Ascites the Urin is red muddy and lixivious the Patient having excessive Thirst slow Fever and difficulty of Urin. I shall not trouble my self to tell you the Ancients Opinion concerning the cause of the Dropsie Four chief causes of the Dropsie but suppose these four things contribute to its Formation viz. 1. Indigestion of the Chyle 2. Loose texture of the Parts 3. Slowness of the Bloods Circulation 4. A general dissolution of its whole Mass 1. Indigestion of the Chyle I begin first with Indigestion of the Chyle which almost always proceeds from the alteration of the dissolvents that serve for the preparation and the consummation of their Oyl and Viscosity when the Chyle is well temper'd prepar'd and freed from the course Particles it 's nothing but a Buttery Mass which passes into the venae Lacteae and from thence into the right Ventricle of the Heart to be united with the Blood which comes from all parts deprived of its Oyl and most active Principles and serves for a Vehicle and Balm for new nourishment It is this Lactaceous Liquor well depurated and extreamly fluid which entertains the parts and which by its mixture unites and ties in the Heart the two substances of Blood viz. the white part to the red which substances well joyned make a whole neither too fluid nor solid but such as Nature judges most proper to circulate without Obstacle in the Vessels But if by chance the Oyl of the Blood and other Humours with which it 's furnish'd should happen to be dissipated either by violent Exercise too serious Meditations extream Grief or by the abundance and exaltation of the Salts the Chyle must of necessity grow sour become Indigested serous and incapable of any Union then it 's so far from preserving the consistence of the Blood that it rather Dissolves Liquefies and disposes it to make Obstructions Rheumatisms Dropsie c. Because the Arterial Blood not being able to receive through this Indigestion and the preparations and triturations necessary for the Life of the parts it 's course must be in a manner intercepted passing into the Vesicles or rather spaces between the Porosities of the Arteries and Veins where the little Oyl frees and disengages its self from the other Principles which it had taken hold of before to change into our proper Substance so that the serosity of the Blood being at full liberty and having lost a part of its motion pours it self into the spaces which it meets with 2. Loose texture of the parts and so causes the Dropsie according to the texture of the parts which we have supposed more or less lax 3. Slow Circulation We must now explain that cause which proceeds from the slow Circulation of the Venal Blood That we may have an Idea of it we must examine by what Mechanism this Blood is carried back to the Ventricle of the Heart which is the focus of its â—â—â—ion How the Venal Blood is carried to the Arteries I set first omitting the Organs of respiration and the assistance of the Valves three principal movers which oblige the Venal Blood to pass through the Heart 1. The Pulsation of the Arteries 2. The Motion of the Muscles 3. The Mixture of the Lympha If the Pulsation of the Arteries be weakned 1. Pulsation of the Arteries help the motion of the Blood the motion of the Venal Blood must be lessen'd because the Arteries beat and actually Flagellate those Vessels and so oblige the Blood which they contain to repair to the Heart with a wonderful facility 2. Motion of the Muscles The Motion of the Muscles is much more important to hasten the Circulation of this Liquor they being as so many Hands which press the Vessels that penetrate or pass through them and determine the Liquor which they contain to a quicker discharge into their Recepticles So that if they have lost a part of their motion for want of Spirits the Circulation of this course Blood wou'd be as it were supended in the Veins 3. The Lympha In the third place I said that the Lympha disposes it self in the Veins to make the Blood more fluid and fit to circulate No 't is certain if its course be impeded either in the Glands or Lymphatic Vessels the Blood wou'd circulate much slower for want of a dissolvent This being suppos'd that Indigestion of the Blood slow and dull Pulsation of the Arteries weak motion of the Muscles and interruption of the course of the Lympha are causes which concur somewhat to Impede the Circulation of the Venal Blood The Venal Blood very poor which is a Blood depriv'd of its Spirituous Particles having no consistence or strait Union between them Then the serosity which serves the rest of the Blood as a Matrix separates it self from it as the serosities of Milk from the Curd it transpires between the intervals of the Fibres or pours it self out as a gentle Rain in some capacity for to frame both kinds of Dropsies Two Experiments confirm me in this Opinion The first is That if we make the Ligature of the Veins in some part and that one hinders the passage of the Blood it does not fail to be overflown in a short time Big Bellied Women subject to Hydropical Leggs The second is we observe That most big Bellied Women have Hydropick Legs or at least Varices This is a Matter of Fact not to be disputed and which is easily explain'd only by the disposition of the parts we observe that as the Foetus grows bigger it enlarges the Matrix and compresses so much the Iliac and crurel Veins which are near that the Blood which comes from the inferior parts not having the liberty to move as it us'd to do by reason of this compression there must a Dropsie follow as we have shewn Dissolution of the Blood What belongs to the cause of the Dropsie which proceeds from the dissolution of the Blood we have already remark'd when he spoke of Indigestion of the Chyle that nothing is so capable of destroying and consuming the Oyl of the Blood as the abundance and exaltations of the sharp and tartarous Salts It 's by the means of their action that we explain how Scorbutick Hypocondriac Lienteric Persons and those who lie long in Prisons become Hydropical Which we cou'd not easily demonstrate if we did not admit the motion and agitation of the cutting and Corrosive Particles which puts the principles of the Blood to the rout and disunites them so that the Sarum escapes on all sides and gives way for the Dropsie to seize on some part whether it transpires in form of a Dew through the Tunicles and Membranes or Filters between their Fibres or the Glands let it escape or it 's spilt by the interruption of its most insensible Vessels in the void spaces which present themselves at their passage It will always be truly said that the parts which Nature has a mind
specific Remedies to hinder the progress of this Disease are Bleeding which keeps the first rank and I say that if it be of any use at all in Surgery it 's without doubt in this occasion Bleeding no where of so great use as here because in emptying the vessels it hinders the Blood from being carried so abundantly to that part and must consequently lessen the bigness of the Tumor in diminishing the quantity of the Blood Approved Remedies in a Plurisy The other Remedies are those which rarify subtilize and attenuate the Blood as Horse or Mule's dung infused in White-wine old He-goat's Blood in Powder all Volatil Salts and several other Remedies of that nature The decoction of Nettles in strong Wine which you sweeten with Sugar is also excellent you may at the same time you take the Decoction lay on the sides the bruised Nettles in form of a Cataplasm Of a Peripneumonia Having thus in general explain'd the Cause of a Plurisy I am obliged to say something of a Peripneumonia that sometimes proceeds from an Impostume of the Brain or from the Inflamation of some Membrane which changes into an Abscess as experience demonstrates in those that die of great Wounds of the Head but for the most part it 's caused by the corruption of the Blood that is to say by the exaltation of its sharpest Particles All the difficulty is to know why the Pus or Blood stops rather in the Lungs than in any part else for to make an Impostumation I say that three Causes contribute to its formation the alteration of the Blood Causes of Peripneumonia long and slow Respiration and the structure of the part First Cause Alteration of the Blood Concerning the first you must only make reflection on the nature and mixture of the Chile and thickest Blood which the right Ventricle of the Heart sends in every Sistole to the Lungs through the Pulmonic Artery We know that these two Liquors pass through the Heart and Lungs for to receive some necessary preparations for the function of the parts therefore we may say that they are the two receptacles of all that is most thick and indigested in the mass of Blood but if the Heart hath the strength and power by its constriction to subtilize and cast off all that is most heavy and material in the mass the Lungs have not the same advantage as we will prove so that the grosser substances being accompanied with some impurity and having only felt the first effects of the Heart for its perfection it must needs stop there and putrefy Second Cause Long and slow I espiration The second Cause which I establish is a long and slow Respiration It 's certain the more free the Air enters into the Breast and the more the Vessels are extended they are in a more fit condition by their elastic vertue or spring to express the Air through the Pipes of the Trachea Arteria and the more the Blood is agitated by the inspiration of the Air it 's driven with greater quickness into the Veins But on the contrary if the Blood is moved slowly by a long Respiration it follows that the Vessicles being not so extended as they should be and not expelling the Blood out of them with such a violence it stops and corrupts there gradually by the arrival and mixture of some ill Leaven or by the exaltation of its salt Particles from whence it comes that those who have a long Neck are more subject to it than others because the Air is obliged to make a long traverse before it comes to the Lungs which makes them dry up and alter insensibly Third Cause on the Structure of the Part. What the Lungs really are The third Cause is grounded upon the Structure of the Part the Lungs are a complication of little Vessicles in which the Arteries pour the Blood and where it 's mingled with the Air to receive some alteration there Now it 's shew'd in the Hydravlic's that a Liquor which passeth from a little Pipe into a greater loseth much of its motion and being the Arteries are very little in proportion to the Cells it 's no wonder if the Blood grow slow there and changeth its nature by the exaltation of some sharp and tartarous Salt and by the Fermentation which they cause there wherefore the alteration of the Blood the irregularity of Respiration and the largeness of the Vessicles of the Lungs in proportion to those of the Arteries are the three Causes that concur to the formation of the Peripneumonia Since the Signs of all these kinds of Diseases are of the greatest importance to succeed well in the Operation and to make a favourable or dangerous Prognostic I will endeavour to describe them with all the Order that is possible Signs of Pus or Blood in the Pleura The Signs which shew us that there is some Pus or Blood stopt in the Pleura are Inflamation penetrating Pain Heaviness a languishing and continual Fever a hard thick and deep Pulse accompanied with shivering difficulty of breathing a dry Cough and Thirst one cannot lie on the sound side by reason the matter lieth heavy on the Pleura and one grows lean and thin in a few days Signs of the Matter on the Diaphragma But if the Impostume break and the matter falls on the Diaphragma all these Symptoms cease and the Patient finds some ease for a time but immediately there comes others not less dangerous and insupportable besides the difficulty of breathing which is common to every Empiema one feels a heaviness upon the Diaphragma fluctuation a great uneasiness the Fever increases and becomes burning the Pulse rises the Pain indeed is not so sharp it being felt towards the false Ribs one cannot lie but on the side where the matter is for if you lie on the opposite side one feeleth a twitching upon the Mediastinum more cruel Pain and a much greater heaviness their spittle is sometimes stinking and there follows very often Impostumes of the Liver after these kind of indispositions even as it is observed after great wounds of the Head If the Pus be diffused on both sides one cannot lie on either by reason of the sharp Pains one suffers to be eased you must lie upon the back or belly Signs of Pus in the substance of the Lungs The Signs when there is Pus in the substance of the Lungs may be divided into equivocal and convincing the equivocal belong to other Diseases of the Lungs it 's very dangerous to be mistaking therefore let 's endeavour to examine them well that we may draw some advantages and that we may not undertake an Operation whose effect would prove not only useless but fatal If there be any Pus in the substance of the Lungs the diseased cannot breathe without pain he finds an insupportable and troublesom heaviness upon the Diaphragma because the weight of the matter deprives it of
to attack are in a very little time Drown'd We observe that the Muscles of all Hypocondriacs are deprived of a part of the Spirits which are necessary to them for their natural motion for if we consider that the Sulphur which we have supposed to be destroyed VVhat the Animal Spirits are contributes only to the generation of the Animaâ— Spirits that the little cutting Particles which this Sulphur wraps up are the Matter of them and the residue the Vehicle and true Oyl with which the Brain is imbued we shall agree that the Glands of the Brain furnish very few Spirits in these Diseas'd Persons whose Bodies are depriv'd of Fat and that consequently their Muscles must lose of their force vigour and motion from whence comes the great heaviness which they feel You must also observe that they are no more provided with this Fat which before made their Fibres supple flexible and capable of activity This being so 't is evident that their motion must be weakned that they can no more communicate any to the Vessels the course of the Liquors must be slackned and the Animal Spirits which bring some formality to every part are no more in a condition to keep the Pores open or at least so wide as ordinarily so the Vessels being as it were sunk and the Arterial Blood not having any more the power or strength to make it's way the parts are almost defrauded of Life I alledge all these reasons because they fortifie our System of the formation of the Dropsie Old Men very subject to the Dropsie which is founded on the slowness of the Circulation of the Blood which is remarkable in old Men who are most subject to Dropsies The reason is because their Blood is only a fluid Indigested and corrupt Mass having lost all its consistence and unctuosity one may say it has lost its Oyl and consequently is made incapable of sustaining its Fermentation I add that those who Inhabit Boggy places being of a cold Temperament and used to moist Food will be more liable to it than others The Dropsie which often effects Fat and full People who nevertheless are in a certain moderate repose has for its cause only the slowness of Circulation through the frequent Obstructions which ordinarily happen in the Glands and Vessels which occasions the Lympha to disengage it self and overflow some part VVhen the Dropsie is incurable The waters sometimes gather together in a Cystis which makes the Dropsie incurable This Cystis is a strange Covert at first insensible but by degrees separates it self from some other covering either of the Peritonaeum or elsewhere by the saline and lixivious nutriture which it has contracted