overcome them As for old Rottenness and Fistula's you must observe the same Circumstances and have regard unto three things to the Nature and Cause of the Disease to the Part affected and to the Supervening Symptomes To judge whether the Fistula's c. are curable and may be overcome by Medicines it 's necessary to examine whether they have been of long continuance the cause that produced them and that which foments them If the Cause of the Rottenness and Fistula's proceed from some Wound or Contusion and the Patient have not been long troubled with it if the Joynt be no way alter'd and the Humours which foment them be not malign Medicines may terminate the Cure But if the Cause proceed from Scrophulous Humours Critical Imposthumations or from the general perversion of the Humours if they be old settled in the Joynts and finally if the Rottenness Callosity Pain and Inflammation be considerable In a word if the part be no longer able to perform it's functions you must have recourse to the Operation provided the strength of the Patient give leave but before you put it in practice you must purifie the Mass of Blood and Humours by general Remedies as Diaphoretic's and Cardiac's I will not give you here an account of the Medicines which are employed as well Internally as Externally to hinder the disorder of the Gangrene being obliged to speak of them in a Treatise of Wounds and as every kind of Gangrene requires particular and different Medicines so it 's the part of a prudent Chyrurgeon and Physician to order and use them according to their Idea's and Understandings Several Circumstances to be observed Before you go about the OPERATION you must observe several Circumstances If it be the Arm you cut off you must cut off as little of it as possible because the little that remains serves in a manner to the functions of Life If it be the Leg though only the Foot should be concern'd you must Amputate 3 Fingers below the Knee just under the Aponevroses which cover the Rotula because of the long suppurations which rot the Tendons and other accidents that may happen and to put on an Artificial one more easily Never Amputate in the Joynt You must never amputate in the Joynts unless it be in the Fingers or Toes which we are obliged to take off If it be the Thigh amputate as little as you can because the more you cut the greater is the Wound suppuration longer and the cure more difficult and consequently the Patient's strength diminishes and grows more weak How to Amputate Having chosen a proper place we perform the Operation thus If it be the Leg you place the Patient on the edge of a Bed lying half backwards one sustains him behind a Servant clasps his two Hands about the inferior part of the Thigh and draws the Skin upwards another holds the Leg whilst the Surgeon puts on the Ham a Compress of several folds of a fitting bigness with another pretty large Compress which encompasses the whole part upon which you place a Ligature which must be streightned with the Torniket but being it must be tied very hard sufficient to compress the great Vessels you may place a Past-board under the Ligature that the Patient may feel less pain and for hindring the Skin from wrinkling Then you make two other Ligatures one over and the other below the first keeps the Skin which you raise upward and the other fastens the Flesh Then the Surgeon places himself between the Patients Legs and with a crooked Knife which he holds in his Right Hand How to cut the Flesh he makes an Incision about the Member even to the Bone and with the Back of the Knife separates the Periostium and cuts at the same time the Flesh and Membranes between the Bones lest you rend them with the Saw and so cause new accidents but before you saw the Bones you take a Fillet of Linnen which you split in two parts and you make use of it to raise the Flesh and to give liberty to saw the Bone as near to the Flesh as possible for seeing it wastes and consumes in suppuration if this precaution were not taken there would stick out an end of the Bone deprived of Skin and Flesh which would serve for nothing but to incommode the Patient How to saw the Bone This being done you take the Saw which you carry obliquely over the Tibia which also serves for a support to saw the Fibula which is the weaket which obliges us to saw it before the Tibia to avoid its cracking or shivering You must observe that in the time of sawing the Servant must bend the Leg a little inward that the Saw may pass more easily The two Bones being sawed off you take off the Ligature above which held the Skin fast you loose the Torniket to find out the Artery you take hold of it with the Crow's Bill How to tye the Artery or Pincers with a Ring then you take a crooked Needle arm'd with Wax'd Thread which you pass twice into the Flesh under the Artery that it may be engaged in the Loop of the Ligature which you tie very hard you make a knot over the Artery upon the knot you apply a little compress which you fasten with two other knots you again loose the Torniket If the Blood should run out with any violence from any other Artery you make another Ligature as the first Some to stop the Blood use an Actual Cautery others a Button of Vitriol which they wrap up in some Cotton some tye the Artery without passing the Ligature through the Flesh But I think the true and surest Method to be as I have describ'd The Ligature being made you take away the Turnstick from off the Stump Where to use the Suitches how to dress Stump and endeavour to cover it again with the Cutis If it be Thigh or Arm it 's not enough to cover the Stump again with the Cutis but you must keep if so by the help of four Stitches which must not be practised at the Leg or below the Elbow because the Knee or Elbow hinder it from rising too high you apply little compresses upon the Vessels and a dry one on the Bone or soaked in Spirit of Wine to correct its alteration then several other Boulsters arm'd with Astringent Powders over that a little Two spread with the same Powders a Defensative and Compress like a Maltha Cross two Longitudinal Compresses and a Circular one sustain'd by the Circular Bandage and Capling some days after you use only the Circular one you need not load the part with too many Compresses A Hogs Bladder of no great use nor apply the Hogs Bladder neither tye the Bandage too hard for besides that all these things excite only Obstructions and Inflammations if by chance the Ligatures should fail the Patient would infallibly perish unawares because the Bladder could retain
