either with hands or Bandage and mean while reduce it into its place If the Hip be forced out forward the Groin is swoln and the Buttocks fallen the Leg is neither longer nor shorter nor cannot be bent but with trouble and the Urine is suppressed Though it be not set aright yet the Patient in time will be able to go well enough upon it though sometimes it falls out that he must somewhat trail his Leg after him To restore it let the Patient lie on his sound side and strongly stretch out his Leg press it into its former place and in case the hand be too weak thrust it in with your Knee If it be dislocated backward the Patient can neither stretch out nor bend his Leg nor is he able to bring his Heel to the ground and if he should force himself to do so he would fall backward the Leg is shorter there is a hollowless in the Groins and if the Buttocks be pressed upwards you shall find an unusual swelling Though it be not put in yet the pain will in time vanish and then the Leg may be bent again but it remains shorter and straight nor is the Foot turned inward nor outward Lay the Patient on his Belly and strongly extend his Leg mean time apprehend the Thigh bone above the Knee stretch it outward from off the sound Leg press the Head into its Cavity in which yet it will not stay if thenceforth the Patient do not keep himself very quiet 10. The Dislocations of the Tibia and Fibula are cured after the same manner as those of the Cubitus and Radius 11. If the Knee pan be out of its place let the Patient stand upright and press it in again lay on the side whence it hath been forced away a hollow Splint answerable to the shape of the said Pan and below in the cavity of the Leg put one or more compressing Splints binding the whole Leg so stiff that the Knee may not bend CHAP. VII Of Ruptures HAving thus roughly handled the boney and hard parts of the Body it now follows that I treat the soft and fleshie more gently and describe their Synthesis or re-unition again Therefore I begin with the broken Peritonaeum which sometimes gives way to the Intestines at other times to the Cawl and not seldom to both to get out of their natural place into the Groins or Scrotum there causing a Rupture called Entorocele or Hernia Intestinalis if the Guts come out an Epiplocele or Hernia Omentalis if the Omentum or Cawl be out The Peritonaeum is made up of two strong but soft Membranes which do so contain whatsoever is included in the Belly or lowest Cavity that when sound nothing can fall out In Women the Os Pubis is its utmost Limit In Men its outermost Membrane reaches farther and constitutes the first proper Coat of the Testicles In the Groins it comprehends the Seminal Vessels as in a Sheath called Processus or Productio Peritonaei This being stretch'd or enlarged or coming to burst is the proximate cause to the lately mentioned Ruptures The Groins therefore are the usual places of Ruptures But do not imagine that the Peritonoeum cannot be distended or burst in other places and there to cause a Rupture It happens sometimes above the Navel yet seldom Beneath and on the side of the Navel far above the Groins I have not only seen it often with many others but seen it ordered and dressed just like an Abscess the Chirurgeon giving no other reason for his mistake than that it was not the place of Ruptures which those that love the Art and their own Honour may take notice of Most times the Ileon falls down yet sometimes the other Guts come out with it and fall into the Scrotum which cannot come to pass by a simple distention of the abovesaid process but that necessarily in all such great Ruptures it must be broken The Causes which make the Peritonaeum to burst or to dilate are Falling Leaping Blows bearing of heavy Burdens strong Vomiting or Coughing difficult going to Stool Winds retained and all vehement Motions of the Body Signs The Tumor is sometimes bigger sometimes lesser sometimes altogether vanisht but with the least Motion returning Though the Caul or Intestines should be fallen down never so much they may easily without any pain be thrust in again unless Wind or Excrement hinder it in which case the Rupture is very painful If the Intestines be full of Wind the whole belly is tense you may hear a noise and the Patient breaks Wind upwards and downwards If the Excrements be grown hard the Patient goes with difficulty to Stool and the swelling weight and hardness little by little encreaseth If the Peritonaeum be only relaxed and widened then the Tumor from little becomes bigger by degrees but if it be broken it suddenly descends Prognosticks In little Children Ruptures are easily cured in aged people slowly or not at all especially if the Peritonaeum be burst If the Intestines be filled with Wind or Excrements there follows pain and if that be not suddenly removed an Inflamation Gangrene and at last Death it self Cure Lay the Patient on his Back with his Legs on high and a little asunder by which it often comes to pass that the Caul or the Intestines return of themselves into their former place but that not happening press them in gently with your fingers And if you cannot effect this by reason of Wind or hardened Excrements then use the following Medicines Where the Excrements are indurated Take Roots of Marsh-mallows two ounces of white Lillies one ounce Leaves of Mallows Violets Pellitory of the Wall of each half a handful Flowers of Camomile and Melilot of each two pugils Bran half a handful Boil them in Water and to the Liquor Add of Barly and Bean-meal of each three ounces Lin-seed and Fenugreek of each two drams Oyl of Roses and white Lillies Ducks-Fat and Hens Fat of each an ounce Make it into Cataplasm In case this Cataplasm be not sufficient or seems not to be so then bathe the Patient two or three hours in Oyl sweet Milk or Water wherein Emollients have been boyled not forgetting in the mean time Clysters and Purges Against Wind. Take Oyl of Camomile Rue of each one ounce Oyl of Nard and Dill of each three drams Spirit of Wine two drams a little Wax Make it into an Oyntment Another Take Oyl of Wormwood one ounce Oyl of Nard and Nutmeg exprest of each half an ounce Oyl of Mace and Carraways distilled of each one dram Malmsey an ounce and half Boil it a little then add to it as much Wax as is sufficient to make it into an Ointment Inwardly use the seeds of Anise Fenel Carraways and others Medicines dispelling Wind which also are to be mixt in the peculiar Clysters requisite to this purpose Also the Cumin Plaister used by some may here do good service Or Take the Styptick Plaister of Crollius Gum-Caranna
Skull is described CHAP. XIX Of Vstion or Burning ENough hath been said of Cutting now a little of Burning when neither Medicine nor Knife bring relief we must then come to the Fire as well in the soft as hard parts In all Burning great care is to be taken that the neighboring parts be not hurt therefore it is very necessary to defend them against it with Lint That burning is certainest which is made by an actual Cautery viz. a red hot Iron than that which is performed a Potential that is by Corrosive Medicines yet for the most part the Patients fearfulness makes choice of this whichsoever you use beware of applying Oyl alone or Butter to remove the Escar for it hath been observed not once only to to have occasioned a Gangrene Diapalma Plaister or Lint wet in Wine will be sufficient CHAP. XX. Of Issues ISsues are little Ulcers made by Art in a sound part of the Body by a red-hot Iron Launcet Scissars or corrosive Medicine to evacuate superfluous humors and so either to cure or prevent Diseases These troublesome Guests are rarely courted and are chiefly prescribed when we see gentler Medicines to profit nothing and after the Body hath been well purged In what part soever they are made it is always to be observ'd they never ought to be inserted in the beginning middle or end of a Muscle but always in the space between two Muscles which requireth the knowledge of Anatomy except according to the example of Quacks whose custom hath taught them to find out a place ev'n blindfold In the Head the place is the middle of the Coronal Suture made oftner by other Nations than is a practice amongst us In the Neck they are not so often made how necessary soever they may appear The Italians use to make them between the Shoulders with success In other places they are either very troublesome or inconvenient The Manner of making Issues is divers If you make use of the Potential Cautery apply a Plaister to the part having a hole in the middle about the bigness of a Pea in which lay a little Costick and over that a Bolster and another Plaister and after three or four hours take off the Plaisters and laying on the Escar a Plaister of Diapalma dress it twice a day that it may the sooner separate Those which desire it rather by Incision the Skin being taken up either by the Forceps or by the Hand divide it with a pair of Scissars or Launcet If Burning be preferred before the other ways burn the Skin but not the subjacent Muscles for indeed the Skin it self is not to be wholly penetrated oftentimes the touching only the Superficies of it is enough When the Scar falls off take little hard Dossels made of Lint spred upon them some Detersive Medicine and press them into the Ulcer until they have made a sufficient Impression then afterward keep in this Cavity a Ball of Wax Wood or Silver or a Pea which is to be often taken out and another put in and so is to be continued till the Disease be cured or Weakness hinder CHAP. XXI Of the Seton ALthough the application of a Seton be with greater trouble than an Issue yet it brings much greater advantage to the sick Patient for what two Issues cannot remove oftentimes is performed by one Seton It may be made in the Arms and Legs and many other parts of the Body but in the Nape of the Neck between the first and second Vertebra or second and third yea between the third and fourth is only in use amongst us but I could wish it was more frequent There are three Instruments necessary to perform this Operation A pair of Forceps a Needle and String The Forceps which are to hold up the Skin must be perforated of each side the Needle must be three-pointed and answer to the hole of the Forceps which it must pass through The String is to be of Silk not exceeding the thickness of the Needle Let the Chirurgion take up the Skin with the Forceps and gripe it hard which being somewhat stupified the Patient will feel the less pain then let him pass the Needle red-hot through both the holes of the Forceps Skin and all after which with another Needle let him bring through the thread The first day to ease pain apply to the Part Lint dipt in Whites of Eggs and Rose-water mixt together