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Compleat Surgeon/Wounds

Of Sutures.
Sutures or Stitches are made only in recent, and as yet bleeding Wounds, when they cannot be re-united by Bandage, as are the transverse; provided there be no Contusion, nor loss of Substance, nor great Hæmorrhages, as also that the Wounds were not made by the biting of venomous Beasts, that there be no violent Inflammations, and that the Bones are not laid open; because generally 'tis necessary to cause 'em to be exfoliated; neither is this Operation to be perform'd in the Breast, by reason of its Motion.

The Instruments proper for the making of Stitches, are streight and crooked Needles, with waxed Thread; and these Sutures are of four sorts, viz. first the Intermittent Stitch for transverse Wounds; the second for the Hare-Lip; the third, commonly call'd the Dry Stitch, for superficial Wounds; and the fourth, term'd the Glover's Stitch.

The Intermittent Stitch is that which is made at certain separated Points, according to the following manner: After having taken away all extraneous Bodies out of the Wound, let a Servant draw together its Sides or Lips; and let a Needle with waxed Thread be pass'd thro' the middle from the outside to the inside, several Points being made proportionably to its length. It is requisite to pierce a good way beyond the Edge of the Wound, and to penetrate to the bottom, lest any Blood shou'd remain in the Space, that might hinder the reuniting.

If the Wound hath Corners, the Surgeon begins to sow there; and before the Knot is made, causeth the Lips of the Wound to be drawn exactly close one to another: The Knots must be begun with that in the middle, and a single one is first made on the side opposite to the running of the Matter; laying upon this Knot (if it be thought convenient) a small Bolster of waxed Linnen, on which is tied a Slip-Knot, to the end that it may be untied if any bad Accident should happen. If a Plaister be apply'd to the Wound after the Stitching, a small Bolster is to be laid over the Knots, to prevent their sticking to the Plaister. In case any Inflammation happens in the Wound, the Knots may be loosen'd and ty'd again when the Symptoms cease: But if the Inflammation continue, the Threads are to be cut by passing a Probe underneath: When the Wound is clos'd, the Threads are cut in like manner with a Probe; and in drawing 'em out, a Finger must be laid near the Knot, lest the Wound should open again.

To make the second sort of Stitch for the Hare-Lip, a small streight Needle is pass'd into the sides of the Wound, and the Thread is twisted round the Needle, by crossing it above at every Stitch.

To form the Dry Stitch in very superficial Wounds, a piece of new Linnen-Cloth is to be taken, wherein are made Digitations, or many Corners; the Selvedge or Hem ought to be on the side of these Corners or Digitations; and a small Thread-Lace is ty'd to every one of 'em. Afterward this Cloth is dipt in strong Glue, and apply'd about a Finger's breadth from the Edges of the Wound; so that a piece thereof being stuck on each side, the Laces may be ty'd together, to cause the Lips of the Wound to meet.

To make the Glover's Stitch, the Operator having drawn together the Lips of the Wound, holds 'em between two Fingers, passeth a Needle underneath 'em, and soweth 'em upward all along, after the manner of Glovers.

Of Wounds in general.
What is a Wound?

A Wound is a recent, violent, and bloody Rupture or Solution of the Natural Union of the soft Parts, made by a pricking, cutting, or bruising Instrument.

What ought to be observ'd before all things in the curing of Wounds?

It is requisite to take notice of their differences, as well as of the Instruments with which they were made; to the end that Consequences may be drawn from thence for the Application of proper Remedies.

From whence arise the differences of Wounds, and which be they?

They are taken either from their Figure or Situation: With regard to their Figure, they are call'd Long, Broad or Wide, Triangular Great, Little, Superficial, or Deep; and with respect to their Situation, they are term'd Simple, Complicated, Dangerous, or Mortal.

What is a Simple and a Complicated Wound?

A Simple Wound is that which only opens the Flesh, and hath no other concomitant Circumstances; but a Complicated Wound, on the contrary, is that which is attended with grievous Symptoms, as Hæmorrhages, Fractures of Bones, Dislocation, Lameness, and others of the like Nature.

What is a dangerous and mortal Wound?

A dangerous Wound is that which is complicated the Accidents whereof are dreadful: As when an Artery is open'd or prick'd, when a Nerve or Tendon is cut, or when the Wound is near a Joynt and accompanied with a Dislocation or Fracture. A mortal Wound is that which must be inevitably follow'd by Death; as is that which is situated deep in a principal Part necessary for the Preservation of Life.

What are the Parts wherein Wounds are mortal?

They are the Brain, the Heart, the Lungs, the Oesophagus or Gullet, the Diaphragm, the Liver, the Stomach, the Spleen, the small Guts, the Bladder, the Womb, and generally all the great Vessels.

Wherein doth the Cure of Wounds consist?

In helping Nature readily to procure the reuniting of the Parts that have been divided, after having taken away or asswag'd every thing that might cause an Obstacle.

What are the things that hinder the speedy reunion of the Parts?

They are extraneous Bodies found therein, as Bullets, Flocks, and Pieces of Wood or Stone, &c. As also sometimes the Accidents which attend 'em; as an Hæmorrhage or Flux of Blood, Inflammation, Esthiomenus or Mortification, Hypersarcosis, or an Excrescence of Flesh, Dislocation, the Fracture of a Bone, the Splinter of a Bone, & sometimes a contrary Air.

REMEDIES.
What are the Remedies proper for stopping an Hæmorrhage or Flux of Blood?

The common Remedy is a kind of Cataplasm, made up with the Powders of Aloes, Dragons-Blood, Bole Armenick and Whites of Eggs, which are mix'd together and laid upon the Wound. But the following is an excellent one.

Take two Ounces of Vinegar, a Dram of Colcothar, two Drams of Crocus Martis Astringens; beat the whole together, steeping Muscus Quercinus therein; then throw upon it the Powder of Mushrooms, or of Crepitus Lupi: Apply this Remedy, and you'll soon stop the Hæmorrhage, taking Care nevertheless to bind the Part well, otherwise the Astringents do not readily take Effect.

To this Purpose you may also make use of Cobwebs, Mill-Dust, and the Powder of Worm-eaten Oak; or else take Oven-Soot mixt with the Juice of the Dung of an Ass or Ox, adding only thereto the White of an Egg.

Besides these Remedies there are also actual and potential Cauteries, or simple Ligatures, which are infallible. Indeed the actual Cautery is not always sure; because when the Escar made by the Fire, falls off the Hæmorrhage breaks out again as before: but the potential Cautery is almost always successful; such as the following.

Take about an equal Quantity of Vitriol and Powder of Mushrooms; apply 'em upon a little Lint to the Place where the Blood issueth forth, and you'll see it stop immediately: But Care must be taken to avoid touching a Nerve or Tendon; by reason that the Vitriol is apt to excite Convulsions.

How is the Inflammation and Mortification of a Wound Suppress'd?

If the Inflammation proceeds from the Presence of an Extraneous Body, it must be taken away as soon as possible with a Pair of Forceps, and if from the Quantity of Pus or corrupt Matter, it must be let out. But in case the Inflammation ariseth from extreme Pains, they are to be asswaged with Cataplasms or Pultises and anodyn Liniments, such as those that have been already prescribed in the Cure of the Phlegmon: or else the Part may be bath'd with Camphirated Spirit of Wine, mixt with as much Water: Saccharum Saturni infus'd in Lime-water, performs the same Effect, and the Water of Crabs alone is admirable in its Operation.

Against the Esthiomenus or Mortification, make use of Wine boil'd with Wormwood, St. John's Wort, Rosemary and Aloes; or else take the Tincture of Aloes and Myrrh, or Spirit of Wine alone impregnated with Camphire and Saffron.

What is to be done in Case a Convulsion happens by reason of a wounded Nerve or Tendon?

If the Convulsion be caus'd by the Presence of an Extraneous Body that bruiseth the Part it must be taken away; and if from the wounding of a Nerve, pour into the Wound some Drops of the Oil of Lavender distill'd, which in that Case is of singular Use; this Oyl may be also taken inwardly in an appropriated Liquour, such as a Decoction of Wormwood and the Tops of the lesser Centory. Balsam of Peru us'd in the same Manner, is an excellent Remedy, and the Oyls of Worms, Snails, St. John's-Wort and Turpentine are frequently apply'd with good Success.

If the Convulsion proceeds from the Biting of some venomous Creature, Cupping-Glasses or Leeches are to be immediately applied, putting into the Wound Treacle with the Spirit of Wine or even Fire it self, and leaving to the Physician's Care the Prescription of other vulnerary Remedies proper to be taken inwardly.

What is to be done to draw the Extraneous Bodies out of a Wound?

When they cannot be taken away with the Fingers or Forceps, the Patient must be set in the same Station or Posture wherein he was when he receiv'd the Wound, in order to get some farther Light to discover 'em; or else such Plaisters may be us'd as are endu'd with an Attractive Quality: Particularly this:

Take an Ounce of Treacle, half a Dram of Gum Ammoniack, one Dram of Bdellium, and two Drams of Bore's Grease, adding a Quarter of a Pound of Wax to make 'em up into the Form of a Plaister. It is reported that Hare's Grease alone hath the same Effect, and that it goes for a Secret among the Surgeons but you may (if you please) mix it with Ointment of Betony. However it hath been observed that Leaden Bullets may sometimes remain in a Man's Body, during his whole Life-time without doing any Harm.

How are Excrescences to be taken away?

They may be consum'd with Powder of Allom, Unguentum Ægyptiacum, or Lapis infernalis.

After having remov'd every thing that hinders the reuniting of the Lips of a Wound, what is to be done to attain thereto?

The Re-Union in Wounds is properly the Work of Nature; but it may be promoted by putting into 'em a little Balsam of Peru, and drawing together their Lips with the Fingers. Afterwards the Lips must be kept closed with a Bandage, a Glutinous Plaister or a dry Stitch, provided the Wound be only superficial, hindring the Air from penetrating into it. For Want of Balsam of Peru, an excellent one may be made with the Flowers here specified.

Take the Flowers of Henbane, St. John's-Wort, and Comfry and let 'em be digested in the Sun during the whole Summer-Season in the Oyl of Hemp-seed, which Oyl, the longer it is kept, proves so much the better, if it be set forth in the Sun every Summer, the Vessel that contains it being well stop'd. There is also the Balsam of Balsams, or the Balsam of Paracelsus call'd Samech.

To avoid the exposing of Wounds to the Air, it is requisite to cover 'em over the Dressings with some sort of Plaister, which is usually termed the Surgeon's Plaister, such is that which is effectual in Dissolving, corroborating and allaying Pain or Inflammation.

