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A59999 A short compendium of chirurgery containing its grounds & principles : more particularly treating of imposthumes, wounds, ulcers, fractures & dislocations : also a discourse of the generation and birth of man, very necessary to be understood by all midwives and child-bearing women : with the several methods of curing the French pox, the cure of baldness, inflammation of the eyes, and toothach, and an account of blood-letting, cup-setting, and blooding with leeches / by J.S., M.D. J. S. (John Shirley), M.D.; Shirley, John, 1648-1679. 1678 (1678) Wing S3496; ESTC R38236 39,001 140

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of wounds are performed in bringing and maintaining together their Extremities by Bandages and Sutures of the first whereof there is three sorts namely 1. The Incarnative which is adapted to simple Wounds and is composed of two heads beginning from the part opposite to the Wound and proceeding towards it 2. Expulsive which consisteth but of one head beginning from the bottom of the Wound upwards to its Orifice 3. The Retentive which is destinated to fasten Topical Remedies and is made according to the figure of the part which is to be bound There are several sorts of Sutures but of the Agglutinatives the most approved is made with a needle held in the Right Hand of the Chirurgeon wherewith he traverseth the two sides of the VVound opposing a pierced Can●lle held in the Left Hand to the point of the Needle which passeth through it with its Thread whereon is made a double knot cutting the thread a little above it and thence it is proceeded to the other stitches remembring always to make the first stitch in the midst of the wounds length There is also another Suture called Dry fit for wounds in the Face and is made by clinging some pieces of Linnen upon it which are being dry brought together with threads pierced through them The third necessary Sature is like to that which Skinners make in sowing their Skins together and is appointed for the Bowels and Gutts when they receive any hurt The others I think needless to describe these being doubtless the best whereunto the ingenious Artist may add what he thinks fit The temperature of the affected part is preserved by a good Diet and a convenient use of the Universal Remedies The first of these ought to be cold and moist till the time obnoxious to accidents be passed Spiced and salt meats are hurtful the Patient must drink Barley water in stead of Wine and wholly abstain from any violent motion of the mind The most usual universal Remedies are Phlebotomy and Purgation which hav● virtue to refresh divert and expel the humours that might prove burthensom to the diseased part Amongst accidents the most urgent is a too great flux of Blood which must be carefully prevented since it is the Treasure of Life and Strength It is performed by astringent refreshing and agglutinative Remedies As Recipe Sealed Earth and Bole Armenian of each half an Ounce Frankincense Mastick Myrrhe and Aloes of each tw● Drachms Flying Flower one Ounce Make a powder to be applyed with the Yolk of an Egg well beaten If then Blood cannot be restrained in this manner the Vein or Artery must be prest with the Thumb till a Thrumbus be made but if that sufficeth not the flowing Vessel ought to be bound and this yet not prevailing we are to use Escarotides as are Burnt powder of Vitriol and of Mercury with a portion of pure burnt Alum leaving the Scars full to mature The last Remedy is the cutting off the flowing Vessel that its Extremities withdrawing in the Flesh the same may stop its flowing But all these Remedies will doubtless come out of use as soon as the Stiptick Elixir to be bought at Doctor Williams's his Majesties Physitian will be known Pain being commonly the cause of much weakness and fluxion to the wounded part the sedation of it ought to be carefully procured by expelling and lenitive Remedies such as is the following Recipe Diacalcitheos Plaister four Ounces Oyl of Roses and Vinegar of each half an Ounce Let all be melted together and applyed For Lenitive Dip the Bands and Compresses in Oxicraton Water and Vinegar is so called or use the following Irrigation Recipe Oyl of Roses and Myrrhe as much as needs and with a white of an Egg make an irrigation But if the pain continueth and is too intense we must with some precaution use Narcoticks whereof here is a Description Recipe The leaves of Henbane and Poppy roasted under the Ashes of each three Ounces Hogs grease and Oyl of Roses of each one Ounce Saffron two Scruples Make a Cataplasm There is often joyned to pain another Symptom called Convulsion which is defined a forced contraction of the Muscles towards their Origin It is of two sorts General and Particular The first whereof is divided in three Species namely Tetonos when the whole Body stands stiff without being able to incline it self The second is called Opisthotonos when it is forced backward