like that which one feels sometime after the cut of a Sword this does not proceed from the first division but by those which are made through the action of the sharp and extravasated Humours No Pain without Solution of continuity so that as often as the Animal feels pain there are some divisions made by which means the Soul which watches and interests it self in the conservation of the parts of our Bodies is afflicted The cause of Convulsions These sharp Humours coming to shake vigorously the little Filaments of the Nerves cause the Spirits to run irregularly into the Muscles which excites the Convulsion The Spirits being put to flight instead of running into the Fibres of the Heart And of Syncopes and ruling their motion are carried in disorder sometimes to one part sometimes to another the Heart being deprived of the influx of the Spirits which are the true Instruments of its ordinary motion and being no more capable of contraction the course of the Blood must be suspended for some moments from whence comes Syncopes And of Vomiting But as soon as they retake their course they double their Action and are Lanch'd with so great Precipitation into the Fleshy Fibres of the Stomach through the familiar commerce and mutual consent between the Cardiac Nerves and those of the Stomach that they oblige it to discharge it self of all that 's in it which is call'd Vomiting And Diarrhaea The Ventricle with its powerful and repeated Contraction passes so hard the Bladder of Gall and the Neighbouring Bilous and Pancreatic Ducts that it squeezes out their Juyces into the Cavity of the Guts which presently causes a Diarrhaea The cause of a Fever These two Liquors being thus prest out of their Vessels without having received all the preparations and alterations which are necessary for them fail not to make the Chyle Acid with mixing themselves in the Intestines they serve for Leven and Ferment to corrupt and produce a Fever Of heaviness of the Head and failure of the Senses The Blood being in Fermentation mounts with such an impetuosity to the Brain that the Sinews thereof which receive all the rest of the Blood of the Interior Head cannot discharge proportionably so much Blood into the Jugulars as the Arteries furnish by reason of the slowness of Circulation in these Sinews so that the Nerves which come from the base of the Skull to be distributed to the Organs of the Senses are a little comprest by the weight of the Blood which causes heaviness of the Head and that the Senses don't receive the impressions of their Objects with the same facility as before through the Obstacle that the Spirits find in their passage How to prevent those ill Accidents To prevent all these Accidents you have nothing to do but to cut the rest of the Tendon if the major part be divided but if the loss of the Fibres be not so considerable and the Symptoms not so pressing you must do nothing rashly If you perform the Operation you must Stitch the Tendon rather than cut it so that the Surgeons intention is to Reunite the two Extremities by Suture If it happen that the Extremity of one part be so far shrunk into the Flesh that it cannot be brought to the other by the Forceps it would be convenient to molifie the Fibres a little with some Oyls extracted without Fire as Ol. Amygd Dul. Ovor. Cerae c. which are proper to relax the Fibres and facilitate their Union for if the Oyl be Extracted without Fire the heat does not so soon dissipate their Viscosity which is the true Cement besides they are more capable of tempering the Acid of the Blood and of appeasing pain The Tendons being molified you must Stitch if you can and seeing they are Compos'd of little Fibres How to perform the Operation you must take half the breadth of a Finger upon the Body of the Tendon that the Stich may better resist the motions of the part and the flowing of the Matter If the Tendon be not discover'd enough you must try to make the Suture without unfleshing it because the Flesh secures it from all alterations After the Surgeon has put the part in a convenient Situation a Servant must uphold one Extremity with the Forceps whilst the Surgeon with his left Hand holds the other and with a strait Needle arm'd with double wax'd Thread knotted at the end pierces them from without inwards and from within outwards bringing them exactly together then lay away your Needle and take a little compress of Cloth with two holes in it to pass the two ends of the Thread through and make a single knot over which apply another little Compress which you fasten with the Surgeons knot and slip knot you must observe to wet the Compresses in some Spiritous Liquor and put some wax Candle on the knot instead of Lint The Suture being made you must humect the first Day with some Oyle and Spirit of Wine the following days we use a Balsam made of Tereh Tinct Aloes Vnctuous Medicices not proper or that of the Tinct Flor. Hyperici the use of Oyls or Fat 's are here to be rejected because they Putrifie the Tendons In the beginning Cataplasms made of the four Meals Wine the Yolk of an Egg and Hony are very proper It must be observed that as soon as Suppuration is made 't is evident that the Tendon begins to be united most good Practitioners Commend in long Suppurations to make use of Spirits on bared Tendons Emplas Andreae è cruce CHAP. V. Of the Hair-Lip VVhy so called IF Sutures have any use in performing Operations 't is doubtless in the Unition of the Hair Lip so call'd because this Animal has naturally the Upper-Lip slit This Malady comes sometimes from an imperfect Conformation and sometimes by Accident viz. it may be caused by some Blow Fall or other like mischance if the Reunion be then neglected it 's to be fear'd least the edges grow Callous and at length a true Hair Lip is form'd 'T is very often an Hereditary Deformity which we keep as long as we live unless we are willing to suffer the Operation however its cure cannot be accomplish'd but by Suture If there be great loss of substance you must not hazard the Operation because the Cutis wou'd be so much extended that it wou'd be very hard to Pronounce well certain Words and to make with care all the other motions which this part is capable of those which happens to the Under-Lip are of difficult cure because the Defluxions are more-frequent and the Lip always humected with many serosities Where cutting Hair-Lips wou'd be useless There are several other occasions where the Operation wou'd be useless as in Children by reason of their continual Crying in the old Scorbutick and Pox'd in irregular Women and in several other vitiated and indisposed Subjects in which the Blood
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
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
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
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
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
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
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
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