Take the Mucilages of the Roots of great Comfrey and Fenegreek, half a Pound of Ceruse or white Lead, two Drams of Crude Opium, one Dram of Camphire, as much of Saffron, two Drams of Sandarack, one of the Oyl of Bays, one half Pound of Rosin, and as much Turpentine and Wax. Boil all these Ingredients together in a sufficient Quantity of Lin-seed-Oyl, and make a Plaister according to Art.

In great Wounds it is expedient to lay over the Dressings a Cataplasm or Pultiss, such as this:

Take the Leaves and Flowers of Camomile, and Melilot, the Tops of Wormwood, common Mallows and Marsh-Mallows, with the Seeds of Line and Cummin powder'd: Then boyl the whole Composition in Wine, and add thereto Barly-Meal, to give it a due Consistence. If there be any Cause to fear a Gangrene, you may also intermix Saffron, Myrrh and Aloes with Spirit of Wine.

Is it necessary to put Tents into all Wounds, and to make use of Digestives and Suppuratives?

No: It is sufficient to procure the Re-uniting of the Parts simply by the Means of Balsam in small Wounds; because they ought not to be brought to Suppuration: so that Digestives and Suppuratives are only necessary in great Wounds, and those that are accompanied with Contusion, avoiding the ill Custom of some Country-Surgeons, that stuff up their Wounds too much with Tents and Pledgets, whereas they might well be content with simple Bolsters or Dossels which shou'd be dipt in the ordinary Digestive composed of Turpentine and the Yolks of Eggs with a little Brandy, or else with the Tincture of Myrrh and Aloes.

Suppuration may also be promoted by mundifying and quickening the Wound, especially if the Bolsters be steep'd in the following Composition.

Take half an Ounce of Aloes and Myrrh powder'd, two Drams of Sal Saturni, twenty Grains of Sal Ammoniack, the same quantity of beaten Cloves, a Dram of Queen of Hungary Water and half an Ounce of Unguentum Basilicon, and let the whole Mass be mingled together.

In fine, the whole Mystery consists in well cleansing the Wounds with a Linnen Cloth, or with the Injections of the Tinctures of Myrrh and Aloes; or with simple Decoctions of Wormwood, Scordium or Water-Germander, Bugle, Sanicle and Hore-Hound in White-Wine; as also by prescribing the Vulnerary Decoctions of Powder of Crab's-Eyes, and Saccharum Saturni, to be taken inwardly, to consume the acid Humours, which are a very great Obstacle that hinders the speedy cure of Wounds.

What are the Vulnerary Plants, the Decoctions of which is to be taken inwardly?

They are Alchymilla or Lion's-Foot, Ground-Ivy, Veronica or Fluellin, St. John's-Wort, Wormwood, Centory, Bugle, Sanicle, Chervil, and others. The Broth of Crabs may also be prescrib'd, which is an excellent Remedy, and may serve instead of a Vulnerary Potion.

Sometimes Sutures or Stitches contribute very much to the re-uniting of the Lips of Wounds, when they cannot be join'd by Bandage.

Of particular Wounds of the Head.
What ought first to be consider'd in a Wound of the Head?

Two things, that is to say, the Wound it self, and the Instrument with which it was made; for by the Consideration of the Wound, we may know whether it be Superficial or Deep; and by that of the Instrument, we are enabled to make a truer Judgment concerning the Nature of the same Wound.

What is a Superficial, and what is a Deep Wound in the Head?

That is call'd a Superficial Wound in the Head, which lies only in the Skin; and that a Deep one which reacheth to the Pericranium, Skull, or Substance of the Brain.

What is to be apply'd to a Superficial Wound?

It is cur'd with a little Queen of Hungary Water; or else with a little Balsam, laying upon it the Surgeon's Plaister, or that of Betony. But if the Wound or Rent be somewhat large, it must be clos'd with a Stitch.

What is to be done to a Deep Wound?

If it be situated in the Pericranium, the Wound must be kept open, waiting for Suppuration; but if it enter the Skull, an Enquiry is to be made, whether there be a Simple Contusion, or a Fracture also. In the Contusion it is necessary to wait for the Suppuration, and the fall of the Splint, and to keep the Wound open; as in the Fracture, to examine whether it be in the first Table only, or in both; it is known to be only in the first, by the Application of an Instrument, and of Ink, as also in regard that there are no ill Symptoms; but a Fracture in both Tables shews it self by the Signs; and it may be found out by making a Crucial Incision in the Flesh, to discover the Fissure.

What are the Signs of the Fracture of the two Tables of the Skull, and of the overflowing of the Blood upon the Membranes of the Brain?

They are the loss of the Understanding at the very Moment of receiving the Wound; an Hæmorrhage or Flux of Blood thro' the Nose, Mouth, or Ears; drowsiness and heaviness of the Head, and more especially Vomitting of Phlegm; from whence may be inferr'd the necessity of making use of the Trepan.

What Consequence may be drawn from the Knowledge of the Instrument with which the Wound was made?

It is according to the Quality of this Instrument; as it is proper to cut, prick, or bruise; if it be cutting, the Wound is more Superficial, and not subject to a great Suppuration: If it be pricking, the Wound is deeper, but of small Moment: If it be a battering or bruising Instrument, the Wound is accompany'd with Contusion, producing a great Suppuration, besides the Concussion and Commotion of the Part, which are inseparable, and often cause very dangerous Symptoms.

Inferences may be made also from the disposition of the wounded Person; for a strong robust Man may better bear the Stroke than a weak one; and even Anger causeth an Augmentation of Vehemency; so that all such Circumstances are not to be despis'd, in regard that they give occasion to profitable Conjectures.

What particular Circumstance is there to be observ'd in undertaking the Cure of Wounds in the Face?

It is, that a more nice Circumspection is requir'd here than elsewhere, in abstaining from Incisions, as well as in making choice of proper Medicines, which must be free from noisome Smells; and it is in this Part chiefly that Balsams are to be used, avoiding Suppuration, to prevent Scars and other Deformities.

Of the particular Wounds of the Breast.
What is to be observ'd in Wounds of the Breast?

Two things, viz. whether they penetrate into the Cavity of the Thorax or not, which may be discover'd by the Probe, and by a Wax-Candle lighted, and apply'd to the Entrance of the Wound, obliging the Patient to return to the same Posture wherein he receiv'd the Hurt, as also to keep his Nose and Mouth shut: For then the Flame may be perceiv'd to be wavering, the Orifice of the Opening being full of Bubbles; a Judgment may be also made from the running out of the Blood.

What is to be done when it is certainly known that the Wound penetrates into the Cavity of the Breast?

It is necessary to examine what Part may be hurt, by considering the situation of the Wound, and its Symptoms: If the Lungs are pierc'd, a spitting of froathy Vermilion-colour'd Blood ensues, with difficulty of Respiration, and a Cough. If any of the great Vessels are open'd, the wounded Person feels a Weight at the bottom of his Breast, is seiz'd with cold Sweats, being scarce able to fetch his Breath, and Vomits Blood, some Portion whereof issueth out of the Wound. If the Diaphragm or Midriff be cut in its Tendinous Part, he is suddenly hurry'd into Convulsions: And if the Heart be wounded either in its Basis or Ventricles, he falls into a Swoon, and dies incontinently.

But if the Probe doth not enter, and none of the above-mentiond Symptoms appear, it may be taken for granted that the Wound is of no great Consequence.

What is to be done when the Wound penetrates into the Chest, yet none of the Parts are hurt, only there is an Effusion of Blood over the Diaphragm?

It is necessary to make an Empyema, or otherwise the diffus'd Blood in corrupting, wou'd inevitably cause an Inflammation, Gangrene, and Death it self.

What is an Empyema?

It is an Operation whereby any sorts of Matter are discharg'd with which the Diaphragm is over-spread, by making a Puncture or Opening in the Breast.

Of the particular Wounds of the lower Belly.
What is to be done to know the quality of a Wound made in the lower Belly?

It is requisite to make use of the Probe, to observe the situation of the Wound, and to take notice of all the Symptoms: For by the help of the Probe, one may discover whether it hath penetrated into the Cavity or not, after having enjoyn'd the Patient to betake himself to the same Posture wherein he was when he first receiv'd the Wound: By its situation a Conjecture may be made that such a particular Part may be hurt; and by a due Examination of the Symptoms, one may attain to an exact Knowledge. As for Example; It is known that one of the thick Guts is open'd, when the Hurt is found in the Hypogastrium, and the Excrements are voided at the Wound; as it is certain that one of the thin Guts is pierc'd, when the Wound appears in the Navel, and the Chyle issueth forth from thence; and so of the others.

What Method ought to be observ'd in curing Wounds in the lower Belly?

It is expedient at first to prevent letting in the Air, and to dilate the Wound, in order to sow up the perforated Gut, and afterward to restore it to its place; as also to bind the Caul, which is let out at the opening, and to cut it off, lest in putrifying it should corrupt the neighbouring Parts. Then these Parts may be bath'd with Lees of Wine, wherein have been boil'd the Flowers of Camomile and Roses with Wormwood: The Powders of Aloes, Myrrh, and Frankincense may be also thrown upon 'em; and the Wound must be sow'd up again to dress it on the outside, the Patient in the mean time being restrain'd to a regular Diet. But Clysters must be forborn on these Occasions, especially when one of the thick Guts is wounded, making use rather of a Suppository or laxative Diet-Drinks, to avoid dilation and straining.

Of Wounds made by Guns or Fire-Arms.
These Wounds are always bruis'd and torn, with the loss of Substance, and commonly with the splitting and breaking of a Bone: They are red, black, livid, and inflam'd, not being usually accompany'd with an Hæmorrhage: They are generally round, and streighter at their Entrance than at their End; at least if they were not made with Cross-Bar-Shot, or Quarter-Pieces.

Of the Prognostick of Wounds by Gun-shot.
When these Wounds penetrate into the Substance of the Brain, or Marrow of the Back-Bone, or into the Heart, Pericardium, great Vessels, and other noble Parts, Death always inevitably follows, and often happens at the very Instant. But one may undertake the Cure of those that are superficial, and which are made in the Neck, Shoulders, Arms, and all other parts of the Body.

Of the Cure of Wounds by Gun-shot.
For the better curing of these sorts of Wounds, it is requisite to be inform'd of the Quality of the Fire-Arms by which the Wounds were made, in regard that a Musquet is more dangerous than a Pistol, and a Cannon much more than a Musquet; as also to examine their situation and concomitant Accidents; for by how much the more complicated they are, so much the greater is the danger. Then the Patient must be set (as near as can be) in the very same Situation and Posture wherein he remain'd when the Wound was receiv'd, in order to discover the direct Passage of the Wound by the help of the Probe, with which a search is to be made, whether a Bullet, or any other extraneous Bodies, as Wood, Flocks, Linnen, or Stuff as yet stick in the Wound; so that Endeavours may be us'd to take 'em out thro' the same Hole where they enter'd, care being more especially had to avoid making Dilacerations in drawing 'em out: But if the Operator hath endeavour'd to no purpose to remove these extraneous Bodies, let him make a Counter-Opening in the opposite Part, where he shall perceive any hardness, nevertheless without touching the Vessels; thus the Incision being made, he may readily draw 'em out with his Fingers, or some other Instrument.