And the third Emprosthotonos when it is contracted forward A particular Convulsion is when the Eye the Tongue or any other part instructed with Muscles is contracted or deprived of its natural motion The Causes are Repiction Emptiness and Pain Paul Amanus ●●suting the Elastick virtue of Will is and its defects That which is caused by Repletion is cured by Evacuating Remedies anointing the Back Neck and contracted part with this following Liniment Recipe Oyl of Camomile and Laurel of each two Ounces Oyl of Foxes one Ounce the Salves of Althea and Martii of each an Ounce Foxes Grease an Ounce Strong Water an Ounce and a half Wax as much as needs Make thereof an Oyntment That which proceeds of Emptiness or Evacuation is helped by the use of restorative meats such as is the following Broth. Recipe Lettice Bourage Purcelane of each a handful of the four Greater cold Seed of each half an Ounce Barberries a drachm Boyl all with a good Chickin and let the sick party take of it every morning That which cometh of Pain is Cured by Remedies contrary to the cause of it and if it be poysonous the wound must be instantly amplified that the matter impacted may flow And this Alexipharmacon poured into the Wound viz. Treacle and Mithridate dissolved in Strong water in a sufficient quantity with a little Mercurial Powder Scarified Cuppings are also very useful to extract venemous matter taking care likewise that the Patient in that Symptom have not his Mouth fast contracted lest he bites off his own Tongue as it often falls out but may conveniently be prevented by an Instrument called Speculum Oris which ought therefore alwayes to be at hand Next to Convulsion a Palsy ought to be prevented and cured It is defined A Mollification of the Sinews with the privation of Motion and Sense not indeed of the whole Body but commonly of one side Its Causes are either inward as the humours of either Ventricle and especially Phlegm obstructing the progress of the Animal Spirits through the Sinews or outward as Falls Blows and such other Accidents It is Cured by Diet and Purgation whereunto the Decoction of Indian wood will be very profitable with this Topical Remedy of Faventinus Recipe Oyl of Laurel and Turpentine of each three Ounces Oyl of Lavender and Petroleum of each an Ounce Malvesie four Ounces strong-Strong-Water two Ounces Pyreth Pepper Mustard-seed Iuniper seed Ivy and Anacardium pure Laudanum of each an Ounce and half Let all be pounded and mixed with Wine and Olives let them boyl in a double Vessel
upper Parts looseness of the Teeth Exulceration of the Mouth and too great a Flux of Blood The Diarhaea is asswaged by the decoction of Guaiac mixt with a little White-Wine and taken for some days in the Morning whereby the humours Acrimony is mitigated and sweetned But in general those evils are remedied by changing of Chamber and Linnen precipitating the Mercury downwards by astringent Gargarisms and Clysters by letting Blood in the Foot and chiefly by purgations wherein some Salt of Tartar must always be added to sweeten and drive down the Humours Some do often swallow a Golden Pill which becomes white but it carries away the Mercury in so little quantity that the other Remedies are not therefore to be omitted The end of Friction is to stimulate a Chris●s which doth not proceed from Nature without it be provoked and helped by some Medicament whose quantity ought to be adapted to the vehementness of the Disease and forces of the Patient least the Medicaments being too strong they cast him into an incurable Consumption or being too weak they do not eradicate the Disease which afterwards is found much more intense and incurable than before The third Cure is by Plaisters and Cerowins and is something slower than the former but more convenient in Relapses and for the mitigation of pain and the resolution of knobs and hardness but because it doth not act so speedily the best of Artists do joyn to it some Frictions Besides the Plaisters of De Vigo the following may be profitably used and applied on the parts mentioned in the Article of Friction Take of Melilot Plaister and Saffron-Vinegar of each half a Pound Quenched Quick-Silver six Ounces Oyl of Laurel and Land Lavendel as much as needs Reduce all to the form of a Plaister The Scope of this Remedy as of the former is the procuring of a Crisis either by insensible transpiration Flux of the Belly or Urines but oftner and better by a flowing of the Mouth which with the Gums and Cheeks is thereby as aforesaid often exulcerated because of the Humours Tenacity and Acrimony and these Ulcers must by no means be repelled but be mitigated by Gargarisms composed of Decocted Barley Cows Milk and the like which may diminish the mouths inflammation and wash off the Humours sticking to it but if this accident as it happens sometimes be too intense that it threatneth an extinction of the natural heat we must for some time defer the proper Cure to cohibit so pernicious a Symptom according to