingly, lest any moisture should insinuate into the Insition. Afterwards Linen Cloths spread with Medicines must be applyed outwardly, and Tents dipt in some inwardly, till the fourth day; and then we must proceed with Driers, as we said before. This must be carefully observed, that in dressing, they loose the Elbow Roller very carefully, especially at the first, lest the Insition should be separated. Therefore an Assistent must with all diligence keep the Patient's Arm in its former posture. As to the stitches, [Page 689]the time when they are to be loosed, is, when manifest tokens of Coalition do shew themselves, which they do in Summer, and a dry Season, on the third or fourth day; But in Winter and Autumn, not till the fifth. It would be absurd to loose all the stitches at once. For thô the Principles of Union shew themselves in all parts; yet it is best to keep some stitches fast, till all be more firmly united. You must begin to loose them first, where the Union is not confirmed. This will be manifest, where the Part is driest. The fleshy and upper Parts usually unite the first. The lower, because they are excarnous and dependent, and so receive the moisture that falls from above, are flower in uniting. Thô sometimes it falls out otherwise. The stitches must be clipt with a pair of keen little Scissars, near the hole, and the thread must be drawn out by the knot. It would be improper to let the stitches alone till the Nose were cicatrized; for so the lips of the holes would grow callous, and would never cicatrize, but the Marks would remain: All which is prevented by taking out the stitches in time. But where the stitches are taken out, we must apply Sarcoticks and Agglutinants. The first stitches are taken out about the fourth day, and all the rest before the seventh; for within that time the Parts do cicatrize. When the stitches are thus taken out, apply dry Lint with Ceratum ex Pompholyge, till the fourteenth day, in which time the Parts unite and clcatrize, as their driness does most certainly testifie. The course of living is either low or midling: For the first week use a low, and for the second, a midling Diet. All must be Spoon-meats, to avoid chewing, which would disturb the Nose. Keep quiet. Be chearful. And be moderate in Sleep and Watching.
CHAP. XIV.
How the Symptoms, attending Ingrafting, are to be corrected.
THE Symptoms attending this Operation, are either proper to the Ingrafting, or common to other parts. Symptoms proper to Ingrafting are Proud Flesh and Excrescence on the inside, and gaping of the Suture. The First is Nature's fault, the Second is the Artist's. Proud Flesh arises in illhabited Bodies, and in cold and moist constitutions. We must not cicatrize, till this Proud Flesh is taken away; and it may be taken away by Tents dipt in Ʋnguentum Isidis, Apostolorum, or Damascewan, and put up the Nose. If there be any gaping of the Suture, it was the Artist's carelesness in taking his stitches, that occasioned it. The only Remedy is, to do it quite over again, as we directed in Insition: For be it little or more that is amiss, the case is the same, the Operation must be performed anew.
The next are the common Symptoms, namely pain occasioned by binding the Arm in the aforesaid posture, for which the only Remedy is Patience, since it may not be loosed, nor can Medicaments be applied. Unless changing sides to lie on may give a little ease. The pain in the Wrist arises from its being tied down to the Scull, upon a rough hood. The Remedy is to put Cotton under the Wrist between it and the Head. Thirst, want of Sleep, and other general Symptoms may be cured in this, as in other cases.
CHAP. XV.
Of Cutting the Graft quite from the Arm, and how it must be Cured.
AS soon as the curt parts are united with the Graft, it is time immediately to take it from the Arm, and to commit it to the new Stock. We must consider therefore, when we may reckon them united, and so at what time the Graft must be cut off, then how it ought to be done, and how cured, and lastly how Symptoms may be helped. The time of full unition is about the Twentieth day. Therefore we should cut it off within Twenty days at the furthest. Somtimes in dry Weather, and a good Constitution, it may be done within a Fortnight or thereabout.
Before the Artist sets upon the Operation, he must have in readiness Whites of Eggs, and Rosewater with a little Powder of Dragon's Blood, to stop Bleeding; round Pledgets and Rollers both for the Arm and Nose. Those for the Arm must be of the same breadth and length as before. For besides the new Ulcer, which arises upon cutting of the Graft, the whole Bed must be oovered, which it may with a plate of Lead and drying Medicaments. The Roller designed for the Nose must have its ends long enough to tie behind the Head. It must be about four Fingers broad. As soon as it reaches further than the Nose, it must be divided into two, and so must have a double end on each Hand. Two of them must be tied above the Ears, upon the tip of the Lambdoeides: And the other two must pass under the Roots of the Ears, and be tied behind on the beginning of the Neck. But the ends on each Hand must cross one another, the lower being tied above, and the upper below. This also must be observed, that where the Roller is whole, and lies upon the Graft, it must, about a Fingers breadth from the bottom, be cut transverse, and another must be put under Perpendicular to it; so that it may reach no farther than the top of the other Roller. For when the Graft passes through this way, it does not turn up, but being prest on each side makes way forward, so that gradually it receives the shape of a Nose. There must be several square pieces of Linnen in readiness at the Fire upon occasion of the Graft, as we shall shew by and by. Then there must be a very sharp Knife or Rasor, wherewith to cut off the Graft. When all things are thus ready, let the Artist proceed to his Administration. He must order two Assistents, one on his Right Hand by [Page 692]the Patient's Face and at the upper part of the Bed; the other on his Left, on the outside of the Bed. First, all the Rollers must be untied, and the Hood must be thrown off the Head upon the Shoulders; and while the Artist is about Cutting, the Assistents must keep the Arm in the same posture, it was in before. He must take the Knife in his Right Hand, and apply his Left to the Graft. He must hold the Root of it between his Thumb on the outside, and his Forefinger on the inside, and with the Knife cut it off by the Root close to the Arm. When this is done, three things remain: The first whereof, which is the Artist's part, is to dress the Graft: The other two, namely, to bring back the Arm, and to dress the new Wound, belong to the Assistents. These actions must not be divided. For each of them requires its Cure immediately; nor can the Artist apply himself to so many Operations all at once. Therefore these charges must be committed to several Persons at one and the same time. And that every one may know what his duty is, we shall first proceed to the Cure of the Graft, which is the principal thing. But here two things give us a great deal of trouble, one is the fresh Wound, the other is the refrigeration of the Graft, after its being cut off. This later is apt to affright People that are unexperienced in the affair, because in the very Moment that the Graft is cut off, they see it turn pale and white, and stiff and cold, as if all its heat were expired. But these fears presently vanish, if we apply but warm Linen Cloths to the Graft, changing them for hot as they grow cold. How long this is to be done, is hard to determine, because of the several Complexions of Mens Bodies; it ought to be continued till the Graft is revived, which we may know by its growing a little redder and more fresh coloured. Then clap on warm Cloths, and underneath some dipt in the Whites of Eggs, then bring the Roller over the Pledgets, and lye it behind the Head, as aforesaid. As for the Assistents parts, he on the Lest Hand must apply a Compress dipt in Whites of Eggs to the fresh Wound; and if there is any Wound remaining in the Bed, he must apply its Medicaments, and roll it all over with a Roller, and sew the end at last: For the Roller must not be tied on a knot. After dressing, it is adviseable to draw the Arm from the Head, and bring it to a middle posture: This must be done by degrees, and not at once. He that dressed it may most conveniently do it, by taking hold of the Patient's Elbow with his Right Hand, and of his Wrist with his Left, and so bring it into its posture. The other may put Pillows underneath, and support and gradually compose the Arm into a middle posture. We will now say somthing further in reference to Cutting. We advised to cut off the Graft close by the Arm, if it were but for the better cure of the Arm. If you think, that there will be more than needs of the Graft to supply the Nose, you may either the very same day, or the next, cut off what you think will prove superfluous; but have a care that you take not too much away: For [Page 693]then the Nose would still be deficient. We must have a care likewise, that we tye not the Graft too hard: For that might repress the Blood and so cause it to perish. The Patient must live on a wholsome Diet, but eat little. He must have a care of cold and uncertain Weather, which often causes the Nose to perish.