or by the too great humidity received after the same manner as the Particles of an Egg or Seed disengage or unfold themselves This Cystis is sprinkled with a multitude of Glands and Vessels which it receives from the part from whence it derives its Origin and from other Neighbouring Parts which are as so many sources that produce new Dropsies Signs of the Dropsie The signs of this Disease are swelling of the Belly transparency of the Waters and Fluctuation Difference between corpulant persons and hydropical Before I speak of the Accidents 't is necessary to give an Idea of the difference between the swelling of the Dropsie and a good habit of body In the Dropsie the Belly is extreamly extended and even the Navels rises and terminates in a point whereas in the latter its soft and less extended being more elevated on the sides than elsewhere where the fleshy Portion of the Muscles lie and the Navel is quite hidden Symptoms of the Dropsie The Symptoms which accompany this Disease are slow Fever weak Pulse heaviness of the whole Body difficulty of Respiration considerable Swelling excessive Thirst and difficulty of Urine 1. Slow Fever The slow Fever is nothing else but an effect of the impurity of the Chyle and other levens which intimately mix with it this mixture design'd to make the life of the part happy being impressed with this brine or rather charg'd with this impure and strange Matter passes to the Heart how corrupt soever it be where it ferments and disorders its motions the Heart communicating its unruly Pulsations to the Arteries excites this kind of Fever which is only felt very slightly 2. Weakness of the Pulse The Pulse's weakness depends on the slow influence of the Animal Spirits into the Fibres of the Heart which being incapable to augment their Action in respect of the Spirits as well as Blood by reason of their scarcity maintain the blood in that little degree of precipitate motion which distinguishes this slow Fever from the other and consequently causes this weakness of the Pulse 3. Heaviness of the Body The pale colour and heaviness of the body proceeds from the slow motion of the Blood and from the dissipation and concentration of the Spirits which are stifled and choak'd as it were in the Waters now as the heat and vigor depend on the presence and natural ferment of the Blood and Spirit which should animate these parts and be carried to the Surface you must not wonder if they be so pale and if the Muscles can't sustain the weight of the Body 4. Difficulty of Respiration The difficulty of Respiration is caused by the swelling and great tension of the belly which presses the Diaphragm against the Lungs and diminishes the Diameter of the Breast so that the Lungs having not the liberty to extend themselves the Respiration grows frequent and forced The excessive thirst is rais'd from the humors that are separated from the Glands of the Stomach 5 Thirst Oesophagus and other parts of the Gula to moisten their coasts and to maintain them in the Humidity which is requisite for them it 's not enough either through the frequent setlings which are made in other parts or that the invincible and intemperate fire which the Fever kindles in all parts dissipates consumes or ratifies it which cause these parts to heat and dry and that saltish Spirits whose actions are not corrected by any dissolvent rush into the little Fibres and produce a motion in the Nerves which excites thirst As to difficulty of Urine I suppose that part of the Water which used to take its course through the Kidneys 6. Difficulty of Vrine tends another way and that the Urinous Volatil and other fixt Salts of the Urine being deprived of a part of their dissolvent stop at the entry of the Pores of the Glands and hinder the Urine from running with that liberty into its Conduit the Salts thus having the upper hand and finding nothing in the Blood capable to blunt their points irritate all the parts through which they pass particularly the Areteries and oblige the Sphincter of the Bladder to a more than usual contraction which causes the Urine to flow very difficultly and by turns I pass to
the others unless the Patient be resolv'd to endure the Operation The 4. is in all old Excrescencies To have an Idea of their generation you must consider that the one attacks the Substance it self and the other its Tunicles after this you must look upon the Spermatic Arteries as the true source and channels which convey the Matter of which the Carnosities are form'd and that the Arterial Blood furnishing the Testicles with the Matter of Seed to be prepared there le ts slip in this Elaboration its most greasie and viscous part which the moderate heat that we find there condenses in the little channels which compose them or in their Tunicles almost as the white of an Egg hardens over a moderate Fire This Matter coming to swell and extend these little tender Pipes produces that which we call a spongy and carcinomatous Excrescence It 's only a swelling of these little Filaments which a strange Humour forces to rise in a tumor You may also observe that by the over-growing of a new Matter it becomes very often so remarkable that one can't long carry this burthen without discharging it If it happen that by what cause soever this Liquor should be determinated rather into the Membranes of the Testicle than any where else and that there 's form'd a Carcinomatous Substance all along the productions of the Peritonaeum which encroaches sometimes upon the Interior parts of the Belly I suppose that the Operation will then be needless because this carnosity occupying not only the vaginal Tunicle which is a dilatation of the productions of the Peritonaeum but also the productions themselves you would ruin the. Vessels Rings and several parts included in the Hypogastrium I will not repeat here the signs of this Disease as for its Prognosticks Prognostick they are always very bad because it costs the Testicles if any carnosity possess its Substance for it can't be consum'd without destroying it and the sarest way is the Operation CHAP. XIII Of Castration THE Patient being laid on his Back the Surgeon Incises with a very sharp Instrument the Membranes of the Scrotum upon the Body of the Testicle to discover the carnosity which must be separated from the Dartos without offending the cover of the seminal Vessels being freed from the Neighbouring parts you make the ligature of the Vessels between the Rings and the tumor you must cut them half the length of a Finger from the ligature and take away the Testicle with the Sarcoma you leave an end of the Thread out of the Wound avoiding to pull the Spermatick Vessels to you The Spermatick Vessels not to be tied too hard or compress them too hard lest the Patient shou'd fall into a Convulsion that they may not slip into the Belly where they wou'd shed Blood and so cause Death in a little time If the tumor be considerable scirrhous inflam'd painful and posfess both the Testicles and of continuance the Operation is very dangerous If the productions of the Peritonaeum be carcinomatous and you have a design to make the Operation you must first consume the Flesh by the help of potential cauteries or molifie them by a powerful suppuration yet it must be avoided if the tumor extend it self into the cavity of the Belly for the reasons before mentioned When the superfluous Flesh is consum'd and the Eschar fallen if the Vessel be preserved you make the ligature by the Rings of the Muscles and take away the Testicle as I have said for should you make it before the fall of the Eschar the Patient would suffer dangerous Convulsions You fill the Wound afterwards with Dossils dip'd in some digestive and emborate and apply defensitives compresses with a suspensorium ordering Bleeding Clysters and other general Remedies CHAP. XIV Of Hydrocele A Hydrocele from Ascites incurable Vnless you cure the Ascites IF the Hydrocele be the consequence of the Dropsie Ascites the Operation is useless because there runs alway new Matter which presently produces another Hydrocele so that unless you dry up the source there 's no hopes of cure In this the waters occupy alway the tunica vaginalis and run from the capacity of the Abdomen through the prolongations of the Peritonaeum All other sorts of Hydrocele proceed from the slow motion of the Blood Other cures or its dissolution Falls and Blows may also contribute to their Formation The reason is that the Blood Stagnates more easily in these parts which causes the serosity to separate from it on the same principle I say that the circumvolutions and serpentine turns which the Spermatick Veins form in their Root are for the most part the cause of it if the Blood be the least dispos'd to it for seeing it doth not circulate here but with much ado the serosities have time enough to separate and distil into the Purses Having examined the signs of the two sorts of Hydrocele when we spoke of those of the Hernia Intestinalis we 'll say nothing more of them than the Prognostick which is only of ill consequence when the waters are included in a Cystis We must now examine all the circumstances of both kinds which require two different ways of Operating We have observ'd when we Treated of the signs that the first kind of Hydrocele is distinguished and known when the waters extraordinarily swell and extend the Membranes of the Scrotum CHAP. XV. Of the Operation of Hydrocele THis Operation consists in making a puncture into the Scrotum with the Trocher accompanied with its Canula through which the water runs freely and when 't is emptied you withdraw your Instrument and the Cutis of the Cods becomes rugous as before and the aperture stops exactly This is performed without trouble or danger but omit not drying up the source by the use of general Remedies otherwise the tumor will not fail to return The second kind of Hydrocele which generally possesses only one side ordinarily attacks the Tunicles of the Testicle It 's also much more painful through the great tension of its Membranes The method of the Operation The method requir'd in this consists in making the aperture deep and large enough as well to give vent to the water as to carry Medicines thither which have the Virtue of dissipating the Membranes that are imbued with them we use to make the aperture at the side of the Scrotum with a Lancet The Caustic better then a Lancet or a Potential cautery to avoid the Spermatick Vessels and seeing the cautery makes a great Eschar 't is to be preferr'd before the Lancet because you are in less danger of offending the Testicle and you dissipate insensibly the Membranes by Suppuration You must Note That seeing the Waters hinder the action of this Remedy in blunting its corrosive Particles if the first that is apply'd makes not an Eschar deep enough it 's necessary to apply another when the Eschar is off you fill the Wound with Dossils and leave
of the bone which press it We are persuaded that it 's compressed c. when the bones are depress'd and appli'd as it were against its surface or that the broken pieces of bones are separated or finally that there is some extravasated blood which offends it We are convinc'd that it 's cut when it 's caus'd by a sharp and cutting Instrument and that the Fracture be of a great length but if the bone be only crackt and some blood be extravasated upon the dura mater only those signs which I have describ'd and which I am going to explain can give us certain evidences of it I need not here repeat the explication of the pain Cause of the Heaviness The Heaviness proceeds from the diffused blood upon the dura mater for since she is to rise and follow the motions of the Brain if the weight give her not liberty to obey and the Brain find any resistance her motion must be somewhat interrupted Now seeing the motions of the Brain depends on that of the Arteries the Impulsion of the Blood not being sufficient to elevate the substance of the Brian and the weight upon it its course must be slower in this part and a heaviness must follow thereon Cause of puft-up and inflamed Eyes The Eyes become puffed up an inflamed to explain this Phoenomena you must only remember that the Sinus's of the Basis of the Skull are only productions of the dura mater and that they receive all the residuous blood that comes from the veins which are distributed about the globe of the Eye This being so it 's evident that if the dura mater be inflamed she communicates it to the Sinusses and so opposes the return of the blood which the veins are to pour into these little reservatories and since the arterial blood still presses forwards the globe of the Eye which is pressed by these two liquors by the reflux of one and arrival of the other must needs tumify and inflame Not to confound the Inflamation of the Eye with that of the Eye-lids you must consider that that which happens to the globe of the Eye proceeds from the Inflamation of the dura mater and that of the Eye-lids from the Inflamation of the pericranium for the interior membrane of the Eye-lids is a production of it We observe that Inflamation of the Eyes doth sometimes not appear till the third fourth or fifth day this can come from nothing else but from the long passage which there is between the Inflamation of the Sinuffes and the more or less progress it makes during that time Reasons of redness of the Face c. The Face groweth red and puffed up by reason the Inflamation of the dura mater obligeth one part of the blood that mounteth to the head through the internal Carotides to spread on the place where they pierce the dura mater even to the neighbouring parts and external Carotides which is so much the more true since we know that all parts of the Face swell and grow red in a very little time after any Inflamation being water'd with a great many sanguiferous vessels for the same reason the blood runs out of the nose mouth and ears and besides the blow that troubleth the whole oeconomy of the brain it 's to be presumed that the blood which flows in abundance some little cappillary vessels may be broken by the great distentions they endure Reason of Drowsiness The Patient is drowsy To explain this kind of Lethargy we must still have recourse to the Inflamation of the dura mater and to the blood which is stopt in its Sinusses or at least to the slowness of its motion be it that the arterial blood is no more mingled with the grosser blood which they contain or that the Inflamation increaseth It happens that the weight of the blood which is pent up in these Sinusses press the corpus callosum and the nerves which are distributed about the organs of the senses so by this means makes the head dull and heavy You must observe that this kind of Lethargy is not so deep as that which comes when the matter is diffused upon the brain as we shall speak of in its place Cause of the Fever The Fever is caused by the inflamation and pain for it 's sufficient it but one drop of corrupted blood be convey'd into the whole mass to produce it Cause of hard Pulse The Pulse is hard To explain this Phoenomena you must consider that the dura mater accompanieth the thick cords of the nerves is their passage and the inflamation and great tention which she suffers are capable to straiten all the little membranous sheaths which invelop them and consequently to hinder the spirits from flowing with that liberty into the fibres of the heart so that its spring being weakned for want of this distribution you must not wonder if it doth not force the blood into the Arteries with the same force and vigour as before and if the Pulse be deep in this occasion Cause of the Shiverings The Shiverings which accompany the Fever can proceed from nothing else than the purulent matter which causes the Impostumation and from the disposition it has to be stopt and prick the membranes at the time when the veins are charged with it to carry it to the heart and from thence to all the parts and seeing the most part of membranes are carnous and each muscle hath its particular membranes which is separated into a million of membranous fillets which spread themselves into the body of the muscle and inchain all the little carnous fibres to one another we have reason to believe that the spirits running tumultuously into the fibres occasioned by the motion which was imprinted in them exciteth shiverings which are so many little convulsive motions The Brain may be offended divers ways The Brain may be hurt by a great commotion of the Head by some blood diffused into its substance or by some particular wound Signs of a Concussion of the Brain If the Commotion be great yet without any vessel broken one falls to the ground with loss of the senses feeling and motion blood comes out of the nose mouth and ears the Excrements and Urine come out involuntary with often swooning and vomiting sometimes soon sometimes late Cause of falling down If one falls down it 's an evident sign that not only the spirits are in disorder but also that the commotion hath violated the nervous fillets of the corpus callosum and that it has so rudely shaked the brain it self that the course of the animal spirits hath been suppressed Now since the spring and tonic motion of the muscles that hold perpendicularly our bones together and sustain the whole machin depend only from the influence of the spirits which pass through the nerves into our muscles if by any misfortune these cords come to slacken and to lose some
