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
the Aperture of the os lachrimale without communicating its alteration to the neighbouring parts I will not call this indisposition a Fistula When the Operation is not necessary but Obstruction which nevertheless permits the serosity to escape involuntary which must be well distinguished because the operation is not necessary if the lachrimal Bone be no way alter'd for the Operation consists in nothing else but to pierce the Bone and consume the Cariosity We use in this occasion general Remedies and all Coliriums proper to deobstruct and disinflame these parts If the Matter which causes the obstruction excoriate and slightly ulcerate the nigh parts one may call it a false Fistula which yields to attenuating Medicines and those which are proper to consume the Calosity that comes upon it But if the serosity by its acidity excoriate the little Tubercle of Flesh which the Ancients took for the lachrimal Gland and the other nigh parts there comes upon it an Ulcer which soon degenerates into a Fistula by the action of the most pungent and acid Particles as I have proved at length in the examination of the Fistula in Anc. So that this impure serosity being capable of Corruption rots the Bone by its lying there What a true Fistula Lachrimalis is and stop the passage of the Tears I will call this the true Fistula where the operation is of great importance It happeneth often that the same Humor which waters the Eye runs to the lachrimal Sac without producing its effect The reason is because it beginneth only to enter into its first degree of Corruption But this Sac being a production of the interior Membrain of the Nose which is extreamly spongy and penitrable the Humor has strength enough to penitrate it and so cause an inflamation which stops the passage of the Tears which by lying there wax sour and afterwards grow so sharp that they cause a Fistulous Ulcer or a kind of Fistula which one might call complete to distinguish it from the others The Matter of the Tears is not always the cause of this Fistula as it is the effect of it It 's very often the consequence of some Imposthume or even of the inflamation of the lachrimal Sac without this pretended serosity contributing any way towards it It may truly by lying still there thicken and harden by heat or it may degenerate mixing with some other strange Humor and so contribute to its Formation You must observe That in this last kind of Fistula there is always some Pus in the lachrimal Sac the most of them that are troubled with it press every day the fide of their Nostrils to squeeze out the Matter so they may avoid the pain of the operation being rather content to have it as long as they live CHAP. XXVIII Of the Operation of the Fistula Lachrimalis How to perform the Operation WE have already said that the operation of the Fistula Lachrimalis consists in piercing the Bone and making the Matter which entertains it flow more easy and in deobstructing the passages For this you introduce the Probe to know whether the Bone be discovered or carnous but particularly whether its hole be stopt If the exterior Orifice of the Fistula permit not the entry of the Probe Caution you must dilate it with a little prepared Sponge or make an incision with the Bistory taking care not to cut the little Bridle which makes the reunion of the two Eye-lids which is nothing else but the Tendon of the Orbiculer Muscle that performs the office of a Ligament for if by chance it should be cut the lower Eye-lid would be revers'd which is an indisposition much more troublesome and deform'd than the first When you have made the Incision you fill the wound with dry Lint to obsorb the Blood and dilate the lips to see more easily the bottom of it The Bone being laid bare you introduce a little Canula into the hole of the Os Lachrimale and with actual Cauteries of different Figures you pierce the Bone which is very thin lightly passing the Cauteries over its surface to hasten Exfoliation and destroy the Cariosity if any After that you procure the suppuration of the would and lay in the bottom of the Fistula Medicines proper to procure Exfoliation of the Bone What to be done to prevent Inflamation You must observe That before you make the Operation it 's necessary to apply on the Eyes some defensative made with Aque Plantag Rosar Album ovi Ol. Rosar tutiae you continue to use it until there is no more fear of Inflamation When the Operation is finished you order the Patient to lie on his Back that the Matter of the Tears may take its course through the Aperture that hath been made you must have regard to two Circumstances The first to stay till the rottenness be destroy'd before you procure the generation of Flesh The second to hinder the cicatrize from rising too high which would be a very disagreeable deformity Finally you apply a Plaister Compress and a Handkerchief a-cross or the lachrimal Band. CHAP. XXIX Of the Polypus FOR to have a Idea of the generation of the Polypus you are only to call to mind what we have advanced when we spoke of a Sarcoma and to make at the same time some reflection upon the structure of the part viz. upon the nature of the inferor Membrain of the Nose which is very thick spongy penitrable actually watered and imbued with a viscous glewy Humor which are all the requisite and necessary Circumstances for to make us think that it contributes much to the formation of the Polypus by reason its Porosities are so disposed that they let pass nothing but the most crass and fungous Particle of the Blood which are very fit to produce some Excrescence True cause of its generation To explain rightly this generation we must only admit a little more heat and intemperies in the Blood The intemperies encreases the motion and exaltation of those viscous Particles and the heat fixes and condenses them by dissipating their humidity Wherefore it s not to be wondered at if there abundance and profusion towards a spongy part furnishes the Matter of a Polypus This Humor I say tho agitated stops in the contexture of this Membrain it the contexture of this Membrain it extends the Vessels blows up the Glands dilates the excressory Channels and obliges all these parts to rise in a Tumor as well by its thick consistency as too great intemperies which makes it be no more in a condition to pass through the Porosities of the Vessels that contain it and so it congeals and by a strange heat changes into a fungous and carcinomatous Substance So that by the addition and presence of a new matter the Polypus grows insensible until it be intirely informed Of Polypus's some are schirrous Difference of Polypus's some are schirrous and some painful There are some which change into a
mortified part is deprived of motion and feeling as because a great pain causeth an Inflammation and sometimes Mortification do not consider that the weight of the courser particles of the Blood which lies in a part presses the Nerves and so interrupts the course of the Spirits and the pulsation of the Artery is no more felt for as Nature delights to glue the Arteries to the Nerves Arteries for the most part joyn'd with Nerves and that she makes use of the pulsation to oblige all the little Nervous Fibres to discharge the Spirits which they contain so it will be always true to say that the Gangrene succeeds great pains and inflammations and that the privation of motion and feeling come chiefly from the Blood since it 's that which hinders by it's stay the distribution of the Spirits I deny not that the want of Animal Spirits in Paralytics may give occasion to a Gangrene to seise the sooner on a part as we shall see in the following Discourse After all I have said it 's easie to comprehend that the heat and life are precisely contain'd in the Blood since the dissipation and absence of it's spirituous and nourishing particles cause the Gangrene and that their presence and exaltation entertain the natural heat True and only cause of a Gangrene I say then in general that the cause of a Gangrene and Mortification is the dissipation absence or concentration of the spirituous particles of the Blood which must vivify the part or at least the interruption of the course of the same and it's coagulation These causes act for the most part separately it may also happen that they act together to cause a Gangrene as I shall make you observe Let us examine all these Causes and first see what is this alteration of the Blood that is deprived of its spirituous particles from which follows Gangrene and Mortification To give a just Idea of it let 's consider the changes that happen to Wine All the World agrees A Comparison that the good condition of Wine consists in the exaltation of its most subtil and spirituous principles as long as these principles have the upper hand the Wine remains in a state of gentle and natural fermentation and consequently of goodness But if it happen by what cause soever that they be weaken'd and dissipated and the acid salts or salt sulphurs take the upper-hand then it is that the Wine grows sower and at least sharp and very disagreeable It happens also very often that after the loss and dissipation of the spirits there remains nothing in the Wine but Earth and Phlegm it 's without taste and is nothing but a dead Mass and barren Liquor which in Latin is call'd Vappa Vinum pendulum which is as it were the Cadaver of the Wine Finally it happens that in cold Weather the spirits of the Wine concentre in the midst of the Vessel which contains it so that all the parts in the circumference being deprived of the spirits congeal I say that when the spirituous particles of the Blood are dissipated or concentred it receives almost the same alteration If the acid salt or salt sulphurs take the upper hand it becometh acid or rank Willis uses the same Example when he explains the alterations that happen to the Blood In tract de ferm p. 68. in comparison to those that happen to Wine Cum a longa fermentatione spiritus absumi actandum deficere incipiunt inducitur defectionis status quo vina aliique Liquores ant in vappam transeunt an t demum sale vel sulphure nimium exaltatis acetosi ant rancidi fiunt pariter sanguis dum in vasis circulatur juxta triplicem hujusmodi Diathesin considerari potest c. Finally when all the spirits are dissipated that the Blood degenerateth into a dead inspir'd mass incapable of any fermentation and whenever the Spirits are concentred in great cold they abandon or forsake the exterior parts which are then only irrigated with Blood deprived of vital and spirituous particles This last state of the Blood answers to turn'd Wine whence depends the mortification of a part in certain cases which I am going to propose Cause of Gangrene in old People First we observe that old People dye very often of Gangrenes and that that it begins by the Extremities and follows through the whole Body in spight of all Remedies that may be used The same thing happens through long abstinence and after all sorts of too great evacuations To give an account of this Phenomena you must observe that the Blood can no more than other Liquors that ferment always remain in the same condition It 's active principles are yet intangled in infancy they get loose in our youth remain in a state of exaltation during a certain age but at last they are dissipated and begin to abandon their subject in old age therefore old People become by little and little incapable of their ordinary motions they loose insensibly their vigour till at last their life in loosing their heat and spirits This being so it 's not hard to explain why old People who dye after this manner are always troubled with Gangrenes in their last days the reason is because their Blood becomes a Languid Mass which no more contains any character of life and which in effect is no more than a Cadaver of Blood This kind of death one may call natural because it happens not but when the heat is extinguished of it self and by degrees Ideoque mori simul dicuntur extingui In this manner it is that a Mortification of the Blood and Spirits happen after an Hectick Fever long Fluxes great Abstinences too great Labour and generally after all sorts of great Evacuations because in these occasions the Matter designed for the entertaining of natural heat is dissipated or is not enough furnished to supply the loss of it which it actually suffers Of the rest though in this state of the Blood the Gangrene be almost universal and need no other cause to manifest it self yet sometimes it happens that the slowness of the circulation gives it occasion to attack certain parts there is a very particular case of it in the 46th Chapter of the Second Book of TULPIUS his Observations Observation Where he relates that an old Man was reduced to such a languishing condition and so great a weakness that the least impression caused him to have a Gangrene he dared not so much as sit down nor lean on an Elbow nor even set a Foot on the Ground or press any of his Members but there appeared some marks of Mortification which followed the Gangrene This Observation is rare and singular We must confess that his Blood was mightily exhausted of spirits since a slight compression only was capable to produce a Gangrene in a part We need not search any where else for the cause of a Gangrene which happens to the Legs and other parts of