A TREATISE OF CHIRURGICAL OPERATIONS After the Newest and most exact Method founded on the Structure of the PARTS CONTAINING Their Causes Signs Symptons together with their Explanation and many curious Observations To which is Annex'd a General Idea of WOUNDS Written Originally by Joseph De la Charrier and Translated into English by R. B. LONDON Printed for Dan. Brown at the Black Swan without Temple-Bar MDCXCV The Author's PREFACE I Was so well satisfied with the Authentic Approbations that those learned Physicians have honour'd me with to give my Book that I was resolved to make no Preface but an accident happen'd which I thought convenient to make known to the Reader A certain Person who passes for a Man of great Merit and who is actually in a Post to distinguish himself desir'd some both of his and my Friends that something might be said in this Tract to his advantage I was in no great trouble to grant him his Desire and I began to flatter my self that he had some esteem for my Work nevertheless he has publickly declared himself against that he had so well approved in particular and many honest Gentlemen have been scandalized at his ill Temper as well as my self One may well think he imagined that this Book would not have the success it deserves and he has reproached me to have made use of his Writings It s no way disadvantagious to me that a man of his Rank should attribute to himself the Fruit of my Labours In the mean time the Reader will very easily see that I am no ill temper'd Man nor any way troublesome since in those things which are not my own I have cited the Authors among which one will not find the name of the Sieur Du its likely he himself has made use of the thoughts of the aforesaid Great men but has not been so ingenuous in owning it as I. Nothing 's so strange as Pride It often carries us to some excess which serves but the more to make our Faults and Weaknesses better known I 'll say nothing of my Book only I believe I have advanced little but what 's founded upon Reason and Experience which I 'll clearly demonstrate according to the Structure of the Parts I desire the Reader to judge of it without prejudice and that he would not esteem Mr. Du to be the Author of the good it contains APPROBATION THE Faculty of Physick in the University of Paris having heard the extraordinary Character that Mr. Le Meine and Mr. Engvehard Doctors Regents in the same Faculty gave of a Book of Chyrurgical Operations composed by Mr. Charrier approve this Work and think it most worthy to be Printed At the Physicians Colledge at Paris Thursday 19. October 1690. Signed Legier Professor to the King and Dean of the Faculty of Physick APPROBATION BY the Order of my Lord Chancellor I have examin'd this Manuscript which treats of Chyrugical Operations which deserves to be printed being inricht with a great number of Observations which will be exceeding useful to Chyrurgeons This I certifie to be true nevertheless I submit to the Gentlemen Physicians of Paris May 3. 1690. Signed Beissier THE PREFACE TO TEH READER WE have an English Proverb though somewhat obsolete yet true which is That good Wine needs no Bush the same I think may well be said of this little Treatise whose every line draws a sufficient Characteristic Note after it without being usher'd in with any Prefatory Discourse to raise its value yet since Prefaces in this Age are as much in Fashion as a pair of Gates before a stately pile of Buildings I hope a few lines will not be amiss to do the Author some justice in so admirable a Tract as this is I shall not pretend to write here an Encomium in the Praises of Chyrurgery nor indeed can I give it those due Graces it worthily deserves it having been already by such a Cloud of learned Men performed to my hand whose most ingenious Footsteps I can follow and those only at a distance not pretend in the least to imitate As for the Contents of this Book they are certainly praise worthy the Author being so famous a Practitioner especiall in the performing Chyrurgical Operations his Works shew him to be a Man of sound Judgment and Learning for he handles the Matter with such strenuous Arguments sound Reasonings and so home that I greatly admire none attempted before now to give it an English Garb when I first perused it and finding it applicable to what I had seen especially of late by an ingenious Gentleman of that Nation I was resolved to make it speak our Mother Tongue never designing it for a Press only as a help in my own Business it having been Translated above fifteen Months before it came to the Publick View and perhaps never had by me but that the Importunities of many Friends almost if I may so say forced me to it besides hearing one or two were on the Design of rendering it into English I thought it might be as well on my side seeing it had been so long done as theirs It must for certain be of great Benefit to our younger Students in the Chyrurgical Art though our Seniors may not be ashamed of having so pretious a Jewel about them who have not the opportunity of seeing many Operations perform'd and those few Authors which have treated of them have done it so slightly and superficially that