CHAP. I. Of Wounds in General.

A Wound is a solution of continuity in any part of the Body, A Wound defined. suddenly made by any thing that Cuts or Tears, with a divisi­on of the Skin.

THIS definition differs much from what is usually delivered by Authors, and it is fit it should, for they generally defining a Wound by a solution in parte molli, do thereby ex­clude a Cut made into a Bone; as that into the Cranium by a Pole-Axe, &c. which why it should not be called a Wound I know not? Se­condly, I say it is made by any thing that Cuts or Tears; other Authors define it to be made by an external Instrument, &c. How then do they call that fracturam cum vulnere, a fracture with a Wound, where the Bone from within makes the Wound, and thrusts it self quite through the flesh? Sennertus adds to his Definition, that it be done à re secante & acutâ; yet he reckons those for [Page 2]Wounds that are made by Bullets, although it be Canon-shot.

I do therefore think it fit to make my definition more comprehensive, and to take in whatsoever makes a sudden solution of continuity, at least im­mediately and by it self, on what part soever it light­eth; so a Cut into a Bone is a Wound, tearing the Flesh, Nerve, Sinew, Tendon or Cartilage, by Bullet, Stone, Splinter, &c. is a Wound; only I add this restriction, that the Skin must be likewise divided: By which last words I exclude fractures that come not through the skin and contusions, if the exterior parts be continuous. But by the word Skin, I understand not only the external cutis, but also the Inward membranes of the Gullet, Ven­tricle, Guts, Bladder, Urethra, Womb, all which are capable of Wounds from sharp Instru­ments, whether swallowed or thrust into them.

A Wound thus defined admits of many differen­ces,Differen­ces of Wounds. of which I know none that can be properly called essential. Great and small, deep and shallow, wide and narrow, streight and crooked, round and Angular, are but Accidental differences. Distincti­ons taken from the Weapons whether sharp or blunt; Sword, Rapier or Bullet; Cut, prick or Tearing, the likewise Accidental: Those that look most like essential differences are they which are taken from the subject in which the Wound (which is it self but an Accident) inhereth, viz. from the Flesh, Skin, Brain, Nerve, Tendon, Artery, Vein, Gristle, Bone &c. All which being the several subjects of Wounds may well be allowed to specifie them, and so much the rather, because from the nature of them we raise our greatest Indi­cations [Page 3]of altering the method of Cure. To this head may also be referred the division of them into Simple or Compound.

Wounds are in themselves so visible,Signs and progno­sticks. that they need no general marks to be known by. But the pe­culiar affections of the particular parts hurt, and the methods of discovering what Inward part is Wounded, by observation made of the symptomes that happen, are fully handled in the Treatise of Gun-shot-wounds, to which I refer you: And not they only, but the prognosticks also are there deli­vered, in w^ch a Chirurgeon ought to be well versed, lest through ignorance of them he undertake the Cure of Wounds that are mortal. I therefore have translated them to that Treatise, because the diffi­culty of Knowing them in cases of Gun-shot, is much greater than in those of other Weapons. The greater symptoms likewise,Symp­toms. as Gangrena, Pa­ralysis, Spasmus, are there distinctly treated of, as being more frequent and important in Gun-shot-wounds than elsewhere; Hemorrhagiae are spoken of in this present Treatise.

As to Intentions of Cure,Intentions of Cure. the Wound being a so­lution of continuity doth require to be made One again. Unity being the perfection of whatsoever hath a being. To effect this, is the work of Nature and Art: both must mutually joyn their helping hands, and unless both the vital faculties and nou­rishment of the part do assist the Art of the Chirur­geon, it will be lost labour, here must be a joynt meeting and agreement of all in one.

In Simple Wounds the Chirurgeon is to afford his assistance Five manner of ways, the omitting [Page 4]of any of which will render him negligent or igno­rant in his Trade.

1 The first is in careful and diligent taking away all such extraneous Bodies, as by their interposition may hinder the true Agglutination of the disjoyned parts, whether they be concrete Bloud, Hair, Sand, Dust, pieces of Bones, Cartilages, or pieces of the Weapons, Rags, &c.

2 The second is performed in bringing the Lips of the Wound even together which were separated.

3 The third is in retaining the Lips so brought toge­ther, that they may be Consolidation be restored to their former Figure.

4 The fourth is in conserving the Temperament and Natural Heat of the part in order to Ʋnition.

5 The fifth is to prevent ill Accidents, and to correct such as have already seized on the part.

Thus much is required of us if the Wound be only Simple; What is required in Com­pound and Contused Wounds. but if it be a Compound Wound with loss of substance, or Contusion, then he hath somewhat more to do: as where there is loss of substance there he must assist Nature with his sarcotics, for regaining what is lost: And where there is Contu­sion, there he must promove the turning what is Contused into pus or Matter, which must be per­formed before there can possibly be Re-union.

As long as there is Alienum quid, The First Intention in taking out Extra­neous Bo­dies. some strange Body or different substance to keep off the Unition, you must not hope to make any Cure of a Wound; therefore if any such be to be drawn forth, before you attempt it, consider seriously; first whether it can be done or no; secondly, whether safe­ly.

For first, sometimes the Weapon sticketh so fast, [Page 5]that by no Art it can be extracted; then it is of necessity to be left to Nature, who this way some­times worketh miracles: Mercatus in Lib. Insti­tut. Chirurg. says, sometimes pieces of Weapons sticking so fast in the Inward parts have lain hid un­der the cicatrized Wound, and have a long time af­ter upon the Apostemation of the part come forth of themselves.

Secondly, You are to consider whether you may with safety pluck out the Weapon or no; some will live a day with the Weapon in their Bodies, which would expire upon the moment of extraction; but if your judgment suggest to you that the Patient is recoverable, make haste out with it before the part be inflamed, or else you must stay until digestion.

If the Weapon have not pierced deep,Which way the Weapon is to be drawn out. and through great Vessels and Nervous places: If the part opposite be full of Veins, Arteries and Nerves, or have a Bone in it over against the Wound; If there be no great fear of Laceration, pull it out the same way it went in; for the effecting of which, our Masters have left us variety of Instruments, the figure and usage whereof you may see in Scultetus. But if the point of the Weapon have pierced above the half way, and there be no Bones nor notable Vessels to hinder you, (here is use of your Anato­my, and exact Knowledge of the parts) either thrust the Weapon through, or make way for it by incision on the contrary side; but beware the Wea­pon be not too big, lest you do make two large Wounds for one.

If the Weapon stick in the Bone,Weapon stuck in a Bone. move it up and down to loosen its point, and then pluck it out; but in case it will not move, cut away the Bone be­fore you extract it.

If a Weapon be fastned betwixt two joynts,Weapon stuck be­tween the Joynts. make an extension of the parts both ways, as it is the manner in Fractures and Dislocations, that so the Tendons and Ligaments being Elonged, the Weapon may with more ease come out; but do this with moderation, lest you break some notable Vessels, and a flux of Bloud or some ill Accident befall you as you extract it. It will be necessary in this work that you consider the Position the part was in when the Wound was Inflicted. Gesner hath a story in his Observ. de Chirurgiae dignitate & praestantia, of a Chirurgeon, who when he could by no means get forth an Arrow, asked the wound­ed Patient in what Figure of his Body he received the Wound, understanding it was done on Horse­back, he placed him in a riding posture, and im­mediately drew out the Weapon.

The Weapon thus drawn out, cleanse it from Rags or ought else, and permit the Wound to bleed accordingly, as you in your judgment shall think fit, you having respect to the constitution and habit of Body, that what is in the small Veins cut asunder may flow out as well to hinder Inflam­mation, as the generation of much Matter. The Bleeding stay'd, if there be Hair growing about the Wound, shave it off, then wipe away the clot­ted bloud with a Spunge dipt in Red-wine, Oxy­crate or Water. But if it stick in the Wound deep, be not too busie with your armed Probe, for thereby you may stir up a new bleeding; whereas this concreted, keeps the Wound warm, and de­fends it from the outward Air, and by digestion Nature will thrust it forth.

CHAP. II. THe Second Intention is performed by bringing the Lips of the Wound exactly together.The Se­cond In­tention.

THIS Intention is delivered in a few words, but they are as a Law to be observed,Unition is to be made. for without that reduction of the Lips a slow and de­formed healing follows. Nature hath nothing to do here in bringing the Lips together, that is the sole work of the Chirurgeon, who must not lay a Pledgit, or croud a Dossel of Lint or Tent into a little Wound. No, that is the way to keep the Wound open, and make it painful, whereby de­fluxions are stirr'd up, the Temperament of the part weakned, and the Cure prolonged; contrary to the Intention of all who have writ of them, and to the practice of our Knowing Chirurgeons here: But amongst the pretenders to that Art, we often meet with such work; particularly in a young man Wounded near Highgate in the Back,Observa­tion con­cerning Dossils in Simple Wounds. slanting un­der the right Scapula, another wound on the Back, and another through the upper part of the other Shoulder, with a long Gash over the forehead, and with other wounds, some whereof not conside­rable: [Page 8]The next day I was carried thither to Dress these Wounds, I found them all distended with Tents and Dossils of Lint, disposed to inflame and swell; the Patient exceeding full of pain: after I had taken out these Extraneous Bodies, my endea­vour was to Dress them so, as I might encline their up-heaved Lips to return to their Natural scite; to which purpose I fomented them with Milk, and drest them with Pledgits spread with my digestive of Tereblnth. cum vitel. ovi, and Em­brocated them with Ol. Ros. and by Empl. è Bolo, and Bandage with gentle compression I drest him up, and afterwards here in Town Cured him by Sarcotics and Epulotics, as in Compound Wounds, a longer work which at first ought to have been by Agglutination: Parts separated and disjoyned are to be brought together gently and equally, that they may touch one another, and so be prepared for Unition.

This must be done first gently sensim & sensim, as Fallopius hath it, by little and little, not hastily at one pluck: If the parts be equally soft bring them equally together:First Gent­ly. if the one soft, the other hard, and not to be moved, but with difficulty, bring the soft part to the stubborn. If the part be grown stiff with cold, as if they had been left in the fields all night, which after a Battel hath often hapned, (and particularly to a merry fellow, a common Souldier, that used to wear an Iron Skull under a Cap, and from thence was call'd by a Nick-name; his wounds were large, and the Lips hardened with the cold, and it was well for him his bleeding being thereby stay'd) in this case you are with Milk or warm-Water, and Oyle to supple them by Fo­mentation or Embrocation, till you perceive the [Page 9]Lips made soft enough for your purpose, before you endeavour Re-union.

Secondly Equally, that the parts cut asunder may answer one another, as well in profundo, as in superficie, the Top as the Bottom, Brim to Brim; and, if possible, underneath Vessel to Ves­sel,Secondly, Equally. that Nature may be in a capacity of doing its own work, and by vertue of its Balsam, Reunite, Ag­glutinate, Consolidate, and Heal the Wounds: In all which Intentions she is the Agent, and the Chirurgeon only the Assistant, which Assistence, that it may be more effectually given, we must go on to the Third.

CHAP. III. Of the Fourth and Fifth In­tention, and of Compound Wounds, &c.

CHAP. IV. Wounds of Veins and Arteries.

THE next thing that offers it self to our con­sideration, is the Wounds of particular parts, and first of the Veins and Arteries, which are subject to great effusion of bloud, where­on the life of your Patient depends. Est enim san­guis Thesaurus vitae: and therefore requires your speedy help.Signes of the Artery wounded. You may distinguish whether the bloud be from an Artery or a Vein, by the flowing of it, and by its colour. From the Artery the bloud rushes impetuously & per saltum, by reason of the dilatation and constriction of the heart, and is of a florid colour.Of the Vein wounded. The Venal bloud flows with a more smooth and even stream, of a gross consi­stence, and of a darkish colour. Of these Wounds there is no great danger,Progno­stick of Vein and cure. Galen's Powder with the white of Egg, with the Suture and the formerly proposed way of dressing and Bandage, will cer­tainly stay the bleeding of Wounds in the greater Veins, and cure the Wound at the same time, or in few days:Progno­stick of Artery. But those of the Arteries are most difficultly stopt, for that the bloud is in a most vi­gorous and strong motion.

If these wounds be not with loss of substance,And cure. [Page 35]and lips bruised,Suture. you are then by Suture to bring the Lips & Artery both together, passing your Needle, with a good strong thred seared through both Arte­ry and Lips, making Guido's suture, which he calls suppressoria or Glovers-stitch. And having thus secured the Vessels for the present, you are then to apply such as this over all.Applica­tives. ℞ Boli Armen. ℥ iij. Sang. Drac. Thuris, Aloes, Glutinis sic. an. ℥ j. Gyp­si, Farin. Volatilis an. ℥ ss. Hipocystidis, Acatiae Su­mach. an. ʒ iij. with the white of Eggs make it to the consistence of Honey, apply this upon a double cloath over the wound and parts about, with a compress squeazed out of Oxicrate or Acetum, and roul up the Member, with the Agglutinative Rouler, beginning on the opposite part,Roulers. bringing both the heads over the wound, and having taken a turn or two there, roul upwards and downwards, so as to press the bloud from below upward, and to hinder the Influx from above. Your Bandage must so be made, as may be to the ease of the Pati­ent, and the position such as may prevent as much as may be all pain, keeping him cool and quiet,Ordering the part and diet. and to a slender diet, and his drink cooling and Incrassating, as Fountain water, with Sal Prunella, or Acetum, or with Gads of Steel quencht in it, sweetned with Syr. of Coral, or Pomegranates, or some of these of Quercitan's, ℞. Croci Martis, Essentiae Corallor. an. ℈ j. Syr. de Ros. Sic. & Mirtill. an. ℥ j. aq. Papaver. Rhead. ℥ iiij. m. or a Decoct, Hordei cum Sem. Papaver. Alb. & Hiosciami, with Rose-water and a little Sugar, as a draught at night, or at present in any great extremity in bleeding; also a grain or two of Laudanum, if the Patient bears it well, in these case is commendable.Bleeding, where, You are to let bloud from the contrary part as the [Page 34] [...] [Page 35] [...] [Page 36]strength of the Patient will permit; only a little at a time for revulsion, as also Cupping, Friction, Binding the remote parts, & the like for derivation.

In such great effusions dress not the Patient again in five or six days;Qu. if the Stitches break. then if all be well, dress him again after the same manner; but if you find the bloud hath made its passage through all, and the Stitches broken, then if you can come to the Arterie, you shall do well to take hold of it by a little hook,Deligation and Ab­cision. and separate the Vessel from its tegu­ments, and with a twisted thread make a deligation upon the upper and lower-most part of the Artery, and divide it in the middle, so the ends will con­tract; and as the Artery Incarns, the Ligature will cast off: Then proceed by digestion and Sarco­ticks, and cicatrize the wound. But if the Artery lies so deep that you cannot possibly come to make deligation upon it,Escaro­ticks, &c. proceed by Escaroticks applied to the Vessel, or by an actual Cautery. If by Es­caroticks, then you are to cleanse the wound of the clotted bloud, and dip it in some such like Powder, ℞ Thur. Pul. ℥ ij. Aloes, Glutinis Sic. an. ℥ j. Chal­cant. Ʋst. ℥ ijss. Arsenici ʒ vj. Gypsi ℥ ijss. apply this upon the Artery thick, and fill up the rest of the wound with Galen's Powder, with Hares Furre cut into it, and over all your digestive è Terebinth. & ovo integro, and dress up the wound as before; and at your next dressing, leave the Escarotick stick­ing, and Incarn as fast as you can, or instead of them, Vitriol powdred and tied in a fine rag, and thrust to the bottom of the wound, and dressings applied over as before.

But if after these former dressings that Artery bleed,Cautery. and you cannot come to divide the Artery, then you must use the actual Cautery. By [Page 37]it the Vessel shrinks up at both ends, the flux is im­mediately stopt, and the part marvellously strength­ned. You are to convey it down by a Canula, and that it may not heat, cover it over with an Empla­ster, and wet the outside with the white of an Egg, or mucilage of Quince-seeds. But before you use your Cautery, you should remove the grumeous bloud, or whatsoever else lies in your way, lest it cool your Cautery, and frustrate your endeavours, and pain your Patient to no purpose:Cautim. Once or twice pressing with your actual Cautery to divide and contract the Artery will be sufficient. Oftner may burn it to a coal, which may cause the falling off of the Eschar before it is Incarned, and a new flux of bloud follow; that done, dress the part with a little of the mucilage of Quince, mixt with the white of an Egg, and Embrocate them about with Ol. Rosar. and apply your Emplaster Diacal­cith. malaxt with some of the same Oile over all; and after you have allay'd the heat of the part, then digest the Wound, and with Sarcoticks Incarn, and by Epuloticks cicatrize the Wound.

A person of a good habit of body, about 35. years of Age, wounded in a Duel on the right side the Aspe­ra Arteria; Observ. 1. Wound of the inter­nal Juga­lar. being run through his neck below the last Vertebra of that side behind: The Wound was small, yet he bled with a full stream, but it stopt by holding a finger upon it while I made dressings ready, which was with a few of our common astrin­gent Powders, with the white of an Egg, and a little Acet. upon a thick Pledgit of Lint, with an Emplaster after of the same, with Compress and such Bandage as it would bear: The Wound be­hind bled, when that before was drest. I applied [Page 38]the said Medicaments to that, and we held them on with our hands, until they were dried on, then we put him to bed in the same house, and kept him cool and quiet. I used all my endeavours for the contemperating his bloud, as is usual in such cases, and drest him but once in four or five days, unless I were necessitated by the bursting out of the bloud from his wound; he bled at times about 16. or 17. days; his wound by the Vertebrae of the neck was cured in few days: and this near the Aspera Ar­teria was cured by this way of Agglutination the nineteenth or twentieth day.

A man wounded in the Artery under the right Eye,Observ. 2. An Artery wounded. was at that instant drest by Mr. Fawcet Chi­rurgeon, the next day in the afternoon it burst out impetuously; I was sent for, and found it bleed­ing with a strong impulse, the wound very small, not so big as a silver penny, made by a blow with the corner of a Trencher; I drest the Wound with Pulv. Galeni, and applied an Emplaster over it made up with my common restrictive Powders, cum Albumin. Ovor. and a little Acetum, with good Compress and Bandage bound it up: The next day his Wound bled again, and upon stopping of that little wound with my finger, the bloud was seen to beat all along the Artery under the Eye to the Tem­poral Muscle, with a greater force than is com­monly seen in an Aneurisma; I then with a crooked Needle peirc'd through both the Lips and Artery, and by Deligation restrained the bleeding, and with Emplastricks drest it up as before, concluding I should have very little more trouble from this wound; but within two or three days after, it burst out bleeding again; then I being absent, some other [Page 39]Chirurgeon was call'd in, and after at another bleed­ing Mr. Fawcet drest him, and at another time Mr. Aris drest him, the wound was now grown large, with the crowding of Dossils, and being in a very inconvenient place for bandage, it bled often, and was drest by such Chirurgions as they could meet with in their necessity; Escaroticks being thus frequently applyed to stop the flux of bloud, his Eye was very much inflamed, so as it was verily believed by us, that if he did recover of his wound, yet his Eye would be lost, his continual bleeding thus for many dayes had so exhausted his Spirits, that there was small hopes of his sur­viving.

At the last bursting out of this Vessel, Mr. E. Mo­lins deceased, Mr. Fawcet and my self met together at his Chamber, we found him lying as dead, with his hand out of his bed upon his breast, we felt for his pulse but it did not beat, we concluded him dead, and took the dressings hastily off the wound, it did not bleed though it was open, we supposed the bloud exhausted, the Artery lay in the wound torn by the Escaroticks, we took up the Ends and tyed them, and drest the wound with Liniment Arcei and an Empl. over it, not believing that the man would ever recover, but from this time, the bleed­ing of the wound ceased, and the wound by very common remedies daily Incarned to my admiration, and he was in less than a month perfectly cured, both of his wound and eye. This Patient was subject to the like bleeding upon every Scratch.

A Butcher was wounded in the Artery between the Thumb and Fore-finger, with a large wound,Observ. 3. Artery wounded. after he had been drest three or four days by some body, the wound continuing still to bleed, he came [Page 40]to me late one night from Westminster bleeding, with dossils crouded in the wound, I threw them out, and with a needle and a thread stitch't up the wound and the Artery with it, sprinkling my ag­glutinative Powders upon the Suture with my Empl. and Bandage, as in the former wounds is said; in three or four dressings I cured him, but after there remained some pulsation extraordinary under the Cicatrix, which proceeded from the too lax Incarnation of the wound, wherefore with a pledgit dipt in a dulcified Tincture of Vitriol prest out, and Applied with a good Compress, and rouled over the affected part, it was dried and shriveled so as from that Application there was seen no more pulsation in the skin from the Artery.

One in the New Exchange had an Aneurisma in the palm of his hand,Observ. 4. Aneurisma broken open. lying a-long to the third and and fourth fingers, which at last broke out, and bled at times the space of eight or ten daies, and being at a loss he sent for me, with this Tincture of Vitriol as above-said, I cured him not only by stopping the bloud, but by making a firm Cicatrix, I drest these Eruptions, but seldom once in four or five days.

A Sedentary young Gentleman of an ill habit of Body,Observ. 5. Wound of the Surall Artery. wounded by a puncture in the Inside of the calf of his leg into the Surall Artery, bled much, a Chirurgion is call'd for; he fills up the wound with his Dossils dipt in albumine ovi, and astrin­gent pouders, wherein was Escarotics calchantum ustum, &c. Applying over this his Emplaster and Bandage, by which he stopt the flux of bloud, and left the Patient to rest: The next day I am cal'd [Page 41]in to dress the Patient. Upon a relation of the wound and this manner of dressing, I propose not to open the wound in four or five daies, unless some Acci­dent happen I visit him daily, he keeps his bed, complains of a disturbance in the wound, as burn­ing, throbbing, and pain at times, not constantly, and is very apprehensive of its bleeding; looks himself often upon the Bandage, and Alarums me by messages as often. The third morning his Chi­rurgion and my self meet, we find the Bandage all bloudy; we propose to dress, The Appara­tus being made we take off the dressings, and find the bloud fresh in the Roulers, but upon taking off the Emplaster see the Dossils come out, and with such a foul bloudy sanies, as is usual in such wounds after the filling them with such Pow­ders. I consider with my Brother Chirurgion, whether the putting in a Tent with Escarotics may not stir up flux of Humours, and be attended with Inflammation, &c. and whether that way we may be sure of meeting with the Artery; and if we do whether our Medicaments will restrain its bleeding; and if not, then whether by pressing upon that Ar­tery we may not raise a flux of bloud anew? To avoid all such I resolve to dress the wound with our common digestive, with Tereb. vitell & ovi with pul­vere Galeni, and so we apply it upon a thick pledgit of Lint, and Embrocate the parts about with ol. Ros. & Aceto, & Empl. è Bolo over all with good Com­press and Bandage; by this I suppos'd the parts would be at ease, the wound at liberty to dis­charge the sloughs and sanies which was made and choaked in by the last dressings; and the Unition of parts within furthered, and the bloud in the Artery restrained. If it did not thus answer ex­pectation, [Page 42]yet I concluded we had done what be­came good Chirurgions, and that at the next dres­sing it would be in our power more easily to lay open the wound, and divide the Artery without hurting the nervous or tendinous bodies near it. For a wound so drest up would either unite or di­late its lips, there being a pledgit proportionable to receive a small quantity of matter, such as might be expected from such a wound, well-condition'd, but a greater quantity, or a new flux of bloud that could not get out so, must necessarily distend the lips, we resolving not to dress the wound again in less than 3 or 4 daies: Thus we left the Patient easie; but the next day I found him unsatisfied how this wound could cure so dress without a Tent, and oft murmuring that it would rancle; yet he con­tinued pretty easie, and did not bleed all these three dayes. The Fourth day at the opening, we found no bloud but what was mixt with matter, and the wound lookt well; but by his importunity I com­plyed with him, and put in a short Tent spread with digestive and dipt in praecipitate, and drest him up again; and the third day open'd, and upon the dressings there was a fresh bloud again, which was followed by a thick white Matter, as from a Phlegmon, more than might reasonably be expected from a small puncture, not above half an Inch deep; wherefore fearing a cavous Ulcer, I resolved to dress without a Tent, and by good com­press and bandage to press out thit Matter from within, and defend the part from Influx of Humours from above: to which purpose I drest with pled­gits as before with my digestive, &c. and open'd the wound once in three dayes, and altered not this method, though I chang'd the ung. upon the pled­git [Page 43]as I thought fit: Thus I kept the part without tumor or Inflammation, and the matter lessened each dressing, but was not well digested nor free from bloud, but his feet swell'd, and himself ill-disposed; Scorbutic and such like affections, with loss of Appetite, fainting, &c. To relieve him in these Dr. W. was consulted, and after a while I caused a straight stocking to be laced on both legs, and got him out of Bed at least for some little while every day, and when he was able he retired into the Country, but hath not yet got off of the disease he heightned, by keeping within doors with this little wound. Doubtless this cure had been shorter, if immediately in the first dressing he had been bound up with an Agglutinative bandage, and the whole committed to nature.

A Cooper living near Maidenhead in the County of Bucks, Observ. 6. Artery wounded in a Coo­pers arm at Windsor. accidentally in letting bloud was prickt in an Artery, the Arm swells and is pained, he puts himself into another Barber Chirurgions hands dwelling in Windsor, who by unfit applica­tions, Relaxes the part, then supposing the soft Tumor he had made was a Suppuration of Matter, (though indeed it was the Arterial bloud) he with his Incision knife or Lancet cutts into it, at which an impetuous flux of blond rushes out, to the quan­tity of four flaggons, he fills up the opening with Lint, and makes a hard bandage round it, which somewhat restrains the flux of bloud, but the Arm swells, and threatens a Gangreen: While this poor man lay thus afflicted, We his Majesties and Royal Highness Chirurgeons attending the Court, did vi­sit him, and proposed to make an apparatus for the taking up this Artery, or in case of failing to [Page 44]take off his Arm by Amputation; We met the next morning, the Patient is taken out of bed and placed in a Chair towards the Light, one of his friends held him in the Chair: Mr. Whittle stood behind his Arm, and held his Elbow with his left hand; and with the other hand was ready to help me in the operation; Mr. L. holds the lame hand: In the first place I viewed the Arm, where finding no Gangreen according to the report of the Chi­rurgeon, but rather (as I thought) an Aneuris­ma, I made a bandage above the wound, to hinder the Influx of bloud into it: Upon this bandage Mr. Pearce made the gripe; I then untied the Li­gature from about the wound, and found that also free from Mortification; I put my finger into it, and finding the skin made thin by distention from the bloud, I call'd for a Knife, which while I was searching in the wound, Mr. Whittle took into his hand: I prayed him to cut through the length of the hallowness. It being done, I with my finger thrust out the Grumous bloud and an Abscess from the lower part of the Arm. When I had cleared the parts more distant, which would have fallen in and blinded my Work, I then made way to the Ar­tery, removing from about it the clotted bloud; upon which it immediately burst out, I prayed Mr. Whittle to hold his finger upon it, he did so; then I separated it from the parts about it, and passed a crooked Needle under it; and being ready to tye it, I desired Mr. Whittle to hold off his finger, that I might be the more sure it was the Artery, upon the doing of which it spurted out: I tyed it; but in tying the Thread broke: This caused a mur­muring in some of the by-standers, as that the Patient would die under our hands while I was endeavour­ing [Page 45]deligation, which by a new wounding of the parts would hasten Mortification and Death; I de­sired they would continue their places, and Mr. Whittle his finger upon the Artery, that it bled not; he did so; in the while I made a strong Ligature of some twisted Threads, seared it, and put it into the eye of one of our common silver searching Probes. Gentlemen, said I, you shall see me pass this probe under the Artery, and thereby you may be assured I shall wound no parts; I imme­diately did so and tyed the Artery, Mr. Whittle took off his finger, it bled not; then Mr. Pearce took off his hands, I then loosened the Bandage, which was all the time before under his hands, It bled no more; I told them there was more to be done in order to the binding that Artery; but in continuation of the continual Fainting of the Pa­tient, we would defer it to the next dressing: then calling for dressings, they brought me what was designed for Amputation, which I refused; and ordered the common digestive è Terebinth. cum Vitell. ovi, which they fetcht.

