according to the following manner: After having taken away all extraneous
Bodies out of the Wound, let a Servant draw together its Sides or Lips; and
let a Needle with waxed Thread be pass'd thro' the middle from the outside
to the inside, several Points being made proportionably to its length. It
is requisite to pierce a good way beyond the Edge of the Wound, and to
penetrate to the bottom, lest any Blood shou'd remain in the Space, that
might hinder the reuniting.
If the Wound hath Corners, the Surgeon begins to sow there; and before the
Knot is made, causeth the Lips of the Wound to be drawn exactly close one
to another: The Knots must be begun with that in the middle, and a single
one is first made on the side opposite to the running of the Matter; laying
upon this Knot (if it be thought convenient) a small Bolster of waxed
Linnen, on which is tied a Slip-Knot, to the end that it may be untied if
any bad Accident should happen. If a Plaister be apply'd to the Wound after
the Stitching, a small Bolster is to be laid over the Knots, to prevent
their sticking to the Plaister. In case any Inflammation happens in the
Wound, the Knots may be loosen'd and ty'd again when the Symptoms cease:
But {140} if the Inflammation continue, the Threads are to be cut by
passing a Probe underneath: When the Wound is clos'd, the Threads are cut
in like manner with a Probe; and in drawing 'em out, a Finger must be laid
near the Knot, lest the Wound should open again.
To make the second sort of Stitch for the Hare-Lip, a small streight Needle
is pass'd into the sides of the Wound, and the Thread is twisted round the
Needle, by crossing it above at every Stitch.
To form the _Dry Stitch_ in very superficial Wounds, a piece of new
Linnen-Cloth is to be taken, wherein are made Digitations, or many Corners;
the Selvedge or Hem ought to be on the side of these Corners or
Digitations; and a small Thread-Lace is ty'd to every one of 'em. Afterward
this Cloth is dipt in strong Glue, and apply'd about a Finger's breadth
from the Edges of the Wound; so that a piece thereof being stuck on each
side, the Laces may be ty'd together, to cause the Lips of the Wound to
meet.
To make the _Glover's Stitch_, the Operator having drawn together the Lips
of the Wound, holds 'em between two Fingers, passeth a Needle underneath
'em, and soweth 'em upward all along, after the manner of _Glovers_.
* * * * *
{141}
CHAP II.
_Of Wounds in general._
_What is a Wound?_
A Wound is a recent, violent, and bloody Rupture or Solution of the Natural
Union of the soft Parts, made by a pricking, cutting, or bruising
Instrument.
_What ought to be observ'd before all things in the curing of Wounds?_
It is requisite to take notice of their differences, as well as of the
Instruments with which they were made; to the end that Consequences may be
drawn from thence for the Application of proper Remedies.
_From whence arise the differences of Wounds, and which be they?_
They are taken either from their Figure or Situation: With regard to their
Figure, they are call'd Long, Broad or Wide, Triangular Great, Little,
Superficial, or Deep; and with respect to their Situation, they are term'd
Simple, Complicated, Dangerous, or Mortal.
_What is a Simple and a Complicated Wound?_
A Simple Wound is that which only opens the Flesh, and hath no other
concomitant Circumstances; but a Complicated Wound, on the contrary, is
that which is attended with grievous Symptoms, as Haemorrhages, Fractures
of Bones, Dislocation, Lameness, and others of the like Nature. {142}
_What is a dangerous and mortal Wound?_
A dangerous Wound is that which is complicated the Accidents whereof are
dreadful: As when an Artery is open'd or prick'd, when a Nerve or Tendon is
cut, or when the Wound is near a Joynt and accompanied with a Dislocation
or Fracture. A mortal Wound is that which must be inevitably follow'd by
Death; as is that which is situated deep in a principal Part necessary for
the Preservation of Life.
_What are the Parts wherein Wounds are mortal?_
They are the Brain, the Heart, the Lungs, the _Oesophagus_ or Gullet, the
Diaphragm, the Liver, the Stomach, the Spleen, the small Guts, the Bladder,
the Womb, and generally all the great Vessels.