of it a Thread which keeps it from going too far under This is call'd Sindon it must be somewhat bigger than the Aperture that the Medicines may have room to extend themselves on the neighbouring parts and the Dura mater not to be hurt in the Motions of the Brain against the edges of the Skull Upon this Sindon you put another of Lint dipt in the same Medicine you fill the rest of the hole with dry Lint and cover the Bone with it and the rest of the wound for the first days is drest with Digestives able to procure a strong Suppuration Great Suppuration very convenient We have already made you observe that great Suppuration of the Exterior Wound very much contributes towards the easing of the Dura mater through the frequent commerce that is between the Exterior and Inferior Vessels You shave the Head for to Embiocate with Ol. Rosat Spirit Vini you make use of Emplast De Betonica or Andreas e Cruce of a Compress temper'd in strong Wine and useful Bandage you dress the Wound the following days with the same care If the Splints be separated you take them away if they stick to the Skull and cannot be replaced you cut them off with the Incisive Pincers The Dura mater is sometimes so inflamed that it rises beyond the Aperture of the Skull in spight of all the precautions that one can take and seeing it 's dangerous to Trepan too much nothing but Bleeding Clysters and an exact Dyet can stop the progress of the Inflammation If Blood or Matter be got between the Membranes there 's no other remedy than to give vent to the Matter To execute which design with prudence you arm a Lancet How to penetrate the Dura mater and dexterously open the Dura mater without the knowledge of the by-standers When the Dura mater and the Brain are hurt there arises very often in the last days upon it a Fungus like a Mushroom which increaseth more or less according as the Matter which contributes to its generation is more or less unctuous Malpigius 's Opinion The Famous MALPIGIUS pretends that the displacing the Glands of the Brain and the little Nervous Pipes frame this Excrescence But without running to the disordering of the Glands is it not more reasonable to believe that it 's bred from the abundance of the Fat Cause of a Fungus and Oleaginous Matters with which the Brain is actually water'd as we have sufficiently proved in several places of this Treatise which Experience also every day shews us in those upon whose Dura mater Oyls are outwardly applied In this Inconvenience you must dry it with Spirit of Wine or Tinct Aloes which dissipates its Humidity and forsake the use of Oyntments How to Consume a Fungus If these Remedies be not sufficient to extirpate the Fungus use the softest Catheretic's as Turpentine in Pouder Pul. Irid. Florent Alurn Ustum some time you may apply Precept Rub. In using these Powders the Flesh must be also a little compress'd or it will not be consumed After these Medicines have perform'd their vertue a Decoct of Traumatic Herbs in White Wine is very advantageous to which add Mel. Rosat more or less according as it's necessary to Humect or Dry up You must correct the Air of the Patient's Chamber by the use of Fire especially when you dress him apply the Medicines as warm as you can When the Flesh is quick and firm you must maintain it in that condition but when it 's too soft you must compress it or use more drying Remedies Whilst you are curing the Interior after this manner you must Externally use the best Traumatics and apply upon the Bone such Remedies as hasten the Exfoliation as Spirit Vini in which Euphorb is infused which is admirable to hasten Exfoliation It must be always used before the Flesh which grows upon the Brain surmount the Aperture and according to the nature of the Accidents which happen general Medicines ought to accompany the Topics CHAP. XXXIII Of the Anevrisma Two sorts of Anevrisma's AN Anevrisma is a Preternatural Tumor form'd by the dilatation of the Artery or by the Rupture of its Tumicles which makes two kind of Anevrisma's the true and false The true one is that which doth not abandon the Pipe of the Artery True and false and which hath correspondence with the Blood which the Heart sends continually there On the contrary the false possesses the nigh parts and hath no communication at all with the Arterial Blood Internal cause of a true Anevrisma Concerning the Internal cause of the true Anevrisma we can attribute it to nothing but to the action of a sharp and corrosive Humour which is separated from the Glands that are spread about the Vessels and which insensibly gnaw the outward Coat of the Artery so that the Blood by reiterated shakings disposes the Inferior Tunicle to extend and dilate it self and after several Impulsions not being in a condition of resisting its motion it gives way and obeys till at last a Tumour is form'd which is call'd an Anevrism Thus I conceive all sorts of Anevrism's to be form'd which naturally happen on the Neck Arms and several other parts We also observe that these kinds of Tumours possess rather Lean and Atrophiated Persons whose Blood is loaden with salt than those that are fat and pampered External causes of a true Anevrisma The External causes of a true Anevrisma cometh from a Punction made on the Exterior Coat of the Artery with a Lancet Sword or other like Instrument or from some Blow c. or finally from the strong Impression which sharp and Corrosive Medicines or Humours which lurk about the Vessels make upon the same Exteriour Coat it 's easie to comprehend that all these causes are capable of weakening the Pipe of the Artery and the Blood beating without intermission extends and forceth outwardly the Pipe and so produceth a Tumour Cause of the false Anevrisma The false Anevrisma is caused by the total ruption of the Tunicles of the Artery which gives vent to the Blood to Extravasate it self between the Porosities of the Flesh and Skin and so forms a Tumour which is followed by troublesom accidents because the Extravasated Blood being no more in motion ferments and suffers alteration which is almost always followed by the Marks of Mortification These two kinds of Anevrisma's increase more or less according as the action of the sharp Juices Contusion Aperture of the Vessel and Impulsion of the Blood are more or less considerable Signs of a true Anevrisma The Signs of the true Anevrisma are sensible pulsation of the Tumour and its softness when it 's pressed with the Fingers it disappears at the same time but as soon as you give over pressing it comes again into its first state The colour of the Skin is not changed because the Blood which maintains the Tumour keeps its liquidness by
the meeting and mixture of new Blood whose motion is continual In its least increase or bigness it 's commonly as big as a Nut or Egg at most some Authors assure us that these Tumours augment sometimes so much that they break nevertheless we know that some have kept them all their lives and that in most Persons who are troubled with them the part of the weaken'd Artery becomes so hard and callous that it resists all the efforts one can make Cause of Induration of the Artery Though this Ossification of the Artery seem very difficult to explain one may nevertheless believe that the saline pungent and most exalted particles of the Blood penetrate the lesser porosites of the Fibres of its Tunicle and they post and mingle themselves with the nourishing Juice of the Artery and so contribute towards its Ossification But the reason which to me seemeth most evident and best grounded is that the Blood which maintains the Anovrism and which is in a continual fermentation must by its motion increase the heat of the part which insensibly dryeth and hardens the Fibres of the dilated part in dissipating and rarefying the humidity which waters and makes them dull That which fortifies more this thought is that the Aorta groweth bony sometimes in old People at its exit from the left Ventricle of the Heart either through the little heat that 's left there dries it or because their Blood hath lost its Viscosity which is necessary to preserve its spring Notwithstanding Experience shews us that it 's Ossified in some Persons Signs of the False Anevrism The Signs of the False Anevrism are opposite to those of the True In the False the Pulsation of the Artery is very deep the Skin almost livid the Tumour is not so high nor round as in the true one but it takes up more room it giveth not way so easily in touching as the true one The most convincing signs of the Arteries being opened is when the Blood comes out impetuously and by jumps which convinces us that its motion is continual and unequal This inequality of the course of the Blood proceeds from two contrary motions the first depends on the strong constriction of the Ventricles of the Heart and the second from the spring of the Arteries But being the Impulsion of the one is much stronger than that of the other it happens that as the Heart driveth the Blood vigorously forward in the time of the Systole the Arteries by their Elastic Virtue beat and drive it back weekly in the Diastole which proves the irregularity and continuation of its motion Signs of a Wounded Artery If you perceive that you have unluckily opened one of the Tunicles of the Artery which is known by the resistance of the blow by the elevation and the violence of its pulsation which is presently communicated to the Vein and which obliges the Venal Blood to come out by jumps as the Arterial Blood but is not so brisk lively or shining and is less swift you must have recourse to Phlebotomy which impedes its motion and by this means hinders the progress of the Tumour you apply thereon a little Compress in which you put half a Bean which presses only the Aperture over that you lay another a little bigger after this manner you apply several Compresses gradually bigger which you keep on with a fitting Bandage and on the neighbouring parts lay good defensatives A certain piece of Money There are some which make use of a Double to compress the Aperture of the Artery but this practice is not approved by reason that being obliged to tie the Bandage strait the Double taking more room than half a Bean which only compresses the Aperture it 's to be feared lest the circumference of the wounded part Gangreen but to supply the want of this strong compression you place at the Internal part of the Arm all along the thick Vessels a Longitudinal Compress which you secure with the Creaping Bandage This Compress produceth very good effects for besides that it moderates the rapid stream of the Blood and by this means you may avoid tying the band too tite it helps also the reunion of the Artery because the Impulsion of the Blood being only weak the Aperture separates very little When the Patient begins to have strength you must reiterate Bleeding for reasons we have alledged you take off the Dressing as late as you can because in a very little time it increases considerably But the Accidents which follow upon a false Anevrism are ordinarily violent and cruel being Gangreen and Mortification are its mournful Consequences you must not differ the Operation unless the use of the Compresses which are applied there and other precautions which must be taken stop its progress or the Resolutive Medicines which we use make the Extravasated Blood re-enter again in commerce with the Liquor or be discust by insensible perspiration in attenuating and rarefying its Molicule lying between the porosites of the flesh on the contrary a true Anevrism may be kept all ones life time or at least some considerable time for which reason one may prolong the Operation in laying on the Tumour some Compresses fortified with a Bandage without the Patients being in any danger unless he resolve to endure the Operation This as hath been said grows to a certain bigness whereas the progress of the false is not limited Lastly if in spight of all precaution and all the care that can be taken in both kinds you succeed not you are obliged to perform the Operation CHAP. XXXIV Of the Operation of the Anevrism Three ways of the Operation of an Anevrism 1. By the Vitriolic Button THis Operation is practised three different ways The first is by the Vitriol Button but the worst is that as the Vitriolic particles melt they spread themselves upon the Ligaments and adjacent Tendons which they carry off rend and cauterise till at last the Patient is lamed being the part groweth incapable of its ordinary motions The second is to disgorge the Tumour before you make the Ligature of the Vessel but behold as I think the surest method The Patient being plac't you lay on the midst of the Arm a strong Compress sustained with a Ligature through which you pass the Tourniket making several turns by which means you benum the Arm stopping the passage of the Blood and Spirits The Surgeon Inciseth with a Lancet the Tumour following the length of the Artery which must be separated from the Nerve to have the liberty of tying the Artery half a Fingers breadth above the Aperture with a little strong wax't Thread You must observe that in a true Anevrism the Tumour regulates the place where you must make the Ligature whereas in the false we are obliged to loose the Turniket to know positively whence the Blood comes which is the most important circumstance of the Operation for to stay the Blood and to avoid making the