Art As for the Teeths loosness it is cured by astringent Gargarisms but more powerfully if the Gums be touched with Aqua secunda of the Goldsmiths The fourth manner by Suffumigations is not so much approved because of many evil dispositions which it leaveth in the Body They nevertheless thus proceed to it The Patient being seated under a Curtain well and carefully extended they cast in a Chaffing-dish a good quantity of persume composed of Cinabre mixt with Brimstone and Quicksilver whereunto is added Iris of Florence Frankinsence Mirrhe Iuncus odoratus Assaodorata Terebenthine and Theriak and continue this Suffumigation till the Mouth begins to flow and that is its Crisis This Diseases Symptoms are so manifold that I think fitter to remit the Reader to such Authors as treat of it at large than to say but a part of what is needful to be known though most may be referred to the General Cure of Impostumes CHAP. VIII Of some other Indispositions which are Cured by Chirurgery HAving thus far proceeded we are to treat in the present Chapter of some other Indispositions cured by Chirurgery whereof some requiring an experienced Artist others yielding themselves to the meanest Capacities and this little Treatise being written only for the use of discreet Beginners we shall only speak of the following Of Baldness Baldness is a falling off of the Hair from the Head caused either by defect of Nourishment or the corruption of it That which proceeds from Old Age the Hectick Feaver Burnings or Tinea is incurable But that which may be cured is thus proceeded unto The Universal Remedies being fitly instituted the remaining Hair must be shaved resolving Fomentations used and having caused the vitious humours to be digested by the application of Cups and Leeches the Head must be washed in Lye made of Iris and Aloes lastly drawing Fomentations must be ministred for the attraction of laudable Vapours If it be caused by want of nourishment the Head must be rubbed with a course Linnen Cloth till it grows red and if it proceeds from the Venerean Pox the body must be anointed with Quick-Silver to a perfect salivation Of the Eyes The Eyes diseases are manifold but their inflammation is the most common their causes are External as Falls Blows Dust Smoke c. or internal namely a defluxion flowing to the Eye It is known by the heavine●s of the Head the Eyes redness pain swelling and pulsation of its Arteries It is cured by the same administration of universal remedies as in Phlegmons and the due application of Topical ones whereof this Collire is of a perspicuous effect Take Rose and Plantain Water of each half an Ounce the mucilage of Gum Tragacant two Ounces and the White of an Egg make a Collire to Distil luke-warm in the Eye applying upon it a double Linnen Cloth dipped in the same Collire The Blood of Doves Pigeons or Hens instilled warm in the Eye mitigates the pain of it and is its proper Balm But if a Relapse is feared Cups applied on the Shoulders and an Issue in the Pole are very fit to divert the Fluxion Tooth-ach There is scarce any pain equal to that of the Tooth-ach It proceeds from the influxion of a hot or cold humour or the Tooth being hollow or rotten from the entrance of ambient Air and the refrigeration of cold Meat or Drink The Internal causes are taken away by a due administration of Universal Remedies and if the pain proceeds from a hot cause which is known by its sharpness and a great pulsation of the Tooth and Temples it is mitigated by remedies contrary to it as to wash the Mouth with Granate juice Plantain Water and a little Vinegar all being boiled with Roses Wild Granate Flowers and Sumach If the Cause be the fluxion of a cold humour which is dis●●rned by a heaviness of the Head and frequent spitting the Teeth are profitably washed with Garland-Libanotis Sage Pierethre decocted in Wine and Vinegar whereunto is added a little Srong-Water and dissolved Treacle But if it proceeds from a rottenness of the Tooth there is no better remedy than the drawing of it and if it be but a Root procure the corruption of it by a Cotten dipt in Aqua-fortis having first tried the Odontalgick Essence of Flubault Of Phlebotomy or Blood letting Phlebotomy being an Operation necessary to be known of a beginner in Chirurgery I have thought fit to say here something of it They define it An Incision of the Vein evacuating the Blood and the other Humours contained with it Before it be administred if there be any Excrements remaining of the former Coction they must be evacuated by a Clyst●r or Suppository and thus when necessity requireth or for precaution in persons neither too old not too young Phlebotomy is celebrated in the following manner The Patient being conveniently scituated the Chirurgeon rubs the part which is to be opened with his hand or a warm Linnen cloth to cause the Bloods attraction then the said part is bound with a Fillet a little above the place of Incision which is designed by a touch of the Nail and the Operation