_Wherein doth the Cure of Wounds consist?_
In helping Nature readily to procure the reuniting of the Parts that have
been divided, after having taken away or asswag'd every thing that might
cause an Obstacle.
_What are the things that hinder the speedy reunion of the Parts?_
They are extraneous Bodies found therein, as Bullets, Flocks, and Pieces of
Wood or Stone, &c. As also sometimes the Accidents which attend 'em; as an
_Haemorrhage_ or Flux of Blood, Inflammation, _Esthiomenus_ or
Mortification, _Hypersarcosis_, or an Excrescence of Flesh, Dislocation,
the Fracture of a Bone, the Splinter of a Bone, & sometimes a contrary Air.
{143}
_REMEDIES._
_What are the Remedies proper for stopping an _Haemorrhage_ or Flux of
Blood?_
The common Remedy is a kind of Cataplasm, made up with the Powders of
Aloes, Dragons-Blood, Bole Armenick and Whites of Eggs, which are mix'd
together and laid upon the Wound. But the following is an excellent one.
Take two Ounces of Vinegar, a Dram of _Colcothar_, two Drams of _Crocus
Martis Astringens_; beat the whole together, steeping _Muscus Quercinus_
therein; then throw upon it the Powder of Mushrooms, or of _Crepitus Lupi_:
Apply this Remedy, and you'll soon stop the _Haemorrhage_, taking Care
nevertheless to bind the Part well, otherwise the Astringents do not
readily take Effect.
To this Purpose you may also make use of Cobwebs, Mill-Dust, and the Powder
of Worm-eaten Oak; or else take Oven-Soot mixt with the Juice of the Dung
of an Ass or Ox, adding only thereto the White of an Egg.
Besides these Remedies there are also actual and potential Cauteries, or
simple Ligatures, which are infallible. Indeed the actual Cautery is not
always sure; because when the Escar made by the Fire, falls off the
Haemorrhage breaks out again as before: but the potential Cautery is almost
always successful; such as the following.
Take about an equal Quantity of Vitriol and Powder of Mushrooms; apply 'em
upon a little Lint to the Place where the Blood issueth {144} forth, and
you'll see it stop immediately: But Care must be taken to avoid touching a
Nerve or Tendon; by reason that the Vitriol is apt to excite Convulsions.
_How is the Inflammation and Mortification of a Wound Suppress'd?_
If the Inflammation proceeds from the Presence of an Extraneous Body, it
must be taken away as soon as possible with a Pair of Forceps, and if from
the Quantity of _Pus_ or corrupt Matter, it must be let out. But in case
the Inflammation ariseth from extreme Pains, they are to be asswaged with
Cataplasms or Pultises and anodyn Liniments, such as those that have been
already prescribed in the Cure of the _Phlegmon_: or else the Part may be
bath'd with Camphirated Spirit of Wine, mixt with as much Water: _Saccharum
Saturni_ infus'd in Lime-water, performs the same Effect, and the Water of
Crabs alone is admirable in its Operation.
Against the _Esthiomenus_ or Mortification, make use of Wine boil'd with
Wormwood, St. _John_'s Wort, Rosemary and Aloes; or else take the Tincture
of Aloes and Myrrh, or Spirit of Wine alone impregnated with Camphire and
Saffron.
_What is to be done in Case a Convulsion happens by reason of a wounded
Nerve or Tendon?_
If the Convulsion be caus'd by the Presence of an Extraneous Body that
bruiseth the Part it must be taken away; and if from the wounding of a
Nerve, pour into the Wound some Drops of the Oil of Lavender distill'd,
which in that Case is of singular Use; this Oyl may be also taken inwardly
in an appropriated Liquour, such as a {145} Decoction of Wormwood and the
Tops of the lesser Centory. Balsam of _Peru_ us'd in the same Manner, is an
excellent Remedy, and the Oyls of Worms, Snails, St. _John_'s-Wort and
Turpentine are frequently apply'd with good Success.
If the Convulsion proceeds from the Biting of some venomous Creature,
Cupping-Glasses or Leeches are to be immediately applied, putting into the
Wound Treacle with the Spirit of Wine or even Fire it self, and leaving to
the Physician's Care the Prescription of other vulnerary Remedies proper to
be taken inwardly.