Afterward let Digestion be procured by the use of convenient Medicines when digested let the String be drawn every day sometimes to this side sometimes to that so that the mattery part may hang out of the Wound Thus the Operation being perfected the Ulcer may be kept open as long as occasion requires or the Patient pleaseth After this manner many Authors both Antient and Modern order the making the Seton but this Oparation is much easier perform'd if in the right place the Chirurgion take up the Skin with one hand and his Servant with another and so pass it through with a sharp-pointed Needle but not made hot the String being of Thread not Silk of convenient Thickness and rubb'd with Wax CHAP. XXII Of the drawing forth of Bullets NOw we are come to the Third Part of Chirurgery call'd Exeresis which removes things superfluous They are of a two-fold Nature either they are generated in the Body it self or else brought thither by Accident We treat of the last first to wit The Extraction of Bullets out of the Body which is not difficult if it appears whether it be nearer to the part where it made its entrance or to the opposite to which it hath penetrated If it be observed to be near the Orifice let it be drawn forth with a convenient Instrument if nearer to the opposite part let the Incision be made upon it and there taken forth But if the Bullet cannot be found out by a Probe the Member is to be so placed that the Bullet by its own weight may come forth which if it happens not to do the Wound is to be cured and let the Chirurgeon expect until the Bullet shews it self near the Skin which very often requires a long time CHAP. XXIII Of the Extraction of a Dead Child and the Secundine THat the Birth may be Natural it is necessary That the Infant the whole time of its continuance in its Mothers-womb lies in such a posture that the Arms and Feet being contracted the Head downwards having the Face towards the Mothers Back the whole Foetus lying transverse in the bottom of the Womb until requiring greater room which happens in the seventh sometimes in the eighth or tenth for the most part in the ninth Month the head of the Infant descends towards the mouth of the womb the Limbs which were before contracted being extended it breaks through the Membranes wherein it was included by which the water that is contained in them flows forth which serve to make the parts slippery and so is convenient to facilitate
10. Of Nerves 233 11. Of the Flesh 237 12. Of the Skin 243 13. Of the Fat Nails and Hair 247 14. Of the generation of the Blood and its Circulation 250 15. The division of the Parts of the Body 266 The second Book of the Head 1. OF the outward parts of the Head 268 2. Of the inward parts of the Head 292 3. Of the Neck 296 The Third Book Of the Breast 1. OF the External parts of the Breast 300 2. Of the Internal parts of the Breast 305 The Fourth Book Of the lower Belly 1. OF the outward parts of this Belly 311 2. Of the Internal parts of the Abdomen 314 The Fifth Book Of the Joynts 1. OF the Hands 332 2. Of the Feet 337 An Index to the Treatise of the Plague A Description of the Plague Page 1 It 's Cause 3 It 's Diagnostick 5 Prognostick 6 It 's Cure 9 Whether Bleeding and Purging is convenient 9 10 The use of Sudorificks 11 Medicaments against the Plague 12 Symptoms of the Plague are 18 Feaver Ibid. Drowsiness 20 Continual watchings 21 Great pain of the Head Ibid. Vomiting and the Hicough 22 A Loosness 23 Spots 25 Bubo Ibid. Preservatives against the Plague 32 Practical Observation 36 BARBETTY'S CHIRURGERY The First Part. CHAP. I. Of Manual Operations in general ALthough the word Chirurgery signifies all Manual Operations in general yet by reason of its pre-eminence above all the rest it is now only given to that Art which endeavours to remove the Diseases of the Body by the assistance of the Hands 'T is true that External Accidents require not only the help of the Hands but also Internal Means therefore it is no wonder for a Part of Physick to require the whole Chirurgery being a Part which depends upon the Body of Physick But these internal Medicines we impart to you not as Chirurgeons but as Physicians The General Operations of this Art to which all the particular ones may be reduced are of four sorts 1. Synthesis which teacheth how to unite parts disjointed 2. Diaeresis To separate parts unnaturally joyned 3. Exaeresis To remove what is superfluous 4. Anaplerosis To supply those that are wanting CHAP. II. Of Synthesis or Vnition UNition is of two sorts one regards the Hard and Boney the other the Soft and Fleshy parts of the Body The Unition of Bones is again twofold the one setting Bones broken the other reducing Bones wrenched or disjointed We will begin with Fractures CHAP. III. Of the Nature Difference Signs Prognosticks and Cure of Fractures in general A Fracture is a Solution of Continuity in the hard parts of the Body caused by an hard Instrument externally forced upon the part The Differences are taken 1. From the Manner there being some transverse which are properly called Fractures others that are made according to the length of the Bone called Fissures and others are Comminutions when the Bone is broken into many small parts 2. From the Part it being some times in the Head sometimes in the Shoulders Ribs Arms Legs c. 3. From the Accidents there being sometimes a Wound accompanying it at other times a Dislocation Inflamation Gangrene c. Cause is Whatever is able to break bruise or cut Sometimes also a Bone corrupted by the Pox Gout or otherwise hath been broken without any external force Signs A Bone being transversly or obliquely broke by handling it you perceive an inequality the Patient is scarce able to move the Part affected and sometimes that Part is shorter than the other the Thigh Leg or Foot being broken the Patient cannot stand at all but he may somewhat though with pain in a Dislocation And this is the surest difference between a Fracture and a Dislocation A Fissure is discerned by the thickness pain and unevenness of the Part and requireth the judgment of a skilful Chirurgion A Comminution is easie to be perceived the Bone being very unequal and here and there yielding to the Fingers Prognosticks A Transverse Fracture is more easie to cure than an Oblique or when accompanied with apparent Inequalities that where but one Bone is broken than where two are or where the Bones are much shattered that which â—s made in the midst of the Bone than what happens to be near the Head and a single one than a compound If the Patient remain undressed beyond the seventh day the Member is in danger of mortifying especially if that the Part be too â—ard bound The Cure A broken Bone requires these four Operations Extention Conjoining Ligature Well-placing and withal the application of outward and inward Remedies Extention can hardly be performed without pain which yet will be much less if the Member be so extended that the Muscles do not labour that is to say The Part must be so laid that when in health they could hold out longest without tiring Sometimes the extension must be greater sometimes lesser which will be performed aright if regard be had to the time of the Fracture to the Age of the Patient and to the greatness of the Bone A recent Fracture a tender Patient a small Bone require a gentler Extention on the contrary an old Fracture a strong Patient and a big Bone a greater The manner of extending I describe not because it is better learnt by the frequent view of Practice than by Reading After Extention you are to join the Bones together in the doing of which the Muscles must not be wrested but retain their natural position and figure Then the Part must be bound with a double Rowler the first is to be rowled thrice about the Fracture and then upwards The second which must be twice as long is to be once wound about the Fracture proceeding downwards and then upwards again a little higher than the first Rowler to which you will give more firmness if you bind some convenient Splints of Wood or rather of Past-board round about the Member The Ligature ought not to be too strait lest it cause pain and rob the Part of its nourishment nor too loose lest the Bones slip out of their place And unless great pain or other symptoms require it must not be opened before the third day and at the second dressing it must be bound somewhat closer and afterwards changed but once every four five or six dayes Lastly The Part ought to be well placed that is softly evenly and a little raised If you lay it too low the Bone will bend outwards if too high it will bend inwards Wherefore you must observe a mean Now whether these four Operations have been duly performed may be known by the ensuing Signs The Extention is well done if the part be strait and as long as its fellow if it appear to outward view every where even and a little hollow about the Fracture The joining together is duly made if the Bone be any thing firm and all about the Fracture be found equal The Ligature is as it ought to be if the Patient as soon
thrusting Instrument and seldom passeth through both Tables A Contra-fissure is made when the part struck remaining whole the opposite part is cleft The Signs are Swimming of the Head dimness of the Eyes Vomiting Bleeding at the Mouth Nose and Ears The Patient grows dumb and suddenly falls to the ground whereupon follows Raving a Feaver Convulsions Palsie Any hard thing as a piece of Wood a Spoon c. being put into his Mouth he is not at all or hardly able to bite upon it Here it must also be carefully enquired in what manner and with what Instrument he hath been hurt Whether he be young or old tender or strong healthy or unhealthy Presently after the Fall or Stroke before the Part swells you may sometimes feel the hurt with your Fingers and if there be a Wound with it you may either see it or find it out with a Probe Prognosticks The Fractures of the Skull how fair soever they may look is never without danger but more dangerous when both the Tables are hurt or broken and more dangerous yet if the Dura Mater and most dangerous if the Pia Mater be also hurt The more Symptoms there are the less hope of a good event If the Bone grow black in the beginning that is a mortal Sign Cure If the Skin be yet whole or the wound not large enough make a cross incision and divide the Pericranium If under it you find a fissure put some Ink into it and bind up the wound The second day or as soon as the bleeding is ceased scrape the Skull at once or at several times until the Ink with the Fissure is altogether gone and the Bone grow somewhat bloody then throw the ensuing Powder upon it Take Dragons Blood burnt Harts-horn of each one dram and half Myrrhe half a dram Frankincense and