Transcriber's note: A few typographical errors have been corrected. They appear in the text like this, and the explanation will appear when the mouse pointer is moved over the marked passage.

T H E

Compleat Surgeon:

O R ,

The whole Art of Surgery explain'd in a moſt familiar Method.

Containing

An exact Account of its Principles and ſeveral Parts, viz. Of the Bones, Muſcles, Tumours, Ulcers, and Wounds ſimple and complicated, or thoſe by Gun-ſhot; as alſo of Venereal Diſeaſes, the Scurvy, Fractures, Luxations, and all ſorts of Chirurgical Operations; together with their proper Bandages and Dreſſings.

To which is added,

A Chirurgical Diſpenſatory; ſhewing the manner how to prepare all ſuch Medicines as are moſt neceſſary for a Surgeon, and particularly the Mercurial Panacæa.



Written in French by M. le Clerc, Phyſician in Ordinary, and Privy-Counſellor to the French King; and faithfully tranſlated into Engliſh.



L O N D O N,

Printed for M. Gillyflower, in Weſtminſter-Hall; T. Goodwin, and M. Wotton, in Fleet-ſtreet; J. Walthoe, in the Middle-Temple Cloyſters; and R. Parker, under the Royal-Exchange, in Cornhill, 1696.



T H E

P R E F A C E.

So great a number of Treatiſes of Surgery, as well Ancient as Modern, have been already publiſh'd, that a plenary Satisfaction ſeems to have been long ſince given on this Subject, even to the Judgment of the moſt curious Inquirers: But if it be conſider'd that a young Surgeon ought always to have in view the firſt Principles of this Noble Art explain'd after a familiar and intelligible manner, it will be ſoon acknowledg'd that there is good reaſon to ſet about the Work anew: For beſides that the Writings of the Ancients being ſo voluminous, are not portable, they are alſo very intricate and confus'd; nay the whole Art has been ſo far improv'd and brought to perfection by able Maſters in the preſent Age, that they are now almoſt become unprofitable.

Some Modern authors have ſet forth certain ſmall Tracts, which only explain a few Chirurgical Operations, and on that account deſerve only the Name of Fragments. Indeed the Works of ſome others ſeem to be ſufficiently compleat, but are printed in ſo large Volumes, and contain ſo many Diſcourſes altogether foreign from the principal Subject, that they have almoſt the ſame Inconveniences with thoſe of the Ancients. Therefore the Reader is here preſented with a ſmall Treatiſe of Surgery, yet very plain and perſpicuous, in a portable Volume; being free from a Multiplicity of impertinent Words, and containing every thing of moment that has been producd by the moſt approv'd Authors both Ancient and Modern.

An Introduction is made into the Matter by ſmall Colloquies or Dialogues, to the end that the young Student may be at firſt lead as it were by the Hand; but as ſoon as he has attain'd to a conſiderable Progreſs in theſe Studies, this innocent and puerile manner of ſpeaking is abandon'd, to conduct him in good earneſt to the moſt ſublime Heights of ſo admirable an Art; to which purpoſe, after having penetrated into its firſt Rudiments and Grounds, he is well inſtructed in Anatomy, and furniſh'd with a general Idea of Wounds and Tumours, which are afterward treated of in particular: He is alſo taught a good Method of curing Wounds made by Gun-ſhot, the Scurvy, and all ſorts of Venereal Diſeaſes: From thence he is introduced into the Practice of all manner of Chirurgical Operations in Fractures and Luxations; together with the uſe of their reſpective Dreſſings and Bandages.

At the end of the Work is added a compleat Chirurgical Diſpenſatory, ſhewing the Method of preparing ſuch Medicinal Compoſitions as are chiefly us'd in the Art of Surgery; ſo that upon the whole Matter, it may be juſtly affirm'd, that this little Manual has all the Advantages of the Ancient and Modern Writings on the ſame Subject, and is altogether free from their Superfluities and Defects.



{1}

T H E

Compleat Surgeon:

O R , T H E

Whole A R T

O F

S U R G E R Y

Explain'd, &c.



C H A P. I.

Of the Qualifications of a Surgeon, and of the Art of Surgery.

Who is a Surgeon?

A Perſon skill'd in curing Diſeaſes incident to Humane Bodies by a methodical Application of the Hand.

What are the Qualifications of a good Surgeon in general?

{2}

They are three in Number: viz. Skill in the Theory, Experience in the Practical part, and a gentle Application of the Hand.

Why ought a Surgeon to be skilful?

Becauſe without a diſcerning Faculty he can have no certainty in what he doth.

Why muſt he be experienc'd?

Becauſe Knowledge alone doth not endue him with a dexterity of Hand requiſite in ſuch a Perſon, which cannot be acquir'd but by Experience, and repeated Manual Operations.

Why muſt he be tender-handed?

To the End that by fit Applications he may aſſwage thoſe Pains which he is oblig'd to cauſe his Patients to endure.

What is Chirurgery or Surgery?

It is an Art which ſhews how to cure the Diſeaſes of Humane Bodies by a methodical Manual Application. The Term being derived from the Greek Word Χεὶρ, ſignifying a Hand and Ἔργον, a Work or Operation.

After how many manners are Chirurgical Operations uſually perform'd?

Four ſeveral ways.

Which be they?

I. Syntheſis, whereby the divided Parts are re-united; as in Wounds. II. Diæreſis, that divides and ſeparates thoſe Parts, which, by their Union, hinder the Cure of Diſeaſes, ſuch is the continuity of Abſceſſes or Impoſtumes which muſt be open'd to let out the purulent Matter. III. Exæreſis, which draws out of the Body whatſoever is noxious or hurtful, as Bullets, Arrows, &c. IV. Proſtheſis adds ſome Inſtrument or Body to ſupply {3}the defect of thoſe that are wanting; ſuch are Artificial Legs and Arms, when the Natural ones are loſt. It alſo furniſhes us with certain Inſtruments to help and ſtrengthen weak Parts, ſuch as Peſſaries, which retain the Matrix in its proper place when it is fallen, Crutches to aſſiſt feeble Perſons in going, &c.

What ought to be chiefly obſerved before the undertaking an Operation?

Four things; viz. 1. What the Operation to be perform'd is? 2. Why it is perform'd? 3. Whether it be neceſſary or poſſible? And 4. The manner of performing it.

How may we diſcern theſe?

The Operation to be perform'd may be known by its Definition; that is to ſay, by explaining what it is in it ſelf: We may diſcover whether it ought to be done, by examining whether the Diſtemper cannot be cur'd otherwiſe: We may alſo judge whether it be poſſible or neceſſary, by a competent Knowledge of the Nature of the Diſeaſe, the Strength of the Patient, and the Part affected: Laſtly, the manner of performing it may be found out, by being well vers'd in the Practice of Surgery.

What are the Fundamental Principles of Surgery?

They are Three in number: viz. 1. The knowledge of Man's Body. 2. That of the Diſeaſes which require a Manual Operation. 3. That of proper Remedies and Helps upon every Occaſion.

How may one attain to the Knowledge of Humane Bodies? {4}

By the ſtudy of Anatomy.

How may one learn to know the Diſtempers relating to Surgery, and the Remedies appropriated for them?

Two ſeveral ways; viz. 1. By the reading of good Books, and Inſtructions receiv'd from able Maſters of that Art. 2. By practice and the Obſervation of what is perform'd by others upon the Bodies of their Patients.

What are the Diſeaſes in general that belong to Surgery?

They are Tumours, Impoſtumes, Wounds, Ulcers, Fractures, Diſlocations, and generally all ſorts of Diſtempers whereto Manual Operations may be applyed.

What are the Inſtruments in general which are commonly uſed in Surgery for the curing of Diſeaſes?

They are Five; viz. the Hand, Bandages, Medicines, the Inciſion-Knife, and Fire.

What is the general Practice which ought to be obſerv'd in the Application of theſe different helps?

Hippocrates teacheth us, in ſaying, that when Medicines are not ſufficient, recourſe may be had to the Inciſion-Knife, and afterward to Fire; intimating that we muſt proceed by degrees.

Are there any Diſtempers that may be cured by the Surgeon's Hand alone?

Yes, as when a ſimple and ſmall Diſlocation is only to be reduced.



{5}

C H A P.  II.

Of Chirurgical Inſtruments, portable and not portable.

What do you call portable and not portable Inſtruments?

Portable Inſtruments are thoſe which the Surgeon carries in his Lancet-Caſe with his Plaiſter-Box; and not portable are thoſe that he doth not carry about him, but is oblig'd to keep at home; the former being appointed for the ready help which he daily adminiſters to his Patients, and the others for greater Operations.

What are the Inſtruments which a Surgeon ought to have in his Plaiſter-Box?

Theſe Inſtruments are a good pair of Sizzers, a Razor, an Inciſion-Knife ſtreight and crooked, a Spatula, a greater Lancet to open Impoſtumes, and leſſer for letting Blood. They likewiſe carry ſeparately in very neat Lancet-Caſes, a hollow Probe made of Silver or fine Steel; as alſo many other Probes, ſtreight, crooked, folding, and of different thickneſs; a Pipe of Silver or fine Steel, to convey the cauterizing Button to a remote Part, without running the hazard of burning thoſe that are near it; another Pipe or Tube ſerving inſtead of a Caſe for Needles, which have Eyes at one end for ſowing; a Carlet, or thick triangular Needle; a ſmall File; a Steel Inſtrument to cleanſe the Teeth; a {6}Fleam; a pair of crooked Forceps to draw a Tooth; a Pelican; a Crow's Bill; ſeveral ſorts of Raſpatories; a Hook to hold up the Skin in cutting, &c.

What are the Inſtruments which a Surgeon ought to keep in his Repoſitory to perform the greater Operations?

Some of them are peculiar to certain Operations, and others are common to all. The Inſtruments appropriated to particular Operations, are the Trepan for opening the Bones in the Head, or elſewhere: The Catheters or Probes for Men and Women afflicted with the Stone, or difficulty of making Water. Extractors, to lay hold on the Stone in Lithotomy, and to gather together the Gravel; large crooked Inciſion-Knives, and a Saw, to make Amputations of the Arms or Legs; great Needles with three Edges, to be uſed in making Setons; ſmall Needles to couch Cataracts; other Needles; thin Plates and Buckles to cloſe a Hair-Lip, &c.

May not the Salvatory be reckon'd among the portable Inſtruments?

Yes, becauſe the Balſams, Ointments, and Plaiſters contain'd therein, are means whereof the Surgeon makes uſe to reſtore Health.



{7}

C H A P.  III.

Of Anatomy in general; and in particular of all the Parts whereof the Humane Body is compos'd.

What is Anatomy?

It is the Analyſis or exact Diviſion of all the Parts of a Body, to diſcover their Nature and Original.

What is requiſite to be obſerv'd by a Surgeon before he goes about to diſſect a Body?

Two things; viz. The external Structure of the Body, and the Proportion or Correſpondence between the outward Parts, and thoſe that are within.

Why ſo?

Becauſe without this exterior and general Knowledge, the Surgeon wou'd be often miſtaken in the Judgment he is to paſs concerning a Diſlocation or Wound, inaſmuch as it is by the Deformity which he perceives in the Member, that he knows the Diſlocation, as it is alſo by the means of the Correſpondence which the outward Parts have with the inward, that he is enabled to draw any certain Conſequences relating to a Wound, which penetrates into the Body.

What is a Part?

It is that whereof the whole Body is compos'd, and which partakes of a common Life or Senſation with it. {8}

How many ſorts of Parts are there in a Humane Body?

We may well reckon up Fifteen diſtinct Parts, which are the Bone, the Cartilage, the Ligament, the Tendon, the Membrane, the Fibre, the Nerve, the Vein, the Artery, the Fleſh, the Fat, the Skin, the Scarf-Skin, the Hair, and the Nails.

What is a Bone?

It is the hardeſt and drieſt Part of the whole Body, and that which conſtitutes its principal Support.

What is a Cartilage or Griſtle?

It is a yielding and ſupple Part, which partakes of the Nature of a Bone, and is always faſten'd to its Extremities, to mollifie and facilitate its Motion.

What is a Ligament?

It is a Membranous Contexture uſually ſticking to the Bones to contain them; as alſo ſometimes to other Parts, to ſuſpend, and retain them in their proper place.

What is a Tendon?

It is the Tail or Extremity of the Muſcles, made by the re-union of all the Fibres of their Body, which ſerves to corroborate it in its Action, and to give Motion to the Part.

What is a Membrane?

It is a Nervous Part, the uſe whereof is to adorn and ſecure the Cavities of the Body on the inſide, and to wrap up or cover the Parts.

What is a Fibre?

They are fleſhy Lines of which the Body of a Muſcle is compos'd.

What is a Nerve?

It is a long, white, and thin Body, conſiſting {9}of many Fibres, enclos'd within a double Tunick, and deſign'd to carry the Animal Spirits into all the Parts, to give them Senſe and Motion.

What is an Artery?

It is a Canal compos'd of Four Coats, that carreyth with a kind of Beating or Pulſe even to the very Extremity of the Parts, the Blood full of Spirits, which proceeds from the Heart, to diſtribute to them at the ſame time both Life and Nouriſhment.

What is a Vein?

It is a Canal made likewiſe of Four Tunicles, which receives the Arterial Blood, to carry it back to the Heart.

What is Fleſh?

It is a Part which is form'd of Blood thicken'd by the natural Heat; and that conſtitutes the Body of a Muſcle.

What is Fat?

It is a ſoft Body made of the Unctuous and Sulphurous part of the Blood.

What is the Derma or Skin?

It is a Net compos'd of Fibres, Veins, Arteries, Lymphatick Veſſels and Nerves, which covers the whole Body to defend it from the Injuries of the Air, and to ſerve as a univerſal Emunctory: It is very thin in the Face, ſticking cloſe to the Fleſh, and is pierc'd with an infinite number of imperceptible Pores, affording a Paſſage to inſenſible Tranſpiration.

What is the Epiderma, or Scarf-Skin?

It is a ſmall fine Skin, tranſparent and inſenſible, having alſo innumerable Pores for the diſcharging of Sweat, and other Humours by {10}imperceptible Tranſpiration: It is extended over the whole inner Skin, to dull its too exquiſite Senſe, by covering the Extremities of the Nerves which are there terminated. It alſo renders the ſame Skin even and ſmooth, and ſo contributes very much to Beauty.

What is the Hair?

The Hairs are certain hollow Filaments planted in the Glandules of the Skin, from whence their Nouriſhment is deriv'd. They conſtitute the Ornament of ſome Parts, cover thoſe which Modeſty requires to be conceal'd, and defend others from the injury of the Weather.

What is a Nail?

The Nails are a Continuity of the Skin harden'd at the end of the Fingers, to ſtrengthen and render them fit for Work.



C H A P.  IV.

Of the general Diviſion of a Humane Body.

How is the Humane Body divided before it is diſſected, in order to Anatomical Demonſtration?

Some Anatomiſts diſtinguiſh it into Similar and Diſſimilar Parts, appropriating the former Denomination to all the ſimple Parts of the Body taken ſeparately, as a Bone, a Vein, a Nerve, &c. but they attribute the Name of Diſſimilar to all thoſe Members that are compos'd of many Similar or Simple Parts together; ſuch are the Arms, {11}Legs, Eyes, &c. wherein are contain'd all at once, Bones, Veins, Nerves, and other parts.

Others divide it into containing and contained Parts, the former encloſing the others, as the Skull includes the Brain, and the Breaſt the Lungs; whereas the contained Parts are ſhut up within others; as the Entrails within the Belly, the Brain within the Skull, &c.

Others again divide the whole Body into Spermatick and Sanguineous Parts; the former being thoſe which are made at the time of Formation; and the latter all thoſe that are grown afterward by the Nouriſhment of the Blood.

Are there not alſo other Methods of dividing the Humane Body?

Yes: Many Perſons conſider it as a Contexture of Bones, Fleſh, Veſſels and Entrails, which they explain in four ſeveral Treatiſes, whereof the firſt is call'd Oſteology, for the Bones; the ſecond Myology, for the Muſcles; the third Angiology, for the Veins, Arteries and Nerves, which are the Veſſels; and the fourth Splanchnology, for the Entrails.

But laſtly, the moſt clear and perſpicuous of all the Diviſions of the Body of Man, is that which compares it to a Tree, whereof the Trunk is the Body, and the Branches are the Arms and Legs. The Body is divided into three Venters, or great Cavities, viz. the Upper, the Middle, and the Lower, which are the Head, the Breaſt, and the lower Belly. The Arms are diſtributed into the Arms properly ſo called, the Elbow and Hands; and the Legs in like manner into Thighs, Shanks, {12}and Feet: The Hands being alſo ſubdivided into the Carpus or Wriſt, Metacarpium or Back of the Hand, and the Fingers; as the Feet into the Tarſus, Metatarſus, and Toes. This viſion is at preſent follow'd in the Anatomical Schools.



C H A P.  V.

Of the Skeleton.

Why is Anatomy uſually begun with the Demonſtration of the Skeleton, or Contexture of Bones?

Becauſe the Bones ſerve for the Foundation Connexion, and Support of all other Parts of the Body.

What is the Skeleton?

It is a gathering together, or Conjunction of all the Bones of the Body almoſt in their Natural Situation.

From whence are the principal differences of the Bones derived?

They are taken from their Subſtance, Figure, Articulation, and Uſe.

How is all this to be underſtood?

Firſt then, with reſpect to their Subſtance, there are ſome Bones harder than others; as thoſe of the Legs compared with thoſe of the Back-Bone. Again, in regard of their Figure, ſome are long, as thoſe of the Arm; and others ſhort, as thoſe of the Metacarpium. Some are alſo broad, as thoſe of the Skull and {13}Omoplatæ or Shoulder-Blades; and others narrow, as the Ribbs. But with reſpect to their Articulation, ſome are joined by thick Heads, which are received into large Cavities, as the Huckle-Bones with thoſe of the Hips; and others are united by the means of a ſimple Line, as the Chin-Bones. Laſtly, with relation to their Uſe; ſome ſerve to ſupport and carry the whole Body, as the Leg-Bones, and others are appointed to grind the Meat, as the Teeth; or elſe to form ſome Cavity, as the Skull-Bone, and thoſe of the Ribs.

What are the Parts to be diſtinguiſhed in the Bones?

They are the Body, the Ends, the Heads, the Neck, the Apophyſes, the Epiphyſes, the Condyli or Productions, the Cavities, the Supercilia or Lips, and the Ridges.

The Body is the greateſt Part, and the middle of the Bone; the Ends are the two Extremities; the Heads are the great Protuberances at the Extremities; the Neck is that Part which lies immediately under the Head; the Apophyſes or Proceſſes are certain Bunches or Knobs at the Ends of the Bones, which conſtitute a Part of them; the Epiphyſes are Bones added to the Extremities of other Bones; the Condyli or Productions are the ſmall Elevations or Extuberances of the Bones; the Cavities are certain Holes or hollow places; the Supercilia or Lips are the Extremities of the Sides of a Cavity, which is at the End of a Bone; the Ridges are the prominent and ſaliant Parts in the length of the Body of the Bone. {14}

How are the Bones join'd together?

Two ſeveral ways, viz. by Articulation and Symphyſis.

How many ſorts of Articulations are there in the Bones?

There are generally two kinds, viz. Diarthroſis and Synarthroſis.

What is Diarthroſis?

Diarthroſis is a kind of Articulation which ſerves for ſenſible Motions.

How many kinds of Diarthroſes, or great Motions are there?

There are Three, viz. Enarthroſis, Arthrodia, and Ginglymus.

Enarthroſis is a kind of Articulation which unites two Bones with a great Head on one ſide, and a large Cavity on the other; as the Head of the Thigh-Bone in the Cavity of the Iſchion or Huckle-Bone.

Arthrodia is a ſort of Articulation, by the means whereof two Bones are join'd together with a flat Head receiv'd into a Cavity of a ſmall depth. Such is the Head of the Shoulder-Bone with the Cavity of the Omoplata or Shoulder-Blade; and that of the Twelfth Vertebra of the Back with the firſt of the Loins.

Ginglymus is a kind of Articulation which unites two Bones, each whereof hath at their Ends a Head and a Cavity, whereby they both receive and are received at the ſame time, ſuch is the Articulation in the Bones of the Elbow and the Vertebræ.

What is Synarthroſis?

Synarthroſis being oppoſite to Diarthroſis, is a {15}cloſe or compacted Articulation, deſtitute of any ſenſible Motion.

How many ſorts of Synarthroſes, or cloſe Articulations are there?

There are Three. viz. Sutura, Harmonia, and Gomphoſis.

A Suture is that which joins together two Bones by a kind of Seam or Stitch, or by a Connexion of their Extremities diſpos'd in form of a Saw, the Teeth whereof are reciprocally let one into another: Such are the Sutures of the Skull-Bones.

Harmonia is the uniting of two Bones by a ſimple Line; as the Bone of the Cheek with that of the Jaw.

Gomphoſis is a kind of cloſe Articulation, which unites two Bones after the manner of Nails or Wooden Pins fixt in the Holes made to receive them: Such is that of the Teeth in their Sockets.

What is Symphyſis?

Symphyſis is the uniting of two Bones by the interpoſition of a Medium, which ties them very ſtreight together, being alſo threefold: Such is the Connexion of the Knee-Pan or Whirl-Bone of the Knee, and the Omoplata or Shoulder-Blade.

Are not theſe three kinds of Articulations or Symphyſes diſtinguiſh'd one from another?

Yes; for tho' they are all made by the means of a third Body intervening, which joins them together; nevertheleſs every one of theſe various Bodies gives a different Denomination to its reſpective Articulation: Thus the Articulation which is caus'd by a Glutinous and {16}Cartilaginous Subſtance, is properly call'd Synchondroſis; as that of the Noſe, Chin, Os Pubis, &c. But an Articulation which is made by a Ligament is termed Synncuroſis, as that of the Knee-Pan. Laſtly, that which is wrought by the means of Fleſh, bears the Name of Syſſarcoſis; as the Jaw-Bones, the Os Hyoides, and the Omoplata or Shoulder-Blade.

Have the Bones any ſenſe of Feeling or Motion?

They have neither; for their ſenſe of Pain proceeds from nothing elſe but their Perioſtium, or the Membrane with which they are cover'd, and their Motion is perform'd only by the Muſcles that draw them.

Doth the Marrow afford any Nutriment to the Bones?

No, all the Bones are nouriſh'd by the Blood, as the other Parts; but the Marrow is to the Bones what the Fat is to the Fleſh; that is to ſay, it is a kind of Oil or Unctuous Subſtance, which moiſtens, and renders them leſs brittle.

Are all the Bones of the ſame Colour?

No, they follow the Temperament and Conſtitution of the Perſons.

How many in number are the Bones of the Humane Skeleton?

There are two hundred and fifty uſually reckon'd, viz. 61 in the Head, 67 in the Trunk or Cheſt, 62 in the Arms and Hands, and 60 in the Legs and Feet; but the true Number cannot be exactly determin'd, by reaſon that ſome Perſons have more, and others fewer; for ſome have more Oſſa Seſamoidea, Teeth and {17}Breaſt-Bones than others: Again, ſome have many indentings in the Lambdoidal Suture, and others have none at all.

Can you rehearſe the Number of the Bones of the Head?

There are Fifteen in the Skull, and Forty ſix in the Face.

The Fifteen of the Skull are the Coronal for the fore-part of the Head; the Occipital for the hinder-part; the two Parietals for the upper-part and each ſide; the two Temporals for the Temples; the Os Sphenoides or Cuneiforme, which cloſeth the Baſis or bottom of the Skull; the Os Ethmoides, or Cribriforme, ſituated at the Root of the Noſe; and the four little Bones of the Ear on each ſide, viz. the Incus or Anvil; the Stapes or Stirrup; the Malleolus or Hammer; and the Orbiculare or Orbicular Bone.

Of the Forty ſix of the Face, Twenty ſeven are counted in the Upper-Jaw, viz. the two Zygomatick, or the two Bones of the Cheek-Knots; the two Lachrymal in the great Corners of the Eyes toward the Noſe; the two Maxillar, that receive the Upper-Teeth, and which form part of the Palate of the Mouth, and the Orbits of the Eyes; the two Bones of the Noſe; the two Palate-Bones which are at its end, and behind the Noſtrils; the laſt being ſingle is the Vomer, which makes the Diviſion of the lower part of the Noſtrils; and there are generally Sixteen Upper-Teeth. The Lower-Jaw contains Nineteen Bones, viz. ſixteen Teeth; two Bones that receive them; and the Os Hyoides, which is ſingle, and fix'd at the Root of the Tongue. {18}

How are the Teeth uſually divided with reſpect to their Qualities?

Into Inciſive or Cutters, Canine or Dog-Teeth, and Molar or Grinders: There are eight Inciſive, and four Canine, which have only one ſingle Root; as alſo twenty Molar, every one whereof hath one, two, or three Roots.

Can you recite the Number of the Bones of the Trunk or Cheſt?

There are generally thirty and three in the Spine or Chine-Bone of the Back, viz. ſeven Vertebra's in the Neck, twelve in the Back, five in the Legs, five, ſix, and ſometimes ſeven in the Os Sacrum, three or four in the Coccyx, and two Cartilages at its end.

There are twenty nine in the Breaſt, viz. twenty four Ribs, two Clavicles or Channel-Bones and commonly three Bones in the Sternum. The Hip-Bones are likewiſe divided into three, viz. Ilion, Iſchion and Os Pubis.

Do you know the Number of the Bones of the Arms?

There are thirty and one Bones in each Arm, that is to ſay, the Omoplata or Shoulder-Blade; the Humerus or Shoulder-Bone; the two Bones of the Elbow call'd Ulna, and Radius; eight little Bones in the Carpus or Wriſt; five in the Metacarpium or Back of the Hand; and fourteen in the Fingers, three to every one except the Thumb, which hath only two.

Can you give us a Liſt of the Bones of the Leg in their Order?

There are thirty Bones in each Leg, viz. the Femur or great Thigh-Bone, the Knee-Pan or {19}Whirl-Bone on the top of the Knee; the Tibia, greater Focile, or Shin-Bone; and the Perone or Fibula, or leſſer Focile, which are the two aſſociated Bones of the Leg; ſeven little Bones in the Tarſus; five in the Metatarſus; and fourteen in the Toes; that is to ſay, three to every one, except the great Toe, which hath only two.

Thus the Number of Bones of the Humane Skeleton amounts to two hundred and Fifty, without reckoning the Seſamoides, the Indentings of the Skull, and ſome others which are not always to be found.



C H A P.  VI.

Of Myology, or the Anatomy of the Muſcles of a Humane Body.

What is a Muſcle?

It is the principal Organ or Inſtrument of Motion; or it is a Portion of Fleſh, wherein there are Veins, Arteries, Nerves, and Fibres, and which is cover'd with a Membrane.

How many parts are there in a Muſcle?

Three, viz. the Head, the Belly, and the Tail: The Head is that part thro' which the Nerve enters; the Belly is the Body or Middle of the Muſcle; and the Tail is the Extremity, where all the Fibres of the Muſcle are terminated to make the Tendon or String which is faſten'd to the Part whereto it gives Motion. {20}

Have all the Muſcles their Fibres ſtreight from the Head to the Tail?

No, ſome have them ſtreight, others tranſverſe, and others oblique or circular, according to the ſeveral Motions to which they are appropriated.

How many ſorts of Muſcles are there with reſpecting to their Action?

There are two different kinds, viz. the Antagoniſts and the Congenerate; the former are thoſe that produce oppoſite Motions; as a Flexor and an Extenſor, a Depreſſor and a Levator. The Congenerate are thoſe that contribute to one and the ſame Action; as when there are two Flexors or two Extenſors, and then one ſupplies the defect of the other; whereas when one of the Antagoniſt Muſcles is cut, the other becomes uſeleſs, and void of Action.

How is the Action of a Muſcle perform'd?

It is done by Contraction and Extenſion; the former cauſeth the <ſpan claſs="correction" title="Original reads 'Anatgoniſt'." >Antagoniſt to ſwell, and the other compels it to ſtretch forth in length.

What is Aponeuroſis?

It is the continuity of the Fibres of a Tendon which makes a Connexion that ſerves to ſtrengthen the Muſcle in its Motion.



{21}

C H A P  VII.

Of the Myology, or Anatomy of the Muſcles of the Head.

How many Muſcles are there appointed to move the Head, and which be they?

The Head is mov'd by the means of fourteen Muſcles, ſeven on each ſide; of theſe, two ſerve to depreſs it, eight to lift it up, and four to turn it round about.

The two Depreſſors are call'd Sternoclinomaſtoidei; they take their Riſe in the Sternum, at the Clavicles, and proceed obliquely to join the Apophyſis Maſtoides.

Of the four Elevators on each ſide the firſt is the Splenius, which begins at the five Vertebræ of the Back and the three lower ones of the Neck, and aſcending obliquely, cleaves to the hinder part of the Head. The ſecond, named Complexus or Trigeminus, having its beginning as the Splenius, ſticks in like manner to the hinder part of the Head, and they form together a figure reſembling that of S. Andrew's Croſs. The third is the Rectus Major, which proceeding from the ſecond Vertebra of the Neck, ſhoots forward to join the hinder part of the Head. The fourth is the Rectus Minor, which begins at the firſt Vertebra of the Neck, and ends likewiſe in the hinder part of the Head.

The two Muſcles on each ſide, which move the Head circularly, are the Obliquus Major and {22}Minor; the greater Oblique taking its riſe from the ſecond Vertebra of the Neck, goes to meet the firſt; but the leſſer Oblique hath its Origine in the hinder part of the Head, and proceeds to join the other obliquely in the firſt Vertebra.

How many Muſcles are there in the Lower-Jaw, and which be they?

The Lower-Jaw hath twelve Muſcles which cauſe it to move; that is to ſay, ſix on each ſide, whereof four ſerve to cloſe and two to open it.

The firſt of the Openers is the Latus, which beginning at the top of the Sternum, Clavicle, and Acromion, cleaves on the outſide to the bottom of the Lower-Jaw-Bone. The ſecond of the Openers is the Digaſtricus, which takes its riſe in a Fiſſure lying between the Occipital Bone and the Apophyſis Maſtoides, from whence it paſſeth to the bottom of the Chin on the inſide.

The firſt of the Shutters is the Crotaphites or Temporal Muſcle, which hath its Origine at the bottom, and on the ſide of the Os Coronale, the Os Parietale, and the Os Petroſum, from whence it is extended till it cleaves to the Apophyſis Coronoides of the Lower-Jaw, after having paſſed above the Apophyſis of the Zygoma: Its Fibres are ſpread from the Circumference to the Center, and it is covered again with the Pericranium, which renders its Wounds very dangerous; ſo that the leaſt Inciſions as can be, ought to be made therein.

The ſecond is the Pterygoideus or Aliformis Externus, whoſe riſe is in the Apophyſis Pterygoides, from whence it ſets forward till it ſtick between the Condylus and the Coronal of the Lower-Jaw.

The third is the Maſſeter, which hath two {23}Sources or Beginnings, and as many Inſertions; the firſt Source thereof is at the Cheek-Knot or Ball of the Cheek, and the ſecond at the lower part of the Zygoma. The firſt Inſertion is at the outer Corner of the Jaw, and the ſecond in the middle part, by that means forming the Figure of the Letter X.

The fourth is the Pterygoideus or Aliformis Internus, which hath its beginning in the Apophyſis Pterygoides, and is terminated in the inner Corner of the Jaw; ſo that Maſtication or Chewing is perform'd by the means of theſe four Muſcles.

How many Muſcles are there in the Face, and which be they?

There are two for the Forehead, call'd Frontal, whoſe Origine is in the upper part of the Head, from whence they deſcend by ſtreight Fibres, until they are faſten'd in the Skin of the Forehead near the Eye-Brows, where they are re-united: Their Action or Office is to draw the Skin of the Forehead upward, whereto they ſtick very cloſe.

There are alſo two others call'd Occipital, which have their Beginning in the ſame place with the preceeding, but they deſcend backward, and cleave to the Skin of the hinder part of the Head, which they draw upward.

There are two Muſcles to each Eye-Lid, one whereof is termed the Attollens or Elevator and the other the Depreſſor. The Elevator takes its riſe in the bottom of the Orbit of the Eye, and is faſtned by a large Aponeuroſis to the edge of the upper Eye-Lid. The Shutter or Depreſſor, call'd alſo the Orbicular, hath its Origine in the great Canthus, or Corner of the Eye, paſſeth over the {24}Eye-Lid upward, and is join'd to the leſſer Corner of the ſame Eye, being extended along its whole Compaſs.

The Eyes have each ſix Muſcles, viz. four Recti and two Obliqui; the Recti or ſtreight Muſcles are the Elevator, the Depreſſor, the Adductor, and the Abductor. The firſt of theſe call'd Elevator, or Superbus, draws the Eye upward, as it is pull'd downward by the Depreſſor or Humilis; the Adductor or Bibitorius draws it toward the Noſe, and the Abductor or Indignarorius toward the Shoulder: All theſe ſmall Muſcles have their Originals and Inſertions in the bottom of the Orbit through which the Optick Nerve paſſeth, and are terminated in the Corneous Tunicle, by a very large Tendon.

The firſt of the Oblique ones is term'd the Obliquus Major, and the other Obliquus Minor, becauſe they draw the Eye obliquely. Theſe Muſcles cauſe Children to ſquint when they do not act together. The Obliquus Minor is faſten'd at the outward part of the Orbit near the great Corner, and draws the Eye obliquely toward the Noſe: But the Obliquus Major is fixt in the inner part of the Orbit, and aſcends along the Bone to the upper part of the great Corner, where its Tendon paſſeth thro' a ſmall Cartilage nam'd Trochlea, and is inſerted in the little Corner with the leſſer Obliquus Minor, to draw the Eye obliquely toward the leſſer Corner.

The Ear, altho' not uſually endu'd with any ſenſible Motion, nevertheleſs hath four Muſcles, viz. one above, and three behind; the firſt being ſituated over the Temporal, and faſten'd to the Ear to draw it upward: The three others have {25}their beginning in the Mammillary Apophyſis, and are terminated in the Root of the Ear, to draw it backward.

There are alſo three Muſcles in the inner part of the Ear, whereof the external belonging to the Malleus or Hammer lies under the exterior part of the Bony Paſſage which reacheth from the Ear to the Palate of the Mouth, being fixt in a very oblique Sinuoſity which is made immediately above the Bone that bears the Furrow, into which is let the Skin of the Tympanum or Drum. The internal Muſcle lies hid in a Bony Semi-Canal, in the Os Petroſum; one part of which Semi-Canal is without the Drum, and clos'd on the top with a Paſſage that leads from the Ear into the Palate. But the other part within the Drum advanceth to the Feneſtra Ovalis, and is inſerted in the hinder part of the Handle of the Malleus. The Muſcle of the Stapes or Stirrup is alſo hid in a Bony Tube, almoſt at the bottom of the Drum, and fixt in the Head of the Stapes.

The Noſe hath ſeven Muſcles, that is to ſay, one common and ſix proper; the common conſtitutes part of the orbicular Muſcle of the Lips, and draws the Noſe downward with the Lip. Of the ſix proper Muſcles of the Noſe, four ſerve to dilate it, being ſituated on the outſide, and two to contract it, which are placed in the inſide.

The two firſt Dilatators of a Pyramidal Figure, take their riſe in the Suture of the Forehead, and are faſten'd by a large Filament to the Alæ of the Noſe. The two other Dilatators reſembling a Myrtle-Leaf have their Source in {26}the Bone of the Noſe, and are inſerted in the middle of the Ala.

The two Reſtrictors are Membranous, beginning in the internal part of the Bone of the Noſe and adhering to the inner Ala of the Noſtril.

The Lips have thirteen Muſcles, viz. eight proper, and five common: Of the proper there are four for the Upper-Lip, and as many for the Lower: with two common for each, and the odd one.

The firſt of the proper of the Upper-Lip bears the Name of the Inciſivus, its Origine being in the Jaw, in the place of the Inciſive Teeth and its Inſertion is in the Upper-Lip.

The ſecond is the Triangulis, Antagoniſt to the former; its Riſe is on the outſide, at the bottom of the Lower-Jaw; and it is implanted in the Upper-Lip, near the Corner of the Mouth.

The third being the Quadratus, ſprings from the bottom of the Chin before, and cleaves to the edge of the Lower-Lip.

The fourth is the Caninus, Antagoniſt to the Quadratus, beginning in the Upper-Jaw-Bone and being terminated in the Lower-Lip near the Corner of the Mouth.

The firſt of the common is the Zygomaticus, the Origine whereof is in the Zygoma and its Inſertion in the Corner of the Mouth, to draw it toward the Ears; ſo that it is the Muſcle which acts when we laugh.

The ſecond of the common is the Buccinator or Trumpeter, which is ſwell'd when one ſounds a Trumpet. It hath its riſe at the Root of the Molar Teeth of both the Jaws, and is extended quite round about the Lips. {27}

The odd Muſcle, or the thirteenth in number, is the Orbicular, which makes a Sphincter round about the Lips to cloſe or ſhut them up.

The Uvula or Palate of the Mouth hath four Muſcles, whereof the two firſt are the Periſtaphylini Externi, taking their riſe from the Upper-Jaw, above the Left Molar Tooth, and being ty'd to the Palate by a thin Tendon.

The two others are the Periſtaphylini Interni, which have their beginning in the Apophyſis Pterygoides on the inſide, and likewiſe ſtick to the Palate.

The Tongue, altho' all over Muſculous and Fibrous, yet doth not ceaſe to have its peculiar Muſcles, which are eight in Number.

The firſt of theſe is call'd Geniogloſſus, taking its riſe in the lower part of the Chin, from whence it is extended till it cleave to the Root of the Tongue before, to cauſe it to go out of the Mouth.

The ſecond is term'd Stylogloſſus, its Riſe being in the Apophyſis Styloides, from whence it paſſeth to the ſide above the Tongue, to lift it up.

The third bearing the Name of Baſigloſſus, commenceth in the Baſis or Root of the Os Hyoides, and thence inſinuates it ſelf into the Root of the Tongue, to draw it back to the bottom of the Mouth.

The fourth is the Ceratogloſſus, deriving its Original from the Horn of the Os Hyoides, and cleaving to the ſide of the Tongue to draw it on one ſide: The Action of theſe Muſcles of both ſides together, cauſeth an Orbicular Motion in the Tongue. To theſe ſome add a fifth {28}Pair of Muſcles, call'd Mylogloſſus, which ſerves to draw it obliquely upward.

What is the Action of the Os Hyoides in the Throat, and how many Muſcles hath it?

The uſe of the Os Hyoides is to conſolidate the Root of the Tongue; and it hath five Muſcles on each ſide, which keep it as it were hung up.

The firſt of theſe, call'd the Geniohyoideus hath its beginning in the Chin on the inſide, and adheres to the top of the Os Hyoides, which it draws upward.

The ſecond is the Mylohyoideus, whoſe Origine is in the inner ſide of the Jaw, from whence it cleaves ſide-ways to the Root of the Os Hyoides, which it draws upward, and to one ſide.

The third is the Stylohyoideus, which after it hath taken its riſe in the Apophyſis Styloides, is faſten'd to the Horn of the Os Hyoides, to draw it toward the ſide.

The fourth is the Coracohyoideus, which ſpringing up from the Apophyſis Coracoides of the Omoplata, cleaves to the Root and ſide of the Os Hyoides, to draw it downward and to the ſide.

The fifth is the Sternomohyoideus, that hath its beginning in the Bone of the Sternum on the inſide and is inſerted in the Root of the Os Hyoides, which it draws downward.

How many Muſcles hath the Larynx?

There are fourteen, viz. four Common, and ten Proper. The firſt Pair of the Common is the Sternothyroideus or Bronchycus, which proceeding from the inſide, and the top of the Sternum, aſcends along the Cartilages of the Wind-Pipe, and is terminated in the bottom of the {29}Scutiformis or Buckler-like Cartilage, which it draws downward. The ſecond is the Hyothyroideus, which ariſeth from the Root of the Os Hyoides, and is inſerted in that of the Scutiforme. This Muſcle ſerves to lift up the Larynx, as alſo to dilate the bottom of the Scutiformis, and to cloſe its top.

The firſt Pair of the Proper is the Cricothyroideus Anticus, which deriving its Original from the hinder and upper part of the Cricoides, or Ring-like Cartilage, is fixt in the upper and lateral part of the Scutiformis, to cloſe or ſhut it up.

The ſecond is the Thyroides.

The third is the Cricoarytenoideus Lateralis, which proceeds from the ſide of the Cricoides within, and is faſten'd to the bottom and ſide of the Arytenoides, which it removes to dilate the Mouth of the Larynx.

The fourth is the Thyroarytenoideus, which <ſpan claſs="correction" title="Original reads 'ari-riſing' on line break." >ariſing from the fore-part on the inſide of the Scutiformis, is terminated on the ſide of the Arytenoides, to cloſe the Orifice of the Larynx.

The fifth is the Arytenoideus, which having its Source in that place where the Cricoides is united to the Arytenoides is inſerted in its upper and lateral part, to cloſe the Larynx.

How many Muſcles hath the Pharynx?

It hath ſeven, the firſt whereof is the Oeſophagieus, which takes its riſe from the ſide of the Scutiformis or Buckler-like Cartilage, and paſſing behind the Oeſophagus or Gullet, is faſten'd to the other ſide of the Cartilage. It thruſts the Meat down by locking up the Pharynx as a Sphincter.

The ſecond named Stylopharingæus, ſprings from within the Acute Apophyſis of the Os Sphenoides, or Cuneiforme, and is inſerted obliquely {30}in the ſide of the Pharynx, which it dilates by drawing it upward.

The third, call'd Sphenopharyngæus, proceeds from the Apophyſis Styliformis, and is terminated in the ſide of the Pharynx, which it dilates by drawing its ſides.

The fourth Pair is the Cephalopharyngæus which ariſeth from the articulation of the Head with the firſt Vertebra, and cloſeth the Larynx.

How many Muſcles are there in the Neck, and which be they?

There are four Muſcles in the Neck on each ſide, viz. two Flexors, and two Extenſors. The Flexors are the Scalenus and the Rectus or Longus; and the Extenders are the Spinatus and the Tranſverſalis.

The <ſpan claſs="correction" title="Original reads 'Scalenu'." >Scalenus or Triangularis hath two remote Sources, viz. one in the firſt Rib, and the other in the Clavicle, and is faſten'd to the third and fourth Vertebra of the Neck.

The Rectus or Longus begins in the ſide of the four upper Vertebra's of the Back, and is join'd to the upper Vertebra's of the Neck, and the hinder part of the Head.

The Spinatus hath its Origine in the fourth and fifth upper Vertebra's of the Back, and is faſten'd to all the ſix lower Vertebra's of the Neck.

The Tranſverſalis ſprings forth out of the upper Vertebra's of the Back, and cleaves to the Extremity of the four Vertebra's of the Neck.



{31}

C H A P.  VIII.

Of the Myology or Anatomy of the Muſcles of the Cheſt; or of the Breaſt Belly, and Back.

How many Muſcles are there in the Breaſt, and which be they?

The Breaſt hath fifty ſeven Muſcles, that is to ſay, thirty that ſerve to dilate it, twenty ſix whoſe Office is to contract it, and the Diaphragm or Midriff, which partakes of both Actions.

The thirty which dilate the Breaſt are equally plac'd to the number of Fifteen, viz. the Subclavius, the Serratus Major Anticus, the two Serrati Poſtici, and the eleven external Intercoſtals.

The twenty ſix which contract the Breaſt are likewiſe equally rank'd to the Number of thirteen on each ſide, viz. the Triangularis, the Sacrolumbus, and eleven internal Intercoſtals.

The Subclavian takes up the whole ſpace between the Clavicle and the firſt Rib: Its Original being in the internal and lower part of the Clavicula, and its inſertion in the upper part of the firſt Rib.

The Serratus Major is a large Muſcle having ſeven or eight Indentings or Jaggs. It takes its riſe in the interior Baſis of the Omoplata or Shoulder-Blade, and its Jaggings are inſerted in {32}the five lower true Ribs, as alſo in the two upper ſpurious Ribs.

The Serratus Poſticus Superior, begins with a large Aponeuroſis in the Apophyſes of the three lower Vertebræ of the Neck, and of the firſt of thoſe of the Back; then paſſing under the Rhomboid, it is join'd obliquely by four Indentings to the four upper Ribs.

The Serratus Poſticus Inferior, commences in like manner with a large Aponeuroſis in the Apophyſes of the three lower Vertebra's of the Back, and of the firſt of thoſe of the Loins, and is afterwards faſten'd by four Digitations to the four lower Ribs.

The eleven External Intercoſtal Muſcles are ſituated in the ſpaces between the twelve Ribs paſſing obliquely and on the outſide from the back part to the fore part. They take their riſe below the Upper Rib, and have their Inſertion above the lower Rib.

The Triangularis is the firſt of thoſe that contract the Breaſt, and poſſeſſeth the inward part of the Sternum: Its Original is in its lower part, and its Inſertion in the top of the Cartilages of the two upper Ribs.

The Sacrolumbus hath its Source in the hinder part of the Os Sacrum, as alſo in the Vertebra's of the Loins, and aſcending from thence, inſinuates it ſelf into the hinder part of the Ribs, to every one of which it imparts two Tendons, one whereof ſticks on the outſide, and the other on the inſide. This Muſcle is fleſhy within, and fibrous without.

