of a part is afflicted the Inflamation hapneth when the course of blood is hindred in any part and that it 's sufficient to produce the Fever which is a Consequence of the Pain and Inflamation if a drop of extravasated and corrupted blood be carried to the heart Cause of Red Cheeks One hath Red Cheeks in an Impostume of the Lungs this comes from the irregular motion which the purulent Particles communicate to the Principles of the Blood and from the great number of Blood Vessels which irrigate the Cheeks Cause of the Dulness of the Eyes The Eyes lose their vivacity and sink into the head because the blood loseth its consistence and colour in losing its oil and unctuosity which makes the Eyes sink and become insensibly wan and dull proportionable as the sharp and tartarous Salts dissipate the oily and sulphureous Particles In all Diseases of the Lungs the Caule and Mesenterium always corrupted This I say is so true that in all Diseases of the Lungs we always find the Epiploon and Mesenterium which are the two Reservatoriums of the Fat corrupted it 's for the same reason that all parts of the body dry up and grow lean What gives the Red Colour to the Blood You must also observe that the Red Colour of the Blood doth not only depend on the mixture of the Sulphurs but also on the action of the Air which whirl about its Particles and being the Air that gets into the impostumated Lungs changes its nature it 's no more capable of setting them in motion neither to excite so lively a Sensation as before Cause of the Nails bending back The Nails bend backward because their Extremity being irrigated with a serous Liquor deprived of Spirits the Cutis must of necessity fall away and dry up now as the Nails are only a production of it it pulls them along and constrains them to bend like as a slice of Bread held to the Fire You must look upon all these signs as certain tokens that the Wound penetrates into the breast you may stay some days to examine its progress for if they proceed from a not penetrating Wound in a few days they cease by bleeding and suppuration and they continue and increase when the Lungs are alter'd or when the Diaphragma is oppressed by the weight of some extravasated matter An Emphisema may happen to any parts of the Body The Emphisema is not always a sign that the Wound penetrates because it may happen not only to Wounds of the breast but also to all other parts We see it even to come on Wounds of the Head where we cannot suppose the Lungs to send any Air so that unless the oppression be very great you must not try the Operation These signs do not only lead us to the knowledge of the nature of the Empiema but they tell us also whether it's necessary to practise the Operation For example Where the Operation would be useless it would be useless in the Empiema of the Lungs by reason the opening of the breast contributes nothing at all to the evacuation of the matter unless the Impostume be on the superficies of the Lungs then it would be of more use because we know that the Lungs are fastned to the Pleura and the Impostume is precisely where one feels a fixed pain but if so be the Impostume should be deep and manifest it self in that place by a fixed pain it would be fruitless If the effusion of the blood should happen from a Wound and that by good luck the Wound were in a place where the extravasated blood could easily get out provided the Lungs were not adherent by enlarging the mouth of the Wound to make way for it or by laying the Patient in a posture convenient for the running out of the matter the Operation would be useless Finally let the Wound be of what manner soever if we can facilitate the evacuation of the Pus by making the Aperture bigger we ought to avoid the Operation but if the Matter cannot have its free course you must make use of it for to deliver the Patient from suffocation and the chiefest circumstance of the Operation is to chuse a proper place to facilitate the exit of the matter The most proper places to perform the Operation Of Necessity There are two places in the breast proper to make the Operation one of Necessity the other of Election of Necessity where the matter appears as in the Impostumation of the Pleura or in that of the superficies of the Lungs adhering to the Pleura because we are forc'd to make the Operation where the Impostume is that of Election Of Election when there is nothing that obliges us to make it rather in one place than another in this case you must chuse the most convenient place which is between the second and third of the true Ribs reckoning from below upwards four fingers from the inferior Angle of the scapula and as much from the spine You must observe that in those who have been troubled with any long Disease of the Breast as with a long Pleurisy c. the Diaphragme is insensibly fastned to the Ribs and reaches sometimes even to the third fourth or fifth Rib A Caution to be observed particularly when the breathing is frequent and forc'd therefore you must inform your self which is the place where the diseased feels the pain if it be about the second of the true Ribs where ordinarily the Diaphragma is fastned or if it be higher which must be well examined before you make the Operation CHAP. XXIII Of the Operation of the Empiema HAving preparel all that must precede such a necessary OPERATION you place the diseased on a Chair or Bed he must keep his Body very strait and be held up by Servants that the Chirurgion may the easier take notice of the place where he 's to make the Incision In fat People you make it somewhat large that you may not be mistaken How to perform the Operation You pinch up the Teguments for to cut them at length with a Bistory and the fibres of the great Musculus Dorsalis cross for if they were cut otherwise they would stop the Aperture of the Pleura and so hinder the running out of the Matter you continue to incise dextrously the Intercostal Muscles some incise them at the uppermost part of the Rib to avoid the Vessels that lie all along its internal lower Sinus but seeing the Wounds which are near the Bones degeneration often into Fistula's Caution it's more proper to make it in the middle of the Intercostal Muscles When you are come to the Pleura you put your finger there all along which you slip a Bistory for to Incise the Pleura minding to guide well the point of the Instrument with the finger and penetrate not too deep lest you offend the Lungs or Diaphragma which are often fastned to the Pleura