Orrise roots of each a dram Make it into a very fine Powder If the Fissure pass through both Tables then are you to make use of Trepanning as likewise in the Contra-fissure Fracture and Contusion of the Skull or else you will quickly lose your Patient The Incision is healed like the Fissure In the Puncture you must put the Trepan just in the middle and not on the sides of the place hurt If you find a Fracture with a Cominution then take out all the small loose Bones committing to Nature those that are yet fast to the Pericranium or cannot be taken away without force And then if the Fracture be so large that you can free the Brains from the coagulated or corrupted Blood or from the pricking Bones Trepanning will be needless but if it should happen otherwise you must with great care apply the Trepan unless the Patient be strong and the matter very little The manner of Trepanning will be taught in another place 2. In a Fracture of the Nose what is raised is to be pressed down and what is pressed inward to be raised with a Spatule or other Instrument afterwards a Pipe or Quill is to be put up and continually kept there till the Cure be done and a Fracture-Plaister is to be laid on without If the Bone be not corrupted it will be healed in ten or twelve days 3. A broken Jaw-bone is restored by ones fingers used both within and without the Mouth and if those be too weak then one is to draw the Head backward and the Chirurgeon forward and so to put it in It is cured in twenty days 4. The Clavicle being broken there must be one to draw the Arm backward and another to draw the Neck or Shoulder forward the Chirurgeon himself in the mean time drawing upwards what was fallen down and downwards what was raised too high If a Ball be put into the Arm-pit and the Elbow be pressed against the Ribs the Operation will prove more easie It is cured in twenty four days 5. If the Shoulder-Blade be broken about the place where it is united to the Arm then is the hurt for the most part incurable If it break in the Acromion which may be easily felt then let the Arm or Shoulder be pulled down either with Hands or Ligatures and in the mean time set it in If it be broken into several pieces make an Incision and take them out unless they be yet fast to the Peri-estium in which case you must leave Nature to her self which will either make them unite again or throw them out It is healed in forty days 6. The Sternum or Breast-bone happens either to be broken and then you 'll find an unevenness which being toucht will yield to the Fingers and cause some cracking or to be pressed in and then you 'll feel a bending inwards which will cause pain a short breath coughing and spitting blood To restore the same lay the Patient on his Back upon a great stone pressing both his Shoulders downwards then press the Ribs backward and forward until the Bone be reduced again in its right place This is cured in twenty days 7. A simple Fracture of the Ribs which is without any great Contusion or Inflamation of the neighbouring parts may be healed in twenty days applying the Fracture-Plaister If the Ribs stand out they must with ones Hand be pressed in If they bend inward let the Patient keep in his Breath and so press the Rib outward in the mean time assisting him with your hand If that succeed not then lay a sticking Plaister upon it and pull the same off so often until the Rib return into its place Cupping-Glasses here are of no use 8. A simple Fracture of the Joynts of the Back-bone is easily set again with ones finger and is made whole in twenty days But if the Marrow of the Back-bone be so hurt or pressed in that the Arms or Legs of the Patient become lame or senseless that he cannot retain his Urine or his Excrement then he seldom escapeth death Yet you are to do your utmost and if one or more small Bones be altogether loose from the Periostium then make Incision and take them out 9. The same is to be understood of the Fracture of the Os sacrum which alone hath this peculiar that you may put your fingers into the Anus and restore it to its right place 10. The Hip-bone being broken is to be set as soon as possible may be and then it will heal in twenty four days otherwise you may expect various accidents But if it be fractured into many pieces then you are forthwith in the first dressing to make an Incision take out the small Splinters and re-place those that have yet any hold-fast Yet by reason of the multitude of the Tendons Muscles Veins Arteries and Nerves that are spread over the whole part such an Incision cannot be made without great danger 11. If the upper-Bone of the Arm be broken first bend the Elbow toward the Breast then take the lower part of that Bone close to the Elbow pulling it straight down towards the ground and so restore
quiet of their Mind and the good of their Patients they would beware of bleeding in Pestilential and other Malignant Fevers as also in all cases that may befal People by Poyson either inward or outward The French Italians Spaniards and Portugueses great Blood-letters will I expect tell me That Nature when by bleeding she hath vent and is somewhat discharg'd shall be better able to throw out the remaining Evil. And this seems to be true for the blood indeed receives Air that the Spirits may the better flie away and is robb'd of that strength which it so necessarily wants whereupon Nature exchangeth the Life of the Patient for death and extorts tears from the By-standers Without alledging other Reasons they ground themselves upon Experience And it were to be wished they had that ground indeed for we find such Patients of theirs who in the morning were in no danger even after but the taking away of five or six ounces of Blood to be cold and stiff at night Whence it may easily be collected what it is they call Experience viz. If the Patient by chance escape death then Bleeding must have the honor of it but if he die as for the most part then the malignity of the Disease was the cause of it Wherefore I alledge Experience against Experience and praise God Almighty that he hath vouchsafed to furnish all those who without envy passion or slavish dependance upon others will duly consider Diseases with surer means The more moderate sort of them would have Bleeding only administred in the beginning of the Disease and before the Malignity appears outwardly This I shall willingly allow them 1. In very hot Countreys 2. In a Plethorick Body 3. If the humors flying to the head cause any grievous symptoms there in which case bleeding in the Hand or Foot may be I think very beneficial Otherwise those that use it in all bodies and without distinction in these cold and moist parts will find the ill effects of it and be puzled withal to give a reason for their Practice allowable by Art the rather because by their own confession they dare not use this their Darling of Bleeding at certain times but find themselves best in the use of Sudorificks and cooling Drinks But enough of this Now how many Ounces of Blood ought to be taken at once the degree of the Disease and the Patients more or less strength will indicate And 't is better too little than too much I have never taken more from the strongest and most plethoric Person under my Cure than twelve ounces at once chusing rather in case of need to let out twenty ounces at two times than fifteen at once of which method I have found good success As to the season of the year and the hour of the day little regard needs to be had in those Diseases wherein bleeding cannot be deferred without danger as in Plurisies Squinancies c. Otherwise the Spring and Autumn and the Morning are best The veins that are wont commonly to be opened are these In the Forehead the Vena frontis in the Temples the Vena Temporalis in the Mouth the Vena sublingualis or Ranularis in the Neck the Jugularis externa in the Arm the Basilica under which lieth an Artery the Mediana under which lieth a Nerve and under both of them a Tendon and the Cephalica which hath under or near it neither Artery Nerve nor Tendon and therefore may safely be opened This last hath but one small Branch that runs outward to the head whence it hath got the name of the Head Vein Without this consideration it little matters which of these three be opened in regard that about the Arm-pits they all acknowledge no more but one Branch In the Hand between the little finger and its neighbour the Salvatella in the Foot the Saphena and Ischiatica The manner of Bleeding is so well known that I think it needless here to describe it only I could wish that some of those that let blood would take care somewhat better to guess of the number of Ounces of Blood they take from their Patients that so we might not find 12 16 18 yea 22 ounces drawn away instead of 6 or 8 that were prescribed To prevent so intolerable a mistake I would advise that small Porringers of Tin or Copper were made in which the number of ounces were mark'd though expert Masters do not at all need them as knowing that Blood is really weightier than it outwardly seems CHAP. XII Of the opening of Abscesses or Imposthumes THe Humors here and there gathered do often cause a Swelling which nature is not always able to dissipate unless Art do succor her by fit means which if fruitless you must use Suppuration and then stay till she of her self make an opening except there be a necessity to hasten one or even not to stay for a perfect Suppuration As 1. When the matter being very sharp or malign upon which happens a Corrosion of the neighboring parts and a corruption of the Bones Tendons or Nerves 2. When it may affect a nobler part 3. When it lieth in the Joynts 4. When it is cast out by a Crisis Before you proceed to the opening you are to consider whether the matter be contain'd in its own proper Tunicle or whether it be without any Tunicle If without any then make your apertion with a right Line observing the Fibres of the Muscles For Example In the head according to the position of the Hair long-ways in the Eye-lids transverse in the Temples the Nose Neck Breast Back Arms Feet Joynts long-ways in the midst of the Abdomen let it be long-ways in the sides of it somewhat oblique in the Groins transverse but not very deep by season of the subjacent seminary Vessels Always beware of touching any great Vein Artery or Nerve though the Fibres be cut a-cross lest from a lesser evil there should arise a greater The properest place for the opening is the most raised and softest part of the Abscess if possible in the depending that the purulent matter may the more conveniently be discharged To which end also you are with a Tent so long to keep open the wound until the part being altogether cleansed of its preternatural Humors may return to its former Functions In the opening thrust not in the Launcet too deep nor further into the Cavity than to the matter and as soon as you perceive that draw it a little back and turn the point upward making your opening through the Skin so big as may afford the contained matter a free vent If the Abscess be included in a Tunicle if small make the Incision long ways if big then make a double incision that is cross-ways and beware of touching the Vesicle otherwise you must expect a foetide and almost incurable Ulceration This being well done press out with your Fingers the Vesicle which seldom or never sticks to the Skin and easily follows cut off the little Artery