I cut off the ends of the Ligature, and dipt some of the pledgits spread with the Liniment in Galen's powder, and applyed them next the Artery, and the rest of the pledgits dipt in ol. Ros. warm, and light­ly fill'd up the wound, then Embrocated the Arm with the same oyl, and laid a Diacalcitheos Em­plaster over the wound and that part of the Arm, and over the hand and Arm below which was Oede­matous, a mixture of Diacalcith. & Paracels. Then with bandage began at the hand and rouled up the wound, and taking a turn or two there, I rouled up to the Axilla. This was the Ligatura Expulsiva, by which I proposed the thrusting back the Influx of [Page 46]humors, and to give strength to the inseebled Mem­ber; He being now again in his Bed, I placed his hand upon his breast in much ease to the great joy of the Patient. At the next dressing, only Mr. Whittle and the Countrey Chirurgeons were present with me, we opened the Member, found the tumor al­lay'd, the wound fresh and tollerably digested, we now passed another Ligature upon the Artery above the first, and in pulling the first to cut it off be­tween the Ligatures, it broke, which was as well: We drest it up with the same digestive, only leav­ing out the Powders; Embrocated and applied our Emplaster, rouled up parts as before; The next time Mr. Whittle and I undrest the member, and found the wound in a very good condition, with assured hopes of curing it in a few weeks, the Lips of the wound being more digested and contracted, we drest it up with Mund. Paracels. And now being Impatiently expected at London, with my diseased Patients, I return, leaving it to Mr. Whittle, who drest it for the space of 10. dayes, it healing up without any return of bloud; In his absence Mr. L. dresses the Patient; but whether in wiping off the knot or what else, it burst out again; Serjeant Knight came in, dresses it with Calcanth. ust. and from that time it bled no more.

The Ancient way of tying this Artery is as I have already said by tying it in two distinct places, and cutting it off between, but here the Patient often fainting interrupted us in that work, and the break­ing between saved us the labour.

The cutting in pieces the Arteries hath often been performed by me in Strumous ulcers, where they ride over the Carious bones; in doing which I never see the Artery break out in bleeding after the day I cut it.

CHAP. V. Wounds of the Nerves, Ten­dons and Ligaments.

NErves may be many wayes wounded, viz. Caesim or Punctim, Wounds of Nerves and Ten­dons. the former way they are usually cut through, and then occasion no new consideration in Chirurgery, because they wholly cease from action and are irrecoverable; but when prickt by a sharp pointed weapon, which is call'd a puncture, they are much to be regarded; so also Tendons, not the small Fibres of them (which are in every wound of the fleshy parts, when they are largely cut, whence they become painful) but the main body of them, which usually make up the tail or head of a Muscle, if you would know whe­ther these are wounded or not, consider the place wounded, viz. whether near the Joint, in the inside the Arm, or Leg, or the end of the Muscle, or if in the Tendinous parts of the hand or foot, whence immediately arise great pains and Inflamma­tion, also a contraction and hardness in the Nerve or Tendon follows. But if the Nerve be quite divided, the pain is little, a kind of Stupor or Numness, and the particular part is Lame.

The most frequent wounds of Nerves,Ill conse­quences of bleeding not alway from a prick of Nerve or Tendon. and most to be taken care of in Chirurgery being Punctures; I shall instance in them, and chuse the most common, viz. those which are made accidentally by letting bloud: and here by the way you must take notice, that in letting bloud, sometimes the Apertion hap­pens to be made when the skin, by the Bandage or position of the Arm, lies equal with the Vein, yet afterwards is not so, or the Apertion is made too small in the skin; so as part of the bloud is choakt, and lies there extravased, whence a Phlegmon is made, or it happens in those that are well Let bloud, yet through the Indisposition and ill habit of Body, the part prickt festers (as they usually say) and is a day or two after sore, and if neg­lected makes a Phlegmon: all these Phlegmons do Inflame and swell the part, and contract the Arm; if a Boyl in a fleshy part be painful, then much more these in the Joynts, amongst the Nerves and Tendons, and this accident hath happened to all that do use to Let bloud, whether Physicians or Chirurgeons.

This was the reason that some of our old Master Chirurgeons did after Letting bloud, always apply a pledgit of Basilicon upon the Apertion with an Emplaster over it, this breathed the part, and se­cured it from corrupting. But we by a contrary way, as by a little Compress dipt in water, endea­vour to restrain the bloud, and should be laught at if we should continue the old way of Basilicon.

At the time we Let people bloud, they are com­monly labouring under some great fermentation, or apprehend it so; no wonder if it sometimes fall upon the part where it was invited by bandage.

I have been sent for into the Countrey to a Per­son, that after a Letting bloud, was seized with a great Inflammation the whole length of the Arm, this was an Erysipelas, the Apertion in the Vein might possibly be the cause, but that place was not affected at all; Dr. R. complained once of a Chi­rurgeon, who was so unconscionable as he said, to ask five pounds for curing an Arm he had made sore by his Letting bloud; but I hope no person is so ignorant or malicious, to impute these acci­dents to a Puncture of the Nerve and Tendon.

But when they are really prickt, their Sym­ptomes,Signs of a Nerve prickt. as you may read in all those that have writ of them, are suddain with vehement pain, faintings, convulsions, and are attended by great defluxions; they do not terminate presently in a Suppuration with good Matter, until great Endea­vours have been used, these yield not to the simple anodyne Cataplasme of white bread and milk.

Here are other considerations; and in the first place whether they lie open, or the Apertion in the skin over them be small, or that the Nerve or Tendon lie covered under the Membrane Adiposa; Cure. if it be so, then you are to open the skin that the Medicaments may penetrate to the wounded Nerve or Tendon, and hereto those Medicaments are pro­per, which are of hot dry and subtil parts to con­sume that Ichorous water, which first affects the Nerve or Tendon, and will cause putrefaction: ol. Ros. with a little bay-salt dissolved in it and dropt into the part scalding hot, dressing it with a pledget spread with Basilicon dipt in the same oyl, and the part Embrocated about with ol. Lumbric. [Page 50]with an Empl. diasulp. over, and this cataplasma over that, ℞ farinae Hordei, & fabar. an. ℥iiij. sem. lini & foenugraeci pul. an. ℥j. flor. ros. rub. flor. cham. Sambuci, & sumit. Absinth. an. ℥iij. boyl this in red Wine, or the com. lixivium, adding oxymellis ℥iij. ol. Ros. ℥j. M. So roul up the part gently; if there be much pain dress it twice a day, and if the part requires Medicaments of more drying and subtle parts dress with Balsam sulphu­ris Terebinthinati, or ol. Sabinae & Terebinth. an. ʒij. Misce or ol. Costinum, Ruthae, Sabinae, Aneth. scorpion. &c. These are all proper Medicines to dress the affected part, they having the quality required to dry and consume that matter which lyes cor­rupting in them, if applyed actually hot, the Ap­plication of the former oyl of Roses and Salt hath alway served my purpose.

In your Application of your Medicaments, you are to consider what degree of heat and Siccity is proper for the offended Nerve or Tendon; if in your use of these Medicaments your Patient feels not the heat of them,Caution. or feels it vehemently, it is then not rightly fitted; For in the former case it doth not enough dry up that sanies, or in the lat­ter it doth withal inflame the part;Progno­sticks. if the Patient feel the heat moderately, the medicine is good, but if from the use of the Medicine the part Itch and Smart, and the Apertion made by the Puncture gape as at first, then the Medicament is stronger than it should be; if the hardness go off and the contraction, and the orifice not too open, 'tis a good sign: if the Nerve be cut according to its length it is the least dangerous, but if transverse most dangerous, all these wounds are accompanied [Page 51]with gleet and great pain which stirs up fluxion; if they yield not in their cure to such Medica­ments as have been proposed, then you are to di­vide them, to prevent convulsions, spasma's, and Gangren, after which they cure as other wounds, but do require more care in their position to keep the member steady, if it be in such a Joint where there are Nerves and Tendons, that move contra­riwise; otherwise the member will not yield to that contraction, and become more difficult in their cure, and of less use when cured.

The Ligaments require much one method with the Tendons,Cure of li­gaments wounded, the same with Ten­dons. only your Medicaments are here to be more drying, as Euphorbium, Sulphur vivum, calx lota Tutia, &c. without acrimony.

A Youth about ten years of Age,Wound in the inside of the wrist one day in the Sessions yard leaning over the spiked pails to see the Malefactors, was suddainly frighted down by the Marshals men; in his falling was catcht by one of these spikes in the inside of his wrist; it passing between the bone and Tendons, he hung thereby until he was taken down, they carried him home, I was sent for, I found the Tendons stretcht out to a great length, and some of them broken; others torn, and one of the bones of the carpus lying loose in the wound. In the dressing this wound there was trouble how to place these Ten­dons; I began in taking out the loose bone, and cleansing the wound, and placing these shatter'd and overstretcht Tendons within the lips of the wound, and made my first Stitch in the middle of the wound, bringing the lips as close together as I could, then I made two stitches more, one of each side the middle [Page 52]stitch, dressing him up with my digestive è Tere­binthina, &c. dipt in this following Balsam, ℞ Tere­binth. lb ij olei olivar. lbiij. ol. Laurini ℥ iiij. Cinnam. ℥ iij. Euphorbii Garyophil. Baccar. Juniperi an. ℥ j. Gum hederae, sagapeni, Ammoniac. opoponac. Galbani an. ℥j ss. Myrrhae, Mastich. Colophoniae pul. an. ʒ iij. distillentur pro usu. Over this I applyed my Empl. è Bolo, with a compress dipt in Oxycrate, and so rouled up the member, and some hours after let him bloud, and gave him that night a draught of Aq. Paralyseos with syr. de meconio. & aq. cardiac. C. iij. that night he rested ill, and in the morning was full of pain. I took off the Bandage, and bathed the affected part with a decoct. radic. Althae, Malvar, violar. cham. verbasci hioscyami, and ap­plied a Cataplasma with farina Hordei, fabar. flor. Ros. rub. Balaust, decocted in Oxymel, with the addition of ol. Lumbric. & rosar. over the former dressing; the next day his pain was much mitigated, the Tendons all drawn up, and the stitches laxe: I thought to have drawn the Lips close, but found them too painful to admit of it, therefore I cut the stitches out, and brought them as close as they easily would, and drest up the wound as before. After some few days, the wound being tolera­bly digested, I drest it with this unguent. dipt in the former Balsam, and applyed over the wound the Empl. Diasulphuris Rulandiae, with bandage and compress as before, ℞ Terebinth. Resinae, pini, ol. Hyperici, an. ℥ iiij. sarcocollae, myrrhae, Thuris, an. ʒ iij. Cerae q. sufficit; dissolve them, and bring it to the form of an unguent: Thus I happily deterg'd and incarn'd, and by ung. Tutiae and my ordinary Epu­lotics cicatrized the wound, and he some while after was restored to the use of his hand.

A Coach man wounded transverse over the back­side of the wrist, deep into the Joynt,Wound on the inside of the wrist into the Joint. so that his hand doubled inward, was carried into the next Inn: I caused a ferula to be placed under his hand the better to support it, and placing the fingers crookt over the ferula, I searcht the wound and pul'd out many fragments of Bones, and after cleansing the wound brought the lipps together by three stitches, leaving a discharge for Matter in the ends of the wounds which were both depending, dressing those ends with a digestive è Terebinthina cum vitel. ovi & far. Hordei with a little crocus. Upon the Suture I sprinkled the powders of myrrhae, Aloes, Thuris, & sang. dracon. and applyed the unguent mentioned in the former Chapter: then taking Bolus Armen. with some of the former Powders, made up with Alb. ovor. Acet. & ol. Ros. mixed to the consistence of a mel. applyed it as a restrictive over the wound and parts about, and placed his hand again upon the ferula, with a soft folded cloath under it, bringing his fingers over the end of the ferula, that they might be in some capacity for future use: Thus having placed his hand I roul'd it upon a good compress dipt in Oxycrate, and after­ward Let him bloud, and gave him ʒ vj. syr. de me­conio in a draught of Mace-Ale for his Supper, and setled him to rest, but he slept little that night. The next day I ordered him a Clyster and a slender diet; the day after I opened his hand again, and fomented the wound and parts about with an Anodyne de­coction, as in the former Chapter, and drest up his wound as before, Embrocating patts well about with ol. Lumbric, and applyed my Emplast. è Bolo, over the wound and adjacent parts; it digested in [Page 54]the declining ends a little, but continued painful, yet much more pained in the fingers: the next days dressing I cut out the stitches, and drest the wound with my digestive è Tereb. dipt in my former mentioned Balsam, and applyed a Cataplasme warm over all the wound and hand, as in the for­mer Chapter, and roul'd up the member again: This wound did not digest kindly, nor was it easie during the whole cure, but the Inflammation went off with the Tumor about the wounded Lips; but in the fingers and back of the hand remained an oedematous Tumor. The day following I took off the dressings, and finding the Lips which I had stitcht lye open, and a white flesh within them, I dropt in some of my Balsam warm into the wound, and fill'd the crude Lips with mer. praecipit. and laid pledgits spread with the above-mentioned unguent, with some succ. Centaur. & Chelidonii, with mel Ros. boyled it gently to a good consistence, and laid the Cataplasma as before over all: Thus I deterg'd and cured this wound, sprinkling the Lips with calx lota, which cicatrized it. After this I put on a Catagmatick Emplaster, and kept the maimd hand still upon the ferula, and afterwards caused a Glove to be made to lace upon his hand and fingers, to take off that pituitous Tumor, which did accordingly answer my expectation. But his pain continued, and so weak, as he kept it upon the ferula a good while after; since the writing of this I am informed he continues in the same service, his wrist is stiff, but he drives his Coach.

A Person of a good Age and ill habit of Body walking in the street,A finger bit off by a Horse. passing by a Coach one of the Horses snapt off the end of his finger the Glove [Page 55]with it: I drest the stump with the common di­gestive dipt in a little ol. Ros. warm, and with Emplast. diacalcitheos, malaxt with a little of the same oyl, roul'd up the stump. This Patient kept not his house with this little hurt, but came to me to be drest once in a day or two, and sometimes drest himself, he not thinking it worth the obser­vation of diet, bleeding, or the like: one day when neither of us suspected ill he came to me, the Ulcer was crude, an Ichor dropt from it, and the part about it was blistered, I scarified the part blistered, and dabbled the wound and about with ol. Terebinth. warm, and strewed mer. praecipitate over all, and with pledgits dipt in Basilicon with a little ol. Terebinth. and with Empl. diacalcith. over it, roul'd it up; and that night came to his Lodging with a fomentation, and other Medica­ments prepared for a mortification, but found it better disposed; so continued the dressing, and afteward Let him bloud, and the next day purg'd him with an infusion of Senn, &c. the wound digesting well from that time, I Incarned and Cicatrized the stump. Thus sometimes great mischiefs attend little wounds, through the con­tempt some of our Patients have of them.

CHAP. VI. Wounds of the Face.

A Lady was wounded down the whole length of the forehead to the Nose, and then trans­verse under the left Supercilium towards the Tem­poral Muscle, her Eye and Face much bruised. This hapned to her travelling in a Hackney Coach, upon the Jetting whereof she was thrown out of the hind-seat, against the forepart of the Coach.

At the first sight of the wound in her forehead, seeing the bone bare and her self so disturb'd, I doubted whether I should stitch it, or keep it open with dossils; but seeing no fissure or Ine­quality in that part of the bone that was bare, and con­sidering the deformity in that place would be great, being the whole length and middle of the forehead, I resolved to make one stitch in the middle of the forehead to bring the lips close together; so as if any Symptome prognosticated ill, I might at pleasure by the cutting off the stitches lay it open again, but if there was no cause, then the next dressing, I pro­posed by dry stitches to bring the Lips of the wound close together; the upper Eye-lid hung down upon the Eye, reaching from the Inner Canthus of the Eye more than half an Inch beyond the outward, it was bruised, excoriated, and much swell'd, [Page 57]not capable of the dry stitch, nor in that place of Bandage, it being all along under the Brow, where­fore I made four stitches at such distance as they might be able to keep the Lips close together, and the last stitch towards the Temporal Muscle, I took in the piece of skin that was divided by a wound above it, as in a double Hair-lip; and over these Sutures and Wounds I sprinkled a little of these powders, Terra. Sigill. Sang. Dracon. Aloes & Thus, and my Pledgits spread with Arceus his Oyntment, and over these my Empl. è Bolo, and with Compress dipt in Oxycrate, and made my Bandage over from the wound, the two heads of the Roulers meeting behind; this I did to keep the wound in the forehead from uniting too close, I still fearing some Fissure or mischief there, she complaining much of her head; I having thus drest her wounds, I caused some Aq. Ros. Rubr. cum Alb. ovi to be beaten together, and dropt in her Eye, and little foulded cloaths doubled and wet in the same to be laid over that part, and over the Cheek my Empl. è Bolo, and forbore the bleeding her that night, in consideration that nunc fluebant catamenia, and she bled the space of five miles com­ing back.

The second day after I drest her again, and find­ing less suspition in the wound of her forehead, of fracture or fissure, I brought the Lips of that wound together with dry stitches, with a little of the powder forementioned, with the white of an Egg, and strengthened those sutures of the Supercilia by the same Medicament, lest the continual motion of the Lid should relax them, and then drest it up, and brought the Bandage now from behind, with both the heads forward, passing one by another [Page 58]to bring the Lips of the wound in the forehead close together, and drest her Eye with Aq. Pomor. Ma­tur. with a few grains of Vitrioll. Alb. this warm to remove the suffusion upon the Cornea; and upon her bruised cheek I applied a Cataplasme of the roots of Orpen beaten in a Mortar, with the white of an Egg.

Two days after I drest her again, and finding that the dry stitches kept those Lips of the wound close together, I cut off the other stitches from out the Lips of the wound, and drest her with my Sar­coticks composed of some of those powders fore­mentioned, which supplied the place of Epuloticks, and that morning I let her bloud, taking away about 10. ounces with a rotten Serum upon it.

The next day she was purged, this was done for the carrying off the flux of humor from her Eye and Face; thus was she Cured and disposed to go out of Town, the same day seven-night she was woun­ded, she was hurt upon the Munday, and the Sa­turday afterward she was cured.

A Servant of the L. B. was wounded on the right Cheek, from under the Eye over the Os Zy­goma down the Muscles of the Cheeks; In clean­sing of the wound, I felt a piece of the same Bone which was cut off by a slanting blow, and hung only by some fleshy fibres in the wound; it was cut over the whole breadth of the Bone; I took it out, & for that the part would not well admit of Bandage, I made two stitches in the wound, bringing the Lips even and close together; I drest this Patient as the former, and the third day after drest him again, and found his wound agglutinated; I cut out the stitches, and drest him with the same agglutinatives [Page 59]as before, and the second day after I opened his wound again, and found it perfectly cured.

And so I have cured all the wounds of the Face as happily; in a Hair-Lip of the Nether-Lip, I cut a little Boy (who lay in London, and lived at Green­wich) of about seven or eight years of Age, and cured him in ten or twelve days, though this Lip by reason of slavering, and a childish trick he had of sucking his Lips in his sleep, was the more troublesome to me; yet he is so well cured, as I believe 'tis scarce discernable.

Whilest I served amongst the Dunkirkers, A Dutch Hambur­ger markt with a Cross on the Right Cheek. where Snick and Snee was, as it were, a fashion, I had much of this kind of work, and for your diversion shall set you down one of them.

Whilest our Squadron rode at Anchor in the Groine, there came in some Hollanders, under the notion of Hamburgers, with three Ships new trim'd up for the King of Spain's service; a Boat­swain of one of these Ships hapned in company a-shore with some of our men, after a little drink the Hollander began to speak of Religion, upbraid­ing our men for their wearing a Cross, and after a little more drink became quarrelsome; and that Sacramenta he would not wear a Cross, no the Di­vil take him, repeating this often, one of our men beat him down and fell with him, kneeling upon his breast, holding his head down, he draws out a knife sticking in his Sash, and cuts him from the Ear down towards the Mouth, then from under the Eye from that Cheek-bone to the nether-Jaw, now said he you shall wear a Cross that the Devil do not carry you away. I was sent for from the next house as a friend to the Cause, and drest him; I brought [Page 60]the corners of the Wound close together and even by stitches, then a stitch in each of the slits brought the Lips of the wound together, then drest him, sprinkling a little Pul. Galeni finely powdred, which we always had in our Pockets, over this a Pledgit with some Emplastick Ʋnguent, so with a Com­press spread with a mixture of the same pow­ders, cum Albumine ovi over the wound, bound him up, he keeping temperate the first three days, feeding only upon Bread and Bear boiled to­gether, with a piece of Butter and a little Sugar in it: The next morning he was let bloud, and the third day after I took off the dressings, and finding the wound as it were agglutinated in the slits, I cut out the stitches, and sprinkled the wound as at first, drest him up with Pledgits and my Empl. è Bolo, with Compress and Bandage; and the second day after drest him again, and cut out all the stitches, and in a dressing or two more he was cured, the stitches brought close together, any thing of a dry­ing quality without acrimony cicatrizes; these, your Suture does all it self, if the part be defended from influx of humors: The Patient was well plea­sed with his cure, though there remained some marks of a Cross.

Some of these kind of people wearing them with much pride in their Faces, as marks of their courage.

CHAP. VII. Wounds of the Limbs.

ONe of our Mariners abroad in Spain fighting a-shore,Observ. 1. Puncture of the arm. was thrust into the outside of the Arm, through the Biceps with a Rapier: A Chi­rurgeon in the Town seeing him bleed much, stitcht the wound with the Glovers-stitch close, and ap­plied over all his restrictives, and rouled up the part well: After three or four days, the Patient belonging to our Ship, came a-board, and being in pain desired me to dress him, the Arm was swel­led and inflamed a little, but did not bleed. I cut the stitches open, their issued out a bloudy Sanies in some quantity, and after followed a digested Matter; by search with my Probe I found the wound wanted little of passing through; I Embro­cated the wound, and drest it up with a short Tent with my common digestives, to see whether it would by good Bandage and the help of Sarcoticks Incarn, but it would not; whereupon I passed a Seton-needle through, and that way dis­charged the Matter, and after that Apertion was digested, I dilated it, and kept a Tent there a few days: In the while, the upper part of the wound healed up, and the wound below digested well with [Page 62]little Matter. I also healed it up. This I insert, not that I approve of stitching Punctures, but this way without stitching wounds, in a good habit of body, by good applications and Bandage, does sometimes agglutinate them in a few days, when drest by Tents they are of longer and difficult cure.

While I was in the King's service in the time of the War in the West-country,Observ. 2. Wound in the Thigh. I was fetcht to Cap­tain M. who in fighting a Duell was run through the Thigh, with a broad sword; I was also fetcht at the same time to the other, I hastily drest this Of­ficers Thigh, with Pledgits spread with my Agglu­tinative, and some Astringent powders mixt with the whites of Eggs, applied it over both the orifi­ces, bringing the Lips of them close, and with Compress and Bandage rouled it up, and left him to go to bed; from whence I went to dress the other, who had many little wounds, as his fingers, hands, and head cut. At my return I visited my Patient, whom I found in his bed with little pain: the second day after I drest him again, and finding all in good temper without pain or swelling, I drest the wounds as before; well satisfied that his wounds would heal up by agglutination, there be­ing little or no Matter, pain or swelling: If it had appeared inflamed with tumor or pain, I ought then to have kept the Orifice most distempered open; and if they had both suffered, to have kept them both open with small short Tents, drest with the common digestives, and have let him bloud, and have proceeded as in a body ill-disposed; but there was no need, there was only required a quiet position of the part which he submitted to. He [Page 63]was happily cured in seven or eight days. This was truly performed by the Balsam of his bloud, I nei­ther bleeding nor purging him in the time of his Cure or after.

A person wounded in the in-side of the Arm,Observ. 3. A Wound in the arm. the sword passing over the joynt, and through the out-side of the Arm, he was first drest by a Chi­rurgeon near the place where he was hurt; he bled much. The next day I opened the wound in the presence of Dr. T.C. one of the Kings Physicians, I found the wound Tented at both Orifices, the Arm swelled, and a little disturbed, as wounds in that place are subject to be, when the bloud is shut in by Tents, and not drest rationally by refrigerants and astringents, and good Bandage. The swelling most between the two orifices, and was from bloud choak'd in the part, which was now more straitned from the influx of humors, so not likely to yield to other than suppuration; yet we foment the wounded parts with discutients and dissolvents, and keep both the orifices open with small Tents dipt in the common digestive, and Embrocated about the wound with Ol. Ros. & Gutt. aliquot Aceti, and over all my Empl. è Bolo, rouled it up: the third dressing there appeared bloud from that orifice in the in-side of the arm, which I fill'd with Precipi­tate and a dossil upon it, then drest the parts up as before. This time I acquainted the Patient with my thoughts of opening the swelled part, between the two apertions; there being no likelihood the Matter there could discharge it self by either of these openings, yet it was not safe to heal them up, wherefore I proposed the opening of that tumor by a little Caustick, after a day or two D. C. was [Page 64]acquainted with it, and it was opened as was afore proposed, and a corrupt Serum was discharged: from that time I threw my Tents out of the wound, and healed them up in four or five days after, and as the Escar separated and the Ulcer digested, I cured that in few days. That the bone was bare under the tumor, may I suppose yet be felt from the Adhesion of the musculous flesh to that bone.