CHAP. XVI.
Of Shaping the Graft, so as it may represent the Nose.
THE shaping of the Graft consists principally in three things, viz. In forming the Nostrils and the Bridge, in its Insition, and last of all in conforming the whole Graft according to Nature's Model. Nothing of this kind must be attempted, till fourteen days are over from the Graft's Cutting off, and then it will be time to begin this Operation. In the mean time the Graft must be carefully guarded by Medicaments and binding. Tents, as we said before, must be dipt in unguentum ex succis or ex pompholyge, either alone or mixt together, and put into the Nostrils. But the end of the Graft, that is, the fresh Wound, requires Suppuration for the first Week; and the later Week unguentum ex succis or de pompholyge may be applied. The Artist must also take care, that the external parts cicatrize neatly. He may accomplish this by several means, of which I shall mention the most experienced and successful. They are either Plaisters applied outwardly, or Fomentations used before the Plaisters are applied. In Summer time ceratum diaphaenicinum and ex cerussa are proper. It will be better, both for the comeliness of the Cicatrice, and the strength of the part, if a little oleum de Beta be mixt with it. And this is no ordinary Plaister; ℞ Styrac. liqu. ℥ iiij. cerae flavae ℥ij. thuris, myrrhae, olibani, ligni aloes à ℥ v. redigantur singula in tenuissimum pollineni, & oleo amygd. dulc. recenti, & cera cum resinae, q. s. ex arte paretur ceratum. But before we apply the Plaister, we have often with good success fomented the part with generous Wine warm, in half a Pint whereof five Grains of Musk were steept. The Graft may be fomented either with a Sponge or with Rags dipt in this Wine, which, when their warmth begins to fail, must be changed for new. For so the Pores are opened, and the Blood is drawn into the Graft. This done, the Artist must cover the whole Skin, and the Nose also, a Fingers breadth, with his Plaister. In the Winter and Autumn [Page 694]we Foment with this; ℞ Vini Cretic. lb ij. oliban. styrac. liquid. an. ʒ j. adipis asini ʒ ij. Infundantur omnia per noctem in vino Cretico supra dicto, deinde his ebulliant, mox colentur & colata serventur. Ceratum Barbarum is good. And this; ℞ Galbani, opopanac. thur. aristoloch. long. mastic. myrrh. an ℥ j. Ammoniac. ℥jss. litharg. aur. ol. commun. an. ℥xviiij. bdel. ʒ ij. lap. calamin. haematit. an ℥j. olei absmth. ℥ iiij. terebinth. lb v. ol. rosac. ℥ j. redigantur in tenuissimum pollinem quae religenda sunt, & gummi aceto dissolutis cum cera, s. a. f. ceratum. This also is excellent good, ℞ Aristoloch. rotund. been alb. & rubr. an. ℥ v. rad. lil. ℥ v. cicer. rubr. lupinor. combustor. an. p. s. nucis moschat. cinnam. an. ʒ ss. amygd. amar. contusar. ℥ ij. ol. tartar. ℥ iij. aqu. pluvial. lb. ii. contrita distillentur, mox ℞ liquoris ℥ ij. ol. caryophyll. de spic. an. ℥ j. Styrac. liquid. ℥ v. ambr. ℈j. mastich. ʒ ij. terebinth. ℥ v. bulliant olea cum liquore, deinde additis reliquis cum cerae q. s. f. ceratum. s. a. Another thing requisite to the guard of the Graft, is the Binding, which must not be inartificial. For because the Graft must come as near the shape of the Nose as may be, it is requisite to make it gradually pliant, to bend it a little, and to form the Tip and the Bridge. In Nature's Model of the Nose there are these things considerable, the Length, the Tip, the Bridge, [...]he Alae or sides of the Nostrils, and the Holes or Nostrils themselves. The length of the Nose is reckoned to be the third part of the Face's length, namely the spac [...] between the Tip-end of the Nose to the middle of the intercilium is equal to that of the Forehead from thence, and to the space between the bottom of the Bridge, and the end of the Chin. The Tip is the round end of the Nose. From hence the Bridge is inserted transverse to the upper Lip; and its length is the space between that insertion and the edge of the upper Lip. The proportion of the Alae or sides is such, as that they pass on either side down to the upper Lip in the shape of an (S), only the bought is far larger where it descends to the upper Lip. The Holes or Nostrils are of an Oval Figure, more acute towards the Tip, and more obtuse towards the lower end. After this Model of Nature therefore must we always form the Cutaneous Graft, when ever the Bridge and the Alae are cut off. And if any part of them remains, the Graft must be formed proportionable. When therefore the Artist would shape the Nose, having first considered its length, let him mark that part with Ink, which he designs for the Tip. Then let him mark the Confines of the Alae, from the Basis to the Tip; and then mark the Bridge from the same Tip to the Basis. When he has done this, let him consider well, whether all things be exact, and then let him take his Knife, which must be very sharp, and cut, as he had designed, the Graft. But he must observe this caution in the Section, to the Bridge he must cut in a right line, but towards the Alae in a bow, deep and oblique. He must put small Tents dipt in Whites of Eggs into the Nostrils, [Page 695]and he must bring the Bridge between them. Then he must put an orbicular Compress below the Nose. This is done to keep the Bridge from starting, and the Tents from slipping out. He must not take away these Tents till the next day. And take this for a rule in forming the Bridge, always take it long enough and broad enough; for one may take away from it, but can never add to it. Therefore of the two extreams the excess is less dangerous than the defect. The reason why the Bridge is cut in a streight line, and the Alae in an oblique or sloping inwards, is because this is best both for the Nostrils and the Bridge. For whatever is taken from the thickness of the Alae, as much is added to the Amplitude of the Nostrils. And we may do it the more boldly, because proud Flesh is apt to grow there. Besides, when the Ulcer is healed, the Skin turns inwards, and so the circumference of the Alae being Skin and not a Cicatrice looks the handsomer. The reason why we Cut the Bridge streight down, is, because so it is the stronger, which would otherwise fade away. But the Cutaneous Graft must be well hollowed out towards the Alae, otherwise you can never make a decent Nose. Wherefore whether there be proud Flesh or any thing superfluous of its substance, it must be taken away thus. The Patient must sit against the light, and lean his Head back upon one of the Assistents. Then the Artist having turned up his Nostrils, and diligently viewed whether there be any thing superfluous; if there be, he must take it away by little and little and very moderately with keen little Knives. He must repeat this often, for upon Cutting, proud Flesh is apt always to arise, the growth whereof must be checkt with Tents dipt either in unguentum isidis or de pompholyge, and clapt into the Nostrils, as soon as the proud Flesh is taken away. Every day the Tents must be twice taken out and new ones dipt afresh put in their room, having first wiped the Nostrils with Cotton or soft Wool. Let the Artist have an Eye to the largeness of the Cavity, and if it be not big enough, let him not fear to cut out enough to enlarge it, till the Graft be proportionable to Nature. To this action I can assign no certain term, I commit it to the Artist's prudence. Only let him take care, while he turns his Knife inward, that he no way hurt the Bridge. For its tender substance could not bear it. Therefore the safest way is never to turn the edge of the Knife that way; but to begin the Section at the Tip, and when he is gone half way, to take the Knife out, and put it in at the Lip, and so make the Sections meet. For if he should carry the Knife round and it should slip, it might endanger the Bridge. You need not fear that this tormenting work will spoil the Graft; on the contrary the oftner it is Cut, the harder and stiffer it grows, when once it is Cicatrized. The time of Cicatrization is uncertain, somtimes three weeks (which is soonest,) somtimes, Forty, Fifty or Threescore [Page 696]days and above; according as the season or the Patient's Constitution is hotter or colder, drier or moister. But this time needs not seem long, since the Patient may all this while go abroad, and live at his Liberty, provided he abuse it not by excess. The warm Air cannot injure him, but a cold one may; wherefore in Winter and Autumn he must be the more careful.