Ligature upon the Aperture of the Vessel instead of making it a little higher because the Blood by its impulsion would not fail to dilate the weaken'd part and to bleed afresh For this purpose you pass a Needle over the pipe of the Artery make first a single knot on which you place a little Compress which you fasten with two other knots Most make another knot in the lower part of the Artery because of the Branches of communication and since it being a precaution not to be despised one may use it The Ligature being made you loose the Tourniket If the Blood be well stopt you open the Tumour to empty the Blood and fill it with Dorsels arm'd with Astringent Powders as Vitriol alb to consume the Bag more easily you cover the rest of the wound with Boulsters accompanied with a Plaister Embrocation of Ol. Rosar Defensatives all along the Arm with Compresses temper'd in strong warm Wine with the Bandage Some time afterwards you must Bleed the Patient if his strength permit you stay two or three days without taking off the Dressings and you leave the Dossels at the bottom of the Sac 3 or 4 days longer lest in taking them out you bleed afresh and procure a fresh suppuration The situation of the Arm which seems a thing of little consequence must nevertheless be regarded as very advantageous for furthering the cure The Arm must be a little bended and the Hand elevated on the Pillow that the circulation be more free But you must particularly recommend the Diseased to bow and stretch it from time to time We daily see that several become lame for not having moved the Arm or Leg during such Indispositions The cause of this accident comes from the little motion of the slimy matter which bedaubs the Joints This Slime is of the consistence of the White of an Egg and which transpires from the Ligaments and Glands of the Joynts serving to entertain the supple Ligaments and to smooth the shining Cartilages as well to facilitate the motion as to hinder the parts from being wasted by their continual attrition but from the moment that this Matter is at rest and no more fluid or liquid by the diversities of motion it groweth thick and hard by the heat of the part so that the Ligaments and Cartilages being no more humected by that Liquor they dry up loose their Elastic Virtue and Humidity till at last they grow incapable of motion Sometimes it happens in old Rottenness and Fistula's of the Joynts that the Purulent and Malign Matters gnaw the Ligaments and Cartilages and gives occasion to the Saline Juice which exuds from the body Fibres to unite the extremity of the two Bones and frame a kind of Anchilose which is much more defectuous than the precedent CHAP. XXXV Of Gangrene and Sphacel which occasions the Amputation SEveral Authors have treated of the Gangrene particularly Willis Etmuller and Silvius and I believe no body doubts but that all whatever our new Discoverers have advanced upon this Subject in their Exercises is nothing but a perpetual pillage of what these great Men had spoken To speak of it methodically we must first give an Idea of the Vivification of the parts and of the Mortification which is its opposite we must relate all particulars which cause a Gangrene and seek all the means to illuminate them with Reasons grounded on the Oeconomy of the Blood and upon some Observations which Experience Authorises Cause of Vivification To know how the parts are Vivified you must consider that the heat and life of Animals consists only in the motion and fermentation of the principles of the Blood that this Fermentation and Motion as well Circular as Intestine are entertain'd by the pulsation of the Heart and Arteries by the motion of the Muscles and action of the subtil and penetrating particles of the Air which we breath It is in effect the spiral and nitrious particles of the Air which attenuate and subtilize the particles of the Blood in mingling themselves intimately together in the substance of the Lungs which make them wave upon their centre and which give them all their vivacity and influence which is necessary to the maintaining of their intestine motion and consequently of their heat and Life It 's certain then that it 's the Blood agitated by these means which vivify and animate the parts repairs the continual losses which they suffer furnishes the matter of the Spirits and of all the different Liquors that are subtilized in passing through a 1000 different Strainers In one word it 's the Master spring that makes the whole Machine go This being so it 's not hard to conceive that it is from the actual distribution presence and action of the spirituous and nourishing particles of the Blood in a part on which entirely depend its motion and life Cause of Mortification so that this dispensation coming to cease or be interrupted for some moments one feels no more there either heat motion or life To convince our selves of it we must only examine that which happens every day in Syncop's where we see that the pulsation of the Heart being hindred and the circulation of the Blood stopt all the Extremities grow cold the Face pale and sometimes lived and the whole Body deprived of feeling and motion but according as the Heart recovers its motion and the Blood conveyed into all the parts they recover their heat motion and life It 's therefore evident that the life of a part depends on the presence and motion of the Blood and on the contrary I say that the cause of a Gangrene and Mortification of a part is doubtless the absence and want of these spirituous and nutritive particles in the same part This is the Explication which the Illustrious Etmuller gives of it in Tome 1. operum pag. 587. where he says Causae Gangren sphaceli in genere sunt quae quacumque ratione sanguinis spirituum vitalium distributionem inhibere valent It is a question whether the Animal Spirits which run from the Brain through the Nerves are not likewise interessed in a Gangrene I say that the most causes which work upon the Blood for the production of a Gangrene may in the same manner work upon the Animal Spirits but in the mean time the Gangrene only depends on the alteration which happens unto the Blood This is proved because a Gangrene is a privation of Life or at least a disposition next to a Mortification now the Functions of Life depend chiefly from the Blood whereas the Animal Functions depend on the Animal Spirits The Nerves may be obstructed and the Animal Functions cease in a part without Mortification as is seen in Paralytics It 's true then to conclude that a Gangrene depends only on the default of the vital and spiritual particles of the Blood Those that will have the Animal Spirits to have much share in the Gangrene as well because a
like that which one feels sometime after the cut of a Sword this does not proceed from the first division but by those which are made through the action of the sharp and extravasated Humours No Pain without Solution of continuity so that as often as the Animal feels pain there are some divisions made by which means the Soul which watches and interests it self in the conservation of the parts of our Bodies is afflicted The cause of Convulsions These sharp Humours coming to shake vigorously the little Filaments of the Nerves cause the Spirits to run irregularly into the Muscles which excites the Convulsion The Spirits being put to flight instead of running into the Fibres of the Heart And of Syncopes and ruling their motion are carried in disorder sometimes to one part sometimes to another the Heart being deprived of the influx of the Spirits which are the true Instruments of its ordinary motion and being no more capable of contraction the course of the Blood must be suspended for some moments from whence comes Syncopes And of Vomiting But as soon as they retake their course they double their Action and are Lanch'd with so great Precipitation into the Fleshy Fibres of the Stomach through the familiar commerce and mutual consent between the Cardiac Nerves and those of the Stomach that they oblige it to discharge it self of all that 's in it which is call'd Vomiting And Diarrhaea The Ventricle with its powerful and repeated Contraction passes so hard the Bladder of Gall and the Neighbouring Bilous and Pancreatic Ducts that it squeezes out their Juyces into the Cavity of the Guts which presently causes a Diarrhaea The cause of a Fever These two Liquors being thus prest out of their Vessels without having received all the preparations and alterations which are necessary for them fail not to make the Chyle Acid with mixing themselves in the Intestines they serve for Leven and Ferment to corrupt and produce a Fever Of heaviness of the Head and failure of the Senses The Blood being in Fermentation mounts with such an impetuosity to the Brain that the Sinews thereof which receive all the rest of the Blood of the Interior Head cannot discharge proportionably so much Blood into the Jugulars as the Arteries furnish by reason of the slowness of Circulation in these Sinews so that the Nerves which come from the base of the Skull to be distributed to the Organs of the Senses are a little comprest by the weight of the Blood which causes heaviness of the Head and that the Senses don't receive the impressions of their Objects with the same facility as before through the Obstacle that the Spirits find in their passage How to prevent those ill Accidents To prevent all these Accidents you have nothing to do but to cut the rest of the Tendon if the major part be divided but if the loss of the Fibres be not so considerable and the Symptoms not so pressing you must do nothing rashly If you perform the Operation you must Stitch the Tendon rather than cut it so that the Surgeons intention is to Reunite the two Extremities by Suture If it happen that the Extremity of one part be so far shrunk into the Flesh that it cannot be brought to the other by the Forceps it would be convenient to molifie the Fibres a little with some Oyls extracted without Fire as Ol. Amygd Dul. Ovor. Cerae c. which are proper to relax the Fibres and facilitate their Union for if the Oyl be Extracted without Fire the heat does not so soon dissipate their Viscosity which is the true Cement besides they are more capable of tempering the Acid of the Blood and of appeasing pain The Tendons being molified you must Stitch if you can and seeing they are Compos'd of little Fibres How to perform the Operation you must take half the breadth of a Finger upon the Body of the Tendon that the Stich may better resist the motions of the part and the flowing of the Matter If the Tendon be not discover'd enough you must try to make the Suture without unfleshing it because the Flesh secures it from all alterations After the Surgeon has put the part in a convenient Situation a Servant must uphold one Extremity with the Forceps whilst the Surgeon with his left Hand holds the other and with a strait Needle arm'd with double wax'd Thread knotted at the end pierces them from without inwards and from within outwards bringing them exactly together then lay away your Needle and take a little compress of Cloth with two holes in it to pass the two ends of the Thread through and make a single knot over which apply another little Compress which you fasten with the Surgeons knot and slip knot you must observe to wet the Compresses in some Spiritous Liquor and put some wax Candle on the knot instead of Lint The Suture being made you must humect the first Day with some Oyle and Spirit of Wine the following days we use a Balsam made of Tereh Tinct Aloes Vnctuous Medicices not proper or that of the Tinct Flor. Hyperici the use of Oyls or Fat 's are here to be rejected because they Putrifie the Tendons In the beginning Cataplasms made of the four Meals Wine the Yolk of an Egg and Hony are very proper It must be observed that as soon as Suppuration is made 't is evident that the Tendon begins to be united most good Practitioners Commend in long Suppurations to make use of Spirits on bared Tendons Emplas Andreae è cruce CHAP. V. Of the Hair-Lip VVhy so called IF Sutures have any use in performing Operations 't is doubtless in the Unition of the Hair Lip so call'd because this Animal has naturally the Upper-Lip slit This Malady comes sometimes from an imperfect Conformation and sometimes by Accident viz. it may be caused by some Blow Fall or other like mischance if the Reunion be then neglected it 's to be fear'd least the edges grow Callous and at length a true Hair Lip is form'd 'T is very often an Hereditary Deformity which we keep as long as we live unless we are willing to suffer the Operation however its cure cannot be accomplish'd but by Suture If there be great loss of substance you must not hazard the Operation because the Cutis wou'd be so much extended that it wou'd be very hard to Pronounce well certain Words and to make with care all the other motions which this part is capable of those which happens to the Under-Lip are of difficult cure because the Defluxions are more-frequent and the Lip always humected with many serosities Where cutting Hair-Lips wou'd be useless There are several other occasions where the Operation wou'd be useless as in Children by reason of their continual Crying in the old Scorbutick and Pox'd in irregular Women and in several other vitiated and indisposed Subjects in which the Blood
stony Matter The good or bad use of Food contributes much to its formation we observe that those who use too spiritous Drinks and dirty Food are more subject to it than others We see also that those who live on Milk Meats Fruit Pulse Rye bread and several other Impurities are often tormented with it The latter contribute to it because of their Impurity and the other by reason of their spiritous Particles the latter furnish the principles of the Stone and the other the Ferment which disposes the Excrements because working on the Colon which is near it gnaws and corrodes the Tunicles and after this manner opens a passage to come out this way Vomiting and Palsy of the Thigh and Leg are also concomitant the Diseased can't stand strait and the Testicle of the same side retires into the Groin Cause of Vomiting in Inflamation of the Reins The Vomiting proceeds from the mutual communication that is between the Nerves of the Kidneys and Stomach by the Irritation of the Spirits in the carnous fibres of the Stomach occasioned by the Inflammation of the Reins Cause of the Palsy of the Thigh c. in Inflamation of the Reins To give a reason for the Palsy you must observe that the Kidney is laid upon the head of the Muscle Psoas which it presses and inflames this Muscle being inflamed also presses a thick string of Nerves which passes through its body and distributes it self into the interior part of the Thigh and Leg from whence follows the stupor by the suppression or obstruction of the Spirits After this manner the Muscle Psoas reciprocally inflames the Iliac to which it 's join'd and seeing these two Muscles serve to bend the Thigh it can no more obey not follow the action of these Extensors which is the cause that we can't stand upright without cruel pain Cause of the contraction or shriveling up of the Testicle into the Groin The Testicle retires into the Groin by reason the Iliac Muscle is join'd to the Cremaster's which embraces the body of the Testicle so that its fibres being shortned by the Inflamation which the Iliac communicates to it the Testicle must necessarily mount into the Groin nevertheless all these Signs are equivocal seeing they may happen in the ordinary Inflamation of the Reins that is to say in the Nephretic Colic Signs of the Stone in the Bladder The Signs of the Stone in the Bladder are palsific burning pains in the time of making Water the Urine comes out by drops and reiterated turns as in Stranguria and as the Bladder is emptied and diminished in bigness its sides apply themselves so hard against the surface of the Stone which if it be rough it fails not to cause sufficient convulsions and break some vessels in which consists the burning pain one feels after pissing and the last drops are often bloody The Water is made by turns because the Stone which lies heavy on the neck of the Bladder Causes of these Signs of the Stone in the Bladder stops partly the passage of the Urine but the worst is that in the time of pissing and when the sides which before were extended come to touch rudely against this rough body its nervous fibres break and gives way to the Urine by its acrimony to prick them so causes convulsions cruel and pungent pains and imprints on the spirits an irregular motion by occasion of which the carnous fibres contract and embrace