If the Bullet sticks so far in a Bone that it cannot be taken away without breaking the same Bone, it is more expedient to let it lie therein; but if the Leg or Arm-Bones are very much split or shattered, then the Amputation of 'em becomes absolutely necessary. The Pain and Inflammation of the Part may be asswag'd by letting Blood, topical Anodyns, cooling Clysters and Purgations; but in case much Blood hath been already lost, Phlebotomy must be omitted. The Clysters may be made with Decoctions of Mercury, Mallows, Beets, a Handful of Barley and Honey of Roses.

Some Surgeons are of Opinion that the Patient ought to be purg'd every other Day, and even on the very same Day that he receiv'd the Wound, if his Strength will permit; however very gentle Purges are to be us'd upon this occasion, such as Cassia, Manna, Tamarins, Syrrup of Violets, and that of White Roses.

In the mean while Anodyns may be compounded to mitigate the Pain; as Cataplasms or Pultisses made with the Crum of white Bread, Milk, Saffron, the Yolk of an Egg, and Oil of Roses us'd hot; which last Ingredient is of it self a very good Anodyn. But to asswage great Inflammations, Oil of Roses, the White of an Egg and Vinegar beaten all together, may be laid on the neighbouring Parts.

At first it is necessary to apply spirituous Medicines to the Wound, and Pledgets steep'd in camphirated Brandy, are admirable for that purpose; but if there be a Flux of Blood, styptick Waters, or other astringent Remedies may be us'd, still remembring that all these Medicaments must be apply'd hot.

To promote the Suppuration of these contused Wounds, a Digestive may be made of Oleum Rosatum, the Yolk of an Egg, and Venice Turpentine.

If the Wound be in the Nerves, Tendons, or other Nervous Parts, it is requisite to use spirituous and drying Medicines, never applying any Ointments, which will not fail to cause Purtrefaction in those Parts: But a Cataplasm may be made with Barley-Meal, Orobus, Lupins and Lentils boil'd in Claret, adding some Oil of St. John's-Wort.

The Balsam of Peru, Oil of Turpentine destill'd, Oil of Wax, destill'd Oil of Lavender, Oleum Philosophorum, Oil of Bays destill'd, Balsam of St. John's-Wort, Spirit of Wine, and Gum Elemi, are excellent Medicaments for the Nerves: Or else,

Take four Ounces of Unguentum Althææ with a Dram and a half of destill'd Bays; mingle the whole Composition, and apply it: Or else,

Take an Ounce of destill'd Oil of Turpentine, a Dram of Spirit of Wine, and half an Ounce of Camphire; let all be intermixt, and dropt into the Wound: Or else,

Take a Scruple of Euphorbium, half an Ounce of Colophonia, and a little Wax; let 'em be mingl'd together, and apply'd very hot to the Nervous Parts.

If the Wounds are deep, Injections may be made with this Vulnerary Water, which is very good for all sorts of Contusions, as also for the Gangrene and Ulcers.

Take the lesser Sage, the greater Comfrey, and Mugwort, of each four Handfuls; Plantane, Tobacco, Meadowsweet, Betony, Agrimony, Vervein, St. John's-Wort, and Wormwood, of each three Handfuls; Fennel, Pilewort Bugle, Sanicle, Mouse-Ear, the lesser Dazy, the lesser Centory, and All-heal, of each three Handfuls; three Ounces of round Birth-Wort, and two Ounces of long: Let the whole Composition be digested during thirty Hours, in two Gallons of good White-Wine, and afterward destill'd in Balneo Mariæ, till one third part be consumed.

If a Gangrene happens in the Part, Spirit of Mother-Wort may be put into it, which is compounded with two Drams of Mastick, Myrrh, Olibanum, and Amber, and a Quart of rectify'd Wine, the whole being destill'd.

This Fomentation may be apply'd very hot to very good purpose, viz. an equal quantity of Camphirated Wine and Lime-Water, with three Drams of Camphire.

This is also an excellent Cataplasm: Take a Pint of Lye, and as much Spirit of Wine, half an Handful of Rue, Sage, Scordium, and Wormwood, a Dram of each of the Roots of both sorts of Birth-Wort, and two Drams of Sal Ammoniack. Let the whole Composition be boil'd till a third Part be consum'd; adding half a Dram of Myrrh and Aloes, and a little Brandy.

Of a Burn made by Gun-Powder.
If the Burn be recent, and the Skin not exulcerated, Spirit of Wine or Brandy is to be immediately apply'd; or else an Ointment may be made with Oil of Olives, or bitter Almonds, Salt, the Juice of Onions, and Verjuice.

If the Skin be ulcerated, and little Bladders or Pustules arise, an Ointment may be compounded with the second Bark of Elder boil'd in Oil of Olives. After it hath been strain'd, add two parts of Ceruse or White-Lead, and one of Burnt Lead, with as much Litharge, stirr'd about in a Leaden-Mortar, to make a Liniment. But it is not convenient to take out the Grains of Powder that remain in the Skin, because they are apt to break, and to be more confounded or spread abroad; so that they must be left to come forth in the Suppuration.

When the Wound is superficial, and the Skin as yet whole, peel'd Onions with common Honey are an excellent Remedy; but if the Skin be torn, it is not to be us'd, by reason that the Pain wou'd be too great; in which case Oil of Tartar per diliquium hath a very good effect.

If the Burn be accompany'd with a Fever, it may be allay'd with fixt Nitre, Nitre prepar'd with Antimony, and Gun-Powder taken inwardly, which are very effectual in their Operation. Crab's-Eyes prepar'd, and even some of 'em unprepar'd, are in like manner admirable Remedies.

As for external Medicaments, when the Burn is only superficial, take Onions and unslack'd Lime, quench'd in a Decoction of Rapes, and apply this Liquor very hot, with double Bolsters dipt therein. Or else take what quantity you please of quick Lime well wash'd, and pound it thoroughly in a Leaden-Mortar, with May-Butter without Salt, to make an Ointment, which may be laid altogether liquid upon the affected Part: Or else,

Take as much quick Lime as you can get up between your Fingers at two several times; Milk-Cream and clarify'd Honey, of each about half the like quantity; let the whole be intermix'd to the Consistence of an Ointment, and apply'd: It is an approv'd Remedy; as also is the following;

Take unslack'd Lime, and put it into common Water, so as the Water may appear four or five Finger's breadth above it. After the Effervescence, pour in Oil of Roses; whereupon the whole Mass will be coagulated in form of Butter, and may be apply'd.

A good Lotion or Washing-Liquor may be prepar'd with the Juice of Garlick and Onions, in recent Burns; otherwise make use of this Ointment. Take an Ounce and an half of raw Onions, Salt, and Venice Soap, of each half an Ounce; mingle the whole Composition in a Mortar, pouring upon it a sufficient quantity of Oil of Roses, to make a very good Ointment: Or else,

Dissolve Minium or Litharge in Vinegar, filtrate this Liquor, and add thereto a quantity of Rape-Oil newly drawn off, sufficient to give it the Consistence of a liquid Liniment; then stir it about in a Leaden-Mortar till it become of a grey Colour, and keep it for Use as an excellent Liniment: Or else,

Pound Crey-Fishes or Crabs alive in a Mortar to get their Blood, and foment the Part with it hot; it is a good Remedy: Otherwise intermix the pounded Crabs with May-Butter without Salt, and let 'em be boil'd up together, and scumm'd, till a red Ointment be made, which may be drawn off, or strain'd for Use. And indeed, all manner of Ointments, and other Medicinal Compositions wherein Crabs are an Ingredient, are true specificks against Burns made by Gun-Powder.

The Mucilages of the Seeds of Psyllium, or rather those of Quince-Seeds prepar'd with Frog's Sperm, and a little Saccharum Saturni, spread with a Feather upon the affected Part, have a wonderful Operation in Burns.

A Medicament compounded with one third part of the Oil of Olives, and two of the Whites of Eggs well beaten and mixt together, is a very simple and singular Remedy. Otherwise take half an Ounce of Line-seed-Oil infus'd in Rose-Water, with four Yolks of Eggs; beat 'em together, and let the whole be apply'd to the burnt Part.

If the Burn be very violent, and hath many Pustules, Etmullerus is of Opinion that they ought to be open'd, and that an Ointment shou'd be apply'd, which is made of Hen's-Dung boil'd in fresh Butter: Otherwise,

Take a handful of fresh Sage-Leaves, two handfuls of Plantane, six Ounces of fresh Butter without Salt, three Ounces of Pullet's-Dung newly voided, and the whitest that can be found; then fry the whole Composition for a quarter of an Hour; squeeze it out, and keep it for use: Otherwise,

Take two Ounces of sweet Apples roasted under Embers, Barly-Meal, and Fenugreek, of each half an Ounce, and half a Scruple of Saffron; let the whole Mass be mingled to make a Liniment or soft Cataplasm, which may serve to asswage Pain, and mollifie the Skin.

If the Wound be yet larger, and hath a Scab, open all the Pustules, and endeavour the two first Days to cause the Escar to fall off by the Application of a Liniment made of the Mucilages of Quince-Seeds steept in Frog's-Sperm, with fresh Butter, the Oil of White Lillies, and the Yolk of an Egg: Otherwise,

Make a Liniment with fresh Butter well beaten in a Leaden-Mortar, with a Decoction of Mallows, which being spread upon hot Colewort-Leaves, and apply'd to the Escar, it will fall off.

But if the Escar be too hard and obstinate, it is requisite to proceed to Incisions to make way for the Sanies, lest a deep and putrid Ulcer shou'd be engender'd Underneath. As soon as the Humour is evacuated, the above-mention'd Emollient Medicines may be us'd, till the separation of the Escar; then the Ulcer may be consolidated with Digestives and Mundificatives; such as the Ointment of quick Lime with Oil of Roses, and the Yolks of Eggs. The white camphirated Ointments, and that of Alabaster, are also good for the same Purpose.

If a Gangrene ensueth, Sudorificks must be taken inwardly; such are camphirated Spirit of Treacle, the Essence and Spirit of Elder-Berries, the Spirit of Hart's-Horn with its own proper Salt, Treacle impregnated with the Spirit of camphirated Wine, Scorpion-Water, Hart's-Horn, Citron with Camphire, &c.

As for external Remedies in the beginning of the Gangrene, the Spirit of Wine apply'd hot is excellent; and yet better if Aloes, Frankincense, and Myrrh be intermixt therein. It ought also to be observ'd, that Camphire must always be mingled in the topical Medicines for the Cure of the Gangrene.