after all your Study and Pains you are as far to seek as ever but this Tract is so exact and Methodical that it leads you as it were by the hand through the whole Course of every particular Operation as well as if you saw it perform'd by any learned Artists it not only demonstrates how to perform the Operations according to Art but also shews the Distemper explicates their Signes Causes Signes of those Causes and Symptoms according to the newest System of Philosophy founded on the Mechanic Formation of the Parts Yours R. B. A TREATISE OF THE OPERATIONS OF CHIRURGERY CAP. I. Of Operations in General AMong all the Parts of Medicine there is none so profitable as this which I undertake to treat of VVhat it teaches It teaches us how we ought to perform the Operations of Surgery it explains the chief Pathologic Phaenomena fortifies us in the knowledge of the Subject on which we practice and I dare boldly say that without the assistance of these Operations the Art of Surgery would never have arrived to so high a point of perfection which at this time it has atain'd and without it the Knowledge which relates to the explication of the Principal Distempers The Excellency of Chyrurgical Operations would have been only dubious and uncertain if light were not borrowed from hence by evident Demonstrations and by reasons which experience authorises It 's a study which contains nothing but what 's worthy to entertain our Wits and engages those who love the Profession to shew the
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
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
those which cover the bottom four or five days before you take them out to the end that by their stay the Matter which is stop'd become more sharp and that they may dissolve more easily the Tunicles which contain the Waters you suppurate it and dress it as an ordinary Wound Before you go further you must also observe that if the waters grow sharp and corrosive or rather lixivious they change often into Pus which makes the Testicle alter and corrupt so that you are forc'd to take it out Cure of Pneumatocele As for Pneumatocele you must use the bandage and all the carminative Remedies as well internal as external and as it 's a part of the Surgeon's prudence to order them according to his Knowledge I shou'd be ridiculous if I should boast here of Remedies which Authors are full of CHAP. XVI Of the Phymosis What Phymosis is THE Phymosis is nothing else but a shrivelling and contraction of the extremity of the Prepuce which compresses so hard the Glans that if you don't give it Air by way of Incision it becomes inflam'd and often mortifies This incommodity is either natural or accidental the natural comes from the parts being yet concentred and as it were retir'd into its Tunicle and that one has not yet betaken himself to any exercise or touching The Prepuce forms in this affect wrinkles which are like so many little Bolsters As Venery between which gathers and stagnates a tenacious Matter separated by the Glans with which the inner surface of the Prepuce is sprinkled which thickens by the heat and growing impure by its stay there is as it were a kind of Glew which fastens the Prepuce to the Glands and so straitly presses it that it will not let the Urin flow The Surgeon therefore first endeavours to free the parts pulling to him the extremity of the Prepuce then introduces at the side of the Virga an Incision knife between the Glands and Cutis piercing the Prepuce without danger and cuting all between the Instrument and Extremity of the Glans If one Incision be not enough to discover it you may boldly make another on the opposite side the sole motion of the parts being capable to extend the Fibres of the Prepuce and render them obedient and make them that they restrain and dilate themselves according to thenecessity of Nature You must not use this Operation till you have tried Fomentations Caution Emollent injections and all other Remedies in vain which method is to be observ'd in all Operations The second kind of Phymosis is caus'd by some Inflamation Shanker Ulcer Induration Callosity and often by irritative Remedies misapplied in all these cases whether the sharp Humour which comes from the Ulcers irritate the parts or corrosive Medicines it happens that the passage of the Blood and Spirits is hindred and the Inflamation becomes so considerable that the Fibres are no more in a condition to obey This is also the reason why this virulent Sanies which comes from the Shanker excoriates these parts excites sharp pains felt only at the extremity of the Yard and Inflamation which is soon followed by a Gangreen if you hinder not its progress Cause of Pulsation in the part The pulsisick pain which is felt in this part can't proceed but from the Glans which is covered with a thin and delicate Membrane humected by a great number of Vessels particularly of Nerves and that its Substance is of a very fine and sensible texture so the motion which these virulent Matters imprint on the Spirits not being able to communicate themselves to the rest of the Yard because of the force and thickness of the coverings of the cavernous Bodies the pain must needs augment and become much more sensible and acute in this part But before you resolve on the Operation use Bleeding Fomentations Suppurations mixt with some prepations of Mercury which you must introduce with the end of your Probe the cerot of GALEN Emollient injections a Ball of Lint put between the Glans and skin compresses wet in Oxycrate in a word all these Remedies must be apply'd but especially the Situation of the Virga which must be laid on the Belly and sustain'd with a little Bandage CHAP. XVII Of Paraphymosis VVhat Paraphymosis is PAraphymosis is a Disease quite contrary to a Phymosis in one the Glans being hidden in the other Strangled and so strip'd of