The Eleven Internal Intercoſtals, contrary to the External, derive their Original from the {33}top of every lower Rib, and aſcend obliquely from the back-part to the fore-part, till they are join'd to the lower Lip of every upper Rib: Thus theſe Internal Muſcles, with the External, form, by the oppoſition of their Fibres, a Figure reſembling a Burgundian Croſs.

The Diaphragm or Midriff is eſteem'd as the fifty ſeventh Muſcle of the Breaſt, and ſerves as well for its dilatation as contraction. It ſeparates the Thorax or Cheſt from the lower Belly, and is tied circularly to all the Extremities of the Baſtard Ribs, immediately under the Xiphoides, or Sword-like Cartilage.

Modern Anatomiſts have diſcover'd that the Diaphragm is compos'd of two Muſcles, viz. one Upper, and the other Lower; ſo that the Upper cleaves to the Extremities of the Spurious Ribs, and is terminated in a flat Tendon in the middle, which hath been always taken for its Nervous part. The Lower begins with two Productions, the longeſt whereof being on the right ſide, ariſeth from the three upper Vertebra's of the Loins, and the other on the Left from the two Vertebra's of the Back, till it is loſt in the Aponeuroſis of the Upper Muſcle.

How many Muſcles are there in the Back and the Loins, and which be they?

There are three in each ſide, viz. one for Flection, and the other for Extenſion.

The Triangularis is the Flexor, taking its riſe in the hinder part of the Rib of the Os Ilion, and the inner part of the Os Sacrum, in paſſing from whence it is joined to the laſt of the {34}Baſtard Ribs, and to the tranſverſe Productions of the Vertebra's of the Loins.

The Extenſors are the Sacer, and the Semi-ſpinatus, which make the Waſte ſtreight, and are ſo interwoven along the Back-Bone, that one would imagine that there were as many Pairs of Muſcles as Vertebra's, affording Tendons to all.

The Sacer ſprings from behind the Os Sacrum, as alſo from the hinder and upper Extremity of the Os Ilium, and is inſerted in the Spines of the Vertebra's of the Loins and Back.

The Semi-ſpinatus hath its Source in the Spines of the Os Sacrum, and is join'd to all the tranſverſe Productions of the Vertebra's from the Back to the Neck, being exactly ſituated between the Sacer and the Sacrolumbus.



C H A P.  IX.

Of the Myology, or Anatomy of the Muſcles of the lower Belly.

How many Muſcles are there in the lower Belly, and which be they?

There are generally ten, five on each ſide, that is to ſay, two Obliqui, one aſcending, and the other deſcending; one Tranſverſus, one Rectus, and two Pyramidal, of which laſt, nevertheleſs, there is ſometimes only one, and ſometimes none at all. {35}

The Obliquus Deſcendens, which is the firſt, hath its Original by digitation in the ſixth and ſeventh of the true Ribs, in all the ſpurious Ribs, and in the tranſverſe Apophyſes of the Vertebra's of the Loins, and comes near to the Serratus Major Anticus of the Breaſt; from whence it proceeds to the external Rib of the Os Ilion, and is terminated by a large Aponeuroſis in the Linea Alba or White Line, which ſeparates the Muſcles that are on each ſide of the Abdomen or lower Belly.

The Obliquus Aſcendens ariſeth from its Source in the upper part of the Os Pubis, and in the Ridge of the Hip-Bone, till it cleaves to the Apophyſes of the Vertebra's of the Loins in the Extremities of all the Ribs, and in the Xiphoides or Sword-like Cartilage, and is terminated in the White Line by a large Aponeuroſis.

The Rectus being ſituated between the Aponeuroſes of the Obliquus, takes its riſe in the Cartilages of the Ribs, in the Xiphoides and the Sternum, and enters into the Os Pubis, having many nervous parts to corroborate it in its length.

The Tranſverſus having its beginning in the tranſverſe Apophyſes of the Vertebra's of the Loins, is faſten'd to the internal Rib of the Os Ilium, and within the Cartilages of the lower Ribs, and is terminated by a large Aponeuroſis in the Linea Alba, paſſing over the Rectus, and ſticking to the Peritonæum.

The Oblique Muſcles, and the Tranſverſe, have Holes toward the Groin, to give Paſſage to the Spermatick Veſſels of Men, and to a round {36}<ſpan claſs="correction" title="Original reads 'ment', 'liga-' only as catch-word." >ligament of the Matrix in Women; ſo that Ruptures or Burſtenneſs happen through theſe parts in both Sexes, although the Holes of theſe three Muſcles are not ſituated one over-againſt another.

The Pyramidal, ſo named by reaſon of its Figure, is ſituated in the lower Tendon of the Rectus, its Origine being in the upper and external part of the Os Pubis; but it is terminated in the White Line, three Fingers breadth above the Pubes, and ſometimes even in the Navel itſelf. Theſe Muſcles are not found in all Bodies for there are ſometimes two, ſometimes only one, and ſometimes none.

The uſe of the Muſcles of the lower Belly is to compreſs all the contain'd parts, in order to aſſiſt them in expelling the Excrements.

How many Muſcles are there in the Teſticles?

They have each of them one, call'd Cremaſter; this Muſcle takes its riſe from the Ligaments of the Os Pubis, and by the dilatation of its Tendon covers the Teſticle, which it draws upward.

How many Muſcles hath the Penis?

It hath two Pair, viz. the Erectores or Directores, and the Dilatantes: The Erectores ariſe from the internal part of the Os Iſchion, under the beginning of the Corpora Cavernoſa, where they are inſerted, and retake their Fibres in their Membranes. The Dilatantes or Acceleratores have their Source in the Sphincter of the Anus and ſlipping from thence obliquely under the Ureter, are join'd to the Membrane of the Nervous Bodies.

How many Muſcles are there in the Clitoris? {37}

It hath two Erectors which ſpring forth from the Protuberance of the Os Iſchion, and are inſerted in the Nervous Bodies of the Clitoris. There are alſo two others ſuppos'd to be its Elevators, which proceed from the Sphincter of the Anus, and are terminated in the Clitoris.

How many Muſcles are there in the Anus?

There are three, viz. the Sphincter, and two Levatores. The Sphincter is two Fingers broad, to open and cloſe the Rectum. This Muſcle being double, is faſten'd in the fore-part to the Penis in Men, and to the Neck of the Matrix in Women, as alſo behind to the Coccyx, and laterally to the Ligaments of the Os Sacrum, and the Hips.

The two Levatores ariſe from the inner and lateral part of the Os Iſchion, and are faſten'd to the Sphincter of the Anus, to lift it up after the expulſion of the Excrements.

The Bladder hath alſo a Sphincter Muſcle to open and ſhut its Orifice.



C H A P.  X.

Of the Muſcles of the Omoplatæ, or Shoulder-Blades, Arms, and Hands.

How many ways doth the Omoplata or Shoulder-Blade move, and what are its Muſcles?

The Omoplata moves upward, downward, forward, and backward, by the means of four proper Muſcles, which are the Trapezius, the {38}Rhomboides, the proper Levator, and the leſſer Pectoral, or Serratus Minor Anticus.

The Trapezius or Cucullaris hath its beginning in the back part of the Occiput, or hinder part of the Head, in the Spines of the ſix lower Vertebra's of the Neck, and of the nine upper of the Back, in paſſing from whence it is implanted in the Spine of the Omoplata or Shoulder-Blade, and the external part of the Clavicula, as far as the Acromion. This Muſcle produceth many Motions by reaſon of its different Fibres, drawing the Shoulder-Blade obliquely upward, downward, and forward.

The Rhomboides is ſituated over the Trapezius, its riſe being in the Apophyſes of the three lower Vertebra's of the Neck, and of the three upper of the Back, but it is afterward join'd to the whole Baſis or Root of the Omoplata, which it draws backward.

The proper Levator commenceth in the Tranſverſe Apophyſes of the four firſt Vertebra's of the Neck, by different Progreſſions, but is afterward re-united, and inſerted in the upper Corner of the Omoplata, which it draws upward.

The leſſer Pectoral, or Serratus Minor Anticus, is ſituated under the great Pectoral, its riſe being by Digitation or Indenting in the ſecond, third, and fourth of the upper Ribs, and its Inſertion in the Apophyſis Coracoides of the Shoulder-Blade, which it draws forward.

How many Motions are there in the Humerus, or Arm; which be they, and what are its Muſcles? {39}

The Arm performs all ſorts of Motions by the help of nine Muſcles: For it is lifted up by the Deltoides and the Infra-Spinatus; it is depreſs'd by the Largiſſimus, and the Rotundus Major; it is drawn forward by the Pectoralis Major, and the Coracoideus; it is drawn backward by the Infra-Spinatus, and the Rotundus Minor. It is drawn near the Ribs by the Subſcapularis, and its circular Motion is performed when all theſe Muſcles act together ſucceſſively.

The Deltoides or Triangular hath its beginning in the whole Spine of the Omoplata, the Acromion, and half the Clavicula, and by its point cleaves with a ſtrong Tendon to the middle of the Arm.

The Infra-Spinatus takes its riſe in the Cavity that lies above the Spine of the Omoplata, which it fills, paſſing over the Acromion, until it is join'd to the Neck of the Shoulder-Bone, which it ſurrounds with a large Tendon.

The Largiſſimus, otherwiſe call'd Ani-ſcalptor, covers almoſt the whole Back, proceeding from a large and Nervous Stock, in the third and fourth lower Vertebra of the Back, the five Vertebra's of the Loins, the Spine of the Os Sacrum, the hinder part of the Lip of the Hip-Bone, and the external part of the lower Baſtard-Ribs, in paſſing from whence it inſinuates it ſelf into the lower Corner of the Omoplata, as alſo into the upper and inner part of the Humerus.

The Rotundus Major, or Teres Major, having its Origin in the external Cavity of the lower Corner of the Omoplata, is confounded with the Largiſſimus, and adheres with it by the ſame {40}Tendon to the upper and inner part of the Humerus, a little below the Head.

The greater Pectoral hath its Source in half the Clavicula, on the ſide of the Sternum; covers the fore-part of the Breaſt, and is faſten'd by a ſhort, broad, and nervous Tendon, to the top of the Shoulder-Bone, on the inſide, between the Biceps and the Deltoides.

The Coracoideus or Coracobrachyæus, beginning in the Apophyſis Coracoides of the Omoplata or Shoulder-Blade, adheres to the middle of the Arm on the inſide, which with the Pectoral it draws forward.

The Infra-Spinatus fills the Cavity which lies below the Spine of the Omoplata, its Origine being in the lower Rib of the Omoplata, from whence it paſſeth between the Spine and the Rotundus Minor, to cleave to the Neck of the Shoulder-Bone, which it embraceth, and draws backward.

The Rotundus Minor, or Teres Minor, proceeds from the lower Rib of the Omoplata, and adheres to the Neck of the Shoulder-Bone with the Infra-Spinatus to draw it in like manner backward.

The Sub-ſcapularis or Immerſus is ſituated entirely under the Omaplata, proceeding from the internal Lip of the Baſis or Root of the ſame Omoplata, and being terminated in the Neck of the Arm-Bone, which it cauſeth to lie cloſe to the Ribs.

How many Motions are there in the Cubitus or Elbow, and what are its Muſcles?

The Cubitus or Ulna is endu'd with two ſorts of Motions, viz. that of Flection and that of {41}Extenſion, the former being perform'd by the help of two Muſcles, that is to ſay, the Biceps, and the Brachiæus Internus; and the later by eight others, which are the Longus, the Brevis, the Brachiæus Externus, and the Anconeus.

The Biceps is a Muſcle with two Heads, one whereof proceeds from the Apophyſis Coracoides, and the other from the Cartilaginous edge of the Glenoid Cavity of the Omoplata or Shoulder-Blade: Theſe two Heads deſcend along the fore-part of the Arm, and are united in one and the ſame Body, from whence ſprings forth a Ligament, which is inſerted in a tuberoſity ſituated in the upper and fore-part of the Radius.

The Brachiæus Internus is a ſmall fleſhy Muſcle, lying hid under the Biceps, which takes its riſe in the upper and fore-part of the Humerus, and is implanted in the upper and inner-part of the Radius, to bend the Elbow with the Biceps.

The firſt of the four Extenders is the Longus having two Sources, viz. one ſituated in the lower Rib of the Omoplata, near its Neck, and the other deſcending to the hinder-part of the Arm, till it is tyed to the Olecranum or Ancon, by a ſtrong Aponeuroſis, which is common thereto, with the Brevis, and the Brachiæus Externus.

The Brevis or ſhort Muſcle of the Elbow ariſing from the hinder and upper-part of the Humerus, is faſten'd to the Olecranum with the Longus.

The Brachiæus Externus is a fleſhy Muſcle which proceeds from the hinder part of the {42}Humerus, and adheres to the Olecranum with the Brevis and the Longus.

The Anconeus or Cubitalis being ſituated behind the Fold of the Cubitus, is the leaſt Muſcle of all; it ſprings from the Extremity of the Arm-Bone, at the end of the Brevis and the Longus, and in deſcending is inſerted between the Radius and the Cubitus or Ulna, three or four Fingers breadth below the Olecranum.

How many Muſcles hath the Radius, and which are its Motions?

The Radius is endu'd with a twofold Motion by the means of four Muſcles: Of theſe the Rotundus and Quadratus cauſe that of Pronation, as the Longus and the Brevis that of Supination.

The Pronator Superior Rotundus, or round Muſcle of the Radius, commenceth from the inner Apophyſis of the Shoulder-Bone, in a very fleſhy Stock, and is terminated obliquely by a Membranous Tendon in the middle and exterior part of the Radius.

The Pronator Inferior Quadratus, ſpringing forth from the bottom and inſide of the Cubitus, is fixt in the lower and outward part of the Radius by a Tail as large as its Head. This Muſcle lying hid under the others near the Wriſt, is that which jointly with the Rotundus, turns the Arm with the Palm of the Hand downward, which is the Motion of Pronation.

The Longus is the firſt of the Supinators, whoſe Origine is three or four Fingers breadth above the external Apophyſis of the Arm-Bone; from whence it paſſeth along the Radius, and cleaves to the inner-part of its lower Apophyſis. {43}

The Brevis, or the ſecond of the Spinators ariſing from the lower part of the Inferior Condylus, and the external of the Humerus, is twiſted round about the Radius, going forward from the hinder-part till it is united to its upper and forepart. This Muſcle, with the Longus, ſerves to turn the Arm and the Palm of the Hand upward, and produceth the Motion of Supination.

How many ſorts of Motions belong to the Wriſt, and what are its Muſcles?

Two ſeveral Motions are perform'd by the Wriſt, viz. one of Flection, and the other of Extenſion, three Muſcles being appropriated to the former, and as many to the later: But it ought to be obſerved, that a ſtrong Ligament, call'd the Annular, appears here, which, ſurrounding all the Tendons of the Muſcles as it were a Bracelet, holds them together, and elſewhere ſerves to unite the two Bones of the Elbow. The three Flexors or Bending Muſcles of the Wriſt are the Cubitæus Internus, the Radiæus Internus, and the Palmaris.

The Cubitæus Internus derives its Original from the part of the Arm-Bone, paſſeth under the Annular Ligament, and is ty'd by a thick Tendon to the ſmall Bone of the Wriſt, which is plac'd above the others.

The Radiæus Internus proceeds from the ſame place with the Cubitæus, and is faſten'd to the firſt Wriſt-Bone which ſupports the Thumb. It lies along the Radius, and paſſeth under the Annular Ligament.

The Palmaris is reckon'd among the Flexors of the Wriſt, although ſituated in the Palm of the Hand. It ariſeth from the inner Proceſs or Knob {44}of the Arm-Bone, and is united by a large Tendon to the firſt Phalanges of the Fingers, ſlipping under the Tranſverſe or Annular Ligament and ſticking under the Skin of the Palm of the Hand.

The three extending Muſcles of the Wriſt are the Cubitæus Externus, and the Radiæus Externus or the Longus, and the Brevis.

The Cubitæus Externus taking its riſe from the hinder-part of the Elbow, paſſeth under the Annular Ligament, and adheres to the upper and outward-part of the Bone of the Metacarpus that ſtayeth the little Finger.

The Radiæus Externus, or the Longus, having its Origine in the edge of the lower part of the Arm-Bone, ſlides from thence along the Radius on the outſide, extends it ſelf under the Annular Ligament, and cleaves to the Wriſt-Bone, which ſtayeth the Fore-Finger.

The Brevis or ſhort Muſcle of the Wriſt ſprings from the lower part of the ſame Edge; afterwards it runs along the Radius, paſſeth under the Annular Ligament, and is terminated in the Bone of the Carpus or Wriſt, which ſtayeth the Middle Finger. But we muſt take notice, that beſides theſe ſix Muſcles, there is alſo Caro quædam quadrata, or a ſquare piece of Fleſh under the Palmaris, which ſeems to ariſe from the Thenar, and ſticks to the eighth Wriſt-Bone. It is ſuppoſed that this Muſculous piece of Fleſh ſerves with the Hypothenar of the little Finger, to make that which is call'd Diogenes's Cup.

How many Motions are there in the Fingers, and what are their Muſcles? {45}

The Fingers are bent, extended, and turn'd from one ſide to the other by the means of twenty-three Muſcles, whereof ten are proper, and thirteen common: The former are thoſe that ſerve all the Fingers in general, and the other thoſe that are particularly ſerviceable to ſome of them: The Common are the Sublimis, the Profundus, the common Extenſor, the four Lumbricales, and the ſix Interoſſei.

The Sublimis or Perforatus, ariſing from the internal part of the lower Proceſs of the Humerus or Shoulder-Bone is divided into four Tendons, which run below the Annular Ligament of the Wriſt, and are inſerted in the ſecond Phalanx of the Bones of the four Fingers, after having ſtuck in paſſing to thoſe of the firſt Phalanx, to help to bend it. It is alſo obſerved that every one of theſe Tendons hath a ſmall cleft in its length, to let in the Tendons of the Profundus.

The Profundus or Perforans lies under the Sublimis, deriving its Original from the top of the Cubitus and Radius. It creeps along theſe two Bones, and is divided into four Tendons, which paſs under the Annular Ligament, and ſlip into the Fiſſures of the Tendons of the Sublimis, to adhere to the third Phalanx of the Fingers, which they bend with the Sublimis: So that theſe two Muſcles make together the bending of the Fingers.

The Extenſor Magnus is that which extends the four Fingers. It ſprings from the external and lower Proceſs of the Arm-Bone, and is divided into four flat Tendons, which paſs under the Annular Ligament, and cleave {46}to the ſecond and third Phalanx of the Fingers.

The four Lumbricales or Vermiculares are in the Palm of the Hand, to draw the Fingers to the Thumb: They proceed from the Tendons of the Profundus, and the Annular Ligament, extend themſelves along the ſides of the Fingers and are inſerted in their ſecond Articulation, to cauſe the drawing toward the Thumb.

The three Interoſſei Interni, and the three Externi, are ſituated between the four Bones of the Metacarpium, as well on the inſide of the Hand as without: They have their beginning in the Intervals or Spaces between the Bones of the Metacarpium, are united with the Lumbrical, and fixt in the laſt Articulation of the Bones of the Fingers, to produce the Motion of drawing back or removing from the Thumb.

The Thumb is mov'd by five particular Muſcles; one whereof ſerves to bend it, two to extend it, one to remove it from the Fingers, and another to draw it to them.

The Flexor of the Thumb takes its riſe from the upper and inner part of the Radius, paſſes under the Annular Ligament, as alſo under the Thenar, and adheres to the firſt and ſecond Bones of the ſame Thumb to bend it.

The two Extenſors of the Thumb are the Longior and the Brevior: The former proceeding from the upper and outward part of the Cubitus, aſcends above the Radius, and is ty'd with a forked Tendon to the ſecond Bone of the Thumb. The Brevior hath the ſame Origin with the Longior, keeps the ſame Track, paſſes under the Annular Ligament, and is terminated in the third Thumb-Bone. {47}

The Thenar removes the Thumb from the Fingers, and forms that part which is call'd the Mount of Venus: It hath its Source in the firſt Bone of the Carpus or Wriſt, and the Annular Ligament, and is inſerted in its ſecond Bone.

The Antithenar draws the Thumb to the other Fingers, having its Origine in the Bone of the Metacarpus, that ſtayeth the middle Finger, and its Inſertion is in the firſt Bone of the Thumb.

The Muſcle which ſerves to extend the Fore-Finger, is call'd Indicator: It proceeds from the middle and outer part of the Cubitus, and is fixt by a double Tendon in the ſecond Articulation of the Fore-Finger, as alſo in the Tendon of the great Extenſor of the Fingers.

That which draws the Fore-Finger to the Thumb is term'd Adductor: It commenceth in the fore-part of the firſt Thumb-Bone, and is terminated in the Bones of the Fore-Finger.

That which removes the Fore-Finger from the Thumb is known by the Name of Abductor, which ariſing out of the external and middle part of the Bone of the Elbow, and paſſing under the Annular Ligament, cleaves to the Lateral and outward part of the Bones of the Fore-Finger.

The Little-Finger hath two proper Muſcles, viz. an Extenſor and an Abductor.

The Extenſor ſprings from the lower part of the Condylus of the Arm-Bone, and is faſten'd by a double Tendon in the ſecond Articulation of the Little-Finger, and in the Tendon of the Extenſor of all the others. {48}

The Abductor, call'd alſo Hypothenar, hath its beginning in the ſmall Bone of the Wriſt, which is ſituated over the others, and is terminated in the firſt Bone of the Little-Finger on the outſide.



C H A P.  XI.

Of the Muſcles of the Thighs, Legs, and Feet.

What are the Motions of the Thighs?

The Thigh performs five kinds of Motions; for it is bent, extended, drawn within ſide and without, and turn'd round: All theſe Motions are produc'd by the means of fourteen Muſcles, viz. three Flexors, three Extenſors, three Adductors, three Abductors, and two Obturators for the Circular Motion.

The Flexors of the Thigh are the Pſoas, Iliacus, and Pectineus.

The Pſoas or Lumbaris is ſituated inwardly in the Abdomen, on the ſide of the Vertebra's. It proceeds from the tranſverſe Apophyſes of the two lower Vertebra's of the Back, and of the upper of the Loins, and lying on the inner Face of the Os Ilion, ſticks to the leſſer Trochanter or Rotator.

The Iliacus Internus hath its Origine in all the Lips of the inner Cavity of the Os Ilion, and being joyn'd by a Tendon to the Lumbaris, is inſerted with it in the leſſer Trochanter. {49}

The Pectineus takes its riſe from the fore-part of the Os Pubis, and is united before to the Thigh-Bone a little below the leſſer Trochanter.

The Extenſors of the Thigh are the Glutæus Major, Medius, and Minimus.

The Glutæus Major ſprings forth out of the lateral part of the Os Sacrum, as alſo the hinder and outer part of the Os Ilion and Coccyx, and enters into the Thigh-Bone, four Fingers breadth below the great Trochanter or Rotator, being the thickeſt of all the Muſcles of the Body.

The Glutæus Medius, deducing its Original from the hinder and outward part of the Os Ilion, is inſerted three Fingers breadth below the great Trochanter.

The Glutæus Minimus ariſeth from the bottom of the Cavity of the Os Ilion, and is faſten'd to a ſmall Hole near the great Trochanter.

The Adductors of the Thigh are the Triceps Superior, Medius, and Inferior.

The Triceps Superior hath its beginning in the top of the Os Pubis, and is terminated in the top of a Line, which is on the inſide of the Thigh.

The Triceps Medius proceeding from the middle of the Os Pubis, is inſerted in the Thigh-Bone a little lower than the Triceps Superior.

The Triceps Inferior hath its Source in the bottom of the Os Pubis, and is implanted in the Thigh-Bone, a little lower than the Triceps Medius. Some Anatomiſts make only one Muſcle of theſe three, attributing thereto three Originals and three Inſertions. Theſe Muſcles ſerve to draw the Thighs one againſt another.

The Abductors of the Thigh are the Iliacus Externus, or Pyriformis, the Quadratus, and the Gemelli. {50}

The Pyriformis ariſing from the upper and lateral part of the Os Sacrum, and the the Os Ilion cleaves to the Neck of the great Trochanter.

The Quadratus or ſquare Muſcle of the Thigh takes its Origine from the external Prominence of the Os Iſchion, and adheres to the outward part of the great Trochanter.

The Gemelli or Twin Muſcles ariſe from two ſmall Knobs in the hinder-part of the Iſchion and inſinuate themſelves into a ſmall Cavity in the Neck of the great Trochanter.

The Circular Motion of the Thigh is performed by the means of two Muſcles, named the Obturatores Externi and Interni.

The Obturator Internus ſprings from the inner Circumference of the Oval Hole of the Iſchion and its Tendons paſſing between the two Gemelli are inſerted in a ſmall Cavity at the Root of the great Trochanter or Rotator.

The Obturator Externus ariſeth from the outward Circumference of the ſame Hole of one Iſchion, and is terminated in the ſide of the other near the great Trochanter.

What are the Motions of the Leg, and what are its Muſcles?

The Leg is mov'd four ſeveral ways, that is to ſay, it is bent, extended, and drawn inward and outward, by the means of eleven Muſcles viz. three Flexors, four Extenſors, two Adductors and two Abductors.

The three Flexors of the Leg are the Biceps, the Semi-nervoſus, and the Semi-membranoſus.

The Biceps hath two Heads, the longer whereof cometh out of the bottom of the Prominence {51}of the Iſchion, and the other from the middle and exterior part of the Femur, and is terminated in the outward and upper part of the Epiphyſis of the Perone or Fibula.

The Semi-nervoſus hath its Origine in the Knob of the Iſchion, and is join'd backward to the top of the Epiphyſis of the Tibia. Theſe three Muſcles are plac'd in the back-part of the Thigh below the Buttocks.

The four Extenſors of the Leg are the Rectus, the Vaſtus Internus, the Vaſtus Externus, and the Crureus.

The Rectus or ſtreight Muſcle of the Leg takes its riſe from the fore-part and the bottom of the Ilion, and deſcends in a right Line: It covers with its Tendon, which is common to the three following, the whole Knee-Pan, and adheres to the top of the Tibia, on the fore-part.

The Vaſtus Internus, being ſituated on the inſide of the Thigh, hath its beginning in the top of the Thigh inwardly, and a little below the leſſer Trochanter or Rotator: Afterward it is ty'd to the Tibia by a large Tendon, common thereto with the preceeding.

The Vaſtus Externus is plac'd on the outſide of the Thigh, ſpringing from the top and the fore-part of the Femur, being united by the ſame Tendon with the two preceeding.

The Crureus proceeds from the top, and the fore-part of the Thigh-Bone, between the two Trochanters; then covering the whole Bone, it is alſo faſten'd to the Leg-Bone with the three preceeding Muſcles, after having cover'd the Knee-Pan with their common {52}Tendon, which ſerves likewiſe as a Ligament to the Knee.

The two Adductors of the Leg are the Sartorius and the Gracilis.

The Sartorius or the Longiſſimus draws the leg inward, deriving its Original from the upper Spine of the Iſchion; from whence it deſcends obliquely thro' the inſide of the Thigh, and cleaves to the top on the inſide of the Tibia.

The Gracilis hath its Origine in the fore-part at the bottom of the Os Pubis, and its Inſertion in the top of the Tibia on the inſide.

The two Abductors of the Leg are the Faſcia lata, and the Poplitæus.

The Faſcia lata, or the Membranoſus, is as it were a kind of large Band, which covers all the Muſcles of the Thigh. It proceeds from the outward Lip of the Os Ilion, is ty'd by a large Membrane to the top of the Perone or Fibula and ſometimes deſcends to the end of the Foot.

The Poplitæus, or Sub-poplitæus, ariſes from the lower and external Condylus of the Thigh-Bone, paſſeth obliquely from the outſide to the inſide, till it is loſt in the upper and inner part of the Leg-Bone under the Ham.

What are the Motions of the Foot, and what are its Muſcles?

The Foot performs two Motions by the help of nine Muſcles, as being bent by two, and extended by ſeven.

The two Flexors are the Crureus Anticus, and the Peronæus Anticus.

The Crureus or Tibiæus Anticus, is plac'd along the Tibia, and takes its riſe from its upper and fore-part: Afterward it is bound by two {53}Tendons to the firſt Os Cuneiforme, or Wedge-like Bone, and to that of the Metatarſus or Inſtep, which ſtayeth the great Toe, after having paſs'd under the annular Ligament.

The Peronæus Anticus ſprings from the middle and outward-part of the Perone or Fibula, and inſinuating it ſelf thro' the Cleft which is under the external Malleolus before, ſticks to the Bone of the Metatarſus that ſupports the little Toe.

The ſeven Extenſors of the Foot are the two Gemelli, or the Soleus, the Plantaris, the Crureus Poſticus, and the two Peronæi Poſtici.

The Gemelli are the Interior and the Exterior; the former having its Source in the inner Condylus, and the other in the outward and lower of the Thigh-Bone; from whence they extend themſelves till they are faſten'd to the Talus or Ankle-Bone by a Tendon common to them, with the two following.

The Soleus ariſeth from the top on the back-part of the Leg-Bone and Perone, and confounding its Tendon with that of the Gemelli, ſticks cloſe to the Talus.

The Plantaris, which lies hid between the Gemelli and the Soleus, hath its Origine from the Exterior Condylus of the Thigh-Bone; then uniting its Tendon with the preceeding, it adheres to them; and this common Tendon is call'd Chorda Achillis.

The Crureus or Tibiæus Poſticus, ſprings from the back-part of the Leg-Bone, from whence extending it ſelf downward, it paſſeth thro' the Fiſſure in the Internal Malleolus, and cleaves to the inner-part of the Os Scaphoides. {54}

The Peronæi, or Fibulæi Poſtici, are otherwiſe call'd the Longus and the Brevis, whereof one proceeds from the upper and almoſt fore-part of the Perone, terminating in the upper-part of the Bone, that ſupports the great Toe in the Metatarſus, and the other from the lower part of the Perone, adhering in like manner to the Bone with which the little Toe is ſuſtain'd.

With what Motions are the Toes endu'd, how many Muſcles have they, and which be they?

The Toes are bent and extended, as alſo drawn inward and outward, by the means of twenty two Muſcles, of which ſixteen are Common, and ſix Proper. The former are two Flexors, two Extenſors, four Lumbricales, and eight Interoſſei. The firſt Flexor is nam'd Sublimis, and the other Profundus.

The Sublimis or Perforatus derives its Original from the lower and inner-part of the Talus and is fixt in its proper place by four cleft Tendons, which are inſerted in the upper-part of the Bones of the firſt Phalanx of the four Toes. It is ſituated under the Sole of the Feet.

The Profundus or Perforans hath its beginning in the top and back-part of the Leg-Bone and Perone, ſlips under the Malleolus Internus thro' the Sinus Calcaris, and makes four Tendons which paſs thro' the Fiſſures of the Tendon of the Sublimis, and cleaves to the Bones of the laſt Phalanx of the Toes, to bow them.

The firſt Extenſor is call'd the Common, and the other the Pediæus.

The Common Extenſor, or the Longus, takes its riſe from the top and fore-part of the Tibia in the place of its joyning with the Perone or {55}Fibula, and divides it ſelf into four Tendons, which after having paſs'd under the Annular Ligament, are inſerted in the Articulations of every Toe.

The Pediæus or the Brevis, being plac'd over the Foot, proceeds from the Annular Ligament, and the lower-part of the Perone, and ſends forth four Tendons, which are fixt to the firſt Articulation of the four Toes on the outſide, Thus this Muſcle, together with the Longus, cauſeth their Extenſion.

The four Lumbrical Muſcles of the Toes ariſe from the Tendons of the Profundus, and a Maſs of Fleſh at the Sole of the Feet. They are joyn'd by their Tendons with thoſe of the Interoſſei Interni, and adhere inwardly to the ſide of the firſt Bones of the four Toes, to incline them toward the great Toe.

The Abductors, or thoſe Muſcles that remove the Toes from the great Toe, are the eight Interoſſei, whereof four are call'd Externi, and as many Interni. The former take their riſe in the Spaces between the Bones of the Metatarſus, and are terminated outwardly in the ſide of the firſt Bones of the Toes. The Internal lie in the bottom of the Foot, and take up the Spaces between the five Bones of the Metatarſus. They ariſe from the Bones of the Tarſus, and the Intervals between thoſe of the Metatarſus, and are implanted with the four Lumbricales inwardly, in the upper-part of the Bones of the firſt Phalanx of the four Toes.

Of the ſix Proper Muſcles of the Toes, there are four appointed for the great Toe, which cauſe it to perform the Motions of Flexion, {56}Extenſion, and drawing forward or backward. The two others are the Adductor of the ſecond Toe to the great Toe, and the Abductor of the little Toe, call'd Hypothenar.

The Proper Flexor of the great Toe, ariſes from the top of the Perone or Fibula, on the back part, paſſeth thro' the Ancle-Bone on the inſide to the ſole of the Foot, and is faſten'd to the Bone of the laſt Phalanx.

The Proper Extenſor of the great Toe ſprings from the middle of the fore-part of the Perone, paſſeth over the Foot, and hath its Inſertion in the upper-part of the Bone of the great Toe.

The Proper Adductor of the great Toe, or the Thenar, taking its riſe inwardly on the ſide of the Talus, the Oſſa Schaphoidea and Innominata, extends it ſelf over the outward-part of the Bone of the Metatarſus, which ſtayeth the great Toe, and adheres to the top of the ſecond Bone of the great Toe, which it draws inward.

The proper Abductor of the great Toe, or the Antithenar, draws it toward the other Toes. It derives its Origine from the Bone of the Metatarſus, which ſupports the little Toe, ſlides obliquely over the other Bones, and cleaves to the firſt Bone of the great Toe on the inſide.

The Adductor appropriated to the ſecond Toe hath its Source in the firſt Bone of the great Toe, on the inſide, and ſticks cloſe to the Bones of the ſecond Toe, which it draws to the great Toe. {57}

The Abductor of the little Toe, or the Hypothenar, proceeds from the outward part of the Bone of the Metatarſus, that ſtayeth the little Toe, and is inſerted in the top of the little Toe, on the outſide, to remove it from the others.

A Liſt of all the Muſcles in the Humane Body.
The Fore-head hath two Muſcles 2
The hinder-part of the Head 2
The Eye-Lids 4
The Eyes 12
The Noſe 7
The Ears on the outſide 8
The Ears on the inſide 6
The Lips 13
The Tongue 8
The Uvula, or Palate of the Mouth 4
The Larynx 13
The Pharynx 7
The Os Hyoides 10
The Lower Jaw 12
The Head 14
The Neck 8
The Omoplatæ or Shoulder-Blades 8
The Arms 18
The Elbows 12
The Radii 8
The Wriſts 12
The Fingers 48
The Breaſt, or the Parts of Reſpiration 57
The Loins 6
The Abdomen or lower Belly 10
The Teſticles 2
The Bladder 1
{58} The Penis 4
The Clitoris 4
The Anus 3
The Thighs 30
The Legs 22
The Feet 18
The Toes 44
Total 425



C H A P. XII.

Of the Anatomy of the Nerves, Arteries, and Veins in general.

What is the Structure of the Nerves?

The Nerves are round white Bodies enclos'd in a double Membrane, communicated to them from the two Meninges of the Brain: Their Office is to convey the Animal Spirits into all the Parts.

Where is the Root and firſt beginning of all the Nerves?

All the Nerves take their Original from the Medulla Oblongata, and that of the Spine.

How is the diſtribution of them made thro' the whole Body?

It is directly perform'd by Conjugations or Pairs, whereof one goes to the Right-hand, and the other to the Left: There are nine Pairs of them that proceed from the Medulla Oblongata and enter into the Skull; and a Tenth that comes from the Marrow which lies between the Occipital and the firſt Vertebra of the Neck. It {59}paſſeth thro' the Hole of the Dura Mater, thro' which the Vertebral Artery enters, to diſtribute its Branches into ſeveral Parts.

To what Uſe are the nine Pairs of Nerves appropriated, which proceed from the Root of the Brain?

They are chiefly deſign'd for the Senſes, and alſo for the Motion of their Organs, of which the Ancients diſcover'd only ſeven.

The firſt Pair of Nerves is call'd the Olfactory, and ſerves for the Smelling.

The ſecond Pair is the Optici or Viſorii Nervi, and beſtows upon the Eyes the Faculty of ſeeing.

The third is term'd Motorii Oculorum, being ſerviceable for the Motion of the Eyes.

The fourth Pair is nam'd Oculorum Pathetici, which ſhews the Paſſion of the Mind in the Eyes, whereto it imparts a String as well as to the Lips.

The fifth is call'd the Guſtative, and appropriated to the Taſte, becauſe it ſends Twigs more eſpecially to the Tongue, as alſo to the Fore-head, Temples, Face, Noſtrils, Teeth, and Privy-Parts.

The Sixth is likewiſe for the Taſte, and goes to the Palate.

The ſeventh is the Auditive Nerve, that enters into the Os Petroſum, where it divides it ſelf into many Branches, which when gone forth, are diſtributed to the Muſcles of the Tongue, Lips, Mouth, Face, Fore-head, Eye-Lids, &c.

The eighth is the Os Vagum, or wandering Pair, which is united to the Intercoſtal Nerve, as alſo to the Recurrent, Diaphragmatick, Meſenterick, &c. {60}

The ninth Pair, after having form'd a Trunk with the eighth, diſperſeth its Twigs ſeveral ways, whereof one is join'd with the Twig to the tenth, to be diſtributed together into the Muſcle Sternohyoideus, and into the Tongue.

The Intercoſtal and Spinal are not Pairs of Nerves, but only Branches or Twigs of other Pairs.

What is the Diſtribution and Uſe of the thirty Pairs of Nerves that proceed from the Spinal Marrow?

There are ſeven that go forth from the ſeveral Vertebra's of the Neck, twelve from thoſe of the Back, five from the Loins, and ſix from the Os Sacrum, according to the following Progreſſion.

The firſt of the ſeven Pairs of Nerves of the Neck proceeds from between the Occipital Bone and the firſt Vertebra, nam'd Atlas, its Fibres being loſt in the Muſcles of the hinder-part of the Head and Neck.

The ſecond Pair ſprings from between the firſt and ſecond Vertebra of the Neck; the Fibres whereof are loſt in the Muſcles of the Head, and in the Skin of the Face.

The third Pair iſſueth from between the ſecond and third Vertebra of the Neck; and its Fibres are loſt in the Flexor Muſcles and Extenſors of the Neck.

The fourth, fifth, ſixth, and ſeventh Pairs proceed from between the Vertebra's, as before, but their Fibres are loſt in the Neck of the Omoplata, in the Arm, and in the Diaphragme or Midriff. Here it ought to be obſerv'd by the way that the Arms receive Branches not only from the {61}four laſt Pairs of the Nerves of the Neck, but alſo from the two firſt Pairs of the Back, which are extended even to the end of the Fingers: Whence it happens that in the Palſie of the Arms, Remedies are uſually apply'd to the Vertebra's of the Neck; and that in Phlebotomy or letting Blood, care muſt be taken to avoid pricking the Nerve, which accompanies the Baſilick Vein in the Elbow.

The twelve Pairs of Nerves that have their Beginning from between the Vertebra's of the Back, are each of them divided into two Branches, as the others; and their Branches are diſtributed in like manner to the Muſcles of the Breaſt, and to thoſe of the Back and Abdomen.

The five Pairs which take their Riſe from between the Vertebra's of the Loins, have thicker Branches than the others, and the diſtribution of them is made to the Muſcles of the Loins, Hypogaſtrium, and Thighs.

Of the ſix Pairs of Nerves that proceed from the Os Sacrum, the four Upper with the three Lower of the Loins, ſend forth Fibres of Nerves to the Thigh, Leg, and Foot; and the two laſt Pairs impart Nerves to the Anus, Bladder, and privy Parts.

What is the Structure of the Arteries?

The Arteries are long and round Canals, conſiſting of four ſorts of Tunicks or Membranes, which have their Riſe from the left Ventricle of the Heart, from whence they receive the Blood, and convey it to all the Parts of the Body for their Nouriſhment.

What is the Conſtruction of theſe four Tunicks or Membranes of the Arteries? {62}

The firſt being thin and Nervous in its outward Superficies, is in the Inſide a Plexus or Interlacement of ſmall Veins and Arteries, and Fibres of Nerves, which enter into the other following Tunicks, to nouriſh them.

The ſecond ſticking cloſe to the former, is altogether full of whitiſh Glandules, that ſerve to ſeparate the ſerous Particles of the Blood.

The third is intirely Muſculous, and interwoven with Annular Fibres.

The fourth is very thin, and hath its Fibres all ſtreight.

Whence proceeds the Pulſe or beating of the Arteries?

It is deriv'd from the Heart, and exactly anſwers to its Motion of Diaſtole and Syſtole.

By what Name is the firſt Trunk of the Arteries call'd, and what is the Effect of the Diſtribution made thence to the whole Body?

The firſt Trunk of the Arteries is nam'd Aorta, or the thick Artery, which proceeds immediately from the left Ventricle of the Heart, whereto it communicates before its departure from the Pericardium, one or two ſmall Branches call'd the Coronary: Afterward it is divided into two Branches, whereof one goes upward, and is term'd the Aſcending Artery; and the other downward, under the Denomination of the Deſcending Artery.

The Aſcending Artery ariſeth upward along the Aſpera Arteria or Wind-Pipe, to the Clavicles, and is there divided into two Branches, call'd the Subclavian Arteries, one whereof goes forward to the Right ſide, and the other to the Left; and they both ſend forth on each ſide {63}divers Branches, which take their Names from the ſeveral Parts, whereto they are diſtributed; ſuch are the Carotides or Soporales Interni & Externi, which paſs to the Head; the Mediaſtina; the Intercoſtal; the Axillar, and others.

The Deſcending Artery, before its departure from the Breaſt, affords certain Branches to the Pericardium, Diaphragm, and lower Ribs; afterward it penetrates the Diaphragm, and conſtitutes ſeven double Branches. The firſt is of thoſe that are call'd Cœliack, and which go to the Liver and Spleen. The ſecond Branch contains the Upper Meſenterick. The third the Emulgent, which paſs to the Reins. The fourth the Spermatick, which are extended to the Genitals. The fifth the Lower Meſenterick. The ſixth the Lumbar. And the ſeventh the Muſcular. But aſſoon as the great Trunk is come downward to the Os Sacrum, it divides it ſelf into two thick Arteries nam'd the Iliack, which are diſtributed on both ſides, each of them making two Internal and External Branches, which likewiſe impart Sprigs or leſſer Arteries, to the Bladder, Anus, Matrix, and other adjacent Parts: Then the Maſter-Branch forms the Crural Arteries on the inſide of the Thighs, which are communicated by multiplying their Number even to the ends of the Toes, in paſſing over the External Ancle-Bones of the Feet.

What is the Structure of the Veins?

The Veins are long and round Canals made of four kinds of Tunicks or Membranes, whoſe Office it is to receive the Blood that remains after the Nouriſhment is taken, and to carry it back to the Heart to be reviv'd. {64}

What is the Form of the four Tunicks that make the Canals of the Veins?

The firſt is a Contexture of Nervous and ſtreight Fibres. The ſecond is a Plexus of ſmall Veſſels that carry the Nouriſhment. The third is all over beſet with Glandules thro' which are filtrated the ſerous Particles of the Blood contain'd in the Veſſels of the ſecond Tunicle. The fourth is a Series of Annular and Muſculous or Fleſhy Fibres.

Which are the moſt numerous, the Arteries or the Veins?

The Number of the Veins exceeds that of the Arteries; and there are ſcarce any Arteries without Veins accompanying them.

Where is the Beginning and Original of all the Veins?

All the Veins have their Root in the Liver, and two of the three great Trunks that proceed from thence, are call'd Vena Portæ, and Vena Cava; and the third is twofold, viz. the aſcending and the deſcending.

The Vena Portæ is diſtributed to all the Parts contain'd in the lower Belly, and terminated in the Fundament; where it makes the Internal Hæmorrhoidal Veins.

The Vena Cava is immediately divided into two thick Branches, one whereof ariſeth upward to the Right Ventricle of the Heart, and forms the aſcending Vena Cava; as the other goes downward to the Feet, and conſtitutes the deſcending.

What is the Diſtribution of the aſcending Vena Cava?

It perforates the Diaphragm, goes to the Heart, and aſcends from thence to the Clavicles, {65}after having communicated to the Midriff in paſſing, a ſmall Branch call'd the Phrenicus; as alſo one or two to the Heart, nam'd the Coronary; and ſome others to the upper Ribs, beſides the ſingle Branch, term'd Azygos, only on the right ſide. But the Trunk of the aſcending Vena Cava, being once come up to the Clavicles, is divided into two Branches, well known by the Name of the Subclavian, one whereof Shoots forth toward the Right ſide, and the other toward the Left; and they both make various Ramifications like to thoſe of the thick aſcending Artery, by producing the Cervicalis or Soporalis, and the Internal and External Jugulars that go to the Head; as alſo the Axillars, which paſs to the Arms and Shoulders, forming the Cephalick, the Median, and the Baſilick on the inſide of the Elbow.

The deſcending Vena Cava in like manner accompanieth the Ramifications of the Aorta, or thick deſcending Artery, to the fourth Vertebra of the Loins, where it ſends forth two Branches, nam'd the Iliack, one whereof goes to the Right ſide, and the other to the Left, both inwardly and outwardly; imparting divers Twigs or leſſer Branches to all the Parts contain'd in the Abdomen or lower Belly, even as far as the Fundament, where it makes the External Hæmorrhoidal Veins. Afterward the outward Branch of the Iliack deſcends in the Thigh, to form the Crural, and others, as far as the Saphæna, together with thoſe that are ſituated at the end of the Feet.