A Decoction of unslack'd lime, in which Brimstone hath been boil'd, with Mercurius Dulcis, and the Spirit of Wine, is a very efficacious Remedy.

In a considerable Gangrene, after having made deep Scarifications, let Horse-Dung be boil'd in Wine, and laid upon the Part in form of a Cataplasm. This is an approved Remedy.

If a Sphacelus be begun, scarifie the Part, and apply thereto abundance of Unguentum Ægyptiacum over and above the Ointments and Cataplasms already describ'd; remembring always, that when the Gangrene degenerates into a Sphacelus, all the mortify'd Parts must be incontinently separated or cut off from the sound.

Of Ulcers in general.
What is an Ulcer?

An Ulcer is a Rupture of the Natural Union of the Parts made a long while ago, which is maintain'd by the Sanies that runs out of its Cavity; or an Ulcer takes its Rise from a Wound that cou'd not be well cur'd in its proper time, by reason of the ill quality of its Pus or corrupt Matter.

What difference is there between a Wound and an Ulcer?

It is this, that a Wound always proceeds from an external Cause, and an Ulcer from an internal, such as Humours that fall upon a Part; or else a Wound in growing inveterate degenerates into an Ulcer.

Whence is the difference of Ulcers deriv'd?

It is taken from the Causes that produce 'em, and the Symptoms or Accidents with which they are accompany'd. Thus upon Account of their Causes they are call'd Benign or Malignant, Great, Little, Dangerous, or Mortal; and by reason of their Accidents, they are term'd Putrid, Corrosive, Cavernous, Fistulous, Cancerous, &c.

Do Ulcers always proceed from external Causes, or from an outward Wound degenerated?

No they sometimes also derive their Origine from internal Causes, as the Acrimony of Humours, or their Malignant Quality; the Retention of a Splint of a Bone, and other things of the like Nature. These Ulcers are commonly call'd Primitive, and the others Degenerate.

What are Putrid, Corrosive, Cavernous, Fistulous and Cancerous Ulcers?

The Putrid Ulcer is that wherein the Flesh is soft and scabby, the Pus and Ichor being viscous, stinking, and of a cadaverous smell.

The Corrosive Ulcer is that which by the Acrimony and Malignity of its Sanies, corrodes, makes hollow, corrupts and mortifies the Flesh.

The Cavernous Ulcer is that the Entrance of which is streight and the bottom broad wherein there are many Holes fill'd with malignant Sanies, without any callosity or hardness in its sides.

The Fistulous Ulcer is that which hath long, streight, and deep Holes, with much hardness in its sides; the Sanies whereof is sometimes virulent, and sometimes not.

The Cancerous Ulcer is large, having its Lips bloated, hard, and knotty, of a brown Colour, with thick Veins round about, full of a livid and blackish sort of Blood. In the bottom are divers round Cavities, which stink extremely, by reason of the ill Quality of the Sanies that runs out from thence.

Are there no other kinds of Ulcers?

Yes, there are also Verminous, Chironian, Telephian, Pocky, Scorbutick, and others, which have much affinity with, and may well be reckon'd among the five Kinds already specify'd.

What are the means to be us'd in the curing of Ulcers?

Ulcers ought to be well mundify'd, dry'd and cicatriz'd; but with respect to the several Causes and Accidents that render 'em obstinate, and difficult to be cur'd, it is also requisite to make use of internal Medicines, which may restrain and consume 'em. If their sides grow callous, they are to be scarify'd, in order to bring 'em to Suppuration; and if there be any Excrescences, they must be eaten away with corroding Powders, such as that of Allom; or by the Infernal Cautery.

What are the Remedies proper to cleanse and dry up Ulcers?

To this Purpose divers sorts of Liquors may be us'd, as also Powders and Plaisters: The Liquors are usually made of Briony-Roots, the greater Celandine, Lime, and Yellow Water; a Tincture of Myrrh, Aloes and Saffron, and Whey, whereto is added Saccharum Saturni; so that the Ulcers may be wash'd or bath'd with these Liquors; and very good Injections may be compounded of 'em.

The Powders are those of Worm-eaten-Oak, Allom, and Cinoper, the last of these being us'd by burning it, to cause the Fume to be convey'd to the Ulcer thro' a Funnel. The Country People often make use of Potter's-Earth to dry up their Ulcers, with good Success; but then they must must be of a Malignant Nature.

The Plaisters are Emplastrum de Betonica, Diasulphuris, Dessiccativum Rubrum, and others; and the Ointments are such as these;

Take three Yolks of Egg, half an Ounce of Honey, and a Glass of Wine, and make thereof a mundifying Ointment, according to Art: Otherwise,

Take Lime well wash'd and dry'd several times, let it be mingled with the Oil of Line and Bolus, and it will make an excellent Ointment to mundifie and dry; a little Mercury Precipitate may be intermixt (if you please) to augment the drying Quality; and Mercurius Dulcis may be added in the Injections.

For Ulcers in the Legs, and Cancerous Ulcers, take Plantain-Water and Allom-Water, or else Spirit of Wine, Unguentum Ægyptiacum, and Treacle; or else an Extract of the Roots of round Birth-Wort made in the Spirit of Wine. Gun-Powder alone dissolv'd in Wine, is of singular Use to wash the Ulcers, and afterwards to wet the Pledgers which are to be apply'd to 'em. But here are two particular and specifick Medicines to mollifie a Cancer.

Take Saccharum Saturni, Camphire, and Soot; let 'em be incorporated with the Juice of House-Leek and Plantain, in a Leaden-Mortar; then make a Liniment thereof, and cover the Part affected as lightly as is possible to be done, as with a simple Canvass-Cloth, or a Sheet of Cap-Paper: Or else,

Take the destill'd Water of rotten Apples, and mingle it with the Extract of the Roots of round Birth-Wort made in Spirit of Wine; reserving this Liquor to wash the Part, and to make Injections.

Of the Chaude-pisse or Gonorrhæa.
The Signs of this Disease are a painful Distention of the Penis or Yard, and a scalding Pain in making Water, the Urine being pale, whitish, and full of Filaments or little Threads: Sometimes the Testicles are swell'd as well as the Glans and Præputium; and sometimes there is a Flux of a kind of Matter yellowish, Greenish, &c.

If there be a great Inflammation in the Yard, endeavours must be us'd to allay it by letting Blood; and afterward the Patient may take a cooling and diuretick Diet-Drink, as also Emulsions made with cold Seeds in Whey. A very good Decoction may be prepar'd in all places, and without any trouble, by putting a Dram of Sal Prunella into every Quart of Water, whereof the Patient is to drink as often as he can: This Decoction is very cooling and diuretick; and the use of it ought to be continu'd till the Inflammation be asswag'd. Then some gentle Purges are to be prescrib'd in the beginning; such as an Ounce of Cassia, and as much Manna, infus'd in two Glasses of Whey, which are to be taken one or two Hours one after another.

Afterward the Patient must be often purg'd with twelve Grains of Scammony, and fifteen Grains of Mercurius Dulcis; and these Purgations must be continu'd, till it appears that the Fluxes are neither yellowish nor greenish, nor of any other bad Colour. When they are become White, and grown Thready, they may be stopt with Astringents: Amber and dry'd Bones beaten to Powder, eighteen Grains of each, with one Grain of Laudanum, the Composition being taken in Conserve of Roses, are very good for this Purpose. Crocus Martis Astringens, or else its Extract, taken from half a Dram to a whole Dram, in like manner performs the same Operation. As soon as the Gonorrhæa is stopt, to be certain of a perfect Cure, a Dram of the Mercurial Panacæa is to be taken, from fifteen to twenty Grains at a time, in Conserve of Roses. In the mean while, if a small Salivation shou'd happen, it must be let alone for the present, since it may be stopt at pleasure by the Purgations. When it is requisite to restrain the Gonorrhæa, Mercury must not be given any longer, in regard that it is a Dissolvent, which is only good when the Glandules of the Groin or Testicles are swell'd, or else when it is expedient to set the Chaude-pisse a running, after it hath been too suddenly stopt. At the same time that the Astringents are taken with the Mouth, Injections also are to be made into the Yard; such as are prepar'd with Lapis Medicamentosus, of which one Dram is put into eight Ounces of Plantane-Water. All Astringents that are not Causticks, are proper for the Syringe.

Of Shankers.
They are round Ulcers, and hollow in the middle, which appear upon the Glans and the Præputium. To cure 'em, they must be touch'd with the Lapis Infernalis, and brought to Suppuration by the means of red Precipitate mixt with the Ointment of Andreas Crucius. Oleum Mercurii laid on a Pledget or Bolster, is very efficacious to open Skankers, and consume their Flesh. The Patient must be well purg'd with Mercurius Dulcis and Scammony, taking twelve or fifteen Grains of each in Conserve of Roses; and after these Purgations are sufficiently reiterated, he may take the Mercurial Panacæa's. It is an excellent Remedy for all sorts of Pocky Distempers not yet consummated, or arriv'd at the greatest height of Malignity.

Of Bubo's.
Bubo's are gross Tumours or Abcesses that arise in the Groin, the perfect Maturity of which is not to be waited for in order to open 'em; because it is to be fear'd lest the corrupt Matter remaining therein too long, might be convey'd into the Blood by the Circulation, and so produce the grand Pox: Therefore it is necessary to open 'em betimes with a Lancet, or else with a Train of potential Cauteries, if they are too hard. They ought to be Suppurated for a considerable time: The Patient must be well purg'd with Scammony and Mercurius Dulcis: He must also take the Mercurial Panacæa's.

Of the Pox.
This loathsome Disease begins sometimes with a virulent Gonorrhæa, and a weariness or faintness at the same time seizeth on all the Members of the Body: It is usually accompany'd with Salivation and the Head-ach, which grows more violent at Night: Pricking Pains are also felt in the Arms and Legs, the Palate of the Mouth being sometimes ulcerated. If it be an inveterate Pox, the Bones are corrupted, and Exostoses happen therein; divers Spots with dry, round and red Pustules appear in the Skin; and the Cartilages or Gristles of the Nose are sometimes eaten up. But when this Disease is come to its greatest height of Malignity, the Hair falls off; the Gums are ulcerated; the Teeth are loose, and drop out; the whole Body is dry'd up; the Eyes are livid; the Ears tingle; the Nose become stinking; the Almonds of the Ears swell; the Uvula or Palate is down; Ulcers break out in the Privy-Parts; Bubo's arise in the Groin; as also Warts in the Glans and Præputium; and Condyloma's in the Anus.

Indeed the Pox may be easily cur'd in the beginning; but when it hath taken deep Root by a long Continuance, it is not extirpated without much difficulty, more especially if it be accompany'd with Ulcers, Caries, and Exostoses; the Person afflicted with it being of an ill Constitution, and his Voice grown hoarse.

