wide as to let out the Entrails. If there be a considerable Wound in the
Intestine, it may be sow'd up with the Glover's Stitch, the manner of
making which we have before explain'd. If {232} the _Omentum_ or Caul be
mortify'd, the corrupted Part must be cut off; to which purpose it is
requisite to take a Needle with waxed Thread, and to pass it into the sound
Part a-cross the Caul, without pricking the Vessels. Then the Caul being
ty'd on both sides with each of the Threads that have been pass'd double,
may be cut an Inch below the Ligature, and the Threads will go thro' the
Wound, so as to be taken away after the Suppuration. Afterward the
Intestines are to be put up again into the Belly, by thrusting 'em
alternately with the end of the Fingers. But if they cannot be restor'd to
their proper Place without much difficulty, Spirituous Fomentations may be
made with an handful of the Flowers of Camomile and Melilot, an Ounce of
Anise, with as much Fennel and Cummin-Seeds; half an Ounce of Cloves and
Nutmegs: Let the whole Mass be boil'd in Milk, adding an Ounce of
Camphirated Spirit of Wine, and two Drams of _Saccharum Saturni_, with two
Scruples of Oil of Anise, and bathe the Entrails with this Fomentation very
hot. Otherwise,
Apply Animals cut open alive; or else boil Skeins of raw Thread in Milk,
and foment 'em with this Decoction in like manner very hot.
Before the Suture of Stitching of the Intestines is made, it is expedient
to foment 'em with Spirit of Wine, in which a little Camphire hath been
dissolv'd: But if they be mortify'd, they must not be sown up again, but
fomented with Spirituous Liquors. No Clysters are to be given to the
Patient, for fear {233} causing the Intestine to swell; but a Suppository
may be apply'd: Or else he may make use of a Laxative Diet-Drink, if it be
necessary to open his Body: He ought also to be very temperate and
abstemious during the Cure, so as to take no other Sustenance than Broths
and Gellies.
If the Intestines cannot be put up again, the Wound is to be dilated,
avoiding the White-Line, and that too at the bottom rather than at the Top,
if it be above. To this purpose the Intestines are to be rank'd along the
side of the Wound, and a Bolster is to be laid upon 'em dipt in warm Wine,
which may be held by some Assistant. Then the Surgeon introduceth a
channel'd Probe into the Belly, and takes a great deal of care to fix the
Intestine between the Probe and the _Peritonaeum_, which may be effected by
drawing out the Intestine a little; then holding the Probe with his
Left-hand, to fit a crooked Incision-Knife in its chanelling, he cuts the
Teguments equally both on the outside and within, and thrusts back the
Entrails alternately into the Wound with his Fore-Finger.
The Stitch must be intermitted, being made with two crooked Needles
threaded at each end with the same Thread. The Surgeon having at first put
the Fore-Finger of his Left-Hand into the Belly, to retain the
_Peritonaeum_, Muscles, and Skin on the side of the Wound, passeth the
Needle with his other Hand into the Belly, the Point of which is guided
with the Fore-Finger, and penetrates very far: Then he likewise passeth the
other {234} Needle thro' the other Lip of the Wound into the Belly,
observing the same thing as in the former, and without taking his Fingers
off from the Belly. If there are many Points or Stitches to be made, they
may be done after the same manner, without removing the Fingers from the
Part, whilst a Servant draws together the Lips of the Wound, and ties the
Knots. Afterward the Wound may be dress'd, and the Preparatives or
Dressings kept close to the Part with the Napkin and Scapulary. But the
Patient must be oblig'd to lie on his Belly for some Days successively, to
cicatrize the Wound thereof, or that of the Entrails.
If the Intestine were entirely cut, it wou'd be requisite to sow it up
round about the Wound, after such a manner that some part of it may always
remain open; for if the Patient shou'd recover, his Excrements might be
voided thro' the Wound; of which Accident we have an Example in a Soldier
belonging to the Hospital _Des Invalides_ at _Paris_, who liv'd a long time
in this Condition.
* * * * *
CHAP. XII.