specific Remedies to hinder the progress of this Disease are Bleeding which keeps the first rank and I say that if it be of any use at all in Surgery it 's without doubt in this occasion Bleeding no where of so great use as here because in emptying the vessels it hinders the Blood from being carried so abundantly to that part and must consequently lessen the bigness of the Tumor in diminishing the quantity of the Blood Approved Remedies in a Plurisy The other Remedies are those which rarify subtilize and attenuate the Blood as Horse or Mule's dung infused in White-wine old He-goat's Blood in Powder all Volatil Salts and several other Remedies of that nature The decoction of Nettles in strong Wine which you sweeten with Sugar is also excellent you may at the same time you take the Decoction lay on the sides the bruised Nettles in form of a Cataplasm Of a Peripneumonia Having thus in general explain'd the Cause of a Plurisy I am obliged to say something of a Peripneumonia that sometimes proceeds from an Impostume of the Brain or from the Inflamation of some Membrane which changes into an Abscess as experience demonstrates in those that die of great Wounds of the Head but for the most part it 's caused by the corruption of the Blood that is to say by the exaltation of its sharpest Particles All the difficulty is to know why the Pus or Blood stops rather in the Lungs than in any part else for to make an Impostumation I say that three Causes contribute to its formation the alteration of the Blood Causes of Peripneumonia long and slow Respiration and the structure of the part First Cause Alteration of the Blood Concerning the first you must only make reflection on the nature and mixture of the Chile and thickest Blood which the right Ventricle of the Heart sends in every Sistole to the Lungs through the Pulmonic Artery We know that these two Liquors pass through the Heart and Lungs for to receive some necessary preparations for the function of the parts therefore we may say that they are the two receptacles of all that is most thick and indigested in the mass of Blood but if the Heart hath the strength and power by its constriction to subtilize and cast off all that is most heavy and material in the mass the Lungs have not the same advantage as we will prove so that the grosser substances being accompanied with some impurity and having only felt the first effects of the Heart for its perfection it must needs stop there and putrefy Second Cause Long and slow I espiration The second Cause which I establish is a long and slow Respiration It 's certain the more free the Air enters into the Breast and the more the Vessels are extended they are in a more fit condition by their elastic vertue or spring to express the Air through the Pipes of the Trachea Arteria and the more the Blood is agitated by the inspiration of the Air it 's driven with greater quickness into the Veins But on the contrary if the Blood is moved slowly by a long Respiration it follows that the Vessicles being not so extended as they should be and not expelling the Blood out of them with such a violence it stops and corrupts there gradually by the arrival and mixture of some ill Leaven or by the exaltation of its salt Particles from whence it comes that those who have a long Neck are more subject to it than others because the Air is obliged to make a long traverse before it comes to the Lungs which makes them dry up and alter insensibly Third Cause on the Structure of the Part. What the Lungs really are The third Cause is grounded upon the Structure of the Part the Lungs are a complication of little Vessicles in which the Arteries pour the Blood and where it 's mingled with the Air to receive some alteration there Now it 's shew'd in the Hydravlic's that a Liquor which passeth from a little Pipe into a greater loseth much of its motion and being the Arteries are very little in proportion to the Cells it 's no wonder if the Blood grow slow there and changeth its nature by the exaltation of some sharp and tartarous Salt and by the Fermentation which they cause there wherefore the alteration of the Blood the irregularity of Respiration and the largeness of the Vessicles of the Lungs in proportion to those of the Arteries are the three Causes that concur to the formation of the Peripneumonia Since the Signs of all these kinds of Diseases are of the greatest importance to succeed well in the Operation and to make a favourable or dangerous Prognostic I will endeavour to describe them with all the Order that is possible Signs of Pus or Blood in the Pleura The Signs which shew us that there is some Pus or Blood stopt in the Pleura are Inflamation penetrating Pain Heaviness a languishing and continual Fever a hard thick and deep Pulse accompanied with shivering difficulty of breathing a dry Cough and Thirst one cannot lie on the sound side by reason the matter lieth heavy on the Pleura and one grows lean and thin in a few days Signs of the Matter on the Diaphragma But if the Impostume break and the matter falls on the Diaphragma all these Symptoms cease and the Patient finds some ease for a time but immediately there comes others not less dangerous and insupportable besides the difficulty of breathing which is common to every Empiema one feels a heaviness upon the Diaphragma fluctuation a great uneasiness the Fever increases and becomes burning the Pulse rises the Pain indeed is not so sharp it being felt towards the false Ribs one cannot lie but on the side where the matter is for if you lie on the opposite side one feeleth a twitching upon the Mediastinum more cruel Pain and a much greater heaviness their spittle is sometimes stinking and there follows very often Impostumes of the Liver after these kind of indispositions even as it is observed after great wounds of the Head If the Pus be diffused on both sides one cannot lie on either by reason of the sharp Pains one suffers to be eased you must lie upon the back or belly Signs of Pus in the substance of the Lungs The Signs when there is Pus in the substance of the Lungs may be divided into equivocal and convincing the equivocal belong to other Diseases of the Lungs it 's very dangerous to be mistaking therefore let 's endeavour to examine them well that we may draw some advantages and that we may not undertake an Operation whose effect would prove not only useless but fatal If there be any Pus in the substance of the Lungs the diseased cannot breathe without pain he finds an insupportable and troublesom heaviness upon the Diaphragma because the weight of the matter deprives it of
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