_What is to be done to draw the Extraneous Bodies out of a Wound?_
When they cannot be taken away with the Fingers or Forceps, the Patient
must be set in the same Station or Posture wherein he was when he receiv'd
the Wound, in order to get some farther Light to discover 'em; or else such
Plaisters may be us'd as are endu'd with an Attractive Quality:
Particularly this:
Take an Ounce of Treacle, half a Dram of Gum _Ammoniack_, one Dram of
_Bdellium_, and two Drams of Bore's Grease, adding a Quarter of a Pound of
Wax to make 'em up into the Form of a Plaister. It is reported that Hare's
Grease alone hath the same Effect, and that it goes for a Secret among the
Surgeons but you may (if you please) mix it with Ointment of Betony.
However it hath been observed that Leaden Bullets may sometimes remain in a
Man's Body, during his whole Life-time without doing any Harm. {146}
_How are Excrescences to be taken away?_
They may be consum'd with Powder of Allom, _Unguentum Aegyptiacum_, or
_Lapis infernalis_.
_After having remov'd every thing that hinders the reuniting of the Lips of
a Wound, what is to be done to attain thereto?_
The Re-Union in Wounds is properly the Work of Nature; but it may be
promoted by putting into 'em a little Balsam of _Peru_, and drawing
together their Lips with the Fingers. Afterwards the Lips must be kept
closed with a Bandage, a Glutinous Plaister or a dry Stitch, provided the
Wound be only superficial, hindring the Air from penetrating into it. For
Want of Balsam of _Peru_, an excellent one may be made with the Flowers
here specified.
Take the Flowers of Henbane, St. _John's-Wort_, and Comfry and let 'em be
digested in the Sun during the whole Summer-Season in the Oyl of Hemp-seed,
which Oyl, the longer it is kept, proves so much the better, if it be set
forth in the Sun every Summer, the Vessel that contains it being well
stop'd. There is also the Balsam of Balsams, or the Balsam of _Paracelsus_
call'd _Samech_.
To avoid the exposing of Wounds to the Air, it is requisite to cover 'em
over the Dressings with some sort of Plaister, which is usually termed the
Surgeon's Plaister, such is that which is effectual in Dissolving,
corroborating and allaying Pain or Inflammation.
Take the Mucilages of the Roots of great Comfrey and Fenegreek, half a
Pound of Ceruse or white Lead, two Drams of Crude _Opium_, one Dram of
Camphire, as much of Saffron, two Drams of Sandarack, one of the Oyl of
{147} Bays, one half Pound of Rosin, and as much Turpentine and Wax. Boil
all these Ingredients together in a sufficient Quantity of Lin-seed-Oyl,
and make a Plaister according to Art.
In great Wounds it is expedient to lay over the Dressings a Cataplasm or
Pultiss, such as this:
Take the Leaves and Flowers of Camomile, and Melilot, the Tops of Wormwood,
common Mallows and Marsh-Mallows, with the Seeds of Line and Cummin
powder'd: Then boyl the whole Composition in Wine, and add thereto
Barly-Meal, to give it a due Consistence. If there be any Cause to fear a
Gangrene, you may also intermix Saffron, Myrrh and Aloes with Spirit of
Wine.
_Is it necessary to put Tents into all Wounds, and to make use of
Digestives and Suppuratives?_
No: It is sufficient to procure the Re-uniting of the Parts simply by the
Means of Balsam in small Wounds; because they ought not to be brought to
Suppuration: so that Digestives and Suppuratives are only necessary in
great Wounds, and those that are accompanied with Contusion, avoiding the
ill Custom of some Country-Surgeons, that stuff up their Wounds too much
with Tents and Pledgets, whereas they might well be content with simple
Bolsters or Dossels which shou'd be dipt in the ordinary Digestive composed
of Turpentine and the Yolks of Eggs with a little Brandy, or else with the
Tincture of Myrrh and Aloes.
