I have treated hitherto of accidents which quickly carry off the
patients; I come now to consider those where the danger is not so
pressing, and which terminate in death by slow degrees, a caries of the
bone, and a cancerous state of the parts; for it is well known, that in
these circumstances amputation is often deemed necessary.
A caries of the bone is either superficial or deep seated, recent
or inveterate, occasioned by a vicious state of the fluids, or the
consequence of some external hurt.
When it is recent and inconsiderable, whatever be the cause, there is
no room to think of amputation at all, but the bone must be laid bare
according to the extent of the caries, and scraped with a scalpel, or
perforated in sundry places with the spike of a trepan; when the caries
has gained the opposite part of the bone, we must then use the crown
of the trepan, in order to take out the entire piece. I do not however
propose entering into a detail of the manner of performing these
operations.
With respect to the medicines proper in a caries of the bone, without
the application of instruments, or which finish what the instruments
have begun, we are furnished with a great many, of which it would be
too tedious to give a list: I must only give a caution not to employ
the mineral acids, even the anodyne mineral liquor of Hoffman, so much
boasted of by some practitioners in diseases of the bones; for they
all do hurt. It is well known that when these acids are used for the
teeth, they whiten them, but at the same time destroy their substance,
rendering them crumbly and friable like limestone; now the other bones
being less solid and hard than the teeth, there is so much the more
reason to apprehend the same effect, by their penetrating from the
affected part of the bone, where they are applied, to that which is
sound. In consequence of this, the bones which appear mended after the
use of these liquors, are, in a short time, worse than before[49].
The real method of doing service to bones consumed by a caries, is like
what happens to boards joined together with nails, if you make them
excessively dry, the nails fall out of themselves; and doubtless it is
this notion that has given rise to the practice of employing hot irons,
and acid liquors, as driers, to promote the exfoliation of bones. But
both these methods are attended with the inconvenience I have already
mentioned, with respect to acids, of acting with so much violence on
the diseased parts, that they extend their action in a dangerous
manner, to those that are sound. We may nevertheless employ hot irons
with success in constitutions abounding with moisture, or when it
is of consequence immediately to stop the progress of the disease.
The following medicines act efficaciously, but with less violence,
frankincense, mastich, myrrh, balsam of Peru, and essential oil of
cloves; but this oil should be used with moderation, since when it is
employed for carious teeth, they become friable, and crumble away by
degrees in a short time[50].
When the caries is removed, in order to compleat the cure, we ought to
prescribe a nourishing diet, but not too oily; broth, in which viper
flesh is boiled, is very useful[51]. The dressing should then only
consist of dry lint, taking all imaginable care to hinder the contact
of the external air. When the caries is accompanied with a vitiated
state of the blood, the external treatment is the same, and succeeds
equally, provided internal medicines, suitable to the nature of the
ailment, be joined with it; with this precaution, a caries from a
venereal cause, may be cured like any other.