{66}

C H A P  XII.

Of the Anatomy of the Abdomen, or lower Belly.

What is the cleareſt Diviſion of the Human Body into various Parts, and that which is moſt followed in the Anatomical Schools?

It is that which conſtitutes three Venters, that is to ſay, the Upper, the Middle, and the Lower, which are the Head, the Thorax or Breaſt and the Abdomen or lower Belly, together with the Extremities, which are the Arms and Legs.

What is the lower Belly?

It is a Cavity of the Body that contains the nouriſhing parts, as the Reins, the Bladder, and all thoſe that are appropriated to Generation in both Sexes.

What is to be conſider'd outwardly in the lower Belly?

Its different Regions, and the ſeveral parts therein contain'd.

What are theſe Regions?

They are the Epigaſtrick, the Umbilical, and the Hypogaſtrick.

What is their Extent?

It is from the Xyphoides or Sword-like Cartilage to the Os Pubis, the diviſion whereof into three equal Parts, conſtitutes the three different Regions; the Epigaſtrium being the firſt upward, the Umbilicus the ſecond, and the Hypogaſtrium the third. {67}

What Are the Parts contain'd in the Epigaſtrium, and what Place do they poſſeſs therein?

The Parts contain'd in the Epigaſtrium are the Liver, the Spleen, the Stomach, and the Pancreas or Sweet-bread, which lies underneath: The Stomach takes up the middle before, the Liver being plac'd on the Right ſide, and the Spleen on the Left; ſo that theſe two ſides of the Epigaſtrick Region, are call'd the Right and Left Hypochondria.

What Parts are there contain'd in the Umbilical Region, and what is their ſituation?

They are the moſt part of the thin Inteſtines or ſmall Guts, viz. the Duodenum, the Jejunum, and the Ileon, which have their Reſidence in the middle, where they are encircled with a Portion of the two great Guts, Cæcum and Colon, that take poſſeſſion of the Sides, otherwiſe call'd the Flanks. The Reins or Kidneys are alſo in this Place, above, and ſomewhat backward.

What Parts are there contain'd in the Hypogaſtrium, and of what Place are they poſſeſt?

The greater part of the thick-Guts, Cœcum, and Colon, are enclos'd therein, with the entire Rectum; there is alſo a Portion of the Ileon, which hides it ſelf in the ſides of the Ilia, or Hip-Bones: In the middle under the Os Pubis, the Bladder is ſituated on the Gut Rectum in Men, and the Matrix in Women lies between the Rectum and Bladder.

After what manner is the opening of a Corps or dead Body perform'd at a publick Diſſection? {68}

It is begun with a Crucial Inciſion in the Skin from underneath the Throat downward, traverſing from one ſide to another in the Umbilical Region; then this Skin is pull'd off at the four Corners, and the Panicula Adipoſa is immediately diſcover'd: Under this Fat lies a Fleſhy Membrane, call'd Membrana Carnoſa; and after that, the common Membrane of all the Muſcles of the lower Belly. Thus we have taken a View of what Anatomiſts commonly term the five Teguments, that is to ſay, the Epiderma or Scarf-Skin, the Derma or true Skin, the Panicula Adipoſa, the Panicula Carnoſa or Membranus Carnoſa, and the common Membrane of the Muſcles.

The five Teguments being remov'd, we meet with as many Muſcles on each ſide, viz. the deſcending Oblique, the aſcending Oblique, the Tranſverſe, the ſtreight, and the Pyramidal, by the means whereof the Belly is extended and contracted. Afterwards appears a Membrane nam'd Peritonæum, which contains all the Bowels, and covers the whole lower Belly, being ſtrongly faſten'd to the firſt and third Vertebra's of the Back. The Fat skinny Net which lies immediately under the Peritonæum, is call'd Epiploon and Omentum, or the Caul; it floats over the Bowels, keeping them in a continual Suppleneſs neceſſary for their Functions, maintains the Heat of the Stomach, and contributes to Digeſtion.

It remains to take an Account of the Bowels viz. the Stomach, Meſentery, Liver, Spleen, Kidneys, Bladder, and Guts, together with the Parts appointed for Generation, which in Men {69}are the Spermatick Veſſels, the Teſticles, and the Penis; and in Women, the Spermatick Veſſels, the Teſticles or Ovaries, the Matrix, and its Vagina or Neck.

What is the Stomach?

It is the Receptacle of the Aliments or Food convey'd thither thro' the Oeſophagus or Gullet, which is a Canal, or kind of ſtreight Gut that reacheth from the Throat to the Mouth of the Stomach. The Stomach it ſelf is ſituated immediately under the Diaphragm or Midriff, between the Liver and the Spleen, having two Orifices, whereof the Left is properly call'd Stomachus, or the Upper, and the Right (at its other Extremity) Pylorus, or the lower Orifice. Its Figure reſembleth that of a Bag-Pipe, and the greater part of its Body lies toward the Left ſide. It is compos'd of three Membranes, viz. one Common, which it receives from the Peritonæum; and two Proper; the two uppermoſt being ſmooth, and the innermoſt altogether wrinkled.

What is the Pancreas or Sweet-bread?

It is a Fat Body, conſiſting of many Glandules wrapt up in the ſame Tunicle, being ſituated under the Pylorus or lower Orifice of the Stomach: It helps Digeſtion, and hath divers other uſes; but its principal Office is to ſeparate the ſerous Particles of the Blood, to be convey'd afterward into the Gut Duodenum, by a Canal or Paſſage, nam'd the Pancreatick. This Juice ſerves to cauſe the Chyle to ferment with the Choler, in order to remove the groſſer Particles from thoſe that ought to enter into the Lacteal Veſſels.

Into how many ſorts are the Guts diſtinguiſh'd? {70}

There are two ſorts, viz. the thin and the thick.

How many thin or ſmall Guts are there?

Three; that is to ſay, the Duodenum, the Jejunum, and the Ileon.

How many thick Guts are there?

Three likewiſe; viz. the Cœcum, the Colon, and the Rectum.

Why are ſome of them call'd thin Guts, and others thick?

Becauſe the thin are ſmaller, being appointed only to tranſport the Chyle out of the Stomach into the Reſerver; whereas the thick are more large and ſtronger, ſerving to carry forth the groſs Excrements out of the Belly.

Are the ſix Guts of an equal length?

No, the Duodenum, which is the firſt of the thin Guts, is only twelve Fingers breadth long. The Jejunum, being the ſecond, ſo call'd becauſe always empty, is five Foot long: The third is nam'd Ileon, by reaſon of its great Turnings which oblige it to paſs to the Os Ilion, where it produceth a Rupture; it extends it ſelf almoſt twenty Foot in length.

The firſt of the thick Guts, known by the Name of Cœcum, is very ſhort, and properly only an Appendix or Bag of a Finger's length. That which follows is the Colon, being the largeſt of all, and full of little Cells, which are fill'd ſometimes with Wind and other Matters that excite the Pains of the Colick. It encompaſſeth the thin Guts, in paſſing from the top to the bottom of the Belly, by the means of its great Circumvolutions, and is from eight to nine Foot long. The laſt is the Rectum or {71}ſtreight Gut, ſo nam'd, becauſe it goes directly to the Fundament: It is no longer than ones Hand, but it is fleſhy, and ſituated upon the Os Sacrum, and the Coccyx or Rump-Bone.

What is the Periſtaltick Motion of the Guts?

It is the ſucceſſive Motion and Undulation, whereby the Guts inſenſibly puſh forward from the top to the bottom, the Matters contain'd in them; and that Motion which on the contrary is perform'd from the bottom to the top, is term'd the Antiperiſtaltick as it happens in the Iliack Paſſion, or twiſting of the Guts, call'd Domine Miſerere, by reaſon of its intolerable Pain.

What is the Meſentery?

It is a kind of Membrane ſomewhat fleſhy, which is join'd to the Spine in the bottom and middle of the Belly, and by its folding, keeps all the Guts ſteady in their place; it is all over beſet with red, white, and Lymphatick Veſſels; that is to ſay, thoſe that carry the Blood, Chyle, and Lympha, which ſerves to cauſe this laſt to run more freely, and to ferment. Three notable Glandules are alſo obſerv'd therein, the greateſt whereof lies in the middle, and is nam'd Aſellius's Pancreas; the two other leſſer are call'd Lumbar Glandules, as being ſituated near the Left Kidney. From each of theſe Glandules proceeds a ſmall Branch; and both are united together to make the great Lacteal Vein, or Thoracick Canal. This Tube conveys the Chyle along the Vertebra's of the Back to the Left Subclavian Vein; from whence it paſſeth into the aſcending Vena Cava, and deſcends in the Right Ventricle of the Heart, {72}where it aſſumes the form of Blood; from whence it paſſeth to the Lungs thro' the Pulmonary Artery; then it returns to the Heart thro' the Pulmonary Vein, and goes forth again thro' the Left Ventricle of the Heart, between the Aorta or great Artery, to be afterward diſtributed to all the Parts of the Body. This is the ordinary Paſſage for the Circulation of the Chyle, and the Sanguification of the Heart.

What is the Liver?

The Liver, being the thickeſt of all the Bowels, is plac'd in the Right Hypochondrium, at the diſtance only of a Fingers breadth from the Diaphragm; its Figure much reſembling that of a thick piece of Beef: It is Convex on the outſide, and Concave within; its Subſtance is ſoft and tender, its Colour and Conſiſtence being like coagulated Blood: It is cleft at bottom, and divided into two Lobes, viz. one greater, and the other leſs: Its Office is to purifie the Maſs of Blood by Filtration; and it is bound by two ſtrong Ligaments, the firſt whereof adheres to the Diaphragm, and the ſecond to the Xiphoides or Sword-like Cartilage. Two great Veins take their Riſe from hence, viz. the Vena Portæ, and the Vena Cava, which form innumerable Branches, as it were Roots in the Body of the Liver. The Gall-Bladder is faſten'd to the hollow part thereof, and diſchargeth its Choler into the Gut Duodenum, thro' the Veſſels that bear the Name of Meatus Choledochi, or Ductus Biliares. This Choler is not a meer Excrement, but on the contrary of ſingular Uſe in cauſing the Fermentation of the Chyle, and bringing it to perfection. {73}

What is the Spleen?

The Spleen is a Bowel reſembling a Hart's Tongue in ſhape, and ſituated in the Left Hypochondrium, over-againſt the Liver: Its length is about half a Foot, and its breadth equal to that of three Fingers; its Subſtance being ſoft, as that of the Liver, and its Colour like dark coagulated Blood: It is faſten'd to the Peritonæum, Left Kidney, Diaphragm, and to the Caul on the inſide; as alſo to the Stomach by certain Veins, call'd Vaſa Brevia; nevertheleſs theſe Ligatures do not hinder it from wandering here and there in the lower Belly, where it often changeth its place, and cauſeth many dreadful ſymptoms by its irregular Motions. Its Office is to Subtilize the Blood by cleanſing and refining it.

What are the Reins?

The Reins or Kidneys are Parts of a Fleſhy Conſiſtence, harder and more firm than that of the Liver and Spleen: They are both ſituated in the ſides of the Umbilical Region, upon the Muſcle Pſoas, between the two Tunicks of the Peritonæum; but the Right is lower than the Left: Their Shape reſembleth that of a French Bean, and they receive Nerves from the Stomach, whence Vomitings are frequently occaſion'd in the Nephritical Colicks: They are faſten'd to the Midriff, Loins, and Aorta, by the Emulgent Arteries; as alſo to the Bladder by the Ureters. The Right Kidney likewiſe adheres to the Gut Cæcum, and the Left to the Colon. Their Office is to filtrate or ſtrain the Urine in the Pelves or Baſons, which they have in the middle of their Body on the inſide, and {74}to cauſe it to run thro' the Veſſels call'd Ureters into the Bladder.

Immediately above the Reins on each ſide, is a flat and ſoft Glandule, of the thickneſs of a Nut; they are nam'd Renal Glandules, or Capſulæ Atribiliariæ, becauſe they contain a blackiſh Liquor, which (as they ſay) ſerves as it were Leaven for the Blood, to ſet it a fermenting.

What is the Bladder?

It is the Baſon or Reſerver of Urines, of a Membranous Subſtance as the Stomach, being plac'd in the middle of the Hypogaſtrick Region; ſo that it is guarded by the Os Sacrum behind, and by the Os Pubis before: Two Parts are to be diſtinguiſh'd therein, viz. its Bottom and Top; by its Membranous Bottom it is join'd to the Navel, and ſuſpended by the means of the Urachus, and the two Umbilical Arteries which degenerate into Ligaments in adult Perſons: As by its fleſhy Neck, longer and crooked in Men, and ſhorter and ſtreight in Women it cleaves to the Inteſtinum Rectum in the former, and to the Neck of the Womb in the latter. Laſtly, its Office is to receive the Urines to keep them, and to diſcharge them from time to time.

What are the Genitals in Men?

They are the Spermatick Veſſels, the Teſticles, and the Penis. The Spermatick Veſſels are a Vein and an Artery on each ſide; the former proceeding from the Aorta, or thick Artery of the Heart; and the other from the Branches of the Vena Cava of the Liver. Theſe Arteries and Veins are terminated in the Body of the {75}Teſticles, which are two in Number, enclos'd within the Scrotum.

The Office of the Teſticles is to filtrate the Seed, which is brought thither from all the parts of the Body, thro' the Spermatick Veſſels, called Præparantia, and afterwards to cauſe it to paſs thro' others nam'd Deferentia, to the Veſiculæ Seminales, from whence it is forc'd into the Ureter, thro' two ſmall and very ſhort Canals.

The Penis or Yard is a Nervous and Membranous Part, well furniſh'd with Veins and Arteries, containing in the middle the Canal of the Ureter: Its Extremity, which conſiſts of a very delicate and ſpongy ſort of Fleſh, is call'd Balanus, or Glans, and the Nut, the Skin that covers it being nam'd the Præputium, or the Fore-Skin. Thus by the means of this ſwell'd Part, and ſtiff thro' the affluence of the Spirits, the Male injects his Seed into the Matrix of the Female, to propagate his Kind.

What are the Parts appropriated to Generation in Women?

They are the Spermatick Veſſels, the Ovaries or Teſticles, and the Matrix. The Spermatick Veſſels are a Vein and an Artery on each ſide, as in Men: The Ovaries or Teſticles, ſituated on the ſide of the bottom of the Matrix, are almoſt of the ſame bigneſs with thoſe of Men, but of a round and flat Figure. The Veſiculæ, or little Bladders which they contain, are uſually term'd Ova or Eggs by Modern Anatomiſts; and the Veſſels that paſs from theſe Teſticles or Ovaries to the Cornua of the Uterus, are call'd Deferentia or Ejaculatoria. {76}

The Matrix, Uterus or Womb, is the principal Organ of Generation, and the place where it is perform'd, reſembling the Figure of a Pear with its Head upward, and being ſituated between the Gut Rectum and the Bladder: It is of a fleſhy and membranous Subſtance, retain'd in its place by four Ligaments, faſten'd to the bottom; whereof the two upper are large ones, proceeding from the Loins, and the two lower round, taking their Riſe from the Groin, where they form a kind of Gooſe-Foot, which is extended to the Os Pubis, and the flat part of the Thighs; which is the cauſe that Women are in danger of Miſcarrying when they fall upon their Knees.

The Exterior Neck of the Womb, call'd Vagina, is made almoſt in form of a Throat or Gullet, extending it ſelf outwardly to the ſides of the Lips of the Pudendum, and being terminated inwardly at the internal Orifice of the Matrix, the ſhape whereof reſembleth that of the Muzzle or Noſe of a little Dog. The outward Neck of the womb is faſten'd to the Bladder and the Os Pubis before, and in the hinder part to the Os Sacrum: Between the Lips of the Pudendum lie the Nymphæ, which are plac'd at the Extremity of the Canal of the Bladder, to convey the Urines; and ſomewhat farther appear four Caruncles, or ſmall pieces of Fleſh, at the Entrance of the Vagina, which when join'd together make the thin Membrane call'd Hymen.



{77}

C H A P.  XIV.

Of the Anatomy of the Thorax, Breaſt, or middle Venter.

What is the Breaſt?

It is a Cavity in which the Heart and the Lungs are principally enclos'd.

What is to be conſider'd outwardly in the Breaſt?

Its extent, and the ſituation of the Parts therein contain'd.

What is its extent?

It is extended from the Clavicles to the Xiphoides, or Sword-like Cartilage on the fore-part, and bounded on the hinder by the twelfth Vertebra of the Back, having all the Ribs to form its Circumference, and the Diaphragm for its Bounds at bottom, ſeparating it from the Abdomen or lower Belly.

What is the ſituation of the Parts contain'd in the Breaſt?

The Lungs take up the upper Region, and fill almoſt the whole Space, deſcending at the diſtance of two Fingers breadth from the Diaphragm; the Heart is ſituated in the middle, bearing its Point ſomewhat towards the Left ſide, under the Lobes of the Lungs, which are divided by the Mediaſtinum that diſtinguiſhes them into the Right and Left Parts,

How is the Breaſt Anatomiz'd or open'd? {78}

After the diſſection of the five Teguments, and the removal of the Muſcles, as in the lower Belly, the Anatomiſt proceeds to lift up the Sternum or Breaſt-Bone, by ſeparating it from the Ribs; then it is laid upon the Face, or elſe entirely taken away, to the end that the internal Parts of the Breaſt may be more clearly diſcover'd; whereupon immediately appear, the Heart, the Lungs, the Diaphragm, and the Mediaſtinum, which ſticks to the Sternum throughout its whole length.

What is the Heart?

It is a moſt noble Part, being the Fountain of Life, and the firſt Original of the Motion of all the others; on which account it is call'd Primus vivens, & ultimum moriens; that is to ſay, the firſt Member that begins to live, and the laſt that dies.

What Parts are to be conſider'd in the Heart?

Its fleſhy Subſtance, with all its Fibres turn'd round like the Skrews of a Vice; its Baſis, Point, Auricles, Ventricles, large Veſſels, Pericardium and Ligatures or Tyes: The Baſis is the uppermoſt and broadeſt part; the Point is the lowermoſt and narroweſt part; the two Auricles or ſmall Ears being as it were little Ciſterns or Reſervers, that pour the Blood by degrees into the Heart, are ſituated on each ſide above the Ventricles. The Ventricles, which are likewiſe two in Number, are certain Cavities in its Right and Left Sides. The large Veſſels are the Aorta or great Artery, and the Vena Cava together with the Pulmonary Artery and Vein. The Pericardium is a kind of Bag fill'd with Water, wherein the Heart is kept; which is {79}faſten'd to the Mediaſtinum by its Baſis, and to the large Veſſels that enter and go out of its Ventricles.

What are the Terms appropriated to the continual beating of the Heart?

They are Diaſtole and Syſtole, from whence proceed two ſeveral Motions, the firſt whereof is that of Dilatation, and the other of Contraction, communicated to all the Arteries which have the ſame Pulſe.

To what uſe ſerves the Water contain'd in the Pericardium?

It prevents the drying of the Heart by its perpetual Motion.

What are the Lungs?

They are an Organ ſerving for Reſpiration, of a ſoft Subſtance, and porous as a Sponge, being all over beſet with Arteries, Veins, Nerves, and Lymphatick Veſſels, and perforated with ſmall Cartilaginous Tubes, that are imparted to it from the Wind-Pipe, and are call'd Bronchia. Their Natural Colour is a pale Red, and marbl'd dark Brown; and their whole Body is wrapt up in a fine ſmooth Membrane, which they receive from the Pleuron. They are ſuſpended by the Wind-Pipe, by their proper Artery and Vein, and by the Ligatures that faſten them to the Sternum, Mediaſtinum, and frequently to the Pleuron it ſelf: They are alſo divided into the Right and Left Parts by the Mediaſtinum; having four or five Lobes, whereof thoſe on the Left ſide cover the Heart. Their continual Motion conſiſts in Inſpiration, to take in the Air, and Expiration, to drive it out. The Larynx makes the Entrance of the Wind-Pipe {80}into the Lungs, and the Pharynx that of the Oeſophagus or Gullet, at the bottom of the Mouth to paſs into the Stomach.



C H A P.  XV.

Of the Anatomy of the Head, or upper Venter.

What is the head?

It is a bony Part, that contains and encloſeth the Brain within its Cavity.

What is moſt remarkable in the outward parts of the Head?

The Temporal Arteries, the Crotaphitæ, or Temporal Muſcles, and the Sutures of the Skull.

Why are theſe things conſiderable?

The Temporal Arteries are of good Note, becauſe they are expos'd on the outſide, lying even with the Skin. The Crotophite Muſcles are ſo likewiſe, in regard that they cannot be hurt without danger of Convulſions, by reaſon of the Pericranium with which they are cover'd. And the Sutures, becauſe the Meninges of the Brain proceed from thence to form the Pericranium.

What is the Pericranium?

It is a Membrane that lies under the thick hairy Skin of the Head, and immediately covers the Skull.

What are the Meninges?

They are two Membranes that encloſe the Subſtance or Marrow of the Brain.

What is a Suture? {81}

It is a kind of thick Seam or Stitch, that ſerves to unite the Bones of the Skull.

How many ſorts of Sutures are there?

There are two ſorts, viz. the true, and the falſe or Baſtard.

What are the true Sutures?

They are three in number, namely the Sagittal, the Coronal, and the Lambdoidal.

What is the diſpoſition or ſituation of the true Sutures?

The Sagittal is ſtreight, beginning in the middle of the Fore-head, and ſometimes at the root of the Noſe, and being terminated behind, at the joining of the two Branches of the Lambdoidal Suture.

The Coronal appears in form of a Crown, paſſing to the middle of the Head, and deſcending thro' the Temples, to finiſh its Circumference in the Root of the Noſe.

The Lambdoidal Suture is made like an open Pair of Compaſſes, the Legs whereof are extended toward the Shoulders; and the Button is in the top of the Head backward.

What are the Baſtard Sutures?

They are thoſe that are call'd Squamous or ſcaly.

What is the diſpoſition of natural ſituation of theſe falſe Sutures?

They are plac'd at the two ſides of the Head, and make a Semi-Circle of the bigneſs of the Ears, round the ſame Ears.

What difference is there between the true and ſpurious Sutures.

The true Sutures are made in form of the Teeth of a Saw, which enter one into the other; and the falſe or Baſtard ones are thoſe that reſemble the Scales of Fiſhes, which {82}are join'd together by paſſing one over the other.

What is the Uſe of the Sutures?

The Ancients were of Opinion, that they were made to hinder the Fracture of one Skull-Bone from paſſing thro' the whole Head; but there is more reaſon to believe that they have the three following Uſes, that is to ſay, 1. To promote the tranſpiration of the Brain. 2. To give Paſſage to the Veſſels that go to the Diploe. 3. To retain the Meninges, and to ſupport the Maſs of the Brain, which is cover'd by them.

What are the Names of the Bones that compoſe the Skull?

The Bone of the fore-part of the Head is call'd Sinciput, or the Fore-head-Bone, as alſo the Frontal or Coronal Bone. The Bone of the hinder-part, enclos'd within the Lambdoidal Suture, is term'd the Occipital. The two Bones that form the upper-part, and are diſtinguiſh'd by the Sagittal Suture, bear the Name of Parietals, one being on the Right ſide, and the other on the Left. And thoſe behind the Ears are call'd Temporal, Squamoſa, or Petroſa. Theſe alſo are diſtinguiſh'd into the Right and Left Temporals, and are join'd to the bottom of the Parietal by a baſtard ſquamous Suture.

What is moſt remarkable in the thickneſs of the Skull-Bones?

The Diploe, which is nothing elſe but a Plexus or Contexture of ſmall Veſſels, that nouriſh the Bones, and in the middle of their thickneſs make the diſtinction of the firſt and ſecond Tablature of the Bones; whence it ſometimes {83}happens that an exfoliative Trepan, or Semi-Trepan, is ſufficient, when the firſt of theſe two Tables is only broken, the other remaining entire.

Is the Brain which is preſerv'd in the Skull all of one Piece, or one equal Maſs?

No, it is diſtinguiſh'd by the means of the Meninges into the Brain it ſelf, and the Cerebellum or little Brain; the Brain, properly ſo called, takes up almoſt the whole Cavity of the Skull, and the Cerebellum is lodg'd altogether in the hinder-part, where it conſtitutes only one entire Body; whereas the former is divided into the Right and Left Parts by the Meninges, which cut it even to the bottom; whence theſe Foldings are call'd Falx; i. e. a Scythe or Sickle.

What is chiefly remarkable in the Subſtance of the Brain?

The Ventricles or Cavities which are found therein, together with the great Number of Veins, Arteries, Lymphatic Veſſels, and Nerves, that carry Senſe to all the Parts of the Body, and Spirits for their Motion.

An exact Hiſtorical Account of all the Holes of the Skull, and the Veſſels that paſs thro' them.

To attain to an exact Knowledge of all the Holes with which the inſide of the Baſis of the Skull is perforated, they are to be conſider'd either with reſpect to the Nerves, or to the Sanguinary Veſſels. {84}

There are nine Pairs of Nerves that ariſe from the Medulla Oblongata, and go forth out of the Skull through many Holes hereafter nam'd.

The firſt Pair is that of the Olfactory Nerves, appropriated to the Senſe of Smelling, which are divided below the Os Cribiforme, or Sieve-like Bone, into divers Threads, that paſſing into the Noſe through many Holes with which this Bone is pierc'd, are diſtributed to the inner Tunick of the Noſe.

The ſecond Pair is that of the Optick or Viſual Nerves, that paſs into the Orbits of the Eyes, thro' certain peculiar Holes made in the Os Sphenoides, or Wedge-like Bone, immediately above the Anterior Apophyſis Clinoides.

In the Portion of the Os Sphenoides, that makes the Baſis of the Orbit, lies a Fiſſure about ſeven or eight Hairs breadth long, which is to be obſerv'd chiefly at the bottom, that is to ſay, below the Hole, thro' which the Optick Nerve paſſeth; where it is almoſt round, and larger than at the top, where it is terminated in a very long and acute Angle.

There are many Pairs of Nerves that enter into the Orbit thro' this Fiſſure, viz. 1. The third Pair, call'd the Motorii Oculorum. 2. The fourth Pair, nam'd Pathetici, by Dr. Willis. And 3. The whole ſixth Pair. Beſides theſe three Pairs, which go entire thro' this Cleft, there is alſo a Paſſage for the upper Branch of the foremoſt Fibre of the fifth Pair, which the ſame renowned Phyſician calls the Ophthalmick Branch. Beyond the lower-part of the ſaid Fiſſure, toward the hinder-part of the Head, is to be ſeen {85}in the Os Sphenoides on each ſide, a Hole that doth not penetrate the Baſis of the Skull, but makes a kind of Ductus, about an Hair's breadth long, which is open'd behind the Orbit on the top of the Space between the Apophyſis Pterygoides, and the third Bone of the Jaw; thro' this Ductus runs the lower Branch of the foremoſt Fibre of the fifth Pair.

About the length of two Hairs breadth beyond theſe Ductus's, we may alſo diſcover in the Os Sphenoides, or Wedge-like Bone, two Holes of an Oblong and almoſt Oval Figure, which are plac'd in the hindermoſt ſides of that of the Os Sphenoides, and gives paſſage to the hindermoſt Fibre of the fifth Pair.

The Hole thro' which runs the Auditory Nerve, that makes the ſeventh Pair, is in the middle of the hinder-part of the Os Petroſum, that looks toward the Cerebellum: This Hole being very large, is the Entrance of a Ductus that is hollow'd in the Os Petroſum, and which ſinking obliquely from the fore-part backward, for the depth of about two Hairs breadth, forms as it were the bottom of a Sack, the lowermoſt part whereof is terminated partly by the Baſis of the Cochlea, and partly by a Portion of the Mouth of the Veſtibulum. At the bottom of this Ductus are many Holes, but the moſt conſiderable is that of the upper-part, thro' which paſſeth a Portion of the Auditory Nerve. This is alſo the Entrance of another Ductus made in the Os Petroſum, which is open'd between the Apophyſis Maſtoides and Styloides: Theſe other Holes afford a Paſſage to the Branches of the ſoft Portion of the ſame Auditory Nerve. {86}

Below this Ductus there is a remarkable Hole form'd by the meeting of two hollow Cuts the larger whereof is in the Occipital Bone and the other in the lower-part of the Apophyſis Petroſi: From the middle of the upper-part of this Hole iſſueth forth a ſmall Prominence or bony Point, whereto is join'd an Appendix of the Dura Mater, which divides the Hole into two parts; ſo that thro' the foremoſt Orifice paſſeth the Nerve of the eighth Pair, and that which is call'd the Spinal Nerve. We ſhall have occaſion hereafter to ſhew the Uſe of the hinder Orifice.

Near the great Hole of the Occipital Bone from whence proceeds the Medulla Oblongata, we may obſerve a Hole almoſt round and oblong thro' which paſſeth the Nerve of the ninth Pair. This Hole is entirely ſituated in the Occipital Bone, and making a little Way in the Bone paſſeth obliquely from the back-part forward. In the inſide of the Skull this Hole is ſometimes double, but its two Entrances are re-united in the outward-part of the Skull; and the two Branches that form the Origine of this Nerve and which paſs thro' theſe two Holes, are likewiſe re-united at their Departure, Theſe are the Paſſages of the nine Pairs of Nerves that proceed from the Medulla Oblongata, and it remains only to ſhow that Paths thro' which the Intercoſtal Nerve goes forth, as alſo that of the tenth Pair. The Intercoſtal runs out of the Skull thro' the Ductus that gives Entrance to the Internal Carotick Artery. As for the tenth Pair, in regard that it ariſeth from the Marrow which is enclos'd between the Occipital {87}Bone and the firſt Vertebra, it goes forth thro' the Hole of the Dura Mater, where the Vertebral Artery enters.

To know well the Holes thro' which the Veſſels that belong to the inner-part of the Head enter, and iſſue forth, it is requiſite to diſtinguiſh them into thoſe which are diſtributed to the Dura Mater, and thoſe that are appointed for the Brain. The Veſſels of the Dura Mater, are Branches of the Carotick or Vertebral Arteries.

In the Os Sphenoides, or Wedge-like Bone, behind the Hole thro' which paſſeth the hindermoſt Fibre of the fifth Pair of Nerves lies another ſmall Hole, almoſt round, that gives Entrance to a Branch of the External Carotick Artery, which in entring, immediately adheres to the Dura Mater, and forms many Ramifications to overſpread the whole Portion of this Membrane, which covers the ſides, and the upper-part of the Brain.

At the bottom and top of the lateral outward part of the Orbit of the Eye, above the acute Angle, for want of the Os Sphenoides, there is a Hole thro' which paſſeth an Artery, being a Twig of a Branch of the Internal Carotick, which is diffus'd in the Eye, and diſtributed to almoſt the whole Portion of the Dura Mater, that covers the fore-part of the Brain.

The Vertebral Artery in entring into the Skull, furniſheth it on each ſide with a conſiderable Branch, which is diſpers'd throughout the whole Portion of the Dura Mater that covers the Cerebellum. {88}

As for the Veins that accompany theſe Arteries, they almoſt all go out of the Skull thro' the ſame Holes where the other enters.

There are four thick Arteries which convey to the Brain the Matter with which it is nouriſh'd, and that whereof the Spirits are form'd, viz. the two Internal Caroticks, and the two Vertebrals.

The Internal Carotick Arteries enter into the Skull thro a particular Ductus made in the Temporal Bone, the Mouth thereof being of an Oval Figure and ſituated in the outward part of the Baſis of the Skull, before the Hole of the Internal Jugular. This Ductus extends it ſelf obliquely from the back-ſide forward, and after having made about three Hairs breadth in length, is terminated in the hinder-part of the Os Sphenoides. The Artery traverſeth the whole winding Compaſs of this Ductus, which reſembles the Figure of the Roman Letter S, and at the Mouth of the ſame Ductus runs under the Dura Mater along the ſides of the Os Sphenoides to the Anterior Apophyſes Clinoides, where it riſeth up again, to perforate the Dura Mater, and to adhere to the Root of the Brain. Theſe Veſſels, in like manner, after their departure from the Bone of the Temples to the place where they pierce the Dura Mater, make a ſecond Circuit in form of the Roman Character S. At the place where theſe Carotick Arteries penetrate the Dura Mater, they ſend forth a thick Branch, which enters into the Orbit of the Eye, by the lower-part of the Hole, thro' which the Optick Nerve hath its Paſſage. {89}

The Vertebral Arteries proceeding from the Holes of the tranſverſe Apophyſes of the firſt Vertebra, turn about in paſſing under the upper oblique Apophyſes of the ſeven Vertebra's: Afterward they perforate the Dura Mater, and running under the Marrow, enter into the Skull thro' the Occipital Hole; then inclining one toward another, they are re-united, and form only one ſingle Trunk.

The Veins that bring back the Blood from the Subſtance of the Brain, are emptied into the Sinus's of the Dura Mater, which are all diſcharg'd into thoſe that are call'd Lateral, which laſt go out of the Skull immediately under the Nerves of the eighth Pair, thro' the hinder-part of the Hole made by the meeting of the Occipital Bone, and the Apophyſis Petroſa. Theſe Lateral Sinus's fall into the Internal Jugulars, which are receiv'd into a conſiderable Sinking hollow'd on each ſide in the outward, part of the Baſis of the Skull, which is nam'd the Pit or Hole of the Internal Jugular.

In the upper and hinder-part of the Hole, from whence the lateral Sinus's iſſue forth, is to be ſeen an opening in the Extremity of a Ductus, the Mouth whereof lies behind the Condyli, which are on the ſides of the Occipital Trunk: This Ductus is extended about the length of two Hairs breadth in the Bone, and the Canal enclos'd therein is open'd immediately into the Vertebral Sinus: So that one might affirm it to be as it were its Original Source. Whence it appears that the Blood contained in the lateral Sinus's is emptied thro' two places; the greater Portion thereof deſcending in the Jugulars {90}from the Neck, and the other in the Vertebral Sinus's: Sometimes thoſe Ductus's are four only on one ſide, another while both are ſtopt up, and the Blood contain'd in the lateral Sinus's is diſcharg'd into the Internal Jugulars.

Behind the Apophyſis Maſtoides on each ſide is a remarkable Hole, thro' which paſſeth a thick Vein, which brings back part of the Blood that hath been diſtributed to the Teguments and Muſcles, which cover part of the Occiput or hinder-ſide of the Head: This Vein is open'd into the lateral Sinus's at the place where they begin to turn about. But in the Heads of ſome Perſons, this Hole is found only on one ſide, and even ſometimes not at all, in which caſe the Blood contain'd in the Veſſels falls into the External Jugulars, with which the Branches of this Vein have a Communication.

In each Parietal Bone on the ſide of the Sagittal Suture, at a little diſtance from the Lambdoidal, appears a Hole, thro' which paſſeth a Vein, that brings back the Blood of the Teguments of the Head, and diſchargeth it ſelf into the upper Longitudinal Sinus. Theſe Holes are ſometimes on both; and then the Blood contain'd in the Branches of this Vein runs into the External Jugulars.

In the middle of the Sella of the Os Sphenoides, we may obſerve one or two ſmall Holes thro' which (according to the Opinion of ſome Modern Anatomiſts) the Lympha contain'd in the Glandula Pituitaria is thrown {91}into the Sinus of the edge of the Os Sphenoides; nevertheleſs it is certain, that theſe Holes are fill'd only with Sanguinary Veſſels, which carry and bring back the Blood of the Bones and Membranes, whereof thoſe Sinus's are compos'd; beſides that, theſe Holes are rarely found in adult Perſons.

Between the Spine of the Coronal Suture and the Criſta Galli, is a Hole which ſerves as an Entrance for a Ductus, which ſinks from the top to the bottom, the length of about two Hairs breadth in the thickneſs of the inner Table of the Coronal: The Root of the upper Longitudinal Sinus is ſtrongly implanted in this Hole, which alſo affords a Paſſage to ſome Sanguinary Veſſels appointed for the Nouriſhment of this inner Table.

Many other ſmall Holes are found in divers places of the Baſis of the Skull; the chief whereof are thoſe that are obſerv'd in the Apophyſis Petroſa, and give Paſſage to a great number of Veſſels that ſerve for the Nutriment of that part of the Temporal Bone which is call'd the Tympanum, or Drum: The other Holes are principally deſign'd for the Veſſels that are ſerviceable in the nouriſhing of divers parts of the Baſis of the Skull.

After what manner is the opening of the Head or Skull perform'd?

It is done by ſawing it aſunder round about and above the Ears; then it is taken off, after having before cut off the Hair, and made a Crucial Inciſion in the Skin from the fore-part to the hinder, and from one Ear to the other; as alſo after having {92}pull'd off and laid down the four Corners to the bottom.

How is the Brain anatomiz'd?

It is done by cutting it Superficially, and by Leaves, in order to diſcover by little and little the Ventricles, Veſſels, and Nerves, with their Original Sources, &c. Or elſe it is taken entire out of the Skull, (the Nerves having been before examin'd) and laid down; ſo that without cutting any thing, all the parts of the Brain may be ſet in their proper places, to find out thoſe that are ſought for.



{93}

A

T R E A T I S E

OF

Straps, Swathing-Bands, Bandages, Bolſters, Splints, Tents, Veſicatories,
Setons, Cauteries, Leeches, Cupping-Glaſſes, and Phlebotomy.



C H A P.  XVI.

Of Straps, Swathing-Bands, Bandages, and Bolſters.

What is a Strap?

It is a kind of Band commonly made uſe of for the Extenſion of the Members in the reducing of Fractures and Luxations; or elſe in binding Patients, when it is neceſſary to confine them, for the more ſecure performing of ſome painful Operation: Theſe ſorts of Ligatures have different Names, {94}according to their ſeveral Uſes, and often bear that of their Inventer.

What is the Matter whereof theſe Straps are compos'd?

They may be of divers ſorts, but are uſually made of Silk, Wooll, or Leather.

What is a Swathing-Band?

It is a long and broad Band, that ſerves to wrap up and contain the Parts with the Surgeons Dreſſings or Preparatives.

Of what Matter are theſe Swathing-Bands made?

They are made at preſent of Linnen-Cloth but in the time of Hippocrates, were made of Leather or Woollen-Stuff.

How many ſorts of Swathing-Bands are there in general?

There are two ſorts, viz. the Simple and Compound; the former are thoſe that are ſmooth, having only two ends; and the other are thoſe which are trimm'd with Wooll, Cotton, or Felt, or that have many Heads, that is to ſay, Ends, faſten'd or cut in divers places according as different Occaſions require.

What are the Conditions requiſite in the Linen-Cloth, whereof the Swathing-Bands are made?

It muſt be clean, and half worn out, not having any manner of Hem or Lift.

What are the Names of the different Swathing-Bands?

There are innumerable, but the greater part them take their Denominations from their Figure or Shape; as the Long, Streight, Triangular, and thoſe which have many Heads, or are trimm'd. {95}

What is A Bandage?

It is the Application of a Swathing-Band to any Part.

How many ſorts of Bandages are there?

As many as there are different Parts to be bound; ſome of them being Simple, and others Compound: The former are thoſe that are made with an uniform Band; as the Bandage call'd the Truſs, and divers other ſorts: The Compound are thoſe that conſiſt of many Bands ſet one upon another, or ſew'd together; or elſe thoſe that have many Heads. They have alſo particular Names taken from the Inventers of them, or from their Effect; as Expulſive Bandages to drive back, Attractive to draw forward, Contentive to contain, Retentive to reſtrain, Divulſive to remove, Agglutinative to rejoin, &c.

There are others whereto certain peculiar Names are appropriated; as Bridles for the lower Jaw, Slings for the Chin, the back part of the Head, Shoulder, and Perinæum; Scapularies for the Body, after the manner of the Scapularies of Monks; Truſſes for Ruptures; Stirrups for the Ankle-Bones of the Feet, in letting Blood, and upon other Occaſions. Laſtly, there are an infinite Number of Bandages, the Structure whereof is learnt by Practice, in obſerving the Methods of able Surgeons, who invent them daily, according to their ſeveral Manners; and the firſt Ideas of theſe can only be taken in reading Authors that have treated of them.

What are the general Conditions to be obſerv'd in the Bandages? {96}

There are many, viz. 1. Care muſt be taken that the Bands be roll'd firm, and that they be not too ſtreight nor too looſe. 2. They are to be untied from time to time in Fractures, they muſt alſo be taken away every three or four Days, to be refitted. 3. They muſt be neatly and conveniently roll'd, that the Patient may not be uneaſie or diſquieted.

What ought to be obſerv'd in fitting the Bolſters?

Care muſt be taken to make them even, ſoft, and proportionable to the bigneſs of the Part affected; to trimm them moſt in the uneven places, that the Bands may be better roll'd over them, and to keep them continually moiſten'd with ſome Liquor proper for the Diſeaſe as well as the Bands.

In treating of every Diſeaſe in particular, we ſhall ſhew the manner of making the particular Bandage that is convenient for it.



{97}

A

T R E A T I S E

OF

Chirurgical Diſeaſes.



C H A P.  I.

Of Tumours in general, Abceſſes or Impoſtumes, Breakings out, Puſtules, and Tubercles.

What is a Tumour?

A Tumour is a riſing or bloated Swelling rais'd in ſome part of the Body by a Setling of Humours.

How is this ſetling of Humours produc'd?

Two ſeveral ways, viz. by Fluxion and Congeſtion.

What is the Setling by Fluxion?

It is that which raiſeth the Tumour all at once, or in a very little ſpace of time, by the Fluidity of the Matter. {98}

What is the Setling by Congeſtion?

It is that which produceth the Tumour by little and little, and almoſt inſenſibly, by reaſon of the ſlow Progreſs and thickneſs of the Matter.

Which are the moſt dangerous Tumours, thoſe that ariſe from Fluxion, or thoſe that derive their Original from Congeſtion?

They that proceed from Congeſtion, becauſe their thick and groſs Matter always renders 'em obſtinate, and difficult to be cur'd.

Whence do the differences of Tumours proceed?

They are taken, firſt, from the Natural Humours, Simple, Mixt, and Alter'd: Simple, as the Phlegmon, which is made of Blood, and the Eryſipelas of Choler; Mixt, as the Eryſipelas Phlegmon, which conſiſts of Blood mingl'd with a Portion of Choler; or the Phlegmonous Eryſipelas, which proceeds from Choler intermixt with a Portion of Blood: Alter'd, as the Melia which is compos'd of many Humours, that can not be any longer diſtinguiſh'd by reaſon of their too great Alteration. Secondly, the difference of Tumours is taken from their likeneſs to ſome other thing, as the Carbuncle and the Talpa, the former reſembling a burning Coal, and the other a Mole, according to the Etymology of their Latin Names. Thirdly, From the Parts where they are ſituated; as the Ophthalmy in the Eye and the Quinſey in the Throat. Fourthly, from Diſeaſe that cauſeth 'em, as Venereal and Peſtilential Buboes. Fifthly, from certain Qualities found in ſome, and not in others; as the Encyſted Tumours, which have their Matter clos'd within their proper Cyſtes or Membranes, and ſo of many others. {99}

How many kinds of Tumours are there that comprehend at once all the particular Species?

They are four in Number, viz. the Natural Tumours, the Encyſted, the Critical, and the Malignant.

What are natural Tumours?

They are thoſe that are made of the four Humours contain'd in the Maſs of the Blood, or elſe of many at once intermixt together.

What are the four Humours contain'd in the Maſs of the Blood?

They are Blood, Choler, Phlegm, and Melancholy, every one whereof produceth its particular Tumour: Thus the Blood produces the Phlegmon, Choler the Eryſipelas, Phlegm the Oedema, and Melancholy the Scirrhus. The Mixture of theſe is in like manner the Cauſe of the Eryſipelatous Phlegmon, the Oedomatous Phlegmon or Phlegmonous Eryſipelas, and the Phlegmonous Oedema, according to the quality of the Humours which are predominant, from whence the ſeveral Tumours take their Names.

What are the Encyſted Tumours?

They are thoſe the Matter whereof is contain'd in certain Cyſtes, or Membranous Bags; as the Meliceris, and the Struma or Kings-Evil.

What are Critical Tumours?

They are thoſe that appear all at once in acute Diſeaſes, and terminate them with good or bad Succeſs.

What are Malignant Tumours?

They are thoſe that are always accompany'd with extraordinary and dreadful Symptoms, and whoſe Conſequences are alſo very dangerous; as the Carbuncle in the Plague. {100}

What are Impoſtumes or Abceſſes, Breakings out and Puſtules?

Indeed, it may be affirm'd, that all theſe kinds of Tumours ſcarce differ one from another, except in their ſize or bigneſs; nevertheleſs, to ſpeak properly, by the Names of Impoſtumes or Abceſſes are underſtood groſs Tumours that are ſuppurable, or may be diſſolv'd, and by thoſe of Breakings out and Puſtules, only ſimple Puſteal Wheals, or ſmall Tumours, that appear in great Numbers, and which frequently do not continue to Suppuration; ſome of them conſiſting of very few Humours, and others altogether of dry Matter.

What difference is there between a Tumour and an Impoſtume or Abceſs?

They differ in this particular, that all Tumours are not Impoſtumes nor Abceſſes; but there is no Impoſtume nor Abceſs that is not a Tumour: As for Example, Wens and Ganglions are Tumours, yet are not Abceſſes nor Impoſtumes; whereas theſe laſt are always Tumours in regard that they cauſe Bunches and Elevations.



