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
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
since the ligaments of the Liver Pancreas and Kidneys being relax'd Also the other Viscera they may as well as the Spleen contribute to its formation According to the order I design in speaking of so nice an Operation I think it more proper successively to describe the Signs of all kinds of Hernias that I may not confound them Signs of Hydrocele I begin with those of the first kind of Hydrocele in which the waters are spilt between the Membranes of the Scrotum which are light tension considerable largeness heaviness we feel an undulation when we handle the tumor and perceive the transparency of the waters when we hold a light behind and the skin becomes tender soft without pain and looks extreamly shining In those of the second kind where the waters possess the Membrane of the Testicles are great tension pain greater heaviness than in the other the skin of the Scrotum is not so much extended and keeps its rugosities though it be very much swell'd through it be very much swell'd it possesses ordinarily but one side the Fluctuation's deep the transparency more obscure It 's to be observed that these two sorts may conjunctly meet together Signs of Sarcocele The signs of Sarcocele are great hardness insupportable weight and insensible augmentation of the tumor if there appears no elevation in the Groin it 's a sign that the preductions of the Peritonaeum are not accompany'd with any carcinomatous substance It 's distinguish'd from the Hernia Intestinalis that the one 's soft the other is hard this tumor may be divided into Scirrhous and Malign in the Scirrhous we feel neither heat nor pain but in the Malign an excessive heat and sharp burning pain Varicoâ—â—… Signs of Varicocele are great inequality heaviness pain and Inflammation particularly when it 's irritated with some Medicine it 's also known because it makes a Man somewhat impotent especially when it possesses both Testicles Circoce Signs of Circocele which is caus'd by the dilatation of the external Vessels different from the Varicocele which comes from the Internal are the same as the former except there is less pain weight and Inflammation add that the Membranes of the Scrotum are more extended and the tumor more apparent Of Pneumatocele Signs of Pneumatocele are when the tumor disappears from time to time it sounds like a Drum when it 's struck without pain weight and inflammation very transparent the colour of the Cutis changes not and the Wind is felt sometimes above sometimes below Sings of Hernias made from the parts Let 's now examine the signs of those Hernias which are caus'd by the parts and enquire exactly into them because 't is of the greatest importance In the beginning of these Hernias they are ordinarily soft without inflammation change of colour disappearing at the least pressure except they be caus'd by some Blow Fall or such-like inconvenience and are not accompanied with some Strangulation caused by Matter stopt and harden'd in the Intestines either by the course of the Blood and Spirits in these parts which presently excites inflammation and often mortification therefore you must do no violence to the tumor by rude handling lest it occasion a Gangreen but that we may have a clearer notion of all these signs let 's examine them in particular and see what are those which make us distinguish all these kinds of tumors 〈◊〉 that â—…ut is If the Gut be engaged without Inflammation Strangulation or adhereing to any part the tumor's soft plain and the colour of the skin not chang'd it disappears from time to time particularly when the Party lies on his back When the Intestine is reduc'd a kind of whistling noise is heard Signs of the Omentum But if it 's in Omentum the tumour's soft and doth not return so easily It 's unequal by reason of the Bands and Fat with which it 's charg'd when press'd with the Fingers there remains a mark and we feel the same resistance as in pressing a Steatomatous tumor This is more subject to mortification because the texture of the parts of which it 's formed is loose spongy and more subject to corruption so that at the least impression the Blood stops more easily there than any where else wherefore you must not delay the Operation in certain occasions as we shall hereafter mention Note That if Inflammation happen it 's always at the Intestines side if it 's the Omentum it grows livid at the least alteration Inflammation a veâ—â— severe â—â—mptome As for the Accidents I find none more dangerous than Inflammation which is always accompanied with pain Fever Strangulation and sometimes with the Illiac passion where the excrements are often forc'd against their own weight to mount and come out of the Mouth the cause of which cruel Symptom proceeds from the Guts being inflam'd by the excrements which are lodged there It communicates this Inflammation to the rings of the Muscles particularly to those of the external oblique which by reason of its tendinous Nature fails not to shut up the Gut and augment the Inflammation by a reciprocal action which causes interruption of the course of the Blood and Spirits in that part from thence comes the reflux of the excrements lividity and mortification It 's easie to conceive that having lost their motion there can follow nothing but divulsion pain and loss of Life There 's yet another kind of lividity which comes from having handled and press'd the tumor too much These unprofitable Touchings are as so many Bruises which are imprinted on the part the Gut and Omentum being press'd the Blood stops in the Vessels which causes immediate mortification and change of colour VVhen the Surgeon ought to avoid the Operation It 's also known by the pain which is greater as we have said The Surgeon seeing all these bad Symptoms ought to retire The rest of the Accidents I reserve till I describe the manner of performing the Operation An Idea of the Vmbilicus I begin with the Exomphalos but before I enter on the Operation I design to give an Idea of the disposition of the Navel It 's form'd by the Reunion of the Umbilical Vessels which slip obliquely into the thickness of the Peritonaeum which accompanies them and piercing conjuctly the Linea alba fasten themselves to the surface of the Cutis where they leave a little tumor which is call'd the Navel after the Birth In the Foetus the way through which these Vessels pass are as manifest as the rings of the Muscles of the lower Belly are in Adults but after the Birth they shrivel up and turn into Ligaments and as the parts where these Vessels meet grow bigger They oblige the Navel by their own weight insensibly From which I conclude that all the difference between the passages of the Umbilical and Spermatic Vessels is that the latter are easily distinguish'd and separated one