The Spring and Summer are the proper Seasons of the Year for undertaking the Cure of this Disease: In order to which, it is necessary that the Patient begin with a regular Diet, lodging in a warm place, and taking such Aliments as yield a good Juice; as Jelly-broath made with boil'd Fowl: Let him drink Sudorifick Decoctions, prepar'd with the Wood of Guayacum, China-Root, and Sarsaparella, and let him abstain from eating any thing that is high season'd: Let him take Clysters to keep his Body open; sometimes also he may be let Blood, and purg'd with half a Dram of Jalap, and fifteen Grains of Mercurius Dulcis. The Purgations may be re-iterated as often as it shall be judg'd convenient; and then the Patient may be bath'd for nine or ten Days, every Morning and Evening; during which time he may take volatile Salt of Vipers, the Dose being from six to sixteen Grains; or else Viper's-Grease from half a Dram to a whole Dram in Conserve of Roses.

Afterward it will be necessary to proceed to Fluxing, which is caus'd by the means of Frictions with Vuguentum Mercurii, which is made of crude Mercury stirr'd about in a Mortar with Turpentine, and then the whole mingled with Hog's-Grease, one part of Mercury being usually put into two parts of Hog's-Grease. The Rubbing is begun at the Sole of the Feet, by a long Continuance, it is not extirpated without ascending to the Legs, and the inside of the Thighs; but the Back-Bone must not be rubb'd at all; When the Persons are tender, or of a weak Constitution, a single Friction may be sometimes sufficient. Thus the Patient must be rubb'd at the Fire, after he hath taken a good Mess of Broath; but I would not advise it to be done with more than one or two Drams of Mercury at a time, without reckoning the Grease. Then the Patient must be dress'd with a Pair of Linnen-Drawers or Pantaloons, and laid in his Bed, where his Mouth may be lookt into from time to time, to see whether the Mercury hath taken effect; which may be easily known, by reason that his Tongue, Gums, and Palate swell and grow thick, his Head akes, his Breath is strong, his Face red, and he can scarce swallow his Spittle; or else he begins to Salivate.

If none of these Signs appear, the Rubbing must be begun again in the Morning and Evening; then if no Salivation be perceiv'd, for sometimes four or five Frictions are made successively, a little Mercurial Panacæa may be taken inwardly, to promote it. During the Frictions, the Patient is to be nourish'd with Eggs, Broaths, and Gellies; he must also keep his Bed in a warm Room, and never rise till it shall be thought fit to stop the Salivation, which continues twenty or twenty five Days; or rather till it becomes Laudable; that is to say, till it be no longer stinking, nor colour'd, but clear and fluid.

If a Looseness shou'd happen during the Salivation, it wou'd cease, so that to renew it, the Looseness may be stay'd with Clysters made of Milk and the Yolks of Eggs; and in case the Salivation shou'd not begin afresh, it must be excited with a slight Friction: But if it shoul'd be too violent, it may be diminish'd by some gentle Purge, or with four or five Grains of Aurum Fulminans, taken in Conserve of Roses.

Three or four Pints of Rheum are commonly salivated every Day in a Bason made for that purpose, which the Patient holds in his Bed near his Mouth, so as the Spittle may run into it. But if the Fluxing shou'd not cease of it self at the time when it ought, he must be purg'd to put a stop thereto. If any Ulcers remain in his Mouth, to dry 'em up, Gargarisms are to be often us'd, which are made of Barley-Water, Honey of Roses, or luke-warm Wine.

The Warts are cur'd by binding 'em, if a Ligature be possible, or else they may be consum'd with Causticks, such as the Powder of Savine, or Aqua-fortis, by corroding the neighbouring Parts; sometimes they are cut, left to bleed for a while, and bath'd with warm Wine.

When the Patient begins to rise, he must be purg'd, his Linnen, Bed, and Chamber being chang'd; and afterward his Strength is to be recruited with good Victuals, and generous Wine. If he were too much weaken'd, let him take Cow's-Milk with Saccharum Rosatum.

If the Pox were not inveterate, the Fluxing might be excited by the Panacæa alone, without any Frictions: For after the Phlebotomy, Purgations, and Bathings duly administer'd; the Patient might take ten Grains of the Mercurial Panacæa in the Morning, and as many at Night; on the next Day fifteen Grains might be given, and the like quantity at Night; on the third Day twenty Grains might be given both Morning and Evening; on the fourth Day twenty five Grains in the Morning, and as many at Night; and on the fifth Day thirty Grains in the Morning, and the very same quantity in the Evening; continuing thus to augment the Dose, till the Fluxing comes in abundance; and it may be maintain'd by giving every two or every three Days twelve Grains of the Panacæa. This Course must be continually follow'd till the Salivation becomes Laudable, and the Symptoms cease.

The manner of making the Mercurial Panacæa.
To prepare this Panacæa, it is requisite to take Mercury reviv'd from Cinnabar, because it is more pure than Mercury which is immediately dug out of the Mine. The Mercury is reviv'd with Cinnabar, after this manner: Take a Pound of artificial Cinnabar pulveriz'd, and mingled exactly with three Pounds of unslack'd Lime, in like manner beaten to Powder: Let this Mixture be put into a Retort of Stone, or Glass luted, the third part of which at least remains empty; Let it be plac'd in a reverberating Furnace; and after having fitted a Recipient fill'd with Water, let the whole be left during twenty four Hours at least; then let the Fire be put under it by degrees, and at length let the Heat be very much augmented, whereupon the Mercury will run Drop by Drop into the Recipient: Let the Fire be continu'd till nothing comes forth, and the Operation will be perform'd generally in six or seven Hours: Then pour the Water out of the Recipient, and having wash'd the Mercury, to cleanse it from some small quantity of Earth that may stick thereto, let it be dry'd with Cloaths, or else with the Crum of Bread: Thus thirteen Ounces of Mercury may be drawn off from every Pound of artificial Cinnabar.

The Panacæa is made of sweet Sublimate, and the later of corrosive Sublimate: To make the corrosive Sublimate, put sixteen Ounces of Mercury reviv'd from Cinnabar, into a Matrass, pour upon it eighteen Ounces of Spirit of Nitre; place the Matras upon the Sand, which must be somewhat hot, and leave it there till the Dissolution be effected: Then pour off this dissolved Liquor, which will be as clear as Water, into a Glass Vial, or into a Stone-Jug, and let its Moisture evaporate gently over the Sand-Fire, till a white Mass remains; which you may pulverize in a Glass Mortar, mingling it with sixteen Ounces of Vitriol calcin'd, and as much decrepited Salt: Put this Mixture into a Matras, two third parts of which remain empty, and the Neck of which hath been cut in the middle of its height; then fix the Matras in the Sand, and begin to kindle a gentle Fire underneath, which may be continu'd for three Hours; afterwards let Coals be thrown upon it till the Fire burn very vehemently, and a Sublimate will arise on the top of the Matras; so that the Operation may be perform'd within the space of six or seven Hours. Let the Matras be cool'd, and afterward broken; avoiding a kind of Flower or light Powder, which flyes up into the Air as soon as this Matter is remov'd; whereupon you'll find nineteen Ounces of very good corrosive Sublimate; but the red Scoria or Dross which settleth at the bottom must be cast away as unprofitable. This Sublimate being a powerful Escarotick, eats away proud Flesh, and is of singular use in cleansing old Ulcers. If half a Dram thereof be dissolv'd in a Pint of Lime-Water, it gives a yellow Tincture; and this is that which is call'd the Phagedonick-Water.

The sweet Sublimate, of which the Panacæa is immediately compos'd, is made with sixteen Ounces of corrosive Sublimate, pulveriz'd in a Marble or Glass-Mortar, intermixing with it by little and little, twelve Ounces of Mercury reviv'd from Cinnabar: Let this Mixture be stirr'd about with a Wooden Pestle, till the Quick-silver become imperceptible; then put the Powder, which will be of a grey Colour, into divers Glass-Vials, or into a Matras, of which two third parts remain empty; place your Vessel on the Sand, and kindle a small Fire in the beginning, the Heat of which may be afterward encreas'd to the third Degree: Let it continue in this Condition till the Sublimate be made; and the Operation will be generally consummated in four or five Hours: whereupon you may break your Vial, and throw away as useless, a little light Earth that lies at the bottom. You must also separate that which sticks to the Neck of the Vials, or of the Matras, and keep it for Ointments against the Itch; but carefully gather together the white Matter which lies in the middle, and having pulveriz'd it, cause it to be sublimated in the Vials or Matras, as before. This Matter must also be separated again (as we have already shown) and put into other Vials to be sublimated a third time. Lastly, the terrestrial parts in the bottom, and the fuliginous in the Neck of the Vials, must be, in like manner, separated, still preserving the Sublimate in the middle, which will then be very well dulcify'd, and amount to the quantity of twenty five Ounces and an half: It is an Efficacious Remedy for all sorts of Venereal Diseases; removes Obstructions, kills Worms, and purgeth gently by stool, being taken in Pills from six Grains to thirty.

Of the proper Composition of the Mercurial Panacæa.
Take what quantity you please of sweet Sublimate, reduce it to Powder in a Marble or Glass-Mortar, and put it into a Matras, three quarters whereof remain empty, and of which you have cut off the Neck in the middle of its Height: Then place this Matras in a Furnace or Balneum of Sand, and make a little Fire underneath for an Hour, to give a gentle Heat to the Matter, which may be augmented by little and little to the third degree: Let it continue in this state about five Hours, and the Matter will be sublimated within that space of time. Then let the Vessel cool, and break it, throwing away as unprofitable a little light sort of Earth, of a reddish Colour, which is found at the bottom, and separating all the Sublimate from the Glass. Afterward pulverize it a second time, and let it be sublimated in a Matras, as before: Thus the Sublimations must be reiterated seven several times, changing the Matrasses every time, and casting away the light Earth. Then having reduc'd your Sublimate to a very fine impalpable Powder, by grinding it upon a Porphyry or Marble Stone, put it into a Glass Cucurbite or Gourd, pour into it alkaliz'd Spirit of Wine to the height of four Fingers; cover the Cucurbite with its Head, and leave the Matter in Infusion during fifteen Days, stirring it about from time to time with an Ivory Spatula. Afterward set your Cucurbite in Balneo Mariæ, or in a Vaporous Bath, make fit a Recipient to the Mouth of the Alembick; lute the Joints exactly with a moistened Bladder, and cause all the Spirit of Wine to be destill'd with a moderate Fire: Let the Vessels be cool'd, and unluted, and the Panacæa will appear at the bottom of the Cucurbite. If it be not already dry enough, you may dry it up with a gentle Fire in the Sand, stirring it with an Ivory or Wooden Spatula in the Cucurbite it self till it be reduc'd to Powder. It may be kept for use in a Glass-Vessel, as a Remedy of very great Efficacy for all sorts of Venereal Diseases, as also for Obstructions, the Scurvy, Scrophula or Kings-Evil, Tettar, Scab, Scurf, Worms, Ascarides, inveterate Ulcers, &c. The Dose is from six Grains to two Scruples, in Conserve of Roses.

title: Compleat Surgeon/Wounds


text:
Compleat Surgeon/Bones

Of the Dislocation of the Bones.
What are the Diseases incident to the Bones?