C H A P.  II.

Of the general Method to be obſerv'd in the curing of Tumours.

What ought a Surgeon chiefly to obſerve in Tumours, before he undertake their Cure?

He ought to know three things, viz. 1. The Nature or Quality of the Tumour. 2. The {101}time of its formation and 3. Its ſituation: The Quality of the Tumour is to be known, becauſe the Natural one is otherwiſe handl'd than that which is Encyſted, Critical or Malignant. As for the time of its Formation, it is four-fold, viz. the Beginning, Increaſe, State, and Declination, wherein altogether different Remedies are to be apply'd. The Situation of the Tumour muſt be alſo obſerv'd, becauſe the dreſſing and opening of it ought to be as exact as is poſſible, to avoid the meeting with an Artery or neighbouring Tendon.

How many ways are all the Tumours that are curable, terminated?

They are terminated after two manners, viz. either by diſſolving 'em, or by Suppuration.

Are not the Scirrhus and the Eſthiomenus or Gangrene, two means that ſometimes ſerve to terminate and cure Impoſtumes?

Yes, but it is done imperfectly, in regard that a Tumour or Impoſtume cannot be ſaid to be abſolutely cur'd, as long as there remains any thing of the Original Malady, as it happens in the Scirrhus, where the Matter is harden'd by an imperfect diſſolving of it, or when the Impoſtume degenerates into a greater and more dangerous Diſtemper, as it appears in the Eſthiomenus or Gangrene that ſucceeds it.

Which is the moſt effectual means of curing Impoſtumes, that of diſſolving, or that of bringing them to Suppuration?

That of diſſolving 'em is without doubt the moſt ſucceſsful, and that which ought to be us'd as much as is poſſible; nevertheleſs ſome Caſes are to be excepted, wherein the Tumours {102}or Abceſſes are Critical and Malignant; for then the way of Suppuration is not only preferable, but muſt alſo be procur'd by all ſorts of means, even by opening; which may be done upon this occaſion, without waiting for their perfect Maturity.

What are the Precautions whereto a Surgeon ought to have regard before he undertake the opening of Tumours?

He muſt take care to avoid cutting the Fibres of the Muſcles, and in great Abceſſes, to cauſe all the corrupt Matter to be diſcharg'd at once, to prevent the Patient's falling into a Swoon.

Ought the opening of Tumours always to be made longitudinally, and according to the direct Courſe of the Fibres?

No, it is ſometimes neceſſary to open 'em with a Crucial Inciſion, when they are large, or when a Cyſtis or Membranous Vehicle is to be extirpated.

How many ſorts of Matter are there that iſſue forth in the Suppuration of Tumours?

There are four ſorts, viz. the Pus, Ichor, Sanies, and Virus.

What isPus?

It is a thick Matter, and white as Milk.

What is Ichor?

It is a thick Matter like the Pus, but of divers Colours.

What is Sanies?

It is a watery Matter that riſeth up in Ulcers, almoſt after the ſame manner as the Sap in Trees.

What is Virus? {103}

It is a kind of watry Matter, being whitiſh, yellowiſh, and greeniſh at the ſame time; which iſſueth out of Ulcers, very much ſtinking, and is endu'd with corroſive and malignant Qualities.

How many general Cauſes are there of Tumours?

There are three, viz. the Primitive, the Antecedent, and the Conjunct: The Primitive is that which gives occaſion to the Tumours; as for Example, a Fall or a Blow receiv'd. The Antecedent is that which ſupplies it with Matter, ſuch is the Maſs of Blood that thickens and maintains the Phlegmon. Laſtly, the Conjunct Cauſe is the overflowing Blood or Matter, which immediately forms the Tumor.

What regard ought to be had to theſe three ſorts of Cauſes in the Cure?

The Primitive Cauſe may be prevented by avoiding the Falls, Blows, or other Hurts, and the Antecedent by diminiſhing the Plethory of the Blood, and cooling the whole Maſs by Phlebotomy. The Conjunct Cauſe, which is the overflowing of the Blood, may be alſo remov'd in diſperſing it by diſſolving, or elſe in diſcharging it by Suppuration.

What is a Criſis?

It is a ſudden ſetling of Humours, which happens in Diſeaſes, whereby they are uſually terminated.

How are theſe Critical Setlings effected?

By the Strength of Nature, which either expels the peccant Humours thro' the Belly, or carries them to the Habitude of the Body; for in the former ſhe cauſeth Fluxes of Humours, Urine and Blood; as in the other ſhe excites Sweatings, Tumours, and even a Gangrene it ſelf.

In what Parts do the Critical Tumours uſually ariſe? {104}

In the Glandules, which the Ancients call'd the Emunctories of the Brain, Heart, and Liver; for they gave the Name of Emunctories of the Brain to the thick Glandules which lie under the Ears, that of the Emunctories of the Heart to thoſe that are under the Arm-Pits; and that of the Emunctories of the Liver to thoſe under the Groin. Now Malignant Tumours may ariſe in all theſe parts, but the Venereal happen only in the Groin.



C H A P.  III.

Of Natural Tumours.



A R T I C L E  I.

Of the Phlegmon and its Dependancies.

What is a Phlegmon?

It is a red Tumour occaſion'd by the Blood diffus'd in ſome part, wherein it cauſeth extenſion, pain, and heat with beating.

Are Aneuriſms and Varices, which are Tumours, made by the Blood, to be reckon'd among the Phlegmons?

No, becauſe the Blood that forms the Aneuriſms and Varices is not extravaſated nor accompany'd with Inflammation, but only a Tumour of Blood proceeding from the Dilatation of the Arteries and Veins. {105}

May Echymoſes or Contuſions conſiſting of extravaſated Blood, be eſteem'd as Phlegmons?

By no means, in regard that it is not ſufficient that the Blood be extravaſated for the producing of a Phlegmon; it muſt alſo cauſe Pain, Heat, and a Beating, with Inflammation, which is not to be found in the Echymoſes, except in great ones, after they have been neglected for a long time; where the corrupted Blood ought to be let out immediately, to prevent the Inflammation, overmuch Suppuration, and many other ill Conſequences.

Is the Phlegmon always compos'd of pure Blood?

No, it may happen ſometimes to partake of Choler, Phlegm, or Melancholy; on which account it is nam'd an Eryſipelatous, Oedomatous, or Scirrhous Phlegmon, always retaining the Name of the predominant Humour, which is the Blood; and ſo of the others.

R E M E D I E S.

What are the Remedies proper for a Phlegmon?

They are of two ſorts, viz. General and Particular; the former having regard to the antecedent cauſe, and the other to the conjunct. The Phlegmon is cur'd in its antecedent Cauſe, by Phlebotomy or letting Blood, by good Diet, and ſometimes by Purgations, by which means the Plethory, Heat, and Alteration of the Blood is diminiſhed; But Fomentations, Cataplaſms and Plaiſters facilitate the Cure in the conjunct cauſe, either by diſſolving the Tumour, or bringing it to Suppuration. {106}

At what time is the Opening of a Vein neceſſary?

In the Beginning and Increaſe.

What are the Remedies proper to be us'd immediately upon the firſt appearing of the Tumour?

They are Reſolvents and Anodynes; ſuch as thoſe that are prepar'd with Chervil boil'd in Whey, adding a little Saffron to waſh the Tumour, and ſoak the Linnen Cloaths apply'd thereto, which are often renew'd, and may be laid on with the Chervil.

Or elſe take the Urine of a healthful Perſon, wherein is boil'd an Ounce of Saffron for a Glaſs, and bath the Tumour with it.

The Sperm of Frogs is alſo made uſe of to very good purpoſe, either alone, or with Lime-Water and Soap mixt together; or Oak-Leaves and Plantane beaten ſmall, and apply'd. But Care muſt be more eſpecially taken to avoid cooling Medicines, Oils, and Greaſe, which are pernicious in great Inflammations.

What ought to be done in the increaſe of the Tumour and Pain?

They are to be aſſwag'd by mollifying and diſſolving; to which end a Cataplaſm or Pultis is to be made with the Leaves of Elder, Wall-wort or Dwarf-Elder, Mallows, Violet-Plants, Camomile, and Melilot; whereto is added beaten Line-ſeed; cauſing the whole Maſs to be boil'd in Whey, and allowing to every Pint, or thereabout, a Yolk of an Egg, twenty Grains of Saffron, a quarter of a Pound of Honey, and the Crum of white Bread, till it comes to a neceſſary Conſiſtence. Or elſe take Cow's Dung inſtead of the above-mention'd {107}Herbs, and mix with it all the other Ingredients, to make a Cataplaſm, which muſt be renew'd at leaſt every twelve Hours.

What is to be done in the State?

If the Tumour cannot be diſſolv'd (as was intended) it muſt be brought to Suppuration by Cataplaſms, conſiſting of theſe Ingredients, viz. Garlick, White Lillies roaſted under Embers, Milk, and Unguentum Baſilicon.

Or elſe only take a Glaſs of Milk, in which an Ounce of Soap is diſſolv'd, to wet the Linnen apply'd to the Tumour; and let it be often reiterated: Otherwiſe make uſe of Sorrel boil'd with freſh Butter, and a little Leaven or Yeaſt. The Plaiſter Diaſulphuris is alſo moſt excellent either alone, or, if you pleaſe, mixt with Diachylon and Baſilicon.

What is to be done in the Declination after the Suppuration?

The Ulcer muſt be at firſt gently dry'd with a Plaiſter of Diaſulphuris or Diachylon, and afterward that of Diapalma may be us'd, and Ceruſe or White Lead.

What Method is to be obſerv'd in caſe there be any Diſpoſition toward a Gangrene?

It is requiſite during the great Inflammation to make uſe of good Vinegar, in an Ounce whereof is diſſolv'd a Dram of White Vitriol, with as much Sal Ammoniack, to bath the Tumour: Or elſe take the Tincture of Myrrh and Aloes, with a little Unguentum Ægyptiacum, and afterward make a Digeſtive of Turpentine, the Yolk of an Egg, and Honey, mingling it with a little Spirit of Wine, or Brandy, if there remains any Putrifaction or Rottenneſs. {108}

Remedies for Aneuriſms and Varices.

What is to be done in order to cure an Aneuriſm?

When it is little, as that which happens after an Operation of Phlebotomy or letting Blood ill perform'd, it may be ſufficient to lay upon the affected Part a thin Plate of Lead, or elſe a Piece of Money or Counter wrapt up in a Bolſter, and to bind it on very ſtreight: But a Piece of Paper chew'd is much better for that purpoſe.

If the Anueriſm be conſiderable, an Aſtringent Plaiſter may be us'd, ſuch as the following.

Take Bolus, Dragon's Blood, Frankincence, Aloes, and Hypocyſtis, of each a Dram; mingle the whole with two beaten Eggs, and add Wax to give it the conſiſtence of a Plaiſter, which may be apply'd alone, or mixt with an equal Portion of Emplaſtrum contra Rupturam, always making a ſmall Bandage to keep it on. Emplaſtrum de Cicuta hath alſo a wonderful effect.

When the Aneuriſm is exceſſive, it is abſolutely neceſſary to proceed to a Manual Operation, the manner whereof ſhall be ſhewn hereafter in the Treatiſe of great Operations.

What is requiſite to be done in the Varices?

Varices are not generally dangerous, but even conduce to the preſervation of Health; nevertheleſs, if they become troubleſome by reaſon of their greatneſs, and the Pains that accompanie 'em, they may be mollify'd with the following Remedy.

Take the Mucilages of the Seeds of Pſyllium and Line, of each two Ounces; of Populeon {109}two Ounces; Oleum Lumbricorum & Hyperici, of each one Ounce; and of the Meal of Wheat one Ounce, adding Wax to make the Conſiſtence of a Plaiſter; part of which ſpread upon Linnen or Leather, muſt be apply'd to the Varix, and ty'd thereto with a ſmall Band.

If the Blood abound too much, it may be diſcharg'd by the Application of Leeches, or by a Puncture made with a Lancet: Afterward lay upon the Part a Piece of Lead ſow'd up in a Cloth, and let it be kept cloſe with a proper Bandage. Otherwiſe you may make uſe of an Aſtringent, ſuch as this.

Take a Pomegranate, cut it in pieces, and boil it with as much Salt as may be taken up with the Tip of your Fingers, in a Gallon of ſtrong Vinegar; then dip a Spunge in this Vinegar, apply it to the Varix, bind it on, and continue the uſe of it twice a Day for a Month together.

Remedies for Echymoſes, Contuſions, or Bruiſes.

How are Echymoſes to be treated?

All poſſible means muſt be us'd to diſſolve 'em, by laying Slices of Beef upon the Part, renewing 'em very often, or applying Linnen Rags dipt in Spirit of Wine impregnated with Saffron.

They may be alſo diſſolv'd with the Roots of Briony grated and apply'd thereto, or elſe with Plaiſter or Mortar, Soot, Oil of Olives and Unguentum Divinum, a Mixture whereof being made, is to be put between two Rags, and laid upon the Tumour or Swelling. {110}

If the Echymoſis happens in a Nervous Part, Balſam of Peru may be us'd, or, for want thereof, Oleum Lumbricorum & Hyperici, with luke-warm Wine, with which the Bolſters muſt be ſoak'd, to be laid upon it.

When the Echymoſis is great, and much Blood is diffus'd between the Skin and the Fleſh, the ſafeſt way is to make an Opening to let it out, leſt a too plentiful and dangerous Suppuration ſhould enſue, or even a Gangrene it ſelf. However, a Surgeon ought to proceed in the curing of an Echymoſis in the Face with great Circumſpection, which muſt be always prepar'd for Inciſion.

Of phlegmonous Tumors or Impoſtumes, and of Remedies proper for 'em.

What are the Tumours or Impoſtumes that partake of a Phlegmon?

They are the Bubo, Carbuncle, Anthrax, Furunculus, Phyma, Phygeton, Panaritium or Paronychia, Burn, Gangrene, and Kibe or Chilblain.

What is a Bubo?

A Bubo is a Tumour which ariſeth in the Groin, being accompany'd with Heat, Pain, Hardneſs, and ſometimes a Feaver.

What is a Carbuncle?

A Carbuncle is a hard Swelling, red, burning, and inſeparable from a Fever: It is cover'd with a black Cruſt or Scab, that afterward falls off at the Suppuration, leaving a deep and dangerous Ulcer, and which ſometimes doth not ſuppurate at all. {111}

What is an Anthrax?

The Anthrax is very near the ſame thing as the Carbuncle, only with this difference, that the latter always appears in the Glandulous Parts, and the Anthrax every where elſe.

What is a Furunculus?

It is a kind of Boil, or benign Carbuncle, which ſomewhat reſembles the Head of a Nail, and is on that Account call'd Clou by the French, cauſing Pains, as if a Nail were driven into the Fleſh.

What is a Phygeton?

The Phygeton is a ſmall, red, and inflam'd Exuberance, ſituated in the Miliary Glandules of the Skin, where it cauſeth a pricking Pain, without Suppuration.

What is a Phyma?

The Phyma appears after the ſame manner as the Phygeton, and ſuppurates.

What are the Remedies proper for all theſe ſorts of phlegmonous Tumours and Impoſtumes?

They are Cataplaſms and Plaiſters Anodyn, Emollient, Reſolvent, and Suppurative, which are us'd proportionably as in the Phlegmons.

What is a Gangrene, Sphacelus, or Eſthiomenus?

The Gangrene and Sphacelus ſignifie the ſame thing, nevertheleſs are commonly diſtinguiſh'd; the former being a Mortification begun, and the Sphacelus an entire or perfect Mortification; call'd alſo Necroſis and Sideratio. An Eſthiomenus is a Diſpoſition to Mortification, diſcover'd by the ſoftneſs of the Part; and a Gangrene is defin'd to be a Mortification of a Part, occaſion'd by the {112}Interception of the Spirits, and the Privation of the Natural Heat.

What are the cauſes of a Gangrene in general?

Every thing that can hinder the Natural Heat from exerting it ſelf in a Part; as ſtrong Ligatures, aſtringent or reſolvent Medicines, not conveniently us'd in great Inflammations; a violent Hæmorrhage; or Old Age, whereby the Spirits are exhauſted; the bitings of Mad Dogs; exceſſive Cold, &c.

By what Signs is the Gangrene known?

It is diſcover'd by the livid Colour of the Skin, which departs from the Fleſh, the ſoftneſs, coldneſs, and inſenſibility of the Part; and ſometimes by its dryneſs and blackneſs, from whence exhales a cadaverous Stench, with Sanies iſſuing forth after Punctures or Scarifications made therein. Laſtly, a Gangrene is perceiv'd by the cold Sweats, Swoonings, Syncope's, and Delirium's that invade the Patient, and which are all the Fore-runners of approaching Death.

Is a Gangrene only found in the Fleſh, and ſoft Parts of the Body?

It happens alſo in the Bones; and is then call'd Caries.

How is this Caries or Gangrene of the Bone diſcover'd, when it lies hid under the Fleſh?

It is known by the black Colour of the Neighbouring Fleſh, the Stink of the Sanies that comes forth, the intolerable Pains felt thereabouts, which are fix'd and continual before the Impoſtume and Ulcer appear; but when the Ulcer is made, a kind of roughneſs may be perceiv'd in the Bone. {113}

R E M E D I E S.

What are the Remedies proper for a Gangrene?

They are thoſe that take away the <ſpan claſs="correction" title="Original reads 'morrify'd'." >mortify'd and corrupt Parts, and recall the Natural Heat; both which Indications are exactly anſwer'd in the Extirpation of what is already corrupted, with the Inciſion-Knife; and the Reſtauration of the Natural Heat by the following Remedies.

Take an Ounce of good Vinegar, ſteeping therein a Dram of White Vitriol, with as much Sal Ammoniack: Let it be us'd in bathing the Part; and apply thereto Bolſters well ſoak'd in the ſame Liquor. This Remedy is convenient in the firſt Diſpoſition toward a Gangrene: Or, if you pleaſe, you may make uſe of the Yellow Water, which is made with Corroſive Sublimate and Lime-Water; taking, for Example, half a Dram of Corroſive Sublimate to be infus'd in a Pint of Lime-Water.

But a Tincture of Myrrh and Aloes is more efficacious, wherein Unguentum Ægyptiacum is ſteep'd; or elſe Lime-Water kept for that purpoſe, in which have been boil'd two Ounces of Sulphur or Brimſtone, with two Drams of Mercurius Dulcis; adding four Ounces of Spirit of Wine, to make an excellent Phegedænick Water, with which the Part may be bathed, and the Bolſters ſoak'd.

If the Gangrene paſſeth to the Bone, the Ulcer muſt be immediately cleans'd with Brandy, and Euphorbium afterward put into it, laying alſo ſome upon the Bolſters, and {114}abſtaining from all ſorts of Oils and Greaſes. But if theſe Remedies prove unprofitable, recourſe is then to be had to the Inciſion-Knife, Fire, or Amputation; the manner of performing which ſeveral Operations, is explain'd hereafter.

What are Kibes or Chilblains?

They are painful Tumours, which are often accompany'd with Inflammation; they happen more eſpecially in the nervous and outward Parts, as the Heel, and are ſo much the more ſenſibly felt, as the Air and Cold are more ſharp and Vehement.

What is to be done in order to cure theſe Kibes or Chilblains?

The Heel or affected Part muſt be waſh'd and dipt in Wine boil'd with Allum and Salt, whereof a Cataplaſm may be afterward made, by adding Meal of Rye, Honey, and Brimſtone. The Juice of a hot Turnep apply'd with Unguentum Roſatum, is alſo very good, or Petroleum alone.

What is a Panaritium?

Panaritium or Paronychia, is a Tumour which generally ariſeth in the Extremity of the Fingers, at the Root of the Nails: It is red, and accompany'd with very great Pain, even ſo exquiſite, that the whole Arm is ſenſible thereof, inſomuch that a Fever ſometimes enſues, and a Gangrene; the Humour being contain'd between the Bone and the Perioſteum, or that little Membrane with which it is immediately inveſted.

What Remedies are convenient for the curing of Panaritium? {115}

Anodyn Cataplaſms are to be firſt apply'd, that is to ſay, ſuch as ſerve to aſſwage exceſſive Pain, as that which is compos'd of Millk, Line-ſeeds beaten, large Figs, the Yolk of an Egg, Saffron, Honey and Oleum Lumbricorum, with the Crum of white Bread. Afterward you may endeavour to diſſolve it, by applying Oil of Almonds, Saccharum Saturni, and Ear-Wax, or elſe Balſam of Sulphur. The Plaiſter of Mucilages, and that of Sulphur or Brimſtone, diſſolv'd in Wine, is alſo a moſt excellent Reſolvent and Anodyn.

If it be requiſite to bring this Tumour to Suppuration, white Lillies roaſted under Embers may be added to the preceeding Cataplaſm; or elſe a new Cataplaſm may be made with Sorrel boil'd, freſh Butter, and a little Leaven.

What is a Burn?

A burn is an Impreſſion of Fire made upon a Part, wherein remains a great deal of Heat, with Bliſters full of ſerous Particles, or Scabs, accordingly as the Fire hath taken more or leſs effect.

What are the Remedies proper for a Burn?

A Burn is cur'd by the ſpeedy Application of freſh Mud re-iterated many times ſucceſſively; by that of peel'd Onions, Unguentum Roſatum, and Populeon, mixt with the Yolk of an Egg and unſlack'd-Lime: Cray-Fiſhes or Crabs pounded alive in a Leaden-Mortar; and a great Number of other things.

If the Burn be in the Face, you may more eſpecially take the Mucilages of the Seeds of Quinces and Pſyllium, and Frog's-Sperm, of {116}each an equal quantity, adding to every four Ounces twenty Grains of Saccharum Saturni. This Compoſition may be ſpread on the Part with a Feather, and cover'd with fine Brown Paper. It is an admirable and approved Receipt.

If the Burn hath made an Eſcar or Cruſt, it may be remov'd with freſh Butter ſpread upon a Colewort or Cabbage Leaf, and apply'd hot. But in Caſe the Scab is too hard, and doth not fall off, it muſt be open'd, to give paſſage to the Pus or corrupt Matter, the ſtay of which would occaſion a deep Ulcer underneath. The ſame Method is to be obſerv'd in the Puſtules or Bliſters, two Days after they are rais'd, applying alſo the Ointment of quick Lime, Oil of Roſes, and Yolks of Eggs.



A R T I C L E  II.

Of the Eryſipelas and its Dependances.

What is an Eryſipelas?

An Eryſipelas, commonly call'd St. Anthony's Fire, is a ſmall Elevation produc'd by a Flux of Choler diſpers'd and running between the Skin and the Fleſh. It is known by its yellowiſh Colour, great Heat and Prickings.

R E M E D I E S.

What are the Remedies proper for an Eryſipelas?

An Eryſipelas that ariſeth in the Head and Breaſt is not without danger, and the Cure of {117}it ought to be undertaken with great Care in the Application as well of internal as external Remedies: For it is requiſite to take inwardly a Doſe of the Diaphoretick Mineral, Crabs-Eyes, Egg-ſhels, Powder of Vipers, and other Medicines; as alſo Potions that have the like Virtues, ſuch as the following. Take four Ounces of Elder-Flower-Water, adding thereto a Scruple of the volatile Salt of Vipers or Hart's-Horn with an Ounce of Syrrup of red Poppies.

Phlebotomy or Blood-letting hath no place here, unleſs there be a great Plethory, but frequent Clyſters are not to be rejected, viz. ſuch as are made of Whay, Chervil, Succory, and Violet-Plants, adding a Dram of Mineral Cryſtal diſſolv'd with two Ounce of Honey of Violets.

As for outward Applications, Linnen-Rags dipt in the Spirit of Wine impregnated with Camphire and Saffron, are to be laid upon the Tumour, and renew'd as faſt as they are dry'd. An equal quantity of Chalk and Myrrh beaten to Powder, may alſo be ſtrew'd upon a Sheet of Cap-Paper over-ſpread with Honey, and apply'd to the Part.

If the Heat and Pain grow exceſſive, take half a Dram of Saccharum Saturni, twenty Grains of Camphire, as much Opium, with two Drams of red Myrrh, to be infus'd in a Gallon of White-Wine: Let this Liquor be kept to ſoak the Cloaths that are laid upon the Eryſipelas, <ſpan claſs="correction" title="Original reads 'ond'.">and often renew'd. But to dreſs the Face, a Canvaſs Cloth may be us'd, which hath been dipt in a Medicine prepar'd with a {118}Gallon of Whey, two Yolks of Eggs, and a Dram of Saffron.

Moreover amidſt all theſe Remedies, it is neceſſary to oblige the Patient to keep to a good Diet, and to preſcribe for his ordinary Drink a Diet-Drink made of Hart's-Horn, the Tops of the leſſer Centory, Pippins cut in Slices with their Skins, and Liquoriſh; a little good Wine may be alſo allow'd, with the Advice of the Phyſician.

Of Eryſipelatous Tumours or Impoſtumes, and their Remedies.

What are the Tumours or Impoſtumes that <ſpan claſs="correction" title="Original reads 'parrake'." >partake of the Nature of an Eryſipelas?

They are the dry and moiſt Herpes, the former being that which is call'd the Tetter or Ring-Worm; and the other a kind of yellow-Bladders, Puſtules, or Wheals, that cauſe itching, and raiſe ſmall corroding Ulcers in the Skin: To theſe may be added divers ſorts of Scabs and Itch.

The Remedies preſcrib'd for the Eryſipelas may be us'd for both theſe kinds of Herpes; as alſo Lotions or Bathing-Liquors made of Lime-Water, and a Decoction of Wormwood and Sal Ammoniack, allowing half a Dram to four Ounces of Liquor. Or elſe take half a Dram of Sal Saturni, and put it into a Glaſs of the Decoction of Fumitory or Chervil. You may alſo make uſe of the Oil of Tartar per deliquium, to make a Liniment either alone, or mingl'd with the above-mention'd Decoctions.



{119}

A R T I C L E  III.

Of the Oedema.

What is the Oedema?

It is a white ſoft Tumour, with very little ſenſe of Pain, which ariſeth from the Settling of a pituitous Humour.

What are the Remedies proper for an Oedema?

They are Fomentations, Cataplaſms, Liniments, and Plaiſters.

The Fomentations are made with Bundles of Wall-Wort or Dwarf-Elder, thrown into a hot Oven after the Bread is bak'd, and ſprinkled with Wine: Afterward being taken out ſmoaking, they are unty'd, open'd, and wrapt about the Part, putting a warm Linnen Cloth over 'em. This Operation is to be re-iterated; and by this means the Humour is diſſolv'd thro' Tranſpiration by Sweat.

The Cataplaſms are compos'd of Camomile, Melilot, St. John's-Wort, Sage, Wall-Wort, Pellitory of the Wall, Roots of Briony and Onions, all boil'd together in White Wine with Honey, adding, if you pleaſe, a few Cummin or Fennel Seeds beaten. Cataplaſms are alſo made of Horſe-Dung and the Seeds of Cummin beaten, which are boil'd in ſtrong Vinegar, and mixt with Barly-Meal to the Conſiſtence of Pap.

The Plaiſters are prepar'd with an Ounce of Diapalma, half on Ounce of Martiatum, a Pint of Oil of Lillies, half an Ounce of {120}Cummin-Seeds powder'd, half a Dram of Sal Ammoniack, and an Ounce of yellow Wax to make a Conſiſtence.

If any hardneſs remains, the Plaiſter of Mucilages may be apply'd, or that which is made of the Gums Bdellium, Ammoniack, and Galbanum, diſſolv'd in Vinegar. But Care muſt be taken not to omit the Purgatives of Jalap to the quantity of a Dram in a Glaſs of White-Wine; or of half an Ounce of Lozenges of Diacarthamum, which are effectual in drawing out the bottom of pituitous and ſerous Humours that nouriſh the Oedema's.

Of Oedomatous Tumours and Impoſtumes.

What are the kinds of Tumours that partake of the Nature of an Oedema?

They are the Phlyctæna, the Emphyſema, the Batrachos or Ranunculus, the Wen, the Talpa, the Bronchocele, the Ganglion, the Fungus, the Scurf, the Scrophula or King's-Evil, and all ſorts of Dropſies both general and particular.

What are Phlyctæna's?

They are Puſtules or Bliſters fill'd with a white and ſomewhat yellowiſh Humour.

What is an Emphyſema?

It is a kind of flatuous Tumour, wherein Wind is contain'd, with a little ſlimy Phlegm.

What is a Batrachos or Ranunculus?

It is a Bliſter fill'd with ſlimy Water, that ariſeth under the Tongue near the String, and in French is call'd Grenouillette, or the little Frog; which is the ſame with its Greek and Latin Names. {121}

What is a Wen?

It is a Tumour conſiſting of thick plaiſtry Phlegm, which is reckon'd among the Encyſted.

What is a Talpa?

It is a ſoft and very broad Tumour, which uſually appears in the Head and Face, containing a white, thick and pituitous Matter.

What is a Bronchocele?

It is a bunch'd Tumour which ariſeth in the Throat, and cauſeth it to ſwell extremely; being compos'd of thick Phlegm mix'd with a little Blood, and ranked among the Encyſted Tumours.

What is a Ganglion?

It is a very hard Tumour, void of Pain and wavering, produc'd by thick Phlegm: But it is always found upon ſome Nerve or Tendon.

What is a Fungus?

It is a ſpungy Tumour that grows upon Tendons bruis'd or weaken'd by ſome Hurt.

What is the Scurf?

It is a whitiſh and ſcaly Tumour rais'd in the Skin of the Head by a viſcous and mixt Phlegm, having its Root in the bottom of the Skin.

What is the Scrophula or King's-Evil?

Scrophulæ or Strumæ, commonly call'd the King's-Evil, are Tumours that generally ſhew themſelves in the Glandules of the Neck, and in all thoſe Parts where there are any. They conſiſt of a viſcous, ſerous, and malignant Phlegm, The Source or Root whereof is ſuppos'd to be in the Glandules of the Meſentery. They are alſo of the number of the Encyſted Tumours. {122}

What is the Dropſie?

It is a ſoft Tumour occaſion'd by the ſetling of abundance of ſerous Matter in the Parts where it appears.

How many ſorts of Dropſies are there?

There are three general Species, viz. the Aſcites, Tympanites, and Leucophlegmatia.

What is an Aſcites?

It is a kind of Dropſy that forms the Tumour or Swelling of the Abdomen or lower Belly, by a Maſs of Water.

What is a Tympanites?

It is a kind of Dropſy, which in like manner cauſeth a Tumour or Swelling in the lower Belly, with this difference, that a great deal of Wind is mixt with the Water, which renders the Tumour tranſparent, and ſounding, as it were a Drum; whence this Diſeaſe hath taken its Name.

What is the Dropſy call'd Leucophlegmatia?

It is a Tumour, or, to ſpeak more properly; a general Swelling or Bloating of all the other Parts of the Body, as well as of the lower Belly. It is produc'd by a viſcous and mucilaginous ſort of Phlegm; whence it happens that the Print of the Fingers remains in thoſe places that have been preſs'd.

What are the particular kinds of Dropſies?

They are thoſe that are incident to different Parts, of which they bear the Names; as the Hydrocephalus, which is the Dropſy of the Head; the Exomphalus, of the Navel, and the Hydrocele of the Scrotum. There is alſo a Dropſy of the Breaſt, and that of the Matrix.

{123}

What are the Remedies proper for all theſe ſorts of Tumours or Dropſies?

They are in general all thoſe that are agreeable to the Oedema, which are variouſly us'd, as Liniments, Fomentations, Cataplaſms, and Plaiſters: Internal Medicines ought alſo to be much conſider'd, as Diaphoreticks, Sudorificks, and Purgatives, when they are aſſiſted by a regular Diet.

A Decoction of the Roots of Briony with Cinnamon and Liquoriſh, provokes Urine very much; as well as a Decoction of Turneps and Carrets, and an Infuſion of Sage in White-Wine.



A R T I C L E  IV.

Of a Scirrhus, and its peculiar Remedies.

What is a Scirrhus?

It is a hard unmoveable Tumour, almoſt altogether void of Pain, and of a livid dark Colour; which is form'd of a Melancholick Humour, frequently ſucceeding Phlegmons and Oedema's that have not been well dreſs'd with convenient Remedies.

How is a Scirrhus cur'd?

By mollifying or diſſolving it, and ſeldom by bringing it to Suppuration.

It may be mollify'd by the application of a Cataplaſm or Pultis, compos'd of the Leaves of Violet-Plants, Mallows, Beets, Elder, Rue, and Wormwood, with Camomile-Flowers, {124}Horſe-Dung, Cow-Dung, and White Lillies. The whole Maſs is to be boil'd together in Wine, afterward adding Honey and Hogs-Lard, to make a Cataplaſm thereof with the Crum of White Bread.

It is diſſolv'd with Plaiſters compos'd of thoſe of Diachylon, Melilot, and Mucilages, to which is added Oleum Lumbricorum, and Flower of Brimſtone. To render the Remedy more effectual, Oil of Tobacco may be alſo mixt with it, and Gum Ammoniack diſſolv'd in Vinegar.

Furthermore, theſe Topical or outward Medicines are to be accompany'd with others taken inwardly, which ſerve to prepare the Humours for convenient Evacuations; Such are Crab's-Eyes, the Decoctions of Sarſaparilla, the uſe of good Wine, and light Meats of eaſie Digeſtion.

Of Scirrhous Tumours, and their Remedies.

What are the Tumours that partake of the Nature of a Scirrhus?

They are the Polypus, Carcinoma, Sarcoma, Natta, and Cancer.

What is a Polypus?

It is an Excreſcence of fungous Fleſh ariſing in the Noſtrils: But Hippocrates confounds the Carcinoma and Sarcoma with the Polypus, of which he ſays they are only a Species.

What is the Natta?

It is a Tumour or Excreſcence of Fleſh that appears in the Buttocks, Shoulders, Thighs, Face, and every where elſe, the various Figures {125}of which cauſe it to be call'd by different Names. For one while it reſembleth a Gooſeberry, at another time a Mulberry, and at another time a Melon or Cherry. Sometimes alſo theſe Swellings are like Trees, Fiſhes, Birds, or other ſorts of Animals, according to the ardent deſire that Women with Child have had for things that they cou'd not obtain when they longed for 'em.

What are the Remedies proper for the Polypus, and other kinds of Excreſcences of the like Nature?

The Polypus may be cur'd in the beginning, but it is to be fear'd leſt it degenerate into an incurable Cancer, when it hath been neglected or ill dreſs'd.

Beſides the general Remedies, which are letting Blood a little, and reiterated Purgations, with an exact Regulation of Diet, there are alſo particular Medicaments which dry up and inſenſibly conſume the Excreſcence; as a Decoction of Biſtort, Plantain, and Pomegranate-Rinds in Claret-Wine, which is to be ſnuff'd up the Noſe many times in a Day, and ſerves to ſoak the ſmall Tents that are put up therein, as alſo often to cool the Part, adding a little Allum and Honey.

The Patient muſt ſometimes likewiſe keep in his Mouth a Sage-Leaf, ſometimes a piece of the Root of Pellitory of Spain; and at another time Tobacco or ſome other thing of this Nature, which cauſeth Salivation. If the Tumour continues too long, and doth not yield to the above-mention'd Remedies, it is neceſſary to proceed to a Manual Operation, {126}which is very often perform'd with good Succeſs.

As for the Natta's, it is moſt expedient not to meddle with 'em at all; nevertheleſs theſe Marks which Infants bring along with 'em into the World, are frequently defac'd by an Application of the After-Burdens, whilſt they are as yet warm, as ſoon as their Mothers are deliver'd.

What is a Cancer?

It is a hard, painful, and ulcerous Tumour, produc'd by an adult Humour, the Malignity whereof can ſcarce be ſuppreſs'd by any Remedies.

How many ſorts of Cancers are there?

There are two kinds, viz. The Primitive and the Degenerate; the Primitive Cancer is that which comes of it ſelf, and appears at firſt about the bigneſs of a Pea or Bean, which nevertheleſs doth not ceaſe to cauſe an inward Pain, continual, and pricking by intervals; during this time it is call'd an Occult Cancer; but when grown bigger, and open'd, it bears the Name of an Ulcerated Cancer; which is ſo much the leſs capable of being cur'd or aſſwag'd, as it makes it ſelf more conſpicuous by its dreadful Symptoms, or concomitant Circumſtances.

The Degenerate Cancer is that which ſucceeds an obſtinate and ill-dreſs'd Tumour or Impoſtume, and which becomes an Ulcerated Cancer, without aſſuming the Nature of a blind or occult one.

What Remedies are requiſite to be apply'd to a blind Cancer? {127}

In regard that it cannot be known in this Condition without difficulty, it is often neglected; nevertheleſs it is a Matter of great Moment to prevent its Conſequences, more eſpecially by a good Diet, and by general Remedies, which may gently rectifie the intemperature of the Bowels: Afterwards Baths may be preſcrib'd, together with the uſe of Whey Aſſes-Milk, and Specificks in general, as Powders of Crab's Eyes, Vipers, Adders, and others. As for Topical Remedies, none are to be adminiſter'd, except it be judg'd convenient to apply to the Tumour a Piece of Lead rubb'd with Quick-ſilver; all others ſerving only to make the Skin tender, and apt to break. The Patient may alſo take for his Drink Water of Scorzonera and Hart's-Horn, with the Flowers of Bugloſs or Borage, and Liquorice: Or elſe Quick-ſilver-Water alone, boiling an Ounce of it in a Quart of Water every time, the Quick-ſilver always remaining at the bottom of the Veſſel.

What are the Remedies for an ulcerated Cancer?

Beſides the general ones, that are the ſame with thoſe of the blind Cancer, there are alſo Topical, which may take place here. The Powders of Toads, Moles, Frogs, and Crabs calcin'd, cleanſe the Ulcers perfectly well. A Decoction of Vipers and Crabs may ſerve to bath 'em, and ſome of it may be taken inwardly. Deterſives made of Lime-Water, or Whey clarify'd, and boil'd with Chervil are very good; and (if you pleaſe) you may add Camphire or Saccharum Saturni. {128}

If the Pains grow violent, recourſe is to be had to Laudanum, one or two Grains whereof may be given in a little Conſerve of Roſes. When the Cancer is ſituated in the Glandules or Fleſh, the Extirpation of it may alſo be undertaken with good Succeſs.

As for the manner of handling Degenerate Cancers, reſpect muſt be always had to the kind of Tumour, from whence it deriv'd its Original.



C H A P.  IV.

Of Baſtard or Encyſted Tumours.

What is an Encyſted or Baſtard Tumour or Impoſtume?

It is that which is made of a Setling of mixt and corrupt Humours, the Matter whereof is contain'd in certain proper Cyſtes or Membranous Bags.

What are the kinds of theſe Tumours?

They are the Steatoma, the Atheroma, the Meliceris, the Wen, the Bronchocele, and the Scrophula or King's-Evil.

How is the difference between theſe Tumours diſcern'd?

The Steatoma is known by its Matter reſembling Suet; as that of the Atheroma reſembleth Pap; and that of the Meliceris is like Honey: Theſe three Tumours cannot be well diſtinguiſh'd on the outſide, in regard that they do not change the natural Colour of the Skin, which {129}equally retains in all three the print of the Fingers that preſs it. But the Bronchocele is diſcover'd by the Place and Part which it poſſeſſeth; that is to ſay, the Throat; as alſo by its ſomewhat hard conſiſtence without the Alteration of the Skin. The Scrophulæ or King's-Evil Swellings are known by their unequal Hardneſs, and their ſituation in the Glandules, either in the Neck, Arm-pits or elſewhere, without alteration likewiſe of the Skin.

R E M E D I E S.

Want is the Method to be obſerv'd in curing theſe ſorts of Tumours?

An Attempt is to be made to diſſolve 'em, as in all the others; nevertheleſs the ſafeſt way is to bring 'em to Suppuration, and to extirpate the Cyſtes, which are apt to be fill'd again after the Diſſipation of the Humour.

What are the Medicines proper to diſſolve theſe Tumours?

They are all ſuch as may be us'd for the Oedema and Scirrhus; but the Specificks or particular Remedies are theſe:

Take Roſemary, Sage, Wormwood, Elder, great Celandine, Camomile, Melilot, St. John's-Wort, and Tobacco; boil 'em in White-Wine with Soot and Mercurial Honey, adding, thereto Cummin-ſeeds beaten, and Oleum Lumbricorum, to make a Cataplaſm, which is to be renew'd twice a Day. Afterward if the Tumour be not diſpers'd, you may apply the following Plaiſter, which hath an admirable Effect. {130}

Take an equal Portion of the Plaiſter of Diachylon, Devigo, and four times as much Mercury, and Emplaſtrum Divinum; let 'em be diſſolv'd together; then intermix Saffron, and Oil of Tobacco, to make a Plaiſter with the whole Maſs, which may be ſpread upon thin Leather, and apply'd to the Tumour, without taking it off only once every eighth Day, to cool it; ſo that it muſt be laid on again after having waſh'd and bath'd the Part with warm Urine or Brine.

But it is to be always remember'd that external Remedies take effect only imperfectly, unleſs they are aſſiſted by internal, ſuch as in this caſe are <ſpan claſs="correction" title="Original reads 'reirerated'." >reiterated Purgations, join'd with a regular Diet.

What are the Remedies proper to excite Suppuration?

To this purpoſe thoſe may be us'd that ſerve in other kinds of Tumours: But as for the extirpation of the Cyſtis, it is done by dividing the Tumour into four Parts, by procuring Suppuration, and by conſuming the Bag by little and little. The Bronchocele alone will not admit this Extirpation, by reaſon of the great Number of Nerves, Veins, and neighbouring Arteries amidſt which the Tumour is ſettl'd. However Bronchotomy, or opening the Throat, may be perform'd; which is an Operation peculiar to this Tumour.



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C H A P.  V.

Of Critical, Malignant, Peſtilential, and Venereal Tumours and Impoſtumes.

What difference is there between Critical, Malignant, Peſtilential, and Venereal Tumours?

It conſiſts in theſe particular circumſtances, viz. that Critical Tumours or Impoſtumes are indifferently all ſuch as are form'd at the End or Termination of Diſeaſes, in whatſoever Place or Part they appear.

Malignant Impoſtumes or Tumours are thoſe that are obſtinate, and do not eaſily yield to the moſt efficacious Remedies.

Peſtilential Impoſtumes or Tumours are thoſe that are accompany'd with a Fever, Swooning, Head-ach, and Faintneſs: They uſually ariſe in the time of a Plague or Peſtilence, and are contagious.

Venereal Tumours or Impoſtumes are thoſe that appear only at the bottom of the Groin, and are the product of an impure Coitus.

However, the Critical Impoſtume may be Malignant, Peſtilential, and Venereal; the Malignant Impoſtume may be neither Critical, nor Peſtilential, nor Venereal: But the Peſtilential and Venereal Tumours are always Malignant. {132}

What are the ordinary kinds of Critical Tumours or Impoſtumes?

They are the Anthrax, the Boil, the Phlegmon, and the Parotides or Swellings in the Almonds of the Ears.

What are the kinds of Malignant Tumours or Impoſtumes?

They are the Cancer, the Scrophula or King's-Evil; and others of the like Nature.

What are the kinds of Peſtilential Tumours or Impoſtumes?

They are Carbuncles that break out every where; a ſort of Anthrax which appears under the Arm-pits, and Bubo's in the Groin.

What are the kinds of Venereal Tumours or Impoſtumes?

They are Botches or Bubo's and Cancers that ariſe in the Yard; as alſo Wens and Condyloma's in the Fundament.

What is the difference between a Peſtilential and a Venereal Buboe?

They may be diſtinguiſh'd by their Situation, and reſpective Accidents; the Peſtilential lying higher, and the Venereal lower: Beſides, a Fever, Sickneſs at the Heart, and an univerſal Faintneſs or Weakneſs, are the ordinary concomitant Circumſtances of the former; whereas the Venereal Buboe is always the conſequence of an impure Coitus, and is attended with no other Symptoms than thoſe of common Tumours, viz. Pain, Heat, Shootings or Prickings, &c.

As for the Remedies, they may be ſought for among thoſe that have been already preſcrib'd for Tumours.



{133}

C H A P.  VI.

Of the Scurvy.

This Diſeaſe is known by the Ulcers of the Mouth, which are very ſtinking; as alſo by exceſſive Salivation, great Pains in the Head, Dizzineſs, frequent Epilepſies, Apoplexies, and Palſies. The Face, being of a pale red, and dark Colour, is ſometimes puff'd up or bloated, inflam'd, and beſet with Puſtules: The Teeth are looſe and ake, the Gums are ſwell'd, itch, putrifie, exulcerate, and are eaten with the Canker; and the Jaw is almoſt unmoveable: The Members are bow'd, and cannot be extended: The Patients become ſtupid and drowſie, ſo that they fetch their Breath with difficulty, are obnoxious to Palpitations of the Heart and Coughs, and fall into Swoons: The Ulcers ſometimes are ſo malignant, that their Cheeks are entirely eaten up, and their Teeth ſeen: They are alſo much inclin'd to Vomitting, Looſeneſs, and Gripes; and their Entrails are ſwell'd: They have red and livid Puſtules on their Belly and Privy-parts, which ſometimes break out into Ulcers; their whole Body being dry'd, &c.

This Diſeaſe may be eaſily cur'd in the beginning; but when it is grown inveterate, and invades the Bowels, it becomes incurable; as well as when it is the Epidemical Diſeaſe of {134}the Country, or the Perſons afflicted with it, are old, or well advanc'd in Years.