A person was wounded in the out-side of the Right Leg,Observ. 4. Wound in the Leg. below the Gartering-place, the wound running upward; after six weeks dressing by the neighbouring Chirurgeons, the part being much disturbed by a flux of humors, I am call'd in; I find the wound sinuous (some two inches) undi­gested, and inflamed with a tumor about it up­ward; the small of the leg and foot Oedematous, the whole member so weakned by the influx of hu­mors, that it was neither able to assimulate its ali­ment, nor yet to resist the crudities that fell upon it, so would be difficult to cure; as all such wounds are where the Patient is ill ordered, as to his diet and dressings in the beginning of the disease: I propose in order to the cure to dissipate this flux about the wound, and to digest the wound by Leni­ents, to mitigate inflammation, and to discuss and breath out that pituitous tumor on the foot and parts about, and with the help of good Bandage to restore the tone of the parts, and then if this sinu­ous Ulcer yielded not to agglutination, to lay it open: To which end I proposed a fomentation of Summit. Absinth. Scordii. Flor. Ros. Rubr. Chamom. Sambuci, Bacc. Myrtillor. Balaust. Nuc. Cypress. these boiled in Aq. Font. adding Vini Rubr. lb ij. and some Spir. Vini; with this I foment the parts, [Page 65]and dress the wound with Ʋng. Basil. Mag. adding Precipitate to it, and Embrocate the parts about with Ol. Ros. cum Aceto, over this I applied Ce­rat. Galeni, and over the Oedematous tumor be­low, Empl. Diacalcith. p. ij. Empl. Stict. Paracels. p. j. and over all these a good Bandage, not open­ing the Oedematous tumor more than once a week, and then to give a breathing to the part, The wound I continued to dress daily as I had begun, and happily freed the part from inflammation and influx of humors: But the wound would not di­gest as I desired, wherefore I laid it open a little more than an inch, and drest it up with dossils spread with the same medicament as before, and incarned and cicatrized it in three weeks or a month after, but not without some difficulty, and the help of a strait Stocking. This person had been long kept in his chamber by this wound, and now sup­posing himself well, he rides to his Country house, unknown to me, seventeen miles off, but that night his Leg swells much, the Cicatrix scarce confirm­ed breaks out again, with great excoriation and in­flamed redness. Thus this Gentleman returns again to his house, and sends for me. To allay this pain and inflammation, I foment the part cum decoct. Malvar. Violar. Plantag. Solan. & Flor. Ros. Rubr. and laying a fine Lawn wet in a solution of Troch. Alb. Rhasis made in some of the same de­coction. I also dress'd it with Ʋng. Alb. Camph. over this Lawn, and spread some of it upon the edges, lest the Matter should be shut in by the Lawns adhesion to the Lips, and the fretted Cuti­cula raised more up. Thus I dress twice a-day, and keep the Leg upon the bed; after some few dressings, that the heat and acrimony were allay'd, [Page 66]then in the place of the former Unguent, I apply Ʋng. Tutiae Mag. Vigon. and dipt the Lawn in a decoction of Fol. Plantag. Summit. Rubi, Equiseti, & Flor. Ros. Rubr. to which I added some Lapis Calaminaris, Tutiae Com. Cervi ust. & Calx lota pul. ostrear. combust. this was set in Balneo, and after­wards strained out, and applied upon Pledgits over the Lawn: Thus with much difficulty I cicatrized this wound and Ulceration, which at first possibly might have been cured by the way of our ancient Masters in few days.

CHAP. VIII. Wounds of the Breast.

WOunds of the Breast are penetrating or not, if they do penetrate, then we are to consider the depth, whether it be only between the Mediastinum in the hollow cavity of that in the lower part of the Breast, or if it pierce into the cavities of the Thorax, or what the parts are that be hurt. How the Breast is circumscribed, with the symptoms of each part when hurt, you may find in the Treatise of Gun-shot.

The signs of the wounds penetration are discove­red by the proportion of the searching Candle or [Page 67]Probe, which enters into the Cavity;Signs of penetra­ting wounds. you may also when it penetrates the cavities of the Thorax perceive it by laying a Down-feather upon the wound, or by holding a lighted Candle near the wound, the Patient holding his breath the whilest, in this case it will move the feather or flame, if it do not blow away the one, and extinguish the other; as also the Air makes a noise in its issuing forth; sometimes it's discovered by the quantity of bloud discharged by the wound or mouth, or both with difficulty of breathing.

Wounds in the hinder part of the Thorax are reckoned dangerous by reason of the Nerves and Tendons, and if they penetrate that way,Progno­stick. there is another danger from the great vessels of bloud which are nearer to the weapon in this case, than in those wounds which are made forward. Yet all wounds in the Breast are dangerous, by reason of the bloud that falls down to the Diaphragma and corrupts.

If the Lungs be wounded deep amongst the great vessels, though they escape the first nine days, yet they commonly terminate in a Pthisis or Fistula.

A Wound in the outer part of the Breast is cured as a simple wound; if it penetrate,Cure. you are to en­deavour first the restraining the bloud, then that the extravased bloud be discharged, and that either by the mouth by expectoration, or by the Wound, or by Urine.

The way by Urine Fab. Aq. Pend. says, is by a branch of the Azygos, which, saith he, passes near the Diaphragma, by the Spine to the Emul­gents. Those that own the circulation will hardly allow of his Hypothesis; however if the matter of fact be true, that there is sometimes a discharge by [Page 68]Urine, which I confess I have not yet observed in my own practice, it will be reasonable to propose as he doth: In this case Diureticks, as the Decoct. Capill. Veneris, Polytrichi, Rad. Petroselini, Be­ton. Apii, Faenicul. Asparag. To prevent inflam­mation, Ptisans with Ol. Sulphuris, Vitrioli, Bar­ly-creams, Emulsions, &c. The Ancients gave Acetum with warm water for dissolving the con­crete bloud, and restraining the present flux.

The second way is by Expectoration, & thereto our Decoctum pectorale, Lohocs, Syr. Capell. Ven. Jujub. Glycirrhiza, Oxymel. &c. whereof our Pharmaco­peia Lond. is full. This I have mentioned for their sakes who cannot have a Physician; but here I leave this work to them, these cures consisting much in their well ordering and prescribing internal Reme­dies, and content my self in the dressing of the Wound,Whether the wound is to be kept open or not? as it appertains to Chirurgery. In the treating these Wounds there is a question, whe­ther the Wound shall be kept open, or agglutina­ted; they that are for a speedy agglutination do urge it, lest the external Air corrupt parts within, and the heat expire: they that propose the keeping them open, do design thereby a readier discharge of Matter; for, says Aq. Pendens, if the Matter be to be discharged by Urine, it must first pass into the substance of the Pleura, then into the Vein Azy­gos, so into the Emulgents, then to the Kidneys, and through the Ureters and Bladder. If by Ex­pectoration; then it must also first pass into the substance of the Lungs, then into the Aspera Ar­teria or Weazond, from thence cought up by the Mouth.

In my practice in these Wounds of the Breast,The Au­thors judg­ment. I [Page 69]consider the wound how it is capable of discharging the extravased Bloud and Matter, if it was inflict­ed so as that the Bloud or Matter may be there discharged, then it is to be kept open, the well-fare of the Patient depending mainly upon the well-dressing and governing it; but if it do not lye well for evacuation of that extravased bloud, then it may do hurt, so ought to be healed up.

A person of about 23. years of Age,Observ. 1. of a good habit of Body, wounded into the Breast, upon which followed immediately great effusion of bloud, almost to the exhausting of his Spirits. Mr. R. Chirurgeon, and my self, were presently sent for, we find him lodg'd in an Inne near Fox-Hall, we view'd his wound, it was four fingers above the Cartilago ensi-formis a little to the left side; he laboured under a small pulse, fainting of­ten: Dr. W. & Dr. Wed. came in while we were pro­viding dressings,How to order Tents in penetra­ting wounds of the Breast. the wound was large and pene­trating, we made a foft Tent with a thread fastned to it; which in these wounds you must be sure to do, lest you lose it in the body: This Tent we dipt in a mixture of a powder composed of Bol. Armen. Sang. Dracon. Thuris, Mastich, &c. with a new-laid Egg and a Pledget spread with the same over all, with Empl. è Bolo, and Compress with conve­nient Bandage. The Phycisians prescribed such things as restrained the bleeding, and were proper to resolve the concrete bloud, and withall to re­lieve his fainting spirits: that night he rested ill, the next day when we met, seeing him labour un­der great difficulty of breathing, with pain above the Diaphragma, his Pulse quick, little Urine, and that high, we agreed he should be let bloud pre­sently, [Page 70]which was done accordingly in the left Arm, the bloud flowed with a quick stream, we took about six or seven ounces, a meer Serum, but the Patient was relieved by it; we took off our dres­sings to look upon the wound, whereon we found some bloud and Sanies discharged: we then drest him with Terebinth. Lot. in Succo Lamii adding some of the former powders with Vitell. ovi, this upon a Tent as before, with an Emplaster and Ban­dage over: Thus we continued to dress him, until we see the bleeding cease. In wounds within the body, I have always endeavoured to preserve the native heat of the part, and further the discharge of Matter from within, by keeping the wound open, until it lessened, and the ill symptoms went off; but shun the casting in of liquid Medicaments which are not easily to be gotten out again, they commonly proving very destructive. Here the Physician is to act by Internals, we only to assist by keeping a way open, if it may be, for the discharge of what is extravased and corrupted within the ca­vity, and commit the cure to Nature. In this Person here was a great effusion of bloud upon the receipt of the wound, and the orifice large to dis­charge the extravased bloud and Matter; the Physi­cians careful in restraining accidents, and remo­ving what he laboured under; through all which our work succeeded prosperously, so as parts within united; we threw out our Tent, and by Sarcoticks cured this wound without, and the Pa­tient was restored in few weeks to perfect health, and continues so.

Another person was wounded into the Breast be­low the fourth Rib on the right side,Observ. 2. coughed up [Page 71]much bloud at times; Sir Fr. Pr. was his Physici­an, he prescribed him Ptisans, Pectoral decocti­ons, &c. by which, and by often Phlebotomy the symptoms went off, the wound digested, the Pati­ent rambled abroad, and was cured by such dres­sings as I left for him at his Chamber, I seeing him no more until he was wounded again.

Another wounded in the right Breast,Observ. 3. coughing up much bloud, with great pain and difficulty of breathing, I took away ten ounces of bloud pre­sently, and ordered him (it being then night) some Syrup de Meconio & Jujub. in a draught of Aq. Papaver. with a few drops Sp. Sulphuris, he slept well that night; against the morning he had the Decoct. Pectorale (the hotter herbs left out) and it I sweetned with Syr. de Ros. Sic. & Jujub. with Sp. Sulph. this he drank in the morning, and at other times as he listed; by his disorder, he cought up bloud at times, and I let him bloud as oft, in the while I kept his wound open and digested: Up­on another relapse I began to be sick of him, and perswaded him to send for a Physician, Sir Ed. Graves was call'd in, who see his wound almost cured, we agreed and let him bloud: and from that time he continued well.

A person run through the Body the breadth of three fingers under the right Clavicle,Observ. 4. and out be­low the Scapula, was first drest by the Chirurgeon near the place where he was wounded: I found him in his bed faint and weak, but without pain or diffi­culty of breathing, Dr. Bacon his Physician: The next day I met him and Mr. Sh. Chirurgeon to his Highness Pr. Rupert. The patient had rested very [Page 72]ill the preceding night, had bled from his wound in his back through the bed, and fowled many Nap­kins that night in coughing up bloud, we took off the dressings from the wound in his Breast, from whence there was bloud discharged, and more came out in the dressing: I drest up the wound with a short Tent dipt in a little Terebinth. with Farina Volatilis, a few of our Agglutinative pow­ders cum Vitello ovi, with an Empl. Diacalcith. over it; the other wound under the Scapula was painful, but so small as it was not reasonable in our judg­ments to keep it open; we laid a Pledgit of the same mixture with an Emplaster upon that, and drest it no more; this method of dressing I conti­nued, and let the Patient bloud: The third day he coughs up bloud, and some little issued from his wound for a few days; after four or five days I waited upon him to his lodgings in London, by the way he cought some bloud, and so more or less day and night; but by the care of his Physicians it lessened, his wound digested, and I now kept in it a hollow Tent made of a Sparadrap, which was composed of Resina, pini, Gum. Amoniac. Bdelli. Galb. Terebinth. & Cora, with Pul. Ireos, dipt in a little Mel. Ros. Rubr. This way of dressing I con­tinued until the coughing of bloud diminished from twelve Napkins in a day and night, to ten, eight, seven, four, two, one, and but one Napkin in a week, and after that in a weeks space I see no bloud one way or other, nor any symptom of ill. I then call'd in his Physicians together, and seve­rally, and had all their positive judgments for throwing out the Tent, and healing up the wound: I did so, and in a week more cured him; five days after, or thereabouts, he sent me his thanks by his [Page 73]servant; and within few days after I made him a visit, and there met Dr. Willis, who enquiring of me whether his wounds were cured, I desired that person that he would shew the Doctor whether they were or not, he presently stript himself of his shirt, and shewed the Doctor, who both see and felt their scars, and replied they are well.

A young man wounded in the Breast,Observ. 5. labouring under very great pain and difficulty of breathing, with a cough, sent for me late one night, he shewed me some little bloud he had then cought up: he had been wounded the night before by a man stand­ing at a door some steps higher than himself, as it were over him, thrusting his Rapier from within the breadth of two fingers of the right Clavicle downward into the Lungs, the Patient run into that house bleeding much, and was seised with such difficulty of breathing, as he was forced to stretch his arms at length over his head, without which doing he could not breathe; he had been let bloud twice, and prescribed Ptisans, &c. But for all this he was little relieved, I presently let him bloud about ten ounces, and ordered the Apothe­cary to give him a draught of Aq. Papaver. with Syr. de Meconio & de Ros. Siccis, with a little Aq. Cordial. frig. Sax. and against the next morning to send for a Physician to meet me, they did so; when I came in the morning, I found the Patient marvellously relieved, and resolved to remove his lodging, which was now by Scotland-yard to his own in Wildstreet: in the presence of his Physician Dr. St. I took off the dressings, found his wound small and shut up from within, but not skin'd, and if it had not, yet the wound within [Page 74]was so much below this without, as it was not ca­pable of discharging the Matter: So this was not worth my attendance, the wound within was the work of the Physician, however he continued me with his Physician, and we agreed to bleed him again; we did so, taking away about ℥ viij. of bloud, and the Physician proceeded by Clysters and Internals proper in his case: That afternoon the Patient, unknown to me, pursued his intention of removing to his old lodging in Wild-street, where going up three pair of stairs to his chamber, he re­lapst into the former difficulties of breathing with pain and coughing bloud, and in the morning after where I met his Physician, the Patient seemed to me quite tired, labouring under great oppression; and by his pains about the Diaphragma and Back there was suspition of extravased bloud; to relieve him there was a necessity of taking away a little bloud; we took away some four or five ounces, and proceeded with Embrocations, Lohocs, Pe­ctoral Decoctions, &c. and got off this difficulty in five or six days, then I left him: But after that, by disorder he relapst again, and was freed again the same way by his Physician, and since holds well, but I never see him since.

Of all these wounded Patients, and many more I have helpt to cure,The Au­thors ob­servation concerning the dis­charge of the Sanies of the Breast by Urine. I never see one that I could say passed their disease by Urine, nor many of them that passed their Urine well during the time of their lying under these wounds; nor have I often seen them who recover, expectorate any such quan­tity of Matter, as might be thought to proceed from the great quantity of bloud extravasated: They cough fresh bloud most of them, like to what [Page 75]they discharge from their wounds, but more florid.

Those who do cough great quantity of Matter from these wounds made by a sharp Weapon, or avoid it by their wounds, do seldom well: They usually terminate in a Tabes, with or without a Fi­stula: Yet by the ninth day one may truly predict their present recovery, if all things have been rightly administred.

CHAP. IX. Wounds of the Abdomen.

A Man wounded with a Rapier into the belly,Observ. 1. through the Right Hypocondrium out to the side of the Back, is brought to my house one night to be drest, he had bled much; I considered the wound, see it had past through, the orifices were small, little advantages to be made by keeping them open, yet I put in two small Tents dipt in a little Digestive è Terebinth. & Vitell. Ovor. and drest up with Empl. è Bolo, and a Bandage over, and advised him to go to his bed and keep quiet. I gave his friend ʒ vj. Syr. de Meconio, mixt with a draught of Aq. Papaver. with a little Cordial-water for the Patient to take in bed: The next morning I found him hot, and his Pulse a little di­sturbed, but without symptoms of any part of the [Page 76] Viscera wounded within:Signs of the inward Viscera hurt by a wound of the Ab­domen. neither Tension of the Belly, Collicke, Vomiting, or ought by Urine or Stool. However I Let him bloud about 10 ounces, and ordered him to keep his bed, and a Clyster of Milk in the afternoon with Sugar, and at night his haust us again. The next day I opened his wounds, and considering here was no Symptome of hurt within by Urine or Stool, nor Tension nor Swelling, only the wound a little heated by the Tents, I threw them out, and drest both the wounds with pledgits spread with the same digestive, Embrocating the parts with ol. Ros. drest him up as before, and de­sired him to keep his bed six or seven dayes. Two daies after I drest him again and found all well, with Inclination to cure; from that time I drest him no more, but ordered him to keep a spare diet, and to lie quiet in bed, and if there were occasion I would see him again: my servant drest him afterward, and before the seven days were expired he was well and walkt abroad not complaining more of that wound. So I have happily sometimes cured such wounds through the body; in this wound here was no con­siderable part toucht, yet if the wound had been kept tented with long tents,Digression concerning the ill use of Tents. they might have stir'd up inflammation, or so the Air might have altered the parts within, or the Matter offended them, whereby putrefaction, Collicke and Ill accidents would have followed: But what could the Chirur­geon have advantaged the Cure of his Patient, if bloud had extravasated within, by keeping such little wounds open? Yet if it be not done, he is usually condemned by the common Vogue; there­fore it is, that against their own Judgments they keep them tented often to the ruin of their Patient. [Page 77]If in these wounds of the Belly the small Intestines be wounded, there follows a continual vomiting of Choller with Griping, and death within few daies;Signs of the gutts wounded. if in the first dressing these wounds a Chirurgeon should propose a cutting open the wound, to seek the wounded Intestine to stitch it,Of open­ing the bel­ly in wounds of the In­testines. Cure of wounds of great In­testines. the friends would not permit it, nor in truth have we Authority or Example for it, so we have nothing to do but stitch up the wound, and refer the Cure to Inter­nal remedies, yet at last when he is dying, they will wish we had attempted it. In the great In­testines where they are fleshy, if the wound be not great enough, you are to enlarge it and seek the Intestine, and stitch it up with the Glovers stitch, and cleanse the Bowels from the Excrements, and sprinkle the Sutures with some of your Incarnative powders, and reduce them to their places, and stitch up the belly, as you shall see presently: you are in these cases to give your Patient Clysters made with Chicken or Veal-broath, wherein Barly flor. Ros. rubr. Chamom. hath been boyled, adding the yolks of Eggs to it, with Mel. Ros. & sacchar. Ros. an. ℥ j. and Internals such as are glutinative, as decoct. plantag. Equesiti, pimpinellae, pilosellae, Rad. Consolid. ma. these sweetned with Sugar of Roses, spec. diatragacan, cons. Cydon. Cons. Ros. rubr. boli. Terrae, sigill: their diet must be sparing, drying and agglutinative: they must be Let bloud, and after some days their Clysters must be agglutina­tive and often repeated. After this manner the wounds of the Viscera are to be treated, only in them you are to keep the wound open in some declining part, whereby they may be drest if occa­sion be, and discharge their Matter. If a flux of bloud happen as in wounds of the Liver and Spleen, [Page 78]the Ancients commonly commend succ. pilosellae, pimpinell. plantag. Pologoni; with pul. Bol. Terr. si­gill. sang. Dracon. Thuris, and such like mixt, and put in by Tents, and after the like mixt with syr. Ros. suc. and parts about Embrocated with ol. Ros. Mirtyl. & Empl. Diacalcith. over all, or a Cata­plasme ex farin. Hord. fabar. flor. Ros. Rubr. coct. cum hydromelite and treat them by Internals as I have said, such as are agglutinative, exsiccant and detergent, I refer you to the treatise of wounds made by Gun-shot, where you shall see their various Symptomes and way of Curing.

A Man wounded and brought to Lambeth sent for me one morning early,A wound in the Abdomen. Observ. 2. he was wounded trans­verse the belly a little below the Navel, on the left side the Omentum, and Intestines thrust out, and kept close with a Hankerchief in his hand, I see parts fresh; the Omentum or Call much out, but not altered. I caused warm cloaths presently to be held upon them very close, and the Patient to be laid low with his head, his Hips raised up, and by the help of his friends raising them up and shaking his body, I reduced them. Then they leaving his Hips high, and he declining with his body on the Right side, by the help of one pressing with his hand a little above the wound (by which the Lips of the wound were a little turned upward, and the viscera kept down;) I with a strong Needle a little crookt at the point with a strong Thread seared take hold of that lower lip,Manner of sewing the Peritone­um in this case. and near the end past my Needle first through the Peritonaeum, and then on the opposite side through the flesh and skin, leaving the Peritonaeum, and so go along passing the Needle from without Inward, till I [Page 79]sewed up the wound, which cannot be very close, then I pulled the stitches as close together as I could,What to have been done in case the Omentum had chang­ed Colour. and fastened my Thread. If any part of the Omentum had been altered in its Colour, I should have tyed it hard and cut it off, and placed it with the Thread hanging out, and so I would have served a great part of it, if I could not have reduced it, I having done so heretofore often; but if the Intestines had been so swell'd,What if the In­testines were swel'd. as by no way of fomenting or po­sition I could have reduced them, I ought then to have cut the wound more open, but these were easier reduced, and the wound stitcht, I then sprink­led them with pul. Aloes, Colophoniae, sang. Dracon. Mastic, sarcocolla, Bol. &c. and over them pled­gits of my Incarnative, and with some of these powders mixt cum Albo ovor. to strengthen my stitches, I applyed them upon a cloath over all, and with compress and a strong Towel bound all fast, then after a while let him bloud, and ordered him to ly quiet upon the well side, and to a spare diet, and to keep his body soluble by Clysters; every other day I drest him after the same manner, and after the wound seemed to be Cicatrized, and that my stitches began to fret, I cut them out the Eighth or Ninth day, and after with the continuance of my sarcoticks, I cured him very well. These wounds are not subject to great Inflammation or defluxion, but by reason of the fatness and thick­ness of the Lips, and manner of sewing, 'tis a troublesom work; and yet if they be not so stitcht as the Peritonaeum and fleshy parts may unite to­gether, a Rupture follows to the great trouble of the Patient, and shame of our profession: the Peritonaeum bears a great stress, therefore you must be sure to take good hold with your stitches, [Page 80]and if you doubt their holding, make dry stitches over them and good Bandage.

CHAP. X. Of Wounds in the Head.

WOunds in the Head according to Hippo­crates and our daily experienced are full of danger, how slight soever they may appear to a common eye.

In this discourse I propose to write of them, not only as they are made by cut, stab, or bruise, but also of those made by Gun-shot, and so by Anticipating part of the discourse next ensuing, to give you the full doctrine of wounds of the Head made by what Instrument soever without the ne­cessity of future repetitions, and that you may understand the Basis whereon these cures are wrought, I shall represent the head to you as it is framed.

The Head according to Galen. de usu part. is the noblest Member of our Body,Parts of the head considered. the principal facul­ties being there seated, for the use of which it was ordained: and is so contrived as to be the foun­tain of the Animal spirits, and also to contain the principal Organs both of the Internal and Exter­nal senses.

In the first part,The Hairy Scalp. the hairy scalp presents it self to our eye, and therein is to be considered its Thickness, Sense and Vessels, with the Muscles that lie under it. The Hairy Scalp is thinnest on the top of the Head, nor is there any Muscle between it and the Skull in that part, unless you will call the membrana carnosa a Muscle, (which some men of late do, and possibly not improperly;) and here the rather, because by it many men move the whole Scalp. If you doubt of a fracture there, you may boldly cut into the Hairy Scalp, it is of an obtuse sense and easily healed up again.Forehead. But be cautious how you make your Incision in the forehead, where a transverse Incision may cause the Eye-brows to fall over the Eyes; therefore if you are forced to make Incision, let it be accord­ing to the length of the Fibres, and avoid the vena frontis, lest its bleeding disturb your work. And be careful that you make no Incision upon the Temporal Muscles,Temporal Muscle. for thereby Convulsions and other ill Accidents may happen.

Under the Hairy Scalp lyes the Pericranium, Pericrani­um. which we are to cut through, in making way to the Cranium; you are to raise them both together when you lay bare the Cranium for the use of the Terebra; for if in perforating you tear this Mem­brane, Inflammation and Fever may follow, the Pericranium arising from the dura mater through the Sutures; by which continuity that may also partake of the Inflammation.

The Cranium follows,Cranium and Su­tures. which is a Bone com­posed of many joyned together by Sutures, of [Page 82]which there are five concern us Coronalis, Lamb­doides, Sagittalis, &c. two false ones. In perfo­rating the Cranium, you are to shun these, (if you may) for through them the dura mater passes, being continued unto the Pericranium. The Su­tures divide the Bones of the Cranium, by which one part of the Cranium may be preserved entire while the other is broken, which otherwise would be in hazard; These Sutures are weak in resisting Blows, and upon them also Matter may be easily contracted and make a Caries the sooner, and sooner worke through to the brain than in either parts of the Skull. It is necessary to know them well, lest as Hippocrates well cautions, you take them for Fissures.The way to find the Sutures. The way of finding them is, by passing one string from ear to ear, and another from the Nose to the Crown of the head; the former of these shews you the Coronal Suture, the second the Sagittal, which usually begins at that point where these lines intersect, being the part where we make Fontanels, and reacheth to the Crown of the head where the Lambdoides begins; sometimes it be­ginneth quite at the Nose. The Lambdoides begins at the end of the Sagittal, and goeth forked down the two sides of the occiput: of the Suturae nothae: the two chiefly to be regarded are the Squamosae, which run under the temporal Muscle of each side, round about the outermost verge of the ear.