_Of the Operation of the _Exomphalus_._
This Operation is necessary when the Intestines or Entrails have made a
kind of Rupture in the Navel, and may be perform'd thus: When the Patient
is laid upon his Back, an Incision is to be made on the Tumour to {235} the
Fat, by griping the Skin, if it be possible, or else it may be done without
taking it up. Then the Membranes are to be divided with a Fleam to lay open
the _Peritonaeum_, for fear of cutting the Intestine; and as soon as the
_Peritonaeum_ appears, it may be drawn upward with the Nails, in order to
make a small Opening therein with some cutting Instrument: Whereupon the
Surgeon having put the Fore-Finger of his Left-Hand into the Belly to guide
the Point of the Sizzers, with which the Incision is enlarg'd, restores the
Intestine to its proper Place, and loosens the Caul if it stick to the
Tumour: But if the Entrails are fasten'd to the Caul, it is requisite to
separate 'em by cutting a little of the Caul, rather than to touch the
Intestine; which last being reduc'd, a Servant may press the Belly on the
side of the Wound; so that if a Mass of Flesh be found in the Caul, which
hath been form'd by the sticking of the Caul to the Muscles and
_Peritonaeum_, this Fleshy Mass must be entirely loosen'd, and then a
Ligature may be made to take it away, with some part of the Caul, as we
have already shewn in the _Gastroraphy_. Afterward the Stitch is to be
made, as in that Operation, and the Wound must be dress'd, observing the
same Precautions. The Dressing is to be supported in like manner with the
Napkin and Scapulary.
* * * * *
{236}
CHAP. XIII.
_Of the Operation of the_ Bubonocele, _and of the compleat Rupture._
When the Intestinal Parts are fall'n into the Groin or the _Scrotum_, the
Operation of the _Bubonocele_ may be conveniently perform'd; to which
purpose the Patient is to be laid upon his Back, with his Buttocks somewhat
high; then the Skin being grip'd a-cross the Tumour, the Surgeon holds it
on one side, and the Assistant on the other, till he makes an Incision,
following the Folds or Wrinkles of the Groin; when the Fat appears, it is
requisite to tear off either with a Fleam or even with the Nails, every
thing that lies in the way, till the Intestine be laid open, which must be
drawn out a little, to see if it do not cleave to the Rings of the Muscles.
The Intestine must be gently handl'd, to dissolve the Excrements; and those
Parts must be afterward put up again into the Belly (if it be possible)
with the two Fore-Fingers, thrusting 'em alternatively; but if they cannot
be reduc'd, the Wound is to be dilated upward, by introducing a channell'd
Probe into the Belly, to let the Sizzers into its Channelling. If the Probe
cannot enter, the Intestine must be taken out a little, laying a Finger
upon it near the Ring, and making a small Scarification in the Ring, with a
streight Incision-Knife guided with the {237} Finger, to let in the Probe,
into which may be put a crooked Knife, to cut the Ring; that is to say, to
dilate the Wound on the inside; but care must be had to avoid penetrating
too far, for fear of dividing a Branch of Arteries; and then the Parts may
be put up into the Belly. If the Caul had caus'd the Rupture, it wou'd be
requisite to bind it, and to cut off whatsoever is corrupted, scarifying
the Ring on the inside, to make a good Cicatrice or Scar.
_The Dressing and Bandage._
The Dressing may be prepar'd with a Linnen-Tent, soft and blunt, of a
sufficient thickness and length, to hinder the Intestines from re-entring
into the Rings by their Impulsion, a Thread being ty'd thereto, to draw it
out as occasion serves. Then Pledgets are to be put into the Wound, after
they have been dipt in a good Digestive, such as Turpentine with the Yolk
of an Egg, applying at the same time a Plaister, a Bolster of a Triangular
Figure, and the Bandage call'd _Spica_, which is made much after the same
manner as that which is us'd in the Fracture of the Clavicle.
_Of the compleat _Hernia_ or Rupture._
It happens when the Intestinal Parts fall into the _Scrotum_ in Men, or
into the bottom of the Lips of the _Matrix_ in Women. To perform this
Operation, the Patient must be laid upon his Back, as in the _Bubonocele_,
and the Incision carry'd on after the same manner; which is to {238} be
made in the _Scrotum_, tearing off the Membranes to the Intestine. Then a
Search will be requisite, to observe whether any parts stick to the
Testicle; if the Caul doth so, it must be taken off, leaving a little Piece
on the Testicle; but if it be the Intestine, so that those Parts cannot be
separated without hurting one of 'em, it is more expedient to impair the
Testicle than the Intestine. If the Caul be corrupted, it must be cut to
the sound Part, and the Wound is to be dress'd with Pledgets, Bolsters, and
the Bandage _Spica_; as in the _Bubonocele_.
* * * * *
CHAP. XIV.