its Prepuce that you can't cover it again The cause of this Strangulation comes sometimes from the overthrow of the Cutis Cause which forms a sort of Bolster and sometimes from Inflamation which a Shanker or some other tumor preceded if the Strangulation be considerable there must needs follow interruption of the course of Blood and Spirits in these parts and consequently a mortification In this affect the Yard-swells so hard that it forms three or four Bags as it were alternately dispos'd half a Finger's breadth one from another These pursings come partly from the obstructions and partly from the reflux of Blood and Spirits in the Body of the Virga they are commonly follow'd by a tumor which occupies the neck of the prepuce and which is full of a reddish water which by the great heat of the part so rarifies ordinarily that from an Aqueous it becomes Windy This tumor augments so considerably the Inflamation that if you don't scarifie deep the tumified places to give a discharge the Penis wou'd not fail to mortifie How to bring over the Prepuce You must endeavour to reduce the Prepuce without compressing the Glans or putting your Thumb on its extremities as most do that treat of this Disease The Reason is that when the extremity of the Glans is pressed it enlarges it self and swells more which instead of making the prepuce slip rather folds up and hinders its reduction You use almost the same Remedies as in Phymosis There be some that pour cold water on the Belly but I think it of no great use or at least see no great effects of it for want of these Remedies you may use in Inflamation some Styptick water in which dip your compresses and apply them about the part you must also keep the same Situation and Bandage as in Phymosis CHAP. XVIII Of the Stone and Lithotomy THe STONE with which Mankind of all other Animals is most troubled is called in Latin Calculus Name and those affected with it Calculosi Its origin wou'd have been always unknown to us if the Chymists Art had not discover'd to us the secret of its formation in shewing the principles which Compose it by the just Analysis that Science makes of it The Opinion of the Ancients concerning its formation All the Ancients and their Abettors have alway maintain'd with great heat that the Stone is form'd by the most Crass Course and viscous particles of Blood which being carried into the Bladder with the Urine came to be
adherence which the Lungs contracts with the Pleura so that they can communicate their inflamation and alteration to one another and that the matter may pass from the Lungs through the aperture of the wound without one drop of it being spill'd in the cavity of the breast which is to be well examined before you separate the Lungs from the Pleura with your finger or Probe as most Practitioners are wont to do that is to say if the matter run with ease through the Aperture and without the Diaphragma being oppressed with it you must no ways break the adherence of them A Quinsy can never cause an Empiema I do not speak here of diseases of the Throat we know well enough that never an Empiema succeeded a Quinsy the reason is that the Pus cannot fall upon the substance of the Lungs without causing a sudden suffocation because the Pus by its weight would hinder the play of the vessels that compose them wherefore there is only Plurisies and Impostumes of the Lungs which precede the Empiema that comes from an internal cause Causes of a Plurisy As for the eause of a Plurisy some say it 's form'd by a boiling and impetuous blood which is extravasated in the Plura others pretend it 's caus'd by a bilous blood which gathers and putrefies between the ribs and Plura Some others maintain that it proceeds from an extravasation of blood that comes from the intercostal veins and the Aziges which is discharged between the duplicature of this membrane where it changeth into pus by its stay there though this last opinion be not over-well grounded yet it is the most common and most received It were to be wish'd that all these opinions were as true as they are authorized by their Partisans for besides that the blood being ordinarily spilt out of the vessels only after some blow or wound it 's evident that the bilous particles are rather capable to dissolve a matter than coagulate it and that it 's only the salt volatil alkalies of the Bile which tend to the exaltation but there must needs be here a coagulating Agent which disposeth it to be obstructed in this membrane There is nothing more common A common Cause of Plurisies than to see in the Summer-season Plurisies affect those who having over-heated themselves by running or some other as violent exercise go imprudently to drink Iced Liquors or in a Cellar to cool themselves having most commonly their Breast open You must consider that in the same moment the Pores being much dilated the blood is in an extraordinary agitation and furnishes abundance of Swetts this being so it happens that at the same time as this cold drink chills as it were the blood in the vessels the impression of the external cold Air suppresseth the Swetts in shutting up the pores and they being quite disingaged from the rest of the mass stop in the duplicature of this membrane where they coagulate the blood by the means of their urinous volatil Salt Urine and Swett analogous Experience teaches us that there is no liquor in the body has more analogy with the Urine than Swett we observe also that it hath the same taste smell and consistence we know that the Urine abounds in a urinous volatil Salt and in a very aetherious Sulphur Now I say that these two spirits which are found in the Swett as well as Urine whose nature and property we have explain'd elsewhere hapning to be united together in the PLVRA in the time of the suppression of abundance of Swett are very capable to condense the blood and cause the