You are also to take notice that the Cranium is thinnest in the middle part of the head,Thickness of the Cra­nium. and thickest in the hinder part, and of a middle thick­ness in the fore part: Hence it is that wounds are most dangerous in the Crown of the head, where the Skull by reason of its Tenuity easily communi­cates its hurt to the brain, and also for that the upper [Page 83]part of the brain lyes there high, one of the largest Sinus being immediately under the Skull, and many Capillary veins running so close with it, as to make themselves Trenches in the Internal part of the Cranium: Wherefore upon a blow or concussion in this place, the veins may easily be broken, and the bloud extravased between the Cranium and dura mater, and ill Accidents follow.

The dura mater, a strong Membrane,Dura ma­ter. is placed under the Cranium, which being wounded is at­tended frequently by Palsies, and in progress of the distemper by Convulsions and other ill Symptoms; and the greater if wounded in the middle part of the head according to its length, there being many Vessels, which if they chance to be cut, will fill the vacant space between the Cranium and dura mater with bloud.

The Pia mater lies upon the body of the Brain so close,Pia mater. that a wound cannot be made into the Pia mater and the Brain escape; and from its many veins a flux of bloud must follow.

The Brain lies under the Pia mater, Brain. in whose ventricles is lodg'd the Plexus choroides, and under whose Basis ly large numerous branches of Ar­teries and Veins, which by great blows of the head may be broken.

From the Description of the head we shall pro­ceed to the Description of its wounds,Wounds of Brain. which are strictly so call'd, when any part of the skin, flesh, bones, membranes or brain is either cut or torne, or when more of these are hurt together.

Contusions and Concussions do not truly belongContusions [Page 84]to this place, yet for the better Information of the young Chirurgeon, I shall say something of those also, and shall treat of all these things by the sol­lowing degrees.

1 First, there may happen Contusions, or great and violent Concussions of the Brain from a blow, fall, &c. when there is no visible wound either in­ward or outward.

2 Sometimes this Concussion is accompanied by a ruption of the Vessels of the Meninges. Some­times a fissure of the Skull, or a spill broken off from the inside of it, &c. the skin all this while remaining whole.

3 Other while the wound begins on the outside being made by Sword, Bill, or Bullet, &c. and either goeth no further, or else penetrates some­times to the Skull, sometimes into the first Table, sometimes through both, or yet further through the dura or pia mater, or into the brain it self.

4 Some are meer cuts, others contused wounds, and in Gunshot, the very outward parts of the head, as hair, skin, flesh, bones, &c. are often driven by the violence of the Bullet into the Brain it self.

5 Of Fissures some are directly under or near the place of the Blow; some on the quite contrary side, and are called contra fissurae.

Celsus in his 8 lib. & 4 ch. gives you the signs;Signs. when you are call'd to such a Patient, presently saies he, you shall enquire num vomuerit, &c. whether he vomited, or was stupified at the first receipt of the Blow or Fall, or a Resolution of the Nerves followed, or tor­por, or delirium, or raving; these shew the Membrane of the brain affected, and the Patient in great danger. [Page 85]But if none of these were, you may then dubitare an os fractum, doubt whether the Bone be broken: then it is to be considered, whether it was Stone, Iron, or Lead, that he was hurt withal, and with what force the Blow was given. But if there be a wound, nothing is more sure than the finger or Probe; if it feel smooth or slippery, the Cranium is safe: But if you feel any Asperity or roughness, if it be not the Suture, then you may be assured of a Fissure or Fracture, the holding a Tread between the Patients Teeth, or biting of a Crust, is men­tioned as a sign of a Fracture, but this way is very uncertain: To find hair cut in a wound may be a sign, if you consider, no small force will cut a hair there.

If by your Probe you make no discovery of the fissure, and yet the Symptomes be grievous, then lay it open, and if the Fissure do not then appear, rub the bared Cranium with Ink, and wiping it off again, you will see the Ink remaining only in the Fissure or crack, then Rugine it.

If no breach of skin appear, you must consider the outer side, numquis locus mollior sit, & tument, eumque aperire; whether any part be softer and swell, which you must open and see whether there be any Fissure, non tam magno negotio, cutis sanescit etiamsi frustra dissecta est, it being no great matter to heal it again, though it should be laid open in vain.

In the Prognostick,Progno­sticks. wounds by much how nearer the Brain, are so much the more dangerous; the solution made by Incision is of less danger than those made by puncture, this of less than those made by Contusion; and those of Gun-shot worst [Page 86]of all wounds. In the middle of the head most dangerous, the hinder part least dangerous, the fore part of a mediocrity between both, it having passages near for discharge of its bloud and matter: Wounds of the Sutures are dangerous, but those are more or less as they fall into good or bad Chi­rurgeons hands, and as the Patient submits to the method of cure. A simple wound by a Blow hath been through ill Chirurgeons, &c. the cause of much danger, that in skilful hands would easily have been cured: All wounds save those of the Brain are curable, if the Chirurgeon be timely call'd in, and that it be discovered in such place where he may lay open safely.

We begin with the cure of Contusions of the Cal­varia, Contusions of the head. where the outer skin is whole, yet with great attrition of the Musculous flesh and membrane underneath; which often happens from blows or Falls, and are subject to great pain, tumor, In­flammation, and Apostemation, &c. caused through the Ill habit of body, or untimely applications, therefore it requires your special care in the first place to prevent the afflux of humors and pain, which is performed presently in the beginning by repellents and astringents, which are to be often re­newed, lest they heat the part affected. You are in the first place to shave the hair, if there be any, then Embrocate with ol. Ros. & myrtil. cum aceto, and apply this or such like over the contused parts; ℞ farin. hordei, fabar. an. ℥ vj. pulv. Nucis, Cupressi, balaust, Alum Rochae, Ros. rubr. an. ʒ j. ol. Ros. ℥ iij. Alb. ovor. nu. ij Aceti q. s. ft. Cataplasma. You are to make your Bandage over this, to further the expulsion of the serous humors from the grieved part, therefore your Bandage begins there, and [Page 87]terminates where it may resist the Influx; then bleed, &c.

The second day you are to foment with Red wine, wherein hath been boyled flor. ros. rubr. Bacc. myrtill. fol. beton. & flor. Chammol. and if much pain Embrocate with ol. Ros. & Chamom, or decoct. beton. ros. rubr. Rad. Althe. sem. Lini, fenugraeci: If after these your endeavours the part affected do tend to Apostemation, you must then use suppura­tores, and open it in the declining part, and digest it as in a Pphlegmon; but if the pain do mitigate, then it will be proper to discuss and breath out the Serosity by such like, ℞ farinae hordei fabar. an. ℥ iij. flor. ros. rubr. Bacc. Mirtill. pulv. an. ℥ j. sumit. Absinthii, fol. beton. slor. sambuci & chamom. pulv. an. ʒ iij. sem. Cumini, pulv. ʒ j. mel. ℥ ij. coq. in vino Austero, ft. Cataplasma, addendo ol. Cham. Ros. an. ℥ j. apply it; then in the next place comes in the use of Emplastr. Vigonis.

If there happen a Concussion from some great Fall or blow without a wound,Concussi­ons. we cause the head to be shaved, Embrocate with ol. Ros. & myrtill. cum Aceto, all the head, neck and behind the ears, and apply a Cataplasm with farin. hordei. fabar. bacc. Mirtill. flor. ros. rubr. decocted in Red wine or Oxycrate, adding mel. ros. to it or Empl. vigonis, or such as this which is his, and hath been often used by me in such cases, ℞ furfuris Tritici ℥ iiij. far. lentium ℥ ij. flor. ros. rub. Bacc. Myrtillor. Balaust. an. ʒ j. Calami Aromatici ℥ j ss. flor. chamomel. Melilot. pulv. an. ℥ ss. nuc. Cypress. no. 6. pulver. omnia coq. in vino Austero q. s. ad consistent. Cata­plasmatis addendo olei Rosati Chamom. an. ℥ iij. or add wax to it, and make it into the form of a Cerott; [Page 88]you may make fomentations of the like; you must remember in these Concussions to bleed largely, even to defailancy of spirits, according as the Symp­tomes do shew to you the greatness of the Malady, and as strength of body will permit, and keep the body soluble by Clysters, also Julips, Emulsions, and what else may allay fermentation of the bloud,

In the cure of wounds of the head,Cure. if it be a simple wound only to the Pericranium, the lips are to be brought close together; the stitching these wounds is objected against by some, lest there­by Matter should be pent in,Simple in­cised wounds. and Inflammation and caries of the Skull follow, but done judiciously; it is safe, if you can satisfie your self that the wound ought speedily to be healed. Abroad I have seen them as commonly stitcht as other incised wounds, and do my self in great wounds of the Scalp make a few stitches to keep it close; however you are not to croud those wounds with dossils, but having shaved the hair bring the lips close together, and cure it by the first Intention, vid. Agglutination; as in simple wounds, by Arceus's Liniment or some incarnative, and keeping the lips close by Empl. è Bolo, or with some of your Astringent powders mixt with album. ovor. Thus in a few days all these simple incised wounds may be cured.

In a wound in the right Temporal Muscle,Observ. 1. Wound in the Tem­poral Muscle. where the Artery was wounded, I have often stitcht them up without any ill Accident. Smith a Tanner some­times in Chester, Captain of a Company of Dra­goons pickt up in hast to disturb us in our flight from the Battel at Worcester, was bleeding almost to death, by a wound he received from some of our routed Forces; when I was brought a prisoner to his [Page 89]Quarters, I stitcht up his wound, taking the Artery up with the lips and with a little wheat-meal, and the white of an Egg, laid over all upon a Compress dipt in aceto, bound his head up; this was upon a necessity, but this served to keep my stitches close; after two or three days, I dressed him again, and found all quiet, I now sprinkled the lips with pul­ver. Thuris, sang. dracon. an. p. aeq. and applyed a pledget with Linim. Arcei & Empl. diacalcit. all which I was now supplied with from Warrington; and the next dressing cut out the stitches, and drest him up again with the same as before, and from that time he was cured: which was before he had recruited his spirits from his loss of bloud.

In wounds of the head where you cannot cure by the first Intention,Contused wounds. as where the wound is contused or some part of the Hairy Scalp torn off, there you are to digest with Terebinth. and the yolk of an Egg, I commonly boyl the Turpentine a little to make it thick, otherwise it is too slabby; add a little farin. Hordei, After Digestion I add a little Sarca­coll. Myrrhae, Aloes, pul. Ireos, with mel. Ros. by which it serves to deterg, I commonly In­carn with this of vigoes, ℞ ol. Rosat. ℥ vj. ol. mastich, ℥ ij. pinguedinis vitulin. porcin. an. ℥ iiij. fol. plantag. matrisylvae, Beton, pimpinellae, pilosellae, flor. Anthos. an. Mss. vini odorif. cochl. iiij. coq. ad Con­sumpt. vini in colat. add mastich. Gum. Elemi, Resin. pini, an. ℥ j. litharg. Auri & argent. an. ℥ ij. Minii ʒ x. Terebinth. venet. ℥ iiij. cerae q. s. ft. vng. S. A. or with Lin. Arcei; touching the lax flesh, as I think fit with either of the stones, and by the help of ung. Tutiae mag. Lint dry or dipt in sp. vini. Aq. calc. Alum, and prest out, I cicatrize these and all such like wounds.

If in a wound of the head by Incision the Pericra­nium be bared,Pericrani­um laid bare or cut. if there be no fissure, you are to keep the Air from it by bringing the lips of the wound close together, that the bone may Incarn: But in these wounds Fabr. ab Aq. Pend. says, and by the authority of Galen, that you ought to Exfo­liate the bone; for says he, it is not likely so thin a membrane as the Pericranium, adhering to the bone, can be cut, and the bone not hurt; and if the Cranium be but a little hurt, there is a necessity of Exfoliation: In my Practice I have often met with wounds in the head, where the Pericranium hath been cut, and the bone only bare; sometimes also the bone is cut: But if I came into the first dres­sing, it hath for the most part Incarned without any difficulty, and the better for the little cut made in­to it. But where the bone hath been bared by a Contusion, the bone is commonly altered by the Air, or Gleet from the contused flesh, and doth for the most part require Exfoliation; yet in this case I have cured without Exfoliation, but with great difficulty.

If a Contusion be made by a blow or musquet-shot,Cranium laid bare by contu­sed wounds. when the force is spent, or when the head is armed, if there be no wound or symptom of fra­cture, or the like, you are to shave the hair off, and Embrocate the part well, and apply over all a Cataplasm, è Farin. Hordei, Flor. Ros. Balaust. decocted in Oximell, adding some Ol. Ros. and let your Patient bloud, and if there be a wound joyned with it, and made by shot or blow, you are to di­gest that wound as in contused or Gun-shot wounds: If there be not a way for discharge of Matter, you are to make one, that it be not shut [Page 91]in, and cause inflammation in Pericranio, and Fe­ver follow. After digestion and separation, you are to proceed to Exfoliation of the bone; for in such wounds the bone is Altered, both by Air and Matter. In order to Exfoliation you are to consi­der, that if the bone were not hurt, it is smooth and slippery, as it were polished, and flesh diffi­cultly grows upon it; wherefore by the Authority of Galen and your own reason, you are with Ru­gines to make it rough and thin, that you may make way for the Callus to sweat out of it: In this case if you rasp it here and there thin, till you see the bloud ready to come out of it, the bone will there­by be sooner supplied with materials for generation of flesh; but if your Patient will not admit of Ru­gines, as in children it will not be allowed, then you are to keep your dossils with Sarcoticks close to the lips of the wound, and make your Exfoliati­on from the edges, that the sound part may thrust off the rotten bone; for neither Crabs-eyes, nor any Medicine inwardly prescribed, or wine out­wardly with Lint or other medicament applied to the middle of a bone, will signifie any thing to the Exfoliation; nay the while you are so trifling, the matter from the edges will rot the bone under­neath, and in continuance pierce through the first table, and run underneath betwixt the two tables, and do much mischief, and put you upon the use of the Terebra, in the curing of your Patient. If therefore you propose Exfoliation, then according to the Ancients you are to use Rugines to scrape the bone, and after the use of them, the bone requires its proper medicaments, Sarcoticks most drying in potestate & actu, as ℞ Rad. Ireos, Aristoloch. Rot. Thur. an. prt. aeq. in moister bodies Thus alone; I [Page 92]suppose that bones raspt require digestion, and therefore dress it with liniment Arcei, and such like spread upon Pledgits of Lint, and so common­ly Incarn them, then proceed with Ʋng. Tutiae, &c. to cicatrize.

Hitherto we have written of wounds and contu­sions of the hairy scalp and Pericranium, Cranium wounded, or fra­cture. and of the Cranium laid bare, as also of concussion: now follow those wounds of the Cranium it self, whe­ther by cutting or puncture, by sharp or pointed weapons, which cannot be without solution of Con­tinuity of the hairy scalp, but by a musquet-bullet shot at a distance, by a fall or blow the skull may be fissured or fractured, and the hairy scalp whole, and this fracture or fissure under the Contusion, or in some other part: If the symptoms do demon­strate that there is a fracture or fissure, you are then without delay to open the hairy scalp, accord­ing as the part will admit, Angular, or in the manner of a Cross, or of the letter T, that the fracture may be discovered by the raising up of the hairy scalp with its Pericranium: For if you shall in doubtful fissures or fractures make a round Incisi­on,Against round in­cisions up­on surmise. and take out the whole piece, then if there chance to be no fissure, you have made your self a long work to little purpose; and if your fissure run farther than your Incision under the Calvaria, not discovered sufficiently, you are to cut it open that length, by which it will appear you have through mistake laid it open more than was necessa­ry in one place, and too little in another, doing that which neither Hippocrates nor any of the Judi­cious would ever allow: Whereas if you made it without cutting off a piece, but only raising the [Page 93]scalp, you might, I say, if reasonably judged, have laid it open, so as you might have discovered the fissure or fracture; and if yet part of the fissure or fracture had lain undiscovered, you might have stretched your Incision to it; and in case after all, there had been no fracture or fissure which often happens, as in counter-fissure, then you might have laid the hairy scalp down again, and easily cured it, which by an excision of part of the scalp you have made, you cannot do.

Objection. As to what may be objected, that the raised up Lips may be troublesome to the Chirurgeon in his work, and are painful to the Patient; there is no such thing; for if the Incision be made the way pro­posed by the Ancients, and that the fracture or fis­sure be all in your view, you may order the lips of the wound as you please.

The Cranium laid bare, you are to fill up the place opened with dossills, pressed out of Red Wine or Oxycrate, or a Spunge prest out of either of the same liquors, and apply an Emplaster over all of Diacalcith. malaxt with Ol. Ros. cum Aceto, and bind it up.

The next day you are to consider the fissure,Trial of Fissures. if it be so small, as you doubt whether it be one or not, then wet it with Ink, and wipe it off again, and where the fissure is, the Ink will discover; but if it do not, then this Emplaster is proposed; ℞ Cerae novae flavae, Thuris, Laudani, an. unc. ij. Farinae Fabar. Terebinth. Aceti an. ℥ j. Misce ad Ignem: you are to apply it on the suspected part, and the next day where it is found moist, that there you are to Rugine.

Fallopius tell us, that where the Cranium is con­tused, certain spots will appear red, not unlike those white ones which are seen in the nails of the fingers; but after the third day the bloud exhales, and that redness ceaseth: If by the former you dis­cover the fissure, or that the bone be contused, you are to Rugine the contused bone, and the whole length of the fissure; To which purpose and for that use to supply your self with various forms of Rugines: Whilest you are working with them, the lips of the wound are to be covered, that neither you hurt them, nor the Air offend them; sometimes these very small fissures, how inconside­rable soever they may seem, are the cause of the Patients death, there being often found extravased bloud upon the Dura Mater, the Veins being broken either by the concussion from the blow, or by the rough edges of the inner table next the Membrane: Therefore you are to consider the symptoms, and accordingly lay open either by Ru­gines or cutting into it, so as the Sanies may be discharged, and the Asperity taken away: But if there be a fracture of the Cranium in one or both tables with a depression of the bone and a fissure al­so,Depressi­on. which often happens, you are presently to make a way to relieve the Membranes underneath, for they cannot be without great disturbance and in­flammation, and a putrifaction will follow, whence those symptoms of Fever, Delirium, Coma, Con­vulsions, Palsies, and Death ensue, if neglected. In this case you are to consider, whether the fissure do discharge the serous bloud or Sanies, and whe­ther by cutting that fissure open, the deprest and fractured bone may not be raised up; if it may, then you are to proceed by inlarging that fissure, [Page 95]and there with your Levatory raise up the deprest bone, and remove the fragments, and cleanse the membrane from the Raspings or ought else hath soiled it: But if the fracture doth not penetrate so far into the bone, nor there be any such depression or fear that Sanies is detained underneath, then you ought not to perforate the bone, nor expose the membrane to the Air, or more than is necessa­ry; in this your eye and symptoms will guide you.

In order to perforation of the Cranium, Perforati­on. the bone is to be cleared of its Pericranium, least in setting on the Terebra (or Modiolus, which are two se­veral names for a Trepan) you tear the membrane, then the lips of the wound to be covered, and the Terebra set on the breadth of a finger distant from the edge of the fissure, on the side which is most depending; if it may be with convenience, when you have set it on, press upon it with your left hand, and turn it round with your right, you must use a little Ol. Ros. or Milk, to cause it move the easier, and as it fouls brush it, in the doing of which it will cool, or you may dip it in water to cool; when you come to the second table, which you will know by the bloud that appears, it will be required that you take out the pin & proceed more warily, not listning to the pratling of the standers by, but often lifting up your hand, lest by your compres­sion or haste you unawares fall upon the Dura Ma­ter and wound it. All this while it is fit his ears were stopped, lest the noise disturb him, and the room close. The perforation made in Cranio, and the bones taken out, you are to smooth away the Aspe­rity, which remains in the lower part of the main bone, and this is to be done by the Lenticular in­strument made for that purpose.

If after this the membrane be fouled by the saw-dust, from the bone you are to wipe it off with a little Lint upon your Probe; the part cleansed, you are to dress the membrane:First dres­sing after perforati­on. About this first Appli­cation Authors differ, Avicen drest the Patient with Lenients, as Ol. Ros. Celsus he dressed the part with Siccantia, as with Aceto acerrimo, you may find him positively for it in these words, His factis, the perforation made, ea Membrana acri aceto, respergenda est, ut sive aliquid sanguinis ex ea profluit cohibeatur, sive intus concretus Cruor re­manet discurtiatur; The Membrane is to be sprink­led with sharp Vinegar, to prevent the flowing of bloud from the part, and that if there should remain any clotted bloud, it may be discust. But the most part of the Ancients and many of the Moderns do propose Lenients, as Ol. Ros. that the crude Sa­nies descending upon the Dura Mater, in pus con­vertatur, may be digested into Matter: In this you are to be guided by your eye: If there be Sanies or putrifaction, Mel. Ros. Spir. Vini, and higher detergents are to be used, as the putrifaction is more or less. If there be much bloud extravased, or that you fear bleeding, that of Celsus may be proper; but if the bloud exceed not in quantity as it seldom doth, and if it be recent, it possibly hap­pened from some scratch of your Terebra or little asperity of the inner bone or Table, or if there be neither of these, but the membrane fresh, and of its natural colour, then you are not to grieve that membrane, new exposed to the Air with deter­gents, nor by the Acrimony of the Vinegar; for if you shall by scratching of the membrane make it bloudy, and then dress it with either Acetum or Mel. Ros. & Spir. Vini, you shall then proceed [Page 97]contrary to the common Indications in Chirurgery, which teacheth to digest recent wounds before you deterge: And indeed what would you deterge?

Therefore I do propose to you Lenients, not on­ly by the Authority of those Ancients and Moderns, but by my own Practice. Galen proposed Sang. Columb. and the bloud of Turtles dropt warm from their wings, Fallop. and Fabric. Aq. Pend. pro­pose, as I said, Ol. Ros. with Resin. Abietis, and afterward they increase the Resina and lessen the Oil; but if there be putrifaction through the long lying of concrete bloud, then Mel. Ros. & Spir. Vini are proper;The thin­ner part. yea Mel. Egyptiac. and higher as occasion shall offer; otherwise in common cases of recent Terebrations by the Emplastick quality from the Resina; the concoction is better made, and the part secured from inflammation, &c. It is to be proportioned to the habit of body; dry bodies re­quire more of the Resina and less of the Oil, and by this simple Medicament, I never failed of good digestion, and afterwards by the tempering this, (as I have said) have deterged and incarned, con­tinuing it until the membrane was well incarned, not finding the least prejudice the bare bone had received from it; but you must take care, you do not too much relax parts; therefore after digesti­on, Mel. Ros. with the Resina instead of the Oil will be answerable to your intentions, both to de­terge and incarn; or you may use this to both pur­poses, its composition will commend it self, ℞ Terebinth. Venet. ℥ j. Ol. Ros. ʒ iiij. Mel. Ros. Colat. ʒ iij. Croci ℈ j. Granor. Kermes ʒ ss. Sem. Hyperici ℈ ij. Vini Hispanici ℥ iij. Coq. ad consumpt. [Page 98]Vini Colat. add Aloes ʒ j. m. In the use of Medica­ments, you are to consider the part and habit of bo­dy, and add or diminish your simples accordingly, and so they will perform all intentions; if the wound be made by Gun-shot, then you are to dress the wounds as is said in simple Gun-shot wounds, and take out the Eschar, and afterwards deterge, as I have said, or with this, ℞ Terebinth. Opt. ℥ iij. Mel. Ros. ℥ ij. Succ. Plantag. & Apii an. ℥ ss. Coq. simul ad succor. consumption. add Farin. Hor­dei ℥ j. Sarcocollae ʒ jss. afterwards add Aloes ℥ ss. Myrrhae ʒ iij. Thuris ʒ ij. and so it will incarn; and apply this Cataplasma, ℞ Farin. Hordei, Flor. Ros. Rubr. Fol. Beton. cum Ol. Myrtill. decoct it in Red-wine, and apply it over all. The Ancients used to the bone after digestion, Pul. Aristoloch. Rot. Rad. Iridis Pucedani, Myrrhae, as their Sar­coticks to sprinkle on the bone, which are very good, but Pledgits of Lint dipt in Spir. Vini, and prest out hard, will at such a time serve your pur­pose well; and an Empl. de Beton. over all, or de minio Mag. or the like; and where the flesh is luxuriant, touch it with either of the stones, or this Pulv. Balaust. Ros. Rubr. & Alumin. an. prt. aeq. Thus at Worcester, Observ. a day or two before the Bat­tel, a Gentleman attended the Earl of Derby thi­ther, with a large wound cut with a sword to the Dura Mater, he had no other dressings on but a Linnen cap, the membrane covered with the shivers of the bone, it had not been drest, and may be the better for him, for if dossils in haste had been prest in the wound, he would have laboured under some severe symptoms; but the shivers lay loose upon the membrane, and he felt not his danger. I took [Page 99]these lightly out, cleansed the wound, and drest him up with lenients, the short time we were toge­ther. Authors have set us a limited time to dress with this or that Medicament, as to the fourth day so, and from that to the seventh to deterge, and so the fourteenth day Sarcoticks, but herein you must make use of your own judgments, persisting to che­rish the native heat of the part.

If the wounds penetrate to the Dura Mater, you must consider the sorce of the Weapon, and make haste to relieve the parts under the Cranium. Gun-shot. But where they are made with Bullets or heavy blunt things, there they are often pasht into one another; there you are presently to lay open the hairy scalp, & raise it up from the Cranium, and relieve the opprest membrane; but if the flux of bloud should be so great as it will not permit, fill up the part with dossils dipt in Wine or Vinegar; accordingly open it again as soon as you may, and in the while dress it up as hath been already said. These bones are to be hastened out with as much speed as may be, and the part afterwards drest with Lenients, as hath been said: If the opening in the fractured Crani­um be not sufficient, make one in the most decli­ning part, and raise up the bones, and free the membranes of whatever may offend it, but do not take out more bones than needs must, like some of those Chirurgeons I have met carrying them about, boasting in that which was their shame; for these bones in recent fractures do unite as those in other parts, therefore having raised them up, dress them lightly with the Catagmatick powders, and they will happily agglutinate and make your cure more facil. In these wounds of the Dura Mater, the lenients of Ol. Ros. or warm Pigeons-bloud are [Page 100]proper, they are Anodyne and digest; Ol. Hyper. and Mastich are also good mixt with Resina, for the curing these wounds, Fabric. Aq. Pend. cites Galen, and he Archigenes using the Succus Cala­menthae dropt into the wound, and sprinkling Pul. Milii over for incarnating them, the Milium mo­derating the heat of the other, he delivers them to us as siccantia, detergentia, & incarnantia. The unition and incarning of the Lips of the Dura Ma­ter is performed by a fleshy substance that ariseth upon the membrane, which afterwards as it in­creaseth, doth unite over it, and becomes one bo­dy, and grows firm; mean-while the bones within Exfoliating thrust from the side a Callus, which uniting with the forementioned flesh becomes one body with it, & filling up the place that was perfora­ted, is in time more firm than the bone itself was; but in the while, you must be careful that your Le­nients make not the part too lax by their greasi­ness, for so a Fungus will thrust out thence which may be vexatious to you; This in the beginning by desiccants, as Pul. Cort. Granat. Balaust. Ros. Rubr. Alum. ust. with a soft dossil and compressi­on by Bandage, will be taken down, or if it grow very big by ligature it is taken off: But to tell you truly, I never met with any such like disturbance as is represented to us by Authors, nor shall you, if you use your desiccants timely: The Vitriol or Allom-stone insensibly takes this off, and disposes the part to cicatrize if daily used.

