the Orbits of the Eyes, thro' certain peculiar Holes made in the _Os
Sphenoides_, or Wedge-like Bone, immediately above the _Anterior Apophysis
Clinoides_.
In the Portion of the _Os Sphenoides_, that makes the _Basis_ of the Orbit,
lies a Fissure about seven or eight Hairs breadth long, which is to be
observ'd chiefly at the bottom, that is to say, below the Hole, thro' which
the Optick Nerve passeth; where it is almost round, and larger than at the
top, where it is terminated in a very long and acute Angle.
There are many Pairs of Nerves that enter into the Orbit thro' this
Fissure, _viz._ 1. The third Pair, call'd the _Motorii Oculorum_. 2. The
fourth Pair, nam'd _Pathetici_, by Dr. _Willis_. And 3. The whole sixth
Pair. Besides these three Pairs, which go entire thro' this Cleft, there is
also a Passage for the upper Branch of the foremost Fibre of the fifth
Pair, which the same renowned Physician calls the _Ophthalmick_ Branch.
Beyond the lower-part of the said Fissure, toward the hinder-part of the
Head, is to be seen {85} in the _Os Sphenoides_ on each side, a Hole that
doth not penetrate the _Basis_ of the Skull, but makes a kind of _Ductus_,
about an Hair's breadth long, which is open'd behind the Orbit on the top
of the Space between the _Apophysis Pterygoides_, and the third Bone of the
Jaw; thro' this _Ductus_ runs the lower Branch of the foremost Fibre of the
fifth Pair.
About the length of two Hairs breadth beyond these _Ductus's_, we may also
discover in the _Os Sphenoides_, or Wedge-like Bone, two Holes of an Oblong
and almost Oval Figure, which are plac'd in the hindermost sides of that of
the _Os Sphenoides_, and gives passage to the hindermost Fibre of the fifth
Pair.
The Hole thro' which runs the _Auditory_ Nerve, that makes the seventh
Pair, is in the middle of the hinder-part of the _Os Petrosum_, that looks
toward the _Cerebellum_: This Hole being very large, is the Entrance of a
_Ductus_ that is hollow'd in the _Os Petrosum_, and which sinking obliquely
from the fore-part backward, for the depth of about two Hairs breadth,
forms as it were the bottom of a Sack, the lowermost part whereof is
terminated partly by the _Basis_ of the _Cochlea_, and partly by a Portion
of the Mouth of the _Vestibulum_. At the bottom of this _Ductus_ are many
Holes, but the most considerable is that of the upper-part, thro' which
passeth a Portion of the Auditory Nerve. This is also the Entrance of
another _Ductus_ made in the _Os Petrosum_, which is open'd between the
_Apophysis Mastoides_ and _Styloides_: These other Holes afford a Passage
to the Branches of the soft Portion of the same Auditory Nerve. {86}
Below this _Ductus_ there is a remarkable Hole form'd by the meeting of two
hollow Cuts the larger whereof is in the Occipital Bone and the other in
the lower-part of the _Apophysis Petrosi_: From the middle of the
upper-part of this Hole issueth forth a small Prominence or bony Point,
whereto is join'd an Appendix of the _Dura Mater_, which divides the Hole
into two parts; so that thro' the foremost Orifice passeth the Nerve of the
eighth Pair, and that which is call'd the _Spinal_ Nerve. We shall have
occasion hereafter to shew the Use of the hinder Orifice.
Near the great Hole of the Occipital Bone from whence proceeds the _Medulla
Oblongata_, we may observe a Hole almost round and oblong thro' which
passeth the Nerve of the ninth Pair. This Hole is entirely situated in the
Occipital Bone, and making a little Way in the Bone passeth obliquely from
the back-part forward. In the inside of the Skull this Hole is sometimes
double, but its two Entrances are re-united in the outward-part of the
Skull; and the two Branches that form the Origine of this Nerve and which
pass thro' these two Holes, are likewise re-united at their Departure,
These are the Passages of the nine Pairs of Nerves that proceed from the
_Medulla Oblongata_, and it remains only to show that Paths thro' which the
Intercostal Nerve goes forth, as also that of the tenth Pair. The
Intercostal runs out of the Skull thro' the _Ductus_ that gives Entrance to
the Internal _Carotick_ Artery. As for the tenth Pair, in regard that it
ariseth from the Marrow which is enclos'd between the Occipital {87} Bone
and the first _Vertebra_, it goes forth thro' the Hole of the _Dura Mater_,
where the Vertebral Artery enters.