CHAP. XVII.
The Insition of the Bridge.
AFter the Bridge and the Cavity of the Nostrils are formed, and a Callus is bred, it will be time to ingraft the Bridge. The reasons why we defer the doing it so long, are various. When the Bridge is ingrafted, we cannot turn up the Nose, nor look into it, nor put a Knife deep, or with any safety into it, all which may very well be done, while the Graft is not inserted into the upper Lip. Nor could it be done, till the Wounds on the sides are healed. Besides, should the Bridge be ingrafted before it were confirmed by a Callus, it would shrink, and draw down the Tip, and so make the Nose imperfect. Therefore it is convenient, to defer it's Insition till the thirty eighth day in Summer, and till the sixtieth in Winter. Though sometimes in each season one may do it sooner. Before we set upon Ingrafting the Bridge, several things must be got ready, as a crooked Needle and a Forceps, which are peculiar to this Operation: Other things also, common to the Insition of the Graft, are here requisite, as sharp Knives, Thread, Whites of Eggs mixt with Rose-water, round Compresses, and Tents dipt in Whites of Eggs and Rose-water. We never use the Forceps, but when the Basis of the Bridge is quite gone. For then we must excoriate the Part which is to receive the Bridge; and this could never be done without this Instrument: For the Callus would hinder one from doing it without the help of a Forceps to take up the Part. This Forceps has two long handles, one with Notches, the other with a Ring fixt at the end, and another Ring running loose in that, to slip over the Notches, and so to hold the Forceps tight. From the joint a circle arises, large enough to encompass the Parts about the mouth. From this divided in the middle, arise thin Plates with a blunt streight edge sharp-pointed, that they may the better be put into the Nose. With this we must take up the Skin, and then cut it. The Needles must be bent Semicircular. It is good to have two or three of them in readiness, tho' there be but occasion for one, if [Page 697]that holds without breaking. There must be also a pair of Scissars, to clip a little off the Bridge, when part of it remains; for it will not bear cutting with a Knife, because of it's acute sense. When the Operation is undertaken, the Patient must sit in a clear light against the Window, and the Artist standing right before him, must open his Forceps, and put it gently up the Nose to the Circle. Then he must try to take up the Skin, which is the Basis of the Bridge, between the Edges of the Forceps, so as that the pressed Skin may start out above the sides of the Forceps. When he has taken it up, let him squeez the Forceps, and put the Ring upon the Handle to keep it fast. Then let him cut off the Callus and the Skin, that stands up above the Forceps, with a small sharp Knife. He may leave off, when the Blood comes freely all over. Then he must take off the Ring, loose the Forceps, and give it to the Assistent. But first let him take care to see, that the Wound of the Basis corresponds to the bigness of the Bridge, before he loose his Forceps. For it is far better, that the Wound should be larger, rather than less, than the Bridge; because the largeness of the Wound is the ground of Unition, and if it be larger than needs, it is no great matter, since the Cicatrice is covered by the Nose. But when the Bridge is not quite gone, but part remains, he must then take a pair of Scissars and clip it off at once, as much as needs, which, if it were cut, would put the Patient to intolerable pain. After excoriation, or clipping, the end of the Bridge (or if it be too long, a little more) must be cut off. Effusion of Blood terminates this operation, as before. The reason, why we excoriate the Basis first, and then the Bridge, is, lest if we should cut the Bridge first, the Blood falling down might hinder the other operation. When things are thus administred, the Artist must take the Needle in his right hand at the middle, and pass it in at the top of the Philtrum (or the dent in the upper Lip,) or, if the bottom of the Bridge be standing, underneath that, till it comes out at the upper part of the Wound on the other side; when he sees the Needle appear, let him thrust it further; but with his left hand let him hold the Nose aside, that he hurt it not; and then taking hold of the Needle with his Fingers, let him draw it quite out, with a little piece of the thread. When he has done this, let him wipe the Needle, that it slip not out of his Fingers, and let him take the Bridge by the end, and pass his Needle through that, taking good hold, lest the holes should break. Then he must tye the thread, and cut off the ends. When he has done stitching, let him put in the Tents, and put underneath the Compresses. He must apply the usual Plaister to the outside of the Nose, and then bind all carefully up. Let the Patient keep himself quiet for one day, either in Bed, or at least in the House. It would not be amiss to cut short his Diet till the fourth day; about which time, especially in warm weather, signs of Unition appear. [Page 698]Wherefore then abouts it will be proper to take out the stitches. But in cold weather, and in moist Bodies, not till the sixth day. As to the rest of the Cure, you have it before in the Cure of the Graft. Every day it must be drest with Tents dipt in Ʋnguentum ex pompholyge, or with such things as were applied to the Graft, dry Lint, &c. which, after the striches are taken out, must be continued till the Parts are strongly united.
CHAP. XVIII.
The further Conformation of the cutaneous Graft.
VVHen the Bridge is firmly united, which in Summer is about the fourteenth day, and in Winter about the twentieth, the care of Conformation ensues, which is a constant molding of the whole Substance of the Graft into the shape of the Nose. For though by the foregoing Configuration, the cutaneous Graft has in a good measure acquired the shape of a Nose; yet it falls far short, both in solidity and shape; because as yet it is but soft and flaccid, and has little in it of the grace of a Nose. For hitherto it has had enough to do to live; but now that the Troubles are over, it begins to provide for it's own strength, and to be clear of another nature. Now the Tip begins to have life in it, and the Nostrils being strengthened inwardly with a Cicatrice, the whole Nose grows more compact and solid. But this will not be complete till a long time, according to the diversities of Bodies, and of the ambient Air. This last Work depends upon two sorts of Means, viz. upon Tubes inwardly and a Cover outwardly, made in the shape of a Nose, wherewith the cutaneous Graft being guarded in it's tender Age, may insensibly grow into the shape of a Nose. As for the Tubes, their Figure is circular, oblong, and unequal. It is circular, but not exactly, for where it comes to the Bridge it is flattish. It is broader below towards the Alae, and narrower above towards the root of the Nose, growing narrower by degrees. Below, they turn back a little, and take hold of the Alae, and towards the Tip they run out like a Myrtle-leaf. They also in a streight line enclose the Bridge, meeting like two Boards exactly plained. Their length is unequal, for on the upper side, towards the ridge of the Nose, they run out farther in length, (to compress those Parts as they swell with proud Flesh,) than on the opposite side, where there is no heed of them. Wherefore that end comes sloping downwards. But on both sides they must be equal [Page 699]in Bulk, Length, and Figure, not too big or long, so as to squeeze the Bridge and kill it; nor too little or short, so as not to be able to repress proud Flesh, and help the Callus. At first they must be made of Lead very thin; afterwards, as the Callus comes on, a little thicker, which it usually does in three months from the time of Coalition. But when the Nose is a little hardned, they must be made of a stiffer substance, either of Silver or Gold. The Cover must be of the same substance with the Tubes, either of Lead, Silver or Gold, according to the time. As soon as ever we use the Tubes, this must be applyed to the Nose. It must be of the exact shape of a Nose. It must cover the tip and the Alae, and then run down the Bridge to the upper Lip. But holes must be left in it for the Tubuli to stick out, and for respiration. The Cover must come up above the Insition, and rest upon the bony Part, to keep all the firmer, and to defend the Cicatrice from external Injuries. It must be lined with Silk or thin Cloth, and the Lining must be changed every, or every other, day. Though this Lining is not needful in hot and dry weather. The Cover is kept on with five Strings, whereof four are in pairs and one single; the single one runs up just between the Eyebrows, along the Forehead, and the Sagittal future behind the Crown of the Head, underneath which it is fastned behind to the other Strings. The upper of