the Stone faster the diseased thinking in that moment to ease himself and desiring to suspend the course of the spirits augments on the contrary the violence of the pain and retards the course of the Urine and so causes some of it to remain always in the Bladder which grows acid and at length becomes stinking by its stay there so renews much sharper and insupportable pains Cause of Itching One feels an Itching in the region of the Perineum which irritating the sphincter of the Anus excites a Tenesmus the Itching continues even to the extremity of the Gland which obliges the Patient to rub it often Cause of Heaviness about the Perineum The Heaviness about the Perineum can't proceed but from the weight of the Stone and the itching from the acrimony of the Urinc Sometimes there happens a Priapism or an involuntary erection of the Penis caus'd by the irritation of the fibres and inflamation of the bladder and urethra which communicates it self to the cavernous bodies It 's easy to see that the irritation of the part join'd with some slight indisposition can awake and hasten the course of the blood and spirits design'd for the functions of the Yard and adjacent muscles which being swell'd by the spirits compress the veins which are distributed in it to hinder the return of the blood the blood and spirits filling all the vacuum or empty spaces of the hollow bodies the Yard must needs grow stiff and extend it self We observe that the Urine is sometimes white sometimes bloody troubled and muddy and is charged with a mucous and sandy sediment HIPPOCRATES in his Aphorisms reports That when the Urine is extreme clear and you find Sand in the bottom of the Urinal it 's an infallible mark of the Stone 's existence in the bladder A certain Sign of two or more Stones in the Bladder When the Stone is smooth it 's a sign that it 's accompanied with some other Stones which by their continual atrition become polished and smooth If the Stone be big and lies heavy on the neck of the bladder it dilates in such a manner that in time it grows as big as its bottom If it adhere to any part or is contain'd in a cistis the Patient may carry it all his life without any detriment or manifesting any of the signs which we have spoken of especially when it 's suspended at the bottom of the bladder An Observation VAN HELMONT assures us that he knew a Priest who going to reach a Book in his Library at the same moment felt a great weight in the Hypogastric Region which was presently followed with all the Symptoms we have describ'd 't was the Stone which was then separated from the bottom of the bladder by this simple effort so that he was obliged to come to the operation but the most sure and certain sign of the Stone is the Probe which convinces us of it by the resistance it makes and noise which we hear when we strike upon it this is also the sign which causes the necessity of the operation if the age season and strength of the Patient permit No Medicine so powerful as to dissolve the Stone Here it is where Mountebanks triumph who by their Impostures endeavour to persuade People that they have infallible Secrets to dissolve the Stone in the Reins and Bladder these sweet hopes flatter the minds of those who are troubled with it but when we shew them by evident demonstration that
various parts which is distinguished by the colour consistence and acrimony of the matter that flows from them which makes all the difference of Fistula's Cause of Fistula's in general The cause of Fistula's in general almost always proceeds from a winding Ulcer which is sorm'd and nourished by the most sharp and salt particles of the blood Causes of Fistula in Ano. The cause of those which happen to the Anus whose nature we are here to explain are Internal or External External Causes The External come from some Wound as from Leeches ill appli'd or from some bruise whether by riding or by some other vilanous exercise as Buggery or finally by some fall or any other violent motion It 's evident that all these Causes must hinder the Circulation of the Juices and give way to Impostumation which in a short time degenerates into a Fistula Internal Causes The Internal are ordinarily Consequences of Obstructions Inflamations Ulcers Haemorrhoids and Impostumations Why the Blood is more easily obstructed here than in other parts Now our business is to give Reasons why the Blood stops more at this part than at any other to produce these kind of Accidents of which Fistula's are troublesom Consequences To have an Idea of it it 's necessary to examine some Circumstances which depend on the structure of the part The first consists in the disposition of the Intestinum Rectum First and in the temperament of its neighbouring parts The second regards the nature and multitude of vessels which water it Second and the abundance of humours which they carry along with them Structure c. of the Intestinum Rectum The Intestinum Rectum is every where encompassed with fat two or three fingers thick especially in full and fat persons which makes the extravasated Juices more easily penetrate these parts to attack the Gut which is a part very subject to alteration by reason of its great humidity and number of vessels that enter into its substance The Vessels of the Intestinum Rectum We know that the Arteries and Hypogastric Veins furnish it with two branches each the Aorta gives it one branch of an Artery which comes from that part where it 's divided into the Iliac and the inferior mesenteric Artery another besides the Hemorrhoidal Veins one of which come from the splenic and the other from the mesenteric It has also many limphatic vessels and several glands that separate a white and viscous humour which lines its interior surface and defends it against the acrimony of the Excrements and other Levens these are the different vessels which water the Intestinum Rectum Now it 's easy to understand from all I have said that the Circulation of the Humours must be very slow in that part because they remount against their own weight and are deprived of the motion of the muscles which is of great use to hasten the Circulation of all the Juices so for any little propension they have to stop and be corrupted there if by chance any of the External Causes which we have spoke of contribute towards it they never fail if so be it comes from the Veins to cause the Haemorrhoids Inflamations and Impostumations if from the Arteries and Excoriations and Ulcers if from the Lymphatic Vessels and Glands And as these parts are extreme penetrable if the blood acquires any malignity or ill quality by its fermentation nothing hinders but it opens it self a way and finds passages to attack sometimes the gut sometimes the flesh sanguiferous vessels nervous parts and bones and finally to produce the diversity of Fistula's which we call strait oblique or winding When the Fistula is in the flesh Signs of Fistula's in divers parts the Pus that comes out of it is thick muddy course and viscous If it attack the nervous parts you have pungent and violent pains and the humour which flows from it is sharp and serous if the matter of the Fistula move towards the sanguiferous vessels and break any of them by its acrimony its colour is like the washings of flesh if the Fistula penetrate to the bone and it be altered or rotten the matter which comes from it is clear thin and in its highest degree of acidity A salt and sharp juice the cause of calosity We likewise observe that in these kind of Fistula's the calosity is much more considerable than in others for as all the world knows that the calosity of a Fistula depends only on the presence and action of a sharp and salt juice-like Brine you must not be astonished if those that reach the bones which are nourished with a humour that 's extremely salt and pungent of its own nature be so calous for from the moment that the sides of an Ulcer care water'd and humected with an humour like it if its intemperies be not corrected its points creep insensibly into the bottom of the Ulcer and after several punctions these little needles which we must consider as so many wedges enter and fix themselves so into the porosities of the flesh and membranes that they render the Ulcer so hard and calous that it turns into a Fistula As for the Prognostics of Fistula's Prognostics I say in general that those which are new which happen in a good temparament of body are well conditioned and that possess such parts where Medicines may be easily appli'd are curable But on the contrary if they be old the Party Cachectical when they possess such parts as are necessary for life as the Bladder and Intestines uncurable Lastly all Fistula's which attack the Bones Tendons Arteries Vertebra's of the Back Breast Belly Paps Axilla Groins and Joints are doubtless difficult to overcome Where Pallatives are convenient Some Fistula's are cured by caustic Medicines others by Iron some where Medicines are not able to vanquish need only Palliatives or such as are proper to stifle and check the violence of the effect and prevent more troublesom Accidents Finally there are some which reduce the parts to such a languishing and deplorable condition that they being unable to perform their ordinary functions we are obliged to amputate the parts as those in the Joints unless it be in the Axilla or other parts where the Operation cannot be perform'd In such dangerous Affects we are to have no other aim than to mollify by all means the Humours which foment and nourish them being they threaten death in all Subjects The Anus subject to several sorts of Fistula's The Anus is liable to several sorts of Fistula's whose knowledge mightily favours their Cure The first is when it pierces the Body of the Intestine and hath no outward Aperture The second openeth outwardly and hath no communication with the Intestine or hath only slightly touched its superficies The third which is call'd complete manifests it self both outwardly and inwardly The fourth is of several Burroughs or Sinusses which discharge themselves into a
adherence which the Lungs contracts with the Pleura so that they can communicate their inflamation and alteration to one another and that the matter may pass from the Lungs through the aperture of the wound without one drop of it being spill'd in the cavity of the breast which is to be well examined before you separate the Lungs from the Pleura with your finger or Probe as most Practitioners are wont to do that is to say if the matter run with ease through the Aperture and without the Diaphragma being oppressed with it you must no ways break the adherence of them A Quinsy can never cause an Empiema I do not speak here of diseases of the Throat we know well enough that never an Empiema succeeded a Quinsy the reason is that the Pus cannot fall upon the substance of the Lungs without causing a sudden suffocation because the Pus by its weight would hinder the play of the vessels that compose them wherefore there is only Plurisies and Impostumes of the Lungs which precede the Empiema that comes from an internal cause Causes of a Plurisy As for the eause of a Plurisy some say it 's form'd by a boiling and impetuous blood which is extravasated in the Plura others pretend it 's caus'd by a bilous blood which gathers and putrefies between the ribs and Plura Some others maintain that it proceeds from an extravasation of blood that comes from the intercostal veins and the Aziges which is discharged between the duplicature of this membrane where it changeth into pus by its stay there though this last opinion be not over-well grounded yet it is the most common and most received It were to be wish'd that all these opinions were as true as they are authorized by their Partisans for besides that the blood being ordinarily spilt out of the vessels only after some blow or wound it 's evident that the bilous particles are rather capable to dissolve a matter than coagulate it and that it 's only the salt volatil alkalies of the Bile which tend to the exaltation but there must needs be here a coagulating Agent which disposeth it to be obstructed in this membrane There is nothing more common A common Cause of Plurisies than to see in the Summer-season Plurisies affect those who having over-heated themselves by running or some other as violent exercise go imprudently to drink Iced Liquors or in a Cellar to cool themselves having most commonly their Breast open You must consider that in the same moment the Pores being much dilated the blood is in an extraordinary agitation and furnishes abundance of Swetts this being so it happens that at the same time as this cold drink chills as it were the blood in the vessels the impression of the external cold Air suppresseth the Swetts in shutting up the pores and they being quite disingaged from the rest of the mass stop in the duplicature of this membrane where they coagulate the blood by the means of their urinous volatil Salt Urine and Swett analogous Experience teaches us that there is no liquor in the body has more analogy with the Urine than Swett we observe also that it hath the same taste smell and consistence we know that the Urine abounds in a urinous volatil Salt and in a very aetherious Sulphur Now I say that these two spirits which are found in the Swett as well as Urine whose nature and property we have explain'd elsewhere hapning to be united together in the PLVRA in the time of the suppression of abundance of Swett are very capable to condense the blood and cause the Plurisy which HIPPOCRATES hath well observed Sect. 5. Aph. 24. when he says that cold things as Snow and Ice are Enemies to the Breast and that they excite Coughs Dysenteries and Fluxions Frigida vcluti nix Glacies pectori Inimica tusses moverit sanguines fluxiones distillationes movent He says likewise that the Scythians do not live long because they drink Ice waters and that the frequent use of these waters offend the Breast for the same reason says HIPPOCRATES Sect. 3. Aph. 23. Plurisies happen most commonly in the winter-time as also Peripneumonia's Coughs pains of the breast and sides Hyeme plureides Peripneumoniae tusses pectoris Laterum Dolores It 's commonly observed that those who expose their breast to the Air in the beginning of hot weather are almost always troubled with a Plurisy the reason of it is evident if we make reflection that no part of the body is so deprived of flesh as the breast which is the inclosure of the treasure of life and which consequently is sooner penetrated by the Air wherefore those who take care to cover at all times their Breast well are much less subject to Plurisies and many other diseases A Plurisy often from a nitrous Air. The cause of a Plurisy doth not always come from having put your self into a heat or exposed your self to too great a cold but it comes often from an Air too much loaded with nitrous and sulphureous Particles which we attract in inspiration and which produce the same effect as the principles which we have said are found in the Swett Those kind of Plurisies which we call Popular or Epidemical happen oftner in Countries where the Earth abounds with Nitre and Sulphur and where the heat is excessive as in Meridional Regions Who most subject to on Plurisy The constitution of persons contribute much to its formation those who are of a quick wit whose blood is subtil and are of a tender Complexion are more subject to it than others An Observation on the blood of a pluretic person It 's observable that after having bled a pleuretic person there is a little skin form'd on his blood like glue and almost of the same consistence which has a kind of spring or elastic vertue for when ever you handle it with your fingers it resists a little and returns into its first posture it swims upon the blood even as certain little flanks swim upon the urine of those troubled with the inflamation of the Reins As for the Prognostic of this Disease Prognostics it is always very dangerous when Bleeding and general Remedies do not dissipate the Tumor HIPPOCRATES says that if one spit from the beginning the disease will be short but if one spit not till some time after it will be long Velut in Pluretide laborantibus si sputum statim appareat inter initia ipsam abbreviat si vero postea appareat producit Yet this Rule is not always true because there are some that do not spit and yet recover in a very short time whether that the Humor which causeth the obstruction be dissipated by insensible Perspriration or by the way of Circulation according to the vertue and operation of the Medicines which are used in this Disease The best way of curing a Plurisy The most