To know well the Holes thro' which the Vessels that belong to the
inner-part of the Head enter, and issue forth, it is requisite to
distinguish them into those which are distributed to the _Dura Mater_, and
those that are appointed for the Brain. The Vessels of the _Dura Mater_,
are Branches of the _Carotick_ or Vertebral Arteries.
In the _Os Sphenoides_, or Wedge-like Bone, behind the Hole thro' which
passeth the hindermost Fibre of the fifth Pair of Nerves lies another small
Hole, almost round, that gives Entrance to a Branch of the _External
Carotick_ Artery, which in entring, immediately adheres to the _Dura
Mater_, and forms many Ramifications to overspread the whole Portion of
this Membrane, which covers the sides, and the upper-part of the Brain.
At the bottom and top of the lateral outward part of the Orbit of the Eye,
above the acute Angle, for want of the _Os Sphenoides_, there is a Hole
thro' which passeth an Artery, being a Twig of a Branch of the _Internal
Carotick_, which is diffus'd in the Eye, and distributed to almost the
whole Portion of the _Dura Mater_, that covers the fore-part of the Brain.
The Vertebral Artery in entring into the Skull, furnisheth it on each side
with a considerable Branch, which is dispers'd throughout the whole Portion
of the _Dura Mater_ that covers the _Cerebellum_. {88}
As for the Veins that accompany these Arteries, they almost all go out of
the Skull thro' the same Holes where the other enters.
There are four thick Arteries which convey to the Brain the Matter with
which it is nourish'd, and that whereof the Spirits are form'd, _viz._ the
two _Internal Caroticks_, and the two _Vertebrals._
The _Internal Carotick_ Arteries enter into the Skull thro a particular
_Ductus_ made in the Temporal Bone, the Mouth thereof being of an Oval
Figure and situated in the outward part of the _Basis_ of the Skull, before
the Hole of the _Internal Jugular._ This _Ductus_ extends it self obliquely
from the back-side forward, and after having made about three Hairs breadth
in length, is terminated in the hinder-part of the _Os Sphenoides_. The
Artery traverseth the whole winding Compass of this _Ductus_, which
resembles the Figure of the _Roman_ Letter S, and at the Mouth of the same
_Ductus_ runs under the _Dura Mater_ along the sides of the _Os Sphenoides_
to the _Anterior Apophyses Clinoides_, where it riseth up again, to
perforate the _Dura Mater_, and to adhere to the Root of the Brain. These
Vessels, in like manner, after their departure from the Bone of the Temples
to the place where they pierce the _Dura Mater_, make a second Circuit in
form of the _Roman_ Character S. At the place where these _Carotick_
Arteries penetrate the _Dura Mater_, they send forth a thick Branch, which
enters into the Orbit of the Eye, by the lower-part of the Hole, thro'
which the _Optick_ Nerve hath its Passage. {89}
The _Vertebral_ Arteries proceeding from the Holes of the transverse
_Apophyses_ of the first _Vertebra_, turn about in passing under the upper
oblique _Apophyses_ of the seven _Vertebra's_: Afterward they perforate the
_Dura Mater_, and running under the Marrow, enter into the Skull thro' the
Occipital Hole; then inclining one toward another, they are re-united, and
form only one single Trunk.