Ascites the Urin is red muddy and lixivious the Patient having excessive Thirst slow Fever and difficulty of Urin. I shall not trouble my self to tell you the Ancients Opinion concerning the cause of the Dropsie Four chief causes of the Dropsie but suppose these four things contribute to its Formation viz. 1. Indigestion of the Chyle 2. Loose texture of the Parts 3. Slowness of the Bloods Circulation 4. A general dissolution of its whole Mass 1. Indigestion of the Chyle I begin first with Indigestion of the Chyle which almost always proceeds from the alteration of the dissolvents that serve for the preparation and the consummation of their Oyl and Viscosity when the Chyle is well temper'd prepar'd and freed from the course Particles it 's nothing but a Buttery Mass which passes into the venae Lacteae and from thence into the right Ventricle of the Heart to be united with the Blood which comes from all parts deprived of its Oyl and most active Principles and serves for a Vehicle and Balm for new nourishment It is this Lactaceous Liquor well depurated and extreamly fluid which entertains the parts and which by its mixture unites and ties in the Heart the two substances of Blood viz. the white part to the red which substances well joyned make a whole neither too fluid nor solid but such as Nature judges most proper to circulate without Obstacle in the Vessels But if by chance the Oyl of the Blood and other Humours with which it 's furnish'd should happen to be dissipated either by violent Exercise too serious Meditations extream Grief or by the abundance and exaltation of the Salts the Chyle must of necessity grow sour become Indigested serous and incapable of any Union then it 's so far from preserving the consistence of the Blood that it rather Dissolves Liquefies and disposes it to make Obstructions Rheumatisms Dropsie c. Because the Arterial Blood not being able to receive through this Indigestion and the preparations and triturations necessary for the Life of the parts it 's course must be in a manner intercepted passing into the Vesicles or rather spaces between the Porosities of the Arteries and Veins where the little Oyl frees and disengages its self from the other Principles which it had taken hold of before to change into our proper Substance so that the serosity of the Blood being at full liberty and having lost a part of its motion pours it self into the spaces which it meets with 2. Loose texture of the parts and so causes the Dropsie according to the texture of the parts which we have supposed more or less lax 3. Slow Circulation We must now explain that cause which proceeds from the slow Circulation of the Venal Blood That we may have an Idea of it we must examine by what Mechanism this Blood is carried back to the Ventricle of the Heart which is the focus of its â—â—â—ion How the Venal Blood is carried to the Arteries I set first omitting the Organs of respiration and the assistance of the Valves three principal movers which oblige the Venal Blood to pass through the Heart 1. The Pulsation of the Arteries 2. The Motion of the Muscles 3. The Mixture of the Lympha If the Pulsation of the Arteries be weakned 1. Pulsation of the Arteries help the motion of the Blood the motion of the Venal Blood must be lessen'd because the Arteries beat and actually Flagellate those Vessels and so oblige the Blood which they contain to repair to the Heart with a wonderful facility 2. Motion of the Muscles The Motion of the Muscles is much more important to hasten the Circulation of this Liquor they being as so many Hands which press the Vessels that penetrate or pass through them and determine the Liquor which they contain to a quicker discharge into their Recepticles So that if they have lost a part of their motion for want of Spirits the Circulation of this course Blood wou'd be as it were supended in the Veins 3. The Lympha In the third place I said that the Lympha disposes it self in the Veins to make the Blood more fluid and fit to circulate No 't is certain if its course be impeded either in the Glands or Lymphatic Vessels the Blood wou'd circulate much slower for want of a dissolvent This being suppos'd that Indigestion of the Blood slow and dull Pulsation of the Arteries weak motion of the Muscles and interruption of the course of the Lympha are causes which concur somewhat to Impede the Circulation of the Venal Blood The Venal Blood very poor which is a Blood depriv'd of its Spirituous Particles having no consistence or strait Union between them Then the serosity which serves the rest of the Blood as a Matrix separates it self from it as the serosities of Milk from the Curd it transpires between the intervals of the Fibres or pours it self out as a gentle Rain in some capacity for to frame both kinds of Dropsies Two Experiments confirm me in this Opinion The first is That if we make the Ligature of the Veins in some part and that one hinders the passage of the Blood it does not fail to be overflown in a short time Big Bellied Women subject to Hydropical Leggs The second is we observe That most big Bellied Women have Hydropick Legs or at least Varices This is a Matter of Fact not to be disputed and which is easily explain'd only by the disposition of the parts we observe that as the Foetus grows bigger it enlarges the Matrix and compresses so much the Iliac and crurel Veins which are near that the Blood which comes from the inferior parts not having the liberty to move as it us'd to do by reason of this compression there must a Dropsie follow as we have shewn Dissolution of the Blood What belongs to the cause of the Dropsie which proceeds from the dissolution of the Blood we have already remark'd when he spoke of Indigestion of the Chyle that nothing is so capable of destroying and consuming the Oyl of the Blood as the abundance and exaltations of the sharp and tartarous Salts It 's by the means of their action that we explain how Scorbutick Hypocondriac Lienteric Persons and those who lie long in Prisons become Hydropical Which we cou'd not easily demonstrate if we did not admit the motion and agitation of the cutting and Corrosive Particles which puts the principles of the Blood to the rout and disunites them so that the Sarum escapes on all sides and gives way for the Dropsie to seize on some part whether it transpires in form of a Dew through the Tunicles and Membranes or Filters between their Fibres or the Glands let it escape or it 's spilt by the interruption of its most insensible Vessels in the void spaces which present themselves at their passage It will always be truly said that the parts which Nature has a mind