The Pia Mater is a most delicate fine membrane, and adheres so close to the brain, that it can scarce be wounded without a wound in the Brain; and these are most commonly mortal, for that it is full [Page 101]of Veins, and subject to great effusion of bloud; the Brain wounded and exposed to the Air corrupts by reason of the external cold which soon extin­guishes the little heat of this part. And by reason of the fluidity of the Brain, and contraction of the Meninges (or membranes) caused by the constant pain and irritation, the brain perpetually ouseth out upon you, till the whole wounded Lobe be spent. You must make way to these wounds by re­moving the shattered flesh and extraneous bodies and bones: but if they will not come easie away, leave it to nature, lest he die under your hands, and you be thought to hasten his death. Your dressings must be with Galen's powder, with Hares Furre, with the white of an Egg to restrain the bleeding, and retain the brain within its bounds, and over them your dressings, as in the wounds of the Dura Mater, and over the wound digestives; remembring in all these Gun-shot wounds to cut off the shattered lips of the Calvariae, Note. lest a Gleet drop from them upon the Meninges and brain, and heighten the inflammation: If the brain be retain­ed within its membranes Pia & Dura Mater, and they digest and incarn, then you are to proceed in the rest of the cure as in fractures of the Cranium, as hath already been said.

In all hurts of the head what sort soever they be of, the Body is to be emptied, and the rather,Internal medicines. if there be Plethora or Cacochymia; for in such ha­bits of body humors are apt to stir up ill symptoms, especially if the wound be great; therefore you are the first day to open a Vein in the Neck or Arm on the same side, and bleed according to the exigency and strength of body; also cupping with scarifica­tion of the Neck and Shoulders, with Fontanels [Page 102]under the Ears is necessary: Then Lenient medica­ments, such as may evacuate the serous bloud, which by reason of its tenuity and heat readily flies to the affected part. These are such as have been proposed in the Fourth Intention of Wounds in General, to which I refer you. In these cases cor­dial Species and Electuaries, with Juleps and Emul­sions may be proper, if they be proportion'd to their temperature, hotter or colder, as there are Fever or other Accidents joyned with the malady. Vulnerary drinks are sometimes in use here, if they be fitted according to the nature of the part, and the ingredients, for these are Beton. Artemis. Ca­ryophilat. primula veris, Lillium convallium, Sal­via: Hypericon. Sanicula, Veronica. Plantag. Flor. Ros. Rubr. Nux Moschat. &c. as in the Chapter forementioned: Of these you may make drinks with Wine and Water or small-Ale, as ℞. Sanic. Beton. Veronic. Artemis. an. ℥ j. Cons. Ros. Rubr. Caryophillat. an. ℥ ss. Torment. ʒ ij. Coquantur in Aq. Pur. & Vini Rhenani an. lb ij. Vase clauso in B. M. colentur per manicam Hippocratis; give ℥ iiij. of this morning and evening, or take ℥ j. of all these Plants well dried and cut, boil these as you do Thè, sweeten it with Mel. or Saccharum to the palate of your Patient, and give them a dish of it to drink twice or thrice a day, you may Aromatize it with Saunder. Cassia Lig. or Sassafras, &c.

In the External Applications to the part affected,External. you are in the first place to prevent flux of humors, which is performed by refrigerants & exsiccants, which also dries up what is already extravased in the part; to which purpose Hippocrates proposes Far. Hordei ℥ viij. Ol. Ros. ℥ iiij. Coct. in Acet. or [Page 103] Oxycrat. and made into a Cataplasma; In Winter he added Flor. Ros. Rubr. Pulv. ℥ ij. and decocted it in Vino, others have since added Bac. Mirt. Ba­laust. to corroborate the relaxt parts, then they Embrocated the head and about the Jugulars, with Albumin. Ovor. Acet. & Ol. Ros. &c. sometimes only with the latter, but without the Acet. the Ol. Ros. seems to me not to penetrate enough. The want of these Embrocations is sometimes the cause that tumors arise behind the Ears. To contused and great wounds speedy digestion is required, not only in the Calvaria, but Meninges of the brain, and these ought to be humectantia & emollientia; and herein, as I have elsewhere said, Terebinthina is the most proper medicament, and in these Ner­vous parts you may use it washt or not; in dry bo­dies they add Thus, in humid bodies and recent wounds Vitel. Ovor. & Ol. Ros. also Farin. Hord. Cribrat. others Terebinth. Venet. ℥ jss. Ol. Hyperic. ʒ vj. Thuris ʒ ij. Vitel. Ovi j m. or R. Resinae Abi­et. ʒ vj. Vitel. Ovi; or R. Terebinth. Lot. in aq. Salviae ℥ j. Ol. Ros. ℥ jss. Gum Elemi cum olco super Ignem dissoluti & colat. ℥ ss. Vitel. ovi ʒ j. Croci ℈ j. m. and if there be much pain a Cataplasma ex Ra­dic. Althae, Flor. Meliloti, Farinae Hord. Ol. Ros. Vitel. Ovor. and a little Crocus, but you must have a care by your slabby medicaments you cause not putrifaction; wherefore Matter thus made, which happens in three or four days, you are then to de­terge by adding Mel. Ros. or Mel. Com. or this, R. Terebinth. ℥ ij. Mel. Ros. ℥ j. Pul. Myrrhae, Aloe, Mastich, an. ʒ ss. m. Discutients are now re­quired outwardly by Cataplasmes, Cerots, and Emplasters, as Empl. Vigonis de Beton. Gum Elemi de Matrisilva, Cerat. Isidis, or R. Succi Beton. [Page 104]℥ ij. Ol. Ros. ℥ iiij. Mastich, Myrtillor. an. ℥ j. Pin­gued. Hirci ℥ jss. Coq. ad Succ. consumption. Colat. add Gum Elemi, Tacamahaca an. ʒ x. Terebinth. ℥ ijss. Cerae Alb. qs. Iterum Buliiant ad consistent. Cerat. or ℞ Gum Elemi ℥ iij. Opoponac. ℥ ij. Bdellii ℥ ss. Resinae pin. ℥ j. Cerae qs. Ft. Ceratum. In all wounds of the head Gum Elemi is much commend­ed, it mitigates pain, and corrects the evil temper of the part, by a peculiar vertue it hath thereunto. Fab. ab Aq. Pend. commends this Empl. R. Beton. Virid. m. viij. Contund. Contus. addantur Ol. lb iiij. Cerae, Terebinth. an. lb j. coquantur, & expriman­tur suc. add Beton. virid. Contus. m. viij. Iterum co­quantur & exprimantur pro usu.

The use of Spir. Vin. is much commended in these wounds of the Meninges, Spir. Vini of what use in these cases. as having such a siccant quality, as is requisite for them; but in recent wounds where there is fear of pain and inflamma­tion, it is not to be admitted, but amongst deter­sives is of great use and proper for the Bones: Vi­go commends this, ℞ Spir. Vini ℥ vj. Myrrhae ℥ ss. Aloes ℥ j. Sarcocol. Thuris an. ʒ ij. or this Bal­sam. ℞ Spir. Vini lb jss. Vin. Malvatici ℥ xvj. Myr­rhae, Thuris an. ʒ x. Pul. Rad. Consolid. ℥ j. Pul. Centaur, Min. ℥ jss. Flor. Hyperici Pul. ℥ ss. Te­reb. lb ss. set this in Balneo a month, then reserve it for your use, drop of it warm upon the Meninges, or mix it with your other medicaments for your use. If the Dura Mater have changed his colour, and do not deterge with what is proposed, then this is commended to you, ℞ Tereb. Lot. in Vin. Alb. ℥ iij. Mel. Ros. Spir. Vin. an. ℥ j. Myrrhae, Aloe, Sacchar. Alb. an ʒ ij. m. If there be yet such ill quality in these wounds that they tend to putri­faction, [Page 105]scarifie the Lips of the wound, and apply this or such like, ℞ Mithridatii ʒ vj. Theriac. ve­net. ʒ ij. mel aegyptiac. ʒ j. pul. scord. myrrhae, an. ℈ j. sp. vin. qs. The putrefaction got off, and the Mem­brane recovered in its colour, you may then dress with the above mentioned, or you may dress it with this of Johan. Andr. à cruce, ℞ ol. Terebinth. venet. mel Rosar. p. aeq. apply it warm, all these Me­dicaments are to be applyed upon a Sindon to the Membranes. A Sindon is a piece of Silk, or fine Lin­ing cut round proportionable to the perforation made in the Cranium, and is to be placed in under the edges of the Cranium by the Lenticular In­strument, that the edges of the fractured or per­forated Cranium hurt not the Dura mater: A Thread or Silk is to be fastned to it to pull it out at plea­sure; over this you are lightly to place soft dossils of Lint dipt in some convenient Medicament, to fill up the void space in the Bone, this serves to cherish the native heat of the part, and to keep the dura mater from rising above the Bone, whereby your Patients life would be in great hazard: the Tin­cture of Myrrhae forementioned is proper to dip the dossils in after digestion.

In wounds of the membranes of the Brain,Medicine in wounds of the Meninges. and Brain it self, this is good, ℞ succ. Beton. ℥ iiij. succ. calamenth. ℥ ij. flor. Centaur. min. p. jss. hyperici, con­tus. ʒ ij. vini odoriferi lb j. Infuse these three days, then boyl them to the consumption of the Juices, then strain it, and add to it Terebinth. clarae ℥ iij. Gum. Elemi ℥ j. dissol. in sp. vini ℥ ij. ol. Hyperi. ℥ jss. mel. Ros. ℥ iiij. boyl these a little, then add pul. myrrhae, Aloes, Sang. dracon. Thuris an. ʒ j. and re­serve it for your use; oleum Aparici prescribed in [Page 106]wounds in general is an excellent good Medica­ment in recent wounds of the Meninges and Brain.

Fabr. ab Aq. pend. proposes this in wounds of the Brain,Qu. whe­ther the dose of ol. chalcanth. be not mistaken, at least if by it he mean ol. vitriol. ℞ farinae milii ℥ ss. olei aparici ℥ j. Mi­thridati ʒ vj. Bals. pervan. ex Aegypto ℥ iij. sp. vini ʒ v. and if more desiccant be required, he adds olei de chalcanto ʒ jss. drop this (saies he) warm and your digestives over the wound, and to Em­brocate the head and parts about with ol. Ros. and lay this Emplaster over all, far. Hordei ℥ viij. pul. chamel. ℥ iiij. pul. spicae Scenanthi an. ʒ iij. pulv. Be­ton. staechad. an. ʒ ij. ol. Mastich. lb ss. ol. Ros. ℥ iiij. oxy mel. simpl. ℥ v. vini albi medioc. potentis. qs, ft.

If the bones be carious and do not readily exfo­liate, you are to Rugine them and dress them with ung. Arcei, and if they do not incarn by that, then ℞ sp. vini ℥ x. Myrrhae ℥ j. Aloes ℥ jss. rad. pucedan. Aristoloch, cort. Thuris, an. ℥ ss. pulveriz. & misceantur pro usu. It is to be used with Lint; In dry Bodies this ℞ pul. Aloe pumic. ust. pomphol. an. ʒ ij. Myrrhae. ʒ j. pul. ostre. combust. ℈ ij. this to be mixt with mel. Ros. & sp. vini. And this Em­plaster over it, ℞ cerae, Resinae pini, amoniaci, Elemi, an. ʒ vj. Terebinth. ℥ iij. pulv. Myrrhae, mastick, Aristoloch. rot. Ireos, Aloes, opoponac. Euphorb. an. ʒ j. ol. Ros. q. s. ft. Emplastrum, after parts are in­carned you may cicatrize with one of these or such like, ℞ plumbi usti cum sulphure & loti Litharg. aur. an. ℥ ij. Antimonii usti & loti cerussae, an. ℥ j. ol. Ros. q. s. ft. ung. or thus, ℞ pulv. Aristoloch. ust. flor. Ros. rub. Balaust. cupress. ustor. ostrearum. an. p. aeq. ft. pul. or thus, ℞ calcis testarum ovor. calcinat. ℥ ss. Alum. usti ʒ j. croci martis ℥ j. ft. pul. Thus I [Page 107]have set you down variety of Medicaments, whereof you may fit your selves according to the exigency, and shall now shew you some of my work, wherein I used but a few.

CHAP. I. Of Gun-shot in General.

GReat hath been the Contention a­mongst the Learned about fire and venome in Gun-shot-wounds;Gun-shot wounds, whether fiery or venom­ous. some maintaining the one, some the other to be in them; and o­thers defending, that there is neither. That which I suppose might be the occasion of their suspecting Empyreuma, and a Venefick quality, was the deadly colour of these Wounds; which in those early dayes, when the Inventi­on of Guns was novel, surprized them; they [Page 2]being not unlike poysoned and burnt Wounds. Where the Bullet pierceth, it extinguisheth the natural heat, and the lips of the Wound are livid, or blackish, and if not drest rati­onally, it inflames round about, from the afflux of humours, and hath ulcuscula, with a foetid smell.

In this condition the Wound is the first day, and so to the seventh, and (if not suc­coured) it Gangreens, and so the Patient com­monly dyes. If in those dayes the Learned thus deceived by their aspect, drest them as venomous Wounds, it will be no marvel that they should write so of them: I verily be­lieving, that in their way of treating them, they were directly as poysoned Wounds, difficult to digest and cure.

In these our times, although they do not call them venomous,Errors in dressing Gun-shot-wounds. yet it is the hardest thing in the world to disswade many of our Chi­rurgions from dressing these Wounds with Tinctures of Myrrhe, and Honey of Roses, and thrusting in of great Tents, by which way of dressing, I have seen these Wounds, undigested the tenth day, one whereof was in the Cheek, with dry and flaggy lips. These lesser fleshy wounds, being undigested, at last Gangreen; and in truth it is not to be won­dered at. I will undertake to shew you the Experiment every day; and that in a Fonta­nel or Issue, made by a Caustick.

Cut you through this livid or black Escar, and put a Pea in the middle of it, with Tin­cture of Myrrhe and Honey of Roses, as I have seen some of them dress Gun-shot-wounds, [Page 3]and the next day, or two dayes af­ter, when you dress it again, it will be to your sight not unlike a Gun-shot-wound; continue your dressing it with a Pea, and with your Tincture of Myrrhe, and if it do not Gangreen, yet it will be Inflamed, and slow in digestion. And this is from the im­proper application in the dressing it. For if you dress this Escar in the Fontanel, with E­mollients and Digestives, as you ought to do the Escars in Fontanels, the Escar will separate with digestion, in the worst habit of Body. And so it will in Gun-shot-wounds, with little distemper or difficulty, if you have timely extracted the extraneous Bodies. But a discontinuance in this kind of Chirur­gery, makes us apt to forget our selves.

Thus at our entring into Worcester, Observa­tion. when the King came out of Scotland with an Army of that vallant People, a Townsman was shot. A Pistol fired by the Cheek, shot him through his lower Jaw and Tongue, and out by the contrary Cheek, the Chirurgion of the Town a good Chirurgion, upon sight of it, conclu­ded it Gangreened from the black colour; and declined the dressing it the way he rationally ought; upon which the part grows exceed­ingly painful, and inflames and Gleets with great tumefaction. After two dayes, I am called in, and by lenient Medicaments and good Bandage, keeping up the fractured Jaw, allaid the pain and digested the Wound, lea­ving it in the same Chirurgeons hands, who cured it. In this person, the Wound was burnt by the flame, the very powder stick­ing [Page 4]in some parts of the Cheek. This, with the putrefaction from the hot weather, con­tributed to our Brother Chirurgeons appre­hension. It is this ugly aspect that puts the inconsiderate Chirurgeon out of his Method, and so makes Gun-shot more difficult of cure, which otherwise would digest, and heal as easily, as any complicated Wound, as I shall make appear in this following Dis­course.

CHAP. II. Cure of Gun-shot-wounds; and First of Extraction of Bul­lets, &c.

WOunds made by Gun-shot are, Im­plicatissimum morbi Genus; The most complicate sort of Wounds that can be inflicted. For they are not onely a solution of continuity, but have joyned to that contusion, Attrition and Dilaceration in a high and vehement kind. To this we may add all sorts of Fractures and Accidents, as Hemorrhage, Inflamation, Erysipelas, Gan­green and Sphacelus; besides the extraneous Bodies, which are violently carried into the Wound. And multiply Indications ex composi­tis, [Page 5]affectibus, non unica elicitur Indicatio, sed plures pro diversitate morborum. The number of the Indications in compound,Com­pound in­tentions. affecti­ons, must answer to the variety of di­sturbances, were it a simple Wound, the cure of it would presently be perform­ed (as you have read in the preceeding Treatise of Simple Wounds) per Astringen­tia & exsiccantia, by such Medicaments as are of an astringent and drying quality: The cure of a Wound is the exsiccation of it; but here is alwayes joyned with these that which Indicateth the use of Emollentia, dige­rentia, & suppurantia, according to that of Hippocrates, Omne quod contusum est, necesse est ut putrescat, & in pus vertatur; What is con­tused must necessarily putrifie, and be turned into matter.

That which is fretted and torn must also be reduced to the whole, or cut off,What is torn is to be redu­ced to the part, or cut off. before your ordinary intentions of Incarning. Moreo­ver, in these Wounds, not onely the Bullet it self is ordinarily lodged; but many times other strange Bodies are carried along with it. For extraction of which, judicious care and industry are required in you; Here in these recent Wounds, we very rarely have a flux of blood, though the Veins and Arte­ries be wounded; they commonly lie quasht in the contused flesh, until separation of the Escar, and about that time when you least think on it, they may burst out violently. I have seen it thus often break forth;Haemor­rhagy. but if such Vessels do bleed upon the receipt of the Wound, and interrupt you in drawing out [Page 6]the Extraneous Bodies, you must endeavour to suppress the blood, for thereupon depends the Life of your Patient. But withall so proceed, that you may extract the Bullet first, and then be careful that in the re­straining the bleeding, by your crowding in Dossils, and strict Bandage, you bring not on a Mortification.Observa­tion. Such a Hemorrhage hap­pened to a Souldier at the surprize of Wey­mouth, by the Garrison of Portland; he was shot through the Heel; for the restraining of bleeding, I applyed my endeavours. But after all, I was put to the use of the actual Cautery, which I did successfully, and have since seen Botallus authority for it: Tu­tius enim est (saith he) eam Ignito ferro constrin­gere. Anodynes Pains are here to be appeased by Ano­dynes, but you must well consider the appli­cation, least you extinguish that small remain­der of heat that is left. How you shall deal with all these Inconveniencies, and not add one evil to another, I shall plainly deliver to you. And first, what must be first put in execution, which is the extracting of Bullets and other Extraneous Bodies.

The Part is at first dressing,Dress pre­sently, during the heat of Battle. with what di­ligence you can, to be cleared of all such Forraign Bodies, as have made violent In­trusion into it, while the Patient is warm with the heat of Battle, and the Wound fresh, and very little altered, by either Air or Accidents, so that less pain must necessarily follow upon the Extraction.

In the Armada Naval de Dunquerquo, where we Chirurgeons were oft imployed in this Ser­vice, [Page 7]we after every fight went together, vi­siting one anothers wounded men: Amongst us it vvas thought a great shame if any thing of this work of Extraction vvere then to be done. For after the first and second day the Wound proveth tumefied,Necessity of it. all the neighbour­ing parts are inflamed and changed so in their temper, that they conceal from your sight both the Bullet and his Companions, that the place they are coucht in can hardly be known; or being discovered, you cannot without hazard of your Patient, or great trouble of the Part, make extraction of them.

And yet if the Wound be near a Joynt, or the Shot lodged amongst the Tendons, it is much to be feared the pain will not off, until those strange Bodies be drawn out; conse­quently the omission of that extraction, will bring Mortification, which hath been the cause of the death of many a brave Souldi­er. And is the cause of all the mischief these Wounds are subject to, as Pain, Inflammati­on, Spasmes, Convulsions, Gangreens, Sphacelus, what not? Every Battel produces Instances of it to the discredit of our Profession.

But if the Bullet be lodged in a less noble Part, as in Musculous Flesh, you may with more ease content your self, unto the seventh day, or until the fierceness of the Accidents be over, and the Wound digested. But withal, it will require more care, for the Wound will be more painful, and slow in digestion then otherwise it would be; yet by the confession of those that allow fire and poyson in it, the Bullet may ly long there, [Page 8]and do little harm; nay, I suppose there are not many, but have heard or seen of Bul­lets that vvithout grievance to the Patient have continued, lying long in fleshly parts of wounded men. Conceive this spoken of Lead­en Bullets, for Iron or Brass cannot (by rea­son of their aptness to rust) remain vvithout doing harm; however let nothing of this en­courage you; for the Bullet pierceth not any part, vvithout carrying raggs along vvith it, vvhich corrupts in the Wound, and makes Apostemations and prolongs the Cure, as must needs be observed by all men in their practice.

The Servant of a Noble man,Observa­tion. was wound­ed and shot in the thigh by High-way men, the Bullet not having been drawn out by his Country Chirurgeon at the first dressing, could not be drawn out by me at the second, but occasioned great pain vvith Inflamation, great heat and vvatchings: Although he had many other considerable Wounds upon him, to make a derivation; yet vvas his Gun-shot more vexatious then all the rest, until I ex­tracted the Bullet and raggs carried in vvith it, yet this vvas but a Pistol Bullet. But af­ter I drew out this Bullet, my digestion be­came good; and by equal Bandage, vvith gentle compression of parts, I united and healed it in ten or twelve dayes, vvhich I doubt vvould not have otherwise been cured in three moneths.

Nay, vvhile any of the raggs remain in the Wound, it vvill never cure, but the Extra­neous Bodies drawn out, there is little diffi­culty [Page 9]in the curing these Simple Wounds; if drest, as I shall here following show, but if handled, as some have lately taught, they are as so many poysoned Gun-shot-wounds.

Now for the taking out of the Bullets,Two me­thods of extra­cting Bul­lets. and other Extraneous Bodies, there are two Methods; 1. One to extract them by the vvay they vvent in; The other to open them a way, by vvhich they would, if their force had not fail'd them, have passed themselves through.

For to take them out the vvay they vvere forced in, you must place the Patient,1. The way the Bullet went in. Methods of search. as near as he can guess in the posture he was in when shot. And, if by reason of his weakness or other Infirmity, he cannot without pre­judice, be so scituated; let him be laid in a position which may as neerly answer it, as may be; Least some part of a Muscle, Ten­don, or Ligament, obscure what you desire to make manifest. Then make search for it with your finger or probe. The Figure of these Wounds is alwayes round; the Bullet forces the Flesh in with it, and its entrance presently contracts closer; but its going out is more laxe; you may guess by view of the Wound, the largeness of the Bullet, and com­paring the Figure with that, make choice of a fit Instrument for extraction, whereof you ought to be alwayes well furnished. Your main care in this work is to find out the Bul­let, which if you fail of by searching into the Wound with your Probe: Then you are to feel the parts about, it being wonderful to consider how these Shots do twirle about, at least seem to do so, when the posture [Page 10]is changed in which the Wound was re­ceived.

As for Example; A man hath been shot in the Cheek, and I have cut out the Bullet be­hind in the Neck: A man shot in the outside of the small of the Leggs, the whole Mem­ber unmeasurably swell'd and inflamed, no possibility of finding it out either way; at last by chance, I felt it in the inner side of the Thigh above the Knee. And so another being wounded in the outside of the Arme, I have cut out the Bullet below the Scapula; If the Bullet have not been in so long (as in some of these cases) that the parts are ex­treamly pained with Inflamation and Tumor, the pain where the Bullet lodges discovers it.

A common Souldier shot in the Breast through the Sternon, Observa­tion. lay roaring very grie­vously, complaining of the pain of his Back. I was fetched to him; and turning him on his side, I saw the Bullet lye like a small Wen or Scrophul, thrusting out under the Skin, not far from the Spine. I made Incision o­ver it, according to the length of the part, and thrust out the Bullet as easily as I could desire. I dressed it, and the Souldier ceased his crying, and acknowledged before us, his pain was from the Bullet in the Skin. For indeed the Lungs and other internal parts, are seldome sensible of pain, when wounded through; they discover their hurt by other symptomes. The common Souldier dyed, as most do that are shot through the Lungs.

If in your searching for the Bullet, you light on the part, though there be no Ex­tuberance, or ought to be felt, yet his pain there, will be a good sign for it; if no ac­cident occasioned that pain. Make your way there by Incision, avoiding the Vessels, and take out the Shot, and what else offers it self; by this you do both quit the part of its troublesome Lodger, and withal make way commodiously for discharge of matter, which in regard most of these Wounds are Sinuous; (the Bullet turning aside, when it is hinder­ed in its journey forward) for want of dis­charge might in those places occasion Fistu­la's and hollow Ulcers, not without ill qua­lity.

In the work of Extraction,Caution. take great care you lay not hold of some Nerve or Tendon, and so pluck them along with the Bullet; for by so doing you may cause intollerable pain and grievous accidents; you must therefore neither open nor dilate your Instrument, until you may take hold of the Bullet, without any of the circumjacent parts.

CHAP. III. The first dressing after Ex­traction.

AS soon as you have made a separation of these Extraneous Bodies, if you judge the Wound to be so well con­ditioned, that there is neither sear of Putrefa­ction, nor Mortification, (as in recent Wounds there is not;)First dres­sing after Extracti­on.) Be not discouraged at what­soever evil aspect it hath at present; but con­sider its Livid colour to be natural in the Wounds, when the Contusion is not simple in the Skin, but through Flesh and all, as far as the Bullet hath entred, depriving parts of their sense, to the very bottom, and hath the colour of a gangreened or poysoned Wound. Therefore I pray disturb not your thoughts; but having taken out the Bullet, dress it up as a contused Wound, with Ol. Catulor. as hot as the part will bear, not gi­ving credit to any that shall perswade you to the contrary; And it is thus made.