The Veins that bring back the Blood from the Substance of the Brain, are
emptied into the _Sinus's_ of the _Dura Mater_, which are all discharg'd
into those that are call'd _Lateral_, which last go out of the Skull
immediately under the Nerves of the eighth Pair, thro' the hinder-part of
the Hole made by the meeting of the _Occipital_ Bone, and the _Apophysis
Petrosa_. These Lateral _Sinus's_ fall into the _Internal Jugulars_, which
are receiv'd into a considerable Sinking hollow'd on each side in the
outward, part of the _Basis_ of the Skull, which is nam'd the Pit or Hole
of the _Internal Jugular_.
In the upper and hinder-part of the Hole, from whence the lateral _Sinus's_
issue forth, is to be seen an opening in the Extremity of a _Ductus_, the
Mouth whereof lies behind the _Condyli_, which are on the sides of the
Occipital Trunk: This _Ductus_ is extended about the length of two Hairs
breadth in the Bone, and the Canal enclos'd therein is open'd immediately
into the _Vertebral Sinus_: So that one might affirm it to be as it were
its Original Source. Whence it appears that the Blood contained in the
lateral _Sinus's_ is emptied thro' two places; the greater Portion thereof
descending in the _Jugulars_ {90} from the Neck, and the other in the
_Vertebral Sinus's_: Sometimes those _Ductus's_ are four only on one side,
another while both are stopt up, and the Blood contain'd in the lateral
_Sinus's_ is discharg'd into the _Internal Jugulars_.
Behind the _Apophysis Mastoides_ on each side is a remarkable Hole, thro'
which passeth a thick Vein, which brings back part of the Blood that hath
been distributed to the Teguments and Muscles, which cover part of the
_Occiput_ or hinder-side of the Head: This Vein is open'd into the lateral
_Sinus's_ at the place where they begin to turn about. But in the Heads of
some Persons, this Hole is found only on one side, and even sometimes not
at all, in which case the Blood contain'd in the Vessels falls into the
_External Jugulars_, with which the Branches of this Vein have a
Communication.
In each _Parietal_ Bone on the side of the _Sagittal_ Suture, at a little
distance from the _Lambdoidal_, appears a Hole, thro' which passeth a Vein,
that brings back the Blood of the Teguments of the Head, and dischargeth it
self into the upper _Longitudinal Sinus_. These Holes are sometimes on
both; and then the Blood contain'd in the Branches of this Vein runs into
the _External Jugulars_.
In the middle of the _Sella_ of the _Os Sphenoides_, we may observe one or
two small Holes thro' which (according to the Opinion of some Modern
Anatomists) the _Lympha_ contain'd in the _Glandula Pituitaria_ is thrown
{91} into the _Sinus_ of the edge of the _Os Sphenoides_; nevertheless it
is certain, that these Holes are fill'd only with Sanguinary Vessels, which
carry and bring back the Blood of the Bones and Membranes, whereof those
_Sinus's_ are compos'd; besides that, these Holes are rarely found in adult
Persons.
Between the Spine of the _Coronal_ Suture and the _Crista Galli_, is a Hole
which serves as an Entrance for a _Ductus_, which sinks from the top to the
bottom, the length of about two Hairs breadth in the thickness of the inner
Table of the _Coronal_: The Root of the upper _Longitudinal Sinus_ is
strongly implanted in this Hole, which also affords a Passage to some
Sanguinary Vessels appointed for the Nourishment of this inner Table.
Many other small Holes are found in divers places of the _Basis_ of the
Skull; the chief whereof are those that are observ'd in the _Apophysis
Petrosa_, and give Passage to a great number of Vessels that serve for the
Nutriment of that part of the Temporal Bone which is call'd the _Tympanum_,
or Drum: The other Holes are principally design'd for the Vessels that are
serviceable in the nourishing of divers parts of the _Basis_ of the Skull.
_After what manner is the opening of the Head or Skull perform'd?_
It is done by sawing it asunder round about and above the Ears; then it is
taken off, after having before cut off the Hair, and made a Crucial
Incision in the Skin from the fore-part to the hinder, and from one Ear to
the other; as also after having {92} pull'd off and laid down the four
Corners to the bottom.