utterly impeded in the part the Tumour increases the part retains all those particles which would have escaped through the Pores the Extravasated Humours being in a greater quantity proportionable to the part which contains it compresses the Flesh and Vessels and of necessity causeth a Mortification Behold the true cause of Gangrene which comes upon Inflammations Contusions Anevrisms and Erisipelas all these causes have been very well observed by Ettmuller when he says Hinc est quod vix saepius oriuntur Gangrene sphaceli quam ex Inflammationibus male curatis imprimis si partis Inflamatae per Emplastica imprudenter admota impediatur insensilis transpiratio tunc sanguis extravasatus stagnat corrumpitur ex toto putrescit partis Inflammate Gangrenam post se trahit In primis Erisipelata per ungt oleosa ac muilaginosa insulsae tractata subito serpentem inducunt Gangrenam But these causes having produced their effect there are that augment it and which give even occasion that it be communicated to the nigh parts it is the corruption of the Blood and Extravasated Humours in a simple Inflammation When the Blood is extravasated and cannot be discust it changes into Pus This change is not only caused by the action of the principles of the Extravasated Blood but also by the soft influence of the Blood and Spirits which are contain'd in the neighbouring parts This makes that the Pus is not altogether a strange substance and enemy to Nature But as I have shew'd that the access of the Blood is entirely press'd towards the Gangren'd parts and the circulation very often intercepted it so happens that the Extravasated Blood is so far from being converted into Pus that it degenerates into a virulent Sanies which first causeth Blisters upon the part and then by its acrimony gnaws the Gangrened parts and insensibly corrupts those that are sound which makes the Gangrene become so angry that it attacks even the parts that suffer no Inflammation Of the rest the Gangrenes which follow upon Inflammations attack rather the soft and fungous parts than other Why the soft parts Gangrenate sooner than other as the Gums Lips Vulva and Membrum Virile Intestine and Brain The reason is these parts being very soft and spongy imbibe a a greater quantity of Humours besides the most of them have no Muscles that might squeeze the Blood which makes it easily lie caking there Ulcers Wounds Scorbutic spots and sharp Medicines may cause a Gangrene Fifthly Gangrene comes upon Ulcers Wounds Scorbutic Spots and upon the Application of sharp and corrosive Medicines which happens two ways 1. When pain which accompanieth all these symptoms causes often great Inflammation on which followeth Gangrene 2. From the Actual Cauteries from Pus and Sanies coming from gnawing Ulcers from Scorbutic Spots and from sharp and Corrosive Medicines which cauterise the Cutis and Vessels so the Blood being no more sent into the parts they lose their motion and life Malignity may cause Gangrene Finally all Authors do admit a malign and occult cause of a Gangrene from thence they say comes the Gangrene in the Plague as Carbuncle which sometimes in 24 hours time causes an entire mortification of a part To the same cause they attribute the Gangrene which happens on Malignant Fevers and sometimes after the Small Pox by a depositum or Crisis of the Matter which the Disease makes in some part Lastly it 's this way which they pretend to explicate the Action of Poysons and Bites of Venemous Animals which they say will cause a Gangrene But without having recourse to the Malign and Occult qualities of the Plague are we to wonder at Carbuncles causing a Mortification in any part Why a Carbuncle mortifies since the Humours which produce them are in the highest degree of Sharpness and Corrosion It gnaws the Flesh and cauterises the Vessels so it 's evident the part must mortifie The same thing may be said of the Matter of Malign Fevers and of the Small Pox where the Blood is loaded with sharp and malign particles if so be that this acrimony cannot be overcome by Nature or by Medicines there is a depositum made of it in some part where the sharp and corrosive Humours do not fail to gnaw the Flesh cauterise the Vessels and even to rot the very Bones as we have seen in many Examples I say the same thing of Poysons that do not work but by their acrimony of which some are acid and others abound with lixivial salt but always they produce the same effect as we daily see it happen by the application of Acids and Potential Cauteries After the Explication of the Causes we must pass to the signs and differences of a Gangrene as for the differences it's easie to draw them from their Causes I pass to the signs which are of more importance Signs of a Gangrene from want of Spirits c. The signs of a Gangrene which attack old People and which comes from the want of Spirits are known by that they feel neither pain nor have Inflammation the parts fade away and are as it were deprived of sense and motion which makes them die insensibly Signs for the Dropsie In a Gangrene which succeeds the Dropsie there is but a slight pain in the beginning but afterwards the Legs inflame and the pain augments Signs from Cold. If it be caused from External Cold the pain is presently sharp the part grows red livid and then black at last the spirits forsake it and mortification seizeth accompanied with a shivering like that in an Ague Signs from Compression Tumours Luxation c. If the Gangrene be the consequence of some compression as of too narrow Ligatures Tumours Luxation Fractures or of too long lying on the Back it 's known by the benumming or by a total privation of feeling and motion according as the compression is more or less strong Signs from Inflammation c. If it be caused by Inflammation the pain and pulsation ceaseth the part which was red groweth pale and livid there are some little Blisters form'd upon the surface of the Skin fill'd with salt Water like muddy Wine the heat is extinguished the part groweth soft and withers so that being pressed with the Fingers the dent remains Finally if the Mortification be perfect the Patient falls into great weaknesses accompanied with a burning malignant Fever with Vomiting and several other symptomes which shew that the Mass of Blood is very much oppressed and Death must needs follow upon it Signs from Repercussives c. The Gangrene which is produced by the use of Repercussives and Emplastic Remedies is accompanied with the same accidents Signs from Caustic Medicines The Signs of that which comes from the use of actual Cauteries and Caustick Remedies are almost always the same as in that which proceeds from too strong Compressions Signs from Malignity As for the Gangrene which comes from
are not applied upon Nervous parts nor upon the great Vessels but always between the Muscles You first rub the part with a warm Cloth to open the Pores and to make the part in a manner insensible you put a Plaister on it with a hole in the middle to put the Caustic in which you cover with a Compress and with a little Fillet A GENERAL IDEA OF WOUNDS CHAP. I. Of Incised or Contused Wounds of the Flesh TO finish this Treatise I thought fit to relate the most Important Observations which regard the Cure of Wounds and to clear the stiffest difficulties which puzle most Chyrurgeons in the Method of discussing them well without which we cannot obtain our wish'd for end Those that hitherto have treated of them have been satisfied to hold long Discourses about their several Kinds Differences and Prognostics but seeing these sorts of useless Discourses serve only to tire the memory of those which seek to be Instructed I will not repeat them I begin first with the most simple and known Symptomes To stop the Hemorrhage in Wounds Being the Hemorrhage is the first and most dangerous Symptome of Wounds it 's that which the Surgeon must quickly correct in closing the vessels from whence the Blood flows For if you stop them the Blood runs no more that is to say you must put into their Apertures some Medicines which hinders the effusion of the Liquors they contain or in tying or compressing them These two last Methods are the surest because one may order them as one please so that the Intention for which we make the Ligature or introduce Lint into a new Wound is to hinder the flux of Blood in pressing the Lint a little to oblige the sides of the Vessels to approach and resist the Impulsion of the Blood yet so that the Compression excite not Inflammation A Wound having been so dressed it 's of importance to prevent the Inflammation and Pain which are the two accidents which always accompany it Cause of Inflammation The Inflammation or Tumour proceeds from the Circulation in the part being impeded by the division of the Vessels the Grumous cloded Blood and the Dressings These strange Bodies are as so many Sluces which oppose the course of the Blood obliging it to stop and excite Inflammation Cause of Pulsative pain I conceive two sorts of Pain The first is a Pulsative pain which depends on the Arteries that creep about the Nerves which at that time are so extended that they strike the Nerves more rudely than they used to do and make them suffer so great distentions that they break and it 's this plurality of divisions which cause the Pain Cause of the quick and burning pain The second is a quick and burning Pain caused by the suppression of the course of the Blood which by the motion and frequent shocks of its most active principles bursts the Vessels and extravasateth between the porosites of the Flesh where it 's rarified by the great quantity of concentred Spirits which penetrate the most insensible Porosities Then doth the Blood by its irregular action shake and violently prick the little Nervous Fillaments from whence proceeds this second kind of burning pain 2. To prevent pain We commonly prevent these two Accidents by repressing the motions of the Blood which comes to the part with too great precipitation by Repercussives and gentle Astringents Bandages are of the first rank which we use very successfully in binding the Wound up gently as also the neighbouring parts whereas too tite a compression would augment the Inflammation It 's for this end we readily employ Defensatives as we call them because they are compounded of a Desiccative Matter which insensibly shuts up the porosities of the Vessels as Terra Sigillata Bole mixt with the White of an Egg or common Water You must observe never to leave them longer on then 24 hours Caution for Reasons which we shall alledge hereafter You must at the same time sweeten the acrimony of the Blood and empty the Vessels by Phlebotomy Clysters and a good Diet. A thin Diet exceeding good in Wounds If the patient would be prudent in his way of living and use only a thin spare Diet he would suffer much less pain and his cure would be quicker because Salt Meat is capable of thickning the Blood and making it fit for fermentation whereas sweet Liquids by their insipidness dissolve and charge themselves with the salt and precipitate it by Urine after this manner the intemperies of the Blood is corrected and the affected part relieved Benefit of Clysters Clysters are also of great use because they hinder the Excrements from heating and boiling back again in the Intestines they dilate the Matter moderate the heat of all the Viscera and contribute much to the cure of Wounds Repercussives used only in the first Dressing You must observe that at the same time Repercussives retain the most subtil and agitated salt particles of the Blood they grow sowr gnaw the Vessels and excite a fermentation upon which a Fever soon follows They are therefore only used in the first Dressing and prefer Discutients which open the Pores and causes the volatile salts to perspire and so empty the part It 's easie to see if one continues the use of Repercussives the salts endeavouring to escape fail not to excite Inflammation and to corrupt the nourishing Juice of the parts in disuniting the principles of the Blood which depend one on another which by the frequent encounter and shock of their particles change figure from which depends the generation of a new Matter and all the changes which happen Discutients and Suppurations must work together If in such an occasion Discutients which causes perspiration and Digestives which excites a quick suppuration should not work together to disengage the part it would tumifie so much as to fall into Gangrene Cataplasms which have Oyls and Fat 's in their composition have almost the same effect as Repercussatives for which Reason good Practitioners disapprove their use We observe that in great Wounds Discutients excite often a fermentation which increases the Inflammation In that Case a Cataplasm made with Crums of Bread Milk the Yolk of an Egg Mallow Roots c. is very proper We ordinarily blame those who let the Pus lie too long in the Wound because it always gets some malignity corrodes the neighbouring Vessels which presently produces Inflammation Putrefaction or else the Veins absorb it carry it to the Heart from whence it diffuseth it self into the whole Mass of Blood and causes the Fever and according to the different alterations which it receives in passing through the parts it obstructs the Liver Lungs or some other part so causes an Imposthume there as we have observed in Wounds of the Head This demonstrates to us that we ought to dry up all the Matter that is in the Wounds and press the Dossels