the lateral Strings comes from the middle of the Cover, passes the Cheeks and the Os jugale, and so above the Ear, and is fastned with it's opposite upon the Occiput at the tip of the Lambdoeides, and to this is the single string fastned; so the lower lateral strings come likewise from the middle of the Cover, and are carried cross the Cheeks under the Ears, and are tied behind in the nape of the Neck. The strings should be of Silk, about a Finger broad. Rings must be fastned to the Cover, whereto the strings must be fastned. Now we will shew, how the Cover is to be tied on. We must consider, that in the tip of the Nose there is a dent; wherefore it must be bound tight to the Graft there, that it may represent a Nose. For this purpose, lest the string should slip any way, we have fastned a Ring to the top of the Nose, through which this string must pass. We have added two more in the sides, through which strings must pass thence along under the Ears, and tie behind in the Neck, to keep the Cover close down to the Nose. This Cover makes the Cicatrice even, and repels the Humors from it. By these two things, the Tubes and Cover, is the fashioning of the Nose completed. They should be used for two years; and if towards the later end they grow irksome, the Cover may be left off in the day time (but not the Tubes,) and put on again at night. And because strings may fret the Flesh, the Cover may be tied on with a Roller, especially in the night time. It must be long enough to the behind, and broader than the Cover, so as it may comprehend the Cover, the Tip, and the Alae. That part which [...] upon the Nose [Page 700]must be whole; but about a Fingers breadth from the Nose on either side it must be slit, and the lower part must be carried above the Ears, and the other below, along the Cheeks, and both must be tied behind. And thus is the whole Art of Engrafting a new Nose fully described. Only it remains, that we inform you, how the Colour and Cicatrice of the Nose may be amended. There is nothing better than, in the heat of Summer, for an hour or an hour and a half, to sir with your Nose against the hot Sun. Do this every day for a good while together. And the heat and dryness will strangely confirm the Callus, and add to the beauty of the Nose. The things following are good for a Cicatrice; Fel bubulum, vitulinum, caprinum, vel testudinis. Illud ladano oportet excipere & coralli pollinem admiscere. This is an excellent Water; ℞ Aq. vitae quartò dest illatae lb v. sem. lupin. eruc. au ʒij. rad. rut. ʒj. Medullam panis albissimi, all. ov. No. iiij. Macerentur per drem & noctem simul, & extrahatur liquor, quem usui servare oportet, & leviter alternis saltem diebus cicatricem illinere. Saevum asini makes a beautiful Cicatrice. Huic prisci fel vituls cum myrrha, melle & croco addebant, & pyxide aereâ recondebant. Alii storem aeris addebant. We prepare an effectual Liquor thus, ℞ Sevi asini, mell. alb. aqu. ardent. lupin. an. ℥j. aq. flor. fabar. ℥ iij. macerato biduum, & mox liquorem per alembicum extrahito. If to this Water we add some ceratum ex cerussa, and a few drops of the Oyl of Ben, it will be very efficacious. Aqua ex vitibus destillans is good, and so is that, quae ex geniculis arundinum effluit. With this and asini sevum and Oyl of Ben, we make a Liquor, which, if added to the Plaister, makes it most effectual. In the day time you may anoint, and in the night apply the Plaister. Astringents must be applied just in due time: For when they are applied too soon, they make a hollow Cicatrice; and when too late, a tumid and uneven one. And thus much of Engrafting the Nose.
CHAP. XIX.
Of Curing the Hare-Lip, and supplying a Lip deficient.
LIps are curt, or deficient, either from the Birth, and then they are called Hare-Lips, or by accident without loss of substance, and then they are called curt Cicatricose; or lastly, they are truly curt, where substance is deficient. And only these last need engrafting. But first we will begin with the Hare-Lip, because this is the most simple evil, and easiest to cure. If both Lips be such, the [Page 701]same method of cure must be used for both. And what that should be, the nature of the Disease shews, namely, the separation of those parts which should be joyned. Somthing indeed seems to be lost, and so there seems somthing to be needful to supply the place of what is lost. But we may very well obtain our end, and perform a cure, without the superaddition of any thing. Now that the disjoyned parts, which ought to be entire, should be united, the seat of the Disease indicates. And this work of unition is owing first to Nature and then to Art, which removes what hinders Nature, and assists her in her Operations. It is Art's task, to excoriate the parts, and keep them close together, that they may unite in their Blood, to sew them when united, to keep them sewed, and to reduce them to a right temper and health. Let the Artist therefore take up that part of the Lip, which must be excoriated, in his Left Hand, and then take off the Skin equally with a very sharp Knife, till the Blood comes, to the very Angle of the Hiatus, and then he must smooth the Wound. This Operation may also be performed very quickly and safely with a pair of Scissars. The same must be done on the other side. Then he must draw the parts together with his Hand, and stitch them. We must observe this, not to take our stiches superficially, but thorow all. The Artist must therefore pass his Needle streight through the Lip from the outside inwards, and on the other side he must pass the Needle from the inside outwards. He must tie the threads and fasten the ends, and then cut them off. He must take his stitches not too near the edges of the Wound, but at a good distance, lest the hold should break. The number of the stitches is best defined by the amplitude of the Wound. After stitching is done, some compresses, dipt in Whites of Eggs and Rosewater, must be applied both to the inside and outside of the Wound. Then a thin, soft, and even Roller of about three Fingers breadth, dipt in Posca, must be brought along obliquely above the Ears, and must be tied tightly behind the Head. A piece of Linen Cloth also, dipt in mild Posca, must be applied to the inside of the Lip, to defend it likewise from Fluxion. Within a day or two the compresses must be removed, and conglutinants must be applied. The outside may have such things applied to it, as are mentioned before in the cure of a curt Nose, as with Lint and unguentum ex cerussa, and a Plaister of ceratum ex cerussa applied over it. But the Medicaments for the inside are Srrupus ex rosis siccis, syrup. myrtin. and where there is much foulness, julep. violarum or mel rosaceum. These used either alone or mixt hasten Coalition. It will do well to add a little pollen myrrhae to them. ℞ Syr. ros. sicc. ℥ j. Mell. ros. ℥ v. pollinis thuris ℈ j. M. We must spread a rag with it, and apply it often to the inside of the Lip. About the beginning of the fourth day we must loose some of the stitches, where the parts seem best united. But then it is best to keep the parts together with a glew, which may stick, till there is a perfect Coalition. [Page 702]And as soon as the Glew sticks, the stitches may be loosed. Flos calcis with the white of an Egg is a good Glew. You may use this. ℞ Gum. tragac. mastic. Arab. thur. an. ʒ v. albumina ovorum No ij. agitentur albumina diligentissimè usque dum spumam ejiciant, hanc blandè detrahere convenit, & quod subter est limpidum, & aequale, retinere, mox reliquorum pollinem inspergere, atque totum ad quandam inter extrema mollia & âura studiosè permiscendo consistentiam perducere. The way of applying it is thus. Two Linen Cloths must be got, double, and about three Fingers long, and as broad as the Lip, with threads fastened at small, but equal, distances in both, as many on the one side as on the other. They must be spread with the Glew, and the ends, where there are no Threads, must be applied wet to the Lip. With this proviso, that the Threads meet at four Fingers distance from the outmost edge of the Linen Cloths, and that the ends of the Linen Cloths be an Inch at least from the edge of the Wound. About six hours after the Glew is applied, (in which time it fastens to the Lips,) we must tye the Threads gently. You may know they are close enough tied, when the Lips of the Wound meet, and when there is no pain. Then we must dress the Wound with drying Liniments, such as we used to the Bed. While he does this, the Artist must loose the Threads, wipe the Wound and apply Medicaments, then he must tie the Threads again, apply a thin Cloth, and then a Roller. This [...] be done twice a day, for fourteen days, in which time the edges of the Wounds will be strongly united. But I would advise the Patient, that, when he goes to Bed, he would apply ceratum ex cerussa, and bind it with a Roller. He may likewise use the same things here as in the Cicatrice of an engrafted Nose.