the most violent and caustie Acids as Aq. Fortis Spirit Nitri c. cannot dissolve it we make them know also that if ever these Impostors had any Medicines capable to produce such Effects without altering any part before they were past the Stomach Intestines Receptacle of the Chile Heart Lungs and in the most insensible ways where they mingle with the Blood and Humors they would doubtless lose their quality and dissolving vertue therefore there 's nothing can free us from such a cruel Disease but the operation Nothing can free us of the Stone but the operation after having used general Remedies as Bleeding gentle Purging and Clysters unless the Stone be of an extraordinary bigness and there be a complication of Diseases If the Stone be of a moderate bigness Prognostics the operation is less dangerous if 't is big and stick in the bladder it 's more to be fear'd because of the ruption of the vessels and of the great laceration it causes to the parts which is always accompanied with Inflamation Convulsion Fever Gangrene and often Death especially in young who are not over Nine years of age and whose parts are soft and tender or in old whose parts are dri'd up and inflexible as it were through the little heat and humidity which we find in them If the Bladder be ulcerated and there be any great Hemorrhage or some Carnosity you must avoid the operation all these Particularities belong to the Prognostics of the Disease you must observe that these sorts of Subjects often relapse and if the operation were not reiterated you would find a Quarry in their Bladder CHAP. XIX Of the Extraction of the Stone HAving thus consider'd the precedent Circumstances you may hazard the Operation but before it 's necessary to stir the Stone by some motion and to empty the Bladder of its Urine The scituation of the Patient in the operation Place the Patient on the brink of a Bed his back on an even sloaping board his thighs open knees near his belly his heels drawn up to his brich and his hands hanging down on the sides of his ankles To keep the Patient in this posture you have a band with which you support the thigh lower end of the leg and hand and after some turns of the band you pass it upwards about the shoulder and slipping it behind the back you repass it about the other should to bind the hand leg and thigh of the opposite side this posture is very proper to execute this design for it upholds the bladder and gives liberty to the muscles of the Abdomen to relax and bend as they formerly did The manner of cutting for the Stone by the Aparatus minor or Gripe The Patient being in this posture the Chirurgion disposes himself to the operation if it 's by the little Aparatus which is not so much in use he wetts his Index and middle finger in some oil or other unctious matter and introduces them a little obliquely into the Anus not stretching them till he has prest gently the Hypogastrium with the other hand then the Operator endeavours to push the bottom of the bladder towards its neck to place it faster between his fingers and the Os Pubis having fixt it the Chirurgion with a Bistory cutting on both sides makes an Incision on the Stone according to its bigness The Place where the Incision must be made on the side of the Raphe and between the os pubis about two fingers breadth from the Anus The Incision being made you extract it with fitting Instruments of which ☞ we 'll speak in the Great Aparatus sometimes it will slip out of the Orifice by only pressing the fingers a little forwards towards the Orifice so much for the lesser Aparatus for seeing we can't use it without making the Intestine and Bladder very livid nor often without endamaging them we ought to reject this method and prefer the Great Aparatus of which we will give the description The manner of cutting for the Stone by the Great Aparatus After we have regulated all that precedes this so important an Operation and having plac'd the Patient in a convenient posture the first thing we must propose to our selves is to search him well Several ways of using the Catheter As for Probes you ought to have some great small and middle-sized ones for all sorts of Ages strait and crooked for both Sexes with canulas garnished with a stillett to empty the bladder of the urine and others hollow as a Directory to perform the Operation with you may use the Probâ—…or Catheter divers ways In the first the Chirurgion takes with his left hand the top of the Yard dilating its passage a little and pulls it upwards that the chanel of the urethra make a strait line to facilitate by that means the entry of the Catheter into the bladder all the difficulty consists in introducing it methodically which is that the extremity which is held in the hand be outward and the convexity inward and as its point approaches towards the neck of the bladder you give it half a turn by which means you make it slip under the Os Pubis and cause it to enter into the hollow of the bladder so that its point is within and its convexity without Second way of Probing The second method is much more easy and less troublesom because you introduce the Probe quite contrary to the former and without giving it a turn you make it slip into the bladder Good Probing is not only necessary for extracting the Stone but also in all carnosities and inflamations of the bladder it 's of great use as often as the Urine is supprest in this passages and very often one perishes in all those occasions for not knowing how to probe well How to perform the operation methodically To make the Operation you use a hollow Probe which being in the bladder the Chirurgion must bring it to the side of the belly that its convexity may press the interior surface of the Perineum and make it rise in a hillock and whilst the Servant holds up the Yard and top of the Probe with his left hand and the Testicles with his right the Operator with his thumb and forefinger fastens the most eminent part of the Probe to the right side of the Perineum and with a Knife cutting on both sides he makes an Incision all along the hollow more or less great according as he judges the bulk of the Stone to be To make the Incision regularly he holds the Instrument like a Lancet beginning to pierce the most elevated part of the Perineum still to the hollow of the Probe which serves to the Knife as a Directory and without any stop pass and repass it several times over the surface of the Probe till it be quite discover'd lest you make divers Incisions on the bladder Before you withdraw the Catheter feel