the Humours yet more than they were before If this Fermentation were capable of causing the fulness and tention of these little Vessels it would be doubtless too slow and weak to break them so soon the Matter lieth long there quiet till having been exalted by the Application of some Medicines How the Cancer ulcerates it gnaws the Vessels and Vesicles which contain it then I say the Cancer ulcerates The Vessels which are puft up in a Cancer are so little and tender that one cannot distinguish them in their natural state nor take them for what they are if one did not see them fill'd and extended the Humour that is within these Channels and Vessicles not being presently able to ferment enough to break them as I have already proved it 's at least sufficient to extend and make them appear You must not think that the extremities of the Vessels are open for the most attenuated and subtilest Particles of the Matter to escape I do not believe that in the Cancer there 's found any Matter in the Interstices of the Vessels till the Vessicles beginning to break that the most active and exalted part of this Humour may run out I say that as soon as some Particles are diffused being they are very corrosive it 's then that the Exulceration of the Cancer hapneth and as it is sometimes long without Ulceration I maintain that during all that time of the Tumour the Humours are always pent up in the Vessels different to other Tumours whose course of Humours are very rapid and their Fermentation very quick and violent which causeth the Vessels to break before one hath perceived the swelling of them We observe that the Vessels of the Eyes which in their natural state are imperceptible grow manifest enough in Opthalmia From what I have said you may easily draw the Differences and Prognostics of Cancers Differences of Cancers there are external and internal great little ulcerated and not ulcerated as in all other Tumours As for their production they must always have an acid Juice from the Lymphatic Vessels whose Obstruction causeth the Retention of the Lympha and makes acid an adust and terrestrial Matter from the Arteries and Veins The Cancers that happen to the Paps Prognostics and other glandulous parts are the most dangerous because it 's always more difficult to remedy the disorders of the Lympha than those of the Blood Besides these parts are very sensible and more susceptible of ill impressions than others which you may more successfully secure from the Symptoms which the Cancers may cause The Cure of Cancers which one may well call Opprobrium Medicinae is very difficult Cure If some Quacks boast of having some infallible Remedies for them Experience soon makes us see their Imposture Cancers are very selfdom cured by the use of Medicines Chyrurgery sometimes succeeds better but is always very dangerous Quibus sunt occulti Canceri saith HIPPOCRATES eos prestat non curare curati namque Citius intereunt Sect. 6. Ap. 38. quam non curati therefore it 's a great piece of Imprudence to undertake the Cure of an Internal Cancer unless it be small and the extirpation of it very easy Cancers exasperated rather than cured by mild Medicines Concerning the external ones they are always difficult to conquer the reason is that unless we use a very great circumspection in chusing Remedies that are proper we do not fail to irritate them whereas the other Humours are appeased by the action of Remedies and grow at least supportable this seems not to receive any impression but rather to become more furious and to make more destruction The general method of curing a Cancer The general Remedies are absolutely necessary for the Cure of a Cancer as a Sobre Regiment of Life frequent and gentle Purges Phlebotomy the Flux of the Hemorrhoids in both Sexes and the regular Flux of Women give the Patient great ease All sorts of Cancers to be handled alike Let the Cancer be in what part soever it 's not treated with much diversity unless it be ulcerated and though it seemeth that we are more timorous to apply Remedies to those which possess the glandulous parts than to others yet when we undertake their Cure we make use indifferently of the same Remedies as we for the one as the other What sort of Medicines not to be used Those that use sharp and corrosive Remedies or else too active and penetrating ones never fail to make the Disease incurable the softer Repercussives and Supuratives one can â—appily employ in other Humours are here the most dangerous The reason of it is most evident to any that knows the Principles of Chymistry The Matter of the Cancer is course The Matter which causes a Cancer ferments not so soon as in other Tumours fixt and tartarous therefore it cannot easily ferment If you let it alone it requireth a considerable time for the exaltation of any of its sulphureous Salts which it contains but if you stir it by some fermentative and penetrating Remedies from being fixt and immoveable as it was it becomes very active and penetrating because the Salt and Sulphur which it contains exalt themselves and take the upper hand then doth this dead Mass which seem'd before uncapable of making any disorder change into a Vitreolic and Arsenical Matter which gnaweth and wastes the parts which contain it and are nigh till at last it arrives to the most internal parts and causeth Death soon or late according to the diverse nature of this Matter and the progress it makes in the parts I say then that the Cure of a Cancer that is not ulcerated must be attempâ—ed with the softest Remedies that which cools tempers dissolves repels the Humours by little and little without exciting them to ferment Remedies most proper that which is capable to stop the flowing Humours as Ap. Solani Plantag Fragrariae Spermat Ranar. Lumbricor Sal. Saturni Cream New Cheese Flesh of Veal which we change when it 's corrupted Finally all that mollifies and softens this Rebellious Tumour and repels it in softning it all this I say may cure Cancers or at least not irritate them And though the Reflux of the Humours could seem dangerous yet it 's the ordinary practice to go about it after this manner What to be used in an ulcerated Cancer When the Cancer is once ulcerated the Remedies which we must use are those which can hinder its progress and ravage nothing stops it more surely than Alkalisaporous Salts mixt with some Astringents these fortify the part with their styptic vertue and the other blunt and absorb the points of the Vitreolic and Corrosive Salts that causes all that disorder All Authors recommend this practice and if it hath not altogether an advantageous success you must have recourse to the Extirpation of it seeing neither Resolution nor Supuration is to be hoped for CHAP. XXV Of the Extirpation
spirits by any mishap the machin must needs fall Cause of loss of the Senses The Senses are lost by reason the course of the spirits is interrupted in the brain and cannot repair to the organs of the Senses now since the functions of the Senses depend on the course of the spirits in the nerves it 's no wonder if the exterior objects make no more impression upon our Senses and we be no more in a condition to distinguish them The Phaenomena is a consequent of the precedent Cause of bleeding of the Nose Mouth and Ears The Blood flows out of the Nose Mouth and Ears To explain which Symptom you must consider that these parts are rudely shaked in the time of the assault that the blood and spirits are stopt in the brain and that the great cords of the nerves which at their passage out of the skull pass between the branches o the carotidal and vertebral Arteries imprint there such a violent motion at the time of the concussion that they oblige the arterial blood to turn short and flow into the external Carotides so that these receiving almost all the blood which mount to the head as well from the Inflamation as from the shakings of the nerves must needs break some capillary vessels The cause of involuntary shedding of Urine and Excrements The Excrements and Urine come forth against one's will because the spirits repair no more in such cases to the sphincters of the Anus and Bladder than to other parts which causes them to lose their spring and permits the issue of those Excrements the motions of the heart are weak and languishing only for want of these same spirits Cause of Vomiting One vomits at the very instant or some time after If one vomits presently it 's a sign that the Commotion has not been one of the greatest and the course of the spirits not long interrupted since the impulse of the blood hath broke the sluce of them and forced them to retake their course and launch with so much quickness into the ventricle that they excite this first vomiting in which one renders nothing but Aliments But if the spirits be long retarded it 's a sign that the shake hath been very rude and that the figure of the Brain is vitiated since we see that when they are at full liberty they run with precipitation into the tunicles of the ventricles and intestines which by their irregular and vermicular motions oblige the Bile which runs into their cavity to force the Pylorus and pass into the stomach from whence it 's driven by the powerful contraction of its carnous fibres You must observe that in this last Vomiting where one renders Bile it 's much more violent than the first and that the diseased lose their strength vigor and ordinary motion these are the Accidents which immediately follow Concussion of the Brian Now it 's very important to examine well those that happen when the Brain is hurt and when any Blood or Pus is extravasated in its substance sometimes it is an effect of the Concussion that hath broken some vessel and sometimes an effect of the blow which hath prickt or cut the dura mater or which has penetrated or carried off some portion of the Brain or finally it 's some Pus between the dura and pia mater which is shed upon the Brian In all these Causes the Fever comes with double Fits and Shiverings accompanied with Vomiting Convulsion Delirium Lethargy and Apoplexy And besides this croud of Symptoms the Liver and Lungs often impostumate which is known by a fixt pain on the Breast or in the region of the Liver and by reiterated Shiverings Cause of the redoubling of the Fever As for the Fever with its Intermittings which come upon it it 's not hard to give Reasons for this extraordinary Fermentation as soon as we be a little attentive upon the changes of corruption which happen to the matter that 's diffused upon the substance of the Brain It 's not to be doubted but that it grows impure and more or less sour according to the time it lieth there that the veins are from time to time charged with it and that a part passeth into the Heart Lungs and all the other Organs which by their continual motions form and grind them as it were into a thousand little parts which lively hasten the impetuous course of the blood and which cause the trouble and perturbation of the spirits which march in disorder which precipitate the motions of the heart and increase the Fever and when ever that strange matter which is offensive to the Brian hath got some degree of corruption and made it self fit to circulate with the venal blood this matter I say receiving the same alterations and triturations which we have supposed sets the blood more sensibly in motion and puts it in a much greater effervescency on which depends the strength of the returns of the Fever After this manner as often as the Blood is charg'd with it the returns which are a sit were periodical are renew'd From all the Reasons which I have alledged it 's easy to understand that there are few parts or corners of the body where this purulent matter is not thrown it pricks the Nerves irritates the Membranes transmits its action on the ventricle nests its self sometimes in one muscle sometimes in another and causes shiverings vomitings and the vicissitude of irregular and convulsive motions which shew that the mass of blood is mightily suppress'd the course of the spirits much agitated so that Delirium and Lethargy must follow Cause of Delirium The Delirium is an effect of the great inequality of the course of the blood in the redoublings of the Fever and of the diffused matter which begins to penetrate and corrupt the substance of the Brain the inequality of the course of the blood in the time of the redoublings rules the irregularity of the course of the spirits in the parts and the extravasated matter gnaws by its acrimony the vessels and nervous fibres of the white part so puts to the rout the spirits into the muscles organs of the senses and in the passages of the brain where the Idea's are weakned with irregularity and confusion Cause of the Lethargy The Lethargy follows when ever there 's much blood spilt upon the brain being in its last degree of motion and exaltation the weight of the extravasated blood presses the brain and the quick motion of the blood causes the courser particles to separate from the fine ones that they stick to the pores of the glands and stop the passage of the spirits so that the brain finding it self oppress'd with the weight of the matter the Patient falls into a profound drowsiness but in the time that this extravasated matter dissipates its self the courser particles which are so many sluces be put out of order by the impulsion of new blood the