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
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
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
the Aperture being made you put your finger into the Cavity of the Breast as well to make the Incision bigger as to push back the Lungs and Diaphragma and to loose them if they are fastned to the Pleura particularly where the Operation is made in a place of election different to that which is practised in a place of necessity without breaking the Adherences as we have observed in the foregoing Chapter If the Lungs strive to come out at the orifice of the Wound you must push them back with a blunt hollow Probe for to help the running out of the Matter or with a Pipe of a thickness and length proportionable to the deepness of the Wound These long Pipes are very useful in the Emphisema because the Aperture of the Wound being little and deep it 's very difficult without their help to give Issue to the Matter You must not make use of a Probe Caution to try whether the Pleura be pierced for in passing it often separates from the Ribs and there is a Vacuum made where some Blood is apt to gather which produces a new Impostume More Blood to be drawn at a time than Matter If it be Blood that comes out of the Aperture you may draw a sufficient quantity of it but if it be Pus less by reason it contains more spirits and the Patient is apt to fall into a Syncope After this you stop the Wound with a blunt Tent of Lint having a large head and being a little crooked at the end lest it offend the Lungs Most commonly we tie a Thread to it fill the rest of the Wound with little Dossels of dry Lint to keep the Tent in and absorb the Blood and lay a Plaister on it with Compress and Napkin about the Body with the Scapular which is cut in two at one end and put cross to fasten the Napkin the easier When the Patient is dressed you make him keep his Bed with his Head high as if it were half sitting and you let him rest till he finds himself oppressed with the weight of a new Matter then take the Dressings off and having made the Matter run out you push the Lungs back with a long Pipe by whose means you facilitate the flowing of the Matter that remains in the Breast you continue to dress it so every day We observe often that the first three or four days Blood comes out the next days Water and afterwards Pus that groweth thick by little and little We have observed already that in case the Empiema should afford much Matter or Water mixed with Pus you must not evacuate it all at once lest the Patient should fall in some weakness The Air to be corrected when you dress the Patients You must always correct the Intemperies of the Air with fire when you dress the Patient and hinder it from entring too abundantly into the Breast because it thickens and coagulates the matter which is extravasated there hinders it from flowing and causes it to come forth in Clods If it be Blood the Serocity separates from it as after letting Blood nevertheless whether the Pus or Blood be thick or mixt with some Water you always use with Prudence Injections of Barley Water and Mel Rosar with which you cleanse the Lungs and Breast you must always cause the injected Liquor to come out by the help of the finger or hollow Probe and if the Lungs should stick you must loose them If in time the Blood should grow too watry and the Patient be oppressed by the quantity of the Pus you would do well to dress him three or four times a day The Matter runs sometimes for the space of three or four months and as soon as there comes nothing out but what comes from the Wound you procure the generation of flesh and cicatrize You must observe that when the Air works upon the Blood that is in the Breast it coagulates it sometimes without changing it into Pus and so it comes out in Lumps Bitter things not to be used in Injections You must not use Injections in the beginning neither make them with Aloes or other bitter things because when the Lungs are open the Patient casts them out through the mouth but after the Vessels are consolidated you may use the tincture of Aloes or Wine mixt with a traumatic Decoction and Mel Rosarum this is used when the Pus comes out in a small quantity Often after a wound of a Sword there comes out of it an abundance of blood and after three or four days no more appears in this occasion you must quickly close the Wound and you have all the reason to believe that there were only some little Vessels broke which gave some blood and which afterwards were stopt by the most glutinous particles of the blood of the rest however the thing happens there remains no danger CHAP. XXIV Of the CANCER I Look upon a CANCER as the most inflamed and rebellious of all the schirrous Tumours the red part of the Blood as well as the white contributing to its formation Principal Causes When CANCERS happen in glandulous parts there is great appearance that the Lympha is the principal cause there if they attack any other part it 's to be presumed that the Tartarous Particles of the Blood have the greatest share therein However it be I say that the concourse of these two Humours is always necessary for the production of a Cancer all the difficulty is well to distinguish which of those two predominate What a Cancer is I say a Cancer is a round hard unequal livid and painful Tumour caused by the meeting of abundance of Acids and of the Tartarous Particles of the Blood from which proceeds the pain and tention of the Vessels which very well represent the Claws of a Crab. Cancers of the Glandulous Parts most painful Those CANCERS which possess the Glandulous Parts are much more painful than the others through the abundance of Nerves which enter into their Composition and if the alteration of the Lympha contribute any thing to their generation it 's because the Glands are its principal Reservatories Cause of the Roundness The Roundness of the Tumour cometh from the Round Figure of the Glands because the Humours which cause the Obstruction and extend the Vessels can easily tumify these Glandulous Bodies without changing their Conformation Cause of the Tentions c. As for the Tention and fulness of the Vessels it 's known that the Matter which they contain is nothing else than the Matter which forms the Tumour This Humour is Tartarous fixt and gross and consequently not very capable of Fermentation the slow progress the Tumour makes in the beginning is a convincing Proof of it The Lympha being acid it may well excite some little Fermentation with a porous and terrestrial Salt which the red part of the Blood furnishes but it serves rather to fix and concenter
cancerous Ulcer and are most ordinarily the consequences of some neglected venereal Distemper whose leaven retires and nestles in diverse corners of the body where it lieth a considerable time without manifesting it self or producing its effect Some of them are white soft and some red the latter are the less adherent and easiest cured The operation is never practised in the painful nor schirrous The painful are of difficult cure the schirrous endure best the action of caustic Medicines Those that ulcerate and become concerous are sometimes conquered with such Remedies as are employ'd in the Pox. The cure of the soft white and red particularly when they have a body and are considerably grown is easily brought to perfection by the Operation or by Catheretic Medicines How to perform the Operation The Operation consists in pinching the Polypus by the Roots with a particular pair of Forceps which we turn from one fide to another and pulling by little and little we tear off the Polypus with its roots When you have extracted it the Patient snuffs up some Wine into his Nose if a flux of Blood follow you blow up some astringent Powders to absorb the Blood and dry up the Ulcer They are sometimes so considerable that they occupy partly the narrow of the Throat and so hinder the respiration and deglutition In this occasion we endeavour to extract it through the Mouth with crooked Forceps CHAP. XXX Of the Cataract Several opinions concerning the cause of a Cataract THose that have treated of the Cataract are divided in their Opinions concerning the cause that produces it The one have maintain'd That its only an obstruction of the apple of the Eye form'd by the most viscous part of the watery Humor which is shut up between the Cronea and Vvea Others thinking to hit better have advanced That it 's a Web which is form'd before the christaline Humor However I conceive the Cataract to be formed after this manner The Author's opnion concerning the causes of a Cataract All the World agree That all the parts are form'd from the first moment of Conformation and we can demonstrate by these incontestable Principles that there 's never a Cist or Membrane generated absolutely-against Nature and that these Cists and Cataracts which come so frequently or to say better which appear and become sensible to our eyes are nothing else than the unfolding of the Membranes and the little Pellicles which compose the parts from which I conclude that the Cataract begins only to be form'd by a little Pellicle which separates its self from the Christaline and swims in the Aqueous Humor which carries it from one place to another according to the various motions we give to the eye The composition of the chrystalline Humor Which we may without pain conceive if we consider that this Humor is nothing but a composition of several little Pellicles one laid upon another and which may easily be taken asunder after it 's boil'd so that if we couch the Cataract when it 's quite framed you change in a manner the figure of the Chrystalline that is to say of convex it 's made flat Now this Humor being no more so convex as it should be there must a weak refraction follow from it and consequently some confusion I say An inconvenience which always follow upon the couching a Cataract that the beams which come from every visible point of an object and which enter into the eye at a certain distance are never soon enough broken by reason of the flatness of the Christalline to be united when they come to the Retina which causes us to see the object confusedly We help this inconvenience by the means of a convex Glass which regulates the distances that 's necessary to make the refraction more favourable and that the Retina may stand just at the reunion of the beams which paint in Minature upon this Coat the Image of the object From whence it follows That those whose Cataracts have been couched never perceive objects so distinctly as others When first they begin to be form'd and keep as yet their transparency one sees the object as if it were through a Cloud and then we call them Suffusions This little Pellicle changes colour and consistence and cometh to be more or less thick according to the nature of the Juice with which it 's water'd and the mixture of the Humors which renders it opake and impenetrable to the light Different colours of Cataracts this makes all the differences of Cataracts there are some white some of a lead colour some green yellow pearl-colour'd others of the colour of Sea-water or of burnished Iron Other differences of Cataracts Some are Lactaceous as the white ones some are more hardned thinner drier and consequently more capable to bear the Needle as those like Pearl or burnished Iron on the contrary the black green and yellow are thick extremely adherent and very difficult to couch There are others which are hard like Parchment and which have a sort of elastic virtue which is the cause why after they are couched they rise presently again the lactaceous or milky cannot resist the Needle by reason of their little consistence and fluidity To know when a Cataract's ripe You may know when the Cataracts are in a condition to be couched when in dilating the Pupilla by rubbing the Eye they remain fixt without any motion If the beams of a Candle that pass through a Bottle full of Water or a Chrystal make the Patient perceive some Colours it 's a sign the Cataract is not quite form'd I do not speak here of the cause of the alteration in the Christalline and of the different changes of the Cataracts I should have been obliged to speak of the Nature of Colours but time hath not given me leave therefore I pass to the Operation How to perform the Operation You place the Patient in a very light place a Servant holds his Head behind taking care to cover the sound Eye that he may not turn aside then bid the Patient turn his Eye towards his Nose The OPERATOR with a round or flat Needle having a handle pierceth the conjunctiva near the Cornea at the little angle and he passes through it the point of the Needle From the Aqueous Humor you place it on the Cataract and endeavour to couch it gently keeping it a little while under If the Patient distinguishes the objects it 's a sign the Cataract is couched but if it rise again we are obliged to reiterate the Operation and to hold it longer down with the Needle After which you apply on the Eye a Medecine made with Aque Plantag Rosar alb ovi with a Compress and Handkerchief a-cross CHAP. XXXI Of Wounds of the Head A simple Wound of the Head may be cured by Suture c. WE have made you observe in the beginning of this Treatise that a simple Wound of
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
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