of it a Thread which keeps it from going too far under This is call'd Sindon it must be somewhat bigger than the Aperture that the Medicines may have room to extend themselves on the neighbouring parts and the Dura mater not to be hurt in the Motions of the Brain against the edges of the Skull Upon this Sindon you put another of Lint dipt in the same Medicine you fill the rest of the hole with dry Lint and cover the Bone with it and the rest of the wound for the first days is drest with Digestives able to procure a strong Suppuration Great Suppuration very convenient We have already made you observe that great Suppuration of the Exterior Wound very much contributes towards the easing of the Dura mater through the frequent commerce that is between the Exterior and Inferior Vessels You shave the Head for to Embiocate with Ol. Rosat Spirit Vini you make use of Emplast De Betonica or Andreas e Cruce of a Compress temper'd in strong Wine and useful Bandage you dress the Wound the following days with the same care If the Splints be separated you take them away if they stick to the Skull and cannot be replaced you cut them off with the Incisive Pincers The Dura mater is sometimes so inflamed that it rises beyond the Aperture of the Skull in spight of all the precautions that one can take and seeing it 's dangerous to Trepan too much nothing but Bleeding Clysters and an exact Dyet can stop the progress of the Inflammation If Blood or Matter be got between the Membranes there 's no other remedy than to give vent to the Matter To execute which design with prudence you arm a Lancet How to penetrate the Dura mater and dexterously open the Dura mater without the knowledge of the by-standers When the Dura mater and the Brain are hurt there arises very often in the last days upon it a Fungus like a Mushroom which increaseth more or less according as the Matter which contributes to its generation is more or less unctuous Malpigius 's Opinion The Famous MALPIGIUS pretends that the displacing the Glands of the Brain and the little Nervous Pipes frame this Excrescence But without running to the disordering of the Glands is it not more reasonable to believe that it 's bred from the abundance of the Fat Cause of a Fungus and Oleaginous Matters with which the Brain is actually water'd as we have sufficiently proved in several places of this Treatise which Experience also every day shews us in those upon whose Dura mater Oyls are outwardly applied In this Inconvenience you must dry it with Spirit of Wine or Tinct Aloes which dissipates its Humidity and forsake the use of Oyntments How to Consume a Fungus If these Remedies be not sufficient to extirpate the Fungus use the softest Catheretic's as Turpentine in Pouder Pul. Irid. Florent Alurn Ustum some time you may apply Precept Rub. In using these Powders the Flesh must be also a little compress'd or it will not be consumed After these Medicines have perform'd their vertue a Decoct of Traumatic Herbs in White Wine is very advantageous to which add Mel. Rosat more or less according as it's necessary to Humect or Dry up You must correct the Air of the Patient's Chamber by the use of Fire especially when you dress him apply the Medicines as warm as you can When the Flesh is quick and firm you must maintain it in that condition but when it 's too soft you must compress it or use more drying Remedies Whilst you are curing the Interior after this manner you must Externally use the best Traumatics and apply upon the Bone such Remedies as hasten the Exfoliation as Spirit Vini in which Euphorb is infused which is admirable to hasten Exfoliation It must be always used before the Flesh which grows upon the Brain surmount the Aperture and according to the nature of the Accidents which happen general Medicines ought to accompany the Topics CHAP. XXXIII Of the Anevrisma Two sorts of Anevrisma's AN Anevrisma is a Preternatural Tumor form'd by the dilatation of the Artery or by the Rupture of its Tumicles which makes two kind of Anevrisma's the true and false The true one is that which doth not abandon the Pipe of the Artery True and false and which hath correspondence with the Blood which the Heart sends continually there On the contrary the false possesses the nigh parts and hath no communication at all with the Arterial Blood Internal cause of a true Anevrisma Concerning the Internal cause of the true Anevrisma we can attribute it to nothing but to the action of a sharp and corrosive Humour which is separated from the Glands that are spread about the Vessels and which insensibly gnaw the outward Coat of the Artery so that the Blood by reiterated shakings disposes the Inferior Tunicle to extend and dilate it self and after several Impulsions not being in a condition of resisting its motion it gives way and obeys till at last a Tumour is form'd which is call'd an Anevrism Thus I conceive all sorts of Anevrism's to be form'd which naturally happen on the Neck Arms and several other parts We also observe that these kinds of Tumours possess rather Lean and Atrophiated Persons whose Blood is loaden with salt than those that are fat and pampered External causes of a true Anevrisma The External causes of a true Anevrisma cometh from a Punction made on the Exterior Coat of the Artery with a Lancet Sword or other like Instrument or from some Blow c. or finally from the strong Impression which sharp and Corrosive Medicines or Humours which lurk about the Vessels make upon the same Exteriour Coat it 's easie to comprehend that all these causes are capable of weakening the Pipe of the Artery and the Blood beating without intermission extends and forceth outwardly the Pipe and so produceth a Tumour Cause of the false Anevrisma The false Anevrisma is caused by the total ruption of the Tunicles of the Artery which gives vent to the Blood to Extravasate it self between the Porosities of the Flesh and Skin and so forms a Tumour which is followed by troublesom accidents because the Extravasated Blood being no more in motion ferments and suffers alteration which is almost always followed by the Marks of Mortification These two kinds of Anevrisma's increase more or less according as the action of the sharp Juices Contusion Aperture of the Vessel and Impulsion of the Blood are more or less considerable Signs of a true Anevrisma The Signs of the true Anevrisma are sensible pulsation of the Tumour and its softness when it 's pressed with the Fingers it disappears at the same time but as soon as you give over pressing it comes again into its first state The colour of the Skin is not changed because the Blood which maintains the Tumour keeps its liquidness by