_How is the Brain anatomiz'd?_
It is done by cutting it Superficially, and by Leaves, in order to discover
by little and little the Ventricles, Vessels, and Nerves, with their
Original Sources, &c. Or else it is taken entire out of the Skull, (the
Nerves having been before examin'd) and laid down; so that without cutting
any thing, all the parts of the Brain may be set in their proper places, to
find out those that are sought for.
* * * * *
{93}
A
TREATISE
OF
_Straps, Swathing-Bands, Bandages, Bolsters, Splints, Tents,
Vesicatories,
Setons, Cauteries, Leeches, Cupping-Glasses, and Phlebotomy._
* * * * *
CHAP. XVI.
_Of Straps, Swathing-Bands, Bandages, and Bolsters._
_What is a Strap?_
It is a kind of Band commonly made use of for the Extension of the Members
in the reducing of Fractures and Luxations; or else in binding Patients,
when it is necessary to confine them, for the more secure performing of
some painful Operation: These sorts of Ligatures have different Names, {94}
according to their several Uses, and often bear that of their Inventer.
_What is the Matter whereof these Straps are compos'd?_
They may be of divers sorts, but are usually made of Silk, Wooll, or
Leather.
_What is a Swathing-Band?_
It is a long and broad Band, that serves to wrap up and contain the Parts
with the Surgeons Dressings or Preparatives.
_Of what Matter are these Swathing-Bands made?_
They are made at present of Linnen-Cloth but in the time of _Hippocrates_,
were made of Leather or Woollen-Stuff.
_How many sorts of Swathing-Bands are there in general?_
There are two sorts, _viz._ the Simple and Compound; the former are those
that are smooth, having only two ends; and the other are those which are
trimm'd with Wooll, Cotton, or Felt, or that have many Heads, that is to
say, Ends, fasten'd or cut in divers places according as different
Occasions require.
_What are the Conditions requisite in the Linen-Cloth, whereof the
Swathing-Bands are made?_
It must be clean, and half worn out, not having any manner of Hem or Lift.
_What are the Names of the different Swathing-Bands?_
There are innumerable, but the greater part them take their Denominations
from their Figure or Shape; as the Long, Streight, Triangular, and those
which have many Heads, or are trimm'd. {95}
_What is A Bandage?_
It is the Application of a Swathing-Band to any Part.
_How many sorts of Bandages are there?_
As many as there are different Parts to be bound; some of them being
Simple, and others Compound: The former are those that are made with an
uniform Band; as the Bandage call'd the _Truss_, and divers other sorts:
The Compound are those that consist of many Bands set one upon another, or
sew'd together; or else those that have many Heads. They have also
particular Names taken from the Inventers of them, or from their Effect; as
_Expulsive_ Bandages to drive back, _Attractive_ to draw forward,
_Contentive_ to contain, _Retentive_ to restrain, _Divulsive_ to remove,
_Agglutinative_ to rejoin, &c.
There are others whereto certain peculiar Names are appropriated; as
_Bridles_ for the lower Jaw, _Slings_ for the Chin, the back part of the
Head, Shoulder, and _Perinaeum_; _Scapularies_ for the Body, after the
manner of the Scapularies of Monks; _Trusses_ for Ruptures; _Stirrups_ for
the Ankle-Bones of the Feet, in letting Blood, and upon other Occasions.
Lastly, there are an infinite Number of Bandages, the Structure whereof is
learnt by Practice, in observing the Methods of able Surgeons, who invent
them daily, according to their several Manners; and the first _Ideas_ of
these can only be taken in reading Authors that have treated of them.
_What are the general Conditions to be observ'd in the Bandages?_ {96}
There are many, _viz._ 1. Care must be taken that the Bands be roll'd firm,
and that they be not too streight nor too loose. 2. They are to be untied
from time to time in Fractures, they must also be taken away every three or
four Days, to be refitted. 3. They must be neatly and conveniently roll'd,
that the Patient may not be uneasie or disquieted.
_What ought to be observ'd in fitting the Bolsters?_
Care must be taken to make them even, soft, and proportionable to the
bigness of the Part affected; to trimm them most in the uneven places, that
the Bands may be better roll'd over them, and to keep them continually
moisten'd with some Liquor proper for the Disease as well as the Bands.