In undertaking the Cure, it is requiſite to begin with a good Diet, and to ſweeten the Blood, let the Patient take the Broth of boil'd Fowl; eating Pullets and Eggs; in the Broth may alſo be put divers ſorts of Antiſcorbutick Herbs; viz. Creſſes, Spinage, Parſly-Roots, Sparagus, Smallage, Scorzonera, Scurvy-Graſs, &c. Let him eat nothing that is high ſeaſon'd, nor acid or ſharp; let him drink pure Claret, without any adulterate Mixture; let him uſe moderate Exerciſe and Reſt; Laſtly, let him keep his Mind ſedate, and free from all manner of violent Paſſion.

The following Remedies taken inwardly are very good for the Scurvy, viz. the Tincture of Flints from ten Grains to thirty; Diaphoretick Antimony, from ſix Grains to thirty; ſweet Sublimate, from ſix Grains to thirty; Mars Diaphoreteus, from ten Grains to twenty; Crocus Martis Aperitivus, from ten Grains to two Scruples; prepar'd Coral, from ten Grains to one Dram; Volatile Spirit of Sal Ammoniack, from ſix Drops to twenty; Water of Creſſes, from fifteen Drops to one Dram; Spirit of Scurvy-graſs, from ten Drops to one Dram; Tincture of Antimony, from four Drops to twenty; Oily Volatile Sal Ammoniack, from four Grains to fifteen; Spirit of Guyacum, from half a Dram to a Dram and a half; Vitrioliz'd Tartar, from ten Grains to thirty; the Volatile Salt of Tartar, Urine, Vipers, and Hart's-Horn, of each from ſix Grains to fifteen; the Spirit of Gum Ammoniack, from eight Drops to ſixteen; White {135}Mercury Precipitate, from four to ten Grains; Mercurial Panacæa, from ſix Grains to two Scruples. We ſhall ſhew the manner of compounding 'em in our Treatiſe of Venereal Diſeaſes.

It is alſo expedient to give Emollient and Deterſive Clyſters to the Patient at Night going to bed, his Body being always kept open with convenient Diet-drinks: Afterward let him take gentle Sudorificks, ſuch as are made of the Decoctions of Fumitory, wild Cicory, Dandelion, Hart's-Tongue, Scabious, the leſſer Houſe-Leek, Germander, Borage, Scorzonera-Root, and Polypody, with Flowers of Broom, Elder, and Marygold.

Theſe are ſtronger for cold Conſtitutions, viz. Decoctions of Scurvy-Graſs, Lepidium, Arſe-ſmart, the leſſer Celandine, Wormwood, little Houſe-Leek, Trifolium Febrinum, Angelico, Juniper-Berries, &c.

Convenient Decoctions to waſh the Mouth may be made with Sage, Roſemary, Hyſſop, Oak-Leaves, Scurvy-Graſs, Creſſes, Tobacco, Roots of Biſtort, Ariſtolochy or Birth-Wort, Tormentil, Flower-de-Luce, Balauſtia or Pomegranate-Flowers, Red Roſes, &c.

To corroborate the Gums, Gargariſms are made of Anti-Scorbutick Plants; as of Spirit of Scurvy-Graſs two Drams, one Scruple of Spirit of Vitriol, one Scruple of common Salt, four Ounces of Roſe-Water and Plantane-Water. But if the Gums are putrefy'd, they are to be rubb'd with Honey of Roſes, and ſome Drops of Spirit of Salt.

To aſſwage the Pains of the Members, Bathings and Fomentations are to be us'd; and a {136}Decoction of Saxifrage taken inwardly, with ſome Grains of Laudanum is good for that Purpoſe.

To allay the Gripes, Clyſters may be given with Whey, Sugar, Yolks of Eggs, Syrrop of Poppies, and Oils of Earth-Worms, Scurvy-Graſs, Camomile, &c.

Againſt the Scorbutick Dropſy, take the Eſſence of Trifolium Febrinum and Elicampane, from twenty four Drops to thirty, and continue the uſe thereof.

Milk taken inwardly hinders Vomitting; and a Broth or Gelly of Crabs ſweetens the Blood. The Looſeneſs may be ſtopt with the Eſſence of Wormwood, and Spirit of Maſtick; as alſo the Fever with Febrifuges and Anti-ſcorbuticks.

The Spots may be fomented with Decoctions of Aromatick and Anti-Scorbutick Herbs and Nitre. For the Ulcers of the Legs, pulverize an equal quantity of Saccharum Saturni, Crocus Martis, Myrrh, and Mercurius Dulcis, and lay it upon the Bolſters that are to be apply'd to the Sores.

To mollifie the ſharpneſs of Acid Humours, this is a good Remedy: Prepare half an Ounce of Spirit of Scurvy-Graſs, two Drams of tartariz'd Spirit Ammoniack, a Dram of the Tincture of Worms. Take thrice a Day fifteen or twenty Drops of this Liquor, in a Decoction of the Tops of Firr.

Againſt the Tubercles, take two Handfuls of the Flowers of Camomile and Elder, three Drams of Briony-Root, and an Handful of White-Bread Crum; Boil the whole Compoſition in Milk, and make Cataplaſms thereof. {137}

To mitigate the Pains in the Head, take twenty or thirty five Drops of the Tincture of Amber, in Anti-ſcorbutick Spirits or Waters.

The difficulty of Reſpiration may be remov'd by a Medicinal Compoſition made of two Drams of an Anti-ſcorbutick Water, two Drams of the Eſſence of Elicampane, and half a Dram of the Spirit of Gum Ammoniack; take three or four Spoonfuls thereof ſeveral times in a Day.

To prevent the putrefaction of the Gums, take one Dram of the Tincture of Gum Lacca, three Drams of the Spirit of Scurvy-Graſs, with fifteen or twenty Drops of Oil of Tartar made per Deliquium, and rub the Gums with this Compoſition many times in a Day. Brandy in which Camphire is infus'd, or Spirit of Wine, is likewiſe a moſt excellent Remedy; as alſo all Lotions or Waſhes made with the Waters or Decoctions of Anti-ſcorbutick Plants.

For Leanneſs, Goat's-Milk with the Spirit of Scurvy-Graſs may be us'd, and other Waters drawn from Anti-ſcorbutick Plants. The Apozemes or Decoctions of Endive, Cicory, Sorrel, Becabunga, and Snail-Water, are in like manner very good for the ſame purpoſe.

Ointment of Styrax is frequently us'd in the Hoſpital call'd Hôtel-Dieu at Paris, and apply'd to Spots and callous Swellings that ariſe in the Legs.



{138}

A

T R E A T I S E

OF

Wounds, Ulcers, and Sutures.



C H A P.  I.

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, {139}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 {140}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.



{141}

CHAP II.

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. {142}

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. {143}

R E M E D I E S.

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 {144}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 {145}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. {146}

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 <ſpan claſs="correction" title="Original reads 'Hmp-ſeed'." >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 {147}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. {148}

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.



{149}

C H A P.  III.

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 {150}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. {151}

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.



C H A P.  IV.

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 {152}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.



{153}

C H A P.  V.

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 {154}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.



C H A P  VI.

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. {155}

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 {156}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 {157}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, {158}

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 {159}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 {160}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 <ſpan claſs="correction" title="Original reads 'be be'.">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 {161}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 {162}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 {163}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 {164}always, that when the Gangrene degenerates into a Sphacelus, all the mortify'd Parts muſt be incontinently ſeparated or cut off from the ſound.



C H A P.  VII.

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. {165}

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? {166}

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 {167}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, {168}

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.



C H A P.  VIII.

Of Venereal Diſeaſes.

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 {169}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, {170}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 {171}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 {172}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, {173}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, {174}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, {175}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 {176}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 {177}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 {178}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 {179}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 {180}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 <ſpan claſs="correction" title="Original reads 'Venenereal'." >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.



{181}

A

T R E A T I S E

O F T H E

DISEASES

O F T H E

B O N E S.



C H A P.  I.

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 {182}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? {183}

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? {184}

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? {185}

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, {186}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 {187}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.



C H A P.  II.

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? {188}

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 {189}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 {190}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? {191}

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 {192}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.



C H A P.  III.

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? {193}

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? {194}

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 {195}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 {196}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.



{197}

C H A P.  IV.

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 {198}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 {199}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.



C H A P.  V.

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 {200}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 {201}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: {202}

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 <ſpan claſs="correction" title="Original reads 'to Seton'.">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 {203}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. {204}

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.



C H A P.  VI.

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 {205}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 {206}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. {207}

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. {208}

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.



{209}

A

T R E A T I S E

O F

Chirurgical Operations.



C H A P.  I.

Of the Operation of the Trepan.

This Operation is to be perform'd, when it is inferr'd from the Signs of which we have already given a particular Account, that ſome Matter is diffus'd over the Dura Mater. The Trepan muſt not be us'd in the Sinus Superciliares, by reaſon of their Cavity; nor in the Sutures, in regard of the Veſſels that paſs thro' 'em; nor in the Temporal Bone without great neceſſity, eſpecially in that part of it which is join'd to the Parietal-Bone, leſt the end of this Bone ſhou'd fly out of its place, ſince it is only laid upon the Parietal; nor in the middle of the Coronal and Occipital-Bones, by reaſon of an inner {210}Prominence wherein they adhere to the Dura Mater; nor in the Paſſage of the Lateral Sinus's that are ſituated on the ſide of the Occipital.

If the Fiſſure be very ſmall, the Trepan may be apply'd upon it, altho' it is more expedient to uſe this Inſtrument on the ſide of the Fiſſure in the lower part; neither is the Trepan to be ſet upon the Sinkings; and if the Bones are looſen'd or ſeparated, there needs no other trepanning than to take 'em away with the Elevatory.

The Operation muſt be begun with Inciſion, which is uſually made in form of a Croſs, if the Wound be remote from the Sutures, and there are no Muſcles to be cut, and in the ſhape of the Letter T. or of the Figure 7. if it be near the Sutures, ſo that the Foot of the 7. or of the T. ought to be parallel to the Suture, the top of the Letter deſcending toward the Temples; it is alſo made in the middle of the Forehead. If it be ſufficient to make a longitudinal Inciſion in the Forehead; its Wrinkles may be follow'd, and there will be leſs Deformity in the Scar; but it is never done Croſſwiſe in this Part, and the Lips of the Wound are not to be cut. If an Inciſion be made on the Muſcle Crotaphites, and on thoſe of the back-part of the Head, it may be done in form of the Letter V. the Point of which will ſtand at the bottom of the Muſcles; nevertheleſs it is more convenient to make a longitudinal Inciſion, by which means fewer Fibres will be cut; and it is always requiſite to begin at the lower part, to avoid being hindred by the Hæmorrhage. {211}The Inciſions are to be made with the Inciſion-Knife, and that too boldly when there are no Sinkings; but if there be any, too much weight muſt not be laid upon 'em: Thus the Inciſion being finiſh'd, the Lips of the Skull are to be ſeparated either with the Fingers, or ſome convenient Inſtrument; Then if there be no urgent Occaſion to apply the Trepan, it may be deferr'd till the next Day, the Wound being dreſs'd in the mean time with Plaiſters, Bolſters, Pledgets, and a large Kerchief or upper Dreſſing, the uſe of which we ſhall ſhew hereafter.

The Operation is begun with the Perforative, to make a little Hole for the fixing of the Pyramid or Pin which is in the Round; afterward the Round is to be apply'd, holding the Handle of the Trepan with the Left-hand, and turning with the other very faſt in the beginning; but when the Round hath made its way, it is lifted up to remove the Pin, leſt this Point ſhou'd hurt the Dura Mater: Thus the Round being taken off from time to time, to be cleans'd from the Filings that ſtick thereto, is ſet on again, and the Operator begins his Work of turning anew, which muſt be carry'd on gently when any Blood appears, to the end that the firſt Table of the piece of Bone which is remov'd may not fly from the ſecond: When it comes near the Dura Mater, the Operator muſt proceed, in like manner, gently, ſearching with a Feather round about the Bone, to obſerve whether he ſtill continueth his Courſe in the Skull. He muſt alſo often lift up the Trepan to ſearch the Hole, to cleanſe the Inſtrument, and to keep {212}it from growing hot. As often as the Trepan is taken off, let him ſearch with a Feather, to ſee whether the Bone be cut equally; and if it be not, he muſt lean more on that ſide which is leaſt cut. If it be neceſſary to make uſe of the Terebella, the Hole muſt be made in the beginning, whilſt the Bone is as yet firm; and when the Piece begins to move, the Terebella is to be put very gently into its Hole, without preſſing the Bone, to draw it out; or elſe it may be taken away with the Myrtle-Leaf, which is an Inſtrument made of a firm Silver-Plate ſomewhat crooked. When the Piece is thus remov'd, the uneven Parts that remain at the bottom of the Hole, are to be cut with the Lenticula; and if there be any Sinkings, they may be rais'd with the Elevatory. Whereupon the Dura Mater may be compreſs'd a little with the Lenticula, to facilitate the running out of the Blood, the Wounded Perſon being oblig'd to ſtoop with his Head downward, ſtopping his Noſe and Mouth, and holding his Breath for a while, to cauſe the Matter to run out: Then the Dura Mater may be wip'd with Lint; but if any Pus or corrupt Matter lies underneath, it muſt be pierc'd with a Lancet wrapt up in a Tent, that it may not be perceiv'd by the Aſſiſtants. Afterward a Sindon or very fine Linnen Rag dipt in a proper Medicament, is put between the Dura Mater and the Skull; the Hole is fill'd with ſmall Bolſters ſteept in convenient Medicinal Liquors; and the Wound is dreſs'd with Pledgets, a Plaiſter, and a Kerchief. {213}

But the Hole ought to be well ſtopt with Bolſters, becauſe the Dura Mater is ſometimes ſo much inflam'd, that it burſts forth; ſo that if any Excreſcences ariſe therein, and go out of the Hole, having ſmall Roots, they may be bound and cut; but if their Roots be large, they muſt be preſs'd cloſe with little Bolſters ſteept in Spirituous Medicines. Here it may not be improper to obſerve, that the Operation of the Trepan ought to be perform'd more gently in Children than in adult Perſons, in regard that their Bones are more tender, and that Oily Medicines muſt not be us'd, but Spirituous. The Exfoliation is made ſometimes ſooner, and ſometimes later; but the Callus uſually covers the opening of the Skull within the ſpace of forty or fifty Days, if no ill Accident happens. In great Fractures, where there is no longer any connexion between the Bones, it is requiſite to take 'em away.

Of the Bandage of the Trepan.

The proper Bandage to be us'd after the Operation of the Trepan, is the great Kerchief, which is a large Napkin folded into two parts after ſuch a manner that the ſide which toucheth the Head exceeds that which doth not touch it in the breadth of four Fingers; it is apply'd to the Head in the middle, whilſt a Servant holds the Dreſſing with his Hand: Then the two upper ends of the Napkin being brought under Chin, the Surgeon takes the two lower, and draws 'em ſtreight by the ſides, ſo as that ſide the Napkin, which is four Fingers broader {214}than the other, may be laid upon the Forehead: Afterward the two ends of the Napkin are croſs'd behind the Head, and faſten'd at their Extremities with Pins, without making any Folds, that might hurt the Part; but the ends of the Napkin which fall upon the Shoulders, are rais'd up to the Head near the leſſer Corner of the Eyes; and the two ends under the Chin are faſten'd with Pins, or elſe tied in a Knot.



C H A P.  II.

Of the Operation of the Fiſtula Lachrymalis.

This Operation is perform'd when there is a Fiſtulous Ulcer in the great Corner of the Eye, after this manner: The Patient being plac'd in a convenient Poſture, and having his ſound Eye bound up, to take away the ſight of the Inſtruments; the Operator cauſeth the other Eye to be kept ſteady with a Bolſter held with an Inſtrument, and makes an Inciſion with a Lancet in form of a Creſcent upon the Tumour, taking care to avoid cutting the Eye-Lid and the little Cartilage which ſerves as a Pulley to the great Oblique Muſcle. If the Bone be putrify'd with a Caries, an Actual Cautery may be apply'd thereto, uſing for that purpoſe a ſmall Funnel or Tube, thro' the Canal of which the Cautery is convey'd to the Bone. {215}But the Bone muſt not be pierc'd, for it is exfoliated entire by reaſon of its ſmallneſs; and ſo the Hole is made without any Perforation.

The Dreſſing and Bandage of the Fiſtula Lachrymalis.

The Wound is fill'd with ſmall dry Pledgets, and cover'd with a Plaiſter and Bolſter: The Bandage is made with an Handkerchief folded triangular-wiſe, the ends of which are faſten'd behind the Head. If the Fleſh grows too faſt, it may be conſum'd with the Lapis Infernalis; and if there be occaſion to dilate the Wound, to facilitate the Exfoliation, it may be done with little pieces of Spunge prepar'd, and put into it. Afterward Cauſticks are to be us'd, to eat away the Callous Parts, which may be mingled with Oily Medicines, to weaken their Action, taking care, nevertheleſs, that the Eye receive no dammage by 'em. If the Bone be corrupted, a little Euphorbium may be apply'd; or elſe the ſmall Pledgets ſteept in the Tincture of Myrrh and Aloes; then the Ulcer may be handled as all others.



{216}

C H A P.  III.

Of the Operation of the Cataract.

This Operation is perform'd when there is a ſmall Body before the Apple of the Eye, which hinders the Sight from entring into it; but it is undertaken only in Blew, Green, and Pearl-colour'd Cataracts, or in thoſe that are of the Colour of poliſh'd Steel; and not in Yellow, Black, or Lead-colour'd. To know whether the Cataract be fit to be couch'd, the Patient's Eye muſt be rubb'd; ſo that if the Cataract remains unmoveable, it is mature enough; but if it changeth its place, it is requiſite to wait till it become more ſolid. The Spring and Autumn are the moſt proper Seaſons for performing the Operation.

To this purpoſe the Patient being ſet down with his Eyes turn'd toward the Light, and having his ſound Eye bound up, the Surgeon muſt likewiſe ſit on a higher Seat, whilſt the Patient's Head is held by a Servant; and his Eye being turn'd toward his Noſe, is kept ſteady with a Speculum Oculi, which is a little Iron-Inſtrument made like a Spoon, pierc'd in the middle, ſo that the Ball of the Eye may be let thro' this Hole: Then the Surgeon taking <ſpan claſs="correction" title="Original reads 'a a'.">a Steel-Needle either round or flat, accordingly as he ſhall judge convenient, perforates the Conjunctive at the end of the Corneous Tunicle, on the ſide of the little Corner of the {217}Eye, and boldly thruſts his Needle into the middle of the Cataract, which he at firſt puſheth upward, to looſen it with the Point of the Needle; and then downward, holding it for ſome time with his Needle below the Apple of the Eye. If it aſcend again after it is let go, it muſt be depreſs'd a ſecond time; but the Operation is finiſh'd when it remains in the ſame place whereto it was thruſt; neither is the Needle to be remov'd till this be done, and the Cataract entirely couch'd. In taking out the Needle, the Eye-Lid muſt be pull'd down, and preſs'd a little over the Eye.

The Dreſſing and Bandage,

Is to cauſe both the Patient's Eyes to be clos'd and bound up; then he muſt be oblig'd to keep his Bed during ſeven or eight Days, and ſome Defenſative is to be laid upon the ſore Eye, to hinder the Inflammation.

M. Dupré, Surgeon to the Hoſpital of Hôtel-Dieu at Paris, a Perſon well vers'd in theſe kinds of Operations, hath obſerv'd, that after the ſame manner as Cataracts were form'd in a very little ſpace of time in perfect Maturity; it happen'd alſo very often, that the Cataracts which were ſuppos'd to have got up again, were not the very ſame with thoſe that were couch'd, but rather a new Pellicula or little Skin, which ſometimes hath its Origine in the top of the Uveous Tunicle, and is caus'd only by a very conſiderable Relaxation of the Excretory Veſſels from the Sources of the Aqueous Humour which in filtrating permits the running {218}of many heterogeneous Parts, the Encreaſe of which produceth a new Cataract.

Of other Operations in the Eyes.

Sometimes a ſort of purulent Matter is gather'd together under the Corneous Tunicle; ſo that to draw it out, the Eye muſt be fixt in a Poſture with the Speculum Oculi, and after a ſmall Inciſion made therein with a fine Lancet, is to be preſs'd a little, to let out the Matter; but if it be too thick, it may be drawn forth by ſucking gently with a ſmall Tube or Pipe, having a little Vial in the middle, into which the Matter will fall as it is ſuck'd out.

Sometimes a ſmall Tumour ariſeth in the Eye, which being ty'd at its Root with a Slip-Knot, to ſtreighten it from time to time, will at length be diſſolv'd: But if the Tumour lie in the Hole of the Apple of the Eye, this Operation muſt not be admitted, leſt the Scar ſhou'd hinder the Paſſage of the Light. ſometimes alſo a ſomewhat hard Membrane, call'd Unguis, appears in the great corner of the eye, which when it ſticks thereto, may be cut off by binding it; this is done with a Needle and Thread, which is paſs'd thro' the Membrane, and afterward ty'd.

If the Eye-Lids are glu'd together, a crooked Needle without a Point may be threaded, and paſs'd underneath 'em; then the ends of the Thread may be drawn, to lift up the Eye-Lids, and they may be ſeparated with a Lancet.

{219}

If the Hairs of the Eye-Lids or Eye-Brows offend the Eye, they muſt be pull'd out with a Pair of Tweezers or Nippers; and when any ſmall, hard, and tranſparent Tumours ariſe in the Eye-Lids, they are to be open'd, to let out the corrupt Matter.



C H A P.  IV.

Of the Operation of the Polypus.

This Operation is neceſſary, when there are any Excreſcences of Fleſh in the Noſtrils, which, nevertheleſs, when they are livid, ſtinking, hard, painful, and ſticking very cloſe, muſt not be tamper'd with, becauſe they are Cancers. But if they are whitiſh, red, hanging, and free from Pain, the Cure may be undertaken after this manner: Take hold of the Polypus with a Pair of Forceps, as near its Root as is poſſible, and turn 'em firſt on one ſide, and then on another, till it be pull'd off. If the Polypus deſcends into the Throat, it may be drawn thro' the Mouth with crooked Forceps; and if an Hæmorrhage ſhou'd happen after the Operation, it may be ſtopt by thruſting up into the Noſtrils certain Tents ſoakt in ſome Styptick Liquor; or elſe by Syringing with the ſame Liquor.



{220}

C H A P.  V.

Of the Operation of the Hare-Lip.

This Operation is perform'd when the Upper-Lip is cleft; but if there be a great loſs of Subſtance, it muſt not be undertaken; neither ought it to be practis'd upon old nor ſcorbutick Perſons, nor upon young Children, by reaſon that their continual Crying wou'd hinder the re-union. But if any are deſirous that it ſhou'd be done to theſe laſt, they are to be kept from taking any reſt for a long time, to the end that they may fall a-ſleep after the Operation, which is thus effected:

If the Lip ſticks to the Gums, it is to be ſeparated with an Inciſion-Knife, without hurting 'em; then the Hare-Lip muſt be cut a little about the edges with Sizzers, that it may more eaſily re-unite, the edges being held for that purpoſe with a Pair of Pincers, whilſt the Servant who ſupports the Patient's Head, preſſeth his Cheeks before, to draw together the ſides of the Hare-Lip: Whereupon the Operator paſſeth a Needle with wax'd Thread, into the two ſides of the Wound, from the outſide to the inſide at a Thread's diſtance from each. But care muſt be had that the two Lips of the Hare-Lip be well adjuſted, and very even; the Thread being twiſted round the Needle by croſſing it above.

{221}

The Dreſſing and Bandage.

After the Lips are waſh'd with warm Wine, the Points of the Needles muſt be cut off, ſmall Bolſters being laid under their ends; then the Wound is to be dreſs'd with a little Pledget cover'd with ſome proper Balſam, putting at the ſame time under the Gum a Linnen Rag ſteep'd in ſome deſiccative Liquor, leſt the Lip ſhou'd ſtick to the Gum, if it be neceſſary to keep 'em a-part. Laſtly, upon the whole is to be laid an agglutinative Plaiſter, ſupported with the uniting Bandage, which is a ſmall Band perforated in the middle; it is laid behind the Head, and afterward drawn forward, one of its ends being let into the Hole which lies upon the Sore: Then the two ends of the Band are turn'd behind the Head upon the ſame Folds where they are faſten'd, ſticking therein a certain Number of Pins, proportionably to the length of the Wound.

The Patient muſt be dreſs'd three Days after; and it is requiſite at the firſt time only to untwiſt half the Needle, looſening the middle Thread if there be three; to which purpoſe a Servant is to thruſt the Cheeks ſomewhat forward. On the eighth Day the middle Needle may be taken off, if it be a young Infant; nevertheleſs the Needles muſt not be remov'd till it appears that the ſides are well join'd; neither muſt they be left too long, becauſe the Holes wou'd ſcarce be brought to cloſe.



{222}

C H A P.  VI.

Of the Operation of Bronchotomy.

This Operation becomes neceſſary, when the Inflammation that happens in the Larynx hinders Reſpiration, and is perform'd after this manner:

The Wind-Pipe is open'd between the third and fourth Ring, above the Muſcle Cricoides, or elſe in the middle of the Wind-Pipe; but in ſeparating the Muſcles call'd Sternohyodei, care muſt be had to avoid cutting the recurrent Nerves, leſt the Voice ſhou'd be loſt; as alſo the Glandules nam'd Thyroides. The Space between the Rings is to be open'd with a ſtreight Lancet, kept ſteady with a little Band, and a tranſverſe Inciſion is to be made between 'em: Before the Lancet is taken out, a Stilet is put into the Opening, thro' which paſſeth a little Pipe, ſhort, flat, and ſomewhat crooked at the end, which muſt not be thruſt in too far, for fear of exciting a Cough. This Pipe hath two ſmall Rings for the faſtening of Ribbans, which are ty'd round about the Neck; and it muſt be left in the Wound till the Symptoms ceaſe. Afterward it is taken away, and the Wound is dreſs'd, the Lips of it being drawn together again with the uniting Bandage, which hath been already deſcrib'd.



{223}

C H A P.  VII.

Of the Operation of the Uvula.

When the Uvula or Palate of the Mouth is ſwell'd ſo as to hinder Reſpiration or Swallowing, or elſe is fallen into a Gangrene, it may be extirpated thus: The Tongue being firſt depreſs'd with an Inſtrument call'd Speculum Oris, the Palate is held with a Forceps, or cut with a Pair of Sizzers; or elſe a Ligature may be made before it is cut; and the Mouth may be afterward gargl'd with Aſtringent Liquors.



C H A P.  VIII.

Of the Operation of a Cancer in the Breaſt.

The Cancer at firſt is not ſo big as a Pea, being a ſmall, hard, blackiſh Swelling, ſometimes livid, and very troubleſome by reaſon of its Prickings; but when it is encreas'd, the Tumour appears hard, Lead-colour'd, and livid, cauſing in the beginning a Pain that may be pretty well endur'd, but in the increaſe it grows intolerable, and the Stink is extremely noiſome. When it is ready to Ulcerate, the Heat is vehement, with a pricking Pulſation; and the Veins round about are turgid, being {224}fill'd with black Blood, and extended as it were the Feet of a Crab or Crey-Fiſh, till Death happen. When this Tumour is not ulcerated, it is call'd an Occult Cancer; and an Apparent one when it breaks forth into an open Ulcer.

To palliate an Occult Cancer, and prevent its Ulceration, a Cataplaſm or Pultis of Hemlock very freſh may be apply'd to the Part. All the kinds of Succory, the Decoction of Solanum or Night-ſhade; the Juices of theſe Plants, as alſo thoſe of Scabious, Geranium or Stork-Bill, Herniaria or Rupture-Wort, Plantain, &c. are very good in the beginning. River-Crabs pounded in a Leaden-Mortar, and their Juice beaten in a like Mortar, are an excellent Remedy; as alſo are Humane Excrements or Urine deſtill'd, and laid upon the Occult Cancer: Or elſe,

Take an Ounce of calcin'd Lead, two Ounces of Oil of Roſes, and ſix Drams of Saffron; let the whole Compoſition be beaten in a Mortar with a Leaden Peſtle, and apply'd. The Amalgama of Mercury with Saturn is likewiſe a very efficacious Remedy.

In the mean while the Patient may be purg'd with black Hellebore and Mercurius Dulcis, taking alſo inwardly from one Scruple to half a Dram of the Powder of Adders, given to drink, with half the quantity of Crab's-Eyes: But very great care muſt be taken to avoid the Application of Maturatives or Emollients, which wou'd certainly bring the Tumour to Ulceration. {225}

When the Cancer is already ulcerated, the Spirit of Chimney-Soot may be us'd with good Succeſs; and the Oil of Sea-Crabs pour'd ſcalding hot into the Ulcer, is an excellent Remedy. But if it be judg'd expedient entirely to extirpate the Cancer, it may be done thus:

The ſick Patient being laid in Bed, the Surgeon takes the Arm on the ſide of the Cancer, and lifts it upward and backward, to give more room to the Tumour; then having paſs'd a Needle with a very ſtrong Thread thro' the bottom of the Breaſt, he cuts the Thread to take away the Needle, and paſſeth the Needle again into the Breaſt, to cauſe the Threads to croſs one another. Afterward theſe four ends of the Threads are ty'd together, to make a kind of Handle to take off the Tumour, which is cut quite round to the Ribs with a very ſharp Raſor. The Cutting is uſually begun in the lower Part to end in the Veſſels near the Arm-Pit, where a ſmall Piece of Fleſh is left, to ſtop the Blood with greater Facility: Then having laid a Piece of Vitriol upon the Veſſels, or Bolſters ſoakt in ſtyptick Water; the ſides of the Breaſt are to be preſs'd with the Hand, to let out the Blood and Humours; and an Actual Cautery is to be lightly apply'd thereto.

The Dreſſing.

The Wound is to be dreſs'd with Pledgets ſtrew'd with Aſtringent Powders, a Plaiſter, a Bolſter, a Napkin round the Breſt, and a Scapulary to ſupport the whole Bandage. {226}

But inſtead of paſſing Threads croſs-wiſe, to form a Handle, with which the Breaſt may be taken off, it wou'd be more expedient to make uſe of a ſort of Forceps turn'd at both ends in form of a Creſcent, after ſuch a manner that thoſe ends may fall one upon another when the Forceps are ſhut. Thus the Surgeon may lay hold on the Breaſt with theſe Forceps, and draw it off, after having cut it at one ſingle Stroak with a very flat, crooked, and ſharp Knife. Neither is it convenient to apply the Actual Cautery to ſtop the Hæmorrhage, becauſe it is apt to break forth again anew, when the Eſcar is fall'n off,

When the Tumour is not as yet ulcerated, a Crucial Inciſion may be made in the Skin, without penetrating into the Glandulous Bodies; then the four Pieces of the Glandules being ſeparated, the Cancerous Tumour may be held with the Forceps, and afterward cut off. If there be any Veſſels ſwell'd, they may be bound before the Tumour is taken away; but if the Tumour ſticks cloſe to the Ribs, the Operation is not uſually undertaken.



{227}

C H A P.  IX.

Of the Operation of the Empyema.

This Operation is perform'd when it may be reaſonably concluded that ſome corrupt Matter is lodg'd in the Breaſt, which may be perceiv'd by the weight that the Patient feels in fetching his Breath; being alſo ſenſible of the floating of the Matter when he turns himſelf from one ſide to another.

If the Tumour appears on the outſide, the Abceſs may be open'd between the Ribs; but if no external Signs are diſcern'd, the Surgeon may chooſe a more convenient place to make the Opening. Thus when the Patient is ſet upon his Bed, and conveniently ſupported, the Opening is to be made between the ſecond and third of the Spurious Ribs, within four Fingers breadth of the Spine, and the lower Corner of the Omoplata; to this purpoſe the Skin is to be taken up a-croſs, to cut it in its length, the Surgeon holding it on one ſide, and the Aſſiſtant on the other. The Inciſion is made with a ſtreight Knife two or three Fingers breadth long, and the Fibres of the great Dorſal-Muſcle are cut a-croſs, that they may not ſtop the Opening. Then the Surgeon puts the Fore-Finger of his Left-hand into the Inciſion, to remove the Fibres, and divides the Intercoſtal Muſcles, guiding the Point of the Knife with his Finger to pierce the Pleuron, for fear of wounding {228}the Lungs, which ſometimes adhere thereto, the Opening being thus finiſh'd, if the Matter runs well, it muſt be taken out; but if not, the Fore-Finger muſt be put into the Wound, to diſjoyn thoſe Parts of the Lungs that ſtick to the Pleuron.

To let out the Matter, the Patient muſt be oblig'd to lean on one ſide, ſtopping his Mouth and Noſe, and puffing up his Cheeks, as if he were to blow vehemently; then if Blood appears, a greater quantity of it may be taken away than if it were Matter, in regard that a Flux of Matter weakens more than that of Blood. It is alſo worth the while to obſerve, that in making the Inciſion, the Intercoſtal Muſcles ought to be cut a-croſs, that the ſide of the Ribs may not be laid bare, by which means the Wound will not ſo ſoon become Fiſtulous.

If it be judg'd that purulent Matter is contain'd in both ſides of the Breaſt, it is requiſite that the Operation be done on each ſide; it being well known that the Breaſt is divided into two Parts by the Mediaſtinum: But in this caſe the two Holes made by the Inciſion muſt not be left open at the ſame time, for fear of ſuffocating the Patient.

The Dreſſing and Bandage.

The Wound is dreſs'd with a Tent of Lint arm'd with Balſam, being ſoft, and blunt at the end, which enters only between the Ribs, for fear of hurting the Lungs; but a good Pledget of Lint is more convenient than a Linnen {229}Tent, however a Thread muſt be ty'd to the Pledget or Tent, leſt it ſhou'd fall into the Breaſt; and Bolſters are to be put into the Wound; as alſo a Plaiſter or Band over the whole. This Dreſſing is to be <ſpan claſs="correction" title="Original reads 'kepc'.">kept cloſe with a Napkin faſten'd round the Breaſt with Pins, and ſupported by a Scapulary, which is a ſort of Band, the breadth of which is equal to that of ſix Fingers, having a Hole in the middle to let in the Head: One of its ends falls behind and the other before; and they are both faſten'd to the Napkin. Thus the Patient is laid in Bed, and ſet half upright. If the Lungs hinder the running out of the Matter, a Pipe is us'd, and the Wound afterward dreſs'd according to Art.



C H A P.  X.

Of the Operation of the Paracenteſis of the Lower-Belly.

This Manual Operation is ſometimes neceſſary in a Dropſie, when Watry Humours are contain'd in the Cavity of the Belly, or elſe between the Teguments. The Diſeaſe is manifeſt by the great Swelling; and the Operation is perform'd with a Cane, or a Pipe made of Silver or Steel, with a ſharp Stilet at the end; altho' the Ancients were wont to do it with a Lancet. The Patient being ſupported, ſitting on a Bed, or in a great Elbow-Chair, to the end that the Water may run downward, {230}a Servant muſt preſs the Belly with his Hands, that the Tumour may be extended, whilſt the Surgeon perforates it three or four Fingers breadth below the Navel, and makes the Puncture on the ſide, to avoid the White-Line; but before the Opening is made, it is expedient that the Skin be a little lifted up. The pointed Stilet being accompany'd with its Pipe, remains in the Part after the Puncture; but it is remov'd to let out the Water; and a convenient quantity of it is taken away, accordingly as the Strength of the Patient will admit. The Stilet makes ſo ſmall an Opening, that it is not to be fear'd leſt the Water ſhou'd run out, which might happen in making uſe of the Lancet, becauſe there wou'd be occaſion for a thicker Pipe. When a new Puncture is requiſite, it muſt be begun beneath the former; but if the Waters cauſe the Navel to ſtand out, the Opening may be made therein, without ſeeking for any other place.

The Bandage and Dreſſing

Are prepar'd with a large four-double Bolſter kept cloſe with a Napkin folded into three or four Folds, which is in like manner ſupported by the Scapulary.

The Operation of the Paracenteſis of the Scrotum

Is undertaken when thoſe Parts are full of Water, after this manner: Aſſoon as the Patient is plac'd in a convenient Poſture, either {231}ſtanding or ſitting, the Operator lays hold on the Scrotum with one Hand, preſſeth it a little to render the Tumour hard, and makes a Puncture, as in the Paracenteſis of the Abdomen. In an Hydrocele that happens to young Infants, the Opening may be made with a Lancet, to take away all the Water at once: But in Men, eſpecially when there is a great quantity thereof, it is more expedient to do it with the ſharp-pointed Pipe; but the Teſticles are to be drawn back, for fear of wounding 'em with the Point of the Inſtrument.

If the Hydrocele be apparently Encyſted, the Membrane containing the Water is to be conſum'd with Cauſticks, which is done by laying a Cautery in the place where the Inciſion ſhou'd be made, and afterward opening the Eſcar with a Lancet.

When the Puncture is made, it ought to be done in the upper-part of the Scrotum, becauſe it is leſs painful than the lower, and leſs ſubject to Inflammation.



C H A P  XI.

Of the Operation of Gaſtroraphy.

This Operation is uſually perform'd when there is a Wound in the Belly ſo wide as to let out the Entrails. If there be a conſiderable Wound in the Inteſtine, it may be ſow'd up with the Glover's Stitch, the manner of making which we have before explain'd. If {232}the Omentum or Caul be mortify'd, the corrupted Part muſt be cut off; to which purpoſe it is requiſite to take a Needle with waxed Thread, and to paſs it into the ſound Part a-croſs the Caul, without pricking the Veſſels. Then the Caul being ty'd on both ſides with each of the Threads that have been paſs'd double, may be cut an Inch below the Ligature, and the Threads will go thro' the Wound, ſo as to be taken away after the Suppuration. Afterward the Inteſtines are to be put up again into the Belly, by thruſting 'em alternately with the end of the Fingers. But if they cannot be reſtor'd to their proper Place without much difficulty, Spirituous Fomentations may be made with an handful of the Flowers of Camomile and Melilot, an Ounce of Aniſe, with as much Fennel and Cummin-Seeds; half an Ounce of Cloves and Nutmegs: Let the whole Maſs be boil'd in Milk, adding an Ounce of Camphirated Spirit of Wine, and two Drams of Saccharum Saturni, with two Scruples of Oil of Aniſe, and bathe the Entrails with this Fomentation very hot. Otherwiſe,

Apply Animals cut open alive; or elſe boil Skeins of raw Thread in Milk, and foment 'em with this Decoction in like manner very hot.

Before the Suture of Stitching of the Inteſtines is made, it is expedient to foment 'em with Spirit of Wine, in which a little Camphire hath been diſſolv'd: But if they be mortify'd, they muſt not be ſown up again, but fomented with Spirituous Liquors. No Clyſters are to be given to the Patient, for fear {233}cauſing the Inteſtine to ſwell; but a Suppoſitory may be apply'd: Or elſe he may make uſe of a Laxative Diet-Drink, if it be neceſſary to open his Body: He ought alſo to be very temperate and abſtemious during the Cure, ſo as to take no other Suſtenance than Broths and Gellies.

If the Inteſtines cannot be put up again, the Wound is to be dilated, avoiding the White-Line, and that too at the bottom rather than at the Top, if it be above. To this purpoſe the Inteſtines are to be rank'd along the ſide of the Wound, and a Bolſter is to be laid upon 'em dipt in warm Wine, which may be held by ſome Aſſiſtant. Then the Surgeon introduceth a channel'd Probe into the Belly, and takes a great deal of care to fix the Inteſtine between the Probe and the Peritonæum, which may be effected by drawing out the Inteſtine a little; then holding the Probe with his Left-hand, to fit a crooked Inciſion-Knife in its chanelling, he cuts the Teguments equally both on the outſide and within, and thruſts back the Entrails alternately into the Wound with his Fore-Finger.

The Stitch muſt be intermitted, being made with two crooked Needles threaded at each end with the ſame Thread. The Surgeon having at firſt put the Fore-Finger of his Left-Hand into the Belly, to retain the Peritonæum, Muſcles, and Skin on the ſide of the Wound, paſſeth the Needle with his other Hand into the Belly, the Point of which is guided with the Fore-Finger, and penetrates very far: Then he likewiſe paſſeth the other {234}Needle thro' the other Lip of the Wound into the Belly, obſerving the ſame thing as in the former, and without taking his Fingers off from the Belly. If there are many Points or Stitches to be made, they may be done after the ſame manner, without removing the Fingers from the Part, whilſt a Servant draws together the Lips of the Wound, and ties the Knots. Afterward the Wound may be dreſs'd, and the Preparatives or Dreſſings kept cloſe to the Part with the Napkin and Scapulary. But the Patient muſt be oblig'd to lie on his Belly for ſome Days ſucceſſively, to cicatrize the Wound thereof, or that of the Entrails.

If the Inteſtine were entirely cut, it wou'd be requiſite to ſow it up round about the Wound, after ſuch a manner that ſome part of it may always remain open; for if the Patient ſhou'd recover, his Excrements might be voided thro' the Wound; of which Accident we have an Example in a Soldier belonging to the Hoſpital Des Invalides at Paris, who liv'd a long time in this Condition.



C H A P.  XII.

Of the Operation of the Exomphalus.

This Operation is neceſſary when the Inteſtines or Entrails have made a kind of Rupture in the Navel, and may be perform'd thus: When the Patient is laid upon his Back, an Inciſion is to be made on the Tumour to {235}the Fat, by griping the Skin, if it be poſſible, or elſe it may be done without taking it up. Then the Membranes are to be divided with a Fleam to lay open the Peritonæum, for fear of cutting the Inteſtine; and as ſoon as the Peritonæum appears, it may be drawn upward with the Nails, in order to make a ſmall Opening therein with ſome cutting Inſtrument: Whereupon the Surgeon having put the Fore-Finger of his Left-Hand into the Belly to guide the Point of the Sizzers, with which the Inciſion is enlarg'd, reſtores the Inteſtine to its proper Place, and looſens the Caul if it ſtick to the Tumour: But if the Entrails are faſten'd to the Caul, it is requiſite to ſeparate 'em by cutting a little of the Caul, rather than to touch the Inteſtine; which laſt being reduc'd, a Servant may preſs the Belly on the ſide of the Wound; ſo that if a Maſs of Fleſh be found in the Caul, which hath been form'd by the ſticking of the Caul to the Muſcles and Peritonæum, this Fleſhy Maſs muſt be entirely looſen'd, and then a Ligature may be made to take it away, with ſome part of the Caul, as we have already ſhewn in the Gaſtroraphy. Afterward the Stitch is to be made, as in that Operation, and the Wound muſt be dreſs'd, obſerving the ſame Precautions. The Dreſſing is to be ſupported in like manner with the Napkin and Scapulary.



{236}

C H A P.  XIII.

Of the Operation of the Bubonocele, and of the compleat Rupture.

When the Inteſtinal Parts are fall'n into the Groin or the Scrotum, the Operation of the Bubonocele may be conveniently perform'd; to which purpoſe the Patient is to be laid upon his Back, with his Buttocks ſomewhat high; then the Skin being grip'd a-croſs the Tumour, the Surgeon holds it on one ſide, and the Aſſiſtant on the other, till he makes an Inciſion, following the Folds or Wrinkles of the Groin; when the Fat appears, it is requiſite to tear off either with a Fleam or even with the Nails, every thing that lies in the way, till the Inteſtine be laid open, which muſt be drawn out a little, to ſee if it do not cleave to the Rings of the Muſcles. The Inteſtine muſt be gently handl'd, to diſſolve the Excrements; and thoſe Parts muſt be afterward put up again into the Belly (if it be poſſible) with the two Fore-Fingers, thruſting 'em alternatively; but if they cannot be reduc'd, the Wound is to be dilated upward, by introducing a channell'd Probe into the Belly, to let the Sizzers into its Channelling. If the Probe cannot enter, the Inteſtine muſt be taken out a little, laying a Finger upon it near the Ring, and making a ſmall Scarification in the Ring, with a ſtreight Inciſion-Knife guided with the {237}Finger, to let in the Probe, into which may be put a crooked Knife, to cut the Ring; that is to ſay, to dilate the Wound on the inſide; but care muſt be had to avoid penetrating too far, for fear of dividing a Branch of Arteries; and then the Parts may be put up into the Belly. If the Caul had caus'd the Rupture, it wou'd be requiſite to bind it, and to cut off whatſoever is corrupted, ſcarifying the Ring on the inſide, <ſpan claſs="correction" title="Original reads 'to to'." >to make a good Cicatrice or Scar.

The Dreſſing and Bandage.

The Dreſſing may be prepar'd with a Linnen-Tent, ſoft and blunt, of a ſufficient thickneſs and length, to hinder the Inteſtines from re-entring into the Rings by their Impulſion, a Thread being ty'd thereto, to draw it out as occaſion ſerves. Then Pledgets are to be put into the Wound, after they have been dipt in a good Digeſtive, ſuch as Turpentine with the Yolk of an Egg, applying at the ſame time a Plaiſter, a Bolſter of a Triangular Figure, and the Bandage call'd Spica, which is made much after the ſame manner as that which is us'd in the Fracture of the Clavicle.

Of the compleat Hernia or Rupture.