is performed with a fit Lancet limiting its evacuation to the strength of the Patient and the curative intention Lastly the incised place must be carefully bound least an Hemoragy might happen Of Cup-setting When the matter is conjoyned and impacted Cupps are commonly applied I have commonly thus seen some proceed to operation having something rubbed the destinated place they set on it some kindled ends of Wax Candle fastened on a Counter or such other thing and over it apply the Cup which then draws very powerfully the Humours up then taking them off Incisions are made in their circle with a Lancet or Instrument called Scarrificatory and they are again applied in the same manner as before laying afterward Plaisters of Diapalma or Album Rasis over the Incisions till they be agglutinated Of Leeches Where Blood-letting or Cup-setting cannot be performed Leeches are commonly applied either by making a little Incision in the skin or anointing it with a drop of some other Blood or Sugard milk for then they will stick fast and when you will make them easily fall off touch but their head with a little Aloes or Salt and if you will know what quantity of Blood they have drawn lay them in the things aforesaid and they will revomit it besides if you will have them to draw more than their capacity is cut their posteriour part when they are well fast and the Blood will run through their Bodies which also is stanched if it flowes when they are taken away by the half of a Bean or some burnt Linnen applied on the little wound Thus I finish and if the Reader takes this short Treatise in good part I have my Desire and END
till the Wine be consumed a strong expression being made add Galbanum Bdelium Euphorbium Myrrhe Castoreum Bear Duck and Storks Grease of each two ounces Make a Salve in the Form of a Liniment whereunto a little Wax if needs be may be added Exercise and Frictions are also very powerful to awake the part affected and cause the motive Spirits to flow in There is another accident when the Patient either by weakness proceeding from the loss of Blood poysonous Vapours or the sight of dreadful Objects falls into frequent Swounds It is discerned 1. When Paleness invades the Face with a Cold Sweat 2. If a Coldness of the whole Body be perceived 3. And if the Party do suddenly Fall when it is in the Paroxysme It is prevented by casting cold Water in the Diseased's Face but if it proceeds from too great Evacuation the Patient must be softly collected on the Ground or on his Bed and a little Bread dipped in VVine given him to taste whereat the Spirits may return But if it proceeds from Poysonous Vapours Let the Patient drink out of a Spoon a little Treacle and Mithridate dissolved in VVine That which comes of Fear is easily cured the Object being removed with encouraging and comfortable Admonitions The loss of Blood Pain and Feaver whereunto Wounds are subject do often distract the Patient in a temporary Phrensy called Delirium which is defined A tempor ary perturbation of the Phansy and other mental Functions Besides the Causes above mentioned poysonous Vapours and a Lesion of the Diaphragme do not seldom effect its Production this last having a plain communication with the Brain by the Nerves of the sixth Conjugation If it proceeds from an Obstruction of the Spirits the same Remedies must be used as when the Body is subject to Swounding but if it coms from an Inslammation of the Brain Diet and Purgation must be instituted and the Hair being shaved the Head being bathed over with Exorodine applying upon it the Plaister of Diacalcitheos dissolved in rose-Rose-water and Vinegar and Sleep provoked by the use of Broths wherein you must boyl refreshing Herbs and a knot of VVhite-poppy Seed and pleasant Company diverting the Patient from other sad thoughts and representations of mournful things may also be very conducible to his health and recovery Of Wounds made by Fire Armes THE Industry of men ever clear sighted to their own destruction having for about 200 yeares since found out a very speedy way to it namely Gun-powder and fire-armes Whose hurts being often waited on by other accidents it obligeth us to treat especially of their Curation They are either simple or composed with dilaceration distemper and tumor Their signs are commonly a round Figure little effusion of Blood a swelling of the part and a greenish livid colour In the first apparel the wound ought to be dilated if the wounded parts conformation can permit it that unnatural Bodies if there be any may be sought out and expelled with the matter In doing which if it be possible the patient must be scituated as he was when he received the wound After the extraction of strange Bodies we must prevent pain and fluxion The first by the repelling and lenitive Remedies above described and the Cataplasme appointed for its sedation The last by Diet and Purgation whereunto Clysters are commonly used lest Catharicks might cause too great an agitation of Humours Thence