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
that the different dgrees of the Fever rule those of the Inflammation as these do them of the Gangrene Bleeding Clysters Sweet and Liquid Food Emollient and Discutient Cataplasms made of the four Meals Honey and the Emollient Herbs boil'd in Wine as Fol. Malve Altheae Senessionis Violar Rarietariae Candilariae Chamomillae Meliot c. All these Medicines are very Efficacious here You must observe to let the Cataplasms be very moist lest they dry up and so instead of Humecting and Mollifying the Fibres they obstruct the Pores as Astringents and hinder Transpiration If in spight of all this care the Inflammation goes not off you relieve the part by some slight Scarifications if they be not enough you make others deeper that the Medicines may have room to work If the Wound be superficial you must dilate it but if it penetrate even to the most intimate parts I mean near the great Vessels or Bones you must keep to Scarifications and Injections made of Traumatic Plants Mel. Rosar and Spirit of Wine because you would be apt to ruine the whole part by the Incision which must afterwards be cut off It often happens that the Gangrene comes on the sides of these kinds of Wounds where the Obstruction is always most considerable in which case your Pleagets must be well charg'd with Digestives If the Inflammation goes not off either by Suppuration or Transpiration and the red colour of the Skin changes not you must use strong Maturative Cataplasms of White Lilly Roots Sorrel Leaven and the common Digestive provided the Inflammation communicates it self not to the adjacent parts Scarifications are not to be used but when the part is extreamly stretched and the red colour changed into a livid and when little Blisters arise which signifies a beginning Mortification and shews that the ferment of the Gangrene is very acid and malignant you must not stay till these little Blisters increase but as soon as you see that the Wound doth not suppurate and the Skin changes colour you ought to Scarifie and lay Compresses upon the neighbouring parts soak'd in warm Wine and Brandy The Fever is sometimes extinguished by Scarification because the Agitated Matter of the Acid ferment hath room to escape so the Inflammation is diminished Suppuration procured and the progress of Putrefaction stopped If the Lips of the Wound be of a Vermilion colour it 's a token that the salt particles prick the Membranes and increase the Fluxion it excites the Fever a-new for some time and the edges of the Wound grow white and dry This change proceeds from the salt Juices which by their too great motion separate themselves from the sulphurous ones so that they irrigate the Fibres and cause a new Obstruction which afterwards makes the Flesh foggy and white We often observe that though the Wound be often ready to Cicatrise yet if the Fever arises a-new it grows bigger and more dangerous than it was before because the Inflammation makes a greater progress in this case you touch the new form'd Skin with Aq. Calcis in which some Mercurius Sublimat has been dissolved but without using any remedy you may cut it off for the ferment of that Membrane infects the neighbouring parts Balsam of Sulphur is very good in this occasion especially in small Putrefactions Flux a dangerous Symptome If a Flux come upon a Flesh Wound it 's a very dangerous symptome because it only happens when the salt particles have left the part and enter into the Mass of Liquors Now as the Volatil salts maintain the motion of the Blood and other Humours and have a vertue of dissolving and making them fluid we are to search no where else the cause of this Symptome This Flux hinders Suppuration and weakens the Sick more than all other accidents together because of the great dissipation of Spirits that is made by the Stools We also observe that the Wound dries shrivels and becomes as it were mortified according as the Spirits abandon it and the stronger the Flux is the more the Inflammation lessens the Flesh dries up and the part becomes more faint adust and putrid You must foment it with Aromatic Wines and hinder the disunion of the salts by the help of Balsam of Sulphur but from the moment that the Spirits exalt themselves towards the surface the motion of the Blood slackens the Flux ceaseth and the Wound which before was inanimate as it were revives again This Flux must be stopt with great Circumspection for it 's a sign that the salts are become very acid since they offend every part where they lie you must always stop it by degrees for fear a sudden suppression might again revive the Fever and render it more malignant and pernicious which would presently unite Putrefaction with Inflammation The Flux being stopt the Patient must be fed with sweet and thick Food The proper Medicines for stopping a Flux are Clysters made of White Broth Mallows Bran Lettice Knot-grass and the Yolk of Eggs. Tisans made of Bugle Sanicle Lemons and Liquorish are also of great help We observe that this Flux happens oftner in great Hospitals than any where else especially in great Wounds because the Wounded receive there an Air loaden with Malign and Pestilential Vapours which not only causes the Looseness but all the other troublesome Accidents which follow upon it We observe that the Wounds which happen to the Legs are most dangerous or of difficult cure but since the Circulation being more flow in them their Tendons and Membranes stretched and their Vesicles more narrow this disposition of parts causes the Humours to settle and employ themselves more easily and that only the serosity is able to disengage it self in time of their settlings by its abode changes into a Virulent Sanies which entertain the Wounds of these hard and callous parts They also require some Medicines capable of carrying off and melting the Callosity and destroying the Sanies which is the chief cause of it When Wounds are of difficult cure and as it were unconquerable with Medicines it 's the evil disposition of the Subject for the most part which contributes to it Some are naturally of an Ill Habit others affected with some Venerial Disease or some other as bad Finally others do not govern themselves and have a greater inclination for that which is hurtful to them and which is capable of heating and altering their Blood If in these kinds of Inconveniencies the Medicines which we have used produce not any effect Cardiac's and Medicines of a Purifying Quality favours their cure What to be used in Venomous Wounds as all Aromatic's Cordial Potions all Preparations of Mercury and Antimony Theriac Confections Powder of Vipers with their Volatil Salt Volatil salt of Hearts-horn and several Medicines of the same Nature which differently according to the different degrees of Corruption This is the Practice which must be followed in Venomous Wounds having applied upon the part all things that resist
A TREATISE OF CHIRURGICAL OPERATIONS After the Newest and most exact Method founded on the Structure of the PARTS CONTAINING Their Causes Signs Symptons together with their Explanation and many curious Observations To which is Annex'd a General Idea of WOUNDS Written Originally by Joseph De la Charrier and Translated into English by R. B. LONDON Printed for Dan. Brown at the Black Swan without Temple-Bar MDCXCV The Author's PREFACE I Was so well satisfied with the Authentic Approbations that those learned Physicians have honour'd me with to give my Book that I was resolved to make no Preface but an accident happen'd which I thought convenient to make known to the Reader A certain Person who passes for a Man of great Merit and who is actually in a Post to distinguish himself desir'd some both of his and my Friends that something might be said in this Tract to his advantage I was in no great trouble to grant him his Desire and I began to flatter my self that he had some esteem for my Work nevertheless he has publickly declared himself against that he had so well approved in particular and many honest Gentlemen have been scandalized at his ill Temper as well as my self One may well think he imagined that this Book would not have the success it deserves and he has reproached me to have made use of his Writings It s no way disadvantagious to me that a man of his Rank should attribute to himself the Fruit of my Labours In the mean time the Reader will very easily see that I am no ill temper'd Man nor any way troublesome since in those things which are not my own I have cited the Authors among which one will not find the name of the Sieur Du its likely he himself has made use of the thoughts of the aforesaid Great men but has not been so ingenuous in owning it as I. Nothing 's so strange as Pride It often carries us to some excess which serves but the more to make our Faults and Weaknesses better known I 'll say nothing of my Book only I believe I have advanced little but what 's founded upon Reason and Experience which I 'll clearly demonstrate according to the Structure of the Parts I desire the Reader to judge of it without prejudice and that he would not esteem Mr. Du to be the Author of the good it contains APPROBATION THE Faculty of Physick in the University of Paris having heard the extraordinary Character that Mr. Le Meine and Mr. Engvehard Doctors Regents in the same Faculty gave of a Book of Chyrurgical Operations composed by Mr. Charrier approve this Work and think it most worthy to be Printed At the Physicians Colledge at Paris Thursday 19. October 1690. Signed Legier Professor to the King and Dean of the Faculty of Physick APPROBATION BY the Order of my Lord Chancellor I have examin'd this Manuscript which treats of Chyrugical Operations which deserves to be printed being inricht with a great number of Observations which will be exceeding useful to Chyrurgeons This I certifie to be true nevertheless I submit to the Gentlemen Physicians of Paris May 3. 1690. Signed Beissier THE PREFACE TO TEH READER WE have an English Proverb though somewhat obsolete yet true which is That good Wine needs no Bush the same I think may well be said of this little Treatise whose every line draws a sufficient Characteristic Note after it without being usher'd in with any Prefatory Discourse to raise its value yet since Prefaces in this Age are as much in Fashion as a pair of Gates before a stately pile of Buildings I hope a few lines will not be amiss to do the Author some justice in so admirable a Tract as this is I shall not pretend to write here an Encomium in the Praises of Chyrurgery nor indeed can I give it those due Graces it worthily deserves it having been already by such a Cloud of learned Men performed to my hand whose most ingenious Footsteps I can follow and those only at a distance not pretend in the least to imitate As for the Contents of this Book they are certainly praise worthy the Author being so famous a Practitioner especiall in the performing Chyrurgical Operations his Works shew him to be a Man of sound Judgment and Learning for he handles the Matter with such strenuous Arguments sound Reasonings and so home that I greatly admire none attempted before now to give it an English Garb when I first perused it and finding it applicable to what I had seen especially of late by an ingenious Gentleman of that Nation I was resolved to make it speak our Mother Tongue never designing it for a Press only as a help in my own Business it having been Translated above fifteen Months before it came to the Publick View and perhaps never had by me but that the Importunities of many Friends almost if I may so say forced me to it besides hearing one or two were on the Design of rendering it into English I thought it might be as well on my side seeing it had been so long done as theirs It must for certain be of great Benefit to our younger Students in the Chyrurgical Art though our Seniors may not be ashamed of having so pretious a Jewel about them who have not the opportunity of seeing many Operations perform'd and those few Authors which have treated of them have done it so slightly and superficially that after all your Study and Pains you are as far to seek as ever but this Tract is so exact and Methodical that it leads you as it were by the hand through the whole Course of every particular Operation as well as if you saw it perform'd by any learned Artists it not only demonstrates how to perform the Operations according to Art but also shews the Distemper explicates their Signes Causes Signes of those Causes and Symptoms according to the newest System of Philosophy founded on the Mechanic Formation of the Parts Yours R. B. A TREATISE OF THE OPERATIONS OF CHIRURGERY CAP. I. Of Operations in General AMong all the Parts of Medicine there is none so profitable as this which I undertake to treat of VVhat it teaches It teaches us how we ought to perform the Operations of Surgery it explains the chief Pathologic Phaenomena fortifies us in the knowledge of the Subject on which we practice and I dare boldly say that without the assistance of these Operations the Art of Surgery would never have arrived to so high a point of perfection which at this time it has atain'd and without it the Knowledge which relates to the explication of the Principal Distempers The Excellency of Chyrurgical Operations would have been only dubious and uncertain if light were not borrowed from hence by evident Demonstrations and by reasons which experience authorises It 's a study which contains nothing but what 's worthy to entertain our Wits and engages those who love the Profession to shew the