sensibility Great Concussions hardly cured Concussions of the Brain are seldom cured if great because it 's impossible to make the Extravasated Matter to come out Vomiting upon Dilirium and Lethargy mortal Observe That if Vomiting come upon it in time of the Dilirium and Lethargy it 's a mortal sign and if Irregular horrors or shiverings come it 's a sign that the Extravasated Blood putrifies and corrupts the white substance of the Brain Wounds of the Cortical part of the Brain are not always mortal especially when the bigness of the Aperture facilitates the entry of Medicines unless the Brain has been too rudely shaked whereas if they penetrate to the white subtance they are always mortal not only because the principle of the Nerves are hurt but also because we cannot penetrate unto that substance without cutting thick Branches of Arteries which are concealed in the Anfractuosities of the Brain from thence cometh the Extravasation of Blood which admits of no cure If the wounds of the Skull considered in themselves had any Indication like other Fractures it would be Re-union but seeing the Skull cannot be broke without the inferior parts receiving some troublesom impression we must trepan there to introduce Medicines and as soon as we know that the Skull is broke we ought not to defer the operation Therefore whether it be split or broken it 's always true to say that the Dura mater is concerned The Fissure causeth a tention because the Dura mater is ordinarily adherent to the Skull by all the Vessels of Communication and those which carry the nourishment to the Inferior Table besides the little Fibres which pass through the Sutures which is particularly observed in young People This Tention is soon followed by an Inflammation for as much as the Vessels cannot long remain stretcht without breaking and spilling of Blood which by its abode inflames the Membrane and if the Inflammation increase it often Gangreens When the Trepans to be used If in Fracture of the Skull the Splints offend the Dura mater either by pressing pricking or rending it we must needs trepan to prevent accidents or to diminish them to take away the Extravasated Blood separate the Pieces which hurt it and to have liberty to apply there convenient Medicines It 's therefore a Rule which we must follow that if the two Tables be broke we must always come to the Operation though there appear no accident for besides that the Operation is not dangerous The Operation not dangerous we have the advantage to hinder symptomes whereas if the Skull be not alter'd and some troublesome symptomes happen we must Trepan because the Skull being found it 's easie to see that the symptomes which follow are the consequences of some ill Concussion of the Brain besides we know neither the place nor existance of the Matter nor where the Brain suffers However some say that provided the Patient can fix with his Hand the place where he feels pain and heaviness we ought to apply the Trepan there Caution which nevertheless the most famous Practitioners dare not undertake lest they should find nothing there and so pass for Rash and Inconsiderate How to Cure Wounds of the Dura mater To Cure Wounds of the Dura mater we must Examine their Nature and Cause we must Bleed to diminish the Inflammation and apply upon the tumified and inflamed part Ol. Amigdal Dulc. Quor Violar Lillior Aquatic which we must mix with some Spirit Vini This attenuates the Blood that 's congealed and the other softens and relaxes the Fibres of the Dura mater You must also endeavour to make the Suppuration of the Exterior Wound very copious that the Vessels of the Dura mater which have communication with the Exterior parts may easily disengage themselves A great Concussion mortal As to what regards the affections of the Brain we know that a great Concussion is mortal and a little one cured with Bleeding and other Universal Remedies Extravasation of the Blood is somewhat more dangerous and it seldom happens that the Vessels are broke without the Brain receiving a great commotion In that case we have no other help than Bleeding and general Medicines observing a very exact Diet. For sometimes in taking these precautions Nature resolveth the Extravasated Blood and the Fever groweth less It 's not the same thing in Wounds of the Brain where the Skull is carried off and where there is Extravasated Blood I have said its necessary to Trepan if the Aperture permits us not to elevate the Pieces above the Extravasated Blood and conveniently apply Medicines We know by Experience that several Patients have been cured and yet a part of the substance of the Brain carried off It 's true that Wounds which enter only the Cineritious or Cortical part of the Brain may be cured provided the Patient be otherwise well disposed whereas those of the white substance of the Brain are mortal for Reasons which we have given CHAP. XXXII Of the Operation of the Trepan BEfore we give a Description of the Operation it 's important to examine all the Circumstances necessary to render the Operation successful It consists in Piercing the Skull and to make an Aperture near the Fractured part To execute these two Intentions it 's necessary to know whether all the parts of the Head can endure the Trepan I speak not here of the Bones which are most easie to break those that know the Asteology are instructed therein If the Fissure be simple apply your Trepan just near the Cleft if it be very little one might Trepan upon the Fissure it self to give an easier vent to the Matter nevertheless with this Circumstance A Caution to be observed in Trepaning which is to Anticipate a little upon the side that hath the most strength which must be observed in all other places of the Skull If you should meet with any strange body that were forced down into the body of the Bone so that it could not be pulled out you must apply the Crown of the Trepan upon the strange Body to carry off the Piece If it be a considerable Fracture where a part is forced down you Trepan upon that part where you think most convenient to elevate the Bone nevertheless you must apply the Trepan upon a part that 's firm enough to sustain it without breaking it down If the first Aperture be not sufficient to lift up all Pieces you must make a second and a third if it be necessary We must not Trepan the Sutures We never Trepan upon the Sutures especially upon that place call'd Fontanella lest we break the Vessels which pass a cross and tear the Dura mater which adheres to the Skull especially in its windings so that the Blood which is extravasated on one side hath no communication with the other Wherefore if the Fracture should cross a Suture and anticipate upon two Bones you must Trepan upon both sides Trepaning
is also forbidden directly in the mid'st of the Coronal and Occipital Bone especially towards their Inferior part by reason of their Spina's where the productions of the Dura mater are fastned which are let in We Trepan not upon the Longitudinal Sinues lest the suppuration should open them which would cause a dangerous Hemorrhagy Neither must we Trepan upon the Eyebrows because of the Sinus Frontalis and of their Cavities which are lin'd with a considerable thick Membrane deckt with an infinite number of Glands which separate a Viscous Humour that actually fills these Cavities which makes that the Wounds of these parts do long suppurate Behold these are all the cases or places of the Skull where the Trepan is to be rejected you may boldly use it in all other parts The Ancients made a difficulty to Trepan at its inferior part because of the weight of the Brain and the propension it has to get out but it 's a Chymerical Error being the situation may remedy this disorder When ever you put the Operation in Practice this must be observed viz. That the place where the Trepan hath been applied must always be elevated or the highest What manner of Incisions convenient We must now speak of the Instruments of the Trepan and of the Means to use them but before it 's proper to know after what manner the Incisions of the Teguments and Flesh are made If upon the Temples If it be upon the Temporal Muscle some make the Incision in the shape of the Cipher 7 or of the Letter V which they mark with the Nail or Ink but I do not believe it can be done after this manner without destroying the Fibres It 's therefore fitter to imitate their Rectitude and to make if somewhat large to have the liberty of placing the Trepan in dilating the lips of the Wound Others recommend to make it every where else in form of a Cross but if the Longitudinal Incision or in form of the Letter T suffice to discover the Fracture and place the Trepan you must absolutely reject that of the Cross If the Wound be on the Forehead you must follow the Wrinkles of it The Pericranium covers not the Temporal Muscle as has been thought As to what concerns the Temporal Muscle it hath hitherto been believed that its Wounds are dangerous being covered with the Pericranium but it 's known that this Membrane exactly covers the Temporal Bone even as in all other places of the Skull and that the part which has been taken for the Pericranium is a lengthening of the Aponevrosis of the Frontal and Occipital Muscles which frame by their re-union a kind of Tendonous Cover which anticipates upon the greatest part of that Muscle and which being prickt or rumpled with some blow causeth the same accidents which accompany Wounds of the other Tendons Of the rest the Wounds of this Muscle are no more to be feared than those of another I pass to the Circumstances of the Operation Let 's now suppose a Wound at the Superior part of the Parietal Bone You must first probe it If you find the Skull discovered and the Aperture not big enough you dilate it even to the Bone to examine the Fracture and you fill the Wound with dry Lint to absorb the Blood which might hinder the fight whether it be of danger If any Artery should bleed much you would be forc'd to make a Ligature and leave the Wound till next day If the Fracture be considerable and some splints of the Bone forc'd down so that you were obliged to elevate them it 's the part of a prudent Surgeon to leave the Dressings for 5 or 6 hours till the Hemorrhagy be a little stop'd and then he may choose a fit place to apply the Trepan How to use the Trepan When you have fixt on a place you stop the Patients Ears with Cotton lay his Head on some firm place scrape the Pericranium off lest you tear it with the Teeth of the Saw you cover the lips of the Wound then you choose a Crown of a Trepan proportionable to the hole you intend to make but first you make a little hole with the Perforative Trepan to fasten the Pyramid which you put into the Crown afterwards you turn the Trepan and saw the Skull and when the Trepan hath taken sufficient hold you take the Pyramid off lest you hurt the Dura mater then you go on sawing the Skull taking care from time to time to cleanse the Teeth and the hole you have made and observe whether you saw equally so you finish to pierce the Scull by several turns if you perceive that the Crown penetrates more in one place than another you lean more on that side which is not so much penetrated to equalize the Aperture You know that you are come to the Diploe when the Teeth of the Trepan are Bloody and seeing the Interior Table of the Scull is much thinner than the Exterior and often adherent to the Dura mater espepecially in young People if you should not take care to turn the Trepan softly and to shake the Piece at every turn of the Saw you would be in danger to hurt the Dura mater When the Piece is disengaged you take it off with the Piercer or Myrtle Leaf and you scrape the circumference of the Aperture with the Lennicular Instrument with which you press a little the Dura mater to facilitate the Issue of the Extravasated Blood and to introduce more commodiously the necessary Instruments as the Levatory to elevate the Pieces that were depressed If the Piece be extreamly adherent to the Dura mater you separate it with the Myrtle Leaf Several Practitioners recommend to let it alone till its fall be procured by Suppuration But since these ties are only in young People who have these parts always moist and relaxt they may be easily separated with the Spatula without any violence When the Piece is taking off we ordinarily give vent to the Extravasated Blood upon the Dura mater in bidding the Patient shut his Mouth and Nose and keep his Breath This ingenious manner of pressing out the Blood is an effect of the Expansion of the Lungs and levelling of the Diaphragm which presses the Descending Aorta that passes between its Tendons and forces the Blood to flow into the Ascending Aorta and so mount to the Head by the Vertebral and Carotid Arteries with such rapidity that the Brain riseth with so much strength as to oblige the Extravasated Blood to flow through the Aperture of the Skull or to appear at the Passage so that it may be absorb'd with ease How to dress the Dura mater Having disingag'd the Dura mater of the Burthen which oppressed it you you wet a little piece of fine Linnen in Mel Rosar with Spirit Vini which you introduce between the Skull and Dura mater as well for to Humect and dry as to resolve the Matter You pass through the middest
Hydropics what I have said explains it sufficiently besides we well enough conceive that the serous Blood is deprived of spirits that it moves more slowly in the Extremities than any where else and consequently the heat must rather be lessen'd in these parts than in others as I have made you observe when I spoke of the Dropsie besides the ferosity filters in so great a quantity between the Fibres and the parts that it may by its weight press the Vessels and so cause a Gangrene Secondly great Cold causeth often Gangrene and Mortification in the Extremities especially the Feet Hands Ears and Nose particularly in Persons obliged to march in the Snow during excessive rigours of Winters as those which Travel in the Northern Regions How Cold causes a Gangrene To explain this Phenomena you must only remember what I have said in the comparison of Wine where we have seen that the spirits of Wine are concentred by the cold and that the exterior parts finding themselves deprived of spirits freeze This happens to a Bottle of Wine exposed to a very cold Air You may observe in breaking the Bottle that the spirits have retired to the center and preserved their fluidity while all the rest is congealed I say that the same thing happens in the Blood by the rigour of cold and while the spirits retire to the center of the Animal the exterior parts remain gangrenated being only irrigated with a dead and insipid Phlegme which congeals in the very substance of the parts It 's easie to comprehend that at the same time the parts feel the pinches of the cold they retire being compress'd by the action of the Air which first causes those quick and penetrating pains and hinders the Blood from continuing its motion in those parts therefore lying there still it insensibly stops every passage and causes an entire mortification Hinc Interdum saith ETTMULLER ex frigore extrinsecus Irruente partes Gangrenosae fiunt So much for what regards all kinds of Gangrenes that depend on the dissipation and concentration of the spirits Tumors Fractures Luxations c. may cause a Gangrene now I come to those that depend on the interruption of the course of the Blood and its motion First Tumours Fractures and Luxations may cause a Gangrene in a part by compressing too hard the Vessels that convey the Blood there I confess that this kind of Gangrene is rare because the Vessels communicate themselves in so many places and there coming so great quantity of different branches from them that it 's difficult that all the supply of Blood should be hindred in a member Nevertheless Fabritius Hildanus assures us Observation that he hath seen a Man who was attack'd with a Gangrene in both Legs and his Feet were always cold and benum'd so he died without a Fever without any other symptomes His Body being opened there was found a schirrous Tumour in the Region of his Reins over the division of his Iliac Branches This Tumor pressed first slightly the Vessels and caused the cold and benumming of the Legs but as it grew it press'd the Artery and Vein so hard that the Blood could no more descend into the inferior parts to vivifie them Concerning Fractures of Dislocations it may happen that the head of a Bone or some pieces may compress the Vessels so hard as to hinder the passage of the Blood for the same reason Bandages Too tite Bandages c. used in Fractures and Luxations strong and close Ligatures of the Vessels may cause a Gangrene especially if one makes it on the great Trunks unless the Branches which communicate together in several places furnish the Blood that 's necessary for the vivification of the parts Ettmuller saith Nimis firmae Ligaturae externae interdum hoc malum inducunt in quod fit interdum si in ossium Fracturis Locus Fractus orcte nimis Ligetur In all these cases it 's very easie to see that the mortification depends simply on the interruption of the course of the Blood without the concurrence of any other cause but you will see in what follows how the ill disposition of the Humours may augment and even produce this kind of Gangrene A Gangrene may happen by long lying on the Buttocks c. Secondly a Gangrene happens often upon the Buttocks of those who have had long Sicknesses and