_Of the Operation of _Castration_._
The Mortification or the _Sarcocele_ of the Testicles, gives occasion to
this Operation; to perform which, the Patient must be laid upon his Back,
with his Buttocks higher than his Head, his Legs being kept open, and the
Skin of the _Scrotum_ taken up, one end of which is to be held by a
Servant, and the other by the Surgeon, who having made a longitudinal
Incision therein, or from the top to the bottom, slips off the Flesh of the
_Dartos_ which covers the Testicle, binds up the Vessels that lie between
the Rings and the Tumour, and cuts 'em off a Fingers breadth beneath the
Ligature: But care must be taken to avoid tying the Spermatick Vessels too
hard, for fear of a Convulsion, and {239} to let one end of the Thread pass
without the Wound. If an Excrescence of Flesh stick to the Testicle, and it
be moveable or loose, it is requisite to take it off neatly, leaving a
small Piece of it on the Testicle; and if any considerable Vessels appear
in the Tumour, they must be bound before they are cut.
_The Dressing and Bandage._
The Dressing is made with Pledgets and Bolsters laid upon the _Scrotum_;
and the proper Bandage is the _Suspensor_ of the _Scrotum_, which hath four
Heads or Ends, of which the upper serve as a Cincture or Girdle; and the
lower passing between the Thighs, and fasten'd behind to the Cincture.
There is also another Bandage of the _Scrotum_, having in like manner four
Heads, of which the upper constitute the Cincture; but it is slit at the
bottom, and hath no Seams; the lower Heads crossing one another, to pass
between the Thighs, and to be join'd to the Cincture. Both these sorts of
Bandages have a Hole to give Passage to the Yard.
* * * * *
{240}
CHAP. XV.
_Of the Operation of the Stone in the_ Ureter.
If the Stone be stopt at the _Sphincter_ of the Bladder, it ought to be
thrust back with a Probe: If it stick at the end of the _Glans_, it may be
press'd to let it out; and if it cannot come forth, a small Incision may be
made in the opening of the _Glans_ on its side.
But if the Stone be remote from the _Glans_, it is requisite to make an
Incision into the _Ureter_; to which purpose, the Surgeon having caus'd the
Skin to be drawn upward, holds the Yard between two Fingers, making a
Longitudinal Incision on its side upon the Stone, which must be prest
between the Fingers to cause it to fly out; or else it may be taken out
with an _Extractor_. Then if the Incision were very small, the Skin needs
only to be let go, and it will heal of it self; but if it were large, a
small Leaden Pipe is to be put into the _Ureter_, lest it shou'd be
altogether clos'd up by the Scar: It is also expedient to anoint the Pipe
with some Desiccative Medicine, and to dress the Wound with Balsam.
Afterward a little Linnen-Bag or Case is to be made, in which the Yard is
to be put, to keep on the Dressing; but it must be pierc'd at the end, for
the convenience of making Water, having two Bands at the other end, which
are ty'd round about the Waste.
* * * * *
{241}
CHAP. XVI.
_Of the Operation of _Lithotomy_._
This Operation is undertaken when it is certainly known that there is a
Stone in the Bladder; to be assur'd of which, it may not be improper to
introduce a Finger into the _Anus_ near the _Os Pubis_, by which means the
Stone is sometimes felt, if there be any: The Finger is likewise usually
put into the _Anus_ of young Virgins, and into the _Vagina Uteri_ of Women,
for the same purpose. But it is more expedient to make use of the Probe,
anointed with Grease, after this manner: The Patient being laid on his
Back, the Operator holds the Yard streight upward, the _Glans_ lying open
between his Thumb and Fore-finger; then holding the Probe with his
Right-hand on the side of the Rings, he guides it into the Yard, and when
it is enter'd, turns the Handle toward the _Pubes_, drawing out the Yard a
little, to the end that the Canal of the _Ureter_ may lie streight. If it
be perceiv'd that the Probe hath not as yet pass'd into the Bladder, a
Finger is to be put into the _Anus_, to conduct it thither. Afterward in
order to know whether a Stone be lodg'd in the Bladder, the Probe ought to
be shaken a little therein, first on the Right-side, and then on the Left;
and if a small Noise be heard, it may be concluded for certain that there
is a Stone: But if it be judg'd that the {242} Stone swims in the Bladder,
so that it cannot be felt, the Patient must be oblig'd to make Water with a
hollow Probe.