It happens when the Inteſtinal Parts fall into the Scrotum in Men, or into the bottom of the Lips of the Matrix in Women. To perform this Operation, the Patient muſt be laid upon his Back, as in the Bubonocele, and the Inciſion carry'd on after the ſame manner; which is to {238}be made in the Scrotum, tearing off the Membranes to the Inteſtine. Then a Search will be requiſite, to obſerve whether any parts ſtick to the Teſticle; if the Caul doth ſo, it muſt be taken off, leaving a little Piece on the Teſticle; but if it be the Inteſtine, ſo that thoſe Parts cannot be ſeparated without hurting one of 'em, it is more expedient to impair the Teſticle than the Inteſtine. If the Caul be corrupted, it muſt be cut to the ſound Part, and the Wound is to be dreſs'd with Pledgets, Bolſters, and the Bandage Spica; as in the Bubonocele.



C H A P.  XIV.

Of the Operation of Caſtration.

The Mortification or the Sarcocele of the Teſticles, gives occaſion to this Operation; to perform which, the Patient muſt be laid upon his Back, with his Buttocks higher than his Head, his Legs being kept open, and the Skin of the Scrotum taken up, one end of which is to be held by a Servant, and the other by the Surgeon, who having made a longitudinal Inciſion therein, or from the top to the bottom, ſlips off the Fleſh of the Dartos which covers the Teſticle, binds up the Veſſels that lie between the Rings and the Tumour, and cuts 'em off a Fingers breadth beneath the Ligature: But care muſt be taken to avoid tying the Spermatick Veſſels too hard, for fear of a Convulſion, and {239}to let one end of the Thread paſs without the Wound. If an Excreſcence of Fleſh ſtick to the Teſticle, and it be moveable or looſe, it is requiſite to take it off neatly, leaving a ſmall Piece of it on the Teſticle; and if any conſiderable Veſſels appear in the Tumour, they muſt be bound before they are cut.

The Dreſſing and Bandage.

The Dreſſing is made with Pledgets and Bolſters laid upon the Scrotum; and the proper Bandage is the Suſpenſor of the Scrotum, which hath four Heads or Ends, of which the upper ſerve as a Cincture or Girdle; and the lower paſſing between the Thighs, and faſten'd behind to the Cincture.

There is alſo another Bandage of the Scrotum, having in like manner four Heads, of which the upper conſtitute the Cincture; but it is ſlit at the bottom, and hath no Seams; the lower Heads croſſing one another, to paſs between the Thighs, and to be join'd to the Cincture. Both theſe ſorts of Bandages have a Hole to give Paſſage to the Yard.



{240}

C H A P.  XV.

Of the Operation of the Stone in the Ureter.

If the Stone be ſtopt at the Sphincter of the Bladder, it ought to be thruſt back with a Probe: If it ſtick at the end of the Glans, it may be preſs'd to let it out; and if it cannot come forth, a ſmall Inciſion may be made in the opening of the Glans on its ſide.

But if the Stone be remote from the Glans, it is requiſite to make an Inciſion into the Ureter; to which purpoſe, the Surgeon having caus'd the Skin to be drawn upward, holds the Yard between two Fingers, making a Longitudinal Inciſion on its ſide upon the Stone, which muſt be preſt between the Fingers to cauſe it to fly out; or elſe it may be taken out with an Extractor. Then if the Inciſion were very ſmall, the Skin needs only to be let go, and it will heal of it ſelf; but if it were large, a ſmall Leaden Pipe is to be put into the Ureter, leſt it ſhou'd be altogether clos'd up by the Scar: It is alſo expedient to anoint the Pipe with ſome Deſiccative Medicine, and to dreſs the Wound with Balſam. Afterward a little Linnen-Bag or Caſe is to be made, in which the Yard is to be put, to keep on the Dreſſing; but it muſt be pierc'd at the end, for the convenience of making Water, having two Bands at the other end, which are ty'd round about the Waſte.



{241}

C H A P.  XVI.

Of the Operation of Lithotomy.

This Operation is undertaken when it is certainly known that there is a Stone in the Bladder; to be aſſur'd of which, it may not be improper to introduce a Finger into the Anus near the Os Pubis, by which means the Stone is ſometimes felt, if there be any: The Finger is likewiſe uſually put into the Anus of young Virgins, and into the Vagina Uteri of Women, for the ſame purpoſe. But it is more expedient to make uſe of the Probe, anointed with Greaſe, after this manner: The Patient being laid on his Back, the Operator holds the Yard ſtreight upward, the Glans lying open between his Thumb and Fore-finger; then holding the Probe with his Right-hand on the ſide of the Rings, he guides it into the Yard, and when it is enter'd, turns the Handle toward the Pubes, drawing out the Yard a little, to the end that the Canal of the Ureter may lie ſtreight. If it be perceiv'd that the Probe hath not as yet paſs'd into the Bladder, a Finger is to be put into the Anus, to conduct it thither. Afterward in order to know whether a Stone be lodg'd in the Bladder, the Probe ought to be ſhaken a little therein, firſt on the Right-ſide, and then on the Left; and if a ſmall Noiſe be heard, it may be concluded for certain that there is a Stone: But if it be judg'd that the {242}Stone ſwims in the Bladder, ſo that it cannot be felt, the Patient muſt be oblig'd to make Water with a hollow Probe.

Another manner of ſearching may be practis'd thus: Let the Yard be rais'd upward, inclining a little to the ſide of the Belly; let the Rings of the Probe be turn'd upon the Belly, and the end on the ſide of the Anus; and then let this Inſtrument be introduc'd, ſhaking it a little on both ſides, to diſcover the Stone.

In order to perform the Operation of Lithotomy, the Patient muſt be laid along upon a Table of a convenient height, ſo as that the Surgeon may go about his Work ſtanding; the Patient's Back muſt alſo lean upon the Back of a Chair laid down, and trimm'd with Linnen-Cloth, leſt it ſhou'd hurt his Body; his Legs muſt be kept aſunder, and the Soles of his Feet on the ſides of the Table, whilſt a Man gets up behind him to hold his Shoulders: His Arms and Legs muſt be alſo bound with Straps or Bands. Then a channell'd Probe being put up into the Bladder, a Servant ſtanding upon the Table on the ſide of the Chair, holds the Back of the Inſtrument between his two Fore-fingers on that Part of the Perinæum where the Inciſion ought to be begun, which is to be made between his Fingers with a ſharp Knife that cuts on both ſides: The Inciſion may be three or four Fingers breadth on the left ſide of the Raphe or Suture: But in Children its length muſt not exceed two Fingers breadth. If the Inciſion were too little to give Paſſage to the Stone, it wou'd be more expedient to enlarge it than to ſtretch the Wound {243}with the Dilatators. When the Convex Part where the channelling of the Probe lies, ſhall be well laid open, the Conductors may be ſlipt into the ſame Channelling, between which the Forceps is to be put, having before taken away the Probe. Some Operators make uſe of a Gorgeret or Introductor to that purpoſe, conveying the end of it into the Chanelling of the Probe; which is remov'd to introduce the Forceps into the Bladder: And as ſoon as they are fixt therein, the Conductors or Gorgeret muſt be likewiſe taken out. Afterward ſearch being made for the Stone, it muſt be held faſt, and drawn out of the Bladder: But if the Stone be long, and the Operator hath got hold thereof by the two Ends, he muſt endeavour to lay hold on it again by the Middle, to avoid the great ſcattering which wou'd happen in the Paſſage. The Stones are alſo ſometimes ſo large, that there is an abſolute neceſſity of leaving 'em in the Bladder. Again, if the Stone ſticks very cloſe to the Bladder, the Extraction ought to be deferr'd for ſome time; and perhaps it may be looſen'd in the Suppuration. Laſtly, when the Stone hath been taken out, an Extractor is uſually introduc'd into the Bladder, to remove the Gravel, Fragments, and Clots of Blood.

After the Operation, the Patient is carry'd to his Bed, having before cover'd the Wound with a good Bolſter; and if an Hæmorrhage happens, it is to be ſtopt with Aſtringents. A Tent muſt alſo be put into the Wound, when it is ſuſpected that ſome Stone or Gravel may as yet remain therein: But if it evidently appears that {244}there is none, the Wound may be dreſs'd with Pledgets, a Plaiſter, and a Bolſter, of a Figure convenient for the Part. The Dreſſing may be ſtaid with a Sling ſupported by a Scapulary; or elſe the Bandage of the double T. may be us'd, the manner of the Application of which we have ſhewn elſewhere. The Patient's Thighs muſt be drawn cloſe to one another, and ty'd with a ſmall Band, leſt they ſhou'd be ſet aſunder again.

The Operation of Lithotomy in Women is uſually perform'd by the leſſer Preparative, which is done by putting the Fore-finger and Middle-finger into the Vagina Uteri, or into the Rectum in young Virgins, to draw the Stone to the Neck of the Bladder, and keep it ſteady, ſo that it may be taken out with a Hook, or other Inſtrument.

This Operation may alſo be effected in Women, almoſt in the ſame manner as in Men; for after having caus'd the Female Patient to be ſet in the ſame Poſture or Situation as the Men are uſually plac'd, according to the preceeding Deſcription, the Conductors may be convey'd into the Ureter, to let in the Forceps between 'em, with which the Stone may be drawn out: But if it be too thick, a ſmall Inciſion is to be made in the Right and Left ſide of the Ureter.

The leſſer Preparative was formerly us'd in the Lithotomy of Men, after this manner: The Finger was put into the Anus, to draw the Stone toward the Perinæum; then an Inciſion was made upon the Stone on the ſide of the Suture, and it was taken out with an Inſtrument.



{245}

C H A P.  XVII.

Of the Operation of the Puncture of the Perinæum.

This Operation is neceſſary in a Suppreſſion of Urine, where the Inflammation is ſo great, that the Probe cannot be introduc'd. Then an Inciſion is to be made with the Knife or Lancet, in the ſame Place where it is done in Lithotomy; and a ſmall Tube or Pipe is to be put in the Bladder, till the Inflammation be remov'd.



C H A P.  XVIII.

Of the Operation of the Fiſtula in Ano.

Fiſtula's are callous Ulcers: If one of theſe happen in the Fundament, and is open on the outſide, it may be cur'd thus: After the Patient hath been laid upon his Belly on the ſide of a Bed, with his Legs aſunder, the Surgeon makes a ſmall Inciſion with his Knife in the Orifice of the Fiſtula, in order to paſs therein another ſmall crooked Inciſion-Knife, at the end of which is a Pointed Stilet with a little Silver Head which covers it, to the end that it may enter without cauſing Pain. When the Surgeon hath convey'd his Knife into the {246}Fiſtula, having the Fore-finger of his Left-hand in the Anus or Fundament, he pulls off its Head, holding the Handle with one Hand, and the Stilet that pierceth the Anus with the other; and at laſt draws out the Inſtrument to cut the Fiſtula entirely at one Stroke.

If the Fiſtula hath an Opening into the Inteſtine, an Inciſion is to be made on the outſide at the Bottom thereof, to open it in the Place where a ſmall Tumour or Inflammation uſually appears, or elſe in the Place where the Patient feels a Pain when it is touch'd. If the Tumour be remote from the Anus, it may be open'd with the Potential Cautery, to avoid a greater Inconvenience. After having thus laid open the very bottom, the little Inciſion-Knife and Stilet, with its Head, is to be paſs'd therein, the end of the Stilet is to be drawn thro' the Anus, and the Fleſh is to be cut all at once. But if the Fiſtula be ſituated too far forward in the Fundament, the Sphincter of the Anus muſt not be entirely cut, otherwiſe the Excrements cannot be any longer retain'd. Laſtly, when the Fiſtula hath been treated after this manner, all its Sinuoſities or Winding-Paſſages ought likewiſe to be open'd, and the Wound being fill'd with thick Pledgets ſteept in ſome Anodyn, is to be cover'd with a Plaiſter and a Triangular Bolſter; as alſo with the Bandage call'd the T.



{247}

C H A P.  XIX.

Of the Suture or Stitching of a Tendon.

It is requiſite to undertake this Operation when the Tendons are cut, and when they become very thick. If the Wound be heal'd, it muſt be open'd again to diſcover the Tendon, and the Part muſt be bended, to draw together again the ends of the Tendons. Then the Surgeon taking a flat, ſtreight, and fine Needle, with a double waxed Thread, paſſeth it into a ſmall Bolſter, and makes a Knot at the end of the Thread, to be ſtopt upon the Bolſter. Afterward he pierceth the Tendon from the outſide to the inſide, at a good diſtance, leſt the Thread ſhou'd tear it, and proceeds to paſs the Needle in like manner under the other end of the Tendon, upon which is laid a ſmall Bolſter, for the Thread to be ty'd in a Knot over it. Then he cauſeth the Extremities of the Tendons to lie a little one upon another, by bending the Part, and dreſſeth the Wound with ſome Balſam. It may not be improper here to obſerve, that Ointments are never to be apply'd to the Tendons, which wou'd cauſe 'em to putrifie, but altogether Spirituous Medicaments; and that the Part muſt be bound up, leſt the Extenſion of it ſhou'd ſeparate the Tendons.



{248}

C H A P.  XX.

Of the Cæſarian Operation.

When a Woman cannot be deliver'd by the ordinary means, this bold and dangerous Operation hath been ſometimes perform'd with good Succeſs. The Woman being laid upon her Back, the Surgeon makes a Longitudinal Inciſion beneath the Navel, on the ſide of the White-Line, till the Matrix appears, which he openeth, taking great care to avoid wounding the Child: Then he divides the Membranes with which it is wrapt up, ſeparates the After-Burden from the Matrix, and takes out the Child. Laſtly he waſheth the Wound with warm Wine, and diſpatcheth the Gaſtroraphy or Stitching up of the Belly, without ſowing the Matrix. After the Operation, Injections are to be made into the Matrix, to cauſe a Flux of Blood; and a pierc'd Peſſary muſt be introduc'd into its Neck.



{249}

C H A P.  XXI.

Of the Operation of Amputation, with its proper Dreſſings and Bandages.

The Leg is uſually cut off at the Ham; the Thigh as near as can be to the Knee; and the Arm as near as is poſſible to the Wriſt: But an Amputation is never made in a Joynt, except in the Fingers and Toes.

In order to cut off a Leg, the Patient is to be ſet on the ſide of his Bed, or in a Chair, and ſupported by divers Aſſiſtants; one of 'em being employ'd to hold the Leg at the bottom, and another to draw the Skin upward above the Knee, to the end that the Fleſh may cover the Bone again after the Operation. In the mean while a very thick Bolſter is laid under the Ham, upon which are made two Ligatures, viz. the firſt above the Knee, to ſtop the Blood, by ſcrewing it up with the Tourniquet or Gripe-Stick; and the ſecond below the Knee, to render the Fleſh firm for the Knife. Before the Ligature is drawn cloſe with the Gripe-Stick, a little piece of Paſte-board is to be put underneath, for fear of pinching the Skin. Thus the Leg being well fixt, the Surgeon placeth himſelf between both the Legs of the Patient, to make the Inciſion with a crooked Knife, turning it circularly to the Bone, and laying one Hand upon the Back of the Knife, which muſt have no Edge. Afterward the Perioſteum is to <ſpan claſs="correction" title="catch-word only, not in text.">be {250}ſcrap'd with an Inciſion-Knife, and the Fleſh with the Veſſels that lie between the two Bones are to be cut. When the Fleſh is thus ſeparated, a Cleft Band is to be laid upon it, with which the Heads are croſs'd, to draw the Fleſh upward, to the intent that the Bones may be cut farther, and that it may cover 'em after the Amputation, as alſo to facilitate the Paſſage of the Saw. Then the Surgeon holds the Leg with his Left-hand, and ſaweth with his Right, which he lets fall upon the two Bones, to divide 'em aſunder at the ſame time, beginning with the Perone or Fibula, and ending with the Tibia. But it is neceſſary to incline the Saw, and to go gently in the beginning, to make way for it, and afterward to work it faſter. The Leg being cut off, the Ligature muſt be unty'd below the Knee, looſening the Gripe-Stick, to let the Blood run a little, and to diſcern the Veſſels with greater facility; and then the Gripe-Stick may be twiſted again, to ſtop the Blood; which ſome Surgeons effect, by laying Pieces of Vitriol upon the Opening of the Arteries, and Aſtringent Powders, on a large Bolſter of Cotton or Tow, to be apply'd to the end of the Stump; but if ſuch a method be us'd, it is requiſite that ſome Perſon be employ'd to keep on the whole Dreſſing with his Hand during twenty four Hours. However this Cuſtom hath prevail'd in the Hoſpital of Hôtel-Dieu at Paris.

Others make a Ligature of the Veſſels, taking up the ends of 'em with a pair of Forceps, having a Spring; or with the Valet a Patin, which is a ſort of Pincers that are clos'd with a ſmall {251}Ring let down to the bottom of the Branches. Theſe Pincers being held by a Servant, the Surgeon paſſeth a Needle with wax'd Thread, into the Fleſh, below the Veſſel, bringing it back again, and with the two ends of the Thread makes a good Ligature upon the ſame Veſſel; then he looſeth the Gripe-Stick and the Band, the Stump is to be ſomewhat bended, and the Fleſh let down to cover the Bones.

The Dreſſing and Bandage.

After the Operation, it is requiſite to lay ſmall Bolſters upon the Veſſels, and dry Pledgets upon the two Bones, as alſo many other Folds of Linnen ſtrew'd with Aſtringent Powders; and over all another large Bolſter or Pledget of Cotton or Tow, cover'd in like manner with Aſtringent Powders; then the whole Dreſſing is to be wrapt up with a Plaiſter and a Bolſter, in form of a Malta Croſs; ſo that there are three or four Longitudinal Bolſters, and one Circular.

The Surgeon uſually begins to apply the Malta Croſs and Bolſter under the Ham, croſſing the Heads or Ends upon the Stump, and cauſeth 'em to be held by a Servant that Supports the Part; then he likewiſe croſſeth the other Heads, and layeth on the two Longitudinal Bolſters that croſs each other in the middle of the Stump, together with a third Longitudinal, which is brought round about the Stump, to ſtay the two former: Theſe Bolſters ought to be three Fingers broad, and very long, to paſs over the Stump. Afterward he proceeds to apply, {252}

The Bandage commonly call'd Capeline by French Surgeons, or the Head-Bandage.

Which is prepar'd with a Band four Ells long, and three Fingers broad, roll'd up with one Ball, three Circumvolutions being made on the ſide of the cut Part, the Band is to be carry'd upward with Rollers, paſſing obliquely above the Knee; and is brought down again along its former Turns; If it be thought fit to make this Bandage with the ſame Band, it muſt be let down to the middle of the cut Part, and carry'd up again to the Knee, many back-folds being made, which are ſtay'd with the Circumvolutions, till the Stump be entirely covered, and the whole Bandage wrapt up with Rollers or Bolſters.

The Capeline or Head-Bandage, having two Heads, is made with a Band of the ſame breadth, but ſomewhat longer. This Band being at firſt apply'd to the middle of the cut Part or Wound, the Heads are carry'd up above the Knee; and one of the Ends are turn'd backward, to bring it down, and to paſs it over the end of the Stump. At every back-fold which is form'd above and below the Knee, a Circumvolution is to be made with the other end of the Band, to ſtrengthen the back-folds, continuing to bring the Band downward and upward, till the whole Stump be cover'd: Then Rollers are made round <ſpan claſs="correction" title="Original reads 'the about the'." >about the Stump, and the Band is ſtay'd above the Knee. Afterward the Part may be brought to Suppuration, cleans'd and cicatriz'd.



{253}

C H A P.  XXII.

Of the Operation of the Aneuriſm.

This Operation is perform'd when the Surgeon hath prickt an Artery, or when a Tumour ariſeth in an Artery.

To this purpoſe the Patient is ſet in a Chair, and a Servant employ'd in holding his Arm in a Poſture proper for the Operation; then a Bolſter is to be laid four double, following the Progreſs of the Artery, to the end that the Ligature may better preſs the Veſſel; and the Arm may be alſo ſurrounded with another ſingle Bolſter, on which is made a Ligature ſcrew'd up with a Gripe-Stick, provided the Arm be not too much ſwell'd; for in this Caſe it wou'd be more expedient to deferr the Operation for fear of a Gangrene. The Artery being thus well ſtopt, the Surgeon lays hold on the Arm with one Hand, below the Tumour, and with the other makes an Inciſion with his Lancet, beginning at the bottom of the Tumour, and ending on the top along the Progreſs of the Artery. When the Tumour is open'd, the coagulated Blood may be diſcharg'd with a Finger; and if there are any Strings at the bottom, they may be cut with a crooked Pair of Sizzers, to the end that all the Clods of Blood, and other extraneous Bodies which are ſometimes form'd in Aneuriſms when they are very inveterate may be more {254}eaſily remov'd. But the Gripe-Stick muſt be looſen'd, to diſcover the Opening of the Artery with greater facility, and the Artery ſeparated from the Membranes with a Fleam; for it wou'd be dangerous to cut it with a ſtreight Inciſion-Knife: The Artery muſt alſo be ſupported with a convenient Inſtrument to divide it from the Nerve and Membranes; and to be aſſur'd of the Place of its Opening, the Gripe-Stick may be ſomewhat looſen'd, and afterward ſcrew'd up again. In the mean time the Surgeon gives the Inſtrument to a Servant to hold, whilſt he paſſeth under the Artery a crooked Needle with a wax'd String, cuts the Thread, and takes away the Needle: Then he begins to make the Ligature beneath the Opening of the Artery, tying at firſt a ſingle Knot, on which may be put (if you pleaſe) a ſmall Bolſter, that may be kept ſteady with two other Knots: It is alſo neceſſary that another Ligature be made in the lower part of the Artery, by reaſon that the little lateral Arteries might otherwiſe let out Blood.

The Artery ought not to be cut between the two Ligatures, leſt the firſt Ligature ſhou'd be forc'd by the Impulſion of the Blood; but the Thread muſt be let fall, that it may rot with the Suppuration. Then the Wound may be dreſs'd with Pledgets, Bolſters ſtrew'd with Aſtringent Powders and a Plaiſter; a Bolſter being alſo laid in the Fold of the Elbow. {255}

The Bandage

Is made with a Band ſix Ells long, and an Inch broad, roll'd with one end, being at firſt apply'd with divers Circumvolutions under the Elbow, and moderately bound. Many turns are to be made, and a thick and ſtreight Bolſter, is to be laid upon the Tumour, (as in the Bandage for Phlebotomy) along the Artery, till it paſs under the Arm-Hole: The Arm and Bolſter muſt be ſurrounded with the Band, which is brought up with ſmall Rollers, to the Arm-Pit, and ſtay'd with Circumvolutions round about the Breaſt. Afterward the Patient is to be laid in his Bed, with the Arm lying ſomewhat bended on the Pillow, and the Hand a little higher than the Elbow.



C H A P.  XXIII.

Of the Operation of Phlebotomy.

To perform this Operation, the Surgeon holds the Lancet between his Thumb and Fore-finger, and three other Fingers lying upon the Patient's Arm, and thruſts the Point of the lancet into the Veſſel, carrying the ſame Point ſomewhat upward, to make the Orifice the greater. If a Tendon, which is known by its hardneſs; or an Artery, which is diſcover'd by Pulſation, appear beyond the Vein, and very near it, the Lancet muſt be only ſet very {256}forward in the Vein, and drawn back again ſtreight, without turning it up, otherwiſe the Artery or Tendon wou'd be certainly cut with the Point. If the Artery or Tendon lies immediately under the Vein, the later muſt be prickt ſomewhat underneath, holding the Lancet inclin'd ſide-ways, and thruſting it very little forward; ſo that the Point will finiſh the Opening, by turning it upward.

If the Artery ſtick too cloſe to the Vein, the later is to be prickt higher or lower than it is ordinarily done; and if the Vein be ſuperficial, and lie cloſe upon a hard Muſcle, the Lancet muſt not be thruſt downright into the Vein, but it is requiſite to carry it ſomewhat obliquely, and to take the Veſſel above, leſt the Muſcle and its Membrane ſhou'd be prickt, which wou'd cauſe a great deal of Pain, and perhaps a vehement Inflammation. It is well known that the Veins of the Right Arm are uſually open'd with the Right-hand, and thoſe of the Left-Arm with the Left-hand.

The Bandage

Is made thus: The Surgeon having laid a Bolſter upon the Orifice, keeps it cloſe with two Fingers, and holds the Band or Fillet with the other Hand; then taking one end of the Fillet with the Middle-Finger, Fore-Finger, and Thumb, and applying it to the Bolſter, he makes with the longeſt end of the Fillet divers Figures in form of the Letters KY in the Fold of the Arm; as alſo a back-fold with the ſhorter end of the Fillet, held between three {257}Fingers. Afterward both ends of the Fillet are ty'd beneath the Elbow.

If an Inflammation happens after the Operation, the Bolſters are to be dipt in Oxycratum: but if the Orifice were ſo ſmall as to produce a Rhombus, it wou'd be requiſite to preſs the Wound often with two Fingers, and immediately to apply a Bolſter dipt in Oxycratum.



C H A P.  XXIV.

Of the Operation of Encyſted Tumours.

If the Tumours are ſmall and hanging, and have a narrow bottom, a Ligature may be made with Horſe-Hair or Silk, dipt in Aqua-Fortis, which will cauſe 'em to fall off of themſelves after ſome time; or elſe they may be cut above the Ligature.

If the Tumour or Wen be thick, and its bottom large, a Crucial Inciſion is to be made in the Skin, without impairing the Cyſtis or Bagg; and when the Inciſion is finiſh'd, the Bag may be torn off with the Nails, or with the Handle of a Pen-Knife; but ſometimes it is neceſſary to diſſect it. If there be any conſiderable Veſſels at the Root, they may be bound, or elſe cut; and the Blood may be ſtopt with Aſtringents. If any parts of the Cyſtis remain, they are to be conſum'd with Corroſives; and the Lips of the Wound are to be drawn together without a Stitch, making uſe {258}only of an agglutinative Plaiſter. But if the Tumour adheres very cloſe to the Pericranium, it is moſt expedient not to meddle with it at all.

Of Ganglions.

Ganglions are Tumours ariſing upon the Tendons and Nervous Parts, which may be cur'd by thruſting 'em violently, and making a very ſtreight Bandage, provided they be very recent; a reſolvent Plaiſter is to be alſo apply'd to the Part.



C H A P.  XXV.

Of the Operation of the Hydrocephalus.

This Operation is perform'd when it is neceſſary to diſcharge watry Humours out of the Head: If theſe Waters lie under the Skin, a very large Opening is to be made with a Lancet, and a ſmall Tube or Pipe left therein to let 'em run out. If the Water be ſituated between the Brain and the Dura Mater, the Membrane is to be perforated with a Lancet, after the Trepan hath been apply'd, according to the uſual Method, of which we have already given ſome account: Cauteries and Scarifications may be alſo us'd to very good purpoſe in this Diſeaſe.



{259}

C H A P.  XXVI.

Of the operation of cutting the Tongue-String.

When the Ligament of the Tongue in Infants is extended to its Extremity, they cannot ſuck without difficulty; and when grown up, they have an impediment in their Speech.

This Ligament may be cut with a little pair of Sizzers; to which purpoſe the Thumb of the Left-hand being laid upon the Gum of the lower Jaw, to keep the Mouth open, the Tongue may be rais'd upward with the Fore-Finger of the ſame Hand, and the Sizzers may be paſs'd between the two Fingers, to divide the String as near as is poſſible to the Root of the Tongue, avoiding the Veſſels: If an Hæmorrhage happens, recourſe may be had to Styptick-Waters. Afterward the Nurſe muſt take care to let a Finger be often put into the Child's Mouth, to prevent the re-uniting of the String.



{260}

C H A P.  XXVII.

Of the Operation of opening ſtopt Ductus's.

If there be only one Membrane that ſtops the Entrance of the Vagina, an Inciſion may be made, and a Leaden Pipe put into it, having Rings to faſten it to the Waſte, to hinder the re-uniting of the Wound.

If the Lips of the Pudendum are conglutinated or clos'd up, the Patient muſt be laid upon her Back, and her Knees rais'd up, in order to make an Inciſion with a crooked Inciſion-Knife, beginning at the Top; and then a Leaden Pipe is to be put into the Opening.

If the Vagina be fill'd with a Fleſhy Subſtance, an Inciſion is to be made therein, till it be entirely perforated, putting at the ſame time a Leaden Tube into the Orifice.

If the Urinary Ductus as well in young Boys as in Virgins, be ſtopt up, an Inciſion is to be made therein with a very narrow Lancet; and if a ſmall Leaden Pipe can be conveniently introduc'd, it may be done; but it is not very neceſſary, in regard that Children are almoſt always making Water, which wou'd of it ſelf hinder the cloſing of the Orifice.

If the Ductus of the Ear be ſtopt with a Membrane, it muſt be perforated, taking care not to go too far, for fear of piercing the Membrane of the Tympanum or Drum, and {261}a ſmall Leaden Pipe is to be put into the Opening.

If there be a carnous Excreſcence on the outſide of the Ear, a Ligature ought to be made therein, or elſe it may be cut with a pair of Sizzers, to cauſe it to fall off; and the reſt of the Fleſhy Subſtance that remains in the Ear muſt be conſum'd with Cauſticks, convey'd to the Part by the means of a ſmall Tube, care being had, nevertheleſs, to avoid cauterizing the Tympanum.



C H A P.  XXVIII.

Of the Operation of the Phimoſis and Paraphimoſis.

When the Præputium is ſo ſtreight that the Glans can be no longer uncover'd, this Indiſpoſition is call'd Phimoſis; but if the Præputium be turn'd back above the Glans, after ſuch a manner that it can no longer cover the ſame Glans, it is a Paraphimoſis. If in the Phimoſis the Præputium cleaves very cloſe round about the Glans, it is moſt expedient to let it alone; but if in handling the Glans it be perceiv'd that it is moveable, or elſe that ſome parts of it only ſtick together, the Operation may be perform'd after this manner: The Patient being ſet in a Chair, a Servant is employ'd in pulling back the Skin to the Root of the Penis, to the end that the Inciſion may be {262}made directly at the bottom of the Glans: Then the Surgeon having drawn out the bottom of the Præputium, introduceth a ſmall Inſtrument with a very ſharp Point on its flat ſide, at the end of which is fixt a Button of Wax, pierceth the Præputium at the bottom of the Glans on the ſide of the Thread, and finiſheth the Inciſion by drawing the Inſtrument toward himſelf.

The Paraphimoſis is cur'd by making Fomentations on the Part, to allay the Inflammation if there be any; and it is to be pull'd down with the Fingers. But if Medicinal Preparations prove ineffectual, Scarifications are to be made round about the Præputium; and afterward convenient Remedies may be apply'd to remove the Inflammation, and prevent the Mortification of the Part; ſo that at length the Præputium may be drawn over the Glans.



C H A P.  XXIX.

Of the Operation of the Varix.

In order to cure this Tumour, the Surgeon having firſt cut the Skin to diſcover the dilated Vein, ſeparates it from the Membranes, and paſſeth underneath a crooked Needle with a double wax'd Thread; then he makes a Ligature both above and below the dilatation of the Vein, opens the dilated Part with a Lancet, to let out the Blood, and applies a convenient Bandage: But without performing this {263}Operation, the Vein might be open'd with a Lancet, to draw out a ſufficient quantity of Blood; and then the Varix is to be preſs'd with a ſomewhat cloſe Bandage.



C H A P.  XXX.

Of the Operation of the Panaritium.

The Panaritium is an Abceſs which ariſeth at the end of the Fingers; ſome of theſe Tumours are only ſuperficial, and others penetrate even under the Perioſteum; nevertheleſs after whatſoever manner the Panaritium may happen, it ought to be open'd on the ſide of the Finger, that the Tendons may not be hurt. If the Abceſs be extended under the Perioſteum, the opening muſt be made on the ſide, and the Lancet thruſt forward to the Bone: Afterward the Pus or corrupt Matter is to be diſcharg'd, which wou'd cauſe the Tendons to putrifie, if it ſhou'd remain too long upon 'em.

The Dreſſing and Bandage

Are made with a Plaiſter cut in form of a Malta Croſs, which is apply'd at the middle to the end of the Finger, the Heads being croſs'd round about. The Bolſters muſt be alſo cut in the ſhape of the Malta Croſs, or of a plain Croſs only; the Band being a Finger's breadth {264}wide, and long enough to be roll'd about the whole Dreſſing: It muſt be pierc'd at one of its ends, and cut the length of three Fingers at the other; ſo that the two Heads may paſs thro' the Hole, to ſurround the Finger with ſmall Rollers.



C H A P.  XXXI.

Of the Reduction of the falling of the Anus.

To reduce the Anus to its proper place when it is fallen, the Patient being laid upon his Belly, with his Buttocks higher than his Head, the Operator gently thruſts back the Roll that forms the Anus with his Fingers dipt in the Oil of Roſes: Then he applies the Bolſters ſteept in ſome Aſtringent Liquor, and cauſeth 'em to be ſupported with a ſort of Bandage, the Nature of which we ſhall ſhew in treating of the Fracture of the Coccyx, that is to ſay, the T. the double T. or elſe the Sling with four Heads.



{265}

C H A P.  XXXII.

Of the Reduction of the falling of the Matrix.

In this Operation, the Patient being laid upon her Back, with her Buttocks rais'd up, Fomentations are to be apply'd to the Part; a Linnen Cloth is to be laid upon the Neck of the fallen Matrix; and it is to be thruſt very gently with the Fingers, without uſing much force. If the Matrix ſhou'd fall out again, it wou'd be requiſite to convey a Peſſary into it, after it hath been reduc'd; and to enjoyn the Patient to lie on her Back with her legs a-croſs.



C H A P.  XXXIII.

Of the Application of the Cautery.

The Cautery is an Ulcer which is made in the Skin, by applying Cauſticks to it, after this manner:

The Surgeon having moiſten'd the Skin for a while with Spittle, or elſe having caus'd a light Friction to be made with a warm Cloth, applies a perforated Plaiſter to the Part, and breaks the Cautery-Stone, to be laid in {266}the little Hole, leaving it for a longer or ſhorter time, accordingly as he knows its Efficacy, or as the Skin is more or leſs Fine. Afterward he ſcarifieth the Burn with his Lancet, and puts a Suppurative, or piece of freſh Butter into the Part, till the Eſcar be fallen off.

The Dreſſing and Bandage.

After the Application of the Lapis Infernalis, or any other Cautery-Stone, it is neceſſary to lay over it a Plaiſter, a Bolſter, and a Circular Bandage, which ought to be kept ſufficiently cloſe, to preſs the Stone, after a Pea or little Piece of Orrice-Root, hath been put into the Ulcer to keep it open. Then the Patient is to make uſe of this Bandage, with which he may dreſs it himſelf. Take a piece of very ſtrong Cloth, large enough to roll up the Part without croſſing above it: And let three or four Holes be made in one of its ſides, as many ſmall Ribbans or Pieces of Tape being ſow'd to the other, which may be let into the Holes, as occaſion ſerves, to cloſe the Band.



{267}

C H A P.  XXXIV.

Of the Application of Leeches.

It is requiſite that the Leeches be taken in clear running Waters, and that they be long and ſlender, having a little Head, the Back green, with yellow Streaks, and the Belly ſomewhat reddiſh. Before they are apply'd, it is alſo expedient to let 'em purge during ſome Days in fair Water, faſt half a Day in a Box without Water. Afterward the Part being rubb'd or chaf'd with warm Water, Milk, or the Blood of ſome Fowl, the Opening of the Box is to be ſet to the Part, or the Leeches themſelves laid upon a Cloth; for they will not faſten when taken up with the Fingers. The end of their Tail may be cut with a Pair of Sizzers, to ſee the Blood run, and to determine its quantity, as alſo to facilitate their ſucking. When you wou'd take 'em away, put Aſhes, Salt, or any other ſharp thing upon their Head, and they will ſuddenly deſiſt from their Work; but they are not to be pull'd off by force, leſt they ſhou'd leave their Head or Sting in the Wound, which wou'd be of very dangerous conſequence. When they are remov'd, let a little Blood run out, and waſh the Part with ſalt Water. {268}

The Dreſſing

Is made with a Bolſter ſoakt in ſome Styptick Water, if the Blood will not otherwiſe ſtop; or in Brandy or Aqua-Vitæ if there be an Inflammation; and it is to be ſupported with a Bandage proper for the Part.



C H A P.  XXXV.

Of the Application of the Seton.

To perform this Operation, a Cotton or Silk Thread is to be taken, after it hath been dipt in Oil of Roſes, and let into a kind of Pack-Needle; then the Patient ſitting in a Chair, is to hold up his Head backward, whilſt the Surgeon gripes the Skin tranſverſely in the Nape of the Neck with his Fingers, or elſe takes it up with a Pair of Forceps, and paſſeth the Needle thro' the Holes of the Forceps, leaving the String in the Skin. As often as the Bolſter that covers the Seton is taken off, that part of the String which lies in the Wound is to be drawn out, and cut off.



{269}

C H A P.  XXXVI.

Of Scarifications.

Scarifications are to be made more or leſs deep, accordingly as neceſſity requires, beginning at the bottom, and carrying them on upward, to avoid being hinder'd by the Hæmorrhage. They muſt alſo be let one into another, that Strings may not be left in the Skin.



C H A P.  XXXVII.

Of the Application of Veſicatories.

Veſicatories are compounded with the Powder of Cantharides or Spaniſh flies, mixt with very ſower Leaven, or elſe with Turpentine. Before they are apply'd, a light friction is to be made on the Part with a <ſpan claſs="correction" title="Original reads 'wram'." >warm cloth, and a greater or leſſer quantity is to be laid on, accordingly as the Skin is more or leſs fine, leaving 'em on the Part about ſeven or eight Hours; then they are to be taken away, and the Bliſters are to be open'd, applying thereto ſome ſort of Spirituous Liquor.



{270}

C H A P.   XXXVIII.

Of the Application of Cupping-Glaſſes.

A Good Friction being firſt made with warm Clothes, lighted Toe is to be put into the Cupping-Glaſs, or elſe a Wax-Candle faſten'd to a Counter, and then it is to be apply'd to the Part till the Fire be extinguiſh'd, and the Skin ſwell'd, re-iterating the Operation as often as it is neceſſary; and afterward laying on a Bolſter ſteept in Spirit of Wine. Theſe are call'd dry Cupping-Glaſſes: But if you wou'd draw Blood, every thing is to be obſerv'd that we have now mention'd, beſides that Scarifications are to be made, according to the uſual manner; and the Cupping-Glaſs is to be ſet upon the Scarifications: But when the Cupping-Glaſs is half full of Blood, it muſt be taken off to be emptied, and the Application thereof is to be re-iterated, as often as it is required to take away any Blood. Laſtly, the Inciſions are to be waſh'd with ſome Spirituous Liquor; and a Bandage is to be made convenient for the Part.



{271}

C H A P.  XXXIX.

Of the opening of Abceſſes or Impoſtumes.

An Abceſs or Impoſtume ought to be open'd in its moſt mature part, and in the Bias of the Humours, endeavouring to preſerve the Fibres of the Muſcles from being cut, unleſs there be an abſolute neceſſity, avoiding alſo the great Veſſels, Tendons, and Nerves. The Opening muſt be rather large than ſmall, and not too much preſs'd in letting out the purulent Matter. If the Skin be thick, as it happens in the Heel, it may be par'd with a Razor; and if the Matter be lodg'd under the Nails, it wou'd be required to ſcrape 'em with Glaſs before they are pierc'd.



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A

T R E A T I S E

O F T H E

OPERATIONS

O F

FRACTURES.



C H A P.  I.

Of the Fracture of the Noſe.

When the Fracture is conſiderable, the Noſtrils are ſtopt up, and the Senſe of Smelling is loſt. In order to reduce it, the Surgeon takes a little Stick wrapt up in Cotton, and introduceth it into the Noſtrils as gently as is poſſible, to raiſe up the Bones again, laying the Thumb of his Left-hand upon the Noſe, to retain 'em in their place. The Bones being thus ſet, he proceeds to prepare {273}

The Dreſſing and Bandage

By conveying into the Noſtrils certain Leaden Pipes of a convenient Bigneſs and Figure, which ſerve to ſupport the Bones, and to facilitate Reſpiration. But care is to be had to avoid thruſting 'em up too far, for fear of hurting the ſides of the Noſe; and they are to be anointed with Oil of Turpentine mixt with Spirit of Wine: Theſe Pipes are alſo to have little Handles, with which they may be faſten'd to the Cap. If there be no Wound in the Noſe, there will be no need of a Bandage; but if the Fracture be accompany'd with a Wound, after having apply'd the proper Medicines, it wou'd be requiſite to lay upon each ſide of the Noſe a Triangular Bolſter, cover'd with a little piece of Paſte-board of the ſame Figure. This ſmall Dreſſing is to be ſupported with a kind of Sling that hath four Heads; being a piece of Linnen-Cloath, two Fingers broad, and half an Ell long; it is ſlit at both ends, and all along, only leaving in the middle a Plain of three Fingers, that is to ſay, a part which is not cut. The Plain of this Sling is to be laid upon the Fracture, cauſing the upper Heads to paſs behind the Nape of the Neck, which are to be brought back again forward; the lower Heads are likewiſe to be carry'd behind, croſſing above the upper, and afterward to be return'd forward. If the Bones of the Noſe be not timely reduc'd, a great Deformity ſoon happens therein, and a Stink caus'd by the Excreſcences and Polypus's.



{274}

C H A P.  II.

Of the Fracture of the lower Jaw.

The Operator at firſt puts his Fingers into the Patient's Mouth, to preſs the Prominences of the Bones; and afterward doth the ſame thing on the outſide. If the Bones paſs one over another, a ſmall Extenſion is to be made. If the Teeth be forc'd out of their Place, they are to be reduc'd, and faſten'd to the ſound Teeth with a wax'd Thread.

The Dreſſing and Bandage.

If the Fracture be only on one ſide, a Bolſter ſow'd to a piece of Paſte-board is to be laid upon the flat ſide of the Jaw, both being of the Figure and Size of the Jaw it ſelf. The Bandage of this Fracture is call'd Cheveſtre, i.e. a Cord or Bridle, by the French Surgeons, and is made by taking a Band roll'd with one Head or End, three Ells long, and two Fingers broad; the Application of it is begun with making a Circumvolution round about the Head in paſſing over the Fore-head; then the Band is let down under the Chin, and carry'd up again upon the Cheek, near the leſſer Corner of the Eye in paſſing over the Fracture; afterward it is rais'd up to the Head, and brought down again under the Chin, {275}to form a Roller or Bolſter upon the Fracture: Thus three or four Circumvolutions and Rollers being made upon the Fracture, the Band is let down under the Chin, to ſtay and ſtrengthen its ſeveral Turns, and is terminated round the Head, in paſſing over the Fore-head.

If the Jaw be fractur'd on both ſides, it wou'd be requiſite to apply thereto a Bolſter and Paſte-board, perforated at the Chin, and of the Figure of the entire Jaw; the Bandage which we have even now deſcrib'd, may be alſo prepar'd in making Rollers on both ſides of the Jaw: Or elſe the double Cheveſtre may be made with a Band of five Ells long, and two Fingers broad, roll'd up with two Balls, that is to ſay, with the two Ends. The Application of this Band is begun under the Chin, from whence it is carry'd up over the Cheek, croſs'd upon the top of the Head, and brought down behind the Head, where it is croſs'd again; then it is let down under the Chin, croſs'd there, and carry'd up over the Fracture; afterward the Band being paſs'd three or four times over the ſame turns, in making Rollers upon the Jaws, is turn'd upon the Chin, and ſtay'd upon the Forehead round about the Head.



{276}

C H A P.  III.

Of the Fracture of the Clavicle.

The Patient is to be ſet in a Chair, and his Arm is to be drawn backward, whilſt an Aſſiſtant thruſts his Shoulder forward: In the mean time the Operator ſets the Bones again in their place, by thruſting the Protuberances, and drawing out the ſunk Bone.

Or elſe a Tennis-Ball may be taken, and put under the Patient's Arm-Pit, whoſe Elbow is then to be preſs'd againſt his Ribs, whilſt the Surgeon reduceth the Fracture.

Otherwiſe, the Patient may be laid upon his Back, putting a Convex Body under both his Shoulders, as a Bowl, or large wooden Porrenger; and then the Shoulders may be preſt, to raiſe up the two ends of the Bones, which the Surgeon muſt take care to reduce,

The Dreſſing and Bandage.

The Cavities which are above and below the Clavicle, are to be fill'd with Bolſters trimm'd with Paſte-boards; another is to be alſo laid upon the Bone, which is almoſt of the ſame Figure with the Clavicle, and a large Bolſter, to cover the three others: This Dreſſing is to be ſecur'd with the Bandage call'd the Capeline or Head-Bandage, provided the Fracture be in the middle of the Clavicle. A Band {277}being taken about ſix Ells long, and four fingers thick, roll'd with two Balls; it is apply'd in the middle to the Fracture; one of its Heads or Ends is let down upon the Breaſt, whilſt the other is paſs'd behind the Back, below the Arm-hole, oppoſite to the indiſpos'd Arm-hole and above the Breaſt, to be carry'd over the other end of the Band, which is rais'd up, to make a Roller or Bolſter upon the Fracture: The other end is paſs'd under the indiſpos'd Arm-pit, and upon the Band that made the Roller, which is elevated by making a third Roller upon the Clavicle: Theſe Circumvolutions around about the Body are continu'd, as alſo theſe Rollers upon the Clavicle, till it be entirely cover'd. Some Circumvolutions are alſo made upon the upper part of the Arm, near its Head: The Space that lies between the Rollers and the Circumvolutions of the Arm, and which bears the Name of Geranium or Stork's-Bill, is likewiſe cover'd with ſome Circumvolutions, and the Band is ſtay'd by making Circumvolutions quite round about the Body.