is only a serous Mass sharp and Corrosive having lost all its consistence and unctuosity and consequently incapable of Reunion You must have regard to some of these circumstances in all other Sutures therefore the Union of the Hair-Lip is not to be undertaken but in adult Persons who have no other incommodity and are willing to endure pain How 't is to be performed To perform this Methodically you must cut a little Filament which fastens the Upper-Lip to the Gums to give liberty to embrace with your Instrument the whole breadth of the Hair-Lip 'T is a particular pair of Pincers with which you must engage the Lip towards the corner of the Mouth and let it slip to the Extremity of the slit you must secure and fasten it with a Ring to have the liberty of refreshing and cutting Dexterously the Superfices afterwards you must unbridle the Upper part for fear there may remain a little swelling which would be as disagreeable as the Deformity it self so that after the two Lips of the Wound have been exactly brought together and that they are in a just level you must pass from one Lip to another one or two Needles arm'd with wax'd Thread according to the length of the Hair Lip and cross the Thread about the Needles as is convenient you must break off the points and lay some little Compresses underneath that they mayn't prick the Patient then apply a little Pledgit wet in some Balm or Styptick Liquor and Embrocate with Ol. Rosar with a Compress dipt in Oxyerate and a little Band or the fourfold Bandage You must not imitate certain Operators who Scarifie to no purpose the sides of the Wound to disengage the part which always suffers some Tension since we can remedy this inconvenience by laying on the Cheeks some Compresses sustain'd by the Bandage you must order the Sick a very exact Diet which consists in using the first three or four Days nothing but Liquids and avoiding all sorts of motion CHAP. VI. Of the Gastroraphia OF all parts of the Body there 's none more subject to Maladies than the Belly and that consequently has more need of the Surgeons assistance The Operations which are Practised there depend from the Wounds that happen to it from the Tumouâ—s called Hernias from Laborious Child-birth from Dropsies Fistula's and Apostems The Wounds of the Belly are either big or little Superficial or Penetrating are made with or without the hurt of the contein'd Parts which very often come out of the Cavity according to their indisposition greatness of the Wound more or less motion as we are going to explain We conjecture there is some part damag'd according to the Figure of the Instrument wounding you may judge what Parts are hurt by the Situation of the Wound and by that in which the Patient was when received Signs of the wounded Viscera But the true Signs which indicate the division of some Internal Parts are acute Pains Inflammation Fever or some Matter coming forth nevertheless all these Signs are equivocal except the least which is known by the Colour Smell and consistence of the Matter which is discharg'd out of the Wound or flows in the Cavity of the Belly After what manner the Viscera get out of the Belly But as the most of these parts are floating and always Relax'd they get out of their Cavity at the least impression or disorder particularly at the time of expiration when the Thorax contracts Though it seems that they should rather escape in the inspiration when the Diaphragm is level'd pushing back as the Antagonist of the Muscles of the lower Belly all the parts that are under it yet its certain that the Muscles of the lower Belly oblige them against their natural motion and inclination to come out of the Wound in time of expiration when they press all the conteining parts of the Belly This being so 't is evident that it 's necessary for the part that is under the Muscle and out of Action to regurgitate and shew it self out of the Wound as a piece of Paste does between the Fingers when squeez'd with the Hand whereof depend those frequent Strangulations and dangerous Inflammations You must also remark that these parts are extream spungy and greezy whose Texture is very loose humected with a quantity of Humours bedewed with an infinite number of Vessels and consequently very subject to Putrefaction for the Air coming to strike and penetrate their Substances they fail not to Tumefie and Condense the Blood which animates them if they be too long expos'd to it These Parts being therefore depriv'd of the motion of the Blood in which consists their Heat and Life there must needs happen a mortification Besides the action of the Air we know that Inflammation is capable of causing the strangulation and mortification It 's easie to conceive that the parts being inflam'd and swell'd must take up more room than before and press the Intestine and Omentum which is commonly found in the passage Cause of the Inflation of the Intestia from which must follow interruption of the course of the Blood and Spirits in those parts and consequently Gangreens It often happens that the Intestine is inflated the cause of which proceeds from the Inflammation which the Wound communicates to the Gut and the Air Obstructs the Pores besides the return of the Venal Blood is in a manner stopt by the Strangulation and the little motion which is to be seen there The Inflammation which attacks the Gut is capable of Rarifying a part of the Serosity and the other Juyces which are contain'd there whose motion is made more slow not being able to escape by reason of the Air which stops all the passages and shuts the Pores of the Intestine so that 't is impossible for the Surgeon to reduce them without dilating the Wound How to Dilate when too narrow To perform which the Surgeon must pass a hollow Probe between the lip of the Wound and Intestine and slip a Bistory all along the hollow of the Probe but before he makes the Incision it will be convenient to examine whether the Gut be not engaged lest he wound it This being known he may boldly dilate the Wound and cut as much off the Peritonaeum as of the Muscles c. because the Strangulation is every where equal against their Opinion who pretend 't is more considerable without than within I shan't here speak of the precautions which the Ancients took in applying Fomentations and several other Medicines But suppose it necessary to Foment and warm the parts with hot Clothes or with Wine If the Omentum be altered cut off the mortified part Before you reduce them you must examine whether they ben't hurt and if the Omentum be not mortified which is known by its Lividity then without delay cut off the Gangreen'd part after having made the Ligature of that which is sound If there be a little Wound in
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 cure of this Disease which is perform'd by the help of Medicines Cure or Operation The most Specifick Remedies are diureticks and those which cause insensible transpiration others being of no great use The strongest Diureticks are Rad. Tinctura Diuretica Ebul Irid. Erysimi Cucum agr fol. Solda nel Cerefol infused in Spirit Vin. Mercurisati It 's an extraordinary remedy Infusus Anthydropiens Rad. brusc Polypond Gladiol Medul sambuc Croc. Chryst miner infus'd cold in White Wine make a wonderful remedy Sal. Rut. Crem Mercurii Spirit Salis taken in Broth without common Slat are admirable There are several other Medicines of which Authors are full I mention here only those which I have experimented If all these won't do you must proceed to the Operation which confists in punction made on some part its name differing according to the place where it practised being call'd when made in the belly Paracentesis in the Scrotum Punction and in the Legs Scarification CHAP. VIII Of the Paracentesis OMitting the Description of the method of the Ancients I proceed ours VVhere the Puncture is made wherein we use the Trocher or Lancet the puncture being ordinarily made on the side four Fingers from the Navel If with the Trocher we make no apparatus but pierce the belly as often as we will draw water from it Description This Instrument is of a triangular Figure and scatters only the Fibres they upon its being withdrawn exactly reuniting again it must always be accompanied with its Canula when the punction is made which we leave in the Belly as long as the water is to be drawn If you use the Lancet you must arm it with a little band of cloath before hand Method of using the Lancet and thrust it in till the water comes forth and before you withdraw it introduce a Probe on the flat of it to facilitate the passage of the Canula into the Belly then having drawn a sufficient quantity according to the strength of the Patient stop the Canula with a small Tent and apply good compress sustain'd with napkin and scapuler but seeing that by this method we can't always hinder the rapid stream of the water we must prefer the Trocher In what parts your Operation is useless You must observe that the Dropsie of the Head Breast and Stomach are never cur'd by Operation but by general Medicines CHAP. IX Of Hernias THE Belly is subject to certain tumors call'd in Greek Definition Cele in Latin Hernia v. Ramex 't is defin'd a preternatural Tumor caus'd by the falling of some part or gathering together of some superfluous Humor VVhat Hernia signifies The word Hernia signifies something that 's troublesome to bear I 'll use the Etymology in opposition to their opinion who pretend it suits not with the Humeral Hernia and I believe every one will agree with me that they are insupportable as well from Humors as Parts Hence I conclude the word Hernia may fit all kind of Tumors which happen to the Belly or Scrotum I confess the word Rupture is only applicable to those in the Groin and Scrotum from the Omentum Interstines or some other part But omitting a useless multiplication of imaginary names I pass to its species and differences And these are drawn from the parts which they attack and the different causes which they produce Names by reason of the Parts they are call'd Exomphales viz. of the Navel Bubonocele of the Groins Oscheocele of the Scrotum and Ventralis Hernta of which hereafter By reason of the causes which produce them the one are made by parts Diferences the other by the humors The first are call'd Enterocele when the Intestines come forth Epiplocele when the Omentum and Enteropiplocele when both The latter are call'd Hydrocele Pneumatocele Sarcocele Varicocele and Circocele from Water Wind Flesh and other Liquors which are capable to dilate the Vessels Those made by the parts are call'd true the Humoral false compleat true or Lips of the Womb not compleat when they don't pass the Groin Causes External Causes are external or internal the external are violent blows great shakings long courses or running dancing leaping continual crying vehement coughing excess of venery too frequent and forced breathings and generally all the exercises and strong efforts to which we are subject The Internal come first from the influx and deposition of a great many Serosities Internal 1. which sometimes come from the Glands of the Intestines or the Groin but principally from those Glands which garnish the interior Surface of the Peritonaeam all these sources make that abundance of Lympha which actually Humects Relaxes and Lubrifies these Parts and consequently puts them into a condition to yield the more to the frequent and reiterated Impulsions of the Intestines The second I suppose depends on the great Dissipations of the oily Particles for if we consider that the Peritoneum is near the Omentum and Mesentery the two chief Repositories of the Fat by which it is actually separated from the Parts by the heat it 's easie to understand that these Parts continually greasing the Fibres of the Peritonaeum so soften and extend them that at the least action or motion they give way very easily to the blows and to all motions which may contribute to their formation The People of Provence mighty Subject to Hermat Hence the People of Provence the Religious especially who eat nothing but Oyl in their Food are more subject to Hernias than others To the third abundance of wind may contribute whether we swallow it with our Food or it be contain'd in it or produced by the setlings and heap of a considerable quantity of dissolvents which by an excessive heat rarifie and may be truly supposed capable of extending the Intestines like a Bladder and of blowing them up to a certain degree of Tension so that taking up more room than usual they impel the Surface of the Peritonaeum and nesting themselves in these productions form the Tumor For the fourth the Dropsie and Fatness in Women may be admitted this last pushing all the Parts against the Diaphragm and determinating them rather to form the Exomphalos than Bubonocele the other Humects and Relaxes the Peritonaeum so considerably that after the dissipation of the Water it can no more resist and support the Motions of the Intestines I pass to the Consequences which we must draw from the Causes of Hernias relating to the Structure of the Parts where they are form'd which depend as well on the disposition of the Peritonaeum as the. Mechanick motion of the Diaphragm Muscles of the Abdomen and Intestines Hook on the Peritonaeum as a Membrane of a considerable thinckness dispos'd in the shape of a sack containing all the Parts of the lower Belly 't is so long as to reach to the Navel and groins What 's to be consider'd in the Peritonaeum to