the Birth If any one of these be wanting then one of these four things necessarily happens either 1. Both the Mother and the Child although they may live yet there follows no Exclusion 2. Or the Mother lives and the Child dies 3. Or the Child lives and the Mother dies 4. Or both the Mother and Infant dies Causes hindering Labour are 1. When the Pains of the Birth are none or not sufficient 2. The great weakness of the Mother 3. The greatness and strength of the Child and on the contrary the slender and tender Constitution of the Mother or when the passages are so straight that the Infant cannot come through them 4. The number of Children especially if they endeavor to come forth at the same time 5. The transverse or any other preternatural posture of the Child 6. If the Child in the Birth it self be fallen down with its Head upon the fore-port of the Ossa-Pubis which case Authors of the greatest account whom I know and our Midwives have not at all observed so by how much the greater the Pains of the Birth are there is so much the less hope of coming out except the Head be first a little raised and the Foetus be turned towards the back and so into its true passage by the hand of the Midwife 7. The Weakness of the Child it self which makes it not able to add any thing towards its Exclusion 8. The Death of the Child 9. The not sufficient recesses of the Hip-bones towards the Back for the Ossa-Pubis except in the very hardest Labours and then but very seldom do divide The Signs of a Dead Child are as followeth The Mother feels no more the Motion of the Infant although strengthening Cordials be exhibit'd but in this case when the Infant is as it were tir'd stirs it self a little you have a much more certain Sign Take a piece of the Crum of Bread and dip it in Canary Wine and apply it to the Navel of the Mother then open a Vein in the Foot and if by the use of these things there follows not a motion of the Infant it is a very ill Sign When the Mother turns her self from one side to the other and perceives the Child to fall on the side laid upon like a stone or a great weight the Face and chiefly the Lips grow pale the extream parts cold as likewise the lower Belly the Paps begin to grow lank the Breath becomes fetid great pains of the Head Faintings and Fevers Water and stinking Gleet flows out of the Womb If the After-Birth be excluded before the Child 't is impossible the Child can live long but the surest sign of all is if the Membrane of the Head of the Child be not observed to be any longer tense for as long as it is tense the Infant lives Prognostick Except the dead Child be suddenly drawn forth it puts the Mother in great hazard of Life The Fever not being great other Symptoms though great and fearful yet take not away the hope of recovery The Cure If Medicines with the aid of Mother and Midwife profit little then must the business be committed wholly to the Chirurgeon except the Woman be too weak or the Child having been dead for many days which he ought to consider lest he lose both his Credit and Labour But first it is diligently to be enquired into which of the Causes it is that hinders the Birth If the Child be greater and the passage straighter than usually they ought to be dilated this some Midwives do with convenient Instruments and so draw forth the Child alive but where they are wanting the Midwife must clutch her hand very close and thrust through the Internal Orifice into the Womb it self then putting her Fingers one after another through the Orifice into the inner part of the Womb to discover the situation of the Child and if she finds the Arms or Feet to come inconveniently let her gently raise it up bringing the Head downwards which if she finds to be next the Orifice if possible let her put in her other hand through the Pudenda into the Womb and so with both her hands laying hold of it draw it forth But if this Operation cannot be performed then with a hook firmly fixt lest it injure the inside of the Womb in the Mouth Eye or Ear of the Child and so gently draw it forth and if the Faetus will not follow then with another Hook blunt on the out-side and sharp within let him cut in pieces the Belly Breast or Head of the Child and if the Arms or Legs cannot be brought forth let him cut them off so at length being deprived of its Limbs the remainder may be drawn forth But if by this way the Woman can neither be deliver'd with a sharp and strong Knife the Limbs one after another are to be cut out and so the Child be drawn forth by piece-meal It is necessary that this be perform'd by none but a good Anatomist The Secundine will presently follow the Birth for it 's of no use that being excluded for the Mouth of the Womb suddenly after delivery is so closly shut that not without great pain it can admit the Hand of the Midwife therefore the Midwife as soon as may be is to draw it forth and with her fingers if it sticks very close to the Womb gently to separate it but not pluck it a way forcibly which is mortal and although many Writers and Midwives of inferior Rank little regard the retention of the After-Birth for some time after delivery yet I think I have good reason to pronounce it one of the greatest Symptoms of Womens Labour CHAP. XXIV Of the Extirpating of a Mortified Part. WHen a Dead Part altogether becomes useless that it may not do any injury to the neighboring Parts it is to be taken away But in what place Most convenient is the Joynt but the cure by such Extirpation is render'd more difficult and the use of the Part altogether lost therefore the Extirpation is better to be made two or three or more fingers breadth below the Joynt except the Mortification hath extended it self to the uppermost part of the Arms or Thighs for then we are forced to take the Joynt it self But again in what Part whether in the whole or Mortified The Amputation is more safe in the sound Part although accompanied with greater Pain The common way both of the Ancient and Modern The Patient having receiv'd convenient nourishment is to be placed upon a Form then let the Skin and fubjacent Muscles be drawn up as much as possible by a strong Man and there kept and an inch above the place where the Member is design'd to be taken off with a narrow Ligature is the Part to be very hard bound this done with a dismembring Knife the Skin with the Flesh is speedily to be cut all round to the Part and the Periostium by scraping is to be separated from the Bone
assistance of the Ligaments Tendons Membranes c. the Parts are so straightly knit together and so abound with Sanguinary Vessels that oftentimes upon the slightest hurt the greatest Symptoms ensue if you order not every thing aright CHAP. III. Of Bones A Bone is a Similar Part cold and dry composed of Seed that it might afford strength to the Body and help its motion Naturally 1. It is hard 2. Covered with a Membrane 3. White with some Redness 4. Hollow or Spungy 5. About the Extremities covered with a Cartilage 6. Smooth 7. Moistened with a fat Humor It is nourished by Blood brought from the Arteries every where so small excepting the lower Jaw that Writers of great esteem have denied them to the Bones but especially contained in the Marrow The Marrow is invested with a Membrane it self is altogether insensible in the Cavities of great Bones 't is White mixed with Red in the lesser White in the Spungy Bones soft and juicy Its Sense it borrows from the covering Tunicle for the most curious Observer never saw Nerves The Bones are joined together partly for the greater firmness partly for the better Motion That Conjunction which is for their firmness is called Symphysis and is six-fold 1. Suture as in the Bones of the Skull 2. Harmony whigh is by a right or oblique Line as in the upper Jaw 3. Gomphosis as the Teeth in the Jaws 4. Sinchondrosis which is by an interposing Cartilage as in the Os Pubis or the Sternum 5. Syneurosis which is by the assistance of a Ligament as the Thigh-Bone with the Hips 6. Syssarcosis which is by the accession of flesh as in the Os Hyodis That Conjunction which is for Motion is call'd Articulation and is twofold 1. Diarthrosis to wit a loose Articulation And 2. Synarthrosis to wit a straighter Articulation And both is performed by three manner of ways 1. Enarthrosis When the Cavity receiving the Bone is great and the process of the Bone to be received also great as in the joining of the Thigh-bone with the Hips 2. Arthrodia When the Cavity is superficial and the Process little as in the hinder part of the Head with the first Vertebra of the Neck 3. Gynglymus When one Bone takes into its Cavity the process of another and contrariwise the other Bone receives into its Cavity the Process of the former as the Bone of the Thigh with the Tibia and the Shoulder-bone the Ulna The number of Bones is greater in Children than in adult People for by years many of them so grow together as that they cannot be separated any more also their number is much lessened when consideration of the Processes and small Bones is not had from hence it is that some reckon 360. some 304 others 249 The use of the Bones is 1. To be a stay or support to the Body 2. Together with the flesh to give it its shape 3. To help motion 4. To defend several Parts Although the Bones ought to be described in particular by us in their proper places yet an Anatomist cannot be perfect that is ignorant of the Bones therefore before we begin the Examination of other parts we think it convenient to exhibit to you the Skeleton in this place The Bones of the Head we divide into the Skull and Jaws The Skull consists of eight Bones which are 1. The Bone of the Forehead 2 and 3. Bones of the fore part of the Head 4 and 5. Bones of the Temples 6. The Bones of the hinder part of the Head 7. Os Sphoenoides 8. Os Ethmoide The upper Jaw consists of eleven Bones to wit five of each side and one common of these 1 2. Os Zygomaticum 3 4. Os Lachrymale 5 6. Os Maxillare 7 8. Bones of the Nose 9 10. Bones of the Palat. 