If the Fracture were near the Head of the Humerus or Arm-Bone, a ſort of Bandage might be prepar'd, which is call'd Spica, with a Band roll'd with one Ball five Ells long, and four fingers broad; one end of this Band is paſs'd under the Arm-pit oppoſite to the indiſpos'd one behind the Back: The other end is convey'd under the indiſpos'd Arm-pit; the Figure of the Letters KY or X is made on the Shoulder; the Band is return'd below the other Shoulder behind; it is brought back again before, to form a ſecond KY upon the {278}Fracture; three or four more KY's are wrought upon the Fracture; two Circumvolutions are made in the upper part of the Humerus, which conſtitute a Triangle call'd Geranium; this Triangle is cover'd with Rollers, and the Band is terminated round about the Breaſt.



C H A P.  IV.

Of the Fracture of the Omoplata or Shoulder-Blade.

The Acromion is uſually fractur'd, but it may be known that the middle of the Omoplata is broken by a Numneſs which is felt in the whole Arm: Whereupon the Surgeon, after having examin'd the place of the Fracture, thruſts back the Prominences of the Bones into their place; and if any Splints happen to prick the Part, he makes an Inciſion to take 'em out, or to cut off their Points.

The Dreſſing and Bandage.

A Bolſter is laid upon the Omoplata, as alſo a large piece of Paſte-board of the bigneſs and Figure of this Bone, and a ſort of Bandage is prepar'd, known by the name of the Star, with a Band roll'd with one Head four Ells long, and as many Fingers broad. This Band is convey'd behind the Back, one of its ends lying under the Arm-hole, oppoſite to the indiſpos'd one; but the other is paſs'd under the {279}Shoulder, and afterward above it, to make a KY in the middle of the Back; then paſſing under the other Arm-hole, it is brought up to the Shoulder, to be let down, and to form a ſecond KY upon the middle of the Back: Theſe Turns are continu'd in making Rollers, till the Omoplatæ are all cover'd: Circumvolutions are alſo made round the upper part of the Humerus, as in the Spica; and the Bandage is finiſh'd by Circumvolutions round about the Breaſt.



C H A P.  V.

Of the Fracture of the Ribs.

When a Rib is broken, one of the ends puſheth into the Breaſt, ſometimes on the outſide; and ſometimes the Ends lie againſt each other. In order to reduce it, the Patient being laid upon the ſound Rib, a Plaiſter of Maſtick is apply'd to the Fracture; and it is drawn out violently; ſo that ſometimes this Attraction brings back the Bone, which is advanc'd into the Breaſt; but the ſureſt way is to make an Inciſion therein, to raiſe it up with the Finger.

If the Rib appear without, the Patient is to be ſet in a a Chair, and oblig'd to bend his Body on the ſide oppoſite to the Fracture, holding his Breath, with which he muſt puff ſtrongly, without letting it forth, in order to dilate the Breaſt, whilſt the Surgeon thruſts the Rib into its place.

{280}

The Dreſſing and Bandage.

A Bolſter is to be apply'd to the Fracture, with two little Pieces of Paſte-board paſs'd in form of a St. Andrew's Croſs; and another Bolſter upon the whole Dreſſing, on which is alſo laid a large ſquare Paſte-board cover'd with a Bolſter. The Bandage is made with a Napkin folded into three Folds, which is put round the Breaſt, being ſow'd and ſupported by the Scapulary; which is a Band ſix Fingers broad, perforated in the middle, to let in the Head. The two ends of the Scapulary are faſten'd before and behind to the Napkin.



C H A P.  VI.

Of the Fracture of the Sternum or Breaſt-Bone.

To reduce this Fracture, the Patient is to be laid upon his Back, with a Convex Body underneath; both his Shoulders are to be preſs'd with ſome weight, to puſh 'em backward, and to raiſe up the Sternum, which is ſunk down; or elſe an Inciſion may be made upon the Bone, to diſcover it; and then a Vectis is to be apply'd thereto very gently, in order to heave it up into its place.

{281}

The Dreſſing and Bandage.

A Bolſter and Paſte-board are to be laid upon the Sternum, almoſt of the ſame Figure with the Part; and the Bandage is to be prepar'd with a Napkin ſupported with a Scapulary. Or elſe the Bandage call'd Quadriga may be made with a Band roll'd with two Heads, five Ells long, and four Fingers broad: The Application of this Band is begun under the Arm-pit; the Figure of KY is form'd under the Shoulder; the Band is carry'd downward with the two Balls, once before, and the other behind; it is paſs'd under the other Arm-hole; the Heads are croſs'd upon the Shoulder, and it is brought down backward and forward, forming a KY before and behind. Afterward the Bank is roll'd about the Breaſt in making Rollers or Bolſters; theſe Rollers are continu'd till the Band be terminated; and it is ſtay'd by a Cirumvolution round the Breaſt.



C H A P.  VII.

Of the Fracture of the Vertebra's.

The Apophyſes of the Vertebra's are commonly broken, and their Bodies but ſeldom: It may be known that the Body of the Vertebra of the Neck and Back is fractur'd by the Palſie of the Arm, accompany'd with the loſs of Feeling; by the ſuppreſſion of Urine; {282}and by the Palſie of the Sphincter of the Anus; ſo that the Excrements cannot be any longer retain'd. If theſe Symptoms appear, it may well be conceiv'd that the Marrow is compreſs'd, and prickt with Points; for the removing of which, it is neceſſary to make an Inciſion upon the Body of the Vertebra in the fractur'd Place.

If the Apophyſes Spinosæ are only fractur'd, theſe Accidents will not happen, only ſome Pain will be felt: To reduce 'em, the Patient is to be laid upon his Belly, and the Surgeon muſt uſe his utmoſt endeavours to raiſe up the Bone again, and to ſet it in its Natural Situation.

The Dreſſing and Bandage.

If the Apophyſis Spinoſa were fractur'd, it wou'd be requiſite to apply to each ſide of it a ſmall long Bolſter, which is to be cover'd with a Paſte-board of the ſame Figure with the Bolſter; another Bolſter lying upon each Paſte-board. The Bandage is to be made with a Napkin ſuſtain'd by its Scapulary; or elſe the Quadriga may be prepar'd, according to the manner we have already deſcrib'd in the Fracture of the Sternum.



{283}

C H A P.  VIII.

Of the Fracture of the Os Sacrum.

It is reduc'd as the other Vertebra's; but its Dreſſing and Bandage are made with the T perforated at the Anus, or elſe with the H or double T. It is made with a Band two Fingers broad, and long enough to encompaſs the Body above the Hips; ſo that to the middle of this Band is faſten'd another Band of the ſame breadth, and of a ſufficient length to paſs over the Dreſſing of the Os Sacrum, as alſo between the Thighs, to be join'd in the fore-part to the firſt Cincture. The double T is made by faſtening two Bands at a Finger's breadth diſtance one from another, to the Band which ought to be roll'd about the Body; and this ſort of Bandage is to be ſupported with a Scapulary.



C H A P.  IX.

Of the Fracture of the Coccyx or Rump-Bone.

This Bone is uſually broken by falls, and ſinks into the inſide; ſo that to reduce it, the Fore-finger of one Hand is to be put into the Anus or Fundament as far as the {284}Fracture, to thruſt it back again into its place, whilſt the other Hand ſetleth it on the outſide.

The Dreſſing and Bandage.

Are the ſame with thoſe in the Fracture of the Os Sacrum; but the Patient muſt be oblig'd to lie on one ſide, and to ſit in a perforated Chair, when he hath a mind to riſe.

If the Os Innominatum be broken, the Spica is to be us'd after it hath been dreſs'd, of which Bandage we have given an Account in the Fracture of the Clavicle.



C H A P.  X.

Of the Fracture of the Humerus or Arm-Bone.

To ſet this Bone, a ſtrong Extenſion is to be made, if the two ends croſs one another, to which purpoſe the Patient is to be plac'd on a little Stool or Seat, and ſupported by a Servant, two other Aſſiſtants being employ'd to draw, one at the upper-part, and the other at the lower, above the Elbow, and not beneath it. In the mean time the Operator reduceth the two Bones, by cloſing 'em on all ſides with the Palms of his Hands, and afterward prepareth {285}

The Dreſſing and Bandage.

It is neceſſary at firſt to lay round the Fracture a Bolſter ſteept in ſome proper Liquor, as Claret or Oxycratum; then three ſeveral Bands are to be taken, three or four Fingers broad, and an Ell and a half long: The firſt of theſe is to be laid upon the Fracture, round which are to be made three very ſtreight Circumvolutions; then it is to be carry'd up with ſmall Rollers to the top of the Arm, and ſtay'd round the Body. The ſecond Band being apply'd to the Fracture, on the ſide oppoſite to the firſt, two Circumvolutions are to be made upon the Fracture; ſo that the ſame Band may be brought down along the whole length of the Arm, making divers Rollers, and at laſt ſtay'd below the Elbow, which, nevertheleſs, it muſt not cover. Afterward our Longitudinal Bolſters muſt be laid upon the Fracture round about the Arm, which are to be kept cloſe with a third Band; it being of no great Importance whether the Application of this third Band be begun at the Top or at the Bottom; but it may be ſtay'd round the Body, or elſe beneath the Elbow. The Arm ought alſo to be encompaſs'd with two thick pieces of Paſte-board made round at the ends, and of the length of the Arm; but they muſt not croſs one another. Theſe Paſte-boards are to be faſten'd with three Ribbands, and the Arm is to be put into a Scarf made with a large Napkin, which is to be firſt apply'd in the middle under the Arm-pit, the Arm reſting upon it, ſo that {286}the four ends may be rais'd up, and faſten'd to the oppoſite Shoulder; but the Hand muſt lie higher than the Elbow.



C H A P.  XI.

Of the Fracture of the Bone of the Elbow.

If both the Bones of the Elbow be broken, a ſtronger Extenſion is to be made than if only one of 'em were ſo hurt; to which purpoſe a Servant is to be appointed to graſp the Arm above the Elbow with both his Hands, and another to hold it above the Wriſt, whilſt the Surgeon ſets the Bones with the Palms of both his Hands, till no unevenneſs be any longer felt in the Part.

The Dreſſing and Bandage

Are the ſame with thoſe in the Fracture of the Arm; but the Bands which are carry'd upward are to be ſtay'd above the Elbow. If the Patient be deſirous to keep his Bed, it is requiſite that his Arm be laid upon a Pillow, the Elbow lying ſomewhat higher than the Hand.



{287}

C H A P.  XII.

Of the Fracture of the Carpus or Wriſt-Bone.

If the Bones of the Carpus, or thoſe of the Metacarpium be fractur'd, a Servant muſt hold the Arm above the Wriſt, and another the Fingers; whilſt the Operator ſets the Bones in their place, ſo as no unevenneſs may appear in the Part.

The Dreſſing and Bandage.

Of the Fracture of the Wriſt are to be prepar'd with a Band roll'd with one Head, being ſix Ells Long, and two Fingers broad; ſo that three Circumvolutions are to be made upon the Wriſt; the Band is to be paſs'd over the Hand, between the Thumb and the Fore-finger, making the Figure of KY upon the Thumb. Then after having made divers Rollers upon the Carpus, a Bolſter is to be apply'd, with a little Piece of Paſte-board of the ſame Shape with the Wriſt; ſeveral Rollers are to be form'd on the top of the Elbow, to ſtay the Band above it; and the Arm is to be put into a Scarf.



{288}

C H A P.  XIII.

Of the Fracture of the Bone of the Metacarpium.

Two Servants are to hold the Hand, after the ſame manner as in the ſetting of the Carpus or Wriſt-Bone, whilſt the Surgeon reduceth the broken Bone by fixing it in its Natural Situation.

The Dreſſing and Bandage

Are made with a Band roll'd up with one Head, five Ells long, and two Fingers broad: This Band being faſten'd to the Wriſt, with a Circumvolution, is to be laid on the Metacarpium, between the Thumb and the Fore-finger, and the Figure of KY is to be made upon the Hand: Then the forming of Rollers and KY's is to be continu'd till the Metacarpium be cover'd; a Bolſter and Paſte-board are to be laid upon the ſame Metacarpium; as alſo one in the Hand, of the <ſpan claſs="correction" title="Original reads 'Skape'." >Shape of the Part: The inſide of the Hand is to be trimm'd; and the whole Contexture is to be cover'd as before, with Rollers; which are continu'd till above the Elbow, where the Band is ſtay'd.



{289}

C H A P.  XIV.

Of the Fracture of the Fingers.

A Light Extenſion is to be made in the Fingers to reduce 'em, and a ſmall Dreſſing is to be prepar'd for every Finger, almoſt like that of the Arm. The Fingers are to be ſomewhat bent, and the inſide of the Hand is to be trimm'd with a Bolſter, to retain 'em in this Situation. The Bolſter is alſo to be ſtay'd with a Band, and the Arm to be put into a Scarf.



C H A P.  XV.

Of the Fracture of the Thigh.

If the Thigh-Bone be broken near its Head, the Fracture is very difficult to be diſcover'd; but if the Bone paſs one over another, it may be ſoon known, becauſe the hurt leg will be ſhorter than the other. Therefore a very great Extenſion is to be made; and if the Hands are not ſufficient for that purpoſe, recourſe may be had to Straps and Engines. In the mean time the Operator is to lay his Thumbs upon the fractur'd Bone, to thruſt it back into its place, and afterward to apply {290}

The Dreſſing and Bandage.

The Cavity of the Thigh is to be fill'd with a thick Bolſter, of the length of its bending; and three Bands four Fingers broad are to be provided, the firſt being three Ells long, and the ſecond four, as well as the third: Then three Circumvolutions are to be made upon the Fracture with the firſt Band, carrying it up with ſmall Rollers, and it is to be ſtay'd round the Body. The ſecond Band is to make two Circumvolutions upon the Fracture, and is to be brought down with ſmall Rollers, which are terminated above the Knee; or elſe they may be continu'd all along the Leg; it is alſo to be paſs'd under the Foot, and to be drawn up again upon the Leg: Then a Bolſter is to be apply'd to the lower part of the Thigh, being thicker at bottom than at top, to render the Thigh everywhere even; and four Longitudinal Bolſters are to be added, on which are laid Splints of the ſame length and breadth, which are to be wrapt up with a ſingle Bolſter. The third Band is to be roll'd upon theſe Splints, beginning at the bottom, and aſcending with Rollers. Then two large Paſte-boards are to be us'd, which may embrace the whole Dreſſing, without croſſing one another, being faſten'd with three Ribbands. Afterward a Pair of Pumps is to be put under the Foot, and the Heel to be ſupported with a ſmall Roll, the Thigh and Leg being let into the Scarves, the inner of which is to extend to the Groin, and the {291}outermoſt is to be ſomewhat longer: Two little Cuſhions are alſo to be laid on each ſide below the Knee, and two others below the Ankles, to fill up the Cavities. Theſe Cuſhions or large Bolſters are to lie between the Scarves; and a thick Bolſter is to be laid upon the Leg all along its length, as alſo on upon the Thigh. The Scarves are to be bound with three Ribbands for the Legs, and as many for the Thighs; the Knots being ty'd without, and on the ſide.



C H A P.  XVI.

Of the Fracture of the Knee-Pan.

The Knee-Pan is cleft or broken in divers pieces in its length, and croſs-wiſe: If it be broken croſs-wiſe or obliquely, the two Pieces fly out one from another; and on this occaſion a ſtrong Extenſion is to be made; whilſt the Surgeon at the ſame time thruſts back again the upper-part of the Knee-Pan into its place.

If the Knee-Pan be fractur'd in its length, no Extenſion can be made, becauſe the pieces of the Bones remain in their place.

The Dreſſing and Bandage.

If the Knee-Pan be broken croſs-wiſe, a Band is to be provided three Ells long, and two Fingers Broad, which may be roll'd with {292}one or two Heads. The Application is to be begun above the Knee-Pan; the Figure of KY is to be made in the Ham, and a Circumvolution under the Knee; then the Band is to be continually carry'd up and down, till the Knee-Pan be entirely cover'd.

If the Knee-Pan be fractur'd in its length, that is to ſay, from the top to the bottom, the Uniting-Band muſt be us'd, being two or three Ells long, and two Fingers broad, perforated in the middle. It is to be at firſt apply'd under the Knee, and one of the Balls is to be paſs'd thro' the Hole; it muſt alſo be well clos'd, and divers Circumvolutions are to be made upon the Knee-Pan, ſo as it may be altogether cover'd.



C H A P.  XVII.

Of the Fracture of the Leg.

If the Tibia be only broken, it puſhes into the Inſide; but if both Bones be fractur'd they are ſometimes ſeparated on both ſides, or elſe they paſs one upon another; and in this caſe the Leg is ſhorter than it ought to be. If the Perone be broken, it puſhes to the outſide.

If one Bone be only fractur'd, ſo ſtrong an Extenſion is not requiſite as when they are both ſhatter'd, and it is to be drawn only on one ſide; whereas the drawing ought to be equal on both ſides when both Bones are concern'd. {293}Thus whilſt the Aſſiſtants are employ'd in drawing, the Surgeon performs the Operation, by laying the ends of the Bones exactly againſt one another; and they are known to be reduc'd when the great Toe remains in its Natural Situation.

The Dreſſing and Bandage.

A ſimple Bolſter dipt in a convenient Liquor is at firſt apply'd, and three Bands three Fingers broad are prepar'd, the firſt being two Ells long, the ſecond three, and the third three and a half. Three very ſtreight Circumvolutions are to be made upon the Fracture; the Band is alſo to be carry'd up with Rollers, and ſtay'd above the Knee. The Application of the ſecond Band is to be begun upon the Fracture with two Circumvolutions; it is to be brought down with Rollers, to paſs under the Foot, afterward carry'd up again, and ſtay'd where it is terminated. The Leg is to be fill'd with a Bolſter thicker at the bottom than at the top; and then are to be laid on the four longitudinal Bolſters, two Fingers broad, and as long as the Leg; to which are to be apply'd the Splints of a plyable and thin Wood: Theſe are wrapt up with a ſimple Bolſter, and ſtrengthen'd with the third Band, which is apply'd indifferently either at the top or bottom, oppoſite to the former; ſo that it is carry'd up or elſe down in making Rollers, and ſtay'd at its end. The whole Contexture is to be encompaſs'd with large Paſte-boards made round at the Ends, which are not to croſs one another, {294}but muſt be ſtreighter at the bottom than at the top, and are to be ty'd with three Ribbands or pieces of Tape, beginning at the middle; ſo that the Knots be ty'd on the outſide. Afterward the Leg is to be put into the Scarves, and the Heel is to be ſupported with a Linnen-Roll, to which are faſten'd two Ribbands that are ty'd upon the Scarves: Theſe Rolls are made with a ſmall piece of Cloth, which is doubl'd, and roll'd up with the ends, in which is contain'd ſome Straw, and a little Stick in the middle, to conſolidate 'em. The Foot is ſupported with a Paſte-board or Wooden Sole, trimm'd with a Bolſter, or ſmall Quilt ſow'd over it. Divers Strings are alſo faſten'd to the middle of the ſides of the Sole or Pump, which are croſs'd to be joyn'd to the Scarves; and another is fixt at the end of the Sole, which is ty'd to a Ribband that binds the middle of the Scarf. Theſe Scarves are likewiſe faſten'd with three Ribbands, beginning with that in the middle, the Knots being without, and trimm'd with four Bolſters, that is to ſay, two on each ſide, to fill up the Cavities that are below the Knee, and above the Ankle. Laſtly, the Leg is to be plac'd ſomewhat high, and a Cradle to be laid upon it, to keep off the Bed-Cloaths, the Scarves paſſing over the Knee and Foot.

The Dreſſing of Complicated Fractures

Of the Arms, Legs, and Thighs is prepar'd with a Bandage having Eighteen Heads or Ends, in order to make which, a Linnen-Cloth is to {295}be taken of the length of the Part, and broad enough to cauſe it to be croſs'd thereby: It is to be folded into three doubles, and cut in three places on each ſide, leaving the middle plain; ſo that eighteen Heads or ſmall Bands are form'd, every one of which will be four fingers broad, the upper Heads being a little ſhorter than the lower. This Band of eighteen Heads is to be laid upon the Scarves, and a Bolſter is to be apply'd to it four Fingers broad, as long as the Scarves. The Leg is laid upon this Bolſter, and it hinders the corrupt Matter from falling on the Bandage.

When the Wound hath been dreſs'd, the fracture is to be incontinently ſurrounded with one of the Heads, which ought to croſs one another: Then after the Leg hath been bound with the firſt Heads, two Longitudinal Bolſters are to be apply'd to the ſide of it; and the other Heads are to be rais'd up, with all the reſt of the Dreſſing, which hath been deſcrib'd in the ſimple Fracture.



C H A P.  XVIII.

Of the Fracture of the Bone of the Foot.

The Reduction of the Bone of the Foot is perform'd after the ſame manner as that of the Hand. {296}

The Dreſſing and Bandage

Are made with a Band roll'd with two Heads, being three Ells long, and two Fingers broad: The Application of it is begun with a Circumvolution above the Ankles; it is paſs'd on the Foot, and in like manner makes a Circumvolution round it: Afterward the ſame Band is croſs'd over the Metatarſus, upon which are made ſome Folds in form of a Rhombus or Diamond; as alſo on the Toes, and it is ſtay'd above the Ankle-Bone; or elſe it is carry'd up along the Leg, to be ſtay'd above the Knee. This Bandage ſerves for all Fractures of the Bones of the Foot, and is call'd the Sandal.



{297}

A

T R E A T I S E

O F T H E

O P E R A T I O N S

Which are perform'd in

L U X A T I O N S.



C H A P.  I.

Of the Luxation of the Noſe.

The Bones of the Noſe may be ſeparated from that of the Fore-head by a Fall, or ſome violent Blow; and the Surgeon in order to ſet 'em, at firſt lays his Thumb upon the Root of the Noſe, and then he introduceth a little Stick trimm'd with Cotton, into the Noſtrils, and by the means thereof thruſts back the Bones into their place. {298}

The Dreſſing and Bandage

Are the ſame with thoſe that have been already deſcrib'd in the Fracture of the Bones of the Noſe.



C H A P.  II.

Of the Luxation of the lower-Jaw.

The Jaw may be luxated either on both ſides, or only on one. When the Diſlocation happens on both ſides, it hangs over the Sternum or Breaſt-Bone, and the Spittle runs abundantly out of the Mouth: To reduce it, the Patient muſt ſit down, and his Head is to be ſupported by a Servant; then the Operator or Surgeon having wrapt up his two Thumbs, puts 'em into the Mouth upon the Molar Teeth, his other Fingers lying under the Jaw, which is to be drawn down by raiſing it up, having before ſet two ſmall Wooden Wedges upon the two Molar Teeth on both ſides of the Jaw, leſt the Surgeon's Fingers ſhou'd be hurt, as the Bone is returning to its place.

If the Luxation be forward, a Band or Strap is to be put under the Chin, an Aſſiſtant having his Knees upon the Patient's Shoulders, where he is to draw the Strap upward, to facilitate the Extenſion; which the Surgeon makes with his Hands, at the ſame time thruſting the Bone back again into its place. {299}

When the Jaw is luxated only on one ſide, the Chin ſtands a-croſs, and the diſlocated ſide is ſquaſh'd down, a ſmall Cavity being perceiv'd in it, and a Riſing on the other ſide; ſo that the Mouth cannot be ſhut cloſe, but <ſpan claſs="correction" title="Original reads 're-remains' on line break." >remains ſomewhat open, the lower Teeth appear farther out than the upper; and the Canine or Dog-Teeth lie under the Inciſive. This Luxation is reduc'd by giving a blow with the Hand upon the luxated Bone, which is ſufficient to cauſe it to re-enter its Natural Place.

The Dreſſing and Bandage

Are altogether the ſame with thoſe us'd in the Fracture of the Bones of the lower Jaw.



C H A P.  III.

Of the Luxation of the Clavicle.

The Clavicle is oftner looſen'd from the Acromion than from the Sternum; when it hath left the former the Arm cannot be lifted up; the Acromion makes a Prominence, and the Clavicle deſcends downward, a Cavity appearing in its place. To reduce this Luxation, the Patient is to be laid upon ſome Convex Body put between his Shoulders; both which are to be preſs'd backward, to raiſe up the Clavicle: Afterward he is to be ſet in a Chair, that his Arm may be drawn backward, whilſt the {300}Surgeon is employ'd in preſſing the Clavicle and Acromion, to join 'em together.

The Dreſſing and Bandage

Are the ſame with thoſe that we have already ſhewn, in treating of the Fracture of the Clavicle.



C H A P.  IV.

Of the Luxation of the Vertebra's.

In the Luxation of the Vertebra's of the Neck, the Head ſtands to one ſide, and the Face is ſwell'd and livid, with a difficulty of Reſpiration.

To reduce this Diſlocation, the Patient is to be ſet upon a low Seat, an Aſſiſtant leaning on his Shoulders, to keep his Body ſteady, whilſt the Surgeon or Operator draws his Head upward, and turns it from one ſide to another: Then if the Accidents or Symptoms ceaſe, the Cure is perform'd; ſo that Fomentations may be apply'd to the Part; and the Patient being laid in his Bed, muſt take care to avoid moving his Head.

When the Vertebra's of the Back or Loins are luxated on the inſide, a ſinking of the Bone is ſoon perceiv'd; whereupon the Patient being laid on his Belly, the Extenſion is to be made with Napkins paſs'd under the Arm-Pits, and upon the Os Ileum, whilſt the Surgeon with {301}a ſtrong Extenſion makes ſome Efforts on the Spine, endeavouring to draw back the Vertebra. If that be not ſufficient, an Inciſion is to be made upon the Apophyſis Spinoſa of the Vertebra; ſo that after having laid open this Proceſs of the Bone, it may be taken out with a Pair of Forceps. Then the Wound is to be dreſs'd with Pledgets, a Plaiſter, and a Napkin, which muſt not be bound too cloſe, for fear of puſhing back the Spine.

When the Vertebra is luxated on the outſide, a Prominence appears; ſo that to reduce this Diſlocation, the Extenſion is to be made as before, the Patient lying in like manner upon his Belly; but in order to puſh back the Vertebra, two little Sticks trimm'd with Linnen-Cloth are to be prepar'd, and laid along the two ſides of the Spine of the Vertebra; yet theſe Sticks ought to be thick enough to remain more elevated than the Apophyſis Spinoſa; and a large wooden Roller is to be often roll'd upon 'em, which by its turning backward and forward, may thruſt the Vertebra's inward; ſo that when all the Vertebra's are of an equal height, the Reduction is finiſh'd. If the Vertebra's are luxated on the ſide, the ſame Extenſions are to be made, and the Prominence is to be puſh'd, to re-eſtabliſh the Vertebra in its place.

The Dreſſing and Bandage.

The Dreſſing is prepar'd by laying two thin Plates of Lead on each ſide of the Spinous Proceſs of the Vertebra, to maintain it in its Place, and a long Bolſter over 'em. The {302}proper Bandage is the Quadriga, which hath been before deſcrib'd, in treating of the Fractures of the Breaſt-Bone.



C H A P.  V.

Of the Luxation of the Coccyx or Rump-Bone.

If the Coccyx be ſunk on the inſide, it is to be rais'd with the Fore-finger of the Right-hand put into the Anus; and if the Luxation be on the outſide, it may be gently thruſt back again. An Account of its proper Dreſſing and Bandage hath been already given in the Fracture of the Coccyx.



C H A P.  VI.

Of the Bunch.

The Bunch is nothing elſe but an exterior Luxation of the Vertebra's, and for the Cure thereof, it wou'd be requiſite <ſpan claſs="correction" title="Original reads 'lo'." >to keep Emollients for a long time upon the Vertebra's, to looſen the Ligaments, and to wear Iron-Bodice; which in compreſſing the Vertebra's by little and little, might perhaps drive 'em back into their Natural Place.



{303}

C H A P.  VII.

Of the Luxation of the Ribs.

The Ribs are luxated either on the outſide, or on the inſide: If they be diſlocated on the inſide, a Cavity is perceiv'd near the Vertebra's, the Patient drawing his Breath with Pain, and not being able to bend his Body.

When the Luxation is on the outſide, and happens in the upper Ribs, the Patient's Hands are to be hoiſted upon the top of a Door, to raiſe up the Ribs, whilſt the Surgeon preſſeth the Prominence of the Rib to reſtore it to its place.

When the lower Ribs are luxated, the Patient muſt be oblig'd to ſtoop, laying his Hands upon his Knees, and the Prominence of the Bone is to be thruſt back.

If a Rib be luxated on the inſide, an Inciſion is to be made to draw it out with the Fingers.

The Dreſſing and Bandage

Are the ſame with thoſe that are us'd in the Fracture of the Ribs.



{304}

C H A P.  VIII.

Of the Sinking of the Xiphoides, or Sword-like Cartilage.

To raiſe up the Xiphoid Cartilage, it muſt be fomented before for ſome time with Oil of Turpentine, or other Fomentations, made with Aromaticks; then the Patient is to be laid upon his Back, with a Convex Body underneath, and the Shoulders, and Sides of the Breaſt are to be preſs'd, to lift up the Cartilage. When this Operation is not ſufficient, dry Cupping-Glaſſes are uſually apply'd, till the Part be elevated, and a ſtrengthening Plaiſter is afterward laid upon it.



C H A P.  IX.

Of the Luxation of the Humerus, or Arm-Bone.

The Head of the Humerus generally falls under the Arm-Pit, ſo that the luxated Arm becomes longer than the other, the Acromion appears pointed on the outſide; the Elbow ſtarts from the Ribs, and cannot be mov'd without great Pain. To reduce this Bone, the {305}Patient is to be ſet upon a low Seat, or elſe on the Ground, whilſt ſome Perſon ſupports his Body with a Napkin: In the mean time the Surgeon is to lay hold on the upper-part of the Humerus, a Servant kneeling behind him, who is to hold the Patient's Arm above the Elbow, which is to paſs between the Surgeon's Legs, and is to be drawn down by the Aſſiſtant as much as is poſſible, whilſt the Surgeon in like manner draws the Arm, to remove the Head of the Bone out of the place where it was ſtopt; inſomuch that the Bone ſometimes makes a Noiſe in re-entring its Cavity.

Or elſe the Patient's Arm may be laid upon the Shoulder of a taller Man than himſelf, who is ſtrongly to draw the luxated Arm upon the Fore-part of his Breaſt; during which time, the Operator is to puſh the Head of the Humerus, to cauſe it to re-enter its Cavity.

Otherwiſe the Patient may lie on the Ground, a Tennis-Ball being put under his Arm-Pit, which a Servant is to draw ſtrongly with a Handkerchief paſs'd under the Shoulder, whilſt another Aſſiſtant ſtands behind the Patient, to thruſt down the Shoulder with his Foot; at the ſame time the Surgeon ſitting between the Patient's Legs, is to puſh ſtrongly with his Heel the Ball that lies under the Arm-hole.

Or elſe, a thick Battoon or Leaver may be laid on the Shoulders of two Men, after a Tennis-Ball hath been nail'd on the middle of it; otherwiſe a Bunch may be made therein, and cover'd with Linnen-Cloth; two Wooden Pins being alſo fixt on each ſide of the Ball: {306}Then the Patient's Arm-Pit is to be ſet between thoſe two Pins, and upon the Ball, where he is to remain hanging, whilſt his Arm is pull'd down by main force. The ſame thing may be done by laying the Patient's Arm-Pit upon a Door, or elſe upon the Round of a Ladder.

The Dreſſing and Bandage

A little Ball of Linnen is to be laid under the Arm-Pit, and underneath a Bolſter with four Heads, which are croſs'd upon the Shoulder; as alſo a Bolſter under the ſound Arm-Hole, that it may not be gall'd by the Bandage Spica, the Nature of which we have ſhewn in treating of the Fracture of the Clavicle.



C H A P.  X.

Of the Luxation of the Elbow.

When the Elbow is luxated on the inſide, the Arm flies out, and the Hand is turn'd outward; but in the Luxation on the outſide, the Arm is ſhortned: If the Luxation be Lateral, a Prominence appears in the Diſlocated, and a Cavity in the oppoſite Part.

To reduce the Internal Luxation, the Humerus and Cubitus are drawn, and at the ſame time the Surgeon bends the Elbow, by carrying {307}the Hand toward the Shoulder; or elſe a Tennis-Ball may be laid in the Fold of the Elbow, and the Arm drawn toward the Shoulder.

For the External Luxation, the Extenſion is to be made, whilſt the Surgeon thruſts back the Elbow into its place: Or elſe a round Stick may be taken, and trimm'd with Linnen-Cloth, with which the Bone is to be puſh'd back into its place during the Extenſion. This Stick may be alſo us'd in the reducing of the Internal Luxation.

For the Lateral Luxations, the Extenſion may be made in like manner; the Surgeon at the ſame time thruſting back the Bone into its Natural Situation.

The Bandage

Is made with a Band five Ells long, and two Fingers broad, roll'd with one Ball: The Application of it is begun with a Circumvolution at the lower part of the Humerus, it is paſs'd over the Fold of the Arm; a Circumvolution is alſo form'd in the upper-part of the Elbow, and the Figure of KY in its Fold. Afterward the Rollers are continu'd upon the Elbow, and the KY's in the inſide of the Arm, till the Elbow be entirely cover'd: The Band is likewiſe carry'd up to the top of the Arm with Rollers, and ſtay'd round about the Body. The Patient muſt be oblig'd to keep his Bed, or elſe his Arm may be put in a Scarf, after the ſame manner as in the Fracture of the Arm.



{308}

C H A P.  XI.

Of the Luxation of the Wriſt.

If the Luxation be Internal, the Hand is turn'd back to the outſide, ſo that for the Reduction thereof, it wou'd be requiſite to cauſe the back of the Hand to be laid upon a Table, and the Extenſion to be made by drawing the Elbow and Hand, whilſt the Surgeon takes care to preſs the Prominence.

If the Luxation be External, the Hand is bended on the inſide; ſo that to reduce it, the inſide of the Hand is to be laid upon a Table, and the Surgeon is to preſs it after the Extenſion.

If the Luxation be on the ſides, the Hand is turn'd to one ſide; ſo that the Extenſion muſt be made, and the Hand turn'd on the ſide oppoſite to the Luxation. But the Fingers are uſually drawn one after another, to the end that the Tendons may be ſet again in their Place.

The eight Bones of the Carpus may be in like manner diſlocated both on the inſide and without; and to ſet 'em right, the Hand is to be laid upon a Table, and the Extenſion to be made, ſo as to preſs the Protuberances on the inſide, if the Luxation be internal, and on the outſide if it be external. {309}

The Bandage

Is prepar'd with a Band ſix Ells long, and two Fingers broad; ſo that three Circumvolutions may be made upon the Luxation; as alſo divers Rollers in paſſing thro' the inſide of the Hand between the Thumb and the Forefinger, and in forming the Figure of KY upon the Thumb, after having made many Rollers upon the Wriſt. Two Pieces of Paſte-board are alſo to be laid on the ſides of the Wriſt, which are bound with the ſame Band in making Rollers; and the Hand is to be trimm'd with a Linnen-Ball, to keep the Fingers in their mean Situation. Then the Band is to be paſs'd above, to ſtrengthen it, and carry'd up with Rollers along the whole length of the Elbow, to be ſtay'd below the ſame Elbow.



C H A P.  XII.

Of the Luxation of the Fingers.

If the Fingers be luxated, it is neceſſary to make an Extenſion to reduce 'em, and afterward to uſe the following

Bandage.

If the Luxation be in the firſt Articulation or Joint, the Bandage Spica is to be apply'd, being made of a Band roll'd with one Head, an {310}Ell long, and an Inch broad: It is begun with Circumvolutions round about the Wriſt, and brought over the Luxation in paſſing between the Fingers. Theſe Circumvolutions are alſo continu'd to form a Spica upon the Luxation; and the Band is ſtay'd at the Wriſt.

If all the firſt Phalanges were diſlocated, it wou'd be requiſite to make as many upon every Phalanx, and with the ſame Band: This ſort of Bandage is call'd the Demi-Gantlet.



C H A P.   XIII.

Of the Luxation of the Thigh.

The Luxation which moſt commonly happens in this Part, is the Internal; ſo that a Protuberance appears on the Hole of the Os Pubis; the indiſpos'd Leg is longer than the other, and the Knee and Foot turn outward; neither can the Thigh be any longer bended, nor drawn near the other.

If the Luxation be External, the Leg becomes ſhorter than the other, the Knee and Foot turning inward, and the Heel to the outſide.

When the Luxation is on the fore-part, a Tumour ariſeth in the Groin, ſo that the Patient cannot draw this Thigh toward the other, nor bend the Leg; his Body reſting only upon the Heel.

{311}

If the Luxation be Poſterior, a Tumour is felt in the Buttocks with great Pain, and the Legg is ſhorter than it ought to be: There alſo appears a ſinking in the Groin, the Leg is lifted off from the Ground, and the hurt Perſon is apt to fall backward.

To reduce the Internal Luxation, the Patient is to be laid with his Back upon a Table, to which is fixt a thick Wooden Pin, about a Foot long, which is to be ſet between his Thighs, to detain his Body when his Legs are drawn down; then a Strap is to be paſs'd above the joynt of the Thigh, to draw the Iſchion upward; and the Thigh is to be drawn down with another Strap faſten'd above the Knee: In the mean while the Surgeon thruſts the Thigh upward, to cauſe it to re-enter its Cavity, the Straps being ſomewhat looſen'd in the time of the Reduction to facilitate the Operation.

To reduce the External Luxation, the Patient is to be laid upon his Belly; and the drawing to be perform'd after the ſame manner as we have even now ſhewn, whilſt the Thigh is thruſt from the outſide inward, to cauſe the bone to re-enter its Cavity.

In reducing the Anterior Luxation, the hurt Perſon is to be laid upon the ſide oppoſite to the Luxation, and Extenſions are to be made, by drawing both upward and down-ward, as before: Then the Head of the Bone is to be forc'd, by the means of a Ball thruſt ſtrongly with the Knee, in drawing the luxated leg toward the other. {312}

The Poſterior Luxation is thus reduc'd; The Patient being laid upon his Belly, the double Extenſion is to be made, and his Knee drawn outward, to ſet the Bone in its place. After the Operation hath been perform'd, a Bolſter is to be apply'd, ſteept in Spirituous Medicaments; and the Bandage call'd Spica, of which we have given an Account in treating of the Luxation of the Shoulder.



C H A P.   XIV.

Of the Luxation of the Knee.

When the Tibia is luxated behind, its Prominences are in the Cavity of the Ham, and the Leg flies off, or is bended. If the ſame Tibia be diſlocated on the ſide, a kind of Tumour appears in the luxated ſide, and a Sinking in the oppoſite. But if the Condylus of the Tibia remains in the inſide, the Leg turns outward; and if it be in the outſide, it turns inward.

The Poſterior Luxation is reduc'd by obliging the Patient to lie upon his Belly, whilſt the Surgeon during the Extenſions bends the Leg, in drawing the Heel toward the top of the Thigh.

If the Tibia be luxated on the ſide, the uſual Extenſions are to be made, and the Bone is to be puſh'd with the Knee. {313}

If the Luxation were in the fore-part, it wou'd be requiſite to lay the Patient upon his Back, to make the Extenſions, by drawing the Thigh and Leg; and to preſs the protuberant Parts.

The Bandage

Is prepar'd with a Band three Ells long, and two Fingers broad, roll'd with two Balls: A Circumvolution being at firſt made above the Knee, the Figure KY is form'd underneath, and a Circumvolution above it; then the Band is carry'd up again over the Knee, in making Rollers and KY's underneath, till the Knee be entirely cover'd.



C H A P.   XV.

Of the Luxation of the Patella or Knee-Pan.

The Knee-Pan is luxated by ſtarting upward; and to reduce it, the Patient's Leg is to be held ſtreight, whilſt it is thruſt back into its place with the Hands. Then he muſt be oblig'd to keep his Bed; and the ſame Bandage is to be apply'd with that which hath been deſcrib'd for the Luxation of the Knee.

If the Perone or Fibula be remov'd from the Tibia, the ſides of the Foot are to be preſs'd, to draw it back again; and it may be kept cloſe {314}with the Bandage which is appropriated to the Fractures of the Tarſus.

The Aſtragalus may be alſo luxated in the fore-part; ſo that the Operator ought to thruſt it back into its place, and to make uſe of the Bandage which we have prepar'd for the Fracture of the Foot.

The Calcaneum ſometimes flies off from the Aſtragalus both in the inſide and without; and the Bones of the Tarſus, Metatarſus, and Toes are likewiſe apt to be luxated. But a little Circumſpection is only requiſite to reduce all theſe Diſlocations.



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A

T R E A T I S E

O F

Medicinal Compoſitions

Neceſſary for a

S U R G E O N.



C H A P.  I.

Of Balſams.



The Balſam of Arcæus.

Take two Pounds of the Suet of a He-Goat, Venice Turpentine and Gum Elemi, a Pound and a half of each; and of Hogs-Lard one Pound. After the Gum Elemi, being cut into ſmall Pieces, hath been melted over a very gentle Fire, add to it the Turpentine, Goats-Suet, and {316}Swines-Greaſe; and when all theſe Ingredients are well diſſolv'd, ſtrain the Liquor thro' a new Linnen-Cloth, to ſeparate the Scum and Dregs from it; then let the whole Maſs cool, and the Balſam is made.

This Balſam ſerves to incarnate and conſolidate all ſorts of Wounds and Ulcers: It is likewiſe us'd in Fractures and Diſlocations of the Bones; as alſo to cure the Contuſions and Wounds of the Nerves.

The Balſam of Spain.

Take pure Wheat, the Roots of Valerian and Carduus Benedictus, of each one Ounce, and beat 'em well in a Mortar with a Pint of White-Wine; ſtrain the whole Compoſition into an Earthen Veſſel Leaded, having a narrow Mouth; ſtop up the Veſſel, and ſet it upon hot Embers during twenty four Hours: Then add ſix Ounces, of St. John's Wort; ſet the whole Maſs in Balneo Mariæ, till the Wine be conſum'd and let it be ſtrain'd and ſqueez'd. Afterward add two Ounces of Frankincenſe well pulveriz'd, with eight Ounces of Venice Turpentine, mixing 'em together over a gentle Fire, and the Balſam will be made.

This is the Balſam which was always us'd by Hieronymus Fabritius ab Aguapendente, a noted Italian Surgeon, and is excellent for all kinds of Wounds, even for the Nervous, which (as it is avouch'd by ſome Perſons) may be cur'd by it within the ſpace of twenty four Hours. But the Wound muſt be at firſt waſh'd with good White-Wine cold, and afterward anointed {317}with this Balſam well heated. If the Wound be deep, it may be ſyringed with the ſame Balſam very hot, and the ſides of it anointed when drawn together. Then a Bolſter ſteep'd in the Balſam is to be apply'd to the Part, and upon that another Bolſter ſoakt in the Lees of Wine; as alſo over this laſt another drie Bolſter.

The Green Balſam.

Take Linſeed-Oil and that of Olives, of each one Pint; one Ounce of Oil of Bays; two Ounces of Venice Turpentine, half an Ounce of the deſtill'd Oil of Juniper-Berries, three Drams of Verdegreaſe, two Drams of Sucotrin Aloes, two Drams and a half of White Vitriol, and one of the Oil of Cloves.

Having made choice of the beſt Olive and Linſeed-Oil well purify'd and mingl'd together in a Skillet or Pan over a very gentle Fire, let the Turpentine and Oil of Bays be incorporated in it; then having taken off the Pan from the Fire, and left the Liquor to be well cool'd, let it be intermixt by little and little with the Verdegreaſe, the White Vitriol, and the Sucotrin Aloes beaten to fine Powder: Afterward the deſtill'd Oils of Cloves and Juniper-Berries being added, and the whole Compoſition well mingl'd together, the Balſam will be entirely compounded according to Art.

This is the Balſam that hath been ſo much talkt of at Paris, and which many Quack-Salvers, pretending to the Art of Phyſick and Surgery, keep as a great Secret. Indeed it is very good for all ſorts of Wounds, whether they {318}be made by the Sword, or other Iron Weapons, or by Gun-ſhot. But it wou'd be requiſite at firſt to waſh the Wound with warm Wine, then to anoint it with this Balſam very hot, and to apply Bolſters that have been ſteept in it, as alſo a large Bolſter over the other, dipt in ſome Styptick Liquor. This Balſam mundifies, incarnates, and cicatrizes Wounds; being likewiſe good againſt the Bitings of venomous Beaſts, and fiſtulous and malignant Ulcers.

Samaritan Balſam.

Take an equal quantity of common Oil and good Wine; boil 'em together in a glaz'd Earthen Veſſel, till the Wine be wholly conſum'd, and the Balſam will be made. I have produc'd this Balſam in particular, by reaſon of its ſimplicity, and in regard that it may be readily prepar'd at all times. It ſerves to mundifie and conſolidate ſimple Wounds more eſpecially thoſe that are recent.



{319}

C H A P.  II.

Of Ointments.



Unguentum Althææ.