Another manner of searching may be practis'd thus: Let the Yard be rais'd
upward, inclining a little to the side of the Belly; let the Rings of the
Probe be turn'd upon the Belly, and the end on the side of the _Anus_; and
then let this Instrument be introduc'd, shaking it a little on both sides,
to discover the Stone.
In order to perform the Operation of Lithotomy, the Patient must be laid
along upon a Table of a convenient height, so as that the Surgeon may go
about his Work standing; the Patient's Back must also lean upon the Back of
a Chair laid down, and trimm'd with Linnen-Cloth, lest it shou'd hurt his
Body; his Legs must be kept asunder, and the Soles of his Feet on the sides
of the Table, whilst a Man gets up behind him to hold his Shoulders: His
Arms and Legs must be also bound with Straps or Bands. Then a channell'd
Probe being put up into the Bladder, a Servant standing upon the Table on
the side of the Chair, holds the Back of the Instrument between his two
Fore-fingers on that Part of the _Perinaeum_ where the Incision ought to be
begun, which is to be made between his Fingers with a sharp Knife that cuts
on both sides: The Incision may be three or four Fingers breadth on the
left side of the _Raphe_ or Suture: But in Children its length must not
exceed two Fingers breadth. If the Incision were too little to give Passage
to the Stone, it wou'd be more expedient to enlarge it than to stretch the
Wound {243} with the Dilatators. When the Convex Part where the channelling
of the Probe lies, shall be well laid open, the Conductors may be slipt
into the same Channelling, between which the _Forceps_ is to be put, having
before taken away the Probe. Some Operators make use of a _Gorgeret_ or
Introductor to that purpose, conveying the end of it into the Chanelling of
the Probe; which is remov'd to introduce the _Forceps_ into the Bladder:
And as soon as they are fixt therein, the Conductors or _Gorgeret_ must be
likewise taken out. Afterward search being made for the Stone, it must be
held fast, and drawn out of the Bladder: But if the Stone be long, and the
Operator hath got hold thereof by the two Ends, he must endeavour to lay
hold on it again by the Middle, to avoid the great scattering which wou'd
happen in the Passage. The Stones are also sometimes so large, that there
is an absolute necessity of leaving 'em in the Bladder. Again, if the Stone
sticks very close to the Bladder, the Extraction ought to be deferr'd for
some time; and perhaps it may be loosen'd in the Suppuration. Lastly, when
the Stone hath been taken out, an Extractor is usually introduc'd into the
Bladder, to remove the Gravel, Fragments, and Clots of Blood.
After the Operation, the Patient is carry'd to his Bed, having before
cover'd the Wound with a good Bolster; and if an Haemorrhage happens, it is
to be stopt with Astringents. A Tent must also be put into the Wound, when
it is suspected that some Stone or Gravel may as yet remain therein: But if
it evidently appears that {244} there is none, the Wound may be dress'd
with Pledgets, a Plaister, and a Bolster, of a Figure convenient for the
Part. The Dressing may be staid with a Sling supported by a Scapulary; or
else the Bandage of the double T. may be us'd, the manner of the
Application of which we have shewn elsewhere. The Patient's Thighs must be
drawn close to one another, and ty'd with a small Band, lest they shou'd be
set asunder again.
The Operation of Lithotomy in Women is usually perform'd by the lesser
Preparative, which is done by putting the Fore-finger and Middle-finger
into the _Vagina Uteri_, or into the _Rectum_ in young Virgins, to draw the
Stone to the Neck of the Bladder, and keep it steady, so that it may be
taken out with a Hook, or other Instrument.
This Operation may also be effected in Women, almost in the same manner as
in Men; for after having caus'd the Female Patient to be set in the same
Posture or Situation as the Men are usually plac'd, according to the
preceeding Description, the Conductors may be convey'd into the _Ureter_,
to let in the _Forceps_ between 'em, with which the Stone may be drawn out:
But if it be too thick, a small Incision is to be made in the Right and
Left side of the _Ureter_.
The lesser Preparative was formerly us'd in the Lithotomy of Men, after
this manner: The Finger was put into the _Anus_, to draw the Stone toward
the _Perinaeum_; then an Incision was made upon the Stone on the side of
the Suture, and it was taken out with an Instrument.
* * * * *
{245}
CHAP. XVII.
_Of the Operation of the Puncture of the _Perinaeum_._
This Operation is necessary in a Suppression of Urine, where the
Inflammation is so great, that the Probe cannot be introduc'd. Then an
Incision is to be made with the Knife or Lancet, in the same Place where it
is done in Lithotomy; and a small Tube or Pipe is to be put in the Bladder,
till the Inflammation be remov'd.