They are five in number, viz. Dislocation, Fracture, Caries or Ulcer, Exostosis, and Nodus.

What is a Dislocation or Luxation?

It is the starting of the Head of one Bone out of the Cavity of another, with an Interdiction of the proper Motion of the Part: Or else it is the disjointing of two Bones united together for the Motion of a Part.

How many causes are there of Dislocation in general?

Two, that is to say, one violent, and the other gentle; thus the Dislocation is made violently in Falls, Strains, Knocks, and Blows; but it is done gently and slowly in Defluctions of Rheum; as also by an insensible gathering together of Humours between the Joints, and upon the Ligaments, the Relaxation or loosening of which gives occasion afterward to the Head of the Bone to go out of its place; whence this Consequence may well be drawn, viz. that a violent Dislocation usually depends upon an external Cause, and a gentle Dislocation upon an internal.

After how many manners doth a Dislocation happen?

Two several Ways; viz. the first is called compleat, total, and perfect; and the second incompleat, partial, and imperfect: But both may happen before, behind, on the inside, and without; and may also be simple or complicated.

What are the signs of a perfect, total, and compleat Dislocation?

It is when a hard Tumour or Swelling is perceiv'd near a Hole in the place of the Joint, great pain being felt in the Part, and the Motion of it abolish'd.

What are the signs of an imperfect, partial, and incompleat Dislocation?

It is when the Motion is streighten'd, and weaker than ordinary, so that some Pain is felt in the Joynt, and a Deformity may be discern'd therein, by comparing the hurt Part with the opposite which is found: This Dislocation is otherwise call'd a Sprain, when it proceeds from an external Cause; or else it is termed a Relaxation, when it happens by an internal.

What is a simple, and what is a complicated Dislocation or Luxation?

The Dislocation is properly simple, when it hath no concomitant Accidents; and it is complicated when accompany'd with some ill Symptoms or Accidents, such as Swellings, Inflammations, Wounds, Fractures, &c.

What are the means proper to be us'd in a simple Dislocation?

A speedy and simple reducing thereof, which is perform'd by stretching out the dislocated or luxated Member, and thrusting back the Head of the Bone into its natural place. Afterward the Joynt must be strengthen'd with a Fomentation made with Provence Roses, the Leaves of Wormwood, Rosemary, Camomile, St. John's-Wort, and Oak-Moss boil'd in the Lees of Wine and Forge-Water, keeping the Part well bound up, and sustain'd in a convenient situation. But if any ill Consequence is to be fear'd, apply Emplastrum Oxycroceum, or Diapalma dissolv'd in Wine.

What is to be done in a complicated Dislocation?

The Accidents must be first remov'd, and then the Bone may be set, which is impossible to be done otherwise; it being dangerous even to make an Attempt before, by reason of the too great Violence with which it is effected, and which would infallibly produce a Convulsion or a Gangrene.

If the Dislocation be accompany'd with a Wound, must the Wound be cur'd before any Endeavours are us'd to reduce it?

No, but the Symptoms of the Wound, which hinder the Operation, must be taken away, as the Swelling, Inflammation, and others of the like Nature; and then it may be reduc'd, and the Wound may be dress'd according to the usual Method.

If the Dislocation be complicated with the Fracture, what is to be done then?

It is necessary to begin with reducing of the Dislocation, and afterward to perform that of the Fracture, by reason of the Extension which must be made to reduce the Dislocation, which would absolutely hinder the Setling of the Fracture.

How is the Inflammation and Swelling to be asswag'd?

With Linnen Cloaths dipt in Brandy and common Water, which must be often renew'd; or else with the Tops of Wormwood and Camomile, with Sage and Rosemary boil'd in the Lees of Wine, wherein the Bolsters and Bands are to be steep'd. But all Repercussives and Astringents must be avoided.

How doth it appear that the Reduction is well perform'd?

By the Re-establishment of the Part in its natural State; by its being free from Pain; by its regular Motion; and by its conformity to the opposite Part which is found.

What Dislocations of Parts are most difficult to be reduc'd?

They are those of the Thighs with the Huckle-Bones, which are almost never perfectly set; that of the first Vertebra's is extremely difficult to be reduc'd; and those of the Lower-Jaw and Soles of the Feet are mortal.

The reducing of Dislocations is perform'd with greater facility in Infants than in Persons advanc'd in Years; but it becomes most difficult when it is deferr'd for many Days, by reason of the overflowing of the Lympha and nutritious Juice.

If an Inflammation shou'd happen before the Member is reduc'd, nothing can be done till it be allay'd, as we have already intimated; but to prevent and mitigate it, the dislocated Joynt, and the neighbouring Parts, may be bath'd with luke-warm Wine, in which hath been boil'd the Tops of St. John's-Wort, Camomile, Rosemary, Stœcas Arabica, and other Ingredients of the like Nature; the Bands must be also steept in the same Liquor.

If an Oedematous Tumour arise in the luxated Member after the Joint hath been set, it is requisite to take internal Sudorificks, and to apply Liniments made with the destill'd Oil of Tartar, and of Human Bones, which may be rectify'd with burnt Hart's Horn, or some other part of Animals, to take away its stink: Or else take yellow-Wax, and very white Rosin, melt the whole Mass, and put into it white Amber and Gum Elemi, a sufficient quantity of each to make a Composition to be incorporated with Balsam of Peru; a Plaister of which may be prepar'd, and apply'd to the dislocated Member; but the Plaister must not be laid a cross, lest it shou'd contract the Part too much. The whole Member may be also anointed with Oil of St. John's-Wort, or with the destill'd Oil of Turpentine; or rather with a simple Decoction of Nervous Plants in Wine.

If the Bone be put out of its place by a coagulated sort of Matter like Mortar or Plaister, Resolutives and Attenuants are to be us'd, such as the volatile Spirit of Tartar prepar'd with the Lees of Wine, volatile Spirit of Tartar destill'd with Nitre in a Retort with a long Neck, or Spirit of Tartar prepar'd by Fermentation with Tartar, and its proper Alkali: This last is the best of all, and the use thereof ought to be continu'd. The volatile Salt of Human Bones is also very efficacious; but it is necessary to begin first with the taking of Laxative and Sudorifick Medicines, appropriated according to the respective Circumstances. The Spirit of Earth-Worms may be also apply'd outwardly, which is made by Fermentation, and may be often laid on the Part either alone, or with the Spirit of Sal Ammoniack.

If a dislocated Bone be not set in good time, a Coagulum or kind of curdled Substance is form'd in the Cavity, which hinders the reducing of it to its place; but this Coagulum may be dissolv'd with the following Medicament, before you attempt to set the Bone. Take one part of the destill'd Oil of Human Bones, two parts of fœtid Oil of Tartar; mingle the whole, and add quick Lime to be destill'd in a Retort: Let the Parts be fomented with this Oil.

If the Dislocation happen'd by the Relaxation of the Ligaments, recourse may be had to universal Sudorificks taken inwardly; as also to such Medicines as are full of an unctuous and volatile Salt, particularly Aromatick Oils, and Spirit of Sal Ammoniack. In the mean while Aromaticks, Resolutives, and moderate Astringents may be apply'd outwardly.

Of the Fractures of Bones.
What is the Fracture of a Bone?

It is the Division of the Continuity of its Parts.

After how many different manners may a Bone be broken?

Three several ways, viz. cross-wise, side-wise, in its length, and perhaps in Shatters or Splinters.

By what means may a Bone be fractured?

It may happen to be done by three sorts of Instruments, viz. such as are fit for bruising, cutting, or wresting; that is to say, a Bone may be divided in the Continuity of its proper Parts, by Contusion, Incision, or Contorsion.

How is the Fracture of a Bone discover'd?

Divers ways, viz. by the ill Disposition of the Part, which becomes shorter; by its want of Motion; by its flexibility or pliantness elsewhere than in its Articulations; by the unevenness that may be perceiv'd in its Continuity; by the cracking which is heard; sometimes also by the shooting forth of one of its ends thro' the Flesh which it hath open'd; and lastly by a Comparison made thereof with the sound Part on the other side, as that of the Right Arm with the Left.

What kind of Fracture is most difficult to be discern'd?

It is that which happens in the length of the Bone, commonly call'd a Cleft or Fissure, which gives occasion to very great Symptoms when it is unknown: But it may be found out by the Pain and Swelling felt at the bottom of the Cleft in touching it; besides the Conjectures which may be made from the Relation of the Person who hath had a Fall, and might have heard the cracking of the Bone.

What sort of Fracture is most difficult to be cur'd?

The shattering or splitting of a Bone in Pieces, by reason of the great Number of Splints which daily cause new Pains and Suppurations.

What is a simple and what is a complicated Fracture?

The simple Fracture is that whereby the Bone is broken, without any other Accident; and the complicated Fracture is that which is follow'd by some Accident; as that in which there is a splitting of the Bone in pieces, or where the Bone is broken in two several places, or else when the Fracture is accompany'd with a Luxation, a Wound, an Inflammation, or other Circumstances of the like Nature.

Are old Men or Children most subject to these Fractures of the Bones?

Old Men, because their Bones are drier; whereas those of Infants are almost Cartilaginous, and yield or give way to the violence offer'd to 'em; from whence proceed the sinkings and hollowness that happen in their Skulls, especially in the Mould of their Heads, or elsewhere; for which a Remedy is found out by the means of Plaisters, Splints, and Bandages, fitted to the shape of the Parts. It is also on the same Account that Bones are more easily broken in the Winter than in the Summer.

In what Parts are the Fractures of Bones most dangerous?

They are those that happen in the Skull and Joints; in the former by reason of the Brain; and in the latter in regard of the Nervous Parts.

What Course is to be taken by a Surgeon who is sent for to cure a Fracture?

He ought to do three things, that is to say, at first he must incessantly endeavour to reduce it, to the end that Nature may re-unite the Parts with greater Facility, and that its Extremities may be brought together again with less trouble, before a Swelling, Inflammation, or Gangrene happen in the Part. Afterward he is to use means to retain the Parts in their proper Figure, and natural Situation, and to prevent all sorts of Accidents.

How is the setting of a broken Bone to be perform'd?

When the Fracture is Cross-wise, it must be reduc'd by Extension and contra-Extension; and when it is in length, the Coaptation or bringing together again of the Sides, is only necessary.

What is to be done in a Fracture complicated with a Wound?