11. Vomer The under-Jaw hath only one Bone except the Cavity for the Teeth of which are numbered 32. Four Fore-Teeth two Dogs or Eye Teeth all the rest are Grinders In the Internal parts of the Ear are four Bones which are called 1. The Hammer 2. The Anvil 3. The Stirrup 4. The round Bone The Mouth hath only one Bone called Os Hyodis The Neck is composed of seven Vertebra's of these 1. Is called Atlas 2. Epistropheus 3. Axis the rest want Names The Bones of the Breast in the upper parts are The two Collar Bones on the sides fourteen true Ribs ten Bastard in all 24. On the fore-part the Sternum with the Sword-like Cartilage In the upper part of the Back are two Shoulder Blades in the middle twelve Vertebra's The hinder part of the Abdomen exhihits five Vertebra's of the Loins to which are joined the Os Sacrum and to it is joined the Os Coccygis On the side of Os Sacrum there is the Os Innominatum or Bone of the Hip which is divided 1. Into Os Ilium which is the greatest 2. Os Ischium the lowest 3. Os Pubis in the fore-part The Arm consists of only one Bone which is called the Shoulder-Bone The Cubit of two the uppermost of which is the Ulna the lowest the Radius The Metacarpus contains eight Bones to which as yet there are no Names given the Carpus four The Fingers 10 each of which consisting of three Joints Besides these about the Joints of the Fingers are sound the Ossa Sessamoidea 10 12 15 or 20. The Thigh hath only one Bone The Leg consists of two one of which is the innermost called Tibia the other which is outermost the Fibula Between these and the Bone of the Thigh is placed forward the Knee-Bone The Tarsus hath seven Bones which are 1. Tarsus or Astralagus 2. Calx or the Heel-Bone 3. Os Naviculare or Cimbiforme 4. Os Cuboides or Tesserae 5 6 7. Ossa Cunciformia or Sphoenoidea The Metatarsus hath five Bones The Bones of the Toes are 14 for there 's only two in the great Toe The Ossa Sessamoidea are found here also 10 12 sometimes 15 or 20. Chirurgical Considerations The Bones are subject to many Diseases Fractures and Dislocations are already discoursed of as also Putrefaction But seeing there may be several ways produced we will declare those which are chiefly worth our consideration Preternatural Humors by what cause soever either General or Particular penetrating the Bone sometimes produce an Ulcerous Excrescency with moistness of the Bone sometimes a Cancer of the Bone to wit Spina Ventosa effects necessary to be distinguished which because no Physician hath made it his business to describe I will impart that which Reason and Experience hath taught us The cause of an Ulcerous Excrescency with the Humidity of the Bone which effect is called by the Dutch een Beensuyger is preternatural Phlegm depriving the Bone of its temper and hardness the flesh cannot be said from this soft foundation to keep also its Natural state but its nourishment passeth into soft spongy flesh which by degrees encreaseth and at length causeth an Ulcer from whence the Tendons Ligaments and
Thumb and fore-finger is opened in palpitations of the Heart either that or the Saphena is to be opened Other Arteries are not to be opened except a Bone lies under them for fear of an Aneurism CHAP. X. Of Nerves A Nerve is a Similar Spermatick Membranous round white hollow part serving for the carriage of the Animal Spirits to the Parts for Sense and Motion The Nerves take their Original from the Brain and are divided within the Skull into eight Parts without the Skull to wit those that come out of the Spinal Marrow into thirty Pares seven of which proceed from the Vertebra's of the Back five from the Vertebra's of the Loins six from the Os Sacrum The eight Pare within the Skull proceeding from the Brain are 1. Smelling pare which adheres to the Mammillary Processes 2. Optick pare which is the greatest and united in the middle 3. The pare that moves the Eyes 4. The Tasting pare 5. The second tasting pare 6. The hearing Pare 7. Par vagum which is vested with strong Membranes it descends through the Orifices of the Bone of the hinder part of the Head to the Throat afterwards sending Branches to the Neck of the Larinx to the Muscles of the Tongue and Os Hyodis then is divided of each side into the external and internal Branch The right External Branch having sent some Branches to the Muscles of the Breast makes the right recurrent Nerve this contributes to the Voice as also to the feeling in the Pleura the Coat of the Lungs the Pericardium and to the upper Orifice of the Stomach seeing all those Parts obtain Branches from it The left external Branch constitutes the left recurrent Nerve which goes to the same Parts as we have declared the right doth being brought to the said Orifice of the Stomach it is joined to the right recurrent and so goes to the lower Orifice of the Stomach and to the lower part of the Liver The right internal Branch sends Branches to each intercostal Muscle then having perforated the Diaphragm furnisheth all the parts of the lower Belly with a Nerve ending about the Os Sacrum Of the left Internal Branch is the same Distribution 8. The Part moving the Tongue The Nerves have a Cavity but so little not to be distinguished by the sight except in the Optick Nerves and those of the Pudendum Use is to carry the Animal Spirits for sense and motion of the whole body Chirurgical Considerations The Cure of wounded Nerves and Tendons is so like as it hath been more than once the occasion of Confusion among the best Authors therefore for the better distinction sake 1. The frequent contusion of the Nerves by a Fall or Blow the Skin having suffered a solution of continuity there happens an Ulcer and many other Symptoms from the afflux of Humors It requires the same Cure we have proposed in another place of Wounds of the Nerves But if the contused Nerve be not bare which may be discerned from the greater and more connual pain than is usual in a simple contusion of the Flesh the greatest care is that the coagulated Blood be as soon as possible resolved for if it should suppurate the Nerve easily would putrifie therefore let there be applied a Cloth dipt in one or other of the following Oyls warm to the affected Part. Oyl of Castor Worms Dill Rue Camomile Rosemary Or let this Fomentation be applied very hot with Spunges Take our Orise Roots two ounces Leaves of Rosemary Marjoram Horse-Mint of each half a handful Boil them in white Wine for a Fomentation Or let the following Plaister be laid on Take Sow-bread Roots in Powder two drams Species Diambrae one dram Oyl of Castor three drams Turpentine a dram Plaister of Betony on ounce Virgins-Honey as much as to make it according to Art into a Plaister Oyl of Lavender is excellent in this Case if taken to the quantity of two drops especially where Convulsions happen 2. The Nerves are not seldom obstructed with a pituitous and tough Humor from whence a stuppor of the Part and sometimes also a stiffness these Symptoms I used to remove after the following manner the whole Body if occasion being first purged Take Gum Caranna half an ounce Galbanum an ounce Oyl of Euphorbium a dram and an half Make it into a Plaister Or Take Mans-fat Goose-Fat of each an ounce Oyl of Earth three drams Make it into a Liniment Let the Part affected be anointed with it Morning and Evening then lay on the Stiptick Plaister of Crollius or of Ladanum or Diachilon with Gums You will hasten the Cure if you use Internal Corroboratives which do wonderfully alter the Nerves although these things properly belong to the Physician yet I think it convenient to prescribe this Decoction of great efficacy of which let the Patient take three or four ounces twice a day Take Roots of Piony Sea-holly of each half an ounce Orrise three drams Leaves of Marjoram Rosemary of each an handful Flowers of the Lime tree Lavender and Lilly of the Valley of each a pugil the lesser Cardomomes three drams Nutmegs a dram Infuse them six hours in a sufficient quantity of White-Wine afterwards boil them and to a quart of the strained Liquor add three ounces of Syrup of Stoechas Mix them There often happens through a Chronick Disease or from a Luxation or Fracture a Contraction of the Member which is not to be ascribed to the Nerves but Tendons This is easily remedied by the use of Oyls and Ointments that have the property of mollifying the indurated Tendons especially if there is to be used a daily extention either by the Hands Weights or Instruments Take Oyl of Camomile Olives Foxes of each half an ounce compounded Ointment of Marsh-mallows an ounce Capons-grease an ounce and an half Make it into a Liniment CHAP. XI Of the Flesh THE Flesh is a similar Bloody Soft Thick part together with the Bones to yield a strengthening to the Body and to cover the spermatick Parts Difference Flesh is three fold 1. Musculous 2. Glandulous 3. Viscerous Musculous is soft red and is properly call'd flesh and for these many ages hath come under the name of Muscles But yet a Muscle is not a Similar Part but compounded of many others to wit Fibres Tendons Nerves a Membrane Veins Arteries that it might be a fitter instrument of voluntary motion to which the Fibres Tendons and Nerves do chiefly contribute It hath a Tendon in its begining and end sometimes round sometimes broad sometimes but one sometimes double It s end is in that place where the Tendons are greater and more It s Head or beginning where the Nerve is inserted the middle where the flesh swells out Use is to promote voluntary motion which is performed after a three-fold manner 1. When the Contraction of the Muscle is so that the end comes to the beginning and then its Antagonist is quiet 2. When the Motion is Tonick so that being contracted