Suppuration may also be promoted by mundifying and quickening the Wound,
especially if the Bolsters be steep'd in the following Composition. {148}
Take half an Ounce of Aloes and Myrrh powder'd, two Drams of _Sal Saturni_,
twenty Grains of _Sal Ammoniack_, the same quantity of beaten Cloves, a
Dram of Queen of _Hungary_ Water and half an Ounce of _Unguentum
Basilicon_, and let the whole Mass be mingled together.
In fine, the whole Mystery consists in well cleansing the Wounds with a
Linnen Cloth, or with the Injections of the Tinctures of Myrrh and Aloes;
or with simple Decoctions of Wormwood, _Scordium_ or Water-Germander,
Bugle, Sanicle and Hore-Hound in White-Wine; as also by prescribing the
Vulnerary Decoctions of Powder of Crab's-Eyes, and _Saccharum Saturni_, to
be taken inwardly, to consume the acid Humours, which are a very great
Obstacle that hinders the speedy cure of Wounds.
_What are the Vulnerary Plants, the Decoctions of which is to be taken
inwardly?_
They are _Alchymilla_ or Lion's-Foot, Ground-Ivy, _Veronica_ or Fluellin,
St. _John_'s-Wort, Wormwood, Centory, Bugle, Sanicle, Chervil, and others.
The Broth of Crabs may also be prescrib'd, which is an excellent Remedy,
and may serve instead of a Vulnerary Potion.
Sometimes Sutures or Stitches contribute very much to the re-uniting of the
Lips of Wounds, when they cannot be join'd by Bandage.
* * * * *
{149}
CHAP. III.
_Of particular Wounds of the Head._
_What ought first to be consider'd in a Wound of the Head?_
Two things, that is to say, the Wound it self, and the Instrument with
which it was made; for by the Consideration of the Wound, we may know
whether it be Superficial or Deep; and by that of the Instrument, we are
enabled to make a truer Judgment concerning the Nature of the same Wound.
_What is a Superficial, and what is a Deep Wound in the Head?_
That is call'd a Superficial Wound in the Head, which lies only in the
Skin; and that a Deep one which reacheth to the _Pericranium_, Skull, or
Substance of the Brain.
_What is to be apply'd to a Superficial Wound?_
It is cur'd with a little Queen of _Hungary_ Water; or else with a little
Balsam, laying upon it the Surgeon's Plaister, or that of Betony. But if
the Wound or Rent be somewhat large, it must be clos'd with a Stitch.
_What is to be done to a Deep Wound?_
If it be situated in the _Pericranium_, the Wound must be kept open,
waiting for Suppuration; but if it enter the Skull, an Enquiry is to be
made, whether there be a Simple Contusion, or a Fracture also. In the
Contusion it is necessary to wait for the Suppuration, and the {150} fall
of the Splint, and to keep the Wound open; as in the Fracture, to examine
whether it be in the first Table only, or in both; it is known to be only
in the first, by the Application of an Instrument, and of Ink, as also in
regard that there are no ill Symptoms; but a Fracture in both Tables shews
it self by the Signs; and it may be found out by making a Crucial Incision
in the Flesh, to discover the Fissure.
_What are the Signs of the Fracture of the two Tables of the Skull, and of
the overflowing of the Blood upon the Membranes of the Brain?_
They are the loss of the Understanding at the very Moment of receiving the
Wound; an Haemorrhage or Flux of Blood thro' the Nose, Mouth, or Ears;
drowsiness and heaviness of the Head, and more especially Vomitting of
Phlegm; from whence may be inferr'd the necessity of making use of the
Trepan.
_What Consequence may be drawn from the Knowledge of the Instrument with
which the Wound was made?_
It is according to the Quality of this Instrument; as it is proper to cut,
prick, or bruise; if it be cutting, the Wound is more Superficial, and not
subject to a great Suppuration: If it be pricking, the Wound is deeper, but
of small Moment: If it be a battering or bruising Instrument, the Wound is
accompany'd with Contusion, producing a great Suppuration, besides the
Concussion and Commotion of the Part, which are inseparable, and often
cause very dangerous Symptoms. {151}
Inferences may be made also from the disposition of the wounded Person; for
a strong robust Man may better bear the Stroke than a weak one; and even
Anger causeth an Augmentation of Vehemency; so that all such Circumstances
are not to be despis'd, in regard that they give occasion to profitable
Conjectures.