accompany the Umbilical and Spermatick Vessels which run between its Duplicature this is in short the Idea you must have of it VVhat about the Muscles Let 's now examine the Muscles of the Abdomen whose carnous Portions garnish the Lateral Parts and their Aponeuroses occupy the forepart of the three Regions three of which Muscles are perforated towards the Groin for the passage of the Spermatic Vessels The first hole is of an Oval Figure belonging to that Aponeurose of the external oblique and being dilated well enough represents the handle of a Hamper whose two extremities are fastned to the Os Pubis reaching a little towards the Crest of the Os Ilium This hole is lin'd externally with a little thin and delicate Membrane which accompanies the Cremaster Muscles to the Testicles and is nothing else but an expansion of the Tendinous Fibres The other two are of the Separations of the fleshy Fibres of the Internal Oblique and Transverse These three Rings don 't directly answer one another being separate about three or four Lines The first that presents it self to us in performing the Operation is that of the external Oblique which is the lowest and in which is made almost all the Strangulation of the Gut because the Tendinous Fibres don't obey so well as the Carnous and are more subject to inflammation for which reason 't is that most don't scarifie this ring in the Operation that of the Internal Oblique is a little higher and that of the Transvers highest of all it 's easily observable that if nature had plac'd them one against another there wou'd at the least effort happen a Hernia The right Muscle reaches from the Cartilago Ensiformis to the Os Pubis lying all along the sides of the Linea Alba and seems to be divided into four Muscles which are distinguished by four Tendons call'd by the Antients Enervations this Muscle partly obscures the Motion of all the others which otherwise would so strongly compress the Guts that if it like a movable Bar did not oppose their powerful contraction they would oblige the Parts every where to regurgitate out of the Belly What the Linea Alba is I 'll add a word or two concerning the Linea alba which is formed by the union of the Tendinous Fibres of the Aponeurosis of the oblique and transvers Muscles which Aponeurosis make a kind of separation and mark the interval between the right Muscles so that to shew these two Muscles we are forc'd to cut those Aponeuroses under which they are hid I pass now to the action of every Muscle in particular The external oblique pass obliquely from above downward according to the disposition of their Fibres just as the internal pass from below upwards The transvers press equally the Flanks and the action of the right is felt all along the sides of the Linea alba These Muscles so dispos'd press equally all parts of the Belly when they are contracted in time of expiration and maintain it in a level always united After all these reflexions if we make a just application of the causes of Hernias according to the Mechanism of the parts where they are felt we shall find something to satisfie our curiosity confidering that violent blows rude shakings long courses excess of venery dancing leaping and generally all efforts are capable not only of moving the Guts but also of relaxing their connexions hence Posts Postilians Dancers Leapers c are troubled often with them To these we have added Crying vehement Coughs and all too frequent expirations and inspirations hence Musicians Singers and Children whose parts are soft and spongy are so much subject to them In all these efforts the Guts are so pressed and repelled on all sides by the Diaphragm and Muscles of the Abdomen which as so many Hands and movable Napkins oblige the Omentum and Intestines to strike and apply themselves so strongly against the surface of the Peritonaeum that they are constrained to regurgitate through the weakest places as a piece of Wax between the Fingers when it 's squeez'd with the Hands they push I say and dilate the interior Membrane of the Peritonaeum where it 's least affisted by the exterior and sink into the rings of the Muscles forming a Sack which is greater or less in proportion to the strength of the Impulse This Sack nests its self all along and at the sides of the productions of the Peritonaeum An Ancient Error confuted which are form'd by its exterior Membrane and not in the productions which invelop the spermatic Vessels as most imagine This Idea we must have of the formation of the Purse which includes the Intestine and which makes the Hernias if there be any little indisposition in the Oyl Water Wind and Tumours which we have establish'd for internal causes The Ventral Hernia remains now to be examin'd Cause of a Ventral Mernia which happens sometimes between the right Muscles sometimes between the Navel and Flanks exactly at the Aponeurosis of the Muscles to be convinc'd of which we are only to represent to our selves how strong the moving force of every Muscle is which occupies the Flanks different from the Aponeuroses which have no other motion than that which their carnous part communicates to them for though it be true that all the Muscles Reunite themselves to one sole point of the Navel where the concourse of their action is yet it 's probable that their carnous part is much stronger and more vigorous and by that means more capable of resisting divers shakes of the Intestines as experience teaches us unless it be bruised or cut by some blow We observe also that that the Ventral Hernia never happens in the carnous part of the Muscles but always in the Aponeuroses or in the space between the right Muscles particularly in the course of some fatness For in these kind of tumours the Belly rises so that it obliges these two Musculous bands to part and the Intestines finding weak places fail not by their impulsions to dilate these parts and so cause the Hernia Ventralis Hernia ventralis and Exomphalos not so common as Bubonotele If this and Exomphales are not so common as Bubonocele 't is because the parts and Humors are more inclining to be carried downwards towards the Groins than elsewhere and the disposition of the rings of the Muscles which contribute the more to it as their overtures are widened and relaxed so that if the parts are put in motion they insinuate themselves and slip insensibly through the opened passages and where least resistance is made Fabritius Hildanus relates Hernia caused by the descent of the Spleen that he has seen a Hernia made by the descent of the Spleen this curious remark shou'd move the Surgeons call'd to this kind of Disease to pronounce not always in favour of the the Epiploon and Intestines before good examination particularly when the tumor is of an extraordinary bulk
the Peritonaeum comes only a clear and lump water The Intestine obeys when you pull it provided it adhere not to the Neighbouring parts different from the Peritonaeum which obeys very little and the Patient feels always a dull pain These are the chief Signs which ought to make a Surgeon circumspect I pass to the particulars of the Operation The Intestine being discovered you slip your hollow Probe between the Membranes of the Scrotum and the Body of the Intestine for to widen the Aperture and to discover it naked to be able to separate it the easier from the Testicle A Servant lifts the Intestine and pulls it gently with his Hands towards the Pubis whilst the Surgeon pulls lightly the Testicle with his Hand to have the liberty to break with the Fleam or point of the Bistory the Membranous ties observing alway to cut them nearer to the Testicle than Intestine If their adherance be very strong it wou'd be better to indammage the Testicle because it 's not so necessary for Life and the Accidents not so dangerous you must alway avoid the Spermatic Vessels for fear the Blood trouble the Operation Having freed the Intestine from the Testicle you introduce your hollow Probe between the Cutis and Intestine and cut without fear to the ring of the Muscle where consequently you are obliged to give way by a new Incision to disengage the Intestine from the Strangulation in case there be any You pass the third time the hollow Probe between the Ring and Intestine stirring it a little to be certain that the Gut be no way engaged and slip a crooked Bistory into the hollowness and you cut from the ring about two Lines and a Portion of the skin avoiding a little branch of an Arteâ—y which runs by the Aponeurosis of this Muscle When you free the Intestine by the dilation you pull it out a little for to disengage it from the internal rings and give liberty to the excrements which it contains to spread themselves by this means it grows less tumid and extended so that the reduction of it is much more easie you do it with your two Fore fingers and press not the Intestine too much lest you bruise it Being reduc'd a Servant must press with his Hands the Neighbouring parts to hinder its falling out again Some make several little Incisions on the Circle of the Ring all along the Purse which makes it incarn and cicatrize stronger others content themselves to introduce into the Rings a thick Tent of Lint tied with a wax'd Thread and a length proportionable to the depth of the Wound to bruise them as it were and excite a speedy suppuration some apply them dry and others dip in some digestive according to the pain which is felt or humidity which relaxes these parts But the true method to hinder this Disease from relapsing is to introduce into the Wound a long Tent of Lint which refists the impulsion of the Intestine which alway endeavours to dilate the rings and so often makes the Operation unsuccessful A Servant holds it on whilst the Surgeon applies the rest of the Apparatus especially good defensitives which oppose Fluxions that may happen There are several Practitioners who wou'd that at the same time the Testicle be cut off but this method is not approved of because it contributes not to the cure of the Hernia but rather as Experience demonstrate prolongs the Operation makes the Patient suffer without necessity and deprives him of the proper means of Propagation but if even the Testicles should be alter'd so that they cou'd not be secur'd 't would be always more advantageous to defer the Operation till the Fluxion be a little moderated If the Omentum be in the part and altered you make the Ligature in the sound part and take off the corrupted It may be avoided if the tumor be recent and preserv'd in its natural State if it be strongly fastned to the Gut you must if possible reduce them together provided there appear no sign of mortification Whether it has contracted any tie with the Intestine Testicle rings of the Muscle or with the productions which include the Spermatic Vessels 'T is alway better to take away some of its Substance than of the Substance of any of these parts if necessity compel you to it Yet I own if it should at all adhere to the Sack that contains the Intestine provided it be sound 't wou'd be better to hurt the Purse than Epiploon But as it cannot remain long in that condition without being altered we are alway forc'd to cut a great Portion of it You must take care in making the Ligature that you don't straiten the part too much because 't is of a loose texture spongy and easie to be cut You pass the Thread several times all about slightly straitning it after having pass'd the Needle through its Substance In the Operation of the Bubonocele you make not so great an Aperture but make it according to the extension and bigness of the tumor Concerning the rest you follow the same Rules and observe the same circumstances formerly mentioned When you have discovered the Purse which makes the Hernia you tear it to pieces dexterously with your Nails or the Fleam and if instead of the Intestine you find water be not surpriz'd with the supposal that you have hurt the Intestine but take Courage and remember only the signs of which we have spoken which will fortifie you and put you into a condition successfully to perform the Operation for 't is only the Purse which is full of waters in which the intestine floats These waters are furnished by the Glands of the internal surface of the Peritonaeum and by those of the Intestines or by the eruption of some Lymphatic Vessels These are if I mistake not most of the particulars which this Operation contains after having Embrocated with Oyl of Roses you must apply good defensitives over the part and Hypogastrick region with good compress moistned in Oxycrate and sustain the applications with the simple Spica in all these affects you must alway ease the Purses by a Suspensorium and prefer Clysters before other general Medicines CHAP. XII Of Castration occasion'd by Sarcocele and Varicocele THis Operation is not alway to be Practis'd unless other methods prove ineffectual In the four following cases I suppose it necessary VVhen the Operation must be perform'd 1. When it 's so closely fastned to the Intestine that one is forc'd to take much of its Substance off The 2. is in contusion when the Vessels and Vesicles are crushed together and the course of the Blood interrupted which is known by the blackness of the Testicle and mortification which follows soon after if the progress of this commotion be not hindred The 3. is when the Testicle is varicous and the virulent Humours which cause the tension and dilatation of the Vessels can't by Medicines be resolved this case is not so pressing as