* * * * *
CHAP. XVIII.
_Of the Operation of the _Fistula in Ano_._
Fistula's are callous Ulcers: If one of these happen in the Fundament, and
is open on the outside, it may be cur'd thus: After the Patient hath been
laid upon his Belly on the side of a Bed, with his Legs asunder, the
Surgeon makes a small Incision with his Knife in the Orifice of the
_Fistula_, in order to pass therein another small crooked Incision-Knife,
at the end of which is a Pointed Stilet with a little Silver Head which
covers it, to the end that it may enter without causing Pain. When the
Surgeon hath convey'd his Knife into the {246} _Fistula_, having the
Fore-finger of his Left-hand in the _Anus_ or Fundament, he pulls off its
Head, holding the Handle with one Hand, and the Stilet that pierceth the
_Anus_ with the other; and at last draws out the Instrument to cut the
_Fistula_ entirely at one Stroke.
If the _Fistula_ hath an Opening into the Intestine, an Incision is to be
made on the outside at the Bottom thereof, to open it in the Place where a
small Tumour or Inflammation usually appears, or else in the Place where
the Patient feels a Pain when it is touch'd. If the Tumour be remote from
the _Anus_, it may be open'd with the Potential Cautery, to avoid a greater
Inconvenience. After having thus laid open the very bottom, the little
Incision-Knife and Stilet, with its Head, is to be pass'd therein, the end
of the Stilet is to be drawn thro' the _Anus_, and the Flesh is to be cut
all at once. But if the _Fistula_ be situated too far forward in the
Fundament, the _Sphincter_ of the _Anus_ must not be entirely cut,
otherwise the Excrements cannot be any longer retain'd. Lastly, when the
_Fistula_ hath been treated after this manner, all its Sinuosities or
Winding-Passages ought likewise to be open'd, and the Wound being fill'd
with thick Pledgets steept in some Anodyn, is to be cover'd with a Plaister
and a Triangular Bolster; as also with the Bandage call'd the T.
* * * * *
{247}
CHAP. XIX.
_Of the Suture or Stitching of a _Tendon_._
It is requisite to undertake this Operation when the Tendons are cut, and
when they become very thick. If the Wound be heal'd, it must be open'd
again to discover the Tendon, and the Part must be bended, to draw together
again the ends of the Tendons. Then the Surgeon taking a flat, streight,
and fine Needle, with a double waxed Thread, passeth it into a small
Bolster, and makes a Knot at the end of the Thread, to be stopt upon the
Bolster. Afterward he pierceth the Tendon from the outside to the inside,
at a good distance, lest the Thread shou'd tear it, and proceeds to pass
the Needle in like manner under the other end of the Tendon, upon which is
laid a small Bolster, for the Thread to be ty'd in a Knot over it. Then he
causeth the Extremities of the Tendons to lie a little one upon another, by
bending the Part, and dresseth the Wound with some Balsam. It may not be
improper here to observe, that Ointments are never to be apply'd to the
Tendons, which wou'd cause 'em to putrifie, but altogether Spirituous
Medicaments; and that the Part must be bound up, lest the Extension of it
shou'd separate the Tendons.
* * * * *
{248}
CHAP. XX.
_Of the _Caesarian_ Operation._
When a Woman cannot be deliver'd by the ordinary means, this bold and
dangerous Operation hath been sometimes perform'd with good Success. The
Woman being laid upon her Back, the Surgeon makes a Longitudinal Incision
beneath the Navel, on the side of the White-Line, till the _Matrix_
appears, which he openeth, taking great care to avoid wounding the Child:
Then he divides the Membranes with which it is wrapt up, separates the
After-Burden from the _Matrix_, and takes out the Child. Lastly he washeth
the Wound with warm Wine, and dispatcheth the _Gastroraphy_ or Stitching up
of the Belly, without sowing the _Matrix_. After the Operation, Injections
are to be made into the _Matrix_, to cause a Flux of Blood; and a pierc'd
Pessary must be introduc'd into its Neck.
* * * * *
{249}
CHAP. XXI.
_Of the Operation of _Amputation_, with its proper Dressings and Bandages._
The Leg is usually cut off at the Ham; the Thigh as near as can be to the
Knee; and the Arm as near as is possible to the Wrist: But an Amputation is
never made in a Joynt, except in the Fingers and Toes.