When a Lip is curt Cicatricose, the Callus must be quite cut away, which you may know to be done by the bleeding every where. That day it must be drest with Medicaments, that stop Blood, and after that with suppuraters. The Lip must be brought into its proper place. Which that you may do, you must fold a Linen Cloth several times in manner of a compress, you may lay Medicaments on it, and keep the Lip higher or lower, as is fit, and then fasten all with a Roller. After Seven days, Sarcoticks and Epuloticks must be used. A thick leaden plate of the shape of a Lip, with Medicines upon it, may be applied. And when it is cicatrized, the business is done. It will be best not to leave off the leaden Plate too soon; but to wear the same in the Night and tie it on fast. For so in time it will be perfectly well, without any fear of breaking open again.
When a great part of the Lip is wanting, it cannot be supplied without a Graft. Therefore I would advise him, that intends this Operation, diligently to peruse what has before been said in engrafting the Nose. For the delineation of the Graft is exactly the same, and the taking of it up partly the same, (namely, when the upper Lip is to be supplied,) and partly different, [Page 703]when the under Lip is to be supplyed: For then the Graft must be cut off at the end next the Elbow. Moreover, the method of Cure is the same from the taking up of the Graft till it's Insition. Only you must take care, that the Callus be well grown on the inside of the Graft. For the moisture, that comes from the Gums, hinders the healing of that Part very much. Insition must be made with crooked Needles; and the Stitches both in the Graft and Lip must be at equal distances. Nor must the Graft be cut from it's Stock, till it is well united with the curt Parts, which it is in Summer within Four and twenty days after Insition; but much a longer time is required in Winter and cold weather. The method for Conformation must be such as the substance of the Lip requires. This will be much holpen by binding, which must be with a Roller carried above the Ears for the upper Lip, and underneath for the lower Lip: Or, with a double-headed Roller, when both the Lips are to be bound. A plate of Lead will be also as necessary for the Lip, as it was to cover the Nose. And this may suffice for the Cure of curt Lips.
CHAP. XX.
Of Supplying curt Ears.
THE business of supplying a curt Ear consists in taking up the Graft, in Engrafting, Curing and Forming of it. Here the Graft is not taken from the Arm, as it was for the Nose and Lips, but from the Region adjacent, behind the Ear. It is at one and the same time delineated, taken up, and engrafted. There must be in readiness Knives, Needles, Thread, Whites of Eggs mixt with Bole Armenick and Terra sigillata, and Compresses. Two things are peculiar to this Operation, viz. Gossypium ustulatum, to stop Blood upon cutting the Artery; and a Roller to go along by the Ears under the Chin, which must tye on the Crown of the Head: The Basis of it, that is, the Part below the Ears, which goes under the Chin, is whole; but from the Roots of the Ears, or lower, it is parted into two, the Part toward the Face, is called the Fore-part, and the Part behind, the Hind-part. That behind keeps on the Dressings, and the Fore-part is assistent to it in keeping all fast. The place whence the Graft must be taken, is the place behind the Ear without hair. The dimension of the Ear will shew the quantity of the Graft. It is best here also to take it large enough. The curt Parts must be carefully scarified all over, and the Graft must be stitcht to the Part, beginning at the Concha interna where the Skin rises from the Head, and not at the Helix [Page 704]externa. The Passage of the Ear must be stopped with Cotton. But first of all the bleeding of the Artery, when the Graft is raised, must be stopt with Gossypium ustulatum, and Compresses wet in Whites of Eggs, and Rose-water must be applyed to the Bed, and great care must be taken to prevent an Inflammation, by applying Clothes about the Neck wet in Posca, and changing them as they grow warm. The Patient must live very temperate, and use Spoonmeat to avoid chewing. Sometime on the third day the Wound may be opened, and the Compresses may be removed; but this may not be done till a Caruncle is grown at the end of the Artery, to plug it up. When these are taken away, the Bed must be treated with Suppuraters for fourteen days as formerly, And the Graft must be exiccated carefully, both in the Coalition, and on the back-side where the Wound is, which must turn to perfect Callus. The very same Medicaments are proper here as in the former Cases. One thing must be taken care of, that the holes of the stitches he filled with strewing on some Powder: And they must be loosed in order, as formerly has been directed. Bolsters must be put between the Head and the Graft, which may both keep it in the shape and posture of an Ear. The Artist must have a care of the proud Flesh that rises in the Bed, especially about the Root of the Graft, which Part is long in healing. As for the Medicaments, what they are, and when they should be changed, what the Symptoms are, and how they should be cured, you may find all in the foregoing Discourse Of Supplying a curt. Nose.
CHAP. XXI.
The History of a Nose artificially Engrafted.
ANN. 1590. When the Duke of S [...]v [...]y made War upon G [...]neva, a Virgin fell into the hands of the Soldiers, whose Chastity when they had attempted in vain, they being e [...]aged cut her Nose off. About two years after she went to Lausanna; where Mr. John Gr [...]ffonius, a most ingenious and successful Chirurgion, then [...]ved. He undertook to cure her, and restored her Nose so artificially, that, to the Admiration of all, it appeared rather Natural than Artificial. I my self have seen her several times, and she continues unmarried at Lausanna this present year 1613. It's true, in the cold of Winter the Tip of her Nose looks livid; but it is nourished as other Parts of the Body, and endued with sense. Griffonius had some hints of the method from an Italian, as he travelled through Lausanna, who had conversed with the famous Taliacautius; though he had neither seen the Operation performed, nor Taliacautius his Works, before he cured this Maid. But he performed the Cure in the same manner as Taliacautius describes it. Hild. obs. chir. 31. Cent. 3.
AN APPENDIX OF THE Venereal Disease.
THat, we call the Venereal Disease, with whose Name one Nation now upbraids another, was first brought from the West-Indies into Europe Ann. Dom. 1493. and till then was not so much as known by name to our Parts of the World. At it's first arrival it was attended with tremendous Symptoms; but within an hundred years last past, they have been in some measure changed, and much altered. Within the said time, and at the present, it generally shews it self first by a virulent Gonorrhoea, only now and then a Shanker gives the first Notice of the Disease. But when it does not discharge it self by a Gonorrhoea, it quickly infects the mass of Blood.
This Venereal Disease is propagated either by descent from Parents to their Children; or by contact of some soft Part, whereby a Virulence and Inflammation are insinuated into the Body upon the Occasions following. First, in sucking, viz. either the Child infects the Nurse by the open Pores of the Nipples; or the Nurse the Child by it's tender Mouth Secondly, Children may get it by lying naked in the same Bed with infected Persons: For though adult Persons can scarce contract it without impure Coition, albeit they lye in Bed together; yet Childrens flesh, being of a more lax and rare texture, is easily susceptive of the venom from infected Persons. Thirdly, the most usual way of contracting it is by impure Coition. The most usual signs of the Taint, are a Gonorrhoea, Shankers, Inflammation, and heat of Urine. So long as it goes no further than a Gonorrhoea, it falls far short in Malignity of a confirmed Pox, when the whole mass of Blood, and several Parts of the Body are infected. Therefore the Cure of a Clap and of the Pox is different.