the Arteries to be conveyed through the whole Body every part of this Blood nourisheth those parts which are of the like temperament with it self the Hot part of it nourisheth the Hot the Dry the Dry the Moist the Moist c. that which is here not well concocted must be brought back again to be perfected Why we say that the Veins are not sufficient and the passages not commodious enough to perform the same whose Office we know is to bring back to the Heart the Blood not sufficiently concocted the Reason is that the Water always remaining in the Vessels rendered the Blood too thin so deprived it of its natural consistence and strength From all those so clearly and distinctly laid down it sufficiently appears what the CIRCULATION OF THE BLOOD is to wit a continual motion of the Blood out of the Arteries into the Vena Cava and Porta to the Liver and Heart that in them it may be fitted for the Nutrition and the life of the whole Body Out of the subtilest part of the Blood are the SPIRITS produced which are two-fold 1. Vital which begotten in the Heart carry life to the parts of the Body 2. Animal who out of the Vitals elaborated in the Brain impart Sense and Motion to the Body The Natural at the same time that the Circulation of the Blood was found out vanished Chirurgical Considerations 1. The Ductus Salivales when the string of the Tongue is to be cut or the Ranine Vein to be opened or any other Disease of the Tongue that is to be cured by Manual Operation warn you to have great care of those little Glandules in which they end that they might not be hurt with the Launcet lest there follow a continual spitting The great Glandule also of the Neck from whence these Ductus's take their rise when it is inflamed admits not of the use of Mercury for from hence a dangerous Salivation may very easily be raised 2. The Lacteal Veins either the greater or the lesser are oftentimes from a Contusion or Wound so greviously hurt that they cannot carry the Chile to the Heart and though the wound be cured with great diligence care and speed yet the Patient will fall into a Consumption whence follows Death inevitably This Truth will defend Chirurgeons from many Calumnies In Children and older People is often perceiv'd an induration and inflamation of the Abdomen the cause of which is the hardness of the Mesaraic Glandules which allow not passage for the Chile to the great Lecteal Vein except the very thinnest of it whence the flesh of the Muscles wasts the Body becomes heavy and weary and at length a Feaver and a wasting of the whole Body This evil I use to remedy without any great trouble with this External Liniment Take compound Oyntment of Marshmallows Ointment of Sow-bread of Martiaton of each two drams Oyl of white Lillies of Camomile of each three drams Mix it into an Ointment Inwardly the following Troches are excellent being continually used the whole time of the Cure Take prepared Steel prepared Crabs-Eyes of each a scruple Vitriolated Tartar half a dram Sal Prunella xvj grains Species Aromatici Rosati a scruple white Sugar two ounces Make them into Troches according to Art In this case Purging is not to be used but with Cassia Cream of Tartar and Laxative Syrups for the Glandules will not bear strong Purges 3. The Blood taken out upon the opening a Vein oftentimes after some few hours space appears very dry and destitute of all Serum which for the most part is ascrib'd to its too great Heat and Adustion but this Argument is very invalid for if the same day the same or another Vein be again opened there will be found a great quantity of Serum in the Blood therefore the true Cause is to be deduc'd from the Circulation of the Blood but especially in the Lymphatick Vessels which at that time draws the Serum and Humidity and so leaves the Blood dry It very often also happens that the Body becomes Tumid Turgid and Languid upon which the fearful Physitian forthwith pronounces nought but dangers When with the use of Internal and External Sudorificks the Patient in a short time may be cured The Cause of this Disease is not from the intemperature and debility of those parts the Ancients call'd Noble for it may easily be distinguished from the Dropsie which these parts occasion for although the sick persons are very dull and weary yet are they not anxious but breath free and the Belly swells not much In the Face and Joynts especially is a watry Matter collected but if the swell'd parts are compressed by the Finger we perceive much less Serum to be contained in the parts than in a true Dropsie from whence those that understand not the true Cause are wont to ascribe this Inflammation to wind But the Lymphatick Vessels when comprest broke or by any other way obstructed so that the natural motion of the Lympha is hindred occasions this evil 1. The Circulation of the Blood requires all venomous and deprav'd Humors which are thrown out either by Nature it self or that outwardly happen to the Body at the very first instant forthwith to be expelled out of the Glandules and the Skin by the means of attractive Medicines lest that the whole Blood in a very short time be infected and the Heart it self opprest and suffer under it The which doth sufficiently declare how dangerous it is to open a Vein and to purge in a Venereal and Pestilential Bubo nay in all venomous Wounds as on the contrary how necessary it is to cast forth the offending matter by the use of Sudorifick and Attracting Medicines As moreover how that the invention of the Circulation of the Blood is of very great use in the Art of Physick CHAP. XV. The Division of the Body MAn's Body is most conveniently divided into the Venters or Regions and Joynts There are three Venters 1. The Head or the supream Region or Cavity to it is joined the Neck which is its prop. 2. The Thorax Breast or middle Region 3. The Abdomen lower Belly or lower Region The Joynts are the two Arms and the two Legs Chirurgical Considerations We divide the Body after this manner that it may be known what place each part of the Body ought to keep to those that read the following every thing will become more manifest But there is so great consent of all the Parts so great concord that no part may be by it self consider'd without a consideration of the whole therefore I think it necessary that in a few words the foundation of this mutual consent be here declar'd 1. In every part is required a natural temper for the Liver being too hot the Stomach too cold the Brain too dry c. the whole Body must be out of order 2. A sufficient number for in the Hand if the least Bone Tendon or Artery c. be wanting forthwith its
the Os Petrosum to be removed a great distance from the Os Parietale so that in the place where the Bones did recede from each other was a motion observed beginning at the Os Petrosum and ending in the Os Parietale there where the Toothy unition in the Os Jugale in the inward part which is covered with a Callus as it ought to be in every Articulation to hinder bruising is observed And this being so it may be concluded that the Pericranium if it had invested the Bone under the temporal Muscles without all doubt it would have passed it self between the Os Petrosum whence from its moving and rubbing in eating speaking or any other Motion would haue always felt intollerable pain Thus have you Sir what I thought hoping to proceed further the reason to the Question propounded c. Farewel This Opinion is indeed judicious and very probable for in dead Mens Skuls the upper Bone of the Temple is movable as is the lower and in the Suture of the Zygomatick Bone is a Cartilage found which is necessary in every Joynt for I confess the motion is little but greater would not be required than what sufficeth to afford passage to the thick Humors either from External or from Internal Causes collected sometimes in the Cavity of the Ear by the which the Brain and Ears may be freed from many and various inconveniences I hope time and diligence will give us greater light in this thing Each Jaw is armed with necessary Weapons which are called Teeth In Men for the most part thirty two in Women twenty eight Four are called Fore teeth or Cutters Two Dog or Eye-Teeth All the rest are called Jaw-Teeth or Grinders After the 20 th 40 th 80 th year oftentimes comes forth with pain two Teeth in the very furthest part of the Jaw which some call the Teeth of Manners or Wisdom others the late Teeth Before we come to the other Muscles of the Head we deem it necessary to describe some parts which are not as yet mentioned that is the Eye Ear Nose Mouth The Eye with the Lids to wit the Membranous coverings before Cartilaginous and Hairy defend from External Injuries hath two Corners or Angles In each corner is a Glandule that which is in the lesser External Corner is great white hard that in the greater External Corner is lesser soft red and covers the Punctum Lachrymale Four Tunicles contain the three Humors One of them which comes from the Pericranium is likewise common to the Lids and is called Conjunctiva or Adnata The other three are proper and are thus reckoned 1. Cornea coming from the Dura Meninx 2. Uvea from the Pia Mater this sometimes dilating it self then again contracting it self constitutes the Pupil shewing the many coloured Oval Circle call'd the Iris. 3. Retina from the Brain it self or rather from the Optick Nerve which proceeding further is changed into the Aranea To these three may be added a fourth Vitrea which is ill omited by many The Humors of the Eyes are 1. The Aqueous 2. The Chrystalline 3. The Vitrecus The second pair of Nerves or the Optick Nerve brings the Spirits for sight the third pair or the Motorious for Motion Branches of the Internal and Carotide-Artery bring to it the Nutritious Blood and the superfluous is returned by the Internal and External Jugular Veins Fat and Muscles make up the rest of the Eye The Fat serving to the Calefaction Humectation and better motion is here in great quantity every where distributed between the Vessels and the Muscles The Eye-lid hath four Muscles One straight Muscle three orbicular The Eye it self hath six of which four are straight 1. Attollens or proud 2. Deprimens or the humble 3. Adducens or the Drinking or Reading Muscle 4. Abducens or disdainful Muscle Two oblique which are call'd the Lovers Muscles of these 1. Obliquus Externus or Troclearis because it passeth through a Pully 2. Obliquus Internus The outward Ear or the Cartilaginous Auricle is join'd to the Bone of the Temples It hath a very sensible Membrane and behind it also some Glandules to which the Head sends the superfluous humors Vessels it receives from the External and Internal Jugular and Carotide Nerves from the second pare of the Nerves of the Neck as also from the six pare of the Nerves of the Brain Here is but little Fat what little there is is below the Lap it receives four Muscles of which the three former are to it common with other parts the fourth proper to it self 1. Antrorsum ducens which moveth it forward 2. Retrorsum ducens which pulleth it backward 3. Quadratus deorsum trahens pulling it down 4. Tripartitus lifting it up The inward part of the Ear hath four Cavities for sound and for defence and strength as many Bones The Cavities are 1. Meatus Auditorius whose extremity a little and strong Membrane covers which is call'd the Tympanum and Membrane of the Drum 2. Tympanum 3. Labyrnthus 4. Cochlea The little Bones are of the same bigness in Children as in older People which are 1. Malleclus or the Hammer 2. Incus or the Anvil 3. Stapes or the Stirrop 4. Os Orbiculare or the Orbicular Bones The Noble Lewis de Bils the great Anatomist in a particular Treatise shews that the Os Petrosum which hitherto by reason of its great thickness and solidness was a vast hindrance to those that had a desire to view these Bones of the Hearing in their natural situation not to consist of one only Bone but to be made up of four joined together by Harmony which may very easily be separated by 〈…〉 Within are two Muscles the one joined to the Meatus auditorius the other to the Malleclus The Nose covered with a Scarf-skin Skin Muscles and the Periostium hath two Cavities separated by a Cartilaginous Septum each of these again is divided into that which ascends to the Os Ethmoides and into that which descends above the Palat into the further part of the Mouth The sides of it are called Pennae Alae or wings the lower fleshy part is called Columna or the fleshy Pillar In the inside they are invested with a thin Membrane which is very sensible arising from the Dura Mater which is as to the Nose likewise common to the Mouth Palat Tongue Larinx Gullet and to the Stomach it self The Bones of which it is compounded are many and spungy replete with Caruncles that the Snot might not voluntarily distil forth Arteries from the Carotide bring nourishment to it Veins from the Jugular return the Blood that is not perfectly concocted Nerves from the first pare according to our order serve for the smelling as do those from the fifth pare serve to the feeling It hath no Fat Its Bones we have already given you its Muscles are six 1 2. Deprimentes depressing the Nose 3 4. Dilatantes or dilating the Nostrils 5 6. Constringentes or pulling the Nostrils