we must proceed to Suppuration as in all other contused Wounds whereunto that which is called digestive and the following Oyl are most conveniently used Recipe Oyl of Violets four pound wherein boyl two young Cats new brought forth till the bones be loosed off adding Earth-worms duly prepared one pound Let them boyl together on a slow fire adding Turpentine of Venice and strong-water three Ounces To be kept in a Glass till there be occasion to make use of it But if there be any danger of Gangrene we use profitably of Egyptiacum dissolved in Wine c. When the wound is brought to Suppuration detersive Medicaments must be applyed such as is the following Recipe Water of boyled Barley the juice of Plantain Parsley Agrimony and of the lesser Centory of each an Ounce let them all boyl together and in the end of the Decoction add Turpentine of Venice three Ounces Hony of Roses two Ounces flower of Barley three Ounces Saffron one Scruple Mix all together and make a cleansing Oyntment Lastly having care to prevent other accidents according to Art the Wound must be brought to a perfect Cure and Sanation Of Gangrenes BUT since Gangrene is often a concomitant of Wounds made by Fire-Armes and other Contusions it will not be amiss here to expound its Nature Signs and Curation It is defined The mortification of a part affected with inflammation And is only distinguished from a Sphacelus by the more or less this last being only when the part is quite mortified and dead The onely Remedy being then its Amputation The general Cause of Gangrene is a corruption of the parts natural Heat by Cold external Heat want of Nourishment stopping of Transpiration or by the dreadful effects of some poysonous substance Its proceeding is two-sold either with some humours in flowing or without it We have deduced the signes of it in the Chapter of Impostumes And for its Curation since that which hath its origin from the second cause is the most general and may in some measure be a Rule for Curing the rest Take these following Precepts If the Body be in the least Plethorical Phlebotomy and Purgation being celebrated the Air by Nature or Art ought to be cold and dry and the Patients diet of the same temper Amongst Topical Remedies Egyptiacum boyled with some Aloes in salted Water adding a little Strong Water in the end is deservedly much esteemed as also the Phadagenick water or the Gray Salve which is made by adding a Drachm of corroding Sublimate to an Ounce of Basilicon in the mean time to defend the Body from the Influxion of Morbisical Humors and putrid Vapours the following defensive may be applyed on the diseased part and often renewed Recipe Oyl of Roses and Myrtle of each four Ounces the juice of Plantain Solanum and Housleek of each two Ounces the whites of Eggs five Bole Armeny and Sealed Earth reduced in a subtil powder of each an Ounce with as much Oxycraton as is needful If it be too Intense and yeilds not to Catharticks and Topical Remedies we are obliged to use actual Causticks And lastly if that will not serve we must proceed to the part 's Amputation which is the only approved Remedy in a Sphacelus wherein observe that to stop the effusion of Blood actual Causticks are almost out of Use the binding of the Vessels being found more commodious Of that Operation see Fab. ab Aqua ●endente in his Chirurgical Operations but now the Stiptick Elixir of Doctor Williams overcomes all other Remedies Where Bones are discovered they use the
difficult and being deem'd against Nature But if the Birth succeedeth happily the Chirurgeon ought to leave the delivering of the party to the Midwife who ought to proceed in this manner The Child being brought forth she ought presently to let follow the Secundine but if they do not instantly succeed she must gently thrust her Hand anointed with Oyl or the following Oyntment along the Navel in the Womb and draw them out The said Ointment is composed in this manner Take Oyl of Lin-seeds one Ounce Oyl of Castor half an Ounce Nutinge three Drams Laudanum one Dram and make a Liniment thereof And then free the Child of them to that end the Midwife must bind the Navel with a double thred two thumbs breadth from the Belly neither too strait nor too loose for fear of Accidents The knot being fitly made the Navil must be cut two fingers breadth beneath the knot and a linnen cloth dipt in Oyl of Roses or of Almonds wrapped about it with another linnen yet over least its coldness till the time of its falling off might cause the Child some pain and inconveniency And thus far ought to be proceeded in the Birth when it happeneth without extraordinary difficulty But because a Chirurgeon is seldom called unless the Birth be difficult here followeth the Method which he ought to observe therein The Birth is rendred difficult chiefly by two Reasons First When the Waters which ought immediately to precede it are evacuated too long before whereby the Womb groweth dry and intractable which is to be remedied by the following