Plurisy which HIPPOCRATES hath well observed Sect. 5. Aph. 24. when he says that cold things as Snow and Ice are Enemies to the Breast and that they excite Coughs Dysenteries and Fluxions Frigida vcluti nix Glacies pectori Inimica tusses moverit sanguines fluxiones distillationes movent He says likewise that the Scythians do not live long because they drink Ice waters and that the frequent use of these waters offend the Breast for the same reason says HIPPOCRATES Sect. 3. Aph. 23. Plurisies happen most commonly in the winter-time as also Peripneumonia's Coughs pains of the breast and sides Hyeme plureides Peripneumoniae tusses pectoris Laterum Dolores It 's commonly observed that those who expose their breast to the Air in the beginning of hot weather are almost always troubled with a Plurisy the reason of it is evident if we make reflection that no part of the body is so deprived of flesh as the breast which is the inclosure of the treasure of life and which consequently is sooner penetrated by the Air wherefore those who take care to cover at all times their Breast well are much less subject to Plurisies and many other diseases A Plurisy often from a nitrous Air. The cause of a Plurisy doth not always come from having put your self into a heat or exposed your self to too great a cold but it comes often from an Air too much loaded with nitrous and sulphureous Particles which we attract in inspiration and which produce the same effect as the principles which we have said are found in the Swett Those kind of Plurisies which we call Popular or Epidemical happen oftner in Countries where the Earth abounds with Nitre and Sulphur and where the heat is excessive as in Meridional Regions Who most subject to on Plurisy The constitution of persons contribute much to its formation those who are of a quick wit whose blood is subtil and are of a tender Complexion are more subject to it than others An Observation on the blood of a pluretic person It 's observable that after having bled a pleuretic person there is a little skin form'd on his blood like glue and almost of the same consistence which has a kind of spring or elastic vertue for when ever you handle it with your fingers it resists a little and returns into its first posture it swims upon the blood even as certain little flanks swim upon the urine of those troubled with the inflamation of the Reins As for the Prognostic of this Disease Prognostics it is always very dangerous when Bleeding and general Remedies do not dissipate the Tumor HIPPOCRATES says that if one spit from the beginning the disease will be short but if one spit not till some time after it will be long Velut in Pluretide laborantibus si sputum statim appareat inter initia ipsam abbreviat si vero postea appareat producit Yet this Rule is not always true because there are some that do not spit and yet recover in a very short time whether that the Humor which causeth the obstruction be dissipated by insensible Perspriration or by the way of Circulation according to the vertue and operation of the Medicines which are used in this Disease The best way of curing a Plurisy The most
the Head may be cured by the Suture or by the uniting Bandage unless the loss of substance be considerable But if the Wound be compound that is if besides the exterior parts the Skull Dura Mater or the substance of the Brain it self be offended the Physitian and Chyrurgeon ought to suspend their Judgments and recollect at the same time their Ideas and Knowledge to prevent the ill Consequences of any Accident whose causes and symptoms are so dangerous and very often Mortal The Skull may be fractured the Dura Mater prick'd cut broken torn depressed and the Brain cut taken away shaked or filed with some extravasated matter The Skull may be hurt 2 ways 5 Kinds of Hippocrates The Skull may be hurt two ways by Incision or Contusion Hippocrates has established five kinds of Fractures which he hath called Fissure Contusion Incision Depression and Counter-Fissure Whether the Fissure be Oblique or Perpendicular 1. Fissure it contains one only difference which is to distinguish well whether there be but one or both Tables fractured The Contusion is of two sorts 2. Contusion the one doth not destroy the Continuity Hippocrates called it Thlasis vel Phlasis it 's nothing else but the forcing down of the Bone without being broke Most incident to Children According to Hippocrates it happens on the Skulls of Children that have as yet the Bone very soft and tender This Depression is after the same manner as a bruise in a Pewter Pot. The other kind of Contusion destroys the Continuity In this the Bones are equal and contiguous It 's a single Fissure which always reaches beyond the place where the blow was given If it be apparent it 's called Khegma If it be insensible it 's called Trikismos or Capillary Fissure The Incision is of three sorts 3. Incision Eccope Diacope and Apokeparnismos Eccope is a perpendicular Incision of the bone without carrying off the piece leaving nothing but a mark HIPPOCRATES calls it Hedra the Latins Vestigium or Sedes Diacope is when the blow lights obliquely and goeth deep into the substance of the bone without carrying it off And Apokeparnismos is when the piece is intirely carried off The Depression destroyeth both the equality and contiguity of the bone 4. Depression HIPPOCRATES calls it Esphlasis or Enthlasis depression or fracture with a splint he hath established three kinds of it Ecpiesma Angisoma and Camarosis Ecpiesma in Greek is a depression of the Skull where the Splints press the Dura Mater Angisoma is a depression where the Splint separates it self and passeth under the sound bone Camarosis or the Vault is the third kind this is divided in five sorts In the first a part of the Bone bends down in breaking and the other turns up In the second the Bone boweth