together In great Noses there are likewise two other Muscles which we call'd Aperientes which open the Nostrils The Mouth the Gate of Air Speech and Nourishment hath two Lips the parts of each side call'd Cheeks as that below is call'd the Chin. The Lips have two Muscles common to the Jaw 1. Quadratus or drawing backward In some this motion is performed by the Zygomative 2. Buccinator The upper Lip hath two Muscles proper to it self 1. Sursum Trahens or drawing it upwards 2. Deorsum Movens or moving it downwards The under Lip hath but one Deorsum trahens or drawing it downward Common to both the Lips are 1. Obliquè sorsum trahens or drawing them obliquely upwards 2. Obliquè deorsum trahens or drawing them obliquely downwards 3. Sphincter Oris Constrictor or Orbicularis which purseth the Mouth together The inward parts of the Mouth are the Teeth the Gums the Palat Uvula Tongue and Os hyodis Of the Teeth we have treated The Gums offer nothing worthy a particular consideration The Palat consists of a sensible Membrane common to the Stomach which hath its rise from the Dura Mater The Uvula is a long little Body it hath two Ligaments as many Muscles but very little The Tongue as a Sword-cutting out Honour either well or ill as it is moved by pure or impure Spirits behind is fastned to the Larinx Os Hyodis to the Jaws and to the Tonsils before to a certain Membranous and strong Body whose extremity makes the String of the Tongue Of both sides the string lies a Glandule call'd Ranina from the neighboring Vessels It hath two Veins call'd Raninae from the Jugulars two Arteries from the temporal two great Nerves from the seventh pare as also many little ones from the fourth and fifth It is destitute of Fat. Its Muscles are 1. Genioglossus which brings the Tongue forward 2. Styloglossus which draws it upwards 3. Myloglossus which draws it obliquely upward 4. Basiglossus which draws it directly inward 5. Ceratoglossus pulling it downwards Os Hyodis by the assistance of Muscles and Ligaments is tied to the sharp process of the temperal Bones and to the Buckler-like Cartilage of the Larinx it is composed of five united Bones the middlemost of these which is the greatest call'd the Basis of the Tongue hath two Cartilaginous Productions which often degenerate into Bones It hath four Muscles on each side 1. Geniohyodes raising it directly upwards 2. Sternohyodes moving it directly downwards 3. Styloceratohyodes obliquely bringing it upwards 4. Coracohyodes obliquely drawing it downwards All these are the outward parts of the Head which is either solely moved by its own proper Muscles or together with them likewise with the Muscles of the Neck these shall be treated of hereafter The proper Muscles are 1. Flectens or the nodding Muscle 2. Splenius or the Muscle that shakes the Head 3. Complexus the associate of the Splenius 4 5. Obliqui drawing the Head obliquely backwards 6 7. Recti drawing the Head straight backwards Chirurgical Considerations Very many as well Internal as External Diseases take their rise from the Head which is is not improperly compared to a House-roof that receives the vapours of the whole House which afterwards being changed into a Catharre distils upon the inferiour parts creating a Pain and Palsie in the Joynts an inflamation in the Eyes and Jawes c. a shortness of breathing in the Breast and in the Stomach a depraved Chylification in the Guts a looseness c. some of the External Diseases shall here be considered by us the Internal belong to the consideration of the Physician 1. There is often in the Head Porago Achor or Favâ—…s which is a crusted Scab happening as well in old as young people these Scurffs are oftentimes very thick sometimes accompanied with moisture which causeth great itching and a very ill smell The Cause is salt Phlegm it is for the most part a stubborn Disease and very easily returning again The Cure In this case are generally used strong Purging Bleeding Sweating Salivation Unctions pulling out of the Hairs But without using any of these Remedies I have often cured this Disease only with this Decoction Take Ashes which are call'd by the Dutch Weidasch in English Pot-ashes with White-Wine make a Lixivium of a moderate Acrimony in a quart of which boil the Leaves of Marjorum Southern-wood of each two handfuls of Maiden-hair a handful and half Rose leaves three pugils Make a Fomentation With this let the head be washed twice or thrice a week warm then dry it well with hot Linnen Clothes and in a few weeks space the Patient with thus doing will be cured You may likewise sometimes use gentle Purging Medicines 2. In a Hydrocephalus and great Cathars an Issue with great success may be made in the Nape of the Neck because the Cavities of the Dura Mater are thereabouts joyned to the Jugular Veins especially in Children in whom very often the Sutures do too much gape 3. Fat things hurt the Head because it is not covered with many Muscles 4. In the Skull sometimes a rough matter is collected in several places which if not remov'd by those Medicines that purge Phlegm and outward discussives in process of time acquire a very great hardness which still increasing grow into a perfect Horn not to be cured but by Chirurgery 5. Upon the Skull likewise comes other Abscesses which although they may belong to a Steatoma Atheroma or Melicerides yet in the Head especially they are call'd Testudo Talpa Natta These give little hope of Cure where the Bone is much corrupted otherwise they may be taken away by a Thred or what is better by a Knife when they reject other Remedies The manner of taking them away by a Knife is this the Skin being divided in form of a Cross the Bladder is to be taken out then the Pericranium being separated the Cranium is to be scraped with a Raspatory till you come to the sound part then sprinkle upon it some Astringent powder and let the Skin forthwith be consolidated again which if it be too loose a little part of it may be taken away which is very seldom necessary to be done when it may be closed enough in the time of the Cure 6. If the Sutures of the Skull are too open they bring a weakness upon the Brain if they are too straightly united they cause the pain of the Head Experienc'd Chirurgions affirm that it is as safe to use the Trepan in the very Sutures themselves as any other part of the Head 7. The Muscles of the Head occasioning nothing differing from other Muscles except upon a Wound or Contusion of the temperal Muscle a Convulsion easily follows neither ought it to be transversly divided lest there happen a distortion of the Mouth 8. The Teeth seeing they neither are furnished with Membranes nor Nerves are altogether insensible but they which attribute the pain to those Membranes which cover the Alveolus
of some Humor which renders the Cure very difficult For this I commend the often praised Restorative Powder 3. A great Tendon is inserted in the Calcaneus or Bone of the Heel which being wounded or much contused brings Convulsions and death it self About this place comes Kibes whose cause is intense cold or heat with driness Here first are observed Fissures in the Skin then follows an Ulceration All fat things and Plaisters profit here especially the following Take Powder of Galls of round Birthwort of each half a dram red Lead a dram Mercury sublimate six grains Litharge Mirrhe of each a dram and half Camphire a scruple Franckincense two drams green Wax as much as sufficeth to make it into a Plaister In the room of green Wax you may take the Fat of Deer or of Rams 4. The Fingers or Toes being frozen must be rubb'd with Snow or with a bruised frozen Turnep then this following Plaister is much commended Take Hogs-grease fresh Oyl of Olives of each an ounce white Wax two ounces boil them a little and make a Plaister 5. Issues are often made in the Joynts we have formerly declared the place In the Arms between the Muscle Deltois and Biceps in the Thigh two fingers breadth above the Knee in the inside in the Leg the uppermost two fingers breadth below the Knee the lowermost two fingers or three above the Ankle That you may make these Issues without pain instead of a Conclusion take this Caustick which works without pain which is also very much to be commended in sordid and cancerous Ulcers and in Excrescencies Take Crude Brimstone white Arsnick Crude Antimony of each two ounces the Brimstone being melted by a gentle fire and stirred about with a Spatula add the Arsnick and Antimony powdred and mix them whilst they are incorporated with the Brimstone and look red Afterwards Take of this Mixture an ounce Caput mortuum of Vitriol half an ounce Mix them and make a Powder let it be washt six times in Spirit of wine and dried for your use A TREATISE OF THE PLAGUE THE Plague is a Disease whose nature is not to be comprehended by us the Cause thereof seems to proceed from a Spirituous and Infectious Vapour which is powerful enough to make a sudden dissolution of the consistence of the Blood by which means the Heart is deprived both of strength and life I do assert that the Nature of it is not to be comprehended by us as well because it is a Punishment inflicted on us by the immediate hand of Almighty God who vouchsafes not that his Incomprehensible Wisdom and Essence which is sometimes faintly described to us should be narrowly pryed into by his creatures as also that it is in it self