℞. Ol. lilior. alb. lb vj. boyl in this two new whelpt Puppies, until the flesh fall from the bones, then add Lumbric. terrest. in vino lotor. lb j. boyl these a while, then strain it by a gentle compression; to the strained liquor add Terebinth. ℥ iij. sp. vini ℥ j. reserve this for your use. Or this;

℞. Ol. lini, Canab. an. ℥ iiij. Ol. lilior. chammeli an. ℥ iij. Terebinth. ℥ j. m. s. A. Or this;

℞. Terebinth. opt. ℥ iiij. Thuris Mastish. an. See of A­panci in simple Wounds. ʒ iij. Myrrhae ʒ j. Ol. Aparici ℥ ij. Ol. lum­bric. & sambuc. an. ℥ iij. m. ℞. Ol. olivar. lb j. Terebinth. lb. ss. Gum. Elemi ℥ ij. aeruginis pul. ʒ ij. Or this;

℞. sp. vini lb ss. Terebinth. lb j. Ol. Hiperici & lini an. lb ss. sang. dracon. subt. pulveris ℥ j. m. s. A.

With this I cured a servant of A. D. shot into his hand, this digested the Wound,Observa­tion. after separation began, I felt part of a bone bare, which I drest with Extrac. scord. dissolved in Mell. Ros. with which I deterg'd, and feel­ing no more of the Bone, I incarn'd and cicatrized with ung. Tut. &c. in few dayes without any difficulty, Linement Arcei with any of the above mentioned Oyles is very good, adding a few drops Ol. Terebinth. which by its subtilty penetrates, and by its heat rouzeth parts, and putteth them upon dige­stion and hastens separation.

Quercitanus proposes this. ℞. succi herbar. Tussilag. oxalidis an. ℥ iij. Caricas ping. Nxx. Thur. ℥ ij. Resin. laric. ℥ ij. ss. Axungiae Gallin. An­scrin. an. ℥ ij. Butyri recentis lb ss. Olci visis po­morum compost. lb j. put this altogether in a Ves­sel close stopt, boyl them by a gentle heat the space of six hours, then strain them out hot, and evaporate them to a good consi­stence: Or this;

℞. Cerae novae, Resiuae, picis naval. an. ℥ iiij. seu Hircini, medullae, cruris, vitulini an. ℥ ij. aesypi, ℥ j. Ol. olivar. aut lini, lb j. liquefactis omnibus [Page 14]transcollatis, F. ung. quod reservetur ad usum. He adds a ʒ j. of praecipit. to every ℥ of this. But this in recent Wounds will not be necessary; for you will find by Experience, that these Wounds will digest and suppurate (and that frees them from putrefaction.) Nor will it be alwayes for your Credit, if you consider the quantity of Balsomes we use in such Wounds, and the prejudice some people have to the use of Mercury; yet praecipitate & Axungiae with a few drops of the Terebinth, was a common Medicament among us. But I refer that to you, it being a good Medica­ment to hasten separation of the Escars; you are to dress up these Wounds lightly with a pro­portionable soft Tent, and Plegdits dipt in some of these digestives very warm, not to scald parts. After that Embrocate the parts about with such like.

℞. Ol. Lumbricor. Ros. Myrtill. an. ℥ iij. A­ceti cochl. ij. mix them; in the first dressing, your Applications over the Wound and parts circumjacent, should be such as have Vim A­stringendi & Intercipiendi, to hinder the flux of humours, and strengthen the part, take farinae hordei & fabar. an. ℥ vj. Ros. rubr. Bacc. myrtill. an ℥ j. s. sem. Cydon. ʒ vj. boyl these in Posca, to the consistence of a Cataplasm, adding at last two new lay'd Eggs, with Oxi­mel ℥ ij. ss. Apply this over the Wound and part; if you apprehend this too heavy, you may add Ol. Myrtill. & Ros. and Wax as much as is necessary, and make it into the form of a Cerote; and above the Wound lay one of the defensatives, of which, or the like, you [Page 15]may have alwayes ready by you.

℞. Bol. Armen. ℥ iiij. Terr. sigill. ℥ iij. sang. dracon. ℥ ij. Corn. Cervi. Ʋst. or burnt bones ℥ ij. ss. our Juice of Sloes dryed, an. ℥ iij, Cerae ℥ iiij. Ol. Ros. & Myrtill. an. ℥. vj. A­cetis ℥ xij. boyl these to the consistence of a Cerote, add four whites of Eggs. Or this;

℞. Pulv. Ros. rubr. Bacc. myrtill. an. ℥ j. Bol. Armen. Terr. sigill. an. ℥ vi. succ. plantagin. so­lan. an. ℥ ij. Aceti opt. ℥ iiij. Ol. Ros. & myrtill. an. ℥ iiij. cerae q. s. m. Apply your Compress, dipped in Aceto or Oxicrate, let your Ban­dage be put on equally and gently, to re­tain your dressings, and hinder the Influx of humours.

Having thus drest the Patient,Bleeding. presently consider of letting of him Blood, to prevent ill accidents, and especially if he lost little or no Blood from the Wound, and that there be a Cachochymia, Revulsio enim quae è directo sit, celerrimam utilitatem adfert. Galen. de sang. Mis­sione.

A Glyster should preceed Phlebotomy,Glysters. made of the decoctions of Mallowes, Violets, Beets, Mercury, Bays and Juniper-berries, with Ol. of Linseeds, honey of Roses, Hyera Picra, or Elect. lenetive. But if you have not this in readiness, make your Glyster with the broath of Flesh, Ol. Chamom. Sugar, and the Yolk of an Egg, and a little Salt, if your broath be not salt, or salt-water, or broath out of the Kettle, with a few flowers of Cha­mom. boyled in it and strained; adding a little Butter or Oyl, and red Sugar, is a good Glyster in time of need.

Then you are to prepare some Cordials to resist the putrid vapours,Epithema you may also for­tifie the spirits if there be need, by some E­pithema of your distilled Waters; as Balm, Bugloss, Acetum, Ros, with the Powder of the roots of Tormentill, Scordium, Scorzonera, Contrayerva, Treacle, Mithridate, &c.

And with these you may make Cordials also,Cordials. adding Syrupe of Citron, Gilliflowers, confect. Alkermes, and for your Common peo­ple, an. ʒ j. of Treatle or Mithridate in White­wine dissolved; for the better sort, take Aq. Bugloss. Cinamom. an. ℥ ij. conf. Alkermes ℈ j lapis Bezoad. occid. gr. xxij. syr. Citri cochl. ij. m. for an Epithema.

℞. Aq. Melessae borage Bugloss. an. ℥ ij. Aceti Rosat. ℥ j. species Diarhodon. ʒ j. Croci ℈ j. As to their manner of Dyet hear Celsus, Lib. 2. Cap. 26.Dyet. Ʋbi aliquis grave vulnus accipit à cibo tantum abstinere debet, quantum vires patiuntur, adco tenuis esse debet dycta, ut vix sustineatur; In great Wounds it is necessary to observe a spare Dyet, as Barly Gruels, Panadoes, thin broath, or a poached Egg, this much availing to the preventing of Inflammation. But in this the Patients custome must be considered, also the Air must be temperate, and dress not in the Air, frigidum enim inimicum vulneribus, Cold is an Enemy to Wounds: rest is also required as well to the mind as the body. Therefore having thus drest him, and laid him to rest, with ʒ vj. syr. de Miconio, with cochl. ij. aq. Cardiacae, in ℥ iiij. aq. papaveris.

We are now to proceed to the second days work,The 2^d days dres­sing. and we are here to consider the habit [Page 17]of body, and more particularly what concerns the Wound. And in these Gun-shot-wounds it may be convenient the Body be gently purged by Lenitives only, as is formerly said; Purga­tio enim per alvum plerisque vulneribus prodest, you thereby carrying off the bilous and serous humor, which from their heat and tenuity, are most apt to ferment and slow into these wounds, and cause Pain and Inflamation, and other ill symptoms. In which cases use Cassia, Manna, Tamarinds, Syr. de Cichor. cum Rhabarb. Ros. so­lut. These are lenitive, and may be taken in Whey or Ptisan, and are fit to prepare the hu­mor.

But as for stronger Purgatives,Purging Hipp. saith well, Cocl a sunt purganda non cruda, which is more especially true when you speak of Scammoniate Me­dicines.

Having this proposed a general way of purg­ing, you must consider the necessity of your particular case; we shall now again prepare our dressings, and look into the wound, and apply such Medicaments as may be fit for the quality thereof: And now it is necessary your Fomentation be ready, where-out may be wrung a hot stupe; to which end,

℞. sumitat. Hiperici, Contauri, Scordii, Fomenta­tion. Absinth. an. m. j. Flor. Ros. Rubr. Chamom. Mililot. Sambu­ci, an. m. ss. Furfuris p. j. coq. in Aq. Fontan. ad lb ij. ss. colat. adde vini Austeri lb j. sp. vini ℥ vj. st. Fotus: These will give a breathing to the parts, and defend the Wound from the Air while you consider it. If all be well, proceed with the same, but if it be accompanied with pain, foment with this ♃ decocti Rad. Althae, malvar. [Page 18]fol. verbas. Chamom. Melilot. sem. lini. faenugraeci. boiled in Sheeps-head-broath,If pain. or other; and of the faeces of this Fomentation you may make a Ca­taplasma, adding farinae hordei lb ss. sem. lini. Cy­donior. pulv. an. ℥ j. ung. Basilic. & ung. Dialthae. an. ℥ j. aux. porc. vet. qs. Croci ℈ ij. four whole Eggs, and apply it over all, or the former Cataplasma. It cherishes the heat of the part, furthers suppura­tion and is Anodyne. You are to make the Bandage as before, and continue this way of dressing to the seventh or ninth day, until you have digested the Wound, and the Escar is separated, and that you have laudable pus (as you are wont to call it) which is Album, aequale, leve & minimè foetidum, Equal, white, light Matter not soetid or ill scented; then we must seek for other kind of succour, which may re­store the wounded part to its former sanity.

If after separation of the Escar parts be not well digested, or want detersion; ♃ succ. Agrimon. Centaur. min. plantag. Apii an. ℥ j. Mucilagin. hor­dei ℥ iiij. boil these together; adding Terebinth. venet. ℥ iij. Mel. Com. ℥ ij. farinae hord. cribratae ʒ iij. Croci pul. ℈ j. ft. mundificativum: To this you may add Aloes, Myrrhae, Sarcocol. Rad. Aristoloch. Gentian Ireos, for the Incarning these Wounds: If you desire rather Injection, the same Ingredi­ents may serve. But in the use of Injections do not stop the Orifice to keep the Liquor in, for you so distend the Ulcer and make it more sinuous.

CHAP. IV. Of Accidents befalling Gun-shot-wounds, and of Sinu­ous Ʋlcers.

BUt from the first to the eleventh day, many Accidents are wont to happen to these Wounds, which not onely im­pede the Cure, but often, without timely help, destroy the Patient. And these are ve­hement Pain, Inflamation, Erysipelas, and o­ther deadly Accidents, as Gangreen and Spha­celus, all which take their beginning from Inflamation. Therefore I have elsewhere par­ticularly treated of Inflamation and Erysipelas, that you feeing what it is may in its begin­ning prevent its increase: It commonly pro­ceedeth from a very ill habit of Body, or from the ill handling of these Wounds in the be­ginning.

The remedy is to prevent the Influx of more humours, & evacuate that which is already fal­len into the part. The first way is by bleeding largly and purging, both which are directed you in the first dayes work, if you omitted that then, you must perform it now.

The second way is by Externals; and that is by Anodynes, which may mitigate and repress [Page 20]the heat of the part; as also by Discutients and Concoction of the matter in the part af­fected; which is performed by those Medica­ments which were proposed in the Cure of the Wound, with observation of dyet, &c.

The Prevention and Cure of these, vvith the manner of handling them, you may see more particularly in the Treatise of Phlegm and Erysipelas, how in the beginning it is to be done with Refrigerants and Repellents; and in their state by moderate Calefaction and Dis­cutients: and afterwards by Dissipants and high­er Discutients, to which Treatise I refer you.

The next and most cruel symptome,Gangreen is Mor­tification of the part, which so often attends great Inflamations; and is shrewdly to be su­spected, when they yield not readily to Dis­cutients or Suppuratives. In their Wounds it happens most commonly through a Suffocati­on of the natural heats of the part; or through the great concourse of humours, or too refrigerating and repellent applications, in the time of great Inflamations and Erysipelas, which have infeebled and hindered the transi­tus of Spirits into the part. It is perceived by the change of colour, it begins to look Li­vid, the lips grow flaggy, the tumor sinks, and it gleets and is blistered, and blew spots after a while appear.

When you see such a change begin, you must presently prepare to withstand a Morti­fication by Scarification, until the blood come, not onely about the lips of the Wound, but deep into it through the Escar to the quick, [Page 21]and suffer it to bleed freely, and make the party sensibly feel, that by such means you may disburden it of part of what would have choaked it, and make way for the entrance of the force of the Medicine.

Then foment the part with a good Lixivium made of Ashes and Salt, with acet. vin. in which you may boyl scord. Absinth. centaur. and such like; and after Fomentation wash the scarified parts, and dress the Wound with Ae­gyptiacum, theriac. venet. dissolved in sp. vini, adding Calcin. vitriol. &c. and a Cataplasm of farine, Hord. fabar. orobj. lupinor. decocted in some of the same Lixivium, adding oxginel to it, applyed over all. But for this I refer you to a particular Chapter of Gangreens and Sphacel. for further directions therein; as the Gangreen, Separates, you are to deterge; to which end use mundificat, ex Apio or Paracelsi, to which by adding praecipitat. you may hap­pily effect your Cure.

But in the separating of contused parts,Haemor­rhage. as I have often told you, great Fluxes of blood usually burst out upon us.Observa­tion. Thus in a Patient of mine wounded by Shot, through the inside of the Radius, upon separation of the Escar, a great deal of blood broke out with impetuo­sity. I stopped the Orifice which was nearest the Artery, with some mild aglutinative Pow­der; suppose Galens Powder ex thuris part. ij. Aloes p. j. cum pilis, leporinis, &c. The blood then bursting out at the other Orifice, I ap­plyed over that also the same Powder, and rouled up the parts with a good Compress dipt in a Styptick Decoction, laying my common [Page 22]Defensative over all, and not opening it till three or four days after.See Trea­tise of Wounds. How such Fluxes of Blood from the Arteries are to be restrained, you may see in its proper place.

Gun-shot-wounds,Sinuous Ulcers. the Escar being once fallen out, become Sinuous Ulcers; espe­cially after great mischievous Accidents, and vvhere Bandage cannot be used to preserve the tone of the parts, as in the upper part of the Thigh and Hipp, &c. these Cavities causing much pain to the Patient, and difficulty and trouble to the Chirurgeon, vve shall consider their Cure. Our indication therein, is from the parts affected, the largeness of the Wound, Contusion and Laceration of parts: for contu­sed Wounds, must of course corrupt, and turn into matter.

And if the Bullet or any Extraneous Body be yet remaining in, the parts become more lax, and are accompanied vvith pain and influx of humours, and the included Body is streight­ned in its passage out, through generation of flesh, which causeth much difficulty in the Cure; especially if a Cacochymia, or Lues ven. be joyn­ed vvith it, you vvill scarce cure your Pati­ent, vvithout exhibiting Antivenerial and Scor­butick remedies.

To prevent Sinuosities, you are to enlarge the Orifice at first, or keep it so wide open, that the matter that is daily there ingendred, may have free passage out, vvhich if it may not by the vvay the shot came in; then you must consider, how in another place the Sinus may discharge it self, this being pru­dently effected, and the matter thereby dis­charged, [Page 23]you shall speedily perfect your Cure, and vvith ease.

But before you make this Apertion, you must consider, vvhether by altering the Posi­tion of the part, or by Compression by Ban­dage, or by hollow Tents, the matter may not be brought out. And to make the Cure of these Cavities more facile, you must endea­vour to place the member in such a figure, as the Wound may be depending, and you must have Stupes, Spunges, Compresses, and the ex­pulsive Bandage; these prest out of red Wine, vvherein is infused Flor. Ros. rubr. myrtillor. Cort. Gran. Balaust. nuc. Cypress. sumach. acacia, and dress it twice a day, and Injections of the same Decoction, vvith Myrrhae, Aloes, sarcocoll. Rad. Irid. Aristoloch. sp. vini. mel. Ros. Aq. Cal­cis, Aluminosa, and such like.

Sometimes in a Wound by the upper part of the Biceps diepe, the matter not being likely to discharge it self, I have by a Seton Needle preforated it through, and retaining the twi­sted Silk, until the parts have been digested, then drawn out the Silk, and by a Tent kept that open a few daies, until the upper part by good Bandage Aglutinated. Then the dis­charged matter below being little and good, I have left of the use of the Tent, and healed it up.

So I have often in Wounds of the Thigh, vvhere by no Position or Bandage I could o­therwise effect it.Observa­tion. And here in the Covent Garden, in an old Sinnous Ulcer, vvhich dischar­ged it self from the right Ilion through under the Inguen, viz. by the inside of the Thigh four [Page 24]fingers breadth below that place. I had great difficulty to make out whither the Sinus tend­ed; at last I found by my searching Candle, that it vvanted a little more then an Inch to pass throughout by the Glutens, and that vvith­out any opening that vvay; the matter vvould continue to make its Cavities, upon which I applyed a Caustick there, vvhither I supposed the end of my Probe tended. Then having ta­ken out that Escar by Incision, I prest vvith my Probe against my finger which vvas vvith­in the Escar, I there felt the end of my Probe, though at a distance, upon vvhich I passed a long Canula instead of my Probe, and feel­ing the end of that, I passed then a Needle through this Canula, and so through the Es­car, vvhich I take hold of, and the while pull back my Canula, and the Needle being free from incumbrance, I pull'd it forward, with a twisted Silk at the end of it, and cutting off the end of the Silk from the Needle, I conti­nue the Silk as a Seton there: the Needle, Ca­nula and Silk vvere first anointed vvith Ʋn­guent. Dialihae. or Ol. lilior. or the like.

One shot in the Face betwixt the Nose and Eye on the right side into the Ethmoides by a Pistol Bullet,Observa­tion. after some years that this Wound was cured, vvas troubled vvith a fret­ting Ichor, vvhich discharged by that Nostril, and at his first arising up in a morning out of bed, vvould discharge half a spoonful of a yellowish colour, and had made a chop or gut­ter at the lower end of this Nostrel, by its a­crimony. After some vvhile, he could feel upon bending of his head backvvards or for­vvards, [Page 25]the Bullet to roul to and fro.

He complained to me of his grievance at the Hague in Holland, a little before His Ma­jesties going into Scotland. I proposed to him, as the onely way to free him from this grie­vance, speedily to cut through the oss. Palati. he assents to it. I placed him in a clear light, one holding his head steadily, I cut into the roof. The flesh was so close tyed as it would not yield to my Spatula, as I expected; upon which, by a quick working Escarolick held to the place upon Lint a few minutes, I consumed the soft part to the bone. Then I cut into the bone such a hole, as I, by the moving of his Head, could see the Bullet lodged in the hole, but this was not done at once sitting. Yet by degrees the Bullet was taken out, and he eased of that discharge of matter, which threatned a filthy, carious, fistulous Ulcer. My atten­dance upon His Majesty into Scotland hindred my prosecution of that Cure. I left him in the hands of a Chirurgeon there; and since have often seen him at Court: but the Ulcer did not shut up with a Callus as it might, had it been closely attended.

This way by making Incision,Method of cure in Sinuous Ulcers. is the speedy way of curing all these Sinuous Ulcers, if it may be safely done without wounding great Vessels, Nerves, or Tendons. Your Incision is to be made according to the length of the Fibres, and a Probe or Canula must be your guide. Having once made your Apertion, you may enlarge it as you see cause by Incisi­on, Gentian, or Spunge, to discharge the im­purities of the Ulcer, then digest it with the [Page 26] Com. digestive ex Terebinth, vittell. ovi, and if there be occasion, you may add a little Mell. to it and Myrrhae Thuris rad. Irios, to make it more exiccant, but commonly the depending part oppened, the Wound is cured by Bandage, and keeping open this last Apertion a few days. If these grow Fistulous, you shall find the Cure of them in another place.

CHAP. V. Gun-shot-wounds with Fra­cture.

HAving declared unto you the way of curing Gun-shot-wounds in the soft and fleshy part; I purpose now to proceed to the curing them, as they are com­plicated with the fracture of the Bones; whose firmness, driness, stability and solidity cannot defend them from these Inconveniencies. Nay, in the case I am to speak of, they are rather Discomodities. For when the Bullet striketh like lightning, were they softer 'twere the better, that the Bullet might pass and not shat­ter them.

Not any of the five sorts of Fractures men­tioned by the Ancients, which these blows will not occasion. Sometimes they will cleave the [Page 27]Bone, assulatim secundum longitudinem, accord­ing to the length; and other times they will per transversum frangere, break the bones a­thwart. Other times they will divide it ad unguem, like the Scales of a Fish. Nay, if the Bones be dryer then ordinary (as in elderly men, and in such a Nature or Diseases have made them so) they will grind the Bone like Meal. Yet I have seen, and drest a Souldier that was shot through the Joynt of the Ancle, without ever breaking the least Cartilage.

The wayes to know when there is a Fracture in the Bone are many; Hipp. bids us compare the sound part with the parts affected, and observe the Inequality.

Secondly, You shall perceive a Cavity if you touch the parts above and under the Fra­cture.

Thirdly, If you handle the fractured mem­ber, you shall perceive a crashing of Bones, by reason of the mutual attrition of the hard Bodies.

Fourthly, There will be commonly extraor­dinary pain, in regard of the divulsion of the Nerves, and distortion of the Tendinous Bo­dies; or the pricking some sensible part, by the shivers of some Bone.

Fifthly, There will be an Impotency of the broken Member, so that the Patient cannot lean upon it.

Sixthly, The antecedent cause will teach much in this case (Gunshot) then which there never was (or ever will be, I believe) inven­ted a more powerful one.

Seventhly and lastly, The Asperity and In­equality, [Page 28]or roughness of the Bone manife­sted to you, but the search will give you no small assurance.

In Fractures made secundum longitudinem, all Authors agree that the Member which is hurt must needs shew thicker then the other. Con­cerning Prognosticks,Progno­sticks. you shall understand,

First, That Fractures are more easily cured in young people then in old, for the greater di­stance there is à pueritia, the more the humi­dum primo-genium is exhausted. Wherefore in Youth, Bones will be again Consolidated by the first Intention, in others only by the se­cond, Interveniente materia (aliena) quae non est ejusdem naturae cum osse.

Secondly, Bones receive a quicker Aggluti­nation in Sanguine, then in Chollerick Bodies, by reason of the benignity of the Serum which sendeth out better matter for a Callus.

Thirdly, Bones are broke with less danger in the middle, then near to the Joynt; they are both more hard to be restored, and to be kept so restored. And because of the multi­tude of Symptomes (which in such Wounds cannot but Supervene) are not without great difficulties to be cured.

Fourthly, Those Fractures are dangerous which are made so deep in the fleshy parts, as our hands cannot well come at them, to place them right.

Fifthly, A great Fracture is of more dan­ger then a small. I term that a great Fracture where the solution of continuety is large, the accidents suddain, many and terrible.

Sixthly, Fractures made by Gun-shot, are of far more danger then any other, in regard of their multiplicity of Complicacie.

Seventhly, Among all Fractures the most to­lerable is the Transverse, if it be oblique 'tis worse; still worse if the Bone be much shi­vered; but worst of all if the Shivers be sharp and pungent. Amongst the Cruisers in par­ticular Frigots from Dunkirk, it was complain­ed that their Chirurgeons were too active in Amputating those fractured Members, as in truth there are such silly Brothers, who will brag of the many they have dismembered, and think that way to ly themselves into credit: but they that truly understand Amputations and their Trade well, know how villanous a thing it is to glory in such a work.

In the Roman History you will find it was not allowed at all. Livy tells you their re­ward among them. But later Experience judgeth it commendable, if it be necessary, and done in its proper time, that is to say, suddenly; whereas Amputations the next day are worse then death to them.

Not so in proper time;Observa­tion. for in the heat of Fight I cut of a mans Arm, and after he was laid down, the Fight growing hotter and hotter, he ran up and helpt to traverse a Gun, and a Wal­loon, while I was cutting of his Legg, cryed; Depechae vous con nous vendrone a terre nous bivron, Haste ye, haste ye, when we come a shore we will so drink: But amongst us aboard in that Service, it were a great shame to the Chirur­geon, if that the Operation were to be done the next day, when symptomes were upon the [Page 30]Patient, and he spent vvith vvatchings, &c. Therefore you are to consider well the Mem­ber, and if you have no probable hope of Sa­nation, cut it off quickly while the Souldier is heated and in mettle. But if there be hopes of Cure, proceed rationally to a right and methodical Cure of such Wounds. This fol­lowing Method is best.

Cleanse the Wound first from all strange Bodies,Cure. as Bullet, Armour, Apparel, Shi­vers of Bones. If the Fracture be near a Joynt, the violence of the blow will many times add a Dislocation also to it. If that happen, restore the Joynt first to its place, before you meddle vvith the Fracture; these dislocations are made by great Shot, or pieces of great Wood, whose force shatters the Limbs in pieces, or carrying it quite away: but this later I never see so done, but that vvhen the Mem­ber is shattered it hangs by the side, by some little part of the Musculous Flesh and Skin.

Here your vvork is vvith a good Razor or Knife presently to plain the Stump,Smooth the stump. and pull up the Flesh, that you may saw off the end of the Bone as even as may be.

In one of these,Observa­tion. whose Arm was shot off above the Elbow, in haste we drest him up, his shoulder proved out of joynt: The next day we could not set it by reason of the An­guish of the stump, it was a greater pain then his Wound, and pained him for some months after, but it happens often and in short stumps is remediless. One of our Captains Reformadoes had been served so formerly with his stump.

If you will endeavour the remedying it, you must do it by help of a Bandage, made above the stump, but if it be above the Elbow, how will you fasten it? yet in some Bodies they will be re­stored easily, therefore attempt it before you dress the member.

In another that had his Leg shot off in the place of Amputation below the Knee;Observa­tion. some two months after, when I wondred the Bone would not scale, I put my Forceps to feel whether any part of the Bone was loose, and feeling it very loose, I took hold of it gently, and found it willing to come away, it was the Apophisis, or head of the great Bone which makes the Knee. I was surpri­zed at it, but considering what is loose must away, I pull'd it out to the amazement of the lookers on, this was relaxt from its ligament, by the force of the blow.