In a Gonorrhoea, therefore (or, as the Town calls it, a Clap,) the stress of the Cure lies upon purging, and especially with such Medicines as carry off bile and serous Humors. A Cooling Diet also must be prescribed all along. This is a [Page 706]good Purge, ℞ Mass. pil. coch. m [...]j. ʒ iij. Extract. Rud. ʒ j. Jaap. Diagrid. an. ʒ ss. cum s. q. Opebalsami f. Pil. è singulis drachmis vj. The Dose of these Pills is four, to be taken every Morning about four or five a Clock, (so that the Patient may sleep upon them,) for Twelve or Fourteen days or longer, if there shall be occasion, that is, till the heat of Urine, and the yellowness of the Running are gone; which when it has succeeded according to expectation, the Patient may take the Pills every other day for a Fortnight longer; then he may take them twice a Week, till the Running is quite ceased: For there is danger in the least Gleet, if one cease purging, before that is gone. If Pills will not do, you may try a Potion and Clysters. It is good to give Twenty five drops of Balm of Gi [...]ead in Sugar, or the quantity of a Wallnut of Turpentine every Night at Bed-time. In the mean while the Patient must abstain from all Salt Meats. He may eat Mutton, Veal, Chicken, Rabbet, or any food easie of Digestion. He must drink no Wine nor strong Drink, nor any sowre Liquor. His Drink may be Water boiled three parts, and Milk one in four; only at Meals he may drink a draught of small Beer. Emulsions of the cold Seeds are good to allay Heat of Urine and Inflammation in the intervals of Purging. After a Month is over, and not sooner, it will be proper to bleed a Sanguine Constitution. Injections are not very safe; only toward the later end an Injection of Rose-Water may be used. This course generally succeeds: For the Cure depends upon good Purging; if so be the Patient drink not the Waters; for they are injurious. If the Prepuce swell, use Emollient Fomentations, Oyntments and Plaisters. If the Scrotum swell, use a Cataplasm of Oxycrate and Bean-Flower. And this method may do well enough for a Clap.
But when the Disease has got footing, so that it may deserve the name of a confirm'd Pox, the only way (as Dr. Sydenham says,) is, to salivate; which may be done thus: ℞ Axungiae porcinae ℥ ij. Mercurii crudi ℥ j. M. With this let the Patient himself chase his Arms, Thighs and Legs, with his own Hands for three Nights one after another. Let him have a care, the Unguent come neither at his Armpits, Groin, nor Belly. He may tie a Flannel therefore about his Belly and Back, to secure it. On the morrow after the last anointing, give of Turbith. miner. gr. viij. in conserva rosar. rubr. After the third anointing, or at least after giving of the Turbith, the Gums begin to swell, and the party Spits. In the mean time, it is the Physician's part to carry on the Salivation with Judgment and an even hand, lest, by raising it too high, he endanger Life. When the Salivation is come to the height, (at which time two quarts of Spittle are discharged in four and twenty hours,) or when the Symptoms, thô the Patient spit little, are vanisht, (which usually happens about four days after the Salivation is at the height,) his Shirt and Sheets, in which he lay before, must be changed: Because they, [Page 707]being dawbed with the Unguent, may carry on the Salivation too far. But if the Salivation fail, before the Symptoms disappear, it must be quickened now and then with a Scruple of Mercurius dulcis in a Dose. If upon the Mercury's getting into the Blood, the Gripes ensue, you must hold your Hand, and use no more Mercury either inwardly or outwardly, till they are stopt; which is done by giving now and then a Drachm and an half of Diascordium, and by setting the Patient on an empty close Stool over a Fume of Cephalick Herbs, boyl'd in Canary Wine. When the Patient begins to recover, you must not stop the Salivation either by Purgers or diet Drinks: For such stopping of it often occasions a Relapse. Only when the Salivation rises too high, it may be depressed by a Purge. When the Mouth is much exulcerated in Salivation, it may be often washt Night and Day with aqua rosarum Damascenarum, or with Lac aquae permistum, or with decoctum hordei, radie alth. & sem. Cydon. The same Diet is good in Salivation, or was ordered before in the purgative [...]urse. And last of all, [...] Dr. Syderham be much against the diet Drinks, so much and so generally celebrated by most Pra [...], yet I think a course of them is very safe, yea requisite, after [...]alivation is over.
AN APPENDIX CONCERNING EMBALMING.
EMbalming goes among the Learned under several Names. It is called Balsamatio à Balsamo; because the medicinal Ingredients, which preserve Bodies from Corruption, are endued with a balsamick Virtue. It is also called Conditura à condiendo: And Mumisatio à mumia, for it's Analogy. Some call it Ʋnctura feralis or Medicatio cadaverum aromatica. The Ancients called it Pollinctura, and those that practised it, Pollinctores from pollingere or pollincire, quod est, poliendo ungere, vel pellem ungere. It may be defined to be An artificial Operation, whereby a human Body is so prepared by a skilful Artist, either with or without Embowelling and Dissection, by the balsamick Quality of medicinal things, that [Page 708]i [...] will endure whole many years, and may be kept free from rottenness and corruption.
That the Hebrews had the Art of Embalming, is apparent from Scripture: For Gen. 50.2. Joseph commanded his Servants the Phy [...]icians to embalm his Father: And the Physicians embalmed Israel. It is very probable, they learned the Art from the Aegyptians, and that in process of time they lost it. For if we consider the maner of Embalming among the Jews, as it is described by Maimonides, and as it was used about the death of Christ, it looks more like a respectful Ceremony paid to the dead, than any Preservative from Corruption. Maimonides words are these: The manner in Israel about the dead and their burial, is this, when any one is dead, they close his Eyes, and and if his Mouth be open, they keep it shut with a Mus [...]ler, tied about his Jaws. The place also by which the Excrements are voided, is stopt up, but it is done after the Body is washt. Then he is anointed with Ointments made of several sorts of Spices, and, after the Head is shaved, the Body is wrapt in white Linen Shrouds made for this purpose, which are of no great value, that a mean may be kept between the rich and the poor. After this manner, in all probability, was Lazarus embalured before his burial, he being none of the meanest Jews; and yet Martha feared he would stink in four days time.
But the accuracy of Embalming is owing undoubtedly to the Aegyptians. The best account whereof, now extant, we find in Herodotus. lib. 2. Histor. Euterp. His words are these; ‘Then they carried the dead Party to be Embalmed. There are certain Persons appointed on purpose to perform this Artifice; who, when the Corps is brought to them, shew to those that bring it, wooden Moulds in the shape of the dead. They say one sort of them is most curiously wrought. A Second is meaner and cheaper. And a Third is of a very small value. When they have shewn these Moulds, they ask, in which Mould they will have their Dead put. When they are agreed of a price, they depart. And they, with whom the Dead is left, do Embalm the Body very carefully, in this manner. First of all, with a crooked Iron they draw out all the Brain through the Nose, and so fill up the place with Medicaments: Then with an Aethiopick stone they cut about the Ilia, and that way they take out all the Paunch; which, when they have cleansed and filled with Phoenician Wine, they stuff again with beaten Spices; then filling the Cawl with pure Myrrh and Cassia, and other Spices (except Frankincense,) they few it up again. When they have done this, they salt it up close seventy days, for they may not salt it longer. After seventy days are over, when they have wash'd the Corps, they wrap it in fine Linen cut into slips, laying on a Gum, which the Aegyptians commonly use instead of Glew. When the Body is restored to the Relations. [Page 709]they make a wooden Coffin in the shape of a Man, into which they put the dead, and entomb him. But they that would save charges, prepare the Body thus; They give a Clyster of Oil of Cedar. Then after this they neither cut nor draw the Belly of the Dead; but fill it by the Vent, and salt it the aforesaid number of days; on the last of which days they draw out the Oil of Cedar, which they had put in, which is of such Virtue, that it brings the Guts wasted along with it. And Nitre consumes the flesh, and leaves only the Skin and Bones. When they have done this, they restore the Dead, and do nothing further. The third way of Embalming is for the poorer sort; They cleanse the Guts by Purging, and dry the Body with Salt for seventy days; and then they restore it. And if an Aegyptian or a Stranger be either kill'd by a Crocodile, or drown'd in the River, the City, where he is cast up, must embalm him, and bury him Honourably in the Sacred Monuments, whom no one, no not a Relation or Friend, but only the Priests of Nile, may touch; because they bury one who is somthing more than a dead Man.’ Now, thô, in this account of Herodotus, one cannot easily imagine, how the Brain could be got ou [...] at the Nose; nor how Salting could contribute so much to the preserving of Bodies; he being a Historian more than a Philosopher, may be excused, as reporting things by hear-say more than from experience. However, from the account he gives, and from what other Historians say; and withal, from a curious inspection into the Mumies brought from Aegypt, it may be concluded, that the Aegyptians and their followers had two sorts of Embalming, the one curious, and costly for great and rich Men; the other cheap, for the common and poorer sort. In the costly way, they used as well outwardly for anointing and dipping the linen Shrowds in, as for stuffing the three Ventricles, divers aromatick Spices, which, by their innate Balsamick Virtue, by their bitterness also, and oleous Sulphur, or the penetrability of their volatil Salt, resist putrefaction; and by their sweet Smell prevent stench and offensiveness; such as Opobalsamum, Oil of Cedar, Aloes, Myrrh, Saffron, Cinamon, Cassia, &c. This was for the Rich. For the poorer sort, they used either Asphaltus, which is the Bitumen Judaicum, that comes off the dead Sea; or Pissasphaltum, which is a mixture of Pitch and Bitumen.