downward without any slit this hapneth only to Children as I have explain'd heretofore The third is a Depression where the sides are forced down the middle remains bent upwards as a kind of Vault leaving some hollowness under it The fourth riseth of it self this is also when the Bones are only membranous because they have a kind of spring or elastic virtue till they begin to ossify Lastly the fifth kind of Camarosis is when the second Table is depress'd and the outward return'd to its first state this last only happens to Infants for Reasons which we have alledged The Contra Fissura which HIPPOCRATES hath established without ground 5. Counter-Fissure hapneth in the same Bone in divers Bones and in different Tables in the same Bone when the uppermost part is struck and the lower broke in divers Bones as when the blow is given on the occipital and the coronal is broke in different Tables when the first is struck and the second broke These are three Chymeric Examples quite contrary to the structure of the part if we see wounds of the head of this nature happen after Concussions of the brain it proceeds not from a Counterfissure as HIPPOCRATES pretends but by true Relapses No such thing as a Counter-Fissure It may easily be seen that when a man has lost his senses and hath recover'd them partly again he is yet all giddy and may after this manner relapse twice or thrice and get new Wounds for it 's impossible that a Machin composed of several pieces as the Skull is can break in a place opposite to that where it received the impression it being certain that the blow dieth in all the circumference of the assemblage and that the diploe hinders the shake from being communicated to the interior Table But without confounding and mistaking our selves we may say that the Skull may be slit depressed fractured cut or carried off If it be slit the Fissure is visible or almost insensible but whether it be apparent or not nothing is capable of giving us convincing marks that it penetrates and that there is blood spilt on the dura mater than these which succeed The use of Ink the Rugine and the Handkerchief in the mouth keeping one's breath is absolutely useless because the Diploe confounds and hinders one from seeing whether it reaches to the dura mater or not besides the practice of the Rugine will never be approved on by good Practitioners not only because they do not give us any knowledge but also because there remains a loss of substance and deformity of the part If it be Depression it presses with it the dura mater and causeth several Accidents which we will examine If it be fractured either the Splinters are separated from the Cranium or not so by either way the dura mater may be compress'd prick'd or torn and the Brain hurt or at least some Blood may be spill'd upon these parts In all these occasions I say if the Fracture do not permit an unition of the shatter'd Bones and vent given to the strange bodies which might alter the dura mater you must without more ado perform the Operation provided some ill Symptoms preceded otherwise the Patient would die If it be cut or carried off either with or without shattering the Bone as for example If the Incision penetrate not and there be only a part of the Bone separated the consequences are not dangerous but if it go deep and there be some Splints separated that offend the dura mater if we do not soon remedy it the Patient is in danger of life Signs of inflamed dura mater If the dura mater be inflamed either by diffused blood or by some pricking compression tention cut or rupture one presently feels pain and heaviness in that part the Eyes grow puft up and inflamed the Face red and swell'd the diseased is drowsy with Fever the Pulse hard with shiverings and blood comes often from the nose ears and mouth just as in great concussions of the brain We know that the dura mater is prick'd or torn when there are some sharp pointed Splints or rugged pieces
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
all the Blood that should run out You must take care in pulling off the Dressings not to handle them with too much violence lest you pull also off the Ligature You must take care after suppuration to press the Stump a little by means of the Compress to hinder the generation of fungeous and superfluous Flesh which ordinarily happens after long Suppurations Caution to be used in applying the Vitreol Button Those that use the Vitriol Button must precisely apply it to the mouths of the Vessels and take care it doth not fall in applying the Bolsters Nevertheless though we have disapproved its use for several Reasons yet those that will make use of it ought to lift the Stump up a little and hold the Hand upon it for 3 or 4 hours until the Vitriol hath begun to produce its effect In happens sometimes that after the Operation the part suffers some Convulsive Motions Cause of after Convulsions occasioned by the Spirits being irritated by sharp corrosive or Vitriolic Matters or by the trouble of the Spirits themselves in the part For if we consider that the Brain actually prepares a certain quantity of Spirits which run through the Nerves to serve the Functions of the whole Body we shall agree that those which are designed for the motions and sensation of that part which is no more existent but separated from the others must needs run back It 's perhaps this unlucky reflux which excites these irregular Convulsions and the involuntary Contractions pull along with them the Arteries and so gives occasion to the Ligature to break and the part to bleed which often causeth Death Therefore in these Occasions a Chyrurgeon must not stand searching for the Artery he must only lay upon it the Vitriolic Button with Bolstâ—…â—oaked in some Styptic Liquor These are the measures which you must take in such Occasions CHAP. XXXVII Of Paronychia PARONYCHIA is a