The Operator must first reduce it, and then administer the other Helps, as in a simple Fracture.

How may it be known that the reducing of the Fracture is well perform'd?

When the Pain ceaseth; when the Part hath resum'd its natural Shape; when no Unevenness is any longer perceiv'd therein; and when it is conformable to the sound Part on the other side.

What are the Signs which shew that the Splints remain in the Fracture after it hath been reduc'd?

They are the secret and continual Workings of the Fibres, or twitchings, that are felt by Intervals in the Part, with great Pains, which are the Indications of an Abcess arising therein; and when a Wound is join'd to the Fracture, the Lips of it are puff'd up, and become more soft and pale, the purulent Matter abounding also more than ordinary.

When the Splints appear, must they be drawn out by force?

By no means; for great care ought to be taken to avoid all manner of violent Operations; it being requisite to wait for their going out with the purulent Matter; or at most to facilitate their Passage by the use of Injections of the Tincture of Myrrh and Aloes; by the application of Emplastrum Andreæ Crucii, and by the help of the Forceps.

How is a simple Fracture to be dress'd, after it hath been reduc'd?

The Parts are to be strengthen'd and consolidated with Liniments of Oleum Lumbricorum, or of Oil of St. John's-Wort mingled with Wine, Brandy, or Aqua-Vitæ; with Fomentations of Red Roses, Rosemary, and St. John's-Wort boil'd in Wine; and with Emplastrum contra Rupturam, or de Betonica, carefully wrapping up the broken Member, but after such a manner that the two Extremities may not cross one another; and that a small Space may remain open between both. Afterward the Splints and Bands are to be apply'd, taking care to avoid binding 'em too hard, and to take 'em off every three Days, in order to refit 'em, to abate troublesome Itchings, and to give Air to the Part; by these means preventing the Gangrene, which might happen by the Suffocation of the natural Heat. If the Thighs or Legs are broken, Scarves are to be us'd to support and stay 'em in the Bed.

What space of time may there be allow'd for curing the Fracture of a Bone?

The Cure will take up more or less time, according to the variety of the Parts, or the different thickness of the Bones: Thus to form the Callus of the broken Jaw-Bone, twenty Days may well be allotted; for that of the Clavicle, or that of the Shoulder-Bone, twenty four; for that of the Bones of the Elbow, thirty; for that of the Arm-Bone, forty; for that of the Wrist-Bone, and those of the Fingers, twenty; for that of the Ribs, twenty; for that of the Thigh-Bone, fifty; for that of the Leg-Bone, forty; for that of the Bones of the Tarsus and Toes, twenty.

What ought to be done in particular to promote the formation of the Callus?

The fractur'd Part must be rubb'd with Oleum Lumbricorum and Spirit of Wine heated and mingled together: The Decoctions of Agrimony, Sayine, and Saxifrage are also to be us'd, and the Lapis Osteocolla is a Specifick: It is usually given in great Comphrey-Water, or in a Decoction of Perewinkle made with Wine, and is often re-iterated.

Of the particular Fractures of the Skull.
What is a Fracture of the Cranium or Skull?

It is a Wound of the Head complicated with a Fracture of the Skull-Bone.

After how many manners may the Skull be fractur'd?

Three several ways, viz. by Contusion, by Incision, and by Puncture.

What is the most dangerous of these Fractures?

It is that which happens by Contusion; because the Concussion and Commotion is greater.

Do all the Fractures of the Skull require the use of the Trepan?

No, the Fractures must be deep which stand in need of the help of such an Instrument; for those that are superficial may be cur'd by a simple Exfoliation.

What is that deep Fracture, wherein the use of the Trepan is absolutely necessary?

It is that which is made in the two Tables of the Skull, penetrating to the Meninges of the Brain; upon which at that time the Blood is diffus'd, and must be taken away by the Operation of the Trepan.

How may it be discover'd that the two Tables of the Skull are broken?

By the Eyes, and by Ratiocination.

Are not the Eyes sufficient alone, and are they not more certain than Ratiocination?

Yes; but forasmuch as things are not always seen, there is often a necessity of making use of rational Deductions to find out that which the Eyes cannot discern.

When doth it happen that the Eyes alone discover the Fracture?

When the Wound is large and wide, so that it may be immediately view'd.

When doth it happen that Ratiocination supplies the defect of the Eyes?

When the Wound is so small that the Bone cannot be seen, and nothing appears but the Accidents.

What are the Accidents or Signs of the Fracture of the Skull?

They are a dimmness of the Sight, and loss of the Understanding, which happen at the very Moment when the Fall or Blow is receiv'd; with the Phlegmatick Vomittings that follow soon after: These Signs are call'd Univocal. And there are others that bear the Name of Equivocal, and which confirm the former; as a Flux of Blood thro' the Nose, Eyes, and Ears, redness of the Eyes, heaviness of the Head, and puffing up of the Face; as also afterward Drowsiness, Shivering of the whole Body, Fever, Deliriums, Convulsions, &c.

Must all these Signs appear before a Determination can be made of the necessity of using the Trepan?

No, it is sufficient to have the Univocal Signs to make a Crucial Incision in the place of the Wound, and to lay bare the Bone, in order to observe the Fracture, which sometimes is so fine, that the Operator is oblig'd to make use of Ink, which insinuates it self into the Cleft, and of a particular Instrument, with which the black Line that hath penetrated to the bottom, cannot be rubb'd out; whereas it may be easily defac'd when the Fracture is only superficial.

How long time is commonly spent before the appearing of the Accidents?

In the Summer Season they appear in three or four Days, and at the latest in seven; in Winter they are slower, and sometimes do not happen till the fourteenth Day: But at the end of this term, it may be affirm'd that the Trepan is often unprofitable.

What is requisite to be done in a doubtful Occasion; Must the Trepan be apply'd or omitted?

The Surgeon is to have recourse to his own conscientious Discretion, which ought to serve as a Guide, and requires that we should always act according to the known Rules of Art; insomuch that after having well consider'd the Accidents, with all the Circumstances of the Wound, if there be no good grounds for the undertaking of the Operation, it is expedient to desist, and in this case to have deference to the Advice of other able Surgeons of the same Society, rather than to rely too much upon his own Judgment, to the end that he may be always secure from all manner of Blame.

Is the Trepan apply'd upon the Fracture?

No; but on one side of it, and always in a firm place.

What Course is to be taken when a Fracture is found in a Suture?

A double Trepan is to be made, and apply'd on each side of the Suture, by reason of the overflowing of the Blood, which may happen therein.

What Method ought to be observ'd in the curing of the Wounds of the Head, and Fractures of the Skull?

In simple Wounds of the Head, it is necessary only to make use of Balsams, and to lay over 'em Emplastrum de Betonica. When there is a Contusion either in the Pericranium, or in the Skull, the Wound must be kept open till after the Suppuration or Exfoliation.

When there is only a Bunch without any Wound or Accident, it must speedily be dissolv'd with Plaister or Mortar, Chimney-Soot, Oil of Olives, and Wine, laid upon the Part between two Linnen-Rags; or else with Soot, Spirit of Wine, and Oil of St. John's-Wort, wherein the Bolsters are soakt, to be in like manner apply'd with a Band.

Wounds of the Head accompany'd with a Fracture, absolutely require the application of the Trepan, wherein it is requisite to make use of Oil of Turpentine to be dropt upon the Membrane of the Brain; or else Spirit of Wine mingled with Oil of Almonds, and not with the Oil or Syrrup of Roses; and to endeavour to cause a plentiful outward Suppuration.

Besides, it must not be neglected to enjoyn the wounded Person to be let Blood both before and after the Operation, if he hath a Fever or a Plethory; and more especially it is to be remember'd to cause his Body to be kept open at least every other Day, with Clysters, obliging him to keep a good Diet, and to avoid all violent Agitations both of Body and Mind, abstaining from eating Flesh till the Fourteenth Day. All manner of Venery and Conjugal Embraces, which prove fatal at this time, are to be prohibited during forty Days, to be counted from the Day of the Operation; as they are also in all other considerable Wounds.

Of the Caries or Ulcer of the Bones, Exostosis, and Nodus.
What is Caries?

It is the Putrifaction of the Substance of the Bone, or else its Ulcer or Gangrene.

Whence doth the Caries of the Bone derive its Original?

It proceeds from an internal and external Cause; the former being that which hath been produc'd at first in the Substance of the Bone; and the other that which takes its Rise from an inveterate Ulcer in the Flesh, which hath communicated its Malignity to the Substance of the Bone, and by that means corrupted it.

How is the Caries known which proceeds from an inward Cause?

By the continual and violent Pains which are felt before, and continue for a long time without diminution; as also afterward by the alteration of the Flesh that covers the Bone, and which becomes soft, spongy, and livid.

By what means is a Caries that derives its Origine from an outward Cause, discover'd?

By the quality of the purulent Matter that issueth out of the Ulcer in the Flesh, which is blackish, Unctuous, and extremely stinking; as also by the help of the Probe, that discovereth asperity or roughness in the Bone when it is laid bare.

What Means are to be us'd in order to cure a Caries proceeding from an external Cause?

The Powder of Flower-de-luce may be us'd, and it is sufficient for that purpose, when the Caries is superficial; but it is necessary to take Oleum Guyaci, and to soak Bolsters therein, to be laid upon the Ulcer when it is deep; or else Aqua-Vitæ or Brandy, in which have been infus'd the Roots of Flower-de-luce, Cinnamon, and Cloves. Lastly, the actual Cautery, which is Fire, must be apply'd thereto.

What is to be done when the Caries proceeds from an internal Cause?

The Flesh must be open'd to give Passage to the Sanies that runs out of the ulcerated Bone, to the end that Exfoliation may be procur'd; and if the Ulcer hath not as yet laid open the Bone on the outside, the Trepan ought to be apply'd; but the Ulcer or Caries must be afterward handled, as we have even now declar'd.

What is Exostosis?

It is the Swelling of a Bone made by the settling of a corrupt Humour in its proper Substance.

What is Nodus?

It is a kind of gummy and wavering Tumour, which is form'd by the settling of a gross Humour between the Bone and the Periosteum.

Are Exostoses and Nodus's suppurable Tumours?

Yes, because they sometimes produce Ulcers and Gangrenes in the Bone, which are call'd Caries, proceeding from an internal Cause; nevertheless they are generally dissolv'd by Frictions with Unguentum Griseum, or by the application of Plaisters of Tobacco, or Emplastrum de Vigo quadruplicato Mercurio; taking also to the same purpose internal Diaphoretick and Sudorifick Medicines, with convenient Purgatives.

Of Cauteries, Vesicatories, Setons, Cupping-Glasses, and Leeches.
What is a Vesicatory?