so mutable that if we should seriously recollect our selves and recount the several Pestilences wherewith all former Ages have been visited we shall not thereby be able to instance in two of that whole number which have agreed with each other in all circumstances From whence we may easily infer that in the Cure of this Disease an Experienced Physician may much more safely follow the Dictates of his own Reason than adhire strictly to the Method Prescriptions of others For although it doth sometimes by the more remarkable symptoms sufficiently evidence it self yet we cannot likely discover its Nature and Essence although we should the most industriously attempt it But that we may cautiously enquire into it we must know that it is sometimes not accompanied by any Fever And it is necessary that what Physician soever is ignorant of this should either by perusing good Authors or his own Experience acquaint himself throughly with it I have been sent for to several Patients my self who although they appeared otherwise in good health not refusing their meat nor disturb'd in their sleep have nevertheless had Buboes arising in their Groin on their Neck under their Arm-pits or behind their Ears which have apparently discovered a greater Malignity than could be discerned in those Buboes which in other persons have been attended by a violent Fever And many hereupon who have been incredulous and lightly regarded the cautions which I have given them upon this account have with great danger to themselves experimented that as soon as those Buboes have sunk down the Pestilential Symptoms which have appear'd have been very dreadful and much more dangerous than in those that have carefully used the means prescribed to them who have been also much more easily and speedily cured than the other Sometimes the Plague is accompanied with a Fever and again there are some Pestilent Fevers without the Plague To distinguish this Fever from the Plague I used to observe that they that are seized with it complain of pain in their Head and Stomach which sometimes is dispersed over the whole Body sometimes it confines it self to the Arm-pits the Neck the Parts behind the Ears or to the Groin To outward appearance there is not the least swelling If the Patient by such means as is requisite be provoked to sweat at the beginning of the Disease the pain utterly ceaseth and in a few dayes he will be perfectly restored to his health the Disease not having at all discovered it self by any outward Symptoms Why such a Fever should be accounted a Species of the Plague I see no reason But there is no one but will confess it to have seized on that Body on which Buboes Carbuncles and Spots do outwardly appear The cause of the Plague is either Internal or External but unto which soever we impute it it is necessary to conclude that there is in it a power of dissolving the natural Consistence of the Blood and depriving the whole Body of its strength As to the Inward Cause which is Meat and Drink it is evident to all that it cannot produce in any Body whatsoever so great sudden a change but it is most certain that by a long continued course of bad Diet the Blood may by degrees be after such a manner dissolved weakned and corrupted that some part of it assuming to it self a malignant quality a man may be surprized by a sudden Disease sometimes be deprived of life it self which hath been observed in sick persons at several times when there hath been no contagion in the place nor any suspected who have been troubled with perfect Buboes and other Symptoms of the Plague much more intolerable than others have been at any time when the Air hath been infected As to the outward Causes every one confesseth that there are such but their Nature is known but to few The Chymists who are able by the force of Fire distinctly to separate the Parts of simple Drugs endeavour to find the Original of the Contagion in a Volatile Salt which suddenly dissolves the fixed Salt of the Blood which hath indeed some appearance of truth though it will not be relished by all men If you enquire into the Cause hereof from others their
it be not given cold lest Gripings Flux and a pain at the Heart such like Maladies should be caused thereby To such who have weak stomachs a pain at their heart I do use to give the liberty when their Fever abates to drink Mosel or Rhenish-wine with Sugar the juice of Limons provided that they take it in a moderate quantity But I believe they do err very much who prescribe to their Patients whilst the Fever continues still very high some sort of French Wine either alone by it self or mixt with their Sudorificks That Oriental Stone call'd Lapis Porcinus or Pedro Porco is of very great use if it be steeped for a while in your ordinary Drink for it strongly provokes Sweat and very much refresheth the Heart This Stone if I mistake not is generated in the Gall of an Hog for it is exceeding bitter and though it be very hard yet every time it is infused it abates somewhat of its quantity which is discoverable by the Tincture which it imparts to the Liquor Nor is the Gall of a man sometimes void of such Stones which are like unto those taken out of an Hog in savour hardness and colour and we might find them too perhaps in their efficacy likewise if we thought fit to make trial of them This Fever is often accompanied with drowsiness which forbids the use of the principal Sudorificks such as Treacle Mithridate Diascordium c. because there is Opium in their composition which makes them not so effectual for the preventing of sleep It is more requisite to use this following which is agreeable for dispelling the Vapours which infect the Head and the heat about the Heart Take Salt of Rue of Scordium Prunella of each half a scruple Vitriolated Tartar 8 grains our Prophylactick Water an ounce Balm-water as much as sufficeth Syrup of Betony an ounce Mix them for a draught Let Sweat be thereby provoked and let it be the care of the Attendants that after the first or second day the Patient may be kept from sleep if it be found that he hath strength to bear it There is sometimes joyn'd with the Fever continual Watchings and a great pain of the Head I do not use to be much concerned for the watchings although it should continue for the first three days without intermission for it often falls out that by the use of Sudorificks only the pain is the first day abated on the 2d becomes tolerable and on the third is quite taken away Opium hath in it the virtue of causing Sweat and is a great Ingredient in Treacle Diascordium and Mithridate which without it would not in my judgment have that Sudorifick quality for which they are now noted It is also reckoned by several Authors amongst those Medicines which are famous for dispelling of Poison whose use is very requisite in all malignant Fevers nor do I believe that there can any other Medicine be named which gives so present relief to the Patient as Opium concerning the operation whereof they are able to give a better account who have been frequent and curious in the use of it I have sometimes in this case though contrary to Custom given it sparingly when I have found the sick person not to sleep in the first second or third days But when he hath waked for six or seven days together and found a great decay of strength this following Prescription taken every quarter of an hour by a spoonful till sleep hath seized on him hath afforded great relief and the sleep produced thereby hath been undisturbed and of long continuance Take our Prophylactick-water an ounce half Borage-water an ounce Cinamon-water three drams Confection of Hyacinth a dram Lozenges of Sugar pearl'd three drams Laudanum Opiat two grains Mix them You may safely make use of Opium after the manner before mentioned but in Gachectick infirm Bodies whosoever gives it too boldly or is fearful of prescribing it at all discovers that he understands not its Virtue and Efficacy Before I come to the use of Opiat Laudanum I endeavour to ease the pain of the Head by these following viz. by applying Ground-Ivy bruised to the nape of the Neck and to the soles of the Feet and palms of the Hands this or some such like Composition Take Leaves of Rue a handful and half sowre Leaven two ounces Pigeons dung an ounce common Salt half an ounce Elder-Vinegar as much as sufficeth to make it into a Poultice to be applied to the soles of the Feet and palms of the Hands Or Take Bolearmenick seal'd Earth common white Chalk of each half an ounce Vinegar of Marigolds as much as sufficeth Apply it as before To the Forehead I have often applied the Powder of Cloves moistened with the Spirit of Wine for I take Vinegar to be hurtful as are also all Emulsions Vomiting and the Hiccough is another symptom of the Plague It hath been observed by several who have been so curious as to open Bodies which have died of the Plague that Carbuncles have often appear'd in the Stomach and amongst the Entrails whose testimony is not to be rejected since it is so agreeable both to Reason and Experience These If they are not the Cause of the Vomiting and Hiccough may be easily removed by a spoonful of this following Preparation taken cold every quarter of an hour Take Mint-water our Prophylactick-water of each an ounce and half Cinamon-water half an ounce Confection of Hyacinth a dram Salt of Coral a scruple Syrup of Myrtles half an ounce Rose-Julep half an ounce Mix them By the use hereof the Vomiting is usually stay'd especially if the Stomach be sometimes anointed with this following Oyl Take Oyl of Nutmegs by Expression a dram and half Oyl of distill'd Mace half a dram Oyl of Wormwood a dram Mix them In the mean while let the sick person forbear to drink too plentifully and as soon as the Vomit is stayed let him make use of some good Sudorifick Another Symptom of the Plague is a great Flux which is usually a sign that Death approacheth but when the sick person hath not voided meer blood nor any thing of a bloody substance I have sometimes found these following Prescriptions to be successful Let him abstain from all things that are either acid or salt which except in this case are of great use in the Plague and likewise from drinking much But if his thirst be so exceeding great that he cannot bear it let him take one two or three spoonfuls of this following Mixture Take Tormentil-Roots an ounce Red Roses a handful Shaving of Harts-horn a dram Seeds of Sorrel and Mirtle of each a dram Boil them in Smiths water and to nine ounces of the Liquor add of the Confection of Hyacinth a dram Syrup of Mirtles an ounce Mix them Many have also from Treacle alone received great benefit by swallowing a little of it every four hours till they have taken the quantity of a dram as likewise