Liniment wherewith the Midwife ought often to anoint the Natural Parts Take fresh Butter without Salt washed in water of Mugwort Mucilagines of Figgs of Lin. Oyl and of Althea extracted with Water of Sabina of each half an Ounce Oyl of Flower de Luce an Ounce make a Liniment The following Powder is also esteemed for hastening Child-birth Take Cinnamon Cassia fistula's burk and Dictamel of each a Dram and a half and as much as the whole of white Sugar make a subtil Powder thereof and let the labouring Woman take half an Ounce of it at a time in a decoction of Lin-seed or White-wine The following Drink is also much esteemed for the same purpose Take broken bark of Cassia fistula two Ounces Red Pease half a handful Boyl them with as much white Wine and Water as needs add in the end two Drams of Sabina and make a decoction In the Colature add for each dose a Dram of Cinnamon and six grains of Saffron which being taken provoke the party to sneeze putting in her Nostrils a little pulverized Pepper or white Hellebore and causing her as aforesaid to stop her mouth and Nostrils The Second and chiefest reason rendering the Birth difficult is the discommodious Figure of the Child coming forth otherwise than the Head or Feet foremost which being perceived the Chirurgeon ought to settle the Patient in a convenient manner as before and then gently bind her with a broad and soft fillet Fascia in this manner The said fillet must first be applied to the Neck and thence brought cross-wise before over the Shoulders to the two feet where being again crossed and in many folds about the Leggs and Thighs it ought to be conveyed thence again to the Neck and there be firmly bound so that the party can in no wise stir and to procure it the better she may set the plants of her Feet against the Beadstead a couple of honest Servants keeping her Knees as much from one another as may easily be this being so disposed to keep out the Ambient Air and to perform the Operation more modestly a warm double linnen cloth may cover the Natural parts and Thighs of the Labouring Woman and the Chirurgeon having first cut his Nails and anointed his Hand and Arm with the abovesaid Liniment must by degrees gently as may be thrust it into the Womb where having explored the position of the Child and whether it be alone or with another or a Mole he ought to turn it so that he may come out the Head or Feet foremost as aforesaid But if this do not succeed or that the Child be dead which is judged when neither the Chirurgeons Hand nor the Mother can perceive it to move and most sure if the Waters are flowed out and the Secundines are come forth Then he ought to proceed in this manner having found one of the Feet he ought to draw it out and having bound it about with a soft and broad fillet put it in again then seek the other which having found draw it also out with his hand and together with it by the fillet that which was bound before then having drawn the Child out to the Flank one of the Arms must be retruded along the Neck over the Head the other being along the side and so must be endeavoured to be drawn out It happeneth sometimes that one of the Hands doth appear and is thrust out which must instantly be throst in again and the Child turned to a more commodious figure but if the Womb's Orifice be so swelled that this cannot be done chiefly if the Child be dead the most convenient is to cut it the Bones as deep in the Flesh as may be least it might hurt the said Orisice of the Womb and then so turn the Foster that it may come out as aforesaid But if the dead Child be so swelled either by Tumor or Winds that it cannot possibly come out then a Hook must be struck if the Head be swelled under the Chin in the Mouth in the hollow of the Eyes or best of all in the Pole if the Breast under the Claviculis and if in the Belly in the False Ribbs or in the Bowels above the Navel Pubis specially if the Child cometh with the Feet foremost Others do endeavour to cut the Foster in pieces in the Womb with a crooked Knife and then extract it by pieces apart in doing which or the other operation if it should happen that the Head alone should remain in the Womb a double Hook or an Instrument called by Pareus a Gryphins Foot must be thrust in with a hollow Hand and struck into some part of the Head as aforesaid drawing it gently forth and thus far can Art be extended in the Birth After the Birth ought to come in consideration what must be done first to the Mother and then to the Child For the first she must be exactly kept from all cold and ambient Air which to obtain more surely it will not be amiss to keep her Leggs some time a Cross for so the divided parts will besides be the sooner conjoyned else ought she to be wrapped with a broad Fascia over the Epigaster to the excluding of Air and Blood remaining in the womb and then take the Broth of a Capon or a piece of roasted Bread dipped in good Aromatic● Wine besides specially in Winter the Secundines may be applied to