In these fractured Wounds made by Gun-shot, the Chirurgeon ought to propose two things to himself, first the Fracture, and then the Wound. To proceed orderly you begin with the Fracture, viz. by Extension and Coaptation, that thereby the Fracture may be reduced to its proper seat; which in all these cases must be performed with much steadiness and discretion, not with such force as in them without a wound, lest the Musculous or Nervous parts being torn, bruised or crushed, should cause extreme Pain, Convulsions, and Mor­tification (and that which in special we seek to prevent) death may unaware ensue.

And therefore this Operation would,Dislocati­ons when to be re­duced. if it possibly might, be dispatched presently after the receipt of the Wound, before Inflamation come on; but if the part be accompanied with a [Page 32]Flux of Humour and Inflamation, before the Pa­tient be brought unto you, then you must forbear the Extension until the third, seventh, or eleventh day, according to Hipp.

And if it should so happen, that through such Inflamation the Operation be delayed longer; it is then to be feared, Putrefaction, and other ill Accidents will happen, and your Patient run great hazards of his life, or a continual lameness of that Member.

The Extension made moderately; fit the Bones into their former place, with what gen­tle dexterity and lenity you can possibly. If the Wound be narrow, dilate it by Incision at the first, for these Wounds require more dila­tation than any other, that not only the bruised and vitiated bloud and other excrements; may have a free passage; but that also by this means the shivers of Bones, of which these Wounds use to be very full, may with less trouble be discharged by nature, or extracted by your selves.

If you make not this dilatation in the begin­ning,Dressing. you may afterwards perhaps be forced to do it, when the part is accompanied with great defluxion and pain, and the bones alter­ed by the retention of matter, and not only to cut and open the Wound to the vexation of your Patient, but to keep it so dila­ted.

Now consider whether the Bone be bare or not; which you may satisfie your self in by your Eye, or your Finger, and the slipping of your Probe. If it be, you must apply next to the Bone some dry or exsiccant Medicine, [Page 33] sicca, siccis Gaudent, dry to dry. Of this sort are dry Lint,Dressing of Gun-shot with Fractures, Powders of the roots of Iris, Myrrh, Aloes, Thus, Spirit of Wine; take heed of Oyl, for it makes the Bones apt to foul, and hindereth Callus. This done, proceed to the Wound, which is alwayes with loss of substance, and commonly with lacera­ted Flesh, what of it cannot be restored to good purpose cut away, and dress up the Wound with your Suppuratives warm, as hath been proposed in simple Gun-shot, with an Emplaister of two parts Diachalchith, and a third Paracels. with Ol. Ros. or Empl. de minio malaxt. with Ol. lumbric. over the Wound, and over the whole fractured Member, this Empl. Diachalcit. with the addition of Colophoniae, pul. Rad. consolide. Mai. Bol. Armen. cort. Gra­nator. Succo plantag. Ol. myrtill. Lumbricor. & ce­rae, qs. as a Cerote over all, or double cloaths dipt in a red Wine vvarm, wherein hath been infu­sed Flo. rosar. Rubr. Balaust. sumach. Baccar. Myrtill. sumit. Absinthii, &c. Ol. Ros. &c.

The third Intention which is required in these fractured Wounds, is Deligation;Deligati­on. for unless they be rightly fitted, none of these Fractures, of what sort soever, can hope for perfect Unition and Cure. In Sim­ple Fractures without a Wound, all kind of Bandage may be admitted,Bandage to be dai­ly loose­ned in Gun-shot-wounds with Fra­cture. whereof you may see in my Lecture of those Fractures various sorts, with many circumvolutions about the Member. And once in seven dayes opening will serve your turn. But in these another method of binding is re­quired, for here the Bandage is to be [Page 34]loosned daily, the Wounds lookt into and drest: They being here to be long kept open, for discharge of Excrementitious and Puru­lent matter made in them, which otherwise wound corrupt the Bones.

Therefore in these like Wounds, you must use such a Bandage as may least shake the fra­ctured Member,Manner of Ban­dage in Gun-shot with Fra­ctures. for these Wounds being every day to be drest, the so often rouling up the Member would cause grievous pains, and hin­der union. Therefore it is that Authors have invented so many kinds of Bandage, to answer the intentions of dressing the Wound, and yet keep the Member immoveable. And your Ban­dage in this case, is to be made of softer and broader linnen clothes, then that we use in Simple Fractures, that it may comprehend both the Fracture and the Wounds, keeping the lips down, yet not hurt them, by its too hard com­pression, Minus astringendae sunt fasciae quam si vulnus non adesset, saith Celsus.

Therefore we make choice of a piece of Cloath soulded three or four times double, to give them the more strength, and of such breadth to incompass the lips of the Wound and fractured parts; and of that length as to come once about the Fracture. It is to be cut into three pieces from the ends to the middle, which middle lyes undivided underneath, to bear more equally the fractured Member; and these ends to come over one another, with a Compress between, over the Wound, to press the lips of the Wound equally down, which would otherwise become crude, and put out great lips. The Compress also serves to receive [Page 35]the matter, and fills up the inequality: These are so to be fastened, as that you may dress and undress the Wound without disturbing the Member.

But for that it happens, that in these Gun-shot-wounds the Bones are shrewdly shatter­ed, and the Wound lacerated; and by reason of the largeness, the Wound is most painful, and the part so weakned by its Fracture, as it cannot be kept steady by this Bandage: there­fore we make use of Ferulae or Splints; Splints. where­of I have made mention in my Lecture of Fra­ctures in General, with the Judgment of the Ancients, who have been very Industrious in contriving wayes to make equal compression, and leave a way for the dressing of these com­pound Fractures.

Their use is not to be until the Inflamation and flux of Humours be off,When to be used. which is not until after the seventh day; Mean while I propose Splenia, which are linnen clothes foulded four times double, and cut in length and breadth like the Ferulae, so as it may encompass the whole Fracture: these are to be spread with Galen's Cerote, or any Oyntment, so thin as they may adhere to the part only until you have put that Bandage over it; and this is that I propose where there is pain and fear of Infla­mation.

These will handsomely strengthen the part, and make such equal compression, as the Bones; may be kept in their place, the serous humours prest out of the Cavernulae, and the fractured Member lye soft, which is a great help in these Wounds; the whole welfare of the Patient de­pending [Page 36]upon the easie Bandage and Position of the Member. The Pain and Inflamation gone off, and the Wound digested, (or if you think the Member not so subject to Inflamation, and that it require a greater strengh to support it) you may use Pastboard cut into pieces pro­portionable to lay over those Splenia, Past­board. or ha­ving fastned those Splenia by the broad Bandage with three heads, cut a peice of Pastboard fit to receive the lower part of the Member, wet it to make it more pliant, cutting a place commo­diously to dress the Wound at. Under this Pastboard three Ligatures are to come, which, after you have placed another Pastboard above to answer that underneath, you are then to firm close by these Ligatures in the most convenient place, for the ease of the Patient: or if the Splenia be wet in whites of Eggs and applyed, they will strengthen the Member, and keep it steady, without those of Past-bord. To this purpose we also use Laminae, Laminae or Plates. Copper or Tin Plates with soft linings to receive the fractured Member, with cuts in the out-side to receive three Ligatures answerable to the first under­neath. These are to fasten and loose at pleasure, without disturbance to the daily dressing of the Wound. These Laminae, or what ever else you use, must have a large cut in them, for the Wound to be drest through.

But I have alwayes observed inconvenience in these Plates, that there being not so good Compression made upon the lips of the Wound through those holes, as to hinder the lips from thrusting. There arises a laxity and indige­sture in the Wound; and besides the matter [Page 37]that so discharges; heats the parts, and in hot weather corrupts and breeds Maggots.

Therefore I make the Pastboard or Laminae over my first to incompass so much of the lower parts as may support the Fracture, and come within an Inch of the Wound. And over the Wound it self I fasten a Splenium of Cloath, folded four times double, or a Ferula of Tin, Copper or Pastboard lined, and this accord­ing as I judge, the part can bear.

The first Bandage next to my Cerote, makes an equal Compression by its three heads meet­ing over one another; the lowermost presseth the Influx from below, and with the help of its next fellow keeps the Bones together, and presseth the matter out of the Wound; and (by the help this middle hath of the uppermost) the matter is also prest out of the upper part of the Fracture and Wound to the Orifice, which also hinders the Influx from above, strengthened by a defensative lying under it. In the dressing these Wounds, you are onely to undo the middle Binder to come to the Wound, having a special care that this Ban­dage be neither too hard or slack, but indiffe­rent, to the ease of the Patient.

Having thus proposed to you the vvay of deligation, I shall now proceed to the last O­peration performed in these Fractures of a Wound,Position of the part. vvhich is a commodious Position or placing of the Member; vvhich as I have told you in the Lecture of Simple Fractures, ought to have three Conditions.

1. Soft, least the Compression offend the hurt parts, and cause Pain and Inflamation.

2. Equal, for if the Member be placed o­therwise, it becomes distorted, and the Ope­ration succeeds ill.

3. Lastly, It must ly higher then the parts next the Body, especially the first three or four dayes, for if it incline downwards, the humours by their own weight, will easily flow to the part afflicted. How this Position is performed, I have set down in the Lecture of Simple Fractures, to which I refer you.

The fractured Bones of the vvounded part thus restored to their natural places, and the Wound digested, and Inflamation and other Accidents gone off; you shall now unloose the Bandages, and take of your restrictive Medi­caments, and apply the Emplaster Cattagmat. in our London Dispensatory, or of these under­written over the fractured Member, which may add strength to the part, and further the Gene­ration of Callus.

℞ Resinae, abietis, cerae an. lb j. pulv. cort. Tiliae ℥ iij. succ. Geran. ℥ iiij. coq. ad Cerot. consist. Or this;

℞ Mucilag. radic. consolid. ma. visci pomor. & populi an. ℥ iiij. succ. Geranii ℥ vj. lap. osteocollae ℥ iij. pul. cortic. Tiliae ℥ ij. Vittel. ovor. N^o xx. Terebinth. lb j. s. ol. Lumbricor. ℥ iij. coq. omnia bene permixta ad ceroti consistentiam, pro usu. But if you conserve the temper of the part, you need not doubt of Callus. I commonly in these cases make use of Emp. stict. Paracels. p. ij. Empl. Diacalcith. p. j. over these a double Cloath dipt in red Wine, wherein hath been boyled some of the above mentioned Plants.

And now place the former Bandage again, [Page 39]and over those Laminae of Copper, or Tin lined; or in the place of these, you may add those Splenia of double Clothes dipt in whites of Eggs, and wrung out hard, they will sit close to the part, and after they are dry, will support the fractured Mem­ber well.

But if it be in the Thighs, the Plates are best, that part requiring such as are of great strength and length, and such compass, as may take in half the Member, you are now to forbear the use of Suppu­ratives, and use such Medicines as are detergent, as the Mundif. Paracels. Or if you please

℞ Vincae pervincae, Paeti, persicariae Beton. an. m. j. slor. Hyperici verbasci, an. P. j. rad. Aristoloch. utri­usque an. ℥ ss. Thuris; myrrhe, sarcocoll. Iridis an. ʒ ij. coq. in vino Albo addendo colaturae mellis rosacei, q. s. This may be cast in with a Syringe, it will de­terge and incarn; or by the addition of Terebinth. Wax and Oyl of Hypericon, you may form it to an Ʋnguent.

If there be Caries you may make a Decoction of Scordium, vinca pervinca, pucedanum gentian. cortic. Guaci Rad. Ireos myrrhae in Wine, and adding sp. Vini or the Extract. scordii. If the Caries yield not to this, touch it now and then with some of the follow­ing Medicines by a Probe armed with Lint.

℞ Ol. myrrhae distillat. per discentum & purisicat. cum sp. Vini ℥ ss. olei cariophil. ʒ ij. ol. sulphuris ʒ j. ss. m. This will in a short time remove the Cariosity, afterward proceed by Epuloticks.

Vulnerary Potions are here of great use: as this, ℞ Aristoloch. rot. ℥ ij. fol. serpentariae, consolidae utri­usque Geranii Columb. saniculae an. m. j. make them into gross Powder, & boyl them in Wine in a Vessel close stopt to a Gallon, give the Patient this, morn­ing [Page 40]and evening ℥ iiij. at a time: you may give in this of Osteocollae ʒ j. poudred, or in a draught of the Decoction of vinca pervinca made with Wine, for confirming and hastening the Callus; in the rest pro­ceed as in the latter end of Simple Fractures.

A Souldier being shot by a Musket Bullet into the forepart of the Arm, near the Biceps, and out behind, the Bone fractured: I endeavoured by Ex­tension to place the fractured Bone even toge­ther, but could not; upon which I dilated the low­er Orifice by a large Incision, according to the rectitude of the Member, to pull out those frag­ments of Bones which hindred their right Coapta­tion; and putting my finger into the Wound to that purpose, I pull'd out a ragged piece of a Bul­let, whether it was part of that which had passed through was the question; some of the By-standers thought he was shot with a brace of Bullets; but I rather think the Bullet was torn by the Bone, and that the other part was it which had made its way thorow: however by this extraction the main Bone was rightly placed, and the Shivers, with the Extraneous Bodies removed, and the matter happily discharged by this depending Orifice, and the Pati­ent as happily cured by the common Intensions of curing these fractured Gun-shot-wounds.

Whereas if I had taken it for granted, that the Bullet was passed through, and contented my self in having endeavoured the reducing of the fractu­red Bones, and so drest him up, it had certainly In­flamed and Gangren'd: This confirms that doctrine in setting of Bones, that if any Bone will not be placed equally amongst his fellows, you ought to cut upon him, and take him out.

CHAP. VI. A Fracture made by a Splin­ter.

IN heat of fight at Sea, amongst the many wounded men that were put down into the Hold to me;Observa­tion. one of them had his Arm ex­tremely shatter'd, it was about two fingers breadth on the out-side above the Elbow, by a great Splinter.

This mans Arm I ought to have cut off pre­sently, but a sudden cry that our ship was on fire, put me in such disorder, that I rather thought of saving my self, than dressing my Patients. I hastily clapt a dressing upon his Wound, and rouled it up, leaving his Arm in his other hand to support it, and endeavoured to get up out of the Hold, as the others did; I verily be­lieving I should never dress him, or any of them more.

But our men bravely quitted themselves of the Fire-ship, by cutting the Sprizil Tackle off with their short Hatchets (which they wore during fight sticking in their Shashes) we were freed of the Fire, and by our hoisting up the top Sails got free of our Enemy.

Now I was at a loss what to do with this man, who lay not far off complaining of his Arm. I would have cut off his Arm presently with a Razor (the Bone being shattered there needed no Saw) but the man would not suffer me to dress his Arm; he cryed, it was already drest.

The Fight over, we got into the next Port; I caused presently the Mariners Bed to be set up (which was four pieces of Wood nailed together and corded, and a Bears skin laid upon it, this was fastned between two Guns to the Carriages:) Upon this I see him placed, he was a lean man, above thirty years of age, of a good habit of Body; it was the right Arm, which I caused to be laid outermost, that I might the better come to dress it.

I having my dressings ready, I laid them or­derly upon a small Pillow well stuft, and quilted in the middle. Upon this Pillow I first laid a soft double linnen cloath, then next I laid three Ligatures, then a Past-board wet in Vinegar, to make it more soft and plyant; upon that I laid a double cloath of such length and breadth, as might serve to encompass the fractured Member, this cut from each end to the middle into three Binders. Over the middle of this I placed a Splenium of cloath four double, four fingers breadth, and of such length as to give strength to the Fracture: Over this lay my Defensative, spread upon a thick Cloath of such breadth and length as to take in the whole Arm. Dressings thus laid upon the Pillow, I cut off the dressings from his fractured Arm, and placed the Pillow with these dressings [Page 43]close by his side, so as I see his Arm laid as I designed upon my Restrictive, and his hand upon his Breast. Then I put my fingers into his Wound, and pull'd out a piece of a Splinter an Inch thick, or thereabouts, more or less, then Rags and Bones great and small; I left not the least shiver.

When I had so cleared the Wound of all the extraneous Bodies and loose Bones; I was a­mazed to feel what a distance or void space there was between the two ends of the Bones: But I proceeded and cut off the lacerated lips, which were of no use, and drest up the ends of the Bones with a couple of Dossils dipt in sp. vin. & Mel. Ros. vvarm, and the rest of the Wound I drest as vvarm vvith Axung. porcin. Mir. praecepitat. vvith some little Ol. Terebinth. mixt upon Dossils lightly within the Wound, and upon Pledgits without, and an Emplaster Diacalcit. malanc. vvith Ol. myrtil. over all the Wound.

Then I embrocated the fractured Arm vvith Ol. myrt. & olivar. Immatur, and a little Acet. and brought my Emplaster Defensative, vvhich lay under the Arm, over the vvhole Arm, from the Axilla to the Elbow, and round the Arm close, only leaving a space to dress the Wound.

This gave a strength to the weak Member, and hindred the Influx from above. Just under this Emplaster there lay a Splenium, to answer that I applyed three more, one on each side, and another above, vvhich four vvere of such a size, as they lying a little off from one a­nother, encompassed the Arm; they vvere spread lightly vvith a little Cerote, Axungiae [Page 44]and Wax, to make them adhere vvhere I placed them.

Then I brought the Bandage vvhich lay un­der the Splenium, with three heads at each end, the lowermost of these took in the lower part of the Arm from the Elbow upward, vvith part of the Fracture, and was fastned on the outer part of the Arm; this prest the Sanies from below to the Wound, and hindred the lapse of matter that vvay. The middlemost was made to press the matter out of the Wound, and keep parts close for unition. The upper­most served for restraining the Influx, and press that out vvhich vvas already in the part: this Bandage vvas made vvith great moderati­on, and so fastned, as they might be loosened vvithout trouble to the Patient.

Then I brought the vvet Pastboard close to the sides, and cut another piece to answer it, vvhich I vvet in Acet. and by the three Liga­tures under, made them fast, but vvithout di­sturbance to the Patient. If it could not have been so put on, I should have forbore the use of them: the Cure of these consists in the ea­sie dressing and quiet position, vvithout that you vvill not cure one of these compound Fractures; the Pastboard as it dryed, recei­ved a shape fit for preserving the Fracture in the position I left it, and that vvith a very slack Bandage.

Thus I finisht the first dressing, leaving my Patient in much case, he slept pretty vvell that night, and vvas the next day as vvell as I could expect; he vvas let blood the second day, and kept to a spare Diet, but vve allowed a little [Page 45]Wine as a Cordial to all our Patients.

The third day I drest again, took off the upper paste-board, and loosened the Heads of the main Bandage, took off that Splenium which was over the Wound; raised up the emplaister from the wound, took out many dossils, found it warm and well-disposed; drest it up quick with my Suppuratives hot, and an emplaster as before, not stirring the restrictive; made now a compress more par­ticularly for the wound, purposing not to remove the two outer heads of the main Ban­dage, unless it were sometime to give a little breathing to the member; but the middle I open'd as often as I thought fit to dress the wound, the other two had short Splenia to make the Bandage equal, but I was not then satisfied how this Arm would be supplied with Bone, yet my Patient was easier then any of my Patients with fractured wounds.

When it came to my turn to be visited by my Brother Chirurgeons of our Squadron, they did not dislike the wound nor my way of dressing, (for we being used to see one ano­thers Patients, had all much one way of dres­sing) but they laught at the excuse I made for not cutting off his Arm, and doubted I should yet be forced to do it. But I kept my Pa­tient flat on his back, and that after a while was his greatest pain, for the Wound digested and the tumor was never considerable.

After the wound digested and a separation made of the contused flesh; I then renewed the dressings, taking all off and fomented the member with vvarm vvater, to give a [Page 46]breathing to it, and applyed a catagmatic Em­plaster, and drest the Wound vvith a mundi­ficative Parac. or such like, and bound up the Member as at first, and so continued my way of dressing as I see cause, putting into the Wound only a Dossil or Tent made upon a skewer soft and hollow to give vvay to the Wound to incarn, I scare ever using Injecti­ons, but by gentle compression assisting Na­ture, who seldome fails in supplying the lost substance in Wounds, if we disturb her not by improper applications.

The next opening and dressing of this fra­ctured Member was occasioned some sixteen or seventeen days after, by a troublesome Itching of the patt; which was I suppose partly from his liberty in diet, the heat of the weather, and want of perspiration: I then took off the Dressings, and bathed with Sea-water, and drest him up with Emplaster de lithargiro; the Wound was about this time well incarned with­in, and the Lips beginning to cicatrize from their edges, I dressing them with Epuloticks, as ung. Tutiae, &c. yet I kept my Patient still up­on his back, and renewed not the whole dres­sing until I was necessitated, which was about the fift or sixt week.

One day coming from the Shore (vvhere those of our wounded had liberty to lodge if they desired it, and vvere drest by us there) I found this Patient vvith a heat all over his body like an Erysipilas, he was much frighted at it, he had it seemed drank Wine a little too liberally vvith his mates, (as they would most of them do if they vvere [Page 47]any thing vvell) unless it rather proceeded from a generation of Callus, Erysipelas upon the generati­on of Cal­lus. in which case it usually happens. I let him blood, and at next dressing finding his Arm pretty strong, and his Wound healed within, and in a fair vvay of cicatrizing. I raised him up, after he had laine about eight vveeks. All vvhich vvhile I believe he never stirr'd his Arm from the time I placed it, but in the time of re­newing the dressing, he being the most pati­ent man in that respect I ever attended; and in truth vvithout that submission, he could scarce have been cured.

There vvas in this Patient a strong Callus, filling up the void place of the lost Bone at least two Inches, vvith little or no shortning of the Arm; but the Joynt of the Elbow vvas so stiff from the position it lay so long in, that he could not stretch that Joynt whilst I knew him, vvhich vvas until that Ship vvas cast away.

My memory vvill be much cryed up for re­membring so many particulars in a Patient, so many years since cured by me: But if you con­sider how remarkable a case it vvas, and in my Trade, there vvill be the less vvondering at the possibility of it. You may enquire what vvas done by me in the Cure of Capt. Reade, vvhere the loss of his Jaw vvas supplyed by a strong Callus, and that Cheek uniform vvith the o­ther, and vvill be long remembred by the then standers by, though not of the Pro­fession.

In our Sea Fights often times a Buttock, the Brawn of the Thigh, the Calf of the [Page 48]Leg are torn off by Chain shot and Splinters; all these are contused Wounds and look black, and do too often deceive the unexperienced Chirurgeon, he taking them by their aspect to be gangreen'd, and by dressing them as Gangrena, vvith Aegyptiacum and Spirit of Wine, hath either gangreen'd them, or drawn the other Symptomes upon them of Pain, Fever, Delirium, Convulsions and Death.

Whereas if they be considered rightly, though they look as flesh long hanged in the air, of a dry blackish colour, yet they have vvarmth, and vvill by Lenients, as is prescribed in Simple Gun-shot-wounds, digest, and as Se­paration is made they vvill deterge and in­carn, but they are slow in digestion, and require good Fomentations and Embrocati­ons to cherish the native heat, vvhich is much vveakned by so great a loss of sub­stance.

These require Oleum Terebinth. to be mixt vvith your digestives, but you must have a care you do not inflame and cause Pain, by adding too much of it. A spoonful to six Ounces of your Suppurative is enough in the dryest habits; your Judgment vvill best direct you, and your Patients complaint: it being unreasonable to hope that Wounds can digest, vvhile they are accompanied vvith much Pain.

In the former Sea-fights vvith the Dutch, Capt. H. had his Hand shattered, and his Fingers torn off; Mr. L. was his Chirurgeon; who entreats me, being call'd into counsel, not to think of cutting of his Hand; I told him [Page 49]it vvill be of small use to him, and the Shivers of the Bone vvithin hurting the Nervous parts, occasioned those convulsive twitches and pain he was subject to and often felt; not­withstanding I promised to comply with him, if he vvould follow such Methods as I vvould propose, vvhich he agrees to, but does not per­form accordingly.

I came two dayes one after another, but finding nothing of it done, at the next meeting he pretends an Excuse, not to dress the Pati­ent. I then discover his craft, and that he had used me onely to defend his Credit, which was questioned for the not taking off the Hand at first, as he ought to have done, of vvhich he now saith I vvas the cause, having craftily drawn me in to be of his Opinion, though conditionally only; viz. that he should have laid open the Hand, and taken out the Shivers, which if he had done, he might have cured it, as I have done some others, as appears by this Treatise. Of the truth of this Mr. H. is Wit­ness, who also was over-witted by him. The Chirurgeon of the Ship committed the first er­ror, he ought at the first dressing, while the Wound was recent, to have pull'd out the Shi­vers of Bones, or to have extirpated the hand, that being the proper time.

CHAP. VII. Gun-shot-wounds in the Joynts with Fracture.

THE Wounds of the Joynts are subject to more grievous Accidents, then those I have heretofore mentioned, therefore they require your more particular care. The Tendons and Ligaments being in­serted near the Joynts for the motion thereof; as also the Membrains, and consequently the parts of a most exquisite sence. The trunk of Nerves also in every great Joynt passeth through for the use of the Member that is beyond it. To which I add, that the part being exanguious, the natural Balsome of the Body is here more sparingly supplyed for the help of the Cure.

What the pains are may be judged by the Wounds in the lesser Joynts. Capt. F. in Mus­selbrough fight, was shot in one of his Fingers, and the next day so grievously tormented, as he walkt up and down like a mad-man, could take no rest until his wounded finger was digested, yet his pain was not so great in his Wound, as in his well fingers. The greater Wounds are attended with much more vehement Pain, In­flamation, [Page 51]Dilirium, Convulsions, Gangreen, and are commonly deadly. Therefore the shot is presently to be extracted, and dressed with such Medicaments as may defend them from pu­trefaction, and these are to be moderately hot and dry of subtle parts and Anodyne; as Ol. Terebinth. de Castoreo scorpion. vulpin. lumbricor. ovor. & pul. scord. Thyris myrrhae, Ter. leminae pul. euphorbi.

And in these Gun-shot-wounds the Orifices of the Wound must be kept open, that your Me­dicaments may penetrate to the bottom: But if the Wound be on the inside of the Joynts, they are commonly attended with great Haemor­rhage: For prevention of which, I refer you to its proper Chapter: And in the first place pro­pose this digestive.

℞. Tereb. lot. in sp. vini ℥ iiij Thuris, myrrhae mastich. an. ʒ j. olei Hyperici ℥ iij. vitell. ovor. N ij. croci ℈ ij. Or,

℞ Terebinth. ℥ ij. myrrhae, Thuris, corn. cervi usti. à ℈ iiij. Ol. scorp. de Castorco lumbricor. sam­buci an. ℥ ss. vitell. ovor. N ij. Apply either of these warm. If stronger be required,

℞. Ol. Terebinth. ℥ j Ol. hyper. cum gumum. ℥ ij. euphorb. pul. ʒ j. drop this very hot, and apply the first mentioned Digestive over all Embro­cate parts about well with Ol. lumbricor. & hype­rici, and apply this following Cataplasma.