_In treating of every Disease in particular, we shall shew the manner
of making the particular Bandage that is convenient for it._
* * * * *
{97}
A
TREATISE
OF
_Chirurgical Diseases_.
* * * * *
CHAP. I.
_Of Tumours in general, Abcesses or Impostumes, Breakings out, Pustules,
and Tubercles._
_What is a Tumour?_
A Tumour is a rising or bloated Swelling rais'd in some part of the Body by
a Setling of Humours.
_How is this setling of Humours produc'd?_
Two several ways, _viz._ by _Fluxion_ and _Congestion_.
_What is the Setling by Fluxion?_
It is that which raiseth the Tumour all at once, or in a very little space
of time, by the Fluidity of the Matter. {98}
_What is the Setling by Congestion?_
It is that which produceth the Tumour by little and little, and almost
insensibly, by reason of the slow Progress and thickness of the Matter.
_Which are the most dangerous Tumours, those that arise from Fluxion, or
those that derive their Original from Congestion?_
They that proceed from Congestion, because their thick and gross Matter
always renders 'em obstinate, and difficult to be cur'd.
_Whence do the differences of Tumours proceed?_
They are taken, _first_, from the Natural Humours, _Simple_, _Mixt_, and
_Alter'd_: _Simple_, as the _Phlegmon_, which is made of Blood, and the
_Erysipelas_ of Choler; _Mixt_, as the _Erysipelas Phlegmon_, which
consists of Blood mingl'd with a Portion of Choler; or the _Phlegmonous
Erysipelas_, which proceeds from Choler intermixt with a Portion of Blood:
_Alter'd_, as the _Melia_ which is compos'd of many Humours, that can not
be any longer distinguish'd by reason of their too great Alteration.
_Secondly_, the difference of Tumours is taken from their likeness to some
other thing, as the Carbuncle and the _Talpa_, the former resembling a
burning Coal, and the other a Mole, according to the Etymology of their
_Latin_ Names. _Thirdly_, From the Parts where they are situated; as the
Ophthalmy in the Eye and the Quinsey in the Throat. _Fourthly_, from
Disease that causeth 'em, as Venereal and Pestilential Buboes. _Fifthly_,
from certain Qualities found in some, and not in others; as the _Encysted_
Tumours, which have their Matter clos'd within their proper _Cystes_ or
Membranes, and so of many others. {99}
_How many kinds of Tumours are there that comprehend at once all the
particular Species?_
They are four in Number, _viz._ the Natural Tumours, the Encysted, the
Critical, and the Malignant.
_What are natural Tumours?_
They are those that are made of the four Humours contain'd in the Mass of
the Blood, or else of many at once intermixt together.
_What are the four Humours contain'd in the Mass of the Blood?_
They are Blood, Choler, Phlegm, and Melancholy, every one whereof produceth
its particular Tumour: Thus the Blood produces the _Phlegmon_, Choler the
_Erysipelas_, Phlegm the _Oedema_, and Melancholy the _Scirrhus._ The
Mixture of these is in like manner the Cause of the _Erysipelatous
Phlegmon_, the _Oedomatous Phlegmon_ or _Phlegmonous Erysipelas_, and the
_Phlegmonous Oedema_, according to the quality of the Humours which are
predominant, from whence the several Tumours take their Names.
_What are the _Encysted_ Tumours?_
They are those the Matter whereof is contain'd in certain _Cystes_, or
Membranous Bags; as the _Meliceris_, and the _Struma_ or Kings-Evil.
_What are Critical Tumours?_
They are those that appear all at once in acute Diseases, and terminate
them with good or bad Success.