_What particular Circumstance is there to be observ'd in undertaking the
Cure of Wounds in the Face?_
It is, that a more nice Circumspection is requir'd here than elsewhere, in
abstaining from Incisions, as well as in making choice of proper Medicines,
which must be free from noisome Smells; and it is in this Part chiefly that
Balsams are to be used, avoiding Suppuration, to prevent Scars and other
Deformities.
* * * * *
CHAP. IV.
_Of the particular Wounds of the Breast._
_What is to be observ'd in Wounds of the Breast?_
Two things, _viz._ whether they penetrate into the Cavity of the _Thorax_
or not, which may be discover'd by the Probe, and by a Wax-Candle lighted,
and apply'd to the Entrance of the Wound, obliging the Patient to return to
the same Posture wherein he receiv'd the Hurt, as also to keep his Nose and
Mouth shut: For then the Flame may be perceiv'd to be wavering, the Orifice
of the Opening being full of {152} Bubbles; a Judgment may be also made
from the running out of the Blood.
_What is to be done when it is certainly known that the Wound penetrates
into the Cavity of the Breast?_
It is necessary to examine what Part may be hurt, by considering the
situation of the Wound, and its Symptoms: If the Lungs are pierc'd, a
spitting of froathy Vermilion-colour'd Blood ensues, with difficulty of
Respiration, and a Cough. If any of the great Vessels are open'd, the
wounded Person feels a Weight at the bottom of his Breast, is seiz'd with
cold Sweats, being scarce able to fetch his Breath, and Vomits Blood, some
Portion whereof issueth out of the Wound. If the _Diaphragm_ or Midriff be
cut in its Tendinous Part, he is suddenly hurry'd into Convulsions: And if
the Heart be wounded either in its _Basis_ or Ventricles, he falls into a
Swoon, and dies incontinently.
But if the Probe doth not enter, and none of the above-mentiond Symptoms
appear, it may be taken for granted that the Wound is of no great
Consequence.
_What is to be done when the Wound penetrates into the Chest, yet none of
the Parts are hurt, only there is an Effusion of Blood over the
_Diaphragm_?_
It is necessary to make an _Empyema_, or otherwise the diffus'd Blood in
corrupting, wou'd inevitably cause an Inflammation, Gangrene, and Death it
self.
_What is an _Empyema_?_
It is an Operation whereby any sorts of Matter are discharg'd with which
the Diaphragm is over-spread, by making a Puncture or Opening in the
Breast.
* * * * *
{153}
CHAP. V.
_Of the particular Wounds of the lower Belly._
_What is to be done to know the quality of a Wound made in the lower
Belly?_
It is requisite to make use of the Probe, to observe the situation of the
Wound, and to take notice of all the Symptoms: For by the help of the
Probe, one may discover whether it hath penetrated into the Cavity or not,
after having enjoyn'd the Patient to betake himself to the same Posture
wherein he was when he first receiv'd the Wound: By its situation a
Conjecture may be made that such a particular Part may be hurt; and by a
due Examination of the Symptoms, one may attain to an exact Knowledge. As
for Example; It is known that one of the thick Guts is open'd, when the
Hurt is found in the _Hypogastrium_, and the Excrements are voided at the
Wound; as it is certain that one of the thin Guts is pierc'd, when the
Wound appears in the Navel, and the Chyle issueth forth from thence; and so
of the others.
_What Method ought to be observ'd in curing Wounds in the lower Belly?_
It is expedient at first to prevent letting in the Air, and to dilate the
Wound, in order to sow up the perforated Gut, and afterward to {154}
restore it to its place; as also to bind the Caul, which is let out at the
opening, and to cut it off, lest in putrifying it should corrupt the
neighbouring Parts. Then these Parts may be bath'd with Lees of Wine,
wherein have been boil'd the Flowers of Camomile and Roses with Wormwood:
The Powders of Aloes, Myrrh, and Frankincense may be also thrown upon 'em;
and the Wound must be sow'd up again to dress it on the outside, the
Patient in the mean time being restrain'd to a regular Diet. But Clysters
must be forborn on these Occasions, especially when one of the thick Guts
is wounded, making use rather of a Suppository or laxative Diet-Drinks, to
avoid dilation and straining.