℞ Farinae, Hordei & fabar. an. lb j. flor. cham. Meliloti ros. rub. scordii Absinthii pulver. an. ʒ vj. Decoct it in the Broath of Offal or in Oxymel. adding Ol. Ros. & chamelaemel. Or this,

℞. Mucilag. Radic. Althaeae consolid. ma. an. ℥ iiij. flor. Ros. rub. beton. cham. subtil. pul. an. ℥ ss. fa­rinae [Page 52]lini. fenug. an. ℥ iij. farinae, hord. & fabar. an. ℥ vj coq. in vino, adde Ol. Ros. & Lumbric. an. ℥ j. ss. Mel. ℥ ij. vitel. ovor. N iij. The Wound digested, you may deterge with this:

℞. Farinae Orobi ℥ j s. Thuris rad. Ireos. an. ʒ vj. succi Apii ℥ iij. Mel. com. & Terebinth. an. ℥ ij. m. F. ungu. The Wound deterged, you may dress with this Sarcotic.

℞. Sumitat. Hyperici equiseti plant. Beton. an. p. j. rad. consolid. ma. Tormentillae an. ʒ iij. sevi Hircini ℥ iiij. lambric. terrest. lot. ℥ ij. Ol. masti­chinae ℥ ij. vini odonf. qs. coquantur ad consum­ptionem vini postea colentur, cum forti expressione, dein. adde Resinae pini ℥ j. Thuris, Myrrhae, Mastich. Aloes, an. ℥ ss. cerae ℥ iiij. m. F. s. A. Ol. Aparici is excellent in these Wounds alone, or height­ned by any of the former Prescriptions; so is the Balsome in the Chapter of the wounded Nerves.

If the Bone be bare, you must be careful that you do not foul it by your greasie or slabby Medicaments; you must here also consider of Phlebotomy and Ʋniversal Regi­ment. If Pain be violent, and yield not to Anodynes, cut off the affected Tendon, and whatsoever corrupts, least it taint the rest.

But in these great Wounds, you are at first to consider how curable they are, and endeavour to preserve the life of your Pa­tient, by a timely extirpation, before his Spirits be too much exhausted: Of which this following story will give you warning.

A Page of Lieutenant Gen. D. L. was shot through the Knee,A shot through the Knee the Bullet entring in by [Page 53]the lower and outer side of the Rotula, passing through the Joynt out in the hollow of the Ham, tearing the Ligaments and Nervous parts, fracturing the Joynt as it passed, and rending the Artery in going out. This Wound was mortal the very minute it was inflicted, and ought then to have been dismembred: But such Proposals will not usually be admit­ted of in the first Dressings, whilst there is hopes: Yet the Accidents in these great Joynts thus made are sudden, from the vehe­ment pain. And while Fever, Delirium, &c. are upon the Patient, then to make such an Amputation, most commonly hastens his death.

Wherefore I proposed my first dressing by digestion upon a Pledgit, applyed warm to the Wound upon the Rotula, there being no place for a Tent; and to inlarge the Wound amongst the Tendons and Ligaments, were to adde one mischief to another. I also embro­cated the parts about with Ol. Ros. cum Aceto, applying my Restrictive over all.

In the depending Orifice, there was a throb­ing of the Arterial blood, as in an Aneurisma, the blood being choakt in by the contused flesh, it therefore was not there to be tented, for fear of making a Flux of blood, nor yet could we endeavor to stop the bleeding by Cautery, Actual or Potential, least thereby new pains should be stir'd up, that part being full of Ligaments and Tendons.

Wherefore I drest that Wound with the same Digestive mixt with pul. Galeni upon a thick Plegdit, and some of the same Restrictive over that, with such Bandage as that Joynt was ca­pable [Page 54]of, hoping this way to hinder the Influx of humour, and that by such dressings the Wound would digest, but the pain continued vehement, and yielded to no Application, nor was there any possibility of conveying any In­strument into it whereby I might pull out the shivers of Bone.

Mr. Penicuke formerly General Chirurgeon to the Scottish Army, was with me at the dres­sing this Patient, but proposed no alteration of what I had done, the pains increasing, a Fever was made and attended by Dilirium and Spasme, Death followed, as commonly it doth in all such Wounds of the great Joynts. I could instance it in many, but the late case of Sir J. L. may serve for all; his Wound, as I have heard, was of the Rotula, he had many of our most ancient Chirurgeons, with the most eminent Physici­ans to help them, Persons who were well ex­perienced in Chirurgery, yet they had no bet­ter success. Therefore at Sea while they are warm with heat of Fight, we dismember them, and by actual Cautery stop the Flux of blood.

CHAP. VIII. Wounds of the Belly.

I Have now briefly run through the Parts not principal; and purpose to say somewhat of the principal Parts, as the Belly and Breast. And that you may more certainly know the part wound­ed, I shall give you a short Description of them; and then shew how they are to be handled in order to their Cure.

The Belly is called Abdomen, or Inferior venter, it begins from the bastard Ribs, and ex­tends it self to the Groins, and is divided into three regions by our Anatomists: The up­per, middle, and lowermost. The uppermost is called Epigastrum; the middle Regio Ʋmbili­calis; Abdomen described. the Inferior Hypogastrium: The sides of the uppermost are the Hypochondria; the right Hypochondrium possesseth all the Liver; in the left is the Spleen, between these is placed the Ventriculus or Stomach. In the middle part [Page 56]of the Abdomen is the Navel, round about which ly the Guts, and behind those, on each side the Kidneys. In the sides of the Inferi­or part are the Ilia, the Pecten or Pubis in the middle, under which lyes the Bladder. Thus much to the Internal Delineation.

The Abdomen consists moreover of parts containing and contained.

Parts containing or teguments of the Ab­domen, are either the common, which reach all over the Body, as the Cuticula, Cutis, Pinguedo, Membrana Carnosa, or the par­ticular and proper to this place, which are the Muscles of the Belly the Peritoneum, and in respect of the Guts, the Omentum. The parts contained are some of them designed for the nutrition of the whole Body: others for Expurgation; and others for Generation.

The Stomack, small Intestines, Mesenteri­um, vena porta, Cava, Arteria magna, & Celiaca, magna, the Liver and Spleen serve for Nutri­tion: The Bladder, Gall, all the Intestines, but especially the great ones, Kidneys, Ʋre­ters for Expurgation; and for Procreation Vasa praeparantia & differentia prostatae & uterus in Women. Which parts containing and contained are subject to this Gun-shot, whence various Species arise of these Wounds, some­times the containing parts; as Cutis, Pin­guedo, Caro musculosa onely are wounded, so as neither the Peritoneum, nor the other In­ternal parts suffer any hurt.

And this hapned to many in Service,Wounds not pene­trating. who have been brought to me as mortally wounded; whereas I upon search have [Page 57]found the Impression only upon a greazy Lea­ther Jerkin, or their Bellies black or a little scratcht by the Bullet: In others the skin and flesh wounded and no further, these latter are call'd Wounds of the Belly, not penetrating, and are cured as Gun-shot-wounds in fleshy parts; in which cases all those things are ap­proved of, which have been delivered in simple Gun-shot-wounds.

But this I must take notice of to you, as having often observed, not onely in Gun-shot-wounds, but in abscesses of the Belly, that from the laxity of the parts, they are subject to great defluxion, especially in the circum­jacent Muscles: to my late vexation, whilst I was writing a rude draught of this Chap­ter, the matter flowed out upon us, Dr. S. Phy­sician, Mr. Gin. and my self Chir. from various Sinuses raising up the Muscles, insomuch that the more we laid them open, the less hopes we had to effect our Cure. The particular where­of I shall give you in another place, with more of that kind, enough to shew you the laxness of these parts, which is the greater, because we cannot make such Bandage here as else­where, by reason of their figure, scite, and per­petual motion.

These thus briefly considered, we pass to the other Species, for the Bullet is for the most part carried with such force, as it not onely wounds the fleshy parts, but also pierces the Peritonaeum, hurting most an end the Internals.Wounds penetra­ting. It being indeed impossible that the Bullet piercing the parts containing, should miss the contained which are soft and tender.

I have seen sometimes in the Wars, a Soul­dier shot scarce to the Peritonaeum, yet the con­tusion hath been so great that the Peritonaeum hath come of upon digestion, and the Bow­els in these commonly labour under Cholicks, and the Patient is troubled with difficulty of breathing.

If the Bullet penetrates through though no further, yet the Contusion makes foul work and requires speedy relief. But if it hath wounded the Internal Viscera, then you are to consider what the parts are that are wounded, whither the Liver, Stomach, or which of the Intestines, which you may apprehend from the scite of the part, and the accidents ac­companying such Wounds, and by the pro­per symptomes of each part.

According to Celsus, Lib. 5. Cap. 26. The Liver being hurt,Signs of the Wounds of In­ternal parts of the Abdo­men. there follows an Ef­fusion of a gross blood; if the Porta or Vena Cava be hurt, the right Hypochondrium is op­prest: If the Artery be wounded, the blood is florid, and with Impetuosity leaps forth, and death follows. But if the Stomack, Singul­tus or Hiccup, with Vomiting and Nausea, and his sustenance comes out of his Wound, with the Chyle, cold Sweats, and the extream parts cold: Of the Intestines, if the lesser be wounded, poraceous Vomiting, what he eats or drinks, will pass out of his Wound in less then half an hour.

If the great Intestines be wounded, the Ex­crements and filthy smell will demonstrate it: If the Wound be of the lest Hipochondrium un­der the short Ribs, you may conclude the Spleen [Page 59]wounded, and the blood floweth forth with great Tension of the Hypocondrium. If the Kidneys, the Wound is in the region of the Loins, near the Vertibra, under the Diaphrag­ma, and the more certain sign is, if the pains reach to the Groins and Testicle, with diffi­culty of Urine mixt with blood, or pure blood voided by the bladder: If the Ʋriters be wound­ed, the Urine comes out of the Wound: If the Bladder be wounded, that part of the Belly is tense, pains are stirr'd up in the Groins, and the Urine is discharged by the Wound, and the Stomach suffers by consent, and the part wounded demonstrates it: If the Womb be wounded, vehement pains reaches to the Groins, and the Coxa and the Blood not only flows by the Wound, but per Vul­vam they are troubled in mind, with other shrewd symptoms of death,

For what concerns the Presage of these Gun-shot-wounds,Progno­sticks. if they be only in the re­gion of the Belly, they are not without pe­ril, and much loss in the middle, where the Linea Alba is; but if they penetrate, (as you may know by the signs forementioned) there is great hazard, seldome parts so shattered recover. What I have here seen from a man discharging his Excrements from the Colon on the left side, and heard of other like of the Stomach, are rather Miracles, then the work of the Chirurgeons; but he was happy that had the managing that Cure.

If Celsus in his time determined these Wounds mortal by cutting Weapons, how much more must they be such that are made [Page 60]in our age by Gun-shot; Yet Nature, as one saith, in his Vulneribus, Saepe miracula face­re solet, is often as merciful and miraculous in the Cure, as the blow was cruel.

In order to the Cure,Cure. we must begin with the Extraction of the Bullet, least it sink in­to the most inward parts, and by its hardness offend the Bowels, as also the rags carried in with it, least it beget Putrefaction. Then we are to reduce the Omentum and Intestines least they be Inflated and altered by the out­ward Air: but in these Wounds they do not often fall out, unless it be by Splinter, or great Shot. Then Hemorrhagia is to be staid, and Inflamation allay'd, and we are to resist Putrefaction, by bringing these contused and lacerated Wounds to digestion.

The Intestines and Omentum are disposed to reduction by warm discutient Fomentati­ons; but if there be not an opening large e­nough, you must enlarge the Wound. If the Omentum be corrupted, make a Ligature below that corrupt part to cut it off, leav­ing the Ligature upon the rest to fall of by digestion.

If there be Haemorrhagia, you must inject such Medicaments as have a Refrigerant and Astringent quality, and those may be Aq. urtic. plant. spermatis Ranar. with Syr. de Ros. sicc. with pul. Bol. Armen. ter. sigil. sang. dracon. Aloes, Thure, making a mixture of some of the same Pouders, with a new laid Egg, with Ol. Mastich. & Lumbricor, and apply it upon a Tent fastned to a thread,Wounds of the Stomach and Guts. as is before descri­bed, and apply the rest upon a Stupe over all. [Page 61]But if there be no Flux of Blood, digest as fast as you can.

Fallopius hath recommended to our use this, by the use whereof he cured a Wound in the Stomach and Intestines.

℞. Fol. Pilosellae plantag. rad. Tormentillae con­solid. maj. flor. hypericii, these were decocted in red Wine; in the latter end of the dres­sing adde a little Manna, Thuris, ol. Mastich. resin. Abiet. Terebinth. Cypriae, croci & verm. terrest. the Wound within to be drest with this.

If there be Putrefaction, you may use such Medicaments as are fit in that case, but those dye in great pain: In all these Wounds of the Belly, to stop fluxes of Blood, I use such like Medicaments as I have proposed, and apply to the Wound it self Digestives, as in simple Gunshot, and by good Fomentations, Em­brocations and Cataplasma's, cherish the na­tive warmth of parts.

In Wounds of the Kidneys,Wounds of the Kidneys. you are to in­ject such Medicaments as have an Abstersive and drying quality as Radices, consolidae, Iri­dis, Aristoloch. rot. and maj. myrtil. caudae equin. plantag. Balaust these decocted in aq. cha­lybeat. adding after some Wine, and Mel. Ros. digestivum Terebinth. & Integ. ovum with a little Terra sigil. Thus & mastic. & ol. Hyperici, with Emp. diacalcith. malaxt. with ol. Ros. and a Cataplas. of far. Hordei. fabar. & orobi deco­cted in Oxymell. adding a new laid Egg to it, with Ol. Ros. to be applyed over all.

If the Liver or Spleen be wounded,Wounds of the Li­ver, Spleen, &c. there will be great Flux of Blood, in which case I offer this to you.

℞. Plantag. pentaphyl. polygoni Mille-follii, myrtil. Ros. rub. to these you may adde Thuris, sang. dracon. Bol. Armen. Acaciae, boyled in water chalibeated, adding a little red Wine, and syr. de Ros. succ. This may serve for an Injection: if the extravasated blood fall down into the Cavity of the Belly, you must leave it to Nature.

Thus you are to dress all the Wounds in particular parts of the Belly.

The Wounds of the Womb are accounted deadly, the very least of them: and so are all these made by Gun-shot, yet you are to pro­ceed in the universal regiment with Glysters and Bleeding, and by good Vulneraries: there Diet here is to be medicated, and all endea­vors to dispose parts to sanity, if it were possible.

CHAP. IX. Gun-shot-wounds of the Tho­rax.

AMongst the principal parts which are subject to this divelish Invention Gunshot, the middle Venter or Thorax is numbred with the parts contained in it, viz. the Heart, Lungs, great Artery and Vessels, with the Mediastinum. The difference of these Wounds is as in those of the Inferior Venter; sometimes it doth not penetrate into the Cavi­ty, so as the plura is not hurt: Other times it doth penetrate through the Membranae and Costae, in which case the principal Viscera are wounded or not wounded.

If the Wound do not penetrate into the Cavity of the Breast,Not pene­trating. but be only in the mus­culous flesh, it shall be cured as Wounds in the fleshy parts.

But if the Bullet hath penetrated into the Cavity, Penetra­ting. it may be easily discerned by the Laceration of the musculous flesh, and com­monly by the Fracture or Perforation a­mongst the Ribs,Signs. whereby the Wound is left open, and the Spirits and Air pass out vvith noise; and if the contained parts be wound­ed, [Page 64]there vvill follow a Flux of blood by the Wound or Mouth, or by both, unless the blood fall down upon the Diaphragma, and then the Symptomes of the difficulty of breathing and such like Accidents, vvill more demonstrate its Penetration. And if the Lungs be wounded, a Cough, with difficulty of breathing, and flux of blood, and sighing often, and a ratling in the Aspera Arteria, the Patient inclining to ly much upon the Wound. If the Heart be hurt, the blood flows vvith impetuosity and reeking hot, their Pulse languishes, cold sweats follow, and they dye.

The Diaphragma hurt, draws upwards, the Spine is grieved, very difficult breathing, and unequal and painful, vvith a hoarse Cough, and great pains about the false Ribs.

If the great Vein or Artery be hurt, a terrible Flux of blood follows; if it flow from the right side, it is the Cava is hurt; but if from the left side, we suppose it the Artery, you vvill discover it by its saltati­on and florid colour. The Aorta wounded, that Patient dies at the instant.

If the Spinalis medulla be vvounded, the Nerves are resolved, and a Palsey follows, more immediately in the part under the Wound. Almost all these Wounds are mor­tal, they generally dye. But it is not consi­sting vvith Religion or Humanity, to leave them without help. And for that I have happily prolonged the life of some, and have known others that have recovered of [Page 65]some of these wounds, in the Lungs and less noble parts thereabouts. I shall therefore proceed to de­liver you what concerns their Cure,Cure. both as to the Internal concerning the wound it self, and to that which relates to the Contusion and Inflamation Ex­ternally, to prevent flux of humors, and facilitate the discharge of Bloud and Matter contained in the Cavity of the Thorax. You are in the first place to draw out the Bullets and Extraneous bodies, amongst which sometimes a part of the Ribs are carried in: All these are to be removed, and the place cleared of shivers, lest they prick the mem­branes, and thereby hasten ill accidents which at­tend these wounds. You are then to dress the wound with a Tent dipt in this or such like, ℞. Bol. Armen. Corn. Cerv. ust. Ol. Ros. & Sambuci, Farinae, Volatilis, and with ovo Integ. Misce; spread a compress with some of the same, and ap­ply it over the wound: If the bloud stop not by this dressing, then it may be proper for you to In­ject some astringent decoction, which is otherwise than was advised in wounds made by puncture: For in Gun-shot-wounds the orifice is wide enough for the Injection to return out again; insomuch that not only the Astrictive intentions ought to be pursued, but also the Detersive; here being loss of substance and putrifaction. Therefore boil in Aq. Ger. querc. Fol. Plantag. Ʋlmi, Ʋrticae, Vincae, Per­vincae, Ros. Rubr. fol. Myrtil. & Balaust. adding a little Bol. Armen. & Mastich. Syr. de Symphyto qs. and if more astringent be required, boil it in Aq. Fabr. Having thus quieted the bleeding, you are to dress with this digestive, ℞. Terebinth. Lot. in decoct. Hordei ℥ ij. Pul. Thuris, Myrrhae, an. ℈ ij. Sem. Faenug. p. ʒ j. Ol. Hyperic. qs. dress with a Tent [Page 66]dipt in this, then apply over it a Pledgit, with some of the same, or with some of your Suppuratives, as in simple Gun-shot-wounds is prescribed, and Embrocate the breast and parts about with Ol. Amygdul. & Lumbric. with Ʋng. Dialth. m. and an Empl. Diach. simpl. cum. ol. Lumbric. dissol. and after digestion you are to Inject such medi­caments as have power to deterge, and are more resolvent, whereby the Matter is disposed to be discharged by the wound; and to this purpose ex­tract. Scordii dissolved in Wine, with the addition of Mel. Ros. is proper, or decoct. Pilosellae, Caude Equinae, Plantag. Tormentillae, Consolidae, Aristo­loch. Rot. Rad. Iridis, & Sarcocollae, these boil'd in Aq. Font. adding Wine to it, with Mel. Ros. qs. and then you may dress the wound with this Mund. ℞. Terebinth. ℥ ij. Farin. Hord. Cribrat. ʒ j. Thuris, Sarcocol. Rad. Iridis, an. ʒ iij. Mellis Ros. ℥ iiij. Misce S. A. You may dip your Canula or Tent in this, and dress the wound in the fleshy parts with the same. The wound deterg'd incarn and cica­trize, as is said in other wounds, but keep a Canula in it, until it cease to run. Celsus proposes, that in all these Internal wounds the outer parts be vesicated, to draw off humors more powerfully from within, and the medicament he proposes thereto is, Sal bene contritus cum cerato mixtus, quia leviter cutim ero­dit, eoque impetum materiae quo pulmo vexatur evocat. This his proposal may be proper in wounds made by sharp weapons, as by Arrows, &c. But here in these wounds there is vexation enough outwardly to make a revulsion, if that signified any thing. In the dressing these wounds you must be careful to cut off the sloughs without, lest from them a stink­ing Gleet distil upon the Viscera within: And in [Page 67]order to the cure there is required Phlebotomy ac­cording as the Patient lost bloud by his wound: Here are also Clysters required to keep the body open, and the more temperate: Pectoral decocti­ons are here proper; such as is in the London dis­pensatory, omitting the hotter Plants; to them may be added Syr. violar. de cichor. de liqueritia, Ju­jub. Capil. Ven. de symphyto, & Lohochs, and such as may take off the harshness which the Aspera Arteria, and Bronchia are subject to. Their diet is to be slender, and medicated. Hydromel is a pro­per drink in all these wounds, and may be medica­cated with agglutinatives and pectorals added to it, and after Fever and such like accidents are dimi­nished, Asses and Goats milk is necessary, yea a diet of Cows milk alone, or mixt with distill'd milks, and sweetned with conserve of Roses; but this will be a work for the Physician a-shore.

From the defeat of the Scotch-army near Dun­bar, Observa­tion. there came many of the wounded to St. John­stons, and amongst them there was several wound­ed into the Breast; they who were so shot as to have the Ribs broken, were in extream pain from the shivers, whereas those whose Bones were not hurt had scarce any pain at all, but what proceeded from difficulty of breathing and coughing: A stink­ing Sanies issuing out both before and after the se­paration of the sloughs in great quantity; in one a very great proportion daily, of a brown thin Matter, of a rank smell; none but this died under my hands; they after some while retiring to their homes, where (as I have often heard them say) their Leeches performed great Cures, by vertue of their Plants which they gave Internally, and with Fats they made Balsams of; yet I believe most of these died Tabid.

CHAP. X. Of Symptomes of Gun-shot, omit­ted in the Fourth Chapter.

THe Symptomes attending Gun-shot, as you have read already elsewhere, are Pain, Fever, Deliri­um, Syncope, Phlegmon, Erisipilas, Gangrene, Convulsi­on & Palsie. The Pain proceeds from Inflamation or Phlegmon or Erisipilas, which I have elsewhere pur­posely treated off, as also of Gangrene; The Fever is Symptomatical, so is the Delirium, & will go off with the Pain, but may with the forementioned be reliev­ed, by bleeding and Lenient purgatives, such as I have mentioned, and to fortifie the Spirits against faint­ing, which proceeds from putrid Vapours and Pain which may affect the part, there are Cordials and Epithemata already taught, so that there re­mains only Convulsion and Palsie.

Convulsion is an involuntary contraction of the Nerves to their Original,Convul­sion. by which contraction the Member is also drawn up, and is said to be caused of Repletion and Inanition; In this our case it ariseth from putrid Vapours or Acrid matter offending the Nerves, which is often found in these wounds; The part affected is the Brain, which being thus provoked causeth an involuntary contraction and rigidity of the Members. In parts dismembred, as near the Knee or Shoulder, there the Contraction cannot be discerned but by a trem­bling, [Page 69]which trembling is usually attended by a Convulsion of the Jaws: It likewise follows great Inflamations, especially in the Nervous parts; The Prognostick here is always Fatal, they being the forerunners of death.Observa­tion. In the Wars I was called to see a poor Souldier who had his Arm shot off, near the Shoulder, his Chirurgeon drest him with Egyptiac. as for a Gangrene, from which sharp dressings great Pain followed, with shivering of the Stump, Inflamations and Gleets, but no change of Colour in the skin, he had roared some days, through the vehement pain; I drest him up with Anodynes, as Linement Arcei cum vitel. ovi, fo­mented the part with fol. malvar. violar. caps. barbat. decocted in lacte, and with Lenients Embrocated, as with ol. Lumbricor. & exped. Bovinis, and applyed Empl. Diapalma cum succis over all, and anointed parts about, as Neck and Spine with ung. Nervin. and blistered the Legs and Thighs, but it was too late; he died howling.

Paralysis or resolutio Nervorum is generally de­fined a privation of Sence or motion or both,Palsie. in some part or parts, and affects the Brain & spinalis medulla; But in Palsies which arise from wounds, the parts im­mediately affected are the Nerves of that part only, this doth not take away the life of the Patient, though it may sometimes threaten a Mortification through the resolution of the part. In a Sea-fight an Irish Mari­ner having discharged his Gun which was hony-combed,Observa­tion. and loaded it suddainly again, whilst he was ramming in a Carthage, the powder took fire, and shot the Rammer out of his hand, it did tear the Palm of his hand, and some of his Thumb and Fingers: The wound was not considera­ble, but it extinguished both Sence and Motion of [Page 70]the Member. I drest him up with our common di­gestive, of which at such a time we had great quan­tity ready, and over all a common Restrictive, so rouled him up, there being then no time for bleed­ing; But after the fight I let him bloud, and the next day or two Purg'd him, and Fomented and Embrocated him, with ol. Lumbricor. Cham. Aneth. lilior. ung. Nervinum, and such like I suppose, and did all that we Chirurgeons of the Squadron thought fitting, but without success; one night lying a-sleep in his Hamock, he was awakened by the wet he felt, and got up to a Candle, and found the dressing upon his hand all bloudy, as also his belly whereon it lay: I was called, taking off his dressings, found the palm of his hand and fingers gnawed by Ratts, they had eaten through his oyl'd clothes, and had knaw'd his hand more if he had not wakened from the trickling of his bloud. I drest his wound with my digestive, purposing not to hasten its cure. I supposing it might be a help to his reco­very. I after the cure of this made him a Fonta­nell in that Arm, and bathed the Member, Cupt and Scarified it, and afterwards used Emplasters of Pitch, to stir up a heat in the part; but he was a young man and otherwise of a strong Constitution, and out of hopes of reward for his lost Arm, he hastened away to Madrid, and at his return had more use of it: These Paralyses do often happen in great Contusions, and after dislocations in the Shoulders, I could instance it in several. Dr. T. C. and Dr. T. W. did both see it in a Lady who had dislocated her Shoulder. I was sent for, and by the help of her Servants set it presently, and she so well the next morning, as Sir W. G. then present scarce believed it had been out; I was dismist, but within a [Page 71]month after she was so Lame, as it was doubted, whether the Bone was Set or not. A Bone Setter was sent for, who at a time in another person pretended he had set so many Bones, where none were dislocated or broken. This man, I being present, acknowledged that the Bone was well Set; but had I been absent, he would have delivered otherwise, and by new Extension have rendred the part Incurable.