The Babylonians buried their Dead in Honey and Wax. And the Persians interr'd their Dead, but ence [...]ed them first. This was also the custom among the Grecians; for in X [...]nophon we read, that Ag [...]lilaus of Lacedaemon, who died of a Fever, was embalmed in Honey. And so was the Body of Alexander the Great, as we may gather from Statius in Sy [...]vis.
Thus far of the Embalming used by the Ancients; Now we will proceed to the modern ways of Embalming; and First of Embowelling, concerning which, I will give you Paraeus his Sentiments in short; First of all, the Body to be embalmed, must be embowell'd. The Heart may be embalmed apart, according to the Relations pleasure. The Skull must be sawn asunder, and the Brain must be taken out. Then deep gashes must be made along the Arms, Legs, Thighs, Back, Loins and Buttocks, especially where the larger veins and arteries run along; First, that the Blood may be got out, which otherwise might occasion corruption; Secondly, that there may be place to put in the Spices. Then the Body must be wash'd with a Sponge dipt in Aqua vitae and strong Vinegar, wherein Wormwood, Aloes, Coloquintida, common Salt, and Alume have been boiled. Afterwards, these gashes, all the passages, and openings, and the three Ventricles must be filled with the following Spices grosly powdered. ℞ pulv. rosar. chamaen. melilot. balsam. menth. salv. lavandul. rorismarin. majoran. thym. absinth. cyper. calam. aromat. gentian. ireos Florent. assae odoratae, caryophyll. nucis mosch. cinnam. styrac. calam. benzo. myrrh. alo. santal. omnium q. s. f. pulvis. The gashes and open places must be sewed up, that the Powders shake not out. Then the whole Body must be anointed with Turpentine melted with Oil of Chamemel and Roses; adding, if you please, some Chymical aromatick Oils; and bestrew it again with the foresaid Powder. Then wrap it in Linen, and after that in Cere-cloth. And put it into a leaden Coffin well sodered, and filled with aromatick Herbs. But if none of the said Spices can be got, as it happens, when Towns are besieged; you must be content with powder of slak'd Lime, and common ashes, suppose Oak. For thus, if the Body be wash'd in strong Vinegar, or Lixivium, it will keep a long time, provided the season be not very hot, nor that it be laid in a hot and moist place. To embalm the better, it is a good way to prick the Body, when embowelled, with sharp Bodkins, that the Liquor preserving it from corruption, may penetrate the deeper. When it is prickt, it must be laid in a wooden Tray, fill'd with a decoction of Vinegar, and aromatick, and bitter things, as Aloes, Rue, Wormwood, and Coloquintida, and it must be kept there Twenty days, pouring upon it six quarts of Aquavitae. Then set it upright in a close and drie place.
Balthasar Timaeus à Guldenkle [...], a Man famous for Embalming, writes thus to his Son, Lib. 6. Epist. Medicinal. Ep. 10. ‘The method of Embalming dead Bodies, which you desire to know of me, is various, and is ordered according to the Parents or Kindred's pleasure. Somtimes the whole Body, and all its Cavities and Limbs are artificially embalmed, oftentimes the middle and lowest Venter, and somtimes [Page 711]only the lowest i [...] taken out, and preserved by convenient Remedies from rottenness and corruption; which are also various, and of divers kinds. Some use Aloes and Myrrh, some Spirit of Wine, some Vinegar and Salt, some a Lixivium and quick Lime, and others use compound Powders, distilled Oils, Ointments and Balsames. I have embalmed several persons in the following method, upon which I now also insist. First of all, I take care to provide necessary Implements, Knives, Razors, Scissars, Tweezers, Bodkins, Needles, Thread, Hooks, Cords, Swathing-bands, a Saw, Sponges, Tow, Linen, Vinegar, Aquavitae, Salt water, Cerecloth, Oils, Balsams, a magistral Powder, described hereafter, &c. These things being all ready in order, when the Corps has been well wash'd and cleansed with warm Wine from the external filth; I order it to be laid on a convenient place, then I cut the lower Belly crossways, and take out the Guts and Mesentery, the Stomach, Kidneys, Spleen, Bladder, and Womb, and order a Servant to empty them. By and by I open the middle Venter or Breast, I take out the Lungs, Heart, Veins, Arteries, Diaphragm, and the Oesophagus to the Epiglottis, and carefully empty all the Vessels. Then I wash all the Cavity of the Belly and Breast, first with cold water, and wipe it well with Sponges; and then with strong Vinegar, and lastly with Aqua-vitae, or Sp [...]ritus Solomonis, which is very effectual in preventing of rottenness and corruption. These things being done, I strew the Powder hereafter described upon all the parts, and rub it in well, then I apply every where Pledgets of Tow or Cotton dipt in Aquavitae, and, strewing on more Powder, I fill the whole Cavity of the Belly and Breast, and then I sew up the Skin, which was cut. The Head I embalm thus; I separate the Skull circularly with a very sharp Saw, or I open it only from the Crown towards the Occiput; then I take out the Brain, and wash the Cavity in the same manner, as I did the Belly; First, with cold water, then with Vinegar, and last of all very well with Aquavitae, or Spiritus Solomonis; then I wipe it with Sponges, and fill it with the Powder and Tow. When I have cleansed the Jaws well with a Syringe, I fill them with powder of Cloves and Cinnamon; I plentifully and iteratedly anoint the Face with Balsame of Peru, or Spiritus Solomonis. Then I divide the musculous and carnous parts with deep incisions, especially about the Buttocks, and, having carefully squeezed out the Blood, I bestrew them with the Powder hereafter described. Last of all, I wrap the Body up in hot Cerecloth, and anoint it all over with Pix navalis, Resina pini, and St [...]rax liquida melted at the fire. If the Body is to be kept a long time, the fleshy parts must be taken away and buried with the Entralls. If it be the Friends pleasure either to put the Heart [Page 712]in its place again, or to keep it apart in a box, let it first of all be washt with Aqua nostra Balsamica ex aloe & myrrha, afterwards with Spiritus Solomonis, and then let it be anointed with Balsamus Peruvianus, But these things must be observed; 1. The Embalming must be hastned after the Parties death, and not be deferred above Four and twenty hours, especially when the weather is hot. 2. The Body must be kept in a cold place, and must not be exposed to the Rays of the Sun. 3. It must not be put in a Coffin of Wood, but in one of Lead, with Tinn or Silver over it. For Wood rots, and in moist or subterraneous places swells, and so bursts the Tin or Silver Coffins. 4. Great care must be taken in the Embalming, lest any putrid exhalation should come out, and offend those about the Funeral; as I remember it once happened, to the disgrace of a certain eminent Physician. 