the meeting and mixture of new Blood whose motion is continual In its least increase or bigness it 's commonly as big as a Nut or Egg at most some Authors assure us that these Tumours augment sometimes so much that they break nevertheless we know that some have kept them all their lives and that in most Persons who are troubled with them the part of the weaken'd Artery becomes so hard and callous that it resists all the efforts one can make Cause of Induration of the Artery Though this Ossification of the Artery seem very difficult to explain one may nevertheless believe that the saline pungent and most exalted particles of the Blood penetrate the lesser porosites of the Fibres of its Tunicle and they post and mingle themselves with the nourishing Juice of the Artery and so contribute towards its Ossification But the reason which to me seemeth most evident and best grounded is that the Blood which maintains the Anovrism and which is in a continual fermentation must by its motion increase the heat of the part which insensibly dryeth and hardens the Fibres of the dilated part in dissipating and rarefying the humidity which waters and makes them dull That which fortifies more this thought is that the Aorta groweth bony sometimes in old People at its exit from the left Ventricle of the Heart either through the little heat that 's left there dries it or because their Blood hath lost its Viscosity which is necessary to preserve its spring Notwithstanding Experience shews us that it 's Ossified in some Persons Signs of the False Anevrism The Signs of the False Anevrism are opposite to those of the True In the False the Pulsation of the Artery is very deep the Skin almost livid the Tumour is not so high nor round as in the true one but it takes up more room it giveth not way so easily in touching as the true one The most convincing signs of the Arteries being opened is when the Blood comes out impetuously and by jumps which convinces us that its motion is continual and unequal This inequality of the course of the Blood proceeds from two contrary motions the first depends on the strong constriction of the Ventricles of the Heart and the second from the spring of the Arteries But being the Impulsion of the one is much stronger than that of the other it happens that as the Heart driveth the Blood vigorously forward in the time of the Systole the Arteries by their Elastic Virtue beat and drive it back weekly in the Diastole which proves the irregularity and continuation of its motion Signs of a Wounded Artery If you perceive that you have unluckily opened one of the Tunicles of the Artery which is known by the resistance of the blow by the elevation and the violence of its pulsation which is presently communicated to the Vein and which obliges the Venal Blood to come out by jumps as the Arterial Blood but is not so brisk lively or shining and is less swift you must have recourse to Phlebotomy which impedes its motion and by this means hinders the progress of the Tumour you apply thereon a little Compress in which you put half a Bean which presses only the Aperture over that you lay another a little bigger after this manner you apply several Compresses gradually bigger which you keep on with a fitting Bandage and on the neighbouring parts lay good defensatives A certain piece of Money There are some which make use of a Double to compress the Aperture of the Artery but this practice is not approved by reason that being obliged to tie the Bandage strait the Double taking more room than half a Bean which only compresses the Aperture it 's to be feared lest the circumference of the wounded part Gangreen but to supply the want of this strong compression you place at the Internal part of the Arm all along the thick Vessels a Longitudinal Compress which you secure with the Creaping Bandage This Compress produceth very good effects for besides that it moderates the rapid stream of the Blood and by this means you may avoid tying the band too tite it helps also the reunion of the Artery because the Impulsion of the Blood being only weak the Aperture separates very little When the Patient begins to have strength you must reiterate Bleeding for reasons we have alledged you take off the Dressing as late as you can because in a very little time it increases considerably But the Accidents which follow upon a false Anevrism are ordinarily violent and cruel being Gangreen and Mortification are its mournful Consequences you must not differ the Operation unless the use of the Compresses which are applied there and other precautions which must be taken stop its progress or the Resolutive Medicines which we use make the Extravasated Blood re-enter again in commerce with the Liquor or be discust by insensible perspiration in attenuating and rarefying its Molicule lying between the porosites of the flesh on the contrary a true Anevrism may be kept all ones life time or at least some considerable time for which reason one may prolong the Operation in laying on the Tumour some Compresses fortified with a Bandage without the Patients being in any danger unless he resolve to endure the Operation This as hath been said grows to a certain bigness whereas the progress of the false is not limited Lastly if in spight of all precaution and all the care that can be taken in both kinds you succeed not you are obliged to perform the Operation CHAP. XXXIV Of the Operation of the Anevrism Three ways of the Operation of an Anevrism 1. By the Vitriolic Button THis Operation is practised three different ways The first is by the Vitriol Button but the worst is that as the Vitriolic particles melt they spread themselves upon the Ligaments and adjacent Tendons which they carry off rend and cauterise till at last the Patient is lamed being the part groweth incapable of its ordinary motions The second is to disgorge the Tumour before you make the Ligature of the Vessel but behold as I think the surest method The Patient being plac't you lay on the midst of the Arm a strong Compress sustained with a Ligature through which you pass the Tourniket making several turns by which means you benum the Arm stopping the passage of the Blood and Spirits The Surgeon Inciseth with a Lancet the Tumour following the length of the Artery which must be separated from the Nerve to have the liberty of tying the Artery half a Fingers breadth above the Aperture with a little strong wax't Thread You must observe that in a true Anevrism the Tumour regulates the place where you must make the Ligature whereas in the false we are obliged to loose the Turniket to know positively whence the Blood comes which is the most important circumstance of the Operation for to stay the Blood and to avoid making the