that are obliged to lie long on their Backs first the Cutis begins to rise afterwards there happens Inflammation in the Flesh which ends in Rotteness and Gangrene The first is caused by the sole compression of the Vessels in the part but if at the same time the Patient involuntary sheds his Water and Excrements the Gangrene comes sooner because they gall and heat the parts by their acrimony and so increase the Inflammation and consequently the Inflammation and Gangrene Great Inflammations Contusions c. may cause a Gangrene In the third place nothing's more common in the practice of Chyrurgery than to see Gangreens follow great Inflammations Contusions and even Anevrisms when ever the Tunicle of the Artery is broke and the Blood extravasated between the Muscles I say that in all these occasions if the Blood be extravasated in great abundance it must needs lie heavy on the part and press at the same time the Blood Vessels so that it entirely stops the passage to the new Blood which comes to irrigate and vivifie the part Behold this is the period of Inflammations proper to produce a Gangrene and as there must be great abundance of Blood to compress hard the Vessels so it happens only upon great Inflammations If I say that in great Inflammations the Extravasated Blood compress the Vessels it 's not a simple Imagination only but a constant Truth since the Pulse ceases to verberate at the same time the part begins to gangrenate and it 's red colour grows pale livid and black which clearly demonstrate that the sanguiferous Vessels are compress'd and the access of new Blood hindred Repercussive Astringent Medicines improperly applied may cause a Gangrene In the 4th place a Gangrene may happen upon the least Inflammation even on Érispielas when ever too strong Repercussive Astringent or Emplastic Medicines are inconsiderately applied To conceive this well you must observe that the Extravasated Liquors transpire very much and that this Transpiration does extreamly discharge the diseased part of the quantity of Humours which it contains so while the Pores are open in Phlegmons and Erisipelases and the most active and agitated particles of the Bile and Blood evaporate the part always discharges it self of some of its Burthen so not much fear of Gangrene This is the reason why in the Southern part of America there never was seen a Gangrene come upon Wounds or Inflammations because the great heat of the Countrey opens the Pores of the Body but when the Pores are closed by Astringent Repercussive or Emplastic Medicines and the transpiration
overcome them As for old Rottenness and Fistula's you must observe the same Circumstances and have regard unto three things to the Nature and Cause of the Disease to the Part affected and to the Supervening Symptomes To judge whether the Fistula's c. are curable and may be overcome by Medicines it 's necessary to examine whether they have been of long continuance the cause that produced them and that which foments them If the Cause of the Rottenness and Fistula's proceed from some Wound or Contusion and the Patient have not been long troubled with it if the Joynt be no way alter'd and the Humours which foment them be not malign Medicines may terminate the Cure But if the Cause proceed from Scrophulous Humours Critical Imposthumations or from the general perversion of the Humours if they be old settled in the Joynts and finally if the Rottenness Callosity Pain and Inflammation be considerable In a word if the part be no longer able to perform it's functions you must have recourse to the Operation provided the strength of the Patient give leave but before you put it in practice you must purifie the Mass of Blood and Humours by general Remedies as Diaphoretic's and Cardiac's I will not give you here an account of the Medicines which are employed as well Internally as Externally to hinder the disorder of the Gangrene being obliged to speak of them in a Treatise of Wounds and as every kind of Gangrene requires particular and different Medicines so it 's the part of a prudent Chyrurgeon and Physician to order and use them according to their Idea's and Understandings Several Circumstances to be observed Before you go about the OPERATION you must observe several Circumstances If it be the Arm you cut off you must cut off as little of it as possible because the little that remains serves in a manner to the functions of Life If it be the Leg though only the Foot should be concern'd you must Amputate 3 Fingers below the Knee just under the Aponevroses which cover the Rotula because of the long suppurations which rot the Tendons and other accidents that may happen and to put on an Artificial one more easily Never Amputate in the Joynt You must never amputate in the Joynts unless it be in the Fingers or Toes which we are obliged to take off If it be the Thigh amputate as little as you can because the more you cut the greater is the Wound suppuration longer and the cure more difficult and consequently the Patient's strength diminishes and grows more weak How to Amputate Having chosen a proper place we perform the Operation thus If it be the Leg you place the Patient on the edge of a Bed lying half backwards one sustains him behind a Servant clasps his two Hands about the inferior part of the Thigh and draws the Skin upwards another holds the Leg whilst the Surgeon puts on the Ham a Compress of several folds of a fitting bigness with another pretty large Compress which encompasses the whole part upon which you place a Ligature which must be streightned with the Torniket but being it must be tied very hard sufficient to compress the great Vessels you may place a Past-board under the Ligature that the Patient may feel less pain and for hindring the Skin from wrinkling Then you make two other Ligatures one over and the other below the first keeps the Skin which you raise upward and the other fastens the Flesh Then the Surgeon places himself between the Patients Legs and with a crooked Knife which he holds in his Right Hand How to cut the Flesh he makes an Incision about the Member even to the Bone and with the Back of the Knife separates the Periostium and cuts at the same time the Flesh and Membranes between the Bones lest you rend them with the Saw and so cause new accidents but before you saw the Bones you take a Fillet of Linnen which you split in two parts and you make use of it to raise the Flesh and to give liberty to saw the Bone as near to the Flesh as possible for seeing it wastes and consumes in suppuration if this precaution were not taken there would stick out an end of the Bone deprived of Skin and Flesh which would serve for nothing but to incommode the Patient How to saw the Bone This being done you take the Saw which you carry obliquely over the Tibia which also serves for a support to saw the Fibula which is the weaket which obliges us to saw it before the Tibia to avoid its cracking or shivering You must observe that in the time of sawing the Servant must bend the Leg a little inward that the Saw may pass more easily The two Bones being sawed off you take off the Ligature above which held the Skin fast you loose the Torniket to find out the Artery you take hold of it with the Crow's Bill How to tye the Artery or Pincers with a Ring then you take a crooked Needle arm'd with Wax'd Thread which you pass twice into the Flesh under the Artery that it may be engaged in the Loop of the Ligature which you tie very hard you make a knot over the Artery upon the knot you apply a little compress which you fasten with two other knots you again loose the Torniket If the Blood should run out with any violence from any other Artery you make another Ligature as the first Some to stop the Blood use an Actual Cautery others a Button of Vitriol which they wrap up in some Cotton some tye the Artery without passing the Ligature through the Flesh But I think the true and surest Method to be as I have describ'd The Ligature being made you take away the Turnstick from off the Stump Where to use the Suitches how to dress Stump and endeavour to cover it again with the Cutis If it be Thigh or Arm it 's not enough to cover the Stump again with the Cutis but you must keep if so by the help of four Stitches which must not be practised at the Leg or below the Elbow because the Knee or Elbow hinder it from rising too high you apply little compresses upon the Vessels and a dry one on the Bone or soaked in Spirit of Wine to correct its alteration then several other Boulsters arm'd with Astringent Powders over that a little Two spread with the same Powders a Defensative and Compress like a Maltha Cross two Longitudinal Compresses and a Circular one sustain'd by the Circular Bandage and Capling some days after you use only the Circular one you need not load the part with too many Compresses A Hogs Bladder of no great use nor apply the Hogs Bladder neither tye the Bandage too hard for besides that all these things excite only Obstructions and Inflammations if by chance the Ligatures should fail the Patient would infallibly perish unawares because the Bladder could retain
all the Blood that should run out You must take care in pulling off the Dressings not to handle them with too much violence lest you pull also off the Ligature You must take care after suppuration to press the Stump a little by means of the Compress to hinder the generation of fungeous and superfluous Flesh which ordinarily happens after long Suppurations Caution to be used in applying the Vitreol Button Those that use the Vitriol Button must precisely apply it to the mouths of the Vessels and take care it doth not fall in applying the Bolsters Nevertheless though we have disapproved its use for several Reasons yet those that will make use of it ought to lift the Stump up a little and hold the Hand upon it for 3 or 4 hours until the Vitriol hath begun to produce its effect In happens sometimes that after the Operation the part suffers some Convulsive Motions Cause of after Convulsions occasioned by the Spirits being irritated by sharp corrosive or Vitriolic Matters or by the trouble of the Spirits themselves in the part For if we consider that the Brain actually prepares a certain quantity of Spirits which run through the Nerves to serve the Functions of the whole Body we shall agree that those which are designed for the motions and sensation of that part which is no more existent but separated from the others must needs run back It 's perhaps this unlucky reflux which excites these irregular Convulsions and the involuntary Contractions pull along with them the Arteries and so gives occasion to the Ligature to break and the part to bleed which often causeth Death Therefore in these Occasions a Chyrurgeon must not stand searching for the Artery he must only lay upon it the Vitriolic Button with Bolstâ—…â—oaked in some Styptic Liquor These are the measures which you must take in such Occasions CHAP. XXXVII Of Paronychia PARONYCHIA is a very painful Tumour which possesseth the Fingers ends caused by the alteration and effervescency of the Bilious and Sulphureous Particles of the Blood Two kinds of Paronychia They ordinarily make two kinds of it in the one the Matter lies between the Periostium and the Bone accompanied with a burning heat acute pain and deep pulsation great Tention and burning Fever The other is only in the Flesh with less heat and pain lighter pulsation less Tention and hardly any Fever at all Cause of the Heat and Pain The heat and pain come from the strong ebullition of the Blood and many irritations whiâ—â—â—he sulphureous particles that â—…elt and are â—â—rn'd into Sanies excite at the Fibres of the Periostium Cause of the Tention The Tention proceeds only from the fermentation of the Humours it 's easie to comprehend that when a Liquor boils it extends it self more in length and breadth than when it is at rest and must consequently dilate the Vessels in a great manner that contain it Cause of the Pulsation The Pulsation is nothing else but a more exquisite and lively feeling that we have of the Arteries beating in the inflamed part caused by a great Tention and Effervescency of the Blood Cause of the Fever The Fever comes from the mutual agitation of the different particles of the Blood that fight against one another with great strength and tear one another in a thousand little particles of a different bigness and figure which being moved in the mass of Blood excites the Fever but after a long struggle the Pus is made the Vessels burst the Matter Extravasates the Tumour grows softer the Fever and all other symptomes diminish then we give the Pus Issue by Incision Where to make the Incision which we make at the side of the Finger to avoid the Tendon we then use those Medicines ordinarily used for other Ulcers I will no longer insist upon the Paronychia though it would furnish us with Matter for a long Discourse and seeing most Authors have given their Opinion of it any one may be Instructed by them CHAP. XXXVIII Of the Use of Cupping-Glasses MOST Practitioners of Physick are wont rather to approve the use of Cupping-Glasses and Leeches than condemn it be it that they either found themselves upon that pretended Attraction of the Ancients Cupping-Glasses of very little use or that they think to discharge sooner a part loaden with the weight of some strange Matter It 's true they use them but with little success besides this Attraction is just a Chimera and is the most cruel and temerarious practice that can be imagined What appearance is there to scarrifie the Back to dissipate Inflammation of the Eyes To slash the Loyns to hinder the progress of malign Fevers No such thing as Attraction to cut the Skin and Flesh in 20 different places to draw one or two Ounces of Blood I do not believe that those who have an Idea of the Circulation of the Blood can shew me by Experience or any other way that the division of some Cupillary Vessels are capable of curing the least Cutaneous affect Nevertheless there are some that do authorize this practice maintain that the Scarifications do determine the Blood and Spirits to repair in abundance to the scarified parts and that in moving the Humours after this manner the afflicted part is disengaged and the Inflammation lessen'd It 's to be wished for the Partisans of this practice that the Inflammation would favour their Opinion For we cannot believe that the Blood and Spirits running into a part in a greater quantity than the used to do without causing some Inflammation which is not observed here besides Inflammation caused only by the interruption of the Blood that the Inflammation comes not but because the motion of the Blood is intercepted by the divulsions of the Vessels as it happens in all new Wounds and not at all by a determination occasion'd by the Pains Lastly all the Vertues which are attributed to Cupping-Glasses shall not hinder me from disapproving their use for I say that they are not only useless in many Diseases where they are employed but also in Venereal Sores and Bites of Venomous Animals since it 's certain that the Poyson of these Animals which consists in a strange acid manifests it self in a moment to the Brain in spight of the influence of the Spirits and that the Mass of Blood is presently oppress'd with it by the Laws of Circulation from whence I conclude that once Bleeding or the least Sudorific in what Disease soever will always do more good than all the Cupping-Glasses you can apply Leeches very often the cause of Fistula's You must observe that in the Hemmorhoides Emollient and Discussing Remedies are to be preferr'd before Leeches which are very often the cause of Imposthumes and Fistula's in the Anus as I have shewed you in the Treatise of Fistula's Where and how to make an Issue by Caustic I also say by the bye that Caustic's