* * * * *
CHAP VI.
_Of Wounds made by Guns or Fire-Arms._
These Wounds are always bruis'd and torn, with the loss of Substance, and
commonly with the splitting and breaking of a Bone: They are red, black,
livid, and inflam'd, not being usually accompany'd with an Haemorrhage:
They are generally round, and streighter at their Entrance than at their
End; at least if they were not made with Cross-Bar-Shot, or Quarter-Pieces.
{155}
_Of the Prognostick of Wounds by Gun-shot._
When these Wounds penetrate into the Substance of the Brain, or Marrow of
the Back-Bone, or into the Heart, _Pericardium_, great Vessels, and other
noble Parts, Death always inevitably follows, and often happens at the very
Instant. But one may undertake the Cure of those that are superficial, and
which are made in the Neck, Shoulders, Arms, and all other parts of the
Body.
_Of the Cure of Wounds by Gun-shot._
For the better curing of these sorts of Wounds, it is requisite to be
inform'd of the Quality of the Fire-Arms by which the Wounds were made, in
regard that a Musquet is more dangerous than a Pistol, and a Cannon much
more than a Musquet; as also to examine their situation and concomitant
Accidents; for by how much the more complicated they are, so much the
greater is the danger. Then the Patient must be set (as near as can be) in
the very same Situation and Posture wherein he remain'd when the Wound was
receiv'd, in order to discover the direct Passage of the Wound by the help
of the Probe, with which a search is to be made, whether a Bullet, or any
other extraneous Bodies, as Wood, Flocks, Linnen, or Stuff as yet stick in
the Wound; so that Endeavours may be us'd to take 'em out thro' the same
Hole where they enter'd, care being more especially had to avoid making
{156} Dilacerations in drawing 'em out: But if the Operator hath
endeavour'd to no purpose to remove these extraneous Bodies, let him make a
Counter-Opening in the opposite Part, where he shall perceive any hardness,
nevertheless without touching the Vessels; thus the Incision being made, he
may readily draw 'em out with his Fingers, or some other Instrument.
If the Bullet sticks so far in a Bone that it cannot be taken away without
breaking the same Bone, it is more expedient to let it lie therein; but if
the Leg or Arm-Bones are very much split or shattered, then the Amputation
of 'em becomes absolutely necessary. The Pain and Inflammation of the Part
may be asswag'd by letting Blood, topical Anodyns, cooling Clysters and
Purgations; but in case much Blood hath been already lost, Phlebotomy must
be omitted. The Clysters may be made with Decoctions of Mercury, Mallows,
Beets, a Handful of Barley and Honey of Roses.
Some Surgeons are of Opinion that the Patient ought to be purg'd every
other Day, and even on the very same Day that he receiv'd the Wound, if his
Strength will permit; however very gentle Purges are to be us'd upon this
occasion, such as Cassia, Manna, Tamarins, Syrrup of Violets, and that of
White Roses.
In the mean while Anodyns may be compounded to mitigate the Pain; as
Cataplasms or Pultisses made with the Crum of white Bread, Milk, Saffron,
the Yolk of an Egg, and Oil of Roses us'd hot; which last Ingredient is of
it self a very good Anodyn. But to asswage great Inflammations, Oil of
{157} Roses, the White of an Egg and Vinegar beaten all together, may be
laid on the neighbouring Parts.
At first it is necessary to apply spirituous Medicines to the Wound, and
Pledgets steep'd in camphirated Brandy, are admirable for that purpose; but
if there be a Flux of Blood, styptick Waters, or other astringent Remedies
may be us'd, still remembring that all these Medicaments must be apply'd
hot.
To promote the Suppuration of these contused Wounds, a Digestive may be
made of _Oleum Rosatum_, the Yolk of an Egg, and _Venice_ Turpentine.