Take of the Roots of Althæa or Marſh-Mallows, ſix Ounces, the Seeds of Line, and Fenugreek, and Squills, of each four Ounces; of yellow Wax one Pound; Colophony and Roſin, of each one Pound; Venice Turpentine, Galbanum, and Gum Hederæ pulveriz'd, two Ounces of each. The Marſh-Mallow-Roots being newly gather'd, are to be well waſh'd and ſlic'd, as well as the Squills. After they have been put into a Copper-Pan or Skillet, tinn'd over on the inſide, together with the Seeds of Line and Fenugreek, and a Gallon of fair Water pour'd upon 'em, the whole Maſs is to be macerated during twenty four Hours, over a very gentle Fire, ſtirring the Ingredients from time to time with a Wooden Spatula: Thus they are to be boil'd ſlowly, often reiterating the ſtirring, till the Mucilages are ſufficiently thicken'd; then, after having well ſqueez'd and ſtrain'd 'em thro' a ſtrong and very cloſe Cloth, and mingl'd 'em with the prepar'd Oil, they are to be boil'd together again over a very gentle Fire, till the Superfluous Moiſture of the Mucilages be wholly {320}conſum'd: Afterward having ſtrain'd the Oil again, the yellow Wax, Colophony, and Roſin cut into ſmall pieces, are to be melted in it; and if any Dregs appear at the bottom of the Pan, when the whole Maſs is diſſolv'd, it is to be ſtrain'd a-new, or at leaſt the pure Liquor muſt be ſeparated from the groſs or impure by Inclination, whilſt it is as yet very hot: The Ointment is to be ſtirr'd about with a Wooden Peſtle; and when it begins to grow thick, you may add the Turpentine, the Galbanum purify'd and thicken'd, and the Gum Hederæ beaten to fine Powder, all which Ingredients were before incorporated together. Then the Ointment is to be continually ſtirr'd, till it be altogether grown cold.

This Ointment ſerves to moiſten, mollifie, and heat gently; it alſo allayes the Pains of the Side, and ſoftens Tumours, particularly the Parotides. It may be us'd either alone, or with other Ointments or Oils.

The mundificative Ointment of Smallage.

Take three handfuls of Smallage-Leaves; with Ground-Ivy, great Wormwood, great Centory, Germander, Sage, St. John's-Wort, Plantain, Milfoil or Yarrow, Perewinkle, the greater Comfrey, the leſſer Comfrey, Betony, Honey-ſuckle, Fluellin, Vervein, Knot-Graſs, Adders-Tongue, and Burnet, of every one of theſe Plants two handfuls; a Gallon of common Oil, white Pitch, Mutton-Suet, yellow Wax, and Turpentine, of each two Pounds. {321}

Bruiſe all theſe Herbs in a Marble-Mortar; let the Wax, white Pitch, and Mutton-Suet cut into pieces, as alſo the Turpentine be melted in the Oil, in a Copper-Pan lin'd with Tin, over a moderate Fire; put the bruis'd Herbs in it, and cauſe the whole Maſs to ſimmer together very ſlowly, ſtirring it about from time to time with a Wooden Spatula. As ſoon as it ſhall be perceiv'd that the Oil of the Herbs is almoſt quite conſum'd, the whole Compoſition is to be ſtrain'd, and ſtrongly ſqueez'd. Then after having let the Ointment cool, to draw off all the Dregs and Moiſture, it is to be diſſolv'd over a very gentle Fire; and after having left it a little while to cool again and thicken, you may add thereto Myrrh, Aloes, Florence Orris, and round Birth-Wort pulveriz'd very fine. When all theſe Ingredients are by this means well incorporated, the Ointment will be brought to perfection.

This Ointment is of ſingular Uſe to cleanſe Ulcers; as alſo to mundifie, cicatrize, and conſolidate all ſorts of Wounds.

The black or ſuppurative Ointment.

Take a Quart of common Oil, white and yellow Wax, Mutton-Suet that lies near the Kidneys, pure Roſin, Ship-Pitch, Venice Turpentine, of each half a Pound; and of Maſtick beaten to fine Powder, two Ounces; let all that is capable of being diſſolv'd, be liquify'd in the Oil; and add the Powder of Maſtick to make an Ointment. {322}

This Ointment ſearches and opens all ſorts of Impoſtumes, as well as Carbuncles, and Peſtilential and Venereal Bubo's. The uſe of the ſame Ointment is alſo to be continu'd after the opening of the Abceſſes, till their perfect Cure be compleated.

Unguentum Roſatum.

Take Bore's-Greaſe well purify'd, and often waſh'd, and Red Roſes newly pickt, of each four Pounds, with the like quantity of White Roſes.

The thin Membrane or Skin which lies upon the Bores-Greaſe, being taken away, it is to be cut into ſmall pieces, well waſh'd in fair Water, and melted in a glaz'd Earthen-Pot over a very gentle Fire; the firſt Greaſe that is diſſolv'd is to be ſtrain'd thro' a Cloth, well waſh'd, and mixt with the ſame quantity of thick Roſe-Buds well bruis'd. Then the whole Maſs is to be put into a glaz'd Earthen-Pot with a narrow Mouth; the Pot is to be well ſtopt, and ſet during ſix Hours in Water, which is between luke-warm and boiling hot. Afterward it is to be boil'd an Hour, ſtrain'd and ſtrongly ſqueez'd. In the mean while four Pounds of White Roſes newly blown are to be taken, well bruis'd, and mingl'd with the former Compoſition, the Pot being cover'd, which is likewiſe ſet for the ſpace of ſix Hours in Water, between luke-warm and boiling hot: Then the Liquor is to be ſtrain'd and ſtrongly ſqueez'd. Laſtly, after the Ointment hath been cool'd, and ſeparated from its Fæces or Dregs, it may be kept for uſe. {323}

If it be deſir'd to give a Roſe-Colour to this Ointment, it wou'd be requiſite a quarter of an Hour before it be ſtrain'd the laſt time, to throw into it two or three Ounces of Orcanet, which is to be ſtirr'd into the Ointment. If it be thought fit to retain the White Colour, and to produce the ſmell of Roſes, it may be done with Damask-Roſes without Orcanet. If you are deſirous to give it the Conſiſtence of a Liniment, you may add Oil of ſweet Almonds to the quantity of a ſixth part of its weight.

This Ointment is a very good Remedy againſt all manner of external Inflammations, particularly againſt Phlegmons, Eryſipelas's, and Tetters; as alſo againſt the Head-ach and Hæmorrhoids or Piles.

Unguentum Album, aut de Ceruſſa.

Take three Pints of Oil of Roſes, nine Ounces of white Wax, one Pound of Venice Ceruſe or white Lead, and a Dram and a half of Camphire.

The Ceruſe being pulveriz'd by rubbing the pieces upon the Cloath of a Hair-Sieve turn'd upſide-down; the Powder is to be receiv'd on a Sheet of Paper laid underneath, and to be often waſh'd with Water in a great Earthen-Pan, ſtirring it about with a Wooden Spatula, and pouring off the Water by Inclination as ſoon as the Powder is ſunk to the Bottom. When the Water of theſe Waſhings grows inſipid, the laſt Lotion is to be made with Roſe-Water, leaving it for the ſpace of five or ſix Hours, which being expir'd, it is to be pour'd off by Inclination, and {324}the Ceruſe muſt be dry'd in the Shade, cover'd with Paper. Then the broken Wax and prepar'd Oil is to put into a glaz'd Earthen-Pot, and the Pot into the boiling Bath. As ſoon as the Wax is melted, the Pot may be taken out of the Bath, and the diſſolv'd Liquor ſtirr'd with a Wooden Peſtle till it begins to grow thick. Afterward the pulveriz'd Ceruſe is to be infus'd, and the Ointment ſtirr'd about till it be almoſt cold. If you ſhall think fit to add Camphire, let it be diſſolv'd in a little Oil, and incorporated with the Ointment when it is cold. The Whites of Eggs may be alſo well mixt with the Ointment, by ſtirring it about, to make an exact union of the ſeveral Ingredients.

This Ointment is good for Burns, Eryſipelas's, the Itch, and many Diſtempers of the Skin; it allayes the Itchings and intemperature of Ulcers; it diſſipates the Chafings and Redneſs that happen in the Bodies of Infants; It is of great efficacy in the healing of Contuſions, and it ſerves to conſolidate and cool light Wounds.

Unguentum Ægyptiacum.

Take eleven Ounces of Verdegreaſe, fourteen Ounces of ſtrong Vinegar, and twenty eight Ounces of good Honey.

Let the Verdegreaſe be put into a Copper-Pan or Skillet over a very gentle Fire; then bruiſe it with a Wooden Peſtle; work it well in the Vinegar, and ſtrain the whole thro' a Hair-Sieve. If a little Verdegreaſe remains on the Sieve, it is to be put again into the {325}Skillet bruis'd and beaten ſmall therein, as before, with a Portion of the ſame Vinegar, ſtraining it thro' the Sieve, till the unprofitable droſſy parts of the Copper be only left. Afterward this Liquor is to be boil'd over a gentle Fire, with the Honey, ſtirring it about from time to time till it hath acquir'd the Conſiſtence of a ſoftiſh Ointment, and a very red Colour.

This Ointment conſumes putrify'd Fleſh, and the Superfluities of Ulcers and Wounds.

Unguentum Baſilicon, or Royal Ointment.

Take yellow Wax, Mutton-Suet, Roſin, Ship-Pitch, and Venice Turpentine, one Pound of each; with five Pints of common Oil.

Cut the Suet, Roſin, and black Pitch into ſmall Pieces, and let 'em be melted together, with the Oil, in a Copper-Pan over a very moderate Fire; then after having ſtrain'd the Liquor thro' a thick Cloth, let it be incorporated with the Turpentine, and the Ointment will be made.

It promotes Suppuration, and cicatrizes Wounds when the purulent Matter is drawn forth. It is often laid alone upon the Bolſters, and ſometimes mixt with the Yolks of Eggs, Turpentine, and other Ointments, or with Oils and Plaiſters. {326}

A cooling Cerate.

Take a Pint of Oil of Roſes, and three Ounces of white Wax.

Let the whole Compoſition be put into a glaz'd Earthen-Pot, and the Pot ſet in Balneo Mariæ, till the Wax be well diſſolv'd in the Oil: Then take the Veſſel out of the Bath, and ſtir the Ointment with a Wooden Peſtle till it be cool'd; add two Ounces of Water, and ſtir it about with the Peſtle till it be imbib'd by the Cerate; let as much more Water be infus'd, and again the ſame quantity, till the Cerate becomes very white, and hath been well ſoakt with freſh Water. Afterward all the Water is to be pour'd off by Inclination, and ſeparated as much as is poſſible from the Cerate, which may then be kept for uſe; but ſome Surgeons cauſe an Ounce of Vinegar to be mingl'd with it.

This Cerate is uſually laid outwardly upon all Parts that ſtand in need of cooling, and aſſwages the Pains of the Hæmorrhoids or Piles. It is alſo good for Chaps, ſore Nipples, and other ill Accidents that happen in the Breaſt; and is us'd for Burns either alone, or mixt with other Ointments. Whenſoever it is neceſſary to apply Deſiccatives and Aſtringents to any Part, this Cerate may be mingl'd with Unguentum de Ceruſſa. {327}

An Ointment for Burns.

Take a Pound of Bores-Greaſe, two Pints of White-Wine, the Leaves of the greater Sage, Ground- and Wall-Ivy, Sweet Marjoram, or the Greater Houſe-Leek, of each two handfuls.

Let the whole Maſs be boil'd over a gentle Fire, and having afterward ſtrain'd and ſqueez'd it, let the Ointment ſo made be kept for uſe.



C H A P.  III.

Of Plaiſters.



The Plaiſter of Diapalma.

Take three Pounds of prepar'd Litharge of Gold, three Pints of common Oil, two Pounds of Hogs-Lard, a Quart of the Decoction of Palm-Tree or Oak-Tops; four Ounces of Vitriol calcin'd till it become red, and ſteept in the ſaid Decoction. Having bruis'd or cut very ſmall two handfuls of Palm-Tree or Oak-Tops, let 'em be boil'd ſlowly in three Quarts of Water till about half be conſum'd; and after the whole Maſs hath been well ſqueez'd, the ſtrain'd Decoction is to be preſerv'd. In the mean time the Litharge is to be {328}pounded in a great Braſs Mortar, and diluted with two or three Quarts of clear Water; but it will be requiſite readily to pour out into another Veſſel the muddy Water which is impregnated with the more ſubtil part of the Litharge, whilſt the thicker remains at the bottom of the Mortar; whereupon this part of the Litharge will ſink to the bottom of the Water, and the Litharge remaining in the Mortar is to be pounded again. Then having diluted it in the Water of the firſt Lotion, or in ſome other freſh Water, the muddy Liquor is to be pour'd by Inclination upon the ſubtil Litharge that remain'd in the bottom of the Veſſel: Afterward you may continue to pound the Litharge, to bruiſe it in the Water, to pour it off by Inclination, and to let the Powder ſettle, till there be left only at the bottom a certain impure part of the Litharge, capable of being pulveriz'd, and rais'd amidſt the Water. As ſoon as the Lotions are well ſettl'd, and care hath been taken to ſeparate by Inclination the Water which ſwims over the Powder of Litharge; this Powder is to be dry'd, and having weigh'd out the appointed Quantity, it is to be put as yet cold into a Copper-Pan lin'd with Tin, and ſtirr'd about to mingle it with the Oil, Lard, and Decoction of Palm-Tree-Tops. When theſe Ingredients have been well incorporated together, a good Charcoal Fire muſt be kindl'd in a Furnace, over which they are to be boil'd, ſtirring 'em continually with a great Wooden Spatula, and conſtantly maintaining an equal Degree of Heat during the whole time of their boiling. At laſt you may add {329}the rubify'd Vitriol diſſolv'd in a Portion of the Liquor that hath been reſerv'd, if you wou'd have the Plaiſter tinctur'd with a red Colour; or elſe white Vitriol melted in the ſame Decoction, if it ſhall be thought fit to retain the Whiteneſs of the Plaiſter, which may be form'd into Rolls, and wrapt up with Paper.

This Plaiſter is us'd for the cure of Wounds, Ulcers, Tumours, Burns, Contuſions, Fractures, and Chilblains, and is alſo laid upon the Cauteries. If you mingle with it the third or fourth part of its weight of ſome convenient Oil, it will attain to the Conſiſtence of a Cerate; and this is that which is call'd Diſſolved Diapalma or Cerate of Diapalma.

The Plaiſter of ſimple Diachylum.

Take of Marſh-Mallow-Roots peel'd, three Drams; the Seeds of Line and Fenugreek, of each four Ounces; three Quarts of Spring-Water; two Quarts of common Oil, and two Pounds of Litharge of Gold.

Let the Mucilages of Marſh-Mallow-Roots, and of the Seeds of Line and Fenugreek be taken, as hath been ſhewn in the making of Unguentum Althææ, and let the Litharge be prepar'd after the ſame manner as for the Plaiſter of Diapalma. Having at firſt well mixt the Oil with the Litharge in a large Copper-Veſſel or Pan, Tinn'd on the inſide, being wide at the top, and tapering like a Cone toward the bottom, as alſo having afterward added and well incorporated the Mucilages, a moderate {330}Charcoal Fire is to be kindl'd in a Furnace, upon which the Veſſel is to be ſet, and the whole Maſs is to be ſtirr'd about inceſſantly with a Wooden Spatula; and as faſt as is poſſible. A gentle Fire is to be maintain'd, and the Boiling and Agitation to be continu'd, till it be perceiv'd that the Plaiſter begins to ſink in the Pan; then the Heat of the Fire muſt be diminiſh'd one half at the leaſt; and it will be requiſite only to cauſe an Evaporation by little and little, of the Superfluous Moiſture that might remain in the plaiſter, which being conſum'd, it will be ſufficiently boil'd, having attain'd to its due Conſiſtence and Whiteneſs.

This Plaiſter ſoftens and diſſolves hard Swellings, and even the Scirrhous Tumours of the Liver and Bowels; ſuch are the Scrophulous or King's-Evil Tumours, the old remains of Abceſſes, &c.

The Plaiſter of Andreas Crucius.

Take two Ounces of Roſin; four Ounces of Gum Elemi, Venice Turpentine and Oil of Bays, of each two Ounces.

After having beat in pieces the Roſin and Gum Elemi, they are to be melted together over a very gentle Fire, and then may be added the Turpentine and Oil of Bays. When the whole Maſs hath been by this means well incorporated, it muſt be ſtrain'd thro' a Cloth, to ſeparate it from the Dregs. The Plaiſter being afterward cool'd, is to be made up in Rolls, and kept for uſe.

{331}

This Plaiſter is proper for Wounds of the Breaſt: It alſo mundifies and conſolidates all ſorts of Wounds and Ulcers, diſſipates Contuſions, ſtrengthens the Parts in Fractures and Diſlocations, and cauſeth the Serous Humours to paſs away by Tranſpiration.

Emplaſtrum Divinum.

Take of Litharge of Gold prepar'd, one Pound and an half; three Pints of common Oil; one Quart of Spring-Water; ſix Ounces of prepar'd Load-Stone; Gum Ammoniack, Galbanum, Opoponax, and Bdellium, of each three Ounces; Myrrh, Olibanum, Maſtick, Verdegreaſe, and round Birth-Wort, of every one of theſe an Ounce and an half; eight Ounces of Yellow Wax, and four Ounces of Turpentine.

Let the Gum Ammoniack, Galbanum, Bdellium, and Opopanax be diſſolv'd in Vinegar, in a little Earthen Pipkin; ſtrain 'em thro' a courſe Cloth, and let 'em be thicken'd by Evaporation, according to the Method before obſerv'd in other Plaiſters: Then prepare the Load-Stone upon a Porphyry or Marble-Stone, and take care to bruiſe ſeparately, the Olibanum, the Maſtick, the Myrrh, the round Birth-Wort, and the Verdegreaſe, which is to be kept to be added at laſt. In the mean while, having incorporated cold the Oil with the Litharge, and mingl'd the Water with 'em, they are to be boil'd together over a very good Fire, ſtirring 'em inceſſantly, till the whole Compoſition hath aquir'd the Conſiſtence of a ſomewhat ſolid {332}Plaiſter, in which is to be diſſolv'd the yellow Wax cut into ſmall pieces. Afterward having taken off the Pan from the Fire, and left the Ingredients to be half cool'd, intermix the Gums, which have been already thicken'd and incorporated with the Turpentine; then the Load-Stone mingl'd with the Birth-Wort, Myrrh, Maſtick, and Olibanum; and laſt of all the Verdegreaſe. Thus when all theſe Ingredients are well ſtirr'd and mixt together, the Plaiſter will be entirely compounded; ſo that it may be made up into Rolls, and preſerv'd to be us'd upon neceſſary Occaſions.

This Plaiſter is efficacious in curing of all kinds of Wounds, Ulcers, Tumours, and Contuſions; for it mollifies, digeſtes, and brings to Suppuration ſuch Matter as ought to be carry'd off this way. It alſo mundifies, cicatrizes, and entirely conſolidates Wounds, &c.



C H A P.  IV.

Of Cataplaſms or Pultiſſes.

Cataplaſms are uſually prepar'd to aſſwage Pain; as alſo to diſſolve and diſſipate recent Tumours, and are made thus:

Take four Ounces and a half of white Bread, one Pint of new Milk, three Yolks of Eggs, one Ounce of Oil of Roſes, one Dram of Saffron, and two Drams of the Extract of Opium.

{333}

The Crum is to be taken out of the inſide of a white Loaf newly drawn out of the Oven, and to be boil'd with the Milk in a Skillet over a little Fire, ſtirring it from time to time with a Spatula, till it be reduc'd to a thick Pap. After having taken the Veſſel off from the Fire, the three Yolks of Eggs beaten are to be put into it, and the Dram of Saffron pulveriz'd; to theſe Ingredients may be added two Drams of the Extract of Opium ſomewhat liquid, if the Pain be great.

Here is another Cataplaſm proper to mollifie and to bring to Suppuration when it is neceſſary.

Take White-Lilly-Roots, and Marſh-Mallow-Roots, of each four Ounces; the Leaves of common Mallows, Marſh-Mallows, Groundſel, Violet-Plants, Brank-Urſin, of every one of theſe Herbs one handful; the Meal of Line, Fenugreek, and Oil of Lillies, of each three Ounces.

The Roots when waſh'd and ſlic'd, are to be boil'd in Water, and the Leaves being added ſome time after, the Boiling is to be continu'd till the whole Maſs becomes perfectly tender and ſoft; at which time having ſtrain'd the Decoction, beat the remaining groſs Subſtance in a Stone-Mortar, with a Wooden Peſtle, and paſs the Pulp thro' a Hair-Sieve turn'd upſide-down: Then let the Decoction and Pulp ſo ſtrain'd be put into a Skillet, and having intermixt the Meal of Line, Fenugreek, {334}and Oil of Lillies; let 'em be boil'd together over a gentle Fire, ſtirring about the Ingredients from time to time, till they be all ſufficiently thicken'd. Theſe two Cataplaſms may ſerve as a Model for the making of many others.



C H A P.  V.

Of Oils.

Oils are made either by Infuſion or Expreſſion.

Simple Oil of Roſes made by Infuſion.

Take two Pounds of Roſes newly gather'd, and bruis'd in a Mortar; half a Pint of the Juice of Roſes, and five Pints of common Oil: Let the whole Compoſition be put into a Earthen-Veſſel, Leaded and well ſtopt, and then let it be expos'd to the Sun during forty Days. Afterward let it be boil'd in Balneo Mariæ; and having ſtrain'd and ſqueez'd the Roſes, let the Oil be kept for uſe.

Compound Oil of Roſes made by Infuſion.

Take a Pound of Red Roſes newly gather'd, and pound 'em in a Mortar; as alſo four Ounces of the Juice of Red Roſes, and two Quarts of common Oil. Let the whole Compoſition be put into an Earthen-Veſſel Leaded, the Mouth {335}of which is narrow, and well ſtopt; and then having expos'd it to the Sun during four Days, let it be ſet in Balneo Mariæ for an Hour, and then ſtrain'd and ſqueez'd. Afterward let this Liquor be put into the ſame Veſſel, adding to it the Juice of Roſes, and Roſes themſelves, in the ſame quantity as before: Let the Veſſel be ſtopt; let the Maceration, Boiling, Straining, and Expreſſion be made in like manner as before; and let the ſame Operation be once more re-iterated: Then let your Oil be depurated, and preſerv'd for uſe.

Theſe Oils qualifie and diſperſe Defluctions of Humours, ſuppreſs Inflammations, mitigate the Head-ach and Deliriums, and provoke to ſleep. They muſt be warm'd before the Parts are anointed with 'em, and they may be given inwardly againſt the Bloody-flux and Worms, the Doſe being from half an Ounce to a whole Ounce. The Parts are alſo anointed with 'em in Fractures and Diſlocations of the Bones, and Oxyrodins are made of 'em with an equal quantity of Vinegar of Roſes.

Oil of Sweet Almonds made by Expreſſion.

Take new Almonds that are fat and very dry, without their Shells, and having ſhaken 'em in a ſomewhat thick Sieve, to cauſe the Duſt to fall off; let 'em be put into hot Water till their Skins become tender, ſo that they may be ſeparated by ſqueezing 'em with the Fingers: Afterward having taken off the Skin, they muſt be wip'd with a white Linnen-Cloth, and ſpread upon it to be dry'd: Then they are {336}to be put into a Stone-Mortar, and pounded with a Wooden-Peſtle, till the Paſte grows very thin, and begins to give Oil: This Paſte is to be put into a little Linnen-Bag, new and ſtrong, the Mouth of which hath been well ty'd; and the Bag is to be plac'd between two Platines of Tin, or of Wood lin'd on the inſide with a Leaf of Tin, ſqueezing the whole Maſs gently at firſt; but afterward very ſtrongly, and leaving it for a long while in the Preſs, that the Oil may have time to run out.

This Oil mitigates the Nephritick Colicks, remedies the Retention of Urine, facilitates Child-birth, allayes the After-Pains in Women after their delivery, and the Gripes in young Infants: It is taken inwardly faſting from half an Ounce to two Ounces; and it is us'd in Liniments to aſſwage and mollifie. The Oils of common Wall-Nuts and Small-Nuts, may be alſo prepar'd after the ſame manner as that of Sweet-Almonds.

The Oil of Bayes.

Take as much as you pleaſe of Laurel or Bay-Berries, well cleans'd, perfectly ripe, and ſoundly bruis'd; let 'em be put into a Kettle, and boil'd with a ſufficient quantity of Water during half an Hour; then ſtrain and ſqueeze 'em ſtrongly; let the Liquor cool, and ſcum off the Fat that ſwims upon the Water: Afterward pound the remaining Subſtance in a Mortar, and cauſe it to be boil'd again for half an Hour, with ſome of the firſt Water which was left, adding a little freſh; then ſtrain and ſqueez it, {337}as before, and take off the Oil that ſwims on the Top. But the firſt Oil is better than the ſecond, and therefore ought to be kept ſeparately. The Oils of Berries of Maſtick, Myrtle, and other oleaginous Plants, may be extracted after the ſame manner.

The Oil of Bayes mollifies, attenuates, and is opening and diſcuſſive: It is very good againſt the Palſie, and the Shiverings or cold Fits of a feaver or Ague in anointing the Back; as alſo againſt Scabs, Tetters, &c.

The Oil of Eggs by Expreſſion.

Take newly laid Eggs, and let 'em be harden'd in Water; then ſeparate the Yolks, and put 'em into a Frying-pan over a gentle Coal-fire, ſtirring 'em about from time to time, and at laſt without diſcontinuing, till they grow reddiſh, and begin to yield their Oil: Then they are to be ſprinkl'd with Spirit of Wine, and pour'd very hot into a little Linnen-Bag, which is to be ty'd, and ſet in a Preſs between two heated Platines; ſo that the Oil may be ſqueez'd out as readily as is poſſible.

This Oil mitigates the Pains of the Ears and Hæmorrhoids, cures Scabs and Ring-Worms or Tetters; as alſo Chaps and Clefts in the Breaſt, Hands, Feet, and Fundament; and is made uſe of in Burns, &c.



{338}

C H A P.  VI.

Of Collyrium's.

Collyrium's are Medicines prepar'd for the Diſeaſes of the Eyes: The following is that of Lanfrancus.

Take a Pint of White-Wine, three Pints of Plantain-Water, three Pounds of Roſes, two Drams of Orpiment, one Dram of Verdegreaſe; Myrrh and Aloes, of each two Scruples.

The Orpiment, Verdegreaſe, Myrrh, and Aloes are to be beaten to a fine Powder before they are intermixt with the Liquors. This Collyrium is not only good for the Eyes, but is alſo of uſe to make Injections into the Privy-Parts of Men and Women; but before the Injections are made, it ought to be ſweeten'd with three or four times the quantity in weight of Roſe, Plantain, or Morel-Water.

A dry Collyrium.

Take two Drams of Sugar-candy; prepar'd Tutty, Lizard's-Dung, of each one Dram; White Vitriol, Sucotrin Aloes, and Sal Saturni, of each half a Dram.

Let the whole Compoſition be reduc'd to a very fine Powder, and mixt together: Two or three Grains of this Powder may be blown at {339}once into the Eye with a ſmall Quill, Pipe of Straw, or Reed, as long as it is neceſſary; and the ſame Powder may alſo be ſteept in Ophthalmick Waters, to make a liquid Collyrium.

A Blue Collyrium.

Take a Pint of Water in which unſlackt Lime has been quench'd, and a Dram of Sal Ammoniack pulveriz'd; mingle theſe Ingredients together in a Braſs-Baſon, and let 'em be infus'd during a whole Night; then filtrate the Liquor and keep it for uſe.

This Collyrium is one of the beſt Medicines that can be prepar'd for all manner of Diſeaſes of the Eyes.



C H A P.  VII.

Of Powders.



A Powder againſt Madneſs or Frenzy.

Take the Leaves of Rue, Vervein, the leſſer Sage, Plantain, Polypody, common Wormwood, Mint, Mother-Wort, Balm, Betony, St. John's-Wort, and the leſſer Centory; of every one an equal quantity.

Theſe Plants muſt be gather'd in the Month of June, during the clear and ſerene Weather, {340}and ty'd up in Noſe-gays, or little Bundles; which are to be wrap'd up in Paper, and hung in the Air to be dry'd in the Shade. Afterward they are to be pounded in a great Braſs-Mortar, and the Powder is to be ſifted thro' a Silk-Sieve.

The Doſe of this Powder is from two to three Drams, mingl'd with half a Dram of the Powder of Vipers, in half a Glaſs of good White-Wine every Morning faſting, for fifty one Days ſucceſſively. It has an admirable effect, provided the wounded Perſon be not bit in the Head nor Face, and that the Wound has not been waſh'd with Water.



C H A P.  VIII.

Styptick-Water.

Take Colcothar or Red Vitriol that remains in the Retort after the Spirit has been drawn off, Burnt Allom, and Sugar-candy, of each thirty Grains; the Urine of a Young Perſon, and Roſe-Water, of each half an Ounce; and two Ounces of Plantain-Water: Let the whole Mixture be ſtirr'd about for a long time, and then put into a Vial. But the Liquor muſt be pour'd off by Inclination when there ſhall be occaſion to take any for uſe. {341}

If a Bolſter ſteept in this Water be laid upon an open Artery, and held cloſe with the Hand, it will ſoon ſtop the Blood; a ſmall Tent may be alſo ſoakt in it, and put up into the Noſe for the ſame purpoſe. If it be taken inwardly, it ſtops the ſpitting of Blood, and the Dyſentery or Bloody-Flux; as alſo the Hæmorrhoidal and Menſtruous Fluxes; the Doſe being from half a Dram to two Drams, in Knot-Graſs-Water.



F I N I S.



A

T A B L E

O F T H E

C H A P T E R S

And of the

Principal Matters

Which are contain'd in every Chapter.



C H A P. I.
Of the Qualifications of a Surgeon, and the Art of Surgery, Page 1
Of Syntheſis, Diæreſis, Exæreſis, and Proſtheſis 2
What ought to be obſerv'd before the undertaking of an Operation 3
C H A P. II.
Of Chirurgical Inſtruments, portable and not portable 5
C H A P. III.
Of Anatomy in general, and in particular of all the Parts of which the Human Body is compos'd 7
C H A P. IV.
Of the general Diviſion of a Human Body 10
C H A P. V.
Of the Skeleton 12
Of the different kinds of Articulations, 14
Of the Number of the Bones of the Human Skeleton 16
C H A P. VI.
Of Myology, or the Deſcription and Anatomy of the Muſcles of the Human Body 19
C H A P. VII.
Of the Myology or Anatomy of the Muſcles of the Head 21
C H A P. VIII.
Of the Myology or Anatomy of the Muſcles of the Cheſt, or of the Breaſt, Belly, and Back 31
C H A P. IX.
Of the Myology or Anatomy of the Muſcles of the lower Belly 34
_Of the Muſcles of the Parts that ſerve for <ſpan claſs="correction" title="Original reads 'Geration'.">Generation in both Sexes_ 36
C H A P. X.
Of the Muſcles of the Shoulder-Blades, Arms and Hands. 37
C H A P. XI.
Of the Muſcles of the Thighs, Legs, and Feet, 48
A Liſt of all the Muſcles of the Humane Body, 57
C H A P. XII.
Of the Anatomy of the Nerves, Arteries, and Veins in general 58
Of the Structure of the four Tunicks of the Arteries 61
Of the Structure of the four Tunicks of the Veins 63
Of the Beginning and Origine of all the Veins 64
Of the Diſtribution of the aſcending Vena Cava Ibid.
C H A P. XIII.
Of the Anatomy of the Abdomen or lower Belly, 66
Of the Opening of a dead Body at a publick Diſſection 67
Of the Periſtaltick Motion of the Guts 71
Of the Parts appointed for Generation in Men 74
Of the Parts appropriated to Generation in Women 75
C H A P. XIV.
Of the Anatomy of the Breaſt, or middle Venter, 77
The manner of opening the Breaſt in order to diſſect it Ibid.
C H A P. XV.
Of the Anatomy of the Head or upper Venter, 80
An exact Hiſtorical Account of the Holes of the Skull, and the Veſſels that paſs thro' 'em 83
The manner of opening the Head, and Anatomizing the Brain 91
C H A P. XVI.
Of Straps, Swathing-Bands, Bandages, Bolſters, and Tents 93

A Treatiſe of Chirurgical Diſeaſes.

C H A P. I.
Of Tumours in general, Impoſtumes or Abceſſes, Breakings out, Puſtules, and Tubercles 97
C H A P. II.
Of the general Method to be obſerv'd in the curing of Tumours 100
How many ſeveral ways may all curable Tumours be terminated 101
What are the beſt means of curing Impoſtumes, whether to diſſolve, or to bring 'em to Suppuration Ibid.
Of the Circumſtances, to be obſerv'd by a Surgeon in the opening of Tumours 102
Of the general Cauſes of Tumours 103
C H A P. III.
Of Natural Tumours, and firſt of the Phlegmon, and its Dependances 104
Of Remedies proper for the Phlegmon 105
Remedies for the curing of Aneuriſms and Varices 108
Remedies for Echymoſes, Contuſions, or Bruiſes 109
Of Tumours, and their Remedies 110
Of a Gangrene 111
Remedies for a Gangrene 113
Of Kibes and Chilblains, and their Remedies 114
Of the Panaritium and its Remedies Ibid.
Of a Burn and its Remedies 115
Of the Eryſipelas and its Dependences 116
Remedies for the Eryſipelas Ibid.
Of Eryſipelatous Tumours or Impoſtumes, and their Remedies 118
Of the Oedema, and its proper Remedies, 119
Of Oedomatous Tumours and Impoſtumes 120
Of a Scirrhus and its Remedies 123
Of Scirrhous Tumours 124
Remedies for the Polypus 125
Of Cancers 126
Remedies for Cancers Ibid. and 127
C H A P. IV.
Of Baſtard or Encyſted Tumours 128
Of the Remedies for Encyſted Tumours 129
C H A P. V.
Of Critical, Malignant, Peſtilential, and Venereal Tumours and Impoſtumes 131
C H A P. VI.
Of the Scurvy, 133

A Treatiſe of Wounds, Ulcers, and Sutures,

C H A P. I.
Of Sutures or Stitches, 138
C H A P. II.
Of Wounds in general 141
Of Remedies proper to ſtop the Hæmorrhage of a Wound 143
What is to be done when a Convulſion happens in a Wound, by reaſon of a Wounded Nerve or Tendon 144
What Courſe is to be taken to draw extraneous Bodies out of a Wound 145
Of Vulnerary Decoctions to be taken inwardly 148
C H A P. III.
Of the particular Wounds of the Head 149
C H A P. IV.
Of the particular Wounds of the Breaſt 151
C H A P. V.
Of the particular Wounds of the lower Belly 153
C H A P. VI.
Of Wounds made by Guns or Fire-Arms 154
Of the Prognoſtick of Wounds by Gun-ſhot 155
Of the cure of Wounds by Gun-ſhot Ibid.
Of a Burn made by Gun-powder 159
C H A P. VII.
Of Ulcers in general 164
C H A P. VIII.
Of Venereal Diſeaſes 168
Of the Chaude-Piſſe or Gonorrhæa Ibid.
Of Shankers 170
Of Bubo's Ibid.
Of the Pox 171
The manner of making the Mercurial Panacæa 175, &c.

A Treatiſe of the Diſeaſes of the Bones.

C H A P. I.
Of the Diſlocation of Bones 181
C H A P. II.
Of the Fractures of Bones 187
C H A P. III.
Of the particular Fractures of the Skull 192
C H A P. IV.
Of the Caries, Exoſtoſes, and Nodus of the Bones 197
C H A P. V.
Of Cauteries, Veſicatories, Setons, Cupping-Glaſſes, and Leeches 199
Of the compounding of Potential Cauteries 201
C H A P. VI.
Of Phlebotomy 204

A Treatiſe of Chirurgical Operations.

C H A P. I.
Of the Operation of the Trepan 209
Of the Bandage of the Trepan 213
C H A P. II.
Of the Operation of the Fiſtula Lachrymalis 214
The Dreſſing and Bandage of the Fiſtula Lachrymalis 215
C H A P. III.
Of the Operation of the Cataract 216
The Dreſſing and Bandage of the Operation of the Cataract 217
Of purulent Matter gather'd under the Corneous Tunicle of the Eye 218
Of a Tumour that ariſeth in the Eye, Ibid.
Of the Eye-Lids glu'd together Ibid.
Of the Hairs of the Eye-Brows that offend the Eye 219
Of the hard and tranſparent Tumours on the Eye-Lids Ibid.
C H A P. IV.
Of the Operation of the Polypus Ibid.
C H A P. V.
Of the Operation of the Hare-Lip 220
The Dreſſing and Bandage for the Hare-Lip 221
C H A P. VI.
Of the Operation of Bronchotomy 222
C H A P. VII.
Of the Operation of the Uvula 223
C H A P. VIII.
Of the Operation of a Cancer in the Breaſt Ibid.
The Dreſſing and Bandage of the Breaſt 225
C H A P. IX.
The Operation of the Empyema 227
The Dreſſing and Bandage for the Operation of the Empyema 228
C H A P. X.
Of the Operation of the Paracenteſis of the lower Belly 229
The Dreſſing and Bandage for that Paracenteſis 230
The Operation of the Parcenteſis of the Scrotum Ibid.
C H A P. XI.
Of the Operation of Gaſtroraphy 231
C H A P. XII.
Of the Operation of Exomphalus 234
C H A P. XIII.
Of the Operation of the Bubonocele, and of the compleat Rupture 236
The Dreſſing and Bandage 237
Of the compleat Rupture Ibid.
C H A P. XIV.
Of the Operation of Caſtration 238
Of the Dreſſing and Bandage for the Caſtration 239
C H A P. XV.
Of the Operation of the Stone in the Ureter 240
C H A P. XVI.
Of the Operation of Lithotomy 241
The Dreſſing and Bandage for the Operation of Lithotomy 243
Of the Operation of Lithotomy in Women by the leſſer Preparative 244
C H A P. XVII.
Of the Operation of the Puncture of the Perinæum 245
C H A P. XVIII.
Of the Operation of the Fiſtula in Ano Ibid.
C H A P. XIX.
Of the Suture of Stitching of a Tendon 247
C H A P. XX.
Of the Cæſarian Operation 248
C H A P. XXI.
Of the Operation of Amputation; with its proper Dreſſings and Bandages 249 and 251
C H A P. XXII.
Of the Operation of the Aneuriſm 253
The Bandage for the Aneuriſm 255
C H A P. XXIII.
Of the Operation of Phlebotomy Ibid.
The Bandage in Phlebotomy 256
C H A P. XXIV.
Of the Operation of Encyſted Tumours 257
Of Ganglions 258
C H A P. XXV.
Of the Operation of Hydrocephalus Ibid.
C H A P. XXVI.
Of the Operation of cutting the Tongue-String 259
C H A P. XXVII.
Of the Operation of opening ſtopt Ductus's 260
Of an Inciſion made to open the Vagina Uteri Ibid.
The manner of ſeparating the Lips of the Pudendum when conglutinated Ibid.
The manner of opening the Vagina when ſtopt with a Fleſhy Subſtance Ibid.
The Method of opening the Urinary Ductus as well in Boys as in young Virgins Ibid.
The Method of opening the Ductus of the Ear, when ſtopt with a Membrane or a Carnous Subſtance 261
C H A P. XXVIII.
Of the Operation of the Phimoſis and Paraphimoſis Ibid.
C H A P. XXIX.
Of the Operation of the Varix 262
C H A P. XXX.
Of the Operation of the Panaritium 263
The Dreſſing and Bandage for this Operation Ibid.
C H A P. XXXI.
Of the Reduction of the falling of the Anus 264
C H A P. XXXII.
Of the reducing of the falling of the Matrix 265
C H A P. XXXIII.
Of the application of the Cautery and its Bandage Ibid.
C H A P. XXXIV.
Of the Application of Leeches, and the Dreſſing 267
C H A P. XXXV.
Of the application of the Seton 268
C H A P. XXXVI.
Of Scarifications 269
C H A P. XXXVII.
Of the Application of Veſicatories Ibid.
C H A P. XXXVIII.
Of the application of Cupping-Glaſſes 270
C H A P. XXXIX.
Of the opening of Abſceſſes or Impoſtumes 271

A Treatiſe of the Operations of Fractures.

C H A P. I.
Of the Fracture of the Noſe 272
The Dreſſing and Bandage for the Fracture of the Noſe 273
C H A P. II.
Of the Fracture of the lower Jaw 274
The Dreſſing and Bandage Ibid.
C H A P. III.
Of the Fracture of the Clavicle 276
The Dreſſing and Bandage Ibid.
C H A P. IV.
Of the Fracture of the Omoplata or Shoulder-Blade 278
The Dreſſing Ibid.
C H A P. V.
Of the Fracture of the Ribs 279
The Dreſſing and Bandage 280
C H A P. VI.
Of the Fracture of the Sternum or Breaſt-Bone Ibid.
The Dreſſing and Bandage 281
C H A P. VII.
Of the Fracture of the Vertebra's Ibid.
C H A P. VIII.
Of the Fracture of the Os Sacrum 283
C H A P. IX.
Of the Fracture of the Coccyx or Rump-Bone Ibid.
The Dreſſing and Bandage for that Fracture 284
C H A P. X.
Of the Fracture of the Humerus or Arm-Bone Ibid.
Its proper Dreſſing and Bandage 285
C H A P. XI.
Of the Fracture of the Bone of the Elbow 286
The Dreſſing and Bandage Ibid.
C H A P. XII.
Of the Fracture of the Carpus or Wriſt-Bone 287
The Dreſſing and Bandage Ibid.
C H A P. XIII.
Of the Fracture of the Bone of the Metacarpium or Back of the Hand 288
The Dreſſing and Bandage Ibid.
C H A P. XIV.
Of the Fracture of the Bones of the Fingers 289
C H A P. XV.
Of the Fracture of the Thigh-Bone Ibid.
The Dreſſing and Bandage 290
C H A P. XVI.
Of the Fracture of the Patella or Knee-Pan 291
The Dreſſing and Bandage Ibid.
C H A P. XVII.
Of the Fracture of the Leg-Bone 292
Its proper Dreſſing and Bandage 293
The Dreſſing for complicated Fractures 294
C H A P. XVIII.
Of the Fracture of the Bones of the Foot 295
The Dreſſing and Bandage 296

A Treatiſe of the Operations which are perform'd in Luxations.

C H A P. I.
Of the Luxation of the Bone of the Noſe 297
The Dreſſing and Bandage proper for ſuch a Luxation 298
C H A P. II.
Of the Luxation of the lower Jaw-Bone Ibid.
The Dreſſing and Bandage 299
C H A P. III.
Of the Luxation of the Clavicle Ibid.
C H A P. IV.
Of the Luxation of the Vertebra's 300
The Dreſſing and Bandage 301
C H A P. V.
Of the Luxation of the Coccyx or Rump-Bone 302
C H A P. VI.
Of the Bunch Ibid.
C H A P. VII.
Of the Luxation of the Ribs 303
The Dreſſing and Bandage Ibid.
C H A P. VIII.
Of the ſinking of the Xiphoides or Sword-like Cartilage 304
C H A P. IX.
Of the Luxation of the Humerus or Arm-Bone, Ibid.
The Dreſſing and Bandage 306
C H A P. X.
Of the Luxation of the Bone of the Elbow Ibid.
The Bandage for the ſame Luxation 307
C H A P. XI.
Of the Luxation of the Carpus or Wriſt-Bone 308
The Bandage 309
C H A P. XII.
Of the Luxation of the Bones of the Fingers Ibid.
The Bandage for that Luxation Ibid.
C H A P. XIII.
Of the Luxation of the Thigh 310
Its proper Dreſſing and Bandage 312
C H A P. XIV.
Of the Luxation of the Knee Ibid.
The Bandage 313
C H A P. XV.
Of the Luxation of the Patella, Knee-Pan, or Whirl-Bone of the Knee Ibid.
Of the Separation of the Perone from the Tibia Ibid.
Of the Luxation of the Aſtragalus 314
Of the Separation of the Calcaneum from the Aſtragalus Ibid.

A Treatiſe of Medicinal Compoſitions neceſſary for a Surgeon.

C H A P. I.
Of Balſams 315
The Balſam of Arcæus Ibid.
The Balſam of Spain 316
The Green Balſam 317
The Samaritan Balſam 318
C H A P. II.
Of Ointments 319
Unguentum Althææ Ibid.
The mundificative Ointment of Smallage 320
The black or ſuppurative Ointment 321
Unguentum Roſatum 322
Unguentum Album, aut de Ceruſſa 323
Unguentum Ægyptiacum 324
Unguentum Baſilicon, or the Royal Ointment 325
A cooling Cerate 326
An Ointment for Burns 327
C H A P. III.
Of Plaiſters 328
Of Plaiſter of Diapalma Ibid.
The Plaiſter of ſimple Diachylum 329
The Plaiſter of Andreas Crucius 330
Emplaſtrum Divinum 331
C H A P. IV.
Of the Cataplaſms or Pultiſſes 332
C H A P. V.
Of Oils 334
Simple Oil of Roſes made by infuſion Ibid.
Compound Oil of Roſes made by infuſion Ibid.
Oil of ſweet Almonds made by expreſſion 335
Oil of Bayes 336
Oil of Eggs made by expreſſion 337
C H A P. VI.
Of Collyriums 338
A dry Collyrium Ibid.
A blue Collyrium 339
C H A P. VII.
Of Powders Ibid.
A Powder againſt Madneſs or Frenzy Ibid.
C H A P. VIII.
A Styptick Water 340

The END of the TABLE.