5. Those that are employed about this operation, must have a care that they take no harm from the Essl [...]via, and Vapors that arise from the corrupt Viscera, especially when the Bodies of such are to be embalmed, as have died of some contagious Disease, or of a Consumption, or Empyema. In Summer time this operation is performed in a Room, with the Windows open to the North. In VVinter it may be performed in a Room with a Fire of Ash, Oak, or Juniper in it; but not in a Stove. He that goes about this work, must take some Alexipharmacks, whereby he may defend his Heart and Brain against hurtful Exhalations. Let him anoint his Nostrils with some Balsam, or hold to them a Sponge impregnate with Bezoardick Vinegar. Let him hold in his Mouth some trochisci de zedoaria, de corticibus citri, or some other preservative. Or, if he have none of these things, let him take some Meat, or a Mouthful of Bread dipt in Wine. I think, it is better to begin with opening the Lower Belly, than the middle; and that it is best to abstain from quick-lime, and other corrosive things: Because Bodies are not kept but consumed by such things. The Powder to fill the the Cavities of the Head, Breast and Belly; ℞ Myrthae electae lb iiij. Croci sylvestr. lb ij. Styrac. calamit. lb ij. cinnam. acutissim. lb j. caryophyll. lb ij. Alo. caball. lb v. rorismarin. siccat. lb ij. Thuris lb j. fol. laur. arid. rosar. rubr. an. lb ss incidenda incidantur, fiatque pulvis grossus. A Cerecloth to wrap the Body in, and to line the Coffin withall; ℞ Cerae flavae lb xxv. Terebinth. Venet. Colophon. resin. an. lb iii. pic. noval. lb ijss. vi [...]id. aeris lb j. thur. styrac. liquid. an. lb ij. ol. spic. lb ss. Laquefactis & mixtis adde sevi lb ij. mixturae huic immergantur telae lineae. The Powder to be strewed on the Cerecloth: ℞ Absinth. vulgar. abrotan. lavandul. rorismarin. fol. laur. an. M. vj. salviae, majoran. ocymi, origan. thym. saturej. hyssop. flor. chamaem. an. M. iij. rad. Ir. Flor. lb. iiij. calam. aromat. [Page 713]angel. cyper. cortic. aurant. citr. an. lb j. lign. Rhod. lb iij. Junip. Sassaph. an. lbjss. santal. citrin. lign. alo. an. lb ss. cinnam. caryophyll. an. lb j. flor. ros. rubr. lb ij. alo. myrrh. thur. styrac. benz. opt. an. lb ij. salis lb iiij. M. f. Pulvis, qui irroretur olei spicae lbss. ℞ Ol. rorismar. lign. rhod. an. ℥ iij. caryoph. ℥ jss. absynth. origan. an. ℥ j. Misce exactissimè pro balsamo. ℞ Styr. liquid. ℥ vj. Balsam. Peruvian. ℥ ij. ol. mac. ℥ss. lign. rhod. ℥ jss. M. f. Balsamus.’
But the greatest Master in Embalming in our Age, was Bilsius, who held strange opinions about the Lymphatick, Lacteal, and Thoracick Vessels, and about his Ductus Roriferus; wherein he contradicted the most famous Anatomists of his time, Bartholine, Sylvius, and Van Horne. He had found out a method of Anatomizing Bodies without effusion of Blood, after a new and unheard of manner, with an accurate separation, and manifest demonstration, of all the parts and little Vessels, thô they were less than Hairs. But he was chiefly skilled in a new and curious way of Embalming Dead Bodies, after they were opened or dissected, replacing the embalmed Bowels in their Natural places, viz. The Brain in the Skull, and the Guts in the Abdomen, and more than that, not any embalming Spices stuck to the parts of the Body. These new secrets of his drew the King of Spain into such admiration of him, that, by his Governour in the Low Countries, he ordered Twenty Thousand Crowns to be paid him, upon condition that he should declare ingenuously upon Oath to the three Estates of Brabant his admired Art; and he, as an Honorary Prosessor in the University of Lovain, should teach Anatomy publickly according to his Manual Operation, for which he was to have a Pension of Two Thousand Crowns per Annum; and he was also obliged to communicate his said peculiar method to some skilful Anatomist, that after his Death it might be perpetuated for the good of the publick and of Physicians. And thô Bilsius had got so vast a Sum of Money, and went to Lovain, to perform his agreement; yet the University of Lovain made bold to refuse him a reception into the Society of the Professors, upon this pretence, that Bilsius being of the Reformed Religion, it might in so doing lay it self obnoxious to an Excommunication from the See of R [...]me, according to the Statutes. There was great bickering about the matter, till at last Bi sius, loden with his Money, bid Lovain farewel, and returned to his United Provinces, where (as far as I can learn,) his famous Secrets were buried with him.
Next to Bilsius comes Clander, who, after various Experiments, gives us this process for Embalming; after the Body designed for Embalming has been dead Eighteen, or at the most Twenty four Hours, let it be laid in a long Tray of Oak, or of some hard Wood. Then get ready some Spiritus salis Ammoniaci balsamans, which may be prepared ex tempore in the manner following. Take of Potashes one Pound, pour on them of [Page 714]common Water Six Pounds, let them stand an Hour, and shake them somtimes for the better dissolution. Into this solution put half a pound or somthing more of Sal Ammoniack powdered. Shake them together somtimes, for the better dissolution of the Powder, and in a stopt Vessel, lest the Volatil parts should fly out. Then filtre it through a brown Paper. Upon the Body thus placed in the Vessel, let as much of this Spirit made in the foresaid proportion be poured, as will stand a quarter of an Ell above the Body. Now because this Spirit, as it is sated with an Alcalick Salt, does immediately r [...]ise the Body, and will not let it sink for some days or weeks, by reason of Crudities, which puff up the Belly like a Tympany, and because Corruption may be feared in the upper part, which the Liquor does not cover; therefore either the Vessel must be every day shaken moderately, that the Balsamick Liquor may come at all the parts. Or, which is better, the Corps may be pent down under the Liquor, with a piece or two of a wooden lathe. Then the Vessel must be most exactly covered, and the chinks must be stopt close with a Paper and Paste; partly that the Volatil Spirits may not fly away; and partly that the external Air may not get in and corrupt it. The Body being placed in the manner aforesaid, if it be a large one, must be left three Months. Six Weeks is sufficient for little Creatures. Yea a Month is time long enough for some. Then you must look whether the Flesh of the Body be hard or soft. They must be kept, if possible in cool places, rather than in hot and moist. This must be observed especially in Summer. After two or three Months, the Vessel may be opened, and the Liquor gently poured off, or taken out. The Body must be tenderly handled. When it is taken out of the Vessel, it may rest for eighteen or four and twenty hours. Then, to dry up the superfluous moisture, you may lay it in a stove moderately hot, or somtimes upon an Oven; somtimes also you may lay hot Bricks upon the Belly; or you may wrap it up, and put it in hot Sand, or you may strew hot Sand upon it, especially on the Lower Belly. In Summer time it may be exposed to the vehement Rays of the Sun. You must take notice, that every day you must turn the Body on a new side; that the moisture in every place may the better be dried up by the external Heat. And last of all, it may be washt with a Sponge, to clear it of filth, if there be any.