those which cover the bottom four or five days before you take them out to the end that by their stay the Matter which is stop'd become more sharp and that they may dissolve more easily the Tunicles which contain the Waters you suppurate it and dress it as an ordinary Wound Before you go further you must also observe that if the waters grow sharp and corrosive or rather lixivious they change often into Pus which makes the Testicle alter and corrupt so that you are forc'd to take it out Cure of Pneumatocele As for Pneumatocele you must use the bandage and all the carminative Remedies as well internal as external and as it 's a part of the Surgeon's prudence to order them according to his Knowledge I shou'd be ridiculous if I should boast here of Remedies which Authors are full of CHAP. XVI Of the Phymosis What Phymosis is THE Phymosis is nothing else but a shrivelling and contraction of the extremity of the Prepuce which compresses so hard the Glans that if you don't give it Air by way of Incision it becomes inflam'd and often mortifies This incommodity is either natural or accidental the natural comes from the parts being yet concentred and as it were retir'd into its Tunicle and that one has not yet betaken himself to any exercise or touching The Prepuce forms in this affect wrinkles which are like so many little Bolsters As Venery between which gathers and stagnates a tenacious Matter separated by the Glans with which the inner surface of the Prepuce is sprinkled which thickens by the heat and growing impure by its stay there is as it were a kind of Glew which fastens the Prepuce to the Glands and so straitly presses it that it will not let the Urin flow The Surgeon therefore first endeavours to free the parts pulling to him the extremity of the Prepuce then introduces at the side of the Virga an Incision knife between the Glands and Cutis piercing the Prepuce without danger and cuting all between the Instrument and Extremity of the Glans If one Incision be not enough to discover it you may boldly make another on the opposite side the sole motion of the parts being capable to extend the Fibres of the Prepuce and render them obedient and make them that they restrain and dilate themselves according to thenecessity of Nature You must not use this Operation till you have tried Fomentations Caution Emollent injections and all other Remedies in vain which method is to be observ'd in all Operations The second kind of Phymosis is caus'd by some Inflamation Shanker Ulcer Induration Callosity and often by irritative Remedies misapplied in all these cases whether the sharp Humour which comes from the Ulcers irritate the parts or corrosive Medicines it happens that the passage of the Blood and Spirits is hindred and the Inflamation becomes so considerable that the Fibres are no more in a condition to obey This is also the reason why this virulent Sanies which comes from the Shanker excoriates these parts excites sharp pains felt only at the extremity of the Yard and Inflamation which is soon followed by a Gangreen if you hinder not its progress Cause of Pulsation in the part The pulsisick pain which is felt in this part can't proceed but from the Glans which is covered with a thin and delicate Membrane humected by a great number of Vessels particularly of Nerves and that its Substance is of a very fine and sensible texture so the motion which these virulent Matters imprint on the Spirits not being able to communicate themselves to the rest of the Yard because of the force and thickness of the coverings of the cavernous Bodies the pain must needs augment and become much more sensible and acute in this part But before you resolve on the Operation use Bleeding Fomentations Suppurations mixt with some prepations of Mercury which you must introduce with the end of your Probe the cerot of GALEN Emollient injections a Ball of Lint put between the Glans and skin compresses wet in Oxycrate in a word all these Remedies must be apply'd but especially the Situation of the Virga which must be laid on the Belly and sustain'd with a little Bandage CHAP. XVII Of Paraphymosis VVhat Paraphymosis is PAraphymosis is a Disease quite contrary to a Phymosis in one the Glans being hidden in the other Strangled and so strip'd of its Prepuce that you can't cover it again The cause of this Strangulation comes sometimes from the overthrow of the Cutis Cause which forms a sort of Bolster and sometimes from Inflamation which a Shanker or some other tumor preceded if the Strangulation be considerable there must needs follow interruption of the course of Blood and Spirits in these parts and consequently a mortification In this affect the Yard-swells so hard that it forms three or four Bags as it were alternately dispos'd half a Finger's breadth one from another These pursings come partly from the obstructions and partly from the reflux of Blood and Spirits in the Body of the Virga they are commonly follow'd by a tumor which occupies the neck of the prepuce and which is full of a reddish water which by the great heat of the part so rarifies ordinarily that from an Aqueous it becomes Windy This tumor augments so considerably the Inflamation that if you don't scarifie deep the tumified places to give a discharge the Penis wou'd not fail to mortifie How to bring over the Prepuce You must endeavour to reduce the Prepuce without compressing the Glans or putting your Thumb on its extremities as most do that treat of this Disease The Reason is that when the extremity of the Glans is pressed it enlarges it self and swells more which instead of making the prepuce slip rather folds up and hinders its reduction You use almost the same Remedies as in Phymosis There be some that pour cold water on the Belly but I think it of no great use or at least see no great effects of it for want of these Remedies you may use in Inflamation some Styptick water in which dip your compresses and apply them about the part you must also keep the same Situation and Bandage as in Phymosis CHAP. XVIII Of the Stone and Lithotomy THe STONE with which Mankind of all other Animals is most troubled is called in Latin Calculus Name and those affected with it Calculosi Its origin wou'd have been always unknown to us if the Chymists Art had not discover'd to us the secret of its formation in shewing the principles which Compose it by the just Analysis that Science makes of it The Opinion of the Ancients concerning its formation All the Ancients and their Abettors have alway maintain'd with great heat that the Stone is form'd by the most Crass Course and viscous particles of Blood which being carried into the Bladder with the Urine came to be
of the CANCER Three ways of extirpating a Cancer THE Cure of a Cancer may be attempted by Incision by Ligature or by Actual Cautery If you undertake it by Incision 1 By Incision you must cut its most deepest Roots that is to say you must anticipate upon the nighbouring parts and having taken it off you must squeeze the adjacent Vessels to make the Blood and Humours come out which may have contracted malignancy In respect of the Ligature 2 By Ligature it 's not much in use but if you would put it in practice it must be when the Bases of the Tumour is but small when the Roots extend themselves not far in compass and when it terminates in a kind of strangulation but being it is rare not to say impossible to meet with such a disposition the Ligature has no other use than that of suspending the Tumour that you may make the Incision more commodious You must observe that if you apply slightly the Actual Cautery after the Operation it 's to stop the blood 3 Actual Cautery and absorb and destroy some portion of the unclean matter which could serve as a Ferment for the Generation of a new Cancer and might even infect the whole mass of blood How to perform the Operation The method used in performing the Operation is this you introduce into the top of the Tumour a Needle arm'd with double Thread to make a sort of Loop with which you uphold the Tumour and the Surgeon cuts it round about the Base 'till to the Ribs with a very sharp Knife having taken off the Tumour you squeeze the blood out and pass slightly over it an Actual Cautery you dress the Wound with Pledgets arm'd with astringent Powders and lay a Plaister on it with Compress Napkin and Scapuler The best way of oxtirpating a Cancer But the best method is to make an Incision cross over the Tumour even to the Ribs and separate dextrously the flesh from the skin by this means you avoid the great deformity and pain and secure better the Wound from the Air. If the Diseased be not in a disposition proper to endure to Operation either through fear of pain or being weak and the Surgeon not make a favourable Prognostic it would be a rashness to undertake it besides that the great loss of substance and dangerous accidents which happen are worthy of reflection which break often the measures that the most daring Practitioners can take for as soon as the Tumour is taken off the Ulcer grows often malign painful and of a round figure which is a mark of slow cicatrisation the sides become calous livid high black and inverted according to the disposition of the Juices with which they are water'd An extraordinary way to cure a Cancer There are some that without performing the Operation do assure us that they have cured ulcerated Cancers with great Red Snails freed from their shells which are laid upon the Ulcer they say that they creep sometimes about the Ulcer fasten to it and leave their foam there that we find the bottom of their belly gnaw'd as it were and they grow so monstrous that in a short time they burst The reason is that these Animals contain an abundance of Volatil Alkalys which charge themselves with the Acids that entertain the Cancer and which grow and ulcerate the belly of these Animals so that being convey'd through the little branches of their veins into their mass of blood according to the order of Circulation they excite such an extraordinary Fermentation that these Animals must needs perish CHAP. XXVI Of Bronchotomia Bronchotomia a nice Operation THere is no Operation in Chyrurgery of a more nice undertaking than the Bronchotomia neither is there any more pressing or useful when ever one has the happiness to succeed in it The Causes of this troublesom Affect Causes proceeds ordinarily from some Wound great Crying long Discourses violent Passions or the alteration of the Humours If a simple Inflamation be capable of hindring Respiration what will not happen if any of these Causes concur to increase it Now whether the Inflamation attack the Muscles of the Larynx or some other parts it communicates it self not only to the Aspera Arteria but also to the Muscles of the Pharinx and neighbouring Glands which obliges the blood and spirits to stop in all these parts and to cause great obstructions then doth the blood which without intermission pressing on not finding its passage free stay there and augment both Inflamation and Tention the Vessels being after this manner distended and swoll'n up take up more space than before and must needs press the Aspera Arteria and hinder the passage of the Air in that part whence follows Suffocation Bleeding Clysters Resolutive Cataplasms Gargariems made with strong Wine in which you boil in B. Mariae Sanicle Golden Rod Perivincle and Angelico with many other Remedies are to precede the Operation unless danger of Suffocation oblige us to make it If the Obstruction and Inflamation attack only the Amigdals or Glandulae Tyroides you must endeavour to open them by the mouth with the point of a Lancet arm'd with a band of Lint If all parts of the Throat be inflamed and all Remedies proved without success you must betake your self to the Operation How to perform the Operation To do it methodically the Patient must sit upon a Bed or Chair with his head back leaning on a Servant's breast who upholds it with his hands Being in this posture the Surgeon chuses the most convenient and less dangerous place where he may make the Operation which is a Thumb's breadth from the Larynx between the third and fourth Ring of the Aspera Arteria he pinches the Cutis c. cross makes an Incision at length and separates very gently and artificially the Brochales and Musculii Sternobyoidei Having discover'd the Aspera Arteria Caution you incise cross-ways with a Lancet arm'd the Carnous Membranes which ties the cartilaginous Rings together avoiding the recurrent Nerves which carry the spirits necessary for the function of the organ of the voice which if they should chance to be cut would be lost The Incision being made before you withdraw the Lancet introduce a Probe which facilitates the entry of a short Pipe which must be crooked and proportionable to the Wound there must be a hole on each side to pass a little Ribon through which is to be ried behind the Neck to keep it fast we put a little Cotton or piece of Sponge at its entry for to modify the Air a little then apply a Plaister on it with holes in it Compress and a pierced Bandage CHAP. XXVII Of Fistula Lachrimalis THe Fistula Lachrimalis is always caused by a sharp and salt Humor If the Matter of the Tears which run through the lachrimal passages have received any alteration it may cause some obstructions in those passages which terminate at