very painful Tumour which possesseth the Fingers ends caused by the alteration and effervescency of the Bilious and Sulphureous Particles of the Blood Two kinds of Paronychia They ordinarily make two kinds of it in the one the Matter lies between the Periostium and the Bone accompanied with a burning heat acute pain and deep pulsation great Tention and burning Fever The other is only in the Flesh with less heat and pain lighter pulsation less Tention and hardly any Fever at all Cause of the Heat and Pain The heat and pain come from the strong ebullition of the Blood and many irritations whiâ—â—â—he sulphureous particles that â—…elt and are â—â—rn'd into Sanies excite at the Fibres of the Periostium Cause of the Tention The Tention proceeds only from the fermentation of the Humours it 's easie to comprehend that when a Liquor boils it extends it self more in length and breadth than when it is at rest and must consequently dilate the Vessels in a great manner that contain it Cause of the Pulsation The Pulsation is nothing else but a more exquisite and lively feeling that we have of the Arteries beating in the inflamed part caused by a great Tention and Effervescency of the Blood Cause of the Fever The Fever comes from the mutual agitation of the different particles of the Blood that fight against one another with great strength and tear one another in a thousand little particles of a different bigness and figure which being moved in the mass of Blood excites the Fever but after a long struggle the Pus is made the Vessels burst the Matter Extravasates the Tumour grows softer the Fever and all other symptomes diminish then we give the Pus Issue by Incision Where to make the Incision which we make at the side of the Finger to avoid the Tendon we then use those Medicines ordinarily used for other Ulcers I will no longer insist upon the Paronychia though it would furnish us with Matter for a long Discourse and seeing most Authors have given their Opinion of it any one may be Instructed by them CHAP. XXXVIII Of the Use of Cupping-Glasses MOST Practitioners of Physick are wont rather to approve the use of Cupping-Glasses and Leeches than condemn it be it that they either found themselves upon that pretended Attraction of the Ancients Cupping-Glasses of very little use or that they think to discharge sooner a part loaden with the weight of some strange Matter It 's true they use them but with little success besides this Attraction is just a Chimera and is the most cruel and temerarious practice that can be imagined What appearance is there to scarrifie the Back to dissipate Inflammation of the Eyes To slash the Loyns to hinder the progress of malign Fevers No such thing as Attraction to cut the Skin and Flesh in 20 different places to draw one or two Ounces of Blood I do not believe that those who have an Idea of the Circulation of the Blood can shew me by Experience or any other way that the division of some Cupillary Vessels are capable of curing the least Cutaneous affect Nevertheless there are some that do authorize this practice maintain that the Scarifications do determine the Blood and Spirits to repair in abundance to the scarified parts and that in moving the Humours after this manner the afflicted part is disengaged and the Inflammation lessen'd It 's to be wished for the Partisans of this practice that the Inflammation would favour their Opinion For we cannot believe that the Blood and Spirits running into a part in a greater quantity than the used to do without causing some Inflammation which is not observed here besides Inflammation caused only by the interruption of the Blood that the Inflammation comes not but because the motion of the Blood is intercepted by the divulsions of the Vessels as it happens in all new Wounds and not at all by a determination occasion'd by the Pains Lastly all the Vertues which are attributed to Cupping-Glasses shall not hinder me from disapproving their use for I say that they are not only useless in many Diseases where they are employed but also in Venereal Sores and Bites of Venomous Animals since it 's certain that the Poyson of these Animals which consists in a strange acid manifests it self in a moment to the Brain in spight of the influence of the Spirits and that the Mass of Blood is presently oppress'd with it by the Laws of Circulation from whence I conclude that once Bleeding or the least Sudorific in what Disease soever will always do more good than all the Cupping-Glasses you can apply Leeches very often the cause of Fistula's You must observe that in the Hemmorhoides Emollient and Discussing Remedies are to be preferr'd before Leeches which are very often the cause of Imposthumes and Fistula's in the Anus as I have shewed you in the Treatise of Fistula's Where and how to make an Issue by Caustic I also say by the bye that Caustic's
that the different dgrees of the Fever rule those of the Inflammation as these do them of the Gangrene Bleeding Clysters Sweet and Liquid Food Emollient and Discutient Cataplasms made of the four Meals Honey and the Emollient Herbs boil'd in Wine as Fol. Malve Altheae Senessionis Violar Rarietariae Candilariae Chamomillae Meliot c. All these Medicines are very Efficacious here You must observe to let the Cataplasms be very moist lest they dry up and so instead of Humecting and Mollifying the Fibres they obstruct the Pores as Astringents and hinder Transpiration If in spight of all this care the Inflammation goes not off you relieve the part by some slight Scarifications if they be not enough you make others deeper that the Medicines may have room to work If the Wound be superficial you must dilate it but if it penetrate even to the most intimate parts I mean near the great Vessels or Bones you must keep to Scarifications and Injections made of Traumatic Plants Mel. Rosar and Spirit of Wine