Ligature upon the Aperture of the Vessel instead of making it a little higher because the Blood by its impulsion would not fail to dilate the weaken'd part and to bleed afresh For this purpose you pass a Needle over the pipe of the Artery make first a single knot on which you place a little Compress which you fasten with two other knots Most make another knot in the lower part of the Artery because of the Branches of communication and since it being a precaution not to be despised one may use it The Ligature being made you loose the Tourniket If the Blood be well stopt you open the Tumour to empty the Blood and fill it with Dorsels arm'd with Astringent Powders as Vitriol alb to consume the Bag more easily you cover the rest of the wound with Boulsters accompanied with a Plaister Embrocation of Ol. Rosar Defensatives all along the Arm with Compresses temper'd in strong warm Wine with the Bandage Some time afterwards you must Bleed the Patient if his strength permit you stay two or three days without taking off the Dressings and you leave the Dossels at the bottom of the Sac 3 or 4 days longer lest in taking them out you bleed afresh and procure a fresh suppuration The situation of the Arm which seems a thing of little consequence must nevertheless be regarded as very advantageous for furthering the cure The Arm must be a little bended and the Hand elevated on the Pillow that the circulation be more free But you must particularly recommend the Diseased to bow and stretch it from time to time We daily see that several become lame for not having moved the Arm or Leg during such Indispositions The cause of this accident comes from the little motion of the slimy matter which bedaubs the Joints This Slime is of the consistence of the White of an Egg and which transpires from the Ligaments and Glands of the Joynts serving to entertain the supple Ligaments and to smooth the shining Cartilages as well to facilitate the motion as to hinder the parts from being wasted by their continual attrition but from the moment that this Matter is at rest and no more fluid or liquid by the diversities of motion it groweth thick and hard by the heat of the part so that the Ligaments and Cartilages being no more humected by that Liquor they dry up loose their Elastic Virtue and Humidity till at last they grow incapable of motion Sometimes it happens in old Rottenness and Fistula's of the Joynts that the Purulent and Malign Matters gnaw the Ligaments and Cartilages and gives occasion to the Saline Juice which exuds from the body Fibres to unite the extremity of the two Bones and frame a kind of Anchilose which is much more defectuous than the precedent CHAP. XXXV Of Gangrene and Sphacel which occasions the Amputation SEveral Authors have treated of the Gangrene particularly Willis Etmuller and Silvius and I believe no body doubts but that all whatever our new Discoverers have advanced upon this Subject in their Exercises is nothing but a perpetual pillage of what these great Men had spoken To speak of it methodically we must first give an Idea of the Vivification of the parts and of the Mortification which is its opposite we must relate all particulars which cause a Gangrene and seek all the means to illuminate them with Reasons grounded on the Oeconomy of the Blood and upon some Observations which Experience Authorises Cause of Vivification To know how the parts are Vivified you must consider that the heat and life of Animals consists only in the motion and fermentation of the principles of the Blood that this Fermentation and Motion as well Circular as Intestine are entertain'd by the pulsation of the Heart and Arteries by the motion of the Muscles and action of the subtil and penetrating particles of the Air which we breath It is in effect the spiral and nitrious particles of the Air which attenuate and subtilize the particles of the Blood in mingling themselves intimately together in the substance of the Lungs which make them wave upon their centre and which give them all their vivacity and influence which is necessary to the maintaining of their intestine motion and consequently of their heat and Life It 's certain then that it 's the Blood agitated by these means which vivify and animate the parts repairs the continual losses which they suffer furnishes the matter of the Spirits and of all the different Liquors that are subtilized in passing through a 1000 different Strainers In one word it 's the Master spring that makes the whole Machine go This being so it 's not hard to conceive that it is from the actual distribution presence and action of the spirituous and nourishing particles of the Blood in a part on which entirely depend its motion and life Cause of Mortification so that this dispensation coming to cease or be interrupted for some moments one feels no more there either heat motion or life To convince our selves of it we must only examine that which happens every day in Syncop's where we see that the pulsation of the Heart being hindred and the circulation of the Blood stopt all the Extremities grow cold the Face pale and sometimes lived and the whole Body deprived of feeling and motion but according as the Heart recovers its motion and the Blood conveyed into all the parts they recover their heat motion and life It 's therefore evident that the life of a part depends on the presence and motion of the Blood and on the contrary I say that the cause of a Gangrene and Mortification of a part is doubtless the absence and want of these spirituous and nutritive particles in the same part This is the Explication which the Illustrious Etmuller gives of it in Tome 1. operum pag. 587. where he says Causae Gangren sphaceli in genere sunt quae quacumque ratione sanguinis spirituum vitalium distributionem inhibere valent It is a question whether the Animal Spirits which run from the Brain through the Nerves are not likewise interessed in a Gangrene I say that the most causes which work upon the Blood for the production of a Gangrene may in the same manner work upon the Animal Spirits but in the mean time the Gangrene only depends on the alteration which happens unto the Blood This is proved because a Gangrene is a privation of Life or at least a disposition next to a Mortification now the Functions of Life depend chiefly from the Blood whereas the Animal Functions depend on the Animal Spirits The Nerves may be obstructed and the Animal Functions cease in a part without Mortification as is seen in Paralytics It 's true then to conclude that a Gangrene depends only on the default of the vital and spiritual particles of the Blood Those that will have the Animal Spirits to have much share in the Gangrene as well because a