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
specific Remedies to hinder the progress of this Disease are Bleeding which keeps the first rank and I say that if it be of any use at all in Surgery it 's without doubt in this occasion Bleeding no where of so great use as here because in emptying the vessels it hinders the Blood from being carried so abundantly to that part and must consequently lessen the bigness of the Tumor in diminishing the quantity of the Blood Approved Remedies in a Plurisy The other Remedies are those which rarify subtilize and attenuate the Blood as Horse or Mule's dung infused in White-wine old He-goat's Blood in Powder all Volatil Salts and several other Remedies of that nature The decoction of Nettles in strong Wine which you sweeten with Sugar is also excellent you may at the same time you take the Decoction lay on the sides the bruised Nettles in form of a Cataplasm Of a Peripneumonia Having thus in general explain'd the Cause of a Plurisy I am obliged to say something of a Peripneumonia that sometimes proceeds from an Impostume of the Brain or from the Inflamation of some Membrane which changes into an Abscess as experience demonstrates in those that die of great Wounds of the Head but for the most part it 's caused by the corruption of the Blood that is to say by the exaltation of its sharpest Particles All the difficulty is to know why the Pus or Blood stops rather in the Lungs than in any part else for to make an Impostumation I say that three Causes contribute to its formation the alteration of the Blood Causes of Peripneumonia long and slow Respiration and the structure of the part First Cause Alteration of the Blood Concerning the first you must only make reflection on the nature and mixture of the Chile and thickest Blood which the right Ventricle of the Heart sends in every Sistole to the Lungs through the Pulmonic Artery We know that these two Liquors pass through the Heart and Lungs for to receive some necessary preparations for the function of the parts therefore we may say that they are the two receptacles of all that is most thick and indigested in the mass of Blood but if the Heart hath the strength and power by its constriction to subtilize and cast off all that is most heavy and material in the mass the Lungs have not the same advantage as we will prove so that the grosser substances being accompanied with some impurity and having only felt the first effects of the Heart for its perfection it must needs stop there and putrefy Second Cause Long and slow I espiration The second Cause which I establish is a long and slow Respiration It 's certain the more free the Air enters into the Breast and the more the Vessels are extended they are in a more fit condition by their elastic vertue or spring to express the Air through the Pipes of the Trachea Arteria and the more the Blood is agitated by the inspiration of the Air it 's driven with greater quickness into the Veins But on the contrary if the Blood is moved slowly by a long Respiration it follows that the Vessicles being not so extended as they should be and not expelling the Blood out of them with such a violence it stops and corrupts there gradually by the arrival and mixture of some ill Leaven or by the exaltation of its salt Particles from whence it comes that those who have a long Neck are more subject to it than others because the Air is obliged to make a long traverse before it comes to the Lungs which makes them dry up and alter insensibly Third Cause on the Structure of the Part. What the Lungs really are The third Cause is grounded upon the Structure of the Part the Lungs are a complication of little Vessicles in which the Arteries pour the Blood and where it 's mingled with the Air to receive some alteration there Now it 's shew'd in the Hydravlic's that a Liquor which passeth from a little Pipe into a greater loseth much of its motion and being the Arteries are very little in proportion to the Cells it 's no wonder if the Blood grow slow there and changeth its nature by the exaltation of some sharp and tartarous Salt and by the Fermentation which they cause there wherefore the alteration of the Blood the irregularity of Respiration and the largeness of the Vessicles of the Lungs in proportion to those of the Arteries are the three Causes that concur to the formation of the Peripneumonia Since the Signs of all these kinds of Diseases are of the greatest importance to succeed well in the Operation and to make a favourable or dangerous Prognostic I will endeavour to describe them with all the Order that is possible Signs of Pus or Blood in the Pleura The Signs which shew us that there is some Pus or Blood stopt in the Pleura are Inflamation penetrating Pain Heaviness a languishing and continual Fever a hard thick and deep Pulse accompanied with shivering difficulty of breathing a dry Cough and Thirst one cannot lie on the sound side by reason the matter lieth heavy on the Pleura and one grows lean and thin in a few days Signs of the Matter on the Diaphragma But if the Impostume break and the matter falls on the Diaphragma all these Symptoms cease and the Patient finds some ease for a time but immediately there comes others not less dangerous and insupportable besides the difficulty of breathing which is common to every Empiema one feels a heaviness upon the Diaphragma fluctuation a great uneasiness the Fever increases and becomes burning the Pulse rises the Pain indeed is not so sharp it being felt towards the false Ribs one cannot lie but on the side where the matter is for if you lie on the opposite side one feeleth a twitching upon the Mediastinum more cruel Pain and a much greater heaviness their spittle is sometimes stinking and there follows very often Impostumes of the Liver after these kind of indispositions even as it is observed after great wounds of the Head If the Pus be diffused on both sides one cannot lie on either by reason of the sharp Pains one suffers to be eased you must lie upon the back or belly Signs of Pus in the substance of the Lungs The Signs when there is Pus in the substance of the Lungs may be divided into equivocal and convincing the equivocal belong to other Diseases of the Lungs it 's very dangerous to be mistaking therefore let 's endeavour to examine them well that we may draw some advantages and that we may not undertake an Operation whose effect would prove not only useless but fatal If there be any Pus in the substance of the Lungs the diseased cannot breathe without pain he finds an insupportable and troublesom heaviness upon the Diaphragma because the weight of the matter deprives it of
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
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