_What are Malignant Tumours?_
They are those that are always accompany'd with extraordinary and dreadful
Symptoms, and whose Consequences are also very dangerous; as the Carbuncle
in the Plague. {100}
_What are Impostumes or Abcesses, Breakings out and Pustules?_
Indeed, it may be affirm'd, that all these kinds of Tumours scarce differ
one from another, except in their size or bigness; nevertheless, to speak
properly, by the Names of Impostumes or Abcesses are understood gross
Tumours that are suppurable, or may be dissolv'd, and by those of Breakings
out and Pustules, only simple Pusteal Wheals, or small Tumours, that appear
in great Numbers, and which frequently do not continue to Suppuration; some
of them consisting of very few Humours, and others altogether of dry
Matter.
_What difference is there between a Tumour and an Impostume or Abcess?_
They differ in this particular, that all Tumours are not Impostumes nor
Abcesses; but there is no Impostume nor Abcess that is not a Tumour: As for
Example, Wens and _Ganglions_ are Tumours, yet are not Abcesses nor
Impostumes; whereas these last are always Tumours in regard that they cause
Bunches and Elevations.
* * * * *
CHAP. II.
_Of the general Method to be observ'd in the curing of Tumours_.
_What ought a Surgeon chiefly to observe in Tumours, before he undertake
their Cure?_
He ought to know three things, _viz._ 1. The Nature or Quality of the
Tumour. 2. The {101} time of its formation and 3. Its situation: The
Quality of the Tumour is to be known, because the Natural one is otherwise
handl'd than that which is Encysted, Critical or Malignant. As for the time
of its Formation, it is four-fold, _viz._ the Beginning, Increase, State,
and Declination, wherein altogether different Remedies are to be apply'd.
The Situation of the Tumour must be also observ'd, because the dressing and
opening of it ought to be as exact as is possible, to avoid the meeting
with an Artery or neighbouring Tendon.
_How many ways are all the Tumours that are curable, terminated?_
They are terminated after two manners, _viz._ either by dissolving 'em, or
by Suppuration.
_Are not the_ Scirrhus _and the_ Esthiomenus _or Gangrene, two means that
sometimes serve to terminate and cure Impostumes?_
Yes, but it is done imperfectly, in regard that a Tumour or Impostume
cannot be said to be absolutely cur'd, as long as there remains any thing
of the Original Malady, as it happens in the _Scirrhus_, where the Matter
is harden'd by an imperfect dissolving of it, or when the Impostume
degenerates into a greater and more dangerous Distemper, as it appears in
the _Esthiomenus_ or Gangrene that succeeds it.
_Which is the most effectual means of curing Impostumes, that of
dissolving, or that of bringing them to Suppuration?_
That of dissolving 'em is without doubt the most successful, and that which
ought to be us'd as much as is possible; nevertheless some Cases are to be
excepted, wherein the Tumours {102} or Abcesses are Critical and Malignant;
for then the way of Suppuration is not only preferable, but must also be
procur'd by all sorts of means, even by opening; which may be done upon
this occasion, without waiting for their perfect Maturity.
_What are the Precautions whereto a Surgeon ought to have regard before he
undertake the opening of Tumours?_
He must take care to avoid cutting the Fibres of the Muscles, and in great
Abcesses, to cause all the corrupt Matter to be discharg'd at once, to
prevent the Patient's falling into a Swoon.
_Ought the opening of Tumours always to be made longitudinally, and
according to the direct Course of the Fibres?_
No, it is sometimes necessary to open 'em with a Crucial Incision, when
they are large, or when a _Cystis_ or Membranous Vehicle is to be
extirpated.
_How many sorts of Matter are there that issue forth in the Suppuration of
Tumours?_
There are four sorts, _viz._ the _Pus_, _Ichor_, _Sanies_, and _Virus_.
_What is_Pus_?_
It is a thick Matter, and white as Milk.
_What is _Ichor_?_
It is a thick Matter like the _Pus_, but of divers Colours.
_What is _Sanies_?_
It is a watery Matter that riseth up in Ulcers, almost after the same
manner as the Sap in Trees.
_What is _Virus_?_ {103}
It is a kind of watry Matter, being whitish, yellowish, and greenish at the
same time; which issueth out of Ulcers, very much stinking, and is endu'd
with corrosive and malignant Qualities.