The Name of Vesicatory may be attributed to every thing that is capable of raising Bladders or Blisters in the Skin; nevertheless in Surgery, by a Vesicatory is understood a Medicament prepar'd with Cantharides or Spanish Flies dried, which are beaten to Powder, and mingled with Turpentine, Plaisters, Leaven, and other Ingredients.

In what places, and after what manner are Vesicatories usually apply'd?

They are apply'd every where, accordingly as there is occasion to draw out or discharge some Humour from a Part: In Defluxions of Rheum upon the Eyes or Teeth, they are laid on the Neck and Temples; in Apoplexies, behind the Ears; and so of the rest, observing always to make Frictions on the places where the Application is to be made, to the end that the Vesicatory may sooner take effect.

How long time must the Vesicatory continue on the Part?

The Blisters are generally rais'd by 'em within the space of five or six Hours; yet this Operation depends more or less upon the fineness of the Skin; and when the Bladders or Blisters appear, it is requisite to deferr the openning of 'em for some time, to the end that Nature may have an Opportunity to introduce a new Scarf-Skin, by which means the Pain may be avoided that would be felt, if the Skin were too much expos'd to the Air.

What is a Cautery?

It is a Composition made of many Ingredients, which corrode, burn, and make an Escar on the Part to which they are apply'd.

How many sorts of Cauteries are there in general?

There are two kinds, viz. the Actual and the Potential; the former are those that have an immediate Operation; as Fire, or a red-hot Iron; and the others are those that produce the same Effect, but in a longer space of time; such are the ordinary Cauteries compos'd of Caustick Medicaments.

Which are the most safe, the Actual or the Potential Cauteries?

A distinction is to be made herein; for Actual Cauteries are safest in the Operation, because they may be apply'd wheresoever one shall think fit, as also for as long a time, or for any purpose: Whereas the Potential cannot be guided after the same manner. But in Hæmorrhages the Potential Cauteries are most eligible, by reason that the Escar produc'd by 'em not being so speedily form'd, the Vessels are better clos'd, and they are not so subject to open again when it falls off; as it often happens in the Fall of an Escar made by Fire.

In what places are Cauteries usually apply'd?

In all places where an Attraction is to be made, or an Intemperature to be corrected, or a Flux of Humours to be stopt, by inducing an Escar on the Part: However they are commonly laid upon the Nape of the Neck, between the first and second Vertebra; on the outward Part of the Arm in a small Hole between the Muscle Deltoides and the Biceps; above the Thigh, between the Muscle Sartor, and the Vastus Internus; and on the inside of the Knee, below the Flexors of the Leg; observing every where that the Cautery be plac'd near the great Vessels, to the end that it may draw out and cleanse more abundantly.

What is the Composition of the Potential Cauteries?

They may be made with quick Lime, Soap, and Chimney-Soot; or else take an Ounce of Sal Ammoniack, two Ounces of burnt Roman Vitriol, three Ounces of quick Lime, and as many of calcin'd Tartar; mingle the whole Mass together in a Lixivium of Bean-Cod Ashes, and cause it to evaporate gently to a Consistence: Let this Paste be kept for use in a dry place, and in a well-stopt Vessel. Or else the Silver-Cautery, or Lapis Infernalis may be prepar'd after the following manner:

Take what quantity you please of Silver, let it be dissolv'd with thrice as much Spirit of Nitre in a Vial, and set the Vial upon the Sand-Fire, to the end that two third parts of its Moisture may evaporate: Then pour the rest scalding-hot into a good Crucible, plac'd over a gentle Fire, and the Ebullition being made, the heat of the Fire must be augmented, till the Matter sink to the bottom, which will become as it were an Oil: Afterward pour it into a somewhat thick and hot Mould, and it will coagulate, so as to be fit for Use, if it be kept in a well-stopt Vial. This Cautery is the best; and an Ounce of Silver will yield one Ounce and five Drams of Lapis Infernalis.

What is a Seton?

It is a String of Silk, Thread, or Cotton, threaded thro' a kind of Pack-Needle, with which the Skin of a Part is to be pierc'd thro', to make an Ulcer therein, that hath almost the same effect as a Cautery.

What is most remarkable in the Application of a Seton?

It ought to be observ'd, that the String must be dipt in Oil of Roses, and that one end of it must always be kept longer than the other, to facilitate the running of the Humours.

In what Parts is the Seton to be apply'd?

The Nape of the Neck is the usual place of its Application, altho' it may be made in any part of the Body where it is necessary. It sometimes happens that a Surgeon is oblig'd to use a kind of Seton in such Wounds made with a Sword, or by Gun-shot, as pass quite thro' from one side to the other; then the String or Skain must be dipt in convenient Ointments or Medicinal Compositions; and as often as the Dressings are taken away, it will be requisite to cut off the Part soakt in the Purulent Matter, which must be taken out of the Ulcer.

What is a Cupping-Glass?

It is a Vessel or kind of Vial, made with Glass, the bottom whereof is somewhat broader than the top, which is apply'd to the Skin to cause an Attraction. There are two sorts of these Cupping-Glasses, viz, the Dry, and the Wet; the former are those that are laid upon the Skin without opening it; and the latter those that are apply'd with Scarification.

In what Diseases are Cupping-Glasses us'd?

In all kinds where it is necessary to make any Attraction; but more especially in Apoplexies, Vapours in Women, Palsies, and other Distempers of the like Nature. But the Applications of Cupping-Glasses are altogether different; for in Apoplexes they are generally set upon the Shoulders or upon the Coccyx; in Vapours upon the inside of the Thighs; and in Palsies upon the Paralytick Part it self.

What is a Leech?

It is an Animal like a little Worm which sucks the Blood, and is commonly apply'd to Children and weak Persons, to serve instead of Phlebotomy: Leeches are also us'd for the discharging of a Defluxion of Humours in any Part; as also in the Hæmorrhoidal Veins when they are too full; in the Varices and in several parts of the Face.

What choice ought to be made of Leeches?

It is requisite to take those that have their Backs greenish, and their Bellies red; as also to seek for 'em in a clear running Stream, and to cast away those that are black and hairy.

Of Phlebotomy.
What is Phlebotomy?

It is an evacuation of Blood procur'd by the artificial Incision of a Vein or Artery, with a design to restore Health.

Which are the Vessels that are open'd in Phlebotomy or Blood-letting?

They are in general all the Veins and Arteries of the Body, nevertheless some of 'em are more especially appropriated to this Operation; as the Vena Præparata in the Forehead; the Ranulæ under the Tongue; the Jugular Veins and Arteries in the Neck; the Temporal Arteries in the Temples; the Cephalick, Median, and Basilick Veins in the inside of the Elbow; the Salvatella between the Ring-Finger and the Little-Finger; the Poplitæa in the Ham; the Saphena in the internal Malleolus or Ankle; and the Ischiatica in the external.

What are the Conditions requisite in the due performing of the Operation of Phlebotomy?

They are these, viz. to make choice of a proper Vessel; not to open any at all Adventures; not to let Blood without necessity, nor without the Advice of a Physician; whose Office it is to determine the Seasons or Times convenient for that purpose; as that of Intermission in an Intermitting Fever; that of Cooling in the Summer; and that of Noon-tide in the Winter; and lastly, to take away different quantities of Blood; for in the Heat of Summer they ought to be lesser, and greater in the Winter.

What are the Accidents of Phlebotomy?

They are an Impostume, a Rhombus, an Echymosis, an Aneurism, Lipothymy, Swooning, and a Convulsion.

What is a Rhombus?

It is a small Tumour of the Blood which happens in the place where the Operation is perform'd either by making the Orifice too small, or larger than the Capaciousness of the Vessel will admit. The Rhombus is cur'd by laying upon it a Bolster dipt in fair Water, between the Folds of which must be put a little Salt, to dissolve and prevent the Suppuration.

How may it be perceiv'd that an Artery hath been prickt or open'd in letting Blood?

The Puncture of an Artery produceth an Aneurism; and the Opening of it causeth a Flux of Vermilion Colour'd Blood, which issueth forth in abundance, and by Leaps.

Are the Leaps which the Blood makes in running, a certain Sign that it comes from an Artery?

No, because it may so happen, that the Basilick Vein lies directly upon an Artery, the beating of which may cause the Blood of the Basilica to run out leaping: Therefore these three Circumstances ought to be consider'd jointly, that is to say, the Vermilion Colour, the great quantity and the Leaps, in order to be assur'd that the Blood proceeds from an Artery.

How may it be discover'd that a Tendon hath been hurt in letting Blood?

It is known when in opening the Median Vein, the end of the Lancet hath met with some Resistance; when the Patient hath felt great Pain, and afterward when the Tendon apparently begins to be puff'd up, and the Arm to swell. A Remedy may be apply'd to this Accident thus; after having finish'd the Operation, a Bolster steep'd in Oxycratum is to be laid upon the Vessel, a proper Bandage is to be made, and the Arm must be wrapt up in a Scarf: If the Inflammation that ariseth in the Part be follow'd with Suppuration, it must be dress'd with a small Tent; and if the Suppuration be considerable, it is necessary to dilate the Wound, and to make use of Oil of Eggs and Brandy, or Arcæus's Liniment, with a good Digestive; as also to apply Emplastrum Ceratum; to make an Embrocation on the Arm with Oil of Roses; and to dip the Bolsters in Oxycratum to cover the whole Part.

Is it not to be fear'd that some Nerve may be wounded in letting Blood?

No, they lie so deep that they cannot be touch'd.

Under what Vein is the Artery of the Arm?

It is usually situated under the Basilica.

What Course is proper to be taken to avoid the Puncture of an Artery in letting Blood?

It must be felt with the Hand before the Ligature is made, observing well whether it be deep or superficial; for when it lies deep, there is nothing to be fear'd; and when it is superficial, it may be easily avoided by pricking the Vein either higher or lower.

What is to be done when an Artery is open'd?

If it be well open'd, it is requisite to let the Blood run out till the Person falls into a Syncope or Swoon, by which means the Aneurism is prevented; and afterward the Blood will be more easily stopt: It remains only to make a good Bandage with many Bolsters, in the first of which is simply put a Counter or a Piece of Money; but a bit of Paper chew'd will serve much better, with Bolsters laid upon it in several Folds.

If the Arteries cause so much trouble when open'd accidentally, why are those of the Temples sometimes open'd on purpose, to asswage violent Pains in the Head?

By reason that in this place the Arteries are situated upon the Bones that press 'em behind; which very much facilitates their re-union.

Are not the Arteries of Persons advanc'd in Years more difficult to be clos'd than those of Children?

Yes.

Are there not Accidents to be fear'd in letting Blood in the Foot?

Much less than in the Arm; because the Veins of the Malleoli or Ankles are not accompany'd either with Arteries or Tendons; which gave occasion to the Saying, That the Arm must be given to be let Blood only to an able Surgeon, but the Foot may be afforded to a young Practitioner.

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title: Compleat Surgeon/Bones