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
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
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
the liberty of moving He suffers a fixed and dull pain which is a common sign of a PLURISY with this difference that the Pluretic Pain is pungent comes all of a sudden whereas the Pneumonic Pain that is to say that which proceeds from an Impostume of the Lungs comes only by little and little and successively The continued Fever doth not leave accompanied sometimes with an immoderate thirst his spittle is purulent his mouth and throat dry he hath red cherry cheeks sunk and hollow eyes having lost their lively and glittering colour his nails bend backward and the whole body grows at lest dry and emaciated and if the Fever increase the Patient falls into Delirium and his Spittle be black livid or ash-colour'd Death is not far off because they are mortal Symptoms which oftentimes accompany it So much for the Impostumation of the Lungs which comes from an internal Cause Let 's now examine those that follow the Impostume of the Lungs caused by Wounds the difficulty of Breathing is not so considerable the Fever is continual accompanied with shivering and cold Sweats which appear from time to time these two last accidents are depending from the Pleura The Patient spits pretty often Blood in the beginning and towards the end it 's frothy and purulent When the Spittle is of a yellow colour it 's mortal he cannot lie but on his back because being on his sound side the wounded Loab lieth heavy upon the Mediastinum and causeth a twitching and cruel pain and when he turns himself on the wounded side the Lungs coming to lie heavy upon the Pleura which is hurt doth not fail to excite the same pain wherefore he dares not stir Signs of the Lungs being wounded In the beginning his eyes are brisk but at last they grow dull and the face puffs up but the most certain Signs that the Wounds reach to the capacity of the breast and of the Lungs being hurt are the Probe the noise which the Air makes in coming forth and the Emphysema When you probe you must observe to make the Patient put himself in the same posture he was in when wounded that the extravasated blood may run easier out If the Wound penetrate to the substance of the Lungs the Blood which flows is forthy and the Air makes less noise and comes not out with such impetuosity as when the Wound penetrates only the Breast without touching the Lungs If one asks Objection Whence cometh the Air that is in the capacity of the Breast the Lungs not being alter'd and the reason why it makes such a noise You may answer Answer That it 's the outward Air which is got in through the mouth of the Wound and endeavouring to escape because of the expansion of the Lungs which press it every where It hapneth that those Particles which appear at the passage not being able to get out but with a great deal of pain through the resistance of the external Air and the smalness of the Aperture push and press one another so hard that they must needs make a noise and produce a kind of whistling passing out of the breast which can put out a Candle held to the mouth of the Wound Cause of the Emphisema The Emphisema is likewise only caused by the particles of the Air which penetrate the Porosities of the neighbouring parts which swells and blows them up so that often one cannot find the mouth of the Wound nor introduce a Probe It 's easy to see from what we have said that the Emphisema and the Air 's coming out of the breast are not always convincing signs of the Lungs being hurt because they happen when the Wound penetrates into the breast without having touched the lungs wherefore there are only the signs which we have spoken of that can give us afterwards certain marks of it but the Probe and the exit of the Air are two true signs that the Wound penetrateth into the breast You must observe Caution that if the breast be pierced through and through you must never let both the orifices be open at once for fear you choke the Patient the reason of it is evident because the Air cannot enter by two opposite sides without compressing the Lungs and hinder the motion of the Breast I have said that the true scituation when the Lungs are alter'd is to lay one down on the back for to ease the Patient because the Bronchia are compressed by the weight of the extravasated blood which presently takes away the liberty of breathing I intend to speak here of the superficial Wounds of the Lungs for if they be deep and that any great Vessel be divided one feels almost as much pain lying on the back as on the sides A certain Sign of extravasated Blood in the body of the Lungs But one of the most certain Signs that there is some Blood extravasated into the body of the Lungs and of which we have not yet spoken is that if we put our Finger far enough into the Wound provided the bigness or Diameter of the breast permit it we find that the Lungs are fastned to the Pleura round about the Wound and reunite themselves there even as the Intestine is united to the Peritoneum A Sign that the Wound has not passed the Pleura The Signs which demonstrate that the Wound doth not pass the Pleura are the Probe and the Air which never passeth through the Wound There are some others as the Pain Inflamation Fever Heaviness and Difficulty of Breathing besides the thickness of the exterior parts which may in some manner guide us for to be sure of it All these Signs nevertheless do not always shew that the Wounds are deep since a simple Inflamation of the Intercostical Muscles hinder free Respiration If we consider that the use of these Muscles is to raise the Ribs to enlarge and widen the Cavity of the Breast and that Inflamation and Tention are utterly contrary to their Action we shall agree that the Lungs cannot dilate themselves but with difficulty and seeing the Contraction of an inflamed Muscle encreaseth the Tention and great Tention many Divulsions and many Divulsions vehement Pain you must not wonder if the Diseased for to ease himself a little from the Pain retard the course of the spirits and have very great difficulty of Breathing Cause of the Heaviness The Heaviness proceeds from the Impotency of the Muscles for as soon as a part is out of action it seems heavy to us for it 's a burthen which the neighbouring parts must support and being they have neither strength nor motion to raise what offends they must succumb under the weight of a new and superfluous matter from whence depends the Heaviness We have explain'd in several places of this Treatise the cause of Pain Inflamation and Fever we have said that the Pain is excited by some actual Divulsions by whose occasion the Soul perceiving the destruction
of a part is afflicted the Inflamation hapneth when the course of blood is hindred in any part and that it 's sufficient to produce the Fever which is a Consequence of the Pain and Inflamation if a drop of extravasated and corrupted blood be carried to the heart Cause of Red Cheeks One hath Red Cheeks in an Impostume of the Lungs this comes from the irregular motion which the purulent Particles communicate to the Principles of the Blood and from the great number of Blood Vessels which irrigate the Cheeks Cause of the Dulness of the Eyes The Eyes lose their vivacity and sink into the head because the blood loseth its consistence and colour in losing its oil and unctuosity which makes the Eyes sink and become insensibly wan and dull proportionable as the sharp and tartarous Salts dissipate the oily and sulphureous Particles In all Diseases of the Lungs the Caule and Mesenterium always corrupted This I say is so true that in all Diseases of the Lungs we always find the Epiploon and Mesenterium which are the two Reservatoriums of the Fat corrupted it 's for the same reason that all parts of the body dry up and grow lean What gives the Red Colour to the Blood You must also observe that the Red Colour of the Blood doth not only depend on the mixture of the Sulphurs but also on the action of the Air which whirl about its Particles and being the Air that gets into the impostumated Lungs changes its nature it 's no more capable of setting them in motion neither to excite so lively a Sensation as before Cause of the Nails bending back The Nails bend backward because their Extremity being irrigated with a serous Liquor deprived of Spirits the Cutis must of necessity fall away and dry up now as the Nails are only a production of it it pulls them along and constrains them to bend like as a slice of Bread held to the Fire You must look upon all these signs as certain tokens that the Wound penetrates into the breast you may stay some days to examine its progress for if they proceed from a not penetrating Wound in a few days they cease by bleeding and suppuration and they continue and increase when the Lungs are alter'd or when the Diaphragma is oppressed by the weight of some extravasated matter An Emphisema may happen to any parts of the Body The Emphisema is not always a sign that the Wound penetrates because it may happen not only to Wounds of the breast but also to all other parts We see it even to come on Wounds of the Head where we cannot suppose the Lungs to send any Air so that unless the oppression be very great you must not try the Operation These signs do not only lead us to the knowledge of the nature of the Empiema but they tell us also whether it's necessary to practise the Operation For example Where the Operation would be useless it would be useless in the Empiema of the Lungs by reason the opening of the breast contributes nothing at all to the evacuation of the matter unless the Impostume be on the superficies of the Lungs then it would be of more use because we know that the Lungs are fastned to the Pleura and the Impostume is precisely where one feels a fixed pain but if so be the Impostume should be deep and manifest it self in that place by a fixed pain it would be fruitless If the effusion of the blood should happen from a Wound and that by good luck the Wound were in a place where the extravasated blood could easily get out provided the Lungs were not adherent by enlarging the mouth of the Wound to make way for it or by laying the Patient in a posture convenient for the running out of the matter the Operation would be useless Finally let the Wound be of what manner soever if we can facilitate the evacuation of the Pus by making the Aperture bigger we ought to avoid the Operation but if the Matter cannot have its free course you must make use of it for to deliver the Patient from suffocation and the chiefest circumstance of the Operation is to chuse a proper place to facilitate the exit of the matter The most proper places to perform the Operation Of Necessity There are two places in the breast proper to make the Operation one of Necessity the other of Election of Necessity where the matter appears as in the Impostumation of the Pleura or in that of the superficies of the Lungs adhering to the Pleura because we are forc'd to make the Operation where the Impostume is that of Election Of Election when there is nothing that obliges us to make it rather in one place than another in this case you must chuse the most convenient place which is between the second and third of the true Ribs reckoning from below upwards four fingers from the inferior Angle of the scapula and as much from the spine You must observe that in those who have been troubled with any long Disease of the Breast as with a long Pleurisy c. the Diaphragme is insensibly fastned to the Ribs and reaches sometimes even to the third fourth or fifth Rib A Caution to be observed particularly when the breathing is frequent and forc'd therefore you must inform your self which is the place where the diseased feels the pain if it be about the second of the true Ribs where ordinarily the Diaphragma is fastned or if it be higher which must be well examined before you make the Operation CHAP. XXIII Of the Operation of the Empiema HAving preparel all that must precede such a necessary OPERATION you place the diseased on a Chair or Bed he must keep his Body very strait and be held up by Servants that the Chirurgion may the easier take notice of the place where he 's to make the Incision In fat People you make it somewhat large that you may not be mistaken How to perform the Operation You pinch up the Teguments for to cut them at length with a Bistory and the fibres of the great Musculus Dorsalis cross for if they were cut otherwise they would stop the Aperture of the Pleura and so hinder the running out of the Matter you continue to incise dextrously the Intercostal Muscles some incise them at the uppermost part of the Rib to avoid the Vessels that lie all along its internal lower Sinus but seeing the Wounds which are near the Bones degeneration often into Fistula's Caution it's more proper to make it in the middle of the Intercostal Muscles When you are come to the Pleura you put your finger there all along which you slip a Bistory for to Incise the Pleura minding to guide well the point of the Instrument with the finger and penetrate not too deep lest you offend the Lungs or Diaphragma which are often fastned to the Pleura