because you would be apt to ruine the whole part by the Incision which must afterwards be cut off It often happens that the Gangrene comes on the sides of these kinds of Wounds where the Obstruction is always most considerable in which case your Pleagets must be well charg'd with Digestives If the Inflammation goes not off either by Suppuration or Transpiration and the red colour of the Skin changes not you must use strong Maturative Cataplasms of White Lilly Roots Sorrel Leaven and the common Digestive provided the Inflammation communicates it self not to the adjacent parts Scarifications are not to be used but when the part is extreamly stretched and the red colour changed into a livid and when little Blisters arise which signifies a beginning Mortification and shews that the ferment of the Gangrene is very acid and malignant you must not stay till these little Blisters increase but as soon as you see that the Wound doth not suppurate and the Skin changes colour you ought to Scarifie and lay Compresses upon the neighbouring parts soak'd in warm Wine and Brandy The Fever is sometimes extinguished by Scarification because the Agitated Matter of the Acid ferment hath room to escape so the Inflammation is diminished Suppuration procured and the progress of Putrefaction stopped If the Lips of the Wound be of a Vermilion colour it 's a token that the salt particles prick the Membranes and increase the Fluxion it excites the Fever a-new for some time and the edges of the Wound grow white and dry This change proceeds from the salt Juices which by their too great motion separate themselves from the sulphurous ones so that they irrigate the Fibres and cause a new Obstruction which afterwards makes the Flesh foggy and white We often observe that though the Wound be often ready to Cicatrise yet if the Fever arises a-new it grows bigger and more dangerous than it was before because the Inflammation makes a greater progress in this case you touch the new form'd Skin with Aq. Calcis in which some Mercurius Sublimat has been dissolved but without using any remedy you may cut it off for the ferment of that Membrane infects the neighbouring parts Balsam of Sulphur is very good in this occasion especially in small Putrefactions Flux a dangerous Symptome If a Flux come upon a Flesh Wound it 's a very dangerous symptome because it only happens when the salt particles have left the part and enter into the Mass of Liquors Now as the Volatil salts maintain the motion of the Blood and other Humours and have a vertue of dissolving and making them fluid we are to search no where else the cause of this Symptome This Flux hinders Suppuration and weakens the Sick more than all other accidents together because of the great dissipation of Spirits that is made by the Stools We also observe that the Wound dries shrivels and becomes as it were mortified according as the Spirits abandon it and the stronger the Flux is the more the Inflammation lessens the Flesh dries up and the part becomes more faint adust and putrid You must foment it with Aromatic Wines and hinder the disunion of the salts by the help of Balsam of Sulphur but from the moment that the Spirits exalt themselves towards the surface the motion of the Blood slackens the Flux ceaseth and the Wound which before was inanimate as it were revives again This Flux must be stopt with great Circumspection for it 's a sign that the salts are become very acid since they offend every part where they lie you must always stop it by degrees for fear a sudden suppression might again revive the Fever and render it more malignant and pernicious which would presently unite Putrefaction with Inflammation The Flux being stopt the Patient must be fed with sweet and thick Food The proper Medicines for stopping a Flux are Clysters made of White Broth Mallows Bran Lettice Knot-grass and the Yolk of Eggs. Tisans made of Bugle Sanicle Lemons and Liquorish are also of great help We observe that this Flux happens oftner in great Hospitals than any where else especially in great Wounds because the Wounded receive there an Air loaden with Malign and Pestilential Vapours which not only causes the Looseness but all the other troublesome Accidents which follow upon it We observe that the Wounds which happen to the Legs are most dangerous or of difficult cure but since the Circulation being more flow in them their Tendons and Membranes stretched and their Vesicles more narrow this disposition of parts causes the Humours to settle and employ themselves more easily and that only the serosity is able to disengage it self in time of their settlings by its abode changes into a Virulent Sanies which entertain the Wounds of these hard and callous parts They also require some Medicines capable of carrying off and melting the Callosity and destroying the Sanies which is the chief cause of it When Wounds are of difficult cure and as it were unconquerable with Medicines it 's the evil disposition of the Subject for the most part which contributes to it Some are naturally of an Ill Habit others affected with some Venerial Disease or some other as bad Finally others do not govern themselves and have a greater inclination for that which is hurtful to them and which is capable of heating and altering their Blood If in these kinds of Inconveniencies the Medicines which we have used produce not any effect Cardiac's and Medicines of a Purifying Quality favours their cure What to be used in Venomous Wounds as all Aromatic's Cordial Potions all Preparations of Mercury and Antimony Theriac Confections Powder of Vipers with their Volatil Salt Volatil salt of Hearts-horn and several Medicines of the same Nature which differently according to the different degrees of Corruption This is the Practice which must be followed in Venomous Wounds having applied upon the part all things that resist