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
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
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
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
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
supple the Ligaments and Glands are not entertain'd in their ordinary fluidity and as I have shew'd in thâ— Anevrism that it condenses at the least heat by the repose of its Particles and it forms an Anchilose so I say its formation must be much quicker here the heat being more excessive Now it 's evident that a concatenation of accidents of this nature may utterly destroy the part for if the Anchilose which grow about the Joynts and Ganglions which are form'd upon the Ligaments by the thickning and coagulation of the Nutritive Juice cause the loss of motion the alteration and mixture of several Liquors of different nature are very fit to putrifie it by their purulancy and acidity The Purulent Hmour corrupts and infects it the Acid pricks and gnaws it and the Viscous obstructs and makes it immovable It 's doubtless by reason of the contrariety of their principles which destroy one another in the actions of the Medicaments which causes them to be of so difficult a cure and so hard to prevent the Ligaments from rotting We have made you observe in the Examination of the Fistula in Ano that Wounds of the Joynts often degenerate into Fistula's because the salt Juice abounds there from every part and the Pus changes into a sharp and malignant Sanies which filters into the Porosities of the Nervous Fibres of the part making the Ulcer callous and fistulous This Humour becomes sometimes so biting that it destroys not only the Tendons and Ligaments but gnaws also the Cartilages and causes a Cariosity of the Bones To prevent all this you must follow the same Method which we have prescribed in Wounds of the Tendons that is to say you must use every thing that tempers sweetens and is capable to correct the acrimony of the salts When the Wound hath run well for some days and the swelling of the part a little gone down you use a Balm made of Ox-gall An Extraordinary Medicine in Wounds of the Joynts c. Spirit of Wine and Mel. Rosat which hath the faculty of discussing and resolving the Coagulate Matters After this manner you prevent the callosity of the Wound and all other accidents We commonly Cicatrise with Humecting Medicaments because Dissicatives make it deform'd The Bones differ from the Tendons and Ligaments in that their Contexture is more thick close and compact and are nourished with a more salt and subtil Juice If the Wounds which happen to them be simple the sole reduction of the Pieces maintained by Bandages is sufficient to cure them If the Fractured Bones press some Vessel or Tendon and the Contusion be considerable if you differ the reduction the part falls into a Gangrene and Mortifies If some pieces of the Bone be separated so that you cannot reduce them you must make an Incision to pull them out I know that this happens very seldom and the Splinters must the very much intangled in the Flesh if they cannot be reduced without Incision If the Bones be quite broke to pieces and some great Vessels lacerated you must cut off the Limb. I speak not here of the Dressings which are used in all sorts of Fractures I only recommend to you that the Bones be tied harder where broke then any where else to keep them reduced and to hinder the Callus from growing too abundantly We know that Compound Wounds comprehend both those of the Flesh and Bones and that besides the 18 tail Bandage they require the application of several different Remedies We use in the beginning Discutient Cataplasms to evacuate part of the Matter by Transpiration You must by all means Suppurate because we are obliged to wait for the generation of the Callus and exfoliation of the Bone besides a great Suppuration alters the Bones in a very little time It 's therefore necessary that Discutients be used in stead of Suppuratives and if in the first days we use Digestives Spirit of Wine and Hony must exceed you apply dry Lint upon the Bone till the Callus be form'd and after it's generation you apply Boulsters on it soaked in Spirit of Wine in which Sal. Armoniac and Camphire has been dissolved which is a most excellent Medicine to cure Ulcers of the Bone and to hasten Exfoliation You must observe that there never grows good Flesh upon a rotten Bone or that which is ready to exfoliate It 's always spongy and one may say that whenever they are of such a nature it 's a certain sign that the Bone must needs Exfoliate which most ordinarily happens in long Suppurations The formation of the Callus grows according to the Patients way of Living It 's observed that it grows too much and renders the part unequal when the Patient eats too plentifully and when they use too spare a Diet it grows not sufficient to reunite the part The Prognostic's of Compound Wounds are always very dangerous to Cachectical Persons Old and Pox't whose Bones rot oftentimes without any Wound coming upon them CHAP. V. Of Gunshot Wounds GUnshot Wounds are always very dangerous as well by reason of the great Contusion which accompanies them for the most part as because the passages of the Blood are utterly stopped We know that the Bullet's passing through a part scatters the substance and breaks the Vessels without any Hemorrhagy or Suppuration before three four five or sometimes six days the age temperament and nature of the part regulate these accidents the reason of it is grounded upon the great agitation of the Bullet and upon its round and blunt figure that enters with so much force and swiftness into the Flesh bruiseth and crushes the Vessels so that it forceth their Tunicles to glue themselves to one another and so opposes the flux of Blood unless some great Vessel be broke and the Blood force a passage by its Impulsion Obstruction great in Gunshot Wounds Of all Wounds there 's none where the Obstruction is greater than in these and which consequently are more capable of Inflammation and Gangrene The contain several Particularities to which the Chyrurgeon ought to give his attention The first is to consider whether they be in any of the Venters or the Limbs if superficial or penetrating if the Bullet hath passed through and through if it has touched some important part tending to the functions of Life in its passage which may be known by the succeeding symptomes But whether it has passed through or found some obstacle in its passage it 's well known that these kinds of Wounds are almost always accompanied with troublesome accidents Accidents accompanying Gunshot Wounds as rupture of some Vessel fracture of a Bone or Contusion which is of least consequence If the Orifice of the Wound be of a round figure and grown less by the fluxion the first Intention which you must satisfie is to dilate it you excite by that means Suppuration and procure a more equal Cicatrice you discharge the part in letting the Wound bleed as much