are not applied upon Nervous parts nor upon the great Vessels but always between the Muscles You first rub the part with a warm Cloth to open the Pores and to make the part in a manner insensible you put a Plaister on it with a hole in the middle to put the Caustic in which you cover with a Compress and with a little Fillet A GENERAL IDEA OF WOUNDS CHAP. I. Of Incised or Contused Wounds of the Flesh TO finish this Treatise I thought fit to relate the most Important Observations which regard the Cure of Wounds and to clear the stiffest difficulties which puzle most Chyrurgeons in the Method of discussing them well without which we cannot obtain our wish'd for end Those that hitherto have treated of them have been satisfied to hold long Discourses about their several Kinds Differences and Prognostics but seeing these sorts of useless Discourses serve only to tire the memory of those which seek to be Instructed I will not repeat them I begin first with the most simple and known Symptomes To stop the Hemorrhage in Wounds Being the Hemorrhage is the first and most dangerous Symptome of Wounds it 's that which the Surgeon must quickly correct in closing the vessels from whence the Blood flows For if you stop them the Blood runs no more that is to say you must put into their Apertures some Medicines which hinders the effusion of the Liquors they contain or in tying or compressing them These two last Methods are the surest because one may order them as one please so that the Intention for which we make the Ligature or introduce Lint into a new Wound is to hinder the flux of Blood in pressing the Lint a little to oblige the sides of the Vessels to approach and resist the Impulsion of the Blood yet so that the Compression excite not Inflammation A Wound having been so dressed it 's of importance to prevent the Inflammation and Pain which are the two accidents which always accompany it Cause of Inflammation The Inflammation or Tumour proceeds from the Circulation in the part being impeded by the division of the Vessels the Grumous cloded Blood and the Dressings These strange Bodies are as so many Sluces which oppose the course of the Blood obliging it to stop and excite Inflammation Cause of Pulsative pain I conceive two sorts of Pain The first is a Pulsative pain which depends on the Arteries that creep about the Nerves which at that time are so extended that they strike the Nerves more rudely than they used to do and make them suffer so great distentions that they break and it 's this plurality of divisions which cause the Pain Cause of the quick and burning pain The second is a quick and burning Pain caused by the suppression of the course of the Blood which by the motion and frequent shocks of its most active principles bursts the Vessels and extravasateth between the porosites of the Flesh where it 's rarified by the great quantity of concentred Spirits which penetrate the most insensible Porosities Then doth the Blood by its irregular action shake and violently prick the little Nervous Fillaments from whence proceeds this second kind of burning pain 2. To prevent pain We commonly prevent these two Accidents by repressing the motions of the Blood which comes to the part with too great precipitation by Repercussives and gentle Astringents Bandages are of the first rank which we use very successfully in binding the Wound up gently as also the neighbouring parts whereas too tite a compression would augment the Inflammation It 's for this end we readily employ Defensatives as we call them because they are compounded of a Desiccative Matter which insensibly shuts up the porosities of the Vessels as Terra Sigillata Bole mixt with the White of an Egg or common Water You must observe never to leave them longer on then 24 hours Caution for Reasons which we shall alledge hereafter You must at the same time sweeten the acrimony of the Blood and empty the Vessels by Phlebotomy Clysters and a good Diet. A thin Diet exceeding good in Wounds If the patient would be prudent in his way of living and use only a thin spare Diet he would suffer much less pain and his cure would be quicker because Salt Meat is capable of thickning the Blood and making it fit for fermentation whereas sweet Liquids by their insipidness dissolve and charge themselves with the salt and precipitate it by Urine after this manner the intemperies of the Blood is corrected and the affected part relieved Benefit of Clysters Clysters are also of great use because they hinder the Excrements from heating and boiling back again in the Intestines they dilate the Matter moderate the heat of all the Viscera and contribute much to the cure of Wounds Repercussives used only in the first Dressing You must observe that at the same time Repercussives retain the most subtil and agitated salt particles of the Blood they grow sowr gnaw the Vessels and excite a fermentation upon which a Fever soon follows They are therefore only used in the first Dressing and prefer Discutients which open the Pores and causes the volatile salts to perspire and so empty the part It 's easie to see if one continues the use of Repercussives the salts endeavouring to escape fail not to excite Inflammation and to corrupt the nourishing Juice of the parts in disuniting the principles of the Blood which depend one on another which by the frequent encounter and shock of their particles change figure from which depends the generation of a new Matter and all the changes which happen Discutients and Suppurations must work together If in such an occasion Discutients which causes perspiration and Digestives which excites a quick suppuration should not work together to disengage the part it would tumifie so much as to fall into Gangrene Cataplasms which have Oyls and Fat 's in their composition have almost the same effect as Repercussatives for which Reason good Practitioners disapprove their use We observe that in great Wounds Discutients excite often a fermentation which increases the Inflammation In that Case a Cataplasm made with Crums of Bread Milk the Yolk of an Egg Mallow Roots c. is very proper We ordinarily blame those who let the Pus lie too long in the Wound because it always gets some malignity corrodes the neighbouring Vessels which presently produces Inflammation Putrefaction or else the Veins absorb it carry it to the Heart from whence it diffuseth it self into the whole Mass of Blood and causes the Fever and according to the different alterations which it receives in passing through the parts it obstructs the Liver Lungs or some other part so causes an Imposthume there as we have observed in Wounds of the Head This demonstrates to